Restrictive pulmonary disorders Flashcards
1
Q
Restrictive disorders characterized by
A
- affects lung parenchyma, pleura or thoracic pump
- inspiration difficulty
- decreased lung or thoracic compliance
- diagnostic measure via decreased volumes or capacities related to reduction in ventilation, decreased lung volume or diminished expansion
2
Q
Changes in lung volumes with restrictive pulmonary disorders
A
- TLV is reduced and all other volumes are reduced
- ratios are normal
3
Q
Restricitive pulmonary disorders
common characteristics
A
- tachypnea/dyspnea
- hypoexmia
- diminished lung sounds often with dry inspiratory crackles
- decreased diffusing capacity
- decreasedlung volumes/capacity
- cough–usually dry and non-productive
- weight loss/muscle wasting
- pulmonary HTN, RV hypertrophy, COR PULMONARE
- increased work of breathing
- abnomral chest X-ray
- can be a portion of the lung
4
Q
Restricitive pulmonary disorders
Supportive measures
A
- corrective measure related to the root of problem
- supplemental O2
- nutritional support
- interventions to promote appropriate physical activity
- interventions to prevent accumulation of secretions/infections
5
Q
Restricitive pulmonary disorders
Interventions to promote appropriate physical activity and ventilation
A
- posture (can be a RPD –scoliosis, kypohsis)
- soft tissue mobilization
- deep breathing/respiratory muscule training
- incentive spirometer
- airway clearance
6
Q
Restricitive pulmonary disorders
Interventions to prevent accumulation of secretions/infection
A
- airway clearance - postural drainage, percussion, vibration and cough
- antibiotic therapy
7
Q
Restricitive pulmonary disorders
Extrinsic factors
A
- obesity/pregnancy
- ascites
- surgery/chemo/radiation
- trauma, surger
- flail chest
- pleural-pneumothorax/pleural effusion
- conntective tissue diseases
- neuromuscular dysfunction
- musculoskeletal dysfunction
- pharmaceutical causes
- radiation therapy
8
Q
Restricitive pulmonary disorders
Flail chest
A
- FX of 2+ ribs with 2 fx on each
- one segment is floating
- move in a peridoxal manner - suck in
- medical emergency
9
Q
Restricitive pulmonary disorders
pharmaceutical causes of restrictive disorders
A
- drug supresses drive to breathe
- radiation for cancer can cause scar tissues
10
Q
Restricitive pulmonary disorders
Inrinsic factors
A
- atelectasis
- pulmonary edema (cardiogenic/noncardiogenic/adult respiratory distress disorder
- maturational causes: abnormalities of fetal development - infant respiratory distress disorder/aging
- idiopathic pulmonary fibrosis
- environmental or occupational fibrosis
- infection –pneumonia
- cancers
11
Q
Restricitive pulmonary disorders
trauma causes of restrictive disorders
A
- crush injuries: results in rib fx, flail chest lung contusions
- penetrating wounds: pneumothorax, hemothorax, pulmonary laceration
- Theramal trauma: burns to thorac/inhalation burns
- surgery: anesthesia, incision, pain
*pneumothorax: penetrate pleural space = air rushes in
air changes the pressure
12
Q
Restricitive pulmonary disorders
Respiratory changes with aging: changes in the chest wall
A
- decrease strength of respiratory muscles and chest compliance
- decreased MVV, and increased O2 consumption in respiratory muscles
- increased minute ventilation and work of breathing
- increased respiratory muscle fatigue
- Results in decreased pulmonary efficiency
13
Q
Restricitive pulmonary disorders
respiratory changes with aging: changes in the lung
A
- increased alveolar compliance and decreased pulmonary capillary bed
- increase RV, increased physiological deadspace
- decreased VC/decrese V/Q matching
- decreased flow rates and PaO2
- look at picture in powerpoint
14
Q
abnormalities in fetal development–infant respiratory distress syndrome
A
- immature lungs and decreased surfacant
