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2012-05-28 22:09:04

respiratory disorders
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  1. Diffuse Interstitial Lung disease is characterized by
    aka pulmonary fibrosis

    characterized by thickening of the alveolar interstitium
  2. What is the most common pt complaint in Diffues interstitial Lung disease??
    progressive dyspnea and nonproductive cough
  3. What is diffues interstitial lung disease possibly related to ??
    an immune reaction that begins w/ injury to the alveolar epithelial or capillary enothelial cells leading to infiltration by immune cells
  4. Sarcoidosis
    An acute or chronic systemic diease of unknown cause, although an immunologic cause is likely
  5. Sarcoidosis is characterized by
    development of multiple granulomas that affect multile organs, most commonly the lymph nodes and lung tissue
  6. Fibrosis of the lung leads to
    • decreased vital capacity
    • decreased tidal volume
    • which both results in elevated RR
  7. What are the symptoms of Sarcoidsis
    progressive dyspnea, fever, enlarged lymph nodes, and generalized symptoms of inflammation

    reduced lung volumes and increased RR
  8. What are the characteristics of Diffuse interstitial pulmonary fibrosis??
    excess fibrin deposition results in stiff noncompliant lungs

    vital capacity, tidal volume, FRC, and diffusion capacity are generally reduced.

    RR increases to compensate for small tidal volume
  9. Hypersensitivity Pneumonitis
    Precipitated by exposure of lung tissue to inhaled organic agents, leading to a type 3 hypersensitivity reaction

    antigens associated w/ mold and bird poop (guano) types of fungul infections common live in dehumidifiers
  10. Occupational Lung disease results from
    inhalation of toxic gases (including atmospheric pollutants) and foreign particles
  11. What happens in Occupational Lung disease??
    the presence of inert particles in the alveoli initiates macrophage activity and inflammation. Inert particls cannot be digested by phagocytes so they are walled off by deposition of fibrous proteins
  12. Pneumoconiosis
    Parenchymal lung disease caused by inhalation of inorganic dust particles

    ex. anthracosis, silicosis, asbestosis

    progressive dyspnea, decreased vital capacity and FRC, and increased RR, hypoxemia, carbon dioxide levels may remain normal or low until late in disease
  13. Atelectatic Disorders
    Acute (adult) Respiratory Distress syndrome (ARDS)
  14. ARDS is characterized by
    damage to the alveolar-capillary membrane

    pts who recover from acute injury may continue to have respiratory abnormalities
  15. ARDS is associated w/ ??
    • Severe trauma
    • sepsis (40%)
    • aspiration of gastric acid (30%)
    • fat emboli syndrome
    • shock from any cause
  16. What are the characteristic findings in ARDS
    • injury to alveoli
    • changes in alveolar diameter
    • injury to the pulmonary circulation
    • disruption of oxygen transport and utilization

    • direct injury to aspiration
    • indirect injury when shock
  17. What are the signs and symptoms of ARDS
    • severe hypoxemia
    • decreased lung compliance
    • decrease in FRC
    • diffuse alveolar infiltrates
    • non-cardiogenic pulmonary edema
  18. What is the pathogenesis of ARDS
    • 1. aspiration of gastric contents is the activation of alveolar macrophage
    • 2. leading to the recruitment of neurtrophils
    • 3. At same time increasing permiability of alveolar capillary allow neutrophils to leave capillary and albumin in the capilary (draws fluid into it create osmotic pressure) no pressure to put it back in

    4. Once inside inflammatory
  19. What is evident on a chest radiograph with someone with ARDS
    noncardiogenic pulmonary edema is evident as "whiteout"
  20. What can be heard on auscultation w/ a pt w/ ARDS
    crackles and wheezing
  21. What can be observed in a pt w/ ARDS
    profound dyspnea and the use of accessory muscles
  22. What are other things found in a pt w/ ARDS
    atelectatsis and pulmonary edema result in right to left pulmonary shunting

    hypercapnia and hypoxemia (do not improve much w/ o2 therapy)
  23. ARDS is a consequence of widespread pulmonary inflammation leading to three major pathophsiologic processes:
    1. Noncardiogenic pulmonary edema associated w/ "leaky" pulmonary capillaries

    2. Atelectasis associated w/ lack of surfactant (normally decreases surface tension in small alveoli and prevents them from collapsing)

    3. Fibrosis (hyaline membranes) associated w/ inflammatory deposition of proteins
  24. Infant Respiratory Distress syndrome
    aka hyaline membrane disease

    a syndrome (similar to ARDS) in premature infants less than 30 wks who are not treated w/ corticosteroids
  25. What is the primary cause of IRDS
    a lack of pulmonary surfactant, leading to increased alveolar surface tension and decreased lung compliance
  26. What is the secondary cause of IRDS
    immaturity of pulmonary blood supply
  27. What are the sympoms of IRDS
    • nasal flaring
    • expiratory grunt
    • thoracic retractions
    • rapid shallow respirations
    • severe hypoxemia and acidosis
    • chest radiograph "whiteout"
  28. Pneumothorax
    an accumulation of air in the pleural space
  29. Spontaneous (primary) pneumothorax
    small rupture or bleb on surfface of the lung (cigarrette smoking increases it), air from lung to cavity
  30. Secondary Pneumothorax
    occurs as a result of pre-existing pulmonary diesease

