Chapter 27 - Alteration In Pulmonary Function Flashcards
(168 cards)
1
Q
Ventilation
A
Movement of air in and out of lungs
2
Q
Oxygenation
A
Loading oxygen molecules onto. Hemoglobin
3
Q
Respiration
A
O2 and co2 exchange of alveoli and systemic capillaries
4
Q
Perfusion
A
Delivery of blood to a capillary bed in tissue
5
Q
Dyspnea
A
Breathlessness
-subjective
-work of breathing is greater than actual result
6
Q
Signs of dyspnea
A
-flaring of nostrils
-use of accessory muscles
-head bobbing in children
7
Q
Paroxysmal nocturnal dyspnea
A
Pulmonary condition that wakes you up gasping for breath in the middle of the night
8
Q
Sputum
A
Color provides information about progression of disease
-microscopic appearance allows microorganism identity
9
Q
Hemoptysis
A
Coughing up blood (usually indicates infection of inflammation of bronchiole)
-if severe can indicate cancer
10
Q
Normal breathing
A
Rhythmic and effortless
-includes short expiratory pause with each breath
11
Q
Sighs
A
1.5 to 2 times normal tidal volume
12
Q
Abnormal breathing patterns
A
Patterns of breathing automatically adjust to minimize WOB
13
Q
Purpose of sigh
A
-twice tidal volume, 10 times per hour
-help maintain normal breathing
-equals out oxygen consumption and CO2 expulsion
14
Q
Hyperpnea: kussmaul respiration
A
Occurs with strenuous exercise
-inc ventilation rate and tidal volume
-no pause
15
Q
Cheyne stokes respiration
A
Alternating deep and shallow breathing
-periods of apnea
16
Q
Periods of apnea
A
15 to 60 seconds
-followed by inc volume ventilations
-eventually returned to normal, triggering another period of apnea
17
Q
Cause for cheyne stokes
A
Reduced blood flow to brain
-reduced brain impulses to respiratory center
18
Q
Both of what can be determined by blood gases
A
Hypoventilation and hyperventilation
19
Q
Hypoventilation
A
Inadequate ventilation
20
Q
Hypoventilation issue
A
Co2 removal doesn’t keep up with co2 production
21
Q
Hypoventilation result
A
Hypercapnia
-inc co2 in blood stream
22
Q
Hyperventilation
A
Alveolar ventilation exceeding needs
23
Q
Hyperventilation issue
A
Removal of more co2 than is produced
24
Q
Hyperventilation result
A
Hypocapnia
-reduced co2 in blood stream
25
Cyanosis
-bluish discolouration of skin
26
Cause of cyanosis
develops when 5 grams of hemoglobin is desaturated
27
Cyanosis is not evident until is is severe =
Insensitive indicator of respiratory failure
28
Peripheral cyanosis
Poor circulation in fingers and toes due to peripheral vasoconstriction
-best seen in nail beds
29
Central cyanosis
Decreased arterial oxidation (low PaO2) from pulmonary disease
-best detected in buccal mucosa membranes and lips
30
Clubbing
Bulbous formations at end of fingertips and toes
31
Clubbing is from
Diseases that disrupt pulmonary circulation causing hypoxemia
-rarely reversible
32
Pain from pulmonary disorders
-where is it located
-what sound does it make
Almost always localized in chest wall
-can be pinpointed by unique sound called pleural friction rub
33
Pleural friction rub
Pleural walls rub together due to reduced fluid in pleural cavity
34
Pain can be reproduced by
Pressing on sternum or ribs
35
Hypercapnia
Increased co2 in blood
-caused by Hypoventilation of alveoli
-increased PaCO2
36
Hypoventilation causes
-decreased drive to breath
-depression of respiratory center
-disease to medulla oblong at a
37
Effects of Hypoventilation
-electrolyte imbalances
-dysrhythmia
-in severe cases comatose
38
Hypoventilation is often overlooked, why?
