Ch. 36 Flashcards
Dyspnea
Subjective sensation of uncomfortable breathing
Orthopnea
Shortness of breath when lying down
Paroxysmal nocturnal dyspnea
Awaking at night and gasping for air; must sit up or stand up
Acute cough
Explosive aspiration that Resolves within 2–3 weeks
Chronic cough
Explosive cough that lasts longer than 3 weeks
Abnormal sputum
Changes in amount, consistency, color, and odor
provide information about the progression of disease and the effectiveness of therapy.
Hemoptysis
Coughing up blood or bloody secretions
Eupnea
Normal breathing pattern
Kussmaul respirations (hyperpnea)
Slightly ↑ RR + very large tidal volume + no expiratory pause.
Labored breathing
Increased work of breathing
Cheyne-Stokes respirations
Alternating periods of deep and shallow breathing;
apnea lasting 15–60 seconds, followed by ventilations that ↑ in volume until a peak is reached, after which ventilation ↓ again to apnea
Hypoventilation
Alveolar ventilation is < metabolic demands
Cause: alterations in pulmonary mechanics or in neurologic control of breathing.
Alveolar ventilation > metabolic demands
Cause: anxiety, head injury, or severe hypoxemia.
Hyperventilation
Bluish discoloration of the skin and mucous
membranes
Cyanosis
Most often caused by poor circulation. • Best observed in the nail beds
Peripheral cyanosis
Caused by ↓ arterial oxygenation (low PaO2).
• Best observed in buccal mucous membranes and lips
Central cyanosis
Bulbous enlargement of the
distal segment of a digit.
Causes: chronic hypoxemia • Bronchiectasis • cystic fibrosis • pulmonary fibrosis • lung abscess • CHD
Clubbing
Is the most common pain caused by pulmonary diseases.
• Is usually sharp or stabbing in character.
• Infection and inflammation of the parietal pleura (pleuritis or pleurisy) can cause pain when the pleurae stretch during inspiration
Pleural pain
May be from the airways.
• May be from muscle or rib pain.
Chest wall pain
↑ CO2 in the arterial blood
➢ Due to ↓ drive to breathe or an inadequate ability to
respond to ventilatory stimulation
Hypercapnia
a below normal level of oxygen in your blood specifically in the arteries
Hypoxemia
A dangerous condition that happens when your body doesn’t get enough oxygen
Hypoxia
➢ Inadequate gas exchange (hypoxemia).
➢ PaO2 is ≤50 mmHg.
➢ → Hypercapnia, during which PaCO2 is ≥50 mmHg. ➢ pH is ≤7.25
Acute respiratory failure (ARF)
Work of breathing ↑, and ventilation may be compromised
because of ↓ TV → hypoxemia, hypercapnia → AR
Chest wall restriction
The instability of a
portion of the chest wall from rib or sternal fractures.
Flail chest
Presence of air or gas in the pleural space→
• Separates pleural layers
• Destroys the negative pressure • Lung collapses
Pneumothorax
Occurs unexpectedly in healthy individuals. Mutation?
Primary (spontaneous) pneumothorax
Is caused by chest trauma, rupture of bleb/bulla (COPD), or
mechanical ventilation
Secondary (traumatic) pneumothorax
Transthoracic needle aspiration
Iatrogenic pneumothorax
Air pressure in the pleural space equals barometric pressure
Air that is drawn into the pleural space during inspiration is forced back out during expiration.
Open Pneumothorax
Site of pleural rupture acts as a one-way valve
Air enters on inspiration but not allowed to escape, by closing up during expiration
Life-threatening
Tension Pneumothorax
Presence of fluid in the pleural space
Pleural effusion
Is watery and diffuses out of the capillaries
Transudative effusion
Is less watery and contains high concentrations of white blood cells and plasma proteins.
Exudative effusion
Chyle exudate
Chylothorax
Blood exudate
Hemothorax
Pus
Pyothorax (Empyema)
→ V̇/Q̇ mismatch
➢ Thicken alveolocapillary membrane→ Hypoxemia ➢ Dyspnea, ↑RR, ↓TV, ↓FVC
Aspiration 2. Atelectasis 3. Bronchiectasis 4. Bronchiolitis 5. pulmonaryfibrosis pulmonaryedema 10. ARDS
Restrictive Lung Disorders
Passage of fluid and solid particles into the lungs
• Right lower lobe is the most frequent site
Aspiration
Collapse of lung tissue
Atelectasis
External compression on the lung
Effusion, tumor
Compression atelectasis
Gradual absorption of air from obstructed or hypoventilated alveoli.
