Block 2 Unit 1- Pulmonary System Flashcards
(141 cards)
1
Q
What is the definition of Ventilation?
A
The movement of air during inhalation and exhalation
2
Q
What is the definition of Oxygenation ?
A
The exchange of oxygen from the air to the blood
3
Q
What happens to air when it passes through the upper airway?
A
The upper airway warms and humidifies air as it passes through before it reaches the lungs
Also traps foreign particles, bacteria, and toxic gases from inhaled air
4
Q
The functions of the nostrils are…?
A
• Warm and moisten inhaled air
• Filter inhaled air before it reaches the lungs.
5
Q
What helps line the nasal cavity and helps trap dust,mold, pollen, and other environmental contaminants?
A
Hair (vibrissae) and ciliated mucus membranes
6
Q
What cranial nerve is the olfactory nerve?
A
cranial nerve one
7
Q
The function of the Paranasal Sinuses includes?
A
• Lightens the weight of skull bones
• serve as resonators for sound production and provides mucus.
8
Q
In order how does air go through the upper respiratory track?
A
1) Air travels through the nostrils
2) past the sinuses through the trachea to the lower respiratory tract.
9
Q
The larynx connects what together?
A
The upper and lower airways.
10
Q
The larynx is made up of what?
A
-the false vocal cords (supraglottis)
-the true vocal cords (glottis)
11
Q
The laryngeal box is made up of what?
A
The epiglottis, thyroid, and cricoid cartilage.
12
Q
The laryngeal muscles assist with what?
A
Swallowing, respirations, and vocalization.
13
Q
The right lung has_____ lobes and the left has _____ lobes with a _____ _____
A
The right lung has 3 lobes
(superior, middle, inferior)
and the left has 2 lobes
(superior and inferior)
with a cardiac notch
14
Q
What is the Hilum?
A
The Hilum is a wedge-shaped area on the central portion of the lung where the bronchi, arteries, veins, and nerves enter and exit.
15
Q
Where does the trachea lies and how long can it be?
A
It lies anterior to the esophagus and is 10-11 cm long.
16
Q
What is the functions of the trachea?
A
• Transport gases between the environment and lung
17
Q
What is dead space?
A
Dead space is space that is filled with air but not available for gas exchange
18
Q
What does the ribs do for the chest wall and diaphragm?
A
Ribs: bones that support and protect chest cavity; move slightly to help lungs expand and contract
19
Q
What is the diaphragm?
A
strong wall muscle that separates
chest cavity from abdominal cavity
20
Q
What is the functions of the Chest Wall and Diaphragm?
A
• Ribs- protect the lungs from injury
• Intercostal muscles and Diaphragm- perform
muscular work of breathing
21
Q
What is the surrounding the bronchi to prevent them from collapsing?
A
Cartilage
22
Q
Break down how the bronchi branches off in order
A
The bronchi are the two large tubes that carry air from the trachea to the lungs.
The right and left main bronchus are further broken down into primary, secondary, and tertiary bronchi.
23
Q
Which bronchus is smaller and longer than the other?
A
The left bronchus is smaller in size and longer than the right bronchus.
24
Q
why when intubating a patient, does the ET Tube tend to go into the right main stem and not the left?
A
The right bronchus is wider and lies straighter than the left bronchus.
The right is straighter which is why when intubating a patient, the tendency is for the endotracheal tube to go into the right main stem.
25
What are the functions for the Bronchus?
• Protects alveoli from small particulate matter in inhaled air
• Lined with goblet cells that secrete mucus which entraps particles
• Cilia sweeps particles upward for swallowing or expulsion
26
Does gas exchange happen in the bronchus?
False
No gas exchange occurs in bronchus
27
What is the transition between the large cartilage supported bronchi and alveolar ducts that connect directly to the alveoli?
Bronchioles
28
The Bronchioles are surrounded by ______ _______ used to constrict or dilate the airway.
Smooth muscles
29
What are the functions of the Bronchioles?
• Carry oxygen rich air to lungs/alveoli
• Carry carbon dioxide out of the lungs
30
The smooth muscles that surround the bronchioles can constrict or dilate the airway, what does these actions aid in?
Aids in the proper amount of oxygen getting into the blood.
