Week 11 Pulmonology pt 1

Key Medical Terms for Patient Description

Coughing

  • Definition: A cough is a forceful spasm of the bronchus that expels air from the lungs.
  • Purpose: To remove any foreign material or irritants from the airway.
  • Sputum: Mucus that is coughed up during the act of coughing.
      - Clinical Relevance: Sputum sampling can be crucial for diagnosing conditions like pneumonia; samples may be analyzed or cultured to identify pathogens.

Hemoptysis

  • Definition: Coughing up blood.

Hypoxemia and Hypoxia

  • Hypoxemia
      - Definition: Low oxygen levels in the blood, measured as partial pressure of oxygen (PaO2PaO_2).
  • Hypoxia
      - Definition: Low oxygen levels in the tissues.
      - They often occur together, but can be separate; for example, myocardial infarction leads to localized hypoxia in cardiac myocytes even if overall blood oxygen levels are normal.

Hypercapnia

  • Definition: Elevated levels of carbon dioxide (CO2) in the blood.

Dyspnea

  • Definition: Subjective feeling of shortness of breath or difficulty breathing.
      - Dyspnea on Exertion: Specifically related to physical activity.
      - Orthopnea: Difficulty breathing while lying down, commonly experienced in conditions like pneumonia or severe respiratory illness.

Respiratory Distress

  • Definition: Clinical finding rather than a diagnosis, indicating a patient is struggling to breathe.
  • Assessment Signs:
      - Accessory muscle use (e.g., straining neck and abdominal muscles while breathing).
      - Tripoding position: leaning forwards to ease breathing.
      - Nasal flaring: noticeable widening of nostrils during inhalation.

Common Respiratory Patterns

  • Kussmaul Respirations: Deep, rapid breathing pattern.
  • Cheyne-Stokes Respirations: Crescendo-decrescendo breathing pattern followed by apneas.

Acute Respiratory Failure

  • Definition: When lungs cannot properly oxygenate the blood or ventilate CO2.
  • Causes include:
      - Overdose on narcotics (e.g., opioids, fentanyl) which depresses the central respiratory drive.
      - Lung diseases (e.g., severe asthma, COPD).
      - Brain injuries affecting the respiratory centers.
  • Patients may require interventions such as non-invasive ventilation (e.g., CPAP, BiPAP) or more aggressive therapy like mechanical ventilation or ECMO (extracorporeal membrane oxygenation).

Pneumothorax

  • Definition: Abnormal accumulation of air in the pleural space, leading to lung collapse.
      - Causes: May involve trauma (e.g., rib fractures) or rupture of blisters on the lungs (particularly in young smokers).
      - Diagnosis: Chest x-ray can detect outlines of the pneumothorax; look for lack of lung markings or costophrenic angles.
      - Symptoms: Sudden chest pain and dyspnea, with pleuritic chest pain characteristics.

Pleural Effusion

  • Definition: Excess fluid in the pleural space.
      - Classifications:
        - Transudative Effusion: Watery fluid, often due to fluid overload.
        - Exudative Effusion: Protein-rich fluid due to infections or inflammatory processes.
        - Hemothorax: Blood in pleural space.
        - Empyema: Pus in pleural space due to severe infection.
  • Diagnosis: Chest x-ray showing blunted costophrenic angles can indicate potential pleural effusion.

Restrictive Lung Diseases

  • Definition: Conditions that decrease lung compliance, making it hard for lungs to expand.
      - Examples:
        - Aspiration Pneumonitis: Inhalation of food or liquid into lungs, leading to inflammation and reduced lung stretch.
        - Atelectasis: Collapsed alveoli, often post-surgery; use incentive spirometry to encourage lung inflation postoperatively.
        - Pulmonary Fibrosis: Scarring that reduces lung elasticity, impeding normal function.

Acute Respiratory Distress Syndrome (ARDS)

  • Definition: A severe, life-threatening form of acute respiratory failure characterized by poor oxygen exchange, bilateral infiltrates on chest x-ray, and decreased PaO2 despite supplemental oxygen.
  • Clinical Findings: Patients often present with severe respiratory distress, tachypnea, and may progress to multiple organ failure due to hypoxia.

Obstructive Lung Diseases

  • Overview: Conditions that cause obstruction of airflow. Main types:
      - Asthma: Chronic condition characterized by reversible airway obstruction due to inflammation and bronchoconstriction, often triggered by allergens.
        - Symptoms: Chest tightness, wheezing, coughing, and dyspnea; treatment involves bronchodilators (e.g., albuterol) especially during acute attacks.
      - COPD (Chronic Obstructive Pulmonary Disease): Primarily associated with long-term smoking or exposure to inhaled irritants.
        - Subtypes:
          - Emphysema: Destruction of alveolar walls leads to trapped air and irreversible obstruction.
          - Chronic Bronchitis: Characterized by chronic mucus production leading to airflow obstruction.