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Pathophysiology > Class 7/8 - Alterations in Respiratory Function > Flashcards

Class 7/8 - Alterations in Respiratory Function Flashcards

1
Q

Differences in Respiratory Structure and Function (Age)

A

Infant/Child

  • Obligatory nose breather for the first 4 weeks
  • Airways narrower, neck muscles and trachea less developed
  • Fewer alveoli
  • Increased oxygen consumption due to higher BMR

Elderly

  • Weaker gag reflexes, weaker cough
  • Stiffer chest wall, weaker respiratory muscles
  • Structural changes to vertebrae and supporting structures
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2
Q

Manifestations of Pulmonary Diseases

A
  • Dyspnea: shortness of breath, not getting enough air
  • Cough
  • Abnormal sputum
  • Hemoptysis (coughing up blood)
  • Pain
  • Clubbing of nail beds (>180 angle, it’s normal to have a v dent)
  • Cyanosis: a bluish, purplish discolouration of the skin/mucous membranes. Central, around the lips (best indicator). Peripheral, fingertips
  • Breathing patterns
    1. Kussmaul
  • Lots of big breaths that are fairly fast
  • Sustained breathing patern
  • Results in excreting CO2 faster
  • People with metabolic acidosis could breath like this (lungs compensating)
  1. Cheyne Stokes
    - Breathing starts off as normal and gradually gets bigger
    - Reaches maximal breath size and gradually gets smaller
    - 10-15 seconds of apnea (no breathing)
    - Cycle restarts
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3
Q

Respiratory Terminology

A

Ventilation: breathing
- Significant to how well the alveoli are working

Diffusion: gasses diffuse from the alveoli into the capillaries

Perfusion: blood flow
- CO2 diffuses from the cell back to the blood stream, to the heart, to the alveolus

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4
Q

Hypercapia

A

An increased of CO2 int he blood (PCO2 > 45 mmHg

Causes - things that affect breathing

  • Neurological disorders
  • Muscular disorders
  • Diaphragm impairment
  • Narcotic/opioids
  • Having small breaths

Manifestations

  • Drop in pH - respiratory acidosis
  • Sleepiness: less responsive, affects consciousness
  • Vasodilation: makes us pink and warm
  • Headache: from the dilated blood vessels in the head
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5
Q

Hypoxemia

A

Low levels of oxygen in the blood stream
Can be measured by blood samples. Test for oxygen saturation and hemoglobin molecule and PO2
- PO2 drops with age, 1 mm each year > 60 yr

Caused by

  • Not enough O2 in the atmosphere
  • Low breathing rade
  • Inadequate perfusion
  • Diffusion through membranes
  • Ventilation - perfusion (blood flowing mismatch)
    1. Perfusion without ventilation - Shunt
  • Blood flow goes through the lungs but does not pick up O2, alveoli don’t work
    2. Ventilation without perfusion - Dead Space
  • Alveoli works but there is no blood flow
  • Not participating in air exchange

Manifestations

  • Decreased LOC - restlessness, confusion, agitation
  • Chest pain and abnormal heart rhythms
  • Pale or cyanosis of finger/toe tips
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6
Q

Hypoxia

A

Low levels of oxygen in the tissues/organs

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7
Q

Respiratory Failure

A

Hypercapnic Respiratory Failure
- Failure to remove carbon dioxide adequately

Hypoxemic Respiratory Failure
- Failure to oxygenate adequalty

Can have both failures at the same tie

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8
Q

Pneumothroax

A
  • Air in the thoracic cavity
  • Air breaks the seal of the pleurae and moves in and out of the pleural space
  • The pleural space keeps the membranes in a certain position in a vacuum to keep the lungs inflated, sealed with suction.
  • Lung collapses inwards

Caused by

  • Physical harm (stab wound)
  • Weak alveoli that can pop and create a hole in the lung

Treatment:
- Put a tube in to reestablish suction in the pleural space (3/4 days)

Disorder of breathing in

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9
Q

Tension Pneumothorax

A
  • Air enters the pleural space but can’t exit
  • Every time we breath, air continues to enter but can’t get out. A flap of tissue usually acts as a one way valve
  • Compresses heart and other lung
  • Life threatening

Treatment
- A needle that acts as a two way vent

Disorder of breathing in

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10
Q

Atelectasis

A
  • Collapse of alveoli
  • Contributors: loss of surfactant or surgery
  • Assessment: quiet lung sounds

