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115 LEC > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

How many R and L lobes of the lungs?

A

R - 3 - upper, middle, lower
L - 2 - upper, lower

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2
Q

What are the braches of the bronchi starting with lobar branch down?

A

Lobar branch (3-R, 2-L)
Segmental bronchi (10-R, 8-L)
Subsegmental bronchi
Bronchioles
Terminal bronchioles
Respiratory bronchioles
alveolar ducts and sacs
Alveolo

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3
Q

What do the segmental bronchi do

A

facilitate effective postural drainage

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4
Q

The conducting airways contain about —–of air in the tracheobronchial tree that does not participate in gas exchange….AKA?

A

150ML
Physiologic dead space

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5
Q

THe lungs are made up of how many alveoli?

A

300million

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6
Q

What are the mechanics of ventilation

A

air pressure variances
resistance to airflow
lung compliance

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7
Q

What are air pressure variances?
During inspiration?
During expiration?

A

air flows from a region of higher pressure to a region of lower pressure
-Inspiration - thoracic cavity enlarges & lowers pressure inside below atmospheric level & air is drawn in
-Expiration- lungs recoil/thoracic decreases creating higher pressure to push air out

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8
Q

What is airway resistance determined by

A

radius or size of airway through which air is flowing

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9
Q

What are factors that determine lung compliance?

A

surface tension fo alveoli, connective tissue adn water content of lungs and thorax

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10
Q

Increased compliance occurs if the lungs are
Decreased compliance occurs if the lungs are

A

lost their elastic recoil (emphysema)
Stiff

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11
Q

Conditions associated with decreased compliance are

A

severe obesity
pneumothorax
hemothorax
pleural effusion
pulmonary edema
atelectasis
pulmonary fibrosis
Acute respiratory distress syndrome

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12
Q

What is pulmonary diffusion

A

the process by which oxygen and carbon dioxide are exchanged from areas of high concentration to areas of low concentration at the air-blood interface

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13
Q

WHat is pulmonary perfusion

A

the actual blood flow through the pulmonary vasculature

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14
Q

The blood is pumped into the lungs by the _____

A

right ventricle through the pulmonary artery which divides to R and L branches to supply both lungs
*2% of blood pumped does not perfuse teh alveolar capillaries - drains into the L side of heart w/o gas exchange

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15
Q

Is pulmonary circulation low-pressure or high pressure

A

low pressure bc the pressure in pulmonary artery is 20-30mmHg and diastolic is 5-15 mmHG

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16
Q

What 3 things determine the patterns of perfusion

A

Artery pressure, gravity, alveolar pressure

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17
Q

What is TIDAL VOLUME
TV or VT
Normal value
Extra

A

The volume of air inhaled and exhaled with each breath
500ML or 5-10mL/kg
**Tidal volume may not vary even with severe disease

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18
Q

What is inspiratory reserve volume
IRV
Normal value

A

The max volume of air that can be inhaled after a normal inhalation
3000mL

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19
Q

What is EXPIRATORY RESERVE VOLUME?
ERV
Normal value
Extra info

A

The max volume of air that can be exhaled forcibly after a normal exhalation
1100mL
*Decreased with restrictive conditions, such as obesity, ascites, pregnancy

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20
Q

What is RESIDUAL VOLUME
RV
Normal value
Extra info

A

The volume of air remaining in the lungs after max exhalation
1200mL
*Residual volume may be increased with obstructive disease

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21
Q

What is VITAL CAPACITY
VC (Formula)?
Normal value
Extra info

A

the max volume of air exhaled from the point of max inspiration VC=TV+IRV+ERV
4600mL

  • may be found in neuromuscular disease, generalized fatique, atelectasis, Pulmonary edema, COPD and obseity
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22
Q

What is INSPIRATORY CAPACITY
IC (formula)?
Normal value
Extra info

A

The max volume of air inhaled after normal expiration IC = TV+IRV
3500ML

*may indicate restrictive disease/obseity

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23
Q

WHat is FUNCTIONAL RESIDUAL CAPACITY?
FRC (formula)?
Normal value
Extra info

A

Volume of air remaining in lungs after normal expiration FRC=ERV+RV
2300mL

*May be increased with COPD and decreased in aRDS and obesity

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24
Q

What is TOTAL LUNG CAPACITY
TLC (formula)?
Normal value
Extra info

A

Volume of air in lungs after max inspiration TLC=TV+IRV+ERV+RV
5800mL

*decrease with the restrictive disease, increased with COPD

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25
Q

What are the 4 possible ventilation/perfusion states V/Q in lungs?

