Final: Ch 23 Disorders of Ventilation & Gas Exchange Flashcards Preview

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Flashcards in Final: Ch 23 Disorders of Ventilation & Gas Exchange Deck (87):
1

what is ventilation

movement of air into the lungs

2

what is perfusion

circulation of blood through pulmonary vessels

3

what is diffusion

oxygen and CO2 x respiratory membrane

4

what is hypoxemia

low arterial PO2

5

symptoms of hypoxemia

mental confusion, restlessness, agitation, combativeness

cyanosis when deoxygenated Hb > 5g/dl

SNS activation

PA vasoconstriction and polycythemia when chronic

6

diagnosis and treatment of hypoxemia

diagnosis: ABG, pulse oximeter

treatment: correct the cause -- give O2 and/or ventilate

7

hypercapnea, symptoms, treatment

High CO2 in blood

hypoventilation or severe V/Q mismatch

symptoms: acidosis

treatment: mechanical support to improve ventilation

8

how to distinguish between cardiac and respiratory pain?

taking a deep breath doesn't increase cardiac pain, but does increase respiratory pain

9

types of pleura

visceral pleura: covers lung

parietal pleura: lines chest cavity

pleural space inbetween - fluid

10

is there normally negative pressure in the lung system?

yes

11

pleuritis

inflammation of the pleura (localized) - acute pain

worse with deep breathing/coughing

may need analgesics, NSAIDS

12

pleural effusion

abnormal collection of fluid in the pleural cavity

13

causes of pleural effusion

negative intrapleural pressure (atelectasis)

high capillary pressure (HF)

high capillary permeability (infection)

low lymph drainage (mediastinal cancer)

14

symptoms of pleural effusion, diagnosis, treatment

symptoms: dyspnea, low breath sounds, hypoxia

Dx: chest x-ray, CT scan

treatment: thoracentesis

15

what is transudate

serous fluid - HF

16

what is exudate

fluid with protein or LDH

inflammatory process

17

what is empyema

pus in the pleural cavity

rupture of an abscess

18

what is chylothorax

lymph in the pleural cavity

trauma, inflammation, malignancy

19

what is hemothorax

blood in the pleural cavity

trauma, aneurysm, malignancy

20

pneumothorax

air in the pleural cavity causing partial or complete lung collapse

spontaneous or traumatic

21

spontaneous pneumothorax is caused by what, and types (primary/secondary)

caused by the rupture of a bleb

primary: no known cause (common in tall men + smokers)

secondary: asthma, TB, CF, lung cancer

22

spontaneous pneumothorax leak

lung collapse can seal the leak

otherwise, the leak continues until a negative intrapleural pressure is abolished

23

traumatic pneumothorax

caused by a rib fracture or penetrating external wound

may be accompanied by other traumatic injuries like a hemothorax

24

tension pneumothorax (life-threatening)

opening from pleural space covered by flap valve

air enters during inspiration but can't leave

pleural pressure > atmospheric

mediastinum shifty and other lung and great vessels compromised

type of traumatic pneumothorax

25

symptoms of pneumothorax

depends on size

respiratory distress and hypoxemia

asymmetry of the chest

tension pneumo can cause cardiovascular collapse

26

diagnosis of pneumothorax

chest x-ray

CT

ABG

pulse oximetry

27

treatment of pneumothorax

a small spontaneous one may resolve itself

needle aspiration or chest tube and closed drainage

tension pneumo - emergency chest tube

cover sucking chest wounds with an airtight dressing

28

on a CXR what does a collapsed lung look like

an empty, dark space

29

what is atelectasis and what are the types

incomplete expansion of part of the lung

caused by a blockage of airway, compression, or lack of surfactant

primary or acquired

30

primary atelectasis

infant's lung fails to expand at birth

seen in premature and high risk infants

31

acquired atelectasis

caused by bronchial obstruction or external compression (tumor, pleural effusion, mucus plug)

once bronchus becomes obstructed, air is absorbed from alveoli leading to the atelectasis

seen post op: pain, anesthesia, immobilization --> retention of secretions

32

symptoms of atelectasis

tachypnea

tachycardia

dyspnea

cyanosis

low breath sounds

fever

33

diagnosis and treatment of atelectasis

Dx: CXR, CT

Rx: mobilization and cough/deep breath for post op patients (produces neg pressure)

may require bronchoscopy

34

what is obstructive airway disease

caused by an obstruction that limits expiration

reversible (asthma), or not (COPD)

bronchial smooth muscle plays a role

SNS dilates and PNS constricts bronchi

35

bronchial asthma

bronchospasm and activation of inflammatory cells

always hyper-responsive

wheezing, cough, SOB

36

asthma acute phase (10-20 min) response

immediate bronchoconstriction (SMC activation) to antigen or irritant

sensitized mast cells release histamine

mucus membranes are permeable to cells/antigen

increased vascular permeability causes mucosal edema

37

what reverses the acute phase of asthma

beta2-agonists

dilators

38

asthma late phase (4-8hrs) response

sensitized mast cells release histamine

strong inflammatory response

multiple types of leukocytes recruited

cholinergic nerves activated

39

are early childhood infections preventative of asthma?

