Rsp - Midterm 1 Flashcards
What is Pneumococcal Pneumonia? What does it lead to? What does it release?
-Streptococcus pneumoniae (most common form)
o Has polysaccharide capsule that makes phagocytosis difficult
o Releases toxins that directly damages airway and alveoli
*It is a bacteria so we will treat them with an antibiotic, inflammatory response will lead to red hepatization of lung - bacteria is typically hospital acquired
Lung cancer Risk factors? It is also related to?
- Smoking
- Heavy smokers have a 20-fold greater chance of developing lung cancer than nonsmokers
- Smoking is also related to cancers of the larynx, oral cavity, pancreas, esophagus, and urinary bladder
- Other:
- Second-hand smoke
- Exposure to workplace toxins, radiation, pollution, tuberculosis
What kind of lung disease is Atelectasis?
It’s a restrictive lung disease
In Hypoxemia hypoventialtion happens because? What does it cause in pts who have COPD, are unconscious, or have neurological, muscular or bone diseases that restrict chest movement ?
1.) Hypoventilation happens b/c less O2 available in the alveoli for diffusion
o Can be corrected by ↑rate and ↑depth of breathing
o See above
2.) Hypoventilation causes hypoxemia in Pts who:
o Are unconscious
o Have neurological, muscular or bone diseases that restrict chest movement
o Have COPD
What is Acute Bronchitis? When does it develop? What causes it?
Acute bronchitis is a contagious viral infection that causes inflammation of the bronchial tubes, this narrows the airways.
Acute bronchitis often develops three to four days after a cold or the flu.
Causes - viral or breathing in something that irritates the lungs such as tobacco smoke, fumes, dust and air pollution, can come from a viral infection that weekens our immune system and makes us more susceptible to infections
*longer than 3 months for 2 consecutive years = chronic bronchitis
What is normal V/Q? Abnormal V/Q ratio is the most common cause of?
0.8
- Amount of air that enters alveoli = V (also FiO2)
- The amount of blood going through alveolar capillaries = Q
- Abnormal V/Q ratio is most common cause of hypoxemia
Disorders due to neoplasia can affect what area of the respiratory system?
- Can affect any part of the Respiratory System
- Nose, mouth, nasopharynx, oropharynx
- Larynx
- Lungs
- Focus – Lung Cancer
What is a Pneumothorax?
-Air leaks into the space between your lung and chest wall
- Presence of air or gas in pleural space by rupture in visceral pleura
- Breaches negative air pressure space and disrupts equilibrium
- Lung collapses inwards
- Can be a complete lung collapse or a collapse of only a portion of the lung
What is Chronic Bronchitis (blue bloaters)? What’s it caused by? What is important to keep in mind with chronic bronchitis?
- Hypersecretion of mucous and chronic productive cough for ≥ 3mon/year for 2yrs (consecutive)
(Prevention is important as pathological changes are not reversible)
Caused by:
o Exposure to cigarette smoke, air pollution, infections
* Bronchial Edema
- Increased risk of pulmonary infection
o Bacterial colonization of damaged airway - Increased number of mucous glands
o Hypersecretion of mucous
o Thick, tenacious
Aspiration of Gastric fluid leads to?
pneumonitis
What is passage of fluid and/or solid particles into the lungs called?
What kind of onset does it have?
Aspiration (relatively large amount of material from the stomach or mouth entering the lungs )
rapid onset – fluid breathed into the lungs or airways leading to the lungs, instead of being swallowed into the esophagus and stomach
What is a severe Pneumothorax?
Severe pneumothorax – tracheal deviation away from affected lung
What is classified as a small airway obstruction? What happens here? What do they manifest as?
o Small airway obstruction (asthma, COPD)
↑ ventilatory rate
↓ tidal volume
↑ effort
Prolonged expiration
Audible wheezing
Ventilation?
Ventilation – movement of air in and out of lungs – doesn’t mean that there has been an exchange of oxygen
Tension pneumothorax requires?
Tension needs immediate treatment as each inhalation causes collapse to increase in size
In chronic bronchitis, Chronically high PCO2 diminishes the sensitivity of? What happens because of this?
Central chemoreceptors and they no longer act as primary stimulus for breathing
What is the most common cause of pulmonary edema?
caused by congestive heart failure – left sided heart failure
What is Hyperventilation? What is it caused by? What does it result in?
o Alveolar ventilation exceeds metabolic demands
Lungs remove CO2
↓ PaCO2
* Hypocapnia – When arterial CO2 < 36mmHg
Results in respiratory alkalosis
o Caused by:
Severe anxiety
Acute head injury
Pain
Response to conditions that cause hypoxemia
Examples of pulmonary diseases or injury (super basic from slides)
1.) Hypercapina
2.) Hypoxemia
3.) Acute respiratory Faulure (VQ mismatch)
What is a Adenocarcinoma? Where are they located?
