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3125 Pathophysiology > (ppt) UNIT 8 The Pulmonary System > Flashcards

(ppt) UNIT 8 The Pulmonary System Flashcards

1
Q

How does the neuro system help us breathe?

A

sets auto rate via brainstem neurons that respond to peripheral chemoreceptors in carotid, aortic, and lungs, then sends impulses to intercostal muscles.​

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2
Q

central chemoreceptors

A

are located below the blood/brain barrier in the near the Medulla Oblongata in the brain​

Central Chemoreceptors sense changes in pH of CSF (reflects CO2 concentration because CO2 diffuses across the blood/brain barrier. ​

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3
Q

peripheral chemoreceptors

A

When arterial hypoxemia occurs, peripheral chemoreceptors in the aortic bodies, aortic arch, and carotid arteries sense the change in arterial blood PO2 and stimulate an increased ventilatory rate. (most sensitive to PO2)​

​

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4
Q

lung receptors (J-receptors, SNS, PSN)

A

J receptors found near capillaries of alveolar septa and sense increased pulmonary capillary pressure, then initiate rapid, shallow breathing, hypotension, and bradycardia​

Sympathetic autonomic nerves promote airway dilation when relaxed​

Parasympathetic promote constriction when needed and in response to irritants

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5
Q

chemoreceptors

A

monitor PO2, PCO2, and pH of arterial blood –both central and peripheral receptors

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6
Q

alveolar surface tension

A

Surfactant​

Reduces surface tension in alveoli

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7
Q

The elastic recoil of the lungs helps…

A

them to return to the resting state after inspiration and allows the lungs to remain passive during expiration. ​

Because of the elastic recoil property of the lungs there is no need for the major muscles to be involved with the action of expiration.

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8
Q

Airway resistance​ is normally…
- decreased…
- increased…

A

Normally low​

Decreased (bronchodilation) with stimulation of Beta-2 adrenergic receptors​

Increased by obstruction​
- Edema of airway​
- Mucous plugging​
- bronchospasm

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9
Q

work of breathing is normally…

A

Muscular effort required to breath, normally low

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10
Q

Vt

A

Tidal Volume (Vt) = amount of air inhaled and exhaled with each breath (500 ml)

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11
Q

IRV

A

Inspiratory Reserve Volume (IRV) = amount of air that can be forcefully inhaled after a normal tidal volume (3000-3300 ml)​

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12
Q

ERV

A

Expiratory Reserve Volume (ERV) = amount of air that can be forcefully exhaled after a normal tidal volume (100-1200)​

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13
Q

RV

A

Residual Volume (RV) = amount of air left in the lungs after forced exhalation (1200)​

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14
Q

TLC

A

Total Lung Capacity (TLC) = maximum amount of air that can be contained in the lungs after max inspiratory effort (TLC=VC+RV)– (5700-6200ml)

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15
Q

VC

A

Vital capacity (VC) = maximum amount of air that can be exhaled after a max inspiration (80%of TLC)= (4500-5000ml)​

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16
Q

Inspiratory Capacity

A

Inspiratory Capacity = maximum amount of air that can be inspired after a normal expiration

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17
Q

FRP

A

Forced Residual Capacity (FRP) = volume of air remaining in lungs after a normal tidal volume exhalation

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18
Q

physiologic dead space

A

Physiologic Dead Space = volume of inspired air that does not exchange gases with pulmonary blood​

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19
Q

Define V

A

Ventilation (V)​

Gas distribution

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20
Q

Define Q

A

Perfusion (Q)​

Blood distribution

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21
Q

Normal V/Q ratio is …

A

0.8 (V=80% of Q)​

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22
Q

Net result: ventilation and perfusion are greatest in…

A

the lower lobes.​

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23
Q

**Blood flow through pulmonary capillary bed increases in …

A

regular increments from the apex to the base.​

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24
Q

**Perfusion is greater than ventilation in …

A

the bases and ventilation exceeds perfusion in the apices of the lung (expressed as the ventilation-perfusion ration (V/! = 0.8)​

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25
Q

V/Q mismatch is

A

a broad term that can be a defect in ventilation OR a defect in perfusion

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26
Q

A shunt occurs in …

A

deadspace where there is no relationship between ventilation and perfusion. ​

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27
Q

*A shunt is a type of …

A

V/Q mismatch, but not all V/Q Mismatches are shunts.

