TEST 3 - RESPIRATORY PART 1 Flashcards
1
Q
WHAT SYSTEM? Air distributor & gas exchanger.
A
RESPIRATORY
2
Q
DEFINITION: air moving in and out of the lungs
A
VENTILATION
3
Q
DEFINITION: the amount the lungs can inflate
A
DISTENSIBILITY
4
Q
DEFINITION: the amount of force that the lungs have to work against
A
RESISTANCE
5
Q
DEFINITION: how well the lungs can recoil
A
ELASTICITY
6
Q
DEFINITION: The delivery of blood flow to a specific organ or an area of the body.
A
PERFUSION
7
Q
Ventilation/perfusion (VQ) ratio:
A
4L air : 5 L of blood per minute
8
Q
VQ scan is used to determine what?
A
whether there’s a blood clot
9
Q
Clinical Manifestations of Respiratory Dysfunction
indicates irritation in upper respiratory tract
A
sneezing
10
Q
Clinical Manifestations of Respiratory Dysfunction
difficulty swallowing
A
dysphagia
11
Q
Clinical Manifestations of Respiratory Dysfunction
hoarse voice eg. laryngitis
A
Dysphonia
12
Q
Clinical Manifestations of Respiratory Dysfunction
protective mechanism; occasional normal, productive is abnormal
A
cough
13
Q
Clinical Manifestations of Respiratory Dysfunction
coughing blood
A
Hemoptysis
14
Q
Clinical Manifestations of Respiratory Dysfunction
shortness of breath
A
dyspnea
15
Q
Clinical Manifestations of Respiratory Dysfunction
positional shortness of breath, person needs to sit up to breathe
A
orthopnea
16
Q
Clinical Manifestations of Respiratory Dysfunction
wake up at night with shortness of breath, eg. Pulmonary edema or CHF
A
Paroxysmal nocturnal dyspnea (PND)
17
Q
Abnormal respiratory patterns - increase in the depth of breathing
A
KUSSMAUL
18
Q
Abnormal respiratory patterns - progressive increase in rate of breathing, followed by a period of apnea
A
Cheyne Stoke
19
Q
Use of accessory muscles - more common in children
A
NASAL FLARING
20
Q
Use of accessory muscles - above the stermum
A
SUPRASTERNAL
21
Q
Use of accessory muscles - above the clavicle
A
SUPRACLAVICULAR
22
Q
Use of accessory muscles - below the stermum
A
SUBSTERNAL
23
Q
Use of accessory muscles - below the ribcage
A
SUBCOSTAL
24
Q
Use of accessory muscles - more common in children
A
intercostal indrawing
25
Abnormal respiratory sounds - snoring
SONOROUS BREATHING
26
Abnormal respiratory sounds - upper respiratory blockage, high pitched sound eg. croup
STRIDOR
27
Abnormal respiratory sounds - discontinuous popping sound
CRACKLES
28
Abnormal respiratory sounds - continuous musical quality
WHEEZE
29
Abnormal respiratory sounds - sound of pleura rubbing together
FRICTION RUB
30
PAIN FROM BREATHING
PLEURITIC
31
WHAT IS THIS?
* fibrotic changes in nail beds
* eg. Cystic Fibrosis, COPD due to chronic hypoxemia
CLUBBING OF DIGITS
32
an early sign of hypoxemia
ANXIETY/RESTLESSNESS
33
Conditions caused by Pulmonary Disease or Injury
| elevated carbon dioxide levels in the blood
HYPERCAPNIA
34
Conditions caused by Pulmonary Disease or Injury
| decreased O2 concentration in the blood
HYPOXEMIA
35
Conditions caused by Pulmonary Disease or Injury
| Inadequate oxygen supply to the cells
HYPOXIA
36
end result of pulmonary disease
RESPIRATORY FAILURE
37
RESPIRATORY FAILURE - ARTERIAL BLOOD GAS OXYGEN LEVEL
< 60 mmhg
38
RESPIRATORY FAILURE - ARTERIAL BLOOD GAS CARBON DIOXIDE LEVEL
> 45 mmhg/pH < 7.25
39
6 Tests to Evaluate Respiratory Function
1. Chest Xray (CXR): easiest & least expensive way
2. Computed tomography (CT scan)
3. Arterial blood gas analysis (ABG’s)
4. Pulmonary function tests (PFT)/spirometry
5. Sputum analysis (C&S, cytology, AFB: acid fast bacilli - test for TB)
6. VQ scan (ventilation/perfusion scan)
40
TRUE OR FALSE?
