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Pathophysiology (NRSG 502) > Ventilation & Gas Exchange (Ch. 31)-- Term First > Flashcards

Ventilation & Gas Exchange (Ch. 31)-- Term First Flashcards

Exam 2

1
Q

Traumatic Pneumothorax

A

Chest Injury (penetrating or non-penetrating)

  • fractured or dislocated ribs
  • CPR
  • Central line insertion
  • Intubation
  • Positive pressure ventilation
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2
Q

Acquired Atelectasis

A

Adults

  • Airway obstruction
  • Lung compression– tumor, exudate, pneumothorax

risk factors– sedation, pain, narcotics, immobility

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3
Q

Atelectasis Clinical Manifestations

A

⇡ RR, ⇡ HR, dyspnea, cyanosis, hypoxemia, decreased chest expansion, absent breath sounds, intercostal retractions

Prevention– incentive spirometer, frequent position changes, ambulate, hydrate

Treatment– fix cause, supplemental O2

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4
Q

Shunt

A

Perfusion without ventilation (LOW V/Q)

  • Hypoxemia
  • Atelectasis
  • PNA
  • Asthma
  • COPD
    • Chronic bronchitis
    • Emphysema
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5
Q

Hypercapnic/Ventilation Failure

A

PaCO2 > 50 mmHg AND pH <7.30

Causes– ⇣ RR or WOB

  • Upper airway obstruction– infection, laryngospasm, tumors
  • Weakness or paralysis of respiratory muscles– brain injury, sedation, drug overdose (opioids), Guillen-Barre syndrome, Muscular Dystrophy, spinal cord injury
  • Chest wall injury– physiologic dead space

Leads to– Vasodilation (systemic circulation), Pulmonary blood vessel constriction

Diagnosis

  • ABG– elevated CO2
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6
Q

Chronic Bronchitis Clinical Manifestations

A
  • Cyanosis
  • Fluid retention
    • R-sided HF (cor pulmonale)
  • Productive cough
  • ⇣ RR
  • Crackles and wheezes
    • d/t mucus in the lungs
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7
Q

Inflammatory Mediators

A

Histamine, leukotrienes, prostaglandins → Bronchoconstriction

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8
Q

Transudate

A

Clear, thin fluid (hydrothorax), specific gravity <1.020

d/t– CHF, renal failure, nephrosis, liver failure, malignancies (cancer)

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9
Q

Emphysema Clinical Manifestations

A
  • Accessory muscle & pursed-lip breathing
    • ⇡ positive pressure
  • Barrel chest
    • d/t air trapping
  • ⇣ Breath sounds
  • ⇡ RR
  • Non-productive cough
  • NO cyanosis
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10
Q

Asthma Attack Triggers

A
  • RTIs
  • Exercise (EIB)
  • Drugs
    • ASA– ⇣ COX, ⇡ LOX → ⇡ Leukotrienes
    • Morphine– Histamine release
  • Emotional Upset
  • Bronchial irritants
    • Smoke
    • Toxins
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11
Q

Late Phase Response

A

Extrinsic/Allergic/Atopic Response

  • 2-8 hrs. after exposure
  • Mucosal edema, ⇡ secretion, ⇡ WBC, epithelial damage, bronchospasm
  • Lasts several days

Treatment– Corticosteroids (ICS)

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12
Q

Cystic Fibrosis Pathogenesis

A
  • Cl- unable to move into epithelial lumen of airway
    • Cl- remains w/i cell
    • Na+ & H2O move from airway into blood
      • Respiratory secretions thicken
  • ⇣ H2O in mucous membranes
    • Dehydration
    • Accumulation of mucus
      • Airway obstruction
      • Pancreatic & biliary duct dysfunction
        • Pancreatic enzyme deficiency
      • Vas deferens dysfunction
        • Azoospermia
  • Increased risk of pulmonary infection
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13
Q

High V/Q

A

High V, Low Q (100:1)

  • Dead air space
  • Low flow states
  • Pulmonary embolism (PE)
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14
Q

Hyperventilation

A

⇣ CO2 in the arterial blood → Hypocapnia/Hypocarbia → Respiratory Alkalosis

d/t– Panic attack, pain, ⇡ RR, hypoxemia

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15
Q

Respiratory Failure Manifestations

A
  • Inadequate gas exchange
  • V/Q mismatch
  • PaO2 < 60 mmHg or PaCO2 > 50 mmHg & pH <7.30 or BOTH
    • Severe Hypoxemia + Hypercapnia + Respiratory Acidosis
  • Post-Surgery
    • Atelectasis
    • PNA
    • Pulmonary edema
    • Pulmonary emboli → Respiratory failure
  • Smoking + lung Disease
  • Underlying disease/infection
    • Renal, cardiac, neurologic, or hepatic
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16
Q