    astham, emphysema, cystic fibrosis, infectious diseases (pneumonia and TB), or interstitial lung disease
  31. Tension Pneumothroax
    Traumatic in origin (peircing woud to chest), air from outside a traumatic ipening of the pleural cavity, air can get in but not out (collapsing the lung and pushes up into the medial sternum pushing on the heart ending up w/ tachycardia hypotension, tracheal shift, kussmals sign, and tracheal bronceal rupture
  32. what are the symptoms of a pneumothorax
    • tachycardia
    • absent breath sounds on auscultation
    • dyspnea or SOB
    • sudden chest pain on affected side
  33. What are the types of pleural effusion
    • Transudates
    • Exudates
    • Empyema
    • Hemothroax
    • Chylothroax
  34. Transudates
    fluids low in protein, less viscous

    associated w/ severe heart failure of other edematous states, such as cirrhosis w/ ascites, nephrotic syndrom and myxedema
  35. Exudates
    fluids high in protein

    caused by malignancies, infections, pulmonary ebolism, sarcoidosis, post-MI syndrome and pancreatic disease
  36. Empyema
    neutrophils build up causing pus from pleural infection
  37. Hemothroax
    blood from chest trauma
  38. Chylothorax
    leakage of lymph following trauma
  39. What are the symptoms of pleural effusion
    • dyspnea
    • cough
    • pleurtic pain ("when i inhale it hurts")
    • dulness to percusion over area of effusion
  40. What are the Neuromuscular disorders that may lead to respiratory disorders
    • Poliomyelitis
    • Amyotrophic lateral sclerosis (ALS)
    • Muscular Dystrophies
    • Guillain-Barre Syndrome
    • Myathenia Gravis
  41. Poliomyelitis
    Poliovirus attacke motor neurons in spinal cord and brain

    paralysis of muscle
  42. Amyotrophic Lateral Sclerosis (ALS)
    Degenerative disease of the nervous system, involving upper and lower motor neurons

    • paralysis
    • C345 keep the diaphragm alive
  43. Guillain-Barre Syndrome
    Presumed immunologic disoder, characterized by demyelination of peripheral nerves

    autoimmune response, usually have pulmonary or GI viral infection 3-4wks prior to symptoms

    moves distally , muscles of respiration are paralyzed
  44. Muscular Dysrophies
    Progressive loss of skeletal muscle cells, with developing muscle weakness

    genetic abnormality that dytrophin is not produced and a lack of, getting inflammatory response in muscle and an infiltration of adipose tissue (affects legs and diaphragm)
  45. Myasthenia Gravis
    Autoimmune destruction of acetylcholine receptors of neuromuscular junction, leading to progressive muscle weakness
  46. What are Chest wall deformities that may lead to respiratory disorders
    They all may limit chest expansion

    • Kyphoscoliosis
    • Ankylosing Spondylitis
    • Flail Chest
    • Disorders of Obesity
  47. Kyphoscoliosis
    • Kyphosis (hunchback-appearance)
    • Scoliosis (lateral curvature deformity)
  48. Ankylosing Spondylitis
    Chronic inflammation of the site of ligamentous insertion into the spine or sacroiliac joints

    • autoimmune response
    • looks like they have a bamboo spine
    • no movement, causes fusion in other ligaments not allowing for expansion
  49. Flail chest
    results from multiple rib fractures as a result of trauma to the chest wall

    due to multiple rib fracture (car accident, blown 20ft from bomb), also single fibs that have multiple fractures--> flail chest dosn't allow for expansion limitting the ability to expand
  50. Disorders of Obesity
    obesity may be associated w/ hypoventilation and airway obstruction

    Obstructive sleep apnea may also occur in obese persons
  51. Pickwickian Syndrome
    disorder of obesity associated w. hypoventilation and airway obstruction
  52. Pneumonia
    Inflammatory reaction in alveoli and interstitium of lung, usually caused by an infectious agent

    bacteria, viruses, fungi mycoplasmids

    symptoms are variable and include fever, cough, headache and malaise
  53. Severe Acute Respiratory Syndrome (SARS)
    severe for of pneumonia occuring in Asia

    Caused by a coronavirus (SARS-CoV), by a droplet infection (sneezes and coughes) 4-5 ft distance

    fevers myalgias, headache, nonproductive cough, and dyspnea

    no affective treatment
  54. Pulmonary Tuerculosis (TB) caused by
    caused by mycobaterium tuberculosis, contacted by inhalation or ingestion of bacterium
  55. what systems are affected by TB
    any organ system can be affected by TB but mos commonly affects the lungs and lymph nodes
  56. primary and reactivating tuberculosis
    primary TB is the initial infection ( usually clincally silent)

    TB may lie dormant for years before reactivation

    reactivation occurs when pts immune system becomes impaired
  57. Clinical features of TB
    • low grade fever
    • cough
    • night sweates
    • fatigue
    • weight loss
    • malaise
    • anorexia
    • chronic cough is common
  58. What is the granuloma response to TB
    the white cells form a barier around it not allwoing inflammatory response, white cells cant kil it and just wall it off making a lot of granulomas, with TB will actually cause antibodies to the bacteria
  59. What happend with Reactivation and granulomas
    we start getting dystruction of lung tissue and breakdown of granulomas and can be dieminated into the blood going to different organ systems (peritenium, GI, liver, spleen, CNS) called miliary TB
  60. What is the drug therapy for TB
    drug therapy continue for 9-12 months for active diease and may be used for shorter periods in persons exposed to TB but not having no active disease