Module 1 - Respiratory System Flashcards
1
Q
When a individual presents with a respiratory illness what are the most important assessments?
A
Rate
Rhythm
Depth
2
Q
_________________ is a normal respiratory rate.
A
Eupnoea
3
Q
If the carbon dioxide levels in the blood are high, what is the pH likely to be?
A
Lower.
4
Q
What is tachypnoea?
A
Respiratory rate faster than acceptable limits for age
5
Q
What is bradypnoea?
A
Respiratory rate slower than the acceptable limit for age.
6
Q
What is dyspnoea?
A
- Difficulty breathing; shortness of breath.
- Can be acute of chronic
7
Q
What is orthopnoea?
A
Difficultly breathing when lying flat
8
Q
What is paroxysmal nocturnal dyspnoea?
A
Difficulty breathing at night. Associated with reclined positioning and rouses individual from sleep in respiratory distress.
9
Q
Define the term hypoventilation.
A
Generic term for not breathing enough to expel sufficient carbon dioxide; may relate to rate or depth or both.
10
Q
Define the term hyperventilation.
A
Generic term for breathing too much and expelling too much carbon dioxide; may relate to rate or depth or both.
11
Q
Define the term apnoea.
A
Absence of breath.
12
Q
What two type of drugs would you use for a obstructive respiratory disorder?
A
- Bronchodilators (opens up airways)
- Corticosteroids (reduces inflammation)
13
Q
When oxygen gets to our blood and carbon dioxide gets out of the blood is called what?
A
Gas exchange.
14
Q
Carbon dioxide level lower the 35mmHg
A
Hypocapnia
15
Q
Reduced oxygen level at the tissues is called what?
A
Hypoxia
16
Q
Carbon dioxide level greater that 45 mmHg is classified as what?
A
Hypercapnia
17
Q
Bulbous enlargement of distal fingers & toes
A
Digital clubbing
18
Q
Bluish discoloration in finger and toes
A
Peripheral Cyanosis
19
Q
Bluish discoloration of lips, tongue, mucous membranes
A
Central Cyanosis
20
Q
What are the three commonly occuring type of diseases affecting the respiratory system?
A
- Obstructive
- Restrictive
- Infectious
21
Q
Name 2 examples of obstructive respiratory disease.
A
COPD (Bronchitis & Emphysema)
Asthma
22
Q
Name 2 examples of Restrictive respiratory diseases.
A
Pulmonary effusion
ARDs
23
Q
Name 2 examples of Infectious respiratory diseases.
A
- URTI
- Pneumonia
24
Q
Define obstructive disorders.
A
Obstructive disorders are those where there is difficulty in exhaling all the air from the lungs. (Trouble getting air out)
25
Define asthma.
Asthma is an obstructive respiratory condition involving chronic airway inflammation
26
In simple terms name three things that happen to the airways of someone with asthma.
1. Inflammation
2. Mucous production
3. Bronchoconstriction.
27
When giving aspirin or beta blockers to patients, its **_always_** important to ask what?
**_Do they have asthma?_**
28
What are some symptoms of asthma?
* Chest tightness
* dysnopea
* wheezing or high pitched whistling
* coughing
* excess mucous production
29
What are some ways to treat or manage symptoms of asthma?
* Avoid contact with triggers
* medications
* oxygen therapy
* Relievers and preventers
30
What is COPD?
**Chronic Obstructive Pulmonary Disorders (COPD)** is the umbrella term given to a group of respiratory disorders resulting in breathing difficulty.
The 2 main conditions include:
* Chronic Bronchitis
* Emphysema
31
What is Chronic Bronchitis?
**Chronic bronchitis i**s a chronic obstructive pulmonary disease which involves too much mucous. Excess mucous resulting in blockackages and narrowing of the airway passages making it difficult to breath and obstructing air flow.
32
Name at least 4 factors that decrease respiratory rate.
* increased intracranial pressure
* alcohol
* narcotics
* rest/sleeping
* hypocapnia
* hypothermia
33
Name at least 5 factors that can increase respiratory rate.
* anxiety
* caffeine
* pain
* exertion
* hypercapnia
* fever
* haemorrhage
* acidosis
* lung disease
* cardiac disease
* young age
34
Name classic alterations in respiratory rhythm.
