Exam 3 - Disorders

Intrinsic asthma

non-allergic constriction of bronchioles that commonly develops in middle adulthood

Common triggers: exercise, stress, pulmonary irritant

extrinsic asthma

caused by allergic reaction that is commonly associated wiht children and associated with hay fever and eczema or positive family hx or skin allergen test

manifestations of asthma

• Wheezing, tightness of chest, dyspnea, increased sputum production, dry or productive cough

• Severe attacks

  • Requires the use of accessory muscles and intercostals

  • Inspiratory wheezing or orthopnea, agitation, tachypnea, tachycardia

  • Cyanotic, irritated, restless, confused

  • PEFR (peak Expiratory Flow Rate) <80L/min = severe obstruction

Status asthmaticus

severe failure to respond to inhaled bronchodilators; need immediate intervention

acute bronchitis

inflammation of bronchial tubes/trachea due to viral infection

manifestations of acute bronchitis

Mild/self-limiting cough, low-grade fever, substernal chest discomfort, sore throat, postnasal drip, fatigue

chronic bronchitis

Type B COPD

chronic bronchitis

inflammatory disorder from long-term cigarette smoking

chronic bronchitis

• Productive cough that lasts 3+ months for 2+ consecutive years

• Irreversible damage due to ongoing inflammation, excessive mucous production, and persistent cough

manifestations of chronic bonchotitis

• SOB on exertion, excessive sputum, chronic cough, excess body fluids, cyanosis

• Overweight (30-40lbs)

• Blue bloater (edema plethora) - cyanotic appearance and bloating due to hypoxia and fluid retention

emphysema

Type A COPD

emphysema

destructive changes to alveolar wall of lung due to enlargement of distal air sacs causing air trapping and hyperinflation, loss of elastic recoil, making expiration difficult

centrarinar (centrilobular) emphysema

destroys bronchioles

panacinar (panlobular) emphysema

destroys alveoli

paraseptal emphysea

affect peripheral lobules

manifestation of emphysema

• Progressive exertional dyspnea, thin, 55+ year old

• Increased SOB, difficulty breathing

• Digital clubbing - fibrous tissue hyperplasia between nail and finger due to prolonged deoxygenation

• Barrel chest = AP:Transverse = 1:1 due to air trapping

  • Pink puffer - use of accessory muscles to breathe

  • Pursed-lip breathing, minimal/absent cough, leaning forward to breath, DOE

cystic fibrosis

autosomal recessive disorder affecting exocrine glands and causing thick secretions lacking water and chloride that results in airway obstruction, atelectasis, airway trapping

manifestations of cystic fibrosis

• Hypersecretion of abnormally think mucous that obstructs exocrine glands/ducts

• Cough, thick sputum, recurrent pulmonary infections with bronchitis, progression to pneumonia, bronchiectasis and r-sided HF

• Digital clubbing, dyspnea, tachypnea, sternal retraction, unequal breath sounds, most basilar crackles, barrel chest

Acute Respiratory Distress Syndrome (ARDS)

acute condition leading to restrictive patterns characterized by damaged alveolar-capillary membranes and a decline in arterial PaO2 → causing need of supplemental O2

aspiration or trauma

direct pathogenesis of ARDS

shock or sepsis

indirect pathogenesis of ARDS

manifestations of ARDS

• Crackles on auscultation

• Use of accessory muscles (intercostal and sternal retraction)

• Tachycardia, tachypnea, restlessness, AMS, forty sputum, cyanosis

spontaneous pneumothorax

air accumulating in pleural space to create pressure and force the collapse of lung

primary spontaneous pneumothorax

lung collapse without underlying cause (disease or injury)

Secondary spontaneous pneumothorax

lung collapse due to complication of other condition

Ex: asthma, emphysema, cystic fibrosis

tension pneumothorax

buildup of air in pleural space to cause pressure to lungs due to inability of air to escape following inspiration

manifestations of pneumothorax

Severe dyspnea, tachycardia, vein distention, decreased/absent breath sounds, tracheal deviation

mediastinal shift

key manifestation of tension pneumothorax

pleural effusions

accumulations of fluid in pleural space

transudates

pleural effusions with clear, pale yellow fluid

Causes: HF, cirrhosis, nephrotic syndrome

exudates

pleural effusions due to inflammation

Causes: cancer, infection, pulmonary embolism

empyema

pleural effusions with purulent buildup caused by infection in pleural space

Causes: pneumonia, TB, lung abscess

Hemothorax/Hemorrhagic

blood trapped in the pleural space

Causes: trauma

Chylothorax/lymphatic

pleural effusions with milky white lymphatic fluid

Causes: thoracic duct disruption

Manifestations

• Dyspnea, pleuritic pain that is sharp and worsen w/ inspiration, absence of breath sounds

Guillain-barre syndrome

demyelination of peripheral nerves causing weak respiratory muscle with unknown cause (potentially viral infection)

manifestation of guillain-barre syndrome

progressive weakness, loss of motor function (start at feet and lungs and go up)

myasthenia gravis

weakness and fatigue of voluntary muscles in peripheral/respiratory muscles caused by uterine B-cell and T-cell components attack neuromuscular junction

manifestations of myasthenia gravis

weakness and fatigue that is worsened with exercise

flail chest

decreased lung expansion during inspiration due to multiple rib fx or fx at two distant sites to cause physical restriction

Manifestation of flail chest

Trauma, paradoxical motion of chest wall, SOB, cyanosis, HTN, hypoxia, low arterial O2, pneumothorax, hemothorax, subQ emphysema

paradoxical breathing

Move in during inspiration and out during expiration

pneumonia

inflammation of the alveoli and interstitium of lung due to infectious agent

manifestations of pneumonia

• Viral = upper repertory infection and wheezing/rales

• Bacterial = crackles/bronchial sounds, chills, cough, purulent sputum, abnormal chest radiograph