Alterations of the Respiratory System Flashcards
1
Q
Where are the pharyngeal (adenoid) tonsils found?
A
in the nasopharynx
2
Q
Where are the palatine tonsils found?
A
on the palate
3
Q
Where are the lingual tonsils found?
A
on the tongue
4
Q
What type of cell creates mucous?
A
goblet cells
5
Q
What shape is the cartilage in the trachea and why?
A
C-shaped
to keep the lumen open and allow for mild compression from the esophagus
6
Q
What is the pleura?
A
double membrane around the lungs
7
Q
The visceral pleura is in contact with the…
A
lungs
8
Q
The parietal pleura lines the ___, covers _____.
A
ribcage and diaphram
9
Q
What muscles are used in forced inspiration?
A
- external intercostals and diaphragm
- accessory muscles (sternocleidomastoid, scalenes, pectoralis minor, trapezius)
10
Q
What is expiration?
A
a passive process where the diaphragm, and intercostal muscles relax; ribs lower, diaphragm curves and air leaves the lungs
11
Q
What happens when you cough?
A
take a deep breath, close the glottis, increase pressure and forcefully blast air upward (from the lower respiratory tract)
12
Q
What happens when you sneeze?
A
same as cough but from the upper respiratory tract
13
Q
What happens when you hiccup?
A
spasm of the diaphragm
14
Q
What happens when you yawn?
A
very deep inspiration with no know cause other then to communicate fatigue and is contagious
15
Q
What are the clinical manifestations of respiratory alterations?
A
- dysphagia
- abnormal breathing patteerns
- hypoventilation/hyperventilation
- cough or sneeze
- hemoptysis (blood in sputum)
- cyanosis
- clubbing
- pain
- abnormal sputum
16
Q
What is sputum?
A
mucus from the lungs
17
Q
What is hemoptysis?
A
blood in the sputum
18
Q
What is dyspnea?
A
uncomforable/difficulty breathing; subjective feeling of not getting enough air
19
Q
When might transient dyspnea occur?
A
during exercise or postural changes (orthopnea)
20
Q
What are some acute causes of dyspnea?
A
laryngeal edema, bronchospasms, MI, pulmonary embolism or pheumothorax
21
Q
What are chronic causes of dyspnea?
A
COPD or fibrosis
22
Q
Why do abnormal breathing patterns occur?
A
adjustments made by the body to minimize work or respiratory muscles (physiological or pathological changes effect RATE, DEPTH, REGULARITY)
23
Q
What are Kussmaul prespirations?
A
also called hyperpnea; indicates strenuous exercise or metabolic acidosis
- slightly increase ventilatory rate
- large tidal volume
- no expiratory pause
24
Q
What might laboured breathing indicate?
A
airway obstruction
25
What does laboured breathing look like?
- slow rate
- large TV
- increased effort
- prolonged inspiration or expiration
- wheezing, strider (high-pitched noise)
26
What can cause restricted breath?
usually due to disorders that decrease compliance (pressure/volume); ex. pulmonary fibrosis that decreases elasticity
27
What does restricted breathing look like?
small TV
| tachypnea
28
What are cheyne-stokes respirations?
respirations that result form slowed blood flow to the brain
| - alternating persons of shallow (apnea 15-60s) and deep breathes
29
What is hypoventilation?
ventilation inadequate to meet metabolic needs
30
What can cause hypoventilation?
chest wall restriction
obstruction
neural control of breathing
31
What can hypoventilation lead to?
hypercapnea (increased PaCO2), and respiratory acidosis
32
What is hypercapnea?
increased PaCO2
33
What is hyperventilation?
ventilation that exceeds metabolic demands
34
What can cause hyper ventilation?
severe anxiety
| head trauma
35
What does hyperventilation lead to?
hypocapnia, respiratory alkalosis
36
Define hemoptysis.
blood in the sputum; bright red with frothy sputum
37
What does hemoptysis indicate?
damage (usually infection) to bronchi or lung tissue
| ex. bronchitis, bronchiectasis, TB, lung cances, pulmonary emboli
38
What is cyanosis?
bluish discolouration of the skin, mucosa due to increased desaturated blood
39
What are the causes of cyanosis?
```
decreased O2
cardiac R-L shunts
decreased CO
cold
anxiety
```
40
Why would you feel pain with pulmonary alterations?
