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NURS 444 > NURS444 Pulmonary > Flashcards

NURS444 Pulmonary Flashcards

1
Q

Hypoventilation RR

A

respiratory rate < 12

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2
Q

Hyperventilation RR

A

respiratory rate > 20

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3
Q

O2 levels in Hypoxia

A

(PaO2) < 60 mmHg

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4
Q

CO2 levels in Hypercapnia

A

(PaCO2) > 50 mmHg

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5
Q

Define Hypoxemia

A

Reduced oxygenation of the arterial blood (PaO2)

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6
Q

When do you get Acute Respiratory Failure?

Hint: Levels!

A

PaO2 <60 mmHg or PaCO2 >50 mmHg at rest

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7
Q

Causes of
Type I Respiratory Failure
(Decrease in PaO2 < 60 mmHg)

A

Pulmonary oedema Infection
Inflammatory lung disease
Pulmonary embolism

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8
Q

Causes of
Type II Respiratory Failure
(PaCO2 > 50 mmHg and in PaO2 < 60 mmHg)

A 
COPD
Asthma
Obesity
Kyphoscoliosis
CNS depression due to drugs
Neuromuscular disease
Pneumothorax
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9
Q

Define Oxygen Saturation

A

% of Haemoglobin (Hgb) binding sites

in the blood that are carrying oxygen.

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10
Q

Define COPD and mention 3 conditions that cause it

Wheeze = always

A

Progressive airflow limitation that is not fully reversible

Emphysema, chronic bronchitis and chronic asthma

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11
Q

Define Emphysema

A

i.e. COPD
Permanent enlargement of airspaces beyond the terminal bronchiole and destruction of alveolar wall (due to alveolar dilation)

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12
Q

Emphysema: Pathophysiology

A

Alveolar walls destroyed - air trapped - no alveoli recoil - bronchioles collapse (expiration)

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13
Q

Emphysema: Causes

A

Alpha- antitrypsin (AAT) deficiency

Cigarette smoking

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14
Q

Emphysema: Clinical manifestations

A

Loss of lung elastic tissue - airway wall collapse during expiration - hyperinflation - increased work of breathing
Barrel-shaped chest
Clubbing (chronic hypoxia)

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15
Q

Define Chronic bronchitis

A

i.e. COPD
Hyper-secretion of mucus and chronic productive cough for at least 3 months of the year and for at least 2 consecutive years

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16
Q

Chronic bronchitis: Pathophysiology

A

Increase in mucus production and damaged cilia in the bronchi

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17
Q

Chronic bronchitis: Causes

A

Smoking
Air pollution
Respiratory tract infection
Genetic predisposition

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18
Q

Chronic bronchitis: Clinical manifestations

A 
Copious grey, white or yellow sputum
Dyspnea
Wheezing and rhonci
Tachypnea
Prolonged expiratory wheeze
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19
Q

COPD: Complications

A

Cor pulmonale - right sided heart failure

Alteration in structure and function of right ventricle (RV) to compensate for increased pulmonary P

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20
Q

Asthma

A

Variable airflow obstruction secondary to inflammation of the airways.
Airways are hyper-responsive and chronically inflamed

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21
Q

Asthma: Clinical manifestations

A 
Decreased FEV1 and PEFR (peak expiratory flow rate)
Use of Accessory muscles 
Hypercapnia
Hyperinflation
Chest tightness - bronchoconstriction
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22
Q

Asthma: Pathophysiology

A

Abnormal stimulation of the inflammatory immune response
Production of IgE.
Inflammatory mediators released e.g. histamine, prostaglandins and leukotrienes
Smooth Muscle swelling + Increased cap permeability

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23
Q

Asthma: 2 types

A

Intrinsic asthma e.g., Familial

Extrinsic asthma

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24
Q

Asthma: Typical clinical symptoms

A

Dyspnoea
Wheeze
Chest tightness

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25
Q

Management of Acute Asthma Episode

A

Observation
Positioning
Continue Treatment
Monitoring

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26
Q

Define Status Asthmaticus

A

Severe asthmatic episode that does not response to pharmacological control

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27
Q

Bronchiectasis

A

Irreversible bronchial dilation and chronic inflammation, resulting in chronic wet cough.

28
Q

Name the 6 Respiratory Tract infections (RTI)

A 
Pneumonia
Tuberculosis
Acute bronchitis
Bronchiolitis
Influenza
Pertussis
29
Q

Define Acute bronchitis

A

i.e. RTI
Acute infection or inflammation of bronchi due to viral illness
No chest infiltrates

30
Q

Define Bronchiolitis

A

i.e. RTI
Lower respiratory tract
Respiratory syncytial virus

31
Q

Causes of Influenza

A

i.e. RTI

Antigenic drift

32
Q

Causes of Pertussis

A

i.e. RTI
Whooping cough
Bordetella pertussis

33
Q

Define Pneumonia

A

i.e. RTI
Acute inflammatory illness of the lung parenchyma that impairs gas exchange
L Parenchyma = gas transfer site

34
Q

What happens in your lungs when you get Pneumonia?

