Respiratory Flashcards
Ventilation
flow of air into and out of the lungs
Perfusion
flow of blood through pulmonary cappillaries
Diffusion
Transfer of gases between the alveoli and pulmonary capillaries
Anatomic dead space
volume of air in the conducting airways (nose, trachea) that is moved with each breath but does not participate in gas exchnge
Alveolar dead space
air contained in the lung which does not participate in gas exchanged
Physiologic dead space
sum of anatomic and alveolar dead spaces
Shunting
the movement of blood from the right side of the heart to the left side of the heart without being oxygenated
Physiologic shunting
occurs when there is impaired movement of air (ventilation) or blood flow (perfusion)
Anatomic shunt
occurs when blood moves from the venous to the arterial side of the circulation without moving though the lungs
V-Q mismatch
occurs when there is a perfusion without ventilation or ventilation without perfusion
V-Q ratio when perfusion is without ventilation
low, atelectasis
V-Q ratio when ventilation is without perfusion
high, PE
pO2
the level of dissolved oxygen in plasma
what happens to hemoglobin saturation when it leaves the left side of the heart?
it drops
Oxygen-Hemoglobin dissociation curve when it shifts to right
increase in tissue metabolism (reduced affinity of hemoglobin for oxygen) d/t fever, acidosis, pulmonary insufficiency, severe anemia, exercise!
Oxygen-Hemoglobin dissociation curve when it shifts to left
decrease in tissue metabolism (increased affinity of hemoglobin for oxygen) d/t alkalosis and decreased body temp
Dorsal group location and function
located in medulla and controls inspiration
ventral group location and function
located in medulla and active when an increase in respirations is needed
Pneumotaxic center location and function
located in upper pons and can turn respirations off, controls rate and resp volume
Apneustic center location and function
located in lower pons and can prolong inspirations
chemosensitive center and what will happen if Ph is low?
are affected by the pH in CSF, if Ph low it will increase rest
Parasympathetic system
acetylcholine NT with muscarinc receptors ex. bronchoconstriction, pulmonary vasodilation
sympathetic system
epinephrine and norepinephrine NTs with B2 adrenergic receptors ex. Broncial smooth muscle relaxation, pulmonary vasoconstriction
lung stretch receptors location and function
in smooth muscle, respond to changes in pressure, control the stretch of a lung
lung irritant receptors location and function
located between airway epithelial cells, respond to irritants and causes airway constriction with rapid shallow breathing
lung Juxtacapillary receptors (J-recptors)
located in alveolar wall, responsible for rapid shallow breathing associated with pulmonary edema or embolism
The effects of gas exhange on pna
there is impaired diffusion of oxygen into cappillaries which causes hypoxemia, HR tachy, respiratoy alkalosis d/t stimulation of pulmonary receptors, hypercapnia
congestion phase of pna
4-24 hours, initial inflammatory response kicks in
red hepatization phase of pna
48 hours, extravasation of RBCs, fibrin into alveoli, tissue is firm and red
Gray hepatization phase of pna
72 hours-1 wk, fibrin accumulates and granulates
s/s of pna
increased HR, increased temp, rales, rhonchi (mucus in bronchi), decreased breath sounds over consoliation, E to A changes, dull percussion , resp alkalosis
Bacterial pna
acute, bacterial infection of lung, more common in adults than children
which bacteria is responsible for community acquired bacterial pna?
streptococcus pneumoniae or Haemophilus influenzae
which bacteria is responsible for hospital acquired bacterial pna?
gram negative rods like pseudomonas or gram positive like staph
which is more prevalent, community or nosocomial bacterial pne?
community
viral pna
inflammatory disease of lungs
viral pna causes
flu, RSV, Cytomegalovirus, varicella, Rubeola
Mycoplasma pna
acute interstitial pna caused by extensive infection of lungs and bronchi of lower lobes
how often do we see mycoplasma pna? and in which age group?
epidemics occur every 4-5 years, in men more than women, prevalent in children
what will WBC look like with mycoplasma?
normal
Bronchiolitis and which age group?
inflammation of bronchioles, out pouching, usually seen in babies
Bronchiolitis causes
viral, chlamydia, eye, nose inoculation, day care exposure
Bronchiolitis s/s
anorexia, cough, cyanosis, expiratory wheezing, fever, inspiratory crackles
Bronchiolitis ABG
hypoxemia, hypercapnia, acidemia
Bronchiolitis tests
infant pulmonary studies, CXR, resp viral cultures
Asthma, Cystic fibrosis, chronic bronchitis, emphysema, bronchiectasis are all which kind of disorder?
obstructive
Thoracic cage disorders, adult resp distress syndrome, sarcoidosis are all which kind of disorder
restrictive
Acute Bronchitis
acute inflammation of bronchi caused by irritants or infection (cigarette smoking)
distinguishing characteristic of acute bronchitis?
