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Flashcards in Pulmonary Deck (108):
1

Ventilation

the movement of air into and out of the lungs

happens in pulmonary system

2

Diffusion

the movement gases between air spaces in the lungs and the blood stream

happens in pulmonary system

3

Perfusion

the movement of blood into and out of the capillary beds of the lungs to body organs and tissues

happens in cardiovascular system

4

Surfactant

is a complex naturally occurring substance made of six lipids (fats) and four proteins that is produced in the lungs.

it reduces the surface tension of fluid in the lungs and helps make the small air sacs in the lungs (alveoli) more stable. This keeps them from collapsing when an individual exhales

5

Surfactant

is a complex naturally occurring substance made of six lipids (fats) and four proteins that is produced in the lungs.

it reduces the surface tension of fluid in the lungs and helps make the small air sacs in the lungs (alveoli) more stable. This keeps them from collapsing when an individual exhales

6

Dyspnea

subjective sensation of uncomfortable breathing aka breathlessness, shortness of breath

objectively, we'll see changes in respiration rate, flared nostrils, accessory muscle use, retraction of skin to intercostal space.

7

Orthopnea

dyspnea when a person is lying down

8

Paroxysmal nocturnal dyspnea (PND)

extreme difficulty breathing at night when lying flat

9

Cough

protective reflex that helps clear the airways by an explosive expiration

Acute: lasts 2 to 3 weeks; is result of infection like pneumonia, etc.

Chronic: longer than 3 weeks; up to 7 or 8

10

Causes of cough

-post nasal drainage
-smoking
-chronic bronchitis
-lung cancer

11

Causes of cough

-post nasal drainage
-smoking
-chronic bronchitis
-lung cancer
-asthema

12

Abnormal sputum

changes in amount, color, consistency provide information about progression of disease

13

Hemoptysis

bloody sputum

usually bright blood and sometimes see dots of blood

usually indicates inflammation of damaged bronchi or lung parenchyma

14

Abnormal breathing patterns

slow breathing is 12 respirations a minute or below

fast breathing is 20 respirations a minute or more

normal is between 12 and 20 per minute with a short expiratory pause after each breath; we sigh 10 to 12 times per hour

15

Kussmaul breathing

is hyperpnea

characterized as labored breathing with slightly increased ventilatory rate, very large tidal volumes and no expiratory pause.

not sustainable although depth and rhythm will be steady, just too deep

is related to a disease process

16

Cheyne-Stokes breathing

characterized by alternating periods of deep and shallow breathing; apnea lasts 15 to 60 seconds, which is then followed by ventilations that increase in volume until a peak is reached

occur with reduced blood flow to brain stem; indicate brain stem damage

17

Hypoventilation

inadequate alveolar ventilation in relation to metabolic demands

occurs when minute volume (tidal volume times respiratory rate) is reduced

C02 removal is slower than C02 production and the level of C02 in the arterial blood increases, causing hypercapnia

results in respiratory acidosis

18

Hypercapnia

excessive C02 levels in arterial blood

19

Hyperventilation

alveolar ventilation exceeding metabolic demands

occurs when the lungs remove C02 faster than it is produced by cellular metabolism, resulting in decreased arterial blood C02, causing hypocapnia (low C02 levels)

results in respiratory alkalosis

20

Causes of hyperventilation

- anxiety
-acute head injury
-pain

21

Cyanosis

bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin (which is bluish) in the blood

22

Clubbing

selective bulbous enlargement of the end of a digit (finger or toe)

is associated with diseases that cause chronic hypoxemia like bronchiectasis, cystic fibrosis, lung abscess and congenital heart disease

23

Pain

pain caused by pulmonary disorders originates in the pleurae, airways or chest wall (see pg 680 in book)

24

Hypoxemia vs. hypoxia

Hypoxemia = reduced oxygenation of arterial blood, caused by respiratory alterations; an abnormal ventilation-perfusion ratio (V/Q) is the most common cause of hypoxemia

Hypoxia = reduced oxygenation of cells in tissues, may be caused by alterations of other systems as well

25

What two factors is diffusion of oxygen from alveoli into the blood dependent on?