31
Explain what a bronchospasm is?
Bronchioles are anchored to the tissues that they carry oxygen to and are supported by smooth muscle.
*This smooth muscle tissue is sometimes prone to contract, reducing the size of the bronchioles.*
This is known as a bronchospasm and is seen in patients with asthma and other lung diseases.
32
What functions as respiratory unit consisting of bronchioles, alveolar ducts, alveolar sacs, and alveoli?
Acinus
33
What is a round cluster of cells, usually epithelial cells, that looks somewhat like a knobby berry?
An Acinus
34
What are the functions of the Alveolar Ducts?
• Transmission of air from respiratory bronchioles to alveolar sacs
• Dispersing the air to the alveoli
35
How many alveolar ducts are there for each bronchiole?
There are 2-11 ducts per bronchiole, and about 2 million alveolar ducts in lungs.
36
How many alveolar sacs are there for each alveolar ducts?
Each duct has 5-6 alveolar sacs.
37
What are the functions of the Alveolar Sacs?
• The alveolar sacs are sacs of many alveoli, which are the cells that exchange oxygen and carbon dioxide in the lungs.
• Contain collagen fibers and elastic fibers that allow alveoli to stretch when filled with air during inhalation.
38
What allows the alveoli to stretch when filled with air during inhalation?
collagen fibers and elastic fibers
39
What does the alveoli secrete that reduces the surface tension inside of the alveoli?
surfactant
40
What is surfactant?
a lipid type substance that is used to lubricate the alveoli so that the surface tension inside the alveoli is reduced, which prevents alveolar collapse (atelectasis).
41
pulmonary arterioles and venules allow for gas exchange and are affected by what?
Positive End Expiratory Pressure (PEEP).
42
The alveoli are surrounded by what that allows gas exchange?
The alveoli are surrounded by pulmonary arterioles and venules that allow for gas exchange
43
What are the functions of the alveoli?
• Oxygen diffuses through a single cell in an alveolus and then across a single cell to a capillary and into the bloodstream. At the same time, carbon dioxide (CO2) molecules, are diffused back into the alveolus where they are expelled out of the body through the respiratory system.
• Type II pneumocytes within the alveoli secrete surfactant that maintains the shape and the surface tension of the alveoli. This surface tension allows for more surface area through which oxygen and CO2 molecules can pass (keeps the alveoli inflated).
44
The respiratory system is controlled by which system?
central nervous system (CNS).
45
Specifically which areas of the CNS controls our breathing rhythm?
within the pons and medulla, nerve impulses are transmitted to control the breathing rhythm.
46
Breathing can be suppressed at the neurological level, what are some of those ways?
The use of narcotics, sedatives, or brainstem injury.
47
Ventilation is the process of what?
Ventilation is the process by which air moves in and out of the lungs.
48
What happens during the Active/ inhalation phase?
impulses received by the brain to the diaphragm, signal the diaphragm movement downward and while the rib cage moves up and out.
This increases volume of thoracic cavity and creates a negative pressure within the lungs.
49
What happens during the passive/ exhalation phase?
diaphragm and thoracic muscles relax and the lungs recoil. This decrease in volume, increases the pressure in the thoracic cavity.
50
What is perfusion and what does it facilitate?
It is the process by which the cardiovascular system pumps blood throughout the lungs.
Facilitates nutrient exchange at the capillary level.
51
External respiration requires adequate delivery of blood to the capillary beds of the lungs via the pulmonary circulation. What happens if this blood supply stops?
In the absence of this blood supply, there will be no transport mechanism for oxygen.
52
What is diffusion in general?
Movement of substance in solution (liquid or air) from higher to lower concentration areas.
It is the spontaneous movement of gases, without the use of any energy or effort by the body, between the alveoli and the capillaries in the lungs.
53
What is diffusion In the case of respiration?
the distribution of oxygen from the atmosphere through the pulmonary capillary walls and into the bloodstream. At the same time, CO2 diffuses from the bloodstream into the alveoli.
54
What are some perfusion disruptions?
shock, hemorrhage, dehydration, pulmonary embolism.
Think blocking from the lungs
55
Clubbed fingers occurs with what?
