Chapter 36: Alterations of Pulmonary Function Flashcards
s/sx of pulm dz
Dyspnea and cough
Altered breathing patterns
Hyperventilation -> resp alk. CO2 lost.
Hypoventilation -> resp acidosis. CO accumulates
Hemoptysis -> coughing up blood
Abnormal sputum
Cyanosis
Chest pain
Clubbing
dyspnea
Subjective sensation of uncomfortable breathing
severe dyspnea
Flaring of the nostrils
Use of accessory muscles of respiration
Retraction of the intercostal spaces
dyspnea on exertion
SOB with activity
orthopnea
Dyspnea when lying down
Often related to left side heart failure
paroxysmal nocturnal dyspnea
Awaking at night and gasping for air; must sit up or stand up
cough and sputum
Cough: Protective reflex that helps clear the airways by an explosive expiration. Acute coughm-> Resolves within 2 to 3 weeks. Chronic cough -> Lasts longer than 3 weeks.
Abnormal sputum: Changes in amount, consistency, color, and odor provide information about the progression of disease and the effectiveness of therapy.
Hemoptysis: Coughing up blood or bloody secretions
abnormal breathing patterns
Adjustments made by the body to minimize the work of the respiratory muscles
kussmaul respirations (hyperpnea)
Slightly increased ventilatory rate, very large tidal volume, and no expiratory pause
Trying to blow off acid -> metabolic acidosis.
labored breathing
increased work of breathing
restricted breathing
Disorders that stiffen the lungs or chest wall and decrease compliance
Ex. Obesity. Weight compresses breathing
Cheyne-stokes respirations
Alternating periods of deep and shallow breathing; apnea lasting 15 to 60 seconds, followed by ventilations that increase in volume until a peak is reached, after which ventilation decreases again to apnea
hypoventilation
Alveolar ventilation is inadequate in relationship to the metabolic demands.
Leads to respiratory acidosis from hypercapnia.
Low RR and Low vT
Result is -Increased CO2 (>40mm Hg) and Decreased pH (Resp Acidosis)
Is caused: Over sedation #1, airway obstruction, chest wall restriction, altered neurologic control of breathing.
Causes:
- Central
Drugs (narcotics), Head injury/Spinal Cord injury - Chest wall disorder: Neuromuscular Diseases, Obesity, Kyphosis/scoliosis
- Damaged Lung Structure: asthma, COPD
hyperventilation
Alveolar ventilation exceeds the metabolic demands.
Leads to respiratory alkalosis from hypocapnia.
Is caused: anxiety, Pain, fever
cyanosis
Bluish discoloration of the skin and mucous membranes
Develops with five grams of desaturated hemoglobin, regardless of concentration
peripheral cyanosis
Most often caused by poor circulation
Best observed in the nail beds
central cyanosis
Caused by decreased arterial oxygenation (low partial pressure of oxygen [Pao2])
Best observed in buccal mucous membranes and lips
clubbing
Bulbous enlargement of the distal segment of a finger or toe.
Graded 1-5 based on nailbed changes
Associated with diseases causing hypoxemia
chest pain
pleural and chest wall
pleural pain
Is the most common pain caused by pulmonary diseases.
Is usually sharp or stabbing in character.
Infection and inflammation of the parietal pleura (pleuritis or pleurisy) can cause pain when the pleura stretch during inspiration and are accompanied by a pleural friction rub.
chest wall pain
may be from the airways
may be from muscle or rib pain
conditions caused by pulm dz or injury
Hypercapnia: Increased carbon dioxide (CO2) in the arterial blood, Occurs from hypoventilation
Hypoxemia: Hypoxemia (blood) versus hypoxia (tissue), Reduced oxygenation of arterial blood
caises of hypoxemia
in order of most to least common
1. V:Q Mismatch** Ventilation and perfusion are different than what it should be
- Hypoventilation
- Shunt
- Thickened diffusion barrier
- Low inspired O2 (Altitude)
most common cause of hypoxemia in pt with pneumonia, atelectasis, PE
V:Q mismatch
* does improve with O2
alveolar shunt
Alveoli blocked from ventilation
Entry of blood into the systemic arterial system without going through ventilated areas of lung
causes: Severe pneumonia, Pulmonary Edema, Atelectasis, ARDS* -> diseased alveoli and inflamed caps, need put on a ventilator
Does not improve with oxygen
thicken diffusion barrier
Diffusion Capacity is reduced by diseases in which the thickness is increased.
