Chapter 27 - Alteration in Pulmonary Function Flashcards
what is ventilation?
movement of air in and out of lungs
what is oxygenation?
loading O2 molecules onto hemoglobin
what is respiration?
O2 and CO2 exchange pf alveoli (external) & systemic capillaries (internal)
what is perfusion?
delivery of blood to a capillary bed in tissue
what dyspnea?
breathlessness
what are the signs of dyspnea?
flaring of nostrils, use of accessory muscles & head bobbing in children
what is paroxysmal nocturnal dyspnea?
wakes you gasping for breath in the middle of night
A color that provides info about progression of disease
sputum
what is hemoptysis?
coughing up of blood
what does coughing up of blood indicates?
infection or inflammation of bronchiole.
*if sever, it can indicate cancer
what is normal breathing?
eupnea
T or F: eupnea is rhythmic and effortless
True
Eupnea: occasionally the person takes a deeper ____ or a ____
breaths; sighs
what is the purpose of sighs?
helps to maintain normal breathing (1), twice tidal vol/ 10 times per hour (2) & equals out O2 consumption and CO2 expulsion
what is hyperpnea?
Kussmaul respiration occurs with strenuous exercise.
what happens during kussmaul respiration
increased ventilation rate & greatly increased tidal volume & no pause at end of expiration
what are some abnormal breathing patterns
cheyne-stokes respiration
what is Cheyne-Stokes respiration?
alternating deep/ shallow breathing (1)
includes periods of apnea (2), followed by increased volume ventilations.
what is apnea?
stopping breathing for 15-60 sec
what does cheyne-stokes cause?
reduced blood flow to brain/ reduced brain impulses to respiratory center
T or F: hypoventilation and hyperventilation can both determined by blood gases.
True
what is hypoventilation?
inadequate ventilation
what is the issue with hypoventilation?
CO2 removal doesn’t keep up with CO2 production
result of hypoventilation?
hypercapnia – increased CO2 in bloodstream
what is hyperventilation
alveolar ventilation exceeding needs.
what is the issue with hyperventilation?
removal of more CO2 than is produced
what is the result of hyperventilation
hypocapnia – reduced CO2 in blood stream
what is cyanosis
bluish discoloration of skin
cause of cyanosis?
develops when 5 grams of hemoglobin is desaturated
T or F: Cyanosis is evident until it is severe = insensitive indicator of respiratory failure.
False; not evident until it is severe
what are the two types of cyanosis
peripheral cyanosis & central cyanosis
what is peripheral cyanosis
poor circulation in fingers/toes due to peripheral vasoconstriction
best seen in nail beds
what is central cyanosis
decreased arterial oxidation (low PaO2) from pulmonary disease.
detected in buccal mucosa membranes and lips
what is clubbing?
bulbous formations at end of fingertips and toes.
what causes clubbing?
diseases that disrupt pulmonary circulation causing hypoxemia/ rarely reversible
pain from pulmonary disorder?
almost localized in chest wall (1)
can be pinpointed by unique sound called the pleural friction club (2)
often be reproduced by pressing on sternum or ribs (3)
what is pleural friction rub?
pleural walls rub together due to reduced fluid in pleural cavity
what is hypercapnia
increased Co2 in blood caused by hypoventilation of alveoli.
what does hypoventilation causes?
decreased drive to breath
depression of respiratory center
disease to medulla oblongata
what does hypoventilation result?
increased work of breathing
what is the effect of hyperventilation?
electrolyte (ionic) imbalances
dysrhythmia (irregular breathing rate)
severe = coma
Hypoventilation often overlooked as it can appear _____. Important to obtain blood ____ to confirm.
normal; gases
what does hypercapnia increased?
PaCO2
what is hypoxemia?
decreased PaCO2 in arterial blood
what are the two causes of hypoxemia?
issue with delivery of O2 to alveoli (ventilation) and delivery of blood to lung (perfusion) (1)
thickening of alveolar membrane or destruction of alveoli (2)
Diffusion of O2 from alveoli to blood dependent up two factors:
(1) amount of ____ entering _____ (ventilation = V)
(2) amount of blood ____ capillaries around alveoli (Q)
air; alveoli; perfusing
what is the most common cause of hypoxemia?
ab ventilation/perfusion ratio (V/Q)
what is the normal PaO2?
