Week 10 Flashcards
Most common signs and symptoms of pulmonary disease
Pulmonary disease is associated with many signs and symptoms, the most common of which are dyspnea and cough.
Other common signs and symptoms of pulmonary disease
Others include abnormal sputum, hemoptysis, altered breathing patterns, hypoventilation and hyperventilation, cyanosis, clubbing, and chest pain.
Dyspnea
Dyspnea is a subjective experience of breathing discomfort.
It is often described as breathlessness, air hunger, shortness of breath, labored breathing, and preoccupation with breathing.
The most severe signs of dyspnea
Flaring of the nostrils and use of accessory muscles of respiration
Most common signs of severe dyspnea in children
Retraction
Retraction
Retraction (pulling back) of the supracostal or intercostal muscles may occur in children but is uncommon in adults.
When does dyspnea first present itself? What is it called?
Dyspnea often first presents during exercise and is called dyspnea on exertion.
Orthopnea
dyspnea that occurs when an individual lies flat, which causes the abdominal contents to exert pressure on the diaphragm.
Paroxysmal nocturnal dyspnea (PND)
occurs when individuals with pulmonary or cardiac disease awake at night, gasping for air, and have to sit or stand to relieve the dyspnea.
Cough
Cough is a protective reflex that helps clear the airways by an explosive expiration.
What initiates cough reflex?
Inhaled particles, accumulated mucus, inflammation, or the presence of a foreign body initiates the cough reflex by stimulating the irritant receptors in the airway.
How is the cough reflex initiated?
a foreign body initiates the cough reflex by stimulating the irritant receptors in the airway.
Cough reflex consists of:
The cough reflex consists of inspiration, closure of the glottis and vocal cords, contraction of the expiratory muscles, and reopening of the glottis, causing a sudden, forceful expiration that removes the offending matter.
Quality of sputum to monitor
Changes in the amount, color, and consistency of sputum provide information about the cause and progression of disease and the effectiveness of therapy.
Hemoptysis
is the coughing up of blood or bloody secretions.
Qualities of blood produced with coughing
Blood produced with coughing is usually bright red, has an alkaline pH, and is mixed with frothy sputum.
Hemoptysis usually indicates
Hemoptysis usually indicates infection or inflammation that damages the bronchi or the lung parenchyma.
What is used to confirm the site of bleeding when hemoptysis occurs?
Chest imaging, often combined with bronchoscopy, is used to confirm the site of bleeding.
Eupnea
Normal breathing (eupnea) is rhythmic and effortless.
Strenuous exercise or metabolic acidosis induces
Kussmaul respiration (hyperpnea),
Kussmaul respiration (hyperpnea),
characterized by a slightly increased ventilatory rate and very large tidal volumes.
Labored breathing
increased work of breathing
What are typical signs of large airway obstruction?
Slow ventilatory rate
Large tidal volume
Increased effort
Prolonged inspiration and expiration
Stridor or audible wheezing
Example disease of small airway obstruction
Asthma
COPD
What are the typical signs of small airway obstruction
Rapid ventilatory rate
Small tidal volume
Increased effort
Prolonged expiration
Wheezing
Cheyne-Stokes respirations
characterized by alternating periods of deep and shallow breathing.
What does Cheyne-Stokes respirations result from?
Cheyne-Stokes respirations result from any condition that reduces blood flow to the brainstem, which in turn slows impulses sending information to the respiratory centers of the brainstem.
Cyanosis
is a bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin (which is bluish) in the blood.
Two types of cyanosis:
- Peripheral cyanosis
- Central cyanosis
Clubbing
is the selective bulbous enlargement of the end (distal segment) of a digit (finger or toe)
What is the most common cause of hypoxemia?
An abnormal ventilation-perfusion ratio (V̇/Q̇) is the most common cause of hypoxemia
The amount of oxygen in the alveoli is the PA O 2 and is dependent on two factors.
- The first factor is the amount of alveolar minute ventilation (tidal volume × respiratory rate)
- The second factor is the presence of adequate oxygen content of the inspired air.
Clubbing is associated with what kind of diseases?
Clubbing is commonly associated with diseases that cause chronic hypoxemia
Hypoxemia,
or reduced oxygenation of arterial blood (reduced PaO 2), is caused by respiratory alterations
Tuberculosis (TB)
Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis
FiO 2.
The amount of oxygen in inspired air is expressed as the percentage or fraction of air that is composed of oxygen
Diffusion of oxygen from the alveoli into the blood is dependent on what?
- The first is the balance between the amount of air that enters alveoli (V̇) and the amount of blood perfusing the capillaries around the alveoli (Q̇)
- The second factor affecting diffusion of oxygen from the alveoli into the blood is the alveolocapillary membrane.
