Chapter 36 Flashcards by Desiree Namou

signs and symptoms of pulmonary disease
______ and _______ !!!!!!!!!!!!!
pulmonary diseaase is associated with many signs and symptoms, and their specific characteristics often help in identifying the underlying disorder
the most common characteristics are:

dyspnea

cough

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_________: subjective sensation of uncomfortable breathing

severe
-flaring of the \_\_\_\_\_\_\_\_
-use of accessory \_\_\_\_\_\_\_ of respiration
-retraction of the \_\_\_\_\_\_\_\_\_
on exertion:
shortness of breath with activity

_______: sitting up in a ______ leaning position generally relieves this type of breathing
-supporing the upper body on several _______

dyspnea
nostrils
muscles
intercostal spaces
orthopnea
forward
pillows

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___________: alveolar ventilation is inadequate in relationship with the metabolic demands

leads to __________ from _________ which is high ___ levels
is caused by airway _________, _______ restriction, or altered ________ control of breathign

hypoventilation
respiratory acidosis
hypercapnea
CO2
obstruction
chest wall
neurologic

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__________: alveolar ventilation exceeds the metabolic demands

leads to __________ from _______ which is low ___ levels
is caused by _______, ________, or severe _________

hyperventilation
respiratory alkalosis
hypocapnia
CO2
anxiety, head injury, hypoxemia

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the selective bulbous enlargement of the end (\_\_\_\_\_\_\_ segment) of a digit and is commonly associated with diseases that interfere with \_\_\_\_\_\_\_\_\_\_\_
such as:
1
2
3
4
5

clubbing
distal
oxygenation
brochiectasis
cystic fibrosis
pulmonary fibrosis
lung abscess
Congenital heart disease

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PaO2 - oxygenation of _______
PAO2- the amount of oxygen in the ______

The ____________ is the measure of the difference between the alveolar concentration of ________
and the arterial concentration of _______. It is used in diagnosing the source of _________
Meausurement helps isolate the location of the problem as either _______(within the ____) or _________(somewhere else in the body

arterial blood
alveoli
alveolar-arterial gradient
oxygen
oxgygen
hypoxemia
intrapulmonary, lungs
extrapulmonary

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reduced oxygenation of cells in tissues

hypoxia

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reduced oxygenation of arterial blood (reduced by _______) is caused by ___________

diffusion of oxygen through the __________ membrane is impaired if it is _________ or if the _______ available for diffusion is decreased
____________ and __________ cause hypooxemia by the mechanism of abnormal thickness, as occurs with __________(swelling), and pulmonary fibrosis (formation of _________), increases the _____ required for diffusion across the alveolarycapillary membrane so bottom line this causes impairing of the alveolar capillary membrane _______

hypoxemia
PaO2
respiratory alternation
alveolocapilarry
thickened 
surface area
pulmonary edema, pulmonary fibrosis
fibrous lesions
time
diffusion

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pleural abnormalities
___________
-presence of fluid in the pleural space

_________
-is watery and diffuses out of the _________

________
-is less watery and contains high concentrations of ________ and _______
________: chyle exudate
_______: blood exudate
clinical manifestations: _______ and ______ pain
treatment: ________, _______ and _______

pleural effusion
transudative effusion
capillaries
exudative effusion
WBC and plasma proteins
chylothorax
hemothorax 
dyspnea, pleural
thoracentesis
chest tube
surgery

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exudative effusion

contains high concentrations of WBBCs and may occur in response to an _________ process
the presence of a __________ can trigger exudative effusion
result of increased ______________

inflammatory
malignant cancer
capillary permeability

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empyema

_______ pleural effusion
______ in the pleural space - causes pulmonary infections (_______,, ________) infected ______

clinical manifestations:
-_____, ____, ______(rapid heart rate), ______, and ________
treatment:
-administration of __________ meds
-drainage of the _________ with a ________
-severe cases: _________ guided pleural drainage, instillation of ________ agents, or ______ injected in the pleural space

infected
pus
pneumonia, abscesses
wounds
cyanosis, fever, tachycardia, cough, pleural pain
antimicrobial
pleural space, chest tube
ultrasound
fibrinolytic
DNAse

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restrictive lung diseases restrict the lung ________

the lungs are unable to _____ normally diminishing the amount of ___ that can be inspired

volume
expand
gas

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obstructive lung diseases affect ________
airflowinto and out of the lung is obstructed
increased ________ to air flow caused by _______ of airways

gas flow
resistance
narrowing

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CXR abnormalities terms
_______ and _______ - air trapping in the alveoli and airways
_________ or _________: consolidation of the lung tissue
__________ or ________: cavities
_______: nodular

asthma, emphysema
pneumonia, pulmonary edema
abscesses or TB
lung cancer

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a loss of lung volume caused by \_\_\_\_\_\_\_ of alveoli and subsequent \_\_\_\_\_\_ of the part of the lung
etiology
1.  \_\_\_\_\_\_\_\_\_(tumor)
2. \_\_\_\_\_\_\_\_\_ pleural effusion
3
4
5 \_\_\_\_\_\_\_\_\_( within \_\_ hours)
6

atelectasis
deflation
collapse
obstructive
nonobstructive
pneumothorax
surfactant deficiency
postoperative, 72
asbestosis

