Respiratory CPGs Flashcards
(31 cards)
Definition of Asthma
An episodic, reversible chronic obstructive pulmonary disease of lower airways characterised by inflammatory hyperresponsiveness to stimuli including bronchospasm, mucous plugging and mucosal oedema
Patho of Asthma
- trigger
- mast cell degranulation and inflammatory mediator release
- increased vascular permeability
- mucous production, mucous plugging, bronchospasm
- gas trapping
- hyperinflation of chest
- increased intrathoracic pressure
- impedes venous return via vena cava
- reduced cardiac output
- PEA arrest
Asthma triggers
Pollution
Infection
Exercise
Drugs
Effects of reassurance and position on Asthma mx
- reduce anxiety, reduce catecholamine release, reduce HR, RR, BP
- reduce WOB by allowing best use of accessory muscles
Effects of O2 on Asthma mx
increase partial pressure of o2 delivery to ischaemic tissues
Effects of Salbutamol on Asthma mx
bronchodilation leads to increased ventilation
Effects of Dexamethasone on Asthma mx
stabilises mast cells leads to relief of inflammatory reactions - provides immunosuppression
Effects of Atrovent on Asthma mx
bronchodilation - blocks vagal tone
Effects of Adrenaline on Asthma mx
alpha: vasoconstriction, increased VR and CO
B1: increased contractility of heart leads to increase CO to overcome ITP
B2: bronchodilation reduces gas trapping - assist to stabilise mast cells
Effects of apnoea on asthma mx
Allows passive exhalation of trapped gas
Reduces ITP to increase VR and CO
COPD definition
A term used to describe a number of lung conditions that are long-term and cause SOB due to a reduction in air flow through the airways.
Bronchitis definition
constant inflammation of bronchi caused by irritants characterised by increased number and size of mucous producing glands, productive cough >3months for 2 consecutive years.
Emphysema definition
destruction and irreversible enlargement of the airways distal to the bronchioles accompanied by destruction and collapse of the alveoli
Signs and symptoms of bronchitis
- chronic productive -cough
- wheeze
- dusky/cyanotic colour - blue bloaters
- hypoxia
- normal/overweight
- digital clubbing
Signs and symptoms of emphysema
- tachypnoea
- increased CO2 -retention (pink)
- pursed lip breathing
- barrel chest
- prolonged expiratory
- use of accessories
- thin build
Signs and symptoms of COPD Exacerbation
Increased dyspnoea
Increased cough
Increased sputum production
* complete removal of wheeze may not be possible in these pts*
Patho of bronchitis
- inspired irritants
- increased mucous production and mucous gland hypertophy
- impaired ciliary function (lungs defence mechanisms compromised making them susceptible to infection)
- reduced mucous clearance
- bronchial walls become inflamed and oedematous
- airway obstruction/narrowed lumen
- airflow limitation
- reduced alveoli ventilation
- V/Q mismatch
Patho of emphysema
- destruction of alveolar septa (breakdown of elastin within the septa by proteases)
- loss of elastic recoil
- reduced volume of air that can be passively expired
- hyperinflation of alveoli
- produces large air spaces
- part of each inspiration becomes trapped
- reduced ventilation and perfusion
Suspect COPD in pts over 40 with:
- smoking hx
- dyspnoea that is progressive, persistent and worse with exercise
- chronic cough
- chronic sputum production
- family hx
Definition of pneumonia
infection of lower resp tract (lung parenchyma) causing inflammation, alveolar exudates, consolidation
Patho of pneumonia
- aspiration of oropharyngeal secretions or strep
- adhere to alveolar macrophages: exposure of cell wall components
- inflammatory response: attraction of neutrophils, release inflammatory mediators, accumulate fibrous exudates, RBCs and bacteria
- red hepatisation and consolidation of lung parenchyma
- leukocyte infiltration
Definition of PE
occlusion of pulmonary vasculature by thrombus, tissue fragment, fat or air
Patho of PE
- venous stasis, vessel injury, coagulopathy
- dislodgment of portion of thrombus
- occlusion of part of pulmonary circulation
- hypoxic vasoconstriction, reduces surfactant, release of neurohumeral and inflammatory substances, pulmonary oedema, atelectasis
- V/Q imbalance, reduces pao2, reduced CO, hT, shock
Hyperventilation definition
Alveolar ventilation exceeds metabolic demands, lungs remove co2 at a faster rate than it is metabolised causing decreased co2
