Restrictive (Can't get air IN) Lung Dysfunction: Exam 2 Flashcards
(105 cards)
1
Q
Lobular Consolidation
Think Lobe==Large
Lobes are LARGE
A
Consolidation IN lobes
Lg. amount bc lobes are LRG
*something in lungs that SHOULD NOT be…
2
Q
Segmental Consolidation
Segments are SMALL
think SMALL amt bc segments are SMALL
A
Small amt of consolidation
INCd attenuation
**More white in chest x-ray instead of black (Air)
3
Q
Atelectasis
A
- Inside lungs
- Collapsed alveoli
- Cond or status lung is in
- inability to fully expand alveoli
- collapsed lung @ alveolar lvl
4
Q
Pleural Effusions
“fire in the wall”
A
“Water ON lung”
- Fluid b/w layers of pleura
- IN lining of lungs
- ***remember the fire IN the wall analogy!!!
5
Q
Pulmonary Edema
“fire in the Room”
A
fluid IN lungs
- remember the “fire in the ROOM” analogy!!
- Think
- CHF
- Infections
6
Q
Ventilation
AIR in and out of lungs
Alllllll of these things go along w/ Ventilation
A
- lung compliance
- elastic recoil
- surface tension
- surfactant
- Inspiratory mm contraction
- intrapleural pressure
- diaphragmatic excursion
7
Q
Ventilation:
Lung compliance
A
allows tissue to stretch aka dispensibility of the lungs
8
Q
Ventilation:
Elastic Recoil
A
INWARD PULL of lungs back to orig. size
*like when you exhale
9
Q
Ventilation
Surface Tension
WHY we blow harder into balloon initially
A
- INWARD pull
- determinant of lung recoil
10
Q
Ventilation:
Surfactant
A
Type II Alveolar cells
DECs surface tension
keeps the alveoli from collapsing after exhalation and makes breathing easy.
11
Q
Ventilation:
Inspiratory muscle contractions create:
A
OUTWARD pull
12
Q
Ventilation:
Intrapleural Pressure
A
when BELOW ATM pressures==> air comes IN
Normally slightly LESS than ATM pressure
13
Q
Ventilation:
Diaphragmatic excursion
A
- Diaphragm descends —> sucks air IN
- diaphragm ascends –> pushes air OUT
Remember the elevator analogy as you breathe IN thru nose—-goes DOWN
14
Q
Diffusion of lungs
tollbooths opening for air to get into lungs
*all of these are tools to get O2 to blood*
A
- Surface area of the capillary membrane
- Diffusion capacity
- thick capillary-alveolar memb’s
- ability of air to diffuse
- V/Q ratio
- zones of west
-
LOWER LUNGS
- BEST potential to expand BUT last recruited when one breathes
15
Q
Perfusion of lungs
think BLOOD
A
- Gravity dependent
- Cardiac output
- CO==HR*SV
**Optimized V/Q is @ MIDZONE in healthy individuals== 0.8
16
Q
Etiology:
Restrictive Lung Disease
A
Everything smaller, BUT ratios are the SAME
17
Q
Pathophysiological aspects of Restrictive Disease
Normal vs. Abnormal Alveolus
A
Cant get air IN
alveoli cannot Expand
18
Q
Actual Restrictive Diseases
We will cover the following Subtopics:
A
- Idiopathic Pulmonary Fibrosis
- Cancers
- MSK
- NMSK
- Pulmonary Edema
- Connective Tissue
- PNA
- Traumatic
- Alteration in Thoracic/Abdominal Pressure Balance
- Others:
19
Q
S/S Restrictive Lung Disease
A
- Tachypnea OR dyspnea
- Dry, nonproductive cough
- Cachectic
- mm wasting/atrophy
- Hypoxemia
- DECd breath sounds
- DECd PFT
- DECd diffusing capacity
- R. sided HF or cor pulmonale
- DEC TLC
- INCd work breathing
20
Q
More S/S Restrictive Lung Disease
A
See chart
21
Q
Changes in Lung Volumes and Capacities
Restrictive vs. Normal vs. Obstructive
A
see chart
22
Q
PFT
A
see chart
NOTE: SAME but smaller ratios
NOTE: FEV1/FVC for Restrictive will be HIGHER
23
Q
Tx Measures for Restrictive Diseases
A
- Supplemental O2
- Exercise
- CORTICOSTEROIDS—-control Inflammation!!! (you will see this OFTEN)
- Smoking cessation
- avoid exposure to irritating stimulus/noxious stim.
