Pulmonary Disease (Pulm II)

Chronic Bronchitis

Inflammatory changes

excessive mucus production

hyperplasia & hypertrophy of mucus-producing glands

prolonged exposure to irritants

Chronic Bronchitiis

 

SxS

Dyspena w/ airway resistance

productive cough

Rhonchi

Peripheral edema

Cyanosis: ‘Blue bloaters”

typically overweight

finger clubbing

Emphysema

 

 

causes

Emphysema is a slow progression

 

Smoking

Pollution

Allergens

Respiratory infection

Emphysema

 

Results

-Decreased alveolar surface area

-increased residual volume

-Reduction in arterial PO2

Effects of decreased alveolar surface area

 

“Barrel chested”

Emphysema

 

Results

Decreased alveolar surface

Increased residual volume

Reduction in arterial PO2

 

Process of expiration

 

“Barrel chested”

Emphysema

 

SxS

Onset

Physical appearence

Chest tightness

DOE

 

Pulse Lipped

Cough

Wheezing & rhonchi

“Pink Puffer”

Emphysena

 

Initial Presentation

Worsening dyspnea

Paroxysmal nocturnal dyspnea (PND)

Sputum production

Generalized malaise

Emphysema

 

Clinical appearence

Orthopnean (difficulty breathing when lying down: is relived once on lies up)

 

Tripod position

Purse-lipped breathing

Accessory muscle use

Emphysema

 

Management

IV access

Supplemental O2

Monitor VS, cardiac rhythm

Pulse oximetery

Visualize sputum is productive cough

Assit ventilation

Intubate

Emphysema

 

Medication

Albuterol

 

Alupent

 

Steriods (long term / hospital)

 

Nebulized anticholinergics

 

Methylxanthines

Asthma

Reactive airway disease

 Exacebating factors

-Extrinsic

-Intrinsic

 

Childhood asthma

Asthma

 

Causes

 

-Airway irritability

-Allergens

-Stress

 

 

Asthma

 

Pathophysiology

Acute

 

Reverse airflow obstruction

Bronchospasm

Excess mucus

Inflammation

Asthma

 

internal resistance to airflow

Increased resistance to airflow results in:

 

-Alveolar hypoventilation

-Ventilation-perfusion mismatching

-Hypercapnia

-Air trapping

Asthma

 

Increased demand on respiration system

 Accessory muscle use

Respiratory fatigue

Asthma

 

SxS

Tripod position

Respiratory distress

Altered mental status

Asthma

 

Breath Sounds

 

 

Expiratory whezzing

Inspiratory wheezing

 

 

In an acute, severe asthmatic…Silence isn’t golden

Asthma

 

SxS

Diaphoresis & pallor

Chest tight, retractions

short word strings

tachypena

Tachycardia

Pulse paradoxus

Elevated BP

Asthma

 

Prehosp care

ABC’s

Hi flow O2

IV fluid

patient assurance

POC

Monitor VS, cardiasc rythm

Pulse Ox

Asthma

 

drugs

Albuterol HHN

 

Epinephrine 1:1000 SQ

Asthma

 

Peak flow meter

Peak flow meter is based upon’

 

Age

Sex

Height

Weight

Respiratory effort

Status Asthmaticus

Prolonged asthma exacebation

 

Imminatent danger of respiratory failure

 

life threating emergency

Status Asthmaticus

 

Prehospital care

IV fluids

High flow O2

Assits ventilation

 

Albuterol HHN

Epinephrine SQ

Haemophilus Influenza (Type A)

 

SxS

 

Cough

Pleurtic chest pain

fever w/ chills

Bacterial Pneumonia

 

Pathophysiology

Infection in the alveoli

Fluid & purulent sputum

Aspiration

 

Bacterial pneumonia

 

SxS

Pleuritic chest pain

Dyspnea

Productive cough

coarse rhonchi

wheezing, rales

Wheezing, rales

Tachycardia

fever w/ chills

Hemoptysis

Bacterial Pneumonia

 

Mangement

Antibiotics

Hydration (oral, IV fluids)

O2 as needed

Monitor pulse ox, ECG rythms

Hospitalization

Aspiration Pneumonia

 

Pathophysiology

Foreigh material

 

inflammation

Aspiration Pneumonia

 

Physiological effects

Volume

pH

Aspiration Pneumonia

 

Aspiration of

Nonbacterial

Stomach contents

 

 

 

Bacterial

Rositive end Expiratory Pressure

(PEEP)

-Maintains a degree of positive pressure pressure AT THE END OF EXHALATION

 

-Intubation w/PEEP

 

 

 

Description of device

-Boehringer valve

connected to a bag-valvedevice

Range of PEEP

Biphasic Positive Airway Pressure

BiPAP

BiPAP

Combines partial ventialtion support & CPAP

Sleep apena

 

leak-tolerant system

 

Why does a COPD patient depend on hypoxic drive to breath vs a CO2 drive?
Patients w/ COPD have an elevated CO2 leve. They depend on a deficiency of oxygen (hypoxia), detected by the the periphheral chemorecptors, as the promary stimulus to breathe
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