RCQ ch. 6 - RLD Flashcards
(120 cards)
1
Q
cardinal presentation of IPF
A
decreased compliance
2
Q
cardinal presentation of lung cancer
A
decreased lung vol
3
Q
cardinal presentation of pulmonary edema
A
decreased diffusion capacity
4
Q
cardinal presentation of sarcoidosis
A
tachypnea
5
Q
cardinal presentation of pneumonia
A
hypoxemia
6
Q
cardinal presentation of connective tissue caused RLD
A
decreased breath sounds
7
Q
cardinal presentation of traumatic caused RLD
A
dyspnea
8
Q
cardinal presentation of obesity/DM caused RLD
A
cough
cor pulmonale
weight loss
9
Q
typical anatomy affected in RLD
A
lung parenchyma
10
Q
breathing phase difficulty associated with RLD
A
inspiration
11
Q
pathophysiology related to RLD
A
decreased lung/thoracic compliance
12
Q
useful measurements in RLD
A
volumes and capacities
13
Q
primary difference between restrictive and obstructive
A
Obstructive = flow of air is impeded
Restrictive = volume of air or gas is reduced
14
Q
Cardinal Presentations of RLD
A
tachypnea
hypoxemia
decreased breathing sounds
decreased lung vol and capacity
decreased DLCO
cor pulmonale
15
Q
tachypnea occurs because
A
increased respiratory rate and decrease volumes in order to maintain minute ventilation
16
Q
hypoxemia occurs because
A
V/Q mismatch due to:
changes in framework of lung scarring in capillary channels distortion of small airways compression from tumors
bony abnormalities
17
Q
what breathing sounds are found in RLD
A
dry inspiratory crackles caused by atelectatic alveoli opening at end inspiration, found at base of lungs
18
Q
what is used to measure lung volume and capacities
A
pulmonary function testing
19
Q
why is DLCO decreased
A
consequence of widening the interstitial spaces due to scar tissue, fibrosis of capillaries and V/Q mismatch
20
Q
what is DLCO
A
diffusing capacity of carbon monoxide
21
Q
what is the value significant to DLCO
A
<50% of predicted value
22
Q
cor pulmonale is _______, which is caused by ______, and it leads to ________
A
right-sided HF due to
pulmonary HTN and increasing RAtrium work
leads to
hypoxemia, fibrosis, compression of pulmonary capillaries
23
Q
what clinically may be seen as a result of cor pulmonale
A
hypoxemia / cyanosis
decreased chest wall
clubbing
24
Q
symptoms of RLD
A
dyspnea
irritating, dry, nonproductive cough
cachectic appearence
25
what symptom typically brings pts into the doctors office
irritating, dry, nonproductive cough
26
compliance definition
relationship between pressure exerted by the chest wall and the volume of air that can be contained within the lungs
27
in RLD, decreased compliance leads to pressure changes. explain
increased transpulmonary pressure to expand lungs
28
what volumes are most affected in RLD
IRV
ERV
29
how are IRV and ERV affected by RLD
decreased distensibility leads to less air coming in and less air able to be expelled
30
connection between transpulmonary pressure and tidal volume
greater transpulmonary pressure is needed to achieve normal TV
31
Physiological Changes that lead to increased work of breathing
decreased TV and increased RR
increased airway resistance leads to increased RR due to decreased lung and chest wall compliance
32
when RR increases, what muscles are affected? how so?
