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Patho > Test 2 Respiratory > Flashcards

Test 2 Respiratory Flashcards

1
Q

Primary function of respiratory system

A

Provide O2 for metabolism in tissues
Remove CO2 that waste product of metabolism

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2
Q

Secondary function of respiratory function

A

Facilitate sense of smell
Produces speech
Maintains acid base balance
Maintains body water levels
Maintains heat balance

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3
Q

components of upper respiratory tract

A

Nasal cavity
Sinuses
Pharyngeal tonsils
Nasopharynx
Pharynx
Larynx
Epiglottis
Esophagus

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4
Q

Nose

A

Humidifies, warms and filters inspired air

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5
Q

Sinuses

A

Air filled cavities within hollow bone that surround nasal passages
Provide resonance during speech *

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6
Q

Pharynx

A

Located behind the oral and nasal cavities
Passage for both respiratory and digestive tracts

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7
Q

Divisions of pharynx

A

Nasopharynx
Oropharynx
Laryngopharynx

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8
Q

Larynx

A

Located above trachea and just below pharynx
“The voice box”
Two pairs of vocal cords

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9
Q

Glottis

A

Opening between the true vocal cords
Important role in coughing

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10
Q

Most fundamental defense mechanism of the lungs

A

Coughing

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11
Q

Epiglottis

A

Leaf shaped elastic structure attached to top of larynx
Prevents food from entering tracheobronchial tree by closing over glottis during swallowing

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12
Q

Components of the lower respiratory tract

A

Trachea
Bronchus
Bronchi
Bronchioles

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13
Q

Trachea

A

Located in front of esophagus
Branches into right and left main stem bronchi

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14
Q

Carina

A

Point where left and right main stem bronchi branch off

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15
Q

Main stem bronchi

A

Divide into 5 secondary or lobar bronchi that enter each of 5 lobes of lung
Bronchi are lined itch cilia, which propel mucus up and away from the lower airway to trachea where it can be expectorated or swallowed

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16
Q

Difference between right and left main stem bronchi

A

Right is slightly wider, shorter and more vertical than left

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17
Q

Bronchioles

A

Branch from the secondary bronchi and subdivide into the small terminal and respiratory bronchioles
Contain no cartilage and depend on elastic recoil of lung for patency

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18
Q

Terminal bronchioles

A

Contain no cilia and do not participate in gas exchange

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19
Q

Alveoli

A

*basic unit of gas exchange
On terminal bronchioles
Alveolus
Alveolar capillary network

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20
Q

Acinus (acini)

A

All structures distal to terminal bronchioles

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21
Q

Alveolar ducts

A

Branch from respiratory clusters

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22
Q

Surfactant

A

Secreted in the walls of alveoli
Phospholipid protein that reduces surface tension in alveoli
Without alveoli would collapse

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23
Q

lobes of lungs

A

3 in right 2 in left

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24
Q

Visceral pleura

A

Covers pulmonary surfaces (lungs)

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25
Q

Parietal pleura

A

Lines the inside of thoracic cavity including upper surface of diaphragm

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26
Q

Pleural fluid

A

Produced by cells lining the pleura and lubricates visceral and parietal pleurae
Allows them to guide smoothly and painlessly during respiration

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27
Q

Accessory muscles

A

Scalene muscles
Sternocleidomastoid muscles
Trapezius and pectoralis muscles

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28
Q

Risk factors for respiratory disease

A

Smoking
Chewing tobacco
Allergies
Frequent resp. Illness
Chest injury
Surgery
Chemicals/pollutants
Crowded living
Fam history of infection disease
Geographic residence and travel

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29
Q

Chest X-ray

A

Provides info regarding anatomic loco and appearance of lungs
Cheap easy and quick

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30
Q

Sputum specimen

A

A specimen obtained by expectoration or tracheal suctioning to assist in identification of organisms or abnormal cells

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31
Q

Sputum specimen pre procedure

A

Determine purpose
Early morning is best
15 mL
Rinse prior, several deep breaths, cough deeply

