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Pathophysiology > Exam 3: Respiratory > Flashcards

Exam 3: Respiratory Flashcards

1
Q

What are the functions of the airway and lungs?

A
  • Gas exchange
  • Inactivates vasoactive substances (bradykinins)
  • Converts Angiotensin I to Angiotensin II
  • Reservoir for blood storage
  • Type II alveoli secrete surfactant (lubricates lungs and protects against pathogens entering airway)
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2
Q

What is ventilation?

A

Movement of O2, Nitrogen, CO2 & gasses w/ pressure gradient from atmosphere and
inside the body

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3
Q

What is compliance?

A

elasticity of the lungs (check function after surgery b/c anesthesia depresses function)

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4
Q

What occurs during inspiration?

A

○ Intrapulmonary pressure decreases
○ Intrapleural Pressure becomes negative (allowing air to flow into lungs)
○ Pressure become negative and air flows into the lungs

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5
Q

How much serous fluid is in the pleural space?

A

4 mL

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6
Q

What is pleurisy?

A

Lack of pleural space causing lungs to stick to the chest wall

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7
Q

This condition occurs when the pleural space has a positive pressure, alveoli rupture due to trauma and air escapes and enters the pleural space

A

Pneumothorax

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8
Q

What occurs during expiration?

A

○ Elastic components of the chest wall/lungs/diaphragm relax & recoil
○ Chest cavity decreases in size
○ Intra-thoracic pressure increases and air flows out

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9
Q

What us atmospheric pressure?

A

760 mmHg

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10
Q

What is partial pressure of O2 and partial pressure of CO2?

A 
SPO2 = 95-100
CO2 = 35-45
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11
Q

What does gasses dissolve across?

A

the alveoli (1 cell thick) and into the capillaries (1 cell thick) = allows efficient gas exchange

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12
Q

What end of the capillary facilities O2 transport? What end exchanges CO2 and is expired via the lungs?

A

arterial end; venous end

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13
Q

This causes a strong increase in intra-thoracic pressure which slows venous return to the right atrium and an example of it is holding breath when in pain/pooping

A

Valsalva Maneuver

Stims the vagus nerve causing hypotension and pt will vagal down

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14
Q

What results when perfusion occurs w/o ventilation and when does this condition occur? How is it prevented?

A

COPD/Atelectasis (part of the alveoli isn’t contributing to gas exchange)

▪ Usually occurs after surgery
□ Use incentive spirometry, cough, deep breathe, etc.

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15
Q

Ventilation w/o Perfusion is:

A

dead air space - there’s air in the lungs, but gas exchange isn’t happening (Pulmonary Emboli)

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16
Q

What is hypoxia?

A

low amounts of dissolved O2 in the blood (whether on Hgb or dissolved)

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17
Q

How is PO2 measured and what is normal PO2?

A

via arterial blood draws; normal PO2 is 80-100 (<50 requires a ventilator)

drop in PO2 does not greatly impact O2

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18
Q

What factors effect the oxygen-hemoglobin dissociation curve?

A

▪ Temperature
▪ Acidotic
▪ Alkalotic

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19
Q

What are some causes of hypoxia?

A

○ Respiratory disease
○ Dysfunction of the neuro system
○ Alterations in circulation
▪ Results in ventilation-perfusion mismatch

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20
Q

What is the patho for hypoxia?

A

○ Low PO2 levels cause the body to switch to ANAEROBIC METABOLISM
○ Causes a buildup of Lactic Acid
○ Results in metabolic acidosis

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21
Q

What are some s/sx of hypoxia?

A

○ **Changes in Mental Status & Hyperventilation (RR 20+)

▪ Restlessness, mood changes, increased respirations, etc.

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22
Q

What are s/sx of severe hypoxia?

A

▪ HR & BP will continue to increase
▪ Delirium, Stupor, Coma
▪ Cyanosis

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23
Q

How is hypoxia diagnosed and treated?

A

○ ABG’s to determine PO2
○ SPO2 %

○ Treat the underlying cause of the hypoxemia
○ Administer supplemental O2 as ordered
▪ Or 2L via nasal cannula w/o M.D. order

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24
Q

What is normal PCO2 levels?

A

35-45

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25
Q

This condition results in increased PCO2 in the blood (ABG’s), decreased pH (acidosis) and increased HR and RR

A

hypercapnia

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26
Q

What are some causes of hypercapnia?

