Pulmonary Disorders

Dyspnea
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Terms in this set (50)
Dyspnea
Shortness of breath (SOB)
Dypsnea on Exertion
DOE, Shortness of breath with exertion
Orthopnea
dyspnea when lying down. Fluid shift leads to increase fluid in lungs. Measured in amount of pillows needed. (2 pillow orthopnea
Lung Function Tests
Forced vital capacity (FVC).
Forced expiratory volume (FEV).
FEV1
Peak expiratory flow (PEF).
Total lung capacity (TLC).
Residual volume (RV).
Expiratory reserve volume (ERV)
Pneumonia Etiology
Etiology-inflammation of parenchyma (essential aspect of organ) of lungs.
-Bacterial, viral or mycroplasmal infection
-inhalation of chemicals, smoke, dusts, or gases
-aspiration of foods, fluids or vomitus
-Pre-disposing factors: chronic illness, debilitation, age, surgery, viral infections
Pneumonia Signs and Symptoms
Coughing, sputum productions, pleuritic chest pain, shaking chills, SOA, rapid shallow breathing, fever
Pneumonia Complications
hypoxemia, respiratory failure, pleural effusion, empyema, lung abscess and bacteremia (spreading infection to other body parts).
Elderly people may see change in mental status due to decreased oxygenation in brain
Pneumonia Treatment
Primary tx=antibiotic therapy
Viral tx with supportive measures unless develop bacterial pneumonia also
Vaccine for elderly and immuno-compromised for pneumococcal pneumonia
Adequate hydration, deep breathing, coughing, chest therapy.
Again: finish all antibiotics (even for small upper RI)
Implications for the PTA: adequate monitoring of breathing rate (16-18 breaths per minute), O2 saturation, positioning.
PREVENTION: early ambulation/mobilization decreases secretions from sitting in lungs, decreases risk of health care acquired infection. Keeps PT in business in the hospital!!!!!!
Bronchial Asthma aka Asthma: Pathophysiology
Allergic reaction to foreign antigens in respiratory tract.
Walls of bronchioles become edematous, cells secrete large amounts of thick mucous, smooth muscle contracts, decreasing diameter of air passages (bronchioles)
breathing difficult, hear wheezing sound because harder to force air out.
Bronchial Asthma aka Asthma etiology
Allergy clearly plays an important role in many asthma cases but not in all.
As with allergy, you can blame your family history; there's certainly a strong genetic component for asthma.
Asthma Early Warning Signsrunny nose, headache, or itchy chin often precedes an asthma attack. Trouble sleeping and feeling tired are other typical signs. So are dark circles under the eyes and less tolerance for exercise. Frequently, people get moody before an asthma attack starts.Signs and Symptoms of Bronchial AsthmaShortness of breath Tightness of chest Wheezing Excessive coughing or a cough that keeps you awake at nightBronchial Asthma TriggersTobacco smoke Infections such as colds, flu, or pneumonia Allergens such as food, pollen, mold, dust mites, and pet dander Exercise Air pollution and toxins Weather, especially extreme changes in temperature Drugs (such as aspirin, NSAID, and beta-blockers) Food additives (such as MSG) Emotional stress and anxiety Singing, laughing, or crying Smoking, perfumes, or sprays Acid refluxHow to Diagnose Bronchial AsthmaSpirometry A lung function test to measure your breathing capacity and how well you breathe. You will breathe into a device called a spirometer. Peak Expiratory Flow (PEF): Using a device called a peak flow meter, you forcefully exhale into the tube to measure the force of air you can expend out of your lungs. Peak flow monitoring can allow you to monitor your how well your asthma is doing at home. Chest X-Ray: Your doctor may do a chest X-ray to rule out any other diseases that may be causing similar symptoms.Treating Bronchial AsthmaMedication Inhalers Oral medications Lifestyle changes to treat and prevent asthma attacks. Long-acting anti-inflammatory asthma inhalers are often necessary to treat the inflammation associated with asthma.Emphysemaprogressive, degenerative disease destroys alveolar walls. Clusters of small air sacs merge to form larger chambers which decreases overall surface area. Also lose their recoil. Loss of elasticity, can't push air out. Exposure to irritants (smoking, pollutants) cause it takes someone with------------far longer to empty their lungs than it does a person without emphysema. ------------- is the main form of chronic obstructive pulmonary disease (COPD).Emphysema Signs & SymptomsSOB Coughing (with or without sputum) Wheezing Excess mucus production Patients may have a deeper a "barrel-shaped" chest Take a longer time to breathe out Severe emphysema can result in heart failure with swelling in the