* Kussmaul
* Cheyne-Stokes
* Biot's
* Cluster and apneustic breathing
35
**Chronic Bronchitis** results from ___________ \_\_\_\_\_\_\_\_\_\_\_\_ of the respiratory tract.
Continuous irritation.
36
Chronic bronchitis leads to… Name 3 things.
* goblet cell proliferation
* mucous hypersecretion
* smooth muscle hypertrophy
37
**TRUE OR FALSE.**
Chronic Bronchitis is incurable.
**TRUE.**
Management focuses on symptom control and prevention of acute exacerbations.
38
What criteria must a individual meet to be diagnosed with chronic bronchitis?
* Cough for 3 months of a year for 2 or more consecutive years.
* Coughing up flem.
39
What is emphysema?
**Emphysema** is a chronic obstructive pulmonary disorder (COPD) that involves airway collapse due to changes in structures to the wall. In emphysema elastin around the alveoli is destroyed causing it to become floppy and air to become trapped impeding gas exchange.
40
Pursed lip breathing helps patients with emphysema because it…..?
Helps keep the small airways open and prevents air trapping.
41
Define restrictive respiratory disorders.
**Restrictive disorders** are those which impede the lungs from fully expanding.
That is people **can't get air in** - as opposed to obstructive where people can't get the air out.
42
What does ARDS stand for?
Acute respiratory distress syndrome
43
What is ARDS?
Acute respiratory distress syndrome (ARDS) is a type of **restrictive airway** disorder occuring **inside the lungs** (parenchymal).
44
**TRUE OR FALSE.**
When a person has ARDS it is enough to just get oxygen in.
**FALSE.**
Its is not enough to simply get oxygen in. The alveoli need to open- manual ventilation PEEP.
45
What is pleural effusion?
A pleural effusion is a type of **restrictive** airway disorder occuring **outside the lungs** (*extraparenchyma*l). Pleural is the space between the chest cavity and lungs and an effusion is a collection of fluid so a pleural effusion is a collection of fluid in the pleural space – restricting lung expansion.
46
What is Albumin?
Albumin is the most abundant protein in the blood plasma. It keeps fluid from leaking out of blood vessels; nourishes tissues; and carries hormones, vitamins, drugs, and ions like calcium throughout the body. Albumin is made in the liver and is sensitive to liver damage.Basically albumin keeps fluid where it is supposed to be!
47
What is hydrostatic pressure?
Force that blood exerts on the walls (pushing force).
Commonly caused by heart failure.
48
What is Oncotic Pressure?
A result of solutes (like albumin) not crossing capillaries. Can be caused by cirrhosis and nephrotic syndrome.
49
Name 3 types of pleural effusion.
Transudative
Exudative
Lymphatic
50
Transudative pleural effusion
Too much fluid leaves the capillaries because of increased hydrostatic pressure or decreased oncotic pressure in the blood vessel.
51
Exudative pleural effusion
Exudative pleural effusions occur when the pleura is damaged, e.g., by trauma, infection or malignancy
52
Lymphatic Pleural Effusion (Chylothorax)
Casued by damage to the thoracic duct. Can be caused by damage during surgery and tumors.
53
Name some symptoms of pleural effusion.
* pain while inhaling
* shortness of breath
* worse when lying down flat
* decreased breath sounds
* dullness to percussion
* decreased tactile fremitus
54
What is a thoracentesis?
Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier.
55
How is transudative fluid described?
Clear
56
How is exudative fluid described?
Cloudy - full of immune cells
57
How is lymphatic fluid described?
Milky - filled with fats.
58
What is the treatment for a pleural effusion?
* Removing fluid
* Treating underlying cause.
59
What does the suffix -itis mean?
Inflammation
60
Infectious respiratory diseases are also usually classified as ______ or ________ infections depending on where they are located.
Upper and lower.
61
Where are the upper and lower respiratory systems are divided?
At the vocal cords.
62
What does URTI stand for?
Upper respiratory tract infection
63
What is Pneumonia?
Pneumonia is an infection in the lung tissue specifically in the alveoli. The alveolar tissue becomes inflamed and leaks fluid filling the alveoli with infected fluid impairing gas exchange. This is usually caused by bacteria (such as Staphylococcus Aureus) or viruses (such as Influenza) that we pick up in the community – known as community acquired pneumonia.
