Respiratory system Flashcards by natalie brown

List and define the major disorders of the pulmonary system

Understand signs and symptoms of cyanosis

Goals for respiratory lecture

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Provides the mechanisms for transport of oxygen from air into blood
Remove carbon dioxide from blood

Purpose of respiratory system

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passageways that conduct air between atmosphere and lung

Upper respiratory tract

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trachea, bronchial tree, lungs
where gas exchange takes place

Also pulmonary circulation, muscles, nervous system

Lower Respiratory tract

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Mucous secreting cells: trap particles
Cilia: sweep mucous and debris out of respiratory tract

Too much mucous or particles: sneeze or cough

Smoking: irritation impairs cilia
Squamous cells replace ciliated epithelium

Respiratory Mucosa

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Food and air: separate at esophagus and trachea
Epiglottis: protects opening into larynx
Trachea: is windpipe: composed of smooth muscle and elastic tissue with cartilaginous C rings

Pharynx

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Sympathetic stimulation
Relax smooth mm
Dilate/enlarge bronchioles

Bronchiolesalveolar ducts alveoli

Bronchodilation

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Single layer of simple squamous epithelial cells
Promotes diffusion of gasses

Respiratory capillary membrane: combined alveolar and capillary wall: gas exchange

Pulmonary capillaries in close contact with alveoli

Macrophages in alveoli: remove foreign material

Alveoli

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Detergent action
Decreases surface tension
Facilitates inspiration
Prevents collapse of alveoli when expires

Surfactant

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Air flows from high pressure to low pressure area

Pressure change in lungs from alteration in size of thoracic cavity

Ventilation

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Ventilatory capacity
Measure air moving in and out of lungs
Disease processes may change this

Pulmonary Volume

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Residual volume: volume remaining in lung after maximal expiration (1500ml)
Vital capacity: max amount of air that can be moved in and out of lungs (4000ml)
Dead space: areas where gas exchange cant take place
Tidal volume: air entering lungs with normal breath (500ml)
Inspiratory reserve; max volume air inspired after max expiration (2500ml)
Expiratory reserve: max volume of air expired following passive expiration (1000ml)
Total lung capacity: total volume of air in lung after max inspiration (5500ml)
Forced Expiratory volume in 1 sec (FEV1) volume of air forcibly expired after maximal inspiration in 1 sec (approx 80% of VC) 3200ml
Minute ventilation: Tidal volume x Rate of Ventilation 500 x 15 = 7500
Inspiratory capacity: TV+ IRV
Functional Residual Capacity; ERV+RV-air left after normal exhalation
Vital Capacity: IRV+TV+ERV-max air exhaled after max inhalation

Pulmonary volumes

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Measured with peak flow meter
Reached within
100 milliseconds of expiration
Used to evaluate asthma

Peak Expiratory Flow

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Medulla and pons
Inspiration: medulla: basic rhythm: phrenic nerve to diaphragm
Expiratory center: used when need forced expiration
Pons: coordination
Depression: meds, shallow breathing, hypothalamus
CO2 levels inhibit voluntary control
Chemo receptors: respond to elevations in CO2 or decrease in oxygen

Control of Ventilation

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Must drop significantly (105 to 60mm Hg) before body responds to hypoxemia
Gas exchange: depends on relative concentration of gases
Gases move from high pressure area to low pressure area
Gas exchange can depend on thickness of membrane
Accumulation of fluid: oxygen diffusion is impaired
Extra fluid impairs blood flow

Oxygen levels

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Affected by surface area
Decreased surface area, decrease in gas exchange
Emphysema or fibrosis
Most oxygen is carried bound to hemoglobin
Oxygen is released so can absorb into cells
Partial pressure of dissolved oxygen determines how much oxygen is released
CO2 diffuses: easily carried out

Gas exchange

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Partial pressure of oxygen in blood
Hypercapnia
Hypoxemia
PaO2: 95-100mmm Hg
PaCO2 35-40 mmHg
Measure arterial blood gasses in radial artery
Pulse oximater
Normal pulse ox 96-100%