can be

40

extrinsic causes of asthma

airborne allergens

familial pattern

41

intrinsic causes of asthma

respiratory infection

inhaled irritants

NSAIDS, beta-blockers

emotional trigger

GE reflux

exercise

42

VE

minute ventilation

VE = Vt x RR

43

FRC

fractional residual capacity

44

FVC

forced vital capacity

45

Vt - Vd

dead space

46

VE =

VT x f (500ml/breath x 12 breaths/min) = 6L/min

47

symptoms of asthma

wheezing, chest tightness

prolonged expiration, air trapping (high RV, low FVC)

alveolar ventilation less effective --> V/Q mismatch (shunt) --> hypoxia

48

symptoms of mild asthma attacks

chest tightness

wheezing

cough

49

symptoms of severe asthma attacks

distant breath sounds

loud wheezing

inaudible breath sounds and wheezing signals onset of respiratory failure

50

FEV1

forced expiratory volume in 1 second

how much was breathed out in 1 second?

51

diagnosis of asthma

H&P

spirometry FEV1/FVC low, PEF low

peak expiratory flow (PEF) meter

methacholine challenge to trigger attack

see if bronchodilators reverse

52

treatment of asthma

education and desensitization to allergens

53

short-term meds for asthma

beta-agonists (albuterol, terbutaline) by inhaler

anti-cholinergics by inhaler

systemic steroids

54

long-term meds for asthma

steroids

mast cell stabilizers

long-acting beta-agonists

SMC relaxers

leukotriene modifiers (block synthesis/receptors)

Xolair: monoclonal Ab against IgE

55

how is asthma classified

by severity

allows proper treatment and identification at those at risk for complications

56

severe asthma

virtually constant symptoms and requires frequent use of steroids

deterioration can be rapid - don't delay treatment

57

chronic obstructive pulmonary disease: COPD

a group of diseases that produce chronic obstruction of air flow

4th leading cause of death in US

58

what causes COPD

smoking

alpha1-antitrypsin deficiency

59

when do you get symptoms of COPD?

when the disease is advanced

60

in COPD, the airway can be obstructed by... 3 things

fibrosis with hypertrophy of bronchial wall

inflammation with hyper-secretion of mucus

destruction of elastic fibers

61

progression of COPD

destruction of alveoli decreases gas exchange area

destruction of elastic fibers causes airway collapse

V/Q mismatch = wasted effort and hypoxia

low elastic recoil causes airway collapse and air trapping

62

2 types of COPD

emphysema - enlarged airspaces

chronic bronchitis - small airway obstructions

63

emphysema

loss of lung tissue (elastic, alveolar walls destroyed)

airspaces enlarged

lungs hyperinflated

high TLC

64

_______ is the leading cause of emphysema

smoking

65

smoking and emphysema

activates macrophages and neutrophils to release elastases

decreases antitrypsin activity (inhibits elastases)

elastin fibers destroyed

66

genetics of alpha1 antitrypsin deficiency

PI (protein inhibitor) genes produce alpha1 antitrypsin

PIZ mutation most severe 5% of population

homozygotes have 1/5 or less of normal enzyme activity

67

if emphysema in a person less than 40 YOA then cause is likely...

alpha1 antitrypsin deficiency

68

2 types of emphysema

centriacinar

paracinar

69

centriacinar emphysema

bronchioles in central lung affected 1st

alveoli initially normal

common in male smokers

70

paracinar emphysema

peripheral alveoli affected 1st

bronchioles initially normal

common in alpha1-antitrypsin deficiency

71

chronic bronchitis cause

caused by inflammation of airways (hyperplasia and a lot of mucus production)

middle aged males that smoke (multiple infections)

bacterial/viral infection

72

diagnosis of chronic bronchitis

cough for 3 months consecutively fo 2 years

73

progression of COPD

from cough to severe respiratory distress

74

older terminology for COPD

pink puffer: emphysema

blue bloater: chronic bronchitis

most people with COPD have some of both

75

emphysema causes loss of both _________ & _________

ventilation & perfusion

76

emphysema causes hypoxia when

late in disease

77

chronic bronchitis leads to _______ obstruction, and low V/Q areas lead to _______

airway, hypoxia

78

symptoms of emphysema

dyspnea with use of accessory muscles

seated position at night

barrel chest from air trapping

pursed lip breathing

79

symptoms of chronic bronchitis

dyspnea

exercise intolerance

hypoxia & hypercapnea

polycythemia --> HTN + Rt HF

80

death from COPD occurs from

exacerbation from infection

eventually respiratory failure

81

diagnosis of COPD

CXR - shower hyperinflation

PFT's: FEV1 and FEV1/FVC are low

TLC & RV high

if FEV1/FVC less than 50% -- severe disease

exercise tolerance test

blood gases

82

CXR of a COPD patient

hyperinflation seen as:

increased lung volume

low flat diaphragm

increased retrosternal air

83

treatment of COPD

stop smoking

prevent respiratory infection

increase physical/psychosocial function

O2 therapy when hypoxia present (PO2 to 60)

84

drugs for COPD

beta-agonists

anti-cholinergics

theophylline

steroids

85

bronchiectasis

uncommon, but serious type of COPD (airway obstruction)

2ndary to persistent infection/inflammation (TB)

86

symptoms of bronchiectasis

productive cough

purulent sputum

hemoptasis

anemia

weight loss

87

diagnosis/treatment of bronchiectasis

H&P, CXT, CT

postural drainage, chest PT, treat infection