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Pathophysiology > Week 10: Respiratory System > Flashcards

Week 10: Respiratory System Flashcards

1
Q

Respiratory System: Purpose and General Function

*Transport of oxygen from air to _________
*Oxygen is necessary for __________ metabolism.

*Removal of _______________ from the blood
*Carbon dioxide is a waste product from _____________.

A

*Transport of oxygen from air to blood
*Oxygen is necessary for cellular metabolism.

*Removal of carbon dioxide from the blood
*Carbon dioxide is a waste product from metabolism.

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2
Q

Respiratory System:

-Two anatomical areas

Upper respiratory tract
* _______________

Lower respiratory tract
* ____________

A

Upper respiratory tract
* Resident flora

Lower respiratory tract
* Sterile

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3
Q

Upper Respiratory Tract includes

A

Nasal cavity
Nasopharynx
Palatine tonsils
Oropharynx
Larynx
Trachea

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4
Q

Nasal cavity
-Warming and moistening of _____
-Foreign material trapped by _________ secretions

A

-Warming and moistening of air
-Foreign material trapped by mucous secretions

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5
Q

Nasopharynx
-Pharyngeal ___________ in posterior wall

A

-Pharyngeal tonsils in posterior wall

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6
Q

Palatine tonsils
-_____________ tissue in posterior portion of the oral cavity

A

-Lymphoid tissue in posterior portion of the oral cavity

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7
Q

Oropharynx
-Common passage for _________________
-Epiglottis protects opening into larynx.
* Closes over glottis at swallowing to prevent _____________

A

-Common passage for air and food
-Epiglottis protects opening into larynx.
* Closes over glottis at swallowing to prevent aspiration

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8
Q

Trachea
-Lined by pseudostratified ciliated epithelium
-C-shaped rings of ____________

A

cartilage

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9
Q

Larynx
-Two pairs of __________________

A

vocal cords

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10
Q

Lower Respiratory Tract includes

_________________ (continuous branching)
-Trachea branches into:
* Right and left primary bronchi
* Secondary bronchi
* Bronchioles
* Terminal bronchioles
* Respiratory bronchioles
* Alveolar ducts
* ___________ —lined by simple squamous epithelium
and surfactant to reduce surface tension and
maintain inflation
>End point for inspired air
>Site of _____ exchange

A

Bronchial tree (continuous branching)
-Trachea branches into:
* Right and left primary bronchi
* Secondary bronchi
* Bronchioles
* Terminal bronchioles
* Respiratory bronchioles
* Alveolar ducts
* Alveoli—lined by simple squamous epithelium
and surfactant to reduce surface tension and
maintain inflation
>End point for inspired air
>Site of gas exchange

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11
Q

Ventilation

  • Process of ________________________
  • Airflow depends on pressure ______________ (Boyle’s law).
  • Air always moves from high-pressure area to low pressure area
A
  • Process of inspiration and expiration
  • Airflow depends on pressure gradient (Boyle’s law).
  • Air always moves from high-pressure area to low pressure area
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12
Q
  • Inspiration—air moves from atmosphere into _________
A

lungs

-Atmospheric pressure higher than pressure in alveoli

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13
Q
  • Expiration—air moves from lungs into ____________
A

atmosphere

  • Pressure in alveoli higher than in atmosphere
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14
Q

_____________ is the amount of air exchanged with quiet inspiration and expiration.

A

Tidal volume

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15
Q

Residual volume- Volume of air remaining in lungs after _____________________

A

maximum respiration

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16
Q

Vital capacity
-Maximal amount of air that can be moved in and out of the lungs with a ___________________ inspiration and expiration

A

single forced

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17
Q

Primary control centers for breathing
- Located in the ___________________

A

medulla and pons

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18
Q

_________________ detect changes in carbon dioxide level, hydrogen ion, and oxygen
levels in blood or cerebrospinal fluid (CSF)

A

Chemoreceptors

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19
Q

Central chemoreceptors
* Located in the ___________

Peripheral chemoreceptors
* Located in the ___________________

A

Central chemoreceptors
* Located in the medulla

Peripheral chemoreceptors
* Located in the carotid bodies

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20
Q

Hypercapnia
-__________________ levels in the blood increase.
-Carbon dioxide easily diffuses into ______.
* Lowers pH and stimulates respiratory center
* Increased rate and depth of respiration (hyperventilation)
* Causes _____________________—nervous system depression

A

-Carbon dioxide levels in the blood increase.
-Carbon dioxide easily diffuses into CSF.
* Lowers pH and stimulates respiratory center
* Increased rate and depth of respiration (hyperventilation)
* Causes respiratory acidosis—nervous system depression

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21
Q

Hypoxemia
-Marked decrease in _________
* Chemoreceptors respond.
* Imp. control mechanism in ind. w/ chronic lung disease—move to hypoxic drive

A

-Marked decrease in oxygen
* Chemoreceptors respond.
* Imp. control mechanism in ind. w/ chronic lung disease—move to hypoxic drive

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22
Q

Hypocapnia

-Caused by low ________________ concentration (low partial pressure of Co2) in blood
* May be caused by ____________
-Excessive amounts of carbon dioxide expired
* Causes respiratory __________

A

-Caused by low carbon dioxide concentration (low partial pressure of Co2) in blood
* May be caused by hyperventilation
-Excessive amounts of carbon dioxide expired
* Causes respiratory alkalosis

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23
Q

Factors Affecting Diffusion of Gases

-________________ gradient

-Thickness of the respiratory __________
[Fluid accumulation in alveoli or interstitial tissue impairs gas exchange]

-Total __________ area available for diffusion
[If part of alveolar wall is destroyed, surface area is reduced, so less exchange]

-________-perfusion ratio
[Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange]

A

-Partial pressure gradient

-Thickness of the respiratory membrane
[Fluid accumulation in alveoli or interstitial tissue impairs gas exchange]

-Total surface area available for diffusion
[If part of alveolar wall is destroyed, surface area is reduced, so less exchange]

-Ventilation-perfusion ratio
[Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange]

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24
Q

Oxygen
-About ____ of oxygen is dissolved in plasma.
-Most is bound (reversibly) to ___________
-Binding and release of oxygen to hemoglobin depend on:
* PO2, PCO2, temperature, plasma pH

A

-About 1% of oxygen is dissolved in plasma.
-Most is bound (reversibly) to hemoglobin.
-Binding and release of oxygen to hemoglobin depend on:
* PO2, PCO2, temperature, plasma pH

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25
Q

Carbon dioxide
-Waste product from ________________
-About 7% dissolved in _____
-About 20% reversibly bound to _______
-Most diffuses into _____ blood cells

A

-Waste product from cellular metabolism
-About 7% dissolved in plasma
-About 20% reversibly bound to hemoglobin
-Most diffuses into red blood cells

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26
Q

Spirometry—pulmonary function test (PFT)
- Test pulmonary __________ and __________ times

A
  • Test pulmonary volumes and airflow times
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27
Q

Arterial blood gas determination
-Checks oxygen, carbon dioxide, bicarbonate, _________

A

serum pH

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28
Q

_________ tolerance testing
-For patients with chronic pulmonary disease

A

Exercise

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28
Q

Oximetry
- Measures O2 _________

A

saturation

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29
Q

Radiography (Xray)
- Helpful in evaluating _______
- Evaluate infections

A

tumors

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30
Q

Bronchoscopy
- Perform _________
- Check site of lesion or bleeding.

A

biopsy.