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28
Q

Oxygen transport​:
- Carried in blood in 2 ways​
1.
2.
O2 is moved into the blood by…

A
  1. Plasma 0.3 ml/100ml​
  2. Hemoglobin 19.7ml/100ml​

concentration gradient until saturated​

-

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29
Q

Binding of O2 occurs in…
Reverse process occurs in …

Oxyhemoglobin dissociation curve =

A
  • lungs.
  • body tissues at cellular level​
  • relationship between association and dissociation​
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30
Q

Carbon dioxide transport​:

A

Carried dissolved in plasma and as bicarbonate and carbamino compounds (bound to Hg)​

CO2 is moved from the blood by concentration gradient​

Highly soluble in plasma for transport from tissues​

O2 transport facilitates CO2 diffusion

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31
Q

…. is the most important cause of pulmonary artery constriction.

A

Low alveolar Partial oxygen pressure

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32
Q

Causes of low alveolar PO2 includes…

A

acidemia

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33
Q

Elasticity​ in aging pulmonary system leads to…

A

Chest wall compliance and muscle strength decreases, diminished recoil

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34
Q

Gas Exchange​ in aging pulmonary system leads to …

A

Decreased capillary network, surface area​

Decreased PO2​

Decreased sensitivity of respiratory centers

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35
Q

Hypoventilation causes:

A

Impaired pulmonary mechanics​

Impaired neurologic control of breathing​

​

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36
Q

hyperventilation causes

A

Anxiety, head injury​

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37
Q

dyspnea

A

Subjective sensation of uncomfortable breathing​

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38
Q

Cheyne-Stokes​

A

Neurologic impairment of brainstem​

Impaired circulation to brainstem​

Long periods of apnea​

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39
Q

Kussmaul Breathing:​

A
  • Labored, Obstructed (increased work of breathing)​
  • Hyperpnea (Kussmaul)​
  • Occurs with acidotic disease states (like metabolic acidosis, or Diabetic Ketoacidosis/DKA).​
  • Increased respiratory rate​
  • No expiratory pause (between breaths)​
  • Sounds like patient is struggling to breathe…often audible​
  • Large tidal volume​
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40
Q

Hemoptysis​

A

Bloody (sputum) expectorant (rule out TB)—can occur with pneumonia too!​

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41
Q

Abnormal Sputum​

mucoid-greyish white–

red–klebsiella

rusty–pneumococcal

salmon–staph

mucopurulent–

A

Abnormal Sputum​

mucoid-greyish white–asthma​

red–klebsiella pneumonia​

rusty–pneumococcal pneumonia​

salmon–staph pneumonia​

mucopurulent–bacterial​

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42
Q

Hypoxemia–

A

Reduced oxygenation of arterial blood PaO2

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43
Q

Hypoxia –

A

reduced oxygenation of cells in tissues​

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44
Q

causes of hypoxia include:

A

Causes include​

Decrease in inspired oxygen–
- high altitude, suffocation, low O2 mixture​

Hypoventilation–
- COPD, lack of neuro stimulation, neuro damage​

Alveolocapillary diffusion abnormality— - emphysema, fibrosis, edema​

Ventilation-Perfusion mismatch–
- asthma, chronic bronchitis, pneumonia​

Shunting–
- ARDS, atelectasis, RDS of newborn​

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45
Q

hypercapnia
- causes:

A

Increased carbon dioxide in blood​.
- Hypoventilation​: Inability to respond to stimuli​

46
Q

flail chest

A
  • 2 or more ribs broken in 2 or more places​
  • Instability of chest wall – paradoxical movement​

Unstable part of chestwall moves in with inspiration and out with expiration (opposite of normal)

47
Q

pneumothorax

A

ccurs when air or gas enters the pleural space .destroys the negative pressure of the pleural space and disrupts the balance between the elastic recoil of the lung and chest wall-

48
Q

Primary pneumothorax:

A

(aka spontaneous Pneumothorax) occurs unexpectedly in healthy people resulting from spontaneous rupture of blebs (like blisters on the visceral pleura)​

