Pulmonary Diseases Flashcards
(117 cards)
1
Q
classifications of pulmonary disease
A
1: obstructive
2: restrictive
3: infectious
4: vascular
5: pleural
2
Q
what is chronic obstructive pulmonary diseases (COPD)?
A
=generic term for group of diseases that rap air in the lungs
- preventable & treatable but not fully reversible
- # 1 risk factor=cigarette smoking (responsible for 80-90% COPD cases)
- associated with abnormal inflammatory response of the lungs to noxious particles/gases (cigs)
- although COPD affects lungs, also produces systemic consequences
- 3rd leading cause of death in US; 6th worldwide
- 2nd leading cause of disability
- estimated cost $42.6 billion in 2007
3
Q
2 major categories of COPD
A
1: non- septic
2: septic
*the difference between the two will help determine if bronchial hygiene will be a primary goal of the PT plan of care
4
Q
non septic COPD diseases
A
emphysema
alpha1 antitrypsin deficiency
bronchiolitis obliterans
asthma
5
Q
septic COPD diseases
A
cystic fibrosis
chronic bronchitis
brochiectasis
*septic COPD typically produces large volume of sputum, productive chronic cough, colonization of bacteria and fungus associated with chronic infections
6
Q
mechanisms of COPD
A
current thinking on the pathophysiology of obstructive diseases, involving mast cells, eosinophils and T lymphocytes, which release a wide range of inflammatory mediators
these mediators act on cells in the airway, leading to contraction of smooth muscle, edema due to plasma leakage and mucus plugging
7
Q
classifications by PFTs
A
Obstructive diseases: can’t get air out so residual volume increases
Restrictive: the residual volume is less than normal
8
Q
COPD: emphysema & chronic bronchitis
A
- includes small airways disease and parenchymal disease
- Chronic bronchitis clinical dx: cough & sputum production for >3 mon to >2years
- Emphysema pathologic dx: destruction of gas-exchanging surface of lung (alveoli & capillaries)
*most pts have components of both
9
Q
non-septic obstructive diseases
A
emphysema, alpha1 antitrypsin (AAT) deficiency, bronchiolitis obliterans, and asthma
- hyperinflation of the lungs
- barrel chest deformity
- excessive accessory muscle use (shortened; elevated shoulders)
- increased lung compliance
- larger lung volume with trapped air due to premature airway closure
- ABGs: show hypoxia w/ or w/out hypercapnia
- PFTs: increased TLC, IRC, RV; decreased FVC, FEV1, carbon monoxide diffusion capacity (DLCO) and ratio of FEV1/FVC
Secondary sequelae from medication & limited activity:
- type I and II muscle atrophy and weakness
- osteopenia and osteoporosis
- development of R sided heart failure
10
Q
emphysema
A
- 2nd most prevalent COPD disease after asthma
- abnormal, non-reversible, airway dilation distal to terminal bronchioles
- decrease in driving & intraluminal pressures leading to impaired expiratory airflow & patent airway during inspiration
- premature airway closure and air trapping, bullae
- increased residual volume
- hyperinflation
- inspiratory muscles are shortened, have decreased sarcomeres and are hypertrophied
11
Q
pretease-antiprotease hypothesis for emphysema
A
- emphysema is result of destruction of CT matrix of alveolar walls by proteolytic enzymes (elastase) released by alveolar neutrophils
- elastase normally inactivated by alpha1 antitrypsin
- smoking upsets balance between these two enzymatic processes
12
Q
signs and symptoms of emphysema
A
- cough and phlegm
- dyspnea on exertion
- increased A-P diameter on CXR (barrel chest)
on auscultation:
- decreased distant breath sounds
- prolonged expiratory phase
- wheezing/ronchi due to secretons
13
Q
signs and symptoms of advance emphysema
A
cachexia R sided heart failure peripheral pitting edema weight gain JVD (jugular venous distention) decreased appetite RUQ (R upper quadrant) discomfort ventricular gallop S3 heart sound osteoporosis depression CVD
14
Q
emphysema medication management
A
smoking cessation drugs
Bronchodilators
- antichoinergics
- B2 agonists
- inhaled corticosteroids
methylxanthines: may improve respiratory muscle strength & endurance
