Ch. 12: Disorders of the Respiratory System Flashcards
SLEEP APNEA: AHI INTERPRETATION
Normal
<5
SLEEP APNEA: AHI INTERPRETATION
Mild Sleep Apnea
5-15
SLEEP APNEA: AHI INTERPRETATION
Severe Sleep Apnea
> 30
SLEEP APNEA: AHI INTERPRETATION
Moderate Sleep Apnea
15-30
SLEEP APNEA: AHI
What does the apnea-hypopnea index (AHI) represent?
The number of apneic and hypopneic episodes occuring per hour.
The degree is of sleep apnea is determined by what?
Apnea-hypopnea index (AHI)
What types of sleep apnea need treatment?
Moderate and severe
What type of sleep apnea is being described
Apnea caused by upper airway anatomic obstruction.
Obstructive sleep apnea
For the lung condition to be considered ARDS, what three criteria must be met?
- Infiltrates on chest x-ray film confirm that fluid is leaking into the interstitial spaces.
- Normal heart function as evidenced by normal PCWP.
- P/F ratio <200
List the treatment options for sleep apnea
- NPPV
- CPAP
- Auto-PAP
APAP allows for pressure adjustments to be made automatically due to increasing or decreasing obstruction.
Obstructive sleep apnea may be associated with:
(1) Obesity
(2) Excessive pharyngeal tissue
(3) Deviated nasal septum
(4) Laryngeal web
(5) Laryngeal stenosis
(6) Enlarged adenoids or tonsils
Symptoms of obstructive sleep apnea
(1) Loud snoring
(2) Hypersomnolence (excessive sleeping during the day)
(3) Morning headache
(4) Nausea
(5) Personality changes
Apnea occurs because of the failure of the central respiratory centers (in the medulla) to send signals to the respiratory muscles.
Central Sleep Apnea
It is characterized by the absence of inspiratory effort with no diaphragmatic movement (unlike obstructive sleep apnea)
What treatment option is most suitable for CSA?
NPPV
Central sleep apnea may be associated with:
(1) Hypoventilation syndrome
(2) Encephalitis
(3) Spinal surgery
(4) Brainstem disorders
Symptoms of central sleep apnea
(1) Insomnia
(2) Mild snoring
(3) Depression
(4) Fatigue during the day
________ refers to events that are recorded graphically while the individual is sleeping.
Polysomnography
Continuous recordings on graph paper (poly- somnogram) during the sleep study include:
a. Eye movement (electrooculogram)
b. Brain wave activity (electroencephalogram
[EEG])
c. ECG
d. Absence of airflow (apnea) is determined with the use of a CO2 analyzer, thermistor, tracheal sound recorder, or pneumotachograph
d. Chest and abdominal movement
e. O2 saturation
f. Limb movement
g. Esophageal pressure
According to GOLD standard, _________ is defined as a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
COPD
When both these diseases occur simultaneously as one disease, the condition is referred to as COPD.
Chronic bronchitis and. emphysema
A permanent abnormal enlargement
of the air spaces distal to the terminal bronchioles, associated with destructive changes of the alveolar walls
Emphysema
What type of emphysema is this?
(1) The acinus is the anatomic gas exchange unit of the lung, made up of the respiratory bronchiole, alveolar duct, alveolar sacs, and the alveoli.
(2) The entire acinus is involved.
(3) There is significant loss of lung parenchyma.
(4) Alveoli are destroyed.
(5) Bullae are present.
(6) Usually is associated with emphysema resulting from a1-antitrypsin deficiency.
Panlobular (panacinar)
What type of emphysema is this?
(1) Lesion is in the center of the lobules, which results in enlargement and destruction of the respiratory bronchioles.
(2) Usually involves the upper lung fields and is most commonly associated with chronic bronchitis.
Centrilobular (centriacinar)
What type of emphysema is this?
Emphysematous changes are isolated and accompanied by the development of bullae, which are weak air spaces and susceptible to rupture.
Bullous emphysema
What is the difference between blebs and bullae?
- Bullae are defined as air spaces in their distended state, more than 1 cm in diameter.
- Blebs are defined as air spaces adjacent to the pleura, usually less than 1 cm in diameter in their distended state.
What are causes of emphysema?
- Smoking
- Antitrypsin deficiency (hereditary)
Emphysema Pathophysiology
Elastic recoil of the lung is diminished, which results in __________.
Premature airway closure
Emphysema Pathophysiology
Air-trapping leads to chronic hyperinflation of the lungs and an __________ FRC.
Increased
Is lung compliance increased or decreased with Emphysema?
Lung compliance (CL) is increased as a result of the destruction of elastic lung tissue.
Lis the clinical signs and symptoms of Emphysema
- Dyspnea
- Digital clubbing
- AP chest diameter
- Accessory muscle use
- Elevate Hg, Hct and RBC count
- Cyanosis
- Right sided-heart failure in advanced stages
What would be the breath sounds of someone with emphysema?
Diminshed breat sounds and hyperresonance to percussion
Why does cor pulmonale manifest in patients with emphysema?
Cor pulmonale results from an increased workload on the right ventricle as it attempts to deliver blood through constricted pulmonary blood vessels.
Emypshema: Characteristics of chest x-ray
a. Flattened diaphragm
b. Hyperinflation
c. Reduced vascular markings
d. Bullous lesions
Is DLCO increased or decreased in patients with emphysema?