Arterial blood gasses

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pH is usually slightly basic 7.35-7.45
Scale 0-14 (acid-base)
Low pH: acidosis
High pH: alkalosis
High PaCO2: respiratory acidosis: chronic bronchitis
Low PaCO2: respiratory alkalosis: pneumonia

Acid Base Balance of Blood

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Radiographs:
Change in lungs
Opacities: lesions
CT: x-rays at various angles
Detailed
MRI
More sophisticated

Chest imaging

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Pulmonary arteriography/angiography
Blood vessels
Detect emboli, vascular abnormalities
Use catheter through femoral vein
Bronchoscopy
Examination of trachea and bronchi
Uses flexible tube
Can take biopsy
Exercise Tolerance

Other testing

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Increase in negative pressure

Children, paralysis of intercostal muscles

Intercostal indrawing

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Exhalation over trachea: higher pitched, longer than inhalation
Lung: vesicular sounds
Inhale: whoosh
Exhale: quiet
Sounds you might hear
Tracheal sounds over lungs (Pneumonia), absence of sound (effusion, collapsed lung, pneumothrax), crackles, wheezing

Breath sounds

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Spirometry: test volumes and airflow
Arterial blood gas: check oxygen, CO2, bicarbonate, serum pH
Exercise tolerance: use with COPD: monitor progress
X-rays: tumors and infections
Bronchoscopy: biopsy check lesion
Culture and sensitivity
Peak expiratory flow: use with asthma
Acid base balance: usually 7.35-7.45 pH
Resp acidosis (pH low) resp alkalosis (pH high)
CT: use to rule out or in several pathologies
MRI:
Pulmonary angiography: look at blood vessels:
Exercise Tolerance
Graded Ex tolerance test: cardio and pulmonary status
Metabolic Equivalent (MET) 1 MET= amnt oxygen required with body at rest in sitting
CBC

Diagnostic Tests

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Upper respiratory infection 
Common cold: 
Viral
Many organisms
Usually self limiting
Spread by respiratory droplets
Mucous membranes red and swollen
Increase in secretions
Sore throat, fever, headache
Treatment: symptomatic: acetaminophen, decongestant

Infectious Disease

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Streptococcus pneumoniae | Inflamed, necrotic mucous membranes

Secondary infection

``` Bacterial? Usually obstructed drainage Pressure builds Haemophilus influenzae, pneumococci, streptococci Nasal congestion Fever Sore throat Treat: decongest, analgesic, antibiotic ```

Sinusitis

``` Viral Upper and/or lower respiratory tract Viruses mutate Sudden onset, fever, marked fatigue, aching pain Can get secondary infection ```

Influenza

Primary infection or secondary to another condition Aspiration or inflammation of lung Classify by agent (bacterial, viral, fungal), location, epidemiology, pathophysiologic changes Lobar pneumonia: usually strep Manifestations: sudden onset, high fever, chills, fatigue, leukocytosis, dyspnea, tachypnea, tachycardia, pleuritic pain, rales, productive cough

Pneumonia

Diffuse infection Lower lobes Pooled secretions

Bronchopneumonia

Atypical pneumonia Spreads rapidly High mortality rate Risk factors: travel to China, Hong Kong, Taiwan

Severe Acute Respiratory Syndrome

``` At one time considered controlled Now increasing globally Prevalence difficult to estimate Caused by Mycobacterium tuberculosis Hard to kill Primary infection: upper lobe local inflammatory rctn Produce granuloma with caseation: usually wall off Ghon complexes ``` Miliary TB: progressive form, doesn’t respond well to treatment Secondary: “active” Transmitted by oral droplets, milk in some countries Crowded conditions, situations when resistance is low Signs/symptoms: anorexia, malaise, fatigue, weight loss Cough: more severe and productive Sputum: purulent, blood Positive TB test, chest x-ray, CT

Tuberculosis

Home or hospital Combination of drugs Treat 3 months to a year

Tuberculosis treatment

``` Cystic Fibrosis Inherited Genetic Thick secretions; mucous is tenacious Obstructs lungs and pancreas Bronchial walls become damaged Infections are common ```

