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Dyspnea
Subjective sensation of breathlessness
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Tachypnea
Increased respiratory rate
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Orthopnea
Dyspnea while lying flat
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PND
- Paroxysmal "attack or spasm"
- Nocturnal "PM"
- Dyspnea "SOB"
- = Wake up at night with dyspnea
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Apnea
the cessation of breathing
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Abnormal Breathing patterns
- 1. Kussmaul Respirations
- 2. Obstructed Breathing
- 3. Restrictive Breathing
- 4. Cheyne-Stokes Respirations
- 5. Hypoventilation
- 6. Hyperventilation
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Slightly increased ventilatory rate, very large effortlest Vt
Kussmaul Respirations
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Slow ventilatory rate, large Vt, increased effort
Obstructed Breathing
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Caused by disorders that stiffen the lungs
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Alternating patterns of deep and shallow breathing and apnea
Cheyne-Stokes Respirations
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Inadequate alveolar ventilation in relation to metabolic demands
- Hypoventilation
- **Increased Co2, metabolic acidosis
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Alveolar ventilation that exceeds metabolic demands.
- Hyperventilation
- ** decreased CO2, metabolic alkalosis
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Define cough
What does the effectiveness depend on?
- An explosive expiration that cleanses the lower airways
- The effectiveness depends on the depth of the inspiration and the degree to which the airways narrow which increases the velocity of expiratory gas.
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Abnormal Sputum could be signs of...
Infection, inflammation, or cancer.
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Hemoptysis
Coughing up of bright red blood.
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Cyanosis
Bluish discoloration of the skin caused by decreased oxygenation of blood. Usually a late symptom.
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Clubbing
- The painless, selective enlargement of distal segement of the digits (ie fingertips)
- Caused by chronic disease of the heart or lungs.
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What is the most common type of pain caused by pulmonary disorders?
Pleural pain
*Infection and inflammation cause pleura to stretch during inspiration causing pain
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Pain in the chest wall is usually due to ____ _____.
excessive coughing
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Define hypoxemia.
- Inadequate oxygenation of blood caused by
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List the 5 causes of hypoxemia
- 1. Decreased oxygen inspiration - suffocation, high altitude
- 2. Hypoventilation- decreased LOC
- 3. Diffusion abnormalities- edema, fibrosis, emphysema
- 4. Abnormal ventialtion/perfusion rates- Most common asthma, bronchitis, pneumonia
- 5. Pulmonary right to left shunts- ARDS, atelectasis
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Hypercapnia
- Increased carbon dioxide
- CO2>45
- leads to respiratory acidosis pH<7.35
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Pulmonary Edema
- accumulation of fluid in the lungs
- **Classic symptom= pink, frothy sputum
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Aspiration
Passage of solid particles into the lung.
-Right lung is more susceptible.
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Ateclectasis
- Collapse of the lung.
- O2<50 , CO2>45
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Bronchiectasis
dilation and loss of elasticity of the walls of bronchi from chronic inflammation and degeneration
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Bronchiolitis
- An inflammatory obstruction of the small airways or bronchioles.
- Common in children. Treated with antibiotics and steroids.
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Abscess Formation and Cavitation
- Lung Abscess: pus-filled cavity in the lung surrounded by inflammed tissue and caused by an infection.
- Usually abscesses rupture into an airway, producing a lot of sputum that gets coughed up. A ruptured abscess leaves a cavity in the lung that is filled with fluid and air.
- Staph or Klebsiella common causes of infection.
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Chest Wall Restriction
Work of breathing is increased and ventilation is compromised if the chest wall is deformed, immobilized, or made heavy by fat.
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Flail Chest
Multiple rib fractures cause the ribs to be unstable leading to paradoxical movement on inspirationa and expiration.
paradoxical movement= part of chest goes out while other goes in.
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List 3 commonly encountered toxic gases...
- 1. smoke
- 2. ammonia
- 3. hydrogen chloride
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Pneumothorax
- Presence of air in the pleural space.Makes it difficult for lungs to expand properly
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Open Pneumothorax
Allows air to enter and exit the pleural space through penetration of the chest wall.
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Closed Pnuemothorax
- Air enters and exits the pleural space without penetration of the chest wall.
- 1. Spontaneous: emphysema, pneumonia
- 2. Traumatic: fractured rib
- 3. Iatrogenic: accidently induced by a physician/medical procedure-- chest Sx, mechanical ventilation
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Tension Pneumothorax
- Air leaks into the pleural space, but cannot escape.
