Patho Pulmonary Module

Lung conditions

Flail Chest 

3 or more ribs broken in 2+ places

Inspiration —> Rib cage piece collapses in

Expiration —> Rib cage piece flails out

Flail Chest S&S

Paradoxical breathing

Pain

Bruising

Dyspnea

Pneumothorax - Cause

Collapsed lung due to negative pressure vacuum in pleural cavity disrupted + air enters

Traumatic pneumothorax

Shot or stabbed so pleural cavity is punctured

Spontaneous pneumothorax

Collapsed lung due to…

Primary risk: <30 thin male, smoker, atmospheric changes

Secondary risk: diseased lung tissue (COPD, Cancer, asthma)

Pneumothorax S&S

Dyspnea

Chest aches

Chest tightness

Cyanosis

Tachycardia

Absent breath sounds where collapse occured

Tension Pneumothorax

Collapsed lung where trapped air causes mediastinal shift —> heart, blood vessels, trachea shift towards uninjured side

Decreased preload in heart and BP drops

Pleural Effusion

Excess fluid in pleural space

Diagnosed with thoracentesis

S&S dyspnea, cough, pain on INSPIRATION, fever, difficulty deep breathing

Transudate Effusion

Clear, low protein, no cells effusion

Non-inflammatory

D/t: congestive heart failure, cirrhosis, nephrotic syndrome, peritoneal disease, salt and fluid retention

Exudative Effusion

Cloudy, thick, high protein, cells present effusion

Inflammatory

Blood, bacteria, WBCs may be present

D/t: infections, cancer, connective tissue disease, inflammatory disorder, coronary bypass surgery, pulmonary embolism

Empyema

Collection of pus in pleuritic space d/t infection

Atelectasis Cause

Reduced alveolar ventilation OR air inside alveolus gets absorbed —> alveolus collapse

Atelectasis risk factors

Confinement to bed, infection, disease, foreign body - risk factors for what?

Atelectasis complications

Complications such as hypoxia, pneumonia, respiratory failure

Atelectasis S&S

Dyspnea, tachycardia, cough, pain, cyanosis, wheezing

3 kinds of Atelectasis

Contraction, resorption, compression

Cardiogenic Pulmonary Edema

Accumulation of fluid in interstitium and alveoli due to high pulmonary capillary hydrostatic pressure d/t heart failure or fluid overload

Non-cardiogenic Pulmonary Edema

Accumulation of fluid in interstitium d/t increase in capillary permeability (decreased oncotic pressure)

d/t injury, inflammation, high altitude, cancer, etc.

Pulmonary Edema S&S

DOE

Orthopnea

Wheezing

Feeling of suffocating/drowning

Anxiety/restless

“Wet” cough

Chest pain

FROTHY sputum

Sweating

Virchow’s Triad

Risk factors for Pulmonary Embolism

1. Hypercoagulable state (cancer, pregnancy, estrogen therapy, trauma or surgery, sepsis)

2. Vascular wall injury (trauma or surgery, venepuncture/IVs, catheters)

3. Circulatory stasis (immobility, paraylsis)

Thrombus

blood clot forming that is attached to original vein where its growing

Embolism

freed blood clot that lodges in pulmonary vasculature

Where do embolisms like to go?

Brain and lungs bc there’s lots of vasculature

Patho of Pulmonary Embolism

Thrombus occludes part of pulmonary circulation

Hypoxic vasoconstriction, decreased surfactant, inflammation, pulm edema, atelectasis

tachypnea, dyspnea, chest pain, VQ imbalance, decreased PaO2, shock

Pneumonia causes

Viral, bacterial, fungal

Pneumonia

Purulent fluid trapped in alveoli

Can occur as lobar (in 1+ lobes of lungs) or bronchial (patches throughout lungs)