Asthma Treatment

A

Limit exposure to allergens

Pharmacologic Agents

Immediate

  • Bronchodilator
    • Albuterol (SABA)
  • Anti-Inflammatory
    • Corticosteroid (ICS)

Long-Term

  • Mometasone (ICS)
  • Salmeterol (LABA)
  • Symbicort– Combination (LABA + ICS)
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17
Q

Pleural Effusion

A

Collection of fluid in the pleural cavity

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18
Q

Acute Lung Injury (ALI)

A

Sudden inflammation that starts at the lungs → Disruption of gas exchange at alveolar-capillary membrane

  • Hypoxemia
    • Less severe form
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19
Q

Exudate

A

Purulent, thick fluid, specific gravity >1.020

d/t– elevated LDH & protein, inflammatory cells

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20
Q

Hypoxemic/Oxygenation Failure

A

PaO2 < 60 mmHG d/t problem with O2 uptake

Causes– COPD, severe PNA, Atelectasis, ARDS, Pulmonary edema, V/Q mismatch (d/t shunt, dead air space…)

  • Decreased O2 to alveoli (d/t high altitude or hypoventilation)
  • Impaired diffusion of O2 from alveoli to blood (d/t V/Q mismatch or alveolar-capillary impairment)
    • Vasodilation (Systemic circulation)
  • Inadequate circulation through pulmonary capillaries (d/t pulmonary embolus or arteriovenous malformation)
    • Pulmonary blood vessels constrict
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21
Q

Tension Pneumothorax

A

Air stuck in pleural space (intrapleural pressure > atmospheric pressure)

Leads to–

  • compression atelectasis
  • trachea and sternum shift L
  • L lung shift
  • Vena cava compression
  • ⇣ venous return
  • ⇣ cardiac output
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22
Q

Dead Air Space

A

Ventilation without perfusion (HIGH V/Q)

  • Hypoxemia
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23
Q

Pneumothorax

A

Air in pleural space → ⇡ Pressure → Partial or complete lung collapse

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24
Q

Bronchial Asthma Types

A

Chronic inflammation of airway → airflow obstruction & airway hyperresponsiveness

