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WGU Pathophysiology > Lesson 8 Respiratory system > Flashcards

Lesson 8 Respiratory system Flashcards

1
Q

What structures make up the Upper respiratory tract?

A

nose, oropharynx, larynx, trachea, and two main bronchi and bronchioles

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2
Q

Is Pneumonia an URI or a LRI?

A

LRI

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3
Q

Is Acute sinusitis an URI or a LRI

A

URI

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4
Q

Is Tuberculosis an URI or a LRI

A

LRI

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5
Q

Is Acute Tonsillitis an URI or LRI

A

URI

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6
Q

Is Epiglottitis an URI or LRI

A

URI

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7
Q

Why does aspiration most often occur in the right lung? (specifically the right middle lobe)

A

The left bronchus is curved as it enters the lung tissue, whereas the right bronchus is vertical and wider, providing a straight path downward into the right lung

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8
Q

How does the exchange of CO2 and O2 occur?

A

Alveoli are thin-walled, balloon-like structures surrounded by pulmonary capillaries, Air enters the alveolus, and oxygen moves across the alveolar membrane to the blood. At the same time, carbon dioxide moves from the blood into the alveolus to be excreted by exhalation.

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9
Q

Under normal conditions, what partial pressure of oxygen allows hemoglobin to be greater than 95% saturated with oxygen?

A

Under normal conditions, Hgb is fully saturated at 100 mm Hg

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10
Q

Would a person with a fever likely have a higher or lower percent
oxygen saturation than someone with a normal temperature

A

Under conditions of hyperthermia (fever), low pH (acidosis), high PCO2, high CO (carbon monoxide), and increased 2,3-DPG,* there is less saturation of hemoglobin. Hgb affinity for oxygen is less than normal.

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11
Q

What is hypoxia and what are some possible causes?

A

occurs when oxygen levels in the blood are insufficient to meet the needs of tissue.
Pulmonary edema, chemical poisoning (carbon monoxide)

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12
Q

What are some signs of impending respiratory failure?

A

Usually, there is a gradual increase in arterial carbon dioxide and a decrease in arterial oxygen when a patient is developing respiratory failure
appears distressed, may be using accessory respiratory muscles, and has difficulty maintaining a normal respiratory rate despite oxygen administration.

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13
Q

What is respiratory failure?

A

occurs when the pulmonary system fails to oxygenate the blood or fails to sufficiently eliminate carbon dioxide. It is classified as either hypoxemic or hypercapnic respiratory failure.

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14
Q

Why are smokers at a higher risk for infection?

A

Smoking paralyzes the mucociliary apparatus, and inhaled particles stimulate smokers to forcibly cough to mobilize mucus. Failure to remove excess particles from the respiratory system increases the risk of infection.

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15
Q

Why do people who live at high altitudes have more RBCs?

A

At high altitude, the decreased air pressure causes decreased levels of PO2, which stimulates erythropoietin. This, in turn, increases production of RBCs, which is why individuals who live in mountainous areas have higher-than-normal levels of hemoglobin and hematocrit.

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16
Q

Why would a patient with a spinal cord injury have trouble breathing?

A

The phrenic nerve, which originates as the fourth cervical spinal nerve (C4), innervates the diaphragm. A spinal cord injury occurring at or above C4 causes motor and sensory conduction to the diaphragm to be interrupted and respirations to cease.

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17
Q

Why does a patient with chronic hypoxia have pulmonary hypertension?

A

The lungs have a built-in compensatory mechanism that attempts to match blood flow and ventilation: where there is little ventilation, pulmonary arterial vessels constrict. Pulmonary artery vasoconstriction leads to redistribution of blood flow to better-ventilated areas of the lung. This causes Pulm HTN as the vessels have constricted increasing the pressure needed to be exerted by the right side of the heart.

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18
Q

Why does a patient with a pulmonary embolism have a ventilation-perfusion imbalance?

A

(V-Q ratio) is defined as the ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli.
When ventilation and perfusion are unequal, there is ventilation-perfusion imbalance. The blockage of the embolism interferes with perfusion

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19
Q

Why does a patient with COPD depend on the hypoxic drive as their main trigger for breathing?

