Respiratory Patho

Chronic Obstructive Pulmonary Disease w Also called COLD-- chronic obstructive lung disease w Emphysema w Chronic bronchitis w Asthma

Emphysema w What is it? w Destruction of alveolar walls-- below the bronchioles w Decreases surface area w Decreases area available for exchange w Increase resistance to pulmonary blood flow

Emphysema cont... w Can lead to pulmonary hypertension w Cor pulmonale = right heart failure w Lungs can not recoil and air is trapped w Residual lung capacity increases w PO2 decreases over time w Increased RBC w Polycythemia-- high hematocrit

Emphysema cont... w PCO2 increased w Hypoxic drive w Causes w Complications of disease w Pneumonia w URI w Dysrhythmias cancer

Emphysema cont... w Home drugs w Bronchodilators w Steroids w Later-- oxygen

Emphysema cont.. w Assessment w Weight loss-- thin w Dyspnea esp on exertion w Cough only in AM w Barrel chest w Tachypnea

Emphysema cont.. w Pink puffers w Enlarged accessory muscles w Clubbing of fingers w Pursed lips-- prolonged expiration-- active now w Wheezing or rhonchi may or may not be present

Chronic bronchitis w Increase in the number of mucous cells w Large amount of sputum w Diffusion normal w Hypercarbia due to deceased alveolar ventilation

Chronic bronchitis w Assessment w Overweight w Blue bloaters w Rhonchi w RHF-- JVD, pedal edema

Management of COPD w Goal??? w Treat hypoxia w Reverse bronchoconstriction w Reassure patient-- EMONTIONAL support w Oxygen using patient distress to determine amount w Monitor for cardiac dysrhythmias

Management of COPD w IV 5% D/W or NS KVO w Nebulizer w Albuterol, Proventil Ventolin w isoethharine, Bronksol w metrproterenol, Alupent w Sympathomimetic, Beta agonist B2 selective

Management of COPD w Bronchodilation w Uses-- COPD, Pul edema, asthma, severe allergic reactions w Contraindications-- tachycardia w Monitor B/P, pulse, ECG w Side effects-- tachycardia, palpitations, anxiety,headache, dizzy

Asthma w Asthma patients do die w Increasing deaths over 45 years old w Higher death rate in Afro-Americians w definition w Chronic disease due to air flow obstruction w Small airways consrtict

Asthma w Causes of acute excerbations w allergens w cold air w irritants-- smoke, pollen w medications

Asthma w Phase one w Release of histamine w Bronchoconstriction and bronchial edema w Usually will respond to Beta agonist w Phase two w WBC invade bronchioles w Cause edema and swelling of bronchioles

Asthma w Phase 2 will not respond well to Beta agonists w May need steroids w Assessment w Dyspnea and wheezing w Cough w Hyperressonance

Asthma w Assessment cont. w Tachypnea w Use of accessory muscles w Speech dyspnea w History-- what did pt take w beta agonist?, steroids, anticholinergics, bronchodilators?

Asthma w History of admissions to hospital for asthma w Hx of intubations? w Management w Corect hypoxia, reverse bronchospasm w Treat inflammatory process

Asthma treatment w Emotional support w Primary and secondary survey w Oxygen w EKG and pulse ox w Beta agonist-- nebulizer w Epinephrine SQ mg or cc 1:1000 solution Peds 0.01 mg.kg up to 0.3mg

Asthma treatment w Aminophyllin-- Xanthine bronchodilator (not a beta agonist) w Solu Medrol--- steroid

Status Asthmaticus w Severe, prolonged asthma attack which can not be broken by usual treatment w Wheezing may be absent-- silent chest w Severe acidosis w May have to intubate

Pneumonia w More prevalent in??? w Elderly w HIV positive w Peds w Infection in the lungs w Bacterial, viral, fungal

Pneumonia w Assessment w “looks sick” w fever and chills w tachypnea, tachycardia w general weakness-- malaise w Productive cough-- yellow, blood-tinged w Chest pain-- upper abd pain

Pneumonia w Rhoncho, wheezing, rales w percussion??? w Management w Emotional support w Primary and secondary survey w O2, EKG, Pulse ox, IV-- may be dehyrated w Position, when would nebulizer be used?

Toxic inhalation w May cause inflammation and constriction or laryngospasm or edema of larynx w superheated air w toxic products w chemicals w inhaled steam

Toxic inhalation w Scene safety w If hoarseness, brassy cough or stridor-- possible laryngeal edema-- be careful w May need to intubate w Humidified O2, IV, EKG, Pulse ox w Be careful about nebulized drugs

Carbon monoxide w Odorless, tasteless gas w binds with hemoglobin 200 faster than oxygen w receptor sites do not transport oxygen w cellular hypoxia w history-- how long and where

Carbon monoxide w Signs and symptoms w headache and irritability w confusion or agitation w vomiting, chest pain, LOC, seizures w Cyanotic, cherry red is late sign

Carbon monoxide w Management w Remove from site w Airway, high oxygen w treat for respiratory depression or shock w Hyperbaric

Pulmonary embolus w Blood, air, foreign body that lodges in pulmonary artery w Many are diagnosed on autopsy w S and S w Sudden unexplained SOB w Chest pain may or may not be present w Shock symptoms

Pulmonary embolus wWwWho is at risk wlwlong term immoblization wBwBCP wHwHx of thrombophlebitis wDwDelivery wlwlong bone fx

w Management w Transport ASAP w High O2, position w Emotional support w IV, pulse ox, EKG, 12 lead w May need to tube

Hyperventilation syndrome w Anxiety or situational problem w consider other medical problems w do not minimize w loss of CO2 cause Respiratory Alkalosis w rapid and shallow respirations w nervous, dizzy, chest pain

Hyperventilation syndrome w Numbness and tingling-- mouth, hands, feet w carpopedal spasms w Treatment w EMOTIONAL SUPPORT w slow respirations

Central nervous system dysfunction w Head trauma, stroke, brain tumor, drugs w dysfunctional of spinal cord, nerves, respiratory muscles w spinal cord trauma, polio, myasthenia gravis, Lou Geriigh’s disease, MS, MD