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Semester 5 PMCP Exam 2 > Restrictive and Other Pulm. Dysfunction > Flashcards

Restrictive and Other Pulm. Dysfunction Flashcards

1
Q

Restrictive DYSFUNCTION (or disorder) - not a disease!!! How do you define it

A

Disorder in which the lungs can’t fully expand

Lung volumes/capacities are dec.

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2
Q

With restrictive dysfunction it is hard to ___ ___ ___

A

get air in

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3
Q

Restrictive dysfunction results from what

A

Diseases
Trauma
Therapeutic interventions
Drugs

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4
Q

With restrictive dysfunction the work of breathing is

A

increased

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5
Q

What happens with pulmonary compliance with restrictive dysfunction

A

decreased due to chest wall and/or lung and their decreased ability to expand

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6
Q

What happens to the lung volumes and capacities with restrictive dysfunction

A

all dec

TV and IRV are the first to dec

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7
Q

How does one compensate for dec volumes and capacities with a restrictive dysfunction

A

breathe faster - is exhausting and can actually lead to mm wasting

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8
Q

6 classic signs of restrictive dysfunction

A 
Tachypnea
Hypoxemia
Dec breath sounds
Dec lung vol and capacities
Dec diffusing capacity
Cor pulmonale
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9
Q

What is tachypnea

A

inc RR

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10
Q

What is Cor pulmonale

A

R heart failure

in this case due to R heart working so much harder and also is getting some backflow

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11
Q

3 hallmark symptoms with restrictive dysfunction

A

Dyspnea
Dry non productive cough (typically)
Weight loss and mm wasting

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12
Q

T or F: a patient with a restrictive lung dysfunction will have inc use of accessory mm

A

TRUE

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13
Q

Disorders of the pleural space

A

Pleural effusion (includes pleural emphysema)
Pleurisy
Pneumothorax

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14
Q

Define pleural effusion

A

accumulation of fluid in the pleural space

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15
Q

What systems are invovled with pleural effusion

A

vascular and/or lymphatic

An underlying pathology exists

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16
Q

What is the fluid called in pleural effusion

A

Transudate or exudate

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17
Q

Describe transudate - what is it made of

A

straw color

low protein count

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18
Q

What causes fluid to be transudate (reason)

A

abnormal hydrostatic pressure

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19
Q

What are some causes of transudate fluid

A

CHF
Nephrotic syndrome
Cirrhosis
Pericardial disease

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20
Q

Describe exudate - what is it made of

A

darker

high protein count, cellular debris, WBCs

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21
Q

What causes fluid to be exudate (reason)

A

change in permeability OR a trauma

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22
Q

What are some causes of exudate fluid

A 
Trauma (Most common)
Malignancies
Pneumonias
Infection
Lupus, RA
Abdominal abscess
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23
Q

General symptoms for pleural effusion (both transudate and exudate)

A

Dyspnea
Nonspecific chest discomfort
Pleuritic (sharp) chest pain

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24
Q

General signs for pleural effusion (both transudate and exudate)

A

as fluid inc, the lung tissue can compress and could potentially collapse
Fluid acts like a space occupying lesion

