Exam 2 - Cardiac and Pulmonary Pathophysiology Flashcards

Question

Sx of congenital heart defects?

Answer 1

``` Respiratory distress Cyanosis Grunting/wheezing Failure to thrive Signs of heart failure Shortness of breath ```

Answer 2

Prenatal screening for genetic disorders Ultrasound Echocardiogram *PT needs to assess activity tolerance, breathing patterns, HR response, posturing, and developmental milestones*

Answer 3

Infectious/inflammatory disorders Obstructive (flow of air is impeded) Restrictive (volume of air is decreased) Malignancy

Answer 4

Infectious/inflammatory classification RF: increasing age, dysphagia (difficulty swallowing), immunosuppression, diabetes, malnutrition, dehydration, hospitalization, immobility (primary cause of pneumonia), altered consciousness, smoking history

Answer 5

A normal immune response does not eliminate bacteria/virus. Organism releases chemicals that stimulate an immune/inflammatory response. The mucous membrane is damaged The alveolar capillary membrane is damaged The cellular debris impedes oxygen diffusion

Answer 6

Bacterial: usually limited to 1-2 lobes of lungs Viral: usually bilateral. Destroys epithelial and goblet cells, mucous glands. Impaired mucociliary escalator

Answer 7

Impaired protection of the airway due to seizures or a depressed gag reflex. Severity of pneumonia depends on the amount of material aspirated and the acidity of the material aspirated.

Answer 8

``` Recent upper respiratory tract infection Pleuritic pain Productive cough Dyspnea Tachypnea/tachycardia Fever Fatigue Generalized myalgias Cyanosis ```

Answer 9

The right lung because the main bronchus is more vertical than the left lung main bronchus.

Answer 10

Same as viral or bacterial pneumonia. Coughing, shortness of breath with eating and shortly thereafter *PT implication: head/neck position and posture is important for swallowing*

Answer 11

Pneumocytes attach onto the alveolar lining and feed on the cell. New pneumocytes form. The alveoli are filled with cellular debris and new pneumocytes and effect the ability of the alveoli to participate in gas exchange. *usually seen in immunosuppressed patients*

Answer 12

``` Usually lasts 1-2 weeks Antibiotics for bacterial pneumonia Hydration Exercise for pulmonary hygiene Alternative feeding Positioning Vaccine the high risk groups (> 65 y/o, chronic lung disease, diabetes, immunocompromised) ```

Answer 13

Hx of upper respiratory infection (URI) Sputum culture Chest x-ray Urine antigen testing for streptococcus pneumonia Auscultation- crackles, decreased lung sounds, wheezing *6th leading cause of death in US (mostly elderly)*

Answer 14

TB is an infectious disease of the lungs. Inhaled droplets contracted from an infected person sneezing, coughing, laughing, talking too close to someone. A proliferation of the epithelial cells in the alveoli occurs and TB particles are "walled off". A latent infection is usually asymptomatic.

Answer 15

Necrotic center Fibrosis of tissues Is spread through the bloodstream and lymphatic system

Answer 16

Productive cough (>3 weeks) Weight loss Fever Malaise (general discomfort or uneasiness)

Answer 17

``` Age HIV Homeless Overcrowded living arrangements Malnutrition Prison inmates ESRD (end state renal disease) Immunocompromised Health care workers ```

Answer 18

Hx Chest x-ray Sputum culture Skin test

Answer 19

Combination of medications for 6-9 months to prevent cell wall biosynthesis. *if untreated prognosis 50-80% fatal in 2.5 years*

Answer 20

``` 2 step ppd test yearly Cover nose/mouth when sneezing Wear appropriate mask when working with client who has TB Disinfect stethoscope after use Hand washing ```

Answer 21

``` Smoking (#1 RF for obstructive diseases) Age Men > women Environmental allergens Heredity ```

Answer 22

- Airway obstruction (causes more constriction during expiration than normal, walls flop down on each other) - Air trapping - Gas exchange abnormalities (if cannot get air out cannot get CO2 out either) - Mucus production (in addition to floppy airways increased mucus production further blocks airway) - Pulmonary HTN (referring to pulm. artery and the right side of the heart pumping against the increased resistance of the lungs) - Systemic effects

Answer 23

Chronic bronchitis is an inflammation of the bronchi with scarring of the bronchial lining. The airway is collapsed and results in air trapping. This decreases the amount of air that reaches the alveoli and thus causes decreased ventilation.

