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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
Chronic Cor Pulmonale
hypertrophy and dilation of the R ventricle d/t disease of the pulmonary parenchyma and/or vascular system (emphysema, and chronic bronchitis)
26
Manifestations of Cor Pulmonale
``` Both peripheral and pulmonary symptoms cough with or w/o sputum JVD Rhonchi and Wheezing Hepatomegaly and a cities Cyanosis ```
27
Cause of Cor Pulmonale
``` 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
Tx of Pulmonary HTN and Cor Pulmonale
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
What do you AVOID when tx pulmonary htn and cor pulmonale
sedatives and respiratory depressants
30
For a person with a pulmonary embolism what would the V/Q scan indicate
the number would go up because ventilation is okay but perfusion is not good
31
Pleural effusion
fluid in the pleural space >15mL
32
Trasudate
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
Exudate
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
Thorocentesis
drawing of fluid out of the lungs - want to draw lower since air is at the base and fluid is at the apex
35
Manifestations of pleural effusion
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
Dx of Pleural Effusion
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
Tx of Pleural Effusion
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
Transudative pleural effusions may be caused by
Hypoalbuminemia
39
Pneumothorax
rapid accumulation of intrapleural air in chest = collapse of lung
40
The pressure in the pleural space is always
Negative (exp -4mmHg; insp -10mmHg)
41
What is pneumothorax caused by
any opening into the pleural space through the visceral pleura, chest wall or mediastinum
42
What are some types of pneumothorax?
``` spontaneous pneumothorax closed pneumothorax tension pneumothorax open pneumothorax hydropneumothorax (accompanied by transudate) hemopneumothorax (accompanied by blood) ```
43
Spontaneous pneumothorax
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
S/Sx of Pneumothorax
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
Closed Pneumothorax
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
Tension Pneumothorax
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
Cardiac tamponade
parietal pleura is continuous with pericardium and increased pressure occurs around the heart to the point where it can't pump **tension pneumothorax
48
Open pneumothorax
open penetrating chest injuries or when the opening in visceral pleura is very large and remains open despite complete collapse of the lung
49
How does an open pneumothorax with with an open chest wound
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
PARADOXICAL BREATHING is related to what type of pneumothorax and can also be called what
open pneumothorax | FLAIL chest
51
Hydropneumothorax
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
Hemopneumothorax
Blood and air enter into the pleural space Most commonly seen with chest trauma or surged where blood vessels are cut
53
Thoracotomy tubes
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
What are the 3 chambers of the collection system for a chest tube
suction control chamber water seal chamber collection chamber
55
What does the collection chamber do
collects any fluid coming back from the patient and prevents air/fluid from returning to the lungs
56
Water Seal
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
Tidaling
up and down movement on inspiration and expiration should occur until lung fully expanded = eventually results in no movement
58
Suction control
determines amount of suction given to pt (the more H2O it receives = the more suction it will give)
59
Care of patient with a chest tube
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
What are things you want to encourage for patients with chest tubes
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
When caring for a patient with a chest tube should you clamp the tube at any time?
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
When caring for a patient with a chest tube what are some things you need to remember about suctioning
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
Removal of a Chest tube
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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