- Causes the affected lung to collapse ->mediastinal shift-> unaffected lung collapse-> severe respiratory and CV distress and death.
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Hemothorax
Presence of blood in the pleural space.
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Pleural Effusion
Presence of fluid in the pleural space.
usually a secondary problem
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Empyema
- Presence of infected fluid in pleural space.
- - uncommon but serious disorder occurs mostly in debilitated pt
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Pleurisy
- Inflammation of the pleura.
- characterized by sudden onset, painful and difficult respiration, and exudation of fluid or fibrinous material into the pleural cavity—called also pleuritis
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Interstitial Lung Disorders
1. aka ___ or ____
2. produce varying amounts of..... ___, ___, ___
3. cause lungs to become... ___ & ___
- 1. fibrotic or restrictive
- 2. inflammation, fibroids (scars), and disability
- 3. stiff and non-compliant
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What are the two types of Occupational Lung Disorders
- 1. Pneumoconiosis - inhalation of inorganic materials like asbestosis, coal, talocosis, silicosis
- 2. Hypersensitivity- inhalation of organic dusts
- - Farmer's Lung: moldy hay
- - Pigeon breeder's lung: birds
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3 patterns of lung dysfunction that the interstitial lung disorders share..
- 1. diminished lung volume
- 2. reduced diffusing capacity
- 3. varying degrees of hypoxemia
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Treatment of interstitial lung disorders include....
- 1. Identifying and removing the injurious agent
- 2. Suppress the inflammatory response
- 3. Preventing progression
- 4. Providing supportive Tx for pt with advance disease
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Pulmonary Fibrosis
- Excessive amount of fibrous or connective tissue in the lung.
- (Excessive Scar tissue in the lung)
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Sarcoidosis
- Tiny grain-like bumps form (granulomas), clump together to form larger lumps that can attack other organs.
- T-lymphocyte alteration is thought to contribute.
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ARF =
- Signs
- ABGs
NOT IN BLUEPRINT
- Acute Respiratory Failure = inadequate gas exchange
- - Signs = increased respiratory rate, use of accessory muscles, flushed face, Dyspnea, late sign is cyanosis, hypotension
- - ABGs= pH<7.30 , pO2<50, pCO2>50
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ARDS
Acute Respiratory Distress Syndrome = a form of pulmonary insufficiency that develops in the aftermath of a shock or shock-like state. Life-threatening.
increase in permeability of lungs leading to lungs that are wet, heavy, congested, hemorrhagic and stiff.
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Clinical symptoms of ARDS
- Early symptoms mistaken as Stress!
- -Change in LOC, Dyspnea, Hypotension- late
- -Tachycardia, Tachypnea
- -Fever
- -Cough
- As syndrome progresses so will symptoms- labored breathing, cyanosis, grunting resp.
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Treatment of ARDS
- ◦Treat the Hypoxia
- ◦Monitoring Parameters
- ◦Drug Therapy
- ◦Fluid Management
- ◦Psychosocial Support
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Of all the Precipitating Factors for ARDS which are the highest correlators?
- ◦Sepsis
- ◦Aspiration
- ◦Multiple blood transfusions
- ◦Bone Fx
- ◦Prolonged hypotension
- ◦Burns
- ◦Pancreatitis
- ◦Pneumonia
- ◦Pulmonary Contusion
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What is the best treatment for ARDS?
- PREVENTION of atelectasis
- TCDB, early amb., etc.
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What are some ways you can prevent atelectasis?
- -T C DB
- -Early Ambulation
- -Changes in position
- -Elevate HOB
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What three lung diseases are grouped as COPD and what is COPD characterized by?
- Chronic Obstructive Pulmonary Disease
- 1. Emphysema
- 2. Bronchitis
- 3. Asthma - more acute but can be chronic
DIFFICULTY BREATHING
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Primary cause of COPD
SMoking
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Emphysema
- a condition characterized by air-filled expansions in interstitial or subcutaneous tissues
- Tx= thin secretions, oxygen and bronchodialators
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Bronchitis
- Hypersecretion of mucous and chronic productive cough. - Usually leads to emphysema
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Asthma
- abnormal respoviveness of the air passages to a certain substance.
- there are widespread narrowing of smaller airways in attacks that end spontaneously or with treatment.
- ** there is a genetic tendency to developing asthma
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Sleep Apnea
- =cessation of air flow during sleep for a period of 10 seconds or longer.