  • Extrinsic/Allergic/Atopic
    • Type I IgE-mediated hypersensitivity reaction
    • Genetic component
  • Intrinsic/Non-allergic/Non-Atopic
    • no allergy component
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25
Pulmonary Embolism Risk Factors
**Virchow Triad** * **Venous stasis (slowing) & Venous endothelial injury** * Bed rest, hip or femur fracture, surgery, childbirth, MI, HF, spinal cord injury * **Hypercoagulability states** * Cancer * Pregnancy * HRT * Oral contraceptives
26
Types of Respiratory Failure
* **Hypoxemic--** Oxygenation Failure * (PaO2 \< 60 mmHg) * COPD * PNA * Atelectasis * Impaired diffusion * Pulmonary edema * ALI/ARDS * **Hypercapnic/Hypoxemic--** Ventilation & Oxygenation Failure * (PaO2 \< 60 mmHg, PaCO2 \> 50 mmHg & pH \<7.30) * Upper airway obstruction * Infection * Laryngospams * Weakness or paralysis of respiratory muscles * Brain injury * Overdose * Guillain-Barre * Muscular Dystrophy * Spinal Cord Injury * Chest wall injury Diagnosis-- **ABGs** (determine if hypoxemic, hypercapnia **or** **BOTH**)
27
Pneumothorax Clinical Manifestations
**Hypoxemia, ⇡ RR, absent breath sounds, dyspnea, chest asymmetry** Treatment-- Fix cause, supplement O2, **thoracentesis** (large needle aspiration) **Tension-- ⇡** HR, ⇣ cardiac output, shock, tracheal deviation (treat w/ **chest tube**)
28
Hypoxemia
Reduced oxygenation of **arterial blood** * **Always** leads to **reduced oxygenation** of cells in **tissues**
29
Pulmonary Embolism Clinical Manifestations
* **Small** emboli * **Asymptomatic** * Not usually * **Moderately-sized** emboli * **Rapid, shallow respirations** * **Pleuritic pain** * Cough * **Blood-streaked sputum** * **Massive** emboli * **Sudden collapse** * **Crushing substernal chest pain** * Can be confused w/ MI * Shock * **LOC** * Rapid, weak pulse * **Hypotension** * Distended neck veins **(JVD)** * **Cyanosis** * Fatal
30
Sympathetic Stimulation
Beta-adrenergic receptors → **Bronchodilation**
31
Pulmonary Embolism
Bloodborne substances lodged in pulmonary artery → Bloodflow obstructed **(High V/Q)** d/t-- Thrombus **(DVT) → Pulmonary circulation**, **Injected air (IV)**, **Fat mobilization** after long bone fracture (femur, humerus, pelvis), **Amniotic fluid entering maternal circulation** during childbirth
32
Hemothorax
**Blood** in pleural cavity d/t **lung puncture** (trauma) * Chest injury, chest surgery complications, malignancies, rupture of great vessel (aortic aneurysm) Treatment-- **Chest tube**
33
Cystic Fibrosis Clinical Manifestations
* Respiratory * **Accumulation of thick mucus** in bronchi * Impaired mucociliary clearance * **Lung infections** * **Bronchiectasis** * Mucus buildup in the lungs * **Chronic bronchitis/bronchiolitis** * Abnormal **pancreatic function** * **Steatorrhea** * Fatty stool * Diarrhea * **Abdominal pain** * **Malabsorption** * Malnutrition
34
Spontaneous Pneumothorax
**Bleb/Blister** ruptures **→ Air** flows from alveoli into **pleural space** **Primary** * Bleb @ top of lungs * Tall, thin people * Smokers **Secondary** * **Lung disease** * Asthma, TB, CF, COPD, lung CA * Potentially life threatening
35
Diffusion
Movement of **O2 and CO2** across the **alveolar-capillary membrane**
36
Gas Exchange
**O2** from air in alveoli diffuses **into blood** in pulmonary capillaries **CO2** moves from blood in pulmonary capillaries **into alveoli** **Location--** Alveolar-capillary membrane
37
Asthma Clinical Manifestations
* **Airways narrow** d/t * Bronchospasm * Bronchial mucosal edema * Mucus plugging * **Prolonged expiration** → Air trapping * Lung hyperinflation * **⇡ WOB** → ⇡ O2 demands * Dyspnea * Fatigue * ⇣ Alveolar ventilation → **Low V/Q** * Hypoxemia * Hypercapnia
38
Early Phase Response
**Extrinsic/Allergic/Atopic** Response * **5-30 mins.** after exposure * ⇡ Release of inflammatory mediators * Vasodilation, vascular damage, bronchospasm Treatment-- **Albuterol** (SABA)
39
Parasympathetic Stimulation
Cholinergic receptors → **Bronchoconstriction**
40
Atelectasis
**Incomplete expansion** of lung/alveoli d/t-- **Pleural effusion, Pneumothorax, loss of surfactant**
41
Pulmonary Embolism Treatment