- Pulm hygiene tech’s ===secretion mgmt
- diaphragm strenghtening
- IMT
- good nutrition
- cytotoxic drugs
- lung transplant for IPF
24
Q
Respiratory Distress Syndrome
Babies
old name== Hyaline Membrane Syndrome
What is it???
A
- dis. of prematurity OR lack of complete lung maturation
- lack of surfactant (allows alveoli to open/close) and inadequate surfactant production
- Diffuse micro-atelectasis
25
Respiratory Distress Syndrome
## Footnote
**Tx**
* Mom's Milk!!!
* surfactant replacement therapy
* Extracorpeal membrane oxygenation (**ECMO)**
* ****blood O2'd outside of body
* Corticosteroids to mother BEFORE birth
26
Normal ventilation
vs.
Ventilators
Normally==\> **Neg. pressure---suction**
Ventilators==\> **Pos. pressure--PUSH air in--barotrauma--this irritates lungs**
27
What do we WANT to see on Chest X-ray for babies??
Sail Sign
28
+ Respiratory Distress Syndrome
\*babies
see pics
29
Clinical Manifestation of Respiratory Distress Syndrome
See chart
30
Bronchopulmonary Dysplasia
Dysplasia==altered growth/production
**what is it and what is the cycle?**
* **Chronic respiratory distress syndrome \> 1month**
* **Cycle:**
* ****Scarring of lung tissue --\> fibrosis--\> thick alveolar walls--\> segmental atelectasis (**collapsing of alveoli)**
31
Idiopathic Pulmonary Fibrosis
## Footnote
**Idiopathic== do not know where came from**
**Fibrosis==scar tissue, difficulty O2 diffusion**
**What is it and Etiology??**
* Inflammatory process of **alveolar wall**
* **Etiology:**
* ****patchy focal lesions scattered, chronic inflamm. changes --\> epithelial damage--\> scarring --\> become fibrotic
32
Idiopathic Pulmonary Fibrosis
## Footnote
**Tx**
* Corticosteroids
* **you will see this w/ anything INFLAMMATORY**
* Cytotoxic drugs
* smoking cessation
* maint. adequate oxygenation/ventilation
* good nutrition
* **for EVERY lung disease**
* **supports extra mm contracts.**
* **extra breathing tools!** ****
* **w/ Restrictive disease, pts are using a LOT of fuel so NEED TO EAT but they do not WANT to eat**
* Tx infection
* lung transplant
33
Idiopathic Pulm Fibrosis
## Footnote
**Normal lungs vs. Lungs w/ Pulm Fibrosis**
see pics
34
Chronic Coal Workers' Pneumoconiosis
\*starts w/ irritant\*
* interstitial lung dis. caused by inhalation of coal dust==fibrotic changes in lungs
* **Tx**
* ****cessation of exposure
* nutrition
* intervents to ensure adeq. oxygenation/vent.
* progress. ex.
