Respiratory System and Disorders- Notes from Slideshow (quiz 3) PART 1 Flashcards
Decreased levels of oxygen in the tissues
Hypoxia
Decreased levels of oxygen in the arterial blood
Hypoxemia
Increased levels of CO2 in the blood
Hypercapnia
Decreased levels of CO2 in the blood
Hypocapnia
Difficulty breathing
Dyspnea
Rapid rate of breathing
Tachypnea
Bluish discoloration of skin and mucous membranes due to poor oxygenation of the blood
Cyanosis
Blood in the sputum
Hemoptysis
The incomplete expansion of the lungs
Atelectasis
characteristic of atelectasis
Collapsed alveoli
Etiology of Atelectasis
- Lack of mobility
- Pneumonia
- Radiation disease
- Granulomatous disease (such as lupus)
irreversible condition causing atelectasis
Pulmonary Fibrosis
Reversible condition causing atelectasis
Pneumonia
Another word for Pulmonary ventilation
Breathing
The process of air flowing into the lungs during inspiration & out during expiration.
Pulmonary ventilation
Why does air flow?
Due to pressure differences b/w the atmosphere & the gases inside the lungs
SEE PICTURE FOR BASIC ANATOMY OF THE RESPIRTORY SYSTEM
ON SLIDE ONE
Is transportations of gases an efficient process?
Yes, very.
What carries O2?
Hemoglobin
Why is Hgb the carrier of O2?
it has great affinity for O2
How many molecules of O2 bind to each Hgb?
4
What happens to O2 that is picked up by Hgb?
It is transported by the blood to various tissues
In what form are CO2 molecules transported?
Dissolved form-in our blood
Why is CO2 transported in the dissolved form and O2 transported in Hgb?
CO2 is more soluble in water than O2
Is all CO2 formed expelled from the body?
No
Why is some CO2 not expelled and instead retained?
It reacts with water to form compounds useful for life processes
This is used when the human body knows when to increase the supply of O2 & when to reduce it
adaptation
Regulatory system that tells the body when to increase the supply of O2 & when to reduce it
medulla
What is the respiratory system very sensitive to?
the concentration of CO2 in the arterial blood
What symptoms occur when there is a decrease or increase in CO2 in the arterial blood?
-acceleration or slowing down of respiration activity –change in rate & depth of breathing.
Where does gas exchange occur?
At the alveolar capillary membrane
- Blood low in O2 and high in CO2 is in artery before alveolar
- Gases dissolve in moist lining
- CO2 diffuses from blood into alveolar to be exhaled
- Oxygen diffuses into blood
- Oxygen is transported around body by RBCs
- Blood low in CO2 and high in O2 leaves the alveolar
Steps of Gas Exchange at the alveolar capillary membrane
Steps of Gas Exchange at the alveolar capillary membrane
- Blood low in O2 and high in CO2 is in artery before alveolar
- Gases dissolve in moist lining
- CO2 diffuses from blood into alveolar to be exhaled
- Oxygen diffuses into blood
- Oxygen is transported around body by RBCs
- Blood low in CO2 and high in O2 leaves the alveolar
What occurs in the respiratory system in some C Spine injuries?
Medulla and respiratory center of brain can be affected and they may not be able to breath
Why might you find yourself unintentionally breathing faster or slower?
The body is trying to achieve equilibrium because it is always working towards homeostasis
What is an example of a disorder that causes the exchange of gases to be impaired?
ARDS
Why does ARDS causes the exchange of gases to be impaired?
Fluid in the alveolar blocks the exchange of gases
The build-up of excess fluid between the layers of the pleura outside the lungs
Pleural effusion (PE)
Where can fluid in PE be visualized on a scan?
at the bottom of one of the lungs (looks like a fluid sac)
Most common Etiologies of PE
- Malignancy
- HF
Etiology of Pleural Effusion
- Heart failure
- Kidney failure
- Pulmonary embolism
- Hypoalbuminemia
- Infection
- Malignancy
- Heart failure
- Kidney failure
- Infection
- Malignancy
- Pulmonary embolism
- Hypoalbuminemia
Etiology of Pleural Effusion
What would a pt with Hypoalbuminemia present with?
- critically ill
- sick
- nutritional status compromised
- at risk for PE
Common Symptoms of PE
- Chest pain
- Difficulty breathing
- Painful breathing (pleurisy)
- Cough (dry or productive)
- Deep breathing typically increases pain.
