Respiratory Function and Alterations in Gas Exchange (exam 4) Flashcards
1
Q
define ventilation
A
- the movement of air in and out of the lungs (alveoli)
2
Q
define perfusion
A
- movement of blood in and out of the capillary beds of lungs to body organs/tissue
3
Q
define diffusion
A
- movement of gas between air spaces in lungs and bloodstream
4
Q
what are the two types of pulmonary congestion
A
- lung
- pulm vascular congestion
5
Q
what is tidal volume
A
- how much you breath in & out
6
Q
what is expiratory reserve volume (ERV)
A
- when you breath out MORE or most
7
Q
what is residual volume?
A
- what stays in lungs 24/7, no matter what
8
Q
what is inspiratory reserve volume (IRV)
A
- the extra volume of air that can be forced air
- extra breath you breathe in
9
Q
what is vital capacity
A
- total volume of gas that can be exhaled during maximal expiration
10
Q
inspiratory capacity
A
- amount of gas that be inspired from a resting expiration
11
Q
what is functional residual capacity
A
- amount of gas left in lungs at the end of a normal expiration
12
Q
what is total lung capacity
A
- amount of gas contained in lungs at maximal inspiration
13
Q
what is pulmonary function testing? (PFT)
A
- evaluations of airflow in the lungs
14
Q
what is spirometry?
A
- patient inhales deeply and exhales as quickly as possible until maximal air is exhaled
- measures how much the breath in & out
15
Q
what is PEF
A
- peak expiatory flow
- force of hair breathed out in 1 second
16
Q
what does FEV1 stand for?
A
- forced expiatory volume
17
Q
what does FVC stand for
A
- forced vital capacity
18
Q
what is airway lung disease
A
- effects the body’s ability to move air in & out of the lungs
- ex: asthma, COPD, bronchitis, emphysema
19
Q
what happens in lung tissue diseases? & what are the examples of such diseases?
A
- damaged tissue from scarring or injury
- ex: pulmonary fibrosis, sarcoidosis
20
Q
what happen in lung circulation disease? & what are some examples of these
A
- affects the circulation of the blood to and from the lungs
- ex: pulmonary hypertension, pulmonary edema
21
Q
define hypoventilation?
A
- insufficient delivery of air to alveoli
- increased paCO2 (hypercapnia) due to decreased respirations
- less co2 out more o2 in
- risk of resp acidosis
22
Q
define hyperventilation
A
- increased in air entering alveoli
- low co2 due to increased resp
- decreased paCO2 (hypocapnia) due to increased respirations
23
Q
define hypoxemia
A
- low levels of blood oxygen
24
Q
what does high V/Q mean?
A
- ventilation with no perfusion
- phys dead space
25
what does low V/Q mean?
- lower paO2
- airway obstruction
- hypoxemia results
26
in pulmonary resistance or pulmonary HTN what is the pathogenesis
- walls of small pulm vessels thicken from an increase in the muscle; internal layer of pulmonary artery wall becomes fibrotic
- sustained pulm HTN results in formation of a network of blood vessels that impede blood flow
27
what are the clinical manifestations of pulmonary HTN?
- vary according to the severity & duration of the cause
- exercise intolerance fatigue
- syncope = light headed
- hemoptysis (cough blood)
- chest pain on exertion
- increasing dyspnea
- cor pulmonale
28
what does "primary" pulmonary HTN mean?
- origin is unknown, and rapidly progressive, long term prognosis is poor and medical treatment is normally ineffective
29
what does "secondary HTN" mean?
- from a known disease
- 3 reasons: increased pulmonary blood flow, increased, resistance to blood flow, and increased left atrial pressures
30
what is an pulmonary venous thromboembolism (PE)
- a undissolved, dethatched material that clogs a blood vessel (often times is a blood clot)
- detaches and lands in the lungs
31
what is Virchow's triad?
- embolism formation risk equation
- venous stasis
- hypercoagulability
- damage to blood vessels
32
what are common risk factors for PE?
- immobility, trauma, pregnancy, cancer, HF, estrogen use
33
what are risk factors for a dislodged blood clot?
- direct trauma
- exercise
- muscle action
- changes in blood flow
34
what are the C.M of a PE
- depending on size of thrombus
- Restlessness, apprehension, anxiety, low grade fever, dyspnea,
tachycardia, tachypnea, chest pain (on inspiration) and hemoptysis
35
how do you diagnose a PE?
