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9633 Swallowing > L5: Swallowing and the Resp System > Flashcards

L5: Swallowing and the Resp System Flashcards

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1
Q

conducting zone =

A

“ventilation”

resp passageways

nasal cavity, oral cavity, pharynx, larynx, trachea, bronchi, bronchioles, terminal bronchioles

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2
Q

respiratory zone =

A

“respiration”

site of gas exchange

resp bronchioles, alveolar ducts, alveoli

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3
Q

what 2 things does the ease of ventilation depend on?

A

integrity of the ventilatory pump - mechanism which air moves into the lungs (musculature/nerves)

compliance of the alveoli and chest wall (recoil pressure - elasticity; resistance to recoil pressure by connection to chest wall) ….partly inflated all the time inc compliance + surfactant

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4
Q

what can damage the ventilatory pump?

A

kyphosis, scoliosis

paralysis

pain

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5
Q

alveolar compliance is altered by…

A

fibrosis, inflammation (thickened/damaged alveoli)

ARDS/Pneumonitis (loss of surfactant)

Atelectasis, pneumothorax (damaged chest wall coupling)

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6
Q

so ventilation needs…

A

an intact pump

compliant alveolar system (elastic alveolar membrane + surfactant to maintain surface tension)

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7
Q

respiration involves…

A

a thin membrane

needs blood in the capillary bed (to exchange gas w atmosphere)

alveolar and capillary gas concentration diff (allows for diffusion to occur)

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8
Q

external resp =

A

gas exchanged bw alveolar air and pulmonary capillaries

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9
Q

internal resp =

A

gas exchanged bw arterial blood and working tissues

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10
Q

O2 and CO2 concentrations are balanced by…

A

the resp system

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11
Q

hypoxemia =

A

poor O2 conc in the alveoli, so poor movement of O2 into blood – relates to external resp

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12
Q

hypoxia =

A

low O2 getting to muscles for example or to brain, related to internal resp

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13
Q

hypercapnia =

A

too much CO2 in the system (those who are hypoxemic are hypercapnia)

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14
Q

external resp can be disrupted by…

A

changes to the resp membrane

inflammation, excess mucous
insufficient clearance of infiltrates

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15
Q

resp failure can be caused by gas concentration being…

A

insufficient for diffusion

build up of CO2 in the lungs (due to insufficient expiratory airflow) [lung fibrosis, emphysema]

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16
Q

respiration needs…

A

porous resp thin membrane

intact capillary perfusion (blood to alveolar air interface, no obstructions)

gas gradient bw air and blood

intact perfusion at organ level

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17
Q

COPD =

A

group of diseases that are characterized by irreversible airway obstruction caused by destruction of lung tissue

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18
Q

to diagnose COPD it involves what symps, risk factors, spirometry?

A

symps= cough + sputum, dyspnea

risk factors = tobacco, occupation, indoor/outdoor pollution

spirometry = FEV1 (forced exp volume across 1 sec) and FVC (forced vital capacity)

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19
Q

chronic bronchitis =

A

productive cough for a min of 3 months/year, for 2 consecutive years

excessive mucous production, narrowing of small airways secondary to edema

eventually dev of tissue fibrosis due to repeated episodes of irritation and inflammation

cyanotic due to inadequate gas exchange - low levels of oxygen in blood trigger inc resp efforts

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20
Q

emphysema =

A

deterioration of alveolar walls; loss of elastic recoil properties

air remains trapped in lungs

diaphragm becomes less efficient as it is flattened by hyperinflated lungs

inc use of accessory muscles of resp to ventilate alveoli (rapid shallow breathing; weight loss)

thin. barrel-chested appearance

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21
Q

gas exchange requires…

A

near constant, predictable cycle of ventilation cycle

resp rate approx 16/min in young and 20/min in old

resp cycle = insp 40% and exp 60%

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22
Q

is swallowing cycle less or more predictable than gas exchange?

alimentary swallow?
saliva swallow?

total swallow duration?
swallow apnea duration?

A

less predictable

alimentary swallowing = unpredictable; > 1 sw/min

saliva swallowing = more preditable; approx 1 sw/min (based on saliva flow rate and vallecular volume)

total swallow duration = inc w age
swallow apnea duration = inc w age, dec w lower lung volumes

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23
Q

describe the set up for the Martin et all (2005) study

A

healthy volunteers across aging continuum

2trials of 5 ml thin liquid (most likely to aspirate on this)

looked at onset of 11 breathing and swallowing events

identified phases of breathing bf and after swallowing

presence, depth, and response to airway penetration was recorded

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24
Q

result of the martin harris et al (2005) study

A

4 resp-phase patterns which change w advanced age

Ex-sw-ex, in-sw-ex, ex-sw-in, in-sw-in

EX-SW-EX = most common/safe

non dominant patterns inc w advancing age

apnea onset and duration were highly variable (apnea offset sig later in oldest group; tendency for total swallow duration to inc w age)

