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PHTH554 - Cardiology > Lecture 9 - Acute respiratory conditions > Flashcards

Lecture 9 - Acute respiratory conditions Flashcards

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1
Q

What is atelectasis?

A

Loss of lung volume due to collapse of lung tissue (alveoli)

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2
Q

What are the 2 causes of atelectasis ?

A

Compression atelectasis: Physical compression of lung tissue

Resorption atelectasis: Complete obstruction of an airway

Passive atelectasis: Inadequate inspiratory volume

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3
Q

Example of compression atelectasis

A

ex: pleural effusion, pneumothorax or other space-occupying lesion

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4
Q

examples of resoprtion atelectasis

A

ex: secretions, mucus plug, tumor

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5
Q

example of passive atelectasis (5)?

A

neurologic conditions resulting in inspiratory muscle weakness

musculoskeletal conditions that hinder lung expansion

post-anesthetic effects
splinting due to pain

upper abdominal, thoracic surgery, trauma

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6
Q

What impact have atelectasis on:
compliance
work of breathing

A

dec lung compliance

inc work of breathing

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7
Q

What causes a localized atelectasis

A
  • > hypoxic vasoconstriction usually limits V/Q mismatching

- >relatively normal gas exchange maintained

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8
Q

What causes an extensive atelectasis?

A

Incr pulmonary arterial pressure overrides the vasoconstriction

intrapulmonary shunt (i.e., blood flows past nonventilated alveoli)

decrgas exchange

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9
Q

symptoms of work of breathing?

A

nasal flaring, grunting

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10
Q

what are the s/s of atel

- resp & vitals

A

± Fever
Tachypnea
Dyspnea

If extensive atelectasis – tracheal shift towards affected side with diaphragm elevation

± Wet or dry cough, sputum can range in color depending on reason for atelectasis

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11
Q

What are the findings in auscultation?

A

Decreased or absent breath sounds over the area

End-inspiratory crackles at involved site

If lobar collapse, absent or bronchial breath sounds

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12
Q

What are the results in PaO2 and SpO2, what does it lead to?

A

↓ PaO2 and SpO2

- Lung units perfused but not ventilated – “SHUNT”

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13
Q

what are the findings on x-rays concerning atelectasis&

A

Increased lung opacity, tracheal and mediastinal shift (toward ateleactasis), and diaphragm elevation on CXR

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14
Q

what are the med tx for atelectasis?

A

Prevention (e.g., airway clearance techniques, breathing exercises, mobilization)

Identification and reversal of the underlying cause

Supplemental O2

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15
Q

What are the physio tx for atelctasis?

A

Deep breathing with end-inspiratory hold, incentive spirometry

Airway clearance techniques

Positioning and mobilization

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16
Q

What is a pneumonia?

A

Inflammation of the lung parenchyma as a result of infection

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17
Q

What are the cases of pneumonia (4)?

A

Inhalation of airborne organism
Bacteria, viruses, mycoplasma, fungi

Hematogenous (circulation)

Occurs more in immuno-suppressed individuals

Infection from trauma or chest tube

Aspiration
Contaminated orophryngeal contents

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18
Q

what conditions are increasing the risk of pneumonia (6)?

A

Impaired airway defense mechanisms
cigarette smoking,
upper respiratory infection
dehydration

Chronic obstructive lung disease

Hospitalization

Debilitation

Dysphagia

Compromised immune status

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19
Q

What are the 3 anatomical classification of pneumonia?

A

Bronchopneumonia: spread and involvement along the bronchi and bronchioles.

Lobar pneumonia: localized to one or more lobes of a lung

Interstitial pneumonia (Primary atypical pneumonia): involves interstitial inflammation

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20
Q

What are the etiological classification of pneumonia?

A

Viral
Bacterial
Fungal
Parasitic

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21
Q

What can be the origin of pathogen in pnemonia (diff names of pneumonia)?

A

Community-acquired pneumonia

Hospital-acquired (nosocomial) pneumonia
- Ventilator-associated pneumonia (VAP)

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22
Q

What are the s/s of viral pneumonia?