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25
Pleural effusion - what will you see on x-ray
blunting (opaque) at the costophrenic angle
26
Pleural effusion - what will happen when you auscultate
you will not hear anything over the fluid
27
Pleural effusion - what will happen to lung volumes
dec if the effusion is large enough
28
Pleural effusion - what will the cough be
dry, non productive | Fluid is outside of the lung
29
Pleural effusion exam findings
Dec chest wall mvmnt Mediastinum shift if large (to contralateral side) Might have pleural friction rub
30
If pt has significant right pleural effusion, the trachea will shift
left
31
Diagnosing a pleural effusion
``` Chest radiograph (AP,PA,lateral decubitus) Thoracacentesis ```
32
Diagnosing a pleural effusion - AP/PA vs. lateral decubitus
Lateral will allow you to see a pleural effusion in the earlier stages
33
Diagnosing a pleural effusion - thoracacentesis
have them lean forward and stick a needle in to drain the fluid Can be treatment or diagnostic
34
Pleurisy (Pleuritis) - define
inflammation of the pleura
35
Pleurisy (pleuritis) - which pleura is causing pain
parietal (visceral does NOT sense pain)
36
What is the parietal pleura innervated by
intercostal nerves
37
What are the causes of pleurisy (pleuritis)
Infection Injury Tumor Complication of lung or other disease process
38
Clinical manifestations with pleurisy (pleuritis)
``` Abrupt onset Unilateral (lower and lateral pleura) Fever and chills Worse with deep breath, cough Pleural rub can be heard Tachypnea ```
39
Complications that can happen from pleurisy (pleuritis)
``` Pleural effusion Significant splinting Dec chest mvmnt Atelectasis Pleural adhesions ```
40
Treatment of pleurisy (pleuritis)
Self-limiting if no underlying pathology Antibiotics and pain meds can be used Encourage breathing as tolerated
41
What to be aware of in regards to pleurisy (pleuritis)
referal patterns can occur to the neck, trap, shoulder, or even lumbar
42
A therapist working with a patient with pleurisy in the acute care setting should
coordinate with other disciplines so that the patient isn't getting everything at once - they need some uninterrupted bed rest
43
Define pneumothorax
accumulation of air within the pleural cavity leading to partial or complete collapse of the affected lung (atelectasis)
44
What happens to the pleura with a pneumothorax
parietal and visceral pleura become separated
45
What happens that causes the atelectasis from a pneumothorax
The negative pressure is lost and recoil of the lungs occurs
46
What are the types of pneumothorax
Spontaneous Traumatic - open AND tension/closed Hemothorax
47
Spontaneous pneumothorax is what
rupture of BLEBs what can happen with a cough or sneeze
48
Two types of spontaneous pneumothorax
Primary - genetic, males 20-40 | Secondary - associated with underlying disease that makes the lung tissue weak
49
Two types of traumatic pneumothorax
Open | Traumatic/Closed
50
What is an open traumatic pneumothorax
Air enters the pleural cavity during inspiration and some is able to exist with expiration Bad, but doesn't progress as quickly since some air is getting out
51
What is a closed/tension pneumothorax
air enters the pleural cavity during inspiration but cannot escape so continues to build up with every inhale
52
What is a hemothorax
accumulation of blood within the pleural space usually due to trauma Blood can fibrose and lead to fibropneumothorax
53
Events associated with what condition are considered an acute life threatening situation
Tension pneumothorax
54
Signs and Symptoms with pneumothorax
``` Inc RR Dyspnea Pleural pain Dec lung volume Dec lung compliance Impaired gas exchange (less SA for it to occur0 ```
55
Exam findings with pneumothorax
Jugular vein distention Dec or absent breath sound over area Ches wall asymmetry Mediastinum deviation to contralateral side
56
Treatment for pneumothorax
Ches tube to release air and alter pressure to return to normal
57
Parenchymal and pulmonary vasculature disorders
