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Pathophysiology Exam 2 > Disorders of Respiratory Function > Flashcards

Disorders of Respiratory Function Flashcards

1
Q

Lung Functions

A 
Gas exchange: Moves O2 into blood/Removes CO2 from blood
Blood reservoir
Regulate vasoconstricting substances
Inactivates Bradykinin
Angiotensin II
Heparin-producing cells
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2
Q

Upper Airways

A 
Move air into lungs
Warm, filter and humidify air
Trap inhaled particles
Cilia move the trapped material toward the oropharynx for expectorating or swallowing
The blood supply closest to the
	surface warms air and adds 
	humidity to improve gas 
	movement and gas exchange
The cough and sneeze 
	reflexes clear the airways
Glottis covers larynx during 
	swallowing
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3
Q

Membranes and Cavities

A

Serous Fluid holds everything together between lungs and chest wall. 10 mL’s
Infusion is when too much Serous Fluid is produced

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4
Q

Inspiration

A 
diaphragm contracts
 and chest cavity expands 
producing a decrease in 
intrathoracic pressure (-2) causing 
air to move into the lungs.
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5
Q

Expiration

A

diaphragm and chest cavity relax producing an increase in intrathoracic pressure which cause air to move out of the lungs.

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6
Q

Respiration

A

Controlled through the medulla in the central nervous system
Depends on a balance between the sympathetic and parasympathetic systems
Depends on a functioning muscular system

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7
Q

Accessory muscles of inhalation

A

External intercostals
Scalene
Sternocleidomastoid

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8
Q

Accessory muscles of exhalation

A

Internal intercostals

Abdominal muscles

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9
Q

Compliance

A 
How easily lungs can be inflated
Depends on:
Elastin and collagen fibers
Water content
Surface tension- reduced by surfactant
Compliance of thoracic cage
Poor compliance: a lot of force from the lungs.
If elastin is replaced by collagen, poor compliance occurs (pulmonary fibrosis)
Water/fluid decreases compliance
Fractured Rib: decreases compliance
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10
Q

A Man’s Lungs Were Damaged
During a Fire …
He developed severe respiratory distress
The doctor said smoke inhalation had caused an inflammation of his alveoli
The damage had also destroyed some of his surfactant
What had happened to his lung compliance?
Why was he given positive-pressure ventilation?

A

DECREASED COMPLIANCE

Positive pressure ventilation: to build pressure in the lungs

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11
Q

Gas Exchange

A

Oxygen moves from alveolar air into blood

Carbon dioxide moves from blood into alveolar air

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12
Q

Ventilation-Perfusion Mismatching

A

Blood goes to parts of the lung that do not have oxygen to give it (Shunt)
Blood does not go to parts of the lung that have oxygen (alveolar dead space)
Obstructed airway, mucous plug, food, stuck in alveolus
Pulmonary Embolism: Ventilation without perfusion
Lack of surfactant can cause a shunt

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13
Q

Oxygen-Hemoglobin Dissociation Curve

A

Shift to right: fever, acidosis

Shift to left: hypothermia, alkalosis

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14
Q

Carbon Dioxide

A

When you exhale you remove CO2 from your blood and also decrease the amount of carbonic acid, raising your blood pH

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15
Q

Apenuestic (respiratory centers)

A

begins inspiration

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16
Q

Pneumotaxic (respiratory centers)

A

stretch receptors increased lung volume

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17
Q

Central chemoreceptors

A

Function in breathing

Located in the resp center of medulla & in the CSF (cerebral spinal fluid)
Measure PCO2 and pH in cerebrospinal fluid
Increase respiration when PCO2 increases or pH decreases

If patient has chronic lung disease, central chemoreceptors aren’t really there.