1. balance btwn the amount of air that enters the alveoli (V)
2. the amount of blood perfusing the capillaries around the alveoli (Q)

26

Respiratory failure

defined as inadequate gas exchange

can result from direct or indirect injury

direct = to lungs, airways or chest wall
indirect = to other system in body, such as spinal cord

27

Causes of respiratory failure

-complication after surgery
-smoking
-poor cardiac function
-chronic liver failure
-chronic renal failure

28

Hypoxemia vs. hypoxia

Hypoxemia = reduced oxygenation of arterial blood, caused by respiratory alterations;

Hypoxia = reduced oxygenation of cells in tissues, may be caused by alterations of other systems as well

29

Hypoxemia

results from
1. poor delivery of oxygen to alveoli
2. poor diffusion of oxygen from alveoli into the blood
3. poor perfusion of pulmonary capillaries

Abnormal ventilation-perfusion ratio is the most common cause of Hypoxemia

V/Q mismatch refers to the abnormal distribution of ventilation and perfusion

30

Parenchyma

cells; the distinguished, functional cells of a gland or organ, which are supported by the stroma (or support cells)

31

Pneumothorax

a pleural abnormality; it is the presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which surrounds the lungs) or the parietal pleura and chest wall

Types: open, tension, spontaneous, secondary

32

General patho of pneumothorax

it destroys the negative pressure of the pleural space and disrupts the equilibrium btwn elastic recoil forces of the lung and chest wall

33

Open and tension pneumothorax

in OPEN: air comes in and goes out through damaged chest wall; so air pressure in pleural space equals barometric pressure

in TENSION: air comes in, but does not go out through damaged chest wall; site of damage acts only as one way valve, closing during expiration; this causes air pressure in the pneumothorax to begin to exceed barometric pressure

34

Spontaneous and secondary pneumothorax

in SPONTANEOUS: occurs unexpectedly in ppls (usually males) btwn 20 and 40 years; caused by spontaneous bursting of bleb (blister-like formation) on the visceral pleura

in SECONDARY: caused by chest trauma (such as rib fracture or stab/bullet wounds that tear pleura); but most often occurs because of mechanical ventilation error

these can be both open and tension situations

35

Transudative effusion

a pleural abnormality;

watery fluid in pleura; fluid diffuses out of capillaries beneath pleura

36

Exudative effusion

a pleural abnormality;

fluid rich in cells and proteins; this fluid migrates out of capillaries

37

Hemothorax (blood)

a pleural abnormality;

hemorrhage into pleural space; most often happens with trauma or surgery

38

Chylothorax

a pleural abnormality;

milky fluid containing lymph and fat droplets that moves from lymphatic vessels into pleural space

39

Empyema (pus)

a pleural abnormality;

microorganisms and debris of infection accumulate in pleural space

has diff S/S of fever, presence of leukocytes, tachycardia, cyanosis

40

Manifestations of all pleural effusions (trans, exudate, emp, hemo, chylo)

-dypsnea
-compression atelectasis w/ impaired ventilation
-pleural pain
-mediastinal shift and cardiovascular manifestations (in extreme situations)
-decreased breath sounds
-dull sound to percussion on affected area
-pleural friction rub over areas of inflamed pleura

41

Chest wall disorders

-Restrictions
-Flail chest

42

Chest wall restrictions

a compromised chest wall d/t deformation, immobilization and/or obesity

pts have to work harder to breath and there is a decrease in tidal volume

43

Flail chest

instability of portion of chest wall

results from the fracture of several consecutive ribs, which causes paradoxical movement of chest wall during inhalation and exhalation (aka. impaired portion of the wall moves inward during inspiration and moves outward during expiration)

biggest S/S: gas exchange impairment

44

Normal movement of chest during inhale/exhale

normally when we inhale, the chest moves out and when we exhale, the chest moves in

