Patho - Exam 4 Obstructive Pulmonary Disorders

Front 1

What disease is the 5th leading cause of death?

Back 1

obstructive pulmonary disease

Front 2

3 Causes of obstruction of the airway:

Back 2

1. obstruction of lumen
2. conditions in wall of lumen
3. obstruction from pressure increase around the outside of the airway lumen

Front 3

What 3 conditions can cause increased pressure around the outside of the airway lumen?

Back 3

emphysema, enlarged lymph node, tumor

Front 4

What 2 conditions cause thickening of lumen walls causing an obstruction?

Back 4

asthma, bronchitis

Front 5

What can generally cause obstruction of the airway lumen?

Back 5

foreign body, increased secretions, aspiration (removing fluids w/ a suction device)

Front 6

4 disease conditions causing obstruction of airway lumen:

Back 6

1. Bronchiectasis
2. Bronchiolitis
3. Cystic Fibrosis
4. Tracheal/Bronchial obstruction

Front 7

Bronchiectasis:

Back 7

-acquired or congenital disorder
-a chronic inflammatory or degenerative condition of one or more bronchi or bronchioles marked by dilation and loss of elasticity of the walls

Front 8

What condition accounts for 50% of bronchiectasis cases?

Back 8

cystic fibrosis

Front 9

What effects does bronchiectasis have on the body?

Back 9

-causes productive cough
-recurrent infections
-inflammation of bronchial walls
-destruction of walls
-obliteration of bronchioles
-bronchial lumen resembles varicose veins
-cause clubbing of fingers dt low O2

Front 10

purulent:

Back 10

-containing, discharging, or causing the production of pus

Front 11

hemoptysis:

Back 11

-expectoration of blood or of blood-streaked sputum from the larynx, trachea, bronchi, or lungs

Front 12

rhonchi:

Back 12

-coarse rattling sound somewhat like snoring, usually caused by secretion in a bronchial tube

Front 13

Dx of bronchiectasis:

Back 13

-Hx of purulent cough
-xray finds small cysts and increased markings
-PF test results low PaO2 and high PaCO2

Front 14

Tx of bronchiectasis:

Back 14

-postural drainage
-bronchodilators
-antibiotics from cultures (causes this condition to now be rare)
-nutrition
-bronchoscopy with lavage (washings w/ water) to irrigate bronchial tubes

Front 15

bronchiolitis:

Back 15

-inflammation of bronchioles by virus or bacteria
-usually in children < 2 YO
-assoc with smoking bc it thickens membranes

Front 16

What effects does bronchiolitis have on the body?

Back 16

-inflammatory exudate displacing surfactant
-bronchiolar constriction
-inflammation with narrowing of airway
-causes wheezing, rhonchi (low sounds)

Front 17

Dx of bronchiolitis:

Back 17

-leukocytosis (increased WBC)
-enlarged air sacs
-atelectasis or hyperinflation

Front 18

Tx of bronchiolitis:

Back 18

-bronchodilators (reduce wheezing)
-humidified O2
-antibiotics
-steroids used to decrease inflammation

Front 19

Cystic Fibrosis:

Back 19

-aka mucoviscidosis
"thick sticky secretions"
-genetic defect
-most common chronic lung disease among white children and young adults
-hypersecretion of abnormal,thick mucus that obstructs exocrine glands and ducts

Front 20

What effects does cystic fibrosis have on the body?

Back 20

-affects pancreas and lungs
-mucus-producing glands from hypertrophy and producing thick mucoproteins
-decreased pancreatic enzymes
-thick mucus decreases ciliary action

Front 21

What glands are affected by cystic fibrosis?

Back 21

sweat, salivary and lacrimal (tear) dt blocking ducts from thickness

Front 22

What other conditions are caused by cystic fibrosis?