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31
Q

Culture and sensitivity tests
- Sputum testing for presence of __________
- Determine antimicrobial sensitivity of pathogen

A

pathogens

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32
Q

General Manifestations of Respiratory Disease

Sneezing
- Reflex response to __________ in upper respiratory tract
* Assists in removing _________
* Associated with ___________ or foreign material

A

Sneezing
- Reflex response to irritation in upper respiratory tract
* Assists in removing irritant
* Associated with inflammation or foreign material

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33
Q

General Manifestations of Respiratory Disease

Coughing
- Irritation caused by ______________
- Inflammation or foreign material in _______ respiratory tract
- Caused by inhaled ________

A

Coughing
- Irritation caused by nasal discharge
- Inflammation or foreign material in lower respiratory tract
- Caused by inhaled irritants

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34
Q

General Manifestations of Respiratory Disease

Sputum

  • Yellowish-green, cloudy, thick mucus
  • Often indication of a ___________ infection
  • Rusty or dark-colored sputum
  • Usually sign of __________________
  • Very large amounts of purulent sputum with foul odor
  • May be associated with ______ectasis
A
  • Yellowish-green, cloudy, thick mucus
  • Often indication of a bacterial infection
  • Rusty or dark-colored sputum
  • Usually sign of pneumococcal pneumonia
  • Very large amounts of purulent sputum with foul odor
  • May be associated with bronchiectasis
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35
Q

General Manifestations of Respiratory Disease

Sputum cont.

-Thick, tenacious mucus
* ________ or _______________, blood-tinged sputum—may result from chronic cough; may also be sign of tumor or tuberculosis

  • Hemoptysis
  • Blood-tinged (bright red) frothy sputum, usually associated with pulmonary _____
A

-Thick, tenacious mucus
* Asthma or cystic fibrosis, blood-tinged sputum—may result from chronic cough; may also be sign of tumor or tuberculosis

  • Hemoptysis
  • Blood-tinged (bright red) frothy sputum, usually associated with pulmonary edema
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36
Q

General Manifestations of Respiratory Disease
Breathing patterns and characteristics

-Eupnea: * _______ rate

-Kussmaul respirations: * ______ _______ respirations—typical for acidosis; may follow
strenuous exercise

A

-Eupnea: * Normal rate

-Kussmaul respirations: * Deep rapid respirations—typical for acidosis; may follow
strenuous exercise

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37
Q

General Manifestations of Respiratory Disease
Breathing patterns and characteristics

-Labored respiration or prolonged inspiration or expiration
* Often associated with __________ of airways

-Wheezing or whistling sounds
* Indicate __________ in small airways

A

-Labored respiration or prolonged inspiration or expiration
* Often associated with obstruction of airways

-Wheezing or whistling sounds
* Indicate obstruction in small airways

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38
Q

General Manifestations of Respiratory Disease
Breathing patterns and characteristics

Stridor
* __________ crowing noise
* Usually indicates ______ airway obstruction

A

Stridor
* High-pitched crowing noise
* Usually indicates upper airway obstruction

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39
Q

Apnea is __________ of breathing

A

cessation

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40
Q

Breath sounds

  • Rales or Crackles
  • Light ______________ sounds, with serous secretions
  • Rhonchi
  • Deeper or harsher sounds from _________ mucus
  • Wheeze
  • Narrowing of airways causing ____________ sound
A
  • Rales or Crackles
  • Light bubbly or crackling sounds, with serous secretions
  • Rhonchi
  • Deeper or harsher sounds from thicker mucus
  • Wheeze
  • Narrowing of airways causing high pitch sound
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41
Q

Dyspnea

  • Subjective feeling of __________
  • May be caused by increased carbon dioxide or hypoxemia
  • Often noted on exertion, such as climbing stairs
A
  • Subjective feeling of discomfort
  • May be caused by increased carbon dioxide or hypoxemia
  • Often noted on exertion, such as climbing stairs
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42
Q

Severe dyspnea indicative of respiratory distress
- ________ of nostrils
- Use of accessory respiratory muscles
- Retraction of muscles between or above _____

A
  • Flaring of nostrils
  • Use of accessory respiratory muscles
  • Retraction of muscles between or above ribs
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43
Q

Orthopnea
- Occurs when ____________
- Usually caused by pulmonary congestion

A

lying down

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44
Q
  • Cyanosis
  • ______ ________ of skin and mucous membranes
  • Caused by large amounts of unoxygenated _________ in blood
A
  • Bluish coloring of skin and mucous membranes
  • Caused by large amounts of unoxygenated hemoglobin in blood
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45
Q

Pleural pain
- Results from________ __ _________ of parietal pleura

A

inflammation or infection

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46
Q
  • Hypoxemia—________ oxygen in blood
  • Hypercapnea—__________ carbon dioxide in blood
A
  • Hypoxemia—inadequate oxygen in blood
  • Hypercapnea—increased carbon dioxide in blood
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47
Q

Friction rub
- Soft sound produced as rough, inflamed, or _____ _______ move against each other

A
  • Soft sound produced as rough, inflamed, or scarred pleural move against each other
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48
Q

Clubbed digits
- Result from chronic ________ associated with respiratory or cardiovascular diseases
* Painless, firm, fibrotic ___________ at the end of the digit

A
  • Result from chronic hypoxia associated with respiratory or cardiovascular diseases
  • Painless, firm, fibrotic enlargement at the end of the digit
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49
Q

Upper Respiratory Tract Infections

Common cold (infectious rhinitis)
- ____ infection
- More than ____ possible causative agents
- Spread through respiratory droplets
- Hand-washing and respiratory hygiene important in prevention
- Symptomatic treatment
- Secondary bacterial infections may occur.
* Usually caused by streptococci
* _________ exudate; systemic signs, such as fever

A
  • Viral infection
  • More than 200 possible causative agents
  • Spread through respiratory droplets
  • Hand-washing and respiratory hygiene important in prevention
  • Symptomatic treatment
  • Secondary bacterial infections may occur.
  • Usually caused by streptococci
  • Purulent exudate; systemic signs, such as fever
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50
Q

Upper Respiratory Tract Infections

Sinusitis
- Usually ________ infection
- _________ for headache and pain
- Course of _________ often required to eradicate infection

A
  • Usually bacterial infection
  • Analgesics for headache and pain
  • Course of antibiotics often required to eradicate infection
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51
Q

Upper Respiratory Tract Infections

Laryngotracheobronchitis (croup)
- Common viral infection, particularly in _________
- Common causative organism- Parainfluenza viruses and __________
- Infection usually self-limited

A
  • Common viral infection, particularly in children
  • Common causative organism
  • Parainfluenza viruses and adenoviruses
  • Infection usually self-limited
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52
Q

Upper Respiratory Tract Infections

Epiglottitis
- Acute infection common in children ages _______ years
- Usually caused by Haemophilus influenza _________
- Rapid onset; fever and sore throat
- Drooling and difficulty swallowing, Heightened anxiety

  • Swelling of the ________ , supraglottic area, and epiglottis; May obstruct airway; Spasm of larynx common if area is touched with instruments
  • Treatment- Oxygen and antimicrobial therapy
A
  • Acute infection common in children ages 3 to 7 years
  • Usually caused by Haemophilus influenza type B
  • Rapid onset; fever and sore throat
  • Drooling and difficulty swallowing, Heightened anxiety
  • Swelling of the larynx, supraglottic area, and epiglottis; May obstruct airway; Spasm of larynx common if area is touched with instruments
  • Treatment- Oxygen and antimicrobial therapy
53
Q

Upper Respiratory Tract Infections

Three groups of influenza viruses
Type A _____________
types B and C

  • Viruses constantly mutate.
A

(most prevalent)

54
Q

Upper Respiratory Tract Infections: Influenza (Flu)

Sudden, acute onset with _____, marked ______, aching ____ in the body
- May also cause viral pneumonia
- Mild case of influenza may be complicated by secondary bacterial pneumonia.
- Commonly, deaths in flu epidemics result from pneumonia.

A

Sudden, acute onset with fever, marked fatigue, aching pain in the body
- May also cause viral pneumonia
- Mild case of influenza may be complicated by secondary bacterial pneumonia.
- Commonly, deaths in flu epidemics result from pneumonia.

55
Q

Upper Respiratory Tract Infections: Influenza (Flu) (Cont.)

-Treatment: Symptomatic and supportive
* Unless bacterial infection develops secondarily
-__________ drugs
* May reduce symptoms and duration
* Reduces risk to infect others

Prevention
- Respiratory _______!
- __________ is recommended for most individuals.