A
  1. Normal ratio
  2. Low ratio (shunt)
  3. High ratio (dead space)
  4. absence of ventilation & perfusion (silent unit)
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26
Q

What is the gaseous mixture of air we breathe?

A

78% nitrogen
21% oxygen
1% argon
trace amounts of other gases

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27
Q

What is the atmospheric pressure at sea level

A

760 mmHg

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28
Q

What is partial pressure?

A

Pressure exerted by each type of gas in a mixture of gases

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29
Q

What would cause a shunt producing disorder?

A

when perfusion exceeds ventilation

a certain % of blood does NOT get reoxygenated and goes back to body to give O2 but is short

*identified by not improving to normal after giving 100% oxygen

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30
Q

What would cause a high perfusion ratio: dead space

A

when ventilation exceeds perfusion

Alveoli do not have adequate blood supply for gas exchange

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31
Q

Why is carbon dioxide higher partial pressure in blood than alveolar gas?

A

due to carbon dioxide being a by-product of oxidation in the cells (there is more of it in the blood)

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32
Q

The partial pressure of alveolar oxygen (PAO2) is

A

approx 100 mmHG

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33
Q

The volume of oxygen physically dissolved in plasma is measured by–

A

the partial pressure of oxygen in arteries (Pa02)
-the higher amount of Pa02 the greater amount of oxygen dissolved

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34
Q

What does oxygen saturation measure

A

the % of 02 that could be carried if all the hemoglobin held the max possible amount of 02

*When Pa02 is 150mmHg, hemoglobin is 100% saturated

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35
Q

What are the partial pressures of 02 and c02 as they travel into the lungs?

A

Atmosphere - P02 - 160mmHg & Pc02 .25%
Alveoli - P02 -100mmHg & Pc02 - 40mmHg
pulmonary veins - P02 - 40mmHg & Pc02 46%
AFTER EXTERNAL RESPIRATION
pulmonary arteries - P02 40mmHg & Pc02 100mmHG
Tissue cells - P02 40 mmHg & PC02 46%

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36
Q

What controls the rate and depth of ventilation to meet the bodys demands?

A

Medulla oblongata and pons

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37
Q

What in the brain promotes deep and prolonged inspirations?

A

Apneustic center in lower pons

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38
Q

What controls the pattern of respirations
(in brain)

A

Pneumotaxic center in upper pons

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39
Q

What do the chemoreceptors located in medulla do to respond to chemical changes in the blood?

A

Respond to an increase or decrease in pH and convey message to the lungs to change depth and rate of ventilation to correct balance

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40
Q

What does the Hering-Breuer reflex do

A

activated by stretch receptors in alveoli

  • when lungs are distended inspiration is inhibited
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41
Q

What do proprioceptors do

A

in muscles and chest/ respond to body movements causing increased ventilation

*ROM exercises

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42
Q

What do baroreceptors do?

A

located in aortic and carotid and respond to increase or decrease in arterial bp and cause reflex hypoventilation or hyperventilation

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43
Q

at approx what age to alveoli begin to lose elasticity?

A

50

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44
Q

What are the majors signs of respiratory disease?

A

Dyspnea
cough
sputum production
chest pain
wheezing
hemoptysis

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45
Q

What is dyspnea

A

subjective feeling of discomfort while breathing

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46
Q

What would sudden dyspnea in a healthy person indicate?

A

pneumothorax, acute respiratory obstruction, allergic reaction, MI

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47
Q

In patients who are immobilized what would sudden dyspnea indicate?

A

may denote pulmonary embolism

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48
Q

Dyspena, tachpnea, hypoxemia in a person who recently experienced lung trauma, shock or cardiopulmonary bypass by signal?