COPD
56
Angiomas (spider nevi) are associated with what?
with liver disease or portal hypertension (evident on chest)
57
You see a patient with a Barrel chest and is in the tripod position, this usually indicates what?
COPD
58
Unequal expansion of the patient’s chest could suggest what?
could suggest a lack of ventilation on the affected side, which could be causing a pulmonary shunt.
59
Unequal chest expansion usually occurs with what?
usually occurs with obstruction or collapsed lung, scoliosis, and kyphosis.
60
You have a patient with hyperinflation of the chest on the right side, with paradoxical rise and fall. What would be a possible dx?
pneumothorax
61
You have a patient with Bilateral hyperinflation. What can this indicate?
a potential obstructive disorder with air trapping and the possible need for a bronchodilator.
62
Crackles that do not resolve after the patient coughs can be indicative of what?
pulmonary edema.
63
Describe what crackles/ rakes sound like?
Fine short high pitched intermittently crackling sounds can be during inspiration or expiration and are defined by their location.
64
When can Crackles/ Rales occur and what can they indicate?
Occur when airways are narrowed by fluid, mucous, or pus.
can indicate an inflammation, infection, or pulmonary edema.
65
High pitched wheezing is a high-pitched musical sound and can be indicative of what?
asthma attack.
66
Low pitched wheezing can be caused by what and can indicate what?
Low pitched wheezing can be caused by secretions in large airways, can indicate bronchitis or pneumonia.
67
• Wheezes are indicative of _______ and typically indicate the need for ________?
Wheezes are indicative of bronchospasm and typically indicate the need for bronchodilators.
68
Patient presents to the ED with their hands around their throat an you can hear a high pitched harsh breathing sounds during inspiration. What is this?
Stridor, obstruction in the upper airway
69
You have a child presenting with stridor, what is an illness known for causing stridor in children?
Epiglottis
70
Describe what a pleural friction rub sounds like?
Low pitched, grating, or creaking sounds that occur when pleural surfaces rub together during inspiration.
71
What is this X-ray showing you?
A normal chest X-ray
72
What is this X-ray showing you?
Pneumonia in the right middle lobe
73
What is this X-ray showing you?
pulmonary edema
74
What is asthma?
A chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyper-responsiveness, airway constriction, and airflow obstruction that is reversible.
75
Impaired expiration causes what?
-air trapping
-hyperinflation distal to the obstruction(mucus & smooth muscle constriction)
-increased work of breathing.
76
You have a pediatric patient come into the ED with coughing, wheezing, chest tightness, tachycardia, tachypnea, SOB, and excessive drooling. What is the dx?
Asthma attack
77
What are the late Sx of asthma that indicates patient demise is pending?
• Accessory muscle use
• Inspiratory/Expiratory wheezes
• Hypoxia
78
What is the Tx for asthma?
• Pulse Oximetry and Oxygen: Maintain SpO2 >90%
• Steroids
• Bronchodilators
• Intravenous Magnesium Sulfate for those not responding
to treatment.
• Respiratory failure requires intubation.
79
What is bronchitis and what are the 2 categories for it?
Inflammation of the large airways and bronchi.
• Acute - viral or bacterial respiratory infection (90% caused by viruses.)
• Chronic – exposure of irritants, family history
(Cigarette smoking is the biggest cause.)
80
You have a patient who presents to the ED and states they’ve been having a cough for the past 3 weeks, sore throat, fever, aching under their sternum with coughing. While doing your exam you note no pulmonary consolidation. What is possible Dx?
Acute bronchitis
81
You have a patient in the ICU with the following Sx.
• Hacking
• Rasping cough
• Thick sputum
• Dyspnea
• Cyanosis
• Clubbing of fingers
• Crackles
• Wheezing
What is a possible Dx?
Chronic bronchitis
82
What are the Tx for bronchitis?
• Viral does not require antibiotics
• Antitussive agent used to suppress the urge to cough
• Bronchodilators to open the airways
• Steroids to reduce inflammation of the airways
• Oxygen therapy
• Pulmonary rehabilitation
83
What is emphysema?
a progressive condition that damages and enlarges the alveoli in the lungs.
a persistent chronic inflammation
84
What is emphysema primarily caused by?
Smoking
Other risk factors include pollution, chemicals, fumes and dust.
