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HLSC 222 - Pathophysiology Across the Lifespan > Chapter 27 - Alteration in Pulmonary Function > Flashcards

Chapter 27 - Alteration in Pulmonary Function Flashcards

1
Q

Ventilation

A

movement of air in and out of the lungs

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2
Q

Oxygenation

A

loading oxygen molecules onto hemoglobin

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3
Q

Respiration

A

O2 and CO2 exchange between alveoli and systemic capillaries

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4
Q

Perfusion

A

delivery of blood to a capillary bed

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5
Q

Dyspnea

A

Difficulty breathing, breathlessness

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6
Q

Dyspnea is a s______ experience

A

subjective

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7
Q

With dyspnea, the work of breathing is ______ than the actual result

A

greater

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7
Q

What are the signs of dyspnea?

A

-flaring of nostrils
-use of accessory muscles
-head bobbing (children)

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8
Q

Paroxysmal Nocturnal Dyspnea

A

pulmonary condition that wakes you up gasping for breath at night

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9
Q

Sputum is colour that provides information about the progression of _________

A

disease (and microorganism identity)

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10
Q

Hemoptysis

A

the coughing up of blood

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11
Q

What does hemoptysis usually indicate?

A

infection or inflammation of the bronchiole

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12
Q

Severe hemoptysis can indicate ______

A

cancer

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13
Q

Eupnea (hint: EupNea)

A

normal breathing

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14
Q

Normal breathing is r______ and e_______

A

rhythmic and effortless

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15
Q

Sigh (deeper breath) has a tidal volume of ___ to ____ times normal

A

1.5 to 2

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16
Q

During normal breathing there is a pause during…

A

expiration

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17
Q

What do breathing patterns adjust to reduce?

A

work of breathing

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18
Q

What is the purpose of a sigh?

A

to help maintain normal breathing by equaling out oxygen consumption and carbon dioxide expulsion

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19
Q

How often per hour does one sigh on average?

A

10x

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20
Q

Hyperpnea

A

increased ventilation rate with a greatly increased tidal volume

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21
Q

Kussmaul Respiration

A

hyperpnea that occurs with strenuous exercise

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22
Q

Is there a pause at the end of hyperpnea respirations?

A

no

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23
Q

Cheyne-Stokes Respiration

A

alternating deep and shallow breathing

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24
Q

Cheyne-stokes involves periods of _______ (stopping breathing)

A

apnea

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25
Q

How long do the periods of apnea last with cheyne-stokes?

A

15-60s

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26
Q

With cheyne-stokes, what follows apnea?

A

increased volume ventilations, ventilation returns to normal, more apnea is triggered

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27
Q

What is the result of Cheyne-stokes respirations?

A

reduced blood flow to brain and reduced brain impulses to the respiratory center

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28
Q

What determines hypo and hyperventilation?

A

blood gases

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29
Q

Hypoventilation

A

inadequate ventilation

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30
Q

When does hypoventilation occur?

A

when CO2 removal can’t keep up with CO2 production

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31
Q

hyper_____ is the result of hypoventilation

A

hypercapnia

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32
Q

Hypercapnia

A

increased CO2 in the blood stream

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33
Q

Hyperventilation

A

alveolar ventilation exceeding needs

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34
Q

When does hyperventilation occur?

A

when more CO2 needs to be removed than is produced

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35
Q

hypo________ is the result of hyperventilation

A

hypocapnia

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36
Q

Hypocapnia

A

reduced CO2 in the blood stream

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37
Q

What is cyanosis?

A

bluish discolouration of the skin

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38
Q

What causes cyanosis?

A

when 5 grams of Hb is desaturated

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39
Q

Cyanosis is not evident until it is _______ making it an insensitive indicator of respiratory failure

A

severe

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40
Q

How many types of cyanosis is there?

A

2

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41
Q

Peripheral Cyanosis

A

poor circulation is fingers and toes due to peripheral vasoconstriction

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42
Q

Where is peripheral cyanosis best seen?

A

nail beds

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43
Q

Central Cyanosis

A

caused by decreased arterial oxidation (PaO2) from pulmonary disease

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44
Q

Where is central cyanosis best seen?

A

buccal mucosa (lip/cheek lining) and lips

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45
Q

What is “clubbing”?

A

bulbous formations at the ends of fingertips and toes

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46
Q

What causes clubbing?

A

diseases that disrupt pulmonary circulation causing hypoxemia

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47
Q

Pain from pulmonary disorders is almost always localized to what area?

A

the chest wall

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48
Q

Pleural Friction Rub

A

sound that pinpoints pain in the chest wall caused by pleural walls rubbing together due to reduced pleural fluid

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49
Q

Pain from pulmonary disorders is reproduced by…

A

pressing on sternum or ribs

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50
Q

What are 3 causes of hypoventilation?

