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Cardio Pulm Units > Unit 3: Pulmonary Pathology > Flashcards

Unit 3: Pulmonary Pathology Flashcards

1
Q

What is the primary problem for patients with obstructive pulmonary or lung diseases?

A
  • Primary problem centers on obstructive air flow
    • Dec airway size = inc resistance
    • Loss of elastic recoil
    • airways tend to collapse
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2
Q

What are the signs of obstructive pulmonary or lung disease?

(not the same for all diseases)

A
  • Dec expiratory flow rate - ALL obstructives have this
  • Inc residual volume
    • inc WOB, inc respiratory rate
  • Vent/Purfuse mismatching
  • Cor Pulmonale (R ventricle hypertrophy
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3
Q

What are the symptoms of obstructive pulmonary or lung disease?

(not the same for all diseases)

A
  • Chronic cough
  • Productive cough
  • Adventitious/abnormal breath sounds
  • Dyspnea on exertion
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4
Q

What two obstructive lung diseases are common in both children and adults?

A
  1. Asthma
  2. Bronchiectasis
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5
Q

What two obstructive lung diseases are seen in children?

A
  1. Bronchopulmonary Dysplasia
  2. Cystic Fibrosis
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6
Q

What two obstructive lung diseases are seen in adults?

A
  1. Chronic Bronchitis
  2. Emphysema
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7
Q

What causes (etiology) Bronchopulmonary Dysplasia?

A
  • Occurs in neonates after mechanical ventilation or treated with high levels of O2
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8
Q

What conditions/syndromes can cause Bronchopulmonary Dysplasia?

A
  • Respiratory Distress Syndrome
  • Post meconium aspiration
  • Neonatal pneumonia
  • Persistent fetal circulation
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9
Q

What vitals/factors may result in Bronchopulmonary Dysplasia?

A
  • Born at < 32 weeks gestation
  • Neonates weighing lass than 1200g at birth
  • Ventilated using continuous positive pressure
  • Oxygen concentrations given at 60% of higher FIO2
  • Supplemental oxygen form more than 50 hours
  • Birth mothers who are diabetic
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10
Q

What happens to the alveoli is Bronchopulmonary Dysplasia?

A

Damage to alveoli caused by mechanical vent leads to inflammation, pulmonary edema and fibrosis

  • lose surface area
  • creates ventilation/perfusion mismatching
  • traps air
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11
Q

What clinical signs are associated with Bronchopulmonary Dysplasia?

A
  1. <!--StartFragment-->Degree of dec lung function based on length O2 supplementation
  2. Ventilation/perfusion mismatching
  3. “Ground-glass” appearance on X-ray, followed by evidence of both atelectasis and fibrotic changes
  4. Possibly cor pulmonale (right ventricular hypertrophy) or congestive heart failure

<!--EndFragment-->

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12
Q

What clinical sympoms are associated with Bronchopulmonary Dysplasia?

A
  • <!--StartFragment-->Tachypnea
  • **Grunting **
  • Cyanosis w/ feeding orcrying
  • Possibly chest retractions, nasal flaring, expiratory grunting

<!--EndFragment-->

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13
Q

What ist the treatment for Bronchopulmonary Dysplasia?

A
  • <!--StartFragment-->Bronchodilators
  • Diuretics
  • Potassium supplement - in place because dieuretic depletes potassium
  • Nutritional support
  • Antibiotics

<!--EndFragment-->

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14
Q

What ist the prognosis for Bronchopulmonary Dysplasia?

A
  • <!--StartFragment-->Death by 1 year in some
  • Survivors: long term battles w/ respiratory tract infections
    • hyperinflated lungs and bronchospasm
  • Respiratory symptoms may persist even into adulthood
  • Often have dec growth and inc incidence of neurodevelopmental sequelae (e.g., cerebral palsy, impairments in gross and fine motor skills, cognition and language development)

<!--EndFragment-->

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15
Q

What causes (etiology) Cystic Fibrosis?

A
  • Autosomal recessive genetic disorder
    • 60 diff mutations
  • Problem affects CFTR (cystic fibrosis transmembrane regulator) - protein channel that controls chloride movement
    • In ability to resorb chloride from sweat glands makes for salty sweat
  • Pancreatic insufficiency
    • inability to absorb nutrients
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16
Q

What are the symptoms of Cystic Fibrosis?

A
  • <!--StartFragment-->Increased sputum production
  • Chronic cough
  • Diffuse coarse rales, rhonchi, or wheezing
  • Nutritional deficiencies
  • Increased work of breathing

<!--EndFragment-->

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17
Q

What are the signs of Cystic Fibrosis?

A
  • <!--StartFragment-->Hyperinflated lungs
  • Increased respiratory rate
  • Digital clubbing
  • Steatorrhea (excessive fat in feces)

<!--EndFragment-->

18
Q

What are the treatments for Cystic Fibrosis?

A
  • <!--StartFragment-->Chest P.T. (bronchial hygiene, postural drainage, etc.)
  • Antibiotics
  • Mucolytics
  • Bronchodilators
  • Nutrition (pancreatic enzyme replacements)
  • Single or double lung transplant, heart-lung transplant

<!--EndFragment-->

19
Q

What is the prognosis for Cystic Fibrosis?

