Ch. 36 Flashcards by Giulia Capalbo

Dyspnea

Subjective sensation of uncomfortable breathing

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Orthopnea

Shortness of breath when lying down

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Paroxysmal nocturnal dyspnea

Awaking at night and gasping for air; must sit up or stand up

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Acute cough

Explosive aspiration that Resolves within 2–3 weeks

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Chronic cough

Explosive cough that lasts longer than 3 weeks

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Abnormal sputum

Changes in amount, consistency, color, and odor

provide information about the progression of disease and the effectiveness of therapy.

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Hemoptysis

Coughing up blood or bloody secretions

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Eupnea

Normal breathing pattern

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Kussmaul respirations (hyperpnea)

Slightly ↑ RR + very large tidal volume + no expiratory pause.

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Labored breathing

Increased work of breathing

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Cheyne-Stokes respirations

Alternating periods of deep and shallow breathing;
apnea lasting 15–60 seconds, followed by ventilations that ↑ in volume until a peak is reached, after which ventilation ↓ again to apnea

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Hypoventilation

Alveolar ventilation is < metabolic demands

Cause: alterations in pulmonary mechanics or in neurologic control of breathing.

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Alveolar ventilation > metabolic demands

Cause: anxiety, head injury, or severe hypoxemia.

Hyperventilation

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Bluish discoloration of the skin and mucous

membranes

Cyanosis

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Most often caused by poor circulation. • Best observed in the nail beds

Peripheral cyanosis

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Caused by ↓ arterial oxygenation (low PaO2).

• Best observed in buccal mucous membranes and lips

Central cyanosis

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Bulbous enlargement of the
distal segment of a digit.

 Causes: chronic hypoxemia
• Bronchiectasis
• cystic fibrosis
• pulmonary fibrosis • lung abscess
• CHD

Clubbing

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Is the most common pain caused by pulmonary diseases.
• Is usually sharp or stabbing in character.
• Infection and inflammation of the parietal pleura (pleuritis or pleurisy) can cause pain when the pleurae stretch during inspiration

Pleural pain

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May be from the airways.

• May be from muscle or rib pain.

Chest wall pain

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↑ CO2 in the arterial blood
➢ Due to ↓ drive to breathe or an inadequate ability to
respond to ventilatory stimulation

Hypercapnia

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a below normal level of oxygen in your blood specifically in the arteries

Hypoxemia

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A dangerous condition that happens when your body doesn’t get enough oxygen

Hypoxia

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➢ Inadequate gas exchange (hypoxemia).
➢ PaO2 is ≤50 mmHg.
➢ → Hypercapnia, during which PaCO2 is ≥50 mmHg. ➢ pH is ≤7.25

Acute respiratory failure (ARF)

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Work of breathing ↑, and ventilation may be compromised

because of ↓ TV → hypoxemia, hypercapnia → AR

Chest wall restriction

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The instability of a | portion of the chest wall from rib or sternal fractures.

Flail chest

Presence of air or gas in the pleural space→ • Separates pleural layers • Destroys the negative pressure • Lung collapses

Pneumothorax

Occurs unexpectedly in healthy individuals. Mutation?

Primary (spontaneous) pneumothorax

Is caused by chest trauma, rupture of bleb/bulla (COPD), or | mechanical ventilation

Secondary (traumatic) pneumothorax

Transthoracic needle aspiration

Iatrogenic pneumothorax

Air pressure in the pleural space equals barometric pressure Air that is drawn into the pleural space during inspiration is forced back out during expiration.

Open Pneumothorax

Site of pleural rupture acts as a one-way valve Air enters on inspiration but not allowed to escape, by closing up during expiration Life-threatening

Tension Pneumothorax

Presence of fluid in the pleural space

Pleural effusion

Is watery and diffuses out of the capillaries

Transudative effusion

Is less watery and contains high concentrations of white blood cells and plasma proteins.

Exudative effusion

Chyle exudate

Chylothorax

Blood exudate

Hemothorax

Pus

Pyothorax (Empyema)

→ V̇/Q̇ mismatch ➢ Thicken alveolocapillary membrane→ Hypoxemia ➢ Dyspnea, ↑RR, ↓TV, ↓FVC ``` Aspiration 2. Atelectasis 3. Bronchiectasis 4. Bronchiolitis 5. pulmonaryfibrosis pulmonaryedema 10. ARDS ```

Restrictive Lung Disorders

Passage of fluid and solid particles into the lungs | • Right lower lobe is the most frequent site

Aspiration

Collapse of lung tissue

Atelectasis

External compression on the lung Effusion, tumor

Compression atelectasis

􏰁 Gradual absorption of air from obstructed or hypoventilated alveoli. 􏰁 Inhalation of concentrated O2 􏰁 Anesthesia

Absorptionatelectasis

􏰁 ↓ production or inactivation of surfactant Preterm, ARDS, anesthesia, ventilator

Surfactant impairment

Persistent abnormal dilation of the bronchi | 1. Cylindrical 2. Saccular 3. Varicose

Bronchiectasis

Diffuse inflammation of small bronchioles ➢ Most common in children ➢ Occurs in adults with chronic bronchitis or those with a viral infection or who have inhaled toxic gases

Bronchiolitis

➢ Fibrotic disease of the airways | ➢ Can occur with all causes of bronchiolitis.

