Cardiopulmonary > Pulmonary Pathologies > Flashcards

Pulmonary Pathologies Flashcards

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1
Q

on an x-ray what color is air?

A

black

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2
Q

T or F: COPD is an umbrella term

A

T: includes emphysema, chronic bronchitis, asthma, bronchiectasis, CF

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3
Q

restrictive pulmonary disease (3)

A

idiopathic pulmonary fibrosis, occupational exposures, mechanical/extrinsic disorders

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4
Q

sequela of chronic lung disease

A

pulmonary HTN -> right heart failure -> a-fib -> obstructive sleep apnea -> polycythemia

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5
Q

polycythemia

A

increased red blood cells in attempt to increase oxygen to the body

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6
Q

T or F: sleep apnea can cause a-fib if untreated

A

T

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7
Q

cor pulmonale

A

right sided heart failure due to a pulmonary pathology

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8
Q

gold standard for measuring pulmonary function

A

spirometry

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9
Q

what happens with breathing in those with COPD

A

they cannot get air out as quickly as someone with healthy lungs

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10
Q

people with mild to mod COPD develop _____ while people with more severe cases (FEV1 > 50%) develop….

A

hypoxemia

hypoxemia and hypercapnia

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11
Q

supplemental O2 orders for COPD is usually to keep levels at greater than _____% why?

A

88%

too much O2 will cause hypoventilation and hypercarbia… it removes the automatic drive to breathe.

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12
Q

clinical diagnosis of chronic bronchitis

A

persistent cough that produces sputum for >3 month per year for at least 2 consecutive years

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13
Q

what is the physiology of chronic bronchitis

A
  • obstruction of airway leads to loss of elastic recoil
  • there is also mucus plugging
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14
Q

what happens during an acute exacerbation of chronic bronchitis

A
  • increased SOB
  • productive cough
  • increased sputum production
  • infection
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15
Q

what is the most important risk factor for chronic bronchitis

A

cigarette smoking

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16
Q

T or F: pts who spend at least 50% of the day in bed are 4x more likely to die than pts who are mobilized early and frequently

A

T: pulmonary rehab is important!

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17
Q

with chronic bronchitis you should encourage _____

A

hydration

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18
Q

emphysema is characterized by

A
  • destruction of elastin protein of alveolar walls
  • decreased surface area for gas exchange
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19
Q

what happens during expiration with emphysema

A

the airway collapses leading to air trapping

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20
Q

what happens to the lungs and diaphragm with emphysema

A

hyperinflated lungs
flattened diaphragm

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21
Q

T or F: cough is common with emphysema

A

F: uncommon, little sputum production

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22
Q

Your pt has become SOB with mild activity. You notice they are using their accessory muscles to breathe and like to rest in the tripod position. They don’t cough much. They are very thin and tell you they have trouble gaining weight. What do they likely have?

A

emphysema

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23
Q

with COPD, you often see ______ chest

A

barrel (increase AP diameter)

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24
Q

your pt becomes SOB with mild exertion. They have a cough with sputum production. You note some edema in the LEs, wheezing, and diminished breath sounds. What do they likely have?

