CP 11 done

Question 0

Obstructive Pulmonary Disease is?

Answer 0

Respiratory tract diseases that produce an
obstruction to air flow which can
ultimately affect the mechanical function andgas exchange of the lungs
We cannot get the gas out.

Question 1

OBSTRUCTIVE: list some

Answer 1

Bronchopulmonary Dysplasia (sounds familiar)• Cystic Fibrosis, muscous
• Asthma, the airways get smaller
• Bronchitis →Bronchiectasis, inflammation of the airways
• Emphysema, is ptherwise known as COPD, chronic OBSTRUCTIVE Pulmonary Disease.

Question 2

Risk Factors for obstructive lung disease…

Answer 2

• Age: (Prematurity, Elderly) All the extreme ages have this problem. Premes do not have enough surfactant. Replace it.
• Immunocompromise
• Environmental Factors
• Smoking Most direct link to emphyzema.
• Genetics Always consider this.
• Restricted Thoracic Movement We are getting less gas in

Question 3

Smoking is involved in obstructive lung disease by…

Answer 3

Produces a low level chronic inflammation in the lungs
Increased phagocytes, neutrophils, and
alveolar macrophages all contribute to the
breakdown of elastin in the alveoli
Destroys the action of cilia
The mucuciliary escalator, they get lowered so
then the materials do not come out, and so there is obstruction of the passageway of the air.

Question 4

Hypoxia is ________________. It canresult from:

Answer 4

inadequate oxygenation…
Pulmonary Disease with impaired diffusion• V-Q mismatching: shunting
• Inadequate O2 transport Sickle cell anemia.
• Inadequate tissue oxygenation

Question 5

Hypoventilation can be caused by…

Answer 5

Respiratory center depression 
Neural conduction interference 
Respiratory muscle disease 
Restriction of the thorax 
Restriction of lung excursion 
How far the lung tissue can move,mthe lung tissue compliance, it cannot move as much, it will affect the compliance.

Question 6

Hyperventilation can be caused by…

Answer 6

Anxiety 
Lesion of CNS 
Medications/ Hormones 
Increased Metabolism 
Hypoxia/ CO2 retention (short term)Acidosis 
Hypotension 
Pain

Question 7

BPD: Chronic lung disease of

Answer 7

early infancy

Question 8

Presentation of bronchiopulmonary displasia

Answer 8

O2 dependency beyond 1 mos., and vent support

Question 9

Infants at risk for BPD include those with:

Answer 9

Prematurity
Meconium aspiration The baby inhales the placentaand waste material.
Persistent fetal circulation (name 2 examples)
TETROLOGY OF FALLOT ASD OR PFO, THEY have a dysatructure but it is not so bad. PDA.

Question 10

BRONCHOPULMONARY DYSPLASIA AKA

Answer 10

Pulmonary Fibroplasia and ventilator lung

Question 11

BRONCHOPULMONARY DYSPLASIA

• Occursmorein

Answer 11

LBWbabieswhorec’dhighflow O2 for 5 d or longer

Question 12

Do LBW infants recover from oxygen induced BPD?

Answer 12

Many infants recover and improve over timehowever severe BPD correlates highly with
developmental delays

Question 13

BPD: Pathology

Answer 13

Stage 1: Hyaline membrane disease caused by
decreased surfactant
Stage 2: Tissue granulation, obliterating bronchitisStage 3: Emphysematous changes (distended
terminal airways and open alveoli)(hyperinflation) Stage 4: Subepithelial fibrosis, right ventricular hypertrophy. The lung have lost compkiance and excursion. And it will cause right venticular hypertrophy, to be able to push against its afterload better. Cor pulmonary.
Babies who have emphyzema, like, in the alveoli, the alveoli loose their elasticity, because we are pushing in that air with the ventilator and it will cause ehhsematous changes. Hyperinflation is related to emphyzema.

Question 14

BPD: Clinical Features

Infants will present with:

Answer 14

Tachypnea
Cyanosis
Bronchiolitis or Pneumonia
May require a tracheostomy

Question 15

Cystic Fibrosis Pathology

Answer 15

Accumulation of hyper viscous secretions
leads to progressive obstruction of mucoussecreting exocrine glands, preventing
delivery to target organs
Organs most affected: lungs, pancreas,
reproductive system, sinuses, and sweat
glands

Question 16

Cystic Fibrosis Impairments

Answer 16

1) Dysfunctional Cl channel epithelial 
function causes abnormal concentrations ofNa and Cl 
2) Blocked exocrine gland function 
3) Increased susceptibility to chronic 
endobronchial colonization 

Bacterial infection.

