respiratory disorders Flashcards
(+) stretch receptors — (+) medulla via vagus nerve (CN 10): When you breathe in, stretch
receptors in your lungs detect that the lungs are expanding.
Inhalation
Pharyngitis can also occur with **(aka “mono”), a viral infection.
mononucleosis
Congenital depression of the sternum that decreases the anterioposterio (A-P) diameter
Funnel Chest (pectus excavatum)
Most common causes are allergy and bacterial infection
o Damage to the mucusa of the sinuses are reversible
Acute Sinusitis
soft, high-pitched, and very brief
- sounds like a lock of hair rolled in between fingers
Fine Crackles
Onset of symptoms
CHRONIC BRONCHITIS EMPHYSEMA
> 35 years > 50 years
Not troubled with breathlessness except with strenuous exercise
0 None
(normal Inspiratory Reserve Volume (IRV) is
approximately )
3,300mL
TREATMENT Viral pharyngitis
❖ salt water gargles
❖ pain relievers
❖ extra fluids t
non-productive to productive cough (constant irritation to
the throat until it produces mucus that causes scar where bacterias will go hence infection or
inflammation)
Dry progressing to productive
non-specific, cardiomegaly could be seen
Chest Radiography
refers to the amount of air can be inhaled after a normal or tidal inspiration
Inspiratory Reserve Volume (IRV)
Decreased PaO2 and increased PaCO2 in chronic bronchitis
Arterial Blood Gases
Refers to the amount of air remaining in the lungs at the end of normal exhalation (approximately
1,200mL)
Functional Residual Capacity (FRC)
FEV 50%-80%
IIA COPD
Refers to the entire process of air flow between the human body and the atmosphere
This is a protective reflex. When your lungs stretch too much during a deep breath, this
reflex tells your brain (via nerves) to stop inhaling to avoid over-expanding the lungs.
Hering-Breuer reflex
condition characterized by the inflammation of the mucus
membrane lining the sinuses
* May either be a bacterial infection or secondary to a viral exposur
SINUSITIS
show hyperinflation with areas of local atelectasis
Chest X-rays –
DIAGNSOSIS for pharyngitis
laryngoscopy
Refers to the amount of air in the lungs with maximal inspiration (approximately 6,000mL)
o Total of the four lung volumes: TV + IRV + ERV + RV
Total Lung Capacity (TLC)
o Refers to a non-invasive method of assessing the functional capacity of the lungs
o Measures air flow rates and calculate lung volumes and lung capacities
Pulmonary Function Test
A decrease in TV with a decrease in RR indicates a
neurological problem
Refers to the maximal amount of air that can be exhaled after maximal inspiration
(approximately 5,000mL)
o Refers to the total of the TV, IRV and ERV
Vital Capacities (VC)
System that is primary responsible in replenishing oxygen supply in the body as well as in excreting carbon
dioxide to the atmosphere through the process of respiration
RESPIRATORY SYSTEM
Sputum specimens are best collected as patient awakens in the
morning
This is the single most important factor. Use of voice during laryngitis results in incomplete or
delayed recovery. Complete voice rest is recommended although it is almost impossible to
achieve. If the patient needs to speak, the patient should be instructed to use a “confidential
voice;” that is, a normal phonatory voice at low volume without whispering or projecting.
. Voice rest
nvolves the use of local anesthesia and may be
accomplished through needle biopsy
Closed Techniques
Inflammatory Disorders
o Pharyngitis
o Laryngitis
o Sinusitis
Because air
moves from high pressure to low
pressure, the lower pressure in the lungs
“sucks” air in from outside, allowing you
to breathe in oxygen
Sucking mechanism
Creamy yellow or rusty sputum
staphylococcal pnemonia
pain caused by inflammation of the pleural membranes, is usually catching
in nature and produced by movement of the thoracic cage; commonly unilateral and
brought on by deep inspiration (pain w/ moving lungs; nasakit nu aganges nauneg)
o Intercostal pain — transient in nature and worse during coughing (nasakit nu aguyek
Pleuritic pain
cough - periodic forceful episodes that are difficult to control / brief episodes
Paroxysma
show decreased oxygen saturation
Pulse Oximetry
often a mild and self-limiting condition that typically lasts for a period of 3 to 7 days.