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32
Q

Bronchoscopy

A

Direct visual exam of larynx, trachea and bronchi with fiberoptic bronchoscope

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33
Q

Bronchoscopy pre procedure

A

Informed consent
NPO midnight prior
Vitals
Monitor coagulation studied
Remove dentures and glasses
Meds for sedation
Need crash cart available

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34
Q

Bronchoscopy post procedure

A

Vitals
Semi- Fowler
Assess gag reflux
NPO until gag reflex returns
Emesis basin
Check for bloody sputum
Monitor resp status, especially if had sedative
Complications
Notify if fever or difficulty breathing

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35
Q

Complications of Bronchoscopy

A

Bronchospasm, bacteremia, bronchial perforation indicated by facial or neck crepitus, dysrhythmias, fever, hemorrhage, hypoxemia, and pneumothorax

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36
Q

Pulmonary angiography

A

Invasive fluoroscopic procedure following injection of iodine or radio plaque or contrast material through a catheter inserted through the antecubital or femoral vein into the pulmonary artery or one of its branches
Lights up vasculator of lungs
Helps see if they have blood clots

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37
Q

Pre procedure pulmonary angiography

A

Informed consent and allergies
NPO 8 hours prior
Monitor vitals
Monitor coagulation studies
Establish IV access
Sedate
Crash cart near
Instruct that they must lie still and may feel urge to cough or experience flushing, nausea or salty taste

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38
Q

Post procedure pulmonary angiography

A

Monitor vitals
Don’t take blood pressure in extremity used for IV for 24 hrs
Monitor peripheral neurovascular status
Assess insertion site for bleeding
Monitor for delayed reaction to dye

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39
Q

Thoracentesis

A

Removal of fluid or air from pleural space via transthoracic aspiration

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40
Q

Pleural effusion

A

Gathering of fluid in the pleural space, can’t respirate well with it
Is not pleural fluid, has unwanted matter

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41
Q

Thoracentesis pre procedure

A

Informed consent
Baseline vitals
Ultrasound or CXR prior if perscribed
Assess coagulation studies
Sitting upright with arms and hear supported by table at bedside
If can’t sit up lay on unaffected side
Informed to NOT cough, breathe deeply or move

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42
Q

Thoracentesis post procedure

A

Monitor vitals and resp status
Pressure dressing and assess puncture site for bleeding and crepitus

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43
Q

Complications of Thoracentesis

A

Pneumothorax, air embolism and pulmonary edema

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44
Q

Pulmonary function tests (PFTs)

A

Include a number of different tests used to evaluate lung mechanics, gas exchange and acid base disturbance through spirometric measurements, lung volumes and arterial blood gases

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45
Q

Pulmonary function tests pre procedure

A

Determine if any analgesics is being admin
Consult physician regarding holding bronchodilators prior to testing
Instruct:
Void before
Wear loose clothing
Remove dentures
No smoking or eating heavy meals for 4-6 hrs before

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46
Q

Pulmonary function tests post procedures

A

Resume to normal diet and bronchodilators that were held prior

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47
Q

Inspiration reserve volume IRV

A

Breath in in in as much as possible and then hold
How much extra can you take in?

48
Q

Tidal volume TV

A

Normal volume of air breathed in and out when not exerting self

49
Q

Expiratory reserve volume ERV

A

The maximum amount of air you can forcible breathe out after a breath

50
Q

Residual volume RV

A

What’s left when a person breaths out as much as possible

51
Q

Vital capacity VC

A

Everything you can take in minus the residual volume

52
Q

Total lung capacity TLC

A

Everything you can take in including residual volume

53
Q

Percutaneous Lung biopsy

A

Performed to obtain tissue for analysis by culture or cytologic examinations

54
Q

Needle lung biopsy

A

Done to identify pulmonary lesions, changes in tissue and the cause of pleural effusion

55
Q

Lung biopsy pre procedure

A

Informed consent
NPO prior
Information of local anesthetic but may feel pressure during needle insertion and aspiration
Admin analgesics and sedatives as prescribed