- ventilation/perfusion scan (V/Q)
- ABG's
- ECG (to check for MI)
- pulmonary arteriography (checking pul arteries)
- ultrasound`
36
what is the treatment for a PE?
- prevention first w/ avoiding prolonged bred rest, active ROM, low does heparin, TEDS
- if PE confirmed: heparin drip (anticoag), thrombolytics, O2, bedrest, embolectomy
37
what does "obstructive pulmonary disorder" entail?
- obstruction to air flow
- soft lung tissue
- loss of tissue
- low FEV1: VC ratio
- Low PERF (force of air out)
- airway obstruction that is worse EXPIRATION
38
what are common signs and symptoms w/ obstructive pulmonary disorders?
- dyspnea & wheezing
- increased work of breathing
- V/Q miss match
- decreased forced expiratory volume in 1 sec
39
what is the etiology of asthma ?
- airway obstruction that is somewhat reversible
- gene + environment interaction
- obstruction caused by INFLAMMATION / bronchoconstriction
- airway inflammation de to MAST cell release (edema, mucus, bronchoconstriction)
- increased airway responsiveness to a variety of stimuli
40
what is extrinsic asthma?
- allergic, pediatric onset
- an IgE- mediated response (allergic)
41
what is intrinsic asthma?
- non allergic, adult onset
- unknown cause
42
what is the cause of exercise induced asthma?
- common in kids & teens
- bronchospasms occur
43
what are examples of drug induced asthma & how does it happen?
- can produce symptoms ranging from mild rhinorrhea to raspatory arrest requiring mechanical ventilation
- ex: aspirin, NSAID's can trigger attacks
44
what is the pathogenesis of asthma
1. mast cell activation, reacts to antigen
2. histamine release activates cytokines
3. inflammation of the airway (mucosal edema & plug formation, along with bronchoconstriction
4. airway wall remodeling = thickening of basement membrane
45
what are the C.M of asthma
- wheezing
- chest tightness
- dyspnea
- accessory muscle use
- cough (dry or productive)
- increased sputum production
- hyper inflated chest
46
what are the C.M of a severe asthma attack
- intercostal retractions
- distant breath sounds w/ inspiratory wheezing
- orthopnea/tachypnea
- tachycardia
- silent chest (bad = pt not breathing)
- agitation, confusion
- cyanosis
47
what is a status asmaticus?
- prolonged asthma attack (bronchospasm) & sever hypoxemia that doesn't go away with normal asthma meds
48
what classifies mild intermittent asthma?
- less than 2 occurrences per week
49
what are the 3 levels of persistent asthma and their severities, and what classifies them?
- mild = more than twice a week
- moderate = daily and may restrict physical activity
- sever = throughout the day w/ frequent severe attacks limiting ability to breathe
50
what is the treatment for asthma?
- Enviromental control = dust control, removal of allergens, air purifiers, air conditioner
- preventive therapy = stop smoking, avoid secondhand smoke, aerosol, order, early treatment for raspatory infections, peak flow monitoring
- meds = goal of meds: decrease inflammation & bronchoconstriction, O2 therapy, small volume nebulizer, B2 agonist, corticosteroids, leukotriene modifiers, mast cell inhibitors
51
what is the treatment for asthmatics?
- epinephrine, sub Q terbutaline, IV corticosteroids, o2 therapy w/ or w/o mehcanical ventilation
52
what is acute bronchitis?
- condition where the bronchial tubes (that carry 02 to the lungs) get inflamed & irritated, making the tubes swell and produce causing mucus to form and an incident cough
53
what is the etiology of acute bronchitis?
- acute inflammation of trachea & bronchi (lumen of these structures)
- may be caused by viral and non viral infections
- smoke inhalation
- inhalation of chemcials
54
define asthmatic bronchitis
- swelling of bronchial mucosa in children associated w/ obstruction, resp distress, & wheezing
55
what happens in acute bronchitis?
- airway becomes inflamed and narrowed
- capillary dilation
- swelling from fluid exudation
- infiltration w/ inflammatory cells (accumulation of immune cells in tissue)
- increased mucus production
- loss of ciliated epithelium & ciliary function
56
what are the clinical manifestations of acute bronchitis
- usually mild and self-limiting
- cough (productive & non)
- low grade fever
- substernal chest discomfort or pain
- sore throat & postnasal drip (excess mucus from nasal passages drips down back of throat)
- fatigue
57
what is the cause of chronic bronchitis?