``` Atelectasis Pneumonitis Pulmonary fibrosis Pneumonia Bronchiolitis obliterans Pulmonary edema Pulmonary embolism ```
58
Define atelectasis
restrictive lunge dysfunction in which parts of the lung are unable to aerate - typically alveoli collapse
59
Atelectasis is considered what -
A condition NOT a disease
60
Types of atelectasis
Compressive Obstructive (absorptive) Post operative
61
Compressive atelectasis - define
something pressing on the lung tissue that leads to collapse
62
Obstructive (absorptive) atelectasis - define
Something plugs a bronchial or the airway and everything distal to the plug collapses This is the most common
63
Post operative atelectasis - define
from anesthesia or narcotics associated with surgery
64
Clinical manifestation of large atelectasis includes what
Dec breath sound over area Dyspnea Cyanosis if large enough Inc RR
65
Primary intervention for preventing atelectasis post op
deep breathing | walking
66
Pneumonitis define
inflammation of the lungs without the toxemia associated with pneumonia Often is localized
67
Pneumonitis is often caused by
environmental exposure to organic material
68
Pneumonitis signs and symptoms
difficulty breathing accompanied by cough | often complain of fatigue
69
tx for pneumonitis
encourage rest avoid the allergen Sometimes will be given corticosteroid or antibiotic if there is an underlying infection
70
Pneumonitis can lead to
pulmonary fibrosis
71
Pulmonary fibrosis - define
inflammatory process involves alveolar wall and progresses to distortion of the lung
72
components of pulmonary fibrosis
inflammatory process | scarring or fibrotic process
73
Which component happens first with pulmonary fibrosis
inflammatory process first and then leads to the scarring
74
Causes of pulmonary fibrosis
Idiopathic Viral Genetic Immune system disorders
75
Signs of pulmonary fibrosis
Dec TLC, VC, FRC, RV Hypoxemia End inspiratory dry rales (adventitious sounds)
76
Symptoms with pulmonary fibrosis
``` Cough - non productive Weight loss Fatigue Dyspnea Dec ex tolerance ```
77
Tx for pulmonary fibrosis
Corticosteroids and/or cytotoxic drugs Supportive measures Lung transplant
78
Define pneumonia
inflammatory process of the lung
79
Classifications of pneumonia
By pathogen By anatomic location By the cause Or can be a combination
80
Risk Factors of pneumonia
1 Lower pt resistance to agents in URT maybe due to smoking, chronic bronchitis, resp infection, sinusitis, poorly controlled DM, malnutrition, existing illness 2 Inactivity/immobility
81
Diagnosis of pneumonia is based on
clinical presentation chest radiographs blood culture sputum cultures
82
Bacterial pneumonia - most common cause
Strep
83
Bacterial pneumonia - signs
Tachypnea Crackles Fluid
84
Symptoms with bacterial pneumonia
``` High fever Chills Dyspnea Tachypnea Productive cough! ```
85
Viral pneumonia - most common cause
adenovirus | Influenza
86
Viral pneumonia - signs
Insidious onset Diffuse infiltrates Hypoxemia
87
Viral pneumonia - symptoms
``` low to mod temp Myalgia Dyspnea Tachypnea Nonproductive cough! ```
88
Fungal pneumonia - cause
Opportunistic infection (immune system is already weak from something else)
89
Fungal pneumonia - signs
bilateral diffuse or interstitial alveolar infiltrates
90
Funal pneumonia - symptoms
``` Fever Dyspnea Cough Chest pain Malaise Fatigue Weight loss Night sweats ```
91
Bronchopneumonia - cause
VIRAL
92
Lobar pneumonia - cause
BACTERIAL
93
Aspiration pneumonia - cause
inhale foreign object | Common in those with dysphagia and neuro pop
94
Symptms with aspiration pneumonia
Dyspnea Wheezing Fatigue Green or bloody sputum
95
Hypostatic pneumonia - cause
immobility
96
Community acquired pneumonia - cause
viral but can turn into bacterial
97
Nosocomial pneumonia (HAP) - cause
opportunistic - after hospital for 48 hours
98
Bacterial pneumonia - tx
Antibiotics | 3 Ps - percussion, position change, postural drainage
99
Viral pneumonia - tx
Supportive | Anti virals
100
Fungal pneumonia - tx
corticosteroids | antifungals
101
