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Cardiopulmonary > Week 11 Obstructive Disease > Flashcards

Week 11 Obstructive Disease Flashcards

1
Q

what are the three main causes of dyspnea?

A

ventilatory pump - hypoxic hypoxia (hypoxemia): not enough oxygen in the blood; carbon dioxide build up
cardiac pump/supply lines - ischemic hypoxia (ischemia): heart is not getting enough blood
blood’s oxygen carrying capacity-anemic hypoxia (anemia)

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2
Q

what is restrictive disease?

A

difficulty in generating the △P required to create airflow (inhaling)

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3
Q

what is obstructive disease?

A

difficulty in generating airflow for a given △P between the atmosphere and alveoli (exhaling)

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4
Q

in restrictive disease, what is stiffness caused by? weakness?

A

stiffness - chest wall or lungs
weakness - weak muscles and damaged nerves

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5
Q

what spirometry volumes are reduced in restrictive disease?

A

all

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6
Q

what characterizes obstructive disease?

A

increased FRC, marked increase in A-P diameter (barrel0chested), and slow expiration

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7
Q

what are the two basic causes of obstructive disease?

A

-increased airway resistance
-decreased elastic recoil; diminished ability to expire has same consequences as physical obstruction

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8
Q

what is the equal pressure point?

A

point in airway anatomy where outside compressive pressure equals inside elastic pressure

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9
Q

where should equal pressure point occur?

A

in the larger airways with cartilaginous rings; if it occurs in the smaller airways they will collapse during forced expiration

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10
Q

what are the four main obstructive diseases?

A

asthma, bronchiectasis, chronic bronchitis, emphysema

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11
Q

Identify each type of hypoxemia described below:
-SOB with normal sPO2 and PO2, normal blood flow, and inadequate O2 carrying capacity
-SOB with normal sPO2 and Po2, normal O2 carrying capacity and inadequate blood flow
-SOM with decreased sPO2 and PO2, normal blood flow and normal O2 carrying capacity

A

-anemic hypoxemia
-ischemic hypoxemia
-hypoxic hypoxemia

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12
Q

what is emphysema?

A

abnormal, permanent enlargement of air spaces distal to bronchioles with destruction of their walls.
decreases elasticity and increased compliance in alveolar walls

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13
Q

what are the signs and symptoms of emphysema?

A

barrel chest, emaciated, hypertrophied SCM and scalene, prolonged expiration, tripod position and pursed lip breathing, FEV1/FVC ratio <.60, classic appearance of “pink puffer”

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14
Q

what can emphysema progress to?

A

cyanosis
cor pulmonale (right sided heart failure)
LHF

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15
Q

what medical and surgical management is used for emphysema?

A

bronchodilators
supplemental O2
lung reduction surgery
(airway clearance is not specifically needed for pure emphysema)

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16
Q

what is chronic bronchitis?

A

excessive sputum production on most days for at least 3 months of the year for at least 2 consecutive years
impaired mucus clearance

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17
Q

what is chronic bronchitis associated with?

A

cigarette smoking, air pollution, infections (hemophilus, strep pneumonia)

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18
Q

what is the progression of chronic cronchitis?

A
  • Smoking predisposes to infection
  • Decreased ciliary clearance
  • Damaged epithelium
  • Interference with WBC function
  • Irritation of airways
  • Hyperplasia of mucus glands in
    large airways
  • Excessive mucus production
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19
Q

what is “blue bloater”?

A

overweight and cyanotic
hypercapnic
cor pulmonale –> LHF

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20
Q

what does medical management of chronic bronchitis consist of?

A

bronchodilators, supplemental O2, antibiotics, airway clearance

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21
Q

what is bronchiectasis?

A

chronic and permanent dilation of bronchi due to inflammation or infection
copious amounts of foul-smelling sputum, dilated obliterated bronchi, mucus plugging of bronchi

22
Q

what are the signs and symptoms of bronchiectasis?

A

chronic coughing, coughing up blood, abnormal sounds of wheezing in the chest on breathing, SOB, chest pain, coughing up large amounts of mucus, daily bad breath odor, skin with blue appearance, weight loss, fatigue, thickening of the skin under nails and toes

23
Q

what are the causes of bronchiectasis?

A

idiopathic, obstruction by tumor or foreign object, immotile cilia, congenital, post-infective/cystic fibrosis

24
Q

what medical/surgical management is used for bronchietasis?

