Exam 3: Respiratory Flashcards
What are the functions of the airway and lungs?
- 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)
What is ventilation?
Movement of O2, Nitrogen, CO2 & gasses w/ pressure gradient from atmosphere and
inside the body
What is compliance?
elasticity of the lungs (check function after surgery b/c anesthesia depresses function)
What occurs during inspiration?
○ Intrapulmonary pressure decreases
○ Intrapleural Pressure becomes negative (allowing air to flow into lungs)
○ Pressure become negative and air flows into the lungs
How much serous fluid is in the pleural space?
4 mL
What is pleurisy?
Lack of pleural space causing lungs to stick to the chest wall
This condition occurs when the pleural space has a positive pressure, alveoli rupture due to trauma and air escapes and enters the pleural space
Pneumothorax
What occurs during expiration?
○ Elastic components of the chest wall/lungs/diaphragm relax & recoil
○ Chest cavity decreases in size
○ Intra-thoracic pressure increases and air flows out
What us atmospheric pressure?
760 mmHg
What is partial pressure of O2 and partial pressure of CO2?
SPO2 = 95-100 CO2 = 35-45
What does gasses dissolve across?
the alveoli (1 cell thick) and into the capillaries (1 cell thick) = allows efficient gas exchange
What end of the capillary facilities O2 transport? What end exchanges CO2 and is expired via the lungs?
arterial end; venous end
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
Valsalva Maneuver
Stims the vagus nerve causing hypotension and pt will vagal down
What results when perfusion occurs w/o ventilation and when does this condition occur? How is it prevented?
COPD/Atelectasis (part of the alveoli isn’t contributing to gas exchange)
▪ Usually occurs after surgery
□ Use incentive spirometry, cough, deep breathe, etc.
Ventilation w/o Perfusion is:
dead air space - there’s air in the lungs, but gas exchange isn’t happening (Pulmonary Emboli)
What is hypoxia?
low amounts of dissolved O2 in the blood (whether on Hgb or dissolved)
How is PO2 measured and what is normal PO2?
via arterial blood draws; normal PO2 is 80-100 (<50 requires a ventilator)
drop in PO2 does not greatly impact O2
What factors effect the oxygen-hemoglobin dissociation curve?
▪ Temperature
▪ Acidotic
▪ Alkalotic
What are some causes of hypoxia?
○ Respiratory disease
○ Dysfunction of the neuro system
○ Alterations in circulation
▪ Results in ventilation-perfusion mismatch
What is the patho for hypoxia?
○ Low PO2 levels cause the body to switch to ANAEROBIC METABOLISM
○ Causes a buildup of Lactic Acid
○ Results in metabolic acidosis
What are some s/sx of hypoxia?
○ **Changes in Mental Status & Hyperventilation (RR 20+)
▪ Restlessness, mood changes, increased respirations, etc.
What are s/sx of severe hypoxia?
▪ HR & BP will continue to increase
▪ Delirium, Stupor, Coma
▪ Cyanosis
How is hypoxia diagnosed and treated?
○ 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
What is normal PCO2 levels?
35-45
This condition results in increased PCO2 in the blood (ABG’s), decreased pH (acidosis) and increased HR and RR
hypercapnia
What are some causes of hypercapnia?
○ 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)
What is a late sign of respiratory failure?
PO2 will decrease to about 50 and PCO2 increases to 50 before O2 decrease = cyanosis
Where is central cyanosis evident? Where is peripheral cyanosis evident?
tongue and lips (more serious); extremities, nose and ears
What are some causes of SOB?
▪ Stimulation of Lung Receptors
▪ Reduction in ventilatory capacity (decreased muscle function)
▪ Stimulation of muscle receptors
▪ Excessive chemoreceptors innervating the CNS
This is a protective mechanism to prevent foreign bodies in the lungs but if chronic, can damage lungs/trachea and tear muscles
cough reflex
This is a cough lasting up to 8 weeks
bronchitis
This is a condition is a obstructive disease that is reversible and is due to inflammation and hypersensitivity to allergens
Asthma
What is bronchial asthma and what does it cause?