no diffs in penetration/asp scores bw patterns

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25
disease can alter... ultimately leads...
ventilation +/- resp... changes how a patient breathes to change in coordination bw breathing and swallowing (and speech)
26
pulomary disease leads to altered...
ventilation +/- gas exchange ex. COPD = effortful airflow; dec permeability of resp mem
27
neurological disease can lead to altered ...
resp control coordination ex. stroke= smaller lung volumes, shorter cycle duration at rest; direction of airflow after swallow (60% expire after swallow vs 95% in health)
28
what are the two airway clearance methods for proximal LRT?
Cough mucociliary action
29
pulmonary clearance is _____ in the superior portion of the lower resp tract
mechanical
30
cough =
reflex involving afferent inputs and forceful expulsion of air from lungs
31
what is involved with a cough?
inc lung volume rise in subglottic pressure abrupt opening of glottis causes narrowing of trachea and major conducting airways rapidly accelerating expiratory airflow sweeps mucosal surface
32
cough reflex can be altered in
various disease states
33
mucociliary action = Cilia?
mucous and foreign particles trapped w/i it are propelled toward major airways and trachea by beating of cilia cilia extend from larynx to terminal bronchiole and adjacent cilia beat in coordination ciliary action and mucous secretion can be altered in certain diseases
34
two ways to clear the airway in the distal LRT are...
clearance of particles clearance of liquids
35
pulmonary clearance differs in the ....
distal LRT
36
clearance of particles involves...
pulmonary clearance of particles is cellular in distal part of LRT (i.e. beyond terminal bronchiole) alveoli are protected by alveolar macrophages which provide phagocytosis (particle ingestion) and carry particles to lymph nodes alveolar macrophages kill pathogens after phagocytosis
37
clearance of liquids involves...
pulmonary clearance for liquids is by lympathics which return fluid to lymph nodes where they are filtered lung lymphatics begin as small vessels at level of resp bronchioles and join to form larger vessels that eventually empty via thoracic duct into the blood vessels lymphatics normally clear 400-700 ml/day persons w reduced lymphatic clearance are at inc risk of pneumonia
38
foreign material interferes w gas exchange in many ways:
block small airways, reduce surfactant concentration, causes inflammation that can inc distance bw airway and blood in pulmonary capillaries atelectasis
39
atelectasis =
collapse of alveoli; may involve a single alveolus or a large part of the lung actelctalsis of larger lung segments is detected as focal infiltrates on chest xray atelectasis is a predisposing factor in pneumonia
40
pneumonia = vs pneumonitis =
pneumonia = lung infection + inflammation pneumonitis = lung inflammation +/- infection
41
what are the predisposing events for pneumonitis?
chemical exposure irritants, allergens radiation therapy medication acidic aspirate (reflex, emesis) = aspiration pneumonitis
42
a predisposing event for pneumonitis leads to...
traumatizes lung tissue leading to acute injury manifests as lung inflammation bacterial infection may occur in later stage of lung injury
43
what are the signs, symps, and outcomes of pneumonitis?
signs = wheezing, dyspnea, cyanosis, coughing, gastric material in oropharynx symps = pulmonary edema outcomes = hypotension, hypoxemia, severe acute resp distress syndrome, death
44
2 types of pneumonia
community acquired pneumonia - ex. airborne, droplet airborne pathogen hospital acquired pneumonia or nosocomial pneumonia - ex. airborne/droplet pathogen, ventilator associated pneumonia
45
2 types of aspiration pneumonia
dysphagia related aspiration pneumonia non dysphagia related aspiration pneumonia
46
dysphagia related aspiration pneumonia =
features of pneumonia infiltrates are in gravity dependent segments of lung (usually lower R lung) pt has dysphagia
47
non dysphagia related aspiration pneumonia =
features of pneumonia no dysphagia symps can conceivably be related to gastroesophageal reflux or emesis
48
aspiration pneumonia has a predisposing event such as
bacterial or viral pathogens in oral cavity/pharynx aspiration
49
during aspiration pneumonia after predisposing event.... what can it lead to?
pathogens colonize in the lungs (portion of lung affected depends on gravitational flow) results in infection and inflammation - pathogens and their waste irritate lung tissue if does not resolve, can spread systematically and lead to... sepsis, multi-organ failure, shock, death
50
signs, symps, outcomes or pneumonia?
signs = cough, sputum production, fever, resp distress symps = leukocytosis (inc WBC count), infiltrates on chest x ray, insp crackles outcomes = sepis, multi-organ failure, shock, death
51
how aspiration pneumonitis managed?
if event is witnesses, suctioning of upper airway antibiotics not indicated unless pneumonitis does not resolve w/i 48 hours may prescribe other meds, like steroids
52
how aspiration pneumonia managed?
if persistent fever (>24 hours), leukocytosis (elevated WBC), new infiltrate on chest xray, resp distress, productive cough antiobiotics are unequivocally indicated (broad spectrum)
53
aspiration pneumonia is a major cause of...
morbidity and mortality among the elderly who are hospitalized or in nursing homes mortality rate ranges from 20-80% most freq infectious cause of death
54
aspiration pneumonia also the leading cause of mortality in ...
children under 5
55
aspiration tolerance is related to 8 factors
nature of aspirate (freq, volume, acidity, depth) status of immune sys pulmonary status nutritional status level of consciousness mobility prior history of pneumonia age
56
bottom line about factors related to aspiration tolerance...
not all aspirators dev aspiration pneumonia
57
what are some predictors of aspiration pneumonia?
advanced age residing in institutional setting predisposing medical conds reduced mental status reduced functional status tube feeding gastoresophageal reflux poor nutritional status oropharyngeal colonization of pathogenic bacteria, reduced pulmonary clearance, and immunocompromise
58
certainly ____ predisposes for aspiration pneumonia, but association not always found
dysphagia
59
across all pt groups best independent predictors of asp pneumonia were:
tube fed before AP dependent for oral care dependent for feeding current smoking number of meds number of decayed teeth multiple medical diagnoses
60
aspiration pneumonia results when...
critical threshold of INVASION and RESISTANCE is passed
61
to cause aspiration pneumonia, aspiration ...
must occur, but aspiration will only lead to pneumonia if quantity of material is great, bacteria are pathogenic, and/or host resistance is compromised
62
dysphagia is an important risk factor for aspiration pneumonia, but...
not sufficient to cause pneumonia in absence of other risk factors

9633 Swallowing (6 decks)

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