Question 17

Pancreatic Dysfunction

Answer 17

Viscous secretions begin to obstruct
pancreas in utero with periductal
inflammation and fibrosis
Maldigestion of protein = greasy, bulky, foulsmelling stools

Question 18

Pulmonary Dysfunction

Answer 18

Obstruction of small airways 
Air trapping and atelectasis 
Progressive airway obstruction 
Decreased gas exchange Shunting because the alveoli arefull of mucus.
Opportunistic bacteria, inflammation, 
bronchiectasis, and irreversible airway 
damage 
Bronchii change shape.

Question 19

Presentation of CF

Answer 19

Patients are likely to present with: Persistent Cough, because rhey have increased mucous, Recurrent Pneumonia, because the mucous allows for the bacteria to grow, Excessive Appetite/Poor
Weight Gain, because they cannot dogest the food proper so the nutrients are lost, Salty Skin/Sweat, they just sweat more Na Cl,Bulky, Foul Smelling
Stools, because the food is really just passed out and the bacteria inside the guts eat it and make it smelly, Infertility, because of blocking if the ducts, Nasal Polyps, Chronic Wheeze, because the passageways are pblocked with mucous,
Glucose Intolerance, Tachypnea, because they do not get enough oxygen they will breath faster to get their oxygen,Cyanosis/Digital
Clubbing, they just are not getting enough oxygen, Exertional Dyspnea, because they have low ventilation and respiration they will get tired with alomost any work, Pneumothorax, The air pressure, dueto the atlectasis changes, and they get bigger and it pulls the lung away from the wall., Hemoptysis, they will bleed in their lungs due to all the pbstruction, Right Sided Heart Failure, because the righht side has to overcome the pressure of the lungs so it will push harder and cause it that the right ventricle will fail.

Question 20

Meds for CF…

Answer 20

There is one medicstion for one type, but all of this is from management, tominimize the recurrent infection.

Question 21

Genetic Counseling

Answer 21

Controversial

Screening for prospective parents to
determine presence of gene

Genetic testing of the fetus to determine presence of the disease

Question 22

Medical Tests for Diagnosis for CF

Answer 22

Sweat Test: Quantitative pilocarpine iontophoresis.Measures Cl levels in sweat.
Nasal PD: Potential difference of electrical charge
across the mucous membrane of the nose. Nl –5 to –30 mV, CF –40 to –80 mV
Stool Analysis: Find malabsorption ↑fatinstool
(>7% is abnl with CF see 20% - 30%)

Question 23

Sputum Cultures• May be positive for:

Answer 23

Strep 
Pseudomonas 
Burkholderia Cepacia (nosocomial)
Haemophilus Influenza 
Klebsiella

Question 24

CXR Findings are ________ early on in the disease process Later, X-rays demonstrate streaky, white bands across the lung fields.

Answer 24

negative

Question 25

Obstructive Components will see what in the PFT?

Answer 25

Air trapping, Increased RV and FRC, IncreasedPaCO2

Question 26

Restrictive Components will see what in the PFT?

Answer 26

Restrictedair flow, Decreased TLC, VC

Question 27

CPT Assessment, looks for?

Answer 27

Auscultation - Rales/sonorous wheezes, because of mucous deposits Increased A/P diameter (Barrel Chest), they keep their chest full so that they can breath in more Chronic, productive cough, because of the mucous Accessory muscle use to breath in harder since it is blocked, SCM, SCALEMNES, TRAPS, SERRATUS ANTERRIOR, PEC MINOR, AND EXTERNAL INTERCOSTALS.

Question 28

CPT Treatment

Answer 28

Postural Drainage Place in position tommake the material come from the distal area tot he center to bring it out. FET (forced expiration technique) (huffing) as effective as 2-3 CPT treatments/day. ACB (Active cycle breathing) uses FET in conjunction with thoracic exp. exercises PEP (positive expiratory pressure) demonstrated to improve exercise tolerance and secretion clearancewhen paired with FET. AD (Autogenic draining)(uses segmental breathing) Huffing is like steaming a minorr, it is more energy conservative than just coughing.