during exacerbations:
- inhaled systemic corticosteroids to relieve SOB
- antibiotics for bacterial infection (acute bronchitis and pneumonia)
15
Q
emphysema treatment
A
Smoking cessation (behavioral management)
Supplemental oxygen:
- usually low flow O2 via NC is adequate
- especially important in pulmonary HTN and polycythemia (excessive RBC)
- only therapy proven to increase survival
BiPAP to decrease work of breathing
mucus clearing devices
AAT replacement therapy
pulmonary rehab
influenza & pneumococcal vaccine
surgery: bullectomy, LVRS (lung volume reduction surgery) or transplant
16
Q
alpha 1 antitrypsin (AAT) deficiency
A
- most common autosomal recessive genetic liver disease in children
- 2nd to CF in genetic pulm diseases
- lungs lack alpha 1 antitrypsin coating. leaving them open to damage by neutrophil elastase. enzyme is synthesized in the liver & inhibits neutrophil elastase which breaks down bacteria from airway -> causes liver and lung damage
- by second decade of life it is primarily a pulmonary disease
- leads to early development of emphysema in 3rd or 4th decade
17
Q
bronchiolitis obliterans (OB)
A
- acute inflammatory injury with diffuse destruction of bronchioles associated with underlying inflammatory pathology
- increase in fibroproliferation in bronchioles and collagen deposition in cartilaginous airways
most common cause is associated with lung transplants- often there is a loss of graft function due to chronic rejection
-post transplant incidence is 80% after 5 years with onset of 16-20 months. more than 50% who survive transplant beyond 3 months will develop OB
also found in children and infants following severe respiratory infections
18
Q
bronchiolitis obliterans (OB) signs and symptoms
A
- SOB with exertion
- wheezing, crackles, ronchi
- persistent cough
- hypoventilation
- hypercapnia (too much CO2)
- intercostal retraction
- tachypnea (fast/ hyperventilation)
- grunting
CXR: hyperinflation w/ patchy atelectasis
PFT: decreased FVC (forced vital capacity) and FEV1; increased RV
CT scan: mosaic perfusion, vascular attenuation, and central bronchiactasis
19
Q
bronchiolitis obliterans treatment
A
- prevention is key
- supplemental oxygen
- antivirals
- corticosteroids
- bronchodilators
20
Q
asthma definition
A
- chronic disease
- airway inflammation
- reversible airway limitation (normal lung function between between episodes)
- bronchial hyper-responsiveness
- unknown cause (associated with maturing immune system & lung tissue)
21
Q
asthma risk factors
A
- maternal smoking
- second hand smoke
- family history
- genetics
- atopy (allergic hypersensitivity)
- childhood asthma
- occupational exposures
- environmental exposures
- gender
- early infection (RSV)
22
Q
asthma prevalence
A
-prevalence rate in 2000 was 7.5% in the US
can occur at any age- most common chronic disease in children
- 80% have age of onset before 5 y/o and 50-70% outgrow it
- 35-40% of children with asthma limited in activity & play
- majority have a family hx
- occupational exposure is related to adult onset
- disproportionately affects those in lower socio-economic levels
- worldwide asthma prevalence and death rates are increasing
23
Q
asthma signs and symptoms
A
- wheezing
- dyspnea
- chest pain/tightness especially at night
- facial distress
- non-productive cough
- decreased breath sounds
- cyanosis
- exhaustion
- hypercapnia
- pending respiratory failure
- status asthmaticus= severe attack that doesn’t respond to bronchodilators
24
Q
asthma triggers/stimulants
A
- indoor irritants (cigs, CO, nitric oxyide) from poorly vented heating systems
- **air pollution (diesel exhaust, ozone, smoke)
- allergens (pollen)
- pesticides
- mold
- dust mites, rodents, cockroaches, animal dander
- respiratory infection
- exertion and/or exercise (usually 10-15 minutes into exertion, resolves with rest over 30-16 min)
- cold air
- **medications: NSAIDS, ACE inhibitors, aspirin, beta blockers
25
exercise induced asthma (EIA)
- results from loss of water and heat from lower respiratory system (mouth breathing)
