Adults Module 2 Pulmonary Conditions

ARDS

Acute respiratory distress syndrome; caused by acute/chronic lung inflammation or injury

ARDS lung injury types

Direct (vaping, infection) and indirect (blunt trauma)

ARDS mortality

Death can occur as fast as 48 hours after onset

ARDS assessment findings

Crackles, worsening hypoxia, retractions, tachycardia

ARDS monitoring

Serial blood gases and chest x-rays to trend progression

ARDS treatment goal

Reduce metabolic demand via pain/fever control, adequate oxygenation/ventilation

ARDS fluid management

Judicious fluids to prevent pulmonary edema

Acute respiratory failure causes

Obstructive or infectious disease (COPD, bronchitis, pneumonia, PE, flu, COVID-19, RSV)

Acute respiratory failure treatment

Oxygenation management, prevent acidosis, fluid/electrolyte monitoring

Asthma

Reactive airway/chronic inflammatory disease with reversible airflow obstruction

Asthma triggers

Allergens, irritants, exercise, cold air, infections, stress

Asthma classic symptoms

Nighttime cough, wheezing, chest tightness, dyspnea

Asthma pathophysiology

Inflammation, bronchoconstriction, mucus production, airway hyperresponsiveness

Extrinsic asthma

Allergic asthma; IgE mediated, type I hypersensitivity

Allergic triad

Asthma, atopic dermatitis (eczema), allergic rhinitis

Intrinsic asthma

Non-allergic asthma; triggered by infection, exercise, cold air, stress, irritants

Airway remodeling

Smooth muscle hypertrophy, goblet cell hyperplasia, subepithelial fibrosis

Airway hyperresponsiveness

Exaggerated bronchoconstrictor response to nonspecific stimuli

Peak flow meter

Device measuring peak expiratory flow rate (PEFR)

Peak flow green zone

80-100% personal best; well controlled, no changes needed

Peak flow yellow zone

50-79% personal best; caution, worsening control, use action plan

Peak flow red zone

Below 50% personal best; medical emergency, seek help

SABA

Short-acting beta2 agonist (albuterol); rescue inhaler for acute symptoms

LABA

Long-acting beta2 agonist (salmeterol, formoterol); maintenance, not for acute attacks

Beta2 agonist mechanism

Binds beta2 receptors, relaxes airway smooth muscle, bronchodilation

Beta2 agonist side effects

Tachycardia, tremors, palpitations, nervousness, hypokalemia

Anticholinergic bronchodilators

Block acetylcholine, relax airway smooth muscle (ipratropium, tiotropium)

SAMA example

Ipratropium bromide (short acting anticholinergic)

LAMA example

Tiotropium (long acting anticholinergic, not for acute attacks)

Anticholinergic side effects

Dry mouth, throat irritation, cough, urinary retention

Anticholinergic caution

Narrow angle glaucoma, BPH, urinary retention

Theophylline

Bronchodilator with narrow therapeutic index (10-20 mcg/dL)

Theophylline toxicity signs

Tachycardia, nausea, vomiting, seizures, arrhythmias

Theophylline interaction

Caffeine increases toxicity risk

Corticosteroids mechanism

Anti-inflammatory; suppress inflammatory cells and cytokines

Corticosteroid route for asthma/COPD

Inhaled preferred for long-term maintenance

Corticosteroid inhaler teaching

Rinse mouth after use to prevent thrush (candidiasis)

Bronchodilator + steroid order

Give bronchodilator first, wait 5 minutes, then steroid

Corticosteroid side effects

Hyperglycemia, osteoporosis, immunosuppression, weight gain, cataracts

Corticosteroid tapering

Never stop abruptly; taper slowly

Leukotriene receptor antagonist

Blocks leukotrienes; reduces inflammation, bronchoconstriction, mucus (montelukast)

Leukotriene antagonist use

Long-term control, not for acute attacks; oral once daily

Leukotriene antagonist side effects

Headache, nausea, vomiting, diarrhea, myalgia; monitor liver function

Metered dose inhaler (MDI)

