Chapter 27 - Alteration in Pulmonary Function Flashcards
1
Q
Ventilation
A
movement of air in and out of the lungs
2
Q
Oxygenation
A
loading oxygen molecules onto hemoglobin
3
Q
Respiration
A
O2 and CO2 exchange between alveoli and systemic capillaries
4
Q
Perfusion
A
delivery of blood to a capillary bed
5
Q
Dyspnea
A
Difficulty breathing, breathlessness
6
Q
Dyspnea is a s______ experience
A
subjective
7
Q
With dyspnea, the work of breathing is ______ than the actual result
A
greater
7
Q
What are the signs of dyspnea?
A
-flaring of nostrils
-use of accessory muscles
-head bobbing (children)
8
Q
Paroxysmal Nocturnal Dyspnea
A
pulmonary condition that wakes you up gasping for breath at night
9
Q
Sputum is colour that provides information about the progression of _________
A
disease (and microorganism identity)
10
Q
Hemoptysis
A
the coughing up of blood
11
Q
What does hemoptysis usually indicate?
A
infection or inflammation of the bronchiole
12
Q
Severe hemoptysis can indicate ______
A
cancer
13
Q
Eupnea (hint: EupNea)
A
normal breathing
14
Q
Normal breathing is r______ and e_______
A
rhythmic and effortless
15
Q
Sigh (deeper breath) has a tidal volume of ___ to ____ times normal
A
1.5 to 2
16
Q
During normal breathing there is a pause during…
A
expiration
17
Q
What do breathing patterns adjust to reduce?
A
work of breathing
18
Q
What is the purpose of a sigh?
A
to help maintain normal breathing by equaling out oxygen consumption and carbon dioxide expulsion
19
Q
How often per hour does one sigh on average?
A
10x
20
Q
Hyperpnea
A
increased ventilation rate with a greatly increased tidal volume
21
Q
Kussmaul Respiration
A
hyperpnea that occurs with strenuous exercise
22
Q
Is there a pause at the end of hyperpnea respirations?
A
no
23
Q
Cheyne-Stokes Respiration
A
alternating deep and shallow breathing
24
Cheyne-stokes involves periods of _______ (stopping breathing)
apnea
25
How long do the periods of apnea last with cheyne-stokes?
15-60s
26
With cheyne-stokes, what follows apnea?
increased volume ventilations, ventilation returns to normal, more apnea is triggered
27
What is the result of Cheyne-stokes respirations?
reduced blood flow to brain and reduced brain impulses to the respiratory center
28
What determines hypo and hyperventilation?
blood gases
29
Hypoventilation
inadequate ventilation
30
When does hypoventilation occur?
when CO2 removal can't keep up with CO2 production
31
hyper_____ is the result of hypoventilation
hypercapnia
32
Hypercapnia
increased CO2 in the blood stream
33
Hyperventilation
alveolar ventilation exceeding needs
34
When does hyperventilation occur?
when more CO2 needs to be removed than is produced
35
hypo________ is the result of hyperventilation
hypocapnia
36
Hypocapnia
reduced CO2 in the blood stream
37
What is cyanosis?
bluish discolouration of the skin
38
What causes cyanosis?
when 5 grams of Hb is desaturated
39
Cyanosis is not evident until it is _______ making it an insensitive indicator of respiratory failure
severe
40
How many types of cyanosis is there?
2
41
Peripheral Cyanosis
poor circulation is fingers and toes due to peripheral vasoconstriction
42
Where is peripheral cyanosis best seen?
nail beds
43
Central Cyanosis
caused by decreased arterial oxidation (PaO2) from pulmonary disease
44
Where is central cyanosis best seen?
buccal mucosa (lip/cheek lining) and lips
45
What is "clubbing"?
bulbous formations at the ends of fingertips and toes
46
What causes clubbing?
diseases that disrupt pulmonary circulation causing hypoxemia
47
Pain from pulmonary disorders is almost always localized to what area?
the chest wall
48
Pleural Friction Rub
sound that pinpoints pain in the chest wall caused by pleural walls rubbing together due to reduced pleural fluid
49
Pain from pulmonary disorders is reproduced by...
pressing on sternum or ribs
50
What are 3 causes of hypoventilation?