A

○ Ventilation-Perfusion Mismatch (hypoventilation or poor CO2 exchange at the alveoli)
○ Increased metabolic rate (fever)
○ High carb intake (tube feedings and TPN contain high amts of carbs; EN and TPN make it worse)

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27
Q

What is a late sign of respiratory failure?

A

PO2 will decrease to about 50 and PCO2 increases to 50 before O2 decrease = cyanosis

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28
Q

Where is central cyanosis evident? Where is peripheral cyanosis evident?

A

tongue and lips (more serious); extremities, nose and ears

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29
Q

What are some causes of SOB?

A

▪ Stimulation of Lung Receptors
▪ Reduction in ventilatory capacity (decreased muscle function)
▪ Stimulation of muscle receptors
▪ Excessive chemoreceptors innervating the CNS

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30
Q

This is a protective mechanism to prevent foreign bodies in the lungs but if chronic, can damage lungs/trachea and tear muscles

A

cough reflex

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31
Q

This is a cough lasting up to 8 weeks

A

bronchitis

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32
Q

This is a condition is a obstructive disease that is reversible and is due to inflammation and hypersensitivity to allergens

A

Asthma

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33
Q

What is bronchial asthma and what does it cause?

A

○ Chronic inflammation of bronchi
▪ Causes hyper-responsiveness & airflow obstruction
* accounts for largest # of ED visits

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34
Q

What is the patho for ashtma?

A

○ Hypersensitivity (allergens, drugs, cold, exercise, etc.)
▪ Level of the reaction depends on the level of hypersensitivity
○ Inflammatory mediators released by:
▪ MAST CELLS!!!!
▪ T-cells
▪ Macrophages
▪ Eosinophils
▪ Basophils
○ Inflammation results in BRONCHO-CONSTRICTION (obstruction)

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35
Q

This type of asthma is induced by Type I Hypersensitivity (exposure to antigen/allergen) and begins in early childhood

A

Extrinsic Asthma (Atopic)

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36
Q

Describe what occurs during acute phase Extrinsic Asthma (Atopic)

A
  • last 10-20 minutes
    □ Release of chemical mediators
    □ Bronchospasm
    □ Edema
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37
Q

Describe what occurs during late phase Extrinsic Asthma (Atopic)

A
  • last 4-8 hours
    □ Inflammation
    □ Hyper-responsiveness (vicious cycle of exacerbation)
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38
Q

This type of asthma is triggered by respiratory infections that release IgE antibodies, exercise, pollutants, hyperventilation, cold air and GERD

A

Intrinsic Asthma (Non-Atopic)

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39
Q

What are some s/sx of asthma?

A 
○ Wheezing
○ Chest tightness
○ Dyspnea (subjective SOB)
○ Cough
○ Increased sputum
○ Tachycardia & Tachypnea
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40
Q

What are some facts about asthma in children?

A

○ Leading cause of chronic illness (80% symptomatic by 6 y/o)
▪ More common in Blacks
○ Exposure to smoke in-utero = huge risk factor
○ 1st sxs are mild but then rapidly progress

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41
Q

How is asthma diagnosed and treated?

A
  • Diagnose w/ spirometry tests to observe signs of obstruction
    ○ Prevention & Controlling exposure to triggers
    ▪ Allergen Immunotherapy
    ▪ Rx w/ epinephrine or inhalers w/ bronchodilators (albuterol)
    □ Medications are the primary method of treatment for symptomatic asthma
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42
Q

This condition is the 4th leading COD, os more common in women with smoking being the most common cause:

A

COPD

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43
Q

What is the second most common cause of COPD?

A

Antitrypsin Deficiency (decreased elasticity in the lungs)

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44
Q

What is the patho for COPD?

A

○ Inflammation & Fibrosis of bronchial wall (decreased elasticity) & Excess mucus secretion result in decreased ventilation d/t obstruction and decrease area for gas exchange
○ Results in destruction of Alveoli and increased air trapping
○ COPD can breathe in normally, but cannot breathe out normally (results in retention of CO2 and atelectasis)

45
Q

What are the s/sx of COPD?

A 
○ Presents no early symptoms
○ Fatigue / Exercise (ADL's) intolerance
○ Productive AM cough
○ SOB
○ Recurrent respiratory infections
○ Chronic respiratory failure (PO2 & PCO2 levels)
46
Q

How is COPD diagnosed and treated?