| before bed is the best time to get a sputum sample
early morning bc of pooling of secretions overnight
41
Categories of Respiratory Disorders
diseases where air has trouble getting in and out of the lungs; resistance to airflow
Obstructive
42
Categories of Respiratory Disorders
disease that result in a decrease in lung expansion; lungs don't expand
restrictive
43
Categories of Respiratory Disorders
diseases caused by virus or bacteria, eg. pneumonia
infectious
44
Categories of Respiratory Disorders
problem is in the bloodflow to the lungs, eg. pulmonary embolism
Disorders of Vascular Origin
45
Categories of Respiratory Disorders
lung cancer
malignancies
46
Obstructive Disorders
- most commonly occurs in 6 months to 5 yr age group.
- characterized by inflammation extending from vocal cords to bronchial lumina
CROUP
47
Obstructive Disorders
Cause:
* parainfluenza virus
* influenza A
* respiratory syncytial virus (RSV)
CROUP
48
Obstructive Disorders
Clinical manifestations:
* catarrhal symptoms
* rhinorrhea
* low-grade fever
* barking cough
* stridor
* nasal flaring
CROUP
49
Obstructive Disorders
TREATMENT & EVALUATION
* based on symptoms
* X-ray to rule out epiglottitis
* Current treatment: glucocorticoid, epinephrine (<1% require intubation
CROUP
50
Obstructive Disorders
Complication: bacterial tracheitis
CROUP
51
Obstructive Disorders
Most common in 2 – 6 year age group, but may also affect adults
Epiglottitis
52
Obstructive Disorders
Cause:
- Haemophilus influenzae type B
- Streptococcus pneumoniae
Epiglottitis
53
Obstructive Disorders
Clinical manifestations:
* sudden onset
* sore throat, dysphagia, drooling, fever
* “sniffing position”, muffled voice, anxious
* stridor, respiratory distress
Epiglottitis
54
Obstructive Disorders
Evaluation:
* based on symptoms
* X-ray of soft tissues of neck.
* Characteristic “thumbprint”
*
Epiglottitis
55
Obstructive Disorders
* Do not attempt to examine pt’s throat because it can put person into laryngospasm and can occlude airway
Epiglottitis
56
Obstructive Disorders
Prognosis:
* fatal
* death may occur in a few hours
Epiglottitis
57
Obstructive Disorders
Treatment: IV antibiotics; may required rapid intubation.
Epiglottitis
58
Obstructive Disorders
Highly contagious
Bronchiolitis
59
Obstructive Disorders
Etiology:
* respiratory syncytial virus (RSV)
* virus can stay on stethoscope for 18 hours
Bronchiolitis
60
Obstructive Disorders
Prevalence:
* 2 – 24 month age group
* November to February
Bronchiolitis
61
Obstructive Disorders
Pathogenesis
* Edema of submucosa, increase in mucus secretion
* Necrosis of bronchial epithelium
Bronchiolitis
62
Obstructive Disorders
Clinical manifestations
* Nasal congestion, mild conjunctivitis,
* Inspiratory crackles, expiratory wheezes
* Use of accessory muscles, (such as intercostal indrawing), nasal flaring, increased work of breathing
Bronchiolitis
63
Obstructive Disorders
Clinical manifestations
* Tachypnea (with resp rate 50 – 60 per min)
* Tachycardia, poor feeding
* Pallor, cyanosis, hypoxemia
* Episodes of apnea
Bronchiolitis
64
Obstructive Disorders
Evaluation & Treatment
* CXR, RSV screening
* Humidity, fluids, rest
* Infection control precautions
Bronchiolitis
65
Obstructive Disorders
Inflammation of the trachea and bronchi
BRONCHITIS
66
Obstructive Disorders
Etiology:
* influenza virus A or B, parainfluenza virus, respiratory syncytial virus (RSV); smoke or inhalation of chemical irritants
BRONCHITIS
67
Obstructive Disorders
Pathogenesis:
* Edema of mucous membranes
* Increased mucous production
* Loss of ciliary function
BRONCHITIS
68
Obstructive Disorders
Clinical manifestations
* Expiratory wheezing, dyspnea, malaise
* Cough (productive or nonproductive)
* Chest pain related to persistent coughing
BRONCHITIS
69
Obstructive Disorders
Evaluation & Treatment:
* based on clinical presentation, CXR
* Increase fluids, smoking cessation expectorants/antitussives, antibiotics not routinely prescribed
