Nurs 2005: Pulmonary Disorders (Part 2) Obstructive and Vascular Disorders, Respiratory Failure

Question 1

Obstructive Disorders

Answer 1

• obstruction d/t problem of getting air into lungs
• inc TLC and inc residual air d/t trapped air
• dec vital capacity

Question 2

Obstructive Disorder Tyes:

1. Asthma
   - def

Answer 2

• chronic inflammatory disease
• hyperresponsiveness of airways
• bronchospasms
• ranges from mild-severe

Question 3

What triggers asthma attacks?

Answer 3

1. allergies:
   - hypersensitivity to dust, pollen, animal dander,
2. respiratory infections:
   - triggers asthma
3. exercise:
   - d/t bronchospasms
4. drug/food additives:
   - interfere w/prostaglandin mediators because irritates airways

Question 4

What is the patho of asthma

Answer 4

Mast cells activated by allergens of irritants

• ->histimine→ inflammation
• -> hyperresponsiveness of airways.
• Inflammatory process produces bronchial smooth muscles spasms
• vascular congestion
• inc vascular permeability and edema and thick mucus
• Air gets trapped in lungs, hypoxemia develops, CO2 inc acidosis

Question 5

What are the clinical manifestations of asthma?

Answer 5

1. dyspnea with inc RR-
   - mostly happens at night
2. inc resp effort
   - with prolonged expiration phase
3. wheezing
   – can hear air move in and out
4. chest constriction
   – d/t bronchiole spasm
5. non-productive cough
   – d/t imflam
6. inc HR
   - d/t heart is compensating

Question 6

Status asthaticus

Answer 6

• more severe and prolonged
• resp failure
• requires hospitalization

Question 7

What type of diagnostic tests are done for asthma? What are the results?

Answer 7

1. PFT
   - dec
2. Blood gas- inc
3. CXR
   - hyperinflation in airways
   - reversible inflam

Question 8

What are the types of treatment for asthma?

Answer 8

Prevent:

• eliminate cause
• educate

Acute:

• meds
  
  • dec bronchospasms and inflam w/ inhalers

Question 9

2. Chronic Obstructive Pulmonary Disease

- def

Answer 9

• affect movement of air in and out of lung
  `
• Inspiratory muscles strong enough but recoil not, so difficult to get air out. = takes longer
• Exp > Insp.
• Chronic bronchitis and/or emphysema

Question 10

What is the etiology of COPD?

• d/t

Answer 10

• chronic irritation of lungs

d/t:

• smoking (main cause)
• chemical/toxin inhalants
• recurrent infections
• happens over time

Question 11

What are the 2 conditions of COPD?

Answer 11

Emphysema and Chronic bronchitis

Question 12

a. Emphysema

Answer 12

1. hyperinflation of alveoli
   
   • d/t inc in compliance
2. loss of lung elasticity
   
   • poor recoil = trapped air
3. narrowing of small airways
   
   • harder to get air out
4. destruction of alveolar and capillary walls
   
   • dec gas exchanges surface area

Question 13

b. Chronic bronchitis

Answer 13

• small and large airways.
• Chronic inflammation of airways–> excessive mucous production
  
  • hard to clear from throat
• thickening of bronchial walls–> blocks or narrows airways causing obstruction of
  airflow esp during expiration
• results in air trapping.

Question 14

What are the clinical manifestations of emphysema?

Answer 14

-SOB-
can compensate by pursed breath breathing

• minimal cough
• pink puffer
• ok O2 levels d/t compensation (early on)
• barrel chest (round chest) d/t hyperinflation of alveoli and flatten diaphragm
• thin d/t altered nutrition

Question 15

What are the clinical manifestations of chronic bronchitis?

Answer 15

• cough
• less SOB
• normal to heavy wt
• more spams and coughing when engaged in activity
• blue bloater- lower O2 levels

Question 16

What diagnostic tests are done for COPD? What are the results?

Answer 16

1. chest x-ray – shows trapping of air
2. PFT- dec vital capacity, inc residual vol
3. blood gas analysis- low O2, CO2 inc (late stages)

Question 17

What is the treatment used for COPD?

Answer 17

1. bronchodilators
2. corticosteroids- anti-inflam and dec inflam in airway
3. low flow oxygen
4. antibiotics
5. smoking cessation
6. breathing exercises
7. relaxation exercises

Question 18

3. Acute Bronchitis

Answer 18

• inflam of bronchi
• d/t infection
• similar to pneumonia
• “acute” = can be treated/cured

Question 19

What are the clinical man of acute bronchitis?