A

○ CHEST XRAY!!!
○ Pulmonary Function tests (spirometry)

○ #1 treatment method = smoking cessation
○ Education, proper nutrition,
○ Medications:
▪ Bronchodilators
▪ Theophylline
▪ Oxygen therapy
○ Oxygen Therapy- low cannula O2 prevents reduction of ventilatory drive (LOW FLOW IS KEY TO COPD)

47
Q

What are the s/sx of COPD blue bloaters?

A

▪ Chronic Bronchitis
▪ Cyanosis
▪ Fluid retention d/t R-sided heart failure
▪ Hypoxemia (blue) can result in polycythemia

48
Q

What are the s/sx of COPD pink puffers?

A

▪ Emphysema
▪ PO2 <65 & PCO2 55+
▪ No cyanosis but they do have Air Trapping (CO2 retention)
▪ Barrel Chest

49
Q

This condition results in persistent and irreversible airway obstruction d/t inflammation and causes hypersecretion of mucus and Chronic Cough x3 months for 2 years

A

CHRONIC BRONCHITIS

50
Q

What causes chronic bronchitis?

A

▪ 80-85% caused by SMOKING
▪ Males > Females
▪ Repeated airway infxn & chronic cough

51
Q

What is the pathway for chronic bronchitis?

A

▪ Chronic inflammation results in scaring & fibrosis of mucous membranes so mucous glands are increased to compensate
▪ Increased wall thickness in bronchi (results in obstruction of airflow)
▪ Inflammation & Fibrosis can extend to alveoli

52
Q

What are the s/sx of chronic bronchitis?

A

▪ BLUE BLOATERS
▪ Hypersecretion of mucous = chronic productive cough
▪ Congested lung fields (crackles, rhonchi, etc.)
□ Fluid retention w/ R-sided Heart failure
▪ Decreased PO2 (less than 65) and increased PCO2
▪ Polycythemia (compensation)

53
Q

This condition results in destruction of alveoli WITHOUT FIBROSIS and abnormal enlargement of air sacs

A

Emphysema

54
Q

What causes Emphysema?

A
  • smoking (teen smokers have high r/o developing by 50)
  • weight loss
  • genetic predisposition
  • results from bacterial infxn
55
Q

What is the patho for emphysema?

A

▪ Smoking damages alveoli 2 different ways:
□ Inflammation of lung tissue
□ Inactivates protective chemicals in the lung tissue
▪ Alveoli destroyed by enzymatic action of neutrophils & macrophages
▪ Results in:
□ Loss of alveolar walls
□ Decreased elasticity in lungs
□ Increased airway pressure
□ Decreased outflow of air
* CO2 becomes trapped in the alveoli

56
Q

What are s/sx of emphysema?

A

▪ PINK PUFFERS
▪ Dyspnea / fatigue
▪ Pursed lip breathing & use of accessory muscles
▪ Decreased PO2 (60-80) and increasing PCO2 (air trapping)
▪ Barrel Chest (hyperinflation d/t air trapping)

57
Q

This condition results from incomplete expansion of the lung or portion of the lung

A

Atelectasis

58
Q

What is the cause of Atelectasis?

A 
○ Airway obstruction
○ Compression of lung tissue
▪ Trauma (pneumothorax)
▪ Tumor- erodes pleural wall and results in fluid buildup places pressure on pleura
inhibiting expansion
○ Lack of Surfactant
59
Q

What are the s/sx of Atelectasis?

A 
○ Tachypnea & Tachycardia (compensation)
○ Dyspnea
○ Cyanosis / Hypoxemia
○ Decreased chest expansion (part of lung isn't inflating
▪ Absent breath sounds
60
Q

This condition results from presence of air within the pleural space (partial or complete collapse of the lung)

A

Pneumothorax

61
Q

What is spontaneous Pneumothorax and its causes?

A

▪ Rupture of a bleb/bullae

▪ Cause unknown, but associated w/ males & heavy smoking

62
Q

What is traumatic Pneumothorax and its causes?

A

□ Severe trauma allows atmosphere air to enter cavity
□ Need to insert Chest Tube to drain blood/air that’s entering the pleural cavity
□ Less emergent than a CLOSED Pneumothorax
- You’re able to apply dressing to wound to control airflow in/out

63
Q

What is tension Pneumothorax and its causes?

A

▪ Intrapleural pressure exceeds atmospheric pressure and prevents airflow into lung
▪ Closed = Tension Pneumothorax
□ Some form of trauma that closes instantly (bullet wound)
□ Tension builds in pleural space d/t air inside lungs escaping
□ THIS IS A SURGICAL EMERGENCY

64
Q

What are some s/sx of Pneumothorax?

