Restrictive Respiratory Disorders Flashcards
Restrictive Respiratory Disorders
Characterized by a restriction in lung volume, caused by decreased compliance of the lungs or
chest wall
Extrapulmonary disorders
involve the central nervous system, neuromuscular system, and chest wall; lung tissue is NORMAL
Intrapulmonary disorders
involve the pleura or the lung tissue.
Pleural Effusion
Not a disease rather a symptom of disease
Types of Pleural Effusion
Transudative
Exudative
Transudative Pleural Effusion
non-inflammatory: HF d/t increased hydrostatic pressure (most common cause); chronic liver or renal disease d/t decreased oncotic pressure
Exudative Pleural Effusion
inflammatory: d/t increase capillary permeability – pulmonary malignancy/infection/embolism; GI disease - pancreatitis
Type of effusion can be determined from a sample of
pleural fluid obtained via thoracentesis
- Transudative –> low protein concentration; fluid clear
or pale yellow - Exudative –> high protein concentration; fluid dark yellow/amber
What else is fluid from a thoracentesis analyzed for?
for RBC, WBC, malignant cells, bacteria, glucose
Empyema
Pleural effusion that contains pus
Causes of Empyema
Pneumonia, TB, lung abscess, infected surgical wounds
Treatment of Empyema
chest tube drainage, antibiotic therapy
Manifestations of empyema include:
those of pleural effusion as well as fever, night sweats, cough, and weight loss.
Clinical Manifestation of pleural effusion
Progressive dyspnea; decreased movement of the
chest wall on the affected side; pleuritic pain from
the underlying disease; dullness to percussion and
absent or decreased breath sounds over the
affected area during physical examination
Collaborative Care of Pleural Effusion
- Treat the underlying cause – HF (diuretics, Na restriction)
- Treatment of pleural effusions secondary to malignant disease is difficult.
- Chemical pleurodesis to sclerose pleural space
Pleurisy
Inflammation of the pleura
Pleurisy Clinical Manifestation
Abrupt onset of pain, esp. with inspiration, shallow
breathing, tachypnea
Causes of pleurisy
pneumonia, TB, chest trauma, pulmonary infarction, neoplasm
Classifications of Pleurisy
fibrous (dry) or wet (effusion)
Treatment of Pleurisy
- Treatment of primary disease causes symptoms resolution
- Analgesics, lying or splinting the affected side
Atelectasis
Condition of the lungs characterized by collapsed,
airless alveoli
Most common cause Atelectasis
retained exudates and secretions
Atelectasis is common in what type of patients?
Common in post operative patients
Prevention of Atelectasis
deep breathing and coughing
Interstitial Lung Disease
Many acute and chronic lung disorders with
variable degrees of pulmonary inflammation and
fibrosis are collectively referred to as interstitial
lung diseases (ILDs) or diffuse parenchymal lung
diseases.
Causes of Interstitial Lung Disease
- Many causes - difficult to classify – 200+ causes as
primary conditions of the lung or parts of
multiorgan processes (SLE, RA) - Most common causes – occupational and
environmental exposures – dust, fumes, gases
Idiopathic Pulmonary Fibrosis (IPF)
Characterized by scar tissue in the connective tissue of the lungs as a sequel to inflammation or irritation
Idiopathic Pulmonary Fibrosis (IPF) risk factors
occupational/environmental exposures, smoking, chronic aspiration
Idiopathic Pulmonary Fibrosis (IPF) Clinical Manifestations
Exertional dyspnea, nonproductive cough, and inspirational crackles with or without clubbing
Idiopathic Pulmonary Fibrosis (IPF) Clinical course
Variable. 5 year survival rate 30-50%
Idiopathic Pulmonary Fibrosis (IPF) Treatment
Corticosteroids, cytotoxic agents, antifibrotic agents, lung transplant
Sarcoidosis
- Chronic, multisystem granulomatous disease of
unknown cause that affects primarily the lungs (also
skin, eyes, liver, kidney, heart, lymph nodes) - Often acute and self limiting, but can also be
chronic with remissions and exacerbations - Severe restrictive lung disease
Sarcoidosis Treatment
corticosteroids, cytotoxic agents
Pulmonary Edema
An abnormal accumulation of fluid in the alveoli and the interstitial spaces of the lungs
Most common complication of Pulmonary Edema
left sided heart failure
Is Pulmonary Edema a Medical Emergency?
YES!
Pulmonary Edema is caused by what?
Increased hydrostatic pressure or decreased oncotic pressure in pulmonary capillaries that outpaces lymphatic drainage; interferes with gas exchange
Pulmonary Edema Clinical Manifestations:
tachypnea, tachycardia, hypoxia, crackles, dyspnea
Pulmonary Edema Treatment:
correct underlying cause; diuretics, Na restriction, oxygen, morphine, nitro
Pulmonary Embolism
Blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumour tissue
Pulmonary Embolism Causes:
Most arise from DVT (legs), also from atrial fibrillation, long bone # (fat emboli), IV therapy errors (air emboli), tumors
Pulmonary Embolism Risk Factors:
immobility, surgery, pregnancy, obesity, heavy smoking HTN
Pulmonary Embolism Clinical manifestations:
slow or sudden onset; varied and non-specific; classic triad - dyspnea, chest pain, hemoptysis; crackles, fever, change in mental status d/t hypoxia,
Pulmonary Embolism Complications:
pleural effusion; pulmonary infarction
Pulmonary Embolism Diagnostic studies:
spiral CT scan with contrast injection is visualize blood vessels; V/Q (ventilation/perfusion) scan
Pulmonary Embolism Collaborative Care:
prevention (early ambulation, SCDs, prophylactic anticoagulants); oxygen, analgesics, turning, DB & C to prevent atelectasis; low molecular weight heparin (to prevent further clots) x 3-6/12; severe cases may require ventilator support, surgery
Vascular Lung Disorders:
- Pulmonary Edema
- Pulmonary Embolism