- loss of heat causes hyperemia (^ BF), vascular engorgement & bronchial edema (narrows bronchioles)
- bronchoconstriction may present 6-8 hours post exercise
26
diagnosis of exercise induced asthma
- history of symptoms in children
- in adults a increase in FEV1 > 15% following use of a bronchodilator
- 15% drop in peak expiratory flow following exercise
severity is determined by minute ventilation during exercise, temperature, humidity of air and baseline airway reactivity
27
exercise induced asthma trigger
inflammatory process -> bronchoconstriction and airway obstruction
28
asthma medication management
-short and long acting beta2 agonists bronchodilators
B adrenergic agonists: increase in smooth muscle relaxation resulting in bronchodilation & inhibits release of mediators
Cromolyn: used to prevent attack; not a rescue drug
Leukotriene modifiers: block proinflammatory mediators that promote smooth muscle contraction, vascular leakage, mucous secretion & airway hyperactivity (montelukast, zafirlukast)
Immunosuppressive meds: (methotraxate & cyclosporine) used in chronic, severe asthma
antibiotics not usually indicated*
29
asthma treatment & management
- EIA can be reduced by meds and warm ups 45-60 minutes prior to exercise; warm up usually consists of 30 second bouts with 2 min rest periods to reduce severity of s&s
- goal is prevention first and minimizing exacerbation second
- routine exercise program has been shown to increase minute ventilation, increase O2 consumption and decrease blood lactate
- objective measure of lung function
- environmental control measures to avoid allergens and irritants and avoidance of triggers
- pharmacologic therapy
- patient education
30
septic obstructive diseases
chronic bronchitis, cystic fibrosis, bronchiectasis
- purulent sputum & high incidence of pulmonary infection
- hallmark is productive cough with excessive secretion production
PFTs: (similar to non-septic); decrease in expiratory effort with increased TLC, hypercapnia which leads to pulmonary hypertension and cor pulmonale (R heart failure)
pulmonary HTN (high BP in pulmonary arteries and lungs)
high pressure & narrowing of vessels causes R heart enlargement and failure (cor pulmonale)
31
chronic bronchitis
clinical diagnosis= cough and sputum production for >3 months to >3 years
- smoking is the #1 risk factor as leads to inflammation and airway destruction
- increased size and number of bronchial mucous glands leads to excess airway mucus
- increased glands, plus airway inflammation thickens airway walls
- structural and functional effects on cilia lead to decreased mucociliary clearance
- small airways (<2 mm) develop narrowing, inflammation, fibrosis
32
chronic bronchitis medications
- often on various antibiotics for bacterial and fungal infection
- short acting beta agonists
- long acting bronchodilators
- inhaled corticosteroids
- smoking cessation drug therapy
- expectorants and mucolytics
- antiprotease treatment (to decrease destruction of elastase by inflammation)
33
chronic bronchitis treatment
- supplemental O2
- bronchial hygiene
- pulmonary rehab
- early mobilization
- smoking cessation behavioral therapy
- influenza and pneumococcal vaccine
34
"pink puffer"
descriptive name for COPD pt with predominant emphysema
```
major symptom: dyspnea
appearance: thin, wasted, not cyanotic
PO2: low
PCO2: normal or low
elastic recoil of lungs: low
diffusing capacity: low
hematocrit: normal
cor pumonale: infrequent
```
35
"blue bloater"
descriptive term for COPD pt with predominant bronchitis
```
major symptom: cough and sputum
appearance: obese, cyanotic
PO2: really low
PCO2: normal or high
elastic recoil of lung: normal
diffusing capacity: normal
hematocrit: often high
cor pulmonale: common
```
36
mucus clearing device
1: flutter mucus clearing device
2: acapella mucus clearance devices (high and low flow)
37
cystic fibrosis prevalence
=autosomal recessive
- most common and lethal genetic disease in US
- incidence is 1 in 3900 live white births
- more than 10 million americans are symptomless carriers of the gene
38
what is cystic fibrosis?