A

-decreased drive to breathe
-respiratory center depression
-medulla oblongata disease

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51
Q

Hypoventilation _______ the work of breathing

A

increases

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52
Q

Hypoventilation can lead to electrolyte imbalances that lead to __________

A

dysrhythmia (irregular heart rate)

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53
Q

Severe hypoventilation may place someone in a ____

A

coma

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54
Q

Why is it important to obtain blood gases to confirm (or disprove) hypoventilation?

A

it can appear as normal breathing and may be overlooked

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55
Q

What are the 2 causes of hypoxemia?

A
  1. issues with oxygen and blood delivery
  2. thickening of alveolar membranes or alveolar destruction
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56
Q

What does the diffusion of O2 from alveoli to blood depend on?

A

-amount of air entering alveoli (V)
-amount of blood perfusing capillaries around alveoli (Q)

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57
Q

What is the more common cause of hypoxemia?

A

abnormal ventilation/perfusion ratio

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58
Q

Shunt: ___ V/Q - ______ perfusion/ _______ ventilation

A

low; normal; inadequate

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59
Q

Alveolar Dead Space: ____ V/Q - _______ ventilation/ _________ perfusion

A

high; normal; inadequate

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60
Q

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 ____

A

60; 50; 7.25

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61
Q

What is normal pH?

A

7.40

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62
Q

What is the treatment for PaO2 less than 60 mmHg?

A

supplemental oxygen

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63
Q

What is the treatment for PaCO2 greater than 50 mmHg?

A

ventilatory support

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64
Q

Acute respiratory failure is a complication of any major _______ procedure

A

surgical

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65
Q

How to prevent acute respiratory failure:

A

-frequent turning (position change)
-deep breathing exercises
-early ambulation

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66
Q

What are the most common conditions of acute respiratory failure?

A

pneumonia, edema, embolism

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67
Q

What causes chest wall restrictions (CWR)?

A

deformity, obesity, neuromuscular disease

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68
Q

What results from CWR?

A

increased work of breathing, decreased tidal volume, increased breathing rate

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69
Q

Pain from injury, surgery, or disease can cause __________

A

hypoventilation

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70
Q

What can CWR lead to?

A

respiratory failure

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71
Q

Flail Chest

A

fracture of consecutive ribs with or without sternum damage

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72
Q

What does flail chest result in?

A

paradoxical chest movement when breathing and impaired ventilation of alveoli

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73
Q

Paradoxical breathing is when during inspiration the chest wall moves ______ instead of _______ and during expiration the chest wall moves ______ instead of ________

A

inward; outward; outward; inward

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74
Q

Pneumothorax

A

air or gas in the pleural space

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75
Q

What causes a pneumothorax?

A

rupture to visceral pleural (layer closer to the lung)

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76
Q

What is the result of a pneumothorax?

A

collapsed lung

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77
Q

Pleural Effusion

A

fluid in pleural space from blood or lymph

78
Q

Pleural effusion is diagnosed by _-___ or ______________

A

x-ray or thoracentesis

79
Q

Thoracentesis

A

needle aspiration

80
Q

Empyema

A

infected pleural effusion by microorganism

81
Q

What indicated empyema?

A

pus in the pleural space

82
Q

What causes empyema?

A

when pulmonary lymphatic tissue becomes blocked and contaminated lymphatic fluid moved into the pleural space

83
Q

Empyema is the result of ______ or bronchial ________

A

surgery; bronchial obstruction

84
Q

Treatment for empyema:

A

antibiotic and drainage of pleural space with chest tube

85
Q

Restrictive lung disease has difficulty with _________

A

inspiration

86
Q

Obstructive lung disease has difficulty with ________

A

expiration

87
Q

What characterizes restrictive lung diease?

A

decreased lung compliance resulting in increased work of breathing at tidal volume

88
Q

Aspiration

A

passage of fluid/solids into lungs

89
Q

What are two causes of aspiration?

A

-abnormal swallowing or cough reflex
-CNS or PNS abnormality

90
Q

Aspiration can lead to _______

A

pneumonia or inflammation

91
Q

Treatment for aspiration:

A

bronchoscopy

92
Q

Atelectasis

A

collapse of the lung

93
Q

Compression Atelectasis

A

caused by external pressure (tumour or fluid)

94
Q

Surfactant Impairment

A

decreased production of surfactant causing atelectasis

95
Q

Atelectasis tends to occur post op when using ______ _______

A

general anaesthetic

96
Q

Treatment for atelectasis:

A

deep breathing exercises to promote ciliary secretion removal

97
Q

Bronchiectasis (hint: large airways)

A

persistent abnormal dilation of bronchi

98
Q

Obstruction may be due to: a) inflammation from ____ plugs or b) chronic inflammation from elastic or muscular wall destruction resulting in permanent _______

A

mucus; dilation

99
Q

Symptoms of bronchiectasis:

A

-chronic productive cough
-foul-smelling sputum

100
Q

Bronchiolitis

A

inflammatory obstruction of small airways

101
Q

Bronchiolitis obliterans

A

fibrosis of airways that leads to scarring

102
Q

Bronchiolitis Obliterans Organizing Pneumonia (BOOP) occurs when ______ become filled with connective tissue

A

alveoli

103
Q

Bronchiolitis symptoms:

A

-rapid ventilatory rate
-dry NON-productive cough

104
Q

Pulmonary Fibrosis occurs with excessive amounts of _____ connective tissue at alveoli

A

fibrous

105
Q

What causes pulmonary fibrosis?