obstruction of airflow
Acute bronchitis s/s
fever, fatigue, rales, rhonchi, wheezing, no pulmonary consolidation, pharynx infected, cough
chronic bronchitis
inflammation of the bronchial walls with hypertrophy of goblet cells, BLUE BLOATER
chronic bronchitis s/s
cough present for at least 3 months out of year for 2 successive years, BLUE BLOATER, cyanosis, Rhonchi, hypercapnia, hypoxemia
chronic bronchitis V/Q mismatch results (what happens with ventilation)
hypoventilation of alveoli d/t trapping hypoxemia, hypercapnia (blue bloater)
Emphysema
destruction of alveoli walls, elasticity of airspaces is gone, PINK PUFFER
Emphysema s/s
tachypnea, barrel chest, dyspnea even at rest, decreased breath sounds, normal ABG
Emphysema V/Q mismatch results (what happens with ventilation)
not prominent d/t loss of capillaries with alveoli
Centrilobular and Panacinar
two type of emphysema
Centrilobular emphysema
associated with smoking, affects resp bronchioles and alveolar ducts
Panacinar emphysema
associated with genetics, destruction and enlargement of alveoli distal to terminal bronchioles
Bronchiectasis
abnormal, chronic permanent dilation of large bronchi
causes of bronchiectasis
airway obstruction (tumor), congenital abnormalities, infection (TB), cystic fibrosis, exposure to toxic gases
classic signs of bronchiectasis
halitosis (because of all the stuff they cough up), Hemoptysis (because of the break down of the wall
Asthma
reactive airway disease that causes episodic reversible airway obstruction
asthma obstruction is caused by what?
bronchospasm, increased mucus secretion and inflammation and edema of bronchial mucosa
Extromsoc atopic asthma (type 1)
is triggered by something you are allergic to mediated by IgE,mast cells release histamine and prostaglandins on exposure
Intrinsic idiopathic (type 2) asthma
adult onset poor prognosis
Exercise induced asthma (EIA) triggers
hypocapnia, cool air
ASA triad
diagnosis of asthma, nasal polops, you take asa or NSAID
What happens to the bronchi during asthma
bronchi widen and lengthen on inspiration BUT collapse on expiration- you cant get air out
why is expiration difficult with asthma?
edema, narrowing of airway, and mucus obstruction occurs
what does PaO2 initially look like with asthma then what does it look like later?
initially low d/t increased RR then later high d/t decreased alveolar ventilation
V/Q mismatch with asthma
unoxygenated blood returns to left atrium which leads to the pulmonary artery vasoconstricting which leads to pulmonary HTN which leads to R ventricular failure
mild asthma symptoms
brief wheezing once or twice per week, thick clear or yellow mucus,
moderate asthma symptoms
weekly, interferes with sleep and exercise, resp distress at rest, diminished breath sounds, hyperresonance, accessory muscles used
severe asthma symptoms
frequent hospitals, absent breath sounds, paO2 70, chest retractions, pulses paradoxous >10
early asthma response, when do s/s show up and how long for recovery
immediate bronchoconstriction on exposure to inhaled irritant, s/s within 10-20 mins, recovery 60-90 mins
late asthma response, when do s/s show up and how long for recovery
develops 3-5 hours after exposure to trigger, may last days or weeks
Cystic fibrosis and what things are seen in sweat with this disease
large amounts of thick mucus, increased concentrations of sodium and chloride in sweat
symptoms to rule in asthma
wheezing and dyspnea, wheezing with no URI symptoms and nocturnal dyspnea
Cystic fibrosis is characterized by what?
chronic pulmonary disease, pancreatic insufficiency, (BS levels will remain high)abnormal high levels of electrolytes in sweat
cystic fibrosis effects on pulmonary
block alveolar ventilation, chronic inflammation, bronchial scarring and destroys airways, reduced lung compliance (ability to stretch)
cystic fibrosis effects on pancrease
pancrease duct clogs, enzymes don’t reach small intestine, decreased insulin secretion, diabetes!
cystic fibrosis effects on liver
bile duct obstruction, biliary cirrhosis, portal HTN, liver failure
cystic fibrosis effects on intestine
blocks digestion=failure to thrive
cystic fibrosis effects on heart
R sided heart failure=cor pulmonale
cystic fibrosis effects on reproductive system
sterile
cystic fibrosis tests
sweat test, genetic screening, chest xray and stool testing
sarcoidosis
non-infectious multisystem disease of unknown cause
sarcoidosis s/s
hilar adenopathy (bila enlarged lymph nodes of lungs), pulmonary infiltrates, ocular and skin lesions, other organs may be involved
Idiopathic pulmonary fibrosis
interstitial pna which leads to pulmonary fibrosis that w cant be explained
tidal volume
the volume of air inspired and expired in a normal breath
Pulsus parodoxus
an abnormal finding in which there is a large decrease in systolic blood pressure during inspiration.
For a patient with a pulmonary embolus, the V/Q scan will show
Perfusion defects with normal ventilation.
Ventilation refers to
Delivery of air to the alveoli.
alveolocapillary membranes
where gas exchange takes place
Increased parasympathetic activity results in
Constriction of the bronchioles
Inspiration involves
Pressures within the lung that are lower than atmospheric.
vital capacity
Maximal amount of air that can be taken in and exhaled with forceful expiration.
Approximately one-third of each breath occupies dead space. This space represents
Volume of non-useable gas in the conducting airways
Oxygen-Hemoglobin Dissociation curve is influenced by what?
pH, temp and carbon dioxide
We blow off CO2 and H20 to make what?
carbonic acid, H2CO3
what 3 things cause systemic vasodilation in order to remove metabolic waste and deliver more O2 to tissues?
a decrease in pH, decrease in O2 and an increase in CO2
empyema
pus in pleural cavity
if chest X-ray reveals pna in upper lobe what diseases do you think of?
TB or aspiration pna
peribronchial thickening may show up on X-ray for which type of pna?
viral pna
what will show on a chest X-ray for bronchiolitis?
flattened diaphragm, increased AP diameter, peribronchial cuffing, air trapping
what can chronic bronchitis cause?
pulmonary HTN, cor pulmonale, Aascities, peripheral edema
alpha antitrypsin deficiency
an inherited condition that increases your risk for lung disease (exp. emphysema)
