Chapter 4 Flashcards
Upper respiratory tract
nose, nasal passages, pharynx, larynx
parts of the larynx
vocal cords, hyoid bone, cartilages, epiglottis
lower respiratory tract
trachea, bronchi, branches of bronchioles, terminal alveoli in the lung
inhalation
diaphragm contracts and pushes down on organs
anatomy of lungs
lobes; pleura; surfactant, bronchopulmonary segments
lobes of the lungs
2 left; 3 right
Pleura
visceral pleura-inner lining and attached to the lung
parietal pleura-lines the thorax and is actually an extension of the visceral pleura
surfactant
fluid to allow the two layers of pleura to glide over each other as the lungs expand during breathing
bronchopulmonary segments
left lung consists of 9
right lung consists of 10
eupnea
normal breathing 12-20 bpm
apnea
not breathing (sleep apnea)
tachypnea
greater than 24 bpm
brandypnea
less that 10 bpm
sleep apnea
stop breathing for a time; not enough O2; do a sleep study; affects memory, growth (growth hormone helps growth and tissue repair), weight gain; immune system problems
hypopnea
disease that reduces ventilation; seen at night; wear O2 at night
cheyne-stokes breathing
breathing pattern done right before death; very distinct; gasp and then shallow (last 5 breaths)
ataxic breathing
disruption of cerebellum; irregular depth breaths
apneustic breathing
brain damage; prolonged inhalation phase and inadequate exhalation (like a gasping)
ventilation control
voluntary and involuntary
voluntary ventilation control
valsalva maneuver
involuntary ventilation control
control centers located in primitive area of brain (medulla and pons); chemoreceptors (in carotid and medulla; vascular system to detect CO2; running and SOB till levels even out; yawn, laughing, vomiting
reflexes that affect ventilation control
hering-breuer; cough; stretch
Hering-Breuer
in smooth mm of trachea; stretch reflex so lungs don’t over inflate; causes a reflex to make mm contract; delays the start of the next inhalation
cough for ventilation control
anything that isn’t supposed to be there (in trachea, lungs, etc)
Problem with spinal cord injury at C6…they don’t have a good cough reflex
stretch for ventilation control
muscle spindles respond to elongation of the mm where they are located. Muscle spindles are located both in the diaphragm and the intercostal mm. When they are stretched it initiates further contraction
Inhalation process
alveoli pressure is lower than atmospheric pressure; external intercostals help with inhale
problems- COPD and emphysema- cause all inhalation mm to contract and will have problems because all of the mm are trying to help
exhalation process
internal intercostals and diaphragm relax and air leaves; very passive; abs help with forced exhalation
tidal volume (VT) OR (TV)
air inhaled/exhaled, each breath, in normal, quiet breathing
inspiratory reserve volume (IRV)
extra air that can be inhaled over tidal volume
expiratory reserve volume (ERV)
extra air that can be exhaled over tidal volume
problem- if it’s too low causes CO2 to stay in body-ketoacidosis
residual volume (RV)
air that stays in lungs after forced expiration
inspiratory capacity
tidal volume plus inspiratory reserve volume
functional residual capacity
expiratory reserve volume plus residual volume minus air left in lungs after normal exhalation
Vital capacity VC or forced vital capacity FVC
inspiratory reserve volume plus tidal volume plus expiratory reserve volume minus max amount of air exhaled after a max inhalation
forced expiratory volume in 1 second
volume of air that is forcibly expired after maximal inspiration in one second; usually 80% of VC
total lung capacity TLC
all lung volumes added together
minute ventilation V
tidal volume X rate of ventilation (500*15=7500)
restrictive vs. obstructive
restrictive-can’t breathe in (asthma); everything will be restricted
obstructive-can’t breathe out; can practice to increase expiratory volume
diffusion
O2 transported into RBC from the alveoli of the lungs
perfusion
relates to blood in the pulmonary vessels that supply the lung tissue; amount of O2 that actually makes it across
ventilation-perfusion ratio or quotient
if perfusion is reduced in an area of the lung, there will also be a reduced ability for O2 to diffuse from the lungs into the BV’s for transport of O2 to tissues. The ratio in a healthy adult is 80%
oxyhemoglobin dissociation curve
correlation between the hemoglobin and the release of O2 from the hemoglobin
muscles of ventilation
diaphragm (main mm); accessory mm, abdominals (forced exhalation); external and internal intercostals
accessory mm of ventilation
sternocleidomastoids, scalenes, serratus anterior, pectoralis major/minor, trapezius, erector spinae
excursion
how much chest wall moves; landmark is the xiphoid process and in a “young adult between 20-30 yrs” the rib excursion should be 8.5 cm
intercostal indrawing
spaces between the ribs occurs in individuals with marked resistance to airflow during inhalation. The skin and intercostal mm tissue between the ribs is drawn inward during inhalation as the result of an increases negative pressure in the thoracic cavity; can be seen more often in children than adults
breath sounds
ausculation-listen in different locations
tracheal vs. lung tissue - the exhalation tracheal breath sound is a little higher pitched and last slightly longer than the inhalation in the trachea.
