Type B COPD, “blue bloater” associated with ________
chronic bronchitis
Hypersecretion of bronchial mucus
chronic bronchitis
1) Chronic or recurrent productive cough >3 months >2+ successive years 2) Persistent, irreversible when paired with emphysema 3) 1:2 male to female ratio 4) >30 to 40 years
chronic bronchitis
Chronic inflammation and swelling of the bronchial mucosa resulting in scarring leads to ______
chronic bronchitis
Elevated IL8 levels recruit neutrophil activation Elevated CD8 T-lymphocytes Extend into surrounding alveoli prevents proper oxygenation and potentiates airway obstruction
chronic bronchitis
Hyperplasia of bronchial mucous gland/goblet cells Formation of mucus plugs
chronic bronchitis
Increased bronchial wall thickness associated with _____
chronic bronchitis
Pulmonary hypertension associated with _____
chronic bronchitis
Pulmonary hypertension in chronic bronchitis caused by _______ and ______
cor pulmonale; r/s heart failure
Results in dilation of airway sacs: bronchiectasis Dilated sacs contain pools of infected secretion that do not clear themselves; can cause further infection that can spread to adjacent lung fields by the lymphatics or venous drainage to other areas of the body, commonly the brain
chronic bronchitis
Typical patient is overweight Commonly associated with emphysema SOB on exertion associated with _______
chronic bronchitis
Excessive sputum Chronic cough (more severe in mornings) associated with _______
chronic bronchitis
Evidence of excess body fluids (edema, hypervolemia) Cyanosis (late sign) associated with _______
chronic bronchitis
You diagnose chronic bronchitis using a ________ and _______ function tests
chest x ray; pulmonary
_____ total lung capacity (TLC) _____ residual volume (RV) _____FEV1 are pulmonary function tests used to diagnose chronic bronchitis
normal; increased; decreased
Increased bronchial vascular markings Congested lung fields used to diagnose ________
chronic bronchitis
Enlarged horizontal cardiac silhouette Evidence of previous pulmonary infection used to diagnose _______
chronic bronchitis
______ PaCO2 ______ PO2 used to diagnose chronic bronchitis
elevated; decreased
Atrial arrhythmias Evidence of right ventricular hypertrophy used to diagnose ________
chronic bronchitis
Secondary polycythemia used to diagnose _______
chronic bronchitis
Block the progression of the disease Return to optimal respiratory function Return to usual activities of daily living are just some goals of _______
chronic bronchitis
Inhaled short-acting B2 agonists is medication for ______
chronic bronchitis
Inhaled anticholinergic bronchodilators Cough suppressants Antimicrobial agents (bacterial infections) meds for _______
chronic bronchitis
Inhaled/oral corticosteroids Theophylline products meds for ______
chronic bronchitis
Low-dose _____therapy Mechanical ventilation may be necessary for ______
O2; chronic bronchitis
Smoking cessation Bronchodilator therapy Reduction to exposure of irritants done to manage ______
chronic bronchitis
Rest, hydration, and physical reconditioning used to manage _____
chronic bronchitis
Influenza and pneumococcal vaccines used to manage _______-
chronic bronchitis
Type A COPD “Pink puffer associated with _______
emphysema
Destructive changes of the alveolar walls WITHOUT fibrosis Abnormal enlargement of the distal air sacs
emphysema
Damage is irreversible Associated with chronic bronchitis
emphysema
Smoking >70 packs/year Air pollution Certain occupations (mining, welding, working with or near asbestos) are just some causes of _______
emphysema
α1-Antitrypsin deficiency notable for causing_______
emphysema
Pathogenesis of _______ includes release of proteolytic enzymes from neutrophils and macrophages leading to alveolar damage
emphysema
Smoking causes alveolar damage, leading to Inflammation in ______-
emphysema
Release of proteolytic enzymes and Inactivated α1-antitrypsin in ______
emphysema
Reduction in pulmonary capillary bed and loss of elastic tissue in lung leads to _______
emphysema
Loss of alveolar wall and air trapping leads to bullae formation in _______
emphysema
Progressive, exertional dyspnea a symptom of ______
emphysema
Thin R/t increased respiratory effect, increased caloric expenditure, and decreased ability to consume adequate calories manifestation of _______
emphysema
Use of accessory muscles manifestation of ______
emphysema
Pursed-lip breathing manifestation of _____
emphysema
Cough (minimal or absent) Digital clubbing manifestations of ______
emphysema
barrel chest manifestation of ______
emphysema
Pulmonary function tests (PFTs) for emphysema include _____ functional residual capacity _______RV, TLC _______ FEV1, FVC
increased; increased; decreased
When diagnosing ________ with a chest x ray, you are looking for Hyperventilation Low, flat diaphragm
emphysema
When diagnosing ________ with a chest x ray, you are looking for Presence of blebs or bullae Narrow mediastinum
emphysema
When diagnosing ________ with a chest x ray, you are looking for Normal or small “vertical” heart
emphysema
When diagnosing emphysema, the ECG is usually normal and will show high _____ waves
P
Sinus _____: first sign of decreased oxygenation Supraventricular arrhythmias Ventricular irregularities will all show up on an ECG for _______
TACHYCARDIA; emphysema
____ decrease in PaO2 _____ PaCO2 (elevated in late stages) in emphysema
mild; normal
