Chapter 27 - Alteration in Pulmonary Function Flashcards
Ventilation
movement of air in and out of the lungs
Oxygenation
loading oxygen molecules onto hemoglobin
Respiration
O2 and CO2 exchange between alveoli and systemic capillaries
Perfusion
delivery of blood to a capillary bed
Dyspnea
Difficulty breathing, breathlessness
Dyspnea is a s______ experience
subjective
With dyspnea, the work of breathing is ______ than the actual result
greater
What are the signs of dyspnea?
-flaring of nostrils
-use of accessory muscles
-head bobbing (children)
Paroxysmal Nocturnal Dyspnea
pulmonary condition that wakes you up gasping for breath at night
Sputum is colour that provides information about the progression of _________
disease (and microorganism identity)
Hemoptysis
the coughing up of blood
What does hemoptysis usually indicate?
infection or inflammation of the bronchiole
Severe hemoptysis can indicate ______
cancer
Eupnea (hint: EupNea)
normal breathing
Normal breathing is r______ and e_______
rhythmic and effortless
Sigh (deeper breath) has a tidal volume of ___ to ____ times normal
1.5 to 2
During normal breathing there is a pause during…
expiration
What do breathing patterns adjust to reduce?
work of breathing
What is the purpose of a sigh?
to help maintain normal breathing by equaling out oxygen consumption and carbon dioxide expulsion
How often per hour does one sigh on average?
10x
Hyperpnea
increased ventilation rate with a greatly increased tidal volume
Kussmaul Respiration
hyperpnea that occurs with strenuous exercise
Is there a pause at the end of hyperpnea respirations?
no
Cheyne-Stokes Respiration
alternating deep and shallow breathing
Cheyne-stokes involves periods of _______ (stopping breathing)
apnea
How long do the periods of apnea last with cheyne-stokes?
15-60s
With cheyne-stokes, what follows apnea?
increased volume ventilations, ventilation returns to normal, more apnea is triggered
What is the result of Cheyne-stokes respirations?
reduced blood flow to brain and reduced brain impulses to the respiratory center
What determines hypo and hyperventilation?
blood gases
Hypoventilation
inadequate ventilation
When does hypoventilation occur?
when CO2 removal can’t keep up with CO2 production
hyper_____ is the result of hypoventilation
hypercapnia
Hypercapnia
increased CO2 in the blood stream
Hyperventilation
alveolar ventilation exceeding needs
When does hyperventilation occur?
when more CO2 needs to be removed than is produced
hypo________ is the result of hyperventilation
hypocapnia
Hypocapnia
reduced CO2 in the blood stream
What is cyanosis?
bluish discolouration of the skin
What causes cyanosis?
when 5 grams of Hb is desaturated
Cyanosis is not evident until it is _______ making it an insensitive indicator of respiratory failure
severe
How many types of cyanosis is there?
2
Peripheral Cyanosis
poor circulation is fingers and toes due to peripheral vasoconstriction
Where is peripheral cyanosis best seen?
nail beds
Central Cyanosis
caused by decreased arterial oxidation (PaO2) from pulmonary disease
Where is central cyanosis best seen?
buccal mucosa (lip/cheek lining) and lips
What is “clubbing”?
bulbous formations at the ends of fingertips and toes
What causes clubbing?
diseases that disrupt pulmonary circulation causing hypoxemia
Pain from pulmonary disorders is almost always localized to what area?
the chest wall
Pleural Friction Rub
sound that pinpoints pain in the chest wall caused by pleural walls rubbing together due to reduced pleural fluid
Pain from pulmonary disorders is reproduced by…
pressing on sternum or ribs
What are 3 causes of hypoventilation?
-decreased drive to breathe
-respiratory center depression
-medulla oblongata disease
Hypoventilation _______ the work of breathing
increases
Hypoventilation can lead to electrolyte imbalances that lead to __________
dysrhythmia (irregular heart rate)
Severe hypoventilation may place someone in a ____
coma
Why is it important to obtain blood gases to confirm (or disprove) hypoventilation?
it can appear as normal breathing and may be overlooked
What are the 2 causes of hypoxemia?
