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Bronchiectasis- pathophysiology permanent dilation & distortion of bronchi 2' destruction of elastic & mm bronchial wall. Dilated regions breed infections Bronchiectasis- etiology A bacterial infection that alters cilia motility, allows secretions to stagnate & destroy tissue. May be R/T asthma, CF, chronic bronchitis, or aspiration Bronchiectasis- clinical features constant cough w/ copious amounts of purulent secretions, crackles, recurrent pulmonary infections w/ hemoptysis Bronchiectasis- late stages Cyanosis, digital clubbing Bronchiectasis- ABGs hypoxemia w/ high CO2 levels Pneumonia- pathophysiology Inflammation of lung parenchyma 2' infection of the lower respiratory tract, alveoli fill w/ exudates (WBC) & edema Bacterial pneumonia- onset, infiltrates, temp, cough, pain, WBC abrupt onset, lobar consolidation, high fever w/ chills, productive cough, pleuritic pain, leukocytosis Viral pneumonia- onset, infiltrates, temp, cough, pain, WBC insidious onset, diffuse infiltrates, mod fever, nonproductive cough, myalgia, nml WBC Pneumonia- ABGs, presentation hypoxemia, bronchial bs, bronchophony, egophony, whispered petriloquy, dullness to percussion Pneumocystic carinii pneumonia, nosocomial, lobar, bronchopneumonia opportunistic infection in immunocompromised pts, hospital-aquired, lung involved at lobar level, at the level of broncioles & alveoli ARDS- general def Acute lung injury from, aspiration, barotrauma, inhaled toxins, trauma, etc ARDS- pathophysiology Increased permeability of alveolar membrane, alveoli fill with fluid causing increased pulmonary vascular resistance. Leads to decreased gas exchange, surfactant production ARDS- late stages Alveolar fibrosis, atelectasis, chronic restrictive dysfunction PE- presentation Hypoxemia, hyperventilation, pleuritic chest pain, respiratory acidosis, V/Q mismatch Normal mean pulmonary arterial pressure, PH values at rest, w/ exercise Norm: <15 mm Hg, PH: (rest) >25 mm Hg, (exercise) >30 mm Hg Pulmonary HTN- etiology secondary- congenital heart defect, lung PATH causing chronic hypoxia & vasoconstriction, scleroderma Pulmonary HTN- presentation heart sounds- S4, split S2 w/ progression to S3, peripheral edema Plumonary edema- pathophysiology accumulation of vascular fluid in the interstitial spaces & alveoli Pulmonary edema- etiology Cardiogenic- LHF, Noncardiogenic- ARDS, acute lung trauma, PE, Post-op fluid overload Pulmonary edema- presentation Difficulty breathing when laying flat, pink frothy sputum Pulmonary effusion- pathophysiology Excessive fluid in the pleural space due to fluid overload, inflammatory process, increased permeability of pleura Pulmonary effusion- presentation atelectasis, decreased chest expansion, pleuritic pain, tracheal shift Pneumothorax- pathophysiology Air or gas in the pleural cavity that disrupts the parietal or visceral pleura Pneumothorax- spontaneous, traumatic, iatrogenic Spontaneous- no MOI, maybe 2' lung path (COPD), Traumatic- Entry of air through chest wall due to rib fracture or wound, Iatrogenic- complication of a treatment or procedure Tension pneumothorax Entered air can't escape, causing atelectasis w/ compromise of CO & venous return. Can lead to shock. Pneumothorax- presentation absent or diminished BS, hyperresonant to percussion, mediastinal shift, respiratory distress Resiratory failure- general definition Pulmonary gas exchange is impaired such that severe hypoxemia results Respiratory failure- etiology Progressive airway obstruction (asthma, emphysema, CF, chronic bronchitis), Altered lung parenchyma, MS NM or respiratory center dysfunction Acute respiratory failure ABGs pH<7.35, PaO2<50 mm Hg, PaCO2>50 mm Hg. Unable to compensate metabolically quick enough