4910: C21 Diseases of the Respiratory System Flashcards
1
Q
surfactant
A
Substance secreted by the alveolar cells (type II) of the lung that serves to maintain the stability of pulmonary tissue by reducing the surface tension of fluids that coat the lung.
2
Q
The upper respiratory tract includes what anatomy?
A
Nose, nasal cavity, frontal & maxillary sinuses, larynx and trachea.
3
Q
The lower respiratory tract includes the?
A
lungs, bronchi, and alveoli.
4
Q
percussion
A
A technique used during physical examination in which the hands are used to strike the body’s surface, and the sounds that are transmitted from the underlying tissues and organs are evaluated.
5
Q
auscultation
A
A technique used during physical examination in which a stethoscope is used to evaluate the sounds created in body organs.
6
Q
pulmonary consolidation
A
changes in tissue structure of the lungs; often visualized as opaque components on a chest x-ray.
7
Q
pleural effusion
A
Accumulation of fluid between the two outer membranes surrounding the lungs.
8
Q
rales
A
Bubbly sounds heard via stethoscope that may indicate pulmonary pathology.
9
Q
pulse oximetry
A
Light waves measure the oxygenation of arterial blood
10
Q
spirometery
A
Machine, calculates the amount of air the lungs can hold and the rate the air can be inhaled and exhaled. Results are compare to “normal”
11
Q
Normal PaO2
A
75-100mmHg
12
Q
Normal PaCO2
A
35-45mmHg
13
Q
Normal oxygen saturation (O2Sat)
A
94-100%
14
Q
Bicarbonate (HCO3)
A
22-26mEq/L
15
Q
Arterial blood gases (ABGs)
A
pH, O2, CO2 content of the blood and can also be used to measure pulmonary function.
16
Q
minute ventilation
A
The V of air per unit time moved into or out of the lungs; measured by collecting expired V for a fixed time.
17
Q
Symptoms of respiratory disease that may affect dietary intake?
A
Early satiety, anorexia, wt loss, cough, dyspnea during eating.
18
Q
Asthma
A
A chronic inflammatory disorder of the airway involving many cells and cellular elements such as mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells.
19
Q
edematous
A
An excessive accumulation of serous fluid in tissue spaces or a body cavity.
20
Q
Leukotrienes
A
Powerful inflammatory mediators produced by the body that are important in inflammation and allergic reactions because of their ability to constrict blood vessels and attract a variety of types of immune cells. Are synthesized from arachidonic acid
21
Q
bronchial hyperreactivity
A
Tendency of the smooth muscle of the tracheobronchial tree to narrow in response to a stimulus; present in virtually all symptomatic patients with asthma.
22
Q
What antioxidants have been investigated in the treatment of asthma?
A
Vitamins A, C, & E, and the carotenoids.
23
Q
Bronchopulmonary dysplasia (BPD)
A
A chronic lung disorder that may affect infants who have been exposed to high levels of oxygen therapy and ventilator support.
24
Q
Sings of bronchopulmonary dysplasia (BPD)
A
Pulmonary inflammation and impaired growth & development of the alveoli.
25
hypoxemia
Condition in which there is an inadequate supply of oxygen in the blood.
26
What vitamin should be supplemented in infants with BPD?
Vitamin A. Preterm infants are deficient at birth, deficiency is associated with increased risk of BPD>
27
The preterm infant and Na, K, Cl status
These electrolytes must be closely monitored, and supplemented as needed. Diuretic therapy may increase loss.
28
Calcium and the perterm infant?
Must be monitored and supplemented when needed. Diuretic therapy increases urinary loss.
29
necrotizing enterocolitis (NEC)
A condition that occurs primarily in preterm infants or sick newborns. Intestinal tissue dies due to decreased blood flow. Feeding is stopped to allow the gut to heal.
30
Chronic Obstructive Pulmonary Disease (COPD)
A disease that limits airflow through either inflammation of the lining of the bronchial tubes or destruction of alveoli.
