patho midterm 2 (acute//chronic resp + neuro)

pulmonary system functions 3

1. Ventilation of the alveoli w/ air
2. Diffusion of gases into and out of the blood (co2 and o2)
3. Perfusion of the lungs to allow organs and tissues of the
body receive blood that is rich in oxygen and low in carbon
dioxide

pleura 2

• visceral » surrounds lungs (INNER)

• parietal » lines chest cavity

SPACE INBETWEEN IS PLEURAL SPACE - has some fluid so lungs can comfortably expand

signs of increased work of breathing

• nasal flairing

• indrawing - intercostal and clavicular muscles go INWARDS

both common in peds

• abdo muscle use

• pursed lip breathing - will actually reduce workload

VQ mismatch

• V = VENTILATION - Air into lungs

• Q = PERF - blood flow to alveolar CAP

Vent to lungs/ min over perf to lungs /min

• Rule 1 » Perfusion is Gravity Dependent - IF BLOCKED VENTILATE THE SIDE OF THE GOOD LUNG

• Rule 2» Match Good Ventilation to Good Perfusion

IF HIGH OR LOW ALWAYS LOOK AT V

LOW VQ

• low vent, normal perf » blockage of air coming into lungs, cap perf is normal

• Pneumonia, asthma, bronch COPD, etc

• SHUNT » perforation of alveoli with 0 ventilation

High VQ

• normal vent, low perf

• air flowing into alveoli, but capillarys arent able to recieve o2 - BLOCKAGE OF BLOOD IN PULMONARY ARTERIES

• PE, Pulmonar HTN, emphasemic COPD -

• Dead space » vent of alveoli with 0 PERF
  
  

hypoxemia vs hypoxia

• hypoxemia » low o2 TO BLOOD

• hypoxia » low o2 to PERIPH tissues + organs (ex. o2 sat to finger)

ABG calculation steps

1. PH

2. ROME - resp = opposite, metabolic = same (PH → CO2 vs PH → hco3)

3. compensation (body will comp with opposite system

- fully comp » PH normal but CO₂ and HCO₃ abnormal.

- partial comp » pH abnormal AND both CO₂ and HCO₃ abnormal.

- uncomp »PH abnormal and only one of CO₂ or HCO₃ abnormal

Ph range

7.35-7.45

• too low = ACIDIC

• too high = ALKALOTIC

pco2

35-45

• IF YOU KNOW PH YOU CAN KNOW co2

• low = ALKALOTIC

• high = ACIDOTIC

po2 range

70-100

• <70 = hypoxemia

• ACCEPTABLE PERCENTAGE GRADE RANGE

bicarb range

22-26 - ACTS AS BUFFER

• low = ACIDOTIC

• high = ALKALOTIC

atelectasis overview

aspiration overview

• foreign material - typically food enters lungs

• airway obstruction inflammation injury or infection

• commonly due to dsyphagia » elderly pop, peds, post op and neurological issues GERD

• can follow infectios process - fever, chills WBC SOB

• hearing crackles wheezez rhonchi or diminished breath sounds

• prevent with swallowing assessments, upright positioning during meals, proper oral hygiene &
  feeding techniques, elevated HOB

atelectasis overview

• collapse of alveoli

• common in recent surge, bed rest obesity, immobility airway obstruction, hypoventillation

• SOB, chest tightness, tachypnea, tachy decreased o2 sat

• diminished or absent breath sounds,

• prevent with incentive spiro, deep breathing and coughing, early ambulation and adequate pain management

pneumothorax general

• AIR in pleural space resulting in collapsed lung (partial or complete

• can be open closed or tension

- closed » no external wound

- open » air enters through chest wall opening

- tension » SERIOUS, open pneumo with RAPID air accumulation ↑↑ pressure

pneumothorax HTT

• Inspection» Unequal chest expansion, tachypnea, cyanosis, apprehension,

• Palpation: Subcutaneous emphysema, crepitus, chest expansion decreased on affected side,
  tachycardia, and decreased blood pressure.

• Percussion: Hyper-resonant DUE TO AIR

• Auscultation: Breath sounds decreased or absent, voice sounds decreased or absent.

tension pneumo SS

• SIGNS WILL BE SAME AS REST OF ASSESSMENT IN ADDITION TO

• Tracheal shift to opposite side (unaffected side), severe respiratory distress, tachycardia and hypotension

hemothorax vs chylothorax

• hemothorax » BLOOD in pleural space » PE, trauma, cancer

• chylothorax» LYMPHATIC fluid in pleural space, white or light pink - trauma, surge, cancer

pleural effusions - general 3

FLUID BUILDUP IN PLEURAL SPACE (like pericarditis of lungs)

• exudative » FLUID AND CELLS FROM INFECTION - pulmonary cancer, infection PE

• transudative » PRESSURE CHANGE FROM BLOODSTREAM - common in CHF or cirrhosis

• empyema » PUS - creamy green or yellow, common with TB pneumonia or abcess

pleural effusion HTT

• Inspection: Unequal chest expansion, tachypnea, increased WOB, accessory muscle use.

• Palpation: chest expansion decreased on affected side

• Auscultation: Breath sounds decreased or absent over fluid, pleural rub

• Percussion: Dullness over fluid.

diagnostics (effusion and chest wall disorders)

• xray » air or fluid confirmation, chest tube placement

• CT» better imaging

• thoracentesis » colour characterstics and PH of fluid, allows for Culture and sensistivity

labs

• CBC

• CRP/ESR

• ABG

• BNP and LFT

planning + interventions

• lung assessment and expansion

• o2 as prescribed

• monitor o2 rest status lung sounds

• high fowlers + encourage resp

• monitor for complications

Chest tube care

• Patient assessment » RR, depth, effort Breath sounds, symmetry and expansion

• Dressing – dry, drainage, secured (3 SIDES NOT 4 IN EMERGENCY), anchor intact, no redness or emphysema

• drainage//system » no leaks or tubing issues, colour consistency and amount of drainage, suction and emergency equip present

• Patient teaching » Ambulation, DB&C exercises, splinting Chest tube safety Symptoms to report immediately?

- tracheal shift, SOB low sats, increase work of breathing