Causes: pulmonary fibrosis, asbestosis, sarcoidosis, ILD
low V/Q
ventilation problem. Perfusion is fine.
shunt (very low) V/Q
blocked vent -> collapse alveolus –any cap passing will not get any O2
high V/Q
no problem with ventilation, problem with perfusion. Ex. PE. Dead space: any O2 that gets into alveoli and not used for perfusion
low inspired ppO2
Low PaO2. Pressure pushes O2 in from high level to low level
Normal or Decreased PaCO2 (hyperventilation)
Causes:
1. FiO2 decreases at higher altitude. hyperventilate. May have normal or deceased PaCO2. People who live high alt accumulates and they have normal PaCO2. Alt sickness is from hyperventilation an low CO2 -> get medicine
2. Decrease in FiO2 (accidental ex.) COPD pt who needs 3L O2 at all time has NC fall off and now they have decrease Fi02
pulmonary vascular resistance
Amount of right ventricular force required to pump blood into lungs depends on resistance to flow present in the pulmonary vascular system
This resistance to flow is PVR
Hypoxemic -> vasoconstriction
Emphasema is common cause for pulm HTN
COPD. -> right vent. Hypertrophy -> death
cor pulmonale
Right ventricular hypertrophy secondary to pulmonary disease
Can cause right sided heart failure
Major cause of death in COPD patients
Increased PVR makes it harder for right side of the heart to pump blood into pulmonary circulation
acute resp. failure
Hypoxia (Gas exchange is inadequate)
Pao2 is ≤50 mm Hg.
Hypercapnia (ventilation is inadequate)
Paco2 is ≥50 mm Hg with a pH of ≤7.25.
Requires ventilatory support, oxygen, or both.
emergency condition, can affect all ages, major cause of death, successful outcome depends on prompt recognition and immediate initiation of supportive rx
chest wall restriction
Chest wall is deformed, traumatized, immobilized, or made heavy by fat; work of breathing is increased, and ventilation may be compromised because of a decrease in tidal volume.
Impaired respiratory muscle function is caused by neuromuscular disease.
can be caused by amiodarone and nitrofurantoin
restrictive lung diseases: parenchymal
interstitial pulm fibrosis: 1ry (idiopathic) occupational, collagenic, granulomatous, irradiation, resection, drug-induced (bleomycin, methotrexate, cyclophosphamide)
restrictive lung diseases: extra parenchymal pleura
pleural effusion, pneumothorax, pleural fibrosis, pleural tumors, pleural thickening.
restrictive lung diseases: extra parenchymal abdomen
severe distension
restrictive lung diseases: chest wall
trauma, kyphoscoliosis, ankylosing spondylitis, NM dz (MG, GB), morbid obesity, scleroderma
flail chest
Is the instability of a portion of the chest wall from rib or sternal fractures.
Causes paradoxical movement of the chest with breathing.
pneumothorax
Pneumothorax refers to air in the intrapleural space
hemothorax
hemothorax refers to blood in the intrapleural space around the lung.
s/sx of pneumotorax
Signs of chest trauma
Tachypnea, tachycardia
Shortness of breath
Unequal Lung Excursion
Diminished or absent breath sounds on one side or one area of lung
ABG: decreased PaO2 and SaO2, respiratory alkalosis
Patient might complain of sharp chest pain on one side of chest
Positive chest x-ray for pneumothorax
spontaneous pneumothorax patho
rupture of a bleb on the lung surface allows air to enter pleural space from airways.
primary affects prev. healthy people. common for a young, tall, thin man. secondary affects people with preexisting lung dz (COPD)
spontaneous pneumothorax s/sx
abrupt onset, pleuritic chest pain, dyspnea, SOB, tachypnea, tachycardia, unequal lung excursion, decreased breath sound and hyperresonant percussion tone on affected side.
traumatic pneumo patho
trauma to the chest wall or pleura disrupts the pleural membrane. open occurs with penetrating chest trauma that allows air from the environment to enter the pleural space. closed occurs with blunt trauma that allows air from the lung to enter the pleural space. iatrogenic involves laceration of visceral pleura during a procedure such as thoracentesis or central line insertion.
traumatic pneumo s/sx
pain, dyspnea, tachypnea, tachycardia, decreased resp. excursion, absent breath sounds in affected area, air movement thru an open wound
tension pneumo patho
air enters pleural space thru chest wall or from airways but is unable to escape, resulting in rapid accumulation. lung on affected side collapses. as intrapleural pressure increases, heart, great vessels, trachea, and eso shift toward unaffected side.
tension pneumo s/sx
hypotension, shock, distended neck veins, severe dyspnea, tachypnea, tachycardia, decreased resp. excursion, absent breath sounds on affected side, tracheal deviation toward unaffected side.
dx of tension pneumo
CXR
ex. left side tension pneumo. sides of push to right, trachea and mediastinum are pushes to right side, not the density bw 2 sides, right side is normal, left side hyperlucent
signs of push:
1. collapse left lung
2. air under tension in left pleural cavity. no bronchovascular markings
3. tracheal shift to right side
4. mediastinal shift to right side
tension pneumo left side
tension penumo tx
needle decompression: 2nd rib space in the mid-clavicular line, immediate rush of air, concerts a tension pneumo to a simple pneumo, asso with complications