Restrictive and Obstructive Lung

Question 1

VO2

Answer 1

Oxygen consumption

Good reflection of O2 demand

(arterial O2 content - venous O2) * cardiac output

Question 2

OER

Answer 2

O2 extraction ratio

VO2/DO2

OER is normally 23% at rest

Question 3

Manifestations of respiratory disease

Answer 3

Impaired oxygenation

Impaired CO2 removal

Question 4

Hypoxemia

Answer 4

Low PaO2 in the blood

Question 5

Hypoxia

Answer 5

Low oxygen in the tissues

Can also occur due to other conditions that can restrict the oxygen supply to tissues

Question 6

Anoxia

Answer 6

Absence of oxygen

Question 7

Signs/symptoms of impaired oxygenation

Answer 7

Cyanosis
Cerebral hypoxia
Cardiac arrhythmia
Pulmonary artery vasoconstriction

Question 8

Hypercapnia

Answer 8

Increased PCO2

Sx/sy...
Increased HR and BP
Dizziness
Headache
Confusion or loss of consciousness
Mm twitching and tremor

Question 9

Hypocapnia

Answer 9

Low PCO2

Sx/sy...
Lightheadedness (Cerebral vasoconstriction, decreased blood flow)
Fatigue
Irritability
Inability to concentrate
Tingling
Impaired consciousness

Question 10

Pneumotaxic area in pons

Answer 10

Sends inhibitory impulses to the inspiratory area

SHORTENS inhalation

Question 11

Drop in CO2 will…

Answer 11

Increase pH

Decrease ventilation

Question 12

Obstruction

Answer 12

Disease of respiratory tract, which produces and obstruction to airFLOW

Question 13

Restriction

Answer 13

Abnormal reduction in pulmonary ventilation often due to diminished lung expansion
Decreased volume of gas moving in and out

Question 14

COPD

Answer 14

Lung diseases that result in air trapping in the lungs

Can affect both mechanical fx and gas exchange

Dx made by pulmonary fx test, symptoms, and hx

Pts usually present c hyperinflation, barrel chest, and increased accessory mm use

Question 15

COPD Pathogenesis

Answer 15

Inflammatory immune response in the lungs usually in response to noxious stimuli

Can also see…
Increased mucus production (impaired clearance)
Inflammation of mucosal lining of bronchi
Mucosal thickening
Bronchospasm (constriction of bronchial walls due to smooth mm spasm)
Decrease in the size of bronchial lumen
HYPERinflated lungs (air gets trapped behind collapsed bronchial walls)

Question 16

COPD signs

Answer 16

Hypoxemia
Hypercapnia
Increase production of mucous/impaired mucous clearance
Pulmonary HTN
Polycythemia (increased RBCs)
Cor pulmonale (R side heart failure)
Increased resistance to coronary artery
Often see productive cough (also can see ineffective cough)
Decreased expiratory flow rates (FEV1)
Increased residual volume

Question 17

COPD symptoms

Answer 17

Dyspnea on exertion
Chronic cough
Expectoration of mucus
Wheezing

Question 18

Types of COPD

Answer 18

Bronchitis
Emphysema
Asthma
Bronchiecstasis
Cystic fibrosis

Question 19

Variability of COPD

Answer 19

Primary cause
Location of obstruction
Reversibility

Common co-existing conditions…
Asthmatic bronchitis
Chronic bronchitis with emphysema
Cystic fibrosis with bronchiecstasis

Question 20

Bronchitis

Answer 20

Productive cough on MOST days for 3 mos during 2 consecutive years

Question 21

Bronchitis sx/sy

Answer 21

Chronic cough
Morning expectoration
Frequent infections
Barrel chest
May be overweight
Cyanotic (blue bloater)
Edema due to heart failure