- can impact them as they are older due to their development
- infants born less than 36 weeks are at higher risk fo RDS related to immature lungs
- dysplagis/fibrotic changes can occur
15
Q
Adult respiratory distress syndrome
A
- increased permeability at the alveoli/capilary membrane
- related to barriers between capilary and alveoli
- noncardiogeneic - failure of microvascular endothelum (increased permability)
16
Q
abnormalities in fetal development
A
- Hypoplasia/Aplasia refers to decrease or lack of organ development. Reduces amounts of lung parenchyma
- Infant Respiratory Distress Syndrome (hyaline membrane disease)-insufficient maturation of lung tissue/insufficient surfactant development leads to alveolar collapse. Infants born at ˂36 weeks are at high risk forIRDS. Incidence of this is 75% for infants born 26-28 weeks
17
Q
What does pulmonary edema impact
A
- alveoli expansion in early stages due to fluid in interstitial space
- then progresses to fluid within alveoli
- OVERALL restricts ventilation
18
Q
acute respiratory distress syndrome/acute lung injury
A
- serious clinical syndrome caused by acute lung injury (trauma, sepsis, drug overdose, inhaled toxins, massive blood transfusion, pneumonia)
- characterized by increased permeability at alveoli/endothelial interface, leading to severe hypoxemia, pulmonary edema, and atelectasis
- Damage occurs to the alveolar cells and the vascular endothelium
- Patient develops edema, narrowing of airways, increasedfluid production into alveoli, decreased surfactant production
Sameas adult respiratory distress syndrome
19
Q
Triggers of ARDS
A
- pneumonia
- inhalation injury (smoke/toxins)
- aspiration injury
- chest trauma
- near drowning (fluid within alveoli)
- sepsis
- major trauma
- burns
- hypovolemia
- transfusion-related acute injury
20
Q
Pulmonary Fibrosis disrders:
discrption
A
- idiopathic, environmental, occupation, viral, genetic causes
- changes within alveoli and between alveoli
- scarring/destruction of lung architecture characterizes the condition
- irreversibly enlarged damged bronchioles and disotred alveoli
- “honeycombing” clustered cystic air spaces
- greatly decreases gas exchange, reducing oxygen transfered into blood
21
Q
Environmental or occupational lung disease (fibrosis): hypersensitivity pneumonitis
A
- farmers lung
- baggassosis
- humidifier/air conditioner lung
- bird breeder’s lung
- cheese worker’s lung
- malt worker’s lung
- paprike splitter’s lung
- mollusk shell hypersensitivity
- chemical worker’s lung
- wheat weevil
22
Q
Environmental or occupational lung disease (fibrosis) : pneumoconiosis
A
- asbestosis
- berylliosis
- silicossis
- coal worker’s lung
- byssinosis
- baritosis
- chalicosis
23
Q
Lung cancer
A
- leading cause of cancer death
- metatsiszes quickly to pleura, lymph, bone, brain, kidney and liver
24
Q
Types of lung cancer
A
- small cell lung cancer
- non-small cell lung cancer
- if a cancer has characteristics of both types it is called a mixed small cell/large cell cancer - uncommon
25
Lung cancer signs and symptoms
- Cough that does not go away or gets wrose
- coughing up blood or rust colored sputum
- chest pain that is often worse with deep breathing, coughing, laughing
- hoarseness
- SOB
- infections such as bronchitis, pneumonia that dont go away or keep coming back
- new onset of wheezing
- loss of appetite
- unexplained weight loss
- feeling tired or weak
26
Pneumonia: pathophysiology
- infection to the lung
- inflammatory response
- alveolar edema and exudate formation (mucus with cellular debris)
- alveoli and respiratory bronchioles fill with serous exudate, blood cells, fibrin, bacteria
- consolidation of lung tissues
27
Types of pneumonia
- community acquired
- nosocomical: hospital acquired
- immunocompromised
- aspiration
28
Community-acquired pneumonia
- pneumococcus
- H. influenzae
- moraxella catarrhalis