A

antibiotics, airway clearance, surgical removal of affected areas

25
Q

which of the following is described as inflammation of the bronchial walls without an increase or change in bronchial wall diameter?

A

bronchitis: no change in the wall diameter, the inflammation narrows the airways

(bronchiectasis: wall are dilated and eventually are destroyed; emphysema: mainly the alveoli are affected)

26
Q

what is the normal mechanism for control of ventilation?

A

primary is negative feedback loop between pH of CSF and ventilation
secondary include negative feed back loop between arterial PO2 and pH and feedforward mechanisms

27
Q

what happens in response to decreased pH?

A

ventilation increases
volatile acid (Co2) is lost to atmosphere
pH is normalized
chronically, kidneys and buffering systems respond to eliminate fixed acid

28
Q

what happens in response to increased pH?

A

ventilation is slowed
Co2 accumulates
pH is normalized
chronically kidneys and buffering systems respond to retain hydrogen ions and excrete more bicarbonate

29
Q

___ results in decreased PaCO2.
___ results in increased PaCO2.

A

hyperventilation
hypoventilation

30
Q

how does high CO2 effect the brain?

A

depresses cerebral function (giddy-somnolent-unconscious-dead)
cerebral blood flow rids brain of CO2 by negative feedback loop (high CO2-increased blood flow-normalized CO2)

31
Q

how does low CO2 effect the brain?

A

(hyperventilation)
decreased cerebral blood flow
compromises cerebral function
lightheaded, dizzy, ataxic, other

32
Q

how is FIO2 increased when using supplemental O2?

A

by increasing flow rate or increasing % O2

33
Q

what is FIO2 of normal air?

A

.21
21% O2

34
Q

if low PaO2 is driving ventilation, excessive FIO2 causes:

A

breathing to slow (hypoventilation) allowing PaO2 to fall to regulated level
hypoventilation = accumulation of CO2
CO2 retention causes respiratory acidosis, possible injury

35
Q

Effective ventilation requires:

A

bulk flow of air in and out of lungs to get oxygen to a place where it could enter the blood
diffusion of gases across the alveoli into the pulmonary capillary blood

36
Q

High ventilation makes alveoli like the atmosphere: ___
low ventilation makes alveoli like venous blood: ___

A

atmosphere: high PO2 and low PCO2
venous blood: low PO2 and high PCO2

37
Q

what is the V/Q ration?

A

the primary determinant of oxygenation of the blood
optimal V/Q = 0.8

38
Q

what occurs when increasing V/Q? decreasing V/Q?

A

increasing V/Q increases PaO2 and lowers PaCO2
decreasing V/Q decreases PaO2 and increases PaCO2

39
Q

low ventilation relative to perfusion results in:

A

low PaO2 and unloaded Hb leaving the alveolar capillaries
hypoxic hypoxia; PCO2 rises causing acidosis

40
Q

high ventilation relative to perfusion causes:

A

PO2 to rise and PCO2 to fall

41
Q

ventilation increases in proportion to:

A

pulmonary blood flow

42
Q

what occurs as V/Q exceeds 0.8?

A

PO2 increases, but oxygen content of blood changes little
wasted ventilation
more oxygen is used by muscles of ventilation than what is added by increasing V/Q above 0.8 (less oxygen is available for the rest of the body)

43
Q

if cardiac output is low and V/Q is normal (or high):

A

PaO2 may be high
result at tissue level is ischemic hypoxic and cellular injury

44
Q

if cardiac output is normal and V/C is low:

A

PaO2 becomes low
results in hypoxic hypoxia and cellular injury

45
Q

FEV1/FVC determines __.

A

extent of obstructive disease

46
Q

what is included in a lung volumes test?

A

tidal volume, IRV, ERV, VC
(require He or N2 washout) RV, TLV and FRC

47
Q

low volumes/ peaked slopes = ___
scooped out (slow decrease in volume) = ___

A

restrictive disease
obstructive disease

48
Q

What does DLCO measure?

A

the ability of the lungs to transfer gas from inhaled air to the red blood cells in the pulmonary capillaries
diffusion barrier at alveolar-capillary interface

49
Q

diffusion is decreased by:

A

anemia
increased diffusion distance
decreased exchange area
poor perfusion

50
Q

oxygenation of tissues requires ___.

A

cardiac output - low CO is great for oxygenating blood, bad for the body

Cardiopulmonary (23 decks)

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