27. Pulmonary Alterations Flashcards
1
Q
subjective experience of breathing discomfort often described as breathlessness, air hunger, shortness of breath, or labored breathing
A
dyspnea
2
Q
Most severe signs of dyspnea
A
- nostril flaring - use of accessory muscles - retraction of supercostal and intercostal muscles (common in children)
3
Q
dyspnea that occurs when an individual lies flat (ABD contents exert pressure on diaphragm)
A
orthopnea
4
Q
Orthopnea is common in what condition
A
heart failure
5
Q
occurs when individuals w/ pulmonary or cardiac disorders awake at night gasping for air and have to sit or stand to relieve dyspnea
A
paroxysmal nocturnal dyspnea (PND)
6
Q
protective reflex that helps clear airways by an explosive expiration
A
cough
7
Q
coughing up blood or bloody secretions
A
hemoptysis
8
Q
normal/rhythmic/effortless breathing
A
eupnea
9
Q
breathing pattern characterized by increased ventilatory rate, very large tidal volumes, and no expiratory pause
A
Kussmaul respiration (hyperpnea)
10
Q
amount of air inspired and expired in a single breath
A
tidal volume
11
Q
causes of Kussmaul respiration
A
strenuous exercise or metabolic acidosis
12
Q
breathing pattern characterized by alternating periods of deep and shallow breathing
A
Cheyne-Stokes respirations
13
Q
Explain the rhythm of Cheyne-Stokes respirations
A
- increased levels of CO2 -> tachypnea - CO2 levels decrease -> leads to apnea until CO2 accumulates again
14
Q
causes of Cheyne-Stokes respirations
A
any condition that reduces blood flow to the brainstem -> slows impulses sending info to respiratory centers of brainstem
15
Q
inadequate alveolar ventilation in relation to metabolic demands (CO2 removal does not keep up w/ CO2 production)
A
hypoventilation
16
Q
PaCO2 is greater than 44 mmHg
A
hypercapnia (increased CO2 levels) -> leads to respiratory acidosis
17
Q
alveolar ventilation exceeds metabolic demands (lungs remove CO2 faster than it is produced)
A
hyperventilation
18
Q
PaCO2 less than 36 mmHg
A
hypocapnia (decreased CO2 levels) -> leads to respiratory alkalosis
19
Q
bluish discoloration of the skin and mucous membranes caused by increased amounts of desaturated or reduced Hgb in the blood; late symptom of deoxygenation
A
cyanosis
20
Q
peripheral vs central cyanosis
A
- peripheral: often caused by poor circulation due to intense peripheral vasoconstriction (best seen in nail beds) - central: caused by decreased arterial oxygenation (low PaO2) from pulmonary disease or cardiac right-to-left shunts (best seen in buccal mucosa and lips)
21
Q
selective bulbous enlargement of the end of a digit
A
clubbing
22
Q
7 causes of hypercapnia
A
- depression of respiratory center by drugs - diseases of the medulla - abnormalities of spinal conducting pathways (spinal cord disruption) - diseases of NMJ or respiratory muscles (MG or MD) - thoracic cage abnormalities - large airway obstruction (tumors/sleep apnea) - increased work of breathing or physiologic dead space
23
Q
hypoxia vs hypoxemia
A
- hypoxia: reduced O2 in cells - hypoxemia: reduced O2 in blood
24
Q
pathological condition which results when the alveoli of the lungs are perfused (Q) with blood as normal, but ventilation (the supply of air or V) fails to supply the perfused region -> low V/Q
A
pulmonary shunt
25
V/Q mismatching results in what?
