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67 Cards in this Set

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What disease is the 5th leading cause of death?
obstructive pulmonary disease
3 Causes of obstruction of the airway:
1. obstruction of lumen
2. conditions in wall of lumen
3. obstruction from pressure increase around the outside of the airway lumen
What 3 conditions can cause increased pressure around the outside of the airway lumen?
emphysema, enlarged lymph node, tumor
What 2 conditions cause thickening of lumen walls causing an obstruction?
asthma, bronchitis
What can generally cause obstruction of the airway lumen?
foreign body, increased secretions, aspiration (removing fluids w/ a suction device)
4 disease conditions causing obstruction of airway lumen:
1. Bronchiectasis
2. Bronchiolitis
3. Cystic Fibrosis
4. Tracheal/Bronchial obstruction
Bronchiectasis:
-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
What condition accounts for 50% of bronchiectasis cases?
cystic fibrosis
What effects does bronchiectasis have on the body?
-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
purulent:
-containing, discharging, or causing the production of pus
hemoptysis:
-expectoration of blood or of blood-streaked sputum from the larynx, trachea, bronchi, or lungs
rhonchi:
-coarse rattling sound somewhat like snoring, usually caused by secretion in a bronchial tube
Dx of bronchiectasis:
-Hx of purulent cough
-xray finds small cysts and increased markings
-PF test results low PaO2 and high PaCO2
Tx of bronchiectasis:
-postural drainage
-bronchodilators
-antibiotics from cultures (causes this condition to now be rare)
-nutrition
-bronchoscopy with lavage (washings w/ water) to irrigate bronchial tubes
bronchiolitis:
-inflammation of bronchioles by virus or bacteria
-usually in children < 2 YO
-assoc with smoking bc it thickens membranes
What effects does bronchiolitis have on the body?
-inflammatory exudate displacing surfactant
-bronchiolar constriction
-inflammation with narrowing of airway
-causes wheezing, rhonchi (low sounds)
Dx of bronchiolitis:
-leukocytosis (increased WBC)
-enlarged air sacs
-atelectasis or hyperinflation
Tx of bronchiolitis:
-bronchodilators (reduce wheezing)
-humidified O2
-antibiotics
-steroids used to decrease inflammation
Cystic Fibrosis:
-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
What effects does cystic fibrosis have on the body?
-affects pancreas and lungs
-mucus-producing glands from hypertrophy and producing thick mucoproteins
-decreased pancreatic enzymes
-thick mucus decreases ciliary action
What glands are affected by cystic fibrosis?
sweat, salivary and lacrimal (tear) dt blocking ducts from thickness
What other conditions are caused by cystic fibrosis?
-thick, tenacious sputum causing recurrent infections, pneumonia, Cor pulmonale, steatorrhea, digital clubbing, dyspnea rhonchi, barrel chest, pancreatic insufficiency, cirrhosis, diabetes, gallstones
steatorrhea:
-overaction of the sebaceous glands
-excessive discharge of fat in the feces, as occurring in pancreatic disease and in malabsorption syndromes.
What other conditions are causes by cystic fibrosis in infants?
-respiratory infections
-jaundice
-failure to thrive
Dx of cystic fibrosis:
-chest xray for PFT
-stool examination for fat
-genetic testing
-ABGs
-sweat electrolyte test to determine amt of salt in sweat
Tx for cystic fibrosis:
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
What is the primary tx aimed at during aggressive pulmonary management for cystic fibrosis pts?
