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183 Cards in this Set
- Front
- Back
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Pulmonary Emobolism
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Substance that lodges in branch of pulmonary and obstructs flow
lungs funtioning but hypoxic |
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#1 cause of Pulmonary Embolism
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Clot from DVT, usally from calf area of immobolized person. Lodges in lungs
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Predisposing factors to PE
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Venous stasis (slugish circulation usually from bedress)
Hypercoagulability disorders Damage to vein wall (usually trauma) platllets gather |
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Patho of PE
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Thrombi disloged & floats free becoming an emboli
Most often lodges in lower lobes of lungs Can obstruct 25% of pulmonary vessels w/out S/S (if more than 50% are obstructed - dangerous) Pressure in pulmonary artery rises and can cause Rt sided heart failure |
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S/S of PE
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Reslessness (caused by hypoxia)
apprehension anxiety sudden dyspena tachycardia tachypnea sudden crushing substernal (with large emboli) |
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Px PE Treat/prevent clots in leg w/
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range of motion/ambulation
do homans assessment heparin SQ |
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Treatment PE
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Emergency!! O2 Stat
heparin IV Thrombolytic drugs embolectomy |
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Thrombolytic drug
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Streptokinase or t-PA
breaks clogs |
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Leading cause of CANCER death in men & women
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Lung
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Risk for lung cancer
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SMOKING
Asbestos coal dust chemicals |
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Types of lung cancer
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Squamous cell carcinoma
Adenocarcinoma Large cell carcinoma Small cell carcinoma |
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Lung Cancer that doubles in size in 100 days
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Squamous cell
Large cell |
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Lung CA that doubles in size in 180 days
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Adenocarcinoma
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Lung CA that doubles in 33 days
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Small cell carcinoma
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Lung CA located in central lung
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Squamous
small cell |
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lung cancer located in peripheral lung
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adenocarcinoma
large cell |
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Lung cancer related to smoking
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squamous cell (definitely)
large cell (definitely) Small cell (strongest association with smoking) |
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20-35% of lung CA
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Squamous Cell
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35-40% of lung cancer
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adenocarcinoma
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5-20% lung cancers
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large cell
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15-20% of lung cancers
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small cell
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Treatment options for lung cancer
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Squamous - surgery
Adenocarcinoma - surgery/chemo Large cell - poor treatment options Small cell - very poor (chemo) hardest to treat |
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lung cancer usually metastasizes to/near lymph nodes
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squamous cell
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lung cancer usually metastasizes to/near unpredictable locations far from lungs
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adenocarcinoma
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lung cancer usually metastasizes to/near distant locations quickly
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large cell
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lung cancer usually metastasizes - wide spread
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small cell
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squamous cell metastasize to
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near by lymph
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adenocarcinoma metastasize
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unpredictable locations far from lungs
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large cell metastasize
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distant locations quickly
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small call metastasize
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wide spread metastis
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Overall lung cancer S/S
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Gradually chronic cough
SOB wheezing hemoptysis dull chest pain non-specific wt. loss and wasting |
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hemoptysis
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coughing of blood
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Chronic Obstructive Pulmonary Disease COPD
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group of disease characterized by obstruction & difficult expiration
chronic & recurrent Often associated w/ smoking, air pollution, occupational exposure |
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Name COPD's
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Asthma
Status Asthmaticus Chronic Bronchitis Emphysema |
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Asthma effect how many people
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15-17 million in US
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most common chronic disease of children less then 17, but dx at any age
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asthma
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Asthma is characterized by
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Reversible airway obstruction (bronchospasm & bronchoconstriction)
Airway inflammation Hyper-responsiveness to stimuli (allergen, cold, exercise) |
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Types of asthma
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Extrinsic (childhood onset)
Intrinsic (adult onset) |
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asthma childhood onset
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extrinsic
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asthma adult onset
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intrinsic
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extrinsic asthma associated w/
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hayfever
family history allergies |
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intrinsic asthma associated w/
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respiratory infections
exercise stress |
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asthma not associated w/ allergy
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intrinsic
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Other types/terms for asthma
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exercise induced
occupational/environmental drug |
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Patho of extrinsic asthma
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allergen/irritant inhled
