Chapter 36 Flashcards
signs and symptoms of pulmonary disease
______ and _______ !!!!!!!!!!!!!
pulmonary diseaase is associated with many signs and symptoms, and their specific characteristics often help in identifying the underlying disorder
the most common characteristics are:
dyspnea
cough
_________: subjective sensation of uncomfortable breathing
severe -flaring of the \_\_\_\_\_\_\_\_ -use of accessory \_\_\_\_\_\_\_ of respiration -retraction of the \_\_\_\_\_\_\_\_\_ on exertion: shortness of breath with activity
_______: sitting up in a ______ leaning position generally relieves this type of breathing
-supporing the upper body on several _______
dyspnea nostrils muscles intercostal spaces orthopnea forward pillows
___________: alveolar ventilation is inadequate in relationship with the metabolic demands
- leads to __________ from _________ which is high ___ levels
- is caused by airway _________, _______ restriction, or altered ________ control of breathign
hypoventilation respiratory acidosis hypercapnea CO2 obstruction chest wall neurologic
__________: alveolar ventilation exceeds the metabolic demands
- leads to __________ from _______ which is low ___ levels
- is caused by _______, ________, or severe _________
hyperventilation respiratory alkalosis hypocapnia CO2 anxiety, head injury, hypoxemia
the selective bulbous enlargement of the end (\_\_\_\_\_\_\_ segment) of a digit and is commonly associated with diseases that interfere with \_\_\_\_\_\_\_\_\_\_\_ such as: 1 2 3 4 5
clubbing distal oxygenation brochiectasis cystic fibrosis pulmonary fibrosis lung abscess Congenital heart disease
PaO2 - oxygenation of _______
PAO2- the amount of oxygen in the ______
- The ____________ is the measure of the difference between the alveolar concentration of ________
and the arterial concentration of _______. It is used in diagnosing the source of _________ - Meausurement helps isolate the location of the problem as either _______(within the ____) or _________(somewhere else in the body
arterial blood alveoli alveolar-arterial gradient oxygen oxgygen hypoxemia intrapulmonary, lungs extrapulmonary
reduced oxygenation of cells in tissues
hypoxia
reduced oxygenation of arterial blood (reduced by _______) is caused by ___________
- diffusion of oxygen through the __________ membrane is impaired if it is _________ or if the _______ available for diffusion is decreased
- ____________ and __________ cause hypooxemia by the mechanism of abnormal thickness, as occurs with __________(swelling), and pulmonary fibrosis (formation of _________), increases the _____ required for diffusion across the alveolarycapillary membrane so bottom line this causes impairing of the alveolar capillary membrane _______
hypoxemia PaO2 respiratory alternation alveolocapilarry thickened surface area pulmonary edema, pulmonary fibrosis fibrous lesions time diffusion
pleural abnormalities
___________
-presence of fluid in the pleural space
_________
-is watery and diffuses out of the _________
________
-is less watery and contains high concentrations of ________ and _______
________: chyle exudate
_______: blood exudate
clinical manifestations: _______ and ______ pain
treatment: ________, _______ and _______
pleural effusion transudative effusion capillaries exudative effusion WBC and plasma proteins chylothorax hemothorax dyspnea, pleural thoracentesis chest tube surgery
exudative effusion
- contains high concentrations of WBBCs and may occur in response to an _________ process
- the presence of a __________ can trigger exudative effusion
- result of increased ______________
inflammatory
malignant cancer
capillary permeability
empyema
- _______ pleural effusion
- ______ in the pleural space - causes pulmonary infections (_______,, ________) infected ______
clinical manifestations:
-_____, ____, ______(rapid heart rate), ______, and ________
treatment:
-administration of __________ meds
-drainage of the _________ with a ________
-severe cases: _________ guided pleural drainage, instillation of ________ agents, or ______ injected in the pleural space
infected pus pneumonia, abscesses wounds cyanosis, fever, tachycardia, cough, pleural pain antimicrobial pleural space, chest tube ultrasound fibrinolytic DNAse
restrictive lung diseases restrict the lung ________
the lungs are unable to _____ normally diminishing the amount of ___ that can be inspired
volume
expand
gas
obstructive lung diseases affect ________
airflowinto and out of the lung is obstructed
increased ________ to air flow caused by _______ of airways
gas flow
resistance
narrowing
CXR abnormalities terms
_______ and _______ - air trapping in the alveoli and airways
_________ or _________: consolidation of the lung tissue
__________ or ________: cavities
_______: nodular
asthma, emphysema
pneumonia, pulmonary edema
abscesses or TB
lung cancer
a loss of lung volume caused by \_\_\_\_\_\_\_ of alveoli and subsequent \_\_\_\_\_\_ of the part of the lung etiology 1. \_\_\_\_\_\_\_\_\_(tumor) 2. \_\_\_\_\_\_\_\_\_ pleural effusion 3 4 5 \_\_\_\_\_\_\_\_\_( within \_\_ hours) 6
atelectasis deflation collapse obstructive nonobstructive pneumothorax surfactant deficiency postoperative, 72 asbestosis
restrictive lung disorders atelectasis \_\_\_\_\_\_\_ of lung tissue -compression atelctasis -\_\_\_\_\_\_ compression on the lung -absorption atelectasis -gradual \_\_\_\_\_\_\_ of air from obstructed or \_\_\_\_\_\_\_\_\_ alveoli -\_\_\_\_\_\_ impairement -decreased production or inactivation of surfactant clinical manifestations -\_\_\_\_\_\_, \_\_\_\_\_\_\_, \_\_\_\_\_\_ and \_\_\_\_\_\_\_\_ treatment: \_\_\_\_\_\_\_\_\_
collapse external absoprtion hypoventilated surfactant dyspnea, cough, fever, leukocytosis deep breathing
restrictive lung disorders
__________: excessive amounts of fibrous or connective tissue in lung
_________ pulm fibrosis: no specific cause
-clinical manifestations: increasing ______ on exertion
pulmonary fibrosis
idiopathic
dyspnea
restrictive lung disorders
_________
-excess water in the lung from disturbances of ______________ pressure, ________ pressure, or _________
-most common cause: ________ heart disease!!!!!