Question 29

CPT Treatment what equipement are used for CF?

Answer 29

``` Flutter device Give resistance, to bring up the materials. Inflatable therapy vest Trunk Mobility/Postural Education Exercise encouragement Mucolytics ```

Question 30

CF Nutrition

Answer 30

Balanced diet - high calorie Enzyme supplementation for fat and proteindigestion May require supplemental nutrition at night by NG or IV (hydration essential for adequate expectoration of secretions)

Question 31

CF Abx

Answer 31

Controversial | Tolerance to antibiotics

Question 32

Steroids to decrease inflammation

Answer 32

.

Question 33

Lung Transplant Criteria

Answer 33

Severe pulmonary disease with marked hypoxemia Increase in the frequency of hospitalizationsIncreased antibiotic resistance No other significant vital organ disease History of medical compliance Acceptable psychological profile Complicated by fact many recipients are adolescents May tend to skip follow up rx in order to fitin better c peers We want someone that is at the end of their alternative treatments, who is fit for the transplant, who will keep to follow ups, and who is sound of mind.

Question 34

Lung Transplant P/O Basicaly it is P/O.

Answer 34

Immunological suppression post op Risk of rejection these two are true by all operations. Pts may be colonized c infectious agents (esp in sinuses) that can infect new lungs, by CF there could have been a culture present before the operation. ``` Unique challenges (only organ transplant that comes intocontact with the outside world) A really stressed organ, because it is exposed to the outside world. ```

Question 35

First drug: for CF...

Answer 35

Kalydeco approved Jan 2012, counters mutation present in 4% CF cases,cost: $294,000 yr

Question 36

Asthma is...

Answer 36

Episodic in nature • Acute episodes alternate with symptom freeperiods • Chronic inflammatory disease • Airways narrow in response to a stimulus

Question 37

ASTHMA: Acute Attack

Answer 37

↑ mucosal edema, ↑ secretions,  hyperactive airways (bronchospasm) Loud audible wheezes, rales and rhonchi Can be a life threatening event

Question 38

Status Asthmaticus:

Answer 38

severe asthmatic attack thatdoes not respond adequately to usual therapy and may require hospitalization Emergency, they are not responding to treatment.

Question 39

ASTHMA: Acute Attack• Acute episodes can be triggered by:

Answer 39

• Allergens • Infection • Environmental Stress (esp cold) Emotional Stress • EXERCISE

Question 40

Exercise Induced Bronchospasm

Answer 40

Caused by loss of heat and water from the lungs during exercise due to hyperventilation of dry cool air • It is estimated that 80% to 90% of people with asthma have EIB • Many patients only have bronchospasm with exercise

Question 41

Asthma Meds | • Long term asthma control medications

Answer 41

Inhaled corticosteroids Low dose, mild, suppose to go to the lung. • Long acting beta agonists (LABAs) • Theophylline (taken in pill form) • Leukotriene modifiers (↓ immune response)• Combination drugs (corticosteroids + LABAs)

Question 42

Asthma Meds | • Quick relief (rescue) medications

Answer 42

Short acting beta agonists– Commonly albuterol Anticholinergics (Ipratropium) (blocks acetylcholine, more often rx for COPD thanasthma) • Oral corticosteroids (for severe attacks (prednisone) ) Vitals can allow us to see if the person is able to go and do the job.

Question 43

Bronchial Thermoplasty

Answer 43

Using bronchoscope, lungs are heated to 149 degrees F • 3 stage procedure (3 weeks in between) • Costs $20,000 • Sig ↓ in ER visits and lost work • Some insurances now covering • NYT Article by Anahad O’Connor 9/4/12

Question 44

Bronchitis

Answer 44

Hypertrophy of the mucous glands and increase in goblet cells Loss of ciliary action Thickening of bronchial wall Obstruction, inflammation, ↑ secretions Thick, tenacious, mucopurulent secretionsStrong, hard to get rid of. Mucous that is like a pearl

Question 45

Chronic Bronchitis Early stage:

Answer 45

10 -100ml of sputum expectorated in the AM Later stage: Prolonged phase of expiration Coarse rales, rhonchi, and wheezes

Question 46

Chronic Bronchitis Chronic productive....

Answer 46

cough with morningexpectoration

Question 47

Why is hydration important for thise who are asthmatic?

Answer 47

So that the mucous could be more watery and come out easier.

Question 48

Bronchiectasis is?

Answer 48

Permanent abnormal dilation and distortion ofbronchi caused by destruction of the elastic and muscular components of the bronchial walls Describes an anatomic abnormality NOT a single disease Many different diseases can lead to bronchiectasis. Like ling term bronchitis.

Question 49

Bronchiectasis Commonly caused by:

Answer 49

Necrotizing infections of the trachea and bronchial tubes Necrotizing PNA (remember, recurrent infections are typically seen in chronic bronchitis and CF) TB Pertussis Wooping cough, bad for kids, can kill a baby, by an adult, it looks like a cold, a baby, they can go into respiratory distress. The vaccine works but does not last.

Question 50

Bronchiectasis | Other causes:

Answer 50

Chronic gastroesophageal reflux and aspiration Foreign body aspiration Lung diseases that upset the pressure balance thatkeeps the lungs open (Sarcoidosis, Interstitial Fibrosis) TB Smoke or other inhalation injury Immotile cilia syndrome Again anything that will keep the airways open and lead to permanent structural changes.

Question 51

Bronchiectasis: Clinical Features | Patients will present with:

Answer 51

Cough, copious | mucopurulent sputum, fetid breath, recurrentpulmonary infections

Question 52

Bronchiectasis is Frequently seen in conjunction with?

Answer 52

Cystic Fibrosis Immotile Cilia Syndrome Kartagener’s Syndrome [which consists of bronchiectasis, sinusitis, situs inversus (heart on the right side)]

Question 53

Emphysema is?

Answer 53

Anatomical changes in the lungs | characterized by hyperinflation especially at the alveolar level

Question 54

Bronchiectosis vs. Emphysema

Answer 54

The brinchi is at the bronchi and the emphysema is att he alveoli

Question 55

Blebs are?

Answer 55

(balloon like stretched out alveoli) | when stressed can cause a pneumothorax

Question 56

Obstructive Pulmonary Disease name me five things that can cause this...

Answer 56

