Ch 27- Alteration in Pulmonary Function Flashcards
what does ventilation mean?
movement of air in and out of lungs
what does oxygenation mean?
loading oxygen molecules onto hemoglobin
what does respiration mean?
O2 and CO2 exchange of alveoli (external) and systemic capillaries (internal)
what does perfusion mean?
delivery of blood to a capillary bed in tissue
what does dyspnea mean?
breathlessness
- experience of breathing difficulty
- work of breathing is greater than the actual result
- signs: flaring of nostrils/use of accessory muscles/head bobbing in children
what does paroxysmal nocturnal dyspnea mean?
pulmonary condition that wakes you gasping for breath in the middle of the night
what is sputum?
the color provides information about progression of disease. Microscopic appearence allows microogranism identity
what does hemoptysis mean?
coughing up of blood= usually indicates infection or inflammation of the bronchiole
- if severe can indicate cancer
what does eupnea mean?
normal breathing
what are some abnormal breathing patterns?
-patterns of breathing automatically adjust to minimize WOB
- purpose of sigh: 2 tidal volume/ 10 times per hour, helps maintain normal breathing, equals out oxygen consumption and carbon dioxide expulsion
what does hypernea mean?
Kussmaul respiration occurs with strenuous exercise
- increased ventilation rate/ greatly increased tidal volume
- no pause at end of expiration
what is cheyne-stokes respiration?
Alternating deep/shallow breathing
- Includes periods of apnea, followed by increased volume ventilations, ventilation then returns to normal, triggering another period of apnea
- Cause: reduced blood flow to brain/reduced brain impulses to respiratory center
what does hypoventilation mean?
- inadequate ventilation
- Issue: co2 removal doesnt keep up with co2 production
- Result: hypercapnia (increased co2 in blood stream)
what does hyper ventilation mean?
alveolar ventilation exceeding needs
- Issue: removal of more co2 than is produced
- Result: hypocapnia (reduced co2 in blood stream)
what does cyanosis mean?
bluish discoloration of skin
- Cause: develops when 5 grams of hemoglobin is desaturated
- Cyanosis is not evident until it is severe= insensitive indicator of respiratory failure
what are the 2 types of cyanosis?
- Peripheral cyanosis:
- Cause: poor circulation in fingers/toes due to peripheral vasoconstriction
- Best seen in nail beds - Central cyanosis:
- Cause: decreased arterial oxidation (low PaO2) from pulmonary disease
-Best detected in buccal mucosa membranes and lips
what does clubbing mean?
-bulbous formation at end of fingertips and toes
- Cause: diseases that disrupt pulmonary circulation causing hypoxemia/rarely reversible
what is the pain from pulmonary disorders?
- almost always localized in chest wall/ can be pinpointed by unique sound called the pleural fiction rub
- pain can often be reproduced by pressing on sternum or ribs
what does pleural fiction rub mean?
pleural walls rub together due to reduced fluid in pleural cavity
what is hypercapnia?
increased CO2 in blood (increased PaCO2) caused by hypoventilation of alveoli
what does hypoventilation cause?
- decreased drive to breath
- depression of respiratory center
- disease to medulla oblongata
- result: increased work of breathing
what is the effect of hypoventilation?
- electrolye (ionic) imbalances
= Dysrhythmia (irregular heart rate) - severe= coma
what does hypoxemia mean?
decreased PaO2 in arterial blood
what are the 2 causes of hypoxemia?
- issues with delivery of O2 to alveoli and delivery of blood to lung
- thickening of alveolar membrane or destruction of alveoli
what 2 factors does the diffusion of O2 from alveoli to blood depend upon?
- amount of air entering alveoli
- amount of blood perfusing capillaries around alveoli
what does shunt mean?
normal perfusion/inadequate ventilation
what does alveolar dead space?
inadequate perfusion/normal ventilation
what is acute respiratory failure?
inadequate gas exchange such that:
- PaO2 is less than 60 mmHg
- PaCo2 is greater than 50
- pH less than or equal to 7.25
potential complication of any major surgical procedure
prevention: frequent turning and position changes/deep breathing exercises/early ambulation
most common conditions are pneumonia, edema, embolism
what is chest wall restrictions?