What does a V/Q mismatch refer to:
V̇/Q̇ mismatch refers to an abnormal distribution of ventilation and perfusion.
PA O 2
The amount of oxygen in the alveoli is the PA O 2
Hypoxemia results from problems with one or more of the major mechanisms of oxygenation
Oxygen delivery to the alveoli
Diffusion of oxygen from the alveoli into the blood
Perfusion of the pulmonary system
What does low V/Q mean?
inadequate ventilation of well-perfused areas of the lung (low V̇/Q̇), resulting in wasted perfusion.
What does high V/Q mean?
poor perfusion of well-ventilated portions of the lung (high V̇/Q̇), resulting in wasted ventilation.
What is the most common cause of high V/Q?
Pulmonary embolism that impairs blood flow to a segment of the lung
hypoxia (or ischemia)
is reduced oxygenation of cells in tissues.
Alveolar Dead Space
An area where alveoli are ventilated but not perfused is termed alveolar dead space.
Clinical manifestations of acute hypoxemia
cyanosis, confusion, tachycardia, edema, and decreased renal output.
Pleural Abnormalities include:
- Pneumothorax
- Pleural effusion
Pneumothorax
Pneumothorax is the presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which surrounds the lungs) or the parietal pleura and chest wall.
The different types of Pneumothorax:
- Primary (spontaneous) pneumothorax
- Secondary pneumothorax
- open (communicating) pneumothorax,
- tension pneumothorax
Primary (spontaneous) pneumothorax
occurs unexpectedly in healthy individuals and is caused by the spontaneous rupture of blebs (blister-like formations) on the visceral pleura.
Secondary pneumothorax
can be caused by chest trauma, such as a rib fracture or stab and bullet wounds that tear the pleura; rupture of a bleb or bulla (a larger vesicle), as occurs in emphysema;
open (communicating) pneumothorax
In open (communicating) pneumothorax, air that is drawn into the pleural space during inspiration (through the damaged chest wall and parietal pleura or through the lungs and damaged visceral pleura) is forced back out during expiration and only partial lung collapse results.
tension pneumothorax
the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration.
Clinical manifestations of spontaneous or secondary pneumothorax begin with what?
begin with sudden pleural pain, tachypnea, and dyspnea.
How would you recognize pneumothorax in a physical examination?
the physical examination may reveal absent or decreased breath sounds and hyperresonance to percussion on the affected side
How is pneumothorax treated?
Pneumothorax is treated by aspiration, usually with insertion of a thoracostomy (chest) tube that is attached to a water-seal drainage system with suction.
Pleural effusion
Presense of fluid in the pleural space.
What are the forms of pleural effusion?
- Transudative (watery)
- Exudative (high concentrations of wbcs and plasma proteins)
- Empyema
- hemothorax
- chylothorax
Transudative Pleural Effusion mean?
watery fluid in pleural space
Exudative Pleural Effusion mean?
presence of (high concentrations of white blood cells and plasma proteins) in pleural space
Empyema pleural effusion
presence of pus in pleural space
How do pts with empyema present?
Individuals with empyema present clinically with cyanosis, fever, tachycardia (rapid heart rate), cough, and pleural pain.
Chylothorax
presence of chyle in pleural space
Restrictive Lung Diseases
Restrictive lung diseases are characterized by decreased compliance (stiffness) of the lung tissue.
Individuals with lung restrictions have what symptoms in common?
Have dyspnea,
An increased respiratory rate,
decreased tidal volume.
What are the most common restrictive lung diseases in adults: (10 things)
aspiration,
atelectasis, bronchiectasis, bronchiolitis,
pulmonary fibrosis, inhalation disorders, pneumoconiosis,
allergic alveolitis, pulmonary edema,
and acute respiratory distress syndrome.
Aspiration
Aspiration is the passage of fluid and solid particles into the lung.
Which lung is more suseptible to aspiration and why?
The right lung, particularly the right lower lobe, is more susceptible to aspiration than the left lung because the branching angle of the right mainstem bronchus is straighter than the branching angle of the left mainstem bronchus.
Clinical manifestations of aspiration
Clinical manifestations of aspiration include the sudden onset of choking and intractable cough with or without vomiting, fever, dyspnea, and wheezing.
Atelectasis
Atelectasis is the collapse of lung tissue. There are three types of atelectasis:
Three types of atelectasis
- Compression atelectasis
- Obstructive (absorption) atelectasis
- Surfactant impairment (adhesive) atelectasis
Compression atelectasis is caused by
is caused by external pressure exerted by tumor, fluid, or air in the pleural space or by abdominal distention pressing on a portion of lung, causing alveoli to collapse.