▪ Acute laryngitis is a temporary condition caused by overusing the vocal cords. It can also be caused
by an infection. Treating the underlying condition causes the laryngitis to go away.
Acute laryngitis
condition where the pulmonary function test resulted in increased residual volume
chronic bronchitis
▪ condition lasts for over 3 weeks
▪ prolonged exposure to one of the risk factors
▪ Chronic laryngitis results from long-term exposure to irritants. It’s usually more severe and has
longer-lasting effects than acute laryngitis
Chronic laryngitis
A simple questionnaire used to determine nicotine dependence
Fagerstrom Test
- A term used to describe the symptom of breathlessness and is a common presentation of
respiratory problems - A subjective symptom and varies from person to person
dyspnea
tidal exchange of air between the lungs & at atmosphere that occurs with respiration
Ventilation
o A test to determine the presence of tuberculosis
o A small amount of purified protein derivative (PPD) (0.1mL) is injected intradermally in the
- Skin Test (Mantoux Test)
- Is a condition characterized by increased responsiveness of the tracheobronchial tree to various
stimuli with resulting bronchospasm and inflammation of the bronchial mucosa - Episodic irreversible obstruction
- Associated with allergens
- BRONCHIAL ASTHMA
Sputum is described in terms of:
Color\
coonsistenncy
amount
Obstructive Diseases Affecting the
Lower Airways
o COPD
o Bronchial Asthma
- soft, low-pitched soundsthat are heard over the majority of the lung fields;
sounds produced - produced by air moving through the bronchioles and filling the alveoli
- E < I
. Vesicular
Breath Sounds
o Used to determine whether or not a patient has been smoking
o a simple, non-invasive way to measure carbon monoxide poisoning in a patient
Breath Analyzer (Carbon Monoxide Breath Test)
total volume of
air in kungs often refilled with air
FVC (Force vital capacity)
condition where the pulmonary function test resulted in : increased total lung capacity
emphysema
- referred to as discontinuoussounds; they are intermittent,
non-musical and brief - may heard either upon inspiration or expiration
- The popping sounds produced are created when air is forced through respiratory
passages that are narrowed by fluid, mucus, or pus - Often associated with inflammation or infection
Crackles
(crepitations, rales)
: can no longer breathe normally
III Severe COPD
a complete loss of voice (
(aphonia)
s the space in the lungs gets bigger,
the air pressure inside drops lower than
the air pressure outside. This is called
negative pressure
ccurs at the connection of the ribs and the cartilage and can be
elicited with pressure on the area ((+) pain upon palpation in costochondral junction)
Costochondral pain
shows increase eosinophil count
Complete Blood Count (CBC) with Differential Count –
o Performed to obtain tissue samples for microscopic examination
o May be performed through either open or closed technique:
Lung Biopsy
a continuous, coarse, whistling sound produced in the respiratory airways during
breathing
- caused by air moving through narrowed airways
- do not clear with coughing
Wheezes
Walks slower than people of same age because of breathlessness or has to stop for breath
2 Moderate
Responsible in the unconscious (while sleeping) control of respiration
MEDULLA OBLONGATA
o Performed to obtain fluid samples from the pleural space, relieve pressure from
accumulated fluid and obtain tissue for biopsy
Thoracentesis (Pleural Fluid Analysis)
Refers to the amount of air remaining in the in the lungs after forced, maximal expiration
(approximately 1,000mL)
Residual Volume (RV)
- Refers to an abnormal irreversible enlargement of air spaces distal to terminal bronchioles
- caused by a complex obstruction and destruction of alveolar walls, resulting in decreased elastic recoil
properties of lungs.