56
Q

Lung biopsy post procedure

A

Monitor vitals
Apply dressing to site and monitor for drainage and bleeding
Monitor for resp distress
Monitor for signs of pneumothorax and emboli

57
Q

Ventilation perfusion lung scan

A

Perfusion scan: blood flow to lungs is evaluated
Ventilation scan: determines patency of the pulmonary airways and detects abnormalities
Radionuclide may be injected
Sees if arteries match veins

58
Q

Ventilation perfusion lung scan pre procedure

A

Informed consent
Allergies for dye
Remove jewelry
Review breathing methods
Establish IV access
Admin sedation if perscribed
Crash cart near

59
Q

Skin tests

A

An intradermal injection used to assist and diagnosing various infectious diseases

60
Q

Skin test procedure

A

Use test site free of excessive body hair dermatitis and blemishes
Apply at upper 1/3 of inner surface of left arm
Circle and mark injection test site
Document date, time and test site

61
Q

skin test pre procedure

A

Determine hypersensitivity or previous reactions to skin tests

62
Q

Skin tests post procedure

A

Instruct not to scratch to prevent infection and abscess formation and to avoid scrubbing
Interpret reaction at injection site 24-72 hours after
Assess site for amount of induration (hard swelling) and presence of erythema and blister like elevations

63
Q

Arterial Blood Gases (ABGs)

A

Measures the dissolved O2 and CO2 in the arterial blood and reveals the acid base state and how well the O2 is being carried in the body
Allen test

64
Q

Normal pH

A

7.35-7.45

65
Q

Normal PCO2 ABG

A

35-45 mmHg

66
Q

Normal HCO3 ABG

A

22-27 mmHg

67
Q

PO2 ABG

A

80-100 mmHg

68
Q

ABG pre procedure

A

Perform Allen test on both writsts
Have rest for 30 minutes prior to
Avoid suctioning prior to drawing blood
Do not turn off O2 unless blood gases are ordered on room air

69
Q

ABG post procedure

A

Place specimen on ice
Not temp on lab form
Note O2 and type of ventilation
Apply pressure to site for 5-10 minutes (longer if on anticoagulants or have bleeding disorder)
Transport the specimens to lab w/in 15 minutes

70
Q

Pulse Oximetry

A

Noninvasive test that registers O2 saturation of hemoglobin
After a hypoxia client uses up the readily available O2 reserve O2 attached to the hemoglobin is drawn on the provided O2 to tissues
Alerts hypoxemia before clinical signs occur

71
Q

Pneumonias

A

Acute inflammation of parenchymal tissues functional parts = alveoli and bronchioles
Affects 1% of pop each year
4 mil cases a year
6th leading cause of death
Most common cause of death from infectious disease

72
Q

Nasopharyngeal defenses

A

Resistance factor of pneumonia
Remove particles from air and destroy invading organisms
Risks: hay fever, common cold, nasal trauma

73
Q

Glottic and cough reflexes

A

Host resistance for pneumonias
Prevents aspiration into tracheobroncial tree
Risk factors: stroke, abdominal or chest surgery, sedation, NG tube

74
Q

Mucociliary blanket

A

Host resistance for pnnemonias
Remove secretions microorganisms and particles
Risk factors: smoking, inhalation if irritating gases

75
Q

Pulmonary macrophages

A

Host resistance of pneumonias
Removes microorganisms
Risk factors: alcohol intoxication and smoking

76
Q

Complications of pneumonias

A

Bacteremia/septicemia
Empyema
Lung abscess

77
Q

Pneumonias etiology

A

Droplet inhalation
Bacterial: streptococcus pneumonia, diplococcus pneumonia
Viral: influenza, parainfluenza, RSV, CMV
Other: mycoplasma pneumoniae
Smoke inhalation
Aspiration

78
Q

Subjective pneumonia manifestations

A

Lassitude and severe malaise
Chest pain that increases with inspiration, dyspnea

79
Q

Objective manifestations of pneumonias

A

^ temp
^ RR, HR, use of accessory muscles, orthopedia
Cough and sputum
Gray complexion
Raleigh (fine crackles)
Rhonchi
Decreased breath sounds over consolidation
Friction rub
Dull to percussion
E > A changes

