Week 8 - Respiratory Flashcards
clinical manifestations of repiratory diseases
dyspnea abnormal breathing patterns hypo- & hyperventilation cough hemoptysis cyanosis pain clubbing abnormal sputum
dyspnea s&s
flaring nostrils
accessory muscle use
retraction of intercostal spaces
cheyne stokes
alternating periods of deep and shallow breathing
apnea for 15-60 seconds then rapid resps
cheyne stokes results from
injury to brainstem
during hypoventilation
co2 removal does not keep up with co2 production an paco2 increases causing hypercapnia, results in respiratory acidosis
causes of hypercapnia
- Depression of resp. centre by drugs
- Diseases/trauma of the medulla
- Spinal cord disruption
- Diseases of neuromuscular junction or respiratory muscles
- Thoracic cage abnormalities
- Large airway obstruction
- Increased work of breathing
hypoxemia causes
decreased oxygen content of inspired gas hypoventilation diffusion abnormalities abnormal ventilation-perfusion ratios pulmonary right-to-left shunt
acute cough
resolves within 2-3 weeks, URI
chronic cough
more than 3 weeks
postnasal drip, bronchitis
hemoptysis
coughing up blood caused from damage to lung parenchyma
asthma
chronic inflammatory disease of the airways, morbidity and mortality has risen over last 2 decades
asthma patho
Inflammation resulting in hyper-responsiveness of the airways to environmental triggers.
Produces bronchial smooth muscle spasm, edema formation, tenacious mucus production, ->obstruction
s&s asthma
Dyspnea, tachypnea Wheezing on inspiration and expiration Tachycardia Circumoral cyanosis Accessory muscle use Diaphoresis Pallor
asthma drugs
1st->bronchodilators 2nd->long acting bronchodilators 3rd->anticholinergic agents 4th->inhaled corticosteroids 5th->oral steroids 6th->IV steroids
s&s copd
Dyspnea Cyanosis Productive cough Respiratory fatigue Severe accessory muscle use Orthopnea
chronic bronchitis
Chronic bronchitis is hypersecretion of mucous and productive cough (at least 3 months of the year for at least 2 years)
Patients have decreased exercise tolerance, infection is common
emphysema
Abnormal permanent enlargement of gas exchange airways
Obstruction results from changes in lung tissues
Loss of elastic recoil in alveolus and narrowed bronchiole
emphysema s&s
Dyspnea on exertion -> marked dyspnea Little cough and little sputum production Use of accessory muscles for ventilation Often very thin Braces for easier breathing
emphysema dx & tx
Pulmonary function tests indicate obstruction to expiratory phase of ventilation
TLC (total lung capacity) may be twice normal
ABG normal until late in disease
Smoking cessation most important tx
Inhaled anticholinergic agents
Relaxation exercises, reconditioning and breathing retraining helpful
tuberculosis
Infection of lower respiratory tract caused by mycobacterium tuberculosis, an acid-fast bacillus
Main reason for recent increases is AIDS - very susceptible to respiratory infections
Multidrug-resistant TB now present
Due to not taking medications and mutation of bacteria
tb patho
Transmitted in airborne droplets
Inspired bacilli cause pneumonitis (lung inflammation)
Neutrophils and macrophages seal colonies of bacilli into a tubercule
Infected tissues inside tubercule die and form a cheeselike substance (all within 10 days)
May lie dormant for years to whole lifetime
Poor nutritional status, IDDM, long term steroids
tb manifestations
Often asymptomatic
Fatigue, weight loss, lethargy, anorexia, low-grade fever in afternoon
Cough- purulent sputum, progresses to hemoptysis
Night sweats, general anxiety
croup
Subglottic edema from the infection (in an already narrow airway)
Increased resistance to airflow -> increased work of breathing-> may cause dynamic collapse of upper airway
Watch for rhinorrhea, sore throat, low-grade fever-> seal-like barking cough
Most resolve spontaneously after a few days
If obstruction severe, needs immediate help
croup s&s
Sore throat
Low-grade fever
Seal-like, barking cough
croup dx & tx
Some controversy over treatment
If no stridor, then little treatment
Now evidence of value of single dose of steroid with half-life of 36-72 hours
Science neither supports or refutes use of mist
pneumonia
Infection of the lower respiratory tract
caused by bacteria, viruses, fungi, protozoa, or parasites
pneumonia risk factors
elderly, immunocompromised, lung disease, alcoholism, altered consciousness, smoking, intubation, malnutrition, immobilization
pneumococcal pneumonia
Best understood pneumoniae
Inflammatory response and exudate cause alveolar edema
This media causes multiplication of bacteria and spread of infection
Phagocytosis takes place in consolidated alveoli
Usually infection limited to 1-2 lobes
viral pneumonia
Mild and self-limiting
Usually sets the stage for another infection (because it provides the perfect environment for bugs to grow)
Primary infection = influenza pneumonia
Caused by another infection such as chic pox, measles
pneumonia s&S
cough dyspnea fever chills malaise pleuritic chest pain
pneumonia dx
Confirmed by chest x-ray
Elevated WBC
Should do sputum Gram stain and possibly blood cultures
lun cancer general info
Arise from epithelium of respiratory tract
Considered an epidemic in the U. S.