*Arise from glands
-Moderate speed of growth
- Grow peripherally
Pleuritic pain
Account for 35-40% of bronchogenic tumors
*Tumors arise of the peripheral region of pulmonary parenchyma
Also included in this category is bronchioloalveolar cell carcinoma
* Located on the terminal bronchioles and alveoli
Slow growing, unpredictable metastasis pattern
What are the clinical presentations of an Empyema? What are they diagnosed by?
Clinical presentation:
o Cyanosis
o Fever
o Tachycardia
o Cough
o Pleural pain
o Decreased breath sounds over empyema
Diagnosis by:
o Xray
o Thoracentesis
o Sputum culture
Hypoxemia is commonly associated with?
o Compensatory hyperventilation; and
o Resulting respiratory alkalosis
Causes of a pulmonary embolism?
-Usually from blood clots that travel to the lungs from deep veins in the legs
-Fat from the marrow of a broken long bone
-Part of a tumor
-Air bubbles.
What are Squamous cell carcinoma? Common manifestations? Where are they located?
Squamous cell carcinoma associated with smoking and COPD presents with nonproductive cough or hemoptysis, chest pain is late symptom
Grow centrally
Slowest growing
Account for 30% of bronchogenic tumors
Located near the hila and project into bronchi
Tumors are localized and do not metastasize until late disease
Common manifestations:
* Nonproductive cough
* Hemoptysis
* Pneumonia
* Atelectasis
Examples of Asthma triggers?
Asthma triggers: (varies from person to person, we want to educate them on how best to avoid them)
Airborne allergens, such as pollen,dust mites, mold spores, pet dander
What are Neuroendocrine tumors/ Small cell Tumours? What do they produce? Side effects?
o Also known as “Small cell carcinoma”
(Also known as “oat cell”)
o Central origin (hilar and mediastinal)
o Highest correlation with smoking
o Grow rapidly, aggressively
o *Metastasize early, worst prognosis
o *Produce ectopic hormones
Results in paraneoplastic syndrome as first manifestation
– central present at stage IV with poor prognosis
Symptoms mimic side effects of smoking so assessment is not sought out right away – usually well advanced
What is shunting? This happens in? What kind of V/Q does this result in?
Shunt – blood is moving through the lung, but no ventilation - we have a 0 V/Q - (can see this in a collapsed lung)
Example - pulmonary shuntoften occurs when the alveoli fill with fluid, causing parts of thelungto be unventilated although they are still perfused.
-Aveolis has no air movement, de oxygenated high CO2 blood enters the vessle and nothing happens to it on the way through the vessel - Blood that is flowing through the lung that is not exposed to an aveolis containg oxygen
Pulmonary edema caused by left-sided heart failure disease Vs capillary injury which increases capillary permeability?
1.) Commonly caused by left-sided heart disease:
o Left ventricle fails, puts pressure on left side of heart
o Increases pulmonary capillary hydrostatic pressure
o When pressure exceeds oncotic pressure, fluid moves from capillary to interstitial space
o When lymphatic system cannot take up additional fluid, edema happens
2.) Another cause is capillary injury which increases capillary permeability:
o Injury and inflammation cause fluid to leave capillary and into interstitial space
Increases interstitial oncotic pressure
Usually very low
o High interstitial oncotic pressure soon exceeds capillary oncotic pressure
Water moves from capillary and into lung
What is Asthma? What does is cause?
-Chronic inflammatory disorder of bronchial mucosa that causes:
o Bronchial hyper-responsiveness
o Constriction of the airways
o Reversible airflow obstructions
Manifestations of TB?
Manifestations:
o Dyspnea
o Persistent cough
o Bloody sputum
o Pleuritic pain
o Fever
o Night sweats
o Fatigue
Manifestations of Squamous cell carcinoma?
- Often attributed to side effects of smoking
- Once severe enough, disease is often advanced:
-Cough
-Increased sputum
*Hemoptysis
-Atelectasis (due to obstruction)
-Wheezing (narrowed airways)
-Pleuritic chest pain
-Hypoxemia
-Hypercapnia
COVID - 19 quarantine Vs isolation?
Quarantine means restricting activities or separatingpeople who are not illthemselves but may have been exposed to COVID-19. The goal is to prevent spread of the disease at the time when people just develop symptoms.
Isolation means separatingpeople who are illwith symptoms of COVID-19 and may be infectious to prevent the spread of the disease
What are some common causes of a chronic cough?
*classified as chronic if cough persists for longer than 3 weeks
o Caused by:
Postnasal drainage syndrome
Asthma
Eosinophilic bronchitis
Laryngeal hypersensitivity
Gastroesophageal reflux disease
Or not identifiable cause
Chronic bronchitis in smokers
* Lung cancer in smokers
Individuals taking angiotensin-converting enzyme inhibitors for CV disease
What is the goal for a ventilation - perfusion (VQ) scan with pulmonary embolisms?
ventilation–perfusion (VQ)scanis a nuclear medicinescanthat uses radioactive material (radiopharmaceutical) to examine airflow (ventilation) and blood flow (perfusion) in the lungs.
