Respiratory System Flashcards
What are the upper respiratory airways?
-nasopharyngeal
-larynx
-tracheobronchial tree
What does the nasopharyngeal airway consist of?
-nose (primary air intake)
-mouth (alternate airway)
-lined with mucous membranes
What does the larynx do in upper airways?
-connects oropharynx and trachea
-vocal cords (folds and elongated opening-glottis)
-epiglottis (when swallowing closes over pharynx)
What does the tracheobronchial tree consist of?
-trachea
-bronchi
-bronchioles
What do lobules do in the lungs?
-gas exchange
-terminal bronchioles/ alveolar ducts/ sacs
What does alveoli do in the lungs?
-terminal air space of respiratory tract
-lined with epithelial tissue
-Type I and II cells
-alveolar macrophages
What are Type I Alveolar cells
squamous cells form barrier between air and alveolar wall
What are type II alveolar cells?
-cuboid cells: produces pulmonary surfactant
-decreases surface tension in alveoli
-phospholipid
What are alveolar macrophages?
responsible for removal of foreign agents
What is a pulmonary vasculature?
pulmonary and bronchial circulation
What happens in the pulmonary circulation?
-pulmonary artery carries poorly oxygenated venous blood to lung capillaries for gas exchange
-pulmonary veins carry freshly oxygenated blood into left side of heart
What happens in bronchial circulation?
-distributes blood to the connecting airways
-provides blood supply to the lung structure
What are the Pleura and Pleural cavity?
-double layered serous membrane
-lines thoracic cavity
-encases lungs, thoracic wall, mediastinum, and diaphragm
What is the thoracic cavity potential space for?
inflammatory exudate to accumulate
What is pleural effusion?
abnormal collection of fluid or exudate in pleural cavity
What is ventilation?
the mechanism of breathing
What is breathing controlled by?
medulla oblongata in the lower brain
What monitors blood levels of CO2, O2, and blood pH?
chemoreceptors in the medulla, carotid arteries, and aorta
What is CO2 narcosis?
-in people with chronic hypercarbia
-people who no linger respond to stimulus and rely upon decreased blood oxygen to increase ventilation
What is the main chemical that determines the rate of breathing?
CO2
What happens when there is too much CO2 in the blood?
breathing rate increases
Decreased pressure inside chest compares to:
air pressure outside chest
What must combine for adequate oxygenation of the blood?
ventilation (V) and perfusion (Q)
What is the normal ventilation-perfusion match?
a ratio of 4:5 or also written as 0.8 (gold standard value)
To optimize oxygenation in the client with unilateral pneumonia, how would the nurse position the client and why? (V-Q Matching Example)
-position the patient in a downward position where their airways are open
-a more gravity downward position
-“GOOD lung down”
Perfusion of blood in the lungs is gravity-dependent. What does this mean?
more blood will be found in lower areas of the lungs
What is Atelectasis?
-incomplete expansion of a lung or part of a lung
-caused by airway obstruction or compression to lung tissue
What are the causes of Atelectasis?
-immobility
-decreased LOC
-medications
-decreased rate/ depth of breathing
What is Hemothorax?
blood collection in chest cavity
What happens to the pleural cavity when lungs are fully expanded?
-normally empty space between visceral and parietal pleura
-with pleural effusion, there is abnormal fluid collection between visceral and parietal pleura
-lung expansion decreases when pleural effusion occurs
Clinical Manifestations- Atelectasis
-increased temp
-decreased mobility
What is lung compliance and why does it matter?
-elastin/ collagen fibers give elasticity to lungs and help provide elastic recoil
-lung compliance helps to push air out of alveoli and airways
What are obstructive pulmonary disease characteristics?
-inspiration (airways open)
-expiration (airways narrow)
-alveoli hyper-inflated by trapped air
-increased lung compliance
What are the types of obstructive pulmonary disease?
-asthma
-emphysema
-chronic bronchitis
Asthma Etiology
-hypersensitivity lung response to stimuli
-leading risk factor= genetic predisposition for hypersensitive response to common allergens
-chronic inflammation of bronchial mucosa
What does chronic inflammation of bronchial mucosa lead to?
-bronchioles hypersensitive o inhaled substances
-airway constriction
-airflow limitation (reversible)
What happens when lungs lose its elasticity?
it has trouble getting air out of the lungs as fast as it should and air that is inhaled sits in the lungs and becomes stale
Environmental Etiology- Peds
-air pollution
-home stress
-cockroach agent
-cat exposure
-lack of healthcare
-vitamin D insufficiency
Environmental Etiology- Adults
-respiratory infections
-esophageal reflux
-obesity
-tobacco smoke
What is primary prevention of asthma?
avoidance of asthma risk factors
Why is asthma categorized as an obstructive pulmonary disease?
because its underlying feature is airway obstruction that worsens in the expiratory phase
Asthma involves alveolar damage and air trapping that leads to what?
alveolar hyperinflation with eventual alveolar destruction
Asthma vs COPD
-both: airflow limitation is a characteristic
-asthma: reversible
-COPD: irreversible
Asthma Pathogenesis
-hypersensitivity cause increased Immunoglobulin E antibody response to inhaled substance
-increased histamine and leukotriene: bronchoconstrictor
Asthma- Symptoms
-severe dyspnea
-chest tightness
Asthma- Signs
-expiratory wheezing
-tachycardia
-tachypnea
-decreased arterial oxygen sat
-respiratory acidosis: alarm for impending respiratory failure
What do arterial blood gases indicate?
elevated pCO2 and decreased pH
Status Asthmaticus
-unresponsive to treatment
-worsening hypoxemia and acidosis
-can be fatal
What is COPD?