Bronchopneumonia - tx
VIRAL!
102
Lobar pneumonia - tx
BACTERIAL Antibiotics 3 Ps
103
Aspiration pneumonia - tx
deep breathing cough mobility
104
Hypostatic pneumonia - tx
depends on if viral or bacterial | Supportive
105
Community acquired pneumonia - tx
Usually meds, rest fluids, maybe pain med
106
Nosocornial (HAP) pneumonia - tx
depends on fending organism Oxygen Supportive
107
Chronic aspiration most often causes recurrent bouts of pneumonia in which lobe
Right! - more vertical
108
Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) - define
Bronchioles and alveoli become inflamed and plugged with connective tissue
109
BOOP is usually from what
necrosis of respiratory epithelium in bronchioles Fluid and debris cause alveolar pulmonary edema Can lead to atelectasis
110
BOOP - cause
``` Peds - viral usually Adults - toxic fumes Can be viral or bacterial CT disease Organ transplant Idiopathic ```
111
BOOP - signs
Dec or norm lung volumes Hypoxemia Rales and wheezing Tachycardia
112
Symptoms - BOOP
``` coughing dyspnea Inc RR Cyanosis Chronic infections ```
113
Tx - BOOP
Supportive measures Peds - postural drainage or suction Adult - corticosteroids
114
Tuberculosis - define
Disease caused by mycobacterium tuberculosis
115
Tuberculosis - includes
two conditions Latent Active
116
Latent TB -
You have the infection and it can present itself later
117
Active TB -
Active bacteria and is multiplying
118
TB can impact
LUNGS first and mainly | but also brain, kidneys, spine, hear, liver
119
TB - process of it
Bacteria replicate in alveoli Inflammatory response Fibrosis and calcification Cavitation and scarring
120
If you auscultate over TB lung what will you hear
absent or dec
121
Symptoms of TB
``` Bad cough for 3 weeks or longer Pain in chest Cough blood or sputum Weakness No appetite Weight loss Chills/fever Sweating at night ```
122
Tx of TB
Antibiotics 6-9 months Prevention Incubation 2-12 weeks
123
If untreated TB - what is mortality rate
80% - usually from heart failure
124
Pulmonary edema - define
Excessive fluid in the interstitial tissue then in the alveoli and alveolar sac
125
Causes of pulmonary edema
Inc hyprostatic press Inc alv cap permeability Lymphatic obstruction Dec serum and albumin
126
The increase in pulmonary capillary hydrostatic pressure with pulmonary edema is caused by
Left ventricular failure
127
Signs of pulmonary edema
Dec lung volume Pleural effusion is common Dec breath sounds Maybe bronchospasm or wheezing
128
Symptoms of pulmonary edema
``` Restless, anxiety Labored breathing Cyanotic Tachypnea Productive cough ```
129
Tx for pulmonary edema
Prevention! Dec preload Maintain oxygenation of tissue Dec Na intake
130
Adult Resp. Distress Syndrome (ARDS) known as
Noncardiogenic pulmonary edema, shock lung, acute lung injury
131
ARDs caused by
lung injury | Trauma, aspiration, drug associated, inhaled toxins, shock...
132
ARDs mortality rate
HIGH! it is a critical illness
133
ARDs causes what to happrn
inc in permeability of pulmonary membrane alveoli become fluid filled atelectasis occurs
134
ARDs- signs
dec FRC, VC, TV Wet crackles, wheezing Tachycardic and arrhythmias Dec breath sounds over fluid areas
135
ARDs - symptoms
Restless, anxious Dyspnea at rest Maybe impaired mental status Cyanotic
136
Pulmonary emboli - define
blood clot lodged in a pulmonary artery obstructing blood supply to lung parenchyma
137
Pulmonary emboli - complication of what
venous thrombosis - most often from leg
138
Common cause of sudden death in hospital is what
pulmonary emboli
139
Risk factors with pulmonary emboli
Blood stasis - immobility Enothelial injury Hypercoaguable states Obesity, smoking, HTN, infection, previous hx
140
Signs pulmonary emboli
Dec lung volume Dec breath sounds Tachycardia
141
Symptoms pulmonary emboli
Dyspnea Pleuritic ches pain Apprehension Persistent cough
142
Tx pulmonary emboli
Prevention Thrombolytics Filter in vena cava Thombectomy/embolectomy

Semester 5 PMCP Exam 2 (6 decks)

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