Flashcards in 109: U4: Chronic Resp Disorders Deck (17):
A condition of INTERMITTENT, REVERSIBLE airflow obstruction affecting the airways.
Triggered by allergens; irritants such as cold air, dry air, or particles; microorganisms; aspirin; exercise; URI; GERD.
May have a genetic component.
Patients with excema (skin allergies) often also have asthma.
Inflammation: Type 1 immediate hypersensitivity reaction.
Bronchoconstriction d/t hyper responsive airway.
Uncontrolled asthma causes changes in the airway -> remodeling (damaged cells are shed and new cells replace, but do not work the same).
Dyspnea, chest tightness, cough, wheezing, excessive mucus production, anxiety.
May follow a cold or URI.
May have other allergic Sx: rhinitis, skin rash, pruritis, clear sinus drainage.
Use of accessory muscles.
Decreased peak flow - classification of severity (expiratory force: blow as hard and as fast as they can three times - 2x a day with a diary is ideal).
Asthma Collaborative Tx
Peak flow monitoring with Asthma action plan. Green zone: 80-100% of peak flow. Yellow zone: cough, wheezing, 50-79% peak flow. Red zone: peak flow <50%: Take albuterol q20 minutes and go to ER!
Meds: bronchodilators, anti-inflammatory meds, mast cell stabilizers, mucolytics. O2 during acute flare-up, hydration (with mucus), Abx for pneumonia.
Help ID and avoid triggers.
Asthma Life Threatening S/S
Increased work of breathing
Silent chest (No air movement in lungs)
Pulsus Paradoxus (drop of SBP during inspiration)
Chronic Bronchitis Definition
An inflammation of the bronchi and bronchioles with EXCESSIVE MUCOUS PRODUCTION. Airway clearance issue.
Chronic Bronchitis Etiology
Smoking. Usually seen between 45-65 years old.
Chronic Bronchitis Pathophysiology
Irritant produces inflammatory response -> vasodilation, congestion, mucosal edema, bronchospasm -> mucus gland hypertrophy -> mucus increase and wall thick and scarred.
Chronic Bronchitis S/S
FREQUENT PRODUCTIVE COUGH
Copious purulent sputum
Frequent URI (d/t retained mucus)
Gurgles, wheezes, crackles
Hypoxemia: incr CO, then decreased CO -> RHF -> pulm HTN (heart tries to compensate, then tires out and CO decreases)
Polycythemia (2ndary to hypoxemia)
Cyanosis (unoxygenated Hgb)
Normal or increased weight
Clubbing (nail bed: later sign)
PFR: increased residual volume: unable to fully exhale all the air that is inhaled.
Chronic Bronchitis Collaborative Treatment
Meds: Albuterol PRN, Fluticasone, Mucolytics/Expectorants, Abx for bacterial infx, Antipyretics.
Diet: Low carb, high protein, small frequent meals (carbs break down into CO2)
Diaphragmatic/pursed lip breathing (in through nose, out through mouth. Use stomach muscles).
Group activities for energy conservation.
Chest PT (clapping on chest)
Hydration (thins the thick secretions)
Prevention (Flu/Pneumonia Vaccine)
Chronic Bronchitis Exacerbation
An acute change in the norm: change in sputum, dyspnea.
A lung condition characterized by destruction of the walls of the alveoli, with resulting enlargement abnormal air spaces. Loss of elasticity of the alveoli (they get stretched out)
Smoking (occurs at 65-75y/o)
Alpha 1 antitrypsin deficiency (potective enzyme in lungs that stops immune processes that would destroy structures).
Excess proteases destroy alveoli and bronchioles. Walls of air sacs torn, small bronchioles collapse, blebs and bullae result (weakened areas of alveoli that collapse - closed pneumothorax).
Air trapped, loss of elastic recoil.
Lung tissue becomes enlarged and inelastic (can't exhale fully).
Barrel chest with decreased breath sounds and increased residual volume
Huff & puff from increased work of breathing
Hypoxemia with exercise
Quiet heart sounds (chest is bigger: more space between heart and stethoscope)
Peripheral cyanosis and clubbing
Thin and underweight
PaCO2 normally low or normal until end stage
Hyperresonant to percussion.