45

Restrictive lung disease

characterized by decreased compliance of the lung tissues

46

Atelectasis

the collapse of lung tissue

tends to develop after surgery

two types:
-compression
-absorption

47

Compression atelectasis

caused by external pressure exerted by tumor, fluid, or air in pleural space or by abdominal distention pressing on a portion of lungs (like distention we see in ascites), causing ALVEOLI to collapse

48

Absorption atelectasis

results from removal of air from obstructed or hypoventilated ALVEOLI or from inhalation of concentrated oxygen or anesthetic agents

49

Manifestations of atelectasis

similar to those of pulmonary infection, include:
-dyspnea
-cough
-fever
-leukocytosis

50

Bronchiectasis (LARGE and dilation)

is persistent abnormal dilation of the bronchi

chronic inflammation of bronchi leads to destruction of elastic and muscular components of their walls and permanent dilation

cystic fibrosis most common cause in children; other respiratory conditions are cause in adults (atelectasis, chronic inflam, TB, pneumonia)

51

Manifestations of bronchiectasis

-chronic, productive cough (in kids)
-recurrent lower respir infections (with foul-smelling, purulent sputum)
-hemoptysis
-clubbing

52

Bronchiolitis (SMALL and obstruction)

is a diffuse, inflammatory obstruction of the small airways or bronchioles occurring most commonly in children

in adults it usually accompanies chronic bronchitis, or in health ppl d/t inhalation of toxic gas or viral infections

lung transplant pts at risk; can lead to scar tissue

53

Manifestations of bronchiolitis

-increased breathing rate, marked by use of accessory muscles
-low-grade fever
-dry, nonproductive cough
-hyperinflated chest
-decrease in V/Q which leads to hypoxiema

54

V/Q

ventilation-perfusion ratio

55

Pulmonary fibrosis

excessive amount of fibrous or connective tissue in the lungs

Causes: genetic; also d/t formation of scar tissue after active pulmonary disease (ARDS, TB); inhalation of harmful substances

Leads to (S/S): decreased lung compliance, difficult ventilation; damaged alveolocapillary membrane can't diffuse well, causing hypoxemia

56

Inhalation Disorders

lung issues caused by inhalation of damaging substances; can damage a lot of mechanisms in lung and can lead to ARDS

Types:
-Pneumoconiosis (inorganic substances)...progressive disease that causes scarring of AC membrane

-allergic alveolitis (organic substances)

-toxic gas including oxygen toxicity (causes severe response that releases free radicals that damage AC membrane

57

Inhalation Disoders

lung issues caused by inhalation of damaging substances; can damage a lot of mechanisms in lung and can lead to ARDS

Types:
-Pneumoconiosis (inorganic substances)...progressive disease that causes scarring of AC membrane

-allergic alveolitis (organic substances)

-toxic gas including oxygen toxicity (causes severe response that releases free radicals that damage AC membrane

58

Pneumoconiosis - manifestations and causes

Causes:
-workplace exposure
-silica, asbestos, coal

S/S:
-cough
-chronic sputum
-dyspnea
-decreased lung volume
-hypoxemia

59

Allergic alveolitis - manifestations and causes

Causes:
-farm dust
-bird droppings, feathers, etc.

S/S (can be acute onset)
-fever
-cough
-chills
-may need hospitalization

60

Toxic gases - manifestations and causes

Causes:
-oxygen overdose
-carbon monoxide
-ammonia
-heated air

S/S:
-burning in eyes, nose, throat
-cough
-tightening of chest
-dyspnea
-hypoxemia

61

Pulmonary Edema

Excessive water in lungs

62

Patho of pulmonary edema

three pathways:

1. valvular dysfunction (increased left arterial pressure)
2. injury to capillary endothelium (increased capillary permeability)
3. blockage of lymphatic vessels (inability to remove excess fluid from interstitial space)