ankles. A bluish tint to the skin (cyanosis) especially in fingertipsEmphysema Treatment:There is no cure for emphysema. The goal of treatment is to slow the development of disabling symptoms. The most important step to take is to stop smoking. Treatments for emphysema caused by smoking include medication, breathing retraining, and surgery. Except for oxygen, it does not respond to any medication. However, emphysema is frequently associated with bronchitis and asthma and the symptoms associated with these processes often can be alleviated with medicationChronic Bronchitis PathophysiologyExcessive mucus production with productive cough for at least 3 months per year for 2 successive years.Signs and Symptoms acute bronchitis or chronic bronchitisCough Production of mucus (sputum), either clear or white or yellowish-gray or green in color Shortness of breath, made worse by mild exertion Wheezing Fatigue Slight fever and chills Chest discomfortacute bronchitis or chronic bronchitis TreatmentMedication Antibiotics cough medicine InhalerTherapy acute bronchitis or chronic bronchitisPulmonary rehabilitation is a breathing exercise program in which you work with a respiratory therapist to help you learn to breathe more easily and increase your ability to exerciseChronic Obstructive Pulmonary Disease (COPDCombination of any or all: emphysema, obstructive bronchitis, asthma. Smoking most common cause Usually presents at 55-60 y.o.Treatment-COPDImprove oxygenation and decrease CO2 retention Smoking cessation, pharmacologic management, pulmonary hygiene, exercise, control of complications, avoiding irritants, psychological support and dietary management. Chest PT, program to improve posture, strengthening of respiratory musculaturePharmacological Tx of COPDBronchodilators, steroids, antibiotics, expectorants, antihistamines Oxygen used when severe hypoxemia at rest or exertional. -usually only 2-3 L/minute Bronchodilators and Exercise: Generally 20-30 minutes before exercise.Pulmonary Embolism PathologyBlood clot, lung Alterations in blood flow: immobilization (after surgery, injury, pregnancy (also procoagulant), obesity (also procoagulant), cancer (also procoagulant) Factors in the vessel wall Factors affecting the properties of the blood (procoagulant state): Estrogen Genetic thrombophilia Acquired thrombophilia Cancer (due to secretion of pro-coagulants)Signs & Symptoms Pulmonary Embolismdyspnea (shortness of breath), tachypnea (rapid breathing), chest pain of a "pleuritic" nature (worsened by breathing), cough and hemoptysis (coughing up blood). More severe cases can include signs such as cyanosis (blue discoloration, usually of the lips and fingers), collapse, and circulatory instability due to decreased blood flow through the lungs and into the left side of the heart. About 15% of all cases of sudden death are attributable to PE.Treatment PEAnticoagulation Thrombolysis Surgery IVC FilterAtelectasisCollapse of the lung Either whole or part of the lung Can occur in premature infants 2* to lack of surfactant produced by immature lungs In adults occurs when fluid collects within the pleura as a result of heart failure or pleural inflammation atelectasis is not synonymous with a pneumothorax, which is a more specific condition that features atelectasis. most common cause is post-surgical -----------, characterized by splinting, i.e. restricted breathing after abdominal surgery. Smokers and the elderly are at an increased risk.Atelectasis S/SXCough Chest pain Low oxygen sat Breathing difficutly Pleural effussion Cyanotic Increase HR Low FeverTreatment of AtelectasisCorrecting the underlying cause. Post-surgical atelectasis is treated by PT, focusing on deep breathing and encouraging coughing. An incentive spirometer is often used as part of the breathing exercises. Walking is also highly encouraged to improve lung inflation.Cystic Fibrosis PathologyLife threatening disorder that causes severe damage to the lungs and pancreasCystic Fibrosis S/SXDifficulty breathing is the most serious symptom and results from frequent lung infections that are treated with antibiotics and other medications. Other Sx Sinus infection Poor growth patterns Infertility Poor weight gain despite normal intake , Thick sticky mucous Frequent chest infections Coughing or SOBCystic Fibrosis RXAntibiotics Lung Transplant Chest PTCor PulmonalePulmonary heart disease Hypertrophy of R ventricle because of disease affecting function or structure of lungs. Leads to R side heart failure Occurs late in other disease states (COPD) poor prognosisCor Pulmonale S/SXDyspnea on exertion (DOE) and at rest Tachypnea Orthopnea Edema weakness and R upper quadrant discomfortCor