If it gets worse...
IV fluids
Antibiotics
Bronchodilators
Steroids
O2

Question 22

Emphysema

Answer 22

Abnormal, irreversible enlargement of airway distal to terminal bronchioles

Alveolar disease

Destructive change in alveolar wall - can see collapse of airway on exhalation

Question 23

Centriacinar emphysema

Answer 23

Begins in the respiratory bronchioles and spreads peripherally
AKA centrilobular emphysema
Associated c long-standing cigarette smoking
Upper half of the lungs

Question 24

Panacinar emphysema

Answer 24

Destroys the entire alveolus uniformly
Lower half of the lungs
Generally observed in pts c AAT deficiency

In those that smoke, focal panacinar may accompany centriacinar

Question 25

Paraseptal emphysema

Answer 25

AKA distal acinar emphysema Involves distal airway sxs, alveolar ducts, and alveolar sacs Process localized around the septae of the lungs or pleura Airflow frequently preserved; however, apical bullae may lead to spontaneous pneumothorax Giant bullae occasionally cause severe compression of adjacent lung tissue

Question 26

Hyper-inflated lungs lead to...

Answer 26

Compensatory changes of chest wall Decreased diaphragmatic excursion

Question 27

Bullae

Answer 27

Emphysemidus spaces that are bigger than 1 cm in size Decreased/no participation in gas exchange or diffusion Increased incidence of pneumothorax

Question 28

Emphysema sx/sy

Answer 28

``` Barrel chest Floppy lungs Flat diaphragm "Pink puffer" SOB/DOE Minimal sputum Increased subcostal angle, horizontal ribs Hypertrophied accessory mm*** PLB at rest Often thin Clinically (ausc, xray, etc) PFT ```

Question 29

Emphysema tx

Answer 29

``` Medication O2 Fluids Bronchodilators Surgery (bullectomy, volume reduction) ```

Question 30

Asthma

Answer 30

Chronic inflammatory disease of the airways Characterized by REVERSIBLE obstruction to airflow

Question 31

Asthma attack is a combination of all these

Answer 31

Increased mucosal edema Bronchospasm > bronchoconstriction Secretions

Question 32

Extrinsic asthma

Answer 32

Begins in childhood | Triggered by allergens

Question 33

Intrinsic asthma

Answer 33

``` Begins as adult (usually after age 35) More severe (non-allergic) ```

Question 34

Exercise induced asthma

Answer 34

Due to loss of water/heat in lower respiratory system

Question 35

Status astmaticus

Answer 35

Attack that persists for hours and is unresponsive to medical management MEDICAL EMERGENCY

Question 36

Bronchiectasis

Answer 36

Abnormal permanent dilation of bronchi and bronchioles Trouble c pulmonary hygiene Frequent infections Mucopurulent sputum Permanent dilation can ulcerate and become fibrotic

Question 37

Bronchiectasis auscultation

Answer 37

Crackles Wheezes Pleural rub

Question 38

Bronchiectasis treatment

Answer 38

``` P/PD Fluids Abx (as needed) O2 Other meds Encourage to drink lots of water to help keep ```

Question 39

Cystic fibrosis

Answer 39

Exocrine gland dysfunction Respiratory - thick, excessive secretions and poor ciliary fx GI - pancreatic enzyme deficiency; can digest fat; stress incontinence Integumentary - increased sweat production

Question 40

Respiratory cystic fibrosis

Answer 40

``` Obstructions of small airways ... Develop mucus plugs and destroy cartilagenous support of airways ... Bronchiecstasis ``` BRONCHIAL HYGIENE IS KEY

Question 41

CF clinical signs

Answer 41

``` CXR - flattening of lungs, increased chest expansion PFT Ausc Cough Accessory mm use Clubbing ```

