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Cardiopulm Final > cardiopulm week 12: respiratory pathophysiology > Flashcards

cardiopulm week 12: respiratory pathophysiology Flashcards

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1
Q
A
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2
Q

What are the signs & symptoms of respiratory acidosis?

A
  • diaphoresis
  • headache
  • tachycardia
  • confusion
  • restlessness
  • apprehension
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3
Q

What are the signs & symptoms of respiratory alkalosis?

A
  • rapid, deep breathing
  • parasthesia
  • light-headedness
  • twitching
  • anxiety
  • fear
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4
Q

What can cause metabolic alkalosis?

A

Loss of hydrochloric acid from prolonged vomiting or gastric suctioning or decreased plasma potassium levels.

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5
Q

What are the signs & symptoms of metabolic alkalosis?

A
  • slow & shallow breathing
  • confusion
  • hypertonic muscles
  • twitching
  • restlessness, irritability
  • apathy
  • tetany
  • coma
  • seizure
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6
Q

What can cause metabolic acidosis?

A

Diarrhea, small bowel fistulas, chronic kidney disease, hepatic disease, and endocrine disease.

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7
Q

What are the signs & symptoms of metabolic acidosis?

A
  • rapid & deep breathing (Kussmaul’s)
  • fatigue
  • fruity breath
  • headache
  • drowsiness
  • lethargy
  • nausea
  • vomiting
  • coma
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8
Q

What characterizes obstructive disorders?

A

Airway obstruction & reduced airway flow rates, especially with forced exhalation.

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9
Q

What percentage of FEV1/FVC indicates an obstructive disorder?

A

< 70

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10
Q

Which lung volumes are decreased in obstructive disorders?

A
  • VC
  • IRV
  • ERV
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11
Q

Which lung volumes are increased in obstructive disorders?

A
  • RV
  • FRC
  • RV/TLC
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12
Q

What are the characteristics of chronic bronchitis?

A
  • excess mucus production
  • airway narrowing
  • productive cough on most days for 3 months during 2 consecutive years
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13
Q

What are the characteristics of emphysema?

A
  • destruction of terminal bronchioles & alveolar walls
  • increased lung tissue compliance
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14
Q

What are the GOLD grades for COPD patients?

A
  • GOLD 1: mild, FEV1 >= 80
  • GOLD 2: between 50-80
  • GOLD 3: between 30-50
  • GOLD 4: lower than 30
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15
Q

What are two types of COPD assessment tests?

A
  • CAT (over 10 more symptoms)
  • mMRC (2 & over more symptoms)
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16
Q

What happens to oxygen saturation during exercise for emphysema patients?

A

Desaturation

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17
Q

What happens to oxygen saturation during exercise for chronic bronchitis patients?

A

May decrease but exercise may help in earlier stages by clearing mucus.

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18
Q

What is panacinar emphysema?

A
  • alveoli affected
  • distributed throughout lungs
  • loss of surface for air exchange
  • predominantly lower lobes
  • genetic
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19
Q

What is centrilobular emphysema?

A
  • most common due to smoking
  • affects respiratory bronchioles
  • primarily upper lobes
  • progression of chronic bronchitis
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20
Q

What does an emphysema x-ray show?

A

Hyperlucency & formation of bullae, which are balloon-like due to hyperinflation.

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21
Q

What deformity results from hyperinflation in emphysema?

A

Barrel chest leading to a flattened diaphragm.

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22
Q

How are levels of PaCO2 & PaO2 initially in emphysema patients?

A

Normal due to increased hyperventilation.

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23
Q

Is cardiac output affected in emphysema patients?

A

False (slight because of muscle wasting & fatigue).

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24
Q

What are the initial stages of emphysema characterized by?