> mast cells attracted >release of histamine decrease in cilia actions causes inflammation of lining hyperresponsiveness (broncospasm & bronchoconstriction) increased vascular permeability > edema & thick mucus productions |
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S/S of asthma
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wheezing
tightness in chest Dsypnea cough & sputum production all that leads to anxiety/apprehension causing tachycardia, sitting up to use accessory muscles to breath |
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Treatment for asthma
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avoid allergens
peak flow meter for home relaxation controlled breathing sympathomimetics- epinephrine, alupent, isoprel (stimulates FFF) bronchodilators (theophyline, relaxes smooth muscle) corticosteriods - prednisone decreases inflammations |
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prednisone
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corticosteriod that decreases inflammations
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satus asthamaticus
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servere bronchospasm that doesn't respond to usual treatment
need epinephrine o2 possible ventilator |
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Chronic Bronchitis
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Inflammation of the bronchi due to chronic irritation from inhaled substances or infection lasting more than 3m/yr for 2+ years > chronic irreversible obstruction
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Chronic obstruction
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Chronic Bronchitis
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Emphysema
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Irreversible destruction of alveolar wall & abnormal enlargment of air sacs
loss of elasticity loss of gas exchange surface area |
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loss of elasticity
loss of gas exchange |
emphysema
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Irritants cause chronic inflammation & swelling > scarring & fibrosis
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chronic bronchitis
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Inreased thick mucus production & increase the size of mucus producing glands
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chronic bronchitis
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cilia action decreased
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chronic bronchitis
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decreased mucus clearance because
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decreased cilia action
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obstruction of airlow due to mucus > hypoventilation & hypoxemia
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chonic bronchitis
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obstruction of airflow due to mucus can lead to
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hypoventilation
hypoxemia |
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hypoxemia
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deficient blood oxygen as measured by low arterial o2 & low hemoglobin saturation as measured by arterial blood gases or pulse oz
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ventilation/perfusion mismatch (blood flow is ok (perfusion), but ventilation is obstructed)
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chronic bronchitis
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elastin is broken down in alveolar septum
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emphysema
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large air spaces r created
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emphysema
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airways collapse and trap air in distal alveoli
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emphysema
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can get air in, but expiration becomes difficult > hyperinflation
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emphysema
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air sacs stay full
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hyperinflation
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inflammation and hyperactivity > bronchospasm & narrowing of airways
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emphysema
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No mucus production
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emphysema
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no ventilation/perfusion mismatch
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emphysema
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can get air in but can't get air out
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emphysema
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ventilaton okay perfusion not
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pulmonary embolism
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ventilation/perfusion mismatch
ok vent/ perf not |
pulmonary embolism
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may be air pollution but 20x greater chance if u smoke
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chronic bronchitis
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may be inherited or due to smoking
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emphysema
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over wt.
30-40's history of smoking SOB wheezing exercise intolerance increased sputum in am chronic cough prolonged expiration |
chronic bronchitis
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thin
in 50's SOB for 3-4yrs history of smoking |
emphysema
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s/s breathing of chronic bronchitis
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SOB
wheezing exercise intolerance increased sputum in am chronic cough prolonged expiration |
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dyspnea on exertion
no wheezing prolonged labored expiration |
emphysema
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a disease that takes some work to breathe
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chronic bronchitis
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extreme work to breathe
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emphysema
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blue (hypoxia) bloater (fluid/mucus)
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chronic bronchitis
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pink puffer
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emphysema
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often must lean foward to breath
pursed lip breathing |
emphysema
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productive cough w/ copious sputum
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chronic bronchitis
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hyperactivity of mucus cells
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chronic bronchitis
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minimal to no cough & mucus
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emphysema
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barrel chest
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emphysema
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cyanosis in end-stage
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chronic bronchitis
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gurgles & rhonci
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chronic bronchitis
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decreased breath sounds
distant & soft sounds no fluid in lungs |
emphysema
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Increased Co2 decreased o2
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chronic bronchitis
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hypercapnia & hypoxia
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chronic bronchitis
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hypoxia
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decrease in tissue o2
