Disorders of the lower Respiratory tract
COPD- a group of diseases that result in persistent obstruction of bronchial airflow that is not fully reversible. Includes both Chronic Bronchitis and emphysema
Risk factors for copd
Smoking
Occupational exposures, pollution, host disorders: alpha1antirypsin def
Chronic inflammation witch the body attempts to repair, causing narrowing in the small peripheral airways. Over time this process causes scar tissue and narrows the airway lumen
Chronic Bronchitis- blue bloater drive to breath is Low 02 so don’t over oxygenate them.
Exacerbations most common in winter months.
Presence of cough and sputum production for at least 3m0/2 consec years. Cyanosis, dyspnea, rhonchi and or wheezes.
COPD- Emphysema- pink puffer. Impaired gas exchange r/t destruction of walls of overdisteneded alveoli No cyanosis at first no right sided symptoms cough sputum, DOE, wt loss
Complications of COPD
Respiratory Failure
May need incubated, these pt may not seem as sick as they really are.
Medical Management
Stop inflammation
Prevent progression
Decrease symptoms
Improve activity tolerance/health status
Prevent exacerbations and complications
Reduce mortality
Smoking cessation
Vaccination against flue and pneumonia
Anxiety management
ACUTE BRONCHITIS
Usually virus,
Treat symptoms and may give bronchodilators
ASTHMA chronic inflammatory disease of the airways that causes hyperreponsiveness to mucosal edema, and mucous production.
Symptoms
Cough, chest tightness, wheezing dyspenea
It is largely reversible
Occurs more at night
Complications
Status asthmaticus
Respiratory failure
Pneumonia
4 levels
1. Mild intermitted- symptoms 2x week, nigh 2x or less/per mo
2. Mild persistent – symptoms grater 2x week and grater then 2x a mo
3. Moderate persistent- daily symptoms and night1x week
4. Sever persistent- continuous symptoms and frequent night
SEE DEVELOPMENT OF PATIENT GUIDE LINES PG 593
Cystic Fibrosis
Genetic 1 in 31 has gene and don’t know it
Lungs= mucous prodcing glands dilate and hypertrophy leading to mucous plugs of the small airways
In sweat glands there is increased NA and CL content of the sweat
S&s
Cough, dyspnea, barrel ches, frequent bulky greasy stools, wt loss, salty taste to skin
Lung Cancer
Non small cell and small cell cancer
Small cell 25% of all lung cancers
Grow rapidly and spread early
Risk factors smoking, second hand smoke, age, radiation exposure, family history
S&S
Can be asymptomatic until late
Assessment/diagnosis
No screening for lung cancer
Cxr
Chest ct
Management- surgical resection is preferred, radiation chemo
Chest trauma Penetrating vs blunt…. If penetrating and item is still in wound leave it there
Tension pneumothorax
1 way air leak that allows rapid accumulation of air b/t the visceral pleura and the parietal pleura
S&S
Resp distress
Asymmetrical chest wall expension, tracheal deviation
JCV
Decreased or absent lung sounds on affected side
Hypotension
Cyanosis
Hyperresonance with percussion
Leathal unless air is removed, never clamp CT
Open Pneumothorax sucking chest wound
Usually result of penetrating trauma
Air flows directly into pleura cavity with each breath
Simple pneumothorax, can be iatrogenic
Hemothorax- blood in chest cavity
Flail chest- associated with mulitpile rib fractures
Av shunting
Crepedious over side
Apply pressure over flaied protion, turn pt onto affected side for transport. Ventialition
Rib fracutures, most common blunt chest injury
Treatment analgesics and rest, may splintingg, deep breath turn and cough while splinting.
ARDS- acute respiratory distress syndrome
Don’t respond to normal treatment
High mortality