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Patho Exam 3 > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

Bronchiectasis

A

abnormal permanent dilation of the large bronchi; associated with infection and destruction of the bronchial walls

Infection damages the cilia and inflammation occurs along with pooling of secretions = more infections

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2
Q

What causes bronchiectasis

A

s/t some type of other condition
ex. TB, fungal infections, tumor, lung abscess or
Cystic Fibrosis
Congenital abnormalities

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3
Q

How does bronchiectasis progress/develop

A

Obstruction of the bronchial airways
Atelectasis (alveoli close off = no gas exchange)
Smooth muscle relaxes and dilation of the airways
Airway remains patent resulting in
Infection, Inflammation and Impaired mucociliary function = Pooling of secretions, chronic inflammation, and the development of new infections

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4
Q

Manifestations of Bronchiectasis

A

Fever and recurrent bronchopulmonary infection
Production of copious amounts of foul smelling purulent sputum
Hemoptysis (blood in airways/lungs)
Weight Loss and anemia
Dyspnea and Cyanosis (typically in the chronic end condition)

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5
Q

Cystic Fibrosis (mucoviscidosis)

A

autosomal recessive genetic defect on chromosome #7 that affects the EXOCRINE glands and cells.

It produces large amounts of thick mucous and increased concentration of Na and Cl in sweat

Lots of thick secretions collect and inspissate (dry thick and harden) in ducts

Typically survive for 40 years

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6
Q

What are some effects of CF

A

Blocks alveolar ventilation
absorption atelectasis (no gas exchange)
edema of the capillary alveolar interfaces
Bronchial scarring and fibrosis destroys bronchial airways
Overinflated barrel chest
Increased risk of pneumonia and chronic bronchitis = and can result in bronchiectasis over time
Clubbing of fingers

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7
Q

What is the main way CF works

A

fluid builds up in the interstitial space causing edema and and increased distance which O2 and CO2 have to diffuse across

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8
Q

How does CF effect the pancreas?

A

mucus clogs the pancreatic ducts and the digestive enzymes don’t reach the small intestines and as a result they auto digest the pancreas itself

over time the decreased insulin secretion can result in Type I diabetes

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9
Q

How does CF effect the liver

A

over years it obstructs the small bile ducts - biliary cirrhosis, portal HTN and Liver failure

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10
Q

How does CF effect the intestines?

A

Blocks digestion and absorption = malabsorption of fats, CHO, and proteins (can’t take nutrients because no digestive enzymes to help them do this

typically have a poor nutritional status and could result in failure to thrive in infants

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11
Q

Manifestations of CF

A

Resp - Wheezing Chronic Cough, Barrel Chest
Developmental - Delayed weight gain and bone grown
GI - Inspissated (dry and thick and harden in ducts) meconium in fetal gut (baby can’t shit), Meconium ileum - blocked GI tract) and Frequent bulky foul smelling pale stool with high fat contents (steatorrhea), Vit K deficiencies, Voracious appetite (eat and eat, but don’t take in nutrients)

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12
Q

How do you diagnoses CF?

A 
Sweat test (1mo-20yr) since you have increased Cl in sweat
Genetic screening- Amniocentesis and Recombinant DNA (since it tends to be genetic in caucasions)
Chest Xray - hyperinflation, fibrotic changes, and consolidation
Stool - measure smelly stools - trypsin (fecal fat is 15-30grams when normal is 4g)
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13
Q

CF nursing care

A

24 hr a day job - you want to prevent and t respiratory failure and pulmonary complications early!!!
Inhale Aerosol with normal saline to prevent bronchodilation (Dnase)

Need to get an annual flu vaccine
Chest physiotherapy/drainage
O2 therapy
Pancreatic enzymes (capsule) to be taken with food so they can digest and get nutritional needs

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14
Q

The major cause of death and disability from cystic fibrosis is

A

recurrent pulmonary infections

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15
Q

What is unique about the pulmonary arteries

A

they carry deoxygenated blood from the heart to the lungs

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16
Q

What is unique about the pulmonary veins

A

they carry oxygenated blood from the lungs to the heart

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17
Q

Pulmonary HTN

A

increased pressure in the pulmonary circulation (**the pulmonary system is naturally a low pressure system in order for in to easily receive blood)

> 30 mmHg SYS and >12mmHg DIAS
(normal is 28 mmHg sys and 8 mmHg Dias)

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18
Q

What are the 2 types of pulmonary HTN

A

Primary and Secondary

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19
Q

Primary pulmonary HTN

A

unknown cause 7% familial, autosomal DOMINANT with variable expression

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20
Q

Secondary Pulmonary HTN

A

d/t alveolar HYPOventilation, COPD, CF, chronic bronchitis, emphysemsa etc.