63

Manifestations of pulmonary edema

-dyspnea
-increased work to breath
-inspiratory crackles **
-dull percussion sound over affected area
-hypoxemia
-pinky frothy sputum **
-decreased lung compliance
-decreased tidal volume
-hypercapnia

64

ARDS (Acute Respiratory Distress Syndrome)

characterized by acute lung inflammation and diffuse AC membrane injury

3 components to define ARDS:

1. acute onset of bilateral infiltrates on x-ray
2. ow ratio of portal pressure of arterial oxygen to the fraction of inhaled oxygen (refractory oxygen)
3. absence of clinical evidence of LV hypertrophy or cardiac hypertension

65

Risk and predisposing factors for ARDS

-sepsis
-multiple traumas
-pneumonia
-burns
-aspiration

death by ARDS is usually in combo with other diseases

66

General progression of ARDS

Dyspnea and hypoxemia

Hyperventilation and respiratory alkalosis

Decreased tissue perfusion, organ dysfunction, and metabolic acidosis

Increased work of breathing, decreased tidal volume, and hypoventilation

Respiratory acidosis and worsening hypoxemia

Hypotension, decreased cardiac output, death

67

Manifestations of ARDS

-inspiratory crackles
-refractory hypoxemia (unresponsiveness to oxygen treatment)

68

Common traits of all Obstructive Lung Diseases

Airway obstruction that is worse with expiration

Common S/S:
-dyspnea
-wheezing **
-prolonged expiration **

Common obstructive disorders are:
-COPD
-Asthema
-Chronic Bronchitis
-Emphysema

Chronic bronchitis and emphysema together are often called COPD, but these two diseases can occur separately

69

Common traits of all Obstructive Lung Diseases

Airway obstruction that is worse with expiration

Common S/S:
-dyspnea
-wheezing **
-prolonged expiration **

Common obstructive disorders are:
-COPD
-Asthma
-Chronic Bronchitis
-Emphysema

Chronic bronchitis and emphysema together are often called COPD, but these two diseases can occur separately

70

Asthma

chronic inflammatory disorder of the bronchial mucosa

causes hyperresponsiveness and construction of the smooth muscle airways (bronchi)

can lead to status asthamaticus

71

Manifestations of asthma

At onset of attack:
-chest constriction
-expiratory wheezing
-dyspnea
-nonproductive coughing
-prolonged expiration
-tachycardia
-tachypnea

Severe attacks:
-use of accessory muscles of respiration
-wheezing on inspiration and expiration
-status asthmaticus (severe bronchospasm), which leads to
-hypoxiema
-decreased ventilation
-acidosis

72

Manifestations of asthma

At onset of attack:
-chest constriction
-expiratory wheezing
-dyspnea
-nonproductive coughing
-prolonged expiration
-tachycardia
-tachypnea

Severe attacks:
-use of accessory muscles of respiration
-wheezing on inspiration and expiration
-status asthmaticus (severe bronchospasm), which leads to
-hypoxiema
-decreased ventilation
-acidosis

73

COPD

defined as preventible and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients

is combo of chronic bronchitis and emphysema

74

Differences of Obstructive disease from picture on PP slide

In EMPHYSEMA will see:
-enlargement of alveoli walls and loss of elasticity

In CHRONIC BRONCHITIS will see:
-mucos plugs
-enlarged submucosal glands
-

75

Differences of Obstructive disease from picture on PP slide

In EMPHYSEMA will see:
-enlargement of alveoli walls and loss of elasticity

In CHRONIC BRONCHITIS will see:
-mucous plugs (and chronic cough to clear mucous)
-enlarged submucosal glands
-imflammation of epithelium

In ASTHMA will see:
-tight bands of smooth muscle (muscle constriction)
-will also have mucous but not like in Chron Bron

76

COPD

defined as preventible and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients

will see trapped air in alveoli!

is combo of chronic bronchitis and emphysema

77

Differences of Obstructive disease from picture on PP slide

In EMPHYSEMA will see:
-enlargement of alveoli walls and loss of elasticity

In CHRONIC BRONCHITIS will see:
-mucous plugs (and chronic cough to clear mucous)
-enlarged submucosal glands
-inflammation of epithelium

In ASTHMA will see:
-tight bands of smooth muscle (muscle constriction)
-will also have mucous but not like in Chron Bron

78

Risk factors for COPD

-smoking
-environmental shit
-genetic factors
-occupational exposure

79

Chronic Bronchitis

hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the the year and for at least 2 consecutive years.