A

The normal stimulus to breathe is hypercapnia, an increase of carbon dioxide in the blood. when central chemoreceptors are exposed to high levels of CO2 for extended periods, they become less responsive. The blunted response to CO2 allows the peripheral chemoreceptors of low O2 to take over as the stimulus of respirations. The hypoxic drive becomes the main trigger for breathing.

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20
Q

Why would a patient have decreased gas exchange in the lungs after surgery?

A

Patients who undergo long surgical procedures often develop atelectasis. It is important to advise postoperative patients to cough, deep-breathe, and use an incentive spirometer to reverse atelectasis.

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21
Q

Why would a patient with chronic hypoxia have right ventricular heart failure?

A

Chronic hypoxia also causes pulmonary arterial vasoconstriction, If there are a large number of lung areas with chronic hypoxia, then the large areas of vasoconstriction of pulmonary arterioles cause the pulmonary artery to increase in pressure; this is termed pulmonary hypertension. High pulmonary artery pressure places high resistance against the right ventricle of the heart, which can lead to right ventricular hypertrophy and eventually excessive strain that leads to right ventricular failure.

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22
Q

This is the involuntary mechanism to clear the bronchial tree

A

Cough

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23
Q

This is the technical term for shortness of breath

A

Dyspnea

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24
Q

What is the name for the collapse of a small number of alveoli

A

Atelectasis

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25
Q

What is the term for when levels of oxygen are insufficient to meet demand of the body

A

Hypoxia

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26
Q

What is the term for production of blood-containing sputum

A

Hemoptysis

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27
Q

This is usually identified by gradual increase of CO2 and decrease of O2

A

Impending respiratory failure

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28
Q

What is the difference between a productive and nonproductive cough?

A

productive means you produce sputum when you cough, non-productive means nothing is coughed up

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29
Q

What causes profuse and thick sputum, possibly yellow or green?

A

presence of bacterial infection

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30
Q

What causes light pink or “rusty” sputum?

A

indicative of minor bleeding, as can occur when capillaries in the lungs rupture because of forceful coughing.

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31
Q

What causes sputum containing red blood (Hemoptysis)?

A

often is associated with TB or lung cancer

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32
Q

What causes grey sputum?

A

occurs from exposure to tobacco smoke

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33
Q

What are the classic signs of TB?

A

chronic cough, weight loss, night sweats, and hemoptysis.

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34
Q

Which upper respiratory infection is considered a medical emergency?

A

Epiglottitis is a medical emergency. A laryngoscope and tracheostomy equipment should be available at the patient’s bedside at all times, because intubation may be needed.

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35
Q

When auscultating lung sounds in a patient suspected of having pneumonia, what adventitious sounds would you anticipate hearing over the peripheral lung fields?

A

bronchial breath sounds
(also: Listening for vocal resonance, Crackles, sometimes called rales are commonly present in pneumonia as well)

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36
Q

What does normal sputum look like

A

Clear and thin

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37
Q

This is inflammation of the lung tissue in which alveolar air spaces fill with purulent, inflammatory cells and fibrin. Infection by bacteria or viruses is the most common cause, although inhalation of chemicals, aspiration of contents from the oropharynx or stomach, or infection by other infectious agents such as rickettsiae and fungi may occur.

A

Pneumonia

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38
Q

What are the 3 types of pneumonia depending on the setting in which it occurs?

A

community acquired, hospital acquired, and ventilator associated

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39
Q

What is the most common etiologic agents involved in pneumonia?

A

Bacteria
(Streptococcus pneumoniae, H. influenzae, Mycoplasma, Klebsiella, Staphylococcus, and Legionella)

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40
Q

What makes Legionella pneumonia unique?

A

spread via water systems such as air conditioning, mists sprayed on produce in grocery stores, and hot tubs

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41
Q

Mycoplasma is a small bacteria-like organism that can cause a syndrome called what, where the patient may not appear very ill but has persistent cough and, commonly, headache and earache.

A

Walking Pneumonia

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42
Q

What is one of the major risk factors for developing pneumonia and why?

A

influenza infection because viruses commonly alter the pulmonary immune defenses and make the lungs vulnerable to bacterial infection, referred to as secondary pneumonia.

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43
Q

How is pneumonia caused?

