Pulmonary Conditions Flashcards
Flail chest
Segment of rib cage breaks from the rest of the chest wall (>3 ribs break on >2 places)
Caused by trauma; it is a life-threatening emergency
Characteristic:
Paradoxical breathing: inspiration = inward; expiration = outward (“flails”)
Pneumothorax
Air in the thoracic cavity or chest wall; causes lung/s to collapse
S/S: Dyspnea, chest ache and tightness, cyanosis, tachycardia, apnea on collapsed lung
Types of pneumothorax:
1. Traumatic (GSW)
- Spontaneous: lung collapses for no apparent reason; primary risk factors: <30 y/o, thin, male, smoker, abrupt changes to atmospheric pressure; secondary risk factors (diseased lung tissue): COPD, asthma, CF, interstitial/inflammatory lung disease
- Tension: a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure; displaces mediastinal structures and compromises cardiopulmonary function (decreases preload, and BP)
Pleural effusion
Build-up of excess fluid in the pleural space
Empyema: collection of pus in pleuritic space d/t infection (exudative)
S/S: Dyspnea, excessive cough, pain on inspiration, fever, difficulty taking deep breaths
Types of effusion:
1. Transudative: non-inflammatory; fluid is clear, low-protein, and absent of cells; typically due to salt and fluid retention/increased venous pressure; causes: CHF, cirrhosis, nephrotic syndrome, peritoneal dialysis
- Exudative: inflammatory; fluid is cloudy, thick, high-protein, cells are present, and contain blood, bacteria and WBCs; causes: infection, malignancy, connective tissue disease, inflammatory disorders, CABG, PE
Bronchiectasis
A condition where the bronchial tubes of the lungs are permanently damaged, widened, and thickened from frequent infection and blockage (inflammation)
Damaged airway and cilia allow bacteria and mucus to build-up and pool in lungs; this can lead to RF and atelectasis if left untreated
Risk factors: Progressive lung diseases (CF), measles, pertussis (whooping cough), TB, fungal infection, immunodeficiencies, connective tissue diseases, environmental, idiopathic
S/S: Dyspnea, excessive cough, increased sputum production, wheezing, chest pain, clubbing, hemoptysis, fatigue, FTT
Bronchiolitis
Inflammation and congestion of the small airway (bronchioles) of the lung; may lead to alveolar destruction
Commonly caused by viral infections among young children and infants
S/S: Tachypnea, accessory muscle use, low-grade fever, dry cough, hyper-inflated chest
Epiglottitis
Inflammation of the epiglottis
Commonly caused by H. influenza and other bacteria among unvaccinated children 2-8 y/o. and adults
S/S: Sore throat, dysphagia, drooling, changes in voice, dyspnea, inspiratory stridor
Atelectasis
A complete or partial collapse of the entire lung or lobe that can lead to hypoxia, pneumonia, and/or RF
Causes:
- Reduced alveolar ventilation (deflation)
- Air and/or fluid trapped inside alveoli
Risk factors: Bed confinement/immobility, infection, disease, FB, surgery
S/S: Dyspnea, tachycardia, cough, pain, cyanosis, wheezing; treated with incentive spirometer
Interstitial lung disease
Lung disorders (CF, sarcoidosis) that cause progressive scarring of lung tissue (pulmonary fibrosis); characterized by inflammation and scarring on supporting tissue
Results in decreased gas exchange; it is commonly fatal and often untreatable (3-5 yr. life expectancy post-diagnosis)
S/S: Dry cough, dyspnea, weight loss, clubbing, enlarged heart, fatigue
Sarcoidosis
Autoimmune inflammatory disease that affects multiple organs, but mostly the lungs and lymph nodes (type IV cell-mediated hypersensitivity)
Chronic inflammation results in deposition of immune cells, granuloma development, and scarring that can lead to pulmonary fibrosis and pulmonary HTN
Restrictive lung disease
Risk factors: >55 yrs. old, occupation, mold exposure, FHX, African or Scandinavian descent, female
S/S: Fatigue, fever, pain, swollen joints, cough, dyspnea, skin lesions
Pulmonary edema
Excess fluid in the lungs
Causes: (1) Excess filtration or (2) disruption in the reabsorption of net filtrate
Types of pulmonary edema:
1. Cardiogenic: caused by increased pressures in the heart (usually a result of LHF)
- Non-cardiogenic: NOT caused by increased pressures in the heart; caused by (1) increased filtrate d/t injury, inflammation, obstruction, high altitude, CA, toxins OR (2) lymph blockage that prevents net filtrate reabsorption
S/S: DOE, orthopnea, wheezing, feeling of suffocating/drowning, anxiety, restlessness, “wet” cough, chest pain, fatigue, frothy sputum, diaphoresis
Pulmonary embolism
Detached clot that lodges in pulmonary vasculature
S/S: Tachypnea, dyspnea, chest pain, increased dead space, hypoxemia, pulmonary infarction and HTN, decreased CO, systemic hypotension, shock
Virchow’s Triad:
1. Circulatory stasis (atrial fibrillation, HF, immobility, paralysis)
- Vascular (endothelial) wall injury (trauma, venipuncture, atherosclerosis)
- Hyper-coagulable state (CA, trauma, sepsis, infection, HRT/ERT, female contraceptives)
Pneumonia
Viral, bacterial or fungal infection of the lungs that causes purulent fluid build-up in alveoli
Locations:
- Lobar: one or more WHOLE sections of lungs
- Bronchial: PATCHES throughout both lungs
Risk factors: >65 and <2 yr. olds, existing lung disease, smoking, unvaccinated
S/S: Cyanosis, productive cough (green/yellow, hemoptysis), fever, diaphoresis, chills, fatigue, tachypnea, dyspnea, tachycardia, chest pain
Tuberculosis
An airborne-transmitted disease caused by Mycobacterium tuberculosis that infects the lungs; 10% infected develop active disease
Chronic granuloma inflammation undergo tubercle formation that are filled with caseous necrosis (to isolate TB bacteria)
Differentiated by placing under blanket of non-tuberculosis Mycobacterium; Dx: TB skin, CXR, sputum analysis
Risk factors: recent exposure, living/visiting countries with high TB rates, <5 yrs. old with pos. TB test, immunodeficiency, housing insecurity, IV drug users, s/p organ transplant, health care workers, diabetes
S/S: Progressive fatigue, malaise, anorexia, weight loss, productive cough with sputum, night sweats, hemoptysis, pleuritic chest pain, low-grade fever
Acute Respiratory Distress (ARDS) and Acute Lung Injury (ALI)
A spectrum of lung diseases characterized by an acute, severe inflammatory process causing diffuse alveolar damage and resulting in a variable degree of V/Q mismatch, severe hypoxemia, and poor lung compliance
High mortality rate (>35%) d/t sepsis and RF
Causes:
- Direct lung injury: trauma
- Indirect lung injury: infection (pneumonia, inhalation of harmful substances, sepsis, shock, drug overdose, severe bleeding)
First symptoms: increased RR and hypoxemia; treatment: mechanical ventilation (maintain arterial PaO2 >60 mmHg and O2 sat. >90%)
Common diagnostics
CXR
Chest CT
Ultrasound (fluids)
Spirometry (lung function)
Sputum culture
Bronchial alveolar lavage
ABG
O2 sat.
Other labs: CBC, CMP