- cause: deformity/obesity/neuromuscular disease
- result: increased work of breathing/usually decrease in tidal volume
- pain from injury, surgery, disease can cause hypoventilation
= decreased tidal volume/increased breathing rate and can lead to respiratory failure
what is flail chest?
fracture of consecutive ribs with/without sternum damage
- Result: chest wall instability= paradoxical movement of chest when breathing
what is paradoxical breathing?
Inspiration: unstable portion of chest wall moves inward (normal movement would be outward)
Expiration: portion moves outward (normal movement would be inward)
- Result: impaired ventilation of alveoli
what are the 2 pleural abnormalities?
- Pneumothorax:
- air/gas in pleural space
- cause: rupture to visceral pleural
- result: lung tends to collapse - Pleural effusion:
- fluid in pleural space/from blood or lymph
- diagnosis: chest x ray or thoracentesis: needle aspiration
what is an empyema?
infected pleural effusion by microorganism
- Indication: pus in pleural space
- Cause: pulmonary lymphatic tissue becomes blocked= contaminated lymphatic fluid moves into pleural space
- Result of surgery, or bronchial obstruction
what does restrictive lung diseases mean?
difficulty with inspiration (expanding their lungs)
what does obstructive lung diseases mean?
difficulty with expiration
what does aspiration mean?
passage of fluids/solids into lungs
- Cause: abnormal swallowing mechanism/cough reflex impaired/ can lead to pneumonia
what are restrictive lung diseases?
characterized by decreased lung compliance= increased work of breathing at tidal volume
RLD- what is atelectasis?
collapse of lung
- tends to occur after surgery when using general anesthetic
what are the 2 types of alveoli collapse?
- compression atelectasis: caused by external pressure (tumor or fluid)
- surfactant impairment: decreased production of surfactant
RLD: what is bronchiectasis?
persistent abnormal dilation of bronchi (large airways)
what are the causes of obstruction?
- inflammation due to mucus plugs
- chronic inflammation= destruction of elastic/muscular bronchi wall= permanent dilation
what are the symptoms of restrictive lung diseases?
- chronic productive cough
- large amount of foul-smelling sputum
RDL: what is bronchiolitis?
inflammatory obstruction of small airways
what is bronchiolitis obliterans?
fibrosis of airways= scaring
what is BOOP?
alveoli becomes filled with connective tissue
what are the manifestations of bronchiolitis?
- rapid ventilatory rate
- dry non-productive cough
RDL: what is pulmonary fibrosis?
- excessive amount of fibrous/connective tissue at alveoli
- Cause: scar tissue left from previous disease
- Result: decreased lung compliance and external respiration
- Results from multiple injuries at different lung sits associated with abnormal healing
- Symptom: dyspnea on exertion
RDL: what is pulmonary edema?
excessive water on lungs
- Cause: left side heart disease= reduced left side cardiac output= blood backed up from heart into lungs= increased blood pressure in pulmonary capillaries=fluid forced into interstitial space between capillary and alveoli
- when fluid flow exceeds lymph system capability to remove= pulmonary edema occurs
RDL: what is COVID-19?
manifested as viral pneumonia-induced Acute Respiratory Distress Syndrome (ARDS)
- post mortem studies: mortality patients had undetectable viral loads (cytotoxic effects of virus not main cause of death, death caused by host’s runaway immune response
= management: intubation
OLD: What is asthma?
chronic inflammatory disorder of bronchial mucosa
- inflammation= restriction of airways and hyper immune response to irritants
What are the characteristics of an early asthma attack?
- Classic immune response: dendritic cells/ helper T cells/ T cell and B cell
- Result= inflammation, increased capillary permeability, increased fluid
what are the characteristics of a late asthmatic attack?
- begins 4-8 hours after early attack
- latent release of inflammatory mediators from original site
- Result: increased damage of epithelial cells= scaring/ increased mucus forming plugs/ increased airway resistance
what is the manifestation of asthma?
- Induviduals normal between attacks/ pulmonary function tests are normal
- If bronchospasms not reversed by usual treatment: considered status asthmaticus and if PaCO2 greater than 70 mmHg= sign of impending death
what is the pathophysiology of asthma?
- Inhaled antigen passes epithelial layer
- Antigen binds to mast cells= release of mediators
- Mediators= mucus production in airway/broncho spasm/edema from increased capillary permeability
- Dendritic cells present antigen to Helper T cells= activate B cells/ activated B cells antibodies
- Helper T cells also activate eosinophil/ neutrophils activated/ inflammation from both results in airway obstruction
What is COPD characterized?