-chronic and recurrent obstruction of airflow
-emphysema + chronic bronchitis often coexist
-irreversible functional change
What are risk factors for COPD?
-tobacco
-air pollution
-poor nutrition
-advanced age
What are the genetic factors of COPD?
-Alpha: 1 anti trypsin autosome recessive defect
-AAT: antiprotease enzyme protects lungs tissue and bile ducts
What are COPD structural changes?
-bronchioles lose their shape and become clogged with mucus
-walls of alveoli are destroyed, forming fewer larger alveoli
Emphysema Pathophysiology
-mucosal inflammation
-alveoli destroyed
-airway collapse
-air trapped in alveoli
-decreased alveolar surface area for gas exchange
What does tobacco smoke inactivate?
the alpha-1 antitrypsin that normally protects airway tissue
What is an example of metaplasia?
a reversible change when an adult cell is REPLACED by a different type of cell in the same category
Emphysema- Clinical Manifestations
-dyspnea
-cough
-barrel chest
-increase pCO2
-Xray: flat diaphragm
Chronic Bronchitis- Chronic airway inflammation
-defined by: Coughing > 3 months x 2 years
-common etiologies involve cigarette smoking and air pollution
-often leads to recurrent respiratory infections
Why do individuals with COPD develop polycythemia?
they have chronic hypoxemia which causes the brain to feel the need to make more RBCs but it will eventually clot
What is Pneumonia?
-infectious or non infectious inflammation of lung parenchyma, bronchi, and/ or alveoli
-8th leading cause of death
-increased risk in older adults or anyone with debilitating conditions
What are the Pneumonia types?
typical and atypical
What is typical pneumonia?
bacteria cause inflammation and fluid exudate in alveoli air spaces
What is atypical?
virus and mycoplasma infection in alveoli septal area and lung interstitium
Typical pneumonia risk factors
-age > 65
-immune compromised
-recent antibiotics
-comorbidities
-recently hospitalized
-smoking
-diabetes mellitus
Atypical pneumonia risk factors
- immunocompromised
-close quarters
-smoking
-children/adolescents
-late summer/fall
Typical Pneumonia- Etiology
-streptococcus pneumonia
-legionella pneumophilia
Atypical Pneumonia- Etiology
Mycoplasma pneumoniae
Typical Pneumonia- Clinical Manifestations
-temp > 100.4 F.
-rales, rhonchi, wheezes
-elevated WBC
-cough often with purulent sputum
-dyspnea
-muscle aches
-abdominal pain
Atypical Pneumonia- Clinical Manifestations
-less signs of infection than typical form
-hacking cough
-fever
-fatigue
-lack of purulent sputum
What are risk factors for Tuberculosis?
-malnutrition
-immunosuppression
-advanced age
-poor sanitation
-crowded living conditions
PPD Skin Tests
-test for TB
-positive test
-does NOT differentiate between active and past infection
What does. false negative for a PPD Skin Test indicate?
too immunocompromised
TB Pathophysiology
-begins with inhalation of tubercle bacillus
-infection spreads vis lymph and blood
-infection walled off
-can be dormant for years
-becomes active when immunocompromised
TB Clinical Manifestations
-low grade fever
-cough
-frothy/ bloody sputum
-night sweats
-anorexia
-weight loss due to metabolic demands of infection
Cystic Fibrosis (CF)
-autosome recessive disorder of Chromosome 7
-carrier gene identified
-75% diagnosed by age 1
What are chloride transport defects in epithelial tissue? (CF)
-airways: mucus plugs
-pancreas: nutrient malabsorption
-sweat ducts: salty skin crystals
-vas deferens: male infertility
Cystic Fibrosis- Pathophysiology
-development of bull in lung tissue
-pneumothorax
-hemoptysis
-pulmonary hypertension
-progressive and irreversible lung deterioration
Cystic Fibrosis- Clinical Manifestations
-frequent respiratory infections
-persistent coughing
-audible wheezing
-dyspnea
-thick sputum
What is Hypoxemia?
-below normal oxygen in blood
Hypoxemia- Etiology
-ventilation disorders
-hypoventilation
-impaired gas exchange
-inadequate circulation
-dysfunction of nervous system
Hypoxemia- Manifestations
-cyanosis
-bluish discoloration of skin and mucous membrane
-dark skin- inspect oral mucosa
Indications for arterial blood gases`
-clients with serious/ critical illness or injury
-acid base status
-adequacy of ventilation
-adequacy of oxygenation
Acid- Base Normal Values
-pH: 7.35-7.45
-paCO2: 35-45 mm Hg
-HCO3-: 22-26 mEq/L
-paCO2: 80-100 mm Hg
What are the steps of an arterial blood gas assessment>
1- check pH
- check paCO2
- check HCO3
What are basic results of arterial blood gas assessments?
-respiratory acidosis
-respiratory alkalosis
-metabolic acidosis
-metabolic alkalosis
Respiratory vs Metabolic Disorder
-if paCO2 is abnormal, problem is respiratory
-if HCO3 is abnormal, problem is metabolic
What are some respiratory acidosis causes?
-hypoventilation
-sedation
-anesthesia
-respiratory arrest
-paralysis of respiratory muscle
-airways obstruction
What are some respiratory alkalosis causes?
-hyperventilation
-hypoxemia
-anemia
-fever
-psychological dyspnea
-anger
