Transcript Respiratory Patho

Respiratory Patho
Chronic Obstructive Pulmonary
Disease
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Also called COLD-- chronic obstructive
lung disease
Emphysema
Chronic bronchitis
Asthma
Emphysema
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What is it?
Destruction of alveolar walls-- below the
bronchioles
Decreases surface area
Decreases area available for exchange
Increase resistance to pulmonary blood flow
Emphysema cont...
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Can lead to pulmonary hypertension
Cor pulmonale = right heart failure
Lungs can not recoil and air is trapped
Residual lung capacity increases
PO2 decreases over time
Increased RBC
Polycythemia-- high hematocrit
Emphysema cont...
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PCO2 increased
Hypoxic drive
Causes
Complications of disease
Pneumonia
URI
Dysrhythmias
cancer
Emphysema cont...
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Home drugs
Bronchodilators
Steroids
Later-- oxygen
Emphysema cont..
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Assessment
Weight loss-- thin
Dyspnea esp on exertion
Cough only in AM
Barrel chest
Tachypnea
Emphysema cont..
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Pink puffers
Enlarged accessory muscles
Clubbing of fingers
Pursed lips-- prolonged expiration-- active
now
Wheezing or rhonchi may or may not be
present
Chronic bronchitis
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Increase in the number of mucous cells
Large amount of sputum
Diffusion normal
Hypercarbia due to deceased alveolar
ventilation
Chronic bronchitis
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Assessment
Overweight
Blue bloaters
Rhonchi
RHF-- JVD, pedal edema
Management of COPD
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Goal???
Treat hypoxia
Reverse bronchoconstriction
Reassure patient-- EMONTIONAL support
Oxygen using patient distress to determine
amount
Monitor for cardiac dysrhythmias
Management of COPD
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IV 5% D/W or NS KVO
Nebulizer
Albuterol, Proventil Ventolin
isoethharine, Bronksol
metrproterenol, Alupent
Sympathomimetic, Beta agonist B2
selective
Management of COPD
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Bronchodilation
Uses-- COPD, Pul edema, asthma, severe
allergic reactions
Contraindications-- tachycardia
Monitor B/P, pulse, ECG
Side effects-- tachycardia, palpitations,
anxiety,headache, dizzy
Asthma
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Asthma patients do die
Increasing deaths over 45 years old
Higher death rate in Afro-Americians
definition
Chronic disease due to air flow obstruction
Small airways consrtict
Asthma
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Causes of acute excerbations
allergens
cold air
irritants-- smoke, pollen
medications
Asthma
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Phase one
Release of histamine
Bronchoconstriction and bronchial edema
Usually will respond to Beta agonist
Phase two
WBC invade bronchioles
Cause edema and swelling of bronchioles
Asthma
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Phase 2 will not respond well to Beta
agonists
May need steroids
Assessment
Dyspnea and wheezing
Cough
Hyperressonance
Asthma
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Assessment cont.
Tachypnea
Use of accessory muscles
Speech dyspnea
History-- what did pt take
beta agonist?, steroids, anticholinergics,
bronchodilators?
Asthma
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History of admissions to hospital for asthma
Hx of intubations?
Management
Corect hypoxia, reverse bronchospasm
Treat inflammatory process
Asthma treatment
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Emotional support
Primary and secondary survey
Oxygen
EKG and pulse ox
Beta agonist-- nebulizer
Epinephrine SQ 0.3-0.5 mg or cc
1:1000 solution Peds 0.01 mg.kg up to
0.3mg
Asthma treatment
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Aminophyllin-- Xanthine bronchodilator
(not a beta agonist)
Solu Medrol--- steroid
Status Asthmaticus
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Severe, prolonged asthma attack which can
not be broken by usual treatment
Wheezing may be absent-- silent chest
Severe acidosis
May have to intubate
Pneumonia
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More prevalent in???
Elderly
HIV positive
Peds
Infection in the lungs
Bacterial, viral, fungal
Pneumonia
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Assessment
“looks sick”
fever and chills
tachypnea, tachycardia
general weakness-- malaise
Productive cough-- yellow, blood-tinged
Chest pain-- upper abd pain
Pneumonia
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Rhoncho, wheezing, rales
percussion???
Management
Emotional support
Primary and secondary survey
O2, EKG, Pulse ox, IV-- may be dehyrated
Position, when would nebulizer be used?
Toxic inhalation
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May cause inflammation and constriction or
laryngospasm or edema of larynx
superheated air
toxic products
chemicals
inhaled steam
Toxic inhalation
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Scene safety
If hoarseness, brassy cough or stridor-possible laryngeal edema-- be careful
May need to intubate
Humidified O2, IV, EKG, Pulse ox
Be careful about nebulized drugs
Carbon monoxide
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Odorless, tasteless gas
binds with hemoglobin 200 faster than
oxygen
receptor sites do not transport oxygen
cellular hypoxia
history-- how long and where
Carbon monoxide
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Signs and symptoms
headache and irritability
confusion or agitation
vomiting, chest pain, LOC, seizures
Cyanotic, cherry red is late sign
Carbon monoxide
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Management
Remove from site
Airway, high oxygen
treat for respiratory depression or shock
Hyperbaric
Pulmonary embolus
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Blood, air, foreign body that lodges in
pulmonary artery
Many are diagnosed on autopsy
S and S
Sudden unexplained SOB
Chest pain may or may not be present
Shock symptoms
Pulmonary embolus
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Who is at risk
long term immoblization
BCP
Hx of thrombophlebitis
Delivery
long bone fx
Pulmonary embolus
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Management
Transport ASAP
High O2, position
Emotional support
IV, pulse ox, EKG, 12 lead
May need to tube
Hyperventilation syndrome
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Anxiety or situational problem
consider other medical problems
do not minimize
loss of CO2 cause Respiratory Alkalosis
rapid and shallow respirations
nervous, dizzy, chest pain
Hyperventilation syndrome
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Numbness and tingling-- mouth, hands, feet
carpopedal spasms
Treatment
EMOTIONAL SUPPORT
slow respirations
Central nervous system
dysfunction
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Head trauma, stroke, brain tumor, drugs
dysfunctional of spinal cord, nerves,
respiratory muscles
spinal cord trauma, polio, myasthenia
gravis, Lou Geriigh’s disease, MS, MD