A

scar tissue left from previous disease (ie. TB)

106
Q

Pulmonary fibrosis results from _________ lung compliance and external respiration

A

decreased

107
Q

Symptoms of pulmonary fibrosis:

A

dyspnea or exertion

108
Q

Pulmonary Edema

A

excessive water on lungs

109
Q

Pulmonary edema is caused by ____ side heart disease

A

left

110
Q

Reduced left side cardiac _____ leaves blood backed up from ____ to _____, increasing BP in pulmonary _______

A

output; heart to lungs, capillaries

111
Q

Where does the backed up fluid go?

A

it is forced into the interstitial space between capillary and alveoli

112
Q

The ______ system is supposed to remove this fluid but when it is overwhelmed this leads to pulmonary edema

A

lymphatic

113
Q

Severe Covid-19 is manifested as viral, pneumonia induced A_____ respiratory d_____ syndrome (ARDS)

A

acute respiratory distress syndrome

114
Q

Death from ARDS via Covid-10 is due to ___________ not cytotoxic effects of the virus

A

out of control immune system

115
Q

How is Covid-19 induced ARDS managed?

A

intubation

116
Q

What are the S&S of obstructive lung disease?

A

dyspnea and wheezing

117
Q

Asthma

A

chronic inflammatory disorder of bronchial mucosa

118
Q

Asthma induced inflammation ______ airways and initiated a _____-immune response to irritants

A

restricts; hyper-immune

119
Q

Early Asthma Attack is a classic _____ response of…

A

immune response of dendritic cells, helper T cells, T and B cells

120
Q

What does the early asthma attack result in?

A

inflammation, increased capillary permeability, increased fluid

121
Q

Late asthma attack begins __ to __ hour after the early attack

A

4 to 8

122
Q

Late asthma attack involves the _____ release of inflammatory mediators from the original site

A

latent

123
Q

What results from the late asthma attack?

A

epithelial cell damage leads to scarring, mucus forming plugs, increased airway resistance

124
Q

Between asthma attacks, pulmonary function is ______

A

normal

125
Q

Status Asthmaticus

A

when bronchospasms are not reversed by usual treatment

126
Q

What mmHg PaCO2 is a sign of impending death?

A

greater than 70

127
Q

Treatment of mild asthma

A

inhaler

128
Q

Treatment of persistent asthma

A

inhaled corticosteroids

129
Q

What needs to bind to mast cells so they can release mediators?

A

antigen

130
Q

What do mediators do?

A

produce mucus to induce bronchospasm and edema

131
Q

What do dendritic cells do?

A

present antigen to helper T cells

132
Q

What do helper T cells do?

A

activate B cells to release antibodies, activate eosinophils, neutrophils for inflammation to obstruct airway

133
Q

COPD is composed of chronic _____ and ______

A

bronchitis and emphysema

134
Q

What is the most common chronic lung disease?

A

COPD

135
Q

What is the 4th leading cause of death?

A

COPD

136
Q

Characteristics of COPD

A

-limited airflow
-chronic inflammatory response to noxious particles/gas
-progressive

137
Q

Chronic Bronchitis

A

hyper-secretion of mucus with a chronic productive cough for at least 3 months of the year for 2 years

138
Q

What causes chronic bronchitis?

A

inspired irritants or reduced airway radius

139
Q

Initially chronic bronchitis affects _____ airways before affecting all airways

A

large

140
Q

How does chronic bronchitis lead to hyperinflation?

A

causes airways to collapse early in exhalation, trapping air in lungs

141
Q

Emphysema

A

permanent enlargement of gas-exchange airways with destruction of alveolar walls

142
Q

Emphysema obstruction results from _____ alveolar walls instead of mucus production

A

destroyed

143
Q

Increasing alveolar spaces increases ________ distance between alveoli and capillary

A

diffusion

144
Q

Emphysema results in reduced O2 and CO2 _______ and difficult ________ due to loss of recoil of alveoli

A

diffusion; expiration

145
Q

Chronic bronchitis = _______ with mucus while emphysema = ________ of breath

A

cough; shortness

146
Q

Acute Bronchitis

A

acute infection or inflammation of the airways

147
Q

Acute bronchitis is usually self-________

A

limiting

148
Q

Acute bronchitis usually occurs due to ______ infection

A

viral

149
Q

Acute bronchitis symptoms are similar to pneumonia and involve…

A

a non-productive cough aggravated by cold, dry, dusty air

150
Q

Acute Bronchitis treatment:

A

rest, aspirin, cough suppressant, antibiotics

151
Q

Pneumonia is an infection of the _____ respiratory tract

A

lower

152
Q

What is the cause of pneumonia?