64
Name 3 ways pneumonia can be casued.
* **Community acquired** pneumonia (bacteria and viruses),
* **Ventilator acquired** pneumonia
* **Aspiration** (vomit,food)
65
Bronchodilators can be classed as what?
**Beta2 agonists** (Cause bronchodilation)
**Anticholinergics** (block bronchoconstriction)
66
**Corticosteroids.**
Name 2 ways they are administered.
**Inhaled** corticosteroids
**Oral** corticosteroids
67
Beta2-Agonist
**Short** Acting
* Salbutamol
* Terbutaline
68
Beta2-Agonist
**Long** Acting
* Formoterol
* Salmeterol
69
When to use Beta2-Agonists?
* Asthma
* COPD
70
**Beta2 Agonists**
Mechanism of Action
Stimulate β2-receptors on airway smooth muscle & mast cells r**esulting in bronchodilatation** & inhibition of mast cell mediator release.
Onset of action:
* short acting - 5-15 mins (lasts 3-6hrs)
* long acting last in excess 12 hrs.
71
**Beta2 Agonists**
Adverse Reactions/Interactions/Considerations:
* Tachycardia
* palpitations
* tremor
* dry mouth
* paradoxical bronchospasm
72
Muscarinic Receptor Antagonists - Short acting
Ipratropium
73
Muscarinic Receptor Antagonists - Long acting
Tiotropium
74
When to use Muscarinic Receptor Antagonists?
* Asthma
* COPD
75
Muscarinic Receptor Antagonists
## Footnote
**Mechanism of Action**
Antagonise the constrictor activity of acetylcholine on airway smooth muscle resulting in bronchodilation. **Blocks the parasympathetic nervous system** rather than stimulating the sympathetic nervous system. Inhibits muscarinic receptors.
76
Muscarinic Receptor Antagonists
## Footnote
**Adverse Reactions/Interactions/Considerations**
* Headache
* dizziness
* dry or sore mouth
* throat irritation
* cough
* nausea
* vomiting
77
**TRUE OR FALSE.**
Muscarinic Receptor Antagonists should be avoided in pregnancy?
**TRUE**
78
Corticosteroids - Anti-inflammatory
Budesonide (Pulmicort)
79
When to use Corticosteroids?
* Asthma
* COPD
80
Corticosteroids
## Footnote
**Mechanism of Action**
Inhibit production of cytokines, leukotrienes, prostaglandins and inhibit recruitment of eosinophils and release of other inflammatory mediators (basically inhibit inflammatory response). Help to increase the diameter of the airways by reducing swelling.
81
Corticosteriods
## Footnote
**Adverse Reactions/Interactions/Considerations**
* **oral candidiasis**
* **hoarseness & changes in voice**
* **cough**
These problems can be minimised through the use of a spacer with a metered-dose inhaler (MDI), brushing the teeth and gargling to help reduce residual medication in the oropharynx after using the inhaled medication.
82
A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which classes of medication right away?
**Bronchodilators.**
_Bronchodilators are the first line of treatment for asthma_ because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but aren’t used for emergency relief.
83
A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, what condition does he most likely have?
Chronic bronchitis.
84
Pleural effusion is a type of which respiratory disease?
Restrictive
85
Arterialpartial pressures of carbon dioxide (PaCO2) need to be maintained at what mmHg?
35-45 MMhG
86
What is Haemoptysis?
**Haemoptysis** is the medical term for coughing up blood from the lungs or bronchial tubes. It can range from small flecks of blood to a lot of blood.
87
Cheyne-Stokes Breathing
Cyclic pattern in a crescendo-descresendo manner of deep, laboured breathing, which becomes shallow and shallower until a episode of apnoea occurs. Followed by pattern of shallow respirations.
Often associated with end of life situations and people with congestive heart failure when sleeping.
88
Biots Breathing (Ataxic Breathing)
Irregular period of rapid breathing followed by variable periods of apnoea. Depth of breath is inconsistant.
Assoicated with neurological damage, meningitis, intracranial pressure.
89
Cluster Breathing
Periods of tachypnoea seperated by periods of apnoea. Associated with damage high in the medulla oblongata or low in the pons.
90
Define hypocapnia.
A state of reduced carbon dioxide in the blood.
91
Name the 3 classifications of asthma specific drugs.