A

ARDS

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49
Q

Orthopnea (shortness of breath when laying flat, relived by sitting or standing) can be found in patients with

A

heart disease
Occasionally COPD

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50
Q

Dyspnea with an expiratory wheeze occurs in patients with

A

COPD

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51
Q

Dyspnea with nosiy breathing may indicate

A

narrowing of airway/obstruction by tumor or foregin body

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52
Q

What questions should the nurse ask to determine the cause of dyspnea

A
  1. Is the SOB related to other symptoms? Cough?
  2. Was the onset of SOB sudden or gradual?
  3. What time does SOB occur? Day or night?
  4. Is SOB worse when laying flat?
  5. How much exertion triggers SOB? Excercise? at rest?
  6. How severe is SOB? Scale of 1-10
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53
Q

A client presents to the emergency department with fluid overload. The nurse is concerned about fluid accumulation in the lungs. On which of the following areas would the nurse focus the lung assessment?

A

Bilateral lower lobes

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54
Q

The nurse is caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?

A

a puncture at the radial artery

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55
Q

Coughing at night may indicate

A

onset of left-sided heart failure or bronchial asthma

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56
Q

A cough in the morning with sputum may indicate

A

bronchitis

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57
Q

A cough that worsens when the patient is supine suggests

A

postnasal drip (rhinosinusitis)

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58
Q

Coughing after food intake may indicate

A

aspiration of material into the tracheobronchial tree or reflux

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59
Q

A cough of recent onset is usually from

A

acute infection

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60
Q

A dry irritative cough is charateristic of

A

upper respiratory tract infection or a side effect of ACE inhibitor therapy

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61
Q

an irritative high pitched cough can be caused by

A

laryngotracheitis

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62
Q

A brassy cough is the result of

A

tracheal lesion

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63
Q

Pleuritic chest pain that accompanies coughing may indicate

A

pleural or chest wall involvement

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64
Q

A patient who has a dry irritating, non-productive cough, nurse should ask?

A

are they taking ACE inhibitors

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65
Q

A lot of purulent (thick yellow/green/rust) sputum is a common sign of

A

bacterial infection

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66
Q

A thin mucoid sputum usually indicated

A

Viral bronchitis

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67
Q

a gradual increase of sputum overtime may indicate

A

chronic bronchitis or bronchiectasis

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68
Q

Pink tinged mucoid sputum suggests

A

lung tumor

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69
Q

Profuse, frothy, pink sputum often welling up into the throat suggest

A

pulmonary edema

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70
Q

Foul smelling sputum indicates

A

lung abscess, bronchiectasis or infection caused by fusospirochetal or other anaerobic organisms

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71
Q

Chest pain associated with pulmonary conditions may feel like?

A

Sharp, stabbing and intermittent or dull, aching and persistent

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72
Q

Why does lung disease not always cause thoracic pain?

A

lungs and visceral pleura lack sensory nerves and are insensitive to pain

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73
Q

How would a patient describe pleuritic pain?

A

Sharp and seems to “catch” on inspiration.
like “being stabbed with a knife”
**more comfortable when laying on affected side

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74
Q

What does Wheezing sound like
What does it mean when a pt wheezes on expiration?
Inspiration?

A

A high-pitched musical sound that is continuous
Expiration- asthma
Inspiration - Bronchitis

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75
Q

What is hemoptysis?

Common causes?

A

Blood from the respiratory tract

*onset is usually sudden and may be intermittent or continuous

Pulmonary infection, Carcinoma, Abnormalities of heart or vessels, PE or infarction

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76
Q

What does clubbing of the fingers indicate?
What conditions is it seen in?

A

lung disease, chronic hypoxic conditions, chronic lung infections, malignancies of the lung, congenital heart disease, endocarditis or inflammatory bowel disease

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77
Q

What is cyanosis

A

A bluish coloring of skin
late indicator of hypoxia / not reliable sign of hypoxia

**Appears at 5g/dL of unoxygenated hemoglobin

**Presence or absence is determined by the amount of unoxygenated hemoglobin in blood

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78
Q

In chronic rhinitis what may develop?
and are distinguished by what color?