A 
○ Increased RR & HR
○ Dyspnea
○ Hypoxemia
○ Decreased/Absent breath sounds
○ Asymmetrical Chest Expansion
○ Mediastinal Shift 
▪ Trachea & vessels will be shifted to one side
▪ Direction of shift dependent on pressure differential
65
Q

This is a viral infection that is highly contagious the first 3 days when symptoms begin; children are the main reservoir:

A

common cold

66
Q

What are the s/sx of a common cold and how is it treated?

A

▪ Watery, clear secretions
▪ Erythematous mucous membranes
▪ Swollen, sore throat
▪ Hoarseness

▪ NO ANTIBIOTICS
▪ Encourage rest
▪ Symptomatic treatment w/ OTC meds

67
Q

This is a viral infection that is a common COD in the elderly and highly contagious 24hrs before s/sx start:

A

flu

68
Q

How long is the flu contagious and how is it transmitted?

A

for 5-10 days and transmitted via droplets (not by contact)

69
Q

What are some s/sx of the flu and how is it treated?

A

▪ MALAISE
▪ NON-PRODUCTIVE Cough
▪ Fever, chills, muscle aches
▪ HA

▪ Rest, fluids, & aspirin (not to be given to those <12 or they can get reyes disease)
▪ Antivirals (Amantadine) prevent replication of DNA (must be used within 30 days of infection)

70
Q

_______ is the Primary Treatment/Focus-

A

Prevention:

▪ Everyone over 6 y/o needs to vaccinated yearly

71
Q

What are the 3 strains of the flu?

A

□ A & B cause the flu epidemics
□ 16 different variations divided into Hemogglutinin & Neuraminidase
□ Tamiflu is a drug that acts against the Neuraminidase
○ If left untreated it can develop into Viral Pneumonia

72
Q

This condition results in inflammatory reaction in the alveoli & interstitial tissue of the lung from a pathogen and is the 6th leading COD (esp. in elders)

A

Pneumonia

73
Q

What is a typical and atypical agent of Pneumonia?

Where is the typical distribution in the lungs?

A

□ Typical = bacteria
□ Atypical = mycoplasmas or viruses d/t disease condition of lungs (stasis of
mucous)

□ Lobular Pneumonia
□ Broncho-pneumonia

74
Q

What is the patho for Pneumonia?

A

▪ Microbial agents multiply & cause inflammation
▪ Alveolar spaces fill w/ exudate/mucous
▪ Results in poor oxygenation d/t less surface area for gas exchange (hypoxemia)
▪ Exudate can solidify and become difficult to expectorate

75
Q

How is Pneumonia diagnosed?

A

▪ Sputum culture & sensitivity
▪ Symptomatology
▪ CHEST XR

76
Q

What is the most common cause of bacterial pneumonia (Pneumococcal Pneumonia)?

A

S. pneumoniae

77
Q

What are the s/sx of Pneumococcal Pneumonia?

A

▪ Fever, chills, malaise (elders rarely run fevers but if they have one infection is severe; watch for signs of mental deterioration)
▪ Productive cough
▪ Bloody sputum

78
Q

How is Pneumococcal Pneumonia diagnosed?

A 
▪ Levofloxacin
▪ Piperacillin
▪ Cefotaxime
▪ Vancomycin
▪ Gentamycin

○ Primarily focus on PREVENTION:
□ Pneumococcal vaccination (65+ y/o & immunocompromised)

□ 2 vaccines: both vaccines recommended for elderly 65+
Prevnar 13® is a pneumococcal conjugate (PCV) vaccine that protects against 13 types of pneumococcal bacteria

Pneumovax® 23 is a pneumococcal polysaccharide vaccine (PPSV) that protects against 23 types of pneumococcal

79
Q

This condition is the #1 COD from a single organism, is associated with HIV and spread by airborne droplets

A

Tuberculosis

80
Q

What is the patho of TB?

A

○ Macrophages initiated a cell-mediated immune response
▪ Contains the infxn and calls on T-cells
▪ T-cells “approve” the macrophages to initiate cell-mediated response
□ Release lytic enzymes and cells undergo apoptosis
▪ This results in the cheese-like appearance of lung tissue in Chest XR
▪ Lasts 3-6 weeks
Indicates the pt is EXPOSED but they DON’T have ACTIVE TB
□ Aka… the TB is walled off and not actively infecting more tissue
○ TB can be latent for a long period of time
* best survives in oxygen rich environments

81
Q

What are the s/sx of TB?