- Persistent airflow limitation
- Chronic inflammatory response to noxious particles or gas
- Progressive
what is COPD composed of?
- Chronic Bronchitis
- Emphysema
What is Chronic bronchitis?
hypersecretion of mucus/chronic productive cough for at least 3 months of the year for 2 consecutive years
what is the cause of chronic bronchitis?
inspired irritants= inflammation/thickening of mucous membrane= reduced radius of airways= obstruction
- Airways collapse early in exhalation= air trapped in distal portions of lung= hyperinflation= hypoventilation
what is emphysema?
permanent enlargement of gas exchange airways/ destruction of alveolar walls
- obstruction due to destroyed walls of alveoli not mucus production or inflammation
- destruction= large alveolar spaces= greatly increases diffusion distance between alveoli and capillary
what is the result of emphysema?
- reduced O2 and CO2 diffusion
- expiration becomes difficult because of loss of recoil of normal alveoli
what is acute bronchitis?
- acute infection/inflammation of airways
- usually self limiting
- occurs due to viral infection
- sym: non productive cough aggravated by cold, dry air, dusty air
TX: rest, aspirin ,cough suppressant, antibiotics
what is pneumonia?
- infection of lower respiratory tract caused by microorganisms
- HAP: hospital acquired pneumonia
- CAP: community acquired pneumonia
- pathogen: streptococcus pneumoniae
what is the pathophysiology of pneumonia?
- guardian cells of lower respiratory tract are cellular alveolar macrophages
- macrophages present antigens to adaptive immune system= activation T and B cells
- Resulting immune response can fill alveoli with debris
what is tuberculosis?
caused by mycobaterium tuberculosis
- leading cause of death from curable disease
- transmission person to person by airborne droplets
what is the pathophysiology of tuberculosis?
- pathogen in lung gets engulfed by macrophage and manages to survive and multiply
- multiplication causes chemotactic response making more macrophages forming a tubercle
- macrophage dies releasing pathogen, forms a center in tubercle- DORMANT STAGE
- tubercle center enlarges (liquefaction)/ fills with air/ aerobic pathogen start to multiply outside macrophage
- Liquefaction continues/ tubercle ruptures/ pathogens disseminate throughout lung
what is a pulmonary embolism?
occlusion of portion of pulmonary vascular bed by embolus
what is the pathophysiology of a pulmonary embolism?
effect depends on:
- extent of pulmonary BF obstruction
- size of affect vessel
- nature of embolus
- resulting secondary effects
what is an occlusion?
blocking or closing of blood vessel
what is pulmonary artery hypertension?
mean pulmonary artery pressure greater than 25 mmHG at rest
what is the pathophysiology of pulmonary artery hypertension?
- endothelial dysfunction/ overproduction of vasoconstrictors
- increased growth factors= fibrosis= thickening of vessel walls= narrowing of vessels/ gas exchange reduced
- increase in pulmonary artery pressure= increased pressure in right ventricle= right ventricle hypertrophy= failure
what is Cor pulmonale?
right ventricle enlargement due to hypertrophy or dilation or both
- the result of pulmonary artery hypertension
what does an increase work of right ventricle mean?
an increased hypertrophy of normally thin-walled heart muscle
- pressure overload= dilation/hypertrophy= failure of right ventricle
what is the primary factor of laryngeal cancer?
smoking/ risk increases when smoking combined with alcohol consumption
what pathogen is linked to laryngeal cancer?
human papillomavirus (HPV)
what are the manifestations of laryngeal cancer/
- hoarseness
- dyspnea, cough
- cough following swallowing
what is the pathophysiology of laryngeal cancer?
- carcinoma of vocal cords most common site
- metastasis occurs in lymph nodes, but distant metastasis is rare
what is lung cancer?
- tumors on respiratory tract epithelium
- leading cause of death in canadians
- common cause= smoking, gas exposure, second-hand smoke
what is the pathophysiology of lung cancer?
- tumour: result of growth factors and production of free radicals
- bronchial mucosa: suffers “hits” from tobacco smoke= epithelial damage
- progression: metastasis to brain, bone marrow and liver