The aim of thescanis to look for evidence of any blood clot in the lungs, called pulmonary embolism (PE)
What is polycythemia?
o Polycythemia (↑RBC) has adequate oxygenation but causes cyanosis
Signs + Symptoms for pulmonary embolism? What can a massive embolus cause?
Sudden onset sharp chest pain, dyspnea, tachypnea, tachycardia, unexplained anxiety
Massive embolus causes severe pulmonary hypertension and shock
Unique breath sounds are are heard over?
Heard over painful aprea (pleural friction rub)
Outcomes of pulmonary embolsim if embolus causes an infection Vs if embolus does not cause an infection?
Embolus does not cause infarction – clot is absorbed circulation returns to normal
Embolus causes infarction – shrinking and scarring occur in affected part of the lung
Where do Squamous cell carcinoma begin to grow?
Usually begins in the bronchial tubes
What is Bronchiolitis? Who do we typically see it in? What population is it more severe in? (upper or lower airway infection)
Acute infection or inflammation of the lower airways
- Common in infants and toddlers
- Due to a viral illness caused by respiratory syncytial virus (RSV)
-Reoccurs – no immunity
-More severe in premature infants or those with underlying pulmonary or cardiac disease
Presents with variable levels of respiratory distress
-Wheezing common, but crackles may be present as well
-Treatment is supportive – NOT antibiotics – viral
Characteristics of Asthma?
Characterized by:
-variable and recurring symptoms
-reversible airflow obstruction
-easily triggered bronchospasms
Pain in chest wall =
*Causes of chest walls pain?
muscle or rib pain
o Excessive coughing
o Rib fractures
o Thoracic surgery
o Inflammation of costochondral junction
What is Status Asthmaticus?
-Status Asthmaticus (Life-threatening asthmatic attack that does not respond to normal treatment)
o Persistent SOB
o Inability to speak in complete sentences
o Agitation, confusion
o Accessory muscle use
o Possible decrease in wheezing
-Acute severe bronchospasm
-Repeated asthma attacks without interruption
-They are not moving ANY air, we will administer bronchodilators to help!
What is hypocapnia? What does it result in? When does it occur?
-Occurs during hyperventilation
- Hypocapnia – When arterial CO2 < 36mmHg
Results in respiratory alkalosis
What is Tonsillitis? What can it cause/develop?
-Infection of the upper airway
-Can cause upper airway obstruction – (can develop an abscess that needs to be drained)
-treated with antibiotics
-recurrent infections can result in a tonsillectomy – not as common now
What is primary TB Vs Secondary TB?
Primary tuberculosis
o Previously unexposed
o Can either go into latency (95%) or can become ill (5%)
Secondary tuberculosis
o Re-activation of first infection
o Another exposure
Perfusion?
delivery of blood to a capillary bed in tissue
What is hypercapnia? When does it occur? What can it result in?
- Hypercapnia – when Arterial CO2 pressure > 44mmHg
Results in respiratory acidosis
-Occurs during hypoventilation
Pain in the chest wall is usually associated with? and caused by?
- Pain is usually localized to part of chest wall
o Unique breath sounds are heard over painful area (pleural friction rub)
o Laughing or coughing makes pain worse
o Commonly from pulmonary infarction (tissue death) from pulmonary embolism - Caused by:
o Pulmonary disorders from pleurae, airways, or chest wall
o Infection/inflammation of parietal pleura (when pleura stretches)
o Infection/inflammation of trachea or bronchi can cause central chest pain
Difficult to distinguish from cardiac pain
o High BP in pulmonary circulation - Pain in chest wall = muscle or rib pain
Poor ventilation of normally-well vented areas of the lungs (low V/Q) is called? It happens in?
This is called shunting
Happens in:
* Atelectasis (lung collapse)
* Asthma from bronchoconstriction
* Pulmonary edema
When blood passes through non-ventilated alveoli, the capillary constricts
* Right-to-left shunt occurs
* Decreases systemic PaO2 and causes hypoxemia
Manifestations of Pneumococcal Pneumonia? What does it start with? What will be found in the assessment?
Start with a viral upper respiratory tract infection
Develop fever, chills, productive or dry cough, malaise, pleural pain
Assessment – pulmonary consolidation, dullness to percussion, inspiratory crackles (the heavier the crackles, the heavier the sputum), increased tactile fremitus, we will have dull purcution
What is Croup? What is it mostly caused by? What kind of cough does it produce?
-Infection of the upper airway
-Interferes with normal breathing – produces barking cough
-Mostly caused by influenza virus & respiratory syncytial virus (RSV) – “steeple” sign – usually short term – acute comes on slower – spasmodic comes on abruptly – humidified air does not improve symptoms
Glucocorticoid steroids, oxygen therapy
Inflammation of the airways (child needs to come into the hospital if they get hypoxic)
Compression atelectasis Vs Absoprtion atelectasis Vs Surfactant imparement?
