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Pathophysiology Flashcards

1
Q

You need to excrete ________ to bring PH levels down

A

Bicarbonate (CO2)

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2
Q

CNS depressing drugs can potentially cause..

A

Respiratory acidosis

-hypoventilation

-not enough bicarbonate being excreted through breathing

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3
Q

PH under __________ is acidosis

A

Under 7.35

Normal: 7.35-7.4

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4
Q

If a patient is compensating for respiratory acidosis, what will be high?

A

HCO3-

(this is a akaline substance and it helps make the PH less acidic).

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5
Q

Respiratory acidosis will lead to

______cardia

confusion

headache

reslessness

A

Tachycardia

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6
Q

__________ventilation will cause respiratory alkalosis

A

Hyperventilation

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7
Q

Drugs that stimulate the respiratory system can cause…

A

Respiratory alkalosis

Note: can also be caused by anxiety, pain, fever, or **sepsis **

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8
Q

Hyperventilation leads to ______

Hypoventilation leads to ________

A

Hyper- alkalosis

Hypo- acidosis

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9
Q

A patient has respiratory alkalosis if PH is above

A

7.45

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10
Q

Rapid deep breathing, parasthesia, light headedness, anxiety

are symptoms of

A

respiratory alkalosis

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11
Q

Diuretics/Renal Disease (too much excretion)

Vomiting/Diarrhea (Loss of hydrochloric acid)

Or decreased plasma potassium levels

These often cause …..

A

Metabolic Acidosis

Please note that **low hydrogren levels often follow low potassium levels **

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12
Q

If someone has metabolic acidosis, what are they retaining too much of?

A

CO2

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13
Q

If someone is compensating for metabolic alkalosis, what will you see?

A

Higher PaCO2 in order to try to make the blood more acidic

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14
Q

Slow, Shallow breathing

Confusion

Hypertonic muscles

restlessness

seizure

These are signs of

A

Metabolic alkalosis

Note: You’re breathing slow and shallow to retain CO2

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15
Q

Hyperkalemia

Liver disease can cause excess HCL acid, this could lead to…

A

Metabolic Acidosis

Note that H+ Follows potassium!

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16
Q

Uncontrolled diabetes -> Hyperglycemia -> Ketone bodies

These cause ___________

A

Metabolic acidosis

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17
Q

Kussmal’s Respiration is often seen with ____________

A

Metabolic acidosis

Rapid Deep breathing in an attempt to excrete CO2 and bring PH back to normal

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18
Q

What are signs of diabetic ketoacidosis

A

Excess Thirst

Urination

Fruity Breath

Drowsiness

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19
Q

When looking at patient stats

HCO3 represents the __________ system

Whereas CO2 represents the ________ system

A

Metabolic system

Respiratory system

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20
Q

Patient 1:

PH 7.55 (high PH)

CO2 = 32 (Low)

HCO3 = 20 (Low)

What is the problem?

A

Respiratory alkalosis

w/ partial compensation (partial because PH is not back to normal, but HCO3 is low)

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21
Q

PH 7.47 (High)

PaCO2: 61 (High)

HCO3: 43 (High)

What is the problem?

A

Metabolic alkalosis w/ partial compensation

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22
Q

PH 7.26 (Low)

PaCO2 (High)

HCO3 (Normal)

What is the problem?

A

Respiratory acidosis w/ no compensation

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23
Q

If vital capacity is under 80% of what is predicted, then you have a _______ lung disorder

A

restrictive
-cannot inhale

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24
Q

If vital capacity is over 120% what is predicted you have a ________ lung disorder