35
Asbestosis
\*macrophages try to eat asbestos===MORE inflammation
asbestos is indestructible
* Diffuse interstitial **pulmonary fibrotic disease due to inflammation** from asbestos exposure
* **long latency pd. after exposure of 15-20yrs**
* **Tx: no cure**
* ****symptomatic support
* dis. progresses even when exposure ceases
36
Bronchiolitis Obliterans
## Footnote
**Popcorn lung disease**
**\*attacks DISTAL airways----\> terminal bronchioles**
* fibrotic lung dis. affects **small airways**
* Pediatrics: **assoc'd w/ viral infection**
* Adults: **assoc'd w/ toxic fume inhalation, viral, bacterial, mycobacterial and connect. tissue dis.**
* Necrosis of **resp. epithel**
* ****inner lining lungs
* **Tx:**
* ****Children
* supportive--\> hydration, O2, postural drainage
* Adults
* O2, fluid balance, **corticosteroids**
37
Atelectasis
## Footnote
**What is it and types?**
* Incomplete expansion of lung OR loss of volume
* Types:
* Primary
* Obstructive
* Post-op
* Compression/Collapse
* **Chest radiograph shows opacification (whiteness) OR collapsed lung and elevated hemidiaphragm**
38
Atelectasis
## Footnote
**Prevention:**
**Tx:**
* Deep breathing
* incentie spirometry
* coughing
* **early mobility**
* **DEC sedation**
**Tx:** chest tube
39
Mechanisms of Atelectasis
* Something pushing on lungs ---cannot expand
* ==Atelectasis
* tracheal deviations
See pics
* Pneumothorax
* Air
* **collapsed lung**
* Hydrothorax
* Fluid
* **Compression**
* Tumor
* **Obstruction**
40
Open Pneumothorax
vs.
Tension Pneumothorax
* Open:
* Air can still get in and out
* Tension
* **Life-threatening emergency**
* **One-way door**
* **Continue to inhale only bc no way for air out**
41
Pneumonia
PNA
**What is it and types**
* inflamm process of **lung parenchyma (site of gas exchange)**
* Begins as **infection in the lower resp. tract**
* **2 types:**
* ****Community acquired
* CAP
* Hospital acquired
42
Pneumonia
Can be ____ and \_\_\_\_\_
**Most common routes?**
Can be bacteria and virus
* **Most common routes of infection:**
* ****inhalation---breathe something in
* aspiration--choke--something down wrong tube==infection
43
Pneumonia
## Footnote
**Tx**
**\*we need the underlying patho.**
* drug therapy
* antibiotics if bacterial
* O2
* Mech. vent OR noninvasive vent.
* Postural drainage
* Airway clearance tech's
* **must get fluid OUT**
44
**Bacterial Pneumonias**
* Streptococcus pneumoniae
* Legionella pneumophila
* Haemophilus influenzae
* Klebsiella pneumoniae
* Pseudomonas aeruginosa
* Staphylococcus aureus:
* **Methicillin-resistant Staphylococcus aureus**
* **== MRSA \*\*\*\***
45
Viral Pneumonias
* Cytomegalovirus
* **CMV**
* Influenza virus
* **Flu**
* **COVID-19**
* **Corona Virus**
46
Fungal Pneumonias
* Pneumocystis carinii
* **PCP**
## Footnote
****
47
Adult Respiratory Distress Syndrome
ARDS
\*\***Diffuse---all alveoli filled w/ fluid**
**2 Characteristics:**
* SEVERE hypoxemia
* **acute respiratory failure**
* INCd permeability of **alveolar-cap membrane**
* ****MORE permeable to fluid==**hypoxia**
**\*\*\*O2 Sats DEC!!!\*\*\***
48
2 Types of Adult Resp Distress Syndrome
* Direct:
* injury TO lungs
* ex. ventilator
* Indirect:
* outside lungs
* fluid from something **other than lungs**
* **ex. burn victim---systemic**
49
ARDS
**Causes:**
* trauma
* lung contusion
* drowning w/ aspiration
* aspiration
* drugs
* heroin, narcotics, amiodarone
* inhaled toxins
* smoke, high O2 conc's on **mech. vents, PNA's**
\*\*\***lungs change from air-filled to fluid-filled organ**
50
ARDS
## Footnote
**Progression:**
* Acute phase:
* resolves completely
* Acute phase:
* **fibrotic subacute phase**
51
ARDS and **Refractory Hypoxemia**
* No matter amount of O2 pt is on---\> **will NOT raise O2 lvls bc O2 cannot get thru**
52
ARDS
## Footnote
**S/S**
see chart
53
ARDS
## Footnote
**Tx**
* Treat **precipitating cause + underlying trigger**
* **flu, toxins, etc..**
* Support **adeq. gas exchange and tissue oxygenation**
* ****mech. vents
* forces fluid out thru (+) pressure==opens lungs up
* ECMO
* O2 blood outside body
* **Prone positioning**
* ****Tummy Time---**improves V/Q matching**
* manage nutritional status and fluid bal.