diaphragm must work harder
SCM and Scalenes are recruited
--> more oxygen needed in muscles to maintain RR, therefore a larger percent of the inhaled air is used by muscles
33
what is the % increase of oxygen inhaled used in muscles to facilitate breathing
5 to 25%
of the oxygen inhaled consumed by muscles
34
treatment option for permanent/progressive RLD
supplemental O2
antibiotic therapy
promotion of adequate ventilation
pulmonary clearance
nutritional support
35
general pulmonary system changes associated with aging
control of ventilation changes
thorax changes
lung tissue changes
cardiac changes
36
how is control of ventilation affected throughout aging
o Ventilatory response mediated by CNS diminishes
o Peripheral chemoreceptors desensitize to hypoxia
o Central chemoreceptors desensitize to acute hypercapnia
37
how is the thorax changed due to aging
o Decalcification of ribs
o Calcification of costal cartilages
o Arthritic changes in rib joints, vertebrae
o Increased dorsal thoracic kyphosis
o Increased anteroposterior diameter (barrel chest)
38
how is the lung tissue affected during aging
Enlargement of air spaces due to enlargement of alveolar ducts and terminal bronchioles
Alveolar surface area decrease
Alveolar parenchymal volume decrease
Alveolar walls become thinner
Capillary beds affected severely due to V/Q mismatching
elastic recoil decrease
39
how are capillary beds affected via age
diffusing capacity decreases
physiologic dead space increases
40
how does elastic recoil change due to aging
alveolar compliance increases
RV increases as IRV/ERV decrease
41
atelectasis definition
Describes a state where a region of the lung parenchyma is collapsed and non-aerated
42
5 types of atelectasis
resorptive/obstructive
passive
adhesive
compressive
cicartization
43
passive atelectasis
- characterized by
- who can have it / why?
Loss of volume in the lung caused by simple pneumothorax or diaphragmatic dysfunction
both resorptive and passive are associated with bedridden patient
Can occur with the use of sedatives or if patient has been in general anesthesia
44
resorptive atelectasis
Obstruction causing resorption of alveolar air distal to the obstruction
Most common
-- large airway vs smaller airway types
45
adhesive atelectasis
surfactant deficiency
Greater tendency for alveoli to collapse, may adhere
46
what may cause adhesive atelectasis
ARDS, pulmonary embolism, pneumonia, cardiac bypass
47
compressive atelectasis
Compression of the lung from space-occupying lesion
48
what may cause compressive atelectasis
pleural effusion
pleural tumor
empyema
49
Cicatrization atelectasis
Volume loss due to decreased pulmonary compliance via fibrosis
50
pneumonia definition
Inflammatory process of the lung parenchyma that begins with an infection in lower respiratory tract
51
categories of pneumonia
Community acquired
hospital-acquired
healthcare associated
ventilator associated
52
symptoms of bacterial pneumonia
high fever, chills, dyspnea, tachypnea, productive cough, pleuritic pain, leukocytosis
53
what bacterial pneumonia is most common?
symptoms?
treatment?
streptococcus pneumonia
Rusty sputum, hemoptysis, bronchial breath sounds, pleuritic pain, pleural effusion (1/4 of patients), liver dysfunction
Penicillin G, ampicillin, tetracyclines
54
how do viral pneumonias work? what do they affect?
localizes in respiratory epithelial cells in those that are immunocompromised
Destruction of the cilia /mucosal surface
Loss of mucociliary function / predisposition to bacterial pneumonia
55
if viral pneumonia gets to the alveoli, what can be seen
edema
hemorrhage
hyaline membrane
possibly ARDS
56
who are most commonly affected by viral pneumonia
infants
children
women late in pregnancy
57
what fungal pneumonia is associated with AIDS
pneumocystis carinii
58
pneumonia will present with these PFT decreases
lung volumes
lung compliance
gas exchange
oxygen uptake
59
pneumonia will result in increased
respiratory rate
inspiratory pressure
work of breathing
60
explain difference between bacterial and viral pneumonia radiographs
bacteria = lobular consolidation in one or more lobes
viral = bilateral bronchopneumonia
--> diffuse fluffy shadows, patchy alveolar infiltrates
61
how does pneumonia affected ABG
decreased PaO2 and PaCO2
62
pneumonia effect on breath sounds
absent breath sounds over pneumonia w/ dull-mediate percussion
63
symptoms of viral pneumonia
moderate fever
dyspnea
tachypnea
nonproductive cough
myalgias
64
ARDS is a result of ____ that leads to
a disease that causes inflammation
increased pulmonary vascular permeability
increased lung weight
loss of aerated tissue
65
triggers of ARDS
pulmonary and extrapulmonary
66
pulmonary triggers of ARDS
Pneumonia
inhalation injury
aspiration
chest trauma
near drowning
67
extra pulmonary triggers of ARDS
sepsis
major trauma
burns, pancreatitis
fat embolism
hypovolemia
cardiopulmonary bypass
68
Three Stages of ARDS
exudative
proliferative
fibrotic
69
exudative ARDS characterized by
capillary leak
alveoli to fill with neutrophilic infiltrate and protein rich edema
--> will be worsened by inflammatory mediators
70
proliferative/fibrotic ARDS described as? what is the result of this?
