1
Q
Main concept based on the chart
A
- Everything decreases in Restrictive but remains proportional
2
Q
ILD
A
Interstitial Lung Disease
3
Q
A
- Decreased Lung volume
- Harder to breath in because working against resistance, compensating with muscles
4
Q
UIP
A
Usual Interstitial pneumonia
- Significant collagen deposition
- Thickening alveolar walls and septa
- Little inflammation
- Fibrosing in the interstitial area leads to stiffening of the lung or decreased compliance
5
Q
Antihypertensives for Pulm HTN (UIP)
A
- Flolan
- Bosantin
6
Q
NSIP
A
Nonspecific Interstitial Pneumonia
- Inflammation
- Thickening alveolar walls and septa
- leads to decreased compliance of the lung
7
Q
Anti-inflammatory medications (NSIP)
A
- Cellcept
- Prednisone
- Azathioprine
8
Q
DIP
A
Desquamative Interstitial Pneumonia
- Primarily inflammatory
9
Q
Fick’s Law
A
Rate of gas transfer is proportional to tissue area and differences in gas partial pressure between 2 sides, but inversely proportional to tissue thickness
10
Q
ILD Prognosis
A
- Poor
- 3 to 6 years from time of diagnosis
- Early diagnosis and treatment are critical in impacting survival
- NSIP much better survival than UIP
11
Q
Pulmonary Sarcoidosis
A
- 20 to 40 yo
- Females more than males
- Disease due to inflammation
- Characterized by the presence of granulomas
- can cause abnormal lung stiffness and loss of lung volume
12
Q
Pulmonary Sarcoidosis: Clinical Findings
A
- Symptoms: Dry couch, Dyspnea, Mild chest pain, fever, fatigue, weight loss
- Breath sounds: RR increased, Chest expansion decreased, wheezes from bronchial obstruction
- Decreased TLC and lung volumes
- Lung Compliance decreased
13
Q
Pulmonary Sarcoidosis: Intervention
A
- May resolve spontaneously
- Corticosteroids
- Supplemental oxygen as indicated
- Pulmonary Rehabilitation
- Lung transplant in advanced disease
14
Q
ILD: Clinical Findings
A
- Dyspea - Progressive and insidious onset
- Untreated Hypoxemia can lead to decreased BP, dizziness, arrythmias
- Weight loss
- Digital clubbing
- Pulmonary HTN, R heart failure
15
Q
ILD: Clinical Findings
A
- Decreased
- Positive
- Rapid, Shallow
- exertion, dry
- Rales
- Decreased volume, honeycombing
16
Q
ILD: Clinical Findings
A
- Positive
- Positive only at end stage
- down
- down
- equal
- down
- down
- down
17
Q
A
18
Q
A
19
Q
Acute Pulmonary Embolism
A
- Blood clot in the lung
- Blood stasis
- Coagulopathy
- Changes in vessel wall permeability
- Symptoms: Dyspnea, decreased SpO2
20
Q
Pulmonary Hypertension value
A
- Normal mean pressure: 15mmHg
- Hypertension: rest greater than 25mmHg, exercise greater than 30mmHg
21
Q
Primary Pulmonary Hypertension (PPH)
A
- Females in mid 30s
Causes: - Genetic
- Appetite suppressant medications
- Illegal Drugs
- Infections
- Reaction to hormonal changes during pregnancy
22
Q
Secondary Pulmonary Hypertension
A
- Occurs after congenital heart defect, lung disease with hypoxia, collagen vascular disease, thromboembolic disease, left heart failure
23
Q
Physiology of Primary Pulmonary Hypertension
A
- Dilation of small arteries that are distal to obstructed large arteries
- Small arteries fill with abnormal endothelium lining
24
Q
Clinical Findings of Pulmonary Hypertension
A
- SOB
- Chest Pain
- Fatigue
- Peripheral edema
- S4 or atrial gallop, split S2
25
Pulmonary Edema
- Accumulation of fluid within the lungs
- Engorgement or perivascular (interstitial) space and progression to alveolar edema
- Results from breakdown to protective barrier of lungs
26
Pulmonary Edema- Risk Factors
- Inhaled Toxins (Chlorine, sulfur dioxide)
- High altitude
27