``` Bronchopulmonary Dysplasia Cystic Fibrosis • Asthma • Bronchitis → Bronchiectasis • Emphysema ```

Question 57

Fremitus is?

Answer 57

Vibration • Produced by voice or presence of secretions inairways • Transmitted to chest wall Piut the dorsim of your hand on the person and ask to breath or listen to their speech. Thats all that it is, just vibration, but depending on the amount and location different amounts and types of vibration will ensue at different parts of the chest wall.

Question 58

Abnormal Findings• Increased Fremitus indicates

Answer 58

presence ofsecretions or consolidation

Question 59

Decreased Fremitus indicates

Answer 59

presence of air or fluid in the pleural space

Question 60

Postural Drainage

Answer 60

* Align segmental bronchi with gravity * Collect secretions centrally * Cough/expectorate to remove secretions * Can supplement with P & V

Question 61

Postural Drainage Contraindications

Answer 61

* ICP > 20 mmHg * Unstabilized head/neck injury * Active hemorrhage * Hemoptysis * Empyema * Bronchopleural fistula * Pulmonary edema assoc with CHF

Question 62

Contraindications Tredelenburg

Answer 62

``` • Neuro dx: Cerebral aneurysm, ICF drain, coma, recent CVA, uncontrolled sz • ↑ ICP contraindicated • Uncontrolled HTN • Distended abdomen • Post esophageal procedures • Cardiovascularly unstable: Acute MI, pulmonary HTN, arrhythmias ```

Question 63

Percussion

Answer 63

Cuped hand to clap them over on 5he person. * Loosens secretions * Use cupped hand * Should sound hollow * Percuss only over ribs * Percuss for at least one minute

Question 64

Vibration

Answer 64

• Gentler than percussion • Uses flat hand • Always go “down and in” Coordinate with exhale

Question 65

Contraindications for percusion and vibration

Answer 65

* Pneumothorax * Platelets < 50,000 * Cardiovascularly unstable pt * Over rib fx or lesion * Osteoporosis, CA mets, prolonged steroid use• Over sx incisions/sternotomy * Over recent graft, burn or wound * When blood too thin (↑ INR, etc.) • Hemoptysis * Undrained empyema * Subcutaneous emphysema * PE * Flail chest * Awaiting R/O for MI * Acute TB * Severe pain * Recent spinal fusion