Unit 3 - Respiratory Diseases pt 3 - restrictive

Question 1

restrictive pulmonary disease

Answer 1

Implies restriction of respiratory depth
No blockage of air flow
Pulmonary Volume Reduction
Pulmonary Under-inflation

Question 2

pulmonary function’s test (PFTs) provide info on specific lung… (3)

Answer 2

volumes
capacities
flow rates

Question 3

terms/abbreviations

Answer 3

Tidal Volume (TV)
Inspiratory Reserve Volume (IRV)
Expiratory Reserve Volume (ERV)
Residual Volume (RV)
Total Lung Capacity (TLC)

Question 4

PFTs in chronic restrictive pulmonary disease

Answer 4

• flow normal
• volume reduced
• atelectasis is common (collapsed lung)

Question 5

chronic restrictive pulmonary disease affecting lung

Answer 5

parenchyma

Question 6

pneumoconiosis

Answer 6

chronic irritation/inflammation

extensive fibrosis

Question 7

examples of pneumoconiosis

Answer 7

Silicosis - silica dust inhalation (“stone cutter”)
Anthracosis – coal dust (“black lung”, “coal miners lung”)
Asbestosis (asbestos dust exposure)

Question 8

orthopedic disorders

Answer 8

Thoracic deformities restricting ventilation, and possibly leading to atelectasis of poorly ventilated alveoli
- scoliosis, kyposcoliosis, pectus excavatum

Question 9

obesity

Answer 9

“Pickwickian Syndrome” – excess body weight leads to hypoventilation with resultant hypoxemia and hypercapnea. Also at increased risk for sleep apnea and heart failure.

Question 10

sarcoidosis

Answer 10

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

Question 11

neurologic pulm restrictive diseases

Answer 11

Quadriplegia

Guillain-Barre Syndrome

Question 12

muscular pulm restrictive diseases

Answer 12

msucular dystrophy

Question 13

carcinoma of the lung

Answer 13

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

Question 14

non-small cell lung cancer (NSCLC) and 3 types

Answer 14

80% of cases

1. Squamous Cell
2. Adenocarcinoma – most common type of lung cancer
3. Large cell

Question 15

small cell lung cancer

Answer 15

20% of lung cancer cases

“oat cell”

Question 16

superior vena cava syndrome

Answer 16

impairs venous return to RA and causing venous distention into large veins of neck and UE

Question 17

Respiratory distress syndrome (RDS)

Answer 17

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.

Question 18

Role of surfactant

Answer 18

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”.

Question 19

surfactant composition/ratio

Answer 19

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.

Question 20

Tx for RDS

Answer 20

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

Question 21

ECMO

Answer 21

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.

Question 22

Adult RDS

Answer 22

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.

Question 23

ARDS Tx

Answer 23

Positive end expiratory pressure (PEEP) to expand alveoli
oxygen therapy
PT, OT, and possible speech therapy if laryngeal damage has occurred.

Question 24

pleuritis and causes

Answer 24

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

Question 25

pleuritis s/s and diagnosis

Answer 25

Symptoms:
Shortness of breath
Chest pain

Diagnosis:
Chest auscultation and mediate percussion
X-ray
Ultrasound
CT scan

Question 26

pleuritis tx

Answer 26

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

Question 27

pleural membrane disorders can cause __ of lung expansion

Answer 27

restriction

Question 28

fibrosis

Answer 28

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

Question 29

hydrothorax

Answer 29

fluid accumulation in the pleural space from an exudate or transudate which can compress the lungs and cause restriction to breathing

Question 30

hemothorax

Answer 30

bleeding into the pleural space perhaps due to trauma

Question 31

pneumothorax

Answer 31

air accumulation in the pleural space, possibly due to a puncture wound.

Question 32

traumatic pneumothorax - open

Answer 32

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”.

Question 33

traumatic pneumothorax - closed

Answer 33

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.

Question 34

Spontaneous Pneumothorax

Answer 34

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

Question 35

scar tissue formation

Answer 35

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.

Question 36

amyloidosis

Answer 36

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.