A

Nasal polyps
Gray

79
Q

What conditions may indicate a displaced trachea?

A

pneumothorax or pleural effusion

80
Q

What is barrel chest?

A

1:1 ratio of chest
occurs as result of overinflation of lungs
EMPHYSEMA and COPD

81
Q

What is a funnel chest?
(Pectus excavatum)

A

depression in lower portion of sternum
may compress heart and vessels resulting in murmurs
*may occur with rickets or Marfan syndomre

82
Q

What is pigeon chest
(pectus carinatum)

A

result of anterior displacment of sternum and increases diameter
*may occur in rickets, Marfan syndrome or sever kyphoscoliosis

83
Q

What is kyphocoliosis?

A

elevation of scapula and S shaped spine
Limits lung expansion
*occurs on osteoporosis and other skeletal disorders

84
Q

How to define bradypnea
Assoc with

A

Slower than 10bpm, normal depth/rhythm
*Intracranial pressure, brain injury, drug OD

85
Q

How to define tachypnea
Assoc with

A

Greater than 24 bpm, rapid/shallow
*pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain, rib fracture

86
Q

How to define hypoventilation

A

shallow, irregular breathing

87
Q

How to define hyperventilation
AKA in what disorders

A

Increased rate/depth that results in decreased PaCO2 levels
*called Kussmals respiration if assoc with DKA or untreated kidney failure

88
Q

how to define Cheyne-stokes?

A

Regular cycle then decrease until apnea (20 sec) occurs

89
Q

How to define Biots respirations
AKA
resulting from

A

Periods of normal breathing (3-4 breathes) followed by apnea (10-60 sec)
AKA ataxic breathing
resulting from respiratory depression from drug OD or brain injury

90
Q

How to define obstructive respirations

A

prolonged expiratory phase
Associ with asthma, COPD, bronchitis

91
Q

Do patients with emphysema exhibit tactile fremitus>

A

Almost no tactile fremitus

92
Q

Percussion over the lungs helps the nurse to determine what

A

if underlying tissues are filled with air, fluid or solid material

93
Q

What is bronchophony?

A

describes vocal resonance that is more intense and clear than normal

94
Q

Egophony

A

Describes voice sounds that are distorted
Patient repeat letter “E” / nurse will hear letter A

95
Q

Whispered pectoriloquy

A

ability to hear clearly and distinctly whispered sounds that should not be heard

96
Q

Formula for minute volume?

A

tidal volume X respiratory rate = Minute volume

97
Q

What do Venous blood gas studies reflect?

A

balance between the amount of oxygen used by tissues and amount of oxygen returning to right side of heart

98
Q

What are normal Sp02 levels?

A

95% or higher
Values lower than 90% indicate tissues are not receiving enough oxygen

99
Q

What is therapeutic bronchoscopy used for

A
  1. remove foreign bodies or secretions from tracheobronchial tree
  2. control bleeding
  3. treat postop atelectasis
  4. destroy and excise lesions
  5. Provide brachytherapy
  6. insert stents and relive airway obstruction
100
Q

What is thoracoscopy?

A

a diagnostic procedure in which the pleural cavity is examined with an endoscope and fluid and tissues can be obtained

101
Q

how is sleep apnea characterized?

A

freq loud snoring with breathing cessation for 10 sec or longer, for at least 5 episodes per hour, followed by awakening abruptly with a loud snort as blood oxygen levels drop

102
Q

What is the surgical management for sleep apnea?

A

Simple tonsillectomy
Uvulopalatopharyngoplast
Nasal sectoplasty
Macillomandibular
Tracheostomy

103
Q

What are the meds for sleep apnea

A

Modafinil
Armodafinil
Protroptyline
AMedroxygrogestrone acetate
Acetazolamide

104
Q

What is Atelectasis?

A

Closure or collapse of alveoli

  • most commonly encountered abnormalities seen on chest Xray
105
Q

Atelectasis commonly occurs in pt who?