Delivers aerosolized medication via propellant; spacer aids delivery

Dry powder inhaler (DPI)

Delivers powdered medication; requires strong fast inhalation

Nebulizer

Converts liquid medication to mist inhaled over 5-15 minutes

Inhaler spacing rule (different meds)

Wait 5 minutes between different inhaler types

Inhaler spacing rule (same med)

Wait 1-2 minutes between doses of same inhaler

COPD

Chronic obstructive pulmonary disease; progressive airflow limitation, not fully reversible

COPD umbrella

Includes emphysema and chronic bronchitis

COPD gas exchange

Increased CO2, decreased O2; hypoxic drive to breathe

COPD risk factors

Smoking, occupational dust/chemicals, air pollution, alpha-1 antitrypsin deficiency

Alpha-1 antitrypsin deficiency

Genetic cause of early-onset COPD/emphysema; alveolar wall destruction

COPD complications

Pulmonary hypertension, cor pulmonale (right-sided heart failure)

Emphysema

Destruction of alveolar walls, loss of elasticity, decreased surface area for gas exchange

Emphysema body type

"Pink puffer" - thin, barrel chest, severe dyspnea

Emphysema hallmark

Air trapping, alveolar collapse, hyperinflation

Chronic bronchitis

Chronic inflammation of bronchial tubes with excessive mucus production

Chronic bronchitis diagnostic criteria

Productive cough for 3+ months in 2 consecutive years

Chronic bronchitis body type

"Blue bloater" - obese, cyanotic, hypoxemic

Polycythemia in COPD

Overproduction of erythropoietin from chronic hypoxia; elevated hemoglobin but poor O2 saturation

COPD treatment

Bronchodilators, inhaled corticosteroids, PDE-4 inhibitors, mucolytics, pulmonary rehab, oxygen, vaccines

COPD severe treatment

Lung transplant or lung volume reduction surgery

COPD exacerbation treatment

Antibiotics for acute exacerbations

Pneumonia

Infection of pulmonary tissue from bacteria, viruses, or fungi

Community-acquired pneumonia (CAP)

Occurs outside hospital/healthcare facility setting

Healthcare-associated pneumonia (HCAP)

Develops 48+ hours after hospitalization or in healthcare settings

Common bacterial pneumonia cause

Streptococcus pneumoniae

Pneumonia symptoms

Cough, fever, chills, chest pain, dyspnea, sputum production

Pneumonia diagnosis

Chest x-ray/CT, sputum culture, blood culture

Pneumonia treatment

Antibiotics (bacterial), antivirals (viral), supportive care, oxygen

Atelectasis

Collapse/closure of alveoli reducing gas exchange

Atelectasis causes

Immobility, shallow breathing, mucus plug, pleural effusion, pneumothorax

Atelectasis prevention

Incentive spirometer, deep breathing, early mobilization, coughing

Pulmonary embolism (PE)

Clot obstructing pulmonary artery, usually from DVT

PE risk factors

Immobility, surgery, trauma, cancer, pregnancy, oral contraceptives, obesity

PE symptoms

Sudden dyspnea, pleuritic chest pain, tachycardia, tachypnea, hypoxemia

PE classic warning sign

Sense of impending doom

PE priority intervention

Optimize oxygenation; position High Fowler's/semi-Fowler's (not Trendelenburg)

PE ongoing treatment

Anticoagulation and supportive care

Venous air embolism positioning

Durant maneuver: left side-lying, head down (Trendelenburg)

Tension pneumothorax

Air in pleural space collapsing lung, putting pressure on heart; medical emergency

Tension pneumothorax classic finding

Tracheal deviation

Tension pneumothorax treatment

Needle decompression

Pneumothorax types

Spontaneous (e.g. Marfan's) or traumatic (penetrating trauma)

Traumatic pneumothorax treatment

Chest tube placement

Asthma acute management

Oxygen, IV/oral steroids, albuterol, IV fluids; intubation last resort

Asthma inhaler education

Fast-acting sympathomimetics for exacerbations, inhaled steroids for maintenance

Breathing exercise benefit

Stress reduction and improved oxygenation/ventilation