80

Patho of Chron Bron

inspired irritants increase mucus production and the size and number of mucous glands

mucous is tenacious and prevalent and thick

81

Patho of pneumonia

-aspiration of oropharynegeal secretions
-inhalation of microorganisms that have been released into air by an infected individual

82

Manifestations of Chron Bron

-bronchospasms
-dyspnea
-productive cough
-V/Q mismatch leads to hypoxemia
-airtrapping
-tidal volume decrease
-hypoventilation and hypercapnia

prone to infections d/t compromised immune sxs

83

Manifestations of Chron Bron

is the blue bloater

-bronchospasms
-dyspnea
-productive cough
-V/Q mismatch leads to hypoxemia
-airtrapping
-tidal volume decrease
-hypoventilation and hypercapnia
-cyanosis ***

prone to infections d/t compromised immune sxs

84

Emphysema

abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis; loss of elasticity

there are changes in the actual lung tissue, which is unlike bronchitis (where there's mucus)

you will see large spaces with no definition and the creation of blebs or blisters around the lung tissue (these result in V/Q mismatch and hypoxemia with airtrapping)

85

Manifestations and risk factors of emphysema

is the pink puffer; often sits in triangular position

S/S:
-hypoventilation and hypercapnia
-chronic inflammation
-anorexia
-trouble breathing
-muscle weakness
-fatigue
-susceptible to co-morbidities
-barrel chest**

Risk factors:
-primary is genetic
-secondary is smoking, occupational exposure, air pollution

86

Manifestations and risk factors of emphysema

is the pink puffer; often sits in triangular position

S/S:
-hypoventilation and hypercapnia
-chronic inflammation
-anorexia and weight loss
-trouble breathing
-muscle weakness
-fatigue
-susceptible to co-morbidities
-barrel chest**

Risk factors:
-primary is genetic
-secondary is smoking, occupational exposure, air pollution

87

Pneumonia

can be viral, bacterial, fungal

can be in upper and lower respiratory

three types:
1. nosocomial
2. community acquired
3. immuno-compromised individuals (ventilator associated)

88

Patho of pneumonia

-aspiration of oropharynegeal secretions
-inhalation of microorganisms that have been released into air by an infected individual

89

Patho of pneumonia

-aspiration of oropharynegeal secretions
-inhalation of microorganisms that have been released into air by an infected individual

90

Risk factors for pneumonia

-age
-compromised immunity
-underlying lung disease
-alcoholism
-smoking

91

Manifestations of Viral and Bacterial pneumonia

Viral:
-mostly self-limiting and short-lived
-mild symptoms
-will use supportive therapy to treat

Bacterial:
-fever
-chills
-pleural pain
-sometimes dypsnea and hemopytosis (bloody sputum)
-inspiratory crackles
-dull percussion
-increased tactile fremitus

92

Tuberculosis

infection caused by mycobacterium tuberculosis, an acid-fast bacillus that usually affects the lungs but may also invade other body systems

airborne transmission

can be active (contagious w/ symptoms) or latent (asymptomatic w/out symptoms)

93

Patho of TB

once bacilli are inspired they lodge in lungs and multiple causing inflammation; some bacilli also migrate to the lymph sxs and initiate an immune response

this inflammation activates macrophages and neutrophils

which then isolate the bacilli and form granulomas

when the bacilli are isolated in the tubercles and immunity develops, you may remain dormant, but if immune system is compromised or impaired, the TB may spread to other body sxs

