RESPIRATORY DISORDER (Medical surgical) for exit exam preparation

Описание: Restrictive lung diseases like pneumothorax, pleural effusion, and atelectasis involve conditions that limit the lungs' ability to fully expand. Below is a detailed description based on the clinical breakdown of these conditions.

1. Pleural Effusion

A pleural effusion is an abnormal accumulation of fluid in the pleural space (the area between the parietal and visceral pleura).

Pathophysiology:

Transudative Effusions: Caused by systemic factors like Congestive Heart Failure (CHF), which increases hydrostatic pressure, or Cirrhosis/Nephrotic Syndrome, which decreases oncotic pressure (low albumin) . These fluids are typically low in protein and LDH .
Exudative Effusions: Caused by local lung injury or inflammation (e.g., pneumonia, malignancy, or tuberculosis) . These fluids are rich in protein and LDH due to increased capillary permeability .

Physical Exam Findings:

Dullness to percussion over the fluid .

Decreased breath sounds and decreased tactile fremitus 

Complications: Large effusions can cause compression atelectasis, leading to VQ mismatch and hypoxemia.

2. Pneumothorax

A pneumothorax occurs when air enters the pleural cavity, causing the lung to collapse .

Types:

Primary Spontaneous: Seen in tall, thin, young males due to the rupture of sub-pleural apical blebs .
Secondary Spontaneous: Occurs in patients with underlying lung diseases like COPD (emphysema) or asthma.

Traumatic: Caused by external injury or medical procedures (e.g., central line placement or thoracentesis).

Tension Pneumothorax (Medical Emergency): A one-way valve effect allows air to enter but not exit the pleural space . This creates a "Mass Effect," shifting the mediastinum, deviating the trachea, and compressing the heart, which leads to hypotension and jugular venous distension (JVD) .
Physical Exam Findings: Hyper-resonance (tympany) to percussion and absent breath sounds.

3. Atelectasis

Atelectasis is the collapse of the alveoli, preventing gas exchange in that part of the lung .

Mechanism in Restrictive Disease: In both pleural effusion and pneumothorax, the increased pressure in the pleural space squeezes the lung tissue, leading to compression atelectasis .

Clinical Impact: It results in a low VQ mismatch (perfusion is normal, but ventilation is reduced), which leads to hypoxemia (low blood oxygen) and compensatory tachypnea (rapid breathing)

Diagnosis and Treatment

Diagnosis: Primarily through Chest X-ray or CT scans. Pleural effusions often show a "meniscus sign" . For effusions, Light’s Criteria is used to distinguish between transudate and exudate
Treatment:

Pleural Effusion: Thoracentesis (tapping the fluid) or chest tubes for empyema (infected fluid)

Pneumothorax: Small ones may be observed; larger ones or those causing respiratory distress require a chest tube 

Tension Pneumothorax: Immediate needle decompression followed by a chest tube

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