Ventilation Disorders Flashcards
dead space
areas of the lungs that involve inhalation but no gas exchange happens
ventilation failure
alveolar cannot do effective gas exchange
-decreased respiratory rate, TV, increased dead space
hypoventilation
inadequate delivery of air to the alveoli, inadequate O2, CO2 is not removed
-hypercapnia (CO2>45)
hyperventilation
increased air entering the alveoli, decreased CO2 hypocapnia (CO2<35)
hypoxemia
deficient blood O2, low arterial O2 and Hb saturation
-measured by ABGs, O2 saturation
hypoxia
decreased O2 in tissues, doesn’t involve blood
-can be from hypoxemia or poor perfusion/circulatory hypoxia, or poor uptake of O2 by tissues (histotoxic hypoxia)
t/f: pneumothorax only affects people with existing lung disorders
false
pneumothorax
ruptured blister/pocket in the lungs
pneumothorax types
-primary: idiopathic, healthy people
-secondary: disease related (asthma, emphysema, Tb, risk factors)
-traumatic: penetrating injury (GSW, stabbing, impaling), open or closed
pneumothorax manifestations
tachycardia, decreased/absent breathing sounds on affected side, chest pain on affected side, dyspnea, asymmetric chest wall expansion!!!!
pneumothorax diagnosis
chest radiograph, ECG, ABGs
pleural effusion
accumulated fluid or pus in the pleural cavity from other disease processes
pleural effusion manifestations
vary by effusion size/cause: dyspnea, cough, inhalation pain, diminished breath sounds, dullness with percussion
pleural effusion diagnosis
testing on transudates, exudates, blood (hemothorax), pus (empyema)
pleural effusion treatment
treat underlying cause
tension pneumothorax
serious, life-threatening, CLOSED
-air enters during inspiration but can’t exit during expiration
-same side (ipsilateral) lung collapses, trachea/heart shift to opposite side
asthma
airway obstruction from inflammation and constriction
-increased airway reactivity to stimuli
nonallergic/intrinsic asthma
less common: exercise, stress, exposure to irritants
-non-atopic, usually adult onset
allergic/extrinsic asthma
inflammatory response from IgE’s as a response to specific antigens
-atopic, child-onset
process of allergic/extrinsic asthma
IgE mediated: B-cells>plasma cells>IgE release>mast cell and histamine release
-family history of allergy, attacks associated with seasons/environment
asthma manifestations
wheezing, tachypnea, dyspnea, coughing, chest tightness, sputum production, anxiety
severe asthma attacks
use of accessory muscles during respiration, intercostal muscles, inspiratory wheezing, tachypnea/tachycardia, PEFR<80
status asthmaticus
severe asthma that does not respond to bronchodilators
-life-threatening
asthma diagnosis
history, sputum test, pulmonary function tests, ABG, chest radiography
asthma treatment
prevention, drug therapy, desensitization, bronchodilators, corticosteroids, O2 therapy
COPD
bronchitis (B), emphysema (A)
-primarily from smoking
bronchitis (type B)
chronic inflammation/swelling of bronchial mucosa that causes scarring
-fibrosis of mucus membranes
-hyperplasia, hypertrophy of goblet cells
-increased bronchiole wall thickness
bronchitis diagnosis
repeated infections from mucus, inhalation of chemicals, genetics
-diagnosed symptomatically
-productive cough>3 months per 2 or more years
-non-reversible damage
-chest radiographs, pulmonary function tests, ABG tests, ECGs, physical exam for polycythemia, cyanosis
bronchitis manifestations
obesity, shortness of breath, excessive sputum, chronic cough, excess bodily fluids, pulmonary vasoconstriction (alveolar hypoxia), pulmonary hypertension, RVH (cor pulmonale) compensation
bronchitis “blue bloater”
hypoxemic patient with systemic edema from RHF, pursed lip breathing, gynecomastia, raised shoulders from trying to breathe
bronchitis treatment
block disease progression, optimal respiratory function, optimal activity levels, drug treatment, O2 therapy, quitting smoking
emphysema (type A)
destructive changes to the alveolar walls, abnormal enlargement of air sacs
-deficiency of a1 activity in lungs from smokers or genetic
emphysema process