31
bronchitis
A condition characterized by inflammation and eventual scarring of the lining of the bronchial tubes accompanied by restricted airflow, excessive mucus production, and a persistent cough.
32
emphysema
A condition characterized by thinning and destruction of the alveoli, resulting in decreased oxygen transfer into the bloodstream and shortness of breath.
33
alpha 1-antitrypsin (ATT)
aka alpha 1-protease inhibitor. An protein made in the liver which protects lungs from destructive actions of common illnesses, exposures. In individuals who lack this enzyme, emphysema may develop.
34
Pathophysiology of Chronic Bronchitis
Generalized inflammation, decreased cilia function, increased phagocytosis, suppressed IgA. Leads to hyperplasia of mucus-secreting cells and resultant edema of bronchioles.
35
Clinical manifestations of chronic bronchitis?
Decreased air flow rates (↓ FEV), dyspnea, hypoxemia, hypercapnia
36
Signs of chronic hypoxemia
cyanosis, clubbing, and secondary polycythemia
37
secondary polycythemia
Condition in which an excessive number of RBC are produced; occurs in response to compensation for chronic hypoxemia.
38
cor pulmonale
An increase in size of the right ventricle of the heart caused by resistance to the passage of blood through the lungs; can lead to heart failure
39
Pathophysiology of emphysema
Loss of connective tissue leads to decreased surface area and ↓ surfactant. Bronchioles collapse during exhalation and trap air in lungs.
40
orthopnea
difficulty breathing while lying down.
41
Clinical manifestation of emphysema
↓ FEV. Dyspnea, orthopnea, hypercapnia & respiratory acidosis. "barrel chest"
42
2,3-diphosphoglycerate (DPG)
An important regulator for the affinity of hemoglobin for oxygen. The synthesis of 2,3-biphosphoglycerate in RBCs is critical for controlling hemoglobin affinity for oxygen.
43
In COPD, what vitamins and minerals are of particular concern?
Phosphate, Ca and Vit D
44
hyperinflation of the lungs
Common in COPD. Results from loss of elasticity of the alveoli, causing air to be trapped; often seen on emphysema.
45
Aerophagia
The swallowing of too much air resulting in gas and bloating.
46
tumor necrosis factor (TNG-a)
One type of cytokine which has been found to possess a wide range of pro-inflammatroy actions.
47
Cystic fibrosis (CF)
Disease characterized by abnormally thick mucus secretions from the epithelial surfaces of various organ systems, including the respiratory tract, the GI tract, the liver, the genitourinary system, and the sweat glands.
48
Cystic fibrosis transmembrane conductance regulator (CFTR)
A ATP-binding cassette (ABC), a transport protein that is mutated in CF, leading to increased transport of Cl⁻ ions and thick, viscous secretions.
49
Chest physiotheapy
Physical therapy that includes a variety of techniques designed to reduce or prevent infection by clearing pooled secretions &/or infected material from the lungs.
50
sweat chloride test
A test to measure the amount of chloride in the sweat by stimulating the skin to produce a large amount of sweat that is then absorbed by a special filter paper and analyzed for Cl⁻ content.
51
pancreatic function tests
Tests to measure pancreatic function, including serum amylase or lipase, a test for the amount of fat in the stool, and an X-ray of the anatomical features of the pancreas and common bile duct.
52
plasma prothrombin concentrations
A measure of blood clotting ability
53
pneumonia
Inflammation of the lungs, usually caused by bacteria, viruses, or fungi
54
aspiration pneumonia
An inflammatory response in the lung that results from aspiration of of inhaled materials (saliva, nasal secretion, bacteria, liquids, food, or gastric contents) into the airway below the level of the vocal cords.
55
esophageal stricture
A significant narrowing of the esophagus that may significantly interfere with swallowing.
56
tracheostomy
A surgical opening placed in the trachea to assist breathing.
