RESPIRATORY - restrictive lung disorders (RLD): pulmonary edema & ARDS Flashcards
EXAM 2 content
what is RLD?
where we need more air volume in order to meet the normal needs of the lung
- disease that inhibits lung compliance
what are the two diseases under RLD?
- pulmonary edema
- ARDs
what is pulmonary edema?
excess accumulation of fluid in lungs
describe the pathophysiology of pulmonary edema
something increases the alveolar capillary pressure + injury to alveolar OR block in drainage –> fluid in interstitial space –> fluid moves into alveoli OR increase capillary permeability (which leads to more fluid) –> decrease compliance of alveoli OR blocks space for ventilation –> hypoxia
what are the risk factors that lead to pulmonary edema?
- left sided heart dysfunction
- alveolar injury
- surgery/blockage of lymph system
what are the manifestations of pulmonary edema?
- Neuro: altered LOC & dizzy
- CV: murmurs, JVD, peripheral edema
- Resp: crackles & pink frothy sputum!!!
- GI: n/v
- GU: oliguria
- Integ/Musc: weakness, paresthesia, cyanosis, delayed capillary refill
what labs and diagnostics would we do for pulmonary edema and why?
- ABGs –> respiratory acidosis
- BNP –> to understand fluid volume status, would be high if fluid overload
- CBC
- Chemistry panel
- X ray –> pulmonary edema, most used
- Pulmonary function testing
how is pulmonary edema managed?
medications are mostly focused on the cardiac manifestations & infection based
- oxygen/ventilatory support
- antibiotics
- cardio: diuretics, ACE inhibitors, ARBs, beta blockers
what are pulmonary edema complications?
- hypercapnia: high levels of CO2
- respiratory acidosis
- acute respiratory failure
- death
what is ARDS?
acute respiratory distress syndrome - an acute lung injury BECAUSE OF systemic inflammation –> fluid in alveoli
describe ARDS pathophysiology
TWO WAYS:
- injury –> release of proinflammatory cytokines –> increases capillary permeability –> fluid + inflammation by-products into interstitial space & alveoli –> V/Q mismatch –> decreased O2 level
- injury –> release of proinflammatory cytokines –> increases capillary permeability –> fluid + inflammation by-products into interstitial space & alveoli –> decreased surfactant production –> stiff + less compliant lungs –> release of more inflammation mediators –> SIRS –> remodeling & fibrosis –> permanent fibrosis + lack of compliance + prolonged respiratory issues
what are the risk factors of ARDS?
- older age
- genetics
- sepsis!
- trauma!
- multiple transfusions
- pneumonia!
- burns! (because of fluid shift)
- aspiration
- pancreatitis
- inhalation injury
what are the manifestations of ARDS?
- Neuro: altered LOC & dizzy
- CV: tachycardia & hypotension
- Resp: hypoxemia that is NOT responsive to O2!!!, tachypnea, dyspnea, crackles, pink frothy sputum!!
- GI: n/v
- GU: oliguria
- Integ/Musc: weakness, paresthesia, cyanosis & delayed capillary refill
what labs and diagnostics are used and why?
ABGs
- early ARDS = respiratory alkalosis
- late ARDS = metabolic acidosis
- CDC: for infection
- chemistry panel
- coagulation studies: to see if you are at risk for clotting
- ESR & CRP: measures of inflammation
- chest x ray: for bilateral infiltrates
when looking at an x-ray, what would the lungs look like if its pneumonia or ARDS?
one side = pneumonia
bilaterally = ARDS