49
Q

Cause of blebs unknown but happens more in …

A

people with emphysema like changes to the lung tissue even without a history of smoking or genetic disorder​

50
Q

Secondary pneumothorax:

A

caused by chest trauma (rib break, stab/bullet wounds that tear the pleura, Rupture of a bleb in a patient that has emphysema from smoking or genetic disorder), OR from mechanical ventilation with PEEP (positive end expiratory pressure)​

51
Q
  1. Open (communicating) pneumothorax= …
A

air pressure in pleural space equals barometric pressure because air is drawn into the space through the injury during inspiration and is forced back out during expiration

52
Q
  1. Closed (Tension) pneumothorax involves …

More and more air comes into the space which results in …

A

an injury that allows the pleural rupture to act like a one-way valve: so air comes in during inspiration but cannot escape during expiration. ​

the pneumothorax exceeding barometric pressure​

53
Q

S/S of pneumothorax:

A

Sudden pleural pain, tachypnea, dyspnea​

Breath sounds may be decreased or absent (depends on size), and percussion should elicit hyperresonance on the injured side​

54
Q

Tension pneumothorax can cause …

A

severe hypoxemia, tracheal deviation away from the affected lung, and hypotension​

Tension pneumothorax deteriorates FAST and requires IMMEDIATE TREATMENT​

55
Q

In pleural effusion there is…

A

No production of sputum because the fluid is located in the pleural space, OUTSIDE of the lung.​

56
Q

Chylothorax:

A

Chyle (milky fluid with lymph and fat) usually drains from lymph thru thoracic duct & into GI tract. With Chylothorax, trauma, infection, or disease disrupts lymph transport so chyle moves into pleural space​

57
Q

Hydrothorax (Transudate):

A

occurs when pulmonary capillary pressure increases due to heart disease, or when plasma protein production is disrupted by liver/kidney disease and causes hypoproteinemia that leads to decreased oncotic pressure in blood vessels. Results in watery fluid that diffuses out of capillaries beneath the pleura​

58
Q

Exudate type:

A

Caused by infection, inflammation or cancer in pleura that stimulates mast cells to release biochemical mediators that increase capillary permeability, So, fluid with WBC and proteins migrates out of capillaries and into pleural space​

59
Q

Empyema (pus):

A

pulmonary infections (pneumonia, abscess, infected wounds) causes debris of infection and microorganisms to accumulate in pleural space. More common in kids and elderly. Typical causes: Staph Aureus, E. Coli, anaerobic bacteria, Klebsiella pneumonia.​

60
Q

Hemothorax (blood):

A

Trauma, surgery, rupture, or cancer that damages blood vessels allows hemorrhage into the pleural space​

61
Q

Restrictive lung diseases characterized by

A

DECREASED COMPLIANCE OF LUNG TISSUE

62
Q

Most common ________ lung diseases in adults: aspiration, atelectasis, bronchiectasis, bronchiolitis, pulmonary fibrosis, inhalation disorders, pneumoconiosis, allergic alveolitis, pulmonary edema, and acute respiratory distress syndrome (ARDS)​

A

Restrictive

63
Q

aspiration

A

a restrictive lung disease where foreign substance gets in lungs.

64
Q

How do we best prevent those at risk of aspiration?

A

Positioning/feeding precautions

65
Q

How do we prevent atelectasis?

A

Incentive Spirometer, position changes q 2, early ambulation, cough, deep breathe exercise ​

66
Q

How do deep breaths help prevent atelectasis?

A

deep breathing promotes clearance of secretions from ciliary, stabilizes alveoli by redistributing surfactant, and promotes collateral ventilation thru the pores of Kohn, which helps expand collapsed alveoli​

67
Q

bronchiectasis
- patho
- associated with:

A

Persistent abnormal bronchial dilation​

Chronic inflammation of bronchi leads to destruction of the elastic/muscle parts of their walls, obstruction of the lumen, and traction from adjacent fibrosis (scarring) —-results in PERMANENT DILATION​

Associated with systemic disorders (RA, IBD, immune deficiency)

68
Q

bronchiolitis
- most at risk:

A

diffuse, inflammatory obstruction of small airways/bronchioles​

Occurs most in kids but can occur in adults with respiratory tract infection, or who inhale toxic gases​

69
Q

bronchiolitis s/s includes …
need…

A
70
Q

bronchiolitis can also be…

A

Can also be a serious complication of stem cell/lung transplant, and when it is, it can progress to BRONCHIOLITIS ABLITERANS​

71
Q

Bronchiolitis obliterans is a …

A

fibrotic (scarring) process that results in progressive scarring that occludes the airways​

72
Q

Bronchiolitis obliterans organizing pneumonia (BOOP) is a complication of bronchiolitis obliterans, …

A

where the alveoli and bronchioles become filled with plugs of connective tissue​

73
Q

pulmonary fibrosis

A

Can be caused by active pulmonary disease, autoimmune disorders, or inhalation of substances that cause chronic inflammation that results in fibrosis ​

74
Q

Fibrosis causes the lung to become stiff which…

A

decreases its compliance.

75
Q

_________ is most common PF and has no specific cause​

A

IDIOPATHIC PULMONARY FIBROSIS (IPF)

76
Q

main symptom of PF?
- auscultation reveals

A

increasing dyspnea on exertion​.
- Auscultation reveals diffuse crackles with inspiration​

77
Q

Oxygen toxicity:

A

prolonged exposure to high concentrations of supplemental oxygen can cause oxygen toxicity which occurs as a severe inflammatory response that is mediated by oxygen free radicals.​

78
Q

Pneumoconiosis​

A

Any change caused by inhalation of inorganic dust particles (usually work)​

  • Occurs after years of working with occupational dusts, which causes progressive fibrosis of lungs (asbestos, silica, coal are the most common causes but talc, fiberglass, clays, mica, slate, cement, and others can too)​
  • The materials are deposited in the lungs which causes the release of proinflammatory cytokines, which leads to chronic inflammation with scarring of the alveolocapillary membrane and results in pulmonary fibrosis and progressive deterioration of the lung tissue​
79
Q

Most COMMON cause of pulmonary edema is …

A

left-sided heart failure​

80
Q

When left ventricle fails, …

A

filling pressures in left heart increase—causes pulmonary capillary hydrostatic pressure to increase. When hydrostatic pressure exceeds oncotic pressures (holds fluid in capillary), fluid moves from the capillary into the interstitial space within the alveolar septum between the alveolus and the capillary. When the flow of fluid out of the capillaries is greater than the lymph system’s ability to remove it, pulmonary edema occurs​

81
Q
  1. Adult respiratory distress syndrome (ARDS) or inhaled toxic gas injury can also cause …
A

pulmonary edema. As a result of the injury, the capillary permeability increases. The capillary injury and inflammation causes water and plasma proteins to leak out of the capillary and move into the interstitial space, which increases the interstitial oncotic pressure. As the interstitial oncotic pressure exceeds the capillary oncotic pressure, water moves out of the capillary and into the lung​

82
Q

Obstruction of the lymph system by tumors or scars OR increased systemic venous pressure …

A

can also cause pulmonary edema​

s/s: dyspnea, hypoxemia, increased work of breathing, inspiratory crackles, dullness to percussion over lung bases​

In severe edema, pink frothy sputum is expectorated, hypoxemia is worse, and hypoventilation with hypercapnia may develop​

83
Q

How do we treat pulmonary edema?

A

Treat the cause:​

Heart failure: treat by improving cardiac output (diuretics, vasodilators, drugs to improve contraction of heart muscle)​

For increased capillary permeability following injury: remove the offending agent and give supportive therapy to maintain adequate ventilation and circulation​

May need mechanical ventilation if ventilation and oxygenation are severely impaired​

84
Q

ARDS

A

acute respiratory distress syndromes

85
Q

What happens in ARDS and ALI?

A

an acute injury to the alveolocapillary membrane

leads to massive pulmonary inflammation,

leads to higher capillary permeability, which

leads to severe pulmonary edema, shunting, VQ mismatch, and hypoxemia.

86
Q

ALI

A

acute lung injury

87
Q

both ARDS and ALI are d/t…

A

injury unrelated to hydrostatic pulmonary edema

88
Q

ARDS can occur directly or indirectly, how?

