Alterations of pulmonary function Flashcards
Kussmaul respirations (hyperpnea)
-Slightly increased ventilatory rate, very large tidal volume, and no expiratory pause
Restricted breathing
disorders that stiffen the lungs or chest wall and decrease compliance
Cheyne-stokes respirations
alternating periods of deep and shallow breathing; apnea lasting 15-60 seconds
Hypoventilation
Leads to respiratory acidosis from hypercapnea
Hyperventilation
Leads to respiratory alkalosis from hypocapnia
Cyanosis
- Peripheral-poor circulation. Best observed in nail beds
- Central-decreased arterial O2 (low PaO2). Best observed in buccal mucous membranes and lips
Pleural pain
- most common from pulmonary diseases
- Sharp or stabbing
- Infection and inflammation of the parietal pleura can cause pain when pleura stretch during inspiration and accompanied by pleural friction rub
Hypercapnea
- Increased Co2
- Decreased drive to breathe or an inadequate ability to respond to ventilatory stimulation
Hypoxemia
Hypoxemia vs. hypoxia
- Ventilation-perfusion abnormalities: most common cause
- Shunting
- Alveolar dead space
Shunting
- Abnormal communication between left and right sides of heart or from pulmonary and systemic vessels allowing blood from one circulatory system to another
- Right to left shunt-allows deoxygenated systemic venous blood to bypass the lungs and return to the body.
Alveolar dead space
area where alveoli are ventilated but not perfused
Flail chest
Instability of a portion of the chest wall from rib or sternal fractures
Pneumothorax
- Presence of air or gas in the pleural space
- Primary (spontaneous) pneumo: Occurs unexpectedly
- Secondary pneumo: caused by disease, trauma, injury, or condition
- Iatrogenic pneumo: medical treatments, esp from needle aspirations
Tension pneumo
-acts as a one way valve-permitting air to enter but not escape.
S/S and Tx of pneumo
- Sudden pleural pain, tachypnea, mild dyspnea, tension
- Tension pneumo: severe hypoxemia, tracheal deviation away from affected lung and hotn
- Tx: CT, if persistent air leak-surgery, thorascopic surgical techniques
Pleural effusions
-Presence of fluid in the pleural space
-Transudative effusion: watery and diffuses out of capillaries
-Exudative effusion: contains high concentrations of WBC’s and plasma proteins
Tx: thoracentesis, CT and surgery
-Dyspnea, chest pain
Empyema
- Infected pleural effusion
- Pus in pleural space
- Cyanosis, fever, tachy, cough and pleural pain
- Tx: administration of antimicrobial meds, drainage
- Severe cases-US guided pleural drainage, instillation of fibrinolytic agents or DNase injected in pleural space
Aspiration
- More common to happen in right lower lobe
- Supplemental O2-may require PEEP, steroids w/in first 72 hours, abx
Atelectasis
- Collapse of lung tissue
- Dyspnea, cough, fever, and leukocytosis
- Tx: prevention, deep breathing
Bronchiectasis
- Persistent abnormal dilation of the bronchi
- Chronic productive cough
- Tx: surgery, chest physiotherapy, supplemental O2, sputum culture abx, bronchodilators, antiinflammatory drugs
Bronchiolitis
- diffuse inflammation of small airways or bronchioles
- Most common in children
- Occurs in adults w/ chronic bronchitis, or those w/ viral infection or who’ve inhaled toxic gases
Pulmonary fibrosis
- Excessive amount of fibrous or connective tissue in the lung
- Tx: corticosteroids, combined tx w/ cytotoxic drugs, antifibrotic drugs, interferon and anticoagulants, lung transplantation
Pulmonary edema pathophysiology
- Injury to capillary endothelium
- Increased capillary permeability, and disruption of surfactant production by alveoli
- Movement of fluid and plasma proteins from capillary to interstitial space (alveolar septum) and alveoli
Pulmonary edema patho w/ valves
- Valvular dysfunction, coronary artery disease, LV dysfunction
- Increased left atrial pressure
- Increased pulmonary capillary hydrostatic pressure
Pulmonary edema patho w/ blockage
- Blockage of lymphatic vessels
- inability to remove excess fluid from interstitial space
- Accumulation of fluid interstitial space
Acute lung injury/acute respiratory distress syndrome w/in 72 hours
(exudative or inflammatory): Alveolocapillary membrane damage, increased capillary membrane, pulmonary edema, surfactant inactivated
ALI/ARDS: W/in 4-21 days
-Proliferative: Resolution of the pulmonary edema and proliferation of type 2 pneumocytes, fibroblasts, and myofibroblasts, hyaline membranes, hypoxemia
ALI/ARDS: w/in 14-21 days:
-Fibrotic: remodeling and fibrosis. Alveoli destruction, severe right to left shunting, acute respiratory failure
Early asthmatic response
- IgE causes mast cells to degranulate, releasing a large number of inflammatory mediators
- Vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction, tenacious mucous secretion
- IL-5 stimulates the activation of eosinophils-contributes to increased bronchial hyperresponsiveness, fibroblast proliferation epithelial injury and airway scarring
Emphysema
- Abnormal permanent enlargement of the gas-exchange airways accompanied by the destruction of the alveolar walls w/out obvious fibrosis
- Loss of elastic recoil
Pulmonary Embolism
- Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment lipids or air bubble
- Commonly arise from DVT
- Virchow triad: venouse stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels
- tx: Filter in the IVC, embolectomy, anticoagulation, O2 and fluids
S/S PE
-Pleural chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety
Cor Pulmonale
- Secondary to PAH
- RV enlargement
- Pulmonary htn creating chronic pressure overload in the right ventricle
Non-small cell lung cancer
- Nonproductive cough or hemoptysis (squamous cell carcinoma)
- Large cell carcinoma-undifferientiated-surgical therapy, radiation and chemo aren’t helpful
- Adenocarcinoma-tumor arising from glands
Mesotheliomas
- Associated w/ asbestos
- May take 20-40yrs before cancer appears
