Respiratory Patho

Chronic Obstructive Pulmonary Disease

 Also called COLD-- chronic obstructive lung disease  Emphysema  Chronic bronchitis  Asthma

Emphysema

 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...

 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...

 PCO2 increased  Hypoxic drive  Causes  Complications of disease  Pneumonia  URI  Dysrhythmias cancer

Emphysema cont...

 Home drugs  Bronchodilators  Steroids  Later-- oxygen

Emphysema cont..

 Assessment  Weight loss-- thin  Dyspnea esp on exertion  Cough only in AM  Barrel chest  Tachypnea

Emphysema cont..

 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

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

Chronic bronchitis

 Assessment  Overweight  Blue bloaters  Rhonchi  RHF-- JVD, pedal edema

Management of COPD

 Goal???

 Treat hypoxia  Reverse bronchoconstriction  Reassure patient-- EMONTIONAL support  Oxygen using patient distress to determine amount  Monitor for cardiac dysrhythmias

Management of COPD

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

Management of COPD

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

Asthma

 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

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

Asthma

 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

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

Asthma

 Assessment cont.

 Tachypnea  Use of accessory muscles  Speech dyspnea  History-- what did pt take  beta agonist?, steroids, anticholinergics, bronchodilators?

Asthma

 History of admissions to hospital for asthma  Hx of intubations?

 Management  Corect hypoxia, reverse bronchospasm  Treat inflammatory process

Asthma treatment

 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

 Aminophyllin-- Xanthine bronchodilator (not a beta agonist)  Solu Medrol--- steroid

Status Asthmaticus

 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

 More prevalent in???

 Elderly  HIV positive  Peds  Infection in the lungs  Bacterial, viral, fungal

Pneumonia

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

Pneumonia

 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

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

Toxic inhalation

 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

 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

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

Carbon monoxide

 Management  Remove from site  Airway, high oxygen  treat for respiratory depression or shock  Hyperbaric

Pulmonary embolus

 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

 Who is at risk  long term immoblization  BCP  Hx of thrombophlebitis  Delivery  long bone fx

Pulmonary embolus

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

Hyperventilation syndrome

 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

 Numbness and tingling-- mouth, hands, feet  carpopedal spasms  Treatment  EMOTIONAL SUPPORT  slow respirations

Central nervous system dysfunction

 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