A

microorganisms (bacteria, virus, fungi, etc.)

153
Q

What are the two categories of pneumonia?

A

hospital vs community acquired

154
Q

Hospital acquired pneumonia is the _______ most common HAI

A

second

155
Q

What is the most common pathogen that causes pneumonia?

A

Streptococcus pneumoniae

156
Q

What is the infectious route of S. pneumoniae?

A

inhalation of infected individuals cough

157
Q

How do suctioning tubes contribute to pneumonia?

A

they might have bacteria on them that seeds the lungs with bacteria

158
Q

What are the guardian cells of the lower RT?

A

alveolar macrophages

159
Q

What do alveolar macrophages do?

A

present antigens to activate the T and B cells but may fill alveoli with debris in the process

160
Q

What do microorganisms release that cause damage?

A

toxins

161
Q

Which bacteria causes TB?

A

Mycobacterium tuberculosis

162
Q

TB is the leading cause of death from a _____ infectious disease worldwide

A

curable

163
Q

TB is transmitted via airborne ______

A

droplets

164
Q

What cells does TB survive and multiply in?

A

macrophages

165
Q

How is a tubercle formed?

A

TB reproduction in the macrophage causes a CHEMOTACTIC response are more macrophages come to the site

166
Q

Chemotaxis

A

direct migration of a cell in response to a chemical stimulus

167
Q

During the TB dormant stage, macrophages start to die, releasing the _______ and forming a center in the tubercle

A

pathogen

168
Q

During the TB liquification stage, the center enlarges and fills with air so the ______ pathogen starts ti multiply outside the macrophage

A

aerobic

169
Q

When the tubercle ruptures, the pathogen _____ throughout the lung

A

spreads

170
Q

Occlusion

A

blocking or closing of blood vessel causing alteration in Q/V ratio

171
Q

Pulmonary Embolism

A

occlusion of portion of the pulmonary vascular bed by embolus

172
Q

The effect of the pulmonary embolism depends on:

A

-how much blood flow is obstructed
-vessel size
-embolus nature
-secondary effects

173
Q

Pulmonary Artery Hypertension occurs when the mean pulmonary artery pressure is greater than ___ mmHg at rest

A

25 mmHg

174
Q

Pulmonary artery hypertension is an e_________ dysfunction where vaso_______s are overproduced

A

endothelial; vasoconstrictors

175
Q

Pulmonary artery hypertension: fibrosis occurs from growth ______ thickening vessel walls

A

growth factors

176
Q

When vessels are narrowed, gas exchange is ________

A

reduced

177
Q

Pulmonary artery hypertension increases pressure in the _______ ventricle of the heart

A

right

178
Q

Cor Pulmonale

A

when a lung issue causes your right ventricle to enlarge and fail due to hypertrophy or dilation

179
Q

Cor Pulmonale results from ______________

A

pulmonary artery hypertension

180
Q

What is the primary risk factor for laryngeal cancer?

A

smoking, especially when combined with alcohol

181
Q

Which pathogen is linked to laryngeal cancer?

A

HPV (human papillomavirus)

182
Q

What is the most common site of carcinoma with laryngeal cancer?

A

vocal cords

183
Q

With laryngeal cancer, metastasis usually occurs in ______ ____ but not usually distantly

A

lymph nodes

184
Q

S&S of Laryngeal cancer

A

-hoarseness
-dyspnea
-cough, especially after swallowing

185
Q

How is laryngeal cancer diagnosed?

A

biopsy, radiation, chemotherapy

186
Q

Lung cancer involves tumour on the _______ _____ epithelium

A

respiratory tract

187
Q

What is the leading cause of death in Canadians?

A

lung cancer

188
Q

Order the common causes of lung cancer from most common to least common: A) second hand smoke exposure B) smoking C) gas exposure

A

B, C, A

189
Q

How many carcinogens does tobacco smoke contain that are responsible for causing 90% of lung cancers?

A

30 carcinogens

190
Q

What causes tumours to grow in the RT?

A

growth factors and free radicals

191
Q

Tobacco smoke damages the b_________ mucosa

A

bronchial mucosa

192
Q

How does lung cancer progress?

A

metastasis to brain, bone marrow, and liver

HLSC 222 - Pathophysiology Across the Lifespan (17 decks)

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