Question 42

CF treatment

Answer 42

``` Pulmonary care Management of pancreatic insufficiency Antibiotics/antifungals Nutritional supplements General exercise ```

Question 43

Bronchopulmonary dysplasia (BPD)

Answer 43

One of the most common chronic lung diseases in children (Asthma, CF also) O2 distress and obstruction within one month of age; abnormal development of lung tissue (scarring/inflammation)

Question 44

Restrictive dysfunction etiology

Answer 44

Abnormal reduction in pulmonary ventilation - can't get air in Not a disease in and of itself, but arises from other disease states in or out of the pulmonary system

Question 45

Restrictive dysfunction pathogenesis

Answer 45

Compliance (of lung and chest wall)... Decreased Stiffer/more difficult to expand Takes greater pulm pressure to expand the lung to a given volume Lung volumes and capacities... Decreased Most marked decrease in IRV and ERV Work of breathing... Pt has to work harder to move air into the lungs

Question 46

Clinical manifestations of restrictive dysfunction

Answer 46

``` Tachypnea Hypoxemia Diminished breath sounds Possible adventitious breath sounds Decreased lung volumes Decreased diffusion capacity Cor pulmonale (R heart failure) Dyspnea Cough (dry, non-productive) Emaciation ```

Question 47

Medical management of restrictive dysfunction

Answer 47

Supportive... Supplemental O2 Management of secretions Nutritional support Prevention of infection Corrective... Treatment specific to injury/dx

Question 48

Pulmonary fibrosis

Answer 48

Inflammatory process of alveolar wall Scarring leads to stiffness (decreased compliance) May be idiopathic (IPF) Immune response Genetic Occupational hazards (coal dust, asbestosis)

Question 49

Pulmonary fibrosis s/s

Answer 49

Shallow/fast breathers

Question 50

Pulmonary fibrosis tx

Answer 50

Corticosteroid

Question 51

Pulmonary prognosis

Answer 51

5-6 years on average | Cause of death respiratory/heart failure related to pulmonary HTN

Question 52

Pneumonia

Answer 52

``` Primary pulmonary pathologies in RLD Inflammatory process of the lung Begins from a lower respiratory tract infection 10% of all nosocomial infections CAP HAP VAP Risk factors... medical condition, environmental conditions Dx... xray ```

Question 53

Pneumonia s/s

Answer 53

Dyspnea Fever Increased WBC

Question 54

Pneumonia tx

Answer 54

Sputum sample to determine bug

Question 55

Acute Respiratory Distress Syndrome

Answer 55

AKA acute lung injury Sudden respiratory failure due to fluid accumulation in alveoli Fluid leaking from smallest blood vessels in lungs into the alveoli Can lead to fibrosis

Question 56

ARDS s/s

Answer 56

``` SOB Labored/unusually rapid breathing Hypotension Confusion Extreme fatigue Cough Fever Hypoxia May not respond to supplemental O2 Xray - diffuse infiltrates (vessels will look normal in size) ```

Question 57

ARDS treatment

Answer 57

``` Treat the cause Maintain the airway Manage nutrition Manage fluid balances Prevent complications Symptomatic management (pain, infection, etc) ```

Question 58

Carcinoma

Answer 58

80-90% of lung cancers are caused by tobacco Leading cause of cancer deaths Small cell vs non-small cell

Question 59

Carcinoma tx

Answer 59

Surgery Radiation Chemotherapy

Question 60

Pleural effusion s/s

Answer 60

``` SOB Pleuritic pain Dry cough Non-productive Poor chest expansion Pleural run heard during ausc ```

Question 61

Pleural effusion dx

Answer 61

Chest xray or US V/Q mismatch Fluid aspiration

Question 62

Pleural effusion tx

Answer 62

Thoracocentesis or chest tube

Question 63

Transudative vs exudative fluid

Answer 63

Exudative - infectious

Question 64

Sarcoidosis

Answer 64

MULTISYSTEM disease with presence of noncaseating epithelioid granulomas Autoimmune disease that results in fibrosis Kidneys, heart, CNS, GI system, skin, eyes Might hear crackles Clubbing SOB Decreased exercise tolerance Chronic steroids Proximal steroidal myopathy Non-productive cough Chest p! c exercise due to attempt to increase TV Tx - chemotherapy

Question 65

Bronchiolitis obliterans (BO)