Answer 24

A productive cough that lasts for at least 3 months each year for two consecutive years. A decreased expiratory flow (FEV1) because chronic bronchitis is an obstructive disease and obstructive diseases affect expiration mainly. Frequent infections

Answer 25

``` Cough Sputum production (worse in morning) Shortness of breath Activity intolerance Enlarged A-P diameter of chest Use of accessory muscles with activity Wheezing (sign of constriction) Cyanosis Cor pulmonale ```

Answer 26

Impaired mucociliary elevator. Destruction of the distal airways beyond the terminal bronchiole resulting in air trapping and insufficient gas exchange. Destruction of elastic properties of the alveolar wall resulting in decreased elastic recoil and bronchi collapse during expiration. Pockets of air (blebs) form between alveolar spaces which increases the dead space in the lungs (the dead space means not getting any air exchange).

Answer 27

DOE progressing to SOB at rest Cor pulmonale (systemic swelling / jugular vein distension) Accessory muscle use to assist in respiration Cachetic (increased work of breathing) Barrel chest (puts the diaphragm at length tension disadvantage)

Answer 28

Air trapping worsens which is known as dynamic hyperinflation. Results in decreased amount of time in expiratory phase and doesn't allow full expiration (tachypnea) As the air trapping worsens it hinders the full excursion of diaphragm. Will lead to dyspnea, early termination of activity, and deconditioning spiral

Answer 29

Systemic effects of COPD cause atrophy of the endurance muscles. Poor strength and endurance is related to higher rates of mortality

Answer 30

Pulmonary function tests (PFTs) Purpose is to evaluate the function of the respiratory muscles, the health/function of the airways, and classify different types of pulmonary diseases

Answer 31

Measuring volume of air. Often used in PFTs

Answer 32

Gas flow rates measure the flow of gas in various parts of the lungs. Helps evaluate the function of the lungs, the magnitude of the impairment as well as the location of the impairment.

Answer 33

Forced Vital Capacity measures the maximum volume of gas a patient can exhale forcefully and quickly

Answer 34

It reduces both.

Answer 35

FEV1 is the amount of air exhaled during the 1st second of a FVC. Is useful because it gives one an idea about the patency of airways and how air flows during expiration

Answer 36

Values are based on pt. age, gender, height, weight and race. Take actual value and divide by predicted value, the result must be < 80% before being considered abnormal Results also effort dependent Serial PFTs are useful for screening exposed populations of workers

Answer 37

PFT will indicate airflow abnormalities FEV1/FVC needs to be < .70 post bronchodilator to be COPD > 80% mild COPD 50-79% moderate COPD 30-49% severe COPD

Answer 38

``` Chest x-ray Arterial blood gas Sputum cultures PFTs Hx of smoking or environmental exposure ```

Answer 39

``` Smoking cessation Steroids to reduce inflammation Bronchodilators (i.e. B-2 agonists and anticholinergics) Mucolytics Antibiotics Oxygen Exercise Breathing retraining Posture training Lung volume reduction surgery Lung transplant ```

Answer 40

It is a reversible obstructive lung disease. Characterized by increased lung reactivity when exposed to a stimulus. Airway hyperresponsiveness, edema, mucous, bronchoconstriction

Answer 41

``` Premature birth Urban/industrialized settings Cold climates Low socioeconomic status African Americans Overcrowded living areas Obesity ```

Answer 42

Older sibling Early exposure to pets Large families Attending daycare

Answer 43

Extrinsic - food and environmental triggers. IgE antibodies and mast cells hyperrespond to allergen and release bronchoconstrictors. Intrinsic - no known trigger, adult onset > 40 y/o, and chronic upper respiratory infection

Answer 44

The trigger causes IgE antibodies and mast cells to resond: - Narrowing airway due to edema and thickening of airway walls - Mucus plugging due to thickening of mucus and decreased function of the mucociliary elevator - Air trapping - V/Q mismatch - Increased WOB *airway inflammation is always present, symptoms abate after treatment or time, the pt will be asymptomatic between episodes and PFTs will return to normal*