85
You have a patient presenting to your clinic with complaining of SOB with exertion and at rest. When patient arrives to clinic you noted that pt has a barrel chest, tachypnea, decreased breath sounds, prolonged expiration, and occasional wheezing. When getting a hx pt states they’ve been smoking a pack for 11 yrs now. What is the possible Dx?
Advanced emphysema
86
What are the Tx for emphysema?
• Oxygen therapy
• Pulmonary Rehabilitation
• Bronchodilators
• Steroids
• Antibiotics: if infection is present (Pneumonia or Bronchitis)
• Vaccines: annual flu and Pneumococcal every 5 years
• Surgery (to remove damaged tissue) or Lung transplant
87
Chronic Obstructive Pulmonary Disease (COPD) is a chronic progressive lung disease that is a combination of what?
• Bronchitis - inflammation of the airways
• Emphysema - structural damage to the alveoli
88
Why should supplemental oxygen should be administered with caution with COPD patients?
When COPD patients’ oxygenation increases, it could lower their spontaneous drive to inhale which could lead to a decrease in responsiveness.
89
What is the Dx?
COPD
90
What are some Sx of COPD?
• Dyspnea on exertion can progress to marked Dyspnea, even at rest.
• Chronic Bronchitis cough- productive; Emphysema cough -non-productive, unless w/Bronchitis
• Weight loss is unintentional.
• Patient will exhibit Tripod Positioning
91
Can COPD be Tx?
No cure; manageable with lifestyle changes & symptom control
92
What Tx can we do to help with COPD?
• Oxygen: Saturation goal 88-92%
• Intermittent or continuous Beta2 agonist and anticholinergic medications
• Smoking cessation
• Chest percussion therapy
• Vaccinations; Influenza and Pneumococcal
• Patient education
93
What is your O2 goal with COPD patients?
Keep oxygen saturation 88-92%
94
What patient education can we teach to help decrease air trapping in COPD patients?
Keep oxygen saturation 88-92% and encourage the patient to use pursed-lip breathing to prolong expiration and decrease air trapping.
95
What is pulmonary HTN?
Pulmonary Hypertension is high blood pressure that affects the arteries in the lungs resulting in narrowed, blocked, or destroyed vessels.
96
What diseases cause the patient to be chronically acidotic and hypoxic leading to hypoxic pulmonary vasoconstriction?
Pulmonary HTN
97
What happens when the body develops hypoxic pulmonary vasoconstriction?
This protective reflex leads to the body diverting blood flow away from hypoxic areas of the lungs to areas with better ventilation and oxygenation.
98
constant vasoconstriction leads to arterial remodeling and hypertrophy of pulmonary arteries causing chronic pulmonary hypertension that will eventually lead to what?
right heart failure.
99
Patients Clinical Presentation:
• Chest X-ray abnormality
• Pallor
• Dyspnea, progressive with exertion
• Fatigue
• Chest pain
• Syncope
• Dry cough
• Right ventricle enlargement
• Rapid weight gain
• Peripheral edema
• JVD- Jugular Vein Distention
What is Dx?
Pulmonary Artery Hypertension
100
What is the Tx for Pulmonary Artery Hypertension?
• Oxygen
• Anticoagulants
• Diuretics
• Administering Medications: Increasing oxygen delivery, slowing heart rate, reducing hypertension
• Contributing Factors Avoidance
• Transplantation
101
What is pulmonary edema?
Excess fluid in the interstitial space and the alveoli. Excessive fluid from the capillary leakage will also appear in the lungs.
102
What causes pulmonary edema?
• Left sided heart failure
• Acute Respiratory Distress Syndrome (ARDS)
• Toxic gases inhalation
• Inhaled hot gases
• Lymphatic obstruction
• Rapid pulmonary re-expansion
• High altitude exposure
103
What can occur in populations with chronic diseases, such as Congestive Heart Failure patients,where there is a slow progress of fluid accumulation?
Pulmonary edema
104
What can occur with a with a massive, rapid fluid bolus and or a direct injury to lung tissue.?
flash Pulmonary Edema/ acute pulmonary edema
105
What is POPE?
Post Obstructive Pulmonary Edema, Negative-pressure pulmonary edema
106
What are the 2 subtypes of POPE and some examples?
