What does a PFT show for restrictive resp. disorders?
-Decr. inspiratory values
-reduced vital capacity
-reduced TLC total lung capacity
What features do all interstitial pulmonary disorders have in common?
They affect the alveoli, blood vessels, and surrounding support tissue of the lungs rather than the airways, they are restrictive
What happens to the alveoli w/ intersititial pulm. disorders?
alveoli becomes inflammed and leads to pulmonary fibrosis, or scarring that becomes stiff, and noncompliant w/ poor recoil and expanision and poor gas exchange
What is the most common sx of interstitial pulmonary disorders?
exertional dyspnea. you may also hear fine crackles and see rapid shallow resps, and clubbing
What are some labs/diagnostics typical of interstitial pulm disease?
-ABG's show hypoxia
-CXR shows characteristic infiltrative patterns
Describe cor pulmonale
cor pulmonale is a result of pulm HTN, as the heart can no longer pump efficiently against the stiff lung, it leads to L sided heart failure and death
What is interstitial pulm. disorders typically caused by? What are they?
caused by occupational exposure
1) pneumoconioses- inhalation of inorganic dust and particulate matter (asbestos, silicosis, coal workers "black lung" disease) has a poor prognosis
2)hypersensitivity pneumonitis (exposure to cotton dust, sugar cane fiber)
What is the goal of care in regards to interstitial pulm disorders?
reduce inflammatory response, prevent disease progression, manage dyspnea and provide supportive care late in the disease
What are some interventions for the pt. w/ interstitial pulm disease?
-corticosteroids and other immunosuppressants (most common med)
-preventative teaching to environmental hazards
-hospice care...reduction of dyspnea by providing morphine: oral, parenteral or nebulized
What is Sarcoidosis?
-A restrictive resp disorder of unknown cause that mostly affects the lungs.
-involves a autoimmune response- T-lymphocytes incr. and cause damage to alveolar cells . Normally T-lymphocytes are protective but w/ Sarcoidosis they form granulomas on the alveoli that cause fibrosis that reduces lung compliance and gas exchange...cor pulmonale often results
How is Sarcoidosis manifested?
-enlarged lymph nodes in the hilar area of the lungs
-lung infiltrate on CXR (the first indication of the disease may be an abnormal CXR in an otherwise healthy pt.)
-cough, dyspnea, hemoptysis and chest discomfort
How is Sarcoidosis treated?
-The goal of therapy is to lessen the s/sx and prevent fibrosis.
-Corticosteroids for severe manifestations, hepatic insufficiency, cardiac dysrhythmias, CNS involvement or disfiguring skin lesions
-Teach about corticosteroids: do not stop abruptly, take w/ food or milk to minimize GI upset, limit Na and incr. K
-symptom relief of inflammatory symptoms (arthralgias, eye inflammation)
What is pneumonia?
Pneumonia= an inflammatory process that results in edema of ung tissue and movement of fluid into the alveoli, causing hypoxemia
The normal protective mechanisms are overcome (warming, filtraionand humididfication of inspired air, closure of epitlottis over trachea, cough reflex, mucociliary movement, secretion of Immunoglobin A, alveolar macrophages)
What are the 2 types of pneumonia?
1) community aquired (CAP), most common streptococcus pneumonia (gram +) treated w/ PCN or cephlosporins
2) Hospital-aquired (nosocomial), most common staphylococcus areus (gram +) treated w/vanco, zosyn, levaquin
Nonsosomial has a high mortality rate: mechanical ventilation incr. risk, contaminated respiratory equipment, immunosuppression and general debilitaion.
How can pneumonia occur in the lungs? Which segments
1) Lobar- w/ consolidation ina segment or entire lobe
2) bronchopneumonia- w/ diffusely scattered patches around the bronchi
What is the general patho of pneumonia?
-fibrin and edema of inflammation stiffen the lung= decr. lung compliance and vital capicity
-decr. producting of surfactant leads to atelectasis
-venous blood passes thru underventilated areas, leading to hypoxemia
-tissue necrosis can result when multiplying organisms from abscesses that perforate bronchial wall
-can lead to sepsis
Discuss Bacterial Pneumonia
-presents w/ rapid onset of shaking, fever, cough of rust-colored purulent sputum
-pleuritic pain common
-fine crackles over affected lobe
-signs of pulm. consolidation (dullness to percussionincr. fremitus, bronchial BS)
Discuss mycoplasma and viral pneumonias
-have gradual and atypical presentations d/t interstitial rather than alveolar inflammation