A

-Treatment: Symptomatic and supportive
* Unless bacterial infection develops secondarily
- Antiviral drugs
* May reduce symptoms and duration
* Reduces risk to infect others

Prevention
- Respiratory hygiene!
- Vaccination is recommended for most individuals.

56
Q

Type A H1N1 Influenza

-This virus contains genes from ____ , _____, , and human flu strains.
-Usually affects children and teens younger than ___ years
-Healthy young adults also at high risk

-High mortality rate caused by acute respiratory syndrome
>Pulmonary edema, Pneumonia, Requires ICU care

A

-This virus contains genes from pig, bird, and human flu strains.
-Usually affects children and teens younger than 20 years
-Healthy young adults also at high risk

-High mortality rate caused by acute respiratory syndrome
>Pulmonary edema, Pneumonia, Requires ICU care

57
Q

Scarlet Fever

  • Caused by group A β-hemolytic ___________ (S. pyogenes)

Symptoms
- Typical “_________” tongue
- Fever, sore throat
- Chills, vomiting, abdominal pain, malaise

Treatment- _________

A
  • Caused by group A β-hemolytic Streptococcus (S. pyogenes)

Symptoms
- Typical “strawberry” tongue
- Fever, sore throat
- Chills, vomiting, abdominal pain, malaise

Treatment- Antibiotics

58
Q

Lower Respiratory Tract Infections: Bronchiolitis

  • Caused by the __________________
  • Transmitted by oral droplet
  • Virus causes _______, inflammation in small bronchi and bronchioles

Signs
- Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise

Treatment- Supportive and symptomatic

A
  • Caused by the respiratory syncytial virus (RSV)
  • Transmitted by oral droplet
  • Virus causes necrosis, inflammation in small bronchi and bronchioles

Signs
- Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise

Treatment- Supportive and symptomatic

59
Q

Lower Respiratory Tract Infections: Pneumonia
- Classification of pneumonias based on:

  • __________ agent
  • Viral, bacterial, fungal
  • Anatomical __________ of infection
  • Throughout both lungs, or consolidated in one lobe
  • Pathophysiological _______
  • Changes in interstitial tissue, alveolar septae, alveoli
  • Epidemiological data
  • Nosocomial (hospital-acquired)
  • Community-acquired
A
  • Causative agent
  • Viral, bacterial, fungal
  • Anatomical location of infection
  • Throughout both lungs, or consolidated in one lobe
  • Pathophysiological changes
  • Changes in interstitial tissue, alveolar septae, alveoli
  • Epidemiological data
  • Nosocomial (hospital-acquired)
  • Community-acquired
60
Q

Lobar Pneumonia

  • __________ pneumonia
  • Community-based, often in healthy young adults
  • Usually caused by ____________ pneumoniae
  • Infection localized in one or more ______
  • Inflammation and vascular congestion—exudate forms in the alveoli
  • Exudate contains fibrin and forms a consolidated mass
  • Exudate produces rusty sputum
  • Adjacent pleurae frequently involved
    -Infection may spread to pleural cavity—empyema

Manifestations
- Sudden onset
- Systemic signs
* High fever with chills, fatigue, leukocytosis
- Dyspnea, tachypnea, tachycardia
- Pleural pain
- Rales
- Productive cough
* Typical rusty-colored sputum
- Confusion and disorientation

A
  • Bacterial pneumonia
  • Community-based, often in healthy young adults
  • Usually caused by Streptococcus pneumoniae
  • Infection localized in one or more lobes.
  • Inflammation and vascular congestion—exudate forms in the alveoli
  • Exudate contains fibrin and forms a consolidated mass
  • Exudate produces rusty sputum
  • Adjacent pleurae frequently involved
    -Infection may spread to pleural cavity—empyema

Manifestations
- Sudden onset
- Systemic signs
* High fever with chills, fatigue, leukocytosis
- Dyspnea, tachypnea, tachycardia
- Pleural pain
- Rales
- Productive cough
* Typical rusty-colored sputum
- Confusion and disorientation

61
Q

Bronchopneumonia
-Diffuse pattern of infection in both lungs
- Several species of microorganisms may be the cause.
- Inflammatory _______ forms in alveoli
- Onset tends to be insidious
- Moderate fever, cough, rales
- Productive cough with ________ sputum—usually yellow or green
- ____________ treatment

A

-Diffuse pattern of infection in both lungs
- Several species of microorganisms may be the cause.
- Inflammatory exudate forms in alveoli
- Onset tends to be insidious
- Moderate fever, cough, rales
- Productive cough with purulent sputum—usually yellow or green
- Antibacterial treatment

62
Q

Legionnaires’ Disease
-Caused by Legionella pneumophila
- Thrives in __________ environments
- Often ___________- infection
- Difficult to identify—requires special culture medium
Untreated infections
- Cause severe congestion and consolidation
- Necrosis in the lung
- Possibly _____

A

-Caused by Legionella pneumophila
- Thrives in warm, moist environments
- Often nosocomial infection
- Difficult to identify—requires special culture medium
Untreated infections
- Cause severe congestion and consolidation
- Necrosis in the lung
- Possibly fatal

63
Q

Primary Atypical Pneumonia
- M____________ pneumoniae—bacterial
- Common in older children and young adults
- Transmitted by aerosol
- Frequent cough, ________ therapy
- Viral form caused by influenza A or B, adenoviruses, RSV
- Unproductive cough, hoarseness, sore throat, headache, mild fever, malaise
- Infection varies greatly in severity.
- Infection is usually self-limiting.

A
  • Mycoplasma pneumoniae—bacterial
  • Common in older children and young adults
  • Transmitted by aerosol
  • Frequent cough, antibiotic therapy
  • Viral form caused by influenza A or B, adenoviruses, RSV
  • Unproductive cough, hoarseness, sore throat, headache, mild fever, malaise
  • Infection varies greatly in severity.
  • Infection is usually self-limiting.
64
Q

Severe Acute Respiratory Syndrome (SARS)

-Acute respiratory infection
- Causative microbe—SARS-associated ________
- Transmission by respiratory droplets—close contact

First signs
* Fever, headache, myalgia, chills, anorexia, possibly diarrhea

Later signs
* Effect on _______ evident—dry cough, marked dyspnea; areas of interstitial congestion, hypoxia; __________________ may be required.

A

-Acute respiratory infection
- Causative microbe—SARS-associated coronavirus
- Transmission by respiratory droplets—close contact

First signs
* Fever, headache, myalgia, chills, anorexia, possibly diarrhea

Later signs
* Effect on lungs evident—dry cough, marked dyspnea; areas of interstitial congestion, hypoxia; mechanical ventilation may be required.

65
Q

Severe Acute Respiratory Syndrome (SARS) (Cont.)

