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POM unit 4 > dyspnea > Flashcards

dyspnea Flashcards

1
Q

dyspnea

A

subjective experience of breathing discomfort that is comprised of qualitatively distinct sensations that vary in intensity. it is a complex sensation like hunger or thirst. breathing feels uncomfortable labored, unsatisfying.

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2
Q

visual analogue scale for measuring dyspnea

A

this is a scale from 0cm-10cm with 10 being the worst shortness of breath.

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3
Q

modified borg scale

A

0-10 with 10 being the maximal of sensation. there are descriptive terms next to the numbers.

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4
Q

modified medical research council scale

A

based on a grade system from 0-4. grade 4 being i cannot leave the house.

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5
Q

is there a single receptor for the sensation of dyspnea?

A

no. there are many throughout the respiratory system that have to be considered,

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6
Q

where is the afferent information processed?

A

in the cortex.

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7
Q

where do the motor commands come from for dyspnea?

A

the cortex and the brainstem

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8
Q

role of chemoreceptors in dyspnea

A

induction of hypercapnea or severe hypoxemia causes dyspnea. however patients with these are not invariably dyspneic

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9
Q

role of chest-wall mechanoreceptors

A

located in the muscle spindles and tendon organs in the respiratory muscles. innervated by the anterior horn cells of the spinal motor neurons

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10
Q

where do the mechanoreceptors project?

A

somatosensory cortex

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11
Q

metaboreceptors

A

located in the skeletal muscle respond to local changes in the tissue environment with respect to byproducts of metabolism.

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12
Q

what do metaboreceptors lead too?

A

they lead to sensation of dyspnea during exercise even without hypercapnea or hypoxemia

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13
Q

what are the types of vagal receptors

A

slowly adapting stretch receptors, rapidly adapting stretch receptors and c-fiber

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14
Q

SARs found where

A

smooth muscle of large airways

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15
Q

SARs are what?

A

the myelinated afferent fibers of the vagus nerve

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16
Q

how are SARs affected by CO2 what is the effect?

A

inhalation of CO2 which inhibits activity

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17
Q

how are SARs affected by volatile anesthetics

A

may inhibit or stimulate depending on concentration and type of SARs

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18
Q

rapidly adapting stretch receptors do what>

A

maintain inflation or deflation of the lung.

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19
Q

what are RASr also known as?

A

irritant receptors

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20
Q

what activates the RASr

A

large number of stimuli either mechanical or chemical. smoke, ammonia, ether vapor. inflammatory and immunological mediators and by airway and lung pathological changes.

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21
Q

can pneumothorax stimulate the RASr?

A

yes it can. so can any other disease process that distorts the lung. this can induce dyspnea as well

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22
Q

what and where are C-fibers?

A

they are jutapulmonary capillary receptors or J receptors localized close to the alveolar capillaries in the pulmonary and bronchial circulation. they are unmyelinated fibers.

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23
Q

what do c-fibers respond to?

A

pulmonary congestion is a strong stimulator

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24
Q

what does hypercapnea stimulate and what does it produce?

A

central receptors and presents as air hunger

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25
Q

what does hypoxia stimulate and what does it produce?

A

peripheral chemoreceptors and also produces air hunger

26
Q

what does muscle contraction stimulate and represent?

A

stimulates chest wall receptors and represents work/effort

27
Q

what does muscle fatigue stimulate and what does it represent?

A

stimulates muscle spindles and represents work/effort

28
Q

what does mechanical load stimulate and what does it represent?

A

joint receptors, tendon receptors and metaboreceptors and signifies work/effort.

29
Q

what does bronchoconstriction stimulate and represent?

A

RARs and C-fibers. represents chest tightness

30
Q

what does lung inflation stimulate and what does it signify?

A

SARs. signifies dyspnea relief.

31
Q

what does the controller do?

A

determines the depth and rate of breathing.

32
Q

what does the ventilatory pump do?

A

facilitates movement of gas into and out of the alveolus

33
Q

what does the gas exchanger do?

A

consists of the pulmonary vasculature and the alveolus

34
Q

examples of diseases of an impaired gas exchanger that cause hypoxemia?

A

PE, asthma, pneumonia, CHF.

35
Q

other diseases that cause acute hypoxemia?