- known as "Blue bloater"
- cigarette smoking (90% if cases)
- repeated airway infection
- genetic predisposition
- inhalation of a physical or chemical irritant
58
define type B COPD chronic bronchitis
- blue bloater
- diagnosed symptomatically
- hypersecretion of bronchial mucus and chronic productive cough for > 3 months for 2 + years
- persistent irreversible obstruction when paired w/ emphysema
59
how does chronic bronchitis progress?
1. w/ pulmonary hypertension that is causes by inflammation in bronchial walls & vasoconsriction of pulmonary vessels
2. increased pulmonary vascular resistance
3. right sided heart failure may occur causing pulmonary resistance (cor pulmonale)
60
what is bronchiectasis?
- destruction of bronchial walls making the airway sacs dilate
- dilated sacs hold pools of infected secretions that don't clear = possible spread of infection
61
what are the clinical manifestations of chronic bronchitis?
- blue bloater (typical pt)
- overweight
- 1:2 men to women
- 30 - 40 + yo
- SOB on excretion
- 3xcessive sputum
- chronic cough
- excessive fluids
- smoker
- R sided HF
- cyanosis (late)
62
how to diagnose chonich bronchitis?
- chest x - ray
- pulmonary function test: normal total lung capacity, increased residual volume, decreased FEV1
- ABG's = elevated PaCO2, decreased PO2 (risk for resp acidosis)
- ECG (rt side HF) = atrial arrythmias, evidence of right ventricular hypertrophy
63
what is the goal of treatment for chronic bronchitis?
- block the progression of the disease (!)
- return to optimal respiratory function
- return to usual activities of daily living
64
what is chronic bronchitis treatment?
- Inhaled short-acting B2 agonists (SNS)
- Inhaled anticholinergic bronchodilators
- cough suppressants
- Inhaled/oral corticosteroids
- Low-dose O2 therapy
- Mechanical ventilation may be necessary
65
what are lifestyle management/changes that would help in lifestyle management?
- Smoking cessation
* Reduction to exposure of
irritants
* Adequate rest
* Proper hydration
* Physical reconditioning
* Treadmill/stationary bike
* Alternating rest and
exercise
* Walking best exercise
* Influenza and
pneumococcal vaccines
66
define emphysema?
- destructive changes of alveolar walls without fibrosis
- abnormal enlargement of distal air sacs
- associated w/ chronic bronchitis
- damage is irreversible
67
what are some of the main causes of emphysema?
- smoking >70 pack years
- air pollution
- certain occupations
- a 1 - antitrypsin deficiency or increased elastase enzyme !
68
what are the C.M of emphysema
- pink puffer
- * Thin
* 55+ y/o
- Progressive, exertional dyspnea
* Accessory muscle use
* Pursed-lip breathing
* Digital clubbing
* Barrel chest
69
how to treat emphysema?
- Same as with chronic bronchitis
* O2 therapy
* Smoking cessation
* Medication = bronchodilator
- Cough suppressants
* Antimicrobial agents (infections)
* Inhaled/oral corticosteroids (decrease inflammation)
70
how can emphysema be diagnosed (4 ways)
- chest X- ray =
- Hyperventilation
* Low, flat diaphragm
* Presence of blebs or bullae
* Normal or small “vertical” heart
- pulmonary function tests (PFTs) =
- Increased functional residual capacity
* Increased RV and TLC
* Decreased FEV1, FVC
- ABG =
- Mild decrease in PaO2
* Normal PaCO2 (elevated in late stages)
- ECG =
- Sinus tachycardia: first sign of decreased oxygenation (SNS)
* Supraventricular arrhythmias
* Ventricular irregularities
71
what is cystic fibrosis?
- autosomal recessive disorder of exocrine glands
- airway gets filled with thick, sticky mucus, and possible infection
- classified as airflow obstructive or suppurative (pus-forming)
- hypersecretion of abnormal thick mucus that obstruct exocrine glands and ducts
- median survival age = 31 years
72
how does cystic fibrosis start?
- dysfunction of CFTR gene (alters chloride & water transport the skin may taste salty)
- bronchopulmonary system is also affected by the thick mucus
- causes airway obstruction, atelectasis & hyperinflation
- provides higher instances of pulmonary infection
73