- issues with oxygen and blood delivery
- thickening of alveolar membranes or alveolar destruction
What does the diffusion of O2 from alveoli to blood depend on?
-amount of air entering alveoli (V)
-amount of blood perfusing capillaries around alveoli (Q)
What is the more common cause of hypoxemia?
abnormal ventilation/perfusion ratio
Shunt: ___ V/Q - ______ perfusion/ _______ ventilation
low; normal; inadequate
Alveolar Dead Space: ____ V/Q - _______ ventilation/ _________ perfusion
high; normal; inadequate
Acute Respiratory Failure: inadequate gas exchange where PaO2 is less than __ mmHg or PaCO2 is greater than __ mmHg with a pH less than or = to ____
60; 50; 7.25
What is normal pH?
7.40
What is the treatment for PaO2 less than 60 mmHg?
supplemental oxygen
What is the treatment for PaCO2 greater than 50 mmHg?
ventilatory support
Acute respiratory failure is a complication of any major _______ procedure
surgical
How to prevent acute respiratory failure:
-frequent turning (position change)
-deep breathing exercises
-early ambulation
What are the most common conditions of acute respiratory failure?
pneumonia, edema, embolism
What causes chest wall restrictions (CWR)?
deformity, obesity, neuromuscular disease
What results from CWR?
increased work of breathing, decreased tidal volume, increased breathing rate
Pain from injury, surgery, or disease can cause __________
hypoventilation
What can CWR lead to?
respiratory failure
Flail Chest
fracture of consecutive ribs with or without sternum damage
What does flail chest result in?
paradoxical chest movement when breathing and impaired ventilation of alveoli
Paradoxical breathing is when during inspiration the chest wall moves ______ instead of _______ and during expiration the chest wall moves ______ instead of ________
inward; outward; outward; inward
Pneumothorax
air or gas in the pleural space
What causes a pneumothorax?
rupture to visceral pleural (layer closer to the lung)
What is the result of a pneumothorax?
collapsed lung
Pleural Effusion
fluid in pleural space from blood or lymph
Pleural effusion is diagnosed by _-___ or ______________
x-ray or thoracentesis
Thoracentesis
needle aspiration
Empyema
infected pleural effusion by microorganism
What indicated empyema?
pus in the pleural space
What causes empyema?
when pulmonary lymphatic tissue becomes blocked and contaminated lymphatic fluid moved into the pleural space
Empyema is the result of ______ or bronchial ________
surgery; bronchial obstruction
Treatment for empyema:
antibiotic and drainage of pleural space with chest tube
Restrictive lung disease has difficulty with _________
inspiration
Obstructive lung disease has difficulty with ________
expiration
What characterizes restrictive lung diease?
decreased lung compliance resulting in increased work of breathing at tidal volume
Aspiration
passage of fluid/solids into lungs
What are two causes of aspiration?
-abnormal swallowing or cough reflex
-CNS or PNS abnormality
Aspiration can lead to _______
pneumonia or inflammation
Treatment for aspiration:
bronchoscopy
Atelectasis
collapse of the lung
Compression Atelectasis
caused by external pressure (tumour or fluid)
Surfactant Impairment
decreased production of surfactant causing atelectasis
Atelectasis tends to occur post op when using ______ _______
general anaesthetic
Treatment for atelectasis:
deep breathing exercises to promote ciliary secretion removal
Bronchiectasis (hint: large airways)
persistent abnormal dilation of bronchi
Obstruction may be due to: a) inflammation from ____ plugs or b) chronic inflammation from elastic or muscular wall destruction resulting in permanent _______
mucus; dilation
Symptoms of bronchiectasis:
-chronic productive cough
-foul-smelling sputum
Bronchiolitis
inflammatory obstruction of small airways
Bronchiolitis obliterans
fibrosis of airways that leads to scarring
Bronchiolitis Obliterans Organizing Pneumonia (BOOP) occurs when ______ become filled with connective tissue
alveoli
Bronchiolitis symptoms:
-rapid ventilatory rate
-dry NON-productive cough
Pulmonary Fibrosis occurs with excessive amounts of _____ connective tissue at alveoli
fibrous
What causes pulmonary fibrosis?
