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Nursing 2005: Clinical Pathophysiology > Nursing 2005: Pulmonary Disorders (Part 1): Respiratory Concepts, Symptoms, Restrictive Diseases > Flashcards

Nursing 2005: Pulmonary Disorders (Part 1): Respiratory Concepts, Symptoms, Restrictive Diseases Flashcards

1
Q

Pulmonary Circulation

A
  • gas exchange
  • pul bed
  • O2 and CO2 are exchanged
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2
Q

Bronchial circulation

A
  • provides oxygenated blood to structures
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3
Q

Ventilation

A
  • inspiration and expiration

- changes in intraathoracic pressures in relation to atm pressure

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4
Q

Total Lung Capacity (TLC)

A

6000 cc

max amount of air the lungs can hold

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5
Q

Tidal Volume (TD)

A

500cc

amount that moves in/out with each breath

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6
Q

Residual volume (RV)

A

1200cc

vol of air after max expiration

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7
Q

Vital Capacity (VC)

A

4500cc

  • max that can be exhaled after max inhale
  • can be done slowly or forced
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8
Q

FEV1 (Forced expired vital compacity in 1 sec)

A
  • exhaled in 1 sec
  • Avg = 80% of VC
  • < 80% = pulmonary disease
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9
Q

Compliance

A
  • elasticity of lungs, thorax, chest
  • dec compliance = hard to take a deep breath
  • inspiration of lungs
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10
Q

Elastic Recoil

A
  • ability of lungs to recoil after being stretched
  • expiration if lungs
  • lungs going back to normal
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11
Q

Diffusion

A
  • O2 and CO2 move across alveolar capillary membrane

- amount of o2 and co2 in blood

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12
Q

PaO2

A
  • amount of O2 dissolved in plasma (mmHg)

- normal 80-100%

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13
Q

SaO2

A
  • amount of O2 carried by hemoglobin compared to the amount it can carry
  • normal 95-100%

ex: O2 sat - 90%
- 90% of hemoglobin attaches for O2 have O2 attach to them

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14
Q

Pulse oximeter

A
  • placed on nail bed to measure O2 levels
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15
Q

PaCo2

A
  • amount of CO2 dissolved in plasma (mmHg)

- normal 35-45%

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16
Q

Oxygen-hemoglobin dissociation curve

  • upper curve
  • lower cutve
A
  • shows relationship b/w O2 sat and PaO2 AND affinity of hemoglobin of O2

upper curve:
- large changes in PaO2 = small changes in O2 sat

lower curve:
- as hemoglobin becomes less saturated w/ O2 - larger amounts of O2 released to blood

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17
Q

Oxygen-hemoglobin dissociation curve

  • shift to the Left
  • shift to the Right
A
  • left:
    • inc in Hb- O2 affinity
    • tissues need less O2
  • right:
    • dec in HbO2 affinity
    • tissues need more O2
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18
Q

Control of Ventilation

A. Chemoreceptors

A
  • monitor pH, PaCo2, PaO2
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19
Q
  1. Central
A
  • in brain (medulla) = H, CO2
  • inc H+
  • causes inc in resp rate
  • responds to changes in PaCO2
  • more CO2 = dec pH = inc RR
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20
Q
  1. Peripheral
A
  • carotid and aortic bodies
  • dec PaO2 = stimulated
  • acid present causes dec
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21
Q

B. Mechanical Receptors

A
  • lungs, diaphragm, chest wall
  • irritants cause bronchial constriction and inc vent
  • stretch receptors regulate vol/size of lungs
  • changes in alveolar pressure stimulate rapid shallow breathing
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22
Q

S/S of Pulmonary disease

A. Dyspnea

A
  • difficulty breathing
  • shortness of breath
  • accessory muscles, flaring nostrils
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23
Q

Orthopenea

A
  • dyspnea when laying down
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24
Q

B. Cough

A
  • rapid inspiration
  • rapid closure of glottis
  • forceful contraction of ab and expiratory muscle
  • glottis opens = air is exhaled
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25
Q

C. Sputum

yellow
green
red
clear

A
  • resp secretions
  • check color, consistency, and how easy it is to clear

Yellow = infection

Green = infection from lower resp

Red = blood

Clear = healthy

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26
Q

D. Pain

A
  • from infection

- stretching of pleura = lungs

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27
Q

What is the normal breath rate?