Clinical Findings of Pulmonary Edema
- Increased RR & BP
- Decreased SpO2
- Pulmonary Vascular congestion
28
Symptoms of Pulmonary Edema
- Respiratory distress (dyspnea)
29
Chest Assessment of Pulmonary Edema
- Decreased to absent BS / Rales (Fluid in lungs)
- Decreased chest wall motion
30
Treatment of Pulmonary Edema
- Treat underlying cause
- Support with diuretics and oxygen therapy
31
Diseases of the Pleura
- Pleural effusion
- Pneumothorax
- Hemothorax
- Empyema ( Pockets of pus enclosed in fibrous adhesions)
32
Pleural Effusion
- Fluid accumulation in the pleural space
- Separates the air filled lung from chest wall
- Blocks transmission of sound
- Results in change in the hydrostatic osmotic pressure
- Dyspnea and fatigue
- Small effusion will reabsorb, large must be drained
33
Pleural Effusion: Causes
- Congestive heart failure
- Edematous (bloating) state
- Change in pressure
- Malignancies and infections
34
Pleural Effusion Clinical findings
35
Pneumothorax
- Leakage of air into the pleural space through blebs, resulting partial or complete collapse of the lung
- Blebs may rupture under increased pressure
36
Open vs. Tension Pneumothorax
-- Describing Mediastinal shift
- Open will see collapse and ipsilateral shift
- Tension will see collapse and contralateral shift ( one way 'valve' causes air to collect in thoracic cavity)
37
Pneumothorax: Clinical Findings
38
Hemothorax
- Penetrating and crush wounds
- Fatigue, dyspnea
- SpO2 will remain normal
- Excessive bleeding, clot formation and decreased HCT
- Decreased chest excursion with inhalation
39
Empyema
- Presence of gross pus into the pleural cavity
- consists of an effusion containing polymorphonuclear leukocytes and fibrin
- Localized infection following pulmonary process or post op complications
- Increased RR, HR, temperature
40
Sleep Apnea
- Temporary cessation of ventilation during sleep
- Occlusion in upper airway
- Severe when apnea periods occur greater than 30 times / minute
- Long term can lead to pulmonary HTN
41
Pregnancy
- 50% increase CO and O2 consumption by end gestation
- Decrease PVR 2nd to dilation of pulm arteries and capillaries
- Decreased chest wall compliance, Increased work of breathing
42
Atelectasis
- Decrease functional residual capacity
- Decrease lung compliance
- Surface tension holds collapsed alveoli shut → Higher pressure to reinflate lungs - Overinflation of unaffected lung areas
- Increased work of breathing → respiratory failure
43
Atelectasis clinical findings
44
Subcutaneous Emphysema
- Develops secondary to air leakage from a disrupted airway
- Air migrates along the great vessels to the mediastinum and then into the soft tissues of the neck and chest
- Can be just cosmetic or represent underlying problem
45
Pneumonia
- Acute inflammation of lung parenchyma from the respiratory bronchioles to the alveoli from an infecting agent
- Protective system of airways are impaired
46
Adult Respiratory Distress Syndrome (ARDS)
- Noncardiogenic pulmonary edema / shock lung
- Hypoxemic respiratory failure from damage to the alveolar capillary membrane
- Increased pulmonary vascular permeability and leads to pulmonary edema
- Ultimately serious damage to alveolar capillary membrane
- Occurs with multiple organ system failure
- Treatment may include prone positioning
47
What are the 4 stages of ARDS
- Edema (Interstitial to alveolar)
- Hemorrhagic derby fills alveoli
- Hyperplasia ( Cells organize and line alveoli)
- IPF develops
Clinical Findings
- Severe respiratory distress with compromised oxygenation
48
Pulm
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