- Fever, chills, & loss of appetite
- Chest pain
- Difficulty breathing
- Painful breathing (pleurisy)
- Cough (dry or productive)
- Deep breathing typically increases pain.
- Fever, chills, & loss of appetite
Common Symptoms of PE
Why do Fever, chills, & loss of appetite often accompany pleural effusions?
Because the PE is caused by infectious agents
Differential Diagnoses
When a practitioner differentiates between two or more conditions that could be behind a person’s symptoms
Differential Diagnoses vs Diagnosis. What’s the difference?
Differential Diagnoses- more than one possible diagnosis
Diagnosis- one single theory
When diagnosing a pt it is important to
Consider all possible etiologies
Example of Differential Diagnoses: You have a client that has a chest x-ray. It shows the pleural effusion. What must a practitioner consider?
That pleural effusion has many etiologies and all possibilities must be considered or ruled out
Example of Differential Diagnoses: A pt has a cough. What must a practitioner consider?
That a cough can be caused by many things such as a common cold or lung cancer.
What type of fluid builds up in PE?
- Can be clear
- Could be an exudate
- Can be all different substances
In what case would exudate build up in PE?
In case of infective process
In what case would all different substances build up in PE?
In case of malignancy
Main Symptoms of Infectious Pneumonia: Systemic
- high fever
- chills
- high fever
- chills
Main Symptoms of Infectious Pneumonia: Systemic
Main Symptoms of Infectious Pneumonia: Central NS
- Headaches
- Loss of appetite
- mood swings
- Headaches
- Loss of appetite
- mood swings
Main Symptoms of Infectious Pneumonia: Central NS
Main Symptoms of Infectious Pneumonia: Skin
- clamminess
- blueness
- clamminess
- blueness
Main Symptoms of Infectious Pneumonia: Skin
Main Symptoms of Infectious Pneumonia: Vascular
-low BP
-low BP
Main Symptoms of Infectious Pneumonia: Vascular
Main Symptoms of Infectious Pneumonia: Lungs
- cough with sputum or phlegm
- SOB
- pleuritic chest pain
- hemoptysis
- cough with sputum or phlegm
- SOB
- pleuritic chest pain
- hemoptysis
Main Symptoms of Infectious Pneumonia: Lungs
Main Symptom of Infectious Pneumonia: Heart
- High HR
- High HR
Main Symptoms of Infectious Pneumonia: Heart
Main Symptoms of Infectious Pneumonia: Gastric
- N and V
- N and V
Main Symptoms of Infectious Pneumonia: Gastric
Main Symptoms of Infectious Pneumonia: Muscular
- fatigue
- aches
- fatigue
- aches
Main Symptoms of Infectious Pneumonia: Muscular
Main Symptoms of Infectious Pneumonia: Joints
-pain
-pain
Main Symptoms of Infectious Pneumonia: Joints
What is occurring at the alveolar capillary level in pneumonia?
- inflamed, thickened alveolar wall
- alveolus filled with fluid
How do the changes on the alveolar capillary level affect the body in pneumonia?
Gases are unable to perfuse through fluid and inflammation
What happens to someone who gets pneumonia who also has underlying respiratory disease?
Makes things more complicated for them than someone who doesn’t have underlying disease
What lab value indicatshypoxemia?
low PaO2
What level of PaO2 is normal?
80-100 mmHg
What test is conducted to find out PaO2?
blood gas
Most Common Pneumonias: Viral
- Influenza A & B
- RSV
Most Common Pneumonias: Bacterial
- Strep
- Mycoplasma
- Staph
- Klebsiella
- Chlamydia
Which category of pathogens is are the most common bacterial pneumonias?
community acquired
Which common bacterial pneumonia is atypical?
Chlamydia
Which common bacterial pneumonia is typical?