**Prevention** is key * **DVT Prevention** * **Hospital** * Sequential Compression Devices **(SCDs)** * **Heparin** (SC) * 2X/day * **Outpatient** * **Warfarin** (PO) * **Lovenox** (SC) * Low molecular wt. heparin * **Multiple or large pulmonary emboli** * Thrombolytic therapy * Streptokinase * Anistreplace * Recombinant tissue plasminogen activators **(tPA)** * “clot buster” * **MI/Stroke**
42
Ventilation
Movement of **air** into the **lungs**
43
Emphysema Etiology
**⇣ Lung elasticity** & abnormal **enlargement of air spaces** → Alveolar wall & capillary bed destruction * ⇡ Serine elastase (Protease) release from neutrophils → Digestion of elastic fibers → **⇣ Alveolar recoil** * Lung hyperinflation → **⇡ Total lung capacity** d/t-- **Genetics, Smoking, Alpha 1 antitrypsin (AAT) (antiprotease enzyme) deficiency**
44
Cor Pulmonale
**Right Sided Heart Failure** d/t-- Primary Lung Disease, Pulmonary Hypertension, Chronic Bronchitis * ⇡ Pulmonary circulation pressures * Fluid retention * **⇡ Work of RV** * **Hypertrophy** → R sided HF
45
**Hypoxemia** Clinical Manifestations
**Acute:** Mild-- SANS activation * **⇡ HR,** * **⇡ RR** * **⇣ mental acuity** * **Vasoconstriction** * **Pale skin** * **Diaphoresis** Moderate/Severe-- Altered mental status * **Confusion** * **Stupor** * **Coma** **Chronic:** * **⇡ RR** * **Pulmonary vasoconstriction** * **Polycythemia (⇡ RBC)** * **Cyanosis** * **Clubbing**
46
Cystic Fibrosis
* Genetic * **Autosomal recessive** * Chronic respiratory disease * Exocrine glands in **epithelium of respiratory, GI, & reproductive tracts** * Pancreatic exocrine deficiency * **⇡ NaCl in sweat** * **Mutation** in cystic fibrosis transmembrane regulator **(CFTR)** * Chloride channel in airway epithelium * **Impermeable to chloride**
47
Hypoventilation
⇡ **CO2** in the **arterial blood → Hypercapnia**/Hypercarbia → **Respiratory Acidosis** d/t-- **⇣ RR**
48
**Hypoxemia** Etiology
Brain, lungs, and heart need O2 → **Compensatory mechanisms** activate ⇣ O2 → Anaerobic Metabolism → ⇡ Lactic Acid → **Metabolic Acidosis**
49
Empyema
**Infection** in pleural cavity d/t **exudate**
50
COPD Types
Chronic and recurrent obstruction of **expiratory** airflow * **Chronic Bronchitis** * **Chronic Emphysema**
51
ALI/ARDS Causes
* **Aspiration** * Near drowning * Gastric contents * Drugs & Toxins * Heroin * Free-base cocaine smoking * Inhaled gases * **Smoke, ammonia** * High O2 Concentrations * **Radiation** * Infections * **Sepsis** * Trauma & Shock * **Burns** * Fat embolism * **Chest trauma** * Disseminated Intravascular Coagulation **(DIC)** * Multiple blood transfusions
52
Types of Pneumothorax
* **Traumatic** * **Tension** * **Spontaneous**
53
Pulmonary Artery
**Deoxygenated** Blood
54
Acute Respiratory Distress Syndrome (ARDS) Clinical Manifestations
**Sudden inflammation** that starts at the lungs **→ Disruption of gas exchange** at alveolar-capillary membrane * Life-threatening **Hypoxemia** * **Refractory to supplemental O2 Therapy** * Diffuse **crackles** * **Dyspnea** * Severe, **sudden onset** * w/i 12-18 hrs. of insult * Hypoxia * **Cyanosis** * **Tachypnea** * ⇡ RR * **Tachycardia** * Diaphoresis * Sweating * **Pulmonary infiltrates** * White on x-ray * **Systemic response** * Multiple organ failure dysfunction syndrome **(MODS)** * **Renal, GI, CV, CNS**
55
Disorders of Lung Inflation
**Loss of negative pressure** in pleural cavity → Collapsed lung * **Pleural effusion** * **Pneumothorax** * **Atelectasis**
56
Hypoxia
Reduced oxygenation of **cells in tissues** * **Does not always** indicate **reduced oxygenation** of **arterial blood**
57
Pulmonary Hypertension Clinical Manifestations
⇡ Pulmonary artery pressure with **normal LV pressure** d/t-- Genetics, Venous HTN, Hypoxemia, Thrombotic/Embolic Disease, Pulmonary Fibrosis * **SOB** * **⇣ Exercise tolerance** * **R HF** * **Peripheral edema** * Legs/ankles * **Functional limitations** * ⇣ ability to perform ADLs ⇡ Pulmonary artery pressure **AND HF or Lung Disease** d/t-- COPD, HF, Sleep Apnea, PE, Interstitial Lung Disease * **Chronic Hypoxemia** * Pulmonary blood vessels constrict * **Resistance** to pulmonary **venous drainage** * Diastolic **dysfunction of LV** * Mitral/Aortic valve disorders * **Chronic thromboembolism**
58
