3220: pulmonary disease

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jam110007
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236849
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3220: pulmonary disease
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2013-09-24 22:54:06
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3220 pulmonary disease
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exam 1 3220
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  1. general sign and symptoms of pulmonary disease
    - Dyspnea [short of breath/hard time breathing]

    - Abnormal breathing pattern

    - Hypoventilation

    - Cough

    - Hemoptysis

    - Cyanosis

    - Pain

    - Clubbing
  2. symptom of dyspnea
    - is subjective 

    - known as "air hunger," shortness of breath

    - may be caused by pulmonary disease, pain, heart disease, anxiety
  3. sign of dyspnea
    - this is objective

    - flaring nostrils

    - use of accessory muscles of respiration
  4. types of dyspnea
    - on exertion 

    - paroxysmal nocturnal dyspnea 

    - orthopnea
  5. dyspnea on exertion
    - short of breath

    - when pt first notices their havinf shortness of breath
  6. orthopnea
    [with pulmonary congestion]

    - hard time breathing while lying down

    you can elevate the pts head
  7. paroxysmal nocturnal dyspnea
    [in and out of short breath]

    - seen in pulmonary or cardiac disease
  8. hemoptysis
    cough up bright red, alkaline, with sputum 

    - associated with infection, inflammatio, or cancer
  9. normal breathing patterns
    - ventilatory rate [VR]: 8-16 breath/min

    - tidal volume [TV]: 400 -800 ml

    - expiratory pause : occurs with each breath

    - sigh breaths: 10-12/hr
  10. what can affect tidal volume
    • - lung compliance
    • - work of breathing
    • - obesity
  11. kussmaul respiration
    - slight increase in ventilatory rate [VR] = breathing faster

    - large increase in tidal volume [TV]

    - NO expiratory pause

    caused by strenuous exercise, metabolic acidosis [e.g. diabetic ketoacidosis - breath is sweet - trying to breath out ketones]
  12. obstructive breathing, breathing pattern
    - slow VR [ventilatory rate]

    - large TV [tidal volume]

    - increased effort

    - prolonged inspiration, expiration 

    - wheezing, stridor [high pitched]
  13. restricted breathing, breathing patterns
    - rapid VR [ventilatory rate]

    - small TV [tidal volume]

    - decreased compliance 

    - caused by stiffening of lungs due to pulmonary fibrosis
  14. cheyne-stokes
    - alternating deep/shallow with apnea for 15-60 seconds 

    - caused by decreased blood flow the the brainstem [i.e. heart failure]

    - watch pt carefully, usually seen in dying pt or pt with stroke
  15. what cases Acid Base Balance to change?
    changes in the concentration of hydrogen ion in the blood
  16. acidemia
    pH of arterial blood is less then 7.4 caused by an increase in hydrogen ions
  17. alkalemia
    pH of arterial blood is greater then 7.4 caused by a decrease in hydrogen ions
  18. respiratory acidosis
    - PaCO2 > 45 means pt is retaining bicarb

    - because of hypoventilation resulting in too much carbon dioxide in the blood

    - can be acute of chronic
  19. signs and symptoms of respiratory acidosis
    • - headache
    • - blurred vision
    • - lethargy 
    • - coma
    • - hypercapnia [when pt has too much bicarb]
  20. respiratory alkalosis
    - PaCO2 < 35

    - hyperventilation resulting in too little carbon dioxide in blood

    - can be acute or chronic

    - causes include hypoxemia, fever, anemia
  21. sign and symptoms of respiratory alkalosis
    • - dizziness
    • - confusion
    • - parasthesias > numbness and tingliness in fingers and toes

    - pass out
  22. peripheral cyanosis
    - caused by poor circulation, vasoconstriction

    - usually a cardiac problem

    - finger tips and toes might be blue/mottled
  23. central cyanosis
    - caused by decreased arterial circulation 

    - seen in low cardiac out put, hypothermia, anxiety 

    - usually not seen until severely hypoxic!!

