respiratory review Flashcards
if sputum is green / yellow rusty thick / copius hemoptysis
green / yellow –> some infection
rusty –> pneumococcal penumonia infection
thick / copius –> CF, asthma, bronchitis
hemoptysis –> full RBC’s in blood
what are expectorants? e.g. guaifensesin
drugs used to make secretions more watery
breathing: what is kussmaul?
Kussmaul –> rapid, deep breathing usually caused by acidosis (need to get rid of CO2) from diabetes
breathing: what is Cheyne-Stokes?
periodic breathing with apnea caused by brain damage
t or f, dyspnea is a perception of difficult inspiration but actually effects expiration
true
wheezing
stridor
rales
Ronchi
wheezing - lower airways
stridor - upper airways, crowing noise
rales - crackling noise from secretions
Ronchi - deep noise from thick mucus
t or f, CO2 is less soluble and diffuses slower than O2
false - CO2 diffuses faster - less affected when there are perfusion issues
get rid of CO2 fast but don’t take in O2 - alkalosis?
what is emphysema?
COPD caused by trypsin related destruction of alveoli walls.
deficiency in anit-trypsin (liver) –> caused by smoking or by congenital reasons.
t or f
emphysema
increase lung compliance
decreased lung recoil (increased radii)
decreases surface area - problem with perfusion
decreases vasculature - V/Q mismatch
decreases interdependence between alveoli
true
why does emphysema cause obstruction?
lower airways are thin
there is lack of recoil
requires increased pleural pressure to expel air which causes airway collapse and expiratory problems
what is hyperinflation?
air trapping –> cannot expel air –> patients become barrel chested due to increased thoracic size
the diaphragm also remains flat at rest (normally its flat during inspiration) –> opens more space for air
what are bullae?
super-alveioli formed in emphysema
how are the following affected in emphysema TLC VC IRV RV FEV1 ERV
TLC - increased (hyperinflation) VC - decreased (less air exchange) IRV - decreased since air is trapped - blocks new air RV - increased since air is trapped FEV1 - decreased - below 70% of FVC ERV - decreased
if there is increased lung recoil and we breath in with high tidal volume what occurs?
if there is increased airway resistance (decreased radius) and we breath with high frequency what occurs?
both situations increase work
high resistance - should combat with tidal volume
high recoil - should combat with frequency
we normally breathe with high Tv and lower frequency –> decreases % of air in dead space
t or f, in emphysema, the work for inspiration is easier than normal
true –> no recoil = easy to breathe in…
but expiration is very difficult
tachycardia
tripod position
pursed lips
compensations of emphysema, explain.
tachycardia –> increases blood flow to lungs
tripod position –> engages pectoral muscles in respiration
pursed lips –> increases airway pressure - avoids airway collapse
during middle stage emphysema, there is a V/Q mismatch - what is this?
ventilation is still high but since their is destruction of so many capillaries, there is poor blood flow and many unperfused area’s which do not take up the available oxygen.
wasted ventilation
what occurs in the lungs when air is not being perfused into capillaries?
vasoconstriction - areas where oxygen uptake is difficult will stop receiving blood
body is trying to redirect blood to O2 rich areas
what is a major consequence of late stage emphysema –> cor pulmonale –> what is this?
Enough area now has poor perfusion –> vasoconstriction occurs everywhere –> increases pulmonary pressure which backs up onto the right heart and causes right heart failure
t or f, middle stage emphysema - hypocapnia
late stage emphysema - hypercapnia
true
middle stage –> you hyperventilate. since CO2 diffuses faster than O2, you get rid of more CO2 then take in O2 –> acidosis
late stage –> your compensatory measures fail - so hard to expire that CO2 builds up and causes hypercapnia
what is the hypoxic drive? what controls respiration?
normally CO2 levels are detected in the medulla and control respiration –> when the CO2 levels are low the hypoxic drive may kick in –> carotid artery O2 receptors take control of respiration if O2 mmHg drop below 60.
why can’t you give someone oxygen therapy who has PaO2 above 60 mmHg?
then the body perceives that you have enough oxygen and slows respiration –> but CO2 levels are still building up –> acidosis
what is chronic bronchitis (3)
- goblet cell hyperplasia - mucosal secretions
- mucosal edema
- fibrosis from chronic inflammation
all cause obstruction
what breathing sound does bronchitis make?
Ronchi - deep due to mucus
emphysema makes wheezing sound