  • vit signs
  • resp
  • body functions
  • WBC count
A 
Fever
Dyspnea
Tachypnea
Tachycardia
Loss of appetite
Myalgia
Persistent non-productive cough
Normal white blood cell count
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23
Q

What are the findings in auscultation of a viral pneumonia?

A

Normal breath sounds throughout both lungs with scattered inspiratory crackles.

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24
Q

What are the med tx for viral pneumonia?

A 
Rest
Salicylates
Antiviral meds: Acyclovir, Amantadine, Tamiflu 
↑ Hydration
Vaccination (prevention)
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25
What are the common etiology of bact pneumonia?
Gram positive bacteria: - Pneumococcal Staphlococcal Streptococcal pyogenes ``` Gram negative bacteria: - Hemophilus influenza - Escherichia coli Pseudomonas aeruginosa Enterobacter ```
26
What are the s/s of bacterial pneumo?
``` Fever, possible shaking chills Dyspnea Tachypnea Tachycardia Fatigue, weakness, malaise Pleuritic chest pain over affected lung region Cough with or without expectoration ↓chest expansion of affected area ```
27
What are the auscultation findings with bact pneumo?
Bronchial breath sounds (consolidation); crackles, reduced breath sounds
28
What are the percussion findings with bact pneumo?
Dullness to mediate percussion
29
What are the PaO2 and PaCO2 findings with bact pneumo?
↓PaO2, PaCO2 may be ↓
30
What are the x-rays findings with bact pneumo?
CXR: Atelectasis, infiltrates, consolidation
31
Can you have a tracheal shift with bact.pneumo?
NO TRACHEAL SHIFT with a consolidation
32
What are med tx for bact.pneumo?
Antibiotic therapy O2 therapy and mechanical ventilation in certain patients Adequate hydration and nutrition
33
What are physio tx for bact.pneumo?
Poor gas exchange: Deep breathing, positioning (side-L opp side of pneumo) Pain due to coughing or pleurisy: relaxation, supported cough Secretion clearance techniques for patients producing more than 30 mL of secretions/day or who have impaired cough. Reduced mobility: bed mobility  ambulation
34
What is a lung abcess?
cavitated infected necrotic lesion within the parenchyma.
35
What is the etiology of a lung abcess?
``` aspiration of a foreign body, cavitary TB, obstruction by a neoplasm, unresolved pneumonia, infection of an infarct, sepsis. ```
36
What are the s/s of a lung abcess? (5)
depends on size of abscess | - fever, malaise, cough with purulent foul sputum, hemoptysis.
37
What are the med tx of a lung abcess?
Treatment of the underlying cause Antibiotic therapy O2 therapy Adequate hydration and nutrition
38
What is the physio tx of a lung abcess?
Deep breathing and positioning if poor gas exchange a problem. Secretion clearance techniques for retained secretions or if lung abscess draining into the airway.
39
What is a pleural effusion?
collection of non-purulent fluid in the pleural space
40
What are the 2 pleural effusion?
Exudates: seen in infectious/inflammatory diseases Transudates: elevated hydrostatic pressure in the pleural capillaries causing fluid to leave the vascular spaces
41
What differentiate the 2 pleural effusion?
Ex: high protein content (albumin) and increased inflammatory cells. Trans: low in protein with no inflammatory cells
42
Give examples of the 2 pleural effusion condiditons
ex: bacterial or viral pneumonia, pulmonary infarction, malignant tumors, TB, postmyocardial infarction syndrome, acute pancreatitis, cancer of the pleura. Trans: congestive heart failure, hepatic cirrhosis (dec albu), kidney failure
43
Pleural effusion s/s (small effusion) - 3?
Rapid or sudden onset of symptoms Pleuritic chest pain with deep breathing and cough ± Fever, possible shaking chills night sweats
44
Pleural effusion s/s (large effusion) - 7?