hypoxemia
26
air in the pleural space caused by a rupture in the visceral pleura
pneumothorax
27
occurs unexpectedly in healthy individuals between 20-40 y/o and is caused by spontaneous rupture of blebs on the visceral pleura
primary (spontaneous) pneumothorax
28
type of pneumothorax caused by chest trauma
secondary pneumothorax
29
air pressure in the pleural space = barometric pressure; air drawn into pleural space on inspiration is forced out on expiration
open (communicating) pneumothorax
30
one-way valve that permits air to enter on inspiration but prevents escape during expiration (causes mediastinal shift) -\> life threatening
tension pneumothorax
31
results from fracture of several consecutive ribs in more than one place or fracture of sternum and several consecutive ribs
flail chest
32
Describe chest wall movement w/ flail chest
paradoxical movement - chest wall moves in on inspiration - chest wall moves out on expiration
33
presence of fluid in the pleural space
pleural effusion
34
Name 5 types of pleural effusion drainage
- transudative (hydrothorax): watery drainage from intact capillaries - exudative: WBC and protein - empyema: pus-like drainage - hemothorax: bloody drainage - chylothorax: milky lymphatic drainage and fat droplets
35
diseases characterized by airway obstruction that is worse w/ expiration (more force is required to expire a given volume of air and emptying of the lungs is slowed)
obstructive lung diseases
36
3 most common obstructive lung diseases
- asthma - emphysema - chronic bronchitis
37
chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyper-responsiveness, constriction of airways, and variable airflow obstruction
asthma
38
Describe an acute asthmatic response
- inhaled Ag binds to mast cells covered w/ preformed IgE - mast cells release mediators - mediators induce bronchospasm, edema from increased capillary permeability, and mucous secretion (goblet cells) - dendritic cells process and present Ag to Th2 -\> produce ILs - eosinophils activated -\> damage respiratory epithelium - neutrophils add to inflammation and airway obstruction
39
clinical manifestations of asthma attack
- chest constriction - expiratory wheezing - dyspnea - nonproductive cough - prolonged expiration - tachycardia - tachypnea
40
decrease in systolic BP during inspiration of more than 10 mmHg; may be seen during asthma attack
pulses paradoxus
41
considered acute severe bronchospasm if asthma symptoms not reversed by usual treatment -\> can lead to death
status asthmaticus
42
reversible bronchospasm
asthma
43
irreversible bronchospasm
chronic bronchitis and emphysema
44
COPD includes what 2 disorders
chronic bronchitis and emphysema
45
hyper-secretion of mucus and chronic productive cough for at least 3 months of the year for at least 2 consecutive years
chronic bronchitis
46
pathogenesis of chronic bronchitis
- chronic irritation from inhaled substances/irritants such as tobacco smoke - inflammation causes bronchial edema, hyper-secretion of mucus (goblet cells), and smooth muscle hypertrophy w/ fibrosis, and bacterial colonization of airways
47
clinical manifestation of chronic bronchitis
- productive cough (classic) - prolonged expiration - cyanosis - chronic hypoventilation - polycythemia - cor pulmonale
48
abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis
emphysema
49
primary emphysema is inherited and linked to what deficiency
a1-antitrypsin deficiency
50
pathogenesis of emphysema
- destruction of alveoli through breakdown of elastin within the septa (increased protease activity) - loss of elastin = loss of recoil of bronchial walls - produces large air spaces within lung parenchyma (bullae)
51
mucous plugs and narrowed airways cause \_\_\_\_; leads to hyperinflation of alveoli and hyper-expansion of chest
air trapping
52
clinical manifestations of emphysema
- dyspnea - wheezing - barrel chest (classic) - prolonged expiration
53
diseases characterized by decreased compliance of lung tissue (takes more effort to expand lungs during inspiration)
restrictive lung disease
54
collapse of lung tissue
atelectasis
55
caused by external pressure exerted by tumor, fluid, or air in the pleural space or by ABD dissension on portions of lung -\> cause alveoli to collapse
compressive atelectasis
56
caused by removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated O2 or anesthetic agents
absorption atelectasis
57
persistent abnormal dilation of bronchi
bronchiectasis
58
diffuse inflammatory obstruction of the small airways or bronchioles occurring most commonly in children
bronchiolitis
59
excessive amount of fibrous or connect tissue in the lung; can be caused by formation of scar tissue after active pulmonary disease, in association w/ autoimmune disorders, or by inhalation of harmful substances
pulmonary fibrosis
60
autosomal recessive defect on chromosome 7 that causes defective epithelial chloride ion transport and deficient Na in airways, bile ducts, pancreas, and sweat ducts