○ Chronic inflammation of bronchi
▪ Causes hyper-responsiveness & airflow obstruction
* accounts for largest # of ED visits
What is the patho for ashtma?
○ 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)
This type of asthma is induced by Type I Hypersensitivity (exposure to antigen/allergen) and begins in early childhood
Extrinsic Asthma (Atopic)
Describe what occurs during acute phase Extrinsic Asthma (Atopic)
- last 10-20 minutes
□ Release of chemical mediators
□ Bronchospasm
□ Edema
Describe what occurs during late phase Extrinsic Asthma (Atopic)
- last 4-8 hours
□ Inflammation
□ Hyper-responsiveness (vicious cycle of exacerbation)
This type of asthma is triggered by respiratory infections that release IgE antibodies, exercise, pollutants, hyperventilation, cold air and GERD
Intrinsic Asthma (Non-Atopic)
What are some s/sx of asthma?
○ Wheezing ○ Chest tightness ○ Dyspnea (subjective SOB) ○ Cough ○ Increased sputum ○ Tachycardia & Tachypnea
What are some facts about asthma in children?
○ 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
How is asthma diagnosed and treated?
- 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
This condition is the 4th leading COD, os more common in women with smoking being the most common cause:
COPD
What is the second most common cause of COPD?
Antitrypsin Deficiency (decreased elasticity in the lungs)
What is the patho for COPD?
○ 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)
What are the s/sx of COPD?
○ Presents no early symptoms ○ Fatigue / Exercise (ADL's) intolerance ○ Productive AM cough ○ SOB ○ Recurrent respiratory infections ○ Chronic respiratory failure (PO2 & PCO2 levels)
How is COPD diagnosed and treated?
○ 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)
What are the s/sx of COPD blue bloaters?
▪ Chronic Bronchitis
▪ Cyanosis
▪ Fluid retention d/t R-sided heart failure
▪ Hypoxemia (blue) can result in polycythemia
What are the s/sx of COPD pink puffers?
▪ Emphysema
▪ PO2 <65 & PCO2 55+
▪ No cyanosis but they do have Air Trapping (CO2 retention)
▪ Barrel Chest
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
CHRONIC BRONCHITIS
What causes chronic bronchitis?
▪ 80-85% caused by SMOKING
▪ Males > Females
▪ Repeated airway infxn & chronic cough
What is the pathway for chronic bronchitis?
▪ 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
What are the s/sx of chronic bronchitis?
▪ 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)
This condition results in destruction of alveoli WITHOUT FIBROSIS and abnormal enlargement of air sacs
Emphysema
What causes Emphysema?
- smoking (teen smokers have high r/o developing by 50)
- weight loss
- genetic predisposition
- results from bacterial infxn
What is the patho for emphysema?
▪ 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
What are s/sx of emphysema?
▪ 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)
This condition results from incomplete expansion of the lung or portion of the lung
Atelectasis
What is the cause of Atelectasis?
○ 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
What are the s/sx of Atelectasis?
○ Tachypnea & Tachycardia (compensation) ○ Dyspnea ○ Cyanosis / Hypoxemia ○ Decreased chest expansion (part of lung isn't inflating ▪ Absent breath sounds
This condition results from presence of air within the pleural space (partial or complete collapse of the lung)
Pneumothorax
What is spontaneous Pneumothorax and its causes?
▪ Rupture of a bleb/bullae
▪ Cause unknown, but associated w/ males & heavy smoking
What is traumatic Pneumothorax and its causes?
□ 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
What is tension Pneumothorax and its causes?
▪ 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
What are some s/sx of Pneumothorax?
○ 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
This is a viral infection that is highly contagious the first 3 days when symptoms begin; children are the main reservoir:
common cold
What are the s/sx of a common cold and how is it treated?
