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Chronic Bronchitis
Is defined clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded.
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Emphysema
Is defined pathologically as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
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The ATS’s definition for Chronic bronchitis is based on...
The major "clinical manifestations" associated with the disease.
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The ATS’s definition for Emphysema is based on...
The pathology, or the "anatomic alterations of the lung," associated with the disorder.
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Chronic Obstructive Pulmonary Disease
- Is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
- The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences
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Anatomic Alterations of the LungsAssociated with Chronic Bronchitis!
- Chronic inflammation and swelling of the peripheral airways
- Excessive mucus production and accumulation
- Partial or total mucus plugging of the airways
- Smooth muscle constriction of bronchial airways (bronchospasm)
- Air trapping and hyperinflation of alveoli—occasionally in the late stages
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Anatomic Alterations of the Lungs Associated with Emphysema
- Permanent enlargement and deterioration of the air spaces distal to the terminal bronchioles
- Destruction of pulmonary capillaries
- Weakening of the distal airways, primarily the respiratory bronchioles
- Air trapping and hyperinflation of alveoli (air-trapping)
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Types of Emphysema
- Panlobular or Panacinar
- Centrilobular or Centriacinar
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Panlobular or Panacinar emphysema
- Abnormal weakening & enlargement of all alveoli distal to the terminal bronchioles
- Most severe type
- More serious clinical manifestations
- Effects lower parts of lungs
- Associated with alpha 1 antitrypsin deficiency
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Centrilobular or Centriacinar emphysema
- Proximal part of acinus
- Most common form
- Strongly associated with smoking & chronic bronchitis
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Risk Factors for COPD!
- Tobacco smoke
- Occupational dusts and chemicals
- Indoor air pollution
- Outdoor air pollution
- Conditions that affect normal lung growth
- Genetic predisposition
- Alpha 1-antitrypsin deficiency
- Airway remodeling with asthma
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Key Indicators for Considering a COPD diagnosis:
- Dysypnea
- Chronic cough
- Chronic sputum production
- History of exposure to risk factors
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The three main spirometry tests for COPD are...
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The presence of COPD is confirmed when...
Both the FEV1 and FEV1/FVC ratio are decreased
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Clinical manifestations of Emphysema!
(Type A: Pink Puffer)
- Thin
- Barrel Chest
- Hyperventilation & marked dyspnea; often occurs at rest
- Late stage: diminished respiratory drive & hypoventilation
- Pursed-lip breathing
- Hoover’s Sign
- Reddish skin
- Use od acessory muscles
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Clinical manifestations of Chronic Bronchitis!
(Type B: Blue Bloater)
- Stocky, overweight
- Diminished respiratory drive
- Hypoventilation common, with resultant hypoxia and hypercapnia
- Productive cought with copious amounts, purulent sputum
- Cyanosis
- Perpherial edema
- Neck vein distention
- Cor pulmonale
- Polycythemia
- Digital Clubbing
- Pulmonary hypertension
- Infections
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Auscultation of Emphysema!
- Decreased breath sounds
- Decreased heart sounds
- Prolonged expiration
- Hyperresonance
- Decreased diaphragmatic excursion
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Auscultation of chronic bronchitis!
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Chest radiograph of emphysema!
- Hyperinflation
- Narrow mediastinum
- Normal or small vertical heart
- Translucent
- Depressed or flattened diaphragms
- Presence of blebs or bullae
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Chest radiograph of chronic brochitis!
- Congested lung fields
- Densities
- Increased bronchial vascular markings
- Enlarged horizontal heart
- Bronchogram Small spikelike protrusions
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Pulmonary Function Study for Emphysema!
Decreased DLCO and DLCO/VA
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Cardiopulmonary Clinical Manifestations Associated with Chronic Bronchitis and Emphysema! (COPD)
- Excessive Bronchial Secretions
- Bronchospasm
- Distal Airway and Alveolar Weakening
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Hoover’s Sign!
The inward movement of the lower lateral chest wall during each inspiration—indicates severe hyperinflation
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Palpation of the Chest in emphysema!
- Decreased tactile fremitus
- Decreased chest expansion
- PMI often shifts to the epigastric area
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Sputum culture for Chronic Bronchitis !
- Streptococcus pneumoniae
- Haemophilus influsenzae
- Moraxella catarrhalis
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The goals of COPD management!