Treatment
- Antivirals, glucocorticoids
- High ________ rate

Risk factors (monitored to prevent outbreaks)
* Travel to endemic or epidemic area
* Close contact with such a traveler
- Presence of a cluster of undiagnosed ________________ cases
- Employment involving close contact with the virus
* Active cases quarantined until clear of infection

A
  • Antivirals, glucocorticoids
  • High fatality rate

Risk factors (monitored to prevent outbreaks)
* Travel to endemic or epidemic area
* Close contact with such a traveler
- Presence of a cluster of undiagnosed atypical pneumonia cases
- Employment involving close contact with the virus
* Active cases quarantined until clear of infection

66
Q

Tuberculosis

Cause
- ____________ tuberculosis transmitted by oral droplets from persons w/ active infection

  • Occurs more frequently with:
  • People living in ________ conditions
  • ______deficiency
  • Malnutrition
  • Alcoholism
  • Conditions of ____
  • _________ disease
  • HIV infection
A

Cause
- Mycobacterium tuberculosis transmitted by oral droplets from persons w/ active infection

  • Occurs more frequently with:
  • People living in crowded conditions
  • Immunodeficiency
  • Malnutrition
  • Alcoholism
  • Conditions of war
  • Chronic disease
  • HIV infection
67
Q

Tuberculosis (Cont.)
- Somewhat resistant to drying and many _________
- Can survive in dried sputum for weeks
- Destroyed by __________ light, heat, alcohol, glutaraldehyde, formaldehyde
- Normal ________ response does not occur
- Cell-mediated immunity normally protection
- Primarily affects _____; other organs may also be invaded

A
  • Somewhat resistant to drying and many disinfectants
  • Can survive in dried sputum for weeks
  • Destroyed by ultraviolet light, heat, alcohol, glutaraldehyde, formaldehyde
  • Normal neutrophil response does not occur
  • Cell-mediated immunity normally protection
  • Primarily affects lungs; other organs may also be invaded
68
Q

Tuberculosis

Primary infection
- When organism first enters the lungs
* Engulfed by __________—local inflammation

  • If cell-mediated immunity is inadequate:
    -Mycobacteria reproduce and begin to destroy _____________
  • This form of disease is contagious!
A
  • When organism first enters the lungs
  • Engulfed by macrophages—local inflammation
  • If cell-mediated immunity is inadequate:
    -Mycobacteria reproduce and begin to destroy lung tissue.
  • This form of disease is contagious!
69
Q

Tuberculosis (Cont.)
- If cell-mediated immunity is adequate:
- Some bacilli migrate to _____________ —granuloma—formation of tubercle (contains live bacilli)—walled off and calcifying
- Tubercle may be visible on chest radiograph.
- Bacilli may remain viable in a ______________ for years.
- Individual’s resistance and immune responses high, bacilli remain walled off

  • Primary or latent infection—individual has been exposed and infected, but does not have disease and is asymptomatic
  • Individual_______ transmit disease
A
  • If cell-mediated immunity is adequate:
  • Some bacilli migrate to lymph nodes—granuloma—formation of tubercle (contains live bacilli)—walled off and calcifying
  • Tubercle may be visible on chest radiograph.
  • Bacilli may remain viable in a dormant stage for years.
  • Individual’s resistance and immune responses high, bacilli remain walled off
  • Primary or latent infection—individual has been exposed and infected, but does not have disease and is asymptomatic
  • Individual cannot transmit disease
70
Q

Tuberculosis (Cont.)

Secondary or re-infection with TB
- Occurs when client’s____________________ is impaired because of:
* Stress
* Malnutrition
* HIV infection
* Age
- Mycobacteria begin to reproduce and infect lung.
- Active TB, which can be spread to others!

A

cell-mediated immunity

71
Q

Miliary or extrapulmonary tuberculosis

______ progressive form more common in children < 5 years
* Early dissemination to other ________
* If lesions are not found in the lungs, this is not ___________
* Common symptoms include weight loss, failure to thrive, and other infections such as measles.

A

Rapidly progressive form more common in children < 5 years
* Early dissemination to other tissues
* If lesions are not found in the lungs, this is not contagious.
* Common symptoms include weight loss, failure to thrive, and other infections such as measles.

72
Q

Tuberculosis (Cont.)

Active TB (primary or secondary)
- Organisms multiply, forming large areas of ________
* Cause large open areas in lung—cavitation
- Cavitation promotes spread into other parts of lung.
* Infection may spread into pleural cavity.
- Cough, positive sputum, radiograph showing cavitation
- Disease in this form is highly infectious when there is close personal contact over a period of time.

A

Active TB (primary or secondary)
- Organisms multiply, forming large areas of necrosis.
* Cause large open areas in lung—cavitation
- Cavitation promotes spread into other parts of lung.
* Infection may spread into pleural cavity.
- Cough, positive sputum, radiograph showing cavitation
- Disease in this form is highly infectious when there is close personal contact over a period of time.

73
Q

Tuberculosis (Cont.)

Diagnostic tests
- First exposure or primary infection
* Indicated by positive________ (skin) test results

  • Active infections
  • Acid-fast sputum test
  • Chest radiograph
  • Sputum culture and sensitivity

Treatment
- Long-term treatment with a combination of drugs
- Length of treatment varies from 6 to 12 months.

A

tuberculin

74
Q

Tuberculosis (Cont.)

-Effective treatment requires monitoring and follow-up and is expensive.

TB is becoming an increasingly serious problem because of:
- Homelessness and _________ in shelters
- _____ infection
- Lack of health care
- Multidrug __________ TB

A
  • Homelessness and crowding in shelters
  • HIV infection
  • Lack of health care
  • Multidrug resistant TB
75
Q

Histoplasmosis

________ infection
- Caused by Histoplasma capsulatum
* Spores can be inhaled on dust particles.
- Common opportunistic infection
- First stage often asymptomatic

Second stage
- Granuloma formation and ________
- Cough, fatigue, fever, night sweats

Treatment—__________ agents

A

Fungal infection
- Caused by Histoplasma capsulatum
* Spores can be inhaled on dust particles.
- Common opportunistic infection
- First stage often asymptomatic

Second stage
- Granuloma formation and necrosis
- Cough, fatigue, fever, night sweats

Treatment—antifungal agents

76
Q

Anthrax

Bacterial infection by __________ bacilli
-Inhalation anthrax
- _______ symptoms
- Severe acute respiratory distress
-Shock caused by release of toxins
- High ______ rates

Treatment with antimicrobial agent ciprofloxacin
-Animal vaccine available
* Recommended for people working with the organism or
in other professions that might cause exposure

A

Bacterial infection by gram-positive bacilli
-Inhalation anthrax
- Flulike symptoms
- Severe acute respiratory distress
-Shock caused by release of toxins
- High fatality rates

Treatment with antimicrobial agent ciprofloxacin
-Animal vaccine available
* Recommended for people working with the organism or
in other professions that might cause exposure

77
Q

Cystic Fibrosis

Inherited (genetic) disorder
- Gene located on chromosome ___
- Tenacious mucus from exocrine glands
-Primary effects seen in lungs and _________

Lungs
-Mucus obstructs airflow in bronchioles and small bronchi.
-Permanent damage to bronchial walls
-Infections are common.
* Commonly caused by Pseudomonas aeruginosa and Staphylococcus aureus

A

Inherited (genetic) disorder
- Gene located on chromosome 7
- Tenacious mucus from exocrine glands
-Primary effects seen in lungs and pancreas

Lungs
-Mucus obstructs airflow in bronchioles and small bronchi.
-Permanent damage to bronchial walls
-Infections are common.
* Commonly caused by Pseudomonas aeruginosa and Staphylococcus aureus

78
Q

Cystic Fibrosis (Cont.)

Digestive tract
- Meconium ileus in newborns
- Blockage of pancreatic ducts
- Obstruction of _____ ducts
- Salivary glands often mildly affected

Reproductive tract
- Obstruction of vas deferens (male)
- Obstruction of _______ (female)

Sweat glands- Sweat has high _____________ content.

A

Digestive tract
- Meconium ileus in newborns
- Blockage of pancreatic ducts
- Obstruction of bile ducts
- Salivary glands often mildly affected

Reproductive tract
- Obstruction of vas deferens (male)
- Obstruction of cervix (female)

Sweat glands- Sweat has high sodium chloride content.

79
Q

Cystic Fibrosis (Cont.)

Signs and symptoms
Meconium ileus may occur at birth.
-_______ skin * May lead to performing sweat test and diagnosis of cystic fibrosis

Signs of _________
* Steatorrhea, abdominal distention

Chronic cough and frequent respiratory infections
* Tend to increase over time

Failure to meet normal _______ milestones

A

Signs and symptoms
Meconium ileus may occur at birth.
-Salty skin * May lead to performing sweat test and diagnosis of cystic fibrosis

Signs of malabsorption
* Steatorrhea, abdominal distention

Chronic cough and frequent respiratory infections
* Tend to increase over time

Failure to meet normal growth milestones

80
Q

Cystic Fibrosis (Cont.)