EMPHYSEMA
Skin color
CHRONIC BRONCHITIS EMPHYSEMA
Pale to cyanotic
Pink
act primarily to relax bronchial smooth muscle and dilate the
airways
Bronchodilators
Occurs as a response to an allergen or trigger to which the patient is hyperresponsive
▪ Mediated by IgE and appears more often in children and may disappear during adolescence
Extrinsic Asthma
one sign of throat filling
Frequent throat-clearing
Troubled with shortness of breath when hurrying on level of ground or walking up slight hill
1 Slight
o Measures the amount of oxygen dissolved in the arterial blood
o Measure through pulse oximetry which makes use of spectrophotometer to determine the
amount of light absorbed by the hemoglobin in arterial blood
o A clip that is placed on a finger or ear allows the oximeter
Oxygen Saturation
FVC <70%
FEV 30%-80%
w/ w/o s/s
II: Moderate COPD
FEV 30%-80%
IIB COPD
Refers to the amount of air expelled with maximally forced exhalation
Forced Vital Capacity (FVC
Responsible in the regulation of the rate and rhythm of respiration (tells the brain how many breathes should the
body make for a period of time, fast or slow, shallow or not)
PONS
amount of air
exhaled forcefully and quickly
FEV (Force expiratory volume)
Too breathless to leave the house or breathless when dressing
4 Very
Severe
A condition characterized by:
o loss of lung elasticity
o narrowed bronchioles
o abnormal dilation of terminal airspaces caused by the destruction of the alveolar walls
EMPHYSEMA
stages of asthma
- Mild (episodic)
- Moderate (one to two times a
week) - Severe
- Status Asthmaticus
Refers to the actual flow of gases into and out (inside and outside) of the respiratory tract
Pulmonary ventilation (breathing)
drug to to decrease inflammation
Corticosteroids
After inhaling, the lungs naturally “recoil” or shrink back to their original size. This
is elastic recoil, and it helps push air out when you exhale.
Elastic recoil — deflate
cough — sudden, short in duration
Acute
- Literally means “looking inside”
- Refers to a procedure which allows the examiner to visualize internal structures through the use of an
instrument known as endoscope
Endoscopy
Cough
CHRONIC BRONCHITIS EMPHYSEMA
Chronic
Absent to mild
Can be helpful in evaluating patients suspected of having tuberculosis, pneumonia or lung
cancer
o To produce a sputum sample, the patient is instructed to rinse the mouth with water, take a
series of deep breaths and then cough to raise sputum and expectorate it into a sterile
container
Sputum Analysis
shows the clinical significance of allergens identified by skin testing
Bronchial Challenge Testing
Percussion
CHRONIC BRONCHITIS EMPHYSEMA
Normal
Hyperresonant
show decreased peak flows and forced expiratory volume in 1 second,
low-normal or decreased vital capacity, and increased total lung and residual capacities.
Pulmonary Function Studies –
Pink & frothy sputum
pulmonary edema
transient in nature and worse during coughing (nasakit nu aguyek)
Intercostal pain
Structure responsible in the conscious (awake) control of respiration but can be overridden by the medulla
oblongata
* Compensates medulla bot not totally since medulla is unconscious
CEREBRAL CORTEX
Refers to the ease with which the lungs are inflated
* The elastic nature of the lungs causes them to stretch when the lungs are inflated and recoil when the lungs are
deflated
Lung Compliance
Provides information about patient’s oxygenation and ventilation hence deemed
valuable in assessing the efficiency of pulmonary gas exchange.
o In this test, the examiner obtains a blood sample (2mL) by direct puncture of a radial, brachial
or femoral artery
o If the radial artery is to be used, the examiner performs an Allen’s test to ensure that
the hand has adequate collateral blood flow
o To prevent clotting of the sample, the examiner uses a pre-heparinized syringe and sample is
placed on ice until it is analyzed
Arterial Blood Gases
cough — gradual in onset and longer in duration
▪ Considered a non-allergic type of asthma
▪ Triggered by intrinsic factors which includes emotional stress, changes in humidity and temperature,
exposure to noxious fumes and coughing
Intrinsic Asthma
dry cough (do not produce sputum, as in dry)
Non-productive
Prompt antibiotic therapy is needed
❖ it can sometimes cause kidney problems and rheumatic fever, which can damage the heart
valves.
