Unit 3 - Respiratory Diseases pt 3 - restrictive Flashcards
restrictive pulmonary disease
Implies restriction of respiratory depth
No blockage of air flow
Pulmonary Volume Reduction
Pulmonary Under-inflation
pulmonary function’s test (PFTs) provide info on specific lung… (3)
volumes
capacities
flow rates
terms/abbreviations
Tidal Volume (TV) Inspiratory Reserve Volume (IRV) Expiratory Reserve Volume (ERV) Residual Volume (RV) Total Lung Capacity (TLC)
PFTs in chronic restrictive pulmonary disease
- flow normal
- volume reduced
- atelectasis is common (collapsed lung)
chronic restrictive pulmonary disease affecting lung
parenchyma
pneumoconiosis
chronic irritation/inflammation
extensive fibrosis
examples of pneumoconiosis
Silicosis - silica dust inhalation (“stone cutter”)
Anthracosis – coal dust (“black lung”, “coal miners lung”)
Asbestosis (asbestos dust exposure)
orthopedic disorders
Thoracic deformities restricting ventilation, and possibly leading to atelectasis of poorly ventilated alveoli
- scoliosis, kyposcoliosis, pectus excavatum
obesity
“Pickwickian Syndrome” – excess body weight leads to hypoventilation with resultant hypoxemia and hypercapnea. Also at increased risk for sleep apnea and heart failure.
sarcoidosis
High incidence in African-Americans
Triggered by abnormal immune system response?
Deposits of gamma globulins (granuloma formation, often in the lungs)
Increased B lymphocytes
Decreased T lymphocytes
neurologic pulm restrictive diseases
Quadriplegia
Guillain-Barre Syndrome
muscular pulm restrictive diseases
msucular dystrophy
carcinoma of the lung
Lung cancer is the leading cause of cancer deaths in the United States!!
The biggest risk factor is smoking, with 85-90% of all lung cancers occurring in smokers.
- airway blockage due to tumor growth
- hemoptysis: coughing up blood
- metastasis
non-small cell lung cancer (NSCLC) and 3 types
80% of cases
- Squamous Cell
- Adenocarcinoma – most common type of lung cancer
- Large cell
small cell lung cancer
20% of lung cancer cases
“oat cell”
superior vena cava syndrome
impairs venous return to RA and causing venous distention into large veins of neck and UE
Respiratory distress syndrome (RDS)
Hyaline Membrane Disease” typically occurs in premature (< 7 months gestation) infants.
Caused by caused by an absence of “surfactant” on the mucosal surfaces of alveoli and small airways.
Role of surfactant
Protects the lungs from collapse due to the “surface tension” (“attractive force between liquid molecules”) that exist on moist mucosal surfaces.
Increases pulmonary compliance (“increased ease of lung inflation during inhalation”), which means a “decreased work-of-breathing”.
surfactant composition/ratio
Surfactant is made up of the lipid substances lecithin and sphingomyelin.
**lethicin/sphingomyelin ratio 2:1 = lung maturity is sufficient to allow normal breathing in infants.
Lecithin/sphingomyelin ratios can be determined from a sample of amniotic fluid, obtained via amniocentesis.
Tx for RDS
Extracorporeal membrane oxygenation (ECMO) – similar to heart-lung bypass
O2 therapy via mechanical ventilation
Possible side effects of oxygen therapy include:
retinal damage (retrolental fibroplasia) and possible blindness
“bronchopulmonary dysplasia” - Lung scarring and inflammation
Synthetic or animal derived surfactant
ECMO
Simplified illustration of how venous blood is oxygenated outside of the lungs and then reintroduced at the level of the ascending aorta so that oxygen rich blood can be delivered throughout the body.
Adult RDS
ARDS is poorly understood and the exact cause is often unclear, though it is commonly linked to trauma.
Leads to pulmonary edema, impaired gas exchange, and release of inflammatory mediators.
Multiple organ failure may ensue quickly if not treated aggressively.
ARDS Tx
Positive end expiratory pressure (PEEP) to expand alveoli
oxygen therapy
PT, OT, and possible speech therapy if laryngeal damage has occurred.
pleuritis and causes
inflammation of the pleura. Causes: Infection (viral infection is most common cause) Immune disorders (examples - RA, SLE) Chest injury Chemical exposure Lung cancer Heart failure Pulmonary embolism
pleuritis s/s and diagnosis
Symptoms:
Shortness of breath
Chest pain
Diagnosis: Chest auscultation and mediate percussion X-ray Ultrasound CT scan
pleuritis tx
Treat the underlying cause when identified
Medication (antibiotics if bacterial infection, anti-inflammatory drugs)
Drainage (“Thoracentesis”, chest tube)
Pleurodesis – involves introducing an irritant (talc powder, bleomycin, etc) in between to plueral layers. This will result in the layers adhering to one another thus preventing fluid accumulation between the two layers.
OT/PT:
Have pt. use pillow for splinting when they cough
Lie on the side that hurts
Encourage deep breaths and airway clearance (“coughing, huffing, etc”)
Use caution with pts who have chest tubes
pleural membrane disorders can cause __ of lung expansion
restriction
fibrosis
secondary to chronic pleuritis or possibly asbestos exposure. Results in thickening fibrotic changes, and calcification. In the case of asbestos exposure, these changes may not occur until many years after the exposure
hydrothorax
fluid accumulation in the pleural space from an exudate or transudate which can compress the lungs and cause restriction to breathing
hemothorax
bleeding into the pleural space perhaps due to trauma
pneumothorax
air accumulation in the pleural space, possibly due to a puncture wound.
traumatic pneumothorax - open
a puncture wound penetrates the thorax and enters the pleural space, and there is no tissue flap covering the wound. Air moves in and out of the pleural space - “sucking chest wound”.
traumatic pneumothorax - closed
a puncture wound penetrates the thorax and enters the pleural space, and there is a tissue flap covering the wound that acts as a one-way valve. This results in air buildup and can lead to a tension pneumothorax.
Spontaneous Pneumothorax
occurs when a fissure occurs spontaneously, or without known cause, in the pleural sac. This condition allows air from the lungs to leak into the pleural space.
Symptoms:
Sudden onset of chest pain and pain with respiration.
Generally is self-limiting, and heals within several days.
**Incidence is highest in smokers, and there is a statistical incidence of higher than usual occurrence in blond males
scar tissue formation
may occur due to collagen vascular diseases such as rheumatoid arthritis.
“Interstitial lung disease”
“Rheumatoid lung disease”
Collagen vascular disease is an autoimmune disease that can affect multiple systems including the joints, lungs, pleura, liver, heart and CNS.
amyloidosis
Amyloid is glycoprotein, which when present in the blood, can be deposited in the lungs, leading to inflammation and scarring, which restricts breathing.
The cause for formation of amyloid is unknown, but it appears to be associated in some way with aging.
