respiratory 1 Flashcards
1
Q
How many lobes are on the lt lung?
A
2
2
Q
How many lobes are on the rt lung?
A
3
3
Q
What does the trachea divide into?
A
two main bronchi
4
Q
What do the two main bronchi branch into?
A
smaller bronchioles, alveolar ducts & alveoli
5
Q
What are the two major components of the respiratory system?
A
- conducting airway
- respiratory airway
6
Q
What is the conducting airway composed of?
A
composed of the upper respiratory tract (nose, mouth, pharynx, larynx, trachea, & bronchi)
7
Q
What is the respiratory airway responsible for?
A
gas exchange
8
Q
What is the respiratory airway composed of?
A
lobules of the lungs; consists of bronchiole & arterioles, pulmonary capillaries, & veins
9
Q
What does the conducting airway carry out?
A
the process of ventilation
10
Q
What does ventilation do?
A
changes the quality of atmospheric air (warms, moistens & filters)
11
Q
What produces mucus?
A
epithelial lining contact goblet cells that produce mucus, as well as cilia
12
Q
How is air transported in the conducting airway?
A
nose → sinuses → nasal cavity → pharynx → larynx → bronchi
13
Q
What are the defense mechanisms of the lungs? (hint: 4)
A
- alveolar macrophages
- neutrophils
- mast cells
- cough reflex
14
Q
What does the lower respiratory tract consist of?
A
lobules & alveoli
15
Q
What forms the respiratory membrane?
A
alveoli (respiratory sacs) at the end of the bronchioles for the respiratory membrane
16
Q
What are alveoli?
A
functional units of the lungs where gas exchange occurs
17
Q
Where is surfactant produced?
A
produced by type II cells in the alveoli
18
Q
What are the lugs separated by and what does it contain?
A
the lungs are separated by the mediastinum; contains the heart, esophagus, thymus gland, and other vessels & nerves
19
Q
How do the alveoli receive unoxygenated blood?
A
the alveoli receive unoxygenated blood from the rt ventricle via the pulmonary artery
20
Q
What is the mucociliary apparatus?
A
a specialized cellular mechanism within the bronchioles that
21
Q
What does the mucociliary apparatus consist of?
A
- ciliated pseudostratified columnar epithelial cella
- goblet cells
22
Q
What happens during the mucociliary apparatus?
A
The wave-like movement enables the movement of mucus downward to the throat and the upward movement of the cilia moves mucus from the bronchioles to the throat, where it is swallowed
23
Q
What is the mucociliary apparatus affected by?
A
- smoking
- respiratory infection
24
Q
Where does gas exchange occur?
A
occurs in the alveoli
25
Where does oxygen enter the lungs?
oxygen enters the alveolus & moves across the alveolar membrane into the blood
26
How does carbon dioxide leave the body?
carbon dioxide diffuses from the blood into the alveolus to be excreted by exhalation
27
What does oxygen combine with in the blood?
oxygen combines with heme portion of hemoglobin to form oxyhemoglobin
28
What is ventilation?
the process of inspiration & expiration of air
29
What is ventilation controlled by?
the respiratory center of the brain which receives input from chemoreceptors and lung receptors (stretch & irritant receptors)
30
How does the vagus nerve help with ventilation?
stimulates the diaphragm to contract
31
What is perfusion
The movement of blood through the pulmonary circulation
32
What is the ventilation- perfusion ratio?
the ratio of the amount of oxygen reaching the alveoli to the amount of blood reaching the alveoli
33
What is the ideal ventilation-perfusion ratio?
want both to be equal
34
What does an imbalance in ventilation-perfusion lead to?
leads to a decrease in gas exchange
35
What is dead space?
an area where there is no perfusion
36
What happens in a left-shift?
increased affinity for O2
- decreased pCO2
- decreased [H+]
- decreased 2,3-DPG
- decreased temp
- HbF
37
What happens in a right-shift?
decreased affinity for O2
- increased pCO2
- increased [H+]
- decreased pH
- increased 2,3-DPG
- increased temp
38
What is measured during a pulmonary function test (PFTs)? (hint: 7)
- forced vital capacity (FVC)
- forced expiratory volume (FEV)
- peak expiratory flow (PEF)
- total lung capacity (TLC)
- functional residual capacity (FRC)
- residual volume (RV)
- tidal volume (TV)
39
What is the most common sign of a pulmonary problem?
dyspnea (shortness of breath)
40
What can a cough be?
productive or non-productive
41
What is a cough?
involuntary response to mechanical or chemical stimulation of the bronchial tree; serves as a mechanism to eliminate the stimulant
42
What is hemoptysis?
coughing up blood
43
What is hemoptysis associated with?