spirometry
a device that encourages patients to inhale deeply after a pulmonary infection or thoracic surgery to prevent further complications
PEF - peak expiratory flow
measured with a peak flow meter; PEF is reached at about 100 milliseconds into exhalation and then starts to reduce as the air continues to be expelled from the lungs
arterial blood gases
hypoxemia-reduction in O2 levels in the blood
hypercapnia- increase CO2 levels in the blood
respiratory acidosis
results from a rise in the CO2 and is present in patients with chronic bronchitis during episodes of exacerbations.
respiratory alkalosis
occurs with a reduction in the CO2 level and is present in persons with pneumonia
lung function tests
chest radiograph computed tomography CT magnetic resonance imaging MRI pulmonary arteriography or angiography bronchoscopy
exercise capacity and tolerance
MET-metabolic equivalence test; based on how much you need at rest
RPE-rate of perceived exertion; how hard patient thinks they’re working
cough
stimulated through stimulus to remove foreign matter. May be productive or nonproductive. For pathology the sputum is collected and sent to lab for identification for diagnosis
types of sputum
saliva-normally present
frothy-pulmonary edema
mucoid-pulmonary condition w/no infection (asthma, chronic bronchitis)
mucopurulent-cystic fibrosis, pneumonia, bronchiecstasis
purulent-pulmonary infections (pseudomonosa)
hemoptysis-infections such as tb or bronchiectasis
black sputum-inhalation of smoke from cigarettes, etc
dyspnea
breathlessness, shortness of breath (SOB), may be an indication of either pulmonary or cardiac problems.
paroxysmal nocturnal dyspnea
result CHF at night. Can measure by how many pillows the patient sleeps with. Laying more flat increases the venous return to the heart and increases stress and exacerbates CHF
Cyanosis
blue tinge of skin from low O2 below 80%. May be due to central or peripheral sources
chest pain
many causes-cardiac, pulmonary, costochondral or pleuritic
chest shape and reduced thoracic mobility
pectus carinatum (pigeon chest), pectus cavus, barrel chest-all result in change in thoracic excursion and loss of volume
pulmonary edema
edema build up in the lungs int he interstitial spaces and alveoli as a result of left ventricular failure
atelectasis
lungs collapse (all or part)
bronchiolitis
inflammation of the bronchi resulting in increased secretions and inflammatory exudate in the lungs resulting in cough
pneumothorax and pleural effusion
life threatening condition when the lung collapses as a result of air or fluid entering between the pleural layers. Can be a result of trauma or spontaneous in response to lung conditions such as asthma, cystic fibrosis, tuberculosis, COPD or whooping cough
lung abscess
lung cavity filled with pus and encapsulated by fibrous tissue. may be caused by cancer, infection, pneumonia. May be result of secondary infection from a traumatic injury. Can develop with aspiration of food when the item festers in the lungs. Treatment is based on the cause of the abscess
type a
“pink puffer” - person with emphysema
type b
“blue bloater” - person with chronic bronchitis
asthma
an acute, reversible, inflammatory, obstructive pulmonary condition affecting both adults and children. Stimuli can be extrinsic (allergens) or intrinsic (exercise)
pneumonia
pulmonary disease involving inflammation of the alveoli and small bronchi
bronchopneumonia
if both lungs are involved and is usually the result of interstitial pneumonia of a viral cause
pyothorax
the whole pleural cavity is filled with pus (if pleural effusion is purulent)
cystic fibrosis