Diagnosis
-_______ testing
-Sweat test
-Testing of stool
-Radiography, pulmonary function tests
-Blood gas analysis

Treatment
-Interdisciplinary approach
* Replacement therapy and well-balanced _____
* ______ physiotherapy

A

Diagnosis
-Genetic testing
-Sweat test
-Testing of stool
-Radiography, pulmonary function tests
-Blood gas analysis

Treatment
-Interdisciplinary approach
* Replacement therapy and well-balanced diet
* Chest physiotherapy

81
Q

Lung Cancer

-About 90% of cases are related to __________

___________ carcinoma
-Most common type of primary malignant lung tumor
-Arises from bronchial epithelium

Squamous cell carcinoma
- Usually develops from __________ lining of a bronchus

Adenocarcinomas and bronchoalveolar cell carcinomas
-Usually found on periphery of ______

A

-About 90% of cases are related to smoking.

Bronchogenic carcinoma
-Most common type of primary malignant lun tumor
-Arises from bronchial epithelium

Squamous cell carcinoma
- Usually develops from epithelial lining of a bronchus

Adenocarcinomas and bronchoalveolar cell carcinomas
-Usually found on periphery of lung

82
Q

Lung tumor effects

-Obstruction of ________ into a bronchus
* Causes abnormal breath sounds and dyspnea
-Inflammation and bleeding surrounding the tumor
* Cough, hemoptysis, and secondary infections
- Pleural effusion, hemothorax, pneumothorax
- Paraneoplastic syndrome occurs when tumor cell secretes ________________
- Usual systemic effects of cancer

A

-Obstruction of airflow into a bronchus
* Causes abnormal breath sounds and dyspnea
-Inflammation and bleeding surrounding the tumor
* Cough, hemoptysis, and secondary infections
- Pleural effusion, hemothorax, pneumothorax
- Paraneoplastic syndrome
* Occurs wen tumor cell secretes hormones or hormonelike substances
- Usual systemic effects of cancer

83
Q

Lung Cancer (Cont.)

Early signs
- Persistent productive cough
- Detection on radiograph
- Hemoptysis
- Pleural involvement
- Chest pain
- Hoarseness, facial or arm edema, headache, dysphagia, or atelectasis

Systemic signs
- ___________, _________, __________

A

Early signs
- Persistent productive cough
- Detection on radiograph
- Hemoptysis
- Pleural involvement
- Chest pain
- Hoarseness, facial or arm edema, headache, dysphagia, or atelectasis

Systemic signs
- Weight loss, anemia, fatigue

84
Q

Paraneoplastic syndrome
-Indicated by signs of an _______________
* Related to the specific _________ secreted

A

Paraneoplastic syndrome
-Indicated by signs of an endocrine disorder
* Related to the specific hormone secreted

85
Q

Lung cancer

Signs of metastases
- _____ pain
- _________ deficits, motor deficits

A

Signs of metastases
-Bone pain
-Cognitive deficits, motor deficits

86
Q

Lung Cancer (Cont.)

Diagnostic tests
-Specialized helical CT scans and ____
- _______ radiography
-Bronchoscopy
-Biopsy and mediastinoscopy

Treatment
-Surgical resection or lobectomy
-Chemotherapy and _________
-Photodynamic therapy

A

Diagnostic tests
-Specialized helical CT scans and MRI
-Chest radiography
-Bronchoscopy
-Biopsy and mediastinoscopy

Treatment
-Surgical resection or lobectomy
-Chemotherapy and radiation
-Photodynamic therapy

87
Q

Aspiration

-Passage of food, fluid, emesis, other foreign material into _________&__________
- Common problem in young children or ppl ________________ when eating or drinking

Result may be:

_______________
* Aspirate is a solid object.

Inflammation and swelling
* Aspirate is an irritating liquid.

Predisposition to ______________

A

-Passage of food, fluid, emesis, other foreign material into trachea and lungs
- Common problem in young children or ppl laying down when eating or drinking

Result may be:

Obstruction
* Aspirate is a solid object.

Inflammation and swelling
* Aspirate is an irritating liquid.

Predisposition to pneumonia

88
Q

Aspiration (Cont.)
Potential complications

Aspiration pneumonia
* Inflammation—gas ____________ is impaired.

Respiratory distress syndrome
* May develop if ____________ is widespread

Pulmonary __________
* May develop if microbes are in aspirate

Systemic effects
* When aspirated materials (solvents) are absorbed into blood

A

Aspiration pneumonia
* Inflammation—gas diffusion is impaired.

Respiratory distress syndrome
* May develop if inflammation is widespread

Pulmonary abscess
* May develop if microbes are in aspirate

Systemic effects
* When aspirated materials (solvents) are absorbed into blood

89
Q

Aspiration (Cont.)

Signs and symptoms
- Coughing and _________ with dyspnea
- Loss of ______ if total obstruction
- Stridor and hoarseness * Characteristic of upper airway obstruction
- Wheezing * Aspiration of _________
- Tachycardia and tachypnea
- Nasal flaring, chest retractions, hypoxia * ________ respiratory distress
- Cardiac or respiratory arrest

A
  • Coughing and choking with dyspnea
  • Loss of voice if total obstruction
  • Stridor and hoarseness * Characteristic of upper airway obstruction
  • Wheezing * Aspiration of liquids
  • Tachycardia and tachypnea
  • Nasal flaring, chest retractions, hypoxia * severe respiratory distress
  • Cardiac or respiratory arrest
90
Q

Obstructive Sleep Apnea

-Result of _____________ tissue collapse during sleep
-Leads to repeated and momentary ___________ of breathing
-Men are affected more often than women.
- Obesity and ________ are common predisposing factors.

Treatment
-Continuous positive airway pressure pump (_____________)
-Oral appliances that reduce collapse of pharyngeal tissue

A

-Result of pharyngeal tissue collapse during sleep
-Leads to repeated and momentary cessation of breathing
-Men are affected more often than women.
- Obesity and aging are common predisposing factors.

Treatment
-Continuous positive airway pressure pump (CPAP machine)
-Oral appliances that reduce collapse of pharyngeal tissue

91
Q

Asthma
- ____________ obstruction
- Occurs in persons with hypersensitive or hyperresponsive __________
- May occur in childhood or have an adult onset
- Often family history of _________ conditions

A

Asthma
- Bronchial obstruction
- Occurs in persons with hypersensitive or hyperresponsive airways
- May occur in childhood or have an adult onset
- Often family history of allergic conditions

92
Q

Extrinsic asthma
-Acute episodes triggered by _______ ____ ______________ reactions

Intrinsic asthma
-Onset during ______________
-Hyperresponsive tissue in airway initiates attack.
-Stimuli include:
* Respiratory infections
* Stress
* Exposure to cold
* Inhalation of irritants
* Exercise
* Drugs

A

Extrinsic asthma
-Acute episodes triggered by type I hypersensitivity reactions

Intrinsic asthma
-Onset during adulthood
-Hyperresponsive tissue in airway initiates attack.
-Stimuli include:
* Respiratory infections
* Stress
* Exposure to cold
* Inhalation of irritants
* Exercise
* Drugs

93
Q

Asthma (Cont.)

-Pathophysiological changes of _______________________
-Inflammation of the mucosa with ________
- Bronchoconstriction * Caused by contraction of smooth muscle
-Increased secretion of thick mucus * In airways
- Changes create ____________ airways, partial or total.

A

-Pathophysiological changes of bronchi and bronchioles
-Inflammation of the mucosa with edema
- Bronchoconstriction * Caused by contraction of smooth muscle
-Increased secretion of thick mucus * In airways
- Changes create obstructed airways, partial or total.