* Relievers (Rescue) - short acting Beta-2 agonists
* Controllers
* Add-on therapies for patient with severe asthma (corticosteriods)
92
What is the main cause of hypocapnia?
Hyperventilation.
93
Name 4 conditions **hypo**capnia is a risk factor for.
* Cerebral Palsy
* Auditory defects
* Poor neuroedvelopment outcomes
* Periventricular Leukomalacia (PVL) - brain injury.
* Contribute toward acute lung injury.
94
What are some neurological effect of worsening hy**per**capnia?
* Increased cerebral blood flow
* Increased intraranial pressure
95
**CLINICAL MANIFESTATIONS**
Hypocapnia results in alkalosis and as the hypocapnia worsens what neurological issues can you expect?
* Dizziness
* Anxiety
* Syncope
* Peripheral paraestesia (pins and needles in hands & feet)
* Muscle cramps.
* Increase in respiratory rate and/or depth
96
**CLINICAL MANIFESTATIONS**
Hy**per**capnia results in acidosis and as the hypercapnia worsens what neurological issues would you expect to see?
* Confusion
* Headache
* Mental obtundation (less than full alertness (altered level of consciousness))
97
What are some measures of dyspnoea severity?
* How far a individual can walk on flat surfaces
* how many stairs they can climb
* whether they are able to speak in sentences without difficulty
* laying flat without getting breathless
98
Define a cough.
* A sudden, expolosive, audible exhalation of air from the lungs.
* Coughing is a respiratory defence mechanism.
99
Name 5 descriptions of sputum.
* **Blood-stained** - tissue damage/ trauma
* **Rust-coloured** - old blood - TB
* **Purulent** (green or yellow) - lung infections
* **Black flecked** (seen in smokers)
* **Frothy** - pulmonary oedema
* **Feculant** (foul smelling) - anaerobic infections
* **Excessive volume** - chronic bronchitis, etc.
100
What is a ABG?
**Arterial blood gas** (ABG) analysis measures serveral artieral blood parameters including oxygen, carbon dioxide, pH and bicarbonate.
101
What is the pH of blood?
7.4
102
When the pH of blood is greater that 7.4 is is considered?
Alkaline
103
When the pH of blood is less that 7.4 is is considered?
Acidic
104
Name at least 5 trigger associated with Asthma.
* Exposure to allergens such as dust mites, pet dander, air pollutants, pollens, moulds
* Exercise
* Cold Air
* Cigarette or wood smoke
* Medications (NSAIDs, especially asprin)
* URTIs
* Stress
* Strong Odours or fumes
* GORD
105
What are the two phases of Allergic Asthma?
* early-phase reaction
* late-phase reaction
106
What are the 4 steps of the National Asthma Council's Australia's four-step asthma first-aid plan?
1. Sit the person upright, be calm and reassuring. Do not leave alone.
2. Give 4 seperate puffs of a blue/grey reliever (ventolin, asmol or Airomir) Use a spacer if available. 1 puff then 4 breather after each puff.
3. Wait 4 minutes, if person cannot breath normal give 4 more puffs.
4. If a person still cannot breath normally, CALL 000. Keep giving 4 puffs every 4 minutes until an ambuilance arrives.
107
What is status asthmaticus?
Status asthmaticus is a severe exacerbation of asthma that is refractory to the usual appropriate therapy.
**It constitutes a medical emergency.**
108
A number of respiratory diseases are preventable by vaccination.
What diseases are notifiable?
* Tuberculosis
* *Haemophilus influenzae* type b (Hib)
* Meningitis
* Influenza
* Pertussis
* Legionellosis
* Diptheria
109
What is Kussmaul breathing?
* Kussmaul breathing is a type of hyperventilation that is the lung’s emergency response to acidosis.
* Kussmaul breathing causes a labored, deeper breathing rate.
* It is most commonly associated with conditions that cause metabolic acidosis, particularly diabetes.
* Because Kussmaul breathing is a sign of severe metabolic acidosis, which is a life-threatening condition, hospitalization is usually necessary.
* As a type of hyperventilation, some people describe Kussmaul breathing as panicked breathing, where someone appears to be gasping for breath. The deep, powerful breathing associated with Kussmaul breathing often causes inhalation and exhalation to become more evident and loud.
* Some compare the sound to exaggerated sighing.