A

environmental hypoxia such as altitude or contained space in a fire.

36
Q

examples of diseases of the impaired gas exchanger that would cause hypercapnea

A

acute severe asthma, COPD, severe pulmonary edema.

37
Q

what diseases of the ventilatory pump would cause hypercapnea

A

muscle weakness or airflow obstruction.

38
Q

what stimulates chemoreceptors? which diseases?

A

seemingly anything that perturbs the O2 or the CO2 status. decreased CO, anemia, hemaglobinopathy, renal disease that causes metabolic acidosis, muscle weakness, airflow obstruction, COPD, asthma, PE, pneumonia, CHF. altitude or fire.

39
Q

what stimulates pulmonary receptors?

A

irritant, mechanical, vascular. interstitial lung disease, pleural effusion, pulmonary vascular disease, CHF, mild asthma

40
Q

what are some behavioral factors that an cause ventilatory issues?

A

hyperventilation syndrome or anxiety and panic attacks.

41
Q

what diseases of muscle weakness can affect the ventilation

A

myasthenia, guillan barre, spinal cord injury, myopathy, post-poliomyelitis syndrome

42
Q

what diseases can decrease the compliance of the chest wall and cause respiratory issues?

A

severe kyphoscoliosis, OBESITY and pleural effusion

43
Q

what diseases can cause airflow obstruction

A

asthma, COPD, laryngeospasm, aspiration of foreign body

44
Q

what is intermittent dyspnea characteristic of? with examples

A

reversible conditions such as asthma, CHF, pleural effusion, acute PE

45
Q

what is persistent or progressive dyspnea characteristic of? with examples

A

chronic conditions such as COPD, interstitial fibrosis, chronic PE, dysfunction of the diaphragm or chest wall.

46
Q

what diseases can give nocturnal dyspnea?

A

asthma, CHF, GERD, OSA, nasal obstruction

47
Q

what diseases can give dyspnea in the recombinant position? or give orthopnea?

A

LVF, abdominal process such as ascites, diaphragmatic dysfunction

48
Q

what diseases can give you playpnea? or upright positional dyspnea?

A

cirrhosis, pulmonary-arterio malformations, interarterial shunts.

49
Q

what is suggestive of cough on deep inspiration or expiration

A

asthma or interstitial lung disease

50
Q

what causes a generalized decrease in lung sounds?

A

emphysema and moderate to severe bronchoconstriction

51
Q

what causes a localized decreased in lung sounds?

A

pneumothorax, pleural effusion, localized airway obstruction

52
Q

what is characteristic of pulmonary HTN on a cardiac exam?

A

right ventricular heave or prominent P2.

53
Q

what is usually found on cardiac exam when there is right ventricular failure?

A

JVD, right-sided S3 gallop

54
Q

what is found on cardiac exam when there is left ventricular failure

A

left-sided S3

55
Q

other signs of HF on cardiac exam?

A

JVP, clubbing, cyanosis, edema, hepatomegaly.

56
Q

what is a test you can do to elicit dyspnea?

A

walk with the patient down that hall

57
Q

instantaneous causes of dyspnea?

A

pneumothorax and PE

58
Q

what are some acute/subacute causes of dispnea?

A

asthma, COPD exacerbation, upper-airway obstruction, pneumonia, pulmonary edema, hypersensitivity pneumonitis, lobar atelectasia, actue interstitial pneumonia, PE, vasculitis, pleural effusion, MI, arrhythmia, valve diseases, tamponade, aortic dissection, metabolic acidosis, hyperventilation, anxiety, SVC obstruction, anaphylaxis

59
Q

what are some chronic causes of dyspnea?

A

COPD, asthma, interstitial disease, sarcoidosis, bronchiectasis, lymphangitic carcinomatous, chronic thromboembolic disease, primary pulmonary HTN, venoocclusive disease, pleural effusion, hypoventilation, anemia, thyrotoxicosis, pregnancy

60
Q

how long does it take for acute/subacute?

A

hours to days

61
Q

how long for chronic dyspnea?

A

months to years.

62
Q

some labs to order for dyspnea?

A

arterial blood gases, CBC, metabolic panel (HCO3, creatinine, anion-gap), cardiac enzyme, BNP

POM unit 4 (5 decks)

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