CH. 23 Flashcards
Decreased Lung Expansion
Alterations in lung tissue, pleura, chest wall, or neuromuscular function.
Acute (Adult) Respiratory Distress Syndrome (ARDS): Etiology
Due to damage/inflammation to the alveolar-capillary membrane Occurs in association with other pathologic processes Mortality 30-63% Hypoxia doesn’t respond to supplemental oxygen therapy Causes Severe trauma Sepsis (>40%) Aspiration of gastric acid (>30%) Fat emboli syndrome Shock
ARDS Pathogenesis
Lung inflammation lung injury
ARDS Clinical Manifestations
History of a precipitating event that has led to a low blood volume state (“shock” state) 1 or 2 days prior to the onset of respiratory failure Late Tachycardia Tachypnea Hypotension Marked restlessness Frothy secretions Crackles, rhonchi on auscultation Use of accessory muscles Retractions Cyanosis
ARDS Diagnosis
Hallmark is hypoxemia refractory to increased levels of supplemental O2
ARDS Treatment
Mostly supportive Enhance tissue oxygenation until inflammation resolves Identify and treat underlying cause Maintain fluid and electrolyte balance Ventilator
Pneumothorax
Etiology
Accumulation of air in the pleural space
Traumatic
Occurs with trauma such as air bag impact, stab wound, contact sports (hard hit to chest)
Primary (spontaneous) pneumothorax
Occurs without apparent cause (no underlying disease factors)
Rupture of small subpleural blebs
Occurs in tall, thin men 20 to 40 years
Cause unknown but cigarette smoking increases risk
Secondary (spontaneous) pneumothorax
Result of complications from preexisting pulmonary disease (COPD – 70%)
May be due to rupture of cyst or bleb
Tension pneumothorax
Traumatic origin
Results from penetrating or nonpenetrating injury
Medical emergency
Results form buildup of air under pressure in pleural space
Air enters pleural space during inspiration but cannot escape during expiration
Lung on ipsilateral (same) side collapses and forces mediastinum toward contralateral (opposite) side
Decreases venous return and cardiac output
Pneumothorax Clinical Manifestations
Tachycardia
Decreased or absent breath sounds on affected side
Sudden chest pain on affected side
Dyspnea
Pneumothorax Treatment
Management depends on severity of problem and cause of air leak
Lung collapse <15% to 25%
Patient may or may not be hospitalized
Treat symptomatically and monitor closely
Lung collapse >15% to 25%
Chest tube placement
Oxygen
Pleural Effusion Etiology
Pathologic collection of fluid or pus in pleural cavity as result of another disease process
Normally, 5-15 ml of serous fluid is contained in pleural space
Many causes, most common include
CHF
Pneumonia
Liver disease
ESRD
Cancer
PE
Pleural Effusion Clinical Manifestations
Vary depending on cause and size of effusion
May be asymptomatic with <300 ml of fluid in pleural cavity
Dyspnea
Decreased chest wall movement
Pleuritic pain (sharp, worsens with inspiration)
Dry cough
Absence of breath sounds
Dullness to percussion (primary finding)
Decreased tactile fremitus over affected area (primary finding)
Pleural Effusion Treatment
Directed at underlying cause and relief of symptoms
Chest tube drainage
Thoracentesis, if large amount of effusion
Ultrasound useful for thoracentesis guidance
Pneumonia
Inflammatory reaction in the alveoli and interstitium caused by an infectious agent
Classifications
Community acquired
Hospital acquired
Bacterial
Atypical
Viral
Pneumonia: Anaerobic Bacteria
present as a lung abscess, necrotizing pneumonia, or empyema; usually caused by aspiration of normal oral bacteria into the lung