• Type I is associated with forced inspiration against an acutely obstructed airway
(Examples of causes: post-extubation laryngospasm, foreign body aspiration, and epiglottitis)
• Type II typically develops after acute relief of a chronic upper airway obstruction
(Examples of causes: adenotonsillectomy or surgical resection of a laryngeal tumor)
107
What is TRALI?
Transfusion-related Acute Lung Injury (TRALI)- a clinical syndrome in which there is an acute, non-cardiogenic pulmonary edema associated with hypoxia that occurs duringor after a transfusion.
108
What are the 3 pulmonary edema pathophysiology?
-Cardiac issues e.g valvular dysfunction, CAD, LVD
- ARDS or the inhalation of toxins/ capillary injury
-blocked lymphatic vessels
109
What is Hydrostatic pressure?
the pressure that any fluid exerts in a confined space.
When there is an issue within the vascular system that is going to cause the system to back up into the pulmonary system
110
Clinical Presentation
• Dyspnea
• Orthopnea- extreme SOB worse when lying down,
and a feeling of drowning when lying down
• Cold, clammy skin
• Palpitations
• Wheezing or gasping for breath
• Pink frothy sputum cough, tinged with blood in severe cases
• Inspiratory crackles
• Percussion dullness over bases
What is the Dx?
Pulmonary edema
111
What is the Tx for HF induced pulmonary edema?
Heart Failure:
• Oxygen
• Improve cardiac output, volume status
• Diuretics, vasodilator, improve cardiac contractility/meds
• Manage weight
• Regular exercise
• Smoking cessation
112
What are the different types of pneumonia?
• Community Acquired Pneumonia (CAP) is pneumonia acquired outside of a hospital setting.
• Healthcare associated pneumonia (HCAP) is pneumonia a patient gets when they are in a healthcare environment inside or outside of a traditional hospital includes HAP.
• Hospital acquired pneumonia (HAP) is any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted.
• Ventilator acquired pneumonia (VAP) is pneumonia that develops in a patient that is on a ventilator.
113
What is tactile fremitus?
Palpable vibrations of the chest wall that results from the transmission of
sound vibration through the lung tissue to the chest wall.
114
Pneumonia will give you a _________ tactile fremitus
Increased
Note: Tactile fremitus typically has a greater intensity in areas of increased lung density.
115
What is the Tx plan for pneumonia?
• Adequate ventilation AND oxygenation; just because the patient is breathing,does not mean there is adequate gas exchange at the capillaries.
• Antibiotics within 4 hours of presentation; broad spectrum when specific microorganism has not been identified, modify based on sputum culture results.
• Position Patient with least affected area of lung in dependent position to maximize gas exchange.
• VAP bundle for prevention
• Daily chest X-ray can be used to determine if patient’s condition is worsening or improving.
• Laboratory studies- monitor white blood cell count and results of cultures.
116
What is included in the VAP Bundle?
• Put the head of bed to at least 30 degrees to allow for better oxygenation and to prevent aspiration.
• Conduct daily Spontaneous Breathing Trials (SBT)
• Peptic Ulcer Prophylaxis- daily Protonix
• Deep Vein Thrombosis (DVT) Prophylaxis- in the most non-invasive form are sequential compression devices. Most patients will get daily heparin or Lovenox as well.
• Turn patients every 2 hours to prevent skin breakdown, open the alveoli, and improve circulation.
• Oral care with chlorhexidine 0.12% (Brush teeth every 12 hours, foam swab every 4 hours, subglottic suctioning per institution protocol and In-line/sterile suction airway every 4 hours).
117
What causes compression and how does it cause atelectasis?
Compression is caused by an external pressure. Such as tumor, fluid or air in pleural space or abdominal distention that compresses the lower portions of the lungs causing them to collapse.
118
What is absorption in relation to atelectasis?
Absorption is loss of gas or air volume by obstructions or hypoventilated alveoli, inhalation of concentrated oxygen or anesthetic agents.
119
What is adhesive in relation to atelectasis?
Adhesive which is a reduction of surface tension needed to keep alveoli open from a decrease or inactivation of surfactant.
120
Incentive spirometer and/or deep breathing is the #1 treatment and prevention technique. It helps with what?