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restrictive  lung disorders
atelectasis
\_\_\_\_\_\_\_ of lung tissue
-compression atelctasis
-\_\_\_\_\_\_ compression on the lung
-absorption atelectasis
-gradual \_\_\_\_\_\_\_ of air from obstructed or \_\_\_\_\_\_\_\_\_ alveoli
-\_\_\_\_\_\_ impairement
-decreased production or inactivation of surfactant
clinical manifestations
-\_\_\_\_\_\_, \_\_\_\_\_\_\_, \_\_\_\_\_\_ and \_\_\_\_\_\_\_\_
treatment:
\_\_\_\_\_\_\_\_\_

collapse
external
absoprtion
hypoventilated
surfactant
dyspnea, cough, fever, leukocytosis
deep breathing

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restrictive lung disorders
__________: excessive amounts of fibrous or connective tissue in lung
_________ pulm fibrosis: no specific cause
-clinical manifestations: increasing ______ on exertion

pulmonary fibrosis
idiopathic
dyspnea

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restrictive lung disorders
_________
-excess water in the lung from disturbances of ______________ pressure, ________ pressure, or _________
-most common cause: ________ heart disease!!!!!

clinical manifestations: dyspnea, orthopenea, hypoxemia, and increased work of breathing

pulmonary edema
capillary hydrostatic
capillary oncotic pressure
capillary permeability
left sided

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these are short parallel lines at the lung periphery. these llines represent ___________, which are usually less than 1 cm in length and paraelll to one another at ________ to the pleura

they are located _________ in contact w the pleura, but are generally absent along ______ surfaces
they may be seen in any zone but are most frequently obserbed at the ______ at the_______ angles on the PA radigraph

Kerley B lines
interlobular septa
right angles
peripherally
fissural
lung bases
costophrenic

perihilar, interstitial opacities shadow of ________ or _____ appearance. the hatched lines are _______ (kerley lines which represent prominent _________ _____ vessels

pulmonary edema
butterfly, bats wings
septal lines
interlobular lymphatic

restrictive lung disorders
\_\_\_\_\_\_\_\_ (ALI) or \_\_\_\_\_\_\_\_\_\_\_\_\_ (ARDs)
-is a \_\_\_\_\_\_\_\_ form of respiratory failure characterized by acute \_\_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_ injury
-injury to the pulmonary capillary \_\_\_\_\_\_\_\_\_\_\_
-\_\_\_\_\_\_\_\_\_ capillary permeability
-\_\_\_\_\_\_\_\_\_\_
-\_\_\_\_\_\_\_\_\_\_\_\_ inactivation
-\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_

acute lung injury
acute respiratory distress syndrome
fulminant
lung inflammation
diffuse alveocapillary
increased
inflammation
surfactant
edema, atelectasis

ARDS pathophys

alveoli and respiratory bronchioles fill with fluid as a result of __________ of surfactant and the impairment of _______ ______ cells
________ release inflammatory mediators such as ____________, ___________, ________, __________ and _______ activating factor

inactivation
type 2 alveolar 
neutrophils
proteolytic enzymes
oxygen-free radicals
prostaglandins
leukotrienes
platelet

obstructive pulmonary disease
1
2
3
4 \_\_\_\_\_\_\_\_ plus \_\_\_\_\_\_\_\_\_ equals \_\_\_\_\_\_\_\_\_\_\_

asthma
chronic bronchitis
emphysema
chronic bronchitis
emphysema
chronic obstructive pulmonary disorder (COPD)

obstructive pulmonary disease
air obstruction is worse with expiration
disease requires more ______ to expire a volume of air

force

_______ episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucous production early asthmatic response -_____, may contribute to the pathophysiologic characteristics of asthma -inflammatory mediators produced by asthma: 1 2 3 4 the release of toxic _________ contributes to increased ________ ___________ clinical manifestations: inspiratory and expiratory ________, ______, ________ cough and _________

``` asthma IgE histamine bradykinin leukotrienes prostaglandins neuropeptides bronchial hyperresponsiveness wheezing dyspnea nonproductive tachypnea ```

chronic bronchitis _______ - _______ is more severe hypersecretion of ____ and chronic productive cough that lasts at least __ months of the year and for at least __ consecutive years pathophysiology the production of mucus associated w this is due to increased in _________ size -inspired irritants increase ______ production, size and number of mucous glands and bronchial ______; mucus is _____ than normal -________ bronchial smooth muscle -______ and _______ -airways ______ early in expiration, ______ gas in the lung

``` blue bloaters hypoxia mucus 3 2 goblet cell mucus edema thicker hypertrophied hypoxemia, hypercapnia collapse trapping ```

``` chronic bronchitis clinical manifestations: - decreased _______ tolerance -________ and ____ -productive ______ "smokers cough" becomes __________ ``` treatment: _______ cessation: disease can be halted