cystic fibrosis
61
Explain pathogenesis of cystic fibrosis
Defective CFTR causes buildup of Cl inside airway epithelial cells -\> Na enters cells to create NaCl -\> water enters cells to offset salts -\> external mucous becomes thick -\> difficulty breathing and increased bacterial infections
62
3 clinical manifestations of cystic fibrosis
- chronic lung inflammation - chronic lung infections - GI malabsorption
63
excess water in the lung
pulmonary edema
64
3 causes of pulmonary edmea
- left heart failure: causes increased pulmonary capillary hydrostatic pressure - injury to capillary endothelium: movement of fluid and protein from capillary to alveoli - blockage of lymphatics: inability to remove excess fluid from interstitial space
65
2 primary features of acute respiratory distress syndrome (ARDS)
- acute lung inflammation - diffuse alveolar-capillary injury
66
Pathogenesis of ARDS
- acute lung injury -\> inflammation and neutrophil aggregation w/ release of mediators and complement - platelet activation -\> micro thrombi in pulmonary circulation -\> decreased flow to lungs -\> pulmonary HTN and V/Q mismatch - damage to alveolar and endothelial cells -\> disrupts alveolocapillary membrane -\> fluid enters interstitial space -\> impaired surfactant production and atelectasis
67
3 phases of ARDS
- exudative phase: pulmonary edema and hemorrhage w/ severe impairment of ventilation - proliferative phase: proliferation of type II pneumocytes; formation of hyaline membrane - fibrotic phase: tissue remodeling (destruction of alveoli and bronchioles)
68
Final result of ARDS
acute respiratory failure - hypoxemia - hypercapnia - acidosis
69
acute infection or inflammation of the airways or bronchi (usually self-limiting)
acute bronchitis
70
most common and lethal cause of outpatient and inpatient pneumonias
streptococcus pneumoniae (pneumococcus)
71
pathologic course of pneumonia
- aspiration of bacteria -\> adherence to alveolar macrophages - inflammatory response - consolidation of lung parenchyma - leukocyte infiltration (neutrophils and macrophages) - phagocytosis in alveoli - resolution of infection
72
clinical manifestation of bronchitis vs pneumonia
- both cause fever, chills, cough, malaise - pneumonia will show signs of pulmonary consolidation (inspiratory crackles) and infiltrates on Xray
73
infection caused by Mycobaterium tuberculosis; airborne transmission
tuberculosis (TB)
74
occlusion of portion of pulmonary vascular bed by an embolus; obstruction occurs distal to clot location; most commonly caused by DVT
pulmonary embolism (PE)
75
clinical manifestation of PE
sudden onset of symptoms - pleuritic chest pain - dyspnea - tachypnea - tachycardia - unexplained anxiety - massive occlusion = pulmonary HTN and shock
76
mean pulmonary A. pressure greater than 25 mmHg at rest
pulmonary artery HTN (PAH)
77
PAH is associated w/ what conditions
- COPD - interstitial fibrosis - obesity-hypoventilation syndrome
78
pathogenesis of PAH
- conditions cause chronic hypoxemia and chronic acidosis - Pulmonary A. vasoconstriction - increased pulmonary A. pressure - intimal fibrosis and hypertrophy of medial smooth muscle layer of pulmonary As.
79
right ventricular enlargement caused by PAH
cor pulmonale
80
Explain how PAH causes cor pulmonale
- resistance and pressure in pulmonary A. increases - workload of RV increases - leads to hypertrophy of RV and right heart failure
81
primary risk factor for laryngeal cancer
tobacco smoking; further increased risk w/ alcohol consumption
82
non-small cell lung cancer that originates from the main stem bronchus; slow growing
squamous cell carcinoma
83
non-small cell lung cancer that usually originates in the peripheral regions of pulmonary parenchyma; moderate growth rate
adenocarcinoma
84
non-small cell lung cancer that grows rapidly and arises centrally to distort trachea and cause widening carina
large cell carcinoma
85
neuroendocrine lung cancer that has the highest correlation w/ smoking and arise centrally (hilar/mediastinal); very rapid growing and poor prognosis
small cell carcinoma
86
3 conditions associated w/ pulmonary shunting/low V/Q
low ventilation of perfused areas - atelectasis - asthma - pulmonary edema
87
1 condition associated w/ alveolar dead space/high V/Q
pulmonary emboli
88
ventilation is adequate but perfusion to lung tissue is not
alveolar dead space
89
2 conditions associated w/ alveolar capillary membrane barrier slowing diffusion of O2
- emphysema: decrease surface area - chronic bronchitis: thickened alveolar capillary membrane w/ edema and fibrosis
90
list 4 pulmonary diagnostic tests
- arterial blood gas (ABG) - pulmonary function test (PFT) - sputum analysis - bronchoscopy
91
Formation of fibrous tissue or nodules in the lungs due to chronic environmental exposure
pneumoconiosis
92
Types of people at high risk for pneumonia and TB
- nursing home pts - prisoners - COPD - TB = pneumonia + pts w/ HIV