80-100 mmHg
what is the severe hypoxemia?
<40 mmHg
what is shunt?
normal perfusion; inadequate ventilation
what is alveolar dead space?
inadequate perfusion/ normal ventilation
what is acute respiratory failure?
inadequate gas exchange.
= potential complication of any major
what are some values of PaCO2, PaO and pH for acute respiratory failure?
PaO2 is less than 60 mmHg
PaCO2 is greater than 50
ph less than or equal to 7.25
what are the normal values of PaO2, PaCO2 & pH
PaO2 = 75-100 mmHg
PaCO2 = 35-45 mmHg
prevention for acute respiratory failure?
frequent turning and position changes; deep breathing exercise; early ambulation
what are the most common conditions for acutre respiratory failure?
pneumonia, edema and embolism
what is the cause of chest wall restrictions (CWR)
- deformity/ obesity/ neuromuscular disease
result of CWR:
increased work of breathing/ usually decrease in tidal volume
when person has CWR, pain from injury, disease and surgery can cause _____
hypoventilation
Summary of CWR:
_____ tidal volume/ ____ breathing rate
can lead to ____ failure
decreased; increased; respiratory
type of CWR: what is flail chest?
fracture of consecutive ribs with/without sternum damage.
what is the result of flail chest?
chest wall instability = paradoxical movement of chest when breathing.
what are the two types of paradoxical breathing:
inspiration - unstable portion of chest wall moves inward
expiration – portion moves outward
what is the result of paradoxical breathing?
impaired ventilation of alveoli
what is pneumothorax
air/gas in pleural space
what is the cause of pneumothorax?
rupture to visceral pleural
result of pneumothorax
lungs tend to collapse
what is pleural effusion
fluid in pleural space/ from blood or lymph
how to diagnose pleural effusion
chest x-ray
thoracentesis (aka needle aspiration)
what is empyema
infected pleural effusion by microorganisms.
indication of empyema?
pus in pleural space
what is the cause of empyema?
pulmonary lymphatic tissue becomes blocked which leads to contaminated lymphatic fluid moves into pleural space
Empyema is the result of ____ or ______ construction
surgery; bronchial
treatment for empyema?
antibiotics and drainage of pleural space with chest tube
what does restrictive lung disease mean?
difficulty with inspiration – expanding lungs
what does obstructive lung diseases mean?
difficulty with expiration
RLD = characterized by ____ lung compliance = ____ work of breathing at tidal volume
decreased; increased
Aspiration?
passage of fluids/solids into lungs
cause of aspiration?
ab swallowing mechanisms/ cough reflex impaired –> can lead to pneumonia.
CNS or PNS ab
treatment for aspiration
bronchoscopy
*failure to remove —> inflammation
Atelectasis?
collapse of lung
what are the two types of alveoli collapse?
compression atelectasis – caused by external pressure (1)
surfactant impairment – decreased production of surfactant (2)
Atelectasis occur _____ surgery when using general _____
after; anaesthetic
treatment for atelectasis?
deep breathing excercise promotes ciliary removal secretions
Bronchiectasis?
peristent ab dilation of bronchi (large airways)
what are the cause of obstruction?
inflammation due to mucus plugs (1)
chronic inflammation = destruction of elastic/muscular bronchi wall = permanent dilation (2)
symptoms of bronchiectasis?
chronic productive cough
large amount of foul-smelling sputum
Bronchiolitis obliterans = ____ of airways = scaring
fibrosis
Bronchiolitis?
inflammatory obstruction of small airways
BOOP: alveoli becomes filled with _____ tissue
connective
Manifestations of bronchiolitis
rapid ventilatory rate (1)
dry non-productive cough (2)
what is pulmonary fibrosis?
excessive amount of fibrous/connective tissue at alveoli
what is the cause of pulmonary fibrosis?
scar tissue left from previous disease (e.g., tb)
result of pulmonary fibrosis?
decreased lung compliance and external respiration (O2 & CO2 exchange)
Results from _____ injuries at different lung sites associated with _____ healing
multiple; abnormal
symptom of pulmonary fibrosis?
dyspnea on exertion
Pulmonary edema?