A

12-20 breaths/min

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28
Q

Abnormal Breathing Patterns

  1. Tachypnea
A
  • inc rate = >24
  • signs of:
    • infection
    • resp problem
    • exercise
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29
Q
  1. Kussamul Respiration
A
  • inc depth and rate
  • heavy fast breathing
  • strenuous exercise
  • compensatory mech for metabolic acidosis
    • breathing out CO2
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30
Q
  1. Cheyne-Stokes
A
  • alt periods of deep breathing followed by periods of apnea

** apnea = lack of breathing

  • Neuro problem
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31
Q
  1. Hyperventilation
A
  • excess ventilation

d/t:

  • anxiety
  • pain
  • head injury
  • getting rid of too much Co2
  • breathe in a bag
32
Q
  1. Hypoventilation
A
  • inadequate ventilation
  • CO2 inc –> O2 dec

d/t:

  • head injury
  • narcotics
  • neuro problem
33
Q
  1. Cyanosis
A
  • bluish discoloration
  • desaturation hemoglobin
  • not enough O2 in the body
  • d/t cardiac and resp problems
34
Q

Conditions d/t Pul Disease:

A. Hypercapnia

-d/t

A
  • inc CO2 in arterial blood.
  • d/t hypoventilation
  • dec of breathing
  • cause headache speech HR BP mental status
35
Q

B. Hypoxemia

  • d/t
A
  • dec O2 in arterial blood.
  • d/t hypoventilation
  • inc hr bp = same as hypercapnia
    • sometimes happens at the same time
36
Q

C. Pulmonary edema

  • d/t
  • symptoms
A
  • excess fluid in lungs
  • d/t
    • Left- sided heart failure
    • resp infection
    • inflam

symptoms:

  • SOB
  • dyspnea
  • cough
  • change in breath sounds
  • bubbly sputum
37
Q

D. Atlectasis

  • d/t
  • symptoms
  • solution
A
  • collapse of lung tissue

d/t:
- air/fluid in pleural space or obstruction

symptoms:

  • dyspnea
  • inc temp

solution:
- deep breathing exercises

38
Q

E. Bronchoiectasis

  • d/t
A
  • persistant abnormal dilation of bronchi

d/t:
- obstruction in airway

39
Q

F. Bronchiolitis

  • d/t
A
  • inflam obstruction of small airways/bronchioles

d/t:
- infection

40
Q

Respiratory Problems

A. Restrictive

  1. What test is done?
  2. What does it show?
A
  • dec compliance of lungs/chest wall/both
    1. PFTs = pulmonary func test
    2. dec TLC, VC, RV
41
Q

B. Obstructive

  1. d/t
  2. What test is done?
  3. What do the results show?
A
  • inc compliance
  1. destruction of alveolar wall
    - loss of tissue elasticity
    - inc resistance to airflow
  2. PTF = pul func test
  3. inc TLC
    - dec VC = can’t recoil
    - inc RV
42
Q

Restrictive Disorders:

  1. Adult Respiratory Distress Syndrome (ARDS)
    - def
A
  • sudden
  • progressive disorder
  • pulmonary edema
  • severe dyspnea
  • reduced lung compliance
  • hypoxemia.
43
Q

What is the etiology of ARDS?

  • d/t
A
  • result of condition/event that traumatizes the lung tissue
  • sepsis = infection in lungs
  • gastic aspiration
44
Q

What is the patho of ARDS?

A
  • injury to alveoli capillary membrane

-> stimulates platelet aggregation, intravascular thrombus formation= clots
inc neutrophil activity

-> more injury

  • > inc capillary membrane permeability = pulmonary edema
    • dec gas exchange
  • ​damage to surfactant cell -> lungs stiff
  • hyaline membrane = atelectasis, fibrosis
45
Q

Clinical Manifestations:

What are the early signs of ARDS?

A
  • can last a few days
  1. tachypnea
  2. dyspnea
  3. cough
  4. restlessness d/t low o2 levels
  5. mild hypoxemia
46
Q

What are the late signs of ARDS?

A
  1. inc work of breathing
  2. tachycardia
  3. progressive hypoxemia
  4. mental status changes
47
Q

What type of diagnostic tests are done for ARDS? What are the results?

A
  • xray
  • analyze blood gases
    • low O2
48
Q

What type of treatment is done for ARDS?

A
  • antibiotics

- diuretics but give fluids d/t renal disease if you get rid of too much flui

49
Q

What is the survival rate of ARDS?

A

50%

50
Q
  1. Pneumonia

- def

A
  • acute inflam of lung parenchyma d/t infection
51
Q

What is the most common pneumonia?

  • classified
A
  • classified according to causative agent

- most common = pneumococcal pneumonia

52
Q

How is pneumonia transmitted?

A
  1. aspiration
    - naso or oral
    - dec immune system
  2. inhalation
    - airborne
  3. hematogenosus spread
    - blood to blood contact
53
Q

What is the patho of pnemonia?

A
  • infection in alveoli
  • Pulmonary membranes inflamed and porous, allowing fluid
  • blood cells to pass from blood into alveoli
  • Lung tissue becomes inflamed and consolidated (clumping)= dec gas exchange
54
Q

What are the clinical manifestations of pneumonia?

