Alterations of Respiratory System Flashcards
What are possible causes of hemoptysis?
bronchitis, TB, abscess, neoplasms and other conditions causing hemorrhage
Define hypoventilation
decreased alveolar ventilation causing increased PaCO2
Can be caused by obstruction or altered neuro status
What are the complications of hypoventilation?
hypercapnia, respiratory acidosis
Define hypercapnia
increase in CO2 in the blood
Can result in low pH >electrolyte abnormalities>dysrhythmias
Can lead to somnolence and coma due to intracranial pressure changes
How does hypoxemia differ from hypoxia ?
Hypoxemia=reduced oxygenation. of arterial blood
Hypoxia=reduced oxygenation of tissues
What is normal blood pH
7.35-7.45
What are obstructive lung diseases?
Asthma, Cystic fibrosis
What are the chronic obstructive pulmonary diseases?
Emphysema
Chronic Bronchitis
Bronchiesctasis
What is the patho of asthma
- Inflammation caused by Hyper-responsiveness of airways to environmental triggers
- Bronchial smooth muscle spasm
- Edema formation
- Tenacious mucus production and obstruction
What are the S&S of an asthma attack
congestion, wheezing, dyspnea, tachycardia, tachypnea, circumoral cyanosis, disphoresis, pallor, use of accessory muscles
In what order should asthma drugs be given in?
- bronchodilators
- Long acting bronchodilators
- Anticholinergics
- Corticosteroids
What defines a COPD
Chronic inflammation and obstruction of airflow from the lungs
How does airway collapse and air trapping present diagnostically?
Decrease in forced expiratory volume
Increase in residual volume and total lung capacity
What are the clinical manifestations of emphysema?
Dyspnea on exertion or at rest (little cough or sputum production)
Use of accessory muscles for ventilation
Often v thin with prolonged respirations
Hyperresonant sounds with percussion
What are the S&S of chronic bronchitis?
wheezing, dyspnea, productive cough and possible hypoxemia with exercise
Cyanosis, cor pulmonae, polycythemia, chronic hypoventilation
What is cor pulmonale
Form of heart failure commonly caused by COPD in which the right side fails due to long term pulmonary hypertension
What are treatments for COPD?
Bronchodilators, anticholinergics, chest physio, resp training, oxygen admin for severe hypoxemia
(Antibiotics for chronic bronchitis)
What is the patho of tuberculosis?
- Transmitted in airborne droplets of bacilli causing pneumonitis
- Macrophages and neutrophils seal bacilli into tubercle, infected tissues inside die within 10 days
- Can lie dormant for years
What increases one’s risk for tuberculosis?
Poor nutritional status, insulin dependant diabtetes, long term steroids, AIDs
What are the clinical manifestations of tuberculosis?
Asymptomatic when latent
Fatigue, weight loss, lethargy, anorexia, low grade fever in afternoon and night sweats
Late symptoms-dyspnea, chest pain, cough with purulent sputum and hemoptysis
What are treatments for tuberculosis?
Antibiotics (isoniazid, rifampin, ethambutol) to control and prevent
Which pulmonary infection causes a characteristic barking cough and subglottic edema
Croup
What is the treatment for croup?
May resolve spontaneously in a couple days
If no stridor, little treatment. Can use steroid with half life of 36-72 hours
Use of misted air?
A pt presents with congestion, dyspnea and cough. The HCP listens to the patient's lungs and discovers crackles and wheezes bilaterally. What does the HCP suspect is the cause? a) Viral Pneumonia b) Strep pneumonia c) tuberculosis
a) Viral pneumonia
Viral pneumonia often begins with a cough and congestion and in abcense of a fever. Viruses affect both sides of the lungs creating a more homogenous inflammatory response
What are risk factors for pneumonia?
Elderly, immmunocompromised, lung disease, alcoholism, altered conciousness, smoking, intubation, malnutritin, immobilization
What are the types of
- Community acquired pneumonias
- Nosocomial pneumonias
- strep, flu, chlamydia
2. staph, aeruginosa
Why might someone get worse after beginning antibacterials for pneumonia?
Lysis of pneumococcal (strep) bacteria releases toxic bacteria proteins, worsening symptoms
What negative effect does the immune response contribute to in pneumonia?
The release of inflammatory mediators and immune complexes can damage bronchial mucous membranes and alveolocapillary membranes causing terminal bornchioles to fill with infectious debris and exudate
-Leads to dyspnea and hypoxemia
How does viral pneumonia create desirable environment for future infections?
- It damages ciliated epithelial cells which normally prevent pathogens from reaching LRT
- Invades bronchial mucous glands and sloughing of destroyed bronchial epithelium occurs, preventing mucociliary clearance
- Bronchial walls become edematous and infiltrated with WBCs
What if CF?
Autosomal recessive inherited disease in chromosome 7 resulting in abnormal expression of cystic fibrosis transmembrane regulator
Define:
Compression atelectasis
Lung collapse caused by external pressure on lung tissue
ex. tumors, fluid, air, or even abdominal distention!
Define:
Absorption atelectasis
from gradual absorption of air from obstructed or hypoventilated alveoli, inhalation of concentrated O2 r anesthetic agents
Define:
Sufactant impairment atelectasis
decreased production or inactivation of surfactant necessary to reduce tension in the aveoli
Can be due to premature burth, acute resp distress syndrome, anesthesia or mechanical ventilation
Define:
Transudative pleural effusion
Presence of fluid in the pleural space
Transudate is watery and diffuse out of capillaries due to conditions lowering intravascular hydrostatic or capillary oncotic pressure which promotes diffusion of fluid out of the capillaries.
(ex. left sided CHF, liver and kidney disorders causeing hypoproteinemia)
Define:
Exudative pleural effusion
Less watery fluid in the pleural space with high contents of WBCs and plasma proteins
Due to infection, inflammation or malignancy that increases capillary permeability
What denotes
- emphyema
- hemothorax
- chylothorax
- pus
- blood
- chyle (fatty lymph)
What is the patho of CF?
- Abnormal secretions in respiratory, digestive and reproductive tracts
- Resp failure caused by plugging, chronic inflammation and infection (causing microabcesses, pneumonia and cysts)
- Mucus secreting cells are increased in number and size and mucus is more viscous
- Resp failure common cause of death
What are S&S of CF?
Persistent cough, resp problems, recurrent pneumonia, wheeze
GI problems, malabsorptive symptoms, meconium ileus
Sweat test denotes a pt secretes high levels of electrolytes in their sweat
What level of [Cl] mEq/L is above normal and what does this mean?
> 60mEq/L denotes cystic fibrosis
What is the treatment for CF
High caloric diet high in fat soluble vitamins
Chest physio, bronchodilators, antibiotics, lung transplant
What is the difference between a pneumothorax and atelectasis?
- Pneumothorax is build up of air in the pleural space caused by a rupture in the visceral or parietal pleura
- Atelectasis is the collapse of lung tissue
Define:
Primary (spontaneous) pneumothorax
-Caused unexpectedly bay rupture of blebs (blister like formations) on the visceral pleura
Define:
Secondary pneumothroax
Caused by trauma such as rib fracture, stab or bullet wounds that tear the pleura, rupture of bleb or bulla in COPD or mechanical ventilation
Define:
Iatrogenic pneumothorax
commonly caused by transthoracic needle aspiration
What is an open and a tension pneumothorax?
Open- air pressure in pleural space=barometric pressure, bc air drawn in through inspiration is forced back out
Tension- air is permitted into pleural space in inhalation, but prevented from removal in expiration. Air pressure exceeds barometric pressure. Can cause compression atelectasis against the mediastinum displacing the heart