* prevent OR treat comps
54
**Cancer**
**Bronchogenic Carcinoma**
**What is it and Causes?**
* _Malignant_ growth of **abnorm epithelial cells**
* **proliferate unchecked**
* **Primary Causitive factor is _cigarette smoking_**
* **Other causes:**
* ****occupational agents
55
Cancer:
## Footnote
**Bronchogenic Carcinoma**
**Types:**
* Small Cell
* Non-Small Cell:
* **Adenocarcinoma**
* **non-smokers, females**
* **Squamous Cell**
* **smokers, men**
56
Cancer
## Footnote
**Bronchogenic Carcinoma**
**TNM:**
* Primary tumor, nodal involvement, metastatic presence
57
Lung Cancers often metastasize to other organs
* **bc lungs are filled w/ everything cancer wants**
* **Cx in lungs can go anywhere**
* **Iatrogenic fx's**
* **can be Cx**
58
Cancer
**Bronchogenic Carcinoma**
**TONS S/S**
**ex's: pain @ night, pain doesn't go away w/ anything**
see chart
just have a relative idea
59
Cancer
**Bronchogenic Carcinoma**
**Risk Factors:**
* Environment:
* smoking
* 2nd hand smoke
* occupation, air pollution
* Nutrition
* **free radicals**
* Genetics
* Age
* Pulmonary Lung Dis.
60
Pleural Effusions
## Footnote
**remember fire in the WALL example**
* accumulation of fluid **w/in pleural space/lining**
* **fire in the WALL**
* disruption in **balance of pleural fluid reabsorption**
61
Pleural Effusions:
## Footnote
**2 types of Fluids/Effusions**
* Transudative Effusions-- fluid in/out
* assoc'd w/ **hydrostatic pressure in pleural caps**
* **more CHF**
* Exudative Effusions--comes from inflamm.
* assoc'd w/ INC in **permeability of pleural surfaces**
62
Pleural Effusions
## Footnote
**Tx**
* Target **underlying cause**
* **Dx thoracocentesis**
* **see pics**
## Footnote
**\*NOTE: Quicker accumulation of fluid===worse/poorer outcomes**
63
Pleural Effusion
## Footnote
**Where exactly is the fluid accumulating???**
see pics
64
Sarcoidosis
You should immediately think...
**Specific----GRANULOMAS ===focal points of inflammation**
65
Sarcoidosis
* Autoimmune **multisystem disease** characterized by **presence of _Granulomas in many organs_**
* Affects: YOUNG 20-40 yo and women
* 90% pts have **lung involvement**
66
3 Distinct Stages of **Sarcoidosis**
* 1. Alveolitis
* 2. Formation of **well-defined granulomas**
* 3. **Pulmonary Fibrosis**
67
Sarcoidosis
## Footnote
**Tx**
* Corticosteroids
* **remember granulomas are focal pts of inflammation-----corticosteroids for inflamm!!!**
68
Vaping-Induced Lung Disease
Electronic Nicotine Delivery Systems
**ENDS**
**what specifically should you remember???**
Solid vitamin E in lungs!!!
