Chapter 27 Flashcards
1
Q
What is ventilation?
A
Movement of air in and out of lungs
2
Q
What is oxygenation?
A
Loading oxygen molecules onto hemoglobin
3
Q
What is respiration?
A
O2 and CO2 exchange of alveoli (External) and systemic capillaries (Internal)
4
Q
What is Perfusion?
A
Delivery of blood to a capillary bed in tissue
5
Q
What is Dyspnea?
A
Subjective experience of breathing difficulty
(breathlessness)
6
Q
Dyspnea: Work of breathing?
A
Is greater than actual result
7
Q
Dyspnea: Signs?
A
Flaring of nostrils, use of accessory muscles, head bobbing in children
8
Q
What is Paroxysmal Nocturnal dyspnea?
A
Pulmonary condition that wakes you up gasping for breath in the middle of the night
9
Q
What does sputum provide info for?
A
-Color of sputum provides info about progression of disease
-Microscopic appearance allows microorganism identity
10
Q
What is Hemoptysis?
A
Coughing up of blood
11
Q
What does Hemoptysis usually indicate?
A
Infection or inflammation of bronchiole
or if severe can mean cancer
12
Q
What is Eupnea?
A
Normal breathing
-Rythmic and effortless
13
Q
Eupnea includes a what with each breath?
A
A short expiratory pause
14
Q
What is the purpose of sighs?
A
1.5 to 2 times normal tidal volume / 10 times per hour to help maintain normal breathing
15
Q
What are abnormal breathing patterns?
A
Patterns of breathing automatically adjust to minimise work of breathing
16
Q
What does sighing equal out?
A
Oxygen consumption and carbon dioxide expulsion
17
Q
What is hyperpnea?
A
Kussmaul respiration that occurs with strenuous exercise
18
Q
Hyperpnea: Ventilation rate and tidal volume?
A
Increased ventilation rate
Greatly increased tidal volume
19
Q
During hyperpnea is there a pause?
A
There is no pause at the end of expiration
20
Q
What is Cheyne-Stokes respiration?
A
Alternating deep and shallow breathing
21
Q
Cheyne-stokes respiration includes periods of?
A
Includes periods of apnea (stopping breathing)
22
Q
How long do the apnea periods last during Cheyne-stokes?
A
15-60 secs
23
Q
What follows apnea periods during Cheyne-stokes?
A
Followed by increased volume ventilation, then returns to normal triggering another period of apnea
24
Q
What causes Cheyne-stokes?
A
Reduced blood flow to the brain —> reduced brain impulses to respiratory centre
25
What determines hypo and hyper ventilation?
Blood gases
26
What is hypoventilation?
Inadequate ventilation
27
What issue is associated with Hypoventilation?
CO2 removal doesn't keep up with CO2 production
-CO2 builds up
28
What is the result of hypoventilation?
Hypercapnia
-Increased CO2 in bloodstream
29
What is Hyperventilation?
Alveolar ventilation exceeding needs
30
What issue is associated with Hyperventilation?
Removal of more CO2 than is produced
31
What is the result of Hyperventilation?
Hypocapnia
-Reduced CO2 in bloodstream
32
What is Cyanosis?
Bluish discolouration of skin indicating (insensitively) respiratory failure
33
What causes cyanosis?
Develops when 5 grams of hemoglobin is desaturated
34
When does Cyanosis become evident?
Only evident when it is severe
35
What are the 2 types of Cyanosis?
1. peripheral
2. central
36
What causes peripheral cyanosis?
Poor circulation in fingers/toes due to peripheral vasoconstriction
37
What causes central cyanosis?
Decreased arterial oxidation (Low PaO2) from pulmonary disease
38
Where is peripheral cyanosis best detected?
In nail beds
39
Where is central cyanosis best detected?
In Buccal mucosa membranes (lip and cheek lining) and lips
40
What is Clubbing?
Bulbous formations at end of fingertips and toes
41
What causes Clubbing?
Diseases that disrupt pulmonary circulation causing hypoxemia
42
Is clubbing reversible?
rarely reversible
43
Where is pain from pulmonary disorders localised?