- Relieve symptoms
- Prevent disease progression
- Improve exercise tolerance
- Improve health status
- Prevent and treat complications
- Prevent and treat exacerbations
- Reduce mortality
- Prevent or minimize side effects from treatment
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Management of COPD!
- Glucocorticosteroids
- Vaccines
- Antibiotics
- Mucolytic
- Antitussives
- Non-pharmacologic treatment
- Rehabilitation
- Oxygen therapy
- Surgical treatment
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Exacerbation of COPD is defined as...
An event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that is beyond normal-day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD
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Respiratory Care Treatment Protocols for chronic bronchitis and emphysema!
- Oxygen
- Bronchopulmonary Hygiene
- Aerosolized Medication
- Mechanical Ventilation
- Other Meds
- ØExpectorants
- ØAntibiotics
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Anatomic Alterations of the Lungs with asthma!
- Smooth muscle constriction of bronchial airways (bronchospasm)
- Bronchial wall inflammation
- Excessive production of thick, whitish, bronchial secretions
- Mucus plugging
- Hyperinflation of alveoli (air-trapping)
- In severe cases, atelectasis caused by mucus plugging
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Extrinsic asthma (Allergic or Atopic asthma
Asthma episodes linked to the exposure of a specific allergen (antigen):
- House dust
- Mites
- Furred animal dander
- Cockroach allergen
- Fungi
- Molds
- Yeast
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Extrinsic asthma!
- Extrinsic asthma is an immediate (Type I) anaphylactic hypersensitivity reaction
- Extrinsic asthma is family related and usually appears in children and adults younger than 30 years old.
- It often disappears after puberty
- Because extrinsic asthma is associated with an antigen-antibody induced bronchospasm, an immunnologic mechanism plays an important role.
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Intrinsic asthma (Nonallergic or Nonatopic asthma)
Occupational sensitizers (Occupational Asthma)
- Asthma episode cannot be directly linked to a specific antigen or extrinsic factor.
- Onset usually occurs after the age of 40 years
- Immunologically mediated
- Latency period of months to years after exposure
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Intrinsic (Non-Allergic) Asthma!
- Not directly linked to a specific antigin
- Contributing factors are elusive
- Normal serum IgE levels
- Usually occurs > 40 years age
- Some overlap with atopic asthma
- Non-specific stimuli
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Test Used in the Diagnosis and Monitoring of Asthma!
- Spriometry
- Peak expiratory flow
- Responsiveness to metacholine, histamine, mannitol, or exercise challenge
- Positive skin tests with allergens or measurement of specific IgE in serum
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Cardiopulmonary Clinical Manifestations Associated with Asthma!
- Bronchospasm
- Excessive Bronchial Secretions
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Vital Signs with asthma!
- Increased respiratory rate (Tachypnea)
- Increased heart rate (pulse)
- Increased blood pressure
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Clinical manifestations of asthma!
- Use of accessory muscles of inspiration
- Use of accessory muscles of expiration
- Pursed-lip breathing
- Substernal intercostal retractions
- Barrel chest
- Cyanosis
- Cough and sputum production
- Pulsus paradoxus
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Chest assessment assicioated with asthma!
- Expiratory prolongation
- Decreased tactile and vocal fremitus
- Hyperresonant percussion note
- Diminished breath sounds
- Diminished heart sounds
- Wheezing and rhonchi
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Sputum culture with asthma!
- Eosinophils
- Charcot-Leyden crystals
- Casts of mucus from small airways (Kirschman spirals)
- IgE level (elevated in extrinsic asthma)
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Chest radiograph of asthma!
- Increased anteroposterior diameter (barrel chest)
- Translucent (dark) lung fields
- Depressed or flattened diaphragms
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Asthma exacerbation is defined as...
A progressive increase in shortness of breath, cough, wheezing, or chest tightness, or a combination of these symptoms.
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Respiratory Care Treatment Protocols with asthma!
- Oxygen Therapy Protocol
- Bronchopulmonary Hygiene Therapy Protocol
- Aerosolized Medication Protocol
- Mechanical Ventilation Protocol
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Anatomic Alterations of the Lungs with cystic fibrosis!
- Excessive mucus production and accumulation of thick, tenacious mucus in the tracheobronchial tree
- Partial or total bronchial obstruction (mucus plugging)
- Atelectasis
- Hyperinflation of the alveoli
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Cystic fibrosis is an...