A

obstructive
-cannot exhale

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25
Obstructive patients tend to have a _______ lung with ________ FVC1
Large Less
26
Asthma Chronic Bronchitis Emphysema Cystic Fibrosis These are all examples of
Obstructive disorders
27
T or F, an obstructive lung patient will have increased Residual Lung Volume
T
28
T or F, an obstructive lung patient will have increased Inspiratory and Expiratory reserve volume
False, these decrease
29
What is FEV1? What is FVC?
FEV1 = forced amount of air out of lung in 1 sec FVC= Forced vital capacity = How much air you can exhale TOTAL
30
If FEV1/FVC is under _______, you've got obstrutive lung disease
70%
31
How does chronic bronchitis obstruct the lung?
Inflamed airways cause excessive mucus production → prevents exhalation and trap air
32
How does emphysema obstruct the lung?
destruction of terminal bronchioles/alveolar walls → stretched out alveoli → reduces SA for O2 diffusion → increase CO2, decrease O2 Alveoli become less efficient at gas exchange (destruction of alveioli wall) and trap air
33
What are the 2 types of COPD?
Chronic Bronchitis and emphysema
34
Emphysema causes ____________ lung tissue compliace
Increased
35
What is better for COPD patient's, huffing or coughing?
Huffing
36
Productive cough on most days for 3 months during 2 consecutive years is the diagnositc criteria for ___________
Chronic bronchitis
37
GOLDS GRADES AND SEVERITY OF AIRWAY OBSTRUCTION IN COPD
Mild- above 80% predicted FEV1 (normal) Moderate 80-50 Severe 50-30 Very Severe 30 and under
38
at what GOLD grades due PT's work with patients?
GOLD 2 and 3 -these patients are symptomatic (SOB and accessory muscle usage)
39
What is predicted FEV1 based on?
Race, weight, height, Gender....
40
COPD Assessment Test
asks about coughing, mucus production, breathlessness, sleep, and energy level -use for baseline/goals
41
Emphysema patients ___________ oxygen desaturation during exercise Chronic bronchitis patients ____________ oxygen desaturation during exercise
Develop MAY DEVELOP (W/ chronic bronchitis sometimes the exercise helps them clear the secretions)
42
At the beginning of Emphysema, their SPO2 is normal at rest, why?
Because they're able to compensate by breathing faster (requires more energy) Exercise will make SPO2 drop when they cant keep up w/ demand ' THIS IS WHY PACED BREATHING IS IMPORTANT FOR EMPHYSEMA
43
at what SpO2 should you be concerned for COPD patients
usually if it drops below low 80s (they live at 88%) *important to consult with physician
44
Two kinds of Emphysema:
Panacinar Centrilobublar
45
panacinar emphysema
**Affects alveoli**, affects **whole lung**, primarily lower lobes, **genetic** predisposition
46
centrilolbar emphysema
most common type due to **smoking**, **affects respiratory bronchioles**, primary upper lobes
47
What is a Bullae?
Hypercompliant "balloon" structure in lung seen in emphysema
48
Emphysema patients might have a ___________ chest deformity causing a ______ diaphram
barrel chest flatter
49
Emphysema patient's have a increased residual volume and an increased ____________
Functional residual volume - (basically Residual volume + expiratory reserve volume)
50
Emphysema patients have ___________ breath sounds
DECREASED bilaterally (too much air, sound doesn't travel well!)
51
How does emphysema lead to R sided Heart Failure
Low oxygen -> Pulmonary artery constriction (to try to balance V/Q ratio) -> Pulmonary hypertension -> Too much work for R side of heart
52
Why are emphysema patient's more prone to clots and pulmonary embolism?
Relative increase in hematocrit because less oxygen in blood = more RBC = Thicker blood
53
Why is there increased risk of nocturnal death w/ emphysema
Less ventilation overall during REM sleep leads to cardiac arrythmia
54
On a patient w/ emphysema, what will you see on their chest xray
More ribs = hyperinflated 5-7 is normal 7+ (I think these numbers are talking about how many ribs you can see covering the lung, more ribs = bigger lung)
55
Why is pursed lip breathing important for obstructive patients?
Maintain positive airway pressure in lungs to prevent collapse upon rapid exhalation
56
Why do chronic bronchitis patients have excessive mucus
Goblet and mucoid cell hyperplasia Reduced cillary activity Frequent infections
57
chronic bronchitis and polycythemia
too many red blood cells (RBCs) in your bloodstream. This increases your hematocrit and hemoglobin levels, which can thicken the blood which increases the workload on the heart
58
Who develops hypoxemia sooner, emphysema patients or chronic bronchitis patients
Chronic bronchitis
59
Chronic bronchitis leads to __________ which leads to R sided heart failure/cor pulmonale
Pulmonary hypertension
60
Why are chronic bronchitis patients blue
Cyanosis due to hypoxemia
61
asthma
obstructive lung disease: bronchospasm and airway narrowing due to increased responsiveness to chemical/environmental irritants
62
status asthmaticus