Disorder of breathing in

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11
Q

Pulmonary Edema

A

Accumulation of water in the alveoli

  • Commonly due to heart failure
  • Increased blood volume in the capillaries pushes water out into the interstitial space, lungs and alveoli
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12
Q

Pneumonia

A

Inflammation/infection of the alveoli/terminal bronchioles

Etiology

  • Infectious: bacteria (Streptococcus pneumoniae) virus
  • Non-infectious: aspiration. Stomach contents sucked into the lungs

Pathophysiology

  • Inhalation of organisms or aspiration of secretions
  • First line of defnence is overwhelmed
  • Activation of 2nd or 3rd line of defence (inflammation, B cells, T cells, alveoli and terminal bronchioles filled with exudate)

Risk Factors

  • Young and elderly
  • Smoking - affects cilia and ciliary action
  • Immunosuppression
  • Altered LOC/ difficulty swallowing

Categories

  • Community-aquired pneumonia (CAP. Caused by S. pneumoniae
  • Healthcare associated pneumonia (HCAP). Contact with the healthcare system, but not the hospital
  • Hospital-acquired (nosocomial) pneumonia
  • Ventilator associated (VAP)

Manifestations

  • Fever
  • O2 levels decrease, heart rate increases, respiratory rate increases
  • Dyspnea
  • Cough with abnormal sputum
  • Crackling lung sounds
  • Decreased level of consciousness (elderly)

Second most common hospital infection

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13
Q

Pneumococcal Pneumonia

A
  • Caused by S. pneumoniae
  • Has polysaccharide capsule that makes phagocytosis difficult
  • Releases toxins that directly damages airway and the alveoli
  • Inflammatory response: accumulation of fluid in the lungs
    1. Red hepatization: bleeding in the lungs, they become more dense, solid.
    2. Grey hepatization: breakdown of RBC’s, reabsorb components, not full off blood anymore, and not as dense or solid.

Primary level of prevention

  • Pneumococcal vaccines for infants and 65+ populations
  • Influenza vaccines for 65+ populations
  • Vaccines for immunocompromised
  • Good hand washing prevention

Secondary LOP

  • Early recognition of signs and symptoms
  • Chest x-ray, blood count, blood cultures, physical assessment

Tertiary LOP

  • Antibiotics
  • Supportive treatment (O2, fluids, nutrition, rest)
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14
Q

Acute Bronchiolitis

A

An acute infection or inflammation in the lower airways

  • Common in infants and toddlers due to tiny airways.
  • Due to viral illness, caused by respiratory syncytial virus (RSV)
  • Reoccurs as infection, does not confer immunity

Manifestations
- Wheezing, stridor (high pitched wheezing sound), lung crackles, cyanosis, tachypnea, indrawing (inward movement above the sternum, bottom of ribcage and intercostal muscles)

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15
Q

Tuberculosis

A

Etiology

  • Mycobacterium tuberculosis
  • Acid-fast bacillus
  • Airborne, can remain suspended for several hours
  • Still very prevalent on a global scale

Pathophysiology

  1. Primary TB
    - Previously unexposed
    - Can either go into latency (95%) or can become ill (5%)
  2. Secondary TB
    - Re-activation of the first infection
    - If we become immunosuppressed
    - Another exposure

Manifestations

  • Dyspnea - shortness of breath
  • Persistent cough
  • Bloody sputum
  • Pleuritic pain
  • Fever
  • Night sweats
  • Fatigue
  • Weight loss
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16
Q

Extrapulmonary TB Infection

A
  • Bacilli spread to other organs via blood stream or lymphatic vessels
  • Meningitis
  • Bones and joints
  • Kidneys
  • Pericarditis
  • Peritonitis
  • Liver
17
Q

Chronic Obstructive Pulmonary Disease

A

60% of COPD patients have both emphysema and chronic bronchitis

Manifestations

  • Coughing
  • Whezing
  • Dyspnea
  • Hypoxemia
  • Hypercapnia
  • Barrel chest (increased A-P diameter)

Complications

  • Pulmonary hypertension
  • Right-sided heart failure (Cor pulmonale)
18
Q

Chronic Bronchitis

A

Chronic inflammation of the bronchi
- Productive cough that alsts for at least 3 months of the year and for at least 2 consecutive years

Caused by
- Exposure to cigarette smoke, air pollution and infection

Bronchial edema

  • Swelling of the bronchiole walls
  • Excessive production of mucus (thick and tenacious/ persistent and sticky)
19
Q

