CH 15: Altered Ventilation Flashcards
1
Q
process of moving air into and out of the trachea, bronchi, and lungs
A
Ventilation
2
Q
process of moving and exchanging the oxygen acquired during ventilation with carbon dioxide waste across the alveolar–capillary membranes.
A
Diffusion
3
Q
process of supplying oxygenated blood to the lungs and organ systems via the blood
vessels.
A
Perfusion
4
Q
process in which cells throughout the body use oxygen aerobically to make energy.
A
Respiration
5
Q
defense mechanisms of the pulmonary systems
A
protective structures
mucosal lining of airway
irritant receptors
immune protections
6
Q
protective structures ex and uses
A
such as hairs and turbinates (shell-shaped structures) in the nose and cilia in the upper and lower airwayswhich trap and remove foreign particles from the air
7
Q
mucosal lining use
A
warms and humidifies air
8
Q
irritant receptors uses
A
recognize injurious agents and respond by triggering a sneeze or cough reflex to remove foreign particles
9
Q
immune protections ex and uses
A
immune coating in the respiratory tract mucosa and
macrophages in the alveoli
which ingest and remove bacteria and other foreign materials via phagocytosis
10
Q
pulmonary circulation is responsible for:
A
delivering oxygen and other nutrients to the lung tissues
filtering clots, air, or other foreign materials from circulation
11
Q
facilitate the exchange or O2 and carbon dioxide
A
capillaries near the alveoli
12
Q
ventilation is regulated by
A
Respiratory control centers in the brain
Lung receptors
Chemoreceptors
13
Q
respiratory control centers comprise:
A
neurons in the pons and medulla, which send neural
impulses to the diaphragm
intercostal muscles, sternocleidomastoid muscles
other accessory muscles, causing them to contract or relax.
14
Q
ANS innervates the lungs by:
A
acts on the smooth muscles of the conducting airways to promote airway constriction (parasympathetic division) or dilation (sympathetic division).
15
Q
neural impulses are direct by:
A
lung receptors that map the current state of breathing and lung function
16
Q
role of epithelium sensing receptors
A
cough reflex
17
Q
role of smooth muscle sensing receptors
A
make you exhale to prevent excessive lung inflation
18
Q
roles of capillary receptors
A
detect increase in capillary pressure and reduce pressure
19
Q
role of chemoreceptors
A
detect gas exchange needs based on the partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2), along with the pH levels in the blood and cerebrospinal fluid (CSF).
– then alter rate of breathing
20
Q
if blood levels become too acidic ____
A
respiratory drive increases to blow off the CO2
21
Q
most sensitive to oxygen levels in the arterial blood
A
peripheral chemoreceptors
22
Q
how do you measure ventilation
A
pulmonary function tests
23
Q
what is a pulmonary function test
A
noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange.
This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders.
24
Q
results of PFT are dependent on
A
Age, sex, race, ethnicity, height
25
the amount of air that is exhaled after passive inspiration –
adults approximately 500 mL
Total Lung Capacity
26
the maximal amount of air that can be moved in and out of the lungs with forced inhalation and exhalation.
Vital Capacity
27
the maximal amount of air that can be expired from the lungs in 1 second.
FEV1
28
A problem of blocking airflow in and out of the lungs, thereby restricting oxygen intake and carbon dioxide removal from the body.
impaired ventilation
28
A problem of blocking airflow in and out of the lungs, thereby restricting oxygen intake and carbon dioxide removal from the body.
impaired ventilation
29
2 mechanisms of impaired ventilation
compression or narrowing of airways disruption of neural transmission needed to stimulate the mechanics of breathing
30
compression or narrowing of the airways
o can occur anywhere between the mouth and alveoli
o trouble with airway clearance
o occlusion can be partial or complete
31
ex of compression or narrowing of the airways
inflammation
edema
exudate
structural narrowing
strangulation
foreign body
32
ex of disruption of the neural transmissions needed to stimulate the mechanics of breathing.