Chest wall
44
What unique sound is caused by pulmonary disorders?
Pleural friction rub
-helps pinpoint area affected
45
What is the pleural friction rub?
Pleural walls rub together due to reduced fluid in pleural cavity
46
How can pain caused by pulmonary disorders often be reproduced?
By pressing on sternum or ribs
47
What is Hypercapnia?
Increased CO2 in blood (Increased PaCO2) caused by hypoventilation of alveoli
48
What does Hypoventilation cause?
Decreased drive to breath
Depression of respiratory center
Disease to medulla oblongata
49
What is the effect of hypoventilation on WOB?
Increased work of breathing
50
What does increased WOB (hypoventilation) lead to?
Electrolyte imbalances
Dysrythmia
if severe a coma
51
How can hypoventilation be confirmed?
testing blood gases
52
What is hypoxemia?
Decreased PaO2 in arterial blood
53
What are the 2 causes of Hypoxemia?
1.Related to issues with delivery of O2 to alveoli (ventilation) and delivery of blood to lung (perfusion
2. Thickening of alveolar membrane or destruction of alveoli
54
What 2 factors is diffusion of Oxygen from alveoli to blood dependent upon?
1. Amount of air entering alveoli (ventilation: V)
2. Amount of blood perfusing capillaries around alveoli (Q)
55
What is the most common cause of hypoxemia?
Abnormal ventilation/perfusion ratio (V/Q)
56
What is the normal PaO2?
80-100 mmHg
57
What is PaO2 of severe hypoxemia?
<40 mmHg
58
What is a shunt?
Normal perfusion but inadequate ventilation
-Alveolus collapses, low V/Q
-Hypoxemia
59
What is alveolar dead space?
Normal ventilation but inadequate perfusion
-High V/Q
-Hypoxemia
60
What is Acute respiratory failure?
Inadequate gas exchange affecting PaO2, PaCO2 and pH
61
Acute respiratory failure: PaO2?
PaO2 less than 60mmHG
62
How is acute respiratory failure decreased PaO2 treated?
Supplemental oxygen
63
Acute respiratory failure: PaCO2?
PaCO2 is greater than 50
64
How is acute respiratory increased PaCO2 treated?
Ventilatory support
65
Acute respiratory failure: pH?
Less than or equal to 7.25
normal is 7.40
66
What is a potential complication of any major surgical procedure?
Acute respiratory failure
67
How is acute respiratory failure prevented?
Frequent turning and position changes
Deep breathing exercises
Early ambulation
68
What are some common conditions of acute respiratory failure?
Pneumonia
Edema
Embolism
69
What causes Chest wall restrictions (CWR)?
Deformity
Obesity
Neuromuscular disease
70
What results from CWR?
Increased WOB
Decrease in tidal volume, increased breathing rate
71
What happens when someone with CWR experiences pain from injury, surgery or disease?
Hypoventilation
72
What can CWR lead to?
Respiratory failure
73
What is associated with CWR?
Flail chest
74
What is flail chest?
Fracture of consecutive ribs with or without sternum damage
75
What is the result of a flail chest?
Chest wall instability leading to paradoxical movement of chest when breathing
76
What is paradoxical breathing?
Inspiration: Unstable portion of chest wall moves inward (normal= outward)
Expiration: Portion moves outward (normal= inward)
77
What does paradoxical breathing result in?
Impaired ventilation of alveoli
78
What are some pleural abnormalities?
1. Pneumothorax
2. Pleural effusion
3. Empyema
79
What is pneumothorax?
Air or gas in pleural space
80
What causes a pneumothorax?
Rupture to visceral pleura (layer closest to lung)
81
What is the result of a pneumothorax?
Lung tends to collapse
82
What is a pleural effusion?
Fluid from blood or lymph in pleural space
83
How is a pleural effusion diagnosed?
Chest x-ray
Thoracentesis (needle aspiration)
84
What is Empyema?
Infected pleural effusion by microorganism
85
What indicates Empyema?
Pus in pleural space
86
What causes empyema?