TB, lung cancer or infection
44
What is atelectasis?
collapse of alveoli, resulting in decreased gas exchange
45
When does atelectasis occur?
commonly occurs post-op
- also can occur due to compression by a mass
46
What is hypoxia?
oxygen level in blood inadequate to meet needs of the tissue
- PAO2 less than 60mg hg
47
What is hypoxemia?
insufficient amount of oxygen in blood
48
When is erythropoietin released?
secreted by the kidneys in response to low oxygen levels
49
What does erythropoietin release lead to?
leads to stimulation of the bone marrow to increase the production of RBCs
50
What will stimulate production of erythropoietin?
any disorder that causes hypoxia will stimulate the production of erythropoietin (COPD, high altitudes, cardiac disease)
51
What causes a cold?
caused by several viruses which invade the upper respiratory tract leading to an inflammatory response (release of histamine & prostaglandin)
52
How long does the common cold usually last?
typically lasts about 5-7 days
53
What happens to mucus & membranes during a common cold?
- mucus membranes engorged
- increase mucus production
54
What are the sx of a common cold?
- sinus pain
- nasal congestion
- runny nose
- sneezing
- watery eyes
- scratchy throat
- headache
55
What should be avoided when having a common cold?
avoid antibiotics
56
What is rhinitis?
inflammation and congestion of the nasal mucosa
57
What is hay fever?
seasonal rhinitis; inflammatory response to a specific allergen
58
What are sx of rhinitis?
- nasal congestion
- sneezing
- stuffiness
- watery eyes
59
What is sinusitis?
inflammation of the mucus membranes lining the Para sinuses
60
What can cause sinusitis?
- viral infection (7 to 10 days)
- allergies
- bacterial infection (up to 4 weeks)
61
is sinusitis acute or chronic?
can be acute, subacute or chronic
62
What are sx of sinusitis?
- headache
- pain over sinuses
- pressure
- nasal congestion
- purulent discharge
63
What is similar about rhinitis & sinusitis?
pathology of both are similar but affects different structures
64
What is nasal congestion?
When nasal passages become blocked due to swollen membranes, inflamed blood vessels, and increased mucus secretions
65
What is a cough?
- forceful expulsion of air from lungs
- protective reflex
- helps remove foreign bodies, irritants, or accumulated secretions
66
What are bronchial secretions a result of?
- can result from numerous disorders, both pulmonary and non-pulmonary
- excessive secretions may impair respirations
67
What do nasal decongestants do?
used to relieve nasal obstruction and discharge
68
What are adrenergic (sympathomimetic) drugs are most commonly used to?
cause vasoconstriction, leading to decreased edema & inflammation of the nasal membranes
69
What are the routes of administration for nasal decongestants?
- oral
- topical (nasal sprays)
- steroid nasal decongestants
70
What pregnancy category are nasal decongestants?
all drugs are pregnancy category C
71
What drugs are considered nasal decongestants?
- pseudoephedrine (sudafed)
- oxymetazoline (afrin)
- phenylephrine (vazculep; neo-synephrine)
- fluticasone (Flonase)
- triamcinolone (nasacort)
72
What are the adverse effects that can be seen with nasal decongestants?
- local stinging & burning
- rebound congestion
- SNS effects: increased HR & BP; urinary retention
73
What are contraindications for nasal decongestants?
- hx of allergy to drugs
- glaucoma
- HTN
- diabetes
- thyroid disease
- coronary disease
- prostate problems
74
What should you educate pts on when taking nasal decongestants?
- should not use the drug for more than 5 days unless instructed
- caution use with other OTC drugs
75
What do antitussives do?
used to suppress non- purposeful couging
76
How do antitussives work?
depress the coughing center in the brain or the cough receptors in the throat, trachea or lungs
77
What drugs are in the antitussive class?
- benzonatate (Tessalon pearls)
- dextromethorphan (delsym)
- codeine
- hydrocodone bitartrate
78
What is the route of administration for antitussives?
oral
79
What pregnancy class are antitussives in?
all drugs are pregnancy category C (D during labor)
80
What are the general adverse effects of antitussives?
- drying of mucus membranes
- headache
- drowsiness
- dizziness
81
What are the adverse effects of dextromethorphan?
- nausea
- drowsiness
- rash
- difficulty breathing
82
What are contraindications for antitussives?
- hx of allergy to drugs
- head inj or could be impaired by CNS depression
- caution in those with asthma & COPD
- caution in children with atopic syndrome
- dextramethorphan; avoid use with alcohol & several psych drugs
83
What pt education should be given for those taking antitussives?
- should not use for more than 5 days unless instructed
- caution use with other OTC drugs
84
What do expectorants do?
increase productive cough to clear the airways by:
- liquifying lower respiratory tract secretions
- decrease the viscosity of secretions
85
What drug is in the expectorant class?
guaifensesin (mucinex)
86
What is the onset and duration of guaifenesin (mucinex)?
onset: 30 min
duration: 4-6 hrs
87
What is the route of administration for expectorants?
oral
88
What pregnancy category are expectorants in?
pregnancy category C
89
What are adverse effects of expectorants?