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21
Q

S/Sx of pulmonary HTN

A

LOOKS LIKE HEART FAILURE
murmurs (s3 and s4)
dyspnea, JVD, chest pain, palpitations, dizziness, syncope, cough

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22
Q

Dx of pulmonary HTN

A

there are lots of tests, but not 1 magically diagnoses it. Need to do a few
Ex. EKG, V/Q scan (perfusion no good), Cardiac cath

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23
Q

Cor Pulmonale

A

Right sided heart failure d/t pulmonary problems in the lungs
Acute and Chronic types

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24
Q

Acute Cor Pulmonale

A

acute dilation of the R ventricle s/t pulmonary HTN (usually d/t pulmonary embolism)

** someone who gets a blood clot in the lung and everything backs up to the Right ventricle = stretches and dilates = acute cor pulmonale

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25
Q

Chronic Cor Pulmonale

A

hypertrophy and dilation of the R ventricle d/t disease of the pulmonary parenchyma and/or vascular system (emphysema, and chronic bronchitis)

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26
Q

Manifestations of Cor Pulmonale

A 
Both peripheral and pulmonary symptoms 
cough with or w/o sputum
JVD
Rhonchi and Wheezing
Hepatomegaly and a cities
Cyanosis
27
Q

Cause of Cor Pulmonale

A 
Bronchiectasis 
Cystic Fibrosis
Tumors
COPD, pulmonary fibrosis, or Granulomatous diseases (Rheumatoid arthritis)
Primary pulmonary HTN
IV drug abuse
Chronic hypoxia at high altitudes

***KNOW that kyphoscoliosis affects the thoracic cage and cause also cause this

28
Q

Tx of Pulmonary HTN and Cor Pulmonale

A

Since they have low flow O2 you want to give O2 >60mmHg on arterial end
Bronchodilators
Diuretics - to remove fluid, but need to monitor electrolytes

29
Q

What do you AVOID when tx pulmonary htn and cor pulmonale

A

sedatives and respiratory depressants

30
Q

For a person with a pulmonary embolism what would the V/Q scan indicate

A

the number would go up because ventilation is okay but perfusion is not good

31
Q

Pleural effusion

A

fluid in the pleural space >15mL

32
Q

Trasudate

A

clear watery fluid with LOW proteins
usually cased by increased pulmonary venous pressure from HF with buildup of back pressure
**alveoli and pleura become filled with fluid “squished” out of capillaries from increased pressure
Low albumin d/t loss of osmotic pressure (hypo albumin)

33
Q

Exudate

A

fluid HIGH in protein and cellular content d/t inflammatory response (ex pneumonia, Tb, gunshot wound)
LOCAL INFECTION OR A TUMOR

Cell content = WBCs or cancer cells or dead cells or both
Air at the apex
Fluid at the base
empyema (pus) in lungs

34
Q

Thorocentesis

A

drawing of fluid out of the lungs - want to draw lower since air is at the base and fluid is at the apex

35
Q

Manifestations of pleural effusion

A

ALWAYS caused by an underlying disease
PAIN - most common s/sx - sharp stabbing intensified by respiration; pleura friction rub (esp exudative)
DYSPNEA - Effusion compresses normal lung
Hemoptysis - coughing up blood d/t underlying cause
Decreased Breath sounds (reduced/absent bronchial)
Mediastinal shift - trachea and mediastinum shifted away from side of effusion (seen on chest X-ray)

36
Q

Dx of Pleural Effusion

A

Throacentesis - fluid w/drawn and examined for protein, blood, and malignant cells
Cone Biopsy - extract small portion of pleural tissue if Tb or tumor suspected

37
Q

Tx of Pleural Effusion

A

TREAT THE UNDERLYING PROBLEM
Chest tube - continuous drainage esp with empyema (pus in lungs)
Decortication/peeling of pleural layers/irritate them to make them fuse when healed so no fluid can get in (does decrease lung function though)
Pleurodesis - pulmonary vessel sclerosis

38
Q

Transudative pleural effusions may be caused by

A

Hypoalbuminemia

39
Q

Pneumothorax

A

rapid accumulation of intrapleural air in chest = collapse of lung

40
Q

The pressure in the pleural space is always

A

Negative (exp -4mmHg; insp -10mmHg)

41
Q

What is pneumothorax caused by

A

any opening into the pleural space through the visceral pleura, chest wall or mediastinum

42
Q

What are some types of pneumothorax?