Oversedation or overdose of medication
Damage to respiratory center of brain, cervical nerves, or thoracic nerves
Examples severing cervical nerves requires mechanical ventilation
33
expected breathing patter characterized by a rate between 10-20 breaths per min in adultsreason for occurence:
eupnea
effective and responsive gas exchange
34
rapid, shallow breathing characterized bu a rate of breathing above 24 breaths per min in adults reason for occurrence:
tachypnea
body needs to release extra carbon dioxide
35
cessation of breathing for 10 sec or longer
reason for occurrence:
apnea
can result from brain injury, premature birth, or obstructive process during sleep
36
increase in the rate and depth of breathing leads to hyperventilation
reason for occurrence:
hyperpnea (Kussmal respirations)
excess carbon dioxide needs to be released
37
slow breathing with regular depth and rate
reason for occurrence:
bradypnea - hypoventilation
drug-induced depression
increased intracranial pressure
diabetic coma
38
a breathing pattern that alternate hyperpnea and apnea
reason for occurrence:
cheyne-stokes
increased intracranial pressure
bilateral damage to breathing areas
drug induced resp depression
heart failure
uremia
39
a breathing pattern of unpredictable irregularity
reason fro occurrence:
ataxic breathing
severe head trauma and damage to resp center
brain abscess
heat stroke
spinal meningitis
encephalitis
40
prolonged and incomplete expiration to overcome increased airway resistance and air trapping
reason for occurrence:
obstructive breathing
COPD
asthma
chronic bronchitis
41
Problem with the transfer of oxygen or carbon dioxide across the alveolar-capillary junction
impaired diffusion
42
When the body is unable to keep up with the demands, this can lead to
Hypoxemia
Hypoxia
Hypercapnia
43
decreased oxygen in arterial blood
hypoxemia
44
causes of hypoxemia
o Oxygen deprivation
o Hypoventilation
o Inadequate perfusion
o Inadequate uptake in oxygen in the blood
o Mild to severe
45
When cells that depend on oxygen for cellular metabolism are deprived of oxygen
hypoxia
46
consequences of hypoxia
Particularly bad for brain, heart, lungs with high oxygen demands
Cell function reduced
When it causes anaerobic metabolism - Leads to metabolic acidosis
Can lead to cell death
47
increase CO2 in the blood
hypercapnia
48
local manifestations of impaired ventilation and diffusion
-vasodilation, increased capillary permeability, exudate formation, and pain in the affected region of the airways, lungs, or chest cavity.
o Cough
o Excess mucus
o Hemoptysis
o Dyspnea
o Use of accessory muscles
o Chest pain
o Barrel chest
49
noninvasive test that measures oxygen saturation
pulse oximetry
50
direct visualization of bronchioles; can be used to take biopsy, take sputum samples, or remove foreign objects from airway
bronchoscopy
51
used to detect structural problems, presence of consodilation, obstruction, or cavitation in the airways and lung tissue
radiograph, CT, MRI
52
detects pulmonary embolism and lung disease, such as emphysema and COPD, by using a nuclear medicine camera and computer imaging
nuclear lung scan
53
determines presence and type of microorganisms in the blood and/or sputum; the results dictate appropriate antibiotic treatment if indicated
culture and sensitivity
54
determines presence of pleural effusion by inserting a needle from chest or back in lung pleural space
fluid is examined
thoracentesis
55
The principles that guide improving ventilation are based on:
Removing obstructions (i.e., foreign body, tumor, edema)
2Restoring the integrity of the chest wall, lungs, and other respiratory structures
3Decreasing inflammation
Decreasing, thinning, and moving mucus out of the airway
Opening and maintaining integrity of the airways
Supplementing oxygen
Controlling infectious processes
Using mechanical ventilation, as indicated
56
reduces inflammatory response by acting on chemical mediators to decrease excess blood flow, swelling, heat, redness, and pain to affected area
anti-inflammatory meds
57
when to use anti-inflammatory meds
inflammation that impinges on ventilatory function suc has with asthma
58
moistens and liquifies secretion to aid in expectoration
humidification
59
when to use humidification
with the presence of excessive, thick, and sticky mucous
60
decreases nasal congestion through vascular vasoconstriction, which decreases blood flow, reduces exudate, and shrinks swollen mucous membranes
decongestants
61
when to use decongestants
with the presence of excessive, thick, and sticky mucous
62
suppressive cough by inhibiting cough receptors in the medulla
antitussives
63
when to use antitussives
when cough is excessive and interferes with sleep
64
opens airway by relaxing bronchial smooth muscles
bronchodilators
65
when to use bronchodilators
conditions that cause bronchoconstriction: asthma, COPD
66
using a pounding motion or vibration on the chest to physically loosen thick secretions
chest physiotherapy
67
when to use chest physiotherapy
conditions that result in thick, tenacious secretions such as in CF
68
antibiotics have a range of mechanisms focused on destroying or reducing impact of bacteria; antivirals may also be prescribed as appropriate
antimicrobials
69
when to use antimicrobials
bacterial infection
70
provides direct oxygen supplementation
oxygen therapy
71
when to use oxygen therapy
hypoxia
72
life support measure that provides the work of breathing
mechanical ventilation
73
when to use mechanical ventilation
respiratory failure
74
surgical treatment of altered ventilation and diffusion
surgical removal of abnormal tissues or structures within the chest
75
Inflammation of the lungs – bronchioles, intersitial lung tissue, alveoli
Older and young people, immunosuppressed or hospitalized are at risk
Top cause of death in the US
pneumonia
76
Failure of the lungs to provide enough oxygen to the body and remove carbon dioxide
respiratory failure
77
total lack of O2
anoxia
78
clinical manifestations of pneumonia
fever, chills, cough, sputum production, fatigue, loss of appetite, dyspnea, tachypnea, tachycardia, pleuritic pain, and adventitious breath sounds caused by fluid accumulation
Crackles bs
Confusion – sometimes first sign
Different colors of sputum
79
rust colored sputum
pneumococcal
80
green colored sputum
haemophilus or pseudomonas
81
treatment of pneumonia
Goal is to restore ventilation and diffusion
Antibiotic or 2 – macrolide
IV fluids dehydration
82
generic term that describes all chronic obstructive lung problems, including asthma, emphysema, and chronic bronchitis, separately or in combination.