94
Q

Asthma:
Signs and Symptoms

-Cough, marked dyspnea, tight feeling in chest
- Wheezing
- ______ and labored breathing
-Expulsion of thick or sticky ______
-Tachycardia
- Hypoxia

  • Respiratory alkalosis- Initially caused by ____________
  • Respiratory acidosis- Caused by ______________
  • Severe respiratory distress
  • Hypoventilation leads to hypoxemia and respiratory acidosis.
    -Respiratory failure
    -Indicated by decreasing responsiveness, cyanosis
A

-Cough, marked dyspnea, tight feeling in chest
- Wheezing
- Rapid and labored breathing
-Expulsion of thick or sticky mucus
-Tachycardia
- Hypoxia

  • Respiratory alkalosis- Initially caused by hyperventilation
  • Respiratory acidosis- Caused by air trapping
  • Severe respiratory distress
  • Hypoventilation leads to hypoxemia and respiratory acidosis.
    -Respiratory failure
    -Indicated by decreasing responsiveness, cyanosis
95
Q

_____________________
- Persistent severe attack of asthma
* Does not respond to usual therapy
* Medical emergency!
* May be fatal because of severe hypoxia and acidosis

A

Status asthmaticus

96
Q

Asthma: Treatment

General measures
- ______________ for allergic reactions
- Avoidance of triggering factors
-Good _____________ of environment
- Swimming and walking
-Use of maintenance _________ or drugs

Measures for acute attacks
-Controlled breathing techniques
-Inhalers * Bronchodilators
-________________

A
  • Skin tests for allergic reactions
  • Avoidance of triggering factors
    -Good ventilation of environment
  • Swimming and walking
    -Use of maintenance inhalers or drugs

Measures for acute attacks
-Controlled breathing techniques
-Inhalers * Bronchodilators
-Glucocorticoids

97
Q

Asthma: Treatment (Cont.)

Measures for status asthmaticus
- Hospital care if no response to ______________

Prophylaxis and treatment for chronic asthma
- Leukotriene receptor antagonists * Block inflammatory resp. in presence of stimulus
* Not effective for treatment of acute attacks
- Cromolyn sodium
* Prophylactic medication
* Inhalation on a _______ basis
* Useful for athletes and sports enthusiasts
* No value during an acute attack

A

Measures for status asthmaticus
- Hospital care if no response to bronchodilator

Prophylaxis and treatment for chronic asthma
- Leukotriene receptor antagonists * Block inflammatory resp. in presence of stimulus
* Not effective for treatment of acute attacks
- Cromolyn sodium
* Prophylactic medication
* Inhalation on a daily basis
* Useful for athletes and sports enthusiasts
* No value during an acute attack

98
Q

Chronic Obstructive Pulmonary Disease

Group of ________ respiratory disorders
- Causes irreversible and progressive damage to ______
- Debilitating conditions that may affect individual’s ability to work
- May lead to the development of cor pulmonale
- Respiratory ________ may occur.

A

Group of chronic respiratory disorders
- Causes irreversible and progressive damage to lungs
- Debilitating conditions that may affect individual’s ability to work
- May lead to the development of cor pulmonale
- Respiratory failure may occur.

99
Q

Chronic Obstructive Pulmonary Disease: Emphysema

-Destruction of alveolar walls and septae > Leads to large, permanently inflated alveolar _____________
-Classified by specific __________ of changes

Contributing factors
- ___________ deficiency or tendency
-Cigarette smoking
- Pathogenic ____________

A

-Destruction of alveolar walls and septae > Leads to large, permanently inflated alveolar air spaces
-Classified by specific location of changes

Contributing factors
- Genetic deficiency or tendency
-Cigarette smoking
- Pathogenic bacteria

100
Q

Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)

Breakdown of alveolar wall results in:
- Loss of surface area for gas ___________
- Loss of pulmonary ___________
- Loss of elastic ______
- Altered ventilation-perfusion ratio
- Decreased support for other structures

Fibrosis
- ___________ airways
- ___________ walls
- Interference with passive expiratory airflow

A

Breakdown of alveolar wall results in:
- Loss of surface area for gas exchange
- Loss of pulmonary capillaries
- Loss of elastic fibers
- Altered ventilation-perfusion ratio
- Decreased support for other structures

Fibrosis
- Narrowed airways
- Weakened walls
- Interference with passive expiratory airflow

100
Q

Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)

Progressive difficulty with expiration
- Air ______________ and increased residual volume
- Over___________ of the lungs
- Fixation of ribs in an respiratory position, increased anterior-posterior diameter of thorax (barrel chest)
- Flattened _____________ (on radiographs)

A

Progressive difficulty with expiration
- Air trapping and increased residual volume
- Overinflation of the lungs
- Fixation of ribs in an respiratory position, increased anterior-posterior diameter of thorax (barrel chest)
- Flattened diaphragm (on radiographs)

101
Q

Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)

Advanced emphysema and loss of tissue
- Adjacent damaged ________ coalesce, forming large air spaces.
- Pneumothorax * Occurs when pleural membrane surrounding large blebs ruptures
- Hypercapnia becomes marked.
- ___________ becomes driving force of respiration
- Frequent infections
- Pulmonary hypertension and cor pulmonale may develop in late stage.

A

Advanced emphysema and loss of tissue
- Adjacent damaged alveoli coalesce, forming large air spaces.
- Pneumothorax * Occurs when pleural membrane surrounding large blebs ruptures
- Hypercapnia becomes marked.
- Hypoxia becomes driving force of respiration
- Frequent infections
- Pulmonary hypertension and cor pulmonale may develop in late stage.

102
Q

Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)

Signs and symptoms
- Dyspnea * Occurs first on exertion
-Hyperventilation with prolonged expiratory phase * Development of barrel chest
- Anorexia and fatigue * Weight loss
- Clubbed fingers
- Diagnostic tests
- Chest radiography and pulmonary function tests

A

Signs and symptoms
- Dyspnea * Occurs first on exertion
-Hyperventilation with prolonged expiratory phase * Development of barrel chest
- Anorexia and fatigue * Weight loss
- Clubbed fingers
- Diagnostic tests
- Chest radiography and pulmonary function tests

103
Q

Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)

Treatment
- Avoidance of respiratory ________
- ____________ against influenza and pneumonia
- Pulmonary rehabilitation
- Appropriate breathing techniques
-Adequate nutrition and hydration
* Improves energy levels, resistance to infection
- Bronchodilators, antibiotics, oxygen therapy as condition advances
- Lung ___________ surgery

A

Treatment
- Avoidance of respiratory irritants
- Immunization against influenza and pneumonia
- Pulmonary rehabilitation
- Appropriate breathing techniques
-Adequate nutrition and hydration
* Improves energy levels, resistance to infection
- Bronchodilators, antibiotics, oxygen therapy as condition advances
- Lung reduction surgery

104
Q

Chronic Bronchitis

  • Inflammation, obstruction, repeated infection, ________________ twice for 3+ months
    in 2 years
  • History of cigarette smoking or living in urban or industrial area
  • Mucosa inflamed and swollen
  • Hypertrophy and hyperplasia of mucous glands
  • Fibrosis and thickening of ___________ wall
  • Low oxygen levels
  • Severe dyspnea and fatigue
  • Pulmonary hypertension and cor pulmonale
A
  • Inflammation, obstruction, repeated infection, chronic cough twice for 3+ months
    in 2 years
  • History of cigarette smoking or living in urban or industrial area
  • Mucosa inflamed and swollen
  • Hypertrophy and hyperplasia of mucous glands
  • Fibrosis and thickening of bronchial wall
  • Low oxygen levels
  • Severe dyspnea and fatigue
  • Pulmonary hypertension and cor pulmonale
105
Q

Chronic Bronchitis (Cont.)

Signs and symptoms
- Constant productive _________
- Tachypnea and shortness of breath
-Frequent thick and purulent _________
- Cough and rhonchi more severe in the ____________
- Hypoxia, cyanosis, hypercapnia * Caused by airway obstruction
- Polycythemia, weight loss, signs of cor pulmonale possible
* As vascular damage and pulmonary hypertension progress

A

Signs and symptoms
- Constant productive cough
- Tachypnea and shortness of breath
-Frequent thick and purulent secretions
- Cough and rhonchi more severe in the morning
- Hypoxia, cyanosis, hypercapnia * Caused by airway obstruction
- Polycythemia, weight loss, signs of cor pulmonale possible
* As vascular damage and pulmonary hypertension progress

106
Q

Chronic Bronchitis (Cont.)