It can appear normal
-it is important then to obtain blood gases to confirm
39
Hypoxemia
Decreased PaO2 in arterial blood
40
What are the two possible causes of hypoxemia
1. Related to issues with delivery of O2 to alveoli and delivery to lung
2. Thickening of alveolar membrane or destruction of alveoli
41
Diffusion of O2 from alveoli to blood is dependant upon two factors
1. Amount of air entering alveoli
2. Amount of blood perfusion capillaries around alveoli
42
What is the most common cause of hypoxemia
Abnormal ventilation/perfusion ratio
(V/Q)
43
V=
Ventilation
44
Q=
Amount of blood perfusion capillaries around alveoli
45
Shunt
Normal perfusion but Inadequate ventilation
-blocked, collapsed alveolus
46
Alveolar dead space
Normal ventilation but inadequate perfusion
47
Shunt causes
Very low V/A
-hypoxemia
48
Alveolar dead space causes
High V/Q
-hypoxemia
49
Acute respiratory failure: levels of PaO2
Is less than 60 mmHg
(TX = supplemental oxygen)
50
Acute respiratory failure: levels of PaCO2
Is greater than 50
(TX = ventilatory support)
51
Acute respiratory failure: pH levels
Less than or equal to 7.25
52
Normal pH
7.40
53
Acute respiratory failure is a potential complication of
Any major surgical procedure
54
How to prevent Acute respiratory failure:
Frequent turning and position changes
-deep breathing exercises
-early ambulating
55
CWR or chest wall restrictions (cause)
Deformity
-obesity, neuromuscular disease
56
CWR or chest wall restrictions (result)
Increased work of breathing
-usually decrease in tidal volume
57
CWR or chest wall restrictions (surgical/injury complications)
Can cause such pain that causes Hypoventilation
58
CWR:
Decreased tidal volume, increased breathing rate, can lead to respiratory failure
59
Flail chest
Fracture of consecutive ribs with or without sternum damage
60
Result of flail chest
Chest wall instability = paradoxical movement of chest when breathing
61
Paradoxical breathing (inspiration)
Unstable portion of chest wall moves inward
-normal movement would be outward
62
Paradoxical breathing expiration
Portion moves outward
-normal movement would be inward
63
PaO2 rule of thumb for normal ventilation
80-100 mmHg
64
Severe hypoxemia PaO2 levels
<40 mmHG
65
Pneumothorax (cause and result)
Air or gas in pleural space
-due to rupture to visceral pleural
-lungs tend to collapse
66
Pleural effusion
Fluid in pleural space
-can be blood or lymph
67
How do you diagnosis a pleural effusion
-chest xray
-thoracentesis (needle aspiration)
68
Empyema
Infected pleural effusion by microorganism
69
What is the indication of empyema
Pus in pleural space
70
Cause of empyema
Pulmonary lymphatic tissue becomes blocked
-contaminated lymphatic fluid moves into pleural space
71
empyema is the result of
Surgery, or bronchial obstruction
72
TX for empyema
Antibiotics and drainage of pleural space with chest tube
73
Restrictive lung diseases have difficulty with
Inspiration
-expanding lungs
74
Obstructive lung diseases have difficulty with
Expiration
75
Restrictive lung diseases
Decreased lung compliance
-increased work of breathing at tidal volume
76
Aspiration
Passage of fluids or solids into lungs
77
Aspiration caused by
Abnormal swallowing mechanism
-cough reflex impaired
-lead to pneumonia
CNS or PNS abnormalities
78
Aspiration TX
Bronchoscopy
-failure to remove results in inflammation
79
Atelectasis
Collapse of lung
80
Atelectasis: compression
Caused by external pressure e
-tumour of fluid
81
Atelectasis: surfactant impairment
Decreased production of surfactant
82
Atelectasis tends to occur
After surgery when using general anaesthetic
83
Atelectasis: TX
Deep breathing exercises promotes ciliary removal of secretion
84
Bronchiectasis
Perisistent abnormal dilation of bronchi
85
Obstruction cause in Bronchiectasis
1. Inflammation due to mucus plugs
2. Chronic inflammation = destruction of elastic/muscular bronchi wall = permanent dilation
86
Symptoms for Bronchiectasis
Chronic productive cough
-large amount of foul smelling sputum