-decreased drive to breathe
-respiratory center depression
-medulla oblongata disease
51
Hypoventilation _______ the work of breathing
increases
52
Hypoventilation can lead to electrolyte imbalances that lead to __________
dysrhythmia (irregular heart rate)
53
Severe hypoventilation may place someone in a ____
coma
54
Why is it important to obtain blood gases to confirm (or disprove) hypoventilation?
it can appear as normal breathing and may be overlooked
55
What are the 2 causes of hypoxemia?
1. issues with oxygen and blood delivery
2. thickening of alveolar membranes or alveolar destruction
56
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)
57
What is the more common cause of hypoxemia?
abnormal ventilation/perfusion ratio
58
Shunt: ___ V/Q - ______ perfusion/ _______ ventilation
low; normal; inadequate
59
Alveolar Dead Space: ____ V/Q - _______ ventilation/ _________ perfusion
high; normal; inadequate
60
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
61
What is normal pH?
7.40
62
What is the treatment for PaO2 less than 60 mmHg?
supplemental oxygen
63
What is the treatment for PaCO2 greater than 50 mmHg?
ventilatory support
64
Acute respiratory failure is a complication of any major _______ procedure
surgical
65
How to prevent acute respiratory failure:
-frequent turning (position change)
-deep breathing exercises
-early ambulation
66
What are the most common conditions of acute respiratory failure?
pneumonia, edema, embolism
67
What causes chest wall restrictions (CWR)?
deformity, obesity, neuromuscular disease
68
What results from CWR?
increased work of breathing, decreased tidal volume, increased breathing rate
69
Pain from injury, surgery, or disease can cause __________
hypoventilation
70
What can CWR lead to?
respiratory failure
71
Flail Chest
fracture of consecutive ribs with or without sternum damage
72
What does flail chest result in?
paradoxical chest movement when breathing and impaired ventilation of alveoli
73
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
74
Pneumothorax
air or gas in the pleural space
75
What causes a pneumothorax?
rupture to visceral pleural (layer closer to the lung)
76
What is the result of a pneumothorax?
collapsed lung
77
Pleural Effusion
fluid in pleural space from blood or lymph
78
Pleural effusion is diagnosed by _-___ or ______________
x-ray or thoracentesis
79
Thoracentesis
needle aspiration
80
Empyema
infected pleural effusion by microorganism
81
What indicated empyema?
pus in the pleural space
82
What causes empyema?
when pulmonary lymphatic tissue becomes blocked and contaminated lymphatic fluid moved into the pleural space
83
Empyema is the result of ______ or bronchial ________
surgery; bronchial obstruction
84
Treatment for empyema:
antibiotic and drainage of pleural space with chest tube
85
Restrictive lung disease has difficulty with _________
inspiration
86
Obstructive lung disease has difficulty with ________
expiration
87
What characterizes restrictive lung diease?
decreased lung compliance resulting in increased work of breathing at tidal volume
88
Aspiration
passage of fluid/solids into lungs
89
What are two causes of aspiration?
-abnormal swallowing or cough reflex
-CNS or PNS abnormality
90
Aspiration can lead to _______
pneumonia or inflammation
91
Treatment for aspiration:
bronchoscopy
92
Atelectasis
collapse of the lung
93
Compression Atelectasis
caused by external pressure (tumour or fluid)
94
Surfactant Impairment
decreased production of surfactant causing atelectasis
95
Atelectasis tends to occur post op when using ______ _______
general anaesthetic
96
Treatment for atelectasis:
deep breathing exercises to promote ciliary secretion removal
97
Bronchiectasis (hint: large airways)
persistent abnormal dilation of bronchi
98
Obstruction may be due to: a) inflammation from ____ plugs or b) chronic inflammation from elastic or muscular wall destruction resulting in permanent _______
mucus; dilation
99
Symptoms of bronchiectasis:
-chronic productive cough
-foul-smelling sputum
100
Bronchiolitis
inflammatory obstruction of small airways
101
Bronchiolitis obliterans
fibrosis of airways that leads to scarring
102
Bronchiolitis Obliterans Organizing Pneumonia (BOOP) occurs when ______ become filled with connective tissue
alveoli
103
Bronchiolitis symptoms:
-rapid ventilatory rate
-dry NON-productive cough
104
Pulmonary Fibrosis occurs with excessive amounts of _____ connective tissue at alveoli
fibrous
105
What causes pulmonary fibrosis?