Answer 19

• productive cough
• fever, chills d/t infection
• malaise, weakeness
• chest pain d/t coughing

Question 20

What diagnostic test are used for acute bronchitis?

Answer 20

• chest xray
  
  • see open/inflammed airways
  • can hear good airflow in lungs

Question 21

What type of treatment is used for acute bronchitis?

Answer 21

• antibiotics
• rest
• fluids
• humidifier to dec inflam

Question 22

Pulmonary Vascular disorder

• def
• d/t

Answer 22

• occlusion (blocked) of protion of pul vasc bed by embolus
  
  • blood clot, air, bacteria, trauma, fat
• d/t:
  
  • deep vein thrombosis
  • heart arrhythmia = afib

Question 23

What is the patho of pulmonary vasc disorder

Answer 23

• emboli go to lungs = lodged in narrow part of circ system
• cause ventilation/perfusion mismatch (VQ mismatch)
  • air in lungs and match it w/ perfusion

Question 24

What are the risk factors for pulmonary vasc disorder

Answer 24

• immobile people = pooling of blood
• varicose veins = effect blood flow to heart = pooling of blood
• oral contraceptive = blood clots
• diabetes = emboli/blood clots developing

Question 25

What are the clinical man of pulmoary vasc disorders?

Answer 25

* depends where the emboli occur: - lower lobes = less pain - major lobes = more pain - inc RR and HR - dyspnea - anxiety - pain d/t inc breathing - infarction: - fever - hemoptysis = blood in sputum - pleural effusion - occlusion - shock - dec BP - pul HTN

Question 26

What diagnostic tests are done for Pul vasc disorder?

Answer 26

- prevention of DVT - elevate leg - ROM - acute - anticoagulants if immobile to dec clots - fibrinolytics = breaks clots if given 6hrs of detection

Question 27

Pulmonary HTN

Answer 27

- high BP in pul arteries - normally low pressure = 25/10 = gas exchange - pul HTN d/t inc workload of right ventricle

Question 28

What is the patho of pul htn?

Answer 28

1. inc left ventricle filling pressure - d/t mitral disease 2. inc blood flow through pulm circulation- d/t congenital heart disease 3. obstruction of pulmonary bed or destruction of alveolar walls- d/t pul embolism 4 inc vasoconstriction of vascular bed - d/t low O2 levels 5. primary pulmonary HTN - unknown development

Question 29

What are the clinical man of pul htn?

Answer 29

- fatigue - chest discomfort - inc RR d/t compensation - dyspnea d/t diff breathing and lack of O2

Question 30

What are the diagnostic tests done for pul htn?

Answer 30

- chest xray - shows enlarged pul arteries and L side heart - echocardiogram - R side enlarged heart

Question 31

What are the treatment options for pul htn?

Answer 31

- primary: - pul vasodilators (Viagra) - lung transplant - secondary: - oxygen - diurectics - inotropics

Question 32

Cor pulmonale

Answer 32

- enlargement of R ventrivle d/t pul HTN | - d/t disease of lungs, chest wall, or pul circulation

Question 33

What are the clinical manifestations

Answer 33

- SOB - productive cough - peripheral edema - d/t poor blood flow - chest pain - fatigue

Question 34

What type of treatment is used for cor pulmonale

Answer 34

- treat cause | - same treatment as pul htn

Question 35

Acute resp failure (ARF)

Answer 35

- PaO2 50 mmHg | - alveolar can't produce enough O2 for the body

Question 36

What is ARF caused by?

Answer 36

1. . Hypoventilation: tidal volumes dec, CO2 levels inc, O2 levels dec. - d/t not breathing enough a. CNS depression (muscular problem)- narcotic use = anesthesia b. injury to nervous system itself- head, spinal cord trauma c. neuromuscular disease 2. Impaired Diffusion: - impairment or difference between O2 pressure in alveoli and pulmonary capillary bed. - impairs gas exchange Cause: a. thicken blood-gas membrane (x) b. reduced pulmonary capillary blood flow- destruction of alveolar walls 3. Mismatching of Ventilation/Perfusion (V/Q): a. adequate ventilation but poor perfusion – pul emboli b. poor ventilation but adequate perfusion – COPD, pneumonia

Question 37

What are the clinical man of ARF

Answer 37

- r/t accum of CO2 - dec O2 in blood S/S of hypoxemia and hypercapnia

Question 38

What type of treatment is used for ARF?

Answer 38

- treat cause | - resp support = mechanical ventilation