Topic 3 Lower Resp, Obstructive Pulm, Respiratory Diag, ABGs

• Cystic fibrosis can cause hyperinflation of lungs, thick mucus, scarring of airways and air trapping.
• Cystic fibrosis causes higher metabolism.
• PJP does not usually occur in humans unless you are immunocompromised.
• A patient is still contagious for TB after 2 weeks of treatment.
• Diarrhea can cause metabolic acidosis due to loss of alkaline fluids.
• Bronchoscopy can be for obtaining specimens, removing mucus plugs or foreign bodies, achieve patency of obstructed airway.
• Lung biopsy is for getting tissue for evaluation if cancer cells are present.
• Thoracentesis, needing in chest to obtain things from pleural space, monitor breath sounds and hypoxia, pneumothorax.
• When are flow meters and spirometers used for pulmonary function tests?

  Asthma, cystic fibrosis, COPD, before or after lung transplant or thoracic surgeries.
• Cystic fibrosis is inherited, airway obstruction causing increased mucus production, affects lungs, GI, pancreas, biliary tract, reproductive organs.
• Cystic fibrosis, mucus becomes very thick, motility is reduced and can block bronchioles which causes "remodeling" in lungs. Can also cause a persistent infection that is uncurable.
• Median age for diagnosis of cystic fibrosis is 6 - 8 months.
• More than 50% of incidences of cystic fibrosis is in adults.
• Signs of cystic fibrosis would be fatigue, chronic cough, thick mucus, chronic hypoxia, low absorption of vitamins, abdominal distension, steatorrhea (fat stinky stools), meconium ileus in newborns.
• Treatments for CF

  High calories, high protein, postural drainage, antibiotics, mucolytics, pancreatic enzymes.
• In CF, there is lower pancreatic functioning which is what causes fat stinky stool.
• Gold standard for CF testing is the sweat chloride test where values over 60 are positive.
• Genetic screening for CF is difficult.
• Interprofessional care for CF

  Antibiotics, nebulizers, aerosols, aggressive pulmonary toileting (chest physiotherapy, incentive spirometer, pursed lip, O2) to maintain airway clearance.
• To loosen mucus, percussion and vibration are chest physiotherapy techniques.
• Asthma is bronchial hyperreactivity with reversible expiratory airflow limitations that are spontaneous or with treatment.
• What are triggers for asthma?

  Allergens, air pollution, exercise, respiratory infections, and stress.
• How does asthma start?

  Edema of airway mucosa, muscle spasm, accumulation of secretions cause problems with expiration.
• Clinical manifestations of asthma are cough, wheezing, chest tightness, troubles with airflow.
• What are the different severities of asthma?

  Mild, moderate, severe, life-threatening
• If symptoms of asthma do not resolve with usual treatment after 30 minutes, seek medical attention.
• How can asthma be assessed with diagnostics?

  Peak expiratory flow rate, spirometry, fractional exhaled nitric oxide (to help determine asthma, gauge loss of asthma control and attacks)
• Drug Therapy for Asthma: Stepwise Approach

  Start without ICS and only SABA, then low dose ICS with SABA, then med/high ICS and SABA, high ICS, SABA, tiotropium.
• Which drugs are used for long term control for Asthma?

  Anti-inflammatory drugs like corticosteroids such as Fluticasone (inhaled), Prednisone (PO), Montelukast, Omalizumab (Anti-IgE). Bronchodilators like long-acting Salmeterol (inhaled), long-acting Albuterol (PO), Theophylline.
• What are quick reliefs for Asthma?

  Bronchodilators like short-acting Albuterol (inhaled), anticholinergics like Ipratropium (inhaled). Anti-inflammatory like corticosteroids such as Prednisone.
• Implementation for Asthma, wash bed/clothes in hot water with detergent and bleach, avoid NSAIDs, avoid irritants, weight loss, exercise.
• Short term controllers are for "rescue" to treat attacks.
• COPD is a progressive lung disease w/ persistent airflow limitation. Enhanced chronic inflammatory response in airways and lungs.
• What are the main causes of COPD?

  Cigarette smoking, noxious particles and gases.
• COPD is slightly more prevalent in men but women who smoke are more likely to get COPD.
• COPD is the 3rd leading cause of death in the United States.
• Defining feature of COPD is airflow limitation.
• COPD is characterized by chronic inflammation of airways, lung parenchyma, pulmonary blood vessels.
• Obstruction in respiratory tract causes air trapping which leads to "reshaping" of lungs and hypercapnia due to COPD.
• COPD can lead to pulmonary hypertension that grows into right sided heart failure.