chronic, hereditary lung disorder; autosomal recessive train on chromosome 7; results in reduced pancreatic enzymes that cause malfunction of the mucous membranes and mucous producing glands of the pancreas and lungs with resultant severe lung abnormalities; high levels of NaCl in sweat for diagnosis;
PEP therapy
positive expiratory pressure therapy; airway clearance technique; the machine resists exhalation of air from the lungs and helps to keep airways open
tuberculosis
bacterial lung disease with similar effects to those of pneumonia; more common among individuals with HIV, homeless and overcrowded prisons; airborne infection;
lung cancer; benign and malignant tumors
smokers at higher risk; many tumors develop in the larger bronchi and spread to occlude the airways and cause atelectasis distal to the blockage; could be secondary sites due to metastasis from brain or breast
pulmonary infarction
areas of lung tissue are deprived of O2; tissue may recover or become necrotic
pneumoconioses
group of lung diseases caused by inhaling small particles from the air (asbestosis, coal-workers lung, etc)
sarcoidosis
inflammatory condition with granuloma formation in various organs of the body including the lymphatic system and the lungs; granulation occurs in the lymph nodes throughout the body, but particularly in those within the thorax and lungs
adult respiratory distress syndrome
rapid lung failure; causes include pneumonia, other infections such as sepsis, cardiac failure, inhalation of toxic fumes or smoke and near-drowning;
bronchopulmonary dysplasia in pediatric respiratory distress syndrome
immature infant with respiratory distress syndrome who is placed on O2 and a ventilator may develop BPD
pneumonectomy
removal of an entire lung. Radical and aggressive procedure. For therapy we are going to focus on airway clearance and management of fluids (huffing over coughing), incentive spirometry and breathing exercises and thoracic excursion
lobectomy
removal of one lobe of the lung usually as a response to cancer or damage to lungs
hemothorax and pneumothorax
air or blood int he pleural cavity; usually caused by trauma
postpulmonary surgery complications
tracheotomy-may require a plug, loss of voice
lung transplant-a last resort procedure; will require mechanical ventilation for first 1-3 ;days
classes of medications used to treat respiratory diseases
antibiotics; antimicrobials; anti-inflammatory agents; bronchodilators; humidification
antibiotics
for bacterial infection and specific to the type of microbial, which is why a diagnosis is required
antimicrobials
a general medication for bacteria or fungus that is nonspecific
anti-inflammatory agents
include corticosteroids or NSAID’s
bronchodilators
used for obstructive air diseases
humidification
add hydration to thick fluids in the lung to allow the fluid to pass out of lungs easier
nebulizer
o2 passed over a humidification and often includes adding of medications to deliver to the lung tissue
intervention for patients with respiratory pathologies
postural drainage; coughing and huffing techniques; breathing exercises; ventilators; CMV
breathing exercises
used to facilitate thoracic excursion for restrictive pathologies; manually resisted thoracic breathing to encourage deep inhalation
CMV - controlled mechanical ventilation
used when patients are paralyzed and unable to participate in breathing
AC units
assist control unit completely controls breathing with the machine programmed at specific settings.
intermittent mandatory ventilation
IMV; patients have no control; the machine delivers preset amounts of O2 at intervals to supplement the breathing, while allowing patients to exhale
PSV pressure support ventilation
provides patients with more control over the breathing, while ensuring a minimum level of inspiration.
