Respiratory disorders Flashcards
Define pulmonary embolism
The blockage of a pulmonary artery by foreign matter such as fat, air, tumor tissue, or a thrombus that usually arises from a peripheral vein.
Define acute respiratory distress syndrome
a form of respiratory failure characterised by acute lung inflammation and diffuse alveolar-capillary injury
Name four conditions that can cause problem with ventilation in the lower airway (lower airway obstruction)
Trauma Obstructive/restrictive lung disease Emphysema Chronic bronchitis Mucus accumulation Reactive airway disease Smooth muscle spasm, including asthma Airway oedema
Name at least four signs of life-threatening respiratory distress in adults
altered mental status
severe cyanosis
audible stridor
inability to speak one or two words without dyspnea
tachycardia
pallor and diaphoresis
retractions and/or the use of accessory muscles to assist breathing
Define congestive heart failure
An abnormal condition that reflects impaired cardiac pumping, usually a result of myocardial infarction, ischemic heart disease, or cardiomyopathy
What effect does pulmonary oedema associated with ARDS have on diffusion, ventilation, perfusion and why?
decreased diffusion - Intrapulmonary shunting
decreased ventilation - Reduced lung compliance
Name 3 signs of LHF
Bi-basilar crackles Pulmonary oedema Pleural effusion Chest pain Diaphoresis
Differentiate between non-cardiogenic and cardiogenic pulmonary oedema
Non-CPO is caused by changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic insult.
CPO
Cardiogenic oedema is caused by elevated hydrostatic pressure in the pulmonary capillaries due to left sided congestive heart failure.
Define abdominal aortic aneurysm
a localised dilation of the wall of the abdominal aorta
What anatomical and physiological elements must be intact for ventilation to occur and why?
Neurological control
Nerves between the brainstem and the muscles of respiration
Functional diaphragm and intercostal muscles
Patent upper airway
Functional lower airway
Alveoli that are functional and have not collapsed
Explain how left ventricular (heart) failure occurs
condition when the left ventricle fails to work as an effective forward pump
Blood is delivered to the left ventricle, but is not fully ejected from the ventricle
The increase in end-diastolic blood volume increases left ventricular end-diastolic pressure
This pressure is transmitted to the left atrium
Pressure is then transmitted to the pulmonary veins and capillaries
As pulmonary capillary hydrostatic pressure increases, the plasma portion of the blood is forced into the alveoli leading to pulmonary oedema
Name three distinctive features that may help in differentiating aortic dissection from that of MI or PE
The severity of pain is maximal from the onset
The pain may migrate from the anterior portion of the chest or inter scapular area downward as dissection progresses
Significant differences in blood pressure occur between the left and right arm or between the arms and the legs
The peripheral pulses are unequal
Neurological deficits result from occlusion of a cerebral vessel
Name five signs and symptoms of spontaneous pneumothorax
shortness of breath chest pain of sudden onset pallor diaphoresis tachypnea altered mental status cyanosis tachycardia decreased breath sounds on the affected side local hyper resonance to percussion subcutaneous emphysema
Describe the management principles for pulmonary embolism
supportive care supplemental high concentration oxygen cardiac and O2 saturation monitoring IV access with Normal Saline or Ringers Lactate transport in position of comfort
Name four conditions that can cause problem with ventilation in the upper airway
Trauma Epiglottitis Laryngotracheobronchitis Abscess Foreign body obstruction Inflammation of the tonsils
What anatomical and/or physiological elements must be intact for perfusion to occur and why?
Adequate blood volume
Adequate haemoglobin in the blood
Pulmonary capillaries that are not occluded
Efficient pumping of the heart that provides a smooth flow of blood through the pulmonary capillary bed
What respiratory complication always develops as a result ARDS?
Non-cardiogenic pulmonary oedema
Define cariogenic shock
shock that results when cardiac action is unable to deliver sufficient circulating blood volume for tissue perfusion
What is ventilation?
The process of air movement into and out of the lungs
What is perfusion?
The circulation of blood to the tissues
What anatomical and/or physiological elements must be intact for diffusion to occur and why?
Alveolar and capillary walls that are not thickened
Interstitial space between the alveoli and capillary wall that is not enlarged or filled with fluid
What is the most common site of thrombus formation?
Deep veins of the legs and pelvis
What aspect of patient’s history is unique to the ARDS syndrome?
most patients who develop this condition have healthy lungs before the event that caused the disease
Name the compensatory mechanisms that restore cardiac output and organ perfusion in heart failure
Tachycardia
Vasoconstriction
Activation of renin-angiotensin-aldosterone system
What is diffusion?
The process in which solid, particulate matter in a fluid moves from an area of higher concentration to an area of lower concentration, resulting in an even distribution of the particles in the fluid
Name four causes of perfusion problems
Inadequate blood volume/haemoglobin levels Hypovolemia Anemia Impaired circulatory blood flow Pulmonary embolus
Explain right ventricular (heart) failure occurs
often results from left ventricular failure that produces elevated pressure in the pulmonary vascular system
This pressure causes resistance to pulmonary blood flow.
It also increases the workload of the right side of the heart to overcome resistance
Over time, the right ventricle fails as an effective forward pump
This causes back pressure of blood into the systemic venous circulation
Name four conditions that can cause problem with ventilation due to chest wall impairment
Spontaneous pneumothorax
Pleural effusion
Neuromuscular disease
Muscular dystrophy
Name four causes of diffusion problems
Inadequate oxygen concentration in ambient air Alveolar pathology Asbestosis; other environmental lung disease Blebs/bullae associated with COPD Inhalation injuries Interstitial space pahtology Pulmonary oedema Acute respiratory distress syndrome Submersion/drowning Acute lung syndrome
What is spontaneous pneumothorax?
A condition that results when a subplural bleb ruptures, allowing air to enter the pleural space from within the lung.
Name four causes of ARDS
trauma gastric aspiration cardiopulmonary bypass surgery gram-negative sepsis multiple blood transfusions oxygen toxicity toxic inhalation drug overdose pneumonia infections sepsis
Name 3 signs of RHF
Peripheral oedema
Jugular venous distention
Engorged liver
Engorged spleen
Increased capillary permeability leads to what type of pulmonary oedema?
Non-cardiogenic pulmonary oedema
What is a bleb?
An accumulation of fluid under the skin
