EXPLANATION QUIZ#1 Flashcards
COPD
EXPLAIN
→ Postural Drainage
▪ It allows the force of gravity to assist in the removal of bronchial secretions.
▪ The secretions drain from the affected bronchioles into the bronchi and trachea and are removed by coughing or suctioning.
▪ Each position contributes to effective drainage of a different lobe of the lungs; lower and middle lobe bronchi drain more effectively when the head is down, whereas the upper lobe bronchi drain more effectively when the head is up
▪ Auscultate before and after the procedure to identify the areas that need drainage.
▪ Advise to perform this procedure before meals to prevent nausea, vomiting, and aspiration.
▪ Take prescribed bronchodilators, water, or saline before postural drainage to dilate the bronchioles, reduce bronchospasm, and decrease the thickness of mucus.
COPD EXPLAIN
❖ CHEST PHYSIOTHERAPY (CPT)
→ Improves airway clearance by removing bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles.
❖ WHY DOES A PATIENT WITH COPD RECEIVES LESS OXYGEN?
The central chemoreceptors found in the medulla oblongata is stimulated due to the presence of CO2 causing inhalation and exhalation. However, patients with COPD, the alveoli are completely dilated, there will be accumulation of CO2 in the lungs, and these can narcotize the medulla oblongata which makes it not responsive or sensitive to CO2.
Therefore, the body will compensate in which Peripheral chemoreceptors (found at carotid and aortic bodies) will take over. These chemoreceptors are only stimulated when there is low oxygen, and this is called Hypoxic Drive. That is why a patient with COPD despite the difficulty of breathing receives lesser than 2L/min of oxygen via venturi mask.
EXPLAIN
❖ COMPLICATIONS OF COPD
▪ COPD is due to emphysema and chronic bronchitis. In which, alveoli are destroyed due to emphysema while in chronic bronchitis there is an increased production of mucus by the goblet cells and these actions led to obstruction of the bronchi which lessens the passageway for the gases. Due to less oxygen in the lungs, the smooth muscles will contract causing bronchoconstriction. This can increase pressure in the lungs (Pulmonary Hypertension) and the right ventricle now is having a hard time pushing blood against the pulmonary valve and this can increase the workload of the heart leading to enlargement of the right ventricle known as Right Ventricular Hypertrophy.
▪ Another cause of Right Ventricular Hypertrophy is a lack of oxygen. In response, the body compensates by increasing the production of red blood cells (RBCs), a condition known as polycythemia vera. The consequence is that an excess of RBCs thickens the blood. When the heart has to pump thickened blood, it adds to the workload of the right ventricle, leading to its enlargement.
▪ Cor Pulmonale is the term used if the etiology is pulmonary caused.
EXPLAIN COPD
EMPHYSEMA - EXPLAIN
E-cigarettes or vaping are devices used to inhale an aerosol, which typically contains nicotine (though not always).
▪ It inactivates the cilia, which are responsible for removing microorganisms. With the cilia not working effectively, it becomes easier for microorganisms to enter the trachea, potentially causing lung infections.
▪ It produces carbon monoxide, wherein hemoglobin is more attracted to this type of gas therefore decreasing the carrier for oxygen.
▪ It causes vasoconstriction which increases blood pressure and delays wound healing.
COPD
Emphysema - Explain:
Hyperinflation
Barrel Chest
✓ Hyperinflation is an excessive expansion of the alveoli due to loss of lung elasticity. This results in larger but less efficient air sacs. As the bronchi are obstructed, patients have difficulty exhaling CO2, which results in elevated levels of CO2 in the bloodstream.
▪ Barrel chest is primarily caused by the loss of lung elasticity and hyperinflation of the alveoli, which results in the chest taking on a more expanded shape
In COPD remember there are 2 things to remember, Chronic Bronchitis and Emphysema
(EXPLAIN NA)
*In chronic bronchitis - bronchi is affected
**If bronchi affected in COPD,
**Goblet cell - seen in bronchi
manifestation? sputum production
that will have PRODUCTIVE COUGH
———————-
emphysema - alveoli affected
*150 million alveoli each lungs and surfactant - seen in alveoli
1. decrease surface tension - decrease attractiveness of water
2. so alveoli will not collapsed
**alveoli collapsed - manifestation? DYSPNEA
PATHOPHYSIOLOGY COPD
→ Exposure to irritants such as smoking, dust, pollen, etc., irritates the goblet cells and these cells respond by increasing sputum production thereby causing an obstruction on the bronchi causing a productive cough and if this last for more than 3 months for 2 consecutive years this is now known as chronic bronchitis. This inflammation can reach the alveoli, wherein it causes alveolar wall destruction called as emphysema. These two conditions obstruct the airway and contribute to Chronic Obstructive Pulmonary Disease
TONSILITIS
✓ Bleeding may be seen as bright red blood if the patient _____ it before swallowing it.
✓ If the patient swallows the blood, it becomes brown because of the ______
expectorates
action of the acidic gastric juice.
PNEUMOTHORAX
EXPLAIN
TENSION PNEUMOTHORAX
TENSION PNEUMOTHORAX
* Will not have this unless open/close pneumothorax happens – if not treated can lead to tension pneumothorax
* Stabbed – air will enter (sucking wound) – air accumulates – lungs will collapse – OPEN PNEUMOTHORAX
* Broken rib – injured pleura – CLOSED PNEUMOTHORAX
* Air keeps coming in but cannot exit
* Pressure will increase and the mediastinum will push to the other side – pressure will go to the heart – unaffected side will also compress – less blood going to the heart because of compression of artery – cardiopulmonary arrest
* Tracheal deviation to the unaffected side (moving of the trachea because of pressure)
* Distended neck veins – causes pressure on blood vessels –SVC and IVC
* Respiratory distress – lung collapse increase pressure
* Cyanosis – less oxygenated blood
* Hypertonic sound on percussion
Asthma
Explain when goblet cells irritated
Goblet cells irritated -> Smooth muscles constrict (Bronchoconstriction) -> Production of mucoid secretions -> Inflammation -> Release of histamine -> Increase capillary permeability -> albumin goes out -> edema -> there will be airway obstruction -> Atelectasis -> alveoli collapse -> ventilation/perfusion mismatch (V/Q Mismatch) -> blood that will enter the lungs will be less oxygenated
ASTHMA
THREE MECHANISMS that can lead to difficulty in breathing (asthma):
- increase mucous that produced by goblet cells
- bronchoconstriction
- inflammation of bronchus
→ When all three of these factors are present, they may lead to _______.
→ Irritants can cause an increased secretion of mucus by the goblet cells, which can lead to the obstruction of the bronchi.
→ Less oxygen due to obstruction of the mucus causes the smooth muscles to contract leading to bronchoconstriction which further narrows the lumen.
→ Asthma, being an inflammatory disease, can lead to edema, which narrows the bronchi.
atelectasis
ASTHMA
How can obstruction of bronchi happen?
Smoking, dust, pollen, or perfume can irritate the goblet cells causing an increase production of mucus, and this can cause obstruction of the
bronchi.
