Pulmonary Pathophysiology Part 1 Flashcards
1
Q
How does COPD affect the lungs
A
- Airways and air sacs lose their elastic quality
- Walls b/w many of the air sacs are destroyed
- Airway walls become thick & airways are narrowed by inflammation
- Airways make more mucus than usual, which can also clog them
2
Q
Common signs and symptoms of COPD
A
- Constant coughing (may be called “smoker’s cough”)
- Shortness of breath while doing everyday activities
- Inability to breathe easily or take a deep breath
- Excess mucus production (coughed up as sputum)
- Wheezing
3
Q
How to diagnose COPD
A
- Spirometry is the primary test
- Pulmonary function test (PFT): used to classify b/w obstructive vs restrictive
- Lung diffusion capacity test
- Chest x-ray
- Chest CT
- SaO2 of blood
4
Q
Warning signs of a COPD exacerbation
A
- Fever
- Increased shortness of breath, wheezing, or coughing
- Change in mucus (color, thickness, or amount)
- Using your rescue inhaler more than usual
5
Q
What are the top 3 most common treatments for COPD
A
- Short acting bronchodilators: quick relief of sx; widen your airways & relaxes the muscles in your lungs
- Long acting bronchodilators: used to relax the muscles around your airways over time & help you breathe easier; not used for quick relief of sx
- Inhaled corticosteroids: work to reduce inflammation in the lungs over time & must be taken daily
6
Q
Tips for quitting smoking
A
- Keep your mouth busy
- Keep your hands busy
- Tell people you are quitting
- Distract yourself
- Understand the urge: replace the urge thoughts with positive ones
- When you feel irritable or restless take a few deep breaths & remind yourself why you’re quitting
- If having trouble sleeping make a sleep schedule & keep your bedroom quiet & dark
- If worried about gaining weight: snack smart & stay active
7
Q
Describe the differences between obstructive and restrictive dysfunction
A
- Obstructive: If the flow of air on exhale is impeded, the defect is obstructive
- Restrictive: If the volume of air or gas inhaled is reduced, the defect is restrictive
8
Q
What is mixed impairment
A
- Diseases and conditions that result in both obstructive and restrictive lung impairment
9
Q
Pathophysiology of restrictive lung disease (RLD) is related to three factors
A
- Decreased compliance of both the lung & the chest wall
- Decreased lung volumes & capacities
- Increased work of breathing
10
Q
Airflow obstruction can be related to
A
- Retained secretions
- Inflammation of mucosal lining of airway walls
- Bronchial constriction related to increased tone or spasm of bronchial smooth muscle
- Weakened structural support of the airway walls
- Alveolar sac destruction & alveolar sac overinflation with surfactant destruction
11
Q
What are the 2 primary causes of COPD
A
- Inhalation factors (smoking, air pollution, chemicals)
- Genetics
12
Q
COPD reduces airflow out of the air sacs & results in ________________ and ________________
A
- Hyperinflation
- Poor gas exchange
13
Q
Signs of lung hyperinflation associated with COPD
A
- Elevation of shoulder girdle
- Horizontal ribs
- Barrel-shaped thorax
- Low, flattened diaphragms
14
Q
Respiratory failure is defined as a PaO2 <60 mmHg describe type I vs type II
A
- Type I: PaCO2 <45 mmHg; PaO2 is low (hypoxemia); V/Q mismatch
- Type II: PaCO2 >45 mmHg (hypercarbia/hypercapnia); PaO2 <60 mmHg (hypoxemia); lungs are not well ventilated
15
Q
Symptoms of hypercapnia (PaCO2 >45 mmHg)
A
- HA
- SOB
- Seizures
- Persistent tiredness of sluggishness during the day
- Neurological symptoms: disorientation, confusion, altered mental status, depression
16
Q
Symptoms associated with obstructive lung diseases
A
- Dyspnea on exertion especially during functional activities
- Possible increased anxiety
- Secretion production & cough
17
Q
Physical changes associated with obstructive lung diseases
A
- Exhalation becomes forced instead of passive
- Stress on the pelvic floor can manifest as urinary incontinence
- Reduction in aerobic metabolism & poor muscle endurance
- Recruitment of accessory muscles during inhale can lead to postural deviations (hypertrophy/shortening of muscle)
- Exercise/activity tolerance reduced
18
Q
Psychologic impairments associated with obstructive lung diseases
A
- Reduced activity tolerance
- Anxiety & depression
- Cognitive impairment
19
Q
What 2 spirometry measures can be followed after PFT to assess progression of COPD
A
- Forced expiratory volume in 1 second (FEV1)
- Forced vital capacity (FVC)
20
Q
Describe a normal, low, or high spirometry
A
- Normal: FEV1/FVC ratio >75%
- FEV1/FVC decreases as disease severity increases
- FEV1 and FEV1/FVC <70% indicates obstructive lung disease
21
Q
COPD is associated with larger TLV and RV as a result of
A
- Air trapping
- Lung hyperinflation
22
Q
Emphysema is a condition of the lung characterized by