-ciliary clearance of secretions
-stabilizes alveoli by redistributing surfactant.
-Permits collateral ventilation of alveoli.
-Allows air to pass from well-ventilated alveoli to collapsed alveoli minimizing collapse.
121
Is Pulmonary Fibrosis reversible?
No
There is an excessive amount of fibrous or connective tissue in the lung, damaging it and making it scarred and stiff.
122
What is a Transudate Pleural Effusion?
Fluid from capillaries diffuses into the lungs or chest wall
123
What causes a Exudate Pleural Effusion?
Caused by inflammatory conditions protein rich fluid/capillaries
124
What are the 2 subtypes of Exudative Pleural Effusion?
• Empyema (pus): Infection products/from blocked lymphatic vessels
• Chylothorax (chyle): Milky fluid with fat droplets and lymph/lymphatic vessels into pleural
space
125
What can patients rapidly develop with Pleural Effusion?
• Cyanosis
• Chest expansion decreased on affected side
• Breath sounds decreased or absent
• Percussion dullness/affected side
126
What is a Pleurodesis?
Chemicals are instilled into the chest cavity, stick to the chest wall, and reduce the risk of fluid build-up; it obliterates the pleural space by adhering the lungs to the chest wall.
127
What are the 2 types of pneumothorax/ hemothorax?
• Open- Air or blood accumulates between the chest wall and the lung as a result of an open chest wound or other physical defect.
Treatment
•Tension- A severe condition that results when air or blood is trapped in the pleural space under positive pressure displacing mediastinal structures, compromising cardiopulmonary functions.
128
What can cause pneumothorax/ hemothorax?
• Spontaneous rupture of blebs, chest trauma, rib
fracture, bleb/bulla (COPD), mechanical ventilation
• Pulmonary Bleb- Air filled cysts that form on the
lung pleura.
• Bulla- Multiple blebs that come together.
129
What are late findings of Pneumothorax/Hemothorax?
• Tracheal deviation toward unaffected side • Tension pneumothorax
• Hypoxia
• Hypotension
130
Patient presents to the ED with the following Sx
• Sudden pleural pain
• Tachypnea
• Dyspnea
• Hyper resonance to percussion
• Absent or diminished breath sounds
What is your Dx?
Pneumothorax
131
What is ARDS?
Acute Respiratory Distress Syndrome, ARDS is a syndrome in which fluid collects in the alveoli, impeding the transfer of oxygen in the blood
132
Is ARDS a cardiac pulmonary edema?
It is a non-cardiac pulmonary edema caused by increased alveolar capillary membrane permeability and usually affects both lungs.
133
In the early stages of ARDS,;the permeability of the capillaries are _______ which allows what to happen?
the permeability of the capillaries increases
which allows more fluid to leak into the alveoli and the interstitial space.
This causes the alveoli to become saturated, produce less surfactant, and have a harder time diffusing oxygen.
134
ARDS does what to the alveoli and capillaries?
increased distance between the alveoli and the capillary, further impairing gas exchange.
If the problem is not fixed the alveoli become thickened which causes an even greater disparity in oxygen saturation.
135
Why is albumin given to patients with ARDS?
Albumin pulls fluid back into the capillaries;
Albumin is a plasma protein fluid that uses osmotic pressure to maintain fluid in the vessels.
It keeps fluid in your bloodstream, so it doesn't leak into other tissues.
136
Define Flail chest
a fracture of three or more sequential ribs, in two or more locations, that result in a flail section.
137
What can happen if a patient has flail chest?
•when the patient moves during breathing, or other movements, the fractured ends of the ribs can cause damage to the surrounding muscles, blood vessels and even the heart and lungs.
• This can potentially lead to pulmonary contusions, pneumothorax or hemothorax
138
What is splinting in relation to breathing?
reduced inspiratory effort as a result of sharp pain upon inspiration.
139
Explain what happen during breathing cycle with a patient that has a flail chest
Affected area draws in when patient breathes in and rest of chest expands, the affected
area moves outwards and patient exhales and the rest of chest contracts.
140
If the patient is splinting in response to pain, this movement may be difficult to visualize. T or F?
True
141
What is dead space?
dead space is space that is filled with air but not available for gas exchange