Dyspnea Mediastinal shift to unaffected side ↓ chest expansion on affected side, ↓ VC Dry nonproductive cough (irritation) Absent br. s./ bronchial breathing just above the effusion Dull to flat over the effusion on mediate percussion Pleural friction rub
45
What are the medical interventions for pleural effusion
Rx of underlying cause. Resolution without intervention. Thoracocentesis: needle aspiration Thorascopy: rigid scope used to remove fluid or perform talc pleurodesis (recurrent malignant pleural effusion) Fluid drained with chest tube (larger effusion) Surgery to drain fluid and remove adhesions
46
What are the physio tx for pleural effusion?
Physio Rx: segmental and diaphragm breathing, mobility and arm ROM when chest tube inserted
47
What is a pleurisy?
inflammation of the pleura
48
T/F Pleurisy comes with pleural effusion
F | With or without a pleural effusion
49
In which conditions can we find a pleurisy?
Pneumonia (bacterial, viral), TB, pulmonary infarction connective tissue diseases, chest wall trauma, carcinoma, mesothelioma
50
What's a fibrothorax?
Fibrous response of pleurisy leads to scarring and pleural adhesion = Fibrothorax
51
What are the s/s of a pleurisy?
Pain: dull and nonspecific/sharp and localized Doorstop breathing Pleural friction rub
52
Whats a pneumothorax?
Leakage of air into the pleural spac
53
Whats the 4 possible causes (mechanisms) of pneumothorax + examples?
Traumatic: - automobile accident, gunshot, stabbing etc. Iatrogenic: - occurring with various cardiac and pulmonary surgeries and biopsies, mechanical ventilation, etc . Artificial or induced: - treatment of TB Spontaneous: - asthma, CF, pulmonary emphysema, malignancies, and infections.
54
The pneumothorax s/s will depend on what? | What happens with small?
Depends on the mechanism, severity/size Small: asymptomatic
55
What are s/s of large pneumothorax (4)?
sudden sharp pain and dyspnea mediastinal shift to the opposite side. diminished breath sounds tympanic sound on mediate percussion
56
What are the tx for pneumothorax (4)?
Simple observation Needle aspiration Chest tube Pleurodesis: a physical attempt to adhere the parietal and visceral pleura (to prevent recurrence).
57
What can happen with a tension penumothorax (4)?
Check-valve mechanisms permits air to enter but not exit the pleural space Can compress the ipsilateral lung, mediastinum (heart and vessels) and contralateral lung ↓ cardiac output, hypotension, shock LIFE-THREATENING!!! (stat chest tube)
58
Whats a hemothorax?
Hemorrhage into the pleura
59
Whats a chylothorax?
Traumatic rupture of the thoracic duct which causes lymphatic fluid to enter the pleural space.
60
Whats a empyema
Localized collection of pus in the pleural cavity - i.e. effusion that has become infected. - often accompanied by formation of fibrous adhesions
61
What are the tx for rib fx?
pain control - no other treatment if rib fractures do not damage the underlying tissue.
62
What is a flail chest and what are the repercussions?
segment of ribs due to multiple fractures of the rib and/or sternum. Flail segment moves in the opposite direction of the rib cage on inspiration/expiration. Restrictive defect: inefficient ventilation, impaired gas exchange.
63
What can happen with a lung contusion?
Hemorrhage into the lung parenchyma – can lead to hemoptysis. Decreased lung compliance, ↓ V/Q matching - ↓ PaO2 May resolve in 3 days – risk for pneumonia, empyema and ARDS.
64
What are the s/s of a chest trauma (6)?
Chest wall pain - especially coughing and sneezing Splinting Rapid shallow breathing Reduced breath sounds, crackles if have atelectasis V/Q mismatching - ↓ PaO2 with incr PaCO2 Weak cough
65
What are the tx for chest trauma?
Pain control Maintain oxygenation: supplemental O2, mechanical ventilation – severe flail chest Breathing exercises – maintain/improve ventilation

PHTH554 - Cardiology (9 decks)

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