Answer 65

BOOP - with Organizing Pneumonia Fibrotic lung dx of smaller airways with necrosis of the respiratory epithelium Infants by RSV (respiratory synctial virus) Adults by toxic fumes or other infections After a bone marrow transplant Pts present as COPD pts, but more restrictive/mixed in nature Progressive dyspnea on exertion Developing cough Wheezes and crackles, especially with more of an obstructive pattern Tx - supplemental O2, antivirals, antibiotics, corticosteroids, bronchodilators

Question 66

Atelecstasis

Answer 66

Incomplete expansion (or collapse) of lung Can result from... Secretion retention Compression of the lung S/s ``` Decreased chest wall movement Absent or diminished breath sounds Fast breathing Fever if related to infection Increased density in involved area ```

Question 67

DO2

Answer 67

O2 delivery Arterial oxygen content * cardiac output

Question 68

Pneumothorax

Answer 68

PTX Presence of air in pleural cavity Signs/symptoms vary based on size and other pulmonary dysfx S/s... Severe disease Pleuritic chest pain Hyperresonant percussion Decreased fremitus

Question 69

PTX tx

Question 70

Types of pneumothorax (PTX)

Answer 70

``` Primary - spontaneous Secondary - COPD underlying disease Iatrogenic - MD causes it Traumatic - GSW, stab wound Tension - when air enters pleural space, but can't escape; can compromise venous return ```

Question 71

PRIMARY pulm pathologies in RLD

Answer 71

``` Pulmonary fibrosis Pneumonia Acute Respiratory Distress Syndrome (ARDS) Carcinoma Pulmonary effusion Sarcoidosis Bronchitis Obliterans (BO) Atelectasis PTX ```

Question 72

SECONDARY pulm pathologies in RLD

Answer 72

``` Pulmonary edema Pulmonary embolism Neurological conditions - SCI, ALS, GBS, MG, MD, CVA Ankylosing spondylitis Lupus (SLE) Obesity Pregnancy Scoliosis Trauma Oxygen toxicity ```

Question 73

Pulmonary edema

Answer 73

Increased fluid in the lung (alveoli), often due to ventricular failure (especially L) Can be a medical emergency S/s... ``` Dyspnea Fast breathing Restless/uncomfortable Crackles (wetter breath sound) Cyanosis Clubbing Ventilator use if severe enough ``` Tx... ``` Treat the cause Diuretics Vasodilators Steroids Supplemental O2 ```

Question 74

Pulmonary embolism

Answer 74

10% mortality rate Blood clot lodges in pulmonary artery (location determines severity) S/s... ``` Acute sign of SOB Sweating Chest pain Wheezing possible Irregular pulse Light headedness Could come from DVT (prox worse than distal) ``` Tx... Early mobilization for prevention Meds - anti-coagulation, thrombolytic drug, surgery

Question 75

CVA?

Answer 75

Hemidiaphragm

Question 76

Ankylosing spondylitis

Answer 76

Spines are getting fused and they are all hunched over

Question 77

Obesity

Answer 77

Decreased chest wall compliance and increased O2 demand, higher resting diaphragm, closure of small airways and alveoli at bases Leads to V/Q mismatch

Question 78

Obesity hypoventilation syndrome

Answer 78

Can't take a deep enough breath bc of how much soft tissue they have Increased O2 demand

Question 79

O2 toxicity

Answer 79

High concentrations can cause interstitial lung disease, alveolar edema, and hemorrhage with atelectasis Need to keep FiO2

Question 80

TB

Answer 80

Restrictive disease Mycobacterium Tuberculosis PREVENTION first line of tx (universal precautions, respiratory isolation) Airborne Incubation period = 2-12 weeks PPD + 6-8 weeks S/s... ``` Unproductive cough Fever Night sweats Weight loss Dyspnea Crackles Xray abnormal c fluffy shadows, atelectasis, enlarged lymph nodes, cavitations in upper lobes, lung scarring ``` Tx... Medication (rifambpin and isoniazid (INH)) for several mos Respiratory isolation