A 
○ Insidious & Non-specific symptoms
▪ Wt loss
▪ Night Sweats
▪ Fever
▪ Cough
82
Q

When can TB be spreaded?

A

Once TB spreads to the sputum, it can be transmitted to another person

83
Q

How can TB be diagnosed?

A

○ PPD, Chest XR

○ Sputum Tests!!!!

84
Q

How can TB be treated?

A

○ Multiple drug combinations are MANDATORY

▪ INH (isoniazid), Rifampin, Pyrazinamide, Ethambutol, Streptomycin for 6+ mos

85
Q

What is normal pH?
What is normal HCO3?
What is normal PCO2?
What is normal PO2?

A

7.35-7.45
22-26
35-45 (indicative of ventilation)
80-100 (indicative of perfusion)

86
Q

What is the main muscle used in ventilation and what are the accessory muscles?

A
  • diaphragm

- sternomastoid, scalene and intercostal

87
Q

What does air movement depend on?

A

the resistance of the

airways and lung compliance

88
Q

What are the functional units of the lung and what do they consist of?

A
  • lobules; bronchioles, alveoli and pulmonary capillaries (where gas exchange takes place)
89
Q

What are the 2 types of alveolar cells?

A
  • type 1 is squamous - provides gas exchange to the lung

- type 2 is progenitor + cuboidal - produces surfactant

90
Q

What is respiratory diffusion?

A

Movement of gases across the alveolar capillary membrane

91
Q

What results from chronic hypoxia?

A
  • increased ventilation

- increased RBC

92
Q

What are considered obstructive respiratory diseases?

A

Asthma
COPD
Chronic Bronchitis
Emphysema

93
Q

What are some r/f for COPD?

A
  • Direct inhalation of tobacco smoke
  • Second hand exposure to cigarette smoke
    Genetics
  • Occupational exposure to various dusts/chemicals
  • Indoor air pollution involving biomass fuels used for heating and cooking in poorly ventilated dwellings
  • Severe respiratory infections
  • Maternal smoking during pregnancy
94
Q

This condition is the leading COD both both men and women with the main r/f beinf smoking. It yields a 15-20 year delay between smoking onset and development

A

lung cancer

95
Q

How is lung cancer diagnosed?

A
  • CT scan of lungs
  • Bronchoscopy performed for biopsy
  • Thoracentesis to obtain cells from pleural space for staging
96
Q

What are the four cell types found inn lung cancer?

A
  • small cell (previously called oat cell) (most aggressive, fast growing, very malignant)
  • adenocarcinoma (most common, most common in women)
  • squamous cell carcinoma (almost exclusively found in smokers)
  • large cell (tend to metastasize early and to the brain).
97
Q

What are the s/sx of lung cancer?

A
  • Most common symptom is persistent cough with or without sputum
  • Sputum streaked with blood
  • Recurrent bronchitis, dyspnea, chest pain, hoarseness, obstructive pneumonia, fatigue, weight loss, paraneoplastic syndromes (production of hormone analogs which cause inappropriate neuroendocrine secretions)
98
Q

A low pH and high PCO2 is:

A

respiratory acidosis

99
Q

A low pH and a low PCO2 is:

A

metabolic acidosis

100
Q

A high pH and a low PCO2 is:

A

respiratory alkalosis

101
Q

A high pH and a high PCO2 is:

A

metabolic alkalosis

102
Q

What are the common COVID symptoms and when do they normally occur?

A
  • fever
  • dry cough
  • fatigue
  • 2-14 days after exposure
103
Q

What is the course of death for COVID?

A

21 days

104
Q

What is the theory for COVID 19 patho?

A

Vasoconstriction in the lungs

Vasoendotheliitis is an immune response in the blood vessels that become inflamed

Hypercoagulopathy- PVT ( clots formed in the Lungs) resulting in severe

105
Q

What is static lung compliance?

A

Compliance of the lungs when the lungs and the muscles of the lungs are at rest; pressure is the only variable

106
Q

What is dynamic compliance?

A

Compliance of the lungs during breathing

107
Q

What intervention works best for the COVID patient?

A

prone positioning with high flow nasal cannula therapy works best for the COVID-19 patient

108
Q

This test tells you if you have a current infection:

A

viral test

109
Q

This test tells you if you had a previous infection:

A

antibody test

Pathophysiology (10 decks)

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