- Strep
- Staph
- H. Flu
Who gets RSV?
infants and children
Where is viral pneumonia visualized on a scan?
mid lung, midline, attached to inside walls
Where is bacterial pneumonia visualized on a scan?
mid lung streaching across from inside wall to outside wall
How are bacterial and viral pneumonia treated
they have different treatments
Types of pneumonias
- Aspiration
- Community-Acquired Acute
- Community-Acquired Atypical
- Chronic
- Nosocomial
- Necrotizing & lung abscess
- In immunocompromised
- Community-Acquired Acute
- Community-Acquired Atypical
- Nosocomial
- Aspiration
- Chronic
- Necrotizing & lung abscess
- In immunocompromised
Types of pneumonias
Pathogens Causing Pneumonias (OVERALL): Community-Acquired Acute
MOST IMPORTANT TO KNOW
- Step
- H. flu
- Staph aureus
- Klebsiella
- MOST IMPORTANT TO KNOW*
- Step
- H. flu
- Staph aureus
- Klebsiella
MOST IMPORTANT TO KNOW
Pathogens Causing Pneumonias: Community-Acquired Acute
MOST IMPORTANT TO KNOW
Pathogens Causing Pneumonias: Community-Acquired Atypical
- Mycoplasma
- Chlamydia
- SARS
- Mycoplasma
- Chlamydia
- SARS
Pathogens Causing Pneumonias: Community-Acquired Atypical
Pathogens Causing Pneumonias: Nosocomial
- Klebsiella spp
- Serratia
- E. Coli
- Klebsiella spp
- Serratia
- E. Coli
Pathogens Causing Pneumonias: Nosocomial
Pathogens Causing Pneumonias: Aspiration
-Anaerobic oral flora (Bacteroides)
-Anaerobic oral flora (Bacteroides)
Pathogens Causing Pneumonias: Aspiration
Pathogens Causing Pneumonias: Chronic
- Nocardia
- Actinomyces
- TB
- Atypical mycobacteria
- Fungal
- Nocardia
- Actinomyces
- TB
- Atypical mycobacteria
- Fungal
Pathogens Causing Pneumonias: Chronic
Pathogens Causing Pneumonias: Necrotizing & lung abscess
- Anaerobic bacteria (foreign body, tumor)
- Anaerobic bacteria (foreign body, tumor)
Pathogens Causing Pneumonias: Necrotizing & lung abscess
Pathogens Causing Pneumonias: In immunocompromised
- CMV
- Pnumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
- CMV
- Pnumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
Pathogens Causing Pneumonias: In immunocompromised
Most common pathogen (s) causing pneumonia (OVERALL): Community-Acquired Acute
MOST IMPORTANT TO KNOW
- Step
- H. flu
- Staph aureus
MOST IMPORTANT TO KNOW
Most common pathogen(s) causing pneumonia (OVERALL): Community-Acquired Atypical
None
Most common pathogen(s) causing pneumonia(OVERALL): Nosocomial
E. Coli
Most common pathogen(s) causing pneumonia: Aspiration
Anaerobic oral flora (Bacteroides)
Most common pathogen(s) causing pneumonia (OVERALL) : Chronic
- Actinomyces
- Atypical mycobacteria
- TB
- Fungal
Most common pathogen(s) causing pneumonia(OVERALL): Necrotizing & lung abscess
None
Most common pathogen(s) causing pneumonia(OVERALL): In immunocompromised
- CMV
- Pneumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
What are all the most common pathogens causing pneumonias?
- Strep
- Staph aureus
- H. flu
- E. Coli
- Anaerobic oral flora (Bacteroides)
- Actinomyces
- Atypical mycobacteria
- TB
- Fungal
- CMV
- Pneumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
- Strep
- H. flu
- Staph aureus
- E. Coli
- Anaerobic oral flora (Bacteroides)
- Actinomyces
- TB
- Atypical mycobacteria
- Fungal
- CMV
- Pneumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
What are all the most common pathogens causing pneumonias?
What does nosocomial mean?
Pt that acquires pneumonia after being in a hospital or facility for 24 hrs
What are the two types of TB?
- Latent TB
- TB Disease
Latent TB vs TB Disease: Is it live?
- Latent TB: yes
- TB Disease: yes
Latent TB vs TB Disease: Does it grow?
- Latent TB: No
- TB Disease: Active and growing in body
Latent TB vs TB Disease: Does it make a person sick and have symptoms?
- Latent TB: No
- TB Disease: Yes
Latent TB vs TB Disease: Can it spread from person to person?
- Latent TB: No
- TB Disease: Yes
Latent TB vs TB Disease: Can it worsen?
- Latent TB: Yes
- TB Disease: Yes if left untreated
Latent TB vs TB Disease: What happens if it worsens?