one of leading causes of death
COPD
83
irreversible enlargement of the air spaces beyond the terminal bronchioles,
most notably in the alveoli, resulting in destruction of the alveolar walls and obstruction of
airflow.
emphysema
84
most notable cause of emphysema
chronic smoking
85
development of emphysema is often due to
genetically inherited deficiency of alpha-1 antitrypsin (AAT).
86
sources of respiratory obstructions
Development of inflammation of small airways
loss of elastic recoil in the alveoli is the primary mechanism of airflow obstruction.
Vascular changes in the lungs develop simultaneously along with the airway obstruction.
inner lining of the arteries and arterioles that perfuse the lungs becomes thick and fibrotic.
Air trapping
87
lung consequences of chronic smoking
The elasticity of the lung is significantly reduced leading to the inability of the alveoli to recoil and release CO2 into the atmosphere.
88
loss of elasticity affects:
ability of the alveoli to contract and move air back out of the body.
89
air trapping decreases
effective O2 intake and especially CO2 release.
90
clinical manifestations of emphysema
Chronic cough upon waking
Dyspnea and wheezing with exertion
Barrel chest
Pursed lip breathing to increase pressure in the airways
91
diagnostic tests for emphysema
PFTs
Increase respiration rate
Cyanosis
Peripheral edema
Hyperinflation on chest xray
92
treatment of emphysema
Goal is to maintain lung function
Smoking cessation
Bronchodilators
Steroids
Mucolytics
Supplemental oxygen
93
presence of a persistent, productive cough with excessive mucus production that lasts for 3 months or longer for two or more consecutive years.
chronic bronchitis
94
most common cause of chronic bronchitis
smoking or environmental
95
Chronic bronchitis results from several changes in the bronchi and bronchioles of the lungs in response to chronic injury including:
Chronic inflammation and edema of the airways
Hyperplasia of the bronchial mucous glands and smooth muscles
Destruction of cilia
Squamous cell metaplasia
Bronchial wall thickening and development of fibrosis
96
clinical manifestastions of chronic bronchitis
Chronic cough
Purulent sputum
Dyspnea with exertion
Prolonged expiratory phase
Wheezing and crackles
Hypoxemia, hypercapnia, cyanosis
97
diagnostics for chronic bronchitis
Productive cough for 3 months or more in 2 years
Recurrent upper and lower respiratory infections
Polycythemia – compesatory to chronic hypoxemia
PFTs = reduce FEV and prolonged FET
98
treatment for chronic bronchitis
Goal is to improve or maintain lung function
Stop smoking
Bronchodilators, steroids, mucolytics, Oxygen
99
chronic inflammatory disorder of the airways that results in intermittent or persistent airway obstruction because of bronchial hyperresponsiveness, inflammation, bronchoconstriction, and
excess mucus production.
asthma
100
possible causes of asthma
-increased in individuals who are frequently exposed to
environmental allergens, such as cigarette smoke or dust mites.
inflammatory and immune response is often stimulated through exposure to an allergen.
There’s also exercise induced asthma – exercise triggers a bronchospasm
Trigger exposure – IgE mediated hypersensitivity reaction
101
clinical manifestations of asthma
Hyperreactivity and inflammation
Times of remission and exacerbation
In times of exacerbation, hyperreactivity and inflammation in the airways causes wheezing, breathlessness, chest tightness, excessive sputum production, and coughing, particularly at night or in the early morning
During an asthma episode, the individual may exhibit anxiety, tachypnea, and the use of accessory muscles. Hyperventilation initially leads to respiratory alkalosis; however, compensation is usually temporary, and acidosis develops because of ineffective expiration.
Even with partial airway obstruction, hypoxia quickly results.
102
diagnostics for asthma
Evidence of respiratory distress
Pulsus paradoxus, an exaggerated decrease in systolic blood pressure during inspiration
Wheezing breath sounds
A prolonged expiratory phase
Atopic dermatitis, eczema, or other allergic skin conditions that may indicate hypersensitivities
Eosinophilia – WBC present during allergic response
Use of spirometry PEFR peak expiratoryu flow rate – Peak flow meter
Xray shows hyperinflation or infiltrates in the lungs
103
During diffusion, two major processes are occurring simultaneously:
(1) Oxygen is trying to get to all cells
(2) carbon dioxide is trying to escape the body through the lungs.