- autosomal recessive genetic disease
- defect involves the epithelial cells of the exocrine glands
- defect in chloride ion transfer: Na+ and Cl- transport disturbed, pulling water back into cell making secretions thicker and drier
- lungs: mucociliary clearance mechanism is hindered, secretions settle in lungs & provide good medium for bacteria to grow
- sets up a cycle of inflammation, infection and destruction of tissues
- in other organs the thickened secretions lead to obstruction and malabsorption (GI tract)
- hallmark of CF is that baby tastes "salty"
- chronic disease with median life span ~ 38 years
39
target organs of cystic fibrosis
```
sinuses
lungs
pancreas
intestines
biliary tracts
vas deferens
uterine cervix
sweat glands
```
primarily affects the lungs and digestive systems
40
cystic fibrosis signs and symptoms
- meconium ileus at birth (intestinal obstruction due to overly thick meconium-(should be passed in feces after birth))
- failure to regain birth weight/failure to thrive
- recurrent respiratory infections (PNA)
- chronic productive cough (hemoptysis)
- "salty kiss" (increased Cl)
- pancreatic insufficiency, pancreatitis, DM
- + nasal polyps
- GERD
- SOB with excess inspiratory accessory muscle use
- + inspiratory crackles and wheezing
- clubbing of nails
- weight loss; nutrient deficit: pancreatic enzymes can't function properly
- decreased activity tolerance
- osteoporosis
- muscle wasting
- chronic low back pain
- developmental delays
41
cystic fibrosis medical treatment
- early detection & tx important to start aggressive nutritional support
- aerobic & strengthening exercise
- energy conservation techniques
increased life expectancy due to:
- pancreatic enzyme replacement
- vitamin supplements
- high caloric diets
- airway clearance techniques
- antibiotics and antifungal treatment
- mucolytic & bronchodilator meds
42
cystic fibrosis treatment complications
- respiratory failure
- R sided heart failure
- severe hemoptysis
- spontaneous pneumothorax (collection of air/gas in the lung causing it to collapse)
43
cystic fibrosis medications
- glucocorticoid steroids (anti-inflammatory)
- bronchodilators
- antibiotics
- pancreatic enzymes (assist with digestion)
44
bronchiectasis
- permanent dilation of bronchi due to destruction of muscular and elastic properties of lungs
- usually associated with other pulmonary diseases (CF, emphysema,etc)
CXR: nonspecific
CT: high resolution, gold standard for dx
45
characteristics of bronchiectasis
- thickening of bronchial walls
- impairment of the mucociliary blanket
- hypersecretion of purulent sputum
46
2 key causes of bronchiectasis
1: intense chronic inflammation
2: inadequate defense to minimize infection resulting in tissue damage
47
bronchiectasis signs & symptoms
- persistant cough
- copious secretions
- frequent hemoptysis (bloody sputum)
- recurrent infections
- +crackles
- +high & low pitch ronchi (course "snoring")
- pleural rubs
- fever
- fatigue
- dyspnea
- digital clubbing
48
bronchiectasis treatment
- management of underlying disease
- often includes antibiotics, corticosteroids, bronchodilators
- nutritional support
- supplemental O2
- airway clearance/bronchial hygiene
*prognosis depends on underlying disease
49
restrictive lung disease
pulmonary fibrosis is linked to immune disorders, occupational exposures, genetic & hormonal abnormalities & complications of lung injuries
50
similar clinical features of restrictive lung disease
- significant hypoxemia (low O2 in blood) with rapid saturation on exercise
- many develop pulmonary hypertension or cor pulmonale
- PFTs consistently have decreased FVC & FEV1 with FEV1/FVC ratio WNL. significant reduction in VC and TLC
51
interstitial lung disease (ILD)
refers to a group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs)
"ILD" is used to distinguish these diseases from obstructive airway diseases
-most types of ILD involve fibrosis
52
restrictive lung disease classifications
1: inhaled substances
2: drug induced
3: connective tissue disease
4: infection
5: idiotpathic
6: malignancy
53
inhaled restrictive lung diseases
Inorganic
- silicosis
- asbestosis
- beryliosis
Organic:
-hypersensitivity pneumonitis
54
drug induced restrictive lung diseases
- antibiotics
- chemotherapeutic drugs
- anti-arrhythmic agents
55
CT disease- restrictive lung disease
- systemic sclerosis
- polymyositis
- systemic lupus
- erythematosus
- rheumatoid arthritis
56
infection-restrictive lung disease
- atypical pneumonia
- pneumocystis pneumonia
- tuberculosis
57
idiopathic restrictive lung disease
- sarcoidosis
- idiopathic pulmonary fibrosis
- Hamman-rich syndrome
58
malignancy-restrictive lung disease
-lymphangitic carcinomatosis
59
restrictive lung disease signs and symptoms
- dry cough
- gradual dyspnea with walking
- crackles at the lung bases
- clubbing
60
restrictive lung disease treatment
- treat the underlying cause
- for idiopathic pulmonary fibrosis, no specific drug treatment can be recommended
- corticosteroids alone should not be used
- corticosteroids & cytotoxic agents are of unproven benefits
- N-acetylcysteine, IFN-gamma, pirfenidone, bosentan, or etanercept may prove useful
- pulmonary rehabilitation, oxygen and lung transplant need to be considered
61
infectious pulmonary disease types
1: empyema
2: pneumonia
3: tuberculocosis
62
empyema
=pus in pleural space
63
pneumonia
=acute inflammation of the lungs; small bronchioles and alveoli become plugged with fibrotic exudate
6th leading cause of death
64
infectious pulmonary disease classifications
1: by infections agent (bacterial, viral, fungal)
2: by environment of infection (community acquired, hospital acquired, nursing home)
65
medical risk factors for infectious pulmonary disease
age
integrity of immune system
acute head, neck or chest trauma
surgery
66
environmental risk factors for infectious pulmonary disease
- increased risk due to hospital admission
- tracheal or gastric devices
- exposure to others
67
respiratory risk factors for infectious pulmonary disease
- increased infection rate associated with use of mechanical ventilation
- need for aerosolized breathing txs
68
aspiration
=removal by suction
common contributing factor to infectious pulmonary diseases
-increased risk of aspiration for pts with nasal or oral gastric tubes, endotracheal tube, head and neck trauma and depressed mental status
69
clinical manifestations of infectious pulmonary diseases
- fever
- productive cough with yellow-green or rust colored
- elevated WBC count
- positive sputum culture
70
treatment of infectious pulmonary disease
- prevention- flu shots
- proper care & cleaning of respiratory equipment
- hand washing
Diagnosed with CXR showing consolidation for at least 48 hours and at least 2 clinical signs: dyspnea, fever, cough, leukocytosis, leukopenia
71
tuberculosis global facts
- 9 million cases of TB in 2006
- 1.7 million deaths from TB in 2006
- leading cause of death in those living with HIV/AIDS
- leading cause of death in women of child bearing years
- worldwide a new infection occurs once every second
- 95% of new diagnoses and 98% of all deaths are related to TB & HIV co-infection
- in US, 15 million are co-infected
72
risk factors for tuberculosis
- HIV
- substance abuse
- cancer of the head or neck
- leukemia or Hodgkin's disease
- diabetes mellitus
- severe kidney disease
- low body weight
- certain medical txs (such as corticosteroid tx or organ transplants)
- specialized tx for rheumatoid arthritis or crohn's disease
- silicosis
73
tuberculosis transmission
- by inhalation of small, dry droplet nuclei that become airborne from cough or sneeze of infected person
- to become infected, person needs to be exposed for an extended period of time, to a person with laryngeal TB or a person with extensive disease
- particles must reach alveoli
- risk of infection depends on concentration of particles in air, length of exposure, hosts' immune system
- incubation period= 2-12 weeks
- test will be positive at 6-8 weeks
- during primary infection most are asymptomatic or may have unproductive cough and fever
74
tuberculosis diagnosis
-to diagnose TB, you have to think about it- consider the possibility
Flags raised:
- if the epidemiologic risk group is presenting: foreign born, medical risk groups (HIV, DM, steroid use)
- any organ system involvement: 80% of TB is pulmonary, 20% TB is extra pulmonary