proteolytic enzyme release>damaged alveoli>decreased surface area>airway collapse, destruction of elastic lung fibers
-smoking>elastase release>decreased or deficient a1 activity>destruction
centrilobular emphysema
respiratory bronchioles affected
paraseptal emphysema
alveolar ducts affected
panacinar emphysema
acinus affected
emphysema manifestations
cyanosis progression, dyspnea, thin body, shortness of breath, clubbing, barrel chest
emphysema diagnosis
history, findings, pulmonary function tests, radiographs, ABGs, ECGs
emphysema treatment
nutrition, drug therapy, O2, quitting smoking
emphysema “pink puffer”
thin appearance, near-normal PO2/PCO2 from compensation, accessory muscle use, O2 therapy, pursed lip breathing
bronchiectasis
recurrent pus infection/inflammation of bronchial walls leading to dilation
-destroyed bronchial walls, obliteration of small bronchioles
bronchiectasis manifestations
hemoptysis, fever, night sweats, crackles, rhonchi, halitosis, pallor, clubbing
bronchiectasis diagnosis
history, radiograph, pulmonary function tests, ABGs, tomography
bronchiectasis treatment
antibiotics, bronchodilators, chest percussion/postural drainage
cystic fibrosis
autosomal-recessive (aa) disorder of the exocrine glands secreting mucus
-obstructive disorder
-low survival age/rate
cystic fibrosis process
mutations in CFTR gene make thick respiratory tract secretions and grow bacteria
cystic fibrosis manifestations
productive cough, thick sputum, recurrent infections, bronchitis, pneumonia, bronchiectasis, RHF, exercise intolerance, clubbing, dyspnea, crackles, tachypnea, pancreas dysfunction
cystic fibrosis diagnosis
ABG measurements, pulmonary function tests, sputum cultures, chest radiography, genetic testing
cystic fibrosis treatment
bronchodilators, postural drainage, forced expiration, antibiotics, heart-lung transplant
restrictive pulmonary disorders
from restricted expansion of lungs from alterations in the pleura, chest wall, or NM function
-decreased TLC, VC, FRC, RV
-low PaO2, normal/low PaCO2 and alkalosis
fibrotic interstitial diseases
diffuse interstitial lung disease
-fibrosis, thickening of alveoli from an immune response following lung injury
occupational lung diseases
from inhalation of toxic gases/mass
-pneumoconiosis: lung disease from inorganic dust particles (coal-mining, lead-poisoning)
sarcoidosis
abnormal protein granulomas in the lung, immunologic
-symptoms: large lymph nodes, generalized systematic inflammation
hypersensitivity pneumonitis
type 3 hypersensitivity reaction, allergic alveolitis from toxins, usually in non-smokers
pulmonary embolism
3 risks for DVT, occludes BV in pulmonary circuit, blood clots travel to respiratory system from venous system, deathly
-treatment: supplemental O2, activity limitations, heparin, thrombolytics, embolectomy
pulmonary hypertension
from emphysema, COPD, increased arterial pressure>25
-primary (unknown), secondary (COPD)
-small pulmonary vessels thicken, fibrotic walls, muscle hypertrophy, hemorrhage, tissue necrosis
pulmonary hypertension manifestations
RHF, cor pulmonale, RV hypertrophy
pulmonary hypertension treatment
control underlying disease, can’t be resolved if chronic, lung transplant, vasodilators/diuretics, prostacyclin
ARDS
alveolar damage, pulmonary edema, bilateral infiltrates, hypoxemia
-causes: COVID, pneumonia, drug overdose, embolism, coagulation, surgery, sepsis, shock, trauma, near-drownings
-alveoli, lung collapse
ARDS diagnosis
ABGs, radiographs, blood/urine cultures, pulmonary function tests
treatment
doesn’t respond to O2 if lung collapses, antibiotics, bronchodilators, corticosteroids, diuretics, PEEPs
spirometry test
test for ARDS, atelectasis, post-op testing
-test is a deep, slow deep breath, SMI, slow inspiration hold
ARF
from ARDS, meds, NM weakness, chest wall deformities/trauma, lung disease
-manifestations: hypoxia, compensation, confusion, tremor, hypotension, tachypnea, tachycardia, unconsciousness
ARF diagnosis
ABGs, PaO2<60, PaCO2>50, chest radiography showing white areas
ARF treatment
airway opening, alveolar ventilation, mechanical ventilation, treatment of the underlying condition