- infection, or inflammation or pleurae, airways, chest wall
- pulmonary hypertension can cause pain (feels like angina)
- tend to have sharp stabbing pain during increased inspiration
41
What is clubbing?
bulbous enlargement of the tips of the fingers or toes; results from chronic hypoxia (usually cancer), vasodilation or hypertrophy
42
What part of the respiratory system does the common cold effect?
upper respiratory
43
What causes a cold?
there are 200 different VIRUSES that can cause cold-like symptoms and the 110 RHINOVIRUSES cause an estimated 30-35% of these
44
What is hyperemic?
edema in the nasal mucosa
45
During the common cold what does hyperemic lead to...
- hyperemic which leads to obstruction of nasal sinuses, mild infiltration of inflammatory cells, and mucus producing cells are over active
- symptoms are due to inflammation and begin 1-5 days after infection
46
How long do cold symptoms last?
2-14 days
47
are colds bacterial or viral?
viral, but can lead to bacterial infection of your middle ear or sinuses
48
What symptoms may indicate more serious illness?
- high fever
- significant swollen glands
- severe sinus pain
- cough that produces mucus
49
How is the common cold spread?
contact (usually from hands); viable on surfaces for 5hrs
50
Who is most effected by the common cold?
children
51
What is the flu?
highly contagious caused by a variety of influenza viruses; difficult to distinguish from other respiratory illness
52
What symptoms are typical of the flu?
more severe disease, very fast onset and includes 1-3 days of whole body pain (moderate-high fever, pains)
53
Who is most effected by the flu?
older and younger
54
How is the flu spread?
droplet
55
Why is the flu more severe then a cold?
more contagious, damages epithelial lining of respiratory tract, increasing the likelihood of a secondary infection
56
What is pneumonia?
- infection of the parenchyma of the lungs (usually lower-bronchioles/alveoli)
- bacterial , viral, or fungal
- pathogens inhaled or blood borne
57
Define virulent.
marked rapid, severe, and destructive course
58
What does the body do to help prevent pneumonia?
- cough reflex and mucociliary clearance prevent most microorganisms from infecting LRT
- Roaming macrophages (dust cells) ingest pathogens without initiating inflammatory response
59
How might the lungs become overwhelmed resulting in pneumonia?
can ingest pathogens without initiating inflammatory response
60
What are the risk factors for pneumonia?
- > 65 years
- aspiration
- smoking
- immunosuppression
- chronic illness (CHF, uremia)
- debility (bed-ridden, Alzheimer’s)
- chronic respiratory disease
- impaired cough reflex (ie. stroke)
61
How is pneumonia classified?
- by distribution (lobar, broncho-, intestitial)
- source (community vs hospital)
- infectious agent (bacterial, viral, fungal)
62
What is CAP?
Community acquired pneumonia (usually low virulence pathogens)
63
What is HAP?
Hospital acquired pneumonia (more virulent pathogens)
64
Which distributions are typically associated with bacterial pneumonia?
bacterial, and lobar
65
What distribution is typical of viral infections?
interstitial
66
What is atypical pneumonia?
bacterial pneumonia
67
What is the common agent that causes typical pneumonia?
Streptococcus pneumoniae (pneumocuccus)
68
Where is bacterial pneumonia typically acquired?
CAP
69
How is bacterial pneumonia characterized?
alveolar inflammation
1. VASCULAR ENGORGEMENT, intra-alveolar EDEMA with few neutrophils and numerous bacteria
2. MASSIVE EXUDATION (usually RBCs, neutrophils and fibrin)
3. RBCs are destroyed, but fibrinous exudate remains, MACROPHAGES arrive
4. exudate undergoes progressive enzymatic digestion and is removed
70
What would would happen to an otherwise health individual if they had pneumonia causing bacterial inflammation in the lungs?
exudate is reabsorbed via lymphatics or coughed out; condition can resolve with no residual damage
71
Define bronchopneumonia.
patches of inflammation throughout the lungs; begins with invasion of bronchial or bronchiolar mucosa, and spreads to adjacent alveoli
72
When is bronchopneumonia most common?
chronically or terminally ill
73
What is lobar pneumonia?
Single lobe becomes filled with inflammatory exudate (consolidation); less common; involved lobe is sharply demarcated from the uninvolved lobes
74
What complications are common in bacterial pneumonia?
- pleurisy
- emphyema (pus)
- tissue destruction and necrosis (possible abscess)
- fibrous scarring
- bacterial spread (heart, brain, kidneys, joints
75
What is atypical pneumonia?
no consolidation in the alveoli (ex. viral pneumonia)
76
What virus causes viral pneumonia?