A

in postop setting following thoracic/upper abdominal procedures
-immobilized & have shallow monotonous breathing
-Excess secretions/mucus plugs
-Pt with chronic airway obstruction

106
Q

Nonobstructive atelectasis occurs as a result of
Obstructive atelectasis occurs

A

Nonobstructive - reduced ventilation
Obstructive - blockage that impedes passage of air

107
Q

Causes of atelectasis include

A

foreign body
tumor or growth
altered breathing patterns
retained secretions
pain
alteration in small airway function
prolonged supine position
increased abdominal pressure
surgical procedures

108
Q

Atelectasis resulting from bronchial obstruction by secretions may also occur in patients with impaired?

A

cough mechanisms, debilitated and confined to a bed, excessive pressure on lung tissue from fluid air or blood

109
Q

What is pleural effusion

A

fluid accumulating within pleural space

110
Q

What is pneumothorax

A

air in pleural space

111
Q

What is hemothorax

A

Blood in pleural space

112
Q

Where is the pleural space

A

area between parietal and visceral pleurae

113
Q

What is pericardial effusion

A

pericardium distended with fluid

114
Q

What are signs of atelectasis

A

increasing dyspnea
cough
sputum production
tachycardia, tachypnea, pleural pain, central cyanosis, difficulty breathing in a supine position

115
Q

What symptoms will diagnosis atelectasis

A

Increased work with breathing
Hypoxemia
Decreased breath sounds and crackles heard of affected area
Xray may reveal patchy infiltrates or consolidated areas
Sp02 lower than 90%

116
Q

What are things a nurse would do to prevent atlectasis?

A

Freq turning
early mobilization & strategies to expand lungs
Voluntary deep breathing every 2 hours
incentive spirometry

117
Q

What is incentive spirometery

A

a method of deep breahting that provides visual feedback to encourgae pt to inhale slowly and deeply to maximize lung inflation

118
Q

What are the 2 types of incentive spirometers

A

Volume - the tidal volume is set using manufacture instructions. Pt deep breath, pause, exhales
Flow - volume is not preset. balls pushed by force of breath

119
Q

What is used in patients who 1st line measures for atelectasis don’t work?

A

PEEP mask, continuous postive airway breahting, or bronchoscopy

120
Q

What is thoracentesis?

A

Removal of the fluid by needle aspiration

121
Q

What is actue tracheobronchitis?

A

an acute inflammation of the mucous membranes of trachea and bronchial tree, often follows infection of upper respiratory tract

122
Q

What are the clinical manifestations of acute tracheobronchitis

A

dry irritating cough and small amount of mucoid sputum
Sternal soreness
fever, chills, night sweats, headache
SOB, noisy inspiration/expiration
Purulent sputum

*servere cases - blood streaked sputum

123
Q

How do we treat acute traceobronchitis

A

ANtibiotics
Fluid intake increased
Suctioning
increase vapor pressure in air
mild analgesics

124
Q

What is pneumonia

A

an inflammation of lung parenchyma caused by various organisms, including bacteria, mycobacteria, fungi and viruses.

125
Q

What are the 4 classifications of pneumonia?

A

CAP - community-acquired pneumonia
HCAP - health-care associated
HAP - hospital-acquired
VAP = Ventilator-associated

126
Q

CAP is defined as

A

Occurs either in a community setting or within 1st 48 hours after hospitalization or institutionalization

127
Q

How is mycoplasma pneumonia spread

A

infected respiratory droplets through person to person contact

128
Q

What is HCAP

A

Health-care associated pneumonia
causative patho is often MDROs

129
Q

What is HAP

A

develops 48 hours or more after hospitalization and does not appear to be incubating at the time of admission

130
Q

What are the contact precautions in patients with MRSA

A

Isolated in private room
Contact precautions (gown, gloves, antibacterial soap)
# of people in contact minimized

131
Q

What is the usual presentation of HAP

A

a new pulmonary infiltrate on Xray
combined with fever, respiratory infection, purulent sputum, or leukocytosis

132
Q

What is VAP

A

Ventilator-assoc pneumonia
w/in 96hr usually antibotic sensitive bacteria
after 96hrs MDROs

133
Q

What is aspiration pneumonia

A

refers to pulmonart consequences resulting from entry of endogenous or exogenous substances into lower airway

*common form is bacterial infection from aspiration of bacteria that normally reside in upper airways

134
Q

How does pneumonia happen?