Compression – external pressure pushing up diaphragm – alveoli collapse
-External pressure (from tumor/fluid/air in pleural space) presses on lung and causes alveoli to collapse
Absorption – less gas enters the alveolus than is removed by uptake by the blood
-Removal of air from obstructed or hypoventilated alveoli or inhaling concentrated O2 or anaesthetic agents
Surfactant impairment – normally surfactant lowers surface tension preventing collapse if there is decreased production or impairment alveoli collapse- Decreased production/inactivation of alveoli surfactant which normally reduces the surface tension in the alveoli
Can be due to premature birth, ARDS, anaesthesia induction, or mechanical ventilation
Risk factors for Asthma?
Risk factors – age of onset of disease (those diagnoses at a younger age will have more serious case), levels of allergen exposure, air pollution, tobacco smoke, recurrent respiratory infections (what they are exposed to), Gastroesophageal reflux disease, Obesity
Manifestations of acute bronchitis?
Fever, cough, chills, malaise like pneumonia
No pulmonary consolidation, chest x-ray clear (rule out pneumonia) but can sometimes see bronchial hazing
Feel like they have pneumonia but they don’t
What does the color of each of these sputums mean?
clear or white
yellow or green
rust
frothy pink
Clear or white: Healthy/normal
Yellow or green: cold flu (green worsening infection)
Signs + Symptoms of aspiration? Prevention measures?
S&S – sudden onset of choking and intractable cough, fever, dyspnea, wheezing
Prevention – semi-fowler for tube feedings, promotility agents NG can help with regurgitation but can also cause during insertion
Aspiration of acidic fluid leads to? result in?
damage of alveolocapillary membrane
Results in hemorrhagic pneumonitis
Risk factors with Pneumococcal Pneumonia?
age, compromised immunity, lung disease, alcoholism, altered LOC, impaired swallowing smoking, ETT, malnutrition, immobilization, long-term care residence (aspiration, because anything we can inhale into our lungs puts us at a greater risk)
What is cystic fibrosis?
-It is a recessive inherited disease (Recessive gene - both parents need to have it)
-It causes a change, or mutation, in a gene called CFTR (cystic fibrosistransmembrane conductance regulator), this gene controls the flow of salt and fluids in and out of your cells causes a sticky mucus builds up in your body
Mutation in a cell and the body produces excessive thick lung mucus lining
Patients are colonizing their own bugs/bacteria because of this they need to stay away from others who have CF
Multi-organ dysfunction
Lungs – mucus plugging, chronic inflammation & chronic infection 75% of CF patients have bacteria colonization – at great risk to each other
Usually don’t survive past 40 yrs because symptoms get so bad
What is a pleural effusion? Where does the source come from?
It’s the build-up of excess fluid between the layers of the pleura outside the lungs
- Source is usually from blood or lymphatic vessels beneath pleural space
o Occasionally abscesses or other lesions drain into pleural space
Asthma pathogenesis pathway? Early response Vs Late response (if untreated it can lead to)?
1.) Antigen activates dendritic cells trigger inflammatory response
Early Asthma Response
o Antigen exposure to bronchial mucosa
o Immune response Th, Th2, cytokines, interleukins, B cells
o Plasma produces IgE for mast cell degranulation
o Vasodilation, increased capillary permeability, mucosal edema, bronchospasms, mucous cell increase and production
Late asthmatic response
o Begins 4-8 hrs later
o Late release of inflammatory mediators
o If untreated, can lead to irreversible long-term airway damage (airway remodeling/sub-epithelial fibrosis/smooth muscle hypertrophy)
What is cyanosis? What is it an indication of? Whats it caused by? it develops when?
bluish tinge to skin and mucous membranes, an indication of severe hypoxemia
- Caused by increased amount of deoxygenated blood
- Develops when 5g if hemoglobin is desaturated (regardless of hemoglobin concentration)
Respiration?
Exchange of oxygen and carbon dioxide in the alveoli as well as capillaries
What is dead space?
Air is moving into the alveoli; no blood is moving by the lung (Example - pulmonary embolism)
Peripheral cyanosis Vs Central cyanosis?
- Peripheral cyanosis
o Slow blood circulation in fingers and toes
Those with Raynaud disease
In cold environments
Those who are severely stressed
o Best seen in the nail beds - Central cyanosis
o Decreased arterial oxygenation (low PaO2)
Cardiac disease
Pulmonary/cardiac right-to-left shunts (see below)
o Best seen in buccal mucus membrane (inside corner of mouth) and lips
What is Empyema? What does it develop from?
- Infected pleural effusion
Presence of pus in pleural space
- Develops from pulmonary lymphatics are blocked
o Leads to breach of contaminated lymphatic fluid into pleural space
- Occurs mostly in older adults and children
- Complications from:
o Pneumonia
o Surgery
o Trauma
o Bronchial obstruction from tumor
Perfusion without ventilation =?
Ventilation without perfusion =?
o Common cause is a mismatch of ventilation to perfusion
Perfusion without ventilation = shunt
Ventilation without perfusion = deadspace
What is hypoventilation? What can it lead to? When does it happen? what can it result in/case?