chronic inflammation will lead to scar formation
V/Q mismatch, reduced compliance
71
diagnosis of ARDS is done by
bilateral opacities consistent with pulmonary edema
ABG - decreased PaO2/CO2
72
signs of ARDS in PFT
decreased
functional reserve capacity
vital capacity
lung compliance with or without increased work of breathing and respiratory rate
DLCO
Flow rates normal or decreased slightly
73
sign of ARDS in breathing sounds
decreased sounds over fluid filled area
wet rales
wheezing
rhonchi
74
symptoms of ARDS
ill appearance
dyspneic at rest or activity
Breathing pattern fast / labored
Cyanotic
Impaired mental status, restlessness, headache, and +/- anxiety
Will experience muscle wasting/weakness
75
treatment of ARDS
Precipitating cause
Mechanical ventilation
Prone positioning
Nutritional status and fluid balance
Preventing treatment complications of condition
early mobility
76
what is interstitial lung disease
Large group of disorders that cause issues with diffusion of oxygen into the blood stream
77
what causes ILD
Resultant of progressive scarring and subsequently fibrosis of the lung tissue
Autoimmune disorders, exposures in environment, medication effects, genetics, idiopathic
78
what is ILD characterized by on PFTs
decreased
- lung volumes
- FVC (normal FEV1/FVC)
- DLCO
increased RR
79
symptoms of ILD
dyspnea
dyspnea on exertion
dry cough
fatigue
decreased exercise tolerance crackles in auscultation
80
treatment of ILD
steroids
removal environmental exposure
supplemental oxygen
81
pulmonary fibrosis is characterized by
Chronic, progressive, irreversible lung disease characterized by progressive worsening of dyspnea and lung function
82
what portion of the lung does pulmonary fibrosis affect
all components of the alveolar wall (epi and endo cells)
the components of the interstitium capillary network.
83
pathophys of pulmonary fibrosis
marked by proliferation and accumulation of fibroblasts and myofibroblasts / deposition of extracellular matrix
84
sarcoidosis characterized by
idiopathic granulomatous inflammatory disorder that affects the lung, heart, skin, CNS, and eyes
85
3 features of sarcoidosis
alveolitis
round/oval granulomas
pulmonary fibrosis
86
explain alveolitis
inflammatory cells entering alveolar walls
87
bronchiolitis obliterans is
fibrotic lung disease that affects smaller airways
can produce restrictive and obstructive dysfunction
88
bronchiolitis obliterans characterized by
necrosis of respiratory epithelium in affected bronchioles
pulmonary edema and obstruction of small airways
if progressed significantly, inflammatory response occurs
89
differences in pediatric and adult bronchiolitis obliterans onset and treatment
ped = result of viral infection
- hydration/supplemental o2
adult = toxic fume inhalation, viral, bacterial or mycobacterial infections
- corticosteroids, antibiotics, bronchodilators
90
RA affects the lungs in 7 ways
Pleural involvement
Pneumonitis
Interstitial fibrosis
Pulmonary nodules
Pulmonary vasculitis
Obliterative bronchiolitis
Bronchogenic cancer
91
prevalence of RA
50-60 years of age
2-3x more in women
men typically have more lung involvement
92
breathing pattern seen in cervical SCI
paradoxical breathing
93
explain paradoxical breathing
Diaphragm is descended, abdomen rises and paralyzed thoracic wall is pulled inward
Relaxation causes abdomen to wall and chest wall to move outward
94
paradoxical breathing leads to _____ volume decreases
Vital Capacity
Max Voluntary ventilation
95
when expiratory muscles are paralyzed via SCI, the likelihood of _____ increases