A

arises from normal flora present in pt whose resistance has been altered or from aspiration of flora present in oropharynx

*Pneumonia affects both ventilation and diffusion

135
Q

What are risk factors for pneumonia

A

Conditions which produce mucus/interfere with normal lung drainage
Immunosuppressed
Smoking
Prolonged immobility
Depressed cough reflex
NPO status/placement of tubes
Antibiotic therapy
Alcohol
General anesthetic, sedative, or opioid preparations
Advanced ages

136
Q

What are the signs of streptococcal pneumonia

A

sudden onset of chills, rapidly rising fever, pleuritic chest pain aggravated by deep breathing and coughing
Tachypnea, sob, use of accessory muscles

137
Q

What are the two pneumonia vaccines?

PCV13 & PPSV23

A

PCV13 - 65 year and older & 19 years with conditions that weaken the immune system
PPSV23 - 65 year and older & 19 who smoke, chronic heart, lungs or liver diesease. Alcoholism

138
Q

WHat is SARS-CoV-2

A

community acquired coronavirus occurs in respiratory tract
Transmitted person to person contact via respiratory droplets

139
Q

What are severe complications of pneumonia?

A

hypotension, septic shock, respiratory failure

140
Q

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What is a parapneumonic effusion

A

any plueral effusion assoc with bacterial pneumonia, lung abscess, or bronchiectasis

141
Q

What are the 3 stages of parapneumonic pleural effusions?

A

uncomplicated
complicated
thoracic empyema

142
Q

what is an empyema

A

occurs when think, purulent fluid accumulates within the plueral space often with fibrin development in a walled off area where infection is located

143
Q

When nonfunctioning nasogastric tube allows teh gastric contents to accumulate in the stomach, what conditon may result?

A

silent aspiration

144
Q

What is TB

A

an infectious disease that primarly affects the lung parenchyma
*may also be transmitted to meninges, kidneys, bones & lymph nodes

Airbone transmission

145
Q

What are the clinical manifestation of tB

A

low-grade fever
cough
night sweats
fatique
weightloss

146
Q

What is pulmonary edema

noncardiogenic

A

abnormal accumulation of fluid in lung tissue, the alveolar space, or both
*severe life threatening condition
**noncardiogenic occurs due to damage of pulmonary capillary lining

147
Q

What is pulmonary Hypertension?

A

elvated pulmonary arterial pressure greater than 25mmHg at rest and greater than 30mmHg with exercise and secondary right heart ventricular failure

148
Q

What are the clinical manifestations of Pulmonary hypertension

A

dyspnea
substernal chest pain
weakness, fatigue, syncope, hemoptysis, signs of right sided heart failure, anorexia and ab pain

149
Q

What is t he medical management of PH?

A

Diuretics, oxygen, anticoagulation, digoxin, exercise

150
Q

Cor pulmonale

A

a condition that results from pulmonary hypertension which causes the right side of the heart to enlarge bc of increased work required to pump blood against resistance

*this causes R sided heart failure

151
Q

WHat is pulmonary embolism?

A

Obstruction of pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or the right side of the heart

*DVT is a related condition, refers to thrombus formation in deep veins
*VTE is a term that includes both DVT and PE

152
Q

What is parenchyma?

