Dz: Ch.4 Respiratory System

Question 1

Respiratory System Divisions

Answer 1

Upper: passageways that conduct air between atmosphere and lung

Lower: trachea, bronchioles, lungs - gas xchanges

Question 2

Respiratory Mucosa

Answer 2

Mucous secreting cells: trap particles

Cilia: sweep mucous/debri out

Question 3

Bronchodilation

Answer 3

Sympathetic stimulation = relax smooth mm

Bronchioles>alveolar ducts>alveoli

Question 4

Alveoli

Answer 4

Single layer of squamous epithelial cells

Promotes diffusion of gasses

Question 5

Surfactant

Answer 5

Decreases surface tension
Facilitates inspiration
Prevents collapse of alveoli when expires

Question 6

Pulmonary Volumes

Answer 6

Forced Expiratory volume in 1 sec (FEV1) = (approx 80% of Vital Capacity) 3200ml
Vital Capacity (VC) 4000ml: max amount of air that can be moved in/out lungs
Residual Vol (1500ml) + Vital Capacity (4000ml) = total lung capacity (5500ml)

Question 7

Control of Ventilation

Answer 7

Medulla: inspiration
Pons: coordination

Question 8

Chest Imaging

Answer 8

Radiographs
CT
MRI

Question 9

Pulmonary Diagnostic Testing

Answer 9

Spirometry: volumes/airflow
Arterial blood gas: check O2, CO2, bicarbonate
Exercise tolerance (COPD): monitor progress
X-rays: tumors/infections
Bronchoscopy: biopsy for lesion
Peak expiratory flow (asthma)
Acid base balance: 7.35-7.45 pH
  - Resp acidosis (pH low)  
  - Resp alkalosis (pH high)

Question 10

Upper Respiratory Disease

Answer 10

Infection causing cold S/S

Question 11

Sreptococus Pneumoniae

Answer 11

Secondary Infection (occurs after initial infection)
Inflamed, necrotic mucous membranes

Question 12

Influenza

Answer 12

Upper and/or lower respiratory tract
Viruses mutate = different strands
Can get secondary infection

Question 13

Pneumonia

Answer 13

Primary infection or secondary to another condition
Aspiration or inflammation of lung
Bacterial/Viral/Fungal
Labor Pneumonai: manifestations

Question 14

Bronchopneumonia

Answer 14

Lower lobes

Pooled secretions

Question 15

Severe Acute Respiratory Syndrome (SARS)

Answer 15

Spreads rapidly
High mortality rate
Risk factors: travel to China, Hong Kong, Taiwan

Question 16

Tuberculosis (Ghon complexes)

Answer 16

Primary infection: upper lobe local inflammatory rctn
Miliary TB: progressive form, doesn’t respond well to treatment
Secondary: “active”
Treat 3 months to a year

Question 17

Obstructive Lung Disease

Answer 17

Cystic Fibrosis
  - Inherited
  - Thick secretions = Obstructs lungs &
    pancreas
  - salty skin
  - Diagnose: sweat test

Question 18

Lung Cancer

Answer 18

90% lung cancer related to smoking
Bronchogenic carcinoma: Most common malignant lung tumor

Tumor: obstruction, inflammation, pleural effusion
Para neoplastic syndrome: secretes hormones (ADH)

Question 19

Asthma

Answer 19

Severe/reversible bronchial obstruction
Extrinsic (type I hypersensitivity) factors to smoke, perfumes, strong smells, molds, dander
Intrinsic (nonimmune) factors to respiratory infx, exposure to cold, meds, psychological stress
Partial/Total obstruction of airway
Chronic: may develop irreversible damage (bronchial walls thicken)
Etiology: fmHx, air pollution
S/S: can lead to respiratory failure
Tx: allergy test, breathing techniques

Question 20

Emphysema

Answer 20

"Pink puffer"
COPD
Breakdown alveolar walls
  - Decrease support for small bronchi:
    collapse walls
Fibrous thickening of bronchial walls
  - Difficulty with passive expiration
Progressive problems with expiration
  - Barrel chest
  - Diaphragm flattened
Advanced emphysema
  - Hypercapnia increases (really high O2)

Question 21

Emphysema (Etiology, S/S, Diagnostics,Tx)

Answer 21

Etiology: Genetics: alpha1 –antitrypsin: inhibits activity of proteases (present during inflammation), air pollution, cigarette smoking
S/S: Dyspnea on exertion (DOE) progress&raquo_space;
rest, HTN (use of accessory muscles), Clubbed fingers
Diagnostics: Pulmonary function tests:
- Increased residual volume
- Increased total lung capacity
Tx: Pulmonary rehab: Pursed lip breathing

Question 22

Chronic bronchitis

Answer 22

“Blue boater”
COPD
Constant irritation from smoking or industrial pollution
Inflammation of mucous
Low O2: may develop cyanosis (not a good early indicator of hypoxia)
S/S: Severe chroniccoughing, systemic edema
Tx: Low flow oxygen, Expectorants, bronchodilators, chest therapy (remove mucous)

Question 23

Aspiration

Answer 23

Passage of fluid or food, vomitus, drugs, other foreign material into trachea and lungs
R-Lung most common: more vertical
Solid Object: ball-valve-effect (air in/little air out), fatty solids can cause inflammation (form
granuloma/fibrous tissue)
Liquid: acidic, etoh, or oils = dispenses quickly causing impaired gas diffusion

Question 24

Aspiration (Etiology, S/S, Tx)

Answer 24

Etiology: young children (smooth round objects most dangerous), depressed swallowing or gag reflex (head trauma), adults (alcohol, eating/talking)
S/S: nasals flaring, choking (dyspnea)
Tx: heimlich maneuver

Question 25

Bronchiectasis

Answer 25

Usually secondary to CF/COPD

Irreversible abnormal dilation or widening of the medium-sized bronchi
S/S: Foul breath, dyspnea, hemoptysis, Copious amounts of purulent sputum
Tx: Bronchodilators, Chest PT

Question 26

Restrictive lung disorders

Answer 26

Lung expansion is impaired

Reduced lung capacity

Some diseases demonstrated obstructive and restrictive signs

Question 27

Pneumonconioses

Answer 27

Chronic long term exposure to irritating substances
- Coal dust, silica, asbestos, fungal spores
Overload of small particles
Destroy connective tissue = loss of fx (irreversible)

Question 28

Asbestos

Answer 28

Can cause pleural fibrosis
Increases risk of lung CA
S/S: Difficulty with inspiration

Question 29

Vascular disorders

Answer 29

Pulmonary edema: fluid collects in alveoli &
interstitial fluid
- Occurs: inflam, plasma protein low, pulm
HTN
Etiology: L-sided CHF, lung inflam, blocked
lymphatic drainage, liver/kidney dz
S/S: mild edema (couch, rales), sever edema
(frothy sputum, drowning feeling)

Question 30

Pulmonary Embolus

Answer 30

Blood clot or mass that obstruct pulmonary artery or branch of it

Usually caused by blood clots in leg veins

Leading cause of death in hospitals