Answer 45

``` Sensation of airway narrowing (tickling, fear) Nonproductive cough Inspiratory and expiratory wheezing Tachypnea, tachycardia Fatigue Nostril flaring Accessory muscle use Cyanosis Restlessness ```

Answer 46

``` Pulse ox (O2) PFT with medications Arterial blood gas tests X-rays Hx ```

Answer 47

Education about what asthma is to pt. Compliance with medications Aerobic fitness Identify trigger (avoid it)

Answer 48

Controllers - medications taken daily for long term Relievers - medications given as needed that act quickly to resolve an acute episode *inhalers preferred over oral med to reduces systemic effects of steroids*

Answer 49

Exercise induced bronchospasm. 5-15 minutes after exercise begins or once exercise is terminated. Breathing through the mouth and nose dehumidifies the airways. Can last 15-60 minutes after exercise and is most common in endurance sports/athletes

Answer 50

10-15% or greater drop in FEV1 when they reach at least 80% of maximum heart rate for at least four minutes Encourage hydration, adequate warm- up, and MD often prescribes a SABA (inhaler )to be taken right before exercise

Answer 51

Characterized as a decreased amount of air you can get into your lungs. Decreased total lung capacity. Primary (pulmonary and cystic fibrosis)

Answer 52

``` DOE (Decreased exercise tolerance) Increased work of breathing Accessory muscle use Weight loss Hypoxemia (abnormally low conc. of O2 in blood) ```

Answer 53

``` Idiopathic (majority of cases) TB (tuberculosis) ARDS (acute respiratory distress syndrome) Asbestos Lupus Chemotherapy Radiation ```

Answer 54

Irreversible proliferation of fibroblasts (Decreased lung compliance, Resistance to expansion) Alveolar and capillary injury (Decreased ability to diffuse gasses, hypoxemia)

Answer 55

Corticosteroids Chronic, progressive disease Median survival <4 years

Answer 56

``` Corticosteroids Maximize use of diaphragm Maintain airway opening Maintain oxygenation Cough training ```

Answer 57

- Autosomal recessive disorder - Disorder of sodium and chloride channels in exocrine glands - Chromosome 7 - -Abnormal CF transmembrane conductance regulator (CFTR) - -Chloride channel malfunctions - -Dehydrated and thick mucous gland secretions - -Increased concentration of NaCl - -Pancreatic enzyme insufficiency

Answer 58

- Obstruction by mucus (mucus gets thick, dry and dehydrated due to the channel abnormality) - Frequent infections (lungs are wet, dark, warm) - Hyperinflation (air trapping) - Bronchiolitis/bronchiectasis

Answer 59

``` “salty” sweat Productive cough Wheezing Frequent infections Weight loss Exercise intolerance Increased WOB Decreased FEV1 ```

Answer 60

- GI system - -Weight loss - -GERD - -Intestinal obstruction - Liver - -Cirrhosis - Pancreas - -Thick secretions block pancreatic ducts - -fibrosis Pancreatic enzymes are blocked - -Loose stools - -Vitamin deficiency - -Anemia - -DM - Genitourinary - -Sterility males - -Infertility in some females

Answer 61

``` Muscle atrophy Rheumatoid arthritis Osteopenia  Nutrition  Steroids  Estrogen deficiency ```

Answer 62

Purulent sputum Frequent infections Hypoxia (Clubbing) Barrel chest

Answer 63

``` Prenatal screening 70% detection rate Failure to thrive, respiratory infections in infancy Sweat test  (+) chloride concentration >60mEq/L; normal is 40 Pancreatic elastase -1  Pancreatic insufficiency PFT’s  Obstructive pattern ```

Answer 64

``` Multidisciplinary Team  Pulmonologist, Endocrinologist, Physical Therapist, Gastroenterologist, RespiratoryTherapist Bronchodilators Mucolytics Corticosteroids Oxygen Antibiotics ```

Answer 65

``` Chest physical therapy Postural drainage Exercise Positioning Theravest Autogenic drainage Adjunct airway clearance PEP  Stents airways Flutter  Provides vibratory force ```

Exam 2 - Cardiac and Pulmonary Pathophysiology Flashcards

(89 cards)