Patho Ch 28 - Pulmonary

Pathophysiology chapter 28 - Alterations in Pulmonary Function

subjective sensation of uncomfortable breathing - “shortness of breath” or “difficulty breathing”

dyspnea

dyspnea when laying down

orthopnea

violent attacks of severe shortness of breath and coughing, generally occurs at night and wakes an individual from sleep

paroxysmal nocturnal dyspnea (PND)

dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), clubbing, and cyanosis are all signs and symptoms of what

pulmonary dysfunction

a physical examination test used to detect nail clubbing by placing corresponding nail beds back to back

schamroth’s sign/window test

protective reflex to clear the airway via an explosive expiration - increasing intra-thoracic and intra-abdominal pressure designed to expel foreign material

cough

an acute cough is resolved within _____

2 weeks

a chronic cough persists _____

beyond 3 weeks

bloody sputum is described as _____

hemoptysis

coughing that produces sputum is described as _____

productive

a dry cough or coughing that produces no sputum is described as _____

non-productive

blood-streaked sputum indicates =

inflammation

pink, frothy sputum indicates =

left sided heart failure

blood with massive amounts of blood indicates =

TB or cancer

sputum with a yellowish color or purulent (pus) indicates =

bacterial pneumonia

normal breathing rate and pattern

eupnea

increased respiratory rate

tachypnea

decreased respiratory rate

bradypnea

normal breathing rate, but with deep respirations

hyperpnea

gradual increases and decreases in respirations with periods of apnea

cheyne-strokes

rapid, deep respirations (gasps) with short pauses between sets

biot’s

tachypnea (increased rate) and hyperpnea (deep breaths)

kussmaul’s

prolonged inspiratory phase with shortened expiratory phase

apneustic

what can cause tachypnea?

fever, anxiety, exercise, shock

what can cause bradypnea?

sleep, drugs, metabolic disorder, head injury, stroke

absence of breathing

apnea

what can cause apnea?

death, head injury, stroke

what can cause hyperpnea?

emotional stress, diabetic ketoacidosis

what can cause cheyne-strokes?

increasing intracranial pressure, brain stem injury

what can cause Biot’s breathing?

spinal meningitis, head injury, many CNS causes

what can cause Kussmaul’s breathing?

renal failure, metabolic acidosis, diabetic ketoacidosis

what can cause apneustic breathing?

lesion in brain stem

the respiratory center is located where in the CNS?

medulla oblongata

respirations: tachy/brady refer to _____ of breath, whereas hyper/hypo refer to _____ of breath

rate, depth

tachypnea range =

more than 20 bpm

respiratory rate is measured in _____

breaths per minute (bpm)

bradypnea range =

less than 10 bpm

a state of having excess or too much carbon dioxide in the blood (hypercapnia) is caused by what type of breathing

hypoventilation

a state of having reduced or not enough carbon dioxide in the blood (hypocapnia) is caused by what type of breathing

hyperventilation

normal breathing rate and range =

12 bpm, range 10-20 bpm

hypoventilation implies what kind of breathing

shallow breaths

hyperventilation implies what kind of breathing

deep breaths

adventitious breath sounds include

crackles/rales, wheezes, rhonchi

abnormal sounds heard during auscultation of the lungs, in addition to normal breath sounds

adventitious breath sounds

type of adventitious breathing sound where fine or coarse crackles can be heard

crackles/rales

type of adventitious breathing sound where a low-pitched rumbly/snoring noise can be heard, suggests secretions such as mucus or fluid in the large airways

rhonchi

type of adventitious breathing sound where air flowing through a narrow passage can be heard

wheezes

a condition where air leaks into the space between the lung and the chest wall (pleural space/cavity), causing the lung to collapse partially or fully

pneumothorax

the parietal pleura lines the _____, whereas the visceral pleura lines the _____

thoracic cavity, lungs

the _____ acts like glue, holding the chest wall and the lungs together & pulling them with one another

pleural fluid

a pneumothorax that is not caused by prior or underlying lung disease or trauma (can be caused by chronic coughing)

spontaneous (primary) pneumothorax

a pneumothorax that is caused by prior or underlying lung disease

secondary pneumothorax

a pneumothorax caused by some form of trauma, can be iatrogenic (ex. thoracentesis) or due to a blunt/penetrating accident (ex. stab wound or car crash)

traumatic pneumothorax

A more severe pneumothorax where air enters the pleural space but cannot escape, creating a one-way valve effect and leading to a buildup of pressure. a consequence of a regular pneumothorax.

tension pneumothorax

a common complication of a tension pneumothorax where the mediastinum shifts away from the affected side due to the increasing pressure in the pleural space

mediastinal shift

sudden pleural pain, tachypnea, dyspnea, hypoxemia, tracheal deviation away from affected lung, hypotension - all clinical manifestations of what

pneumothorax

laser/welding, pleurodesis, chest tube, surgery, and talcum powder are all treatments/interventions for what

pneumothorax

a category of lung disease wherein the lungs are restricted from fully expanding, the air has trouble entering the lungs. includes conditions like stiffness of the lungs, stiffness of the chest wall, weak muscles, or damaged nerves that may cause this disorder

restrictive pulmonary disorder

a category of lung disease wherein it is hard to fully exhale, the air in the lungs has a hard time escaping. includes conditions in which there is damage to the lungs or narrowing of the airways, exhaled air comes out slower than normal

obstructive pulmonary disorder

atelectasis, fluid (edema, pus, blood), acute resp. distress syndrome (ARDS), trauma, autoimmune, occupational (asbestos, coal), environment (fire smoke, dust), infection (TB) - can cause what category of lung disease