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hypercapnia
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greater than normal amounts of carbon dioxide in blood
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T or F chronic bronchitis is respiratory acidosis
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T
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relatively normal blood gases
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emphysema
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death of chronic bronchitis pt
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early age
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death of emphysema pt
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older age
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Chronic Bronchitic treatment
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limit o2
avoid smoking & irritants control respiratory infections good nutrition & fluids breathing training bronchodilators percussion & postural drainage |
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emphysema treatment
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limit o2
avoid smoking & irritants control respiratory infections good nutrition & fluids breathing training |
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meds for chronic bronchitis
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bronchodilators (theophyline)
expectorants corticosteriods adrenergics |
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Limit o2 for chronic bronchitis and emphysema pt because
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if given to high a concentration will decrease stimulus to breath
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how much o2 for chronic bronch. & emphysema pt
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no more than 2L
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atelectasis
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collapse of lung tissue (alveolar)
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several diseases cause _______ = collapse of lung tissue
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atelectasis
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Diseases caused by atelectasis
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ARDS
Infant RDS |
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Respiratory failure characterized by acute lung inflammation and alveolar damage
hypoxia that doesn't responds to o2 treatment |
ARDs
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ARDS stands for
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adult respiratory distress syndrom
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Complications not really a disease
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ARDS
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ARDS is
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Respiratory failure
acute lung inflammation alveolar/capillary membrane damage > hypoxia that doesn't respond to o2 treatment |
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causes of ARDS
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sepsis
major trauma shock surgery burns pneumonia |
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patho
Injury to alveolar capillary membrane increases cap permeability leading to fluid in alveoli surfactant becomes damaged & alveoli collapse & become hard to inflate again Increased respiration & impaired gas exchange fibrosis & decreased pulmonary compliance (hyaline membrane form) leads to resp. failure & MODS |
ARDS
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hyaline membrane
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a fibrous covering of the alveolar membrans in infants caused by lack of surfactant
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S/S of ARDS
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follows an event
low blood volume state like shock sudden resp. distress > tachycardia, dyspnea, low o2 hypoxia unresponsive to o2 |
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treat the cause
humidified o2 & PEEP incubation w/ ventilator if needed |
ARDS
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PEEP
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positive end-expiratory pressure that forces o2 in
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leading cause of death in premature babies
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infant respiratory distress syndrome
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Infant RDS is associated w/
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pulmonary immaturity less than 30 weeks (lack of surfactant)
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infantRDS patho
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increase pressure is needed to inflate alveoli > atelectasis
alveoli collapse between each breath or baby can't work hard enough to open it all |
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alveoli collapse between each breath or can't work hard enough to open it all
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infant RDS
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infant RDS S/S
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tachypnea
shallow respiration retractions working hard to breathe decreased breath sounds low o2 saturation central cyanosis (due to hypoxia) |
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Monitor o2
o2 by PEEP mechanical ventilation surfactant replacement/therapy |
treatment for Infant RDS
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pneumothorax
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collapsed lung not just alveoli because
air gets between the linings of the pleura & lung collapse |
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destroys the negative pressure of the respiratory system
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pneumothorax
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names of pneumothorax
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primary
secondary open tension |
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primary pneumothorax
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occurs spontaneously in health people
usually smokers age 20-40 rupture of air blebs in top of lungs |
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secondary pneumothorax
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due to existing pulmonary diseas
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open pneumothorax
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fracure ribs & medical procedures "puncture lung"
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tension pneumothorax
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air gets in (due to trauma) but can't get out again increased pressure in chest (like a one-way valve)
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S/S pneumothorax
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sudden chest pain
increased respiration (1 lung) increased heart rate (1/2 o2) chest asymmetry mediastinal shift to ok side decreased breath sounds or absent on one side |
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Dx CXR and o2 sat & chest auscultation
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pneumothorax
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Treatment - Sometime spontaneously resolves (whole lung may not be collapsed)
chest tube to reinflate lung |
pneumothorax
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TB caused by
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mycobacterium TB
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Increased in blacks, hispanics, homeless, refugess & HIV
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TB
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an acid-fast bacilli
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TB
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TB transmitted
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airborne - droplet nuclei, from secretions in small droplets lodges in the upper lobes of the lung
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Lung destruction is NOT due to the organism but the immune response to the organism
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TB
