2) Cardiopulm Pathologies

Question 1

Restrictive Diseases

Answer 1

Restricted inspiratory capacity bc lungs can’t fully expand

Question 2

Obstructive Diseases

Answer 2

Decr airflow during expiration

Question 3

Characteristics of Obstructive Diseases

Answer 3

• Decr elastic recoil
• Incr compliance
• Decr alveolar ventilation
• VQ mismatch
• DOE
• Hyperinflated Lungs
• Flattened diaphragm
• Enlarged R ventricle

Question 4

Main diseases of COPD

Answer 4

• Emphysema
• Chronic bronchitis
• Asthma
• Bronchiectasis

Question 5

Chronic Bronchitis

Answer 5

Cough producing sputum for at least 3 months of 2 consecutive yrs

Question 6

Explain the patho of chronic bronchitis

Answer 6

• Goblet cell & mucus gland hyperplasia
• Decr # of cilia
• Ciliary dysfxn

Question 7

What are the causes of chronic bronchitis?

Answer 7

• Long-term irritation of tracheobronchial tree (smoking)
• Pollution
• Infection

Question 8

Why does smoking cause chronic bronchitis?

Answer 8

Smoking stims goblet cells & mucus glands to secrete mucus & inhibits ciliary action, which causes constriction in the tracheobronchial tree

Question 9

Characteristics of pt’s w/chronic bronchitis

Answer 9

• Blue bloaters
• Stocky build
• Incr PaCO2
• Polycythemia
• Incr PAP
• R ventricular hypertrophy

Question 10

Exacerbations of chronic bronchitis

Answer 10

• Incr purulent sputum
• VQ abn’s
• Hypoxemia
• Incr RR, work of breathing, & VO2 w/CO2 production
• Incr PAP
• R heart failure (look for edema in ankles & feet)

Question 11

Emphysema

Answer 11

Hyperinflated alveoli so air can’t flow out during exhalation

*Leads to alveolar destruction w/enlarged air space in lungs

Question 12

Sx’s of Emphysema

Answer 12

• Pink puffers bc of incr respiratory work
• Thin build
• I AP diameter of chest
• Accessory muscle use
• Seen leaning forwards w/hands on thighs
• Decr breath sounds
• Slight PaO2 abns
• Overinflatted lungs & flattened diaphragm
• SOB w/heart failure in the end

Question 13

What causes emphysema?

Answer 13

Not sure but it tends to incr w/age, in smokers, & could be hereditary

Question 14

What is used to consider the prognosis of chronic bronchitis & emphysema?

Answer 14

Pt’s age & inital FEV1

Question 15

What are the most common causes of death for pt’s w/chronic bronchitis or emphysema?

Answer 15

• CHF
• Pneumonia
• PE
• Respiratory Failure

Question 16

Asthma

Answer 16

Incr responsiveness of the trachea & bronchi to various stimuli so it narrows

Question 17

What happens during an asthma attack?

Answer 17

• Bronchial smooth muscle spasm
• Lumen of AW becomes narrowed/occluded
• Mucosal inflammation
• Overproduction of mucus

Question 18

Allergic/Extrinsic Asthma

Answer 18

Begins in pt’s <35y/o bc of allergies

Question 19

Non-Allergic/Intrinsic Asthma

Answer 19

Begins in pt’s >35y/o bc of chronic AW obstruction w/bronchospasm & not from a specific trigger

Question 20

Sx’s of asthma

Answer 20

• Incr RR w/accessory muscle use
• Prolonged expiration w/wheezing & ronchi
• Underproductive cough w/chest tightness
• Hyperinflated lungs w/small areas of atelectasis
• Decr PaO2 & incr PaCO2
• Nocturnal awakenings

Question 21

Status Asthmaticus

Answer 21

Asthma attack that persists for hours so pt becomes exhausted from breathing

Question 22

For a pt w/a restrictive disorder, what would you expect their PFT to look like?

Answer 22

Decr VC, IC, & TLC

Question 23

Sx’s of restrictive disorders

Answer 23

• SOB
• Non-productive cough
• Emaciated appearance

Question 24

Causes of restrictive disorders

Answer 24

• Maturational
• Pregnancy
• Pulmonary
• Cardiac
• Neuromuscular
• MSK
• Immunologic
• CT issues
• Nutritional/metabolic issues
• Traumatic
• Radiologic
• Pharmacologic

Question 25

ARDS

Answer 25

Clinical syndrome characterized by severe hypoxemia & incr alveolar capillary membrane permeability

Question 26

What is ARDS associated w/?