- chronic, debilitating illness or prolonged febrile illness unresponsive to antibiotic
75
gold standard for TB diagnosis
=smear and culture
in the US a positive smear has a 90% accuracy in an HIV negative
20% of TB in the US is culture negative
76
TB general treatment principles
appropriate regimen
close follow up care
4 drug regimen-induction (intensive phase)
2 drug regimen-continuation phase
77
appropriate regimen for TB tx
- pt can tolerate
- will not select resistant organisms
- not adversely interact with other meds
78
close follow-up care for TB tx
- compliance
- efficacy of regimen
- complications of therapy
79
4 drug regimen-induction (intensive phase) for TB tx
- first 2 months of tx
- INH, Rifampin, Ethambutol, PZA
- if susceptibility testing is available, drug regimens may be tailored to the results, ie ethambutol dropped if fully susceptible
80
2 drug regimen-continuation phase for TB tx
INH-Rifampin for 4 months
INH-Ethambutol for 6 months
81
vascular pulmonary disease types
1: pulmonary emboli
2: pulmonary hypertension
3: pulmonary edema
82
pulmonary embolism (PE)
- 600,000/year
- closely associated with DVT
- 3rd leading cause of cardiovascular death
- only 1/3rd treated are symptomatic
- PE accounts for 3% of deaths post op
- blood, air, fat, amniotic fluid
83
Pulmonary emboli risk factors
- immobilization
- surgery within last 3 months
- stroke
- previous history of thromboembolism
- chronic heart disease
- acute MI
- CHF
- cancer
- >40 y/o
- obese
- lupus
- major trauma
- SCI
- oral contraceptives
84
pulmonary embolism signs and symptoms
* dyspnea
* pleuritic chest pain
* tachypnea
* *97% present these 3!!
- unexplained sudden & rapid onset of dyspnea (#1 sign)
- cough
- hemoptysis (coughing blood)
- tachycardia
- crackles
- most don't have LE signs at dx
- syncope (loss of consciousness)
- decreased breath sounds
- abnormal lung sounds
- rales
85
pulmonary embolism diagnosis
Spiral CT angiography= gold standard
- sensitivity= 83%
- specificity=96%
clinical probability still very important
-identify at risk pts and take preventative measures
color flow duplex imaging used to detect DVT
86
pulmonary embolism treatment
PREVENTION!
-includes early mobilization, compression stockings, anticoagulants, and IVC (inferior vena cava) filter
Thrombolysis
Anticoagulation
Surgical and catheter embolectomy
87
normal mean pressure in pulmonary arterial system
<15 mmHg
88
pulmonary hypertension
mean pressure in pulmonary arterial system= >25 mmHg at rest, 30mmHg during exercise
(normal=<15)
hypertension caused by increase in pulmonary vascular resistance
idiopathic; may be caused by genetic?
young and middle aged women are most affected
89
pulmonary HTN pathophysiology
- sustained elevation of pressure creates overload on RV which results in RV hypertrophy and later cor pulmonale
- initally, compensatory tachycardia and RVH maintain CO at rest but is unable to meet needs with exercise
- continued RV overload results in RV failure leading to venous congestion and inadequate CO at rest
- most die of RV failure
90
pulmonary HTN clinical manifestations
- dyspnea on exertion
- fatigue, weakness
- exertional chest pain
- lightheadedness, syncope
- palpitations
- possible hemoptysis
- s&s of cor pulmonale (RV hypertrophy & dilation)
91
pulmonary hypertension diagnosis
```
gold standard= cardiac catheterization
PFTs
echocardiogram
pulmonary angiography
V/Q and CT scans
```
92
pulmonary hypertension treatment
- treat underlying disease
- supplemental O2
- medications: anticoagulants, diuretics, vasodilators
- lung transplant
- prognosis is poor; mean survival=2.8 years
93
pulmonary edema
=accumulation of extravascular fluid in the interstitial and alveolar spaces in the lung
94
2 types of pulmonary edema
1: increased pressure, hydrostatic or cardiogenic pulmonary edema
2: increased permeability or non cardiogenic pulmonary edema
95
cardiogenic pulmonary edema
AKA: increased pressure, hydrostatic pulmonary edema
high pressure in L heart is reflected back to small vessels in pulmonary system resulting in flooding of the pulmonary interstitial space and alveoli with low-protein fluid.