Pulmonale RXIf possible correct underlying condition, bed rest, pulmonary artery vasodilators, digoxin, restricted fluid intake, supplemental O2Common causes include: Anxiety Fever Hyperventilation Any lung disease that leads to shortness of breathRespiratory Alkalosiscondition marked by low levels of carbon dioxide in the blood due to breathing excessively.Respiratory Alkalosis S/SXDizziness Light-headedness Numbness of the hands and feetRespiratory Alkalosis RXRarely life threatening Treatment is aimed at the condition that causes respiratory ---------. Breathing into a paper bag -- or using a mask that causes you to re-breathe carbon dioxide -- sometimes helps reduce symptomsRespiratory Acidosiscondition that occurs when the lungs cannot remove all of the carbon dioxide the body produces. This disrupts the body's acid-base balance causing body fluids, especially the blood, to become too acidic.Respiratory Acidosis S/SXConfusion Easy fatigue Lethargy Shortness of breath SleepinessRespiratory Acidosis RXTreatment is aimed at the underlying lung disease, and may include: Bronchodilator drugs to reverse some types of airway obstruction Noninvasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or mechanical ventilation if needed Oxygen if the blood oxygen level is low Treatment to stop smokingPneumonthoraxA collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions Many pneumothoraces occur after physical trauma to the chest, blast injury, or as a complication of medical treatment. Symptoms are determined by the size of the air leak and the speed by which it occursPneumonthorax S/SXSudden, sharp chest pain on the same side as the affected lung — this pain doesn't occur in the center of your chest under the breast bone Shortness of breath, which may be more or less severe, depending on how much of your lung is collapsed A feeling of tightness in your chest A rapid heart rate If only a small amount of air enters the space between your lungs and your chest wall (pleural space), you may have few signs or symptoms. However, even a slightly collapsed lung is likely to cause some chest pain and some shortness of breath that slowly improves over a few hours to a day or so, even if there is no reduction in the size of the collapsePneumonthorax RXObservation. If your lung is less than 20 percent collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the air is completely absorbed and your lung has re-expanded. Because it may take weeks for a pneumothorax to heal on its own, however, a needle or chest tube may be used to remove the air, even when the pneumothorax is small and nonthreatening. Needle or chest tube insertion. When your lung has collapsed more than 20 percent, your doctor is likely to remove the air by inserting a needle or hollow tube (chest tube) into the space between your lungs and your chest wall. Chest tubes are often attached to a suction device that continuously removes air from the chest cavity and may be left in place for several hours to several days.Possible complications pneumothorax includeRecurrence. Close to half the people who have had one pneumothorax have another, usually within three years of the first. Persistent air leak. After several days to a week or so, it may be necessary to surgically close the air leak. Complications of a ------------ ------are more serious and include: Low blood oxygen levels (hypoxemia). Cardiac arrest. If air continues to build up, the increasing pressure can push your heart and blood vessels toward the uncollapsed lung, compressing both your healthy lung and heart Respiratory failure. Shock.ARDS: Acute Respiratory Distress SyndromeThis is a life-threatening lung condition that prevents enough oxygen from getting into the blood. See also: Infant respiratory distress syndromeARDS: Acute Respiratory Distress Syndrome S/SXLabored, rapid breathing Low blood pressure and organ failure Shortness of breath Symptoms usually develop within 24 to 48 hours of the original injury or illness. Often, people with ARDS are so sick they are unable to complain of symptomsARDS: Acute Respiratory Distress Syndrome RXTypically people with------need to be in an intensive care unit (ICU). The goal of treatment is to provide breathing support and treat the underlying cause of ------. This may involve medications to treat infections, reduce inflammation, and remove fluid from the lungs. A breathing machine is used to deliver high doses of oxygen and a continuous level of pressure called PEEP (positive end-expiratory pressure) to the damaged lungs. Patients often need to be deeply sedated with medications when using this equipment. Treatment continues until you are well enough to breathe on your own.