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TB test shows
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if you have been sensitized to the organism - may not actually be in the lungs anymore
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Primary TB infection patho
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exposure usually unknown (breathe in TB directly to alveoli (so small))
macrophages engulf the bacillus & WBC fuse around bacillus to isolate it encapsulation occurs (ghons tubercle) & central portion of tubercle necroses scar tissue forms around the tubercle + TB test can be seen on chest xray remains dormant until tuberucle is broken down during times of immunosupression |
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encapsulation (primary TB)
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ghons tubercle
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caseous necrosis
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central portion of tubercle necroses
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Usually DONT get active TB disease with
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intial infection; get it from secondary infection
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Secondary TB (reactivation)
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reactivation of healed tubercle during times of deceased defenses
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Low grade fever
night sweats fatigue wt. loss decreased appetite eventual cough w/ mucoid bloody sputum eventually |
secondary TB
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+ TB test
sputum culture CXR |
secondary TB
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Gold standard for TB test
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sputum culture
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Meds for secondary TB
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INH
rifampin ethambutol |
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Multiple drugs for a long time to treat
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secondary TB
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Drugs usally give 2+ at a time many people exp hiv pt get a drug resistant form
course of treatment 6-9m hiv pt will take meds longer |
secondary TB
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viral infection of the larynx
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croup
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inflammatory edema of the --------- caused by H. flu virus
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epiglottitis
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viral infection of the lower airway often infected with RSV
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bronchiolitis
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RSV
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respiratory syncytial virus
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childhood respiratory diseases
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croup
epiglottitis bronchiolitis |
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inflammation of the vocal cords down
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croup
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bronchioles swell and cellular debris forms little plugs > can get air in but not out
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bronchiolitis
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child resp. disease
children 3m to 2yrs; more common in winter |
croup
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child resp. disease
children 2-4yrs |
epiglottitis
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child resp. disease
family with cold transmitis it to a child less then 2yrs old |
bronchiolitis
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S/S croup
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barking cough
inspiratory stridor crying anxiety preceded by URI |
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S/S epiglottitis
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VERY soar throat
sudden airway obstruction can't swallow drooling pale anxious fever |
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S/S bronchiolitis
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Wheezing
dyspnea crackles retraction sputum tachypnea fever listessness |
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cool mist/ mist tent or runn shower
cool vaporizer night air o2 hydration epinephrine |
treatment of coup
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ER quickly (trach & antibotics)
don't lay child down don't look down throat |
epiglottitis
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o2 - humidified
bronchodilators prevent dehydration |
bronchiolitis
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heridity autosomal recessive disorder of exocrine glands
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cystic fibrosis
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exocrine glands in lungs, on skin, & in pancreas
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cystic fibrosis
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Cystic fibrosis patho
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gene mutation leads to thick mucus & stasis of mucus (anywhere mucus cells are located)
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thick tenacious sputum - can't cough up
recurrent pulmonary disorders dyspnea tachypnea retractions crackles/gurgles > chronic lung disease pancreatic insufficiency > malabsorption of food |
S/S of cystic fibrosis
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Dx for Cystic Fibrosis
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sweat test - stimulate skin with electrode & pilocarpine
"salty baby" usually dx at 6m of age |
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Tx for Cystic Fibrosis
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Respiratory support - because respiratory problems kill them
chest visotherapy (postural drainage & percussion) expectorants treat infection quickly pancreatic enzymes |
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used to be rare to live past 20, now many live beyond 30 and have children
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cystic fibrosis
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Pneumonia
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acute inflammation of the alveoli & bronchi
may be bacterial or viral |
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pneumonia organism - community
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strep. pneumoniae
Nosocomial E. Coli Klebsiella Pseudamonas staph. Aureus |
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Can be lobar or bronchial
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pneumonia
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aspirations of organism spread by aerosol (cough or contaminated air)
Inflammatory response - accumulation of exudate, RBC & bacteria in alveoli consolidation of lobe as exudate fills air spaces & thickens (can't be coughed up) |
Patho bacterial pneumonia
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viral pneumonia doesn't cause
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exudate
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sudden onset of malaise
shaking chills Increased WBC Fever cough crackles pleuritic pain sputum color varies |
S/S of bacterial pneumonia
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destroys cilited epithelial cells leading to increase mucus production with poor clearance
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bacterial pneumonia
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slow onset
low fever cough crackles |
S/S of viral pneumonia
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mild to self-limiting disease
can have secondary infection with bacteria |
viarl pneumonia
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Dx pneumonia
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find the organism
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Tx pneumonia
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antibotics (bacterial)
deep breathing & coughing exercises hydration |