A

chronic bronchitis

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25
"blue bloaters"
chronic bronchitis
26
"pink puffers"
emphysema
27
how is COPD staged?
gold classification predicted FEV1
28
COPD gold classification
Mild: FEV1>80% Mod: FEV1 50-80% Severe: FEV1 30-50% Very Severe: FEV1 <30%
29
An FEV1/FVC ratio of less than _____ is classified as COPD
0.7
30
What assesses prognosis for COPD
Bode Index
31
what 4 item does Bode index take into account?
1 - FEV1 2 - BMI 3 - 6MWT 4 - MMRC dyspnea scale
32
asthma is characterized by...
reversible obstruction to airflow within the lungs
33
T or F: between asthmatic episodes, lung function is relatively normal
T
34
what is the most common disease in children
asthma
35
asthma is the onset of an _____ process
inflammatory
36
status asthmaticus
- a severe, life-threatening asthma attack... pending respiratory failure! - decreased breath sounds, cyanosis, exhaustion, hypercapnia
37
what are classic symptoms of asthma?
wheezing dyspnea chest pain facial distress non-productive cough
38
what are possible stimulants for an asthmatic episode
- air pollutants - respiratory infections - exertion/exercise - meds (NSAIDS, aspirin, ACE inhibitors, beta-blockers)
39
with pulmonary hypertension, pulmonary arterial pressure is greater than _____ mmHg at rest and greater than ______ mmHg during exercise
25 30
40
what is normal arterial pressure
less than 15 mmHg
41
what is the gold standard for diagnosis of pulmonary hypertension
heart catheterization
42
in the lungs, oxygen causes _______ and carbon dioxide causes _________
vasodilation vasoconstriction *opposite in periphery!
43
you are performing exercises with a pt who has pulmonary hypertension. he is experiencing a drop in blood pressure and dizziness. What is happening?
1 - increasing hypoxia is causing more pulmonary vasoconstriction 2 - as pulmonary vascular resistance increases, right ventricular stroke volume decreases. 3 - decrease in blood volume from R side of heart causes decrease in oxygenated blood volume on L side 4 - leads to decreased cardiac output and drop in BP
44
cystic fibrosis
disease that causes persistent lung infections and limits the ability to breathe over time
45
T or F: cystic fibrosis is progressive
T
46
CF is autosomal ___________
recessive
47
what is the most common lethal genetic disease in Caucasian pops?
cystic fibrosis
48
those with CF are on ______ precautions
reverse - you are protecting them by masking
49
what is the ultimate treatment for CF?
double lung transplant
50
how is CF diagnosed?
sweat chloride test - CF causes a lot of salt to be lost in the sweat
51
what are some other treatments for CF besides a lung transplant?
1 - bronchodilators 2 - airway clearance techniques 3 - mucolytics
52
what are some common symptoms of CF? (5)
- salty tasting skin - persistent cough (can be productive) - frequent lung infections - SOB, wheezing, decreased breath sounds - clubbing
53
bronchiectasis
permanent dilation of the bronchi from the destruction of the muscular and elastic properties of the lung
54
what happens to the bronchial walls in bronchiectasis? What about the mucociliary blanket?
- they become thicker - mucociliary blanket becomes impaired - this causes hypersecretion of purulent sputum and bacterial colonization
55
what is the clinical presentation of bronchiectasis?
- persistent production of large volumes of secretions - frequent hemoptysis - recurrent infections
56
restrictive lung disease involves the... (3)
thorax rib cage spine *lots of causes (infections, neuromuscular, MSK, cancer, etc...)
57
in restrictive lung disease, all lung volumes are ___ and the work of breathing is _____
decreased increased
58
T or F: those with restrictive lung diseases have decreased respiratory rate. why or why not?
F: increased RR to overcome decreased pulmonary compliance
59
what pediatric disorder may you see restrictive lung disease with
muscular dystrophy
60
6 classic signs of restrictive lung dysfunction
1 - tachypnea 2 - hypoxemia 3 - dry inspiratory crackles 4 - decreased breath sounds 5 - decreased lung volumes 6 - cor pulmonale "the hungry, drowsy dinosaur cried" (combine decreased breath sounds and lung volums)
61
3 hallmark symptoms of restrictive lung dysfunction
1 - dyspnea 2 - dry and non-productive cough 3 - wasted, emaciated appearance
62
idiopathic pulmonary fibrosis is a ______ lung disease
interstitial
63
how is idiopathic pulmonary fibrosis characterized
chronic, progressive inflammation that causes progressive scarring or thickening of tissues between the lungs alveoli
64
when is idiopathic pulmonary fibrosis typically diagnosed? what is the mean survival?
40-70 years old 2-3 years
65
is idiopathic pulmonary fibrosis more common in men or women
men
66
how does idiopathic pulmonary fibrosis present clinically?
hypoxia
67
what is the treatment for idiopathic pulmonary fibrosis
- corticosteroids - cytotoxic drugs - lung transplantation - antifibrotic meds
68
what do you see on a CT scan with idiopathic pulmonary fibrosis
honeycombing
69
obstructive sleep apnea
recurrent, temporary cessation of ventilation during sleep
70
what is obstructive sleep apnea commonly due to
occlusion of upper airway
71
what are some conditions sleep apnea is associated with (3)
- obesity - nasal obstruction - large tonsils/adenoids
72
hallmark signs of sleep apnea
snoring and daytime somnolence
73
what position do pts with sleep apnea typically avoid
lying flat
74
how is sleep apnea diagnosed? how is it treated
- diagnosed with sleep study - treated with lifestyle changes and CPAP