Autosomal recessive gene disorder caused by mutations in a pair of genes located on chromosome 7.
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Screening and Diagnosis for cystic fibrosis!
- Sweat Test
- Immunoreactive Trypsinogen Test
- Stool Fecal Fat Test
- Nasal Potential Difference (NPD)
- Genetic Testing
- Prenatal Testing
- Amniocentesis
- Chorionic villus biopsy
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Cardiopulmonary Clinical Manifestations Associated with Cystic Fibrosis!
- Atelectasis
- Bronchospasm
- Excessive Bronchial Secretions
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Vital signs with cystic fibrosis!
- Increased respiratory rate (Tachypnea) Increased heart rate (pulse)
- Increased blood pressure
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Clinical Manifestations of cystic fibrosis!
- Use of accessory muscles of inspiration
- Use of accessory muscles of expiration
- Pursed-lip breathing
- Barrel chest
- Cyanosis
- Digital clubbing
- Peripheral edema and venous distension
- Productive cought
- Hemoptysis
- Spontaneous Pneumothorax
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Chest Assessment Findings with cystic fibrosis!
- Decreased tactile and vocal fremitus
- Hyperresonant percussion note
- Diminished breath sounds
- Diminished heart sounds
- Bronchial breath sounds (over atelectasis)
- Crackles, rhonchi, and wheezing
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Hematology with cystic fibrosis!
- Increased hematocrit and hemoglobin
- Increased white blood count
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Chest Radiograph with cystic fibrosis!
- Translucent (dark) lung fields
- Depressed or flattened diaphragms
- Right ventricular enlargement
- Areas of atelectasis and fibrosis
- Bronchiectasis (often a secondary complication)
- Pneumothorax (spontaneous)
- Abscess formation (occasionally)
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Respiratory care treatment protocols with cystic fibrosis!
- Oxygen therapy protocol
- Bronchopulmonary Hygiene Therapy Protocol
- Lung Expansion Therapy Protocol
- Aerosolized Medication protocol
- Mechanical Ventilation Protocol
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Medication and special procedures prescribed by the physician
for management of cystic fibrosis!
- Xanthines
- Expectorants
- Antibiotics
- Lung or heart/lung transplantation
- Future Treatments
- ØSome advances in gene therapy
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Pertussis
- Seasonal
- Droplet transmission
- Contact isolation
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Pertussis treatment!
Oxygen and humidity often done with oxyhood or tent
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Anatomical alterations of pertussis
- Hyperinflation
- Mucus accumulation
- Inflammation airways
- Damaged paralyzed cilia
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CVA/Stroke respiratory complications
- Increased risk of aspiration pneumonia
- Upper airway is partially paralyzed
- History of OSA
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CVA tratment!
- Speech therapy
- Reduce risk of aspiration
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Ischemic
Due to a sudden interruption of blood flow to the brain
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Hemorrhagic
When a blood vessel in the brain leaks, causin blood to spill in surrounding spaces of the brain tissue!
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A person can be HIV positive but...
Not have AIDs
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AIDS
Acquried immune defficiency syndrome
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AIDs/HIV
- T cells are reduced CD4
- Kaposi sarcoma
- TB
- PCP
- only assicioated with AIDS
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Diagnostic test for HIV/AIDS
Western BLOT test
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Drug regimin for AIDS!
- HAART
- Highly active anti retra viral therapy
- 3 or more drugs
- Used to supress the progression of the disease
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Transmission route for HIV/AIDS
- During Sex
- Blood transfusions
- From mother to child
- Organ donors
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Management of RC protocol!
- O2 therapy
- Bronchopulmonary Hygiene therapy
- Thoracentesis
- Mechanical ventilation protocol
- Antibiotics
- Prophylactics
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ALS
- motor neurons in the spinal cord, brain, and brain stem
- Upper and lower neurons are affected
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Sickle cell disease!
- Primarily a disease in Africian americans
- 8 percent of AA have trait
- .15% have disease
- 50k USA
- Mandatory screening
- Early penicillin profolatic
- Hyper reactive airways
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Clinical manafestations of sickle cell!
- SOB
- Pain
- Dizziness
- Headache
- Cold hands/feet
- Pulmonary emboli
- Pulmonary hypertension
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PFTs with sickle cell disease!
- Airway obstruction
- Retructive
- Hypocemia
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