Pathophysiology Flashcards
You need to excrete ________ to bring PH levels down
Bicarbonate (CO2)
CNS depressing drugs can potentially cause..
Respiratory acidosis
-hypoventilation
-not enough bicarbonate being excreted through breathing
PH under __________ is acidosis
Under 7.35
Normal: 7.35-7.4
If a patient is compensating for respiratory acidosis, what will be high?
HCO3-
(this is a akaline substance and it helps make the PH less acidic).
Respiratory acidosis will lead to
______cardia
confusion
headache
reslessness
Tachycardia
__________ventilation will cause respiratory alkalosis
Hyperventilation
Drugs that stimulate the respiratory system can cause…
Respiratory alkalosis
Note: can also be caused by anxiety, pain, fever, or **sepsis **
Hyperventilation leads to ______
Hypoventilation leads to ________
Hyper- alkalosis
Hypo- acidosis
A patient has respiratory alkalosis if PH is above
7.45
Rapid deep breathing, parasthesia, light headedness, anxiety
are symptoms of
respiratory alkalosis
Diuretics/Renal Disease (too much excretion)
Vomiting/Diarrhea (Loss of hydrochloric acid)
Or decreased plasma potassium levels
These often cause …..
Metabolic Acidosis
Please note that **low hydrogren levels often follow low potassium levels **
If someone has metabolic acidosis, what are they retaining too much of?
CO2
If someone is compensating for metabolic alkalosis, what will you see?
Higher PaCO2 in order to try to make the blood more acidic
Slow, Shallow breathing
Confusion
Hypertonic muscles
restlessness
seizure
These are signs of
Metabolic alkalosis
Note: You’re breathing slow and shallow to retain CO2
Hyperkalemia
Liver disease can cause excess HCL acid, this could lead to…
Metabolic Acidosis
Note that H+ Follows potassium!
Uncontrolled diabetes -> Hyperglycemia -> Ketone bodies
These cause ___________
Metabolic acidosis
Cusmal’s Respiration is often seen with ____________
Metabolic acidosis
Rapid Deep breathing in an attempt to excrete CO2 and bring PH back to normal
What are signs of diabetic ketoacidosis
Excess Thirst
Urination
Fruity Breath
Drowsiness
When looking at patient stats
HCO3 represents the __________ system
Whereas CO2 represents the ________ system
Metabolic system
Respiratory system
Patient 1:
PH 7.55 (high PH)
CO2 = 32 (Low)
HCO3 = 20 (Low)
What is the problem?
Respiratory alkalosis
w/ partial compensation (partial because PH is not back to normal, but HCO3 is low)
PH 7.47 (High)
PaCO2: 61 (High)
HCO3: 43 (High)
What is the problem?
Metabolic alkalosis w/ partial compensation
PH 7.26 (Low)
PaCO2 (High)
HCO3 (Normal)
What is the problem?
Respiratory acidosis w/ no compensation
If vital capacity is under 80% of what is predicted, then you have a _______ lung disorder
restrictive
If vital capacity is over 120% what is predicted you have a ________ lung disorder
obstructive
Obstructive patients tend to have a _______ lung with ________ FVC1
Large
Less
Asthma
Chronic Bronchitis
Emphysema
Cystic Fibrosis
These are all examples of
Obstructive disorders
T or F, an obstructive lung patient will have increased Residual Lung Volume
T
T or F, an obstructive lung patient will have increased Inspiratory and Expiratory reserve volume
False, these decrease
What is FEV1?
What is FVC?
FEV1 = forced amount of air out of lung in 1 sec
FVC= Forced vital capacity = How much air you can exhale TOTAL
If FEV1/FVC is under _______, you’ve got obstrutive lung disease
70%
How does chronic bronchitis obstruct the lung?
Inflamed airways cause excessive mucus production prevent exhalation and trap air
How does emphysema obstruct the lung?
Alveoli become less efficient at gas exchange (destruction of alveioli wall) and trap air
What are the 2 types of COPD?
Chronic Bronchitis and emphysema
Emphysema causes ____________ lung tissue compliace
Increased
What is better for COPD patient’s, huffing or coughing?
Huffing
Productive cough on most days for 3 months during 2 consecutive years is the diagnositc criteria for ___________
Chronic bronchitis
GOLDS GRADES AND SEVERITY OF AIRWAY OBSTRUCTION IN COPD
Mild- above 80% predicted FEV1 (normal)
Moderate 80-50
Severe 50-30
Very Severe 30 and under
What is predicted FEV1 based on?
Race, weight, height, Gender….
Emphysema patients ___________ oxygen desaturation during exercise
Chronic bronchitis patients ____________ oxygen desaturation during exercise
Develop
MAY DEVELOP (W/ chronic bronchitis sometimes the exercise helps them clear the secretions)
At the beginning of Emphysema, their SPO2 is normal at rest, why?
Because they’re able to compensate by breathing faster.
Exercise will make SPO2 drop whem they cant keep up w/ demand ‘
THIS IS WHY PACED BREATHING IS IMPORTANT FOR EMPHYSEMA
Two kinds of Emphysema:
Panacinar - Affects alveoli, affects whole lung, primarily lower lobes, genetic predisposition
Centrilobublar - most common type due to smoking, affects respiratory bronchioles, primary upper lobes
What is a Bullae?
Hypercompliant “balloon” structure in lung seen in emphysema
Emphysema patients might have a ___________ chest deformity causing a ______ diaphram
barrel chest
flatter
Emphysema patient’s have a increased residual volume and an increased ____________
Functional residual volume - (basically Residual volume + expiratory reserve volume)
Emphysema patients have ___________ breath sounds
DECREASED
(too much air, sound doesn’t travel well!)
How does emphysema lead to R sided Heart Failure
Low oxygen ->
Pulmonary artery constriction (to try to balance V/Q ratio) ->
Pulmonary hypertension ->
Too much work for R side of heart
Why are emphysema patient’s more prone to clots and pulmonary embolism?
Relative increase in hematocrit because less oxygen in blood = more RBC = Thicker blood
Why is there increased risk of nocturnal death w/ emphysema
Less ventilation overall during REM sleep leads to cardiac arrythmia
On a patient w/ emphysema, what will you see on their chest xray
More ribs = hyperinflated
5-7 is normal
7+
(I think these numbers are talking about how many ribs you can see covering the lung, more ribs = bigger lung)
Why is pursed lip breathing important for obstructive patients?
Maintain positive airway pressure in lungs to prevent collapse upon rapid exhalation
Why do chronic bronchitis patients have excessive mucus
Goblet and mucoid cell hyperplasia
Reduced cillary activity
Frequent infections
Who develops hypoxemia sooner, emphysema patients or chronic bronchitis patients
Chronic bronchitis
Chronic bronchitis leads to __________ which leads to R sided heart failure/cor pulmonale
Pulmonary hypertension
Why are chronic bronchitis patients blue
Cyanosis due to hypoxemia
What will you hear often w/ asthma patients (more on expiration)
wheezing
How is asthma treated?
Corticosteroids
Or medications that activate sympathetic NS and supress parasymp NS
Reversability of asthma w/ ____________ is greater than other obstructive lung diseases
Bronchodilators
What is the key to diagnosing asthma?
When they take a bronchodilator you see a 12% increase in FEV1