pulmonary infection via loss of coughing mechanism
96
circulation of parietal vs visceral pleura
parietal = systemic arterial
visceral = pulmonary
97
explain pleural effusion
fluid moves from parietal pleural capillaries into the pleural space and reabsorbed into visceral pleural capillaries
when damaged, fluid accumulates in pleural space and limits lung expansion
98
transudative pleural effusion is caused by
elevation in hydrostatic pressure in pleural capillaries
left sided heart failure, right sided or both
99
exudative pleural effusion is caused by
Increase in permeability of pleural surfaces
Allows protein and excess fluid to move into pleural space
100
pulmonary edema is described as ______, this is caused by
increase in fluid within the lung
excessive fluid movement from the pulmonary vascular to the extravascular system
101
pulmonary edema results in decreased _____ and increased ______ on PFTs
decreased
gas exchange
increased
V/Q mismatching
work of breathing
102
forms of pulmonary edema
cardiogenic
noncardiogenic
103
cardiogenic pulmonary edema is caused by
arrythmias and low CO
congenital heart defects
left ventricular failure
MI
pulmonary embolus
renal failure
heart disease
systemic hypertension
104
what causes noncardiogenic pulmonary edema
increased capillary permeability
decreased oncotic pressure
decreased intrapleural pressure lymphatic insufficiency
105
what is the significant value related to pulmonary vascular hydrostatic pressure? what does that cause?
>25-30 mmHg
oncotic pressure loses its holding force and spills into interstitial space
106
what does pulmonary edema disrupt
tight alveolar epithelium
floods alveolar spaces
moves through visceral pleura and causes pleural effusion
107
treatment of pulmonary edema
Decreasing cardiac preload / maintaining oxygenation to tissues
venous return is decreased decreased left ventricle filling pressure
Venodilators / diuretics
Angiotensin converting enzyme inhibitors
Positive inotropes
Supplemental oxygen
Albumin to increase osmotic pressure
108
symptoms of pulmonary emboli
dyspnea
hemoptysis
pleuritic chest pain
109
pathophys of pulmonary emboli
Occlusion of one or more pulmonary arterial branches
coagulative necrosis of alveolar walls
pneumoconstriction
surfactant production decrease
V/Q mismatch
110
treatment/prevention of pulmonary emboli
Ankle pumping
Early ambulation
graded compression
estim of calf muscles
Medicines that decrease coagulation
111
characteristics of systemic lupus erythematosus
chronic inflammatory connective tissue disorder
112
what is caused by systemic lupus erythematosus
fibrous pleuritis
hypoxemia
shortness of breath
cyanosis
tachypnea
tachycardia
diaphragmatic weakness
113
scleroderma is categorized as
fibrosing disorder that causes degenerative changes
114
explain how scleroderma occurs
collagen replaces normal connective tissue framework of the lung
fibrotic replacement of connective tissue in alveolar walls
115
polymyositis is described as
connective tissue disease leading to proximal muscle weakness and pain
116
coal worker's pneumoconiosis is caused by
accumulation of coal dust in the lungs
117
explain types of coal workers' pneumoconiosis
simple = <1cm opacities
complicated = >1 cm opacities
118
excavatum vs carinatum
excavatum - sternal depression and decreased ant-post diameter
carinatum - sternum protrusion anteriorly
119
what is flail chest? what causes it?
thoracic cage disconnected from thoracic wall
free floating segment of ribs due to multiple rib fractures because
120
flail chest is similar to
paradoxical breathing