Hypoventilation – inadequate alveolar ventilation in relation to metabolic needs
Assessment – PCO2 > 45 – if it continues to climb we will get respiratory acidosis
o Inadequate alveolar ventilation for metabolic demands
o Happens when minute volume (tidal volume x respiratory rate) is reduced
o CO2 removal is not equal to CO2 production
Causes CO2 pressure increase in arterial blood
↑ PaCO2
It can cause hypoxemia (below-normal level of oxygen in your blood, specifically in the arteries) which manifests in sleepiness, disorientation and hypoxia or decreased O2 in our tissues
Treated with 02 and increased respirations
Symptoms of Laryngeal Cancer? What affects that risk of this cancer?
*Tobacco products combined with alcohol can affect the risk of laryngeal cancer.
Hoarseness, dyspnea, and cough
Progressive can result in voice loss
Will cough up bits of blood, can go into vocal cords
What are Extrapulmonary tuberculosis infections?
Bacilli spread to other organs via blood stream or lymphatic vessels
* Meningitis
* Bones & joints
* Kidneys
* Pericarditis
* Peritonitis
* Liver
Closed Vs Open Vs Tension Pneumothoraxes?
Closed – air pressure is < barometric pressure
Open – air pressure in the pleural space equals barometric pressure
Tension – site of rupture is a one-way valve – in during inspiration and closed during expiration
Closed – no air movement
Open – air movement inhalation/exhalation
Tension – air movement in on inhalation only
Open pneumothorax:
Air can come in and leave pleural cavity
Barometric pressure equals atmospheric pressure
Tension pneumothorax:
Chest wall acts as a one-way seal
Draws air in on inhalation but prevents it from leaving on exhalation
Buildup of pressure pushes against:
* Recoiled lung
* Heart
* Great vessels
* Trachea (mediastinal shift)
*Tension pneumothorax can be life threatening
What is Hypoxemia? it can lead to?
Reduced oxygen of arterial blood PaO2 (↓PaO2)(Remember HYPOXIA is reduced oxygenation of cells)
o Hypoxemia can lead to hypoxia
Risk factors for a pulmonary embolism?
Immobility
Inherited conditions
Having surgery on bones, have had a broken bone
Complications with Emphysema?
1.) Pneumothorax due to bullae
2.) Weight loss due to work of breathing
Hypoexmia can be complicated by? and manifast as?
- Hypoxemia can be complicated by hypercapnia and respiratory acidosis
- May manifest as:
o Cyanosis
o Confusion
o Tachycardia
o Edema
o Decreased renal output
Effective coughing is dependant on?
Cough reflex is a protective reflex used to clear that airways
Depth of inspiration
Degree the airways narrow (increases velocity of airflow)
Signs + Symptoms of pulmonary edema?
S&S – dyspnea, hypoxemia, increased work of breathing, inspiratory crackles, dullness (thick and heavy) to percussion to lower lobes, and Pink frothy sputum in severe edema
What is abnormal sputum?
- Progression of a disease/therapy can be measured in changes in:
o Amount
o Color
o Consistency
What is a common cause of Atelectasis?
General anesthesia is a commoncauseofatelectasis – change in natural ventilation
What is pulmonary edema?
Excess fluid in the lungs - localized in the lung, to much fluid is in the lung - water backed up into the alveoli
-Capillary injury – increase in permeability
-Obstruction of the lymphatic system – tumours or fibroids
Transudative (watery)
Vs
Exudative (w/ WBCs and plasma proteins)
Vs
Empyema (pus)
Vs
Hemothorax (blood)
Vs
Chylothorax (chyle)
o Transudative (watery)
-Transudative (hydrothorax)– fluid leaking from capillaries, seen in cardiovascular disease
o Exudative (w/ WBCs and plasma proteins)
-Exudative – infection or inflammation, seen in lung disease, breast cancer, lymphoma
o Empyema (pus)
-Empyema – pus seen in pneumonia, lung abscesses, or localized infection
o Hemothorax (blood)
-Hemothorax – blood seen in trauma, surgery, rupture
o Chylothorax (chyle)
-Chylothorax – lymph & fatty fluid seen in rare complication of surgeries in the neck and mediastinum
Where do large cell carcinomas usually begin?
Usually begin in the outer edges of the lungs
Prevention measures for Status Asthmaticus?
Avoid triggers or inducers – smoke, cold air, horses, pets – allergies, viruses
Use medications as prescribed - pharmacy
Be prepared for an emergency
Tend to underestimate severity of disease
What is pneumonia? What are the two causes?
- Inflammation/infection of alveoli / terminal bronchioles
1.) Infectious
Bacteria
Virus
Fungi
Protozoa
Parasites
2.) Non-infectious (aspiration)
o 8th leading cause of death in Canada
Higher in older adults
What is Atelectasis? What causes it?