scar tissue left from previous disease (ie. TB)
Pulmonary fibrosis results from _________ lung compliance and external respiration
decreased
Symptoms of pulmonary fibrosis:
dyspnea or exertion
Pulmonary Edema
excessive water on lungs
Pulmonary edema is caused by ____ side heart disease
left
Reduced left side cardiac _____ leaves blood backed up from ____ to _____, increasing BP in pulmonary _______
output; heart to lungs, capillaries
Where does the backed up fluid go?
it is forced into the interstitial space between capillary and alveoli
The ______ system is supposed to remove this fluid but when it is overwhelmed this leads to pulmonary edema
lymphatic
Severe Covid-19 is manifested as viral, pneumonia induced A_____ respiratory d_____ syndrome (ARDS)
acute respiratory distress syndrome
Death from ARDS via Covid-10 is due to ___________ not cytotoxic effects of the virus
out of control immune system
How is Covid-19 induced ARDS managed?
intubation
What are the S&S of obstructive lung disease?
dyspnea and wheezing
Asthma
chronic inflammatory disorder of bronchial mucosa
Asthma induced inflammation ______ airways and initiated a _____-immune response to irritants
restricts; hyper-immune
Early Asthma Attack is a classic _____ response of…
immune response of dendritic cells, helper T cells, T and B cells
What does the early asthma attack result in?
inflammation, increased capillary permeability, increased fluid
Late asthma attack begins __ to __ hour after the early attack
4 to 8
Late asthma attack involves the _____ release of inflammatory mediators from the original site
latent
What results from the late asthma attack?
epithelial cell damage leads to scarring, mucus forming plugs, increased airway resistance
Between asthma attacks, pulmonary function is ______
normal
Status Asthmaticus
when bronchospasms are not reversed by usual treatment
What mmHg PaCO2 is a sign of impending death?
greater than 70
Treatment of mild asthma
inhaler
Treatment of persistent asthma
inhaled corticosteroids
What needs to bind to mast cells so they can release mediators?
antigen
What do mediators do?
produce mucus to induce bronchospasm and edema
What do dendritic cells do?
present antigen to helper T cells
What do helper T cells do?
activate B cells to release antibodies, activate eosinophils, neutrophils for inflammation to obstruct airway
COPD is composed of chronic _____ and ______
bronchitis and emphysema
What is the most common chronic lung disease?
COPD
What is the 4th leading cause of death?
COPD
Characteristics of COPD
-limited airflow
-chronic inflammatory response to noxious particles/gas
-progressive
Chronic Bronchitis
hyper-secretion of mucus with a chronic productive cough for at least 3 months of the year for 2 years
What causes chronic bronchitis?
inspired irritants or reduced airway radius
Initially chronic bronchitis affects _____ airways before affecting all airways
large
How does chronic bronchitis lead to hyperinflation?
causes airways to collapse early in exhalation, trapping air in lungs
Emphysema
permanent enlargement of gas-exchange airways with destruction of alveolar walls
Emphysema obstruction results from _____ alveolar walls instead of mucus production
destroyed
Increasing alveolar spaces increases ________ distance between alveoli and capillary
diffusion
Emphysema results in reduced O2 and CO2 _______ and difficult ________ due to loss of recoil of alveoli
diffusion; expiration
Chronic bronchitis = _______ with mucus while emphysema = ________ of breath
cough; shortness
Acute Bronchitis
acute infection or inflammation of the airways
Acute bronchitis is usually self-________
limiting
Acute bronchitis usually occurs due to ______ infection
viral
Acute bronchitis symptoms are similar to pneumonia and involve…
a non-productive cough aggravated by cold, dry, dusty air
Acute Bronchitis treatment:
rest, aspirin, cough suppressant, antibiotics
Pneumonia is an infection of the _____ respiratory tract
lower
What is the cause of pneumonia?
microorganisms (bacteria, virus, fungi, etc.)