- Latent TB: Can progress to TB disease
- TB Disease: Can cause death left untreated
Types of TB
- Primary Pulmonary
- (Established) Pulmonary
- Extrapulmonary
- Return of Dormant
- Military
- Pleuritis
All possible NON SPECIFIC symptoms of TB
- poor appetite
- night sweats
- weakness
- fever
- dry cough
- weight loss
- GI symptoms
Symptoms of TB: (Established) Pulmonary
- productive cough
- weakness
- fever
- weight loss
- productive cough
- weakness
- fever
- weight loss
Symptoms of TB: (Established) Pulmonary
Symptoms of TB: Primary Pulmonary
- structural abnormalities
- night sweats
- poor appetite
- weakness
- fever
- dry cough
- weight loss
- GI symptoms
- structural abnormalities
- night sweats
- poor appetite
- weakness
- fever
- weight loss
- dry cough
- GI symptoms
Symptoms of TB: Primary Pulmonary
Symptoms of TB: Military
- poor appetite
- weakness
- fever
- weight loss
- poor appetite
- weakness
- fever
- weight loss
Symptoms of TB: Military
Symptoms of TB: Return of Dormant
- cough with increasing mucous
- coughing up blood
- night sweats
- poor appetite
- fever
- weight loss
- cough with increasing mucous
- coughing up blood
- night sweats
- poor appetite
- fever
- weight loss
Symptoms of TB: Return of Dormant
Symptoms of TB: Pleuritis
- chest pain
- fever
- dry cough
- chest pain
- fever
- dry cough
Symptoms of TB: Pleuritis
Symptoms of TB: Extrapulmonary
- Common sites: meninges, lymph nodes, bone and joints, genitourinary tract
- GI symptoms
- Common sites: meninges, lymph nodes, bone and joints, genitourinary tract
- GI symptoms
Symptoms of TB: Extrapulmonary
Symptoms specific to this type of TB: (Established) Pulmonary
- productive cough
Symptoms specific to this type of TB: Primary Pulmonary
- structural abnormalities
Symptoms specific to this type of TB: Military
-none
Symptoms specific to this type of TB: Return of Dormant
- cough with increasing mucous
- coughing up blood
Symptoms specific to this type of TB: Pleuritis
-chest pain
Symptoms specific to this type of TB: Extrapulmonary
-Common sites: meninges, lymph nodes, bone and joints, genitourinary tract
Is TB eradicated in the US?
It was then there was a resurgence
Why was there a resurgence of TB in the US?
Because these organisms change/evolve to become resistant to our medications
If you find out you have a pt with newly diagnosed TB what should you do?
Report it to the state. TB is reportable.
What happens if a pt is refusing their TB medications?
They will be incarcerated in some sort of facility while they are infected (according to our public health guideline)
What happens to homeless people who get TB and are non-compliant with medications?
They must show up daily to a clinic or a medical professional will go out to the street to find them and give them their medications
Daily productive cough for three months or more, in at least two consecutive years
Chronic Bronchitis
Permanent enlargement and destruction of airspaces distal to the terminal bronchiole
Emphysema
Bronchitis vs Emphysema: weight
Bronchitis: heavy
Emphysema: thin
Bronchitis vs Emphysema:
coloring
Bronchitis: cyanotic
Emphysema: -
Bronchitis vs Emphysema:
Hgb
Bronchitis: elevated
Emphysema: -
Bronchitis vs Emphysema:
physical body changes too look for
Bronchitis: peripheral edema
Emphysema: barrel chest
Bronchitis vs Emphysema:
chest sounds
Bronchitis: Ronchi
Emphysema: quiet
Bronchitis vs Emphysema:
age
Bronchitis: -
Emphysema: old
Bronchitis vs Emphysema:
breathing
Bronchitis: wheezing
Emphysema: severe dyspnea
What does emphysema look like on an x-ray?
hyperinflation with flattened diaphragms
What causes barrel chest?
Air trapping
Bronchitis vs Emphysema: lung characteristics
Bronchitis: inflammation, excess mucus, muscle constriction
Emphysema: alveolar membrane degraded
What is the number one cause of COPD?
Smoking
Imagine someone who has emphysema is having an acute exacerbation of COPD in the ER. O2 level is extremely low and they are not doing well, so we are going to put them on bypass.
Do we want to bring their 02 level up to the same level as someone who does not have COPD? Why?