Emphysema

A

Breathing out is harder than normal

  • Air trapping
  • Hyperinflation of lungs

Permanent damage to terminal bronchioles and alveoli

  • Destruction of walls between alveoli
  • Destruction of accompanying capillary bed
  • Floppy terminal bronchioles
  • Loss of elasticity of alveoli (expansion and recoil)

Etiology

  • Smoking and chronic exposure to environemtn irritants
  • Genetic - lack of enzyme alpha 1 antritrypsin
20
Q

Asthma

A
  • Chronic disease with flares
  • Hypertrophy of smooth muscles
  • Edema of bronchiole walls
  • Increased number of mucous producing cells
  • Number of people affected by asthma keeps on increasing but the mortality has flattened out

Manifestations

  • Dyspnea
  • Cough
  • More sputum
  • Sometimes hemoptysis
  • Cyanosis

Treatment

  1. Long term control
    - Minimize exposure to triggers
    - Peak flow monitors
    - Corticosteroids, inhaled, oral
    - Mast cell stabilizers
    - IgE inhibitors
  2. Quick relief medications
    - Beta 2 agonists
    - Anticholinergic inhalers
21
Q

Status Asthamticus

A

Life threatening asthmatic attack that does not respond to normal treatment

  • Persistent shortness of breath
  • Inability to speak in complete sentences
  • Agitations, confusion
  • Accessory muscle use
  • Possible decrease in wheezing
22
Q

Lung Cancer

A

Epidemiology

  • # 1 cause of cancer deaths in men/women in Canada/USA
  • Overall 5 year survival rate is 15%
  • Inuit population was once cancer free, now has one of the steepest rates of lung cancer anywhere in the owrld
  • 60-80% are smokers

Risk factors

  1. Smoking
    - Heavy smokers have a 20x greater chance of developing lung cancer than nonsmokers
    - Smoking is also related to cancers of the larynx, oral cavity, pancreas, esophagus and urinary bladder
  2. Other
    - Second hand smoke
    - Exposure to workplace toxins, radiation, pollution, tuberculosis

Tumour types

  1. Small cell tumours (neuroendocrine tumours)
    - Also known as small cell carcinoma
    - Highest correlation with smoking
    - Grows rapidly, aggressively
    - Metastasize early, worst prognosis
    - Produces ectopic hormones (first sign that the tumour is there)
  2. Non-small cell tumours (75-80%)
    a. Large cell carcinoma (10%)
    - Undifferentiated
    - Rapid growth
    - Grows centrally
    b. Adenocarcinoma (35-40%)
    - Moderate speed of growth
    - Arise from glands
    - Grow peripherally
    - Pleuritic pain
    c. Squamous cell carcinoma (30%)
    - Grows centrally
    - Slowest growing

Manifestations

  • Often attribute to side effects of smoking
  • Once severe enough, disease is often advances
  • Cough
  • Increased sputum
  • Hemoptysis
  • Atelectasis (due to obstruction)
  • Wheezing (narrowed airways)
  • Pleuritic chest pain
  • Hypoexmia
  • Hypercapnia
23
Q

Cystic Fibrosis

A

Epidemiology

  • Autosomal recessive disorder
  • In Canada 1/3600 children born have CF
  • Primarily caucasians
  • Mostly affects the lungs, but also affects sweat glands, the pancreas and GI system

Etiology

  • The gene mutation on a single gene (chromosome #7)
  • Affects the production and function of a protein
  • The gene mutations causes abnormal cystic fibrosis transmembrane conductance regulator (CFTCR) protein
  • Abnormal chloride channels in cell membrane
  • Results in altered levels of sodium and chloride
Results
Lungs
- Dehydrated and thick mucus in the lungs
- Impaired cilia activity
- Recurrent lung infections and colonization with pseudomonas aeruginosa and Staphylococcus aureus
- Cough, recurrent pneumonia, wheezing
GI Tract
- Impaired exocrine pancreatic function
- Altered GI function
Skin
- Salt travels to the skin surface

Diagnosis

  • Look at manifestations
  • Blood test and sweat test, looking for high chloride concetration
  • Genotyping, newborn screening

Treatment

  • Pulmonary health
  • Chest physio, respiratory medication, antibiotic therapy
  • Lung transplant
  • Nutrition, enzyme replacement.

Pathophysiology (21 decks)

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