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18
Q

Peripheral chemoreceptors

A

Located in the carotid and aortic bodies
Measure PO2 in arterial blood
Increase respiration when PO2 <60 mm Hg

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19
Q

Signs and Symptoms

of Pulmonary Disease

A 
Dyspnea (difficulty breathing) and cough (productive/nonproductive)
Altered breathing patterns
Hyperventilation (low CO2)
Hypoventilation (high CO2)
Hemoptysis
Abnormal sputum (cough spit)
Cyanosis (turning blue, lips, nailbeds)
Chest pain
Clubbing
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20
Q

Dyspnea

A

Sign and Symptom of Pulmonary Disease
shortness of breath
Uncomfortable breathing

Severe dyspnea
Flaring of the nostrils
Use of accessory muscles of respiration
Retraction of the intercostal spaces

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21
Q

Orthopnea

A

Dyspnea when lying down

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22
Q

Paroxysmal nocturnal dyspnea

A

GABY.
Awaking at night and gasping for air; must sit up or stand up
Pushes adipose tissue onto diaphragm, depends on sleep position

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23
Q

Cough

A

Protective reflex that helps clear the airways by an explosive expiration
Acute: 2-3 weeks
Chronic 3+ weeks

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24
Q

Hemoptysis

A

Coughing up blood or bloody secretions

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25
Q

Eupnea

A

Normal breathing

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26
Q

Kussmaul respirations (hyperpnea)

A

Slightly increased ventilatory rate, very large tidal volume, and no expiratory pause (eliminate CO2)

27
Q

Cheyne-Stokes respirations

A

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

28
Q

Hypoventilation

A

Alveolar ventilation is inadequate in relationship to the metabolic demands.
Leads to respiratory acidosis from hypercapnia.
Is caused by airway obstruction, chest wall restriction, or altered neurologic control of breathing.

29
Q

Hyperventilation

A

Alveolar ventilation exceeds the metabolic demands.
Leads to respiratory alkalosis from hypocapnia.
Is caused by anxiety, head injury, or severe hypoxemia.

30
Q

Cyanosis

A

Bluish discoloration of the skin and mucous membranes

Develops when have five grams of desaturated hemoglobin, regardless of concentration

31
Q

Peripheral cyanosis

A

Most often caused by poor circulation

Best observed in the nail beds

32
Q

Central cyanosis

A

Caused by decreased arterial oxygenation (low partial pressure of oxygen [Pao2])
Best observed in buccal mucous membranes and lips

33
Q

Clubbing

A

Chronic respiratory problem, lower O2 levels
Found in people with COPD
Round fingers

34
Q

Pleural pain

A

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.

35
Q

Chest wall pain

A

May be from the airways.

May be from muscle or rib pain.

36
Q

Hypercapnia

A

caused by hypoventilation
Increased carbon dioxide (CO2) in the arterial blood
Occurs from decreased drive to breathe or an inadequate ability to respond to ventilatory stimulation

37
Q

Hypoxemia

A

caused by hyperventilation, O2 is abnormally low.
Hypoxemia versus hypoxia: hypoxia is low O2 in blood.
Ventilation-perfusion abnormalities: Most common cause of Hypoxemia.

Shunting
Alveolar dead space: Area where alveoli are ventilated
but not perfused

38
Q

ATELECTASIS

A

Incomplete expansion of a lung or portion of a lung (alveolar collapse)
most commonly occurs postoperatively because of sedation (Under sedation, a patient’s respiratory rate decreases and shallow breathing occurs.)

39
Q

A Mucus plug is not a high risk in post-op patients

A

False, they are at high risk

40
Q

How do you treat atelectasis?

A

To treat atelectasis, the patient needs to cough and deep breathe to open all the alveoli—an incentive spirometer is used.

Supplemental oxygen; may require mechanical ventilation with positive end-expiratory pressure (PEEP).
Restrict fluids to decrease blood volume and minimize pulmonary edema.
Administer steroids during the first 72 hours after aspiration.
May need broad-spectrum antibiotics.

41
Q

Clinical Manifestations of Atelectasis

A 
Dyspnea
Cough 
Fever 
Leukocytosis 
Absent breath sounds
42
Q

What lobe is most frequently impacted when food/saliva go down in a patient with atelectasis?