Strep throat
Controlled by the movement of the chest cavity, the compliance
of the lungs and the surface tension within the alveoli
* A single cycle of ventilation consists of inhalation (inspiration)
followed by
exhalation (expiration)
Pulmonary Ventilation
o Performed to assess the perfusion of the lungs
o A radioactive contrast dye is injected into a vein or an artery and a series of X-rays of the
chest are taken to detect blood flow abnormalities (these films provide a picture of the
vasculature that can detect pulmonary embolism or infarction)
o Patient Preparation:
▪ Patient must fast for at least 6 hours prior the procedure (NPO)
▪ Inform the patient that a needle will be placed in his/her
Pulmonary Angiography (Pulmonary Arteriography)
These are chemoreceptors that are located near the medulla and are very sensitive to changes in carbon dioxide
levels
* These are the primary chemoreceptors that regulate ventilation
CENTRAL CHEMORECEPTORS
Used to describe a group of conditions that is
characterized by permanent changes in the airways
leading to the impairment of air flow
* In COPD, air flows in and out of the airways
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
* AKA Chronic Airway Limitation (CAL), Chronic Obstructive Lung
Disease (COLD), Chronic Restrictive Lung Disease (CRLD)
reveals hypoxemia
Arterial Blood Gas (ABG) analysis
Other findings
CHRONIC BRONCHITIS EMPHYSEMA
Infections, right sided heart failure
Weight loss
decrease in the transmission of light
Transillumination
dietary restriction is recommended for patients with gastroesophageal reflux disease. This
includes avoiding caffeinated drinks, spicy food items, fatty food, chocolate, peppermint.
Dietary modification
Green sputum
= pseudomonas pneumonia
Refers to the amount of air that can be inhaled with maximal effort after normal exhalation
(approximately 3,000mL)
Inspiratory Capacity (IC
May result from untreated acute sinusitis
o Damage to the mucosa of the sinuses are irreversible
Chronic Sinusitis
amount of air you breathe in and out during normal, relaxed breathing. How
much air fills your lungs depends on how well your lungs expand and contract.
Tidal volume
FVC <70%
FEV >80%
w/ w/o s/s
I: Mild COPD
cough described according to onset as:
o Acute
o Chronic
o Paroxysmal
Inhaling humidified air enhances moisture of the upper airway and helps in the removal of
secretions and exudates.
3. Avoidance of
Steam Inhalation
Stops for breath after walking approximately 100 yards (approx 30 meters) after a few minutes
on level ground
3
Severe
normal spirometry
with chronic symptoms
0: at risk
- Also known as radical anthrum surgery
- Indicated for chronic maxillary sinusitis
- Usually done when antibiotic treatment is no longer effective
An incision is made under the upper lip (point of entry), above the lateral incisor teeth and part of
the bony anthrum is removed, producing a permanent window allowing drainage and removal of
the deceased mucosa and p
Caldwell-Luc Surgery
Use of fiberoptic endoscope is used to disect nasal tissue
o Complications:
o Nasal bleeding
o Orbital hematoma
o Injury to the optic nerve which may lead to blindness
Functional Endoscopic Sinus Surgery (FESS)
refers to the reflex which serves as the protective mechanism of the body towards
tracheobronchial irritation (anything that goes to the tracheo bronchial will irritate/will trigger the
active mechanism)
cough
Laboratory Tests FOR RESPIRATORY DISORDERS
Complete Blood Count (CBC)
* Arterial Blood Gases
Sputum Analysis
scarring or mild inflammation
I Mild COPD
Medium-pitched and continuous with muted characteristics of both
bronchial and vesicular breath sounds
- Produced by air moving through large airways and are heard over the first
and second intercostals spaces along the sterna border and
between the scapula
Bronchovesicular Breath
Sounds
if the PaO2 is less than 55mmHg or the oxygen saturation is less than 88%
Low-flow oxygen
Obtained to diagnose disorders of the lung
o Normal lung tissue is radiolucent and that foreign bodies, infiltrates, tumors and fluids appear
as white areas or densities
o Performed in the radiology department or at the bedside with a portable unit; they are
completed in a few minutes and are painless
Chest Roentgenograms/Chest X-ray
predisposing factor of
rheumatic heart disease
GABHS (group A beta-hemolytic streptococcal) infection
o Refers to the amount of air inspired or exhaled during normal, quiet breathing
o Amount is approximately 500mL in a 70kg person
o Volume capacities are 20-25% lower in women
Tidal Volume (TV)
Refers to the exchange of gases ( or gas exchange) across the alveolar membrane
between (inside) the respiratory and circulatory tracts
Alveolar ventilation
enlargement of the right ventricle
cor pulmonale or right sided heart failure
performed in the operating room and require general
anesthesia
Open Technique
force required to expand the lungs to a particular volume is referred to as
compliance
o increased anterioposterio (A-P)diameter, giving the chest a rounded appearance with sternum pulled
out (equal or nearly equal)
Barrel Chest
- Also refers to protective mechanism for clearing the airways
- Can also be defined as the reflexive to irritating stimuli in the tracheobronchial tree or the lary
cough
COPD embraces several diseases which includes:
o Chronic Bronchitis
o Emphysema
STAGES OF
Dyspnea
CHRONIC BRONCHITIS EMPHYSEMA
Predominant Symptom
May be absent in early stages
Inflammation of the vocal cords can alter the way the vocal cords come together and vibrate, causing
voice changes.