clinical manifestations: dyspnea, orthopenea, hypoxemia, and increased work of breathing
pulmonary edema capillary hydrostatic capillary oncotic pressure capillary permeability left sided
these are short parallel lines at the lung periphery. these llines represent ___________, which are usually less than 1 cm in length and paraelll to one another at ________ to the pleura
- they are located _________ in contact w the pleura, but are generally absent along ______ surfaces
- they may be seen in any zone but are most frequently obserbed at the ______ at the_______ angles on the PA radigraph
Kerley B lines interlobular septa right angles peripherally fissural lung bases costophrenic
perihilar, interstitial opacities shadow of ________ or _____ appearance. the hatched lines are _______ (kerley lines which represent prominent _________ _____ vessels
pulmonary edema
butterfly, bats wings
septal lines
interlobular lymphatic
restrictive lung disorders \_\_\_\_\_\_\_\_ (ALI) or \_\_\_\_\_\_\_\_\_\_\_\_\_ (ARDs) -is a \_\_\_\_\_\_\_\_ form of respiratory failure characterized by acute \_\_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_ injury -injury to the pulmonary capillary \_\_\_\_\_\_\_\_\_\_\_ -\_\_\_\_\_\_\_\_\_ capillary permeability -\_\_\_\_\_\_\_\_\_\_ -\_\_\_\_\_\_\_\_\_\_\_\_ inactivation -\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_
acute lung injury acute respiratory distress syndrome fulminant lung inflammation diffuse alveocapillary increased inflammation surfactant edema, atelectasis
ARDS pathophys
- alveoli and respiratory bronchioles fill with fluid as a result of __________ of surfactant and the impairment of _______ ______ cells
- ________ release inflammatory mediators such as ____________, ___________, ________, __________ and _______ activating factor
inactivation type 2 alveolar neutrophils proteolytic enzymes oxygen-free radicals prostaglandins leukotrienes platelet
obstructive pulmonary disease 1 2 3 4 \_\_\_\_\_\_\_\_ plus \_\_\_\_\_\_\_\_\_ equals \_\_\_\_\_\_\_\_\_\_\_
asthma chronic bronchitis emphysema chronic bronchitis emphysema chronic obstructive pulmonary disorder (COPD)
obstructive pulmonary disease
air obstruction is worse with expiration
disease requires more ______ to expire a volume of air
force
_______
episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucous production
early asthmatic response
-_____, may contribute to the pathophysiologic characteristics of asthma
-inflammatory mediators produced by asthma:
1
2
3
4
the release of toxic _________ contributes to increased ________ ___________
clinical manifestations:
inspiratory and expiratory ________, ______, ________ cough and _________
asthma IgE histamine bradykinin leukotrienes prostaglandins neuropeptides bronchial hyperresponsiveness wheezing dyspnea nonproductive tachypnea
chronic bronchitis
_______ - _______ is more severe
hypersecretion of ____ and chronic productive cough that lasts at least __ months of the year and for at least __ consecutive years
pathophysiology
the production of mucus associated w this is due to increased in _________ size
-inspired irritants increase ______ production, size and number of mucous glands and bronchial ______; mucus is _____ than normal
-________ bronchial smooth muscle
-______ and _______
-airways ______ early in expiration, ______ gas in the lung
blue bloaters hypoxia mucus 3 2 goblet cell mucus edema thicker hypertrophied hypoxemia, hypercapnia collapse trapping
chronic bronchitis clinical manifestations: - decreased \_\_\_\_\_\_\_ tolerance -\_\_\_\_\_\_\_\_ and \_\_\_\_ -productive \_\_\_\_\_\_ "smokers cough" becomes \_\_\_\_\_\_\_\_\_\_
treatment: _______ cessation: disease can be halted
exercise wheezing, SOB cough copious smoking
emphysema
______, ________ breathing, _____ chest
-abnormal permanent enlargement of the __________ airways accompanied by the destruction of the ________ walls without obvious ________
-loss of _________
-primary emphysema
-_________ deficiency of the enzyme __________
-secondary emphysema
-_________: main cause
-________, occupational ______ and _______ respiratory infections, possible contributers
pink puffer pursed barrel gas-exchange alveolar fibrosis elastic recoil inherited a1-antitrypsin cigarette smoke air pollution exposures childhood
emphysema
clinical manifestations
include unexplained ________, ______ on exertion, use of _______ muscles, and ______ with prolonged ________
weight loss dyspnea accessory tachypnea expiration
emphysema
