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127 Cards in this Set
- Front
- Back
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Airway obstruction in what lung disease is completely reversible?
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Asthma
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The most common disease treated by RTs is
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Asthma
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Two major types of COPD diseases are
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Emphysema and Chronic Bronchitis
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What is COPD?
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Pathologic condition = excessive secretions, inflammation, mucosal plugs, and distal airway weakening.
Gas flow is reduced in and out of the lungs, significantly decreaseed during exhalation / out Polycythemia due to poor gas exchange Chronic hypoxemia Late signs of COPD may include use of accessory muscles of respiration (E.G., sternocleidomastoid). |
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Anatomic Alterations of the Lungs in COPD
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Chronic inflammation and swelling of the peripheral airways
Excessive mucus production and accumulation = plugging Loss of elasticity parenchyma Hyperinflation of alveoli (air-trapping) Smooth muscle constriction of bronchial airways (bronchospasm) |
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FEV1/FVC ratio
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The FEV1/FVC ratio, also called Tiffeneau-Pinelliindex, is a calculated ratio used in the diagnosis of obstructive and restrictive lung disease.
It represents the proportion of a person's vital capacity that they are able to expire in the first second of expiration |
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Clinical Manifestations of Chronic Bronchitis
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sputum may be clear, yellowish, greenish, or occasionally, blood-tinged.
Smokers cough Chronic inflammation of peripheral airways Excessive mucous production Dyspnea Hyperinflation of Alveoli Crackles, rhonchi and wheezing upon auscultation recurrent infections |
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The main cause of Chronic Bronchitis
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cigarette smoking and second hand smoke (ETS)
Some researches suggest that about 90% of cases. Paralyzes Cilia and increases mucous production |
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What is Chronic Bronchitis?
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A sputum producing cough lasting at least 3 months of the year for 2 consecutive years
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Chronic Bronchitis: Clinical Data Obtained at the Patient's Bedside
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use of accessory muscles of inspiration/expiration (late development)
Excessive sputum production Pursed-lip breathing Air trapping, hyperinflation of lungs Increased anteroposterior chest diameter (barrel chest) Cyanosis, Digital clubbing (blue bloater) |
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General Management of Chronic Bronchitis
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Assessment and monitoring of the disease
Exposure to risk factors Family history Patterns of symptom development Effectiveness of current meds Family support available Can risk factors be reduced? Respiratory care treatment protocols Oxygen therapy protocol Bronchopulmonary hygiene therapy protocol PD&P, CPT - prosteril drainage and percussion Aerosolized medication (bronchodilator) protocol REGULAR / CONTINUOUS USE Antibiotics Mechanical ventilation protocol Recognize and manage exacerbations |
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What is Emphysema?
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A chronic progressive disease of the lungs(s) occurs when the alveolar walls are destroyed along with the capillary blood vessels that run within them.
Reduction in total area within the lung(s) where gas exchange can occur, limiting the potential for O2 and CO2 transfer. Centrilobular emphysema is the most common occurrence. |
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What is the most common occurrence of Emphysema?
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Centrilobular emphysema
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Emphysema - Anatomic Alterations of the Lungs:
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Permanent enlargement and deterioration of the air spaces distal to the terminal bronchioles
Destruction of pulmonary capillaries Weakening of the distal airways, primarily the respiratory bronchioles Bronchospasm (with associated bronchitis) Hyperinflation of alveoli (air-trapping, destruction of alveoli, possible bursting) |
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Panlobular Emphysema
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Associated with alpha1 proteinase inhibitor deficiency
A1 protects tissue from enzymes of inflammatory cells Involves all air spaces distal to terminal bronchioles (alveoli sacs) Most of the alveolar destruction caused by the LOSS of Elastanc |
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FEV1
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forced exhalation Volume in 1 second
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Xanthines
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phosphodiesterase inhibitor
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atelectasis
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collapsed lung - deflated / collapsed alveoli
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dyspnea
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SOB - shortness of breath
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diaphoresis
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sweating
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Anatomic Alterations of the Lungs due to Asthma
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Reversible bronchial smooth airway muscle constriction
Airway inflammation Increased airway responsiveness Excessive production of mucous Mucous plugging - may lead to atelectasis Hyperinflation with air trapping |
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bvm
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bag valve mask
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Two types of Asthma
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Extrinsic & Intrinsic
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the most common cause of occupational asthma
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Tolunee diisocyanate
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PEFR
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peak expiratory flow rate
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What Inhaled irritant most often used?