Bronchiolitis obliterans

➢ ↑↑ amount of fibrous or connective tissue in the lung ➢ Caused by scar tissue, due to TB, autoimmune,.. ➢ inhalation of dangerous substances ➢ Loss of compliance ➢ Poor prognosis

Pulmonary fibrosis

➢Men > 60 ➢ 2-5 year survival ➢ environmental insults and genetic, epigenetic, and metabolic factors

Idiopathic pulmonary fibrosis

➢ Excess water in the lung from disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability ➢ Most common cause: LVF

Pulmonary edema

➢ Forms of respiratory failure characterized by: • Acute lung inflammation • Diffuse alveolocapillary injury

Acute lung injury (ALI) / ARDS

1. Aspiration of vomit 2. Toxic gas inhalation 3. Pneumonia

Direct causes of ARDS

1. Sepsis 2. Trauma 3. Multiple transfusions 4. Noncardiogenicpulmonaryedema→shunting,V/̇Q̇ mismatch, ↓ lung compliance, and hypoxemia

Indirect causes of ARDS

Chronic inflammatory disorder of the bronchial mucosa leading to: ➢ Bronchial hyperresponsiveness ➢ Constriction of the airways ➢ Variable airflow obstruction

Asthma

Episodic attacks of: 1. Bronchospasm 2. Bronchial inflammation 3. Mucosal edema 4. ↑ mucous production

Pathophysiology of asthma

a condition involving constriction of the airways and difficulty or discomfort in breathing Airflow limitation 􏰀 Not fully reversible 􏰀 Usually progressive 1. Chronic bronchitis 2. Emphysema

COPD chronic obstructive pulmonary disease

􏰀 Infection or inflammation of the large airways or bronchi; self-limiting 􏰀 Caused by viruses

Chronic Bronchitis

Abnormal permanent enlargement of the gas-exchange airways + destruction of the alveolar walls without obvious fibrosis

Emphysema

Septal destruction occurs in the respiratory bronchioles and alveolar ducts, 􏰀 Usually in the upper lobes. 􏰀 Alveolar sac remains intact. 􏰀 Tends to occur in smokers with chronic bronchitis.

Centriacinar (Centrilobular) emphysema

Involves the entire acinus Damage is more randomly distributed. Involves lower lobes of the lung

Panacinar (Panlobular) emphysema

1. Aspiration 2. Inhalation 3. Endotracheal tubes and suctioning 4. Bacteremia in lungs 5. Respiratory defenses can’t destroy the microorganism

Pneumonia Routes of infection

Infection of the lungs caused by a virus Most common is influenza

Viral pneumonia

Infection caused by Mycobacterium tuberculosis, an acid-fast bacillus

Tuberculosis

➢ Airborne droplet transmission ➢ Tubercle formation: Granulomatous lesion ➢ Caseous necrosis: Cheeselike material ➢ May remain dormant for life or cause active disease ➢ Isolation of bacilli by enclosing them in tubercles and surrounding the tubercles with scar tissue

Pathophysiology if tuberculosis

death and decay) of consolidated tissue: abscess empties into the bronchus, leaving a cavity

Necrosis

Process of abscess emptying and cavity formation

Cavitation

➢ Is the occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, foreign body, amniotic fluid, or air bubble. ➢ Pulmonary emboli commonly arise from the deep veins in the thigh

Pulmonary embolism, PE

* Venous stasis * Hypercoagulability * Injuries to the endothelial cells that line the vessels

Virchow triad

* Release of neurohumoral substances * Widespread vasoconstriction * Atelectasis of the affected lung segments, further contributing to hypoxemia * Pulmonary edema, pulmonary hypertension, shock, and even death

Pathophysiology of a pulmonary embolism

➢ Mean PA pressure > 25 mmHg at rest | ➢ Idiopathic, familial, or associated

Pulmonary artery hypertension (PHT)

A condition that causes the right side of the heart to fail 􏰀 Secondary to PHT 􏰀 RV enlargement 􏰀 PHT → chronic pressure overload in RV

Cor Pulmonale

Ch. 36 Flashcards

(70 cards)