Pulmonary lymphatic tissue becomes blocked leading to contaminated lymphatic tissue moving into pleural space
87
What can lead to empyema?
Surgery or bronchial obstruction
88
How is empyema treated?
Antibiotics and drainage of pleural space with a chest tube
89
What is restrictive lung disease?
Characterized by decreased lung compliance
-Difficulty with inspiration (expanding lungs)
90
restrictive lung disease: WOB at tidal volume?
WOB= Increased at tidal volume
91
What are some types of restrictive lung diseases?
Aspiration
Atelectasis
Bronchiectasis
Bronchiolitis
Pulmonary fibrosis
Pulmonary edema
COVID-19
92
What is aspiration?
Passage of fluids or solids into lungs
93
What causes aspiration?
a. Abnormal swallowing mechanism
b. Impaired cough reflex
c. CNS or PNS abnormalities
94
What can aspiration lead to?
Pneumonia
95
How is aspiration treated?
Bronchoscopy
96
What happens is aspiration is not treated?
Inflammation
97
What is Atelectasis?
Collapse of lung
98
What are the two types of alveoli collapse?
1. Compression atelectasis
2. Surfactant impairment (decreased production of surfactant)
99
What causes compression atelectasis?
External pressure like a tumor or fluid
100
When does Atelectasis tend to occur?
After surgery when using general anaesthetic
101
How is atelectasis treated?
Deep breathing exercises to promote ciliary removal of secretions
102
What is bronchiectasis?
Persistent abnormal dilation of bronchi (large airways are obstructed)
103
What can cause bronchi to be obstructed leading to Bronchiectasis?
Inflammation due to mucous plugs
Chronic inflammation caused by destruction of elastic/muscular bronchi wall
104
What does chronic inflammation of bronchi wall cause?
Permanent dilation
105
What symptoms of Bronchiectasis?
Chronic productive cough
Large amount of foul-smelling sputum
106
What is bronchiolitis?
Inflammatory obstruction of small airways
107
What are 2 kinds of bronchiolitis?
Bronchiolitis obliterans
BOOP
108
What is Bronchiolitis obliterans?
Fibrosis of airways causing scarring
109
What is BOOP?
Alveoli becomes filled with connective tissue
110
How does Bronchiolitis manifest?
Rapid ventilatory rate
Dry non-productive cough
111
What is pulmonary fibrosis?
Excessive amount of fibrous/conenctive tissue at alveoli
112
What causes pulmonary fibrosis?
Scar tissue left from previous disease e.g tuberculosis
-Multiple injuries at different lung sites associated with abnormal healing
113
What results from pulmonary fibrosis?
Decreased lung compliance and external respiration (O2/CO2 exchange)
114
What is a symptom of pulmonary fibrosis?
Dyspnea on exertion
115
What is pulmonary edema?
Excessive water on lungs
(lung should be dry)
116
What causes pulmonary edema?
Left side heart disease
117
What is left side heart disease?
Left side of heart has reduced cardiac output and blood gets backed up from heart into the lungs and forced into interstitial space between capillary and alveoli
118
Where does blood pressure increase during Left side heart disease?
In pulmonary capillaries bc blood igets backed up into lungs
119
When does pulmonary edema occur?
When fluid flow exceeds lymph system capability to remove it
120
What can severe COVID-19 manifest as?
Viral pneumonia-induced Acute Respiratory Distress Syndrome (ARDS)
121
What causes death by ARDS?
Host's runaway immune response not cytotoxic effects of virus
122
How is ARDS managed?
Intubation
123
What is obstructive lung disease?
Lung diseases causing difficulty with expiration
124
What are some types of obstructive lung diseases?
Asthma
COPD
125
What are signs and symptoms of obstructive lung disease?
Dyspnea
Wheezing
126
What is asthma?
Chronic inflammatory disorder of bronchial mucosa
127
When bronchial mucosa is inflamed what happens?
Airways restricted
Hyper-immune response to irritants
128
What is an early asthmatic attack?
Classic immune response of dendritic cells, helper T cells, T cells and B cells
129
What is the result of an early asthmatic attack?