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methacholine
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NAEP
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National Asthma Education Project
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will emphysema cause chronic bronchitis?
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No
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Will CB lead to emphysema?
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Yes
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I am Air trapping - alveolar hyperinflation - loss of elasticity...who am I?
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emphysema
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I am excessive mucous & ciliary impairment. Who am I?
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Chronic bronchitis
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What's the word for overproduction of RBCs?
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Polycythemia
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why purse lip breathing?
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IE ratio 1:3 (COPD) - eases WOB - helps get out trapped air.
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Although emphysema and CF are two completely different diseases, what do they have in common?
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they are both inherited
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signs and symptoms of CB?
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excessive mucous production
chronic inflammation of the airways mucous plugging air trapping alveolar are hyperinflated rhonchi / wheezing recurrent infections |
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will emphysema or CB lung tissues regenerate if you stop smoking?
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no
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in panlobular emphysema, what causes alveolar destruction?
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loss of elasticity & collagen fibers
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which form of emphysema is caused by the alpha 1 deficiency?
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Panlobular
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what part of the airway does centrilobular emphysema affect?
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proximal to the alveoli
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what part of the airway does Panlobular emphysema affect?
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distal to the respiratory bronchioles
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What are the two main diseases of COPD?
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Chronic Bronchitis
Emphysema |
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Clinical manifestations of CB?
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increased respiratory rate
productive cough yellow / green sputum dyspnea crackles / rhonchi / wheezing |
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what is the main cause of CB?
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cigarette smoking
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What is the primary detrimental affect on the lungs with CB?
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destruction and paralyzation of the cilia
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What things might cause exacerbations to CB?
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2nd hand smoke
chemical fumes smog solvents common cold / infections |
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what are some other clinical signs and symptoms for CB? (end stages)
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use of accessory muscles
barrel chest blue bloaters purse lip breathing cyanosis jvd |
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what's the first thing comes to mind with CB?
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excessive mucous production
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what's the first thing comes to mind with emphysema?
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air trapping - hyperinflation - alveolar destruction
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what's the most common kind of emphysema?
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centrilobular
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what breath sounds would you associate with emphysema?
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decreased / diminished
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what kind of therapies are recommended for CB?
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mucolytics
bronchodilator - MDI / SVN anti-inflammatories / antibiotics |
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how do you mobilize secretions without medication?
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chest compression - postural drainage and percussion (PD&P) - ciliary escalator not functioning
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I have abnormal dilation and remodeling of the airways, fetid secretions, chronic infection of the bronchi. Who am I?
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bronchiectasis
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what is a smokers cough, and what disease is it mostly associated with?
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Buildup of mucus - CB
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what does the blood count look like for COPD?
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polycythemia
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what comes to mind when I say abnormal and permanent enlargement of the air spaces?
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emphysema
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what is the most evident sign or symptom that is mostly closely associated with respiratory failure in a COPD patient?
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mental deterioration - diminished loc
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what does the word adventitious mean?
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abnormal breath sounds
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what is an antigen?
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an allergen - causes inflammation and allergic reaction
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What is IgE?
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antibody
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what would an anticoagulant do?
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Help stop the blood from coagulating.
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How do you measure an apical pulse?
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With a stethoscope
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When would you measure an apical pulse?
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If you can't palpate
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what is broncho provocation and when would I use it?
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to quantify the severity of asthma - causing an asthma attack
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what's CHF?