excessive water on lungs
cause of pulmonary edema?
left side heart disease
- reduced left side heat cardiac output
- blood backed up from heart into lungs
- increased b.p in pulmonary capillaries
- fluid forced into interstitial space between capillary and alveoli
- when fluid flow exceeds lymph system capability to remove = pulmonary edema occurs
Severe COVID-19 manifested as viral pneumonia-induced ________
Acute Respiratory Distress Syndrome (ARDS)
management of COVID-19?
intubation
Mortality pts had _____ viral loads, meaning…
____ effects of virus not main cause of death
Death caused by _____ runaway immune response
undetectable; cytotoxic; host’s
OLD: signs and symptoms?
dyspnea and wheezzing
Asthma?
chronic inflammatory disorder of bronchial mucosa.
what happens to the body when person is experiencing asthma?
inflammation
- restriction of airways
- hyper-immune response to irritants
what is early asthma attack
classic immune response
result of early asthma attack
inflammation, increased capillary permeability, increased fluid
what is late asthmatic attack
begins 4-8 hours after early attack.
latent release of inflammatory mediators from original site
result of late asthma attack
increased damage of epithelial cells = scaring/ increased mucus forming plugs/ increased airway resistance.
T or F: during asthma, if PaCO@ is greater than 70 mmHg = sign of impending death
true
T or F: if bronchospasms not reversed by usual treatment – it is considered as status asthmaticus
true
tx of asthma
mild: inhalers
persistent: inhaled corticosteroids
Pathopyhsiology of asthma:
(1) inhaled ____ passes epithelial layer
(2) antigen binds to ____ cells = release _____
(3) mediators = ___ production in airway/ ___ spasm/ ___ from increased capillary permeability
(4) ____ cells present antigen to ___ T cells = activate ___ cells/ activated ____ cells release antibodies
(5) Helper T cells also activate ____ / ___ activated/ inflammation from both results in airway _____
(1) antigen
(2) mast; mediators
(3) mucus; broncho; edema
(4) dendritic; helper; B;B
(5) eosinophil; neutrophil; obstruction
COPD?
composed of chronic bronchitis & emphysema
T or F: COPD is the most common chronic lung disease in the world
true
T or F: COPD is the 1st leading cause of death worldwide.
False – fourth
what is COPD characterize?
persistent airflow limitation, chronic inflammatory response to noxious particles or gas, progressive
Chronic bronchitis?
hypersecretion of mucus/ chronic productive cough for at least 3 months of year of 2 consecutive years
cause of chronic bronchitis?
inspired irritants (1) = inflammation/thickening of mucous membrane
reduced radius airways (2) = obstruction
in Chronic bronchitis, airways collapse ___ in exhalation = air trapped in distal portions of lung = ___ = hypoventilation
early; hyperinflation
Emphysema?
permanent enlargement of gas-exchange airways/ destruction of alveolar walls
the obstruction of emphysema is due to destroyed walls of ____
alveoli
result of emphysema?
reduced O2 and CO2 diffusion, expiration becomes difficult bec of loss of recoil of normal alveoli
symptom difference between CB and Emphy:
CB = frequent cough with mucus
Emphy = shortness of breath
large alveolar spaces = greatly ____ diffusion distance between alveoli and capillary
increases
What is the result of large alveolar spaces with people with emphysema?
-reduced O2 and CO2 diffusion
- expiration becomes difficult bec of loss of recoil of normal alveoli
What is the symptom difference between chronic bronchitis and emphysema?
Chronic bronchitis
- frequent cough with mucus
Emphysema
- shortness of breath
What is acute bronchitis?
- acute infection
- inflammation of airways
T or F: Acute bronchitis is usually self-limiting.
True
T or F: Pneumonia mostly occurs due to viral infection.
FALSE; acute bronchitis
What are the symptoms of acute bronchitis?
- similar to pneumonia
- non-productive cough aggravated by cold, dry air and dusty air
What are the tx for acute bronchitis?
rest, aspirin, cough suppressant and antibiotics
Which medication is commonly used for relieving pain, lowering fever and reducing inflammation?
aspirin
What is the most common pathogen for pneumonia?