parenchymal restrictive

diseases such as obesity and scoliosis can cause what category of lung disease

extra pulmonary restrictive

diseases such as myasthenia gravis and amyotrophic lateral sclerosis (ALS) can cause what category of lung disease

neuromuscular restrictive

a lung disorder characterized by inflammation, disease and/or scarring (fibrosis) of the lung tissue, causing impaired breathing characterized by difficulty expanding the lungs or decreased lung volume

parenchymal restrictive lung disease

a lung condition where the lungs' ability to expand is restricted due to issues outside the lungs themselves

extra pulmonary restrictive lung disease

breathing difficulties arising from weakness or dysfunction of the muscles involved in breathing, such as the diaphragm and intercostal muscles, can be due to muscles themselves or because of denervation/impaired nerve function

neuromuscular restrictive lung disease

a condition where the individual alveoli collapse which can then cause total/partial lung collapse, “a condition where one or more areas of your lungs collapse or don't inflate properly”. alveoli become airless, inability of lungs to expand

atelectasis

the most common cause of atelectasis is =

after general anesthesia surgery

the other causes of restrictive atelectasis include =

compression and surfactant deficiency

surfactant deficiency causing restrictive atelectasis is more commonly observed in what demographic

premature neonates

valvular dysfunction, coronary artery disease, left ventricular dysfunction, ARDS, inhalation injury, surgery, tumors, and fibrosis are all conditions/events that can cause what

pulmonary edema

a condition where fluid builds up in the lungs, making it difficult to breathe

pulmonary edema

pneumothorax vs atelectasis: in a pneumothorax, the issue is with the _____. in atelectasis, the issue is with the _____.

pleural space, lung tissue (alveoli)

an acute lung injury accompanied by an inflammatory response in the alveolocapillary membrane. multiple organ dysfunction and failure. most severe form of acute lung injury

acute respiratory distress syndrome (ARDS)

what is the most severe form of acute lung injury - might lead to multiple organ dysfunction or failure?

acute respiratory distress syndrome (ARDS)

dyspnea and hypoxia, hyperventilation, decreased tissue perfusion, increased work of breathing, respiratory failure, decreased cardiac output, hypotension, death - all signs and symptoms of what

ARDS

treatments for acute respiratory distress syndrome (ARDS) include what

treat underlying cause, supportive therapy

greater strain on accessory breathing muscles, increased work of breathing, ventilation-perfusion mismatch, decreased forced expiratory volume, dyspnea and wheezing (usually on exhalation) are all signs/symptoms associated with

obstructive lung diseases

obstructive lung diseases discussed include =

asthma, COPD (emphysema & chronic bronchitis)

restrictive vs obstructive lung disease: in restrictive lung diseases, the air has a hard time getting _____, whereas in obstructive lung diseases, the air has a hard time getting _____

in, out

acute, reversible airway obstruction (no damage to the lung tissue), type I hypersensitivity, prevalent chronic disease in childhood with the possibility for growing out of it, multifactorial: genetics & environmental - cough, marked dyspnea, wheezing, rapid and labored breathing, nasal flaring, use of accessory muscles, exercise intolerance - all describe what obstructive lung disease

asthma

what happens during an asthmatic attack?

airways narrow, lining swells, mucosal edema

a condition characterized by persistent airflow limitation or obstruction, causes irreversible and progressive damage to the lungs. most common chronic lung disease in the world.

chronic obstructive pulmonary disease (COPD)

what is the most common chronic lung disease in the world

COPD

COPD risk factors include =

cigarette smoking, air pollution, genetics

COPD diseases include =

chronic bronchitis, emphysema

hypersecretion of mucus and chronic productive cough that lasts for at least 3 consecutive months of the year and at least 2 consecutive years - strict criteria for diagnosing _____

chronic bronchitis

mucosa inflamed and swollen, hypertrophy and hyperplasia of mucous glands, fibrosis and thickening of bronchial wall - pathophysiology of what disease

chronic bronchitis

the most common cause of COPD (emphysema and chronic bronchitis) is what

smoking cigarettes

abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis, loss of elastic recoil, loss of pulmonary capillaries, loss of surface area for gas exchange, air gets trapped in the alveoli, altered ventilation-perfusion ratio, decreased support for other structures = what disease

emphysema

inherited emphysema is caused by what

alpha-1 antitrypsin deficiency

what age does inherited emphysema typically start showing signs/symtpoms?

25-30

a protein produced in the liver that protects the lungs and liver from damage. It acts as a protease inhibitor, meaning it regulates enzymes (proteases) that can break down tissues, especially in the lungs

alpha-1 antitrypsin

exertional dyspnea, increased shortness of breath, hyperventilation with prolonged expiratory phase, development of a “barrel chest”, anorexia and fatigue, weight loss, clubbed fingers - clinical manifestations of what disease

emphysema

the formal diagnosis for emphysema is what

spirometry

forced expiration volume in 1 second over forced vital capacity (FEV1/FVC) is a spirometry test used to diagnose emphysema. what is the diagnostic value for this test

less than 70%

there is no treatment or cure for _____. the best recommendation for this condition is smoking cessation, and patient education in order to prevent flare-ups or aggravation/progression of the disease. other treatments include oxygen therapy and lung transplant.

COPD

COPD diseases: productive cough, overweight and cyanotic, peripheral edema, rhonchi and wheezing is consistent with _____. older and thin, severe dyspnea, enlargement and destruction of lung tissue is consistent with _____.

chronic bronchitis, emphysema

any infection of the lung tissue (parenchyma) of the lower respiratory tract, alveoli is filled with fluid and pus. causative agent can be viral or bacterial

pneumonia

difference in presentation between pneumonia types: typical pneumonia often presents with =

fever, productive cough, chills/rigors

pneumonia types =

community acquired and nosocomial