A

Right Lower Lobe

43
Q

Who is most at risk for atelectasis?

A 
Bed ridden patients with a lot of sputum
Stroke patients (weak swallowing muscles)
Cerebral palsy (decreased consciousness, muscle weakness)
44
Q

Pneumonia

A

is an inflammation of parenchymal structures of the lungs (alveoli/bronchioles)

45
Q

Typical Pneumonia

A

Typical: bacteria that multiply in the alveoli
Lobar: affect part or entire lobe of the lung (in the middle lobe)
Bronchopneumonia: patchy distribution over more than one lobe

46
Q

Atypical Pneumonia

A

Viral & Mycoplasma infections of alveolar septum or interstitium
Less severe symptoms

47
Q

Pneumonia: Predisposing factors

A

Loss of cough reflex
Damage to the ciliated endothelium
Impaired immune function
The critically or chronically ill

48
Q

Pneumonia: S/S

A 
Fever
Malaise: Discomfort
Cough
Productive or non-productive 
Sputum characteristics
Pleuritic pain (sharp)
Elderly (losing appetite, mental process)
49
Q

Dx of Pneumonia

A

Sputum Culture, H&P, CXR

50
Q

Tuberculosis

A

Infection caused by Mycobacterium tuberculosis, an acid-fast bacillus
Leading cause of death from a curable infectious disease throughout the world
Airborne droplet transmission
Tubercle formation: Granulomatous lesion
Caseous necrosis: Cheeselike material

51
Q

Clinical Manifestations of Tuberculosis

A

Latent tuberculosis infection: Asymptomatic
Fatigue, weight loss, lethargy, anorexia (loss of appetite), a low-grade fever that usually occurs in the afternoon, and night sweats; purulent cough

52
Q

Diagnosis of Tuberculosis

A

Positive tuberculin skin test (TST) a purified protein derivative (PPD): Does not differentiate past, latent, or active disease
Sputum culture, immunoassays
Chest radiographs

53
Q

Tuberculosis Treatment

A

Isoniazid, rifampin, pyrazinamide, and ethambutol
Drug-resistant bacilli: Combination of at least four drugs to which the microorganism is susceptible, administering for 18 months. Check every 6 months

54
Q

Secondary TB

A

Re-infection from inhaled droplet nuclei/Reactivation of a previously healed primary lesion
Bacteria damage tissues in the airways, creating cavities
Immunocompromised MOST at risk
Signs of chronic pneumonia: gradual destruction of lung tissue
S&S: cough (dry→productive purulent or blood-tinged), low-grade fever, night sweats, weight loss, anorexia, fatigue.

55
Q

Pleural Effusion

A

Collection of fluid in the pleural cavity. (too much fluid)

Caused by CHF (increased capillary pressure), protein malnutrition, kidney failure, etc.

56
Q

Hemothorax

A

collection of blood in the pleural cavity.

Causes: Blunt trauma

57
Q

Pneumothorax

A

Air in the pleural cavity.

Causes: Spontaneous, ruptured blebs, emphysema, trauma, tension.

58
Q

Different types of Pleural Effusion

A

Hydrothorax: serous fluid
Empyema: pus (maybe pneumonia)
Chylothorax: lymph
Hemothorax: blood

59
Q

Spontaneous Pneumothorax

A

An air-filled blister on the lung ruptures

60
Q

Open Pneumothorax

A

air enters pleural cavity through the wound on inhalation but cannot leave on exhalation, FATAL

61
Q

Tension Pneumothorax

A

air enters pleural cavity through the wound on inhalation and leaves on exhalation, medical emergency

62
Q

Who is MOST at risk for pneumothorax?

A

Weight lifters, smokers, etc. are at risk for the bleb to form/pop

63
Q

Pneumothorax—S&S

A 
Chest pain (ipsilateral)
Tachypnea: rapid/shallow respirations
Dyspnea
Tachycardia
Hyperresonant chest percussion (a lot of air)
Decreased or absent BS on affected side
Hypoxemia

Pathophysiology Exam 2 (4 decks)

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