    - a pt can be hypoxic before the become cyanotic
  24. clubbing of fingers
    due to chronic low oxygenation 

    - is greaded from 1-5 

    - seen in pt with cystic fibrosis
  25. what is hypoxemia
    - decreased PaCO2: reduced oxygenation of arterial blood

    • Hypoxia - 
    • is reduced oxygenation of cells in tissues, often due to decreased blood flow
  26. causes of hypoxemia
    - Dec. O2 content of inspired air

    - Hypoventilation (coma, COPD)

    - Diffusion abnormality (emphysema, cystic fibrosis)

    • - Ventilation/perfusion ratio mismatch (bronchoconstriction, fluid
    • filled alveoli)

    - Pulmonary right-to-left shunt (ARDS) – can cause a low R/Q
  27. ventilation
    gas into and out of the lungs
  28. perfusion
    blood supply to lungs from pulmonary circulation
  29. what is a V/Q mismatch
    when the ventilation and perfusion are not balanced with one another
  30. causes of V/Q mismatch
    - any disorder that thickens the alveolar membrane so that has and oxygen can't be exchanged 

    - inadequate ventilation

    - shunting 

    - impaired perfusion
  31. impaired ventilation V/Q mismatch
    - low ventilation 

    - inadequate ventilation in well-perfused areas e.g. bronchoconstriction, pulmonary edema
  32. shunting V/Q mismatch
    - very low ventilation with normal perfusion
  33. impaired perfusion V/Q mismatch
    - ventilation is OK

    - poot perfusion 

    - decreased PaO2

    can be seen in pulmonary embolus
  34. causes of aspiration
    - decreased level of consciousness [e.g. sedation, coma, anesthesia, seizure disorder, CVA]

    - right ling, right lower lobe [right main stem bronchus is straighter]
  35. aspiration can cause what pulmonary problem
    - pneomonitis [inflammation of the lungs. esp if they aspirate gastric contents], 

    - bronchspasm

    - aspiration pneumonia

    - death rate > 50%
  36. whose at risk for aspirating
    • - stroke
    • - lethargic 
    • - over sedated 
    • - pts who cant swallow
    • - etc.
  37. Atelectasis: compression
    due to tumor, fluid abdominal distention
  38. atelectasis: absorption
    dues to inhalation of O2, anesthetic gases
  39. atelectasis is common after what?
    after surgical procedures
  40. broncoiectasis
    • - persistent dilation of bronchi
    • - due to obstruction by mucus plugs, atelectasis, bronchitis, aspiration object, infection. etc. 
    • - similar to side effects of bronchitis [but with lots more mucus]
    • - can be congenital
  41. Tx for bronchiectasis
    - antibiotics, bronchodilator, something to thin the mucus or cough it up [expectorants], chest PT
  42. Pneumothorax
    - air or gas in pleural space due to rupture in visceral pleura or chest wall

    - air separates the pleurae, destroying the negative pressure 

    - can be idiopathic or spontaneous 

    - common in men between 20-40
  43. open pneumothorax
    - air is drawn into pleural space during inspiration through damaged area

    - lung recoils and collapses toward the hilus

    - known as a secondary pneumothorax
  44. tension pneumothorax
    - site of pleural rupture acts as one-way valve

    - air does not escape during expiration 

    - causes compression, lung, heart, great vessels. dec. CO, B/P!

    - tracheal deviation will occur where it will shift away from the bad lung toward the good lung 

    - no breath sounds will be found on the side of the collapsed lung
  45. pleural effusion
    - fluid in pleural space

    - may cause compression atelectasis

    - lung sounds: friction rub

    - empyema [collection of pus] due to infection

    - shortness of breath
  46. what procedure can be done for pleural effusion
    • Thoracentesis
    • - may remove several liters of fluid - pt B/P will drop if too much is pulled out at once
  47. pleural effusion can be due to?
    cancer, congestive heart failure, infection
  48. flail chest
    - Caused by several fractured consecutive ribs

    - Causes instability

    - Due to trauma [usually]

    - Treatment: they splint it
  49. Acute Respiratory Distress Syndrome (ARDS)
    - Due to Acute lung inflammation and alveolocapillary injury

    - Acute infiltrates [fluid] seen on chest xray

    - Hypoxemia – affect perfusion to other vital organs

    - Causes include sepsis, trauma, pneumonia, burns, aspiration, CABG, blood transfusions

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