▪ Watery, clear secretions
▪ Erythematous mucous membranes
▪ Swollen, sore throat
▪ Hoarseness
▪ NO ANTIBIOTICS
▪ Encourage rest
▪ Symptomatic treatment w/ OTC meds
This is a viral infection that is a common COD in the elderly and highly contagious 24hrs before s/sx start:
flu
How long is the flu contagious and how is it transmitted?
for 5-10 days and transmitted via droplets (not by contact)
What are some s/sx of the flu and how is it treated?
▪ 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)
_______ is the Primary Treatment/Focus-
Prevention:
▪ Everyone over 6 y/o needs to vaccinated yearly
What are the 3 strains of the flu?
□ 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
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)
Pneumonia
What is a typical and atypical agent of Pneumonia?
Where is the typical distribution in the lungs?
□ Typical = bacteria
□ Atypical = mycoplasmas or viruses d/t disease condition of lungs (stasis of
mucous)
□ Lobular Pneumonia
□ Broncho-pneumonia
What is the patho for Pneumonia?
▪ 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
How is Pneumonia diagnosed?
▪ Sputum culture & sensitivity
▪ Symptomatology
▪ CHEST XR
What is the most common cause of bacterial pneumonia (Pneumococcal Pneumonia)?
S. pneumoniae
What are the s/sx of Pneumococcal Pneumonia?
▪ 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
How is Pneumococcal Pneumonia diagnosed?
▪ 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
This condition is the #1 COD from a single organism, is associated with HIV and spread by airborne droplets
Tuberculosis
What is the patho of TB?
○ 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
What are the s/sx of TB?
○ Insidious & Non-specific symptoms ▪ Wt loss ▪ Night Sweats ▪ Fever ▪ Cough
When can TB be spreaded?
Once TB spreads to the sputum, it can be transmitted to another person
How can TB be diagnosed?
○ PPD, Chest XR
○ Sputum Tests!!!!
How can TB be treated?
○ Multiple drug combinations are MANDATORY
▪ INH (isoniazid), Rifampin, Pyrazinamide, Ethambutol, Streptomycin for 6+ mos
What is normal pH?
What is normal HCO3?
What is normal PCO2?
What is normal PO2?
7.35-7.45
22-26
35-45 (indicative of ventilation)
80-100 (indicative of perfusion)
What is the main muscle used in ventilation and what are the accessory muscles?
- diaphragm
- sternomastoid, scalene and intercostal
What does air movement depend on?
the resistance of the
airways and lung compliance
What are the functional units of the lung and what do they consist of?
- lobules; bronchioles, alveoli and pulmonary capillaries (where gas exchange takes place)
What are the 2 types of alveolar cells?
- type 1 is squamous - provides gas exchange to the lung
- type 2 is progenitor + cuboidal - produces surfactant
What is respiratory diffusion?
Movement of gases across the alveolar capillary membrane
What results from chronic hypoxia?
- increased ventilation
- increased RBC
What are considered obstructive respiratory diseases?
Asthma
COPD
Chronic Bronchitis
Emphysema
What are some r/f for COPD?
- 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
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
lung cancer
How is lung cancer diagnosed?
- CT scan of lungs
- Bronchoscopy performed for biopsy
- Thoracentesis to obtain cells from pleural space for staging
What are the four cell types found inn lung cancer?
- 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).
What are the s/sx of lung cancer?
- 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)
A low pH and high PCO2 is:
respiratory acidosis
A low pH and a low PCO2 is:
metabolic acidosis
A high pH and a low PCO2 is:
respiratory alkalosis
A high pH and a high PCO2 is:
metabolic alkalosis
What are the common COVID symptoms and when do they normally occur?
- fever
- dry cough
- fatigue
- 2-14 days after exposure
What is the course of death for COVID?
21 days
What is the theory for COVID 19 patho?
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
What is static lung compliance?
Compliance of the lungs when the lungs and the muscles of the lungs are at rest; pressure is the only variable
What is dynamic compliance?
Compliance of the lungs during breathing
What intervention works best for the COVID patient?
prone positioning with high flow nasal cannula therapy works best for the COVID-19 patient
This test tells you if you have a current infection:
viral test
This test tells you if you had a previous infection:
antibody test
