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Pathophysiology and Pharmacology 2 > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Describe the nervous control of breathing

A
  • Respiration is an automatic function needing no conscious awareness
  • The respiratory centres in the medulla oblongata and pons in the brainstem (respiratory centre - control depth and rate of breathing)
  • Excitatory impulses are transmitted to the diaphragm and external intercostal muscles to contract and commence inspiration
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2
Q

Describe central chemoreceptors

A
  • Located near respiratory centre in the medulla
  • Sensitive to carbon dioxide levels
  • Most important
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3
Q

Describe peripheral chemoreceptors

A
  • Located in the carotid and aortic bodies

- Sensitive to arterial carbon dioxide and oxygen levels

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4
Q

What is the function of the respiratory system?

A

Function of respiratory system is to transfer O2 from atmosphere to blood and remove CO2 from blood

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5
Q

Define respiratory failure

A

Inability of the lung to meet the metabolic demands of the body. This can be failure of tissue oxygenation and/or failure of CO2 homeostasis

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6
Q

Describe Type 1 and Type 2 Respiratory Failure

A

Type 1 = Low O2 levels

Type 2 = High CO2 levels and low O2 levels

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7
Q

What is the treatment for respiratory system infections?

A

Focus to ensure effective gas exchange between lungs, blood and tissues

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8
Q

Describe Pneumonia

A
  • Inflammation (and often infection) of the alveoli and bronchioles
  • Alveoli and terminal bronchioles fill with infectious debris (WBC) and exudate, reducing gas exchange
  • Some microorganisms also release toxins which damage lung tissue
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9
Q

What is Hospital Acquired Pneumonia?

A
  • Occurs 48-72 hours or more post admission
  • Highest mortality rate of all the nosocomial infections
  • Organisms responsible for hospital-acquired pneumonia are different from those responsible for community-acquired pneumonia
  • Many are antibiotic resistant and difficult to treat
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10
Q

List the other pneumonias

A
  • Aspiration Pneumonia
  • Parasitic Pneumonia
  • Opportunistic Pneumonia
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11
Q

Describe Aspiration Pneumonia

A
  • Abnormal entry of bacterial-filled secretions from the pharynx or gastrointestinal tract into lower airway
  • Suppressed or incomplete gag and cough reflexes (e.g. due to loss of consciousness, stroke, drug overdose)
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12
Q

What are the pre-disposing factors of pneumonia?

A
  • Age -> elderly and very young
  • Decreased conscious state - decreased cough and reflexes allow in inspiration
  • Chronic illnesses, coexisting respiratory disease
  • Mechanical ventilation and airway instrumentation
  • Immunosuppression - impaired defence mechanisms
  • Smoking
  • Upper respiratory tract infection (URTI)
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13
Q

List the signs and symptoms of pneumonia

A
  • Fever
  • Tachypnoea
  • Tachycardia
  • Dyspnoea
  • Cough
  • Hypoxaemia
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14
Q

What is the nursing management associated with pneumonia?

A
  • Auscultation
  • Vital signs
  • O2 therapy
  • Positioning
  • Hydration - assists with cleaning mucus
  • Pain relief
  • Oral and general hygiene
  • Chest physio - deep breathing and coughing
  • Antibiotics as prescribed
  • Nutrition
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15
Q

Describe Myobacterium Tuberculosis

A
  • Fundamentally a respiratory disease
  • Into lungs by inhalation
  • The bacteria has ability to persist in the form of a long term asymptomatic infection
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16
Q

Describe Whooping Cough

A
  • Infection by the bacteria (Bordetella Pertussis) - toxins with the bacteria are released when it bursts
  • Bacteria attaches to ciliated cells of trachea
  • First impede ciliary action and then progressively destroy cells
  • Production of several toxins which can enter bloodstream
17
Q

Describe Influenza

A
  • Influenza epidemics regularly occur worldwide and cause significant morbidity and mortality
  • Influenza viruses can affect all levels of the respiratory tract and cause a range of clinical conditions
18
Q

List the signs and symptoms of influenza

A
  • Body aches, especially joints and throats
  • Coughing and sneezing
  • Irritated watery eyes
  • Nasal congestion
  • Redenned eyes, skin, mouth, throat and nose
19
Q

What is the pathophysiology of Bronchial Asthma?

A
  • Triggering stimuli bring about an exaggerated hypersensitivity
  • Causes inflammation of the airway epithelium
  • This leads to bronchospasm and increased secretion of mucus
  • Onset within 10-20 minutes
  • Release chemical mediators by pre-sensitised mast cells
  • Inflammatory response
  • Bronchoconstriction
  • Mucosal oedema
  • Increased mucus secretions
  • Wheezing, chest tightness, dyspnoea and cough
20
Q

How is asthma diagnosed?

A
  • Detail history and physical exam
  • Chest x-ray
  • Arterial blood gas (ABGs)
  • Peak flow monitoring
  • Peak Expiratory Flow Rate (PERF) = highest flow rate of air in forced expiration (L/sec)
21
Q

List the signs and symptoms of a Mild Episode of Asthma

A
  • Feeling of chest tightness
  • Increased respiratory rate with prolonged expiration
  • Mild wheezing
  • Productive or non-productive cough
  • PEFR 60-80% of expected
22
Q

List the signs and symptoms of a Moderate Episode of Asthma

A
  • Use of accessory muscles
  • Distant breath sounds (air trapping)
  • Loud wheezing
  • Fatigue, anxiety, apprehension
  • PEFR >80% of normal/expected
23
Q

List the signs and symptoms of Severe and Life Threatening Asthma

A
  • Severe dyspnoea
  • Inaudible breath sounds (lungs hyperinflated)
  • Diminished or no wheeze
  • Ineffective cough
  • Cyanosis
  • PEFR <60% of expected (if can do at all)
    These are signs of impending respiratory arrest
24
Q

What nursing management is associated with Asthma?

A
  • O2 therapy
  • Bronchodilators - Beta 2 agonists (salbutamol) and anticholinergic drugs
  • Anti inflammatories
  • SpO2 monitoring, ABGs, lung function
  • Intubation and mechanical ventilation
  • High fowler’s position and IV fluids
25
Q

Describe the pathophysiology of a Pulmonary Embolism Deep Vein Thrombosis

A
  • Obstruction of blood flow causes vasoconstriction and bronchoconstriction in the affected areas of the lungs
  • Greatly reduced ventilation, impaired gas exchange, loss of alveolar surfactant
  • Massive PE may cause pulmonary hypertension and right-sided heart failure as blood ‘backs-up’ through the heart and can result in death
26
Q

List the signs and symptoms of a PE DVT

A
  • Chest pain
  • Dyspnoea
  • Increased respiratory rate (tachypnoea)
  • May have moderate hypoxia
  • May have haemoptysis
  • Slight fever
  • Massive PE = crushing pain, shock, loss of consciousness
27
Q

What nursing management is associated with PE DVTs?

A
  • O2 therapy
  • Deep breathing and coughing
  • Anticoagulant therapy (heparin then warfarin)
  • Observation and monitoring
  • Positioning - sitting up, not laying down
  • Pain relief
28
Q

What is included in the prevention of PE DVTs?

A
  • Identifying at risk patients
  • Avoid venous stasis and hyper coagulability
  • Graded compression elastic stockings on lower limbs (TEDs)
  • Encourage early ambulation post surgery
  • Sequential pneumatic calf compression devices (flowtrons)
  • Prophylactic anticoagulation (s/c heparin)
  • Foot ankle exercises

Pathophysiology and Pharmacology 2 (12 decks)

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