What are the two categories of pneumonia?
hospital vs community acquired
Hospital acquired pneumonia is the _______ most common HAI
second
What is the most common pathogen that causes pneumonia?
Streptococcus pneumoniae
What is the infectious route of S. pneumoniae?
inhalation of infected individuals cough
How do suctioning tubes contribute to pneumonia?
they might have bacteria on them that seeds the lungs with bacteria
What are the guardian cells of the lower RT?
alveolar macrophages
What do alveolar macrophages do?
present antigens to activate the T and B cells but may fill alveoli with debris in the process
What do microorganisms release that cause damage?
toxins
Which bacteria causes TB?
Mycobacterium tuberculosis
TB is the leading cause of death from a _____ infectious disease worldwide
curable
TB is transmitted via airborne ______
droplets
What cells does TB survive and multiply in?
macrophages
How is a tubercle formed?
TB reproduction in the macrophage causes a CHEMOTACTIC response are more macrophages come to the site
Chemotaxis
direct migration of a cell in response to a chemical stimulus
During the TB dormant stage, macrophages start to die, releasing the _______ and forming a center in the tubercle
pathogen
During the TB liquification stage, the center enlarges and fills with air so the ______ pathogen starts ti multiply outside the macrophage
aerobic
When the tubercle ruptures, the pathogen _____ throughout the lung
spreads
Occlusion
blocking or closing of blood vessel causing alteration in Q/V ratio
Pulmonary Embolism
occlusion of portion of the pulmonary vascular bed by embolus
The effect of the pulmonary embolism depends on:
-how much blood flow is obstructed
-vessel size
-embolus nature
-secondary effects
Pulmonary Artery Hypertension occurs when the mean pulmonary artery pressure is greater than ___ mmHg at rest
25 mmHg
Pulmonary artery hypertension is an e_________ dysfunction where vaso_______s are overproduced
endothelial; vasoconstrictors
Pulmonary artery hypertension: fibrosis occurs from growth ______ thickening vessel walls
growth factors
When vessels are narrowed, gas exchange is ________
reduced
Pulmonary artery hypertension increases pressure in the _______ ventricle of the heart
right
Cor Pulmonale
when a lung issue causes your right ventricle to enlarge and fail due to hypertrophy or dilation
Cor Pulmonale results from ______________
pulmonary artery hypertension
What is the primary risk factor for laryngeal cancer?
smoking, especially when combined with alcohol
Which pathogen is linked to laryngeal cancer?
HPV (human papillomavirus)
What is the most common site of carcinoma with laryngeal cancer?
vocal cords
With laryngeal cancer, metastasis usually occurs in ______ ____ but not usually distantly
lymph nodes
S&S of Laryngeal cancer
-hoarseness
-dyspnea
-cough, especially after swallowing
How is laryngeal cancer diagnosed?
biopsy, radiation, chemotherapy
Lung cancer involves tumour on the _______ _____ epithelium
respiratory tract
What is the leading cause of death in Canadians?
lung cancer
Order the common causes of lung cancer from most common to least common: A) second hand smoke exposure B) smoking C) gas exposure
B, C, A
How many carcinogens does tobacco smoke contain that are responsible for causing 90% of lung cancers?
30 carcinogens
What causes tumours to grow in the RT?
growth factors and free radicals
Tobacco smoke damages the b_________ mucosa
bronchial mucosa
How does lung cancer progress?
metastasis to brain, bone marrow, and liver