- staph aureus
- mycoplasma
- ligionella
- chlamydophila
- gram negative bacteria
- virsus
- unknown
29
Nosocomical pneumonia
- gram (-) bacteria
- klebsiella
- escherichia coli
- pseudomonas
- MRSA
- polymicrobial
- unknown
30
Immunocompromised pneumonia
- cytomegalovirus
- pneumocystis jiroveci
- mycobacterium avium
- aspergillosis
- candidiasis
- others
31
Aspiration pneumonia
- anaerobic oral flora
- aerobic - pneumococcus, staoh, haemophilus influenzar, pseudomonas aeruginosa
32
# RSV
Respiratory syncytial virus
- spread via respirtory droples
- can be spread via airbrone or direct contacct
- intiates in the upper respiratory tract
- seasional virus that is realtively common
- complication of pneumonia occurs when it spreads to the lower respiratory tract
33
# RSV s
signs and symptoms
- mild -flu like symptoms
- upper respiratory congestion
- mild headache
- mild cough
- mild fever
- sore throat
- V/Q mismatch
Severe symptoms
- cyanosis
- dyspnea
- tachpnea
- wheezing
- severe cough
- fever
34
what is coronavirus
- primarily cause respiratory symptoms but occasionall enteric, hepatic, and neurological symptoms are seen
- mostly mild symptoms
- can be zoonotic, animal to human
- new type jumped from animal species and then spread
- spread via large and small droplets (airborne)
35
What makes up COVID
- RNA
- nucleoproteins: give virus its structure and enable replication
- Viral envelope: protects the virsu when it is outside host cell
- Spike proteins: allow it to grab onto things like hooks
36
ACE2 and COVID
- a glycoprotein that resides on the cell surface serves as a receptor site for COVID
- broadly distributed throughout the human body including the kidney, intestine, lung, CV system
- possible endothelial cell dysfucntion
- allows virsl entry and ACE2 normal function is blocked
37
ACE-2 receptor is the site of cell entry for
- matrix products
- antithrombotic factors
- procoagulant factors
- growth factors
- vasoconstricting factors
- vasodilator factors
- inflammatory mediateors
- lipid metabolism
38
Post-acute COVID/chronic covid
- originally post-covid was thought to be the short period after ilness
- considered impact of being hospitalized
- Post intensive care syndrome or hospital acquired waekness
- in July 2021 is was recognized as long COVID
- post-covid conditions are a wide range of new, returning, or ongoing health problems that people experience for 4 or more weeks after first being infected with the virus
39
Long haul COVID
- can be vaired but may appear to have symtposm similar to myalgic encephalitis/chronic fatigue syndreom (MECFS) and postural tachycardiac syndroem (POTS)
40
Myalgic encephalomyelitis/chronic fatigue syndrome
- long term illness that affects many systems
- etiology unclear
- people with ME/CFS are often not able to do usual activites
- sleep issues. significant fatigue, post-exertional fatigue
- sometimes confusion dizziness, pain
41
Postural Orthostatic tacycardia syndrome
| What is it, common symptoms and a diagnoistic test
- POTS
- autonmic dysfunction
- abnormally large increases in HR with standing - lightheadedness
- difficulty thinking and concentrating
- fatigue
- intolerance of exercise
- headache
- blurry vision
- palpitations
- tremor and nausea
- standing toerance test is diagnotic
- UNRELATED TO ORTHOSTATIC HYPOTENSION
42
Post exertional malaise
- PEM
- symtpoms that exacerbate after physical, mental or emtional effort
43
Post exertional symptom exacerbation
- PESE
- worsening of symptoms 24-72 hours following exertion
- exertion refers to cognitive, emotional, or social acitvity and is often minimal or at a threshold previously tolerated
44
energy envelope
- used with PEM,PESE
- the area that one can consistently function without symptoms
45
Pacing
- strategies that reduce spikes in exertion
- avoid push followed by crash (PEM,PESE)