Low V/Q
Low V, High Q (1:100) * **Shunt** * **Chronic bronchitis** * **Asthma**
59
Cystic Fibrosis Diagnosis & Treatment
Diagnosis-- * **Respiratory & GI manifestations** * **Family history** * **Newborn screening** * **+** = ⇡ immunoreactive trypsinogen * **Sweat chloride test** * 2X normal NaCl in sweat * **CFTR** functional testing & genetic analysis Treatment-- * Goal: **Slow progression** of secondary organ dysfunction * **Chronic lung infection** * **Antibiotics** * **Bronchodilators** * **Chest percussion** * Postural draining * **Pancreatic insufficiency** * **Pancreatic enzyme replacement** * Vitamin supplements
60
Perfusion
Movement of **blood** through **pulmonary circulation**
61
Pleural Effusion Clinical Manifestations
**Dyspnea, Hypoxemia** * ⇣ lung expansion on affected side * Dull to percussion * ⇣ breath sounds **Treatment--** antibiotics, thoracentesis (large needle aspiration), chest tube
62
Primary Atelectasis
Newborns * **Lack of surfactant** * Aspiration of amniotic fluids
63
Pleural Cavity
**Space** between **parietal pleura** and **visceral pleura**
64
**VQ Mismatch**/Inadequate Gas Exchange
**VQ ratio not 1:1** * Ventilation **(V)** * Perfusion/Blood Flow **(Q)**
65
ARDS Treatment
Goals-- * **Oxygenate lungs and vital organs** * Recognize & **treat underlying medical condition** * **Prevent further injury** and complications * Venous thromboembolism * Aspiration * Infection * Decrease risk for mortality Treatment-- **Intubation & Mechanical ventilation**
66
Pulmonary Hypertension
Abnormal **elevation of pressure** within pulmonary **arterial** circulation * **⇣ Size of lumen** in pulmonary arteries * Vasoconstriction → **Hypoxia** * **⇡ Inflow of blood** to pulmonary arteries * **Occlusion of outflow** of blood from pulmonary circulation * **⇡ Pressure in LV**
67
Very Low V/Q
Low V, Very High Q (1:1000) * **Atelectasis** * **ARDS** * **Pneumonia**
68
Atopic Asthma Etiology
Exaggerated **Type I IgE-mediated hypersensitivity** response to inflammatory mediators Leads to-- * **Bronchoconstriction** * Vascular permeability * ⇡ Mucus production * **Prolonged expiration** → Air trapping * Lung hyperinflation * ⇡ Pulmonary artery pressure
69
COPD Treatment
* **Smoking cessation** * Avoid bronchospasm triggers * **Pulmonary rehab** * ⇡ efficiency * ⇣ WOB * Prevent RTIs * Bronchodilators * **Albuterol** (SABA) * **Anticholinergics** * Ipratropium bromide * **O2 therapy** w/ significant hypoxemia (PaO2 \< 55 mmHg) * 1-2 L low-flow oxygen * Limit to stimulate breathing * Goal: PaO2 55-65 mmHg * Goal: SpO2 88-92%
70
Obstructive Airway Disorders
Limited **expiratory** airflow →Trapped air → **Flattened diaphragm** Low V/Q-- * **Bronchial Asthma** * **COPD** * **Cystic Fibrosis (CF)**
71
Cor Pulmonale Manifestations
* S/S **Primary Chronic Lung Disease--** Chronic Bronchitis * **Cyanosis** * **Polycythemia** * ⇡ RBCs * **⇣ SpO2** * Drowsiness * Altered Mental Status **(AMS)** * ⇡ CO2 * S/S R Sided HF * Venous congestion * **Peripheral edema** * **SOB** * **Productive cough** Management-- Treatment of lung disease & HF, **Low-flow O2 Therapy**
72
ALI/ARDS Pathophysiology
Pulmonary insult → **Inflammatory response** (neutrophils secrete proteases, cytokines, & ROS) ⇡ **Permeability** of alveolar-capillary membrane → **Fluid, plasma, proteins, and blood cells** **into interstitium** & alveoli **Loss of surfactant & damage** (Type I & Type II pneumocytes) → ⇣ Pulmonary compliance → **Lung collapse** Injury to alveolar epithelium → Disorganized repair → **Fibrosis** → Lungs stiffen (difficult to inflate, **⇡ WOB**) **⇣ Gas exchange** at alveolar-capillary membrane → **⇡ Intrapulmonary shunting** (find alveolus that has O2) → **⇣ V/Q Ratio** Hypoxemia refractory to supplemental O2 **→ Alveoli collapse**
73
Measures of blood oxygenation
Pulse Oximetry Arterial Blood Gas **(ABG)**
74
Chronic Bronchitis Etiology
Thick mucus hypersecretion → **Mucus plugs** → Gas trapped in distal portion of lungs * Lung hyperinflation * Chronic, productive cough * **Smoking** * ⇡ mucus production * ⇡ size and # of mucus glands
75
Pulmonary Veins
**Oxygenated** Blood

Pathophysiology (NRSG 502) (16 decks)

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