A
- Destruction of alveolar walls
- Enlargement of airspaces distal to terminal bronchioles
23
Q
COPD is a combination disease caused by a mixture of
A
- Parenchymal alveolar disease (emphysema)
- Small airway disease (obstructive bronchiolitis)
24
Q
What are the 3 subtypes of emphysema
A
- Centrilobular: proximal dilation of the respiratory bronchioles with alveolar ducts & sacs remaining normal
- Panlobular: dilation of all respiratory airspaces in the acinus; occurs most frequently in the lung bases
- Distal acinar: dilation of airspaces underneath the apical pleura
25
Describe chronic bronchitis
- Presence of chronic productive cough for 3mo in each of 2 successive yrs
- Hypersecretion of mucus begins in larger airways and move to smaller
- Leads to hypertrophy of submucosal glands
- Degree of small airway involvement determines degree of disability
- May develop cyanosis & pulmonary edema
26
Physical exam findings for COPD
- Auscultation of the lungs show prolongs expiratory phase
- Pt may assume tripoding position
- Chest x-ray changes noted late in disease progression
- CT scan can help to detect the presence of bullae
27
Medical management for COPD
- Smoking cessation
- Pharmacotherapy
- Influenza vaccine (yearly) and pneumococcal vaccine (one time) to help prevent respiratory infections
- Treatment of sleep disorders (e.g., sleep apnea)
- Pulmonary rehabilitation, breathing retraining, and exercise training to improve exercise tolerance and reduce dyspnea and fatigue
28
What is bronchiectasis
- Bronchial tubes become widened, scarred, & swollen causing difficulty breathing
- Cilia in airways become damaged making them unable to clear mucus from bronchial tubes
- Mucus stuck in the airways can lead to infection
- Progressive disease with no cure
29
Symptoms of bronchiectasis
- Cough & mucus production
- Shortness of breath with activity
- Frequent lung infections
- Tiredness (fatigue)
- Chest pain
29
What are some causes of bronchiectasis
- Severe lung infections: repeated infections
- Lung injury: aspiration happening over a period of months to years leads to inflammation/damage of airways
- Immune deficiencies
- Inflammatory diseases: ulcerative colitis, Crohn's disease, RA, Sjögren's syndrome
- Genetic disorders
30
Key physical exam findings of bronchiectasis
- Dx by presence of signet ring sign on chest CT
- Classified as 3 types based on appearance of bronchial walls: cylindrical, varicose, & saccular
- Blood gases become abnormal
- Sputum testing
31
What is the signet ring sign found on chest CT for bronchiectasis
- Dilated bronchus is larger than the accompanying pulmonary artery
32
warning signs of a bronchiectasis exacerbation
- Change in color, thickness, odor, or amount of mucus
- Increased coughing
- Increased SOB
- Increased tiredness that lasts more than one day
- Low grade fever that doesn't go away
- Increased use of fast acting or rescue medications
- If use O2 you may find that you need more O2 than usual
33
Medical management for bronchiectasis
- Goal is to reduce the number of exacerbations & improve QoL
- Nebulized medication, bronchodilators if indicated
- Increase hydration
- Secretion clearance techniques
34
What is cystic fibrosis
- Multisystem disorder in children/young adults affecting every organ system with epithelial surfaces
- Mucus stasis occurs in conducting airways
- Prominent sx related to pulmonary, intestine, & pancreatic involvement
35
Goals for medical management of cystic fibrosis
- Controlling lung infection
- Promoting mucus clearance
- Improving nutritional status
36
What is asthma
- Chronic inflammatory disorder of the airways
- Associated with increased hyperactivity to certain stimuli
- Causes recurrent episodes of wheezing, dyspnea, chest tightness, & coughing
37
A slow onset asthma exacerbation is characterized by
- A slow, subacute worsening of the peak expiratory flow rate (PEFR) over days
38
A sudden onset asthma exacerbation presents with
- Severe deterioration within hrs
- Often precipitated by sudden massive exposure to external triggers like allergens, food particles, & sulfites
39
What is status asthmaticus
- Medical emergency
- Extreme form of asthma exacerbation characterized by hypoxemia, hypercarbia, & 2ndy respiratory failure
- If not managed appropriately can lead to acute ventilatory failure & even mortality
40
Key physical exam findings for asthma
- Reversibility of airway obstruction following use of bronchodilator medications
- Results of pulmonary function test (PFT) help classify severity
41
What are the 4 treatment recommendations for asthma
- Use objective measures of pulmonary function
- Identify/eliminate factors that worsen symptoms
- Provide pharmacologic therapy to reverse bronchoconstriction & prevent airway inflammation
- Create therapeutic partnership b/w pt & care provider