- (occurs 30 or more times over 7 hours of sleep)
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Obstructive Apnea
- -caused by obstruction of upper airway
- -common in obesity, middle aged men
- - "Pickwickian syndrome": named after charles dickens book
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Central Apnea
- cessation of respiratory drive so there is no movement of chest or abdomen
- causes= encephalitis, brain stem infarction, polio
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Mixed Apnea
mixture of central and obstructive apnea
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Cystic Fibrosis
- = dysfunction of endocrine system to produce abnormally thick secretions of mucous
- -Genetic
- -Glands most effected = resp, pancreatic, sweat
- - Can Dx prenatally through sweat test
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Pneumonia
an acute, inflammatory infection of the lungs caused by bacteria, virus, fungi, protozoa or parasites
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Who is at risk of developing pneumonia?
elderly, immunocompromised, alcoholics, smokers, decreased LOC, malnurished, immobilized, people with preexisting lung diseases
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What are the routes organisms use to enter the lungs?
- 1. Aspiration - infected sneeze, cough, talk = airborn droplets
- 2. Contaminated respiratory equipment
- 3. Bacteria in blood spread to lungs
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What is the most common type of bacterial pneumonia?
- Streptococcus pneumonia
- accounts for 90% of all bacterial pneumonias
- vaccine available
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What is the most common type of viral pneumonia?
- Viral pneumonia influenza (Type A)predisposes the patient to bacterial pneumonia
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Which type of pneumonia are school age children most likely to acquire?
Mycoplasma pneumonia
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Which type of fatal pneumonia are AIDS patient most likely to develop?
Pneumocystis Carcinii Pneumonia (PCP)
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Legionnaires Disease
- = a serious type of bacterial pneumonia
- •Widely found in H2O. Discovered in 1976.
- •Highest risk: chronic disease or impaired immune system
- •Prognosis= 20-30% mortality rate in previously healthy individuals. Can be as high as 80% in immunosuppresed individuals
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TB
Tuberculosis= A chronic infectious pulm./exo pulm disease that affects the lungs and can invade other body systems like kidneys, bones and lymph nodes
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How is active TB diagnosed?
positive skin test (may also be positive with dormant TB), a sputum culture and a chest x-ray
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How might dormant TB become reactivated?
- immune impaired through...
- 1. poor nutrition
- 2. diabetes
- 3. steroid use
- 4. chemotherapy
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How is TB transmitted?
airborne droplets
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Treatment for TB
- • Isolation precautions for active TB = private, negative pressure rooms
- •Antibiotic therapy to control active or dormant bacteria and prevent transmission. Drugs depend on the
- individual, bacteria and the presence of the active disease.
- •In the past a combination of 2 drugs has been sufficient today combinations of 4
- drugs may be used: INH, Rifampin, Pyrazinamide and either Streptomycin or Ethambutal.
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Clincal manifestations of TB include:
- - fatigue, lethargy
- - weight loss, anorexia
- - low grade fever in afternoon
- - night sweats
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Pulmonary Embolism
= Obstruction of pulmonary artery by a thrombus (DVT) that becomes dislodged and carried to lung
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Predisposing factors for developing PE
- 1. venostasis-prolonged bedrest
- 2. venous injury -surgery or fracture
- 3. increased blood coaguability
- 4. Disease- CHF, lung, MI
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BEST treatment of PE?
and other ways to treat
- BEST TREATMENT = PREVENTION -- TCDB, EARLY AMB., ETC
- - analgesic, bronchodilator, antibiotic, oxygen, sedative, bedrest
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What is Virchow's triad
3 factors leading to thrombosis - stasis, hypercoaguability, intimal changes (injury or change in vessel)
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What are the risk factors of developing lung cancer?
- -Smoking = LEAD
- - evvironmental and occupational hazards
- - family history
- - reccurring pulm. inflam
- - vitamin A deficiency
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NSCLC
Best prognosis!
metastisizes slow
Squamous Cell Carcinoma
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"Oat Cell carcinoma"
-Strongest correalation to smoking
-Grows rapidly, early and widely
-Worst prognosis
-20-25%
Small cell carcinoma
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NSCLC accts for 30-35%
- arises from glands
- weakest correalation to smoking
- slow and unpredictable
Adenocarcinoma
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NSCLC accts for 10-15%
-Grow to distort trachea and cause carina to widen
-surgical treatment is limited
Large Cell Carcinoma
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