Many different viruses
| adenovirus, influenza viruses
77
Describe viral pneumonia.
- Self-limiting
- provides opportunity for bacteria to invade
- invade alveolar lining cells (few PMN exudated to lumen)
- described as interstitial pneumonia
78
What is interstitial pneumonia?
- no alveolar exudate, no productive cough
| - fewer manifestations (fever, headache, muscle aches and pains)
79
What does SARS stand for?
severe acute respiratory syndrome
80
What are the symptoms of SARS?
- alveolar damage causes a cough and breathing difficulties
- fever, fatigue and joint pain
- fatal in 6-20% of cases
81
Describe fungal pneumonia.
- opportunistic infection of the lungs
- rarely seen in persons with normal immune system
- was a major killer for pt with HIV, but now it is almost entirely preventable/treatable
82
What kind of exudate is characteristic of fungal pneumonia
Foamy alveolar exudate with infiltration in the alveolar septae as well
83
What most often precedes pneumonia
upper respiratory tract infection
84
What symptoms tend to develop with pneumonia?
```
fever
chills
cough
malaise
pleural pain
dyspnea
signs of systemic disease or sepsis
```
85
How is pneumonia diagnosed?
- WBC count elevated
- pathogen identified in sputum or blood culture
- Diagnosed through MANIFESTATIONS and CHEST X-RAY
86
What is the treatment of pneumonia?
depends on pathogen
- bacterial use antibiotics (pneumococcal strains are resistant)
- pt are to be kept well hydrated and use good oral and pulmonary hygiene (deep breathing, coughing, physical therapy)
87
What is the incidence of TB in the world?
- 1/3 world pop are infected
| - worlds #2 cause of death by infectious agent
88
How does Canada's rate of TB compare to the rest of the world?
really low
89
Who does TB usually affect?
usually persons with decreased resistance due to malnutrition or decreased immune function
90
What is TB?
tuberculosis is a chronic bacterial infection caused by myobacterium tuberculosis
91
What makes mycobacterium tuberculosis persistent?
they have a waxy capsule makes them resistant to destruction and allows them to persist in old necrotic and calcified lesions
92
How is TB spread?
inhalation of airborne droplets
| - are digested by alveolar macrophages once they reach alveoli
93
Where does tuberculosis replicate?
within the phagosome and usually burst free
94
How does TB spread within the body?
via macrophages in lymphatics and blood stream
95
Growth is virtually ______ both in the initial pulmonary focus and the metastatic foci before development of the specific cellular _____
granulomas
| immunities
96
When do helper T cells activate macrophages, when fighting TB?
3 weeks in; become bactericidal
97
What is the concern with granuloma's containing TB?
latent infection
98
When does initial infection typically appear to be arrested?
once cellular immunity develops
99
What is a tubercle?
Neutrophils, macrophages seal off colonies of bacilli forming granulomatous lesions (TB may remain dormant)
100
Where does TB spread to in the lung?
apex of the lung because there is more O2
101
What is cavitation?
necrosis destroying bronchial walls (bleeding if ruptured vessels)
- immune response considered hypersensitivity and much of the damage is thought to be caused by immune system
102
What is a hilar lymph node?
lymph node where vessels and nerves enter organ
103
Most individual exposed to TB have ___ symptoms
no
104
What might you see in someone with TB?
positive TB test (Mantoux test)
opaque areas (calcified tubercles) on chest x-ray
calcified lymph nodes
105
How often are TB cases un recognized?
95% of the time (resemble bacterial pneumonia)
106
What are the manifestations of TB?
```
fatigue
weight loss
lethargy
loss of appetite
low-grade fever
cough (with purulent sputum)
dyspnea
chest pain
```
107
TB is diagnosed though
skin test, sputum test, chest xray
108
What is the treatment of TB?
6months of multiple antibiotics
109
How long do TB pt need to remain at home?
until sputum cultures show no bacilli
110
What does MDR-TB stand for?
MDR-TB
| Multi Drug Resistant TB
111
What is bronchiolitis?
inflammatory obstruction of bronchioles (normally due to viral infection), more common in under 2years
112
What does bronchiolitis lead to?
leads to wheezy cough, dyspnea, tachypnea, and hypoxia may develop
113
What is the significance of bronchiolitis obliterans?
they are a nonspecific manifestation of acute lung injury, which causes abnormal healing with SCARRING an plugs of fibrous tissue TYPICALLY PERMINANT