87
Bronchiolitis
Inflammatory obstruction of small airways
88
Bronchiolitis obliterans
Fibrosis of airways = scaring
89
BOOP
Alveoli becomes filled with connective tissue
90
Manifestations of Bronchiolitis
Rapid ventilatory rate and dry non productive cough
91
Pulmonary fibrosis
Excessive amount of fibrous and connective tissue at alveoli
92
Pulmonary fibrosis cause
Scar tissue left from previous disease
-example tuberculosis
93
Result of Pulmonary fibrosis
Decreased lung compliance and external respiration (O2/CO2 exchange)
-due to multiple injuries at different lung sites associated with abnormal healing
94
Symptoms of Pulmonary fibrosis
Dyspnea on exertion
95
Pulmonary Edema
Excessive water on lungs
-normal lung is dry
96
Cause of pulmonary edema
Left side heart disease
-reduced CO, blood backed up from heart into lungs, inc bp in pulmonary capillaries, fluid into interstitial space, fluid flow exceeds lymph system = pulmonary edema
97
COVID 19
Manifested as viral pneumonia induced acute respiratory distress syndrome
98
Post mortem studies of COVID 19
Mortality patients had undetectable viral loads
-cytokines effects of virus not main cause of death
-death caused by hosts runaway immune response
99
Management of COVID 19
Incubation
100
Restrictive lung disease have difficulty with
Inspiration
101
Obstructive lung diseases have difficulty with
Expiration
102
S/s of obstructive lung diseases
Dyspnea and wheezing
103
Asthma
Chronic inflammatory disorder of bronchial mucosa
104
Asthma inflammation =
Restriction of airways
-hyper immune response to irritants
105
Early asthmatic attack: classic immune response
Dendritic cells, helper T cells, B cell
106
Result of early asthmatic attack
Inflammation, inc capillary permeability, inc fluid
107
Late asthmatic attack
Begins 4-8 hours after early attack
-latent release of inflammatory mediators from original site
108
Result of late asthmatic attack
Inc damage of epithelial cells = scaring
-inc mucus forming plugs and airway resistance
109
Manifestation of asthma
Individuals normal between attacks
-pulmonary function tests are normal
110
If bronchospams are not reversed by usual treatment they are considered
Status asthmaticus
111
If PaCO2 (asthma) is greater than ___ it means
70 mm HG
-sign of impending death
112
TX asthma
-short acting inhalers, or inhaled corticosteroids
113
asthma (1)
Inhaled antigen passes epithelial layer
114
Asthma (2)
Antigen binds to mast cells
-releasing mediators
115
Asthma (3)
Mediators
-mucus production in airway
-bronchi spams
-edema from inc capillary permeability
116
Asthma (4)
Dendritic cels present antigen to helper T cells
-activate B cells, and release antibodies
117
Asthma (5)
Helper T cells also activate eosinophil
-neutrophils activated
-inflammation from both results in airway obstruction
118
COPD
Composed of chronic bronchitis and emphysema
-most common
119
Characteristics of COPD
-persistent airflow limitation
-chronic inflammatory response to noxious partials or gas
-progressive
120
COPD: chronic bronchitis defined
As hypersecretion of mucus
-chronic cough for at least 3 months of the year for 2 consecutive years
121
Cause of COPD: chronic bronchitis
Inspired irritant-> inflammation and thickening of mucous membrane
-reduced radius of airways causing obstruction
122
Initially COPD: chronic bronchitis affects
Large airways and eventually all airways
123
COPD: chronic bronchitis airways collapse
Early in exhalation
-air trapped in distal portions of lungs
-hyperinflation = Hypoventilation
124
COPD: emphysema
Permanent enlargement of gas exchange airways
-destruction of alveolar walls
-obstruction due to destroyed walls of alveoli
125
COPD: emphysema does not
Mucus production of inflammation
126
COPD: emphysema destruction =
Large alveolar spaces = greatly inc diffusion distance between alveoli and capillary
127
Result of COPD: emphysema
-reduced O2 and CO2 diffusion
-expiration becomes difficulty because of loss of recoil of normal alveoli
128