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Congestive heart failure - left side
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What side of the heart does Cor Pulmonale affect?
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Right Side.
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what provokes right sided heart failure?
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pulmonary hypertension
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What is Bronchiectasis?
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a necrotizing infection of bronchi leading to abnormal dilation and destruction of these airways
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Etiologic factors associated with the onset of nocturnal asthma
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GERD Gastroesophageal reflux (HOB @ 30 degrees)
Retained secretions (no coughing NOC) Exposure to irritants in bedroom Prolong time between med doses |
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Asthma: Early Clinical Manifestations
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Wheezing *******
Chest tightness Dyspnea cough prolonged expiratory phase [1:3 or 1:4] |
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NAEP recommends what device to record breath flow raes for home use?
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Peak Flow Meter
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What Inhaled irritant is most often used for Bronchoprovocation?
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methacholine
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Methylxathines Xanthines
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Less effective than beta-adrenergics
naturally occurring in the body phosphodiesterase inhibitors Oral, injection, suppository form NOT FOR USE IN EMERGENCY OR ACUTE ATTACK |
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Mild intermittent Asthma
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Symptoms no more than once/wk
No daily meds - Rescue (short acting )B2 agonist FEV1 or PEFR > or equal to 80% w/<20% variability from baseline |
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what happens in the airways during an asthma attack?
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inflammation, increased secretions, broncho constriction, remodeling
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what types of symptoms might you see during an asthma attack?
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SOB, wheezing, increased respiratory rate, coughing, dyspnea, chest tightness
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what disease comes with thick, productive, large amounts of foul smelling sputum?
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bronchiectasis
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Three types of bronchectasis:
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1. cylindrical or tubular bronchiectasis
2. varicose or fusiform bronchiectasis 3. cystic or saccular bronchiectasis |
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why is bronchectasis not often seen anymore?
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antibiotics
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If I am an asthmatic performing PEFR, when should I seek medical attention?
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sustained 60%
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Whats the first things I can do as an extrinsic patient?
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limit environmental triggers
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what are the four factors involved in nocturnal asthma?
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gap in dosage
gastroesophageal reflux disease (Gerd) irritants inability to clear secretions |
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will a B2 adrenergic help in the late onset symptoms of asthma?
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Not much. ventilator or anti-inflammatory
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what is the name for the natural phosphodiesterine inhibitor in our bodies?
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Theophylline
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phosphodiesterise inhibitors - what do they do?
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They inhibit phosphodiesterise from consuming cAMP
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what can impair the amount of theophylline in our bodies?
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smoking, phenobarbital
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how do you test for asthma if patient is symptom free?
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bronchoprovocator - methacholine
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What is Refractory Asthma?
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Patients are considered refractory when they experience persistent symptoms, frequent asthma attacks or low lung function despite taking asthma medications. Some refractory asthma patients have to take oral steroids such as prednisone to manage their asthma.
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What are Leukotriene inhibitors?
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Leukotrienes are mediators of inflammation and bronchoconstriction
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What is Dysphonia?
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disorders of the voice: an impairment in the ability to produce voice sounds using the vocal organs (it is distinct from dysarthria which signifies dysfunction in the muscles needed to produce speech).
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What is paroxysmal?
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Paroxysmal attacks or paroxysms are a sudden recurrence or intensification of symptoms, such as a spasm or seizure.
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what is hypovolemia?
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decreased blood volume
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what is pericardial tamponade?
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Cardiac tamponade, also known as pericardial tamponade, is an acute type of pericardial effusion in which fluid accumulates in the pericardium (the sac in which the heart is enclosed).
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What is ARDS?
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ARDS is not a disease, but a syndrome which can occur as a result of many causes.