94

Patho of TB

once bacilli are inspired they lodge in lungs and multiple causing inflammation; some bacilli also migrate to the lymph sxs and initiate an immune response

this inflammation activates macrophages and neutrophils

which then isolate the bacilli and form granulomas

when the bacilli are isolated in the tubercles and immunity develops, you may remain dormant, but if immune system is compromised or impaired, the TB may spread to other body sxs

95

Patho of Cor Pulmonale

Develops as pulmonary HTN exerts chronic pressure overload on the right ventricle, which increases the work of the right ventricle and causes hypertrophy of the normally thin walled heart muscle.

This eventually progresses to dilation and failure of the ventricle.

96

Manifestations of TB

-cough will produce pussy sputum**
-general anxiety
-S/S develop gradually

97

Pulmonary Embolus (PE)

occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble

pulmonary emboli commonly arise from the deep veins in the thigh (remember Virchow triad)

98

Manifestations of PE

Small one: S/S will depend on size and location where it lands

Large one:
-sudden onset of pleural pain
-unexplained anxiety
-tachypnea
-tachycardia
-friction rub
-fever
-occasionally hemopytisis
-leukocytosis

99

Pulmonary Embolus (PE)

occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble

pulmonary emboli commonly arise from the deep veins in the thigh (remember Virchow triad)

100

Manifestations of PE

Small one: S/S will depend on size and location where it lands

Large one:
-sudden onset of pleural pain
-unexplained anxiety
-tachypnea
-tachycardia
-friction rub
-fever
-occasionally hemopytisis
-leukocytosis

101

Lung Cancers

See Googledocs

102

Pulmonary Hypertension

defined as pulmonary artery pressure 5 to 10 mm Hg above normal 20 mm Hg pressure

associated with left sided heart disease, lung disease (COPD), hypoxia. COPD, hypoxia or both can cause complications further pulmonary vasoconstriction and increase pulmonary artery pressure.

103

Patho of Pulmonary HTN

1. characterized by endothelial dysfunction and overproduction of vasoconstrictors.

2. Remodeling of the pulmonary smooth muscle. Fibrosis and vessel wall thickening occur, which narrows luminal walls and constriction of blood flow.

3/ These changes cause resistance to pulmonary artery blood flow, which in turn increases the pressure in the pulmonary arteries.

4. As resistance and pressure increase, the workload of the right ventricle increases and subsequently causes right ventricular hypertrophy, which leads to failure (cor pulmonale).

104

Manifestations of Pulmonary HTN

-Initially, pulmonary HTN may be seen on x-ray (enlargement of right heart) or on EKG that reflects right ventricular hypertrophy.
-fatigue
-chest discomfort
-tachypnea
-dyspnea (particularly with exercise) are common.

Exam may reveal:
-peripheral edema
-jugular vein distention (JVD)
-precordial heave, and accentuation of the pulmonary component of the second heart sound.

105

Cor Pulmonale

defined as right ventricular enlargement (hyptertrophy, dilation or both) caused by pulmonary hypertension—chronic airway issues (COPD)

106

Path of Cor Pulmonale

Develops as pulmonary HTN exerts chronic pressure overload on the right ventricle, which increases the work of the right ventricle and causes hypertrophy of the normally thin walled heart muscle.

This eventually progresses to dilation and failure of the ventricle.

107

Manifestations of Cor Pulmonale

- Heart may appear normal at rest but cardiac output falls with exercise.
- EKG may show right vent. Hypertrophy.
- Pulmonary component of the second heart sound, which represents closure of the pulmonic valve, may be accentuated and a pulmonic valve murmur may also be present.
-Tricuspid murmur may develop with the development of right vent. Failure.
- Increased pressure in the systemic venous circulation cause: JVD, hepatosplenomegaly and peripheral edema.

108

Tidal Volume

The volume of air inspired or expired in a single breath during regular breathing