A

Inflammation and oedema
Alveoli filled with debris and exudate
Consolidation is formed (WBC, RBC and platelets)

35
Q

Pneumonia: Causes

A

Upper resp tract infection

  • bacteria
  • virus
  • fungi
36
Q

Hospital (nosocomial) Acquired Pneumonia

Definition and Pathogens

A

Appears 48 hours or more after admission
Not incubating at the point of admission
- Staphlycoccus aureus
- Pseudomonas

37
Q

Community Acquired Pneumonia

Pathogens

A
  • Streptococcus pneumoniae
  • Mycoplasma pneumoniae
  • Influenza, Legionella
38
Q

Pneumonia: Symptoms

A

SOB
Wheezing
Fatigue
Fever

39
Q

Pneumonia: Clinical manifestations (7)

A
  • Fever, pleuritic pain, chills - inflammatory process
  • Productive cough, yellow sputum
  • Dyspnea
  • Pleuritic chest pain
  • Rhonchi, crackles and wheezes
  • Tachycardia - hypoxic
  • Cyanosis
40
Q

Pneumonia: Clinical investigations

A

White blood cell (WBC) count above 11 × 109/L
Urea >7 mmol/L
Blood and sputum cultures

41
Q

Define Tuberculosis (TB)

A

Pulmonary infiltrates and formation of granulomas with fibrosis and cavitation

42
Q

Tuberculosis (TB)

Pathogens

A

Airborn transmitted

  • Mycobacterium tuberculosis
  • Mycobacterium bovis
43
Q

TB: Pathophysiology

1° and 2° Infection

A

1° Infection
- Upper lobes
- Lymphocytes and neutrophils congregation
- Bacilli in fibrous tissue.
2° Infection
- Bacilli reactivation and multiplication
- Symptomatic and Infectious

44
Q

TB: Clinical manifestations (6)

A
  • Heamoptysis
  • Fever/night sweat
  • Weight loss
  • Appetite loss
  • Sputum
  • Persistent cough
45
Q

What happens in Restrictive Lung Disease?

A

Difficulty in expanding thorax

46
Q

What happens in Pulmonary Oedema?

A

Fluid in extravascular spaces

47
Q

Pulmonary oedema:

Cardiogenic vs Non-cardiogenic Pressures (P)

A 
Cardiogenic = increased P in pulmonary capillaries
Non-cardiogenic = P unaffected
48
Q

Define Acute Respiratory Distress Syndrome (ARDS)

A

Pulmonary oedema that can quickly lead to acute respiratory failure
Immune mediators = inflammation = decrease O2 exchange

49
Q

ARDS: Pathophysiology

A

Sepsis

  • Leaky capillaries
  • No surfactant
  • Decrease lung compliance (stiff lungs)
50
Q

ARDS: Clinical presentation case scenario

A

A 42-year-old female presents with dyspnoea, rapid, shallow breathing, tachycardia, inspiratory crackles, decreased lung compliance and hypoxaemia.

51
Q

What is Dyspnea?

A

SOB

52
Q

Define Atelectasis

A

Partial/complete lung collapse due to incomplete expansion of alveolar sacs

53
Q

Atelectasis: Clinical manifestations

A
  • dyspnea
  • cough
  • fever
  • leukocytosis
54
Q

What happens in Pleural Effusion?

A

Excess fluid (protein and WBC) in the plural space

55
Q

How is Empyema different to Pleural Effusion?

A

Pus in the plural space

56
Q

What happens in Pneumothorax?

A

Partial/complete lung collapse due to air in the pleural cavity

57
Q

Pneumothorax: Clinical manifestations

A

Reduced chest wall movement
Diminished breath sounds
Surgical (subcutaneous) emphysema = air under skin
Trachea deviation

58
Q

Tension Pneumothorax Complications

A

Decrease venous return = decreased CO
Hypoxemia
Cardiac arrest

59
Q

What happens to bronchi and bronchioles in Bronchiectasis?

A

Chronic dilation of the bronchi and bronchioles due to inflammation

60
Q

Croup

Definition and symptoms

A

In infants:
Upper airways infection due to immature immune system
- Barking cough

61
Q

Respiratory distress syndrome (RDS)

Definition and symptoms

A

In newborns:
Immature lung and no surfactant
- Tachypnoea, expiratory grunting, use of accessory
muscles, nasal flaring, pallor

62
Q

What happens in Cystic fibrosis?

A
  • Autosomal recessive
  • Defective epithelial Cl+ transport
  • Decrease in airway surface liquid
  • Non rhythmic beating of cilia
  • Exocrine glands produce excessive thick mucus
63
Q

Sudden infant death syndrome (SIDS)

A

Preterm / low birth weight babies

Possible relationship to respiratory infections

64
Q

Pulmonary embolism

A

Blood clot wedged into an artery in lungs due to venous stasis, hypercoagulability and bleeding injuries

65
Q

Causes of Increased Pulmonary Pressure

A

hypoxic vasoconstriction
acidosis
obstructions in the pulmonary vasculature
increased blood volumes

NURS 444 (7 decks)

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