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What are the classifications of restrictive disease?
Skeletal, abdominal, neuromuscular, and pulmonary
What is kyphosis?
A-P curvature \"hunchback\"
What is scoliosis?
Lateral curvature \"S\"
What is kyphoscoliosis?
Combined lateral and A-P curvature most commonly associated with severe respiratory problems
What is pectus excavatum?
Sternum abnormally depressed
What is pectus carinatum?
Pigeon chest
What are the problems a associated with skeletal restrictive diseases?
Decreased VC, Decreased TLC, Increased WOB, Decreased compliance, may not be clinically significant unless combines with another disease
How are skeletal restrictive diseases treated?
Surgical correction if needed
What are the types of abdominal restrictive diseases?
Obesity (pick wicking syndrome), tumour, advanced pregnancy, and ascites (serious fluid in peritoneum)
What are the problems associated with abdominal restrictive diseases?
Decreased diaphragmatic excursion, decreased VC, decreased TLC, decreased compliance, increased WOB
What are the types of neuromuscular restrictive diseases?
Myasthenia gravis, guillan barre syndrome, paralysis, polio, and tetnus
What is myasthenia gravis? Who does it affect?
Descending paralysis which can cause drooplids and difficulty swallowing. Primarily affects women, aged 30-40
What are the characteristics of myasthenia gravis?
Decreased VC, decreased TLC, gradually decreasing IC and VT, and respiratory hypoventilation/academia
What are the causes and effects of myasthenia gravis?
Decreased acetylcholine transfer, weakness decreased with repetition of muscular contraction, and patient may have acute cholinergic crisis
How is myasthenia gravis treated?
Drugs that prevent breakdown of ACH (acetylcholinesterase inhibitors) and ventilatory assessment indicating ventilatory support (monitor VT, VC and ABG\'s for deterioration and if ventilatory failure impending - commit to CMV)
What are the characteristics of Guillan Barre syndrome?
Ascending and descending paralysis, initially leg weakness/difficulty walking, failure of ventilatory muscles, usually occurs 2 weeks after URI (upper respiratory infection) , decreased VC, decreased VT, and respiratory acidosis
How many Guillan Barre patients have respiratory complications?
33%
What is the treatment for Guillan Barre syndrome?
Ventilatory support until the return of function, ancillary support of CMV (Mobilization of secretions)
What are the characteristics of respiratory disease caused by paralysis?
May still have diaphragmatic movement (phrenic nerve C3-C5), no abdominal contraction (inability to move secretions and no valsalva maneuver
How is restrictive respiratory disease caused by paralysis treated?
maintenance and bronchial hygiene and cough assist by abdominal pressure?
What are the characteristics of restrictive respiratory disease caused by polio?
respiratory paralysis or weakness
What are the characteristics of restrictive respiratory disease caused by tetanus?
Constant contraction of muscles, decreased chest expansion, and decreased :VT, VC, TLC, IC
What is the treatment for restrictive respiratory disease caused by tetanus?
Paralyze patient and ventilate mechanically
What are the types of pulmonary restrictive diseases?
ARDS, pulmonary edema, pneumonia, and pneumoconiosis
What can cause ARDS?
Shock, septicemia, near drowning, and burns (chemical or physical), O2 toxicity, trauma, aspiration, and multiple transfusions
What are the clinical characteristics for ARDS?
Decreased FRC, refractory hypoxemia, decreased compliance, diffuse infiltrates (ground glass)
What are the treatments for ARDS?
Increased FRC with PEEP and/or pressure control, oxygenate to maintain PaO2 at 50-60, and CMV support
what can cause pulmonary edema?
Hydrostatic pressure increase (cardiogenic)
What are the characteristics of pulmonary edema?
Pink, frothy, watery secretions, decreased TLC, X-ray shows fluffy infiltrates
How is pulmonary edema treated?
Diuretics to decrease fluid(decrease hydrostatic pressure), increase O2, position in high semi-fowlers to decrease venous return, BiPAP/PEEP, nebulized ETDH(decrease surface tension to break bubbles and 70% used up to 24 hours
What causes pneumonia?
Bacteria, virus, and fungus
What are the characteristics of pneumonia?
Shunting(decreased PaO2), X-ray will show consolidation, and may increase WBC
What are treatments for pneumonia?
O2, hydration, and bronchial hygiene
What is pneumoconiosis?
Any disease of the lung caused by chronic inhalation of inorganic dust, usually mineral dusts of occupational or environmental origin
What are the types of pneumoconiosis?
Coal workers pneumoconiosis-coal dust, asbestosis-asbestos, silicosis-silica dust, stenosis-tin dust, talcosis-talc dust, and baeitosis-barium dust
What are the characteristics of pneumoconiosis?
decrease chest movement, rales-dry, decrease lung on x-ray
How is pneumoconiosis treated?
Removal from environment, possible rehabilitation/graded exercises, O2 if needed, bronchial hygiene
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