ARDS is an acute, diffuse, inflammatory lung injury that leads to increased pulmonary vascular permeability, increased lung weight, and a loss of aerated tissue. |
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Risk factors for developing ARDS
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Breathing vomit into the lungs (aspiration)
Inhaling chemicals lung transplant pneumonia septic shock trauma |
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pathogenesis of ARDS
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Regardless of the cause, the same events will occur:
Damage of endothelium and epithelium leaky alveolar capillary membrane inflammatory response in the lung |
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RT treatments for ARDS
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1. increase O2
2. Ventilator 3. decrease VT & increase RR 4. Permissive Hypercapnia 5. Careful titration of PEEP. 6. DuoPAP, APRV, BiLevel 7. Prone position |
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What is Permissive hypercapnia?
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Permissive hypercapnia is hypercapnia, (i.e. high concentration of carbon dioxide in blood), in respiratory insufficient patients in which oxygenation has become so difficult that the optimal mode of mechanical ventilation (with oxygenation in mind) is not capable of exchanging enough carbon dioxide.
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Pneumonia etiology
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1. The lung parenchyma become inflamed.
2. Serous fluid and blood effuse out of the capillaries and flood the alveoli 3. Macrophages and leukoctyes fill the alveoli to fight the infection 4. The alveoli become filled with cellular debris called consolidate. 5. The alveoli collapse (atelectasis) |
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Which Gram + bacteria is responsible for most pneumonia?
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Streptococcus > 80%
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Atypical Pneumonias
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Mycoplasma - symptoms are milder than bacterial or viral pneumonias. Found in areas where people congregate - schools, day care, etc. Sometimes called "walking pneumonia"
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Viral Pneumonias
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Viruses cause approx 90% acute URI's and 50% LRI's
Viral PNA is the most common cause of pneumonia in young children, exp 2-3 year olds Influenza RSV Adenovirus SARS |
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Influenza
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Several Types; A & B most common
Usually occur in winter Spread person to person via aerosol |
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RSV
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Respiratory Syncytial Virus
Accounts for 25% of Resp illness in children < 1 year old transmitted by aerosol & direct contact |
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Parainfluenza
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Leads to upper and lower respiratory infections
related to mumps, reubella and RSV *** Type 1 associated with Croup **** |
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Adenovirus
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More than 30 types
appears in all age groups type 7 related to fatal pneumonia in children also accouns for conjunctivitis infection, UTI, GI infections Aerosol transmission (lungs) |
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SARS
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severe acute respiratory syndrome
** caused by Corona virus ** (crown like appearance) |
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Pneumonias - Clinical manifestations
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1. Tachypnea
2. Elevated HR, BP, CO 3. Decreased Chest expansion 4. Cynanosis 5. Fever (possible) 6. Cough, purulent sputum, hemoptysis 7. Positive sputum cultures, CXR |
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Pneumonia- RT Tx
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1. O2 prn
2. CPT 3. Hyperinflation therapy 4. Antibiotics 5. Analgesics 6. Ribavirin (RSV) SPAG II aerosol *** 7. Pentamidine (Pneumocystis jiroveci) HIV patients ** 8. Thoracentesis (pleural effusion)** |
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Etiology - Lung abscess
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Most commonly from aspiration
Risk factors: ETOH abuse, seizure disorders, general anesthesia, head trauma, CVA, swallowing disorders More common in R lung, specifically superior segments of LL, and posterior segments upper lobes. (gravity) ** |
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Lung abscess - anatomic alterations
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1. Inflammation of lung parenchyma
2. Capillary permeability (blood and serious) 3. Macrophages and leukocytes fill the alveoli to fight the inflammation 4. The alveoli become filled with cellular debris and consolidate ** 5. The alveoli collapse (atelectasis) 6. Tissue necrosis occurs- forming a localized air/fluid filled cavity (abscess) |
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Lung abscess - Management / Treatment
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O2
CPT Hyperinflation Diagnostic Bronchoscopy Antibiotics Surgery if unresponsive |
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Lung abscess - Clinical manifestations
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Tachycardia
Tachypena Hypertension Chest pain / decreased expansion cyanosis cough, sputum, hemoptysis cull percussion over abscess cavity lesions on CXR |
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Tuberculosis - etiology
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caused by mycobacterium tuberculosis (rod shaped)
"acid fast bacilli" on gram stain cultures most infections occur by inhalation of the airborne droplets of an infected person with active TB. Mycobacteria are highly aerobic and like oxygen enriched areas-like the lung apices. Bacilli implant in lung and multiply (2-3 weeks). Lung area becomes inflamed. WBC's and macrophages surround the bacilli-pulm capillaries swell, fluid seeps into alveoli and consolidation occurs. Person will show + PPD test at this stage. Lung tissue produces a protective wall that encases the bacilli-forming a tubercule or granuloma. If TB is controlled-tubercle will eventually become fibrotic and calcify Although patients will continue to test + on TB test-patients will be asymptomatic. **** |
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Disseminated TB
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Spread from lungs through lymph system.