Streptococcus pneumoniae
What are the common infections route for Streptococcus pneumoniae?
inhalation of infected individual’s cough
What respiratory tract infections is associated with infection of lower respiratory tract caused by microorganisms (e.g., bacteria, viruses, fungi, protozoa & parasites)?
pneumonia
What are the 2 categories of pneumonia?
HAP = hospital acquired pneumonia
CAP= community acquired pneumonia
T or F: CAP is the second most common health-care associated infection.
FALSE; HAP
The most common health care associated infection is _____ tract infection.
urinary
For pneumonia, the hospitals suctioning tubes can become colonized with bacterial ____ which results to suction in seeding lung with bacteria. The guardian cells of lower respiratory tract are cellular ______ ______. Then the macrophages present antigens to Adaptive immune system which will activate _ & _ cells. The immune response can fill alveoli with debris, which then the microorganisms release ___ causing further damage.
biofilms; alveolar macrophages; B, T; toxins
What causes the infection for tuberculosis?
Mycobacterium tuberculosis
T or F: Acute bronchitis is the leading cause of death from a curable infectious disease in world.
FALSE; TB
What respiratory tract infection is transmitted person-to-person via airborne droplets?
TB
TB:
1. Pathogen reach ____, then engulfed by ____. They survive and ____ in macrophage.
2. Reproduction in macrophage causes ___ responses = more macrophages respond = ____ forms.
3. Macrophage start to ___, releasing pathogens and forms a center in tubercle – ____ stage.
4. Tubercle center enlarges (_______). The enlargement fills with air, thus ____ pathogen start to multiple outside macrophage.
5. Liquification continues, the tubercle rupture then the pathogens _____ throughout lung
- lung, macrophages, multiplies
- chemotactic, tubercle
- die, dormant
- liquification, aerobic
- disseminate
What does pulmonary vascular diseases causes?
dramatic alterations in perfusion/ ventilation ratios
Pulmonary blood flow disrupted causing ______ which leads to destruction of vascular bed
occlusion
What is occlusion?
blocking or closing of blood vessel
What is pulmonary embolism?
occlusion of portion of pulmonary vascular bed by embolus.
The effecto pulmonary embolism depends on:
- extent of pulmonary blood flow obstruction
- size of affect vessel
- ## nature of embolus
Pulmonary artery hypertension is the mean pulmonary artery pressure greater than 25 mmHg at rest.
pulmonary artery hypertension
What is the normal pulmonary artery pressure?
20 mmHg or less
Pulmonary artery hypertension is associated with _____ dysfunction, which overproduced ______. This increased growth factors, leads to _______ (thickening of vessel walls). Thus there is the narrowing of vessels = gas exchange reduced. Then there is an increased in pulmonary artery pressure = increased pressure in _____ ventricle. Leads
endothelial; vasoconstrictions; fibrosis; right
T or F: Cor pulmonale is associated with right ventricle hyperthropy
True
What pulmonary vascular disease is associated with right ventricle enlargement due to hypertrophy or dilation or both?
Cor pulmonale
What is Cor pulmonale the result of?
pulmonary artery hypertension
What is the pathogen linked to laryngeal cancer?
HPV - human papillomavirus
What are the primary risk factor for laryngeal cancer?
smoking - risk increases when smoking combined with alcohol consumption
What are some manifestations for laryngeal cancer?
hoarseness, dyspnea, cough; cough following swallowing
What are the diagnosis/tx for laryngeal cancer?
diagnosis - biopsy
tx - chemo & radiation
Laryngeal cancer: The carcinoma of ___ ___ is the most common site. Metastasis occurs in ___ ___, but distant metastasis is rare.
vocal cord; lymph nodes
What is the leading cause of death in Canadians?
lung cancer
What malignancies of respiratory tract is associated with the tumors on respiratory tract epithelium?
lung cancer
What is the most common cause of lung cancer?
smoking, gas exposure, second-hand smoke exposure
What is responsible for causing 90% of lung cancers?
tobacco
Tobacco smoke contains ___ carcinogens
30
What is the progression for lung cancer?
metastasis to brain, bone marrow and liver
How does tobacco affect bronchial mucosa?
suffers ‘hits’ from tobacco smoke = epithelial damage
For lung cancer, the tumour is the result of growth factors and production of ____ ____.
free radicals