A

inhalation of droplets containing bacteria or other pathogens. The droplets enter the upper airways and then enter the lung tissue. Pathogens adhere to respiratory epithelium and stimulate an inflammatory reaction. The acute inflammation spreads to the lower respiratory tract and alveoli.

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44
Q

The symptoms for this infection include: fever, tachypnea, tachycardia, possibly cyanosis, crackles in lungs, pleuritic chest pain, dyspnea, hemoptysis, and decreased exercise tolerance

A

Pneumonia

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45
Q

Drug resistance is a significant concern for treatment of this infection

A

Pneumonia AND TB

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46
Q

This infection causes more deaths in the US than any other infection

A

Pneumonia

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47
Q

What is the most important diagnostic study in the diagnosis of pneumonia?

A

Chest xray

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48
Q

How is Pneumonia treated?

A

Antibiotic therapy and oxygenation, Analgesia, antipyretics, and bronchodilators may be needed.

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49
Q

This is a localized area of purulent exudate that results in tissue necrosis and a central area of liquefaction and a common cause of it is aspiration of oral contents containing anaerobic bacteria into the lungs.

A

Lung Abscess

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50
Q

This is an infection most commonly occurring in the lungs due to a specific bacterial organism.

A

TB

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51
Q

What other parts of the body can TB infect?

A

adrenal gland, vertebrae, meninges, and lymph nodes

52
Q

In this form of TB the infected individual has symptoms and clinical evidence of active disease. They are usually severely ill, infectious to others, and can die if not treated.

A

TB disease

53
Q

In this form of TB the individual has been infected with the M. tuberculosis organism but the disease is dormant. The individual has no clinical symptoms and is noninfectious.

A

Latent TB infection

54
Q

What can happen to a person with latent TB infection if they are not treated?

A

can convert to active TB disease at any point during the individual’s lifetime

55
Q

How is TB spread?

A

spread by the inhalation of airborne droplets containing M. tuberculosis bacteria. Inhalation is the main route for transmission;

56
Q

Which infection causes a lesion of granulomatous accumulation of WBCs, bacteria, and fibrotic tissue walled off by the body’s cell-mediated immune response in the lungs? What is the lesion called?

A

TB
tubercle

57
Q

In TB the macrophages and T cells continue to be stimulated, secrete enzymes, and kill bacteria, which also damage lung tissue. Necrotic lung tissue takes on a cheese-like appearance; histologically, it is called what?

A

Caseous Necrosis

58
Q

The symptoms of this infection include: chronic cough, which produces purulent sputum; hemoptysis; weight loss; anorexia; chest pain; and a low-grade fever with night sweats. Older adults usually do not exhibit all the classic signs because they cannot mount a strong immune response. crackles or bronchial sounds in the lungs over the area of involvement

A

TB

59
Q

Why is sputum testing essential when chest x-ray is consistent with TB?

A

up to 20% of patients with active TB may not have any symptoms.

60
Q

What is the screening test for TB?
What can the test indicate (what is the limitation?)
If the test is positive, what is required next?

A

Mantoux tuberculin skin test (or PPD)
The test can indicate only if an individual has had prior exposure and sensitization to the organism M. tuberculosis
Require a chest x-ray.

61
Q

How is TB treated? (generalized)

A

Multidrug therapy is required for a long time, usually 6 to 12 months, and may need to continue longer in patients with an HIV infection or those with drug-resistant strains of TB

62
Q

How does the body compensate for hypoxia?

A

increasing ventilation, stimulating pulmonary arteriole vasoconstriction, and having the kidney release erythropoietin

63
Q

What sign shows up in the fingers due to chronic hypoxia?

A

clubbing of the fingers

64
Q

What occurs in patients with long-term COPD affecting the chest?

A

“barrel shaped” chest

65
Q

This type of obstructive airway disease is also called hyperreactive airway disease, is a chronic inflammatory disorder that causes reversible airway constriction because of bronchial hyperreactivity. With each acute attack, remodeling and inflammatory changes develop in the bronchioles,

A

Asthma

66
Q

What is the most common cause/etiology of asthma?

A

allergy: exhaust fumes, perfumes, pollen, grasses, flowers, dust, cigarette smoke, animal dander, molds, and spores. Tobacco smoke is particularly known for triggering bronchospasm.