A
  • decreased breath sounds
  • increased FRC & RV
  • decreased FEV1, FEV1/FVC, VC
  • equal deficit of V & Q
  • compliance increased
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25
What gas level increases in emphysema intermediate stages?
CO2 while O2 diffusion decreases.
26
What happens to ventilation during forced exhalation in emphysema intermediate stages?
Decreased ventilation.
27
What are the end-stage effects of emphysema?
- hypoxemia leading to pulmonary artery hypertension - edema & fluid overload from sodium retention - right-sided heart failure - increased risk of nocturnal death - pulmonary embolism due to increased hematocrit - multi-organ ischemia
28
How many ribs should normally show in an x-ray?
5-7
29
What can cause cyanosis in chronic bronchitis patients?
Hypoxemia.
30
Which COPD disease has polycythemia?
Chronic bronchitis.
31
What are two signs associated with cor pulmonale?
- JVD - fluid retention/edema
32
Is CO2 diffusion increased with chronic bronchitis?
False (normal).
33
How are PaCO2 & PaO2 affected in chronic bronchitis?
- CO2 increased - O2 lowered
34
What is cor pulmonale?
Right ventricle failure due to pulmonary hypertension from chronic bronchitis.
35
What is status asthmaticus?
Acute exacerbation of asthma leading to respiratory failure or death.
36
What characterizes juvenile asthma?
Allergenic with periodic exacerbations.
37
What characterizes adult asthma?
Intrinsic with chronic low-level bronchospasm.
38
What leads to wheezing in asthma?
Bronchospasm during expiration.
39
What can cause inflammation of the bronchial wall in asthma?
Eosinophilic reaction.
40
What do asthma patients experience due to hyperinflated lungs?
Air trapping, difficulty exhaling, & reduced FEV1.
41
What is bronchoconstriction?
Occurs within minutes of completion of exercise-induced asthma due to water or heat loss in airways.
42
What is bronchiectasis?
Dilation of bronchial walls with retained secretions, usually resulting from recurrent infections.
43
What is the primary treatment of bronchiectasis?
Bronchial hygiene.
44
What are the three types of bronchiectasis?
- cylindrical - varicose - saccular (cystic)
45
What characterizes restrictive disorders?
Reduction in vital capacity.
46
What else is decreased in restrictive disorders?
- RV - FRC - VT - TLC - compliance
47
What pressure is required in restrictive lung disease?
Greater pressure to give the same increase in volume.
48
What happens to pressure/volume relationship in obstructive lung disease?
Normal with normal breathing but requires greater pressure when breathing rapidly, leading to smaller volume of each breath.
49
What are some acute pulmonary restrictive disorders?
- atelectasis - pneumothorax - pneumonias (lobar, bronchial) - acute respiratory distress syndrome (ARDS)
50
What are some chronic pulmonary restrictive disorders?
- bronchopulmonary dysplasia - pulmonary fibrosis - SLE - scleroderma - occupational lung diseases (silicosis, asbestosis, pneumoconiosis) - lung carcinomas (bronchogenic)
51
What are some skeletal extrapulmonary restrictive disorders?
- fractures - kyphosis - scoliosis - RA - ankylosing spondylitis
52
What are some neuromuscular extrapulmonary restrictive disorders?
- stroke - spinal cord injury - amyotrophic lateral sclerosis - multiple sclerosis - muscular dystrophy - myasthenia gravis
53
What are some other extrapulmonary restrictive disorders?
- pleural effusion (empyema) - abdominal ascites (pushes diaphragm up) - intrathoracic surgical implants (LVAD)
54
What is atelectasis?
Partial collapse of lung parenchyma (alveoli).
55
What is microatelectasis?
Alveolar collapse perhaps related to surface tension changes.
56
What is obstructive/regional atelectasis?
When bronchus becomes occluded, air distal to obstructed is absorbed, leading to lung region collapse.
57
What type of atelectasis is most common and occurs quickly?
Microatelectasis, most often due to bed rest & immobility.
58
What causes microatelectasis?
Hypoventilation and low mechanical pressure in the lung.
59
What disorders are associated with microatelectasis?
Respiratory distress syndrome & left ventricular failure.
60
What are some signs of microatelectasis?
- reduced chest wall expansion - crackles - bronchial sounds (consolidation) - tracheal & mediastinal shift on x-ray
61
What direction does tracheal shift occur in obstructive atelectasis?
Towards the collapse.
62
What characterizes bronchial pneumonia?
- caused by staph or strep - little consolidation - inflammation of airways (secretions & mucus) - fever, SOB - productive cough with purulent sputum
63
What characterizes lobar pneumonia?
- caused by pneumococcus - inflammation of distal airways (alveoli) - consolidation of parenchyma (inflammatory exudate fills alveoli) - hepatization (red or gray depending on RBC or fibrin) - pleural membranes involved - fever, SOB, PAIN - cough initially dry but then later productive with small amounts of golden, viscous, blood-flecked sputum
64
What is the exudative phase of ARDS?
Leakage of water, protein, & inflammatory & RBCs into interstitium & alveolar lumen, damaging alveolar epithelium & vascular endothelium.
65
Which alveolar cell damage is irreversible in ARDS?
Type I alveolar cells, associated with deposition of proteins, fibrin, cellular debris, & producing hyaline membranes.
66
What occurs in the proliferative phase of ARDS?
Type II cells proliferate, epithelial cells regenerate, & there's fibroblastic reaction & remodeling.
67
What occurs in the fibrotic phase of ARDS?
Irreversible fibrosis, development of microcysts, & collagen deposition in alveolar, vascular, & interstitial beds.
68
How does a patient with ARDS present?
- dyspnea - tachypnea - decreased lung compliance - pulmonary interstitial edema - x-ray: fluffy infiltrates - hypoxemia leading to confusion, SOB, cyanosis, labored breathing

Cardiopulm Final (8 decks)

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