Inflammation, increased capillary permeability and increased fluid
130
What is a late asthmatic attack?
Latent release of inflammatory mediators from original site beginning 4-8 hours after an early attack
131
What is the result of a late asthmatic attack?
Increased damage of epithelial cells causing scaring, increased mucus forming plugs and increased airway resistance
132
How does asthma manifest?
In between attacks: individuals are normal, pulmonary friction tests are normal
133
If asthmatic bronchospasm are not reversed by usual treatment what is it considered?
Status asthmaticus
134
When PaCO2 is greater than 70mmHg with Asthma what is it a sign of?
Impending death
135
How is asthma treated?
Mild asthma: Short acting inhalers
Persistent: Inhaled corticosteroids
136
What is the pathophysiology of asthma?
1. Inhaled antigen passes epithelial layer
2. Antigen binds to mast cells = release of mediators
3. Mediators = mucus production in airway / broncho spasm / edema from increased capillary permeability
4. Dendritic cells present antigen to Helper T cells = activate B cells / activated B cells release antibodies
5. Helper T cells also activate eosinophil / neutrophils activated / inflammation from both results in airway obstruction
137
What is COPD?
Chronic obstructive pulmonary disease
138
What is COPD composed of?
Chronic bronchitis and emphysema
139
What is the most common chronic lung disease?
COPD
140
What is the fourth leading cause of death worldwide?
COPD
141
What is COPD characterised by?
-Persistent airflow limitation
-Chronic inflammatory response to noxious particles or gas
-Progressive
142
What is chronic bronchitis?
Hypersecretion of mucous, chronic productive cough for at least 3 months of the year fro 2 consecutive years
143
What causes chronic bronchitis?
Inspired irritants causing inflammation/thickening of mucous membrane
144
What does inflammation/thickening of mucous membrane cause? (COPD: chronic bronchitis)
Reduced radius of airways ---> obstruction
145
What is initially affected by chronic bronchitis?
Large airways but eventually all airways are affected
146
How does chronic bronchitis cause hypoventilation?
Airways collapse early in exhalation so air become strapped in distal portions of the lung leading to hyperinflation
147
What is emphysema?
Permanent enlargement of gas-exchange airways and destruction of alveolar walls
148
What causes the emphysema obstruction?
Destroyed walls of alveoli
(NOT mucous production or inflammation)
149
What does the destruction of alveolar walls (emphysema) cause?
Causes large alveolar spaces which greatly increase diffusion distance between alveoli and capillary
150
What is the result of Emphysema?
Reduced O2 and CO2 diffusion
Expiration becomes difficult because of loss of recoil of normal alveoli
151
What is a symptom of emphysema?
Shortness of breath
152
What are some Respiratory tract infections?
Acute bronchitis
Pneumonia
Tuberculosis
153
What is acute bronchitis?
Acute infection causing inflammation of airways
154
Can one recover from acute bronchitis without medicine?
Usually they can. It is self-limiting
155
What causes acute bronchitis?
Viral infection
156
What are the symptoms of acute bronchitis?
Similar to pneumonia
-Non-productive cough aggravated by cold, dry air or dusty air
157
How is acute bronchitis treated?
Rest
Aspirin
Cough suppressant
Antibiotics
158
What is Pneumonia?
Infection of lower respiratory tract caused by microorganisms
-Many categories of pneumonia exist
159
What is HAP?
Hospital acquired pneumonia
160
What is CAP?
Community acquired pneumonia
161
What is the second most common health care associated infection?
HAP
-1st is UTIs
162
What pathogen most commonly causes pneumonia?
Streptococcus pneumoniae
163
What is the infectious route of Strep. pneumoniae?
Inhalation of infected individual's cough
164
How is HAP spread?
Suctioning tubes can become colonized with bacterial biofilms
= suction results in seeding lung with bacteria
165
What immune cells are found in the lower respiratory tract?
Guardian cells that are alveolar macrophages
166
What do macrophages do in the spread of pneumonia?
They present antigens to adaptive immune system and T and B cells become activated. Immune response fills alveoli with debris.
-Microbes release toxins
167
What causes a tuberculosis infection?