``` exercise wheezing, SOB cough copious smoking ```

emphysema ______, ________ breathing, _____ chest -abnormal permanent enlargement of the __________ airways accompanied by the destruction of the ________ walls without obvious ________ -loss of _________ -primary emphysema -_________ deficiency of the enzyme __________ -secondary emphysema -_________: main cause -________, occupational ______ and _______ respiratory infections, possible contributers

``` pink puffer pursed barrel gas-exchange alveolar fibrosis elastic recoil inherited a1-antitrypsin cigarette smoke air pollution exposures childhood ```

emphysema clinical manifestations include unexplained ________, ______ on exertion, use of _______ muscles, and ______ with prolonged ________

``` weight loss dyspnea accessory tachypnea expiration ```

emphysema _______ inflamed lungs mean that is filled with more air than usual. this is a common finding in someone with _____. The hyperinflation also causes the ____________ _______ lateral chest xray the _____ of the diaphragm are significantly ______. the thorax can be described as ___________

``` hyperinflamed COPD flattened diaphragm domes flattened barrel chest ```

``` emphysema treatment the initial step in the management of emphysema: __________ pulmonary _____ improved ______ ______ techniques ```

smoking cessation rehab nutrition breathing

pneumonia infection of the _______ respiratory tract responsible for more disease and death than any other infection

lower

community acquired pneumonia (CAP) one of the most common reasons for hospitilization in the USA 1 2 3

streptococcus pneumoniae H. influenza Moraxella Catarrhalis

``` Ventilatory associated pneumonia (VAP) develops after 48 hours on a ventilator 1 2 3 ```

``` pseudomonas staphylococcus aureus (MRSA) klebsiella ```

heath care associated pneumonia (HCAP) recent hospitilization residence in a nursing home extended care facility, home infusions therapy 1 2 3

``` pseudomonas staphylococcus aureus (MRSA) klebsiella ```

hospital acquired pneumonia most common nosocomial infection. has the greatest _______ develops after 48 hours of being inpatient 1 2 3

``` pseudomonas staphylococcus aureus (MRSA) klebsiella ```

pneumonia routes of infection ___________ most common route of _______ respiratory tract infection is via _________ of _______ secretions

aspiration lower aspiration oropharyngeal

streptococcus pneumoniae ``` ________ pneumonia -___, resulting in inflammatory _____ and cells, causes ______ edema -edema creates a medium for the multiplication of _______ and aids in the spread of infection into ______ portions of the lung -involved lobe undergoes __________ four phases: 1 2 3 4 ```

``` pneumococcal ALI cytokines alveolar bacteria adjacent consolidation consolidation red hepatization gray hepitazation resolution ```

pneumonia _______ pneumonia -is seasonal; usually mild and self limiting -can set the stage for a ______ bacterial infeciton -provides an ideal environment for bacterial growth and by damaging _______ epithelial cells, which normally prevents _____ from reaching the airways most common form: ________ clinical manifestations: for ___________ look for rapid onset of ______ _____ preceded by an ______ respiratory infection, followed by ______, ______ chest pain, productive ______ (_____-_____ or _____)

``` viral secondary ciliated pathogens influenza streptococcus pneumoniae shaking chills upper fever pleuritic cough yellowish-green rust ```

pneumonia treatment bacterial pneumonia: _______ viral pneumonia: supportive ________ ______, unless ________ bacterial infection is present

antibiotics therapy alone secondary

tuberculosis a bacterial infection caused by mycobacterium tubercolisis typically affects the lungs pathophys airborne droplet transmission tubercle formation: granulomatous lesion caseous necrosis:cheese like material may remain dormant for life or cause active disease isolation of ________ by enclosing them in _______ and surrounding them with _________

bacilli tubercles scar tissue

tuberculosis how the body walls off the bacilli in TB, the body walls off the bacilli in a tubercle by stimulating ______ __________ ______ that activate _________ in defense, ________ and _________ release _______, which inhibits the replication of the microorganism and stimulates more ______ to attack the bacterium.

``` apoptotic infected macrophages cytotoxic T cells macrophages, lymphocytes interferon macrophages ```

tuberculosis (picture in slide) a patchy ____ infiltrate can be seen in upper _______

dense | left lobe

acute bronchitis is an acute infection or inflammation of airways or bronchi commonly follows a _______ illness -causes symptoms similar to _________ but does not demonstrate pulmonary ________ and chest ________ -clinical manifestations: ________ cough occurs in _______ and is aggravated by ____, _____ or dusty air -treatmentL rest, _______, _______ and __________ (_____)

``` viral pneumonia consolidation infiltrates nonproductive paroxysms cold, dry aspirin, humidity, cough suppressant codeine ```

pulmonary emblolus that impairs blood flow to a segment of the lung results in an area where ______ are ventilated but not ______, which causes ____________

alveoli perfused alveolar dead space

aging and the pulmonary system loss of _______ ________ of the chest wall

recoil | stiffening