module 11 general concepts in altered pulmonary function

Question 1

general concepts in altered pulmonary function

Answer 1

hypoventilation and hyperventilation
hypoxemia and hypoxia 
acute respiratory failure
alterations in pulmonary vasculature
pulmonary malignancy

Question 2

obstructive pulmonary disease

Answer 2

inc. airway resistance develops in localized regions d/t
- obstruction of airway from inc. sputum production
- mucosal hypertrophy and edema
- loss of structural integrity
- narrowing of airway from bronchial small muscle contraction
- - during expiration air leaves following path of least resistance -> maldistribution of gas

Question 3

hypoxemia

Answer 3

deficient levels of blood oxygen

- low PaO2 or Hgb saturation

Question 4

hypoxia

Answer 4

dec. in tissue oxygenation
- hypoxic hypoxia
- anemic hypoxia
- circulatory hypoxia
- histotoxic hypoxia

Question 5

hypoxic hypoxia

Answer 5

dec PaO2 despite normal O2 carrying capacity

• high altitude
• hypoventilation
• airway obstruction
• • O2 therapy adequate tx

Question 6

anemic hypoxia

Answer 6

dec. O2 carrying ability r/t low Hgb

Question 7

circulatory hypoxia

Answer 7

dec. blood flow/CO
- shock
- cardia arrest
- blood loss
- thyrotoxicosis
- CHF

Question 8

histotoxic hypoxia

Answer 8

toxic substances prevent tissue oxygenation

Question 9

normal VQ

Answer 9

from pulmonary artery -> alveolocapillary membrane w/ full alveoi, able to have gas exchange -> pulmonary vein

Question 10

low VQ

Answer 10

pulmonary artery -> alveolocapillary membrane
impaired ventilation -> minimal gas exchange
-> pulmonary vein w/ hypoxemia

Question 11

shunt (very low) V/Q

Answer 11

pulmonary artery -> alveolocapillary membrane
blocked ventilation-> collapsed alveoli -> no gas exchange
-> pulmonary vein w. hypoxemia (higher)

Blood goes from R - L side of heart with out passing through ventilated area of lungs

Question 12

High V/Q

Answer 12

impaired perfusion -> alveolar dead space
-> hypoxemia
no blood flow to a ventilated alveoli

Question 13

anatomical shunts

Answer 13

VSD
ASD
patent ductus arteriosus

Question 14

intrapulmonary shunts

Answer 14

alveoli perfused but not ventilated

• localized pneumonia
• ARDS

Question 15

acute respiratory failure defined as

Answer 15

disturbed gas exchange -> abnormal arterial blood gas values

• PaO2 < 60
• PaCO2 > 50
• pH < 7.30

Question 16

acute respiratory failure 3 contributing factors

Answer 16

• failure of respiration (oxygenation) -> hypoxemia with normal/ low CO2
• failure of ventilation -> hypercapnia
• Combination resp and ventilatory failure

general r/t poorly matched V/Q -> hypoxemia

Question 17

acute respiratory failure pahtogenesis

Answer 17

can develop from any abnormality in

• airways
• alveoli
• CNS/PNS
• resp. muscles
• hypoperfusion
• chest wall
• diaphragm
• pleural space

Question 18

acute resp failure and ventialtion

Answer 18

ventilatory demands > ventilatory capacity

Question 19

acute resp. failure s/s general

Answer 19

hypoxia
hypercapnia
HA
dyspnea
confusion
dec. LOC
restless
agitation
dizzy
tremors
initial HTN -> hypoTN and inc. HR

Question 20

acute resp. failure early s/s

Answer 20

rapid, shallow breathing

inc. inspiratory muscle movement

Question 21

acute resp. failure late s/s

Answer 21

cyanosis 
nasal flaring 
retractions
cool, clammy skin
dysrhythmia 
dec. cap refill

Question 22

pulmonary HTN

Answer 22

sustained increase in pulmonary artery pressure > 25mmHg
constricted vessels in lungs
hypertrophy of RV

Question 23

primary pulmonary HTN

Answer 23

idiopathic
rare, rapily progressive
women > men
associated with portal HTN, HIV, appetite suppressing drugs

Question 24

secondary pulmonary HTN

Answer 24

vasoconstrictive
obstructive
obliterative (loss of capillary bed) 
inc. left atrial pressure
inc. pulmonary blood flow
inc. resistance to blood flow

Question 25

pulmonary HTN s/s

Answer 25

often asymptomatic until significant damage done d/t distensibility of capillaries and ability to recruit more. - exercise intolerance - syncope - inc. dyspnea - chest pain on exertion - fatigue - hemoptysis - pulmonary edema

Question 26

pulmonary venous thromboembolism

Answer 26

``` >90% from veins of lower extremities virchow's triad - venous stasis - hypercoagulability - intimal injury Causes V/Q mismatch (dead space) - alveoli is adequate but no blood flow ```

Question 27

thrombotic embolism

Answer 27

blood clots develop in venous system, predominately in thighs and legs

Question 28

fat embolism

Answer 28

globules of fat secondary to fx of pelvis or long bones

Question 29

amniotic fluid embolism

Answer 29

collections of fluid, hair, or other debris r/t complicated labor

Question 30

air embolism

Answer 30

venous access through IV catheters

Question 31

tumor embolism

Answer 31

fragment from malignant tissue

Question 32

foreign material embolism

Answer 32

foreign bodies - bullets - sutures - catheter tips - PO meds injected IV

Question 33

septic embolism

Answer 33

infected tissue or related substances

Question 34

parasitic embolism

Answer 34

parasites present in lung vasculature

Question 35

lobes associated with pulmonary embolism

Answer 35

lower lobes d/t increased blood flow

Question 36

pulmonary embolism s/s

Answer 36

``` restless apprehension anxiety dyspnea inc. HR inc RR sudden dyspnea and chest pain medium to massive PE can worsen into HF, shock, or respiratory arrest ```

Question 37

pulmonary malignancies

Answer 37

``` 85% r/t tobacco smoke large cell: 10-15% small cell: 15-20% squamous cell: 20-30% adenocarcinoma: 35-40:% - 32% of cancer deaths in men, 25% in women ```

Question 38

pulmonary malignancy s/s

Answer 38

vague asymptomatic till advanced stage intrathoracic vs extrathoracic

Question 39

highest risk for pulmonary malignancy

Answer 39

started smoking before 25 one or more packs a day for 20 years work with asbestos > 50 y/o

Question 40

intrathoracic malignancy s/s

Answer 40

``` dyspnea cough chest pain hemoptysis inc. sputum hoarsness phrenic nerve -> paralysis of hemidiaphragm on affected side -> pneumonia, atelectasis ```

Question 41

extrathroacic malignancy s/s

Answer 41

``` wt loss fatigue anorexia anemia clubing facial and upper extremity edema with vena cava compression ```