Treatment
- Cessation of ___________ and reduction of exposure to irritants
- Treatment of infection
- ____________ for prophylaxis
- Expectorants
- Bronchodilators
- Appropriate chest therapy * Including postural drainage and percussion
-Low-flow oxygen
- Nutritional supplements

A

Treatment
- Cessation of smoking and reduction of exposure to irritants
- Treatment of infection
- Vaccination for prophylaxis
- Expectorants
- Bronchodilators
- Appropriate chest therapy * Including postural drainage and percussion
-Low-flow oxygen
- Nutritional supplements

107
Q

Bronchiectasis
- Usually a secondary condition
- Irreversible abnormal ___________ of the mediumsized __________ (primarily)
- May be saccular or elongated
-Arises from recurrent _____________ and infection
- Leads to obstruction of airways, weakening of muscle and elastic fibers in bronchial walls, or both
- Infecting organisms
- Usually mixed * Streptococci, staphylococci, pneumococci, H. influenzae

A
  • Usually a secondary condition
  • Irreversible abnormal dilation of the mediumsized bronchi (primarily)
  • May be saccular or elongated
    -Arises from recurrent inflammation and infection
  • Leads to obstruction of airways, weakening of muscle and elastic fibers in bronchial walls, or both
  • Infecting organisms
  • Usually mixed * Streptococci, staphylococci, pneumococci, H. influenzae
108
Q

Bronchiectasis (Cont.)

Signs and symptoms
- Chronic ________
- Production of copious amounts of purulent, foulsmelling _______

Treatment
-Antibiotics
-Bronchodilators
-Chest physiotherapy
- Treatment of primary condition

A

Signs and symptoms
- Chronic cough
- Production of copious amounts of purulent, foulsmelling sputum

Treatment
-Antibiotics
-Bronchodilators
-Chest physiotherapy
- Treatment of primary condition

109
Q

Restrictive Lung Disorders

Group of disorders with impaired lung _____________ and reduced total lung capacity

First group
- Abnormality of __________ —limits or impairs lung expansion
* Kyphosis or scoliosis, poliomyelitis, amyotrophic lateral sclerosis, botulism, muscular dystrophy

Second group
-Diseases affecting the supporting ___________ of lungs
* Idiopathic pulmonary fibrosis, occupational diseases

A

Group of disorders with impaired lung expansion and reduced total lung capacity

First group
- Abnormality of chest wall—limits or impairs lung expansion
* Kyphosis or scoliosis, poliomyelitis, amyotrophic lateral sclerosis, botulism, muscular dystrophy

Second group
-Diseases affecting the supporting framework of lungs
* Idiopathic pulmonary fibrosis, occupational diseases

110
Q

Pneumoconioses
- Chronic restrictive diseases resulting from long-term exposure to _______________
-Inflammation—gradual destruction of connective tissue
- Functional areas of the lungs lost
-Onset insidious
-Dyspnea develops first
- Treatment—ending exposure, treatment of infection

A
  • Chronic restrictive diseases resulting from long-term exposure to irritating particles
    -Inflammation—gradual destruction of connective tissue
  • Functional areas of the lungs lost
    -Onset insidious
    -Dyspnea develops first
  • Treatment—ending exposure, treatment of infection
111
Q

Vascular Disorders: Pulmonary Edema
- _______ collecting in alveoli and interstitial area
- Can result from many primary conditions
- Reduces amount of _________ diffusing into blood
- Interferes with lung expansion

May develop when:
- Inflammation in lungs is present. * Increases permeability of capillaries
Plasma protein levels are low. * Decreases osmotic pressure of plasma
-Pulmonary hypertension develops.

A
  • Fluid collecting in alveoli and interstitial area
  • Can result from many primary conditions
  • Reduces amount of oxygen diffusing into blood
  • Interferes with lung expansion

May develop when:
- Inflammation in lungs is present. * Increases permeability of capillaries
Plasma protein levels are low. * Decreases osmotic pressure of plasma
-Pulmonary hypertension develops.

112
Q

Pulmonary Edema (Cont.)

Signs and symptoms
-Cough, orthopnea, rales—in mild cases
- Hemoptysis
- Frothy, blood-tinged _______

Treatment
- Treat causative factors.
- Supportive care
- Possibility of positive-pressure _____________ ventilation

A

Signs and symptoms
-Cough, orthopnea, rales—in mild cases
- Hemoptysis
- Frothy, blood-tinged sputum

Treatment
- Treat causative factors.
- Supportive care
- Possibility of positive-pressure mechanical ventilation

113
Q

Pulmonary Embolus
- _________________ that obstructs pulmonary artery or any of its branches
- Effect of embolus depends on material, size, and location
- Small pulmonary emboli might be “silent” unless they involve a large area of lung.
- Large emboli may cause ___________.
- 90% of pulmonary emboli originate from deep vein thromboses in legs; are preventable

A
  • Blood clot or mass that obstructs pulmonary artery or any of its branches
  • Effect of embolus depends on material, size, and location
  • Small pulmonary emboli might be “silent” unless they involve a large area of lung.
  • Large emboli may cause sudden death.
  • 90% of pulmonary emboli originate from deep vein thromboses in legs; are preventable
114
Q

Pulmonary Embolus (Cont.)

Signs and symptoms
- Transient chest pain, cough, dyspnea—small emboli
- Larger emboli—increased ____________ with coughing or deep breathing; tachypnea and dyspnea develop suddenly.
* Later—__________ and fever
* Hypoxia—causes anxiety, restlessness, pallor, tachycardia
- Massive emboli
* Severe crushing chest pain, low blood pressure, rapid weak pulse, loss of ___________

A

Signs and symptoms
- Transient chest pain, cough, dyspnea—small emboli
- Larger emboli—increased chest pain with coughing or deep breathing; tachypnea and dyspnea develop suddenly.
* Later—hemoptysis and fever
* Hypoxia—causes anxiety, restlessness, pallor, tachycardia
- Massive emboli
* Severe crushing chest pain, low blood pressure, rapid weak pulse, loss of consciousness

115
Q

Pulmonary Embolus (Cont.)

Prevention
-Health teaching prior to surgery
- Antiembolic ___________
- ___________ to prevent thrombosis
-Use of anticoagulant drugs

Diagnosis
- Radiography, lung scan, MRI, pulmonary angiography

A

Prevention
-Health teaching prior to surgery
- Antiembolic stockings
- Exercise to prevent thrombosis
-Use of anticoagulant drugs

Diagnosis
- Radiography, lung scan, MRI, pulmonary angiography

116
Q

Pulmonary Embolus (Cont.)

Treatment
- Assessment of risk factors
- Prolonged ___________ and compression stockings
-Surgically Inserted filter into vena cava (some cases)
-__________ or streptokinase
- Mechanical ventilation
- Embolectomy

A

Treatment
- Assessment of risk factors
- Prolonged bed rest and compression stockings
-Surgically Inserted filter into vena cava (some cases)
-Heparin or streptokinase
- Mechanical ventilation
- Embolectomy

117
Q

Expansion Disorders- Atelectasis
- Nonaeration or _________ of lung or part of a lung
- Leads to ___________ gas exchange and hypoxia
- Alveoli become _________
- Collapse and inflammation or atrophy occur.
-Process interferes with _________ flow through the lung.
- Both ventilation and perfusion are altered.
- Affects oxygen diffusion

A
  • Nonaeration or collapse of lung or part of a lung
  • Leads to decreased gas exchange and hypoxia
  • Alveoli become airless.
  • Collapse and inflammation or atrophy occur.
    -Process interferes with blood flow through the lung.
  • Both ventilation and perfusion are altered.
  • Affects oxygen diffusion
118
Q

Atelectasis (Cont.)