Inhalation of concentrated O2
Anesthesia
Absorptionatelectasis
↓ production or inactivation of surfactant
Preterm, ARDS, anesthesia, ventilator
Surfactant impairment
Persistent abnormal dilation of the bronchi
1. Cylindrical 2. Saccular 3. Varicose
Bronchiectasis
Diffuse inflammation of small bronchioles
➢ Most common in children
➢ Occurs in adults with chronic bronchitis or those with a viral infection or who have inhaled toxic gases
Bronchiolitis
➢ Fibrotic disease of the airways
➢ Can occur with all causes of bronchiolitis.
Bronchiolitis obliterans
➢ ↑↑ amount of fibrous or connective tissue in the lung ➢ Caused by scar tissue, due to TB, autoimmune,..
➢ inhalation of dangerous substances
➢ Loss of compliance
➢ Poor prognosis
Pulmonary fibrosis
➢Men > 60
➢ 2-5 year survival
➢ environmental insults and genetic, epigenetic, and
metabolic factors
Idiopathic pulmonary fibrosis
➢ Excess water in the lung from disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability
➢ Most common cause: LVF
Pulmonary edema
➢ Forms of respiratory failure characterized by:
• Acute lung inflammation
• Diffuse alveolocapillary injury
Acute lung injury (ALI) / ARDS
- Aspiration of vomit 2. Toxic gas inhalation 3. Pneumonia
Direct causes of ARDS
- Sepsis
- Trauma
- Multiple transfusions
- Noncardiogenicpulmonaryedema→shunting,V/̇Q̇ mismatch, ↓ lung compliance, and hypoxemia
Indirect causes of ARDS
Chronic inflammatory disorder of the bronchial mucosa leading to:
➢ Bronchial hyperresponsiveness ➢ Constriction of the airways
➢ Variable airflow obstruction
Asthma
Episodic attacks of:
- Bronchospasm
- Bronchial inflammation
- Mucosal edema
- ↑ mucous production
Pathophysiology of asthma
a condition involving constriction of the airways and difficulty or discomfort in breathing
Airflow limitation
Not fully reversible Usually progressive
1. Chronic bronchitis 2. Emphysema
COPD chronic obstructive pulmonary disease
Infection or inflammation of the large airways or bronchi; self-limiting
Caused by viruses
Chronic Bronchitis
Abnormal permanent enlargement of the gas-exchange airways + destruction of the alveolar walls without obvious fibrosis
Emphysema
Septal destruction occurs in
the respiratory bronchioles and alveolar ducts,
Usually in the upper lobes.
Alveolar sac remains intact.
Tends to occur in smokers with chronic bronchitis.
Centriacinar (Centrilobular) emphysema
Involves the entire acinus
Damage is more randomly distributed.
Involves lower lobes of the lung
Panacinar (Panlobular) emphysema
- Aspiration
- Inhalation
- Endotracheal tubes and suctioning
- Bacteremia in lungs
- Respiratory defenses can’t destroy the microorganism
Pneumonia Routes of infection
Infection of the lungs caused by a virus
Most common is influenza
Viral pneumonia
Infection caused by Mycobacterium tuberculosis, an acid-fast bacillus
Tuberculosis
➢ Airborne droplet transmission
➢ Tubercle formation: Granulomatous lesion
➢ Caseous necrosis: Cheeselike material
➢ May remain dormant for life or cause active disease
➢ Isolation of bacilli by enclosing them in tubercles and
surrounding the tubercles with scar tissue
Pathophysiology if tuberculosis
death and decay) of consolidated tissue: abscess empties into the bronchus, leaving a cavity
Necrosis
Process of abscess emptying and cavity formation
Cavitation
➢ Is the occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, foreign body, amniotic fluid, or air bubble.
➢ Pulmonary emboli commonly arise from the deep veins in the thigh
Pulmonary embolism, PE
- Venous stasis
- Hypercoagulability
- Injuries to the endothelial cells that line the vessels
Virchow triad
- Release of neurohumoral substances
- Widespread vasoconstriction
- Atelectasis of the affected lung segments, further contributing to hypoxemia
- Pulmonary edema, pulmonary hypertension, shock, and even death
Pathophysiology of a pulmonary embolism
➢ Mean PA pressure > 25 mmHg at rest
➢ Idiopathic, familial, or associated
Pulmonary artery hypertension (PHT)
A condition that causes the right side of the heart to fail
Secondary to PHT
RV enlargement
PHT → chronic pressure overload in RV
Cor Pulmonale