* People are at risk of reoccurring pulmonary infections
BRONCHITIS
70
```
Obstructive Disorders
Risk factors:
* Family history
* Allergen exposure
* Exposure to air pollution and cigarette smoke
* Urban residence
```
Asthma
71
Obstructive Disorders
Pathogenesis
* Hypersensitivity
* Release of inflammatory mediators
* Mucosal edema
* Increased mucus production
* Bronchospasm
Asthma
72
Obstructive Disorders
Clinical Manifestations
* Dyspnea, with increased respiratory effort
* Wheezing (inspiratory and expiratory)
* Prolonged expiration
* Cough – nonproductive during acute attack; productive with thick mucous as attack resolves
* Use of accessory muscles, respiratory distress with severe attacks
* May lead to respiratory failure
Asthma
73
Obstructive Disorders
Acute attacks: inhaled bronchodilators, oral corticosteroids, oxygen prn
Asthma
74
Obstructive Disorders
Chronic management: avoidance of allergens and triggers, patient education, anti-inflammatories (ie. inhaled corticosteroids), antileukotrienes. Airway inflammation may be still be present in some individuals, even though they are asymptomatic
Asthma
75
Obstructive Disorders
FOR ASTHMA PATIENTS
* give ____________ first, short acting bronchodialator
* give ____________ second, long acting cholinergic
ventolin
| atrovent
76
bronchospasm not reversed by usual measures.
Status asthmatics:
77
Narrowing of the bronchi and bronchioles because of abnormal contraction of the smooth muscles of the bronchial walls
Bronchospasm:
78
Obstructive Disorders
* Permanent damage
* Cannot be cured
* Person must live with symptoms
COPD
79
Obstructive Disorders
* Hypersecretion of mucus and chronic productive cough for 3 months a year for 2 consecutive years
* Increase in the size and number of mucous glands and goblet cells
* Airway obstruction caused by chronic infection and injury
Chronic Bronchitis
80
Obstructive Disorders
Risk factors
* cigarette smoking (90% of cases),
* 12 repeated airway infections,
* genetic predisposition
* inhalation of physical or chemical irritants
Chronic Bronchitis
81
Obstructive Disorders
Clinical Manifestations
* shortness of breath on exertion,
* excessive amounts of sputum
* chronic cough
* evidence of excess body fluids (edema, hypervolemia)
Chronic Bronchitis
82
Obstructive Disorders
Clinical Manifestations
* history of smoking.
* chills,
* malaise,
* muscle aches,
* fatigue
* "blue bloaters"
Chronic Bronchitis
83
Obstructive Disorders
Pharmacologic treatment
* use of inhaled short-acting β2 agonists and inhaled anticholinergic bronchodilators, cough suppressants, and antimicrobial agents for infections.
* Inhaled or oral corticosteroids may also be used in the treatment of some patients for acute exacerbations
Chronic Bronchitis
84
Obstructive Disorders
Treatment
* Low-dose oxygen therapy
* Mechanical ventilation may become necessary
* smoking cessation is essential
Chronic Bronchitis
85
Obstructive Disorders
* Loss of elastic recoil occurs from destruction of alveolar walls resulting in permanent enlargement of gas-exchange airways
* big and boggy alveoli
* air becomes trapped in alveoli
emphysema
86
Obstructive Disorders
deficiency of alpha1-antitripsin which protects against proteolytic enzymes that want to destroy lung tissue
primary emphysema
87
Obstructive Disorders
injury to lungs from inhaled toxins
secondary emphysema
88
Obstructive Disorders
Clinical manifestations
* barrel chested
* "pink puffers"
* tripod position
* thin and emaciated appearance
* high risk of pneumonia
emphysema
89
Obstructive Disorders
Treatment
* ventolin (bronchodilator)
* flovent (corticosteroid inhaler)
emphysema
90
Obstructive Disorders
* Dilation of the bronchi
* risk of rupture
* threat of infection as a result of rupture
* Saccular, cylindrical, fusiform
* Weakening of muscle and elastic fibers of bronchial wall
* Congenital or acquired
Bronchietasis