A
  1. fever, chills
  2. productive cough, sputum (various colors)
  3. pleuritic chest pain
  4. malaise, weakness
  5. SOB
55
Q

What are diagnostic tests of pneumonia? What are the results?

A
  1. Inc WBC count
  2. blood and sputum cultures
    - clumping and edema in tissue
  3. CXR
56
Q

What type of treatment is used for pneumonia?

A
  • antibiotics
  • rest
  • fluid
  • oxygen hydration
57
Q
  1. Tuberculosis

- def

A
  • infectious disease caused by mycobacterium tuberculosis
58
Q

What is the patho of TB?

A
  • Airborne droplets
  • Bacillus inspired into lung –> inflammation
  • > inc neutrophil and macrophage activity
  • Engulf bacilli, sealed off, forming tubercle lesion= scarring of lungs
  • Infected tissue within tubercle dies
  • scar tissue grows around lesion.
59
Q

Clinical Manifestations of TB:

What are the early signs of TB?

A
  1. fatigue
  2. wt loss
  3. low grade fever
60
Q

What are the later signs of TB?

A
  1. loss of appetite
  2. productive cough
  3. night sweats
61
Q

What types of diagnostic tests for TB?

A
  1. tuberculin skin test – not as accurate
  2. sputum culture
  3. CXR (chest x ray)
62
Q

What types of treatment is used for TB?

A
  • antibiotics for 6-9 months

- if stopped = drug resistance

63
Q
  1. Interstitial Fibrosis (aka Pulmonary Fibrosis)

- def

A
  • Excessive amounts of fibrous tissue
  • Caused by formation of scar tissue
  • inhalation of harmful substances (environmental lung disease) = aspectus (sp?)
  • idiopathic = no known cause
64
Q

What is the patho of interstitial fibrosis?

A

-result of tissue repair after inflammation

  • Inert particles initiate macrophage activit
    y –> walled off by deposition of fibrous proteins
  • Fibrosis cause dec lung compliance
  • leads to dec lung volume
  • dec in diffusion of gases –> hypoxemia
65
Q

What are the clinical man of interstitial fibrosis?

A
  1. dyspnea
  2. cough
  3. chest pain
66
Q

What type of diagnostic tests and results of interstitial fibrosis?

A
  1. PFT pulmonary function test
  2. CXR chest X-ray
    - shows scarring
  3. blood gas
    - dec in o2
    - co2 normal in beginning but then is effected later
67
Q

What type of treatment is used for interstitial fibrosis?

A
  1. oxygen
  2. anti-inflammatory meds
    - to dec inflam in lungs = steroids
  3. bronchodilators- open airways
68
Q
  1. Pneumothorax

- def

A
  • Accumulation of air in pleural space d/t puncture of lining of lung = accumulate of air
  • Destroys the negative pressure so lung recoils and collapses.
69
Q

Types of Pneumothorax

  1. Open
A
  • air enters through chest wall opening
  • it can come out so not as much collapse
  • ex: gunshot wound
70
Q
  1. Closed
A
  • No external wound
  • d/t:
    • fracture of rib
    • mechanical vent because of pressure
    • rupture of blebs = blister on lung, mostly in smoking men
71
Q
  1. Tension
A
  • life threatening
  • open/closed
  • one way valve= air enters only= pressure builds = displacements heart and blood vessels
    • Dec co
  • needs immediate tx
72
Q

clinical manifestations of pneumothorax

A
  1. hypoxemia
    - lack of gas exchange
  2. dyspnea with inc RR
  3. pain
  4. dec BP
    - effected blood vessels
  5. initially inc HR, then dec
  6. shift of heart, blood vessels, trachea
73
Q

What types of treatment is used for pneumothorax?

A
  • chest tube in pleural space and air is collected in a chamber, placed high and front
  • emergency use large needle in pleural space and withdraw air
74
Q
  1. Plueral effusion

- def

A
  • Fluid accumulation in pleural space.
75
Q

What is the patho for pleural effusion?

A

Fluid migrates through walls of capillaries.

Related to:

  1. inc capillary pressure
  2. inc capillary permeability​
  3. dec colloidal osmotic pressure
  4. inc intrapleural negative pressure​
  5. impaired lymph drainage​

If pleural effusion infected = empyema

76
Q

What are clincal manifestations of pleural effusion?

A
  1. pain
  2. inc HR
  3. dyspnea
  4. fever if empyema
    - infected pleural effusion
  5. cough
  6. shift of heart and blood vessels if large effusion
77
Q

What type of treatment for pleural effusion?

A
  1. thoracentesis - needle in pleural space and drain fluid
  2. chest tube - low chest tube and back
  3. antibiotics for empyema

Nursing 2005: Clinical Pathophysiology (9 decks)

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