75
what is the long term consequence of sleep apnea
- chronic pulmonary hypertension - a-fib
76
occupational lung diseases result from...
- inhalation of inorganic dusts, organic particles, and industrial gases, fumes, and smoke (asbestos, 9/11, coal miners, construction)
77
what does occupational lung disease lead to?
scarring and pulmonary fibrosis due to a chronic inflammatory process
78
what is the leading cause of cancer related deaths in the US
lung cancer
79
what are the majority of lung cancer cases due to
smoking
80
T or F: lung cancer can be primary or secondary
T
81
2 types of lung cancer
small cell non-small cell
82
where does small cell lung cancer start
bronchi and then spreads quickly throughout the body
83
what is the leading cause of cancer deaths worldwide
non-small cell lung cancer
84
what are some common metastasis sites of lung cancer
brain, bone, liver, adrenal gland
85
symptoms of lung cancer
- dyspnea - persistent non-productive cough - hemoptysis - weight loss
86
treatments for lung cancer
surgery, radiation, chemotherapy
87
T or F: the majority of patients with small cell cancer are metastatic at time of dx
T: generally inoperable
88
measures for obstructive vs restrictive lung diseases
obstructive = flow rates restrictive = volumes or capacities
89
anatomy affected for obstructive vs restrictive lung disease
obstructive = airways restrictive = lung parenchyma, thoracic pump
90
pathophysiology for obstructive vs restrictive lung disease
obstructive = increased airway resistance restrictive = decreased lung or thoracic compliance
91
atelectasis
collapse of normally expanded and areated tissue at any structual level (partially collapsed lung)
92
what is the primary cause of atelectasis? what are other causes?
primary = obstruction of bronchus others = hypoventilation (post-op, paralysis, over sedation, mass in thorax), decreased surfactant
93
S/S of atelectasis
- rapid shallow breathing - wheezing - coughing - dyspnea or respiratory failure - hypoxemia - pleuritic chest pain
94
how to diagnose atelectasis
chest x-ray
95
treatment for atelectasis
- deep breathing/coughing - treating the cause
96
where does the trachea deviate with atelectasis? what happens to the diaphragm
- trachea deviates towards the collapsed side - ipsilateral diaphragm elevation
97
acute bronchitis
contagious viral infection causing inflammation of trachea and bronchial tubes and increased mucus production *common cold
98
Sx of acute bronchitis
- dyspnea - wheezing - low fever - chest tightness - productive cough
99
pneumonia
- acute inflammation of lungs - bronchioles and alveoli become plugged with fibrotic exudate
100
3 types of pneumonia
viral, bacterial, aspiration
101
sx of pneumonia
- fever - productive cough and yellow/green/rust colored sputum - increased fatigue - dyspnea, tachycardia, tachypnea, and hypoxemia
102
T or F: pneumonia can cause issues with cognition
T: similar to UTI - change in mental status, increased falls, incontinence
103
T or F: hospital acquired pneumonia is the 1st leading cause of noscomial infections
F: UTI is the first pneumonia is the second
104
if your patient has aspiration precautions the HOB should remain elevated to greater than ______ degrees
30 *may also need thickened liquids
105
pleural effusion
excessive collection of fluid between the parietal and visceral pleura
106
what are symptoms of pleural effusion
dyspnea, cough, pleuritic chest pain
107
how is pleural effusion treated (3)
thoracentesis pigtail catheter chest tube
108
empyema
pus in the pleural cavity
109
what could empyema result from
pleural effusion
110
treatment for pleural empyema
drainage and antibiotics
111
pulmonary edema is typically due to...
heart failure
112
pulmonary edema
fluid in the air sacs and bronchioles
113
how do those with pulmonary edema present
dyspnea, tachypnea, crackles eventually hypoxemia > respiratory distress > respiratory failure
114
how is pulmonary edema treated
- diuretics - meds to support cardiac function/BP - corticosteroids to decrease inflammation
115
acute respiratory distress syndrome (ARDS)
- respiratory failure following a disease/pulmonary insult - diffuse alveolar damage (inactivates surfactant) - pulmonary edema
116
how is ARDS treated
supplemental O2 (CPAP, mechanical vent)
117
pneumothorax
air in the pleural cavity between parietal and visceral pleura
118
5 types of pneumothorax
1: primary - spontaneous (young, tall, thin men) 2: secondary - associated with disease 3:iatrogenic - complication from procedure 4: traumatic - stabbing, rib fx 5: tension - life threatening... air enters pleural space and can't escape, progressive collapse
119
with pneumothorax which air way does the trachea and mediastinum shift
AWAY from the collapsed side
120
Sx of pneumothorax
acute dyspnea, pleuritic chest pain
121
what is the 3rd leading cardiovascular death
pulmonary embolism
122
pulmonary embolisms are closed linked to the presence of...
DVT
123
s/s of PE
- sudden dyspnea - pleuritic chest pain - tachypnea - hemoptysis - tachycardia - decreased breath sounds
124
what are some major risk factors for PE
- previous DVT or PE - major trauma - SCI - LE ortho surgery - oral contraceptives
125
How is TB diagnosed
- purified protein derivative test - chest x-ray - blood work
126
what kind of precautions for TB
airborne
127
s/s of active TB
- cough longer than 3 weeks - coughing up blood - chest pain - weight loss - loss of appetite, fever, chills, fatigue, night sweats
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