A

Includes any form of lung tissue, including bronchioles, blood vessles, interstitium and alveoli

153
Q

What is COPD

A

Preventable, treatable slowly progressive respiratory disease of airflow obstruction invovling airways, pulmonary parenchyma or both

154
Q

What is the pathophysiology of COPD

A
  1. Lungs abnormal inflam response to noxious particles or gases
  2. In the proximal airways (treachea & bronchi <2mm) increases globlet cells & enlarged submucosal glands = hypersecretion of mucous
  3. In perihperal airways (>2mm) inflam causes thickening of airway wall overtime this causes scar formation and narrowing of airway lumen
  4. Alveolar wall destruction leads to decrease in elastic recoil
  5. Lastly, thickingen of lining of vessel and hypertrophy of smooth muscle
155
Q

Define Chronic Bronchitis

A

disease of airways
presence of cough and sputum production for at least 3 months in each of 2 consecutive years
*more susceptible to respiratory infection due to increased mucus which reduces ciliary function

156
Q

Define emphysema

A

Impaired oxygen and CO exchange from the destruction of the walls of overdistended avlveoli.
*increase in dead space
**Alveoli surface area in direct contact with capillary is decreased

Can lead to hypoxemia, hypercapnia, respiratory acidosis

157
Q

What is Cor pulmonale

A

complication of emphysema
-right sided heart failure brought on by long term high blood pressure in pulmonary arteries
*edema, distended neck veins, pain in region of liver

158
Q

What is panlobular emphysema?

A

destruction of respiratory bronchiole, alveolar duct, and alveolus.
*all air spaces are essentially enlarged but there is little inflammatory disease

**hyperinflated chest, dyspnea on exertion, weight loss typically occur / expiration becomes an active process requiring muscular effort

159
Q

What is centrilobular emphysema

A

takes place in center of secondary lobule, preserving peripheral portions.

*leads to central cyanosis and respiratory failure, also develops peripheral edema

160
Q

What is Alpha1-antitrypsin deficiency

A

enzyme inhibitor that protects lung parenchyma from injury
*May lead to lung and liver disease

161
Q

What are the clinical manifestations of COPD

A

Chronic cough, sputum production, dyspnea
*Symptoms worsen over time
**weight loss, barrel chest, musculoskeletal wasting, metabolic disturbances, depression

162
Q

Spirometry is used to evaluate airflow obstruction, which is determined by

A

ratio of FEV to forced vital capacity
*results are expressed in absolute volume and as a % of the predicted value

163
Q

What diagnostic tests are performed for COPD

A

Spirometry
arterial blood gas
Chest Xray
High resolution CT scan
Screening for alpha1-antitrypsin deficiency

164
Q

What are the 4 grades for COPD?

A

I - Mild - FEV > 80%
II - Moderate - FEV 50-79%
III - Severe - FEV 30-49%
IV - Very Severe - FEV - <30%

165
Q

What are the complications of COPD

A

Respiratory insufficiency & Failure
pneumonia
chronic atelectasis
pneumothorax
pulmonary arterial HTN

166
Q

Oxygen transport to tissues depends on what factors?

A

cardiac output
arterial oxygen content
concentration of hemoglobin
metabolic requirments

167
Q

Hypoxemia

A

decrease in arterial oxygen tension in the blood
*results in changes in mental status, dyspnea, increase in BP, changes in HR, arrhythmias, central cyanosis, diaphoresis and cool extremities.

168
Q

Difference between low flow systems and high flow systems

A

Low flow - Patient breathes some room air. Do not provide constant or precise concentration of inspired oxygen
High flow - provide the total inspired air. specific % is delivered