Symptom difference between chronic bronchitis and emphysema
B- frequent couch with mucus
E- shortness of breath
129
Acute bronchitis
Acute infection and inflammation of airways
-self limiting
-occurs due to viral infection
130
Symptoms of acute bronchitis
Similar to pneumonia
-non productive cough, aggravated by cold, dry, dusty air
131
TX for acute bronchitis
Rest, aspirin, cough, suppressant, antibiotics
132
Pneumonia
Infection of lower respiratory tract caused by microorganisms
133
HAP pneumonia
Hospital acquired pneumonia
134
CAP pneumonia
Community acquired pneumonia
135
HAP or CAP is the second most common health care associated infection
HAP
136
Pneumonia most common pathogen
S.pneumoniae
137
Pathophysiology of HAP pneumonia
In hospitals suctioning tubes can become colonized with bacterial biofilms and suction results in seeding lungs with bacteria
138
Guardian cells of lower respiratory tract
Cellular alveolar macrophages
139
Macrophages present antigens to
Adaptive immune system = activation T and B cells
140
resulting immune response can
Fill alveoli with debris
141
Further damage is caused when
Microorganisms release toxins
142
Tuberculosis
Infection caused by M.tuberculosis
-leading cause of death although curable
143
How is TB spread
person to person via airborn droplets
144
TB pathophysiology
-pathogen reaches lung and is engulfed by macrophages
-survives and multiplies
-reproduction causes chemotactic response and more macrophages respond causing tubercul formation
145
Macrophage start to die and release (TB)
Pathogen, this form a centers in tubercle (dormant stage)
146
Tubercle center enlargens… (TB)
Enlargement fills with air, aerobic pathogen starts to multiply outside macrophage
147
Liquifidcation continues (TB)
Tubercle ruptures and pathogen sdisseminate throughout lung
148
Pulmonary vascular diseases
Pulmonary blood flow disrupted causing occlusions
-destroys vascular bed
149
When pulmonary blood flow is disrupted it causes
Dramatic alterations in perfusion and ventilation ratios
150
Pulmonary embolism
Occlusion of portion of pulmonary vascular bed by embolus
151
Effect of pulmonary embolism depends on
-extent of pulmonary blood flow
-size
-nature of embolus
-secondary effects
152
Pulmonary artery hypertension
Mean pulmonary artery pressure greater than 25 mmHG at rest
153
Endothelial dysfunction (pulmonary artery hypertension)
Overproduction of vasoconstrictiors
154
pulmonary artery hypertension: increased growth factors
=fibrosis=thickening of vessel walls=narrowing of vessels and gas exchange is reduced
155
pulmonary artery hypertension: inc pulmonary artery pressure
Increased pressure in right ventricle = right ventricle hypertrophy = failure
156
Cor pulmonale
Right ventricle enlargement due to hypertrophy or dilation or birth
-result of pulmonary artery hypertension
157
In cor pulmonale there is an increased
Work of right ventricle = increased hypertrophy of normally thin walled heart muscle
158
pulmonary artery hypertension: pressure overload
=dilation/hypertrophy= failure of right ventricle
159
Laryngeal cancer: Primary risk factor
Smoking
-increased when smoking combined with alcohol consumption
160
What pathogen is linked to laryngeal cancer
HPV or human papilloma virus
161
Pathphysioloy of laryngeal cancer
Carcinoma of vocal cords (most common site)
-metastsis occurs in lymph nodes, but distant is rare
162
Manifestation of laryngeal cancer
Hoarseness, dyspnea, cough
-cough following swallowing
163
Diagnosis and TX for laryngeal cancer
Biopsy, radiation, chemotherapy
164
Lung cancer
Tumours on respiratory tract in epithelium
-leading cause of death in Canadians
165
Msot common cause of lung cancer
Smoking, gas exposure, second hand smoke exposure
166
Pathophysiology of lung cancer
Bronchial mucosa suffers hits from tobacco smoke = epithelial damage
-metastasis to brain, bone marrow and liver
167
Tobacco smoke
Contains 30 carcinogens
-90% of lung cancers
168
Tumour in lung cancer is result of
Growth factors and free radicals
