Nursing 2005: Pulmonary Disorders (Part 1): Respiratory Concepts, Symptoms, Restrictive Diseases Flashcards
Pulmonary Circulation
- gas exchange
- pul bed
- O2 and CO2 are exchanged
Bronchial circulation
- provides oxygenated blood to structures
Ventilation
- inspiration and expiration
- changes in intraathoracic pressures in relation to atm pressure
Total Lung Capacity (TLC)
6000 cc
max amount of air the lungs can hold
Tidal Volume (TD)
500cc
amount that moves in/out with each breath
Residual volume (RV)
1200cc
vol of air after max expiration
Vital Capacity (VC)
4500cc
- max that can be exhaled after max inhale
- can be done slowly or forced
FEV1 (Forced expired vital compacity in 1 sec)
- exhaled in 1 sec
- Avg = 80% of VC
- < 80% = pulmonary disease
Compliance
- elasticity of lungs, thorax, chest
- dec compliance = hard to take a deep breath
- inspiration of lungs
Elastic Recoil
- ability of lungs to recoil after being stretched
- expiration if lungs
- lungs going back to normal
Diffusion
- O2 and CO2 move across alveolar capillary membrane
- amount of o2 and co2 in blood
PaO2
- amount of O2 dissolved in plasma (mmHg)
- normal 80-100%
SaO2
- 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
Pulse oximeter
- placed on nail bed to measure O2 levels
PaCo2
- amount of CO2 dissolved in plasma (mmHg)
- normal 35-45%
Oxygen-hemoglobin dissociation curve
- upper curve
- lower cutve
- 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
Oxygen-hemoglobin dissociation curve
- shift to the Left
- shift to the Right
- left:
- inc in Hb- O2 affinity
- tissues need less O2
- right:
- dec in HbO2 affinity
- tissues need more O2
Control of Ventilation
A. Chemoreceptors
- monitor pH, PaCo2, PaO2
- Central
- in brain (medulla) = H, CO2
- inc H+
- causes inc in resp rate
- responds to changes in PaCO2
- more CO2 = dec pH = inc RR
- Peripheral
- carotid and aortic bodies
- dec PaO2 = stimulated
- acid present causes dec
B. Mechanical Receptors
- 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
S/S of Pulmonary disease
A. Dyspnea
- difficulty breathing
- shortness of breath
- accessory muscles, flaring nostrils
Orthopenea
- dyspnea when laying down
B. Cough
- rapid inspiration
- rapid closure of glottis
- forceful contraction of ab and expiratory muscle
- glottis opens = air is exhaled
C. Sputum
yellow
green
red
clear
- resp secretions
- check color, consistency, and how easy it is to clear
Yellow = infection
Green = infection from lower resp
Red = blood
Clear = healthy
D. Pain
- from infection
- stretching of pleura = lungs
What is the normal breath rate?
12-20 breaths/min
Abnormal Breathing Patterns
- Tachypnea
- inc rate = >24
- signs of:
- infection
- resp problem
- exercise
- Kussamul Respiration
- inc depth and rate
- heavy fast breathing
- strenuous exercise
- compensatory mech for metabolic acidosis
- breathing out CO2
- Cheyne-Stokes
- alt periods of deep breathing followed by periods of apnea
** apnea = lack of breathing
- Neuro problem
- Hyperventilation
- excess ventilation
d/t:
- anxiety
- pain
- head injury
- getting rid of too much Co2
- breathe in a bag
- Hypoventilation
- inadequate ventilation
- CO2 inc –> O2 dec
d/t:
- head injury
- narcotics
- neuro problem
- Cyanosis
- bluish discoloration
- desaturation hemoglobin
- not enough O2 in the body
- d/t cardiac and resp problems
Conditions d/t Pul Disease:
A. Hypercapnia
-d/t
- inc CO2 in arterial blood.
- d/t hypoventilation
- dec of breathing
- cause headache speech HR BP mental status
B. Hypoxemia
- d/t
- dec O2 in arterial blood.
- d/t hypoventilation
- inc hr bp = same as hypercapnia
- sometimes happens at the same time
C. Pulmonary edema
- d/t
- symptoms
- excess fluid in lungs
- d/t
- Left- sided heart failure
- resp infection
- inflam
symptoms:
- SOB
- dyspnea
- cough
- change in breath sounds
- bubbly sputum
D. Atlectasis
- d/t
- symptoms
- solution
- collapse of lung tissue
d/t:
- air/fluid in pleural space or obstruction
symptoms:
- dyspnea
- inc temp
solution:
- deep breathing exercises
E. Bronchoiectasis
- d/t
- persistant abnormal dilation of bronchi
d/t:
- obstruction in airway
F. Bronchiolitis
- d/t
- inflam obstruction of small airways/bronchioles
d/t:
- infection
Respiratory Problems
A. Restrictive
- What test is done?
- What does it show?