Atelectasisis the collapse or closure of alveoli NOT filled with fluid
Causes - blocked airway (obstructive) or pressure from outside thelung(nonobstructive).
What is Dyspnea? Whats it caused by?
- Subjective experience
- Described as being “breathless” or “shortness of breath”
*Dyspnea – breathlessness, air hunger, shortness of breath, laboured breathing, & preoccupation with breathing
- Greater feeling of effort needed to breath
- May be the result of pulmonary disease
o May also be from pain, heart disease, trauma, and psychogenic disorder
Consider what is being aspirated:
Solid particles
Liquid
Aspiration of gastric juices damage to airways and alveoli
What do they result in?
Consider what is being aspirated:
Solid particles = obstruction
Liquid = aspiration pneumonia
Aspiration of gastric juices damage to airways and alveoli
Common causes of an acute cough?
-Resolves within 2 - 3 weeks
o Common of:
Upper respiratory tract infections
Allergic rhinitis
Acute bronchitis
Pneumonia
Heart failure
Pulmonary embolus
Aspiration
Pain associated with clubbing comes from? What is clubbing usually associated with? What are some causes of clubbing?
Pain from pleurae, airways or chest wall
- Associated with diseases that disrupt normal pulmonary circulation and chronic hypoxemia
o Ie. Bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, congenital heart disease
Causes:
infection or inflammation
Pulmonary embolus (PE)
Infection and inflammation of trachea or bronchi
Excessive coughing
Manifestations of Asthma (early signs + symptoms)?
- Chest constriction
- Expiratory wheezing
- Dyspnea
- Non-productive coughing
- Prolonged expiration
- Tachycardia
- Tachypnea
What develops with status asthmaticus?
Respiratory acidosis develops PaCO2 rises
Clinical manifestations of atelectasis? Prevention + Treatment?
S&S dyspnea, cough, fever, leukocytosis
- Clinical manifestations are: (similar to pulmonary infection)
o Dyspnea
o Cough
o Fever
o Leukocytosis
Prevention & Treatment – teaching deep breathing and coughing, incentive spirometer, removing condition causing problem
What causes Emphysema? Airflow limitation is due to?
Caused by repeated exposure to irritants
Inflammatory response – elastin breakdown (Smoking and chronic exposure to environment irritants, Genetic (1-3%) – lack of enzyme alpha-1 antitrypsin)
- Airflow limitation is due to loss of elastic recoil of lung tissue
o Destruction of walls between alveoli
o Destruction of accompanying capillary bed
o Floppy terminal bronchioles
o Loss of elasticity of alveoli
Where do adenocarcinoma’s usually begin?
Usually begins in the outer regions of the lungs
What is Aveolar dead space? it can cause?
Good ventilation, no perfusion (pulmonary edema or fibrosis – oxygen is there, circulation is there, but gas cannot be exchanged due to membrane impairment)
-Can cause hypoexmia
Primary and secondary pneumothorax manifests as? Signs + Symptoms?
o Sudden pleural pain
o Tachypnea
o Dyspnea
o Absent/decreased breath sounds
o Hyper-resonance to percussion on affected side
S&S of all – pleural pain, increased RR & HR, may have absent or decreased breath sounds
Aspiration of Pharyngeal secretions leads to?
aspiration pneumonia
What is a pulmonary embolism?
blockage in one of the pulmonary arteries in your lungs (occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung)
Clinical manifestations of pneumonia?
o Dyspnea
o Cough
o Abnormal sputum
o Hemoptysis
o Pain
o Breathing Pattern
Kussmaul
Cheyne Stokes
o Clubbing of nailbeds
o Cyanosis
What are Cheyne-Stokes respiration? What do they cause?
o Alternating periods of deep/shallow breathing
o Apnea lasts 15-60sec
Deep breathing (tidal volume) increases, peaks, and decreases afterwards
o Reduces bloodflow to brainstem
Slows impulses to respiratory centre of brainstem
o Neurological impairment above brainstem is a contributing factor
Lack of cyanosis does not mean good oxygenation, explain? In adults cyanosis occurs from?
o In adults, cyanosis occurs from severe hypoxemia
o Anemia and carbon monoxide poisoning can cause inadequate oxygenation w/o cyanosis
o Polycythemia (↑RBC) has adequate oxygenation but causes cyanosis
- Cyanosis must be interpreted from underlying pathophysiological condition
Primary Vs Secondary pneumothorax?
Primary (spontaneous) pneumothorax:
-Occurs in healthy individuals (usually men) between 20-40 years of age
-Caused by spontaneous rupture of blebs (blister-like formation) of visceral pleura
Blebs can rupture in sleep, rest, or exercise
Blebs are usually located on apex of lung
-Unknown cause those 80% of victims have emphysema-like changes in lungs (even w/o smoking)
(Linked to mutations in the folliculin gene)
Secondary pneumothorax:
o Caused by chest trauma
Rib fracture
Stab
Bullet wound
Rupture of a bleb or bulla
Emphysema
Mechanical ventilation (esp positive end-expiratory pressure (PEEP))
o Commonly caused by transthoracic needle aspiration
Hypercapnia is rare b/c?
person with impaired diffusion would die from hypoxemia before hypercapnia could occur
What is eupnea? Sigh breaths are?