- rash
- headache
- N/V
- dizziness
90
What are contraindications for expectorants?
- hx of allergy to drugs
- persistent cough due to smoking, asthma, emphysema
- productive cough lasting more than 1 week
91
What do mucolytics do?
breakdown and liquify respiratory tract secretions
92
What are mucolytics used to treat?
- cystic fibrosis
- asthma
- bronchiectasis
- COPD
- chromic bronchitis
93
What medications are in the mucolytic class?
acetylcysteine (acetadote, parvolex)
dornase alfa (pulmozyme)
94
What mucolytic has fast onset via nebulizer?
acetylsteine (acetadote, parvolex)
95
What are the routes of administration for mucolytics?
- oral
- nebulizer
- IV
96
What pregnancy category are mucolytics?
pregnancy category C
97
What are adverse effects of mucolytics?
- GI upset
- stomatitis
- rhinorrhea
- bronchoconstriction
- bronchospasm
- urticaria
- rash
98
What are contraindications for mucolytics?
- hx of allergy to drug
- presence of acute bronchospasm
99
What pt education should be given for mucolytics?
how to use nebulizer
100
What are herbal preparations used as?
have been used as cold remedies
101
What are the three herbal remedies used?
- echinacea
- vitamin C
- zinc sulfate
102
How is echinacea used?
has different preparations
103
is echinacea effective?
no better than a placebo
104
What does vitamin C do?
decreases incidence & severity of colds & flu
105
What does regular use of vitamin C play a role in?
regular use appears to play a role in the defense mechanism of the respiratory system
106
What does zinc sulfate do?
decrease incidence and severity of cold sx in adults
107
What can nasal zinc lead to?
can lead to loss of smell
108
What is the first chemical mediator released in the immune and inflmmatory response?
histamine
109
What cells release histamine?
mast cells & basophils
110
What are the 3 main types of histamine receptors?
histamine 1
histamine 2
histamine 3
111
Where are histamine 1 receptors located?
mainly on smooth muscle cells in blood vessels, respiratory & GI tract
112
What is allergic rhinitis?
inflammation of the nasal mucosa caused by type 1 hypersensitivity reaction to inhaled allergens
113
What is allergic rhinitis characterized by?
- nasal congestion
- itching
- sneezing
- watery discharge
114
What are the two types of allergic rhinitis?
seasonal
perennial
115
What causes seasonal allergic rhinitis?
produces acute sx in response to protein components of airborne pollens
116
when does allergic rhinitis usually occur?
occurs mainly in spring and fall
117
Who is at higher risk for seasonal allergic rhinitis?
those with personal or family hx of other allergies
118
When does perennial allergic rhinitis occur?
occurs year-round
119
What is perennial allergic rhinitis caused by?
- dust mites
- animal dander
- molds
120
How do antihistamines work?
block the release or action of histamine at the histamine-1 receptor sites
121
What effect do antihistamines have?
- anticholinergic
- antipruritic
122
What are antihistamines used for?
used for relief of sx associated with allergic responses (I.E. seasonal allergies, angioedema, motion sickness, allergic reactions)
123
What are contraindications for antihistamines?
- pregnancy or lactation
- those with hx of arrhythmias/ prolonged QT intervals
124
What are adverse effects of antihistamines?
- drowsiness
- sedation
- drying of respiratory & GI mucus membranes
- GI upset
- nausea
- arrhythmias
- dysuria
- urinary hesitancy
125
What drugs are first generation antihistamines?
- diphenhydramine (Benadryl)**
- hydroxyzine (vistaril)**
- drompheniramine (brovex, J-tan, respa-ar)
- chlorphemiramine (aller-chlor)
- clemastine (dayhist allergy)
- dexchlorpheniramine
- dimenhydrinate (dimentabs)
- meclizine (antivert)
- phromethazine (phenergan)
126
What drugs are second generation antihistamines?
- certirizine (zyrtec)**
- loraradine (alavert, clartin)**
- azelastine (astelinm, asterpro)
- olopatadine (patanase)
127
What drugs are third generation antihistamines?
- fexofenadine (allegra)**
- desloratadine (clarinex)
- levocertirizine (xyzal)
128
What pt education should be given when taking antihistamines?
- may cause dryness of mucus membranes & thickening of secretions (drink plenty of fluids)
- take w/ meals to avoid Gi upset
- may cause drowsiness, dizziness, or impaired mental alertness
- do not smoke
- do not drive or operate heavy equipment after taking
- avoid other medications that also cause sedation
- do not take more than one (many OTC cold or sleep aids have antihistamines)
- avoid prolonged exposure to sunlight