Mechanisms that can result in atelectasis

  • Obstructive or resorption atelectasis
  • Caused by total ___________ of airway
  • Compression atelectasis
  • Mass or tumor exerts _________ on part of the lung.
  • Increased surface tension in ________
  • Prevents expansion of lung
  • Fibrotic tissue in lungs or pleura
  • May restrict expansion and lead to collapse
  • Postoperative atelectasis * Can occur after surgery
A
  • Obstructive or resorption atelectasis
  • Caused by total obstruction of airway
  • Compression atelectasis
  • Mass or tumor exerts pressure on part of the lung.
  • Increased surface tension in alveoli
  • Prevents expansion of lung
  • Fibrotic tissue in lungs or pleura
  • May restrict expansion and lead to collapse
  • Postoperative atelectasis * Can occur after surgery
119
Q

Atelectasis (Cont.)

Signs and symptoms
- Small areas are asymptomatic.

  • Large areas
  • Dyspnea
  • Increased heat and _____________ rates
  • Chest pain
A

Signs and symptoms
- Small areas are asymptomatic.

  • Large areas
  • Dyspnea
  • Increased heat and respiratory rates
  • Chest pain
120
Q

Expansion Disorders- Pleural Effusion
- Presence of excessive ________ in the pleural cavity
- Causes increased ____________ in pleural cavity
- Separation of pleural membranes
-Exudative effusions - Response to inflammation

Transudate effusions
- Watery effusions (hydrothorax)- Result of increased hydrostatic pressure or decreased osmotic pressure in blood vessels

A
  • Presence of excessive fluid in the pleural cavity
  • Causes increased pressure in pleural cavity
  • Separation of pleural membranes
    -Exudative effusions - Response to inflammation

Transudate effusions
- Watery effusions (hydrothorax)- Result of increased hydrostatic pressure or decreased osmotic pressure in blood vessels

121
Q

Pleural Effusion (Cont.)

Signs and symptoms
- Dyspnea
- Cyclic _______ pain
- Increased respiratory and heart rates

Treatment
- Remove underlying cause to treat respiratory impairment.
- Analyze ______ to confirm cause.
- Chest ______________ , thoracocentesis to remove fluid and relieve pressure

A

Signs and symptoms
- Dyspnea
- Cyclic chest pain
- Increased respiratory and heart rates

Treatment
- Remove underlying cause to treat respiratory impairment.
- Analyze fluid to confirm cause.
- Chest drainage, thoracocentesis to remove fluid and relieve pressure

122
Q

Pneumothorax
- ____ in pleural cavity

  • Closed pneumothorax
  • Air can enter pleural cavity from internal airways— no opening in chest wall
  • Simple or spontaneous pneumothorax
  • Tear on the surface of the lung
  • Secondary pneumothorax
  • Associated with underlying __________ disease
  • Rupture of an emphysematous bleb on lung surface or erosion by a tumor or tubercular cavitation
A
  • Air in pleural cavity
  • Closed pneumothorax
  • Air can enter pleural cavity from internal airways— no opening in chest wall
  • Simple or spontaneous pneumothorax
  • Tear on the surface of the lung
  • Secondary pneumothorax
  • Associated with underlying respiratory disease
  • Rupture of an emphysematous bleb on lung surface or erosion by a tumor or tubercular cavitation
123
Q

Pneumothorax (Cont.)

-Open pneumothorax
-Atmospheric air enters the pleural cavity though an opening in the ______ wall.
-“Sucking” wound

  • Large opening in chest wall
    -Tension pneumothorax
  • Most serious form
  • Result of an opening through chest wall and parietal pleura or from a tear in the __________________ and visceral pleura
  • Air entry into pleural cavity on inspiration but hole closes on expiration
  • Trapping air leads to increased pleural pressure and ____________
A

-Open pneumothorax
-Atmospheric air enters the pleural cavity though an opening in the chest wall.
-“Sucking” wound

  • Large opening in chest wall
    -Tension pneumothorax
  • Most serious form
  • Result of an opening through chest wall and parietal pleura or from a tear in the lung tissue and visceral pleura
  • Air entry into pleural cavity on inspiration but hole closes on expiration
  • Trapping air leads to increased pleural pressure and atelectasis
124
Q

Flail Chest
- Results from fractures of _______, which allow ribs to move independently during respiration

  • During inspiration
  • Flail or broken section moves inward rather than outward.
  • Inward movement of ribs prevents ____________ of affected lung.
  • Large flail section can compress adjacent lung tissue.
  • Pushing air out of that section—up the bronchus
  • Air (stale) from damaged lung crosses into the other lung with newly inspired air.
A
  • Results from fractures of ribs, which allow ribs to move independently during respiration
  • During inspiration
  • Flail or broken section moves inward rather than outward.
  • Inward movement of ribs prevents expansion of affected lung.
  • Large flail section can compress adjacent lung tissue.
  • Pushing air out of that section—up the bronchus
  • Air (stale) from damaged lung crosses into the other lung with newly inspired air.
125
Q

Flail Chest (Cont.)
- During expiration
- Unstable fail section pushed ___________ by increasing intrathoracic pressure.
-Large flail section
* Paradoxical movement of ribs alters ____________ during expiration.
-Air from unaffected lung moves across into affected lung.
- __________ results from limited expansion and decreased inspiratory volume.

A
  • During expiration
  • Unstable fail section pushed outward by increasing intrathoracic pressure.
    -Large flail section
  • Paradoxical movement of ribs alters airflow during expiration.
    -Air from unaffected lung moves across into affected lung.
  • Hypoxia results from limited expansion and decreased inspiratory volume.
126
Q

Infant Respiratory Distress Syndrome
- Usually related to ___________ birth
- Lack of surfactant in alveoli
- Poorly developed alveoli are difficult to _________
- Diffuse atelectasis results.
-Decreased pulmonary blood flow—pulmonary vasoconstriction—severe hypoxia
- Poor lung perfusion and lack of surfactant
- Increased alveolar capillary permeability
- Fluid and protein leak into interstitial area and alveoli, hyaline membrane formation

A
  • Usually related to premature birth
  • Lack of surfactant in alveoli
  • Poorly developed alveoli are difficult to inflate.
  • Diffuse atelectasis results.
    -Decreased pulmonary blood flow—pulmonary vasoconstriction—severe hypoxia
  • Poor lung perfusion and lack of surfactant
  • Increased alveolar capillary permeability
  • Fluid and protein leak into interstitial area and alveoli, hyaline membrane formation
127
Q

Adult Respiratory Distress Syndrome
- Results from ________ to the alveolar wall and capillary membrane
- Causes the release of chemical ___________
* Increases ____________ of alveolar capillary membranes
* Increased fluid and protein in interstitial area and alveoli
* Damage to surfactant-producing cells
* Diffuse necrosis and fibrosis if patient survives
- Multitude of predisposing conditions
- Often associated with multiple organ dysfunction or failure

A
  • Results from injury to the alveolar wall and capillary membrane
  • Causes the release of chemical mediators
  • Increases permeability of alveolar capillary membranes
  • Increased fluid and protein in interstitial area and alveoli
  • Damage to surfactant-producing cells
  • Diffuse necrosis and fibrosis if patient survives
  • Multitude of predisposing conditions
  • Often associated with multiple organ dysfunction or failure
128
Q

Acute Respiratory Failure
-May result from ______________ disorders
- Emphysema
-Combination of chronic and acute disorders
-Acute respiratory disorders
-Many neuromuscular diseases
- Signs may be masked or altered by primary problem

Treatment
-________________ must be resolved
- Supportive treatment to maintain respiratory function

A

-May result from acute or chronic disorders
- Emphysema
-Combination of chronic and acute disorders
-Acute respiratory disorders
-Many neuromuscular diseases
- Signs may be masked or altered by primary problem

Treatment
-Primary problem must be resolved
- Supportive treatment to maintain respiratory function

Pathophysiology (23 decks)

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