Pneumonia risk factors

>65 or <2 y/o, existing lung disease, smoking, unvaccinated, immobility post-op

Pneumonia S&S

Cyanosis

Productive cough: green, yellow, hemoptysis

Fever, sweating, chills

Fatigue

Tachypnea, dyspnea, tachycardia

Chest pain

Tuberculosis precaution

Airborne/ Droplet precaution for this lung disease

Tuberculosis cause

Mycobacterium tuberculosis bacteria

Tuberculosis patho

Forms granulomatous inflammation filled with caseous necrosis

Causes cavities in lung tissue

Tuberculosis risk factors

Recent exposure

Living in/visiting areas where rates are high

<5 y/o with positive test

Immune deficiency

Housing insecure

IV drug users

Recent organ transplant

Health care workers

Chronic diseases like diabetes

Tuberculosis S&S

Progressive fatigue

Anorexia/weight loss

Chronic productive cough (hemoptysis)

Night sweats

Pleuritic chest pain

Low grade temp in afternoon

ALI/ARDS

Acute inflammation caused by trauma or infection

Disrupts alveoli lining and capillary lining

Increased cap permeability —> Edema

Surfactant inactivated

Refractory hypoxemia

High mortality rate d/t sepsis and resp failure

Refractory Hypoxemia

VQ mismatch

No matter how much O2 you give gaseous exchange not happening

ALI/ARDS S&S

Hypoxemia

Cyanosis

Dyspnea

Restless

Tachycardia and tachypnea

Heart arrhythmia

Confusion

Coma 

Death

ALI/ARDS Tests

CXR

Chest CT

Ultrasound

Spirometry

Sputum culture

Bronchial alveoli lavage

Blood work/ABG

pH

7.35-7.45

PaO2

75-100 mmHg

PaCO2

35-45 mmHg

HCO3

22-26 mEq/L

O2 Sats

95-100%

Obstructive Lung Disease

Type of lung disease where pt has trouble expelling air from lungs

Mucous, inflammation, lung tissue destruction

Ex. COPD, asthma, cystic fibrosis

Restrictive Lung Disease

Type of lung disease where it’s hard to inhale

Could be from pregnancy, structural abnormality, pulmonary fibrosis

Normal spirometry

FEV1: 4 FVC: 5

80%

FEV1

Forced expiratory volume in 1st second

FVC

Forced vital capacity

Obstructed Spirometry

FEV: 1.3 FVC:3.1

42% (always below 80%)

Restrictive Spirometry

FEV:2.8 FVC:3.1

90% (above 80%)

Asthma

Chronic inflammatory airway disease of BRONCHI mucosa characterized by recurrent episodes of wheezing and/or breathlessness

Asthma triggers

Indoor allergens, outdoor allergens, viral triggers, other lung diseases, cold weather, exercise, stress

Asthma risk factors

Family history

Low birth weight

Respiratory complications in infancy

Smoking

Obesity

Allergies

Job

Asthma patho

Immune activation

1. Vasodilation and increased cap permeability

Mast Cells Degranulate

1. Cap permeability and Vasodilation

Bronchospasm, vascular congestion, mucous secretion, airway inflammation, airway obstruction

Asthma S&S

Wheezing

Dyspnea

Anxiety

Coughing

Chest tightness/pain

Trouble exhaling

Can be reversed with bronchodilators

COPD

Umbrella term for progressive obstructive lung diseases

Chronic bronchitis, emphysema, refractory asthma (not reversible)

COPD Risk factors

Long-term exposure to allergens/irritants

Smoking

Obesity

>40 y/o

Family history

Chronic Bronchitis Patho

Chronic exposure to irritant

1. Inflammation and epithelial injury causing bronchial edema + narrowed airways

2. Dysmotility of cilia compromising airway clearance

   1. Increased mucous production

Chronic Bronchitis S&S

Blue Bloater

Cyanotic

Recurrent productive cough

Hypoxia

Hypercapnia (CO2)

Resp Acidosis

High hemoglobin

High RR

DOE

High incidence in smokers

Clubbing

Cardiac enlargement —> R sided heart failure

Bipedal edema

Emphysema Patho

Chronic exposure to irritant

1. Inflammation and epithelial injury causing lung connective tissue breakdown

2. Dysmotility of cilia compromising airway clearance

   1. Destruction of alveolar cell walls

Emphysema S&S

“Pink Puffer”

High CO2 Retention (Pink)

Minimal cyanosis

Pursed lip breathing

Dyspnea

Hyperresonance on chest percussion

Orthopnea

Barrel chest

DOE

Prolonged expirations

Speak in short jerky sentences

Anxious

Thin appearance