Mortality rate still rising in women, higher even than breast cancer
Most common cause is smoking
Passive smoking = 30% higher risk
Genetic predisposition to lung cancer
Also environmental & occupational risk factors
lung cancer manifestations
Early symptoms are non-specific
Coughing, sputum production, hemoptysis, airway obstruction, pleural effusions
Disease usually well advanced before medical advice is sought
Only proven reduction method is smoking cessation
cystic fibrosis
Autosomal recessive inherited disease
In middle of chromosome 7
Gene mutation that results in abnormal expression of cystic fibrosis transmembrane regulator
Results in abnormal secretions that obstruct tracts in respiratory, digestive, and reproductive systems
Generally affects Caucasians
Carriers are healthy
cystic fibrosis patho
Autosomal recessive inherited disease
In middle of chromosome 7
Gene mutation that results in abnormal expression of cystic fibrosis transmembrane regulator
Results in abnormal secretions that obstruct tracts in respiratory, digestive, and reproductive systems
Generally affects Caucasians
Carriers are healthy
cystic fibrosis clinical manifestations
Age of diagnosis 6 mos -> 1 year
10% not diagnosed until after age 10
Respiratory problems - persistent cough or wheeze and recurrent pneumonia
GI problems - meconium ilius, failure to thrive, malabsorptive symptoms
Males are typically infertile
Severity not predictable by genotype, affected siblings may be very different
cystic fibrosis dx
Standard test is sweat test
CF patients secrete high levels of electrolytes in their sweat
sweat chloride concentration > 60 mEq/L
4 types of pneumonthorax
Spontaneous
Tension
Open
Secondary
pleural effusion
Can be fluid - Exudative - Transudative Can be blood - Hemothorax Can be pus - Empyema
flail chest results from
rib or sternal fractures that disrupt mechanics of breathing
pneumothorax
accumulation of air in pleural space
tension pneumothorax
trapping of air in pleural space, life threatening
pleural effusion
accumulation of fluid in pleural space
empyema
presence of pus in pleural space
aspiration
passage of fluid and solid particles into lung
atelectasis
collapse of alveoli
bronchiectasis
inflammatory obstruction of small airways
bronchiolitis obliterans
an inflammatory, fibrotic
process that occurs as a complication of lung transplantation.
pulmonary fibrosis
excessive amount of connective tissue
in the lung
pneumoconiosis
inhalation of dust particles in workplace
pulmonary edema
presence of excess water in the lung
caused by disturbances of capillary hydrostatic pressure,
capillary oncotic pressure, or capillary permeability
ALI/ARDS
results from an acute, diffuse inflammatory injury
to the alveolocapillary membrane and decreased surfactant
production, which increases membrane permeability and
causes pulmonary edema and atelectasis
acute bronchitis
acute infection or inflammation of the large
airways or bronchi; it is usually self-limiting and caused by
viruses.