Back 22

-thick, tenacious sputum causing recurrent infections, pneumonia, Cor pulmonale, steatorrhea, digital clubbing, dyspnea rhonchi, barrel chest, pancreatic insufficiency, cirrhosis, diabetes, gallstones

Front 23

steatorrhea:

Back 23

-overaction of the sebaceous glands
-excessive discharge of fat in the feces, as occurring in pancreatic disease and in malabsorption syndromes.

Front 24

What other conditions are causes by cystic fibrosis in infants?

Back 24

-respiratory infections
-jaundice
-failure to thrive

Front 25

Dx of cystic fibrosis:

Back 25

-chest xray for PFT
-stool examination for fat
-genetic testing
-ABGs
-sweat electrolyte test to determine amt of salt in sweat

Front 26

Tx for cystic fibrosis:

Back 26

1. aggressive pulmonary management
2. antibiotic therapy (intravenous, oral, aerosol)
3. low fat-high protein diet
4. pancreatic enzymes, vitamins
5. possible transplant of heart or lung
6. gene therapy

Front 27

What is the primary tx aimed at during aggressive pulmonary management for cystic fibrosis pts?

Back 27

-bronchodilators
-postural drainage
-chest physiotherapy

Front 28

causes of tracheal/bronchial obstruction:

Back 28

-foreign body
-malpositioned endotracheal tube
-laryngospasm
-trauma
-tumor nodes

Front 29

Condition of pt with tracheal/bronchial obstruction:

Back 29

-abnormal breathing sounds
-inability to talk (pt holds their throat)
-pt progresses to unconsciousness

Front 30

Tx of tracheal/bronchial obstruction:

Back 30

Heimlich maneuver, suctioning, tracheotomy, stents

Front 31

3 disease conditions causing obstruction from conditions in wall of lumen:

Back 31

1. asthma
2. chronic bronchitis
3. acute bronchitis

Front 32

asthma:

Back 32

"broncho constriction"
-recurrent paroxysms of diffuse wheezing, dyspnea, and cough resulting from spasmodic contractions of the bronchi

Front 33

6 types of asthma:

Back 33

1. extrinsic
2. intrinsic
3. excercise induced
4. occupational
5. drug-induced
6. cardiac

Front 34

extrinsic asthma:

Back 34

aka "allergic asthma"
-1/3 to 1/2 of all cases
-IgE mediated
-determined by skin tests

Front 35

intrinsic asthma:

Back 35

-frequently develops in middle ages
-less favorable type
-caused by respiratory infections
-not IgE mediated
-caused by stress, irritants, and exercise
-antigen-antibody reactions play a minimal role

Front 36

exercise induced asthma:

Back 36

-more likely in cold water
-caused by cooling and dehydration of airways

Front 37

occupational asthma:

Back 37

-resembles allergic asthma
-positive work allergens on skin testing
-improvement when off work

Front 38

drug-induced asthma:

Back 38

-caused by aspirin and related products
-food additives (MSG)

Front 39

cardiac asthma:

Back 39

-bronchospasm
-induced by CHF

Front 40

Causes of asthma:

Back 40

-bronchospasm, increased secretions and mucosal edema
-antigen reacts with antibody
-release of chemical mediators
-parasympathetic (vagus)stimulation
-response, duration, degree of obstruction are all variable

Front 41

List the 3 chemical mediators released during asthma:

Back 41

1. histamine
2. prostaglandins
3. serotonin

Front 42

What happens to the body during an asthma attack?

Back 42

-wheezing, dyspnea, cough
-tachycardia
-hypoxemia
-symptoms are related to severity of attack

Front 43

During an asthma attack, where is wheezing more prominant - during expiration or inspiration?

Back 43

during expiration bc the pt has more control over inspiration that expiration

Front 44

Dx of asthma:

Back 44

-hyperinflation on chest xray
-forced expiratory volumes decrease
-skin testing for allergens
-increase in WBCs, esp eosinophils
-eosinophils + on sputum exam

Front 45

Tx of asthma:

Back 45

1. initial therapy aimed at prevention
2. chemotherapy
3. hyposensitization by injections

Front 46

status asthmaticus:

Back 46

-an attack of asthma of long duration characterized by dyspnea, cyanosis, exhaustion, and sometimes collapse

Front 47

Tx for status asthmaticus:

Back 47

-epinepherine
-aminophylline
-IV corticosteroids
-inhaled aerosols

Front 48

5 causes of chronic bronchitis:

Back 48

1. smoking
2. viral
3. bacterial
4. physical irritants
5. chemical irritants

Front 49

What effects does chronic bronchitis have on the body?