Mycobacterium tuberculosis
168
What is the leading cause of death from a curable infectious disease?
Tuberculosis
169
How is TB transmitted?
Person-to-person via airborne droplets
170
What happens when the tuberculosis pathogen reaches the lung?
It is engulfed by macrophages and survives and multiplies within them.
171
What occurs when reproduction of the tuberculosis pathogen happens within macrophages?
It causes a chemotactic response, leading to more macrophages responding and the formation of a tubercle.
172
What is the dormant stage of tuberculosis?
Macrophages begin to die, releasing the pathogen, which forms a center in the tubercle, marking the dormant stage.
173
What happens during the liquification stage of tuberculosis?
The tubercle center enlarges, fills with air, and aerobic pathogens start to multiply outside the macrophages
174
What occurs when the liquification of the tubercle continues?
The tubercle ruptures, and the pathogens disseminate throughout the lung.
175
What are some pulmonary vascular diseases?
Pulmonary embolism
Pulmonary Artery Hypertension
Cor Pulmonale
176
What is a pulmonary vascular disease?
Pulmonary blood flow is disrupted causing occlusions (blood vessel blocked) leading to the destruction of vascular bed
177
What is a Pulmonary Embolism?
Occlusion of portion of pulmonary vascular bed by embolus
178
What does the effect of a pulmonary embolism depend on?
Extent of pulmonary blood flow obstruction
Size of affected vessel
Nature of embolus
Resulting secondary effects
179
What is Pulmonary Artery Hypertension?
Mean pulmonary artery pressure is greater than 25mmHg at rest
180
What initiates the pathophysiology of Pulmonary Artery Hypertension?
Endothelial dysfunction leads to the overproduction of vasoconstrictors.
181
How does increased growth factor production contribute to Pulmonary Artery Hypertension?
It leads to fibrosis and thickening of vessel walls.
182
What is the consequence of fibrosis and thickening of vessel walls in Pulmonary Artery
It results in narrowing of vessels, reducing gas exchange.
183
What is the effect of increased pulmonary artery pressure in Pulmonary Artery Hypertension?
It leads to increased pressure in the right ventricle.
184
What cardiac condition may arise due to right ventricle hypertrophy in Pulmonary Artery Hypertension?
Right ventricle hypertrophy may lead to failure, known as Cor Pulmonale.
185
What is Cor pulmonale?
Results from Pulmonary artery hypertension. Right ventricle enlargement due to hypertrophy or dilation or both
186
What occurs because of the increased work on right ventricle during Cor pulmonale?
Increased hypertrophy of normally thin-walled heart muscle
187
When the heart muscle becomes hypertrophied (cor pulomnale), what is the result?
A pressure overload leading to dilation and hypertrophy causing the failure of the right ventricle
188
What are some Malignancies of the respiratory tract?
Laryngeal cancer
Lung cancer
189
What is the primary risk factor for laryngeal cancer?
Smoking.
Alcohol + Smoking = increased risk
190
What pathogen is linked to laryngeal cancer?
Human papilloma virus
191
What is the most common site for laryngeal cancer?
Vocal cords
192
Where does metastasis of laryngeal cancer occur?
Lymph nodes
-Distant metastasis is rare
193
How does laryngeal cancer manifest? sign/symptoms
Hoarseness, dyspnea, cough
Cough after swallowing
194
How is Laryngeal cancer treated/diagnosed?
Biopsy ---> Chemo, radiation
195
What is Lung cancer?
Tumors on respiratory tract epithelium
196
What is the leading cause of death in Canadians?
Lung cancer
197
What is the most common causes of lung cancer?
1. Smoking
2. Gas exposure
3. Second-hand smoke
198
What is responsible for causing 90% of lung cancers?
Tobacco smoke which contains 30 carcinogens
199
What causes the lung cancer tumours?
Growth factors and production of free radicals
200
How is the Bronchial mucosa damaged by lung cancer?
Suffers hits from tobacco smoke causing the epithelial layer to take damage
201
Is lung cancer progressive?
Yes, metastasis to brain, bone marrow and liver