57
Acute lung injury (ALI)
Term designating clinical and radiographic changes in lung function associated with critical illness. ARDS is the most severe form of acute lung injury.
58
Acute respiratory distress syndrome (ARDS)
Respiratory failure (RF) resulting from an acute insult to the lungs that occurs when the respiratory system is no longer able to preform its normal functions.
59
Sings and symptoms of ARDS
dyspnea, severe hypoxemia, decreased lung compliance, loss of surfactant, and leakage of a protein-rich fluid into the interstitium and alveolar lumen.
60
Diagnostic criteria for ALI
Acute onset, bilateral infiltrates in the lungs, hypoxemia w/out cardiac changes.
61
Upper respiratory infection (URI)
A nonspecific term used to describe acute infections involving the nose, sinuses, pharynx, larynx, trachea, and bronchi; often referred to as the common cold.
62
functio laesa
loss of function, one of the classical signs of inflammation.
63
Which antibody is most associated with asthma?
IgE
64
Why have omega-3 fatty acids been investigated as a potential nutrition intervention in the treatment of asthma?
They decrease leukotriene production.
65
Although infants with BPD will have increased protein needs, intakes of greater than 4 g/kg/day should be avoided. Why?
Excessive protein increases risk of acidosis due to immaturity of kidneys.
66
What protects the alveoli form bacterial infection?
scavenger cells
67
Increased intake of which of the following may contribute to longer dependence on mechanical ventilation in the patient with ARDS?
Water
68
She is on mechanical ventilation in the ICU. This hospital does not have the ability to perform indirect calorimetry. Which method should the dietitian use to estimate this patient's energy needs?
25kcal/kg UBW
69
tidal volume
V inspired and expired during a normal breath
70
Inspiratory reserve V
Amount that can be inspired above TV
71
Expiratory reserve V
Amount that can be forcibly exhaled
72
Residual V
Amount of gas left after maximum exhalation
73
Total lung capacity
Equal to sum of all volumes
74
Vital capacity
IRV + TV + ERV
75
Functional residual
ERV + RV
76
Inspiratory capacity
TV + IRV
77
Control of breathing
Located in medulla & pons. Rate & depth set by medullary center can by modified by - depression on the CNS. Activity of hypothalamus (emotions). Voluntary control. Chemoreceptors.
78
Factors that increase the work of breathing
Elastic recoil. Compliance. Alveolar surface tension. Airway resistance. Dead space ventilation.
79
Elastic recoil
The inherent resistance of a tissue to changes in shape, the tendency of a tissue to revert to its original shape. Loss requires that accessory muscles assist with exhalation.
80
Compliance
A measure of the ease of of expansion of the lungs and thorax, determined by pulmonary V & elasticity. Decrease in compliance causes dyspnea.
81
Alveolar surface tension
Surfactant normally opposes surface tension. Without it the alveoli collapse. It reduces the required amount of pressure for inflation of the alveoli.
82
Dead space ventilation
Amount of air not used in gas exchange.
83
Symptoms of respiratory disease
Dyspnea. Apnea. Tachypnea. Hypercapnia. Cough. Sputum. Hemoptysis.
84
What causes clubbing of fingers
Chronic hypoxia
85
Chronic Obstructive Pulmonary Disease
Slowly progressive disease that is characterized by a gradual loss of lung function. Bronchitis & emphysema.
86
Etiology of chronic bronchitis
Repeated exposure of airways to pollutants. Cigarette smoking.
87
Chronic inflammation of lung tissue causes?
Hyperplasia (more cells) of mucous cells. Airway edema, & increased mucus production.
88
Pathophysiology of chronic broncitis
Chronic inflammation = hyperplasia of mucous cell. Cilia damaged. Airway walls thicken = increased resistance. Unable to increase work of breathing enough to overcome hypoxemia / hypercapnia.