likes aerobic areas such as: Brain Kidneys Genitals Bones Meninges |
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Postprimary TB
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Even though most patients with primary TB remain "cured", the TB bacilli can remain dormant for decades (immunocompromised = reoccurrence
If the TB spreads into other parts of the body thru the blood/lymph system, it is called disseminated TB |
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What is Pulmonary Edema?
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Excessive fluid seeps from the pulmonary vasculature into the air spaces of the lungs.
Fluid becomes frothy-pink tinged, and may fulminate through the nose and mouth. Very critical, often fatal if not treated promptly. |
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Pulmonary Edema etiology
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Cardiogenic (CHF)
1. LV weakens 2. Blood backs up into lungs 3. Increased pressure in lung vasculature forces fluid to seep thru cap walls. 4. Gluid floods lungs Non-Cardiogenic 1. Infections or inflammation increase capillary permeability 2. lymphatic system blockage 3. Decreased intrapleural pressure |
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Pulmonary edema causes
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Cardiongenic
CHF PE Renal Failure Mycocarditis hypertension Non Cardiogenic Drug OD Metal poisoning Chronic ETOH Aspiration drowing Cardiac tamponade High altitude |
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Pulmonary edema manifestations
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increased RR, HR, BP, CO
Cheyne Stokes Respirations Orthopnea/ PND Cyanosis Pink, frothy sputum increased vocal, tactile fremitus Diffuse wet crackles, wheezes decreased PaO2, SpO2 Puffy infultrates on CXR (batwing) |
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Pulmonary edema treatment
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O2 therapy - high FIO2 (60-100%)
CPT (suctioning excess secretions) Hyperinflation with CPAP/PEEP Positive inotropic drugs (dig, dopamione) Antihypertensive, vasodilators Alchohol (vodka) upright positioning |
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Pulmonary embolism
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a blood clot (thrombus) that travels through the bloodstream and becomes lodged in the pulmonary arterial circulation
600K annually in US most common postpartum cause of death 70% missed diagnosis |
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Pulmonary embolism - etiology
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Most common cause are blood clots from the deep leg veins (DVT)
When a DVT breaks loose it is carred through the systemic circulation and is wedged in the narrow pulmonary arteries or arterioles forming a pulmonary embolism |
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Risk facts for Pulmonary embolism
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Venous stasis
trauma (particularly long bone fractures) post/op surgery oral contraceptives polycythemia obesity malignant neoplasm pregnancy |
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Pulmonary embolism - Clinical Manifestations
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increased RR, HR
decreased BP, CO dypsnea cyanosis cough, hemoptysis chest pain syncope, light headedness, confusion, anxiety heart arrhythmias feeling of impending doom |
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Pulmonary embolism - Diagnostic procedures
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V/Q scan used to be the preferred test to diagnose PE, but has been largely replaced by the faster CT scan.
If CT scan is not definitive, may require a pulmonary angiogram |
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Pulmonary embolism - management and treatment
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Hospital admit (usually ICU)
O2 as needed Anticoagulant therapy (heparin, Coumadin) Thrombolytic agents (streptokinase) vein filters (IVC) Compression stockings Pneumatic compression devices mechanical Vent prn Pulmonary embolectomy |