due to CAD, hypertensive heart disease, aortic or mitral valve disease and cardiomyopathy
96
non-cardiogenic pulmonary edema
AKA increased permeability pulmonary edema
due to acute lung injury- ARDS
97
pulmonary edema signs and symptoms
- dyspnea, respiratory distress
- orthopnea, paroxysmal nocturnal dyspnea
- pallor or cyanosis
- diaphoresis (sweating)
- tachycardia, possible arrhythmias
- anxiety, agitation
- diffuse crackles, possible wheezes
- abnormal CXR w/ pulmonary congestion
- S3 heart sound
98
pulmonary edema treatment
- prompt dx is critical
- treat underlying cause
- supplemental O2
- prevent and treat complications
- may require assisted ventilation
99
pleural pulmonary disease types
pneumothorax
hemothorax
pleural effusion
100
pleural disease
- can involve air or fluid within the pleural space
| - may require drainage of the fluid (thoracentesis or chest tube)
101
mesothelioma
=tumor of the pleura
| associated with asbestos exposure
102
primary pneumothorax
Primary: air or fluid in the pleural space causing a spontaneous collapse
- tall, thin young mean
- no underlying disease
103
secondary pneumothorax
associated with underlying disease, especially COPD
104
blebs & bullae pneumothorax
=imbalance of protease and antiprotease enzymes and increased # of neutrophils & macrophages create bullae.
Blebs & bullae can rupture under pressure (cough, valsalva) causing air into pleural space
105
Iatrogenic pneumothorax
=a result of complications from diagnostic or treatment procedure
106
traumatic pneumothorax
=penetrating wound allows air through chest wall
knife, GSW, rib fx,
pleura fill with air/blood
107
tension pneumothorax
potentially life threatening-many causes
- air enters pleural space and can't escape causing progressive collapse of lung
- displaces mediastinum to contralateral side
108
hemothorax
=pleural effusion with blood in the pleural cavity
109
pneumothorax & hemothorax treatment
- needle or chest tube to aspirate air or blood from pleural space
- multiple times may use chemical pleurodesis= chemical, talc, or tretracycline into pleural space to adhere visceral pleura to parietal pleura. chemical causes inflammation and scarring
- thoracotomy to resect bullae
- prognosis related to size of pneumothorax
110
pleural effusion
=excessive collection of fluid between parietal and visceral pleurae
*when fluid is extra purulent=empyema
111
2 types of pleural effusion
1: transudate
2: exudate
112
transudate
results from increased hydrostatic pressure within pleural capillaries due to CHF, PE, renal disease
113
exudate
due to infection, malignancy, PE, or infarct
114
pleural effusion pathophysiology
excess fluid compresses lung tissue, leading to atelectasis, which reduces alveolar ventilation & increases work of breathing
increased pressure of fluid restricts lung expansion and causes mediastinum to shift away from the affected side
115
pleural effusion signs and symptoms
- possibly asymptomatic
- dyspnea
- pleuritic chest pain, aggravated by deep breathing and coughing
- possible fever, shaking chills, night sweats
- decreased or absent breath sounds over effusion, possible pleural rub
- dullness to percussion
116
common causes of pleural effusion
1: CHF
2: pneumonia
3: malignancy
117
pleural effusion treatment
- observe for natural reabsorption
- segmental expansion and diaphragmatic breathing exercises to prevent atelectasis
- increased mobilization
- thoracentesis-needle used to withdraw fluid