- dec compliance of lungs/chest wall/both
1. PFTs = pulmonary func test
2. dec TLC, VC, RV
B. Obstructive
- d/t
- What test is done?
- What do the results show?
- inc compliance
- destruction of alveolar wall
- loss of tissue elasticity
- inc resistance to airflow - PTF = pul func test
- inc TLC
- dec VC = can’t recoil
- inc RV
Restrictive Disorders:
- Adult Respiratory Distress Syndrome (ARDS)
- def
- sudden
- progressive disorder
- pulmonary edema
- severe dyspnea
- reduced lung compliance
- hypoxemia.
What is the etiology of ARDS?
- d/t
- result of condition/event that traumatizes the lung tissue
- sepsis = infection in lungs
- gastic aspiration
What is the patho of ARDS?
- 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
Clinical Manifestations:
What are the early signs of ARDS?
- can last a few days
- tachypnea
- dyspnea
- cough
- restlessness d/t low o2 levels
- mild hypoxemia
What are the late signs of ARDS?
- inc work of breathing
- tachycardia
- progressive hypoxemia
- mental status changes
What type of diagnostic tests are done for ARDS? What are the results?
- xray
- analyze blood gases
- low O2
What type of treatment is done for ARDS?
- antibiotics
- diuretics but give fluids d/t renal disease if you get rid of too much flui
What is the survival rate of ARDS?
50%
- Pneumonia
- def
- acute inflam of lung parenchyma d/t infection
What is the most common pneumonia?
- classified
- classified according to causative agent
- most common = pneumococcal pneumonia
How is pneumonia transmitted?
- aspiration
- naso or oral
- dec immune system - inhalation
- airborne - hematogenosus spread
- blood to blood contact
What is the patho of pnemonia?
- 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
What are the clinical manifestations of pneumonia?
- fever, chills
- productive cough, sputum (various colors)
- pleuritic chest pain
- malaise, weakness
- SOB
What are diagnostic tests of pneumonia? What are the results?
- Inc WBC count
- blood and sputum cultures
- clumping and edema in tissue - CXR
What type of treatment is used for pneumonia?
- antibiotics
- rest
- fluid
- oxygen hydration
- Tuberculosis
- def
- infectious disease caused by mycobacterium tuberculosis
What is the patho of TB?
- 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.
Clinical Manifestations of TB:
What are the early signs of TB?
- fatigue
- wt loss
- low grade fever
What are the later signs of TB?
- loss of appetite
- productive cough
- night sweats
What types of diagnostic tests for TB?
- tuberculin skin test – not as accurate
- sputum culture
- CXR (chest x ray)
What types of treatment is used for TB?
- antibiotics for 6-9 months
- if stopped = drug resistance
- Interstitial Fibrosis (aka Pulmonary Fibrosis)
- def
- Excessive amounts of fibrous tissue
- Caused by formation of scar tissue
- inhalation of harmful substances (environmental lung disease) = aspectus (sp?)
- idiopathic = no known cause
What is the patho of interstitial fibrosis?
-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
What are the clinical man of interstitial fibrosis?
- dyspnea
- cough
- chest pain
What type of diagnostic tests and results of interstitial fibrosis?
- PFT pulmonary function test
- CXR chest X-ray
- shows scarring - blood gas
- dec in o2
- co2 normal in beginning but then is effected later
What type of treatment is used for interstitial fibrosis?
- oxygen
- anti-inflammatory meds
- to dec inflam in lungs = steroids - bronchodilators- open airways
- Pneumothorax
- def
- 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.
Types of Pneumothorax
- Open
- air enters through chest wall opening
- it can come out so not as much collapse
- ex: gunshot wound
- Closed
- No external wound
- d/t:
- fracture of rib
- mechanical vent because of pressure
- rupture of blebs = blister on lung, mostly in smoking men
- Tension
- life threatening
- open/closed
- one way valve= air enters only= pressure builds = displacements heart and blood vessels
- Dec co
- needs immediate tx
clinical manifestations of pneumothorax
- hypoxemia
- lack of gas exchange - dyspnea with inc RR
- pain
- dec BP
- effected blood vessels - initially inc HR, then dec
- shift of heart, blood vessels, trachea
What types of treatment is used for pneumothorax?
- 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
- Plueral effusion
- def
- Fluid accumulation in pleural space.
What is the patho for pleural effusion?
Fluid migrates through walls of capillaries.
Related to:
- inc capillary pressure
- inc capillary permeability
- dec colloidal osmotic pressure
- inc intrapleural negative pressure
- impaired lymph drainage
If pleural effusion infected = empyema
What are clincal manifestations of pleural effusion?
- pain
- inc HR
- dyspnea
- fever if empyema
- infected pleural effusion - cough
- shift of heart and blood vessels if large effusion
What type of treatment for pleural effusion?
- thoracentesis - needle in pleural space and drain fluid
- chest tube - low chest tube and back
- antibiotics for empyema