- Obstructive (absorption) atelectasis is caused by:
results from obstructed or hypoventilated alveoli as the air is gradually absorbed out of the alveoli and into the blood.
- Surfactant impairment (adhesive) atelectasis results from
results from decreased production or inactivation of surfactant, which is necessary to reduce surface tension in the alveoli and thus prevent lung collapse during expiration.
Why might surfactant impairment occur
Surfactant impairment can occur because of premature birth and from any serious lung injury, such as occurs with aspiration, acute respiratory distress syndrome, anesthesia induction, or mechanical ventilation.
Clinical manifestations of atelectasis include:
Clinical manifestations of atelectasis include dyspnea, cough, fever, and leukocytosis and therefore may be mistaken for infection.
Bronchiectasis
Bronchiectasis is persistent abnormal dilation of the bronchi.
The primary symptom of bronchiectasis
The primary symptom of bronchiectasis is a chronic productive cough.
Hemoptysis and clubbing of the fingers (from chronic hypoxemia) are common.
How is bronchiectasis treated?
Bronchiectasis is treated with sputum culture, antibiotics, antiinflammatory drugs, bronchodilators, chest physiotherapy, and supplemental oxygen.
Bronchiolitis
is a diffuse, inflammatory obstruction of the small airways or bronchioles that occurs most commonly in children.
Clinical manifestations of bronchiolitis
Clinical manifestations include a rapid ventilatory rate, use of accessory muscles, low-grade fever, and a nonproductive cough
How is bronchiolitis treated?
Bronchiolitis is treated with antibiotics, corticosteroids, immunosuppressive agents, and chest physical therapy (humidified air administration, coughing and deep-breathing exercises, postural drainage).
Pulmonary fibrosis
Pulmonary fibrosis is an excessive amount of fibrous or connective tissue in the lung.
What is the primary symptom of pulmonary fibrosis?
The primary symptom of pulmonary fibrosis is increasing dyspnea on exertion.
Physical examination of pulmonary fibrosis reveals what?
The physical examination reveals diffuse inspiratory crackles. The diagnosis is confirmed by pulmonary function testing (a decreased FVC), x-rays, CT, and lung biopsy
Treatment of pulmonary fibrosis includes:
Treatment includes oxygen, corticosteroids, antifibrotic and cytotoxic drugs, and lung transplantation
Inhaled toxins cause damage to what?
Inhaled toxins cause damage to the airway epithelium and promote mucus secretion, inflammation, mucosal edema, ciliary damage, pulmonary edema, and surfactant inactivation.
Treatment for inhaled toxins include:
Treatment includes administration of supplemental oxygen, mechanical ventilation, bronchodilators, corticosteroids, and support of the cardiovascular system.
Why would someone who is treated for inhaled toxins improve initially and then deteriorate?
may improve initially and then deteriorate as a result of bronchiectasis or bronchiolitis.
Prolonged exposure to high concentrations of supplemental oxygen can lead to?
Oxygen toxicity
Pulmonary edema
is excess water in the lung.
How are normal lungs kept dry?
- Lymphatic drainage and a balance among capillary hydrostatic pressure, capillary oncotic pressure, and capillary permeability.
- surfactant lining the alveoli repels water, keeping fluid from entering the alveoli.
What is the most common cause of pulmonary edema?
Left sided heart disease
Clinical manifestations of pulmonary edema:
Clinical manifestations of pulmonary edema include dyspnea, hypoxemia, and increased work of breathing.
Physical examination of pulmonary edema reveals?
The physical examination may disclose inspiratory crackles (rales) and dullness to percussion over the lung bases.
Acute respiratory distress syndrome (ARDS)
is a form of acute lung inflammation and diffuse alveolocapillary injury that results from direct pulmonary injury or from severe systemic inflammation.
What are the two ways that ARDs is defined?
ARDS is defined as
(1) the acute onset of bilateral infiltrates on a chest radiograph (i.e., pulmonary edema) and
(2) a low ratio of PaO 2 to FiO 2 (i.e., persistent hypoxemia despite supplemental oxygen).
All disorders causing ARDS results in:
- inflammation
- acute injury to the alveolocapillary membrane
What makes up the alveolocapillary membrane?
The alveolocapillary membrane consists of the epithelial cells that line the alveoli and the endothelial cells that line the capillaries, separated by the interstitial space.
Obstructive lung disease
is characterized by narrowing of the airways, resulting in airway obstruction that is worse with expiration.
Why do people with Obstructive Lung Diseases have to use their accessory muscle and have an increased work of breathing?