80
Q

Sputum for diff types of pneumonias

A

Pneumococcal: purulent, rusty
Staphylococcal: yellow, blood streaked
Klebsiella: red gelatinous
Mycoplasma: non productive that advances to muciod

81
Q

Diagnostics of pneumonias

A

^ WBC and ESR
CXR is patchy or lobar pulmonary infiltrates
Sputum/blood cultures

82
Q

ABGs for pneumonias

A

Hypoxemia
Respiratory alkalosis

83
Q

Pathologic changes in pneumonia

A

Congestion 4-24 hrs
Red hepatization 48 hrs
Gray hepatization 1 week
Resolution 7-12 days

84
Q

Congestion

A

Serous exudate from initial inflammatory response pours into alveoli

85
Q

Red hepatization

A

Extravasation of RBCs, fibrin, PMNs into alveoli
Tissue is firm and red

86
Q

Gray hepatization

A

Fibrin accumulates and granulates, RBCS and PMNs start disintegrating

87
Q

Pneumonias treatment

A

Pneumococcal: penicillins and cephalosporins
Gram negative: gentamycin or tobramycin

88
Q

Obstructive airway disorders

A

Asthma
Chronic bronchitis
Emphysema
Chronic obstructive pulmonary disease
Cystic fibrosis

89
Q

Restrictive airway disorders

A

Pleural effusion
Hemothorax
Pneumothorax
Pneumoconioses
Thoracic cage disorders
Adult respiratory distress syndrome

90
Q

Asthma

A

Hyper-responsive, reversible form of airway disease caused by restriction in airway size from bronchospasm, chronic inflammation and increased airway secretion
- bronchial and bronchiolar narrowing from ^ smooth muscle tone
- mucosal edema
- hypersecretion of mucus

91
Q

Asthma epidemiology

A

9-12 mil in US
^ incidence prevalence and mortality
Most common cause of chronic illness in <17

92
Q

Extrinsic atopic asthma (type 1)

A

Immediate hypersensitivity response mediated by IgE
Mast cells release histamine and prostaglandins on exposure to allergens
Usually have fam history of allergies, urticaria or hay fever
Usually affects children
Good prognosis - complete remission in adolescence

93
Q

Intrinsic (non-atopic) idiopathic asthma (type 2)

A

Adult onset (> 30)
Chronic mucopurulent bronchitis
More serious, more difficult to control
Poorer prognosis

94
Q

Exercise induced asthma

A

40-90%
Triggers: hypocapnia, cool air with less water vapor

95
Q

Bronchospastic asthma triggers

A

Cold air - loss of heat and water
Exercise
Emotional upset - vagal pathways
Exposure to bronchial irritants - receptors and vagal reflex

96
Q

Inflammatory asthma triggers

A

Exert effects through inflammatory response
IgE mediated response to allergens
- dust mite and cockroach excrement
- molds and mildew
- animal dander

97
Q

Asthma early response

A

Immediate bronchoconstriction on exposure to inhaled irritant or antigen
Sx’s w/in 10-20 min
Recovery 60-90 min
Caused by re;ease of chem mediators from IgE coated mast cells on mucosa

98
Q

Asthma late response

A

Develops 3-5 hours after exposure to trigger may last for days or weeks
Involves inflammation and increased airway responsiveness
Caused by release of chemical mediators from mast cells, macrophages and epithelial cells (induce migration and activation of other inflammatory cell)
Produces epithelial edema and injury changes in mucociliary function, reduced clearance or secretions
^ airway responsiveness

99
Q

Asthma manifestations 1

A

Bronchi widen and lengthen on inspiration BUT collapse on expiration
Expiration becomes difficult d/t edema, narrowing and mucus obstruction
Primary problem is getting air out of lungs
Expiration requires use of accessory muscles

100
Q

Asthma manifestations 2

A

Decreased FEV and PEFR
Dyspnea - orthopnea
Wheezing esp. on expiration
PaO2 60-72 mmHg
PaCO2 low initially
D/t ^ RR but ^ D/t decrease in alveolar ventilation
V/Q mismatch
Cyanosis
Intercostal retraction
Fatigue