89
Clinical manifestations of chronic bronchitis
Decreased FEV. Respiratory acidosis. Dyspnea. Signs of chronic hypoxemia. Cor pulmonale
90
Signs of chronic hypoxemia
cyanosis. clubbing. secondary polycythemia.
91
Treatment of Chronic Bronchitis
Bronchodilators. Anticholinergics. Steroids. Mucolytic agents. Pulmonary rehabilitation program.
92
Bronchodilators
beta-agonists - relax smooth muscle & anticholinergics - decrease airway contraction and mucus production
93
Steroids
decrease swelling and mucus production.
94
Emphysema
Abnormal permanent enlargement of alveoli. Often develops as last stage complication of chronic bronchitis.
95
a1-antitrypsin deficiency
Autosomal recessive - predisposition to development of emphysema. Caused by deficiency of a1- antitrypsin. they can't break down mucus.
96
Pathophysiology of emphysema
Inflammation or enzymes destroy lung tissue causing loss of surface area & decreased surfactant. Loss of connective tissue resulting in airway collapse on exhalation. Air becomes trapped in the alveoli.
97
Impact of elastase release on lungs
chronic inflammation causes the release of elastase which destroys elastin, resulting in decrease in recoil of alveoli. Alveoli rupture
98
Bulla
Non-functional unit of collapsed alveoli in lung. It can also rupture = lung collapse.
99
clinical manifestations
Decreased FEV. Barrel chest. Inspiration is not impaired. Dyspnea. Orthopnea. Hypercapnia. Hypoxemia - in last stages.
100
Treatment of emphysema
Enzyme replacement. Treat symptoms w/ meds. Pulmonary rehabilitation. Surgical advances - lung V reduction, transplant.
101
Nutritional issues for COPD
Weight loss common. SOB w/ difficult w/ ADLs. Meds may cause peptic ulcer, N/V. Increased energy expenditure due to ↑ work of breathing. Catabolism of LBM. CO2 retention common = incoherence.
102
EAL treatment for COPD
Focus on prevention & treatment of wt. loss and other comorbidities.
103
Assessment of body comp in COPD
Use BMI & %wt. change as primary risk markers.
104
Supplements for treatment of COPD
Antioxidants. Omega-3 fatty acids. Medical nutrition supplements
105
Nutrition therapy for COPD
small frequent meals. ↑ nutrient density.
106
Relationship between respiratory function, ventilation and nutrition.
Influenced by nutrient metabolism. RQ > 1.0 is undesirable; indicates accumulation of excess CO2.
107
RQ
ratio of CO2 production to O2 consumption in the lungs.
108
Effect of malnutrition on respiration
↓ function of lung parenchyma. Wasting of respiratory muscles & diaphragm. Reduced ventilatory drive. ↑ incidence of pulmonary infection.
109
Pulmonary rehabilitation
Combines education with therapeutic exercise & functional activities into a comprehensive 12 week program. The goal is to help the patient understand and cope with the disease & function more comfortable & independently at home.
110
Physical activity in Pulmonary rehab
Aerobic conditioning. Resistance training.
111
propofol
strong anesthetic. used to sedate ventilated pt. Provides 1.1 cal/mL.
112
Positive end Expiratory Pressure (PEEP)
A technique used in respiratory therapy in which pressure is maintained in the airway so that the lungs empty less completely in expiration.
113
Synchronized Intermittent Mandatory Ventilation (SIMV)
Delivers a minimum number of assisted breaths per min that are synchronized with pt breathing. Breaths taken between are not assisted.
114
Assist-Control
The Vt (tidal V) of each breath is the same weather trigged by pt or machine.
115
FiO2
An index of arterial oxygenation efficiency that corresponds to the ratio of partial pressure of arterial O2 to the fraction of inspired O2. The % of O2 participating in gas exchange.
116
mandatory breath
A breath for which either the timing, or size is controlled by a ventilator.
117
spontaneous breath
In mechanical ventilation, when the timing and size of the breath is controlled by the pt
