Nur 509 Pulmonary II Alterations Student PDF

The Pulmonary System II Alterations Wencan Lu DNP, FNP-BC Nur 509 The Pulmonary System: Alterations Pleural Abnormalities Pneumothorax Restrictive Lung Disorders Atelectasis Bronchiectasis Pulmonary fibrosis Obstructive Lung Disorde...

The Pulmonary System II Alterations Wencan Lu DNP, FNP-BC Nur 509 The Pulmonary System: Alterations Pleural Abnormalities Pneumothorax Restrictive Lung Disorders Atelectasis Bronchiectasis Pulmonary fibrosis Obstructive Lung Disorders Asthma Chronic Obstructive Pulmonary Disease (COPD) Respiratory Tract Infections Acute Bronchitis Pneumonia Tuberculosis Pulmonary Vascular Disease Pulmonary Embolism Geriatric Considerations Pleural Abnormalities/Pneumothorax Presence of air or gas in the pleural space Primary (spontaneous) pneumothorax Occurs unexpectedly in healthy individuals. Secondary pneumothorax Caused by chest trauma, rupture of bleb, or mechanical ventilation Clinical presentation Sudden sharp chest pain, often unilateral, increases with inhalation Dyspnea Tachycardia, tachypnea Restrictive Lung Disorders Characterized by decreased compliance of the lung tissue → ↑ effort to expand the lungs during inspiration Atelectasis Bronchiectasis Pulmonary fibrosis Restrictive Lung Disorders/Atelectasis Collapse of lung tissue Compression atelectasis External compression on the lung Absorption atelectasis When pure O2 is given Surfactant impairment Decreased production or inactivation of surfactant Clinical presentation Mimic respiratory infection: Dyspnea, cough, fever, and leukocytosis Restrictive Lung Disorders/Bronchiectasis Persistent abnormal dilation of the bronchi, usually occurs in conjunction with other respiratory conditions: Chronic bronchial inflammation, atelectasis, infection, cystic fibrosis, rheumatologic disease, AIDS Clinical presentation Chronic productive cough, hemoptysis Restrictive Lung Disorders/Pulmonary Fibrosis Pulmonary fibrosis Excessive amount of fibrous or connective tissue in the lung → ↓ lung compliance Caused by scar tissue Acute respiratory distress syndrome, tuberculosis, autoimmune disorders (e.g., rheumatoid arthritis) Clinical presentation Dyspnea, dry cough, fatigue Obstructive Lung Disorders Characterized by airway obstruction that is worse with expiration. More force or more time is required to expire a given volume of air, and the emptying of the lungs is slowed Asthma Chronic Obstructive Pulmonary Disease (COPD) Obstructive Lung Disorders/Asthma Description: Chronic inflammatory disorder of the bronchial mucosa, causes bronchial hyperresponsiveness, constriction of the airway, and intermittent airflow obstruction that is reversible Pathophysiology: Airway epithelial exposure to antigen initiates both an innate and an adaptive immune response in sensitized individuals → Episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucous production Early asthmatic response due to release of inflammatory cytokines Vasodilation Increased capillary permeability Mucosal edema Bronchial smooth muscle contraction (bronchospasm) Tenacious mucous secretion Obstructive Lung Disorders/Asthma Description (con’t) Pathophysiology (con’t) Late asthmatic response Begins 4–8 hours after the early response Chemotactic recruitment of lymphocytes, eosinophils, basophils, neutrophils, and lymphocytes occurs Increased bronchial hyperresponsiveness Impaired mucociliary function with accumulation of mucous and cellular debris, forming plugs in the airways Leads to airway remodeling if left untreated Genes have been identified that may play a role Obstructive Lung Disorders/Asthma Copyright © 2019, Elsevier Inc. All rights reserved. 11 Obstructive Lung Disorders/Asthma Description Epidemiology Affects about 8 % of adults in the US Commonly associated conditions Obesity, gastroesophageal reflux disease, allergic rhinitis, eczema Clinical presentation Asymptomatic between attacks Chest constriction, dyspnea, nonproductive cough Expiratory wheezing, prolonged expiration Tachycardia, tachypnea Status asthmaticus Bronchospasm not reversed by usual measures Life-threatening https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm Obstructive Lung Disorders/Asthma Diagnosis H&P Spirometry: Reduced FEV1 Reduced FEV1/FVC ratio with reversibility after using a short-acting bronchodilator 4 stages by severity Treatment Avoid triggers Rescue and maintenance Obstructive Lung Disorders/COPD Description: COPD is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases The chronic airflow limitation that is characteristic of COPD is caused by a mixture of small airways disease (e.g., obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person Considered irreversible - GOLD Global Initiative for Chronic Obstructive Lung Disease, 2017 Obstructive Lung Disorders/COPD Description: Pathophysiology Exposure to noxious gasses or particles leading to inflammation of airway epithelium → infiltration of inflammatory cells → bronchial inflammation and increase protease activity Bronchial inflammation → bronchial edema, increases in the size and number of goblet cells → hypersecretion of thick, tenacious mucus → impaired ciliary function → impaired clearing of mucus → smooth muscle hypertrophy with fibrosis, and narrowing of airways → hyperinflation of alveoli Obstructive Lung Disorders/COPD Description (con’t) Pathophysiology (con’t) Increase protease activity → Breaks down elastin in connective tissue of the lungs → alveolar wall destruction → Loss of elastic recoil An inherited mutation in the α1-antitrypsin gene results in the development of COPD (emphysema) at an early age (