A

directly by aspiration of acidic gastric contents OR inhalation of toxic gases

indirectly from systemic disorders, that cause inflammatory mediators to circulate

89
Q

What are the 3 overlapping phases of ARDS

A
  1. Exudative phase
    - 72 hrs later…
    - inflammatory mediators lead to pulmonary vasoconstriction
    - leads to endothelial damage and capillary permeability
    - leads to systemic inflammatory response syndrome (SIRS)
    - can lead to multiple organ dysfxn syndromes (MODS)
  2. Proliferative phase
    - 4-21 days later…

3.Fibrotic phase
- 14-21days
- fibrosis of lung
- decreased FRC, V/Q mismatch worsens, etc. leads to ARF

90
Q

ARF
- results in

A

acute respiratory failure
- PaO2 less than 60mmHg or CO2 less than 50mmHg with pH less than 7.2

91
Q

Type 1 ARF

A

Hypoxemic RF. O2 exchange between capillaries and alveoli is insufficient

92
Q

Type 2 ARF

A

hypercapnic RF. Alveoli no ventilate or CO@ production increases

93
Q

Normal Values​

Partial pressure of oxygen (PaO2) - 75 - 100 mmHg.​

Partial pressure of carbon dioxide (PaCO2) - 38 - 42 mmHg.​

Arterial blood pH of 7.38 - 7.42.​

Oxygen saturation (SaO2) - 94 - 100%​

Bicarbonate - (HCO3) - 22 - 28 mEq/L.​

A
94
Q

obstructive pulmonary diseases characterized by…

A

expiration making it worse, as more force is needed to expire volume of air

95
Q

obstructive pulmonary diseases are (3)

A
  1. asthma
  2. chronic bronchitis
  3. emphysema
96
Q

symptoms across all 3 OPDs are (2)

A

dyspnea and wheezing

97
Q

plasma cells produce anitgen-specific IgE in which OPD?

A

asthma

98
Q

if asthma hypoxemia is not stopped what can occur to lungs

A

respiratory alkalosis (as pH increases from compensation) and inevitably r. acidosis

99
Q

main cause of COPD

A

smoking

100
Q

inherited mutation of which gene can lead to COPD and how?

A

alpha- 1 antitrypsin gene
A-1 antitrypsin is a protein made by liver. Fx is to protect lungs. If they aren’t shaped right, they get stuck in liver, neutrophil moves into lungs and wreaks havoc.

101
Q

COPD airway inflammation occurs with…

A

inspiration of irritants. Neutrophils, macrophages, and lymphocytes will infiltrate bronchial wall.

102
Q

continued bronchial inflammation leads to…

A

edema and number+size of mucous glands, goblet cells increase in the airway epithelium

103
Q

emphysema

A

abnormal, permanent enlargement of acini of alveolar walls without fibrosis. Loss of elastic recoil.

104
Q

what differentiates acute bronchitis from pneumonia?

A

AB will have no infiltrates on CXR

105
Q

s/s of pneumonia

A

accumulation of exudate in acinus will cause V/Q mistmatch and hypoxemia

106
Q

________ most common and lethal cause of both CAP and HAP pneumonias​

A

STREPTOCOCCUS PNEUMONIAE

107
Q

Which disease is this?

fatigue, weight loss, lethargy, anorexia, low grade fever that usually occurs in the afternoon. COUGH with purulent sputum develops slowly and becomes more frequent over next few weeks/months​

Night sweats and anxiety are hallmark signs! (B symptoms)​

​

A

Active TB symptoms

108
Q

Normal pulmonary artery pressure is __ mm Hg at rest. If the pressure in the pulmonary artery is greater than__mm Hg at rest or __ mmHg during physical activity, it is abnormally high and is called pulmonary hypertension

A
  • 8-20 mmHg
  • 25
  • 30
109
Q

Cor Pumonale

A

Right ventricular enlargement (hypertrophy, dilation or both) caused by Pulmonary Hypertension.

Progresses to dilation and failure of the ventricle

110
Q

which laryngeal cancer is most common?

A

Squamous cell carcinoma most common but small cell carcinoma can occur

3125 Pathophysiology (19 decks)

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