A 
spontaneous pneumothorax
closed pneumothorax
tension pneumothorax
open pneumothorax
hydropneumothorax (accompanied by transudate)
hemopneumothorax (accompanied by blood)
43
Q

Spontaneous pneumothorax

A

air gains access to pleural cavity through defect in bronchus/alveloi (such as a rupture or blebs) s/t emphysema
Primary and Congenital may occur in otherwise healthy young adults 20-40yrs old

44
Q

S/Sx of Pneumothorax

A

Primary symptom = CHEST PAIN OR SHOULDER PAIN thats worse with inspiration or cough
DYSPNEA from pain and lung collapse
Decreased respiratory excursions/asymmetry
Decreased breath and voice sounds
**won’t hear air moving in that spot)

45
Q

Closed Pneumothorax

A

caused by air leaking into the pleural space from an opening within the lung (ex. perforation of the peripheral pleura while the visceral remains intact)

Interferes the least with reparations because the opposite lung is unaffected

**Body will eventually reabsorb extra air problem if there is NOT TOO MUCH!

46
Q

Tension Pneumothorax

A

valve like opening in versceral pleura permits the entry of air during inspiration but closes during exportation

air accumulates under excessive positive pressure and completely collapses the lung = compresses mediastium = the lung, aorta, vena caves, heart and trachea deviate away from the side with the pneumothorax (away from the pressure)

MUST BE DEALT WITH IMMEDIATELY OR CAN RESULT IN DEATH WITHIN MINUTES

47
Q

Cardiac tamponade

A

parietal pleura is continuous with pericardium and increased pressure occurs around the heart to the point where it can’t pump

**tension pneumothorax

48
Q

Open pneumothorax

A

open penetrating chest injuries or when the opening in visceral pleura is very large and remains open despite complete collapse of the lung

49
Q

How does an open pneumothorax with with an open chest wound

A

affected lung DOES NOT EXPAND on inspiration bc no neg pressure an be created around it
Positive pressure develops in trachea on EXPIRATION an affected lung Expands to some degree
Air in trachea is rebreathed by unaffected lung on next inspiration
PARADOXICAL BREATHING - rising of chest wall on expiration and fall on inspiration on affected side

50
Q

PARADOXICAL BREATHING is related to what type of pneumothorax and can also be called what

A

open pneumothorax

FLAIL chest

51
Q

Hydropneumothorax

A

TRANSUDATE FLUID at bottom
air moves to the top of the lung intrapleurally and fluid steals at the base

can be caused by a misplaced IV catheter in subclavian vein = ALWAYS check placement before infusing fluid

52
Q

Hemopneumothorax

A

Blood and air enter into the pleural space

Most commonly seen with chest trauma or surged where blood vessels are cut

53
Q

Thoracotomy tubes

A

removes air, fluid, or blood from intrapleural space and reexpands the lung
Typically used after chest surgery; it is inserted between the ribs through ICS (6-7th for fluid)
Holes in the ruble allow air/fluid to get out

**when air and fluid must be removed may use 2 chest tubes - 1 @ top for air and 2 @ bottom for fluid

54
Q

What are the 3 chambers of the collection system for a chest tube

A

suction control chamber
water seal chamber
collection chamber

55
Q

What does the collection chamber do

A

collects any fluid coming back from the patient and prevents air/fluid from returning to the lungs

56
Q

Water Seal

A

allows air into the chamber, but not back to the lungs

Obvious BUBBLING IN THE WATER SEAL occurs when the pt is known to have an air leak from bronchopleural fistula or if tube is disconnected btwn pt and water seal allows for entrance of atmospheric air
**if air is bubbling through, the brochopleural fistula has no closed

57
Q

Tidaling

A

up and down movement on inspiration and expiration should occur until lung fully expanded = eventually results in no movement

58
Q

Suction control

A

determines amount of suction given to pt (the more H2O it receives = the more suction it will give)

59
Q

Care of patient with a chest tube

A

Pleurevac/Thoraklex ***MUST BE BELOW THE LEVEL OF THE CHEST TUBE AT ALL TIMES
Pt in semi fowlers or turned toward side of the tube
DO NOT MILK TUBING
DRESSING DOES NOT GET CHANGED - if soiled/saturated put more gauze on and notify the MD

**we don’t change it because we don’t want it to open - if it opens air can get in and it defeats the whole purpose

60
Q

What are things you want to encourage for patients with chest tubes

A

MOBILITY

Encourage ROM on affected side (so pneumonia doesn’t occur)
Deep breath and coughing ESSENTIAL for re-expansion of the lungs and preventing atelectasis
Deep inspiration - expands lung and pushes air and fluid into the tube
**Deep breathing hurts = split it put pillow over area and allow them to cough

61
Q

When caring for a patient with a chest tube should you clamp the tube at any time?

A

NEVER clamp unless changing a full collection device or system has been opened by damage

If patient has an air leak - clamping will result in tension pneumothorax

62
Q

When caring for a patient with a chest tube what are some things you need to remember about suctioning

A

Gentle continuous bubbling in suction chamber is all that is necessary
Use the device to regulate pressure (wall unit can be set to anything)
Check fluid levels in suction chamber (if decreased add more ASEPTICALLY)
Check and record the amount of drainage frequently - look blood
VS
Fluid drainage should stop in 3-4 days
The amount will be ordered by a physician (usu. 20 cm H2O)

63
Q

Removal of a Chest tube

A

CXR FIRST
always done by a MD PA or NP
ALWAYS give pain medication prior to removal
Suture clipped - pt takes deep breath and bears down
REGULAR gauze and tape to prevent reentry of air

Patho Exam 3 (4 decks)

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