o Laryngitis can be acute (short-term), lasting less than three weeks. Or it can be chronic (long-term),
lasting more than three weeks.
LARYNGITIS
are somewhat louder, lower in pitch, and last longer than fine crackles
- sounds like opening a Velcro lock
Coarse Crackles
drug if patient does not improve with combination therapy
Long Acting Bronchodilators
These are chemoreceptors that are located in the carotid bodies and aortic arch and are very sensitive to changes in
oxygen levels
* May assume the primary chemorecptor’s responsibility in the event that the central chemoreceptors fail
PERIPHERAL CHEMORECEPTORS
A sharp metal instrument (known as trocar) is inserted through anthrum into the lateral wall of the
nose into the sinus
Anthral Irrigation
o A sharp meta
Upper Respiratory Airways/Tracts
Nose and sinuses, pharynx, larynx, nasal cavity, trachea
Radiologic Test
Chest Roentgenograms/Chest X-ray
Pulmonary Angiography (Pulmonary Arteriography)
may identify specific allergens
Skin Testing
efers to the production of sputum however not all patients with a
productive cough can expectorate sputum ((+) sputum but can’t expectorate =
productive)
Productive
Lower Respiratory Airways/Tracts
Trachea, bronchi, bronchioles and alveoli, lungs
reveals increase from allergenic reaction
Serum IgE levels
FVC <70%
FEV ,<30%
espiratory failure
III: SEvere COPD
- A recurrent inflammation of the bronchial walls with hypertrophy of the mucous goblet cells,
- characterized by hypersecretion of mucus
- accompanied by a chronic/recurrent productive cough for a minimum of 3 months a year for two successive
years
CHRONIC BRONCHITIS
A-P Diameter
CHRONIC BRONCHITIS EMPHYSEMA
Normal to slight increase
Increased
most effective diagnostic tool. It is also used to rule out other local or
systemic disorders, such as tumor, fistula, and allergy
Computed tomography scanning
- Sound produced when airways are constricted by swelling,secretions or bronchoconstriction and
where exhalation requires effort - Ask about when wheezing occurs, what makes the patient wheeze, whether others can hear the
wheezing and what makes the wheezing
Wheezing
Normalsputum is clear, thin and averages
100mL/day
Kabaliktaran ni funnel, rimwar ni sternum
Pigeon
produced by the goblet cells as well as the submucosal glands
Sputum
detect sinus opacity, mucosal thickening, bone destruction, and air-fluid levels.
Sinus x-rays
Patients with this disorder were described as blue bloaters because the increased
secretions and airway obstruction causes hypoxemia (hence cyanosis [blue]) and
peripheral edema from right sided heart failure (hence bloater)
chronic bronchitis
Smoking and alcohol should be avoided. Smoking delays prompt resolution of the disease
process
Avoidance of irritants
Refers to the mount of air that can be forcibly exhaled after normal or tidal expiration
Expiratory Reserve Volume (ERV)
A decrease in TV without a decrease in respiratory rate (RR) indicates a
restrictive disorder
such as pulmonary fibrosis
Provides information about RBC, hemoglobin, hematocrit and WBC
Complete Blood Count (CBC)
heard over the trachea and are harsh and discontinuous
- E > I
Tracheal
Breath Sounds
drug to improve air flow
Bronchodilators
Long Term control medications
Corticosteroids, leukotriene modifiers
o sympathomimetic aerosol sprays
REVIEW ASTHMA STAGE
used for clearing secretions.
mucolytics
commonly known as sore throat
o is an inflammation of the pharynx, resulting in a sore throat.
o Thus, pharyngitis is a symptom, rather than a condition.
PHARYNGITIS
used to increase the effects of
bronchodilators
Anticholinergics