69
Vaping-Induced Lung Disease
Electronic Nicotine Delivery Systems
**ENDS**
**Vit. E Acetate Theory**
* Vit. E cuts well w/ nicotine or weed
* theory is Vit. E converts BACK to solid IN lungs
70
Vaping-Induced Lung Disease
Electronic Nicotine Delivery Systems
**ENDS**
**Pt present/CT**
* Pt. Presentation
* wheezing/dyspnea
* CT scan shows:
* **acute eosinophilic pneumonia**
* **diffuse alveolar damage**
* **groud-glass opacity**
71
Vaping-Induced Lung Disease
Electronic Nicotine Delivery Systems
**ENDS**
**Patho. Findings**
* Giant-cell interstitial PNA
* Hypersensitivity pneumonitis
* Diffuse alveolar hemorrhage
72
Pulmonary Edema
Fire in the ROOM
Inc in amt of fluid **w/in the lung**
73
Pulmonary Edema
## Footnote
**2 Primary Causes:**
* INC pulmonary capillary hydrostatic **pressure**
* **L. sided CHF**
* **_Cardiogenic_ pulmonary edema**
* INC in alveolar capillary membrane **permeability**
* **ARDS**
* **Pulmonary edema**
74
Pulmonary Edema
## Footnote
**Tx**
* aimed @ **DECing cardiac Preload and maint. oxygenation**
75
what sounds will you hear w/ pulmonary edema?
Crackles
INC voice sounds
LOTS of consolidation
76
S/S Pulmonary Edema
see chart
77
Cervical Spinal Cord Injury
C3, C4, C5 keeps
Keeps the Diaphragm Alive!!!!!!!
78
**NMSK cause of Restrictive Lung Disease**
**C/S Injury**
**SCI**
* damage to OR interruption of neuro. pathways contained in SC
* **Cervial Injuries:**
* ****lead to **_expiratory mm_ paralysis/weakness**
* results in **poor cough**
* **_inspiratory mm_** **paralysis/weakness**
* inability to **completely inflate lungs/hypoventilatin**
* prone to **atelectasis**
* bc lose mm's that open up lungs--diaphragm
* V/Q mismatching
79
C/S SCI
## Footnote
**Tx**
* strengthen + INC endurance of **any remaining ventilatory mm's**
* **active/passive chest wall stretch**
* **PNF**
* Clear secretions
80
Cervical SCI and **Paradoxical Breathing**
https://www.youtube.com/watch?v=8TnrNrrEjuE
* OPP breathing pattern
* INHALE---stomach IN
* EXHALE---stomach OUT
81
Diaphragmatic Paralysis
**NMSK cause of Restrictive Lung Disease**
**\*lose Phrenic N. C3, C4, C5**
* Loss or impairment of **motor function of diaphragm** due to lesion in the neuro or MSK system
* Cause commonly injury to **phrenic N******
82
Diaphragmatic paralysis leads to diaphragm pulled ______ and ant. ribs pulled\_\_\_\_\_\_\_
THIS RESULTS IN???
leads to diaphragm pulled **UPWARD** and Ant. ribs pulled **INWARD**
This results in **alveolar hypOventilation**
83
Diaphragmatic Paralysis
## Footnote
**Tx:**
* If **unilateral involve...**
* ****usually NO Tx
* **B/L involve...**
* ****req's lvl of **mech. vent.**
84
Kyphoscoliosis
## Footnote
**MSK cause of Restrictive Lung Dis.**
* Combo of:
* **excess A/P and Lat. curvature of T-spine**
* **skeletal abnorms DEC lung compliance**
* **\*\*MOST ventilation occurs in upper lobes**
* **so now V/Q mismatch**
85
Kyphoscoliosis
## Footnote
**Over life-time**
* Develop **Atelectasis and R.side HF**
86
Kyphoscoliosis
## Footnote
**Sig. spinal curvature must be present before Pulm. sx's develop**
* Angles \<70degs
* **no pulmonary dysf.**
* Angles 70-120degs
* **some pulm dysf**
* Angles \>120degs
* **SEVERE RLD and resp. failure**
87
Kyphoscoliosis
## Footnote
**Tx:**
* Conservative
* orthotics + exercise
* Sx
* **Harrington distraction strut bars**
* Preventative + Supportive measures for **pulm. compromise**
88
Pectus Excavatum
**MSK cause of RLD**
\*funnel chest
\*connective tissue disorder
89
Pectus Excavatum
## Footnote
**MSK cause RLD**
* Funnel chest:
* congenital abnorm
* Sternal depression, DEC A/P diameter
* If SEVERE...