67
Q

Asthma can be silent in individuals and only present during this, bronchospasm occurs during vigorous physical activity in some individuals with airway hyperreactivity. Exposure to cold air often worsens this.

A

Exercise (induced asthma)

68
Q

What WBC in particular are involved in the pathophysiology of asthma?

A

T lymphocytes

69
Q

What are responsible for the development of bronchoconstriction, bronchial hyperreactivity, edema, and eosinophilia?

A

Leukotrienes

70
Q

T cells release cytokines called _________that maintain the damaging effects of the asthma attack.

A

interleukins

71
Q

These migrate to the reactive airway, compounding cell damage and airway edema.

A

Eosinophils

72
Q

Which chemical released by mast cells contributes to bronchospasm and inflammation.

A

Histamine

73
Q

This respiratory condition is characterized by wheezing, cough, dyspnea, and chest tightness. The severity of the symptoms depends on the degree of bronchial hyperresponsiveness and reversibility of the bronchial obstruction

A

Asthma

74
Q

Prolonged exhalations are commonly an early sign of what?

A

airway obstruction

75
Q

Severe asthma attacks are accompanied by what?

A

use of accessory muscles, distant breath sounds, and diaphoresis.

76
Q

What is the rescue med for Acute asthma attacks?

A

Short-acting bronchodilators

77
Q

In this complication of asthma: is defined as persistent bronchoconstriction that endures despite attempts to treat the attack with medications. In this severe asthma attack, pulmonary gas exchange is diminished by the uneven distribution of ventilation resulting from generalized bronchoconstriction. The major physiological abnormality is a grossly uneven V-Q distribution

A

Status Asthmaticus

78
Q

This disease is a combination of chronic bronchitis, emphysema, and hyperreactive airway disease. It is characterized by the features of these three disorders.

A

Chronic obstructive pulmonary disease (COPD)

79
Q

What is the major cause of COPD, as 90% of people with COPD also do this.

A

Smoking

80
Q

What is COPD characterized by?

A

poorly reversible airflow limitation caused by a combination of chronic bronchitis, emphysema, and hyperreactive airway disease.

81
Q

The characteristic features of ______ are hypersecretion of mucus in the large and small airways, hypoxia, and cyanosis. To be diagnosed with this, the person has to have had a cough for 3 months out of the year for 2 consecutive years.

A

Chronic Bronchitis

82
Q

In _______ the characteristic finding is overdistention of alveoli with trapped air, which creates obstruction to expiratory airflow, loss of elastic recoil of the alveoli, and high residual volume of carbon dioxide in the lung. The airways are also hyperreactive to irritants

A

Emphysema

83
Q

Inflammation is part of the pathology of the disease: Asthma, COPD or Both?

A

Both

83
Q

Inflammation causes stimulation of macrophages, leading to an accumulation of neutrophils, T lymphocytes, and cytokines. Does this occur in Asthma, COPD or both?

A

COPD

84
Q

Activation of helper T lymphocytes results in inflammatory response and symptoms of the disease, including bronchospasm, increased mucous production and vasodilation. Does this occur in Asthma COPD or Both?

A

Asthma

85
Q

Poor ventilation results in pulmonary arterial vasoconstriction, which leads to right ventricular hypertrophy and possibly right ventricular failure. Does this occur in Asthma, COPD, or Both?

A

COPD

86
Q

The FEV1/FVC ratio is reduced. Does this occur in Asthma, COPD or both?

(FVC is the total volume of air that can be exhaled with maximum effort. FEV1 is the volume of air expelled during the first second of exhalation of air from the lungs.)

A

COPD: Airflow limitation of COPD is identified by a FEV1/FVC ratio of less than 70%. FEV1 significantly diminishes in COPD because the patient’s exhalation phase is slow and prolonged
Asthma: During an acute asthma attack, FEV1 decreases, which diminishes the overall FEV1/FVC ratio.

87
Q

V-Q mismatching can occur, where ventilated areas of the lung don’t have adequate circulation and vice versa. Does this occur in Asthma, COPD or Both?