A
  • 35 years
  • Cause of death - typically respiratory
20
Q

What causes (etiology) Asthma?

A
  • Chronic inflammatory disease of airways
    • Inc bronchial activity to stimuli
    • Irritants cause bronchospasm → wheezing
  • Stimuli
    • Allergens
    • Exercise
    • Infections
    • Stress (occupation, environment, pharmacological, emotional)
21
Q

What are the clinical signs of Asthma?

A
  • Wheezing
    • better with bronchodilator (inc by 10-12%)
  • Non smoker
  • Intermittent course
22
Q

What is the treatment for Asthma?

A
  • Bronchodilators
  • Avoid irritants
  • Exercie goals
    • improve chest & trunk mobility
    • control of breathing
    • inc strength, posture, and tolerance to exercise
23
Q

What causes (etiology) Bronchiectasis?

A

<!--StartFragment-->

  • Abnormal permanent dilation of medium-sized bronchi that extends distally (fibrotic)
  • Areas filled with secretions, are swollen, inflamed, and can be ulcerated

<!--EndFragment-->

​

24
Q

What are the signs of Bronchiectasis?

A
  • <!--StartFragment-->X-rays show line shadows → thickened areas, fibrosis, & atelectasis (atelectasis if plugging is extensive)
  • If diffuse involvement (decreased FVC, FEV1, FEV1/FVC, FEF25-75)
  • Arterial hypoxemia
  • Presence of bacteria in sputum
  • Moist rales or crackles
  • Rhonchi and dullness to percussion over mucus
  • Dullness to percussion over mucus
  • Decreased breath sounds distal to mucus plug

<!--EndFragment-->

25
Q

What are the symptoms of Bronchiectasis?

A
  • <!--StartFragment-->Chronic, productive cough
  • Hemoptysis or bleeding
  • Dyspnea
  • Pleuritic chest pain

<!--EndFragment-->

26
Q

What is the treatment for Bronchiectasis?

A
  • <!--StartFragment-->Antibiotic
  • Pulmonary hygiene
  • Hydration
  • Immunizations to prevent influenza and pneumonia
  • Surgical resection of segments (severe cases)

<!--EndFragment-->

27
Q

What is the prognosis for Bronchiectasis?

A
  • With antibiotics as needed → 70’s and 80’s
28
Q

What is Emphysema?

A
  • inability to get air out, inc residual volume
  • “condition of lung characterized by abnormal permanent enlargement of airspaces distal to terminal bronchioles, accomanied by destruction of their walls”
29
Q

What are the two types of Emphysema?

A
  • Centilobular - 20x more common
    • Inflammation, edema & thickening of bronchiole walls destruction of respiratory brochioles
  • Panlobular
    • Enlargement of destruction of the alveoli
    • Affects primarily lower lobes
30
Q

What is the cause (etiology) of Emphysema?

A
  • problem with trapping air
  • destruction of alveolar walls and elastic tissue distal to the terminal bronchioles
    • permanent enlargement of gas exchanging airways
31
Q

What factors cause Emphyzema to occur?

A
  • # 1 = smoking in most people
  • <!--StartFragment-->α1-antitrypsin deficiency (inherited)<!--EndFragment-->
    • deteriation 2x faster than from smoking → worse prognosis
32
Q

What are the clinical signs of Emphysema?

A
  • Dec FEV
  • Inc TLC (total lung capacity), FRC and RV (residual volume)
  • Hyperresonance to mediate percusiion
  • and more
33
Q

What are the clinical symptoms of Emphysema?

A
  • DOE (dyspnea on exersion)
  • No wheezing or coughing
  • Trouble getting air out
  • Thin w/ rosy skin (“pink puffer”)
34
Q

What are the treatment for Emphysema?

A
  • Emphysema is an irreversible disease
    • lungs do not repair
  • Physical therapy
    • breathlessness positions
    • pursed lip breathing
    • possibly use accesory muscles
35
Q

What is Chronic Bronchitis?

A
  • Productive cough (> 100 ml/day) for 3 months of the year for 2 consecutive years (mainly Dec, Jan, Feb)
36
Q

What is the cause of Chronic Bronchitis?

A
  • # 1 = smoking
  • Can be due to pollution
37
Q

What is the pathology of Chronic Bronchitis?

A
  • cilia are damaged and mucus collects
38
Q

What are the clinical signs Chronic Bronchitis?

A
  • Low PaO2
  • High PaCO2
  • Inc red blood cells production (polycythemia) secondary to hypoxemia
  • Inc hematocrit
  • Rhonchi “rattle”
  • Dec FEV1
39
Q

What are the clinical symptoms of Chronic Bronchitis?

A
  • Coughing in morning
  • SOB (shortness of breath)
  • Right-sided heart failure → swollen ankles (fluid retention)
    • secondary to smoking
    • capillaries shrink & heart has to work harder
  • Obesity
40
Q

What is the treatment for Chronic Bronchitis?

A
  • Quit smoking
  • If infection present → IV fluid antibiotics
  • Chest PT
    • postural drainage
    • how to have a productive cough

Cardio Pulm Units (13 decks)

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