acute exacerbation of asthma → respiratory failure/death
63
causes of obstruction in asthma
bronchospasm increased bronchial wall thickness recurrent bronchial wall remodeling hyper inflated lungs
64
early-mild exacerbations versus respiratory arrest asthma
early: wheezing onset of respiratory arrest → wheezing stops
65
What will you hear often w/ asthma patients (more on expiration)
wheezing
66
extrinsic versus intrinsic asthma triggers
extrinsic: allergens intrinsic: not associated with allergens
67
exercise induced asthma
mediated by water and/or heat loss from the airway
68
How is asthma treated?
Corticosteroids Or medications that activate sympathetic NS and supress parasymp NS
69
Reversability of asthma w/ ____________ is greater than other obstructive lung diseases
Bronchodilators
70
What is the key to diagnosing asthma?
When they take a bronchodilator you see a 12% increase in FEV1
71
bronchiectasis
dilation of bronchial walls as a result of recurrent infections (retaining secretions)→ scar tissue weakens walls and walls are stretched by coughing
72
primary treatment for bronchiectasis
bronchial hygiene to remove secretions
73
3 types of bronchiectasis
cylindrical varicose saccular
74
restrictive disorders lung volumes
cannot inhale → DECREASED VC, RV, FRC, VT, TLC → small lung
75
effect of decreased lung compliance in restrictive lung diseases
decreased lung compliance → increased stiffness of lung → limits expansion → a greater pressure is required to give the same increase in lung volume
76
when breathing rapidly, greater pressure is needed to overcome the resistance to flow, resulting in
the volume of each breath gets smaller *increase RR → increase resistance
77
acute pulmonary disorders examples
atelectasis pneuomothorax pneumonias ARDS
78
chronic pulmonary disorders examples
bronchopulmonary dysplasia pulmonary fibrosis SLE scleroderma occupational lung diseases lung carcinomas
79
bronchopulmonary dysplasia
lungs are not fully developed → lack surfactant
80
extra pulmonary restrictive disorders
fractures kyphosis scoliosis rheumatoid arthritis ankylosing spondylitis neuromuscular disorders pleural effusion abdominal ascites intrathoracic surgical implants
81
atelectasis
partial collapse of lung parenchyma (alveoli)
82
microatelectasis
**alveolar collapse** related to surface tension changes
83
what can cause microatelectasis
laying on side for too long → lung blocked from expansion → decreased ventilation low mechanical pressure (PEEP)
84
signs of microatelectasis
discontinuous crackles bronchial sounds (consolidation) tracheal deviation
85
obstructive/regional atelectasis
bronchus becomes occluded (mucus) → air distal to obstruction is absorbed → lung region collapses
86
what side does a tracheal shift occur?
towards the side of atelectasis
87
bronchial pneumonia
OBSTRUCTIVE - caused by staple/streptococcal - LITTLE consolidation → patchy infiltrates on x-ray -INCREASED MUCUS PRODUCTION → productive cough (purulent sputum)
88
lobar pneumonia
RESTRICTIVE -CONSOLIDATION of parenchyma → hepatization -PAINFUL -dry cough
89
hepatization
Hepatization is a pathological term used to describe the solidification of lung tissue that normally is soft and air-filled—making it feel and look like liver tissue
90
three phases of ARDS
exudative proliferative fibrotic
91
exudative phases
produces leakage of water, protein, and inflammatory and red blood cells into interstitum and alveolar lumen damage to type 1 and type 2 alveolar cells
92
result of damage to type 1 alveolar cells
irreversible damage → decreased respiration
93
result of damage to type 2 alveolar cells
impaired surfactant production (restrictive problem) → increase lung surface tension → lung collapse
94
proliferative phase
type 2 cells proliferate
95
fibrotic phase
irreversible fibrotic phase collagen deposition in alveolar, vascular, and interstitial beds → **increases distance of capillary alveolar membrane**
96
ARDS clinical presentation
dyspnea tachypnea decreased lung compliance hypoxemia
97
why are ARDS patients sedated?
to decrease the demand on the lung
98
emphysema alveoli characteristics
destruction of alveolar walls and half of the total available number of capillaries
99
restrictive disease alveoli characteristics
obstruction of alveolar duct and decreased area for gas exchange
100
PE alveoli characteristics
obstruction of the pulmonary circulation; no alvrolocapillary blood flow
101
alveoli characteristics during exercise
increase in number of open capillaries
102
mitral stenosis alveoli characteristic
capillary enlargement
103
ARDS alveoli characteristics
longer paths for diffusion due to thickening of alveolar epithelium
104
fibrotic alveoli characteristics
longer paths for diffusion due to tissue separating alveolar capillary from alveolar epithelium
105
pulmonary edema alveoli characteristics
longer paths for diffusion due to non ventilated alveoli filled with edema fluid or exudate

Lauren (93 decks)

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