169
Q

```

NASAL CANNULA
Flow rate
02%
Advantages
Disadvantages

A

Low flow
1-6L/min
24-44%
Pro- lightweight, move
Con - drying, easily removed

170
Q

SIMPLE MASK
Flow rate
02%
Advantages
Disadvantages

A

LOW FLOW
5-8L/min
40-60%
Pro-simple to use
Con - poor fit, must remove to eat

171
Q

Partial rebreathing
Flow rate
02%
Advantages
Disadvantages

A

LOW FLOW
8-11L/min
50-75%
Pro- moderate 02 concentration
Con - poor fit, remove to eat

172
Q

NONREBREATHER
Flow rate
02%
Advantages
Disadvantages

A

LOW FLOW
10-15L/MIN
80-95%
Pro- High 02 concentratin
Con - poor fit, remove to eat

173
Q

VENTURI MASK
Flow rate
02%
Advantages
Disadvantages

A

HIGH FLOW
4-8L/min
24-40%
Pro- low levels of sup 02 precise, humidity
Con - Must remove to eat

174
Q

TRANSTRACHEAL OXYGEN CATHETER
Flow rate
02%
Advantages
Disadvantages

A

HIGH FLOW
1/4-4L/min
60-100%
Pro - comfortable, concealed by clothing
Con- freq cleaning, surgical intervention, complications

175
Q

AEROSOL MASK
Flow rate
02%
Advantages
Disadvantages

A

HIGH FLOW
8-10L/.MIN
28-100%
Pro - humidity, accurate
Con - Uncomfortable

176
Q

Desaturate

A

precipitous drop in hemoglobin molecule saturation with oxygen

177
Q

What are treatments for
Grade I COPD-
Grade II or III
Grade III or IV

A

Grade I - Short acting bronchodialtor
Grade II or III - Short acting bronchodilator & reg treatment with 1 or more long actiong bronchodialtor
Grade III or IV - reg treatment with long action bronchodialtor and inhaled corticosteroids

178
Q

What are pMDI’s

Pressured metered-dose inhalers

A

Pressurized devices that contain aerosolized powder of medications
*a precise amount of medication is released

deep inhalation followed by 10s hold

179
Q

What are DPI’s

Dry-powdered inhalers

A

rely soley on patients inspiration for medication delivery
*user press lever

Rapid deep inhalation

180
Q

WHat is SVN?

Small volume nebulizer

A

handheld device - requires a power source

181
Q

What are the classes of bronchodialtors used to treat COPD

A

Beta-2-adrenergic Agonist - Terol
Anticholinergic agents - IUM
Combo - Salbutamol/ipratropium
Inhaled corticosterioids -
Combo corticosteroids/beta 2

182
Q

What are some surgical options for COPD?

A

Bullectomy - removal of bullous that do not contribute to ventilation but occupy space
Lung volume reduction - removal of portion of diseased lung
Lung transplant

183
Q

What is chest physiotherapy?

A

postural drainage
chest percussion & vibration
breathing retraining

184
Q

Bronchiesctasis

A

Chronic irreversible dilation of bronchi and bronchioles that results in destruction of muscles and elastic connective tissue

185
Q

What contributes to bronchiecstasis?

A

Recurrent respiratory infections, CF, rheumatic and other systemic diseases, primary ciliary dysfunction, TB, immune deficiency disorders

186
Q

What are the clinical manifestations of bronchiestasis

A

Chronic cough
production of purulent sputum
Hemoptysis
Clubbing fingers
episodes of pulmonary infection

187
Q

What are the treatements for bronchiectasis>

A

Chest physiotherapy
bronchoscopy
Antibiotics
Secretion management
Nebulzized mucolytics & bronchodilators

188
Q

What is asthma

A

heterogeneous disease characterized by chronic airway inflammation
*causes hyperresponsiveness, mucosal edema, mucus production

189
Q

Patho of asthma

A

Cells (lymphocytes, neutrophils, eosinophils, mast cells, macrophages) play role in inflammation.

Cells release inflam mediators causing increased blood flow, vasoconstriction, WBC, mucus, and bronchoconstriction.

IgE-dependent release of mediators from mast cells

190
Q

W

Clincial manifestations of asthma

A

Cough, dyspnea, wheezing

191
Q

Quick relief meds for Asthma

A

Inhaled short acting Beta 2 adrenergic agonist - TEROL
Anticholinergics - ipratropium
Corticosteriods - prednisone

192
Q

Long term meds for Astham

A

Inhaled corticosteriods - “nide”, fluticasone, “sone”
Systemic corticosteroids - prednisone
Long acting beta 2 adrenergic agonists - “terol”
Phosphodiesterase inhibitors - theophylline
Combo -
Leukotriene modifiers - “lukast”
5-Lipoxygenase inhibitor - Zileuton
Immunomodulators - omalizumab
IL-5R - “zumab”
IL-4ra - dupilumab

193
Q

Status asthmaticus

A

rapid onset, severe, and persistent asthma that does not respond to conventional therapy

194
Q

Status asthmaticus

A

rapid onset, severe, and persistent asthma that does not respond to conventional therapy

115 LEC (5 decks)

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