- Normal breath (eupnea) – 8-16 breaths per minutes
o Tidal volume 400-800mL
o Sigh breaths are 1.5-2x normal tidal volume, 10-12x per hour
Symptoms of Emphysema?
-Dyspnea
-Minimal cough
-Increased minute ventilation
-Pink skin, pursed lip breathing
-Accessory muscle use
-Cachexia
-Hyperventilation (barrel chest)
-Decreased breath sounds
-Tachypnea
Ventilation can be compromised (↓ tidal volume) if chest wall is?
o Deformed
o Traumatized
Flail chest – fracture to multiple ribs where a portion of the chest is free-floating from ret of ribcage. Will not inflate/deflate in rhythm
o Immobilized
o Heavy (from accumulation of fat)
What is Dyspnea caused by? What are some serious signs?
- Caused by:
o Diffuse or focal disturbances in ventilation
o Gas exchange
o Ventilation-perfusion relationships
o Any disease that causes lung damage - Serious signs of:
o Flaring of nostrils
o Use of accessory muscles to breathe
o Pulling back of super/intercostal muscles in children
o Significant anxiety
** Can be transient and chronic
What is Dyspnea on exertion, Orthopnea and paroxysmal Noctural dyspnea?
- Dyspnea on exertion - when dyspnea appears first on exercise
- Orthopnea - dyspnea on heart failure. Individual lies flat and puts pressure on diaphragm
- Paroxysmal Nocturnal Dyspnea (PND) – Pts with pulmonary or cardiac disease are aware at night, gasping for air
Hypoxeima can result from?
- Can result from:
o Blood bypassing the lungs
o Intracardiac defects that cause shunting
o Intrapulmonary arteriovenous malformation
What is hepatization?
- When lung tissue is gorged with effusion matter
- Lung tissue then resembles liver tissue
- Is a stage of pneumonia (3rd stage)
What is acute respiratory failure? and what can it result from?
-Inadequate gas exchange measures as:
Low PaO2 - < 60, or high PCO2 - >50 pH <7.25
Respiratory failure can result from:
o Direct injury to lungs, airways or chest wall
o Indirect from disease or injury to another body system (CNS, heart)
Large cell carcinomas?
-undifferentiated grows rapidly – late symptoms
-Usually begins in the outer edges of the lungs
- Transformed epithelial cells
o Squamous glandular
o Neuroendocrine precursor cells
Rapid growth
Grow centrally - Can distort the trachea and widen the carina
Make up 10% of bronchogenic tumors
Causes of hypoxemia?
- Poor oxygen delivery to alveoli
hypoventilation causes a decrease in oxygen
available to exchange with CO2 so CO2 stays in blood
O2 content of air brought in (FiO2)
Ventilation of alveoli
Treatment - increase rate and depth of respirations
2.) 2 – Poor movement of oxygen from alveoli to blood
Balance between alveolar ventilation/perfusion (V/Q)
Diffusion of O2 through alveolar capillary wall
Called a V/Qmismatch whichhappens when part of your lung (1) receives oxygen without blood flow or (2) we have blood flow without oxygen.
What is bulbous enlargement of the end of a digit?
Clubbing
What are the 4 different categories of pneumonia?
1.) CAP – community-acquired pneumonia
2.) HCAP – health-care-associated pneumonia
In hospital for 48hrs or longer for it to be considered hospital-acquired
3.) HAP – hospital-acquired pneumonia (nosocomial) -
4.) VAP – ventilator-associated pneumonia
Hypercapnic resp failure Vs Hypoxemic resp failure? What kind do many people have?
o Hypercapnic respiratory failure (inadequate alveolar ventilation – failure to remove CO2 adequately) can be resolved by (PCO2 ≥ 50mmHg):
Bag-valve mask
Non-invasive positive pressure
Intubation and placement on mechanical ventilator
Hypoxemic respiratory failure (inadequate exchange of O2 – failure to oxygenate) can be resolved by (PO2 ≤ 50mmHg):
Pt must receive supplemental O2 therapy
*Many people have both kinds of respiratory failure a require both therapies
What is Hemoptysis? What does it indicate? What is it often confused with?
- Coughing up of blood or bloody secretions
- Often confused with hematemesis
o Hematemesis – vomiting of blood - Indicates the following:
o Infection
o Inflammation that damages the bronchi (bronchitis, bronchiectasis)
o Lung parenchyma (pneumonia, tuberculosis, lung abscesses)
o Cancer
o Lung infarction
o Pulmonary venous stenosis
What is Emphysema? How do we diagnose it?
Abnormal, permanent enlargement of gas-exchange pathways along with destruction of alveolar walls (Permanent enlargement of gas exchange airways + destruction of alveolar walls)
Diagnosis:
pulmonary function tests (PFTs)
Spirometry
lung volume tests
What is Hypercapnia? What is it caused by? What does it lead to? why is it often overlooked? What does it cause?