Answer 26

Multi-organ failure

Question 27

Causes of ARDS

Answer 27

Acute Lung Trauma * Fat emboli * Heart-lung transplant * Massive blood transfusion * Aspiration * Drugs * Inhaled toxins * Primary pneumonia * Shock

Question 28

Pulmonary Fibrosis

Answer 28

Chronic inflammation that causes fibrosis, destruction, & distortion of lung parenchyma

Question 29

Sx's of pulmonary fibrosis

Answer 29

* Rapid, shallow breathing * Decr breath sounds * Rales * DOE progressing to DOR * Cyanosis * Hypoxemia * Nonproductive cough * Fatigue * Digital clubbing * Loss of appetite * Weight loss

Question 30

Atelectasis

Answer 30

Collapsed lung bc of collapsed alveoli

Question 31

What is atelectasis associated w/?

Answer 31

Pathological & mechanical pulmonary abn's caused by obstruction, insufficient surfactant production, & inadequate inspiratory volume

Question 32

Atelectasis can only occur when?

Answer 32

When there's blood flow to the affected alveoli that are trying to absorb gas

Question 33

True or False: Atelectasis will decr lung compliance & incr work of breathing.

Answer 33

True

Question 34

What are the effects of acute atelectasis?

Answer 34

* Profound dyspnea * Hypoxemia * Reduce/absent breath sounds * Crackles * Tracheal & mediastinal shift towards the affected side

Question 35

Pneumonia

Answer 35

Inflammatory process of the lungs caused by respiratory infections leading to consolidation of alveoli as they fill w/exudate & cellular debris

Question 36

Angina Pectoris

Answer 36

Chest pain bc of ischemia of the myocardium

Question 37

What is the referred pain pattern of angina pectoris?

Answer 37

* Shoulders * Between scaps * UE's * Jaw * Ear * Teeth * Neck

Question 38

Describe the pain of angina pectoris

Answer 38

* Squeezing * Pressure * Tightness * Crushing * Burning

Question 39

What are the 3 types of angina?

Answer 39

* Stable * Unstable * Prinz-Metal

Question 40

Stable Angina

Answer 40

Occurs during physical activity

Question 41

Describe the pain of stable angina

Answer 41

Substernal, non-radiating, lasting 5-15min

Question 42

Tx for stable angina

Answer 42

Nitroglycerin

Question 43

Unstable Angina

Answer 43

Occurs during low-level exercise & stress

Question 44

What is unstable angina indicative of?

Answer 44

CAD progression

Question 45

Prinz-Metal Angina

Answer 45

Occurs at rest, usually during waking

Question 46

MI

Answer 46

Necrosis of a portion of the myocardium

Question 47

Describe the pain of MI

Answer 47

Similar to angina, but it radiates, waxes, & wanes, & NTG doesn't do anything

Question 48

Transmural MI

Answer 48

Full wall thickness

Question 49

Subendocardia (Non Q-wave) MI

Answer 49

Portion of the wall is involved & can extend to transmural

Question 50

Uncomplicated MI

Answer 50

Small infarction w/no complications during recovery

Question 51

Complicated MI

Answer 51

Pt's may have one or a combo of dysrhythmia, heart failure, thrombosis, & damage to heart structures

Question 52

What happens if an MI involves >40% of the L ventricle?

Answer 52

Cardiogenic shock & death

Question 53

Sx's of MI in women

Answer 53

* Nausea * Fatigue * Dizziness * Pain from the waist up * Pain when sleeping

Question 54

True or False: Menopause & estrogen levels are risk factors for MI in women?

Answer 54

True

Question 55

CHF

Answer 55

Syndrome where the heart is unable to sufficiently pump blood to supply the body's needs

Question 56

LV failure=

Answer 56

CHF

Question 57

RV failure=

Answer 57

Cor pulmonale

Question 58

Explain the patho of CHF

Answer 58

LV doesn't pump effectively so blood backs up into the lungs

Question 59

Explain the patho of cor pulmonale

Answer 59

RV fails to pump effectively so blood backs up into the R atrium & then the periphery

Question 60

Can NSAID's exacerbate heart failure?

Answer 60

Yes