-bronchodilators
-postural drainage
-chest physiotherapy
causes of tracheal/bronchial obstruction:
-foreign body
-malpositioned endotracheal tube
-laryngospasm
-trauma
-tumor nodes
Condition of pt with tracheal/bronchial obstruction:
-abnormal breathing sounds
-inability to talk (pt holds their throat)
-pt progresses to unconsciousness
Tx of tracheal/bronchial obstruction:
Heimlich maneuver, suctioning, tracheotomy, stents
3 disease conditions causing obstruction from conditions in wall of lumen:
1. asthma
2. chronic bronchitis
3. acute bronchitis
asthma:
"broncho constriction"
-recurrent paroxysms of diffuse wheezing, dyspnea, and cough resulting from spasmodic contractions of the bronchi
6 types of asthma:
1. extrinsic
2. intrinsic
3. excercise induced
4. occupational
5. drug-induced
6. cardiac
extrinsic asthma:
aka "allergic asthma"
-1/3 to 1/2 of all cases
-IgE mediated
-determined by skin tests
intrinsic asthma:
-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
exercise induced asthma:
-more likely in cold water
-caused by cooling and dehydration of airways
occupational asthma:
-resembles allergic asthma
-positive work allergens on skin testing
-improvement when off work
drug-induced asthma:
-caused by aspirin and related products
-food additives (MSG)
cardiac asthma:
-bronchospasm
-induced by CHF
Causes of asthma:
-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
List the 3 chemical mediators released during asthma:
1. histamine
2. prostaglandins
3. serotonin
What happens to the body during an asthma attack?
-wheezing, dyspnea, cough
-tachycardia
-hypoxemia
-symptoms are related to severity of attack
During an asthma attack, where is wheezing more prominant - during expiration or inspiration?
during expiration bc the pt has more control over inspiration that expiration
Dx of asthma:
-hyperinflation on chest xray
-forced expiratory volumes decrease
-skin testing for allergens
-increase in WBCs, esp eosinophils
-eosinophils + on sputum exam
Tx of asthma:
1. initial therapy aimed at prevention
2. chemotherapy
3. hyposensitization by injections
status asthmaticus:
-an attack of asthma of long duration characterized by dyspnea, cyanosis, exhaustion, and sometimes collapse
Tx for status asthmaticus:
-epinepherine
-aminophylline
-IV corticosteroids
-inhaled aerosols
5 causes of chronic bronchitis:
1. smoking
2. viral
3. bacterial
4. physical irritants
5. chemical irritants
What effects does chronic bronchitis have on the body?
-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
4 types of chemotherapy used to treat asthma:
1. inhaled bronchodilators
2. inhaled corticosteroids
3. beta-adrenergic drugs
4. oral corticosteroids (scheduled)
Give a symptomatic description of chronic bronchitis:
-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
fibrosis mucosa:
-formation of excessive fibrous tissue on the mucus-secreting membrane lining all body cavities (or passages that communicate with the exterior)
Dx of chronic bronchitis:
1. xray noting congestion
2. reduced PFT
3. possible RVH
4. possible polycythemia
5. findings related to severity
Tx of chronic bronchitis:
-bronchodilators
-antibiotics
-possible steroids
-oxygen (caution in COPD pts)
acute bronchitis:
-primarily viral
-mostly mild and self-limited
-usually only supportive tx
-danger of croup or epiglottis in children (could be emergency)
croup:
-pathological condition of the larynx
-especially in infants and children
-characterized by respiratory difficulty and a hoarse, brassy cough
What condition can cause obstruction related to the loss of lung parenchyma?
emphysema
emphysema:
-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
causes of emphysema:
-smoking
-loss of alveolar walls reducing pulmonary capillary bed
-loss of elasticity of lungs
-causes air trapping or bullae (bubbles)
What effects does emphysema have on the body?
-progressive exertional dyspnea
-increased respiratory rate keeping O2 levels adequate until severe state occurs
Dx of emphysema:
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
Tx of emphysema:
-stop smoking
-bronchodilators (limited effect)
-O2 therapy
Name 3 diagnostic tests used with respiratory disorders:
1. spirometry
2. ABGs
3. administration of allergens as tests
ABG norms of pH, PaO2 and PaCO2:
pH: 7.4
PaO2: 80-100
PaCO2: 40
How do ABGs (pH, PaO2 and PaCO2) change with COPD pts?
pH is decreased
PaO2 is decreased
PaCO2 is increased
spirometry:
-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)
What will the spirometric ratio be with severe obstruction of air flow?
< 50%