101
Q

Bronchial Asthma in children

A

Most frequent admitting dx in children’s hospitals
Sex: 10-15% of boys 7-10% of girls
Onset: 30% by age 1, 80-90% by age 4-5
Fam links: 1 parent = 25% risk, both = 50%
Polygenic / multifactorial determinants

102
Q

Asthma pharmacologic treatment

A

Beta 2 adrenergic bronchodilator
- albuterol
- epinephrine
- xanthines
Anticholinergic bronchodilator: Ipratropium (atovent)
Corticosteroids
- beclomethasone
- hydrocortisone, methylprednisolone, IV if severe
Heukotriene receptor antagonists
Mast cell stabilizers FOR PREVENTION ONLY
- cromolyn sodium

103
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

Aka chronic obstructive lung disease (COLD) or chronic airway obstruction (CAO)
Group of diseases that result in obstruction of airflow

104
Q

COPD includes

A

Chronic bronchitis
Emphysema

105
Q

Chronic bronchitis

A

Inflammation on bronchial walls with hypertrophy of the mucous goblet cells
Characterized by a chronic productive cough (copious mucus)
Present for at least 3 months out of year OR 2 months/yr for 2 successive years
Often have frequent and recurrent respiratory infections
“blue bloater”

106
Q

Bronchitis etiology

A

Cigarette smoking
Inhalation of industrial gases and other toxic substances

107
Q

COPD etiologies

A

Air pollution, smoking, chronic respiratory infections, exposure to molds and fungi, allergic reactions

108
Q

Effects of bronchitis

A

Inhibits cilia and macrophages
Inflammation of major and small airways
Hypertrophy of mucosal glands
Excessive secretion
Narrowing and smooth muscle constriction

109
Q

Manifestations of bronchitis

A

DOE
Decreased PaO2 ^ PaCO2
D/t decreased alveolar ventilation
V/Q mismatch
Hypoventilation of of alveoli d/t air trapping, hypoxemia, hypercapnia, cyanosis
Scattered rhonchi and rales on forced expiration
Abnormal ABGs
Chronic cough
Copious yellow green sputum
Exercise intolerance
Plycythemia
Clubbing of fingers

110
Q

Emphysema

A

Destruction of walls of alveoli
Dilatation and less of elasticity of airspaces distal to terminal bronchioles and loss of normal elastic recoil
Results in air trapping with ^ AP diameter “barrel chest”
Larger airways become thinned and atrophied > become more collapsible
Less prone to acute bronchitis or pneumonia but is very serious or fatal when they do get it
“Pink Puffer”

111
Q

Etiology emphysema

A

Cigarette smoking
Often genetically determined
- autosomal recessive
- esp. early onset and severe progression
- deficiency of alpha antitrysin which inhibits proteolytic enzymes of leukocytes
- loss of inhibition -> digestion of lung tissue with bacteria

112
Q

Centrilobular emphysema

A

Assoc. with smoking
Affects respiratory bronchioles and alveolar ducts
Unevenly distributed BUT affects upper and posterior portions of lungs more severely

113
Q

Panacinar emphysema

A

Destruction and enlargement of alveoli distal to terminal bronchioles
Results of genetic abnormality or progression of chronic bronchitis
* lower portions of lung more affected

114
Q

Emphysema manifestations

A

Dyspnea even at rest
Tachypnea
V/Q mismatch NOT prominent d/t loss of capillaries with alveoli
- cyanosis and heart failure less prominent
- pink puffers
Usually little cough or sputum
ABGs usually normal or respiratory alkalosis d/t hyperventilation
May be unable to eat
Hyperinflation of lungs “barrel chest”
Slowly debilitating

115
Q

Treatment of bronchitis and emphysema

A

Control of environment irritants and infection
Nutritional support
Exercise training
Breathing exercises and retraining
Managing secretions
Pharmacologic treatment
Oxygen therapy
Psycho-emotional support

Patho (6 decks)

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