Decreased
a. Increased residual volume (RV) and FRC
b. Decreased diffusion capacity
c. Decreased vital capacity (VC)
d. Decreased forced expiratory volume in 1 second (FEV1)
e. Decreased FEV1/FVC (,70%)
f. Prolonged nitrogen washout
EXAM NOTE
If the PaO2 increases above 70 mm Hg and the PaCO2 begins increasing after a patient with severe COPD starts receiving O2, what is happening?
The patient’s ventilatory drive is suppressed or V/Q mismatching is increasing; decrease the O2 percentage.
For COPD patients a PaO2 level of ____ should be maintained.
50-65 mm Hg
Identify the disease process.
Chronic excessive mucus production,
resulting from an increase in the number and size of mucus glands and goblet cells. Symptoms are a cough and increased mucus production for at least 3 months of the year for more than 2 consecutive years.
Chronic bronchitis
What is the cause of chronic bronchitis?
Smoking
List the pathophysiology of chroni bronchitis.
a. Increase in the size of mucus glands
b. Increase in the number of goblet cells
c. Inflammation of bronchial walls
d. Mucus plugs in peripheral airways
e. Loss of cilia
f. Emphysematous changes in advanced stages of disease
g. Narrowing airways, leading to airflow limitation
What are the clinical signs and symptoms of chronic bronchitis?
a. Cough with sputum production
b. Dyspnea on exertion progressing to dyspnea with less effort
c. CO2 retention and hypoxemia in advanced stages
d. Increased pulmonary vascular resistance (PVR) in advanced stages
e. Increased Hb level, Hct, and RBC count in advanced stages
f. Cor pulmonale in advanced stages
g. Breath sounds: coarse crackles and wheezes
IDENTIFY THE DISEASE PROCESS
A clinical syndrome characterized by airway obstruction, which is partially or completely reversible either spontaneously or with treatment. Characteristics include airway inflammation and airway hyperresponsiveness to various stimuli.
Asthma
What is is the least severe of the four asthma classifications?
Intermittent
The cause of asthma is associated with what factors?
a. Allergic response
b. Heredity
c. Environmental factors
d. Infection
e. Psychosocial factors
f. Socioeconomic factors
GOLD standard for severity of airflow limitation in COPD patients with FEV1/FVC less than ____%
70
Gold 1 Mild FEV1
> 80% predicted
Gold 2 Moderate FEV1
50-79% predicted
Gold 3 Severe FEV1
30-49% predicted
Gold 4 Very severe FEV1
29% or less than predicted
GOLD standard guidelines for drug therapy
The preferred route of administration is ______.
inhaled over oral
________ are referred to as rescue drugs and are recommended for symptomatic management of all COPD patients
Inhaled short-acting beta adrenergics
(SABAs) such as albuterol or levalbuterol (Xopenex)
What breathing technique prevents premature airway closure by producing a back pressure into the airways?
Pursed-lip breathing
List an example of a long-acting beta adrenergics
Salmeterol (Serevent)
List an exmaple of a long-acting anticholinergic
Tiotropium bromide
Care must be taken when administering O2 to patients with COPD who chronically retain CO2 and who have chronic hypoxemia. PaO2 levels should be maintained between ________ to avoid blunting the respiratory drive or increasing ventilation/perfusion (V/Q) mismatching.
50 - 65 mm Hg
Rather than increasing the dose of a medicationto get a stronger response, what could be done?
combine different classes of bronchodilators, which can reduce side effects.
Combining long-acting bronchodilators and in- haled corticosteroids will be more effective than using either drug individually but may increase the risk of _______.
pneumonia
Roflumilast can be helpful with GOLD 3 and GOLD 4 patients who what?
have a history of acute exacerbations and chronic bronchitis and who are using oral corticosteroids.
Something to know.
Theophylline added to salmeterol (long-acting bronchodilator) has been shown to increase FEV1 more than with salmeterol by itself.
Okay.
What is classified as MILD PERSISTENT ASTHMA?
Symptoms of coughing or wheezing are experienced more than twice per week but less than once per day.
What measurement can be helpful in determining airway inflammation?
FENO
Normal FENO levels in adults and children
Normal FENO levels in adults is less than 25 parts per billion (ppb) and less than 20 ppb in children.
FENO levels of greater than 50 ppb may indicate that ______.
The patient needs to increase his or her normal medication.
The FENO level is commonly increased as a result of the patient’s noncompliance with corticosteroid use.
CLINICAL SIGNS AND SYMPTOMS
Asthma (9)
- Mild wheezing and coughing initially, which may
progress to severe dyspnea if the attack is not
reversed. - The cough is initially nonproductive, progressing
to a productive cough by the end of the episode. - Secretions contain high levels of eosinophils.
- Intercostal and supraclavicular retractions.
- The use of accessory muscles to breathe (in a
severe attack). - Paradoxical pulse
- Tachycardia and tachypnea
- ABG levels initially reveal hypoxemia and low
PaCO2. - Cyanosis
Describe how asthm CXR (3)
- Hyperinflation (hyperlucency of lung fields) 2. Atelectasis
- Infiltrates
Asthma Preventative Drugs
- Cromolyn sodium (Intal): mast cell stabilizer referred to as a noncorticosteroid antiinflammatory drug
- Leukotriene modifiers: zafirlukast (Accolate) or montelukast (Singulair)