scar tissue left from previous disease (ie. TB)
106
Pulmonary fibrosis results from _________ lung compliance and external respiration
decreased
107
Symptoms of pulmonary fibrosis:
dyspnea or exertion
108
Pulmonary Edema
excessive water on lungs
109
Pulmonary edema is caused by ____ side heart disease
left
110
Reduced left side cardiac _____ leaves blood backed up from ____ to _____, increasing BP in pulmonary _______
output; heart to lungs, capillaries
111
Where does the backed up fluid go?
it is forced into the interstitial space between capillary and alveoli
112
The ______ system is supposed to remove this fluid but when it is overwhelmed this leads to pulmonary edema
lymphatic
113
Severe Covid-19 is manifested as viral, pneumonia induced A_____ respiratory d_____ syndrome (ARDS)
acute respiratory distress syndrome
114
Death from ARDS via Covid-10 is due to ___________ not cytotoxic effects of the virus
out of control immune system
115
How is Covid-19 induced ARDS managed?
intubation
116
What are the S&S of obstructive lung disease?
dyspnea and wheezing
117
Asthma
chronic inflammatory disorder of bronchial mucosa
118
Asthma induced inflammation ______ airways and initiated a _____-immune response to irritants
restricts; hyper-immune
119
Early Asthma Attack is a classic _____ response of...
immune response of dendritic cells, helper T cells, T and B cells
120
What does the early asthma attack result in?
inflammation, increased capillary permeability, increased fluid
121
Late asthma attack begins __ to __ hour after the early attack
4 to 8
122
Late asthma attack involves the _____ release of inflammatory mediators from the original site
latent
123
What results from the late asthma attack?
epithelial cell damage leads to scarring, mucus forming plugs, increased airway resistance
124
Between asthma attacks, pulmonary function is ______
normal
125
Status Asthmaticus
when bronchospasms are not reversed by usual treatment
126
What mmHg PaCO2 is a sign of impending death?
greater than 70
127
Treatment of mild asthma
inhaler
128
Treatment of persistent asthma
inhaled corticosteroids
129
What needs to bind to mast cells so they can release mediators?
antigen
130
What do mediators do?
produce mucus to induce bronchospasm and edema
131
What do dendritic cells do?
present antigen to helper T cells
132
What do helper T cells do?
activate B cells to release antibodies, activate eosinophils, neutrophils for inflammation to obstruct airway
133
COPD is composed of chronic _____ and ______
bronchitis and emphysema
134
What is the most common chronic lung disease?
COPD
135
What is the 4th leading cause of death?
COPD
136
Characteristics of COPD
-limited airflow
-chronic inflammatory response to noxious particles/gas
-progressive
137
Chronic Bronchitis
hyper-secretion of mucus with a chronic productive cough for at least 3 months of the year for 2 years
138
What causes chronic bronchitis?
inspired irritants or reduced airway radius
139
Initially chronic bronchitis affects _____ airways before affecting all airways
large
140
How does chronic bronchitis lead to hyperinflation?
causes airways to collapse early in exhalation, trapping air in lungs
141
Emphysema
permanent enlargement of gas-exchange airways with destruction of alveolar walls
142
Emphysema obstruction results from _____ alveolar walls instead of mucus production
destroyed
143
Increasing alveolar spaces increases ________ distance between alveoli and capillary
diffusion
144
Emphysema results in reduced O2 and CO2 _______ and difficult ________ due to loss of recoil of alveoli
diffusion; expiration
145
Chronic bronchitis = _______ with mucus while emphysema = ________ of breath
cough; shortness
146
Acute Bronchitis
acute infection or inflammation of the airways
147
Acute bronchitis is usually self-________
limiting
148
Acute bronchitis usually occurs due to ______ infection
viral
149
Acute bronchitis symptoms are similar to pneumonia and involve...
a non-productive cough aggravated by cold, dry, dusty air
150
Acute Bronchitis treatment:
rest, aspirin, cough suppressant, antibiotics
151
Pneumonia is an infection of the _____ respiratory tract
lower
152
What is the cause of pneumonia?
microorganisms (bacteria, virus, fungi, etc.)