More force is required to expire a given volume of air, so individuals must use their accessory muscles of expiration and have an increased work of breathing.
What is the unifying symptom of obstructive lung diseases?
The unifying symptom of obstructive lung diseases is dyspnea
What is the unifying sign of obstructive lung diseases?
wheezing
What are the most common obstructive diseases?
asthma, chronic bronchitis, and emphysema.
Asthma
usually characterized by chronic airway inflammation.
The chronic inflammation associated with asthma causes:
bronchial hyperresponsiveness,
constriction of the airways, and
variable airflow obstruction that is reversible.
Asthma flow chart thing
NO IDEAAAAAAA
Chronic obstructive pulmonary disease (COPD)
associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.”
Two clinical phenotypes of COPD
chronic bronchitis and emphysema.
Chronic Bronchitis
Chronic bronchitis is defined as hypersecretion of mucus and a chronic productive cough for at least 3 months of the year (usually the winter months) for at least 2 consecutive years.
FLOW CHART FOR BRONCHITIS AND EMPHYSEMAAA
AGAIN NO IDEAAAA
Emphysema
Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis.
Two forms of emphysema?
Primary emphysema
Secondary emphysema
Primary emphysema
is commonly linked to an inherited deficiency of the enzyme α1-antitrypsin.
α1-antitrypsin
inhibits the action of many proteolytic enzymes (i.e., elastases released by neutrophils) that serve to breakdown lung tissue
Secondary emphysema
The major cause of secondary emphysema is the inhalation of cigarette smoke, although air pollution, occupational exposures, and childhood respiratory tract infections are known to be contributing factors.
Respiratory Tract infections (Pulmonary infections) include
- Acute Bronchitis
- Pneumonia
- Tb
Acute bronchitis
is acute infection or inflammation of the airways or bronchi and is usually self-limiting.
Majority of cases of acute bronchitis are caused by:
viruses
Clinical manifestations of acute bronchitis is similar to what disease?
pneumonia
How does acute bronchitis differ from pneumonia?
Many of the clinical manifestations are similar to those of pneumonia (i.e., fever, cough, chills, malaise), but the physical examination does not reveal signs of pulmonary consolidation (i.e., dullness to percussion, crackles, egophony), and chest radiographs do not show infiltrates.
What is the treatment of acute bronchitis?
Treatment consists of rest, aspirin, humidity, and a cough suppressant, such as codeine. Antibiotics are indicated for bacterial bronchitis.
Pneumonia
Pneumonia is infection of the lower respiratory tract caused by bacteria, viruses, fungi, protozoa, or parasites.
Types of pneumonia:
- community-acquired (CAP),
- hospital-acquired (HAP), or
- ventilator-associated (VAP).
Most common cause of CAP
The most common cause of viral CAP is influenza
What is the leading cause of death from a curable infectious disease?
TB is the leading cause of death in the world from a curable infectious disease.
How is Tb transmitted?
TB is highly contagious and is transmitted from person to person in airborne droplets.
latent TB infection (LTBI)
Occurs in immunocompetent individuals, the microorganism is usually contained by the inflammatory and immune response systems.
Is associated with no clinical evidence of disease
Pulmonary Vascular Disease:
Blood flow through the lungs can be disrupted by disorders that occlude the vessels, increase pulmonary vascular resistance, or destroy the vascular bed.
Major disorders associated with Pulmonary Vascular Disease?
Pulmonary embolism
Pulmonary hypertension
cor pulmonale
Pulmonary embolism (PE)
Pulmonary embolism (PE) is occlusion of a portion of the pulmonary vascular bed by an embolus.
What does a PE mostly result from? What is this called?
E most commonly results from embolization of a clot from deep venous thrombosis involving the lower leg
VTE
Flow chart of PE:
Venous stasis, Vessel injury, hypercoagulability –> Thrombus formation –> dislodgement of portion of thrombus –> occlusion of part of pulmonary circulation –> hypoxic vasoconstriction, decreased surfactant, release of neurohumoral and inflammatory substances, pulmonary edema, atelectasis
PE will lead to what symptoms:
Tachypnea
Dyspnea
Chest pain
increased dead space
V/Q inbalance
Decrease PaO2
Pulmonary infarction
Pulmonary hypertension
Decreased CO
Systemic hypotension
Shock
Pulmonary arterial hypertension (PAH)
Pulmonary arterial hypertension (PAH) is defined as a mean pulmonary artery pressure greater than 25 mm Hg at rest (normal is 15 to 18 mm Hg).
What are the most common causes of lung disease associated with PAH?
COPD and interstitial fibrosis
