RESPIRATORY - restrictive lung disorders (RLD): pulmonary edema & ARDS Flashcards

EXAM 2 content

1
Q

what is RLD?

A

where we need more air volume in order to meet the normal needs of the lung
- disease that inhibits lung compliance

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2
Q

what are the two diseases under RLD?

A
  • pulmonary edema
  • ARDs
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3
Q

what is pulmonary edema?

A

excess accumulation of fluid in lungs

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4
Q

describe the pathophysiology of pulmonary edema

A

something increases the alveolar capillary pressure + injury to alveolar OR block in drainage –> fluid in interstitial space –> fluid moves into alveoli OR increase capillary permeability (which leads to more fluid) –> decrease compliance of alveoli OR blocks space for ventilation –> hypoxia

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5
Q

what are the risk factors that lead to pulmonary edema?

A
  • left sided heart dysfunction
  • alveolar injury
  • surgery/blockage of lymph system
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6
Q

what are the manifestations of pulmonary edema?

A
  • Neuro: altered LOC & dizzy
  • CV: murmurs, JVD, peripheral edema
  • Resp: crackles & pink frothy sputum!!!
  • GI: n/v
  • GU: oliguria
  • Integ/Musc: weakness, paresthesia, cyanosis, delayed capillary refill
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7
Q

what labs and diagnostics would we do for pulmonary edema and why?

A
  • ABGs –> respiratory acidosis
  • BNP –> to understand fluid volume status, would be high if fluid overload
  • CBC
  • Chemistry panel
  • X ray –> pulmonary edema, most used
  • Pulmonary function testing
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8
Q

how is pulmonary edema managed?

A

medications are mostly focused on the cardiac manifestations & infection based
- oxygen/ventilatory support
- antibiotics
- cardio: diuretics, ACE inhibitors, ARBs, beta blockers

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9
Q

what are pulmonary edema complications?

A
  • hypercapnia: high levels of CO2
  • respiratory acidosis
  • acute respiratory failure
  • death
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10
Q

what is ARDS?

A

acute respiratory distress syndrome - an acute lung injury BECAUSE OF systemic inflammation –> fluid in alveoli

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11
Q

describe ARDS pathophysiology

A

TWO WAYS:

  1. injury –> release of proinflammatory cytokines –> increases capillary permeability –> fluid + inflammation by-products into interstitial space & alveoli –> V/Q mismatch –> decreased O2 level
  2. injury –> release of proinflammatory cytokines –> increases capillary permeability –> fluid + inflammation by-products into interstitial space & alveoli –> decreased surfactant production –> stiff + less compliant lungs –> release of more inflammation mediators –> SIRS –> remodeling & fibrosis –> permanent fibrosis + lack of compliance + prolonged respiratory issues
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12
Q

what are the risk factors of ARDS?

A
  • older age
  • genetics
  • sepsis!
  • trauma!
  • multiple transfusions
  • pneumonia!
  • burns! (because of fluid shift)
  • aspiration
  • pancreatitis
  • inhalation injury
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13
Q

what are the manifestations of ARDS?

A
  • Neuro: altered LOC & dizzy
  • CV: tachycardia & hypotension
  • Resp: hypoxemia that is NOT responsive to O2!!!, tachypnea, dyspnea, crackles, pink frothy sputum!!
  • GI: n/v
  • GU: oliguria
  • Integ/Musc: weakness, paresthesia, cyanosis & delayed capillary refill
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14
Q

what labs and diagnostics are used and why?

A

ABGs
- early ARDS = respiratory alkalosis
- late ARDS = metabolic acidosis

  • CDC: for infection
  • chemistry panel
  • coagulation studies: to see if you are at risk for clotting
  • ESR & CRP: measures of inflammation
  • chest x ray: for bilateral infiltrates
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15
Q

when looking at an x-ray, what would the lungs look like if its pneumonia or ARDS?

A

one side = pneumonia
bilaterally = ARDS

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16
Q

how is ARDS managed?

A
  • oxygen & mechanical ventilation
  • medications are focused on stabilizing: sedation, paralytics (muscle relaxants), anticoagulation, diuretics & meds for pressure support
17
Q

what are some complications for ARDS?

A
  • when not intervened early –> acid base imbalance & acute respiratory failure
  • inflammatory process & systemic response –> SIRS (Systemic inflammatory response syndrome), MODS, shock
  • dysrhythmia –> cardiac arrest
  • death