- ↑CO2 concentration in blood
o Caused by hypoventilation of the alveoli - Leads to respiratory acidosis
- Often overlooked due to normal ventilation rate and breathing pattern
Causes: decreased drive to breathe
S&S
Similar to respiratory acidosis – vasodilation of blood vessels, depression of CNS
What is Kussmaul respiration? Charatceristics?
(Hypernea - fast abnormal respirations)
Kussmaul respirations – deep breathing in response to exercise or strenuous effort
o Strenuous exercise/metabolic acidosis
o Slight ↑ respiratory rate
o ↑ tidal volume
o No pause between breaths
Health promotion topics for patients with COPD? What are the 2 common phenotypes?
Quit smoking – secondhand smoke as well
Wash your hands
Avoid/minimize air pollution
Wear protective mask if exposed
- 2 common phenotypes are:
1.) Chronic bronchitis
2.) Emphysema
Pathophysiology of Tuberculosis?
1.) Inhalation of M. tuberculosis bacilli
o immune response
o Bacilli lodge in the upper lobe of the lungs
2.) Macrophages surround the bacilli in alveoli
o Some macrophages carry bacilli to local lymph nodes
3.) Immune response kills bacilli and tissue - granuloma (called a tubercle)
o TB is “walled off” and tissue in tubercle dies
o Inside the granuloma is cheese-like material (caseous necrosis)
o Inside the granulomas, small numbers of bacilli remain viable for years
What is Flash pulmonary edema?
Flash Pulmonary Edema – rapid onset of pulmonary edema – caused by myocardial infarct, heart failure – treated with diuretic, oxygen, nitroglycerin – vasodilator reduce pre-load
In obstructive lung disease breathing (blank) is harder?
-Breathing out is harder than normal
- → Air trapping
- → Hyperinflation of lungs
What is sleep apnea? what are the risk factors? signs + symptoms? and treatment?
Apnea that occurs during sleep
Assessment – monitored sleep to assess periods of apnea, frequency and length
Risk factors for sleep apnea – obesity, upper airway obstruction – large neck, recessed chin
Contributes to heart disease hypertension, atrial fibrillation, DVT
Treatment – continuous positive airway pressure (CPAP), exercise, weight loss
- Apnea events - reduced or absent breathing
2.) Compromised attention, concentration, and motor skills
3.) Heafaces and dry mouth after waking up
4.) Habitual or loud snoring
5.) Gasping for air during sleep
6.) Sleep deprivation
7.) Diminished libido
What is Hyperventilation? What is it caused by? What does it result in?
o Alveolar ventilation exceeds metabolic demands
Lungs remove CO2
↓ PaCO2
* Hypocapnia – When arterial CO2 < 36mmHg
Results in respiratory alkalosis
o Caused by:
Severe anxiety
Acute head injury
Pain
Response to conditions that cause hypoxemia
Oxygenation?
Oxygenation – delivery of oxygen to the organs – doesn’t mean that there has been ventilation
Tension pneumothorax can be complicated by?
o Severe hypoxemia
o Tracheal deviation away from affected lung
o Hypotension (low BP)
-Treatment is done through insertion of a chest tube (w/ one-way valve)
Poor perfusions in well-ventilated portions of lung (high V/Q) results in? Is caused by? This occurs in?
Results in wasted ventilation
Caused by:
* Pulmonary embolus restricting blood to portion of lung
* Alveolar dead space – good ventilation, no perfusion (Alveolocapillary membrane is impaired)
-Occurs in Hypoexmia
- Those with an inability to effectively cough have greater risk for?
pneumonia
Symptoms of chronic bronchitis?
-Chronic, productive cough
-Purulent sputum
-Hemoptysis
-Mild dyspnea initially
-Cyanosis (due to hypoxia)
Peripheral edema (due to cor pulmonale)
-Carakles and wheezes
-Prolonged expiration
-Obese
What is Hypercapina caused by?
Decreased drive to breathe OR Inadequate ability to respond to ventilatory stimulation
Depression of the respiratory centre by medication
Disease of the medulla (infections of the CNS or trauma)
Abnormalities of spinal conducting pathways (spinal cord disruption, poliomyelitis)
Disease of neuromuscular junction or respiratory muscles
Thoracic cage abnormalities
Large airway obstruction (tumor, sleep apnea)
Increased work of breathing or physiological dead space (emphysema)
Clinical manifestations of aspiration?
Clinically manifests as:
o Sudden onset of choking
o Intractable cough (w/ or w/o vomiting)
o Fever
o Dyspnea
o Wheezing
o Recurrent lung infection
o Chronic cough
Pneumonia & bronchitis both affect the airways resulting in? What is the difference between the two?
Pneumonia & bronchitis both affect the airways resulting in coughing and discomfort – bronchitis is an inflammation – pneumonia is an infection
