Disorders of Respiratory Function Flashcards
Lung Functions
Gas exchange: Moves O2 into blood/Removes CO2 from blood Blood reservoir Regulate vasoconstricting substances Inactivates Bradykinin Angiotensin II Heparin-producing cells
Upper Airways
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
Membranes and Cavities
Serous Fluid holds everything together between lungs and chest wall. 10 mL’s
Infusion is when too much Serous Fluid is produced
Inspiration
diaphragm contracts and chest cavity expands producing a decrease in intrathoracic pressure (-2) causing air to move into the lungs.
Expiration
diaphragm and chest cavity relax producing an increase in intrathoracic pressure which cause air to move out of the lungs.
Respiration
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
Accessory muscles of inhalation
External intercostals
Scalene
Sternocleidomastoid
Accessory muscles of exhalation
Internal intercostals
Abdominal muscles
Compliance
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
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?
DECREASED COMPLIANCE
Positive pressure ventilation: to build pressure in the lungs
Gas Exchange
Oxygen moves from alveolar air into blood
Carbon dioxide moves from blood into alveolar air
Ventilation-Perfusion Mismatching
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
Oxygen-Hemoglobin Dissociation Curve
Shift to right: fever, acidosis
Shift to left: hypothermia, alkalosis
Carbon Dioxide
When you exhale you remove CO2 from your blood and also decrease the amount of carbonic acid, raising your blood pH
Apenuestic (respiratory centers)
begins inspiration
Pneumotaxic (respiratory centers)
stretch receptors increased lung volume
Central chemoreceptors
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.
Peripheral chemoreceptors
Located in the carotid and aortic bodies
Measure PO2 in arterial blood
Increase respiration when PO2 <60 mm Hg
Signs and Symptoms
of Pulmonary Disease
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
Dyspnea
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
Orthopnea
Dyspnea when lying down
Paroxysmal nocturnal dyspnea
GABY.
Awaking at night and gasping for air; must sit up or stand up
Pushes adipose tissue onto diaphragm, depends on sleep position
Cough
Protective reflex that helps clear the airways by an explosive expiration
Acute: 2-3 weeks
Chronic 3+ weeks
Hemoptysis
Coughing up blood or bloody secretions
Eupnea
Normal breathing
Kussmaul respirations (hyperpnea)
Slightly increased ventilatory rate, very large tidal volume, and no expiratory pause (eliminate CO2)
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.
Is caused by airway obstruction, chest wall restriction, or altered neurologic control of breathing.
Hyperventilation
Alveolar ventilation exceeds the metabolic demands.
Leads to respiratory alkalosis from hypocapnia.
Is caused by anxiety, head injury, or severe hypoxemia.
Cyanosis
Bluish discoloration of the skin and mucous membranes
Develops when have 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
Chronic respiratory problem, lower O2 levels
Found in people with COPD
Round fingers
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.
Hypercapnia
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
Hypoxemia
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
ATELECTASIS
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.)
A Mucus plug is not a high risk in post-op patients
False, they are at high risk
How do you treat atelectasis?
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.
Clinical Manifestations of Atelectasis
Dyspnea Cough Fever Leukocytosis Absent breath sounds
What lobe is most frequently impacted when food/saliva go down in a patient with atelectasis?
Right Lower Lobe
Who is most at risk for atelectasis?
Bed ridden patients with a lot of sputum Stroke patients (weak swallowing muscles) Cerebral palsy (decreased consciousness, muscle weakness)
Pneumonia
is an inflammation of parenchymal structures of the lungs (alveoli/bronchioles)
Typical Pneumonia
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
Atypical Pneumonia
Viral & Mycoplasma infections of alveolar septum or interstitium
Less severe symptoms
Pneumonia: Predisposing factors
Loss of cough reflex
Damage to the ciliated endothelium
Impaired immune function
The critically or chronically ill
Pneumonia: S/S
Fever Malaise: Discomfort Cough Productive or non-productive Sputum characteristics Pleuritic pain (sharp) Elderly (losing appetite, mental process)
Dx of Pneumonia
Sputum Culture, H&P, CXR
Tuberculosis
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
Clinical Manifestations of Tuberculosis
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
Diagnosis of Tuberculosis
Positive tuberculin skin test (TST) a purified protein derivative (PPD): Does not differentiate past, latent, or active disease
Sputum culture, immunoassays
Chest radiographs
Tuberculosis Treatment
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
Secondary TB
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.
Pleural Effusion
Collection of fluid in the pleural cavity. (too much fluid)
Caused by CHF (increased capillary pressure), protein malnutrition, kidney failure, etc.
Hemothorax
collection of blood in the pleural cavity.
Causes: Blunt trauma
Pneumothorax
Air in the pleural cavity.
Causes: Spontaneous, ruptured blebs, emphysema, trauma, tension.
Different types of Pleural Effusion
Hydrothorax: serous fluid
Empyema: pus (maybe pneumonia)
Chylothorax: lymph
Hemothorax: blood
Spontaneous Pneumothorax
An air-filled blister on the lung ruptures
Open Pneumothorax
air enters pleural cavity through the wound on inhalation but cannot leave on exhalation, FATAL
Tension Pneumothorax
air enters pleural cavity through the wound on inhalation and leaves on exhalation, medical emergency
Who is MOST at risk for pneumothorax?
Weight lifters, smokers, etc. are at risk for the bleb to form/pop
Pneumothorax—S&S
Chest pain (ipsilateral) Tachypnea: rapid/shallow respirations Dyspnea Tachycardia Hyperresonant chest percussion (a lot of air) Decreased or absent BS on affected side Hypoxemia