Back 49

-chronic inflammation, swellings, fibrosis mucosa
-thickening of mucus and loss of ciliary action
-involvement of small pulmonary arteries causing pulm HTN and Cor pumonale
-can also lead to bronchiectasis

Front 50

4 types of chemotherapy used to treat asthma:

Back 50

1. inhaled bronchodilators
2. inhaled corticosteroids
3. beta-adrenergic drugs
4. oral corticosteroids (scheduled)

Front 51

Give a symptomatic description of chronic bronchitis:

Back 51

-hypersecretion of bronchial mucosa with chronic or recurrent cough over 3 months
-shortness of breath
-cough and sputum worse in the AM
-pt is usually a smoker

Front 52

fibrosis mucosa:

Back 52

-formation of excessive fibrous tissue on the mucus-secreting membrane lining all body cavities (or passages that communicate with the exterior)

Front 53

Dx of chronic bronchitis:

Back 53

1. xray noting congestion
2. reduced PFT
3. possible RVH
4. possible polycythemia
5. findings related to severity

Front 54

Tx of chronic bronchitis:

Back 54

-bronchodilators
-antibiotics
-possible steroids
-oxygen (caution in COPD pts)

Front 55

acute bronchitis:

Back 55

-primarily viral
-mostly mild and self-limited
-usually only supportive tx
-danger of croup or epiglottis in children (could be emergency)

Front 56

croup:

Back 56

-pathological condition of the larynx
-especially in infants and children
-characterized by respiratory difficulty and a hoarse, brassy cough

Front 57

What condition can cause obstruction related to the loss of lung parenchyma?

Back 57

emphysema

Front 58

emphysema:

Back 58

-aka pulmonary emphysema
-pathological condition of the lungs marked by an abnormal increase in the size of the air spaces
-causes labored breathing
-highly prone to infection
-can be caused by irreversible expansion of the alveoli or by the destruction of alveolar walls

Front 59

causes of emphysema:

Back 59

-smoking
-loss of alveolar walls reducing pulmonary capillary bed
-loss of elasticity of lungs
-causes air trapping or bullae (bubbles)

Front 60

What effects does emphysema have on the body?

Back 60

-progressive exertional dyspnea
-increased respiratory rate keeping O2 levels adequate until severe state occurs

Front 61

Dx of emphysema:

Back 61

1. PFT with an increase of residual volume, decrease of FEV and vital capacity
2. hyperventilation and blebs (air bubbles) on xray
3. decreased breathing sounds and hyperresonance (high amplitude, low pitch)
4. barrel chested

Front 62

Tx of emphysema:

Back 62

-stop smoking
-bronchodilators (limited effect)
-O2 therapy

Front 63

Name 3 diagnostic tests used with respiratory disorders:

Back 63

1. spirometry
2. ABGs
3. administration of allergens as tests

Front 64

ABG norms of pH, PaO2 and PaCO2:

Back 64

pH: 7.4
PaO2: 80-100
PaCO2: 40

Front 65

How do ABGs (pH, PaO2 and PaCO2) change with COPD pts?

Back 65

pH is decreased
PaO2 is decreased
PaCO2 is increased

Front 66

spirometry:

Back 66

-measurement by means of a spirometer of the air entering and leaving the lungs
-ratio of FEV/FVC which should be > 75-80%
-FEV is tested after bronchodilator (if improves by > 15% then condition is partially reversible bronchospasm)

Front 67

What will the spirometric ratio be with severe obstruction of air flow?

Back 67

< 50%