153
What are the two categories of pneumonia?
hospital vs community acquired
154
Hospital acquired pneumonia is the _______ most common HAI
second
155
What is the most common pathogen that causes pneumonia?
Streptococcus pneumoniae
156
What is the infectious route of S. pneumoniae?
inhalation of infected individuals cough
157
How do suctioning tubes contribute to pneumonia?
they might have bacteria on them that seeds the lungs with bacteria
158
What are the guardian cells of the lower RT?
alveolar macrophages
159
What do alveolar macrophages do?
present antigens to activate the T and B cells but may fill alveoli with debris in the process
160
What do microorganisms release that cause damage?
toxins
161
Which bacteria causes TB?
Mycobacterium tuberculosis
162
TB is the leading cause of death from a _____ infectious disease worldwide
curable
163
TB is transmitted via airborne ______
droplets
164
What cells does TB survive and multiply in?
macrophages
165
How is a tubercle formed?
TB reproduction in the macrophage causes a CHEMOTACTIC response are more macrophages come to the site
166
Chemotaxis
direct migration of a cell in response to a chemical stimulus
167
During the TB dormant stage, macrophages start to die, releasing the _______ and forming a center in the tubercle
pathogen
168
During the TB liquification stage, the center enlarges and fills with air so the ______ pathogen starts ti multiply outside the macrophage
aerobic
169
When the tubercle ruptures, the pathogen _____ throughout the lung
spreads
170
Occlusion
blocking or closing of blood vessel causing alteration in Q/V ratio
171
Pulmonary Embolism
occlusion of portion of the pulmonary vascular bed by embolus
172
The effect of the pulmonary embolism depends on:
-how much blood flow is obstructed
-vessel size
-embolus nature
-secondary effects
173
Pulmonary Artery Hypertension occurs when the mean pulmonary artery pressure is greater than ___ mmHg at rest
25 mmHg
174
Pulmonary artery hypertension is an e_________ dysfunction where vaso_______s are overproduced
endothelial; vasoconstrictors
175
Pulmonary artery hypertension: fibrosis occurs from growth ______ thickening vessel walls
growth factors
176
When vessels are narrowed, gas exchange is ________
reduced
177
Pulmonary artery hypertension increases pressure in the _______ ventricle of the heart
right
178
Cor Pulmonale
when a lung issue causes your right ventricle to enlarge and fail due to hypertrophy or dilation
179
Cor Pulmonale results from ______________
pulmonary artery hypertension
180
What is the primary risk factor for laryngeal cancer?
smoking, especially when combined with alcohol
181
Which pathogen is linked to laryngeal cancer?
HPV (human papillomavirus)
182
What is the most common site of carcinoma with laryngeal cancer?
vocal cords
183
With laryngeal cancer, metastasis usually occurs in ______ ____ but not usually distantly
lymph nodes
184
S&S of Laryngeal cancer
-hoarseness
-dyspnea
-cough, especially after swallowing
185
How is laryngeal cancer diagnosed?
biopsy, radiation, chemotherapy
186
Lung cancer involves tumour on the _______ _____ epithelium
respiratory tract
187
What is the leading cause of death in Canadians?
lung cancer
188
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
189
How many carcinogens does tobacco smoke contain that are responsible for causing 90% of lung cancers?
30 carcinogens
190
What causes tumours to grow in the RT?
growth factors and free radicals
191
Tobacco smoke damages the b_________ mucosa
bronchial mucosa
192
How does lung cancer progress?
metastasis to brain, bone marrow, and liver