_______ inflamed lungs mean that is filled with more air than usual. this is a common finding in someone with _____. The hyperinflation also causes the ____________ _______
lateral chest xray
the _____ of the diaphragm are significantly ______. the thorax can be described as ___________
hyperinflamed COPD flattened diaphragm domes flattened barrel chest
emphysema treatment the initial step in the management of emphysema: \_\_\_\_\_\_\_\_\_\_ pulmonary \_\_\_\_\_ improved \_\_\_\_\_\_ \_\_\_\_\_\_ techniques
smoking cessation
rehab
nutrition
breathing
pneumonia
infection of the _______ respiratory tract
responsible for more disease and death than any other infection
lower
community acquired pneumonia (CAP)
one of the most common reasons for hospitilization in the USA
1
2
3
streptococcus pneumoniae
H. influenza
Moraxella Catarrhalis
Ventilatory associated pneumonia (VAP) develops after 48 hours on a ventilator 1 2 3
pseudomonas staphylococcus aureus (MRSA) klebsiella
heath care associated pneumonia (HCAP)
recent hospitilization residence in a nursing home
extended care facility, home infusions therapy
1
2
3
pseudomonas staphylococcus aureus (MRSA) klebsiella
hospital acquired pneumonia
most common nosocomial infection. has the greatest _______
develops after 48 hours of being inpatient
1
2
3
pseudomonas staphylococcus aureus (MRSA) klebsiella
pneumonia
routes of infection
___________
most common route of _______ respiratory tract infection is via _________ of _______ secretions
aspiration
lower
aspiration
oropharyngeal
streptococcus pneumoniae
\_\_\_\_\_\_\_\_ pneumonia -\_\_\_, resulting in inflammatory \_\_\_\_\_ and cells, causes \_\_\_\_\_\_ edema -edema creates a medium for the multiplication of \_\_\_\_\_\_\_ and aids in the spread of infection into \_\_\_\_\_\_ portions of the lung -involved lobe undergoes \_\_\_\_\_\_\_\_\_\_ four phases: 1 2 3 4
pneumococcal ALI cytokines alveolar bacteria adjacent consolidation consolidation red hepatization gray hepitazation resolution
pneumonia
_______ pneumonia
-is seasonal; usually mild and self limiting
-can set the stage for a ______ bacterial infeciton
-provides an ideal environment for bacterial growth and by damaging _______ epithelial cells, which normally prevents _____ from reaching the airways
most common form: ________
clinical manifestations: for ___________ look for rapid onset of ______ _____ preceded by an ______ respiratory infection, followed by ______, ______ chest pain, productive ______ (_____-_____ or _____)
viral secondary ciliated pathogens influenza streptococcus pneumoniae shaking chills upper fever pleuritic cough yellowish-green rust
pneumonia
treatment
bacterial pneumonia: _______
viral pneumonia: supportive ________ ______, unless ________ bacterial infection is present
antibiotics
therapy alone
secondary
tuberculosis
a bacterial infection caused by mycobacterium tubercolisis typically affects the lungs
pathophys
airborne droplet transmission
tubercle formation: granulomatous lesion
caseous necrosis:cheese like material
may remain dormant for life or cause active disease
isolation of ________ by enclosing them in _______ and surrounding them with _________
bacilli
tubercles
scar tissue
tuberculosis
how the body walls off the bacilli
in TB, the body walls off the bacilli in a tubercle by stimulating ______ __________ ______ that activate _________
in defense, ________ and _________ release _______, which inhibits the replication of the microorganism and stimulates more ______ to attack the bacterium.
apoptotic infected macrophages cytotoxic T cells macrophages, lymphocytes interferon macrophages
tuberculosis
(picture in slide)
a patchy ____ infiltrate can be seen in upper _______
dense
left lobe
acute bronchitis
is an acute infection or inflammation of airways or bronchi
commonly follows a _______ illness
-causes symptoms similar to _________ but does not demonstrate pulmonary ________ and chest ________
-clinical manifestations: ________ cough occurs in _______ and is aggravated by ____, _____ or dusty air
-treatmentL rest, _______, _______ and __________ (_____)
viral pneumonia consolidation infiltrates nonproductive paroxysms cold, dry aspirin, humidity, cough suppressant codeine
pulmonary emblolus that impairs blood flow to a segment of the lung results in an area where ______ are ventilated but not ______, which causes ____________
alveoli
perfused
alveolar dead space
aging and the pulmonary system
loss of _______
________ of the chest wall
recoil
stiffening