Thin, wasted individual hunched forward Using accessory muscles symptoms of
emphysema
Decreased breath sounds, lack of crackles and rhonchi Prolonged expiration symptoms of _______
emphysema
Decreased heart sounds Hyperresonance signs of _______
emphysema
Decreased diaphragmatic excursion Chronic morning cough signs of ______
emphysema
O2 therapy, smoking cessation, and meds like Inhaled short-acting B2 agonists and Inhaled anticholinergic bronchodilators used to treat _______
emphysema
Meds like Cough suppressants Antimicrobial agents (infections) Inhaled/oral corticosteroids used to treat _______
emphysema
Meds like Theophylline products used to treat _______
emphysema
Cystic fibrosis is an autosomal recessive disorder of ________ glands
exocrine
Most common genetic lung disease in the U.S. Classified as airflow or suppurative (pus-forming)
Cystic Fibrosis
Hypersecretion of abnormal, thick mucus that obstructs exocrine glands and ducts Median survival age: 31 years
Cystic Fibrosis
Dysfunction of ______ gene in cystic fibrosis
CFTR
Primarily affects the pancreas, intestinal tract, sweat glands, and lungs, and in males causes infertility
Cystic Fibrosis
High concentrations of sodium and chloride in sweat, salivary, and lacrimal secretions
Cystic Fibrosis
_____-producing glands in the ____tract enlarge in cystic fibrosis
mucus; GI
Increased production of pancreatic enzymes, causing ______ fat and protein in the stool in _______
decreased; cystic fibrosis
______ system is also affected by the thick, tenacious mucus in cystic fibrosis
bronchopulmonary
Failure of chloride channels to function Decreased flow of ions and water results in viscid mucus
Cystic Fibrosis
Causes airway obstruction, atelectasis, and hyperinflation and also decreases ciliary action Provides a medium for pulmonary infection
Cystic Fibrosis
History of cough in young adult or child Thick, tenacious sputum
Cystic Fibrosis
Recurrent pulmonary infections and bronchitis Dyspnea, tachypnea Sternal retractions
Cystic Fibrosis
Unequal breath sounds Moist basilar crackles and rhonchi
Cystic Fibrosis
Barrel chest hyperresonant to percussion Digital clubbing (late)
Cystic Fibrosis
Pancreatic insufficiency, cirrhosis of the liver, diabetes mellitus, gallstones, nasal polyps, and failure of development of the vas deferens in males are just some manifestations of ________
Cystic Fibrosis
Depleted fat stores Steatorrhea (fatty stools) signs of ________
Cystic Fibrosis
Anorexia Decreased growth rate in children (wt, ht, head circ) signs of _______
Cystic Fibrosis
_______ and hypercapnia are signs of cystic fibrosis
hypoxemia
_____ VC, airflow, TV _____ airway resistance, functional residual capacity in cystic fibrosis
decreased; increased
Patchy atelectasis, bronchiectasis, cystic lung fields seen through a chest X-ray with ______
cystic fibrosis
Some typical ways to diagnose _________include sputum C&S
cystic fibrosis
When diagnosing cystic fibrosis, the sweat test looks for elevated _______ levels
Na; Cl
Used to determine fat absorption and fecal fat excretion when testing for cystic fibrosis
72 hour stool collection
Genetic marker ______ confirms diagnosis for cystic fibrosis
AF-508
Aggressive treatment of respiratory infections Postural drainage and chest physiotherapy (priority) Forced expiratory technique treatments for __________
cystic fibrosis
Treatment includes bronchodilators, and Dornase alfa
cystic fibrosis
Treatment includes high dose antibiotics (bacterial infections) and the influenza vaccine
cystic fibrosis
Nutritional therapy: Unrestricted fat consumption: 30% of caloric intake High protein Vitamin supplements, esp., A, K, D, E used for _______
cystic fibrosis
Nutritional therapy: Pancreatic enzymes Intake of 150% normal caloric intake May need enteral feedings or IV feedings used for ________
cystic fibrosis
Heart-lung or lung transplant may be needed for _____
cystic fibrosis
Demonstrates obstruction of airflow in lungs
Pulmonary Function Testing (PFT)
ØDetermines severity and diagnosis of COPD
ØPatient inhales deeply and exhales as quickly as possible until maximal air is exhaled
Also a type of pumonary function testing
Spirometry
- Total volume of air exhaled
- Time required for exhaling the air is also measured
ØForced vital capacity (FVC) in spirometry
Forced ______volume in 1 second is another popular type of spirometry
expiratory
FEV1/FVC ratio >75% spirometry measure
no significant obstruction
Spriometry measure: FEV1/FVC ratio between 60% and 70%
Mild obstruction
Spirometry measure: FEV1/FVC ratio 50% to 60%
moderate obstruction
Spirometry measure: FEV1/FVC ratio <50%
Severe obstruction
A type of spirometry test given is when inhaled bronchodilator (albuterol or metaproterenol) given, repeat test in ___ to ____minutes
15-20
Positive bronchodilator response is when
- FEV1 improves >_____
- Indicative of partially reversible bronchospasm of smooth muscle (asthma, asthmatic bronchitis)
15%
ØMeasures ability of alveolar gases to diffuse into capillary blood
ØValuable for determining fibrosis or destruction of membrane
Diffusion capacity
ØDecreased FEV1
ØLow FEV1/FVC ratio (<70%)
diagnose ________
obstructive disorder
Improvement in FEV1 after use of bronchodilator (asthma) diagnose ________
obstructive disorder
ØIncreased residual volume (RV)
ØIncreased functional residual capacity (FRC)
diagnose _______
obstructive disorder