A

Asthma: severe asthma attack, pulmonary gas exchange is diminished by the uneven distribution of ventilation resulting from generalized bronchoconstriction. The major physiological abnormality is a grossly uneven V-Q distribution, leading to a dramatic fall in arterial oxygenation; this is referred to as ventilation-perfusion (V-Q) mismatching.

88
Q

When caring for a patient with severe COPD why should you be cautious when administering O2?

A

the patients stimulus to breathe is hypoxia, and high oxygen levels can decrease the patient’s independent drive to breathe. Oxygen administration higher than 2 liters per minute will decrease or interrupt the stimulus for breathing and can result in respiratory arrest.

89
Q

What are individuals with chronic bronchitis known as because of hypoxia, cyanosis and edema?

A

Blue Bloaters: blue because of hypoxia and cyanosis, and bloater because of the edema that occurs as a result of right ventricular failure.

90
Q

What are individuals with emphysema known as and why? (a way to remember the characteristics of the disease)

A

Pink puffers: pink because they remain well-oxygenated until late in their disease, and puffer because they have a characteristic manner of exhalation using pursed-lip breathing.

91
Q

This is also known as a collapsed lung, is the presence of air in the pleural cavity that causes collapse of a large section or whole lobe of lung tissue

A

Pneumothorax

92
Q

What are the 5 types of pneumothorax?

A
  1. Primary spontaneous pneumothorax (PSP)
  2. Secondary spontaneous pneumothorax (SSP)
  3. Traumatic pneumothorax
  4. Tension pneumothorax
  5. Iatrogenic pneumothorax
93
Q

This occurs in people without underlying lung disease and in the absence of an inciting event. Air is present in the intrapleural space without preceding trauma and without underlying clinical or radiological evidence of lung disease.

A

Primary spontaneous pneumothorax (PSP)

94
Q

This occurs in people with a wide variety of lung diseases, an underlying pathological process occurs in the lung. Air enters the pleural space via ruptured blebs, which are overly distended and damaged alveoli.

A

Secondary spontaneous pneumothorax (SSP)

95
Q

This is commonly caused by a penetrating wound of the thoracic cage and underlying pleural membrane. Commonly caused by a rib fracture puncturing the pleural membrane, the opening allows air from outside the body to build up in the pleural space, compresses the lung, causing collapse

A

Traumatic pneumothorax

96
Q

This occurs when there is an escalating buildup of air within the pleural cavity that compresses the lung, bronchioles, cardiac structures, and vena cava. A closed penetrating wound allows air in, but not out, causes increase in pressure which inhibits venous return and optimal function of heart and lungs.

A

Tension pneumothorax

97
Q

This is a complication of medical or surgical procedures. It most commonly results from transthoracic needle aspiration but can be caused by therapeutic thoracentesis, pleural biopsy, central venous catheter insertion, transbronchial biopsy, positive pressure mechanical ventilation, and inadvertent intubation of the right mainstem bronchus.

A

Iatrogenic Pneumothorax

98
Q

What is the clinical presentation of a patient with a pneumothorax?

A

chest pain, dyspnea, and increased respiratory rate, may be obvious asymmetry of the chest, and intercostal muscle retractions

99
Q

What can confirm a diagnosis of pneumothorax?

A

Chest xray or CT scan

100
Q

What is the treatment for pneumothorax?

A

chest tube with suction on the affected side
A tension pneumothorax is an emergency situation that requires a large-bore needle inserted into the affected side to pull the air out of the chest to relieve the accumulated pressure
O2 administration for all patients with pneumothorax

101
Q

This procedure intentionally causes chemical or surgical irritation of the layers of the pleural membrane. The irritation causes the visceral and parietal pleural membrane layers to adhere to each other and close off the pleural space. It is used to prevent recurrence of spontaneous pneumothorax

A

Pleurodesis

102
Q

This is an abnormal collection of fluid within the pleural cavity that compresses lung tissue and inhibits lung inflation. It is commonly edematous fluid that accumulates within the pleural space because of heart failure, severe pulmonary infection, or neoplasm.

A

Pleural effusion

103
Q

This is is inflammation of the pleural membrane.

A

Pleuritis (also called pleurisy)

104
Q

These are filtrates of the blood that accumulate within the pleural space because of an imbalance in the capillary forces: hydrostatic and oncotic pressure. Elevated hydrostatic pressure causes fluid to leak out of capillaries into the pleural space. noninfectious, clear, and low in protein content.