- No
- the medulla will think they don’t need to breathe as much because it is used to living at a low level of 02 to begin with
- Used to living with CO2 retention
Normal O2 for regular person and normal 02 for COPD
Normal: 93-94+
COPD: 88-92
What class of medication is given for COPD?
antiinflammatories
What type of antinflammatories are given for COPD
Steroids
What happens to a pts blood sugar when we give them steroids?
Increases blood sugar
What would an APRN order for a pt on steroids for COPD?
Order finger stick BS
Why is high BS bad for COPD?
High blood sugar increases risk of infection
What should treatment of Asthma focus on?
Decrease/Eliminate Cause Factors
Asthma: Mild/Moderate vs Severe vs Life Threatening: SpO2
Mild/Moderate: >92%
Severe: <92%
Life Threatening: <92%
Asthma: Mild/Moderate vs Severe vs Life Threatening: RR/HR
Mild/Moderate: <30 (over 5s) <40 (over 5s) Severe: >30 (over 5s) >40 (under 5s) Increased HR Life Threatening: -
Asthma: Mild/Moderate vs Severe vs Life Threatening:
PEFR
Mild/Moderate: -
Severe: 33-50% predicted
Life Threatening:
Asthma: Mild/Moderate vs Severe vs Life Threatening:
Chest sounds
Mild/Moderate: Wheeze (may only be audible with stethoscope
Severe: Audible wheeze
Life Threatening: Silent chest
Asthma: Mild/Moderate vs Severe vs Life Threatening:
Accessory muscle use
Mild/Moderate: No/minimal use
Severe: Use of accessory muscles
Life Threatening: poor respiratory effort
Asthma: Mild/Moderate vs Severe vs Life Threatening:
feeding/talking
Mild/Moderate: feeding and talking well
Severe: too breathless to feed or talk
Life Threatening: Altered consciousness, agitation, confusion, exhaustion, cyanosis
What causes respiratory distress in asthma?
Swelling and thickening mucous will not allow air through
Do people die from asthma exacerbations often?
Yes
What should pts with asthma have a home?
Pulse ox reader
What is a BAD sign in an asthma exacerbation? why?
- No breath sounds or wheezing
2. No air can get through
Asthma Grading: Grade meaning
Grade 1: Intermittent/Mild
Grade 2: Chronic/persistent, mild
Grade 3: Chronic/persistent, moderate
Grade 4: Chronic/persistent, severe
Asthma Grading: Daytime Symptoms
Grade 1: 2 times per week or less
Grade 2: more than twice a week, but not daily
Grade 3: daily
Grade 4: continuous
Asthma Grading: Nighttime Symptoms
Grade 1: once a month or less
Grade 2: 2-4 times per month
Grade 3: more than once per week, but not nightly
Grade 4: frequent
Asthma Grading: Peak flow while exhaling
Grade 1: 80% or more of child’s predicted best
Grade 2: 80% or more of child’s predicted best
Grade 3: between 60-80% of child’s predicted best
Grade 4: less than 60% of child’s predicted best
What should we always teach our asthma pt?
- Understanding/knowing about their oxygenation
- Knowing when they need to see care
- BE AWARE OF TRIGGERS
What is one way of finding out triggers?
skin testing
What happens to the bronchial tube in an asthma attack?
- Tightened smooth muscle
- Swelling
- Mucus
A complication arising from DVT that results in a blood clot blocking the pulmonary branches
Pulmonary embolism (PE)
When part of your lung receives oxygen without blood flow or blood flow without oxygen
AV/Q mismatch
When does a VQ mismatch occur? Why?
- PE
2. Because no perfusion (no blood) = no ventilation
Most common cause of PE
DVT
Where do DVTs most like occur?
Legs
Where can a thrombus lodge?
Anywhere (brain, heart, vessel, lungs)
Where does a PE embolus lodge?
lungs
What happens if a person does not die within the first couple of hours of pulmonary embolism?
They have a much greater chance of survival
How are PE pts treated?
- Antithrombotic medications
2. Maybe stay overnight for observation then sent home
Term used for fluid in the alveoli
Pulmonary Edema
What occurs with Pulmonary Edema
VQ mismatch
Pulmonary Edema Etiology
- Increased Capillary Permeability
- Decreased plasma protein
- Lymphatic Obstructions
- Increased hydrostatic pressure
- Decreased interstitial pressure
- HEART FAILURE
How does HF cause pulmonary edema?
Heart isn’t pumping well and end up retaining fluid and going into pulmonary edema