* **DECd TLC, VC**, **MVV (max voluntary ventilation)**
* **MVV== tot. volume air exhaled during 12s of rapid deep breathing**
90
Pectus Carinatum
* Pigeon breast
* Sternum **protrudes ANT**
* **\*\*\*Assoc'd w/ prolonged childhood asthma\*\*\***
91
Kyphoscoliosis/Pectus Excavatum
## Footnote
**MSK causes RLD**
**PFT:**
* in proportion to deformity....
* DECd **volumes and capacities**
* **Diffusions usually normal**
92
Kyphoscoliosis/Pectus Excavatum
## Footnote
**Chest X-ray**
* GROSSLY impaired due to **severe spinal/chest deformity**
* Compressed side visible w/ **incd vasculature**
93
Kyphoscoliosis/Pectus Excavatum
## Footnote
**ABG:**
* Hypoxemia
94
Kyphoscoliosis/Pectus Excavatum
## Footnote
**Auscultation:**
* DECd breath sounds **over restricted side**
* **no air going in!**
## Footnote
****
95
Kyphoscoliosis/Pectus Excavatum
## Footnote
**Cardio:**
* Potential for **pulm HTN and R.sided HF**
96
Scleroderma
## Footnote
**Connect. Tissue cause of RLD**
**What is it?**
* Progressive systemic sclerosis
* Progressive fibrosing disorder causes **degen changes in:**
* ****skin
* sm. blood vessels
* esophagus
* intestinal tract
* lung
* heart
* kidney
* articular structures
97
Scleroderma
## Footnote
**In lungs?**
* In lung appears as **progressive diffuse interstitial fibrosis**
98
Scleroderma
## Footnote
**Tx:**
* No effective drug intervention
* specific symptoms treated
* supportive care
99
Pregnancy
NOT A DISEASE CONDITION
* Cannot descend diaphragm efficiently bc baby
* **progesterone INCs RR**
**see chart**
100
Obesity Hypoventilation Syndrome
## Footnote
**explain Obesity**
* BW \> 20% or more over ideal BW
101
Obesity Hypoventilation Syndrome
## Footnote
**Affect on Lungs:**
* Extra tissue req's add. O2
* Excess adipose tissue around chest wall **DECs compliance of thorax**
* **LESS diaphragmatic excursion**
* **LESS chest wall expansion**
* **shallow breaths**
* Extra adipose rests on lungs:
* == **inad. diaphragm use**
* **== stresses access. resp. mm's**
102
Pharmaceutical causes of RLD
* more than 350 drugs **pot. cause RLD**
103
Pharmaceutical causes RLD
**Adversely Affect:**
* lung parenchyma directly
* drug induced interstitial lung disease
* ventilatory pump
* ventilatory drive
* **suppressed**
* chest wall compliance
104
Pharmaceutical causes RLD
Ex's
* O2
* \>21%==Drug
* antibiotics
* anti-inflamm's
* CV drugs
* Amyoteran
* Chemotherapeutic
* poisons
* anesthetics
* mm relaxers
* ilicit drugs
* vapes/Vit E
* nicotine/THC
* radiation to chest
\*\*\*\***Remember- Inflamm==scar tissue==RLD**
105
Comparing Obstructive (cant get air OUT) vs. Restrictive (cant get air IN)
* Obstructive
* cannot get air OUT
* vol's/ratios DIFFERENT
* BIG/INC TLC
* INC RV
* Restrictive
* cannot get air IN
* vol's REDUCED but ratios/vol's compared to **Normal** are the SAME