A

Transudates

105
Q

These are mainly caused by pleural or lung inflammation or infection. they can also come from impaired lymphatic drainage of the pleural space or from extension of inflammatory fluid from the peritoneal space. cloudy, edematous fluid with high protein content.

A

Exudates

106
Q

These symptoms indicate what?
dyspnea, tachypnea, sharp pleuritic chest pain, dullness to percussion, and diminished breath sounds on the affected side. Percussion over the area demonstrates a flat, dull sound that indicates fluid blocking the normally resonant lung tissue

A

Pleural effusion

107
Q

What are some etiologies of transudative pleural effusion?

A
  • Atelectasis
  • Cirrhosis
  • Congestive heart failure
  • Constrictive pericarditis
  • Hypoalbuminemia
  • Myxedema
  • Nephrotic syndrome
  • Peritoneal dialysis
108
Q

What are some etiologies of exudative pleural effusion?

A
  • Asbestos exposure
  • Chylothorax
  • Collagen-vascular conditions
  • Drug use
  • Esophageal perforation
  • Malignancy
  • Meigs syndrome
  • Pancreatitis
  • Parapneumonic causes
  • Postcardiac injury syndrome
  • Radiation pleuritis
  • Sarcoidosis
  • Trauma
  • Tuberculosis
109
Q

How is pleural effusion diagnosed?

A

Chest x-ray, CT scan, and ultrasound

110
Q

How is pleural effusion treated

A

aimed at the cause of the pleural effusion. Suction and drainage of a pleural effusion are usually necessary. Surgical intervention is most often required for effusions that cannot be drained adequately by needle or small-bore catheters.

111
Q

Is Asthma a restrictive or obstructive lung disease?

A

Obstructive

112
Q

Is COPD a restrictive or obstructive lung disease?

A

obstructive

113
Q

Is pneumothorax a restrictive or obstructive lung disease?

A

restrictive

114
Q

Is pleural effusion a restrictive or obstructive lung disease?

A

restrictive

115
Q

This general category for pulmonary diseases are those that prevent complete ventilation, diminish total lung capacity, and impede the opening of all the alveoli.

A

Restrictive pulmonary diseases (like Pneumothorax and pleural effusion)

116
Q

This general category for pulmonary diseases is characterized by an increase in resistance to airflow from the trachea and larger bronchi to the terminal and respiratory bronchioles.

A

Obstructive pulmonary diseases (like asthma, COPD)

117
Q

This is the accumulation of fluid around the alveoli that inhibits oxygen transfer at the alveolar–capillary interface. It occurs when there is an increase in hydrostatic pressure in the capillary bed of the lungs. most commonly caused by LV heart failure

A

Pulmonary edema

118
Q

This is a clot that has traveled to the pulmonary arterial circulation and caused obstruction of arterial blood flow through the lungs. the clot has typically originated as a DVT in leg or in right side of heart as atrial thrombus.

A

Pulmonary Embolism, PE

119
Q

This is abnormally high pressure within the pulmonary arteries.

A

Pulmonary HTN

120
Q

This type is a genetic disorder caused by abnormal structure of the pulmonary blood vessels.

A

Primary pulmonary HTN

121
Q

this is an increase in pulmonary artery pressure as a result of elevated pulmonary venous pressure, increased pulmonary blood flow, pulmonary vascular obstruction, or hypoxemia. COPD, collagen vascular disease, and recurrent pulmonary thromboemboli may be causes

A

Secondary pulmonary HTN

122
Q

This is pulmonary dysfunction characterized by diffuse alveolar injury, pulmonary capillary damage, bilateral pulmonary infiltrates, and severe hypoxemia. It occurs in critically ill patients and is commonly a sequela to trauma, sepsis, drug overdose, massive transfusion, acute pancreatitis, or aspiration.

A

Acute respiratory distress syndrome (ARDS)

123
Q

What is a defining feature of ARDS?

A

arterial hypoxemia that does not improve with administration of oxygen.

124
Q

Is treatment of ARDS effective?

A

No, it’s often ineffective, making it a major cause of death

125
Q
A

WGU Pathophysiology (7 decks)

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