Obstructive Lung Disease

``` Salty skin Malabsorption Steatorrhea: bulky, fatty, foul stools Frequent respiratory infections Hypoxia, fatigue, exercise intolerance Diagnose: sweat test Treat: pancreatic enzymes, bile salts, chest therapy, bronchodilators, aggressive treatment when necessary ```

Cystic Fibrosis

Primary and secondary cancers 3rd most common cancer 90% lung cancer related to smoking Metastatic cancer: due to lymphatic and venous return

Lung Cancer

``` Broncho genic carcinoma From bronchial epithelium Most common malignant tumor Oat cell (small cell) carcinoma Rapid growth Usually near major bronchus Very invasive, metastasize early Large cell Found in periphery of lung Rapid growth, metastasize early ```

Pathophysiology of lung cancer

Most common malignant lung tumor First change: metaplasia Chronic irritation Lung tissue more vulnerable Tumor: obstruction, inflammation, pleural effusion Para neoplastic syndrome: secretes hormones (ADH)

Bronchogenic carcinoma: from bronchial epithelium:

``` Persistent, productive cough Chest x-ray evidence Hemoptysis Chest pain Weight loss, anemia ```

Signs/symptoms of lung cancer

Chest x-ray MRI/CT Mediastinoscopy

Diagnosis for lung cancer

Surgery | Photodynamic therapy

Treatment for lung cancer

Severe/reversible bronchial obstruction Hypersensitive or hyper responsive airways Acute or chronic Rate from mild to severe Extrinsic: type I hypersensitivity: immune rctn to smoke, perfumes, strong smells, molds, dander Intrinsic: nonimmune, occur in adults; respiratory infx, exposure to cold, exercise, medications, psychological stress

Asthma

Inflammation of mucosa Edema Contraction of smooth muscles Increase in thick mucous Partial obstruction of small bronchi, bronchioles: air trapping Hard to get fresh air in

Pathophysiologic changes in asthma

Total obstruction of airway Mucus plugs block airflow Atelectasis occurs Section of lung can collapse Oxygen levels are reduced Vasoconstriction Reduced blood flow through lungs Increase workload of right side of heart

Pathophysiologic changes of asthma

May develop irreversible damage to lungs Bronchial walls thicken Fibrous tissue in areas of atelectasis

Chronic asthma

Family history of hay fever, asthma, eczema Viral URI Air pollution Sedentary lifestyle with poorly ventilated houses

Etiology of asthma

``` Cough, dyspnea, tight feeling in chest Wheezing Thick, sticky mucous Tachycardia Hypoxia Hyperventilation Hypoventilation Can lead to respiratory failure ```

Signs and symptoms of asthma

``` Check for allergens Avoid triggers Good ventilation Exercise (swimming) Prophylactic medication Inhalers: relax bronchiole smooth muscles Breathing techniques glucocorticoids ```

Treatment of asthma

Alveolar walls are destroyed Permanent permanently inflated air spaces Genetics: alpha1 –antitrypsin: inhibits activity of proteases (present during inflammation) Cigarette smoking: increases neutrophils and decreases effectiveness of alpha 1 –antitrypsin

Emphysema

``` Breakdown alveolar walls Surface area for gas exchange decreases Loss of pulmonary capillaries Decreased elastic fibers Alter ventilation/perfusion ratio Decrease support for small bronchi: collapse walls Fibrous thickening of bronchial walls Narrow airways Weakened walls Difficulty with passive expiration ```

Emphysema

Air trapping Over inflation of lungs Barrel chest Diaphragm flattened

Progressive problems with expiration with emphysema

``` Large airspaces, blebs Tissue near bleb can rupture Hypercapnia increases Hypoxic drive for inspiration Frequent infections Pulmonary hypertension ```

Advanced emphysema

Cigarette smoking Genetics (early development) Air pollution

Etiology Emphysema

Dyspnea on exertion (DOA) progress to dyspnea at rest Hyperventilation, use of accessory muscles Anorexia, fatigue Clubbed fingers

Signs and symptoms Emphysema

Chest x-ray Pulmonary function tests: Increased residual volume Increased total lung capacity

Diagnostics Emphysema

Avoid irritants Stop smoking Immunization against influenza and pneumonia Pulmonary rehab: appropriate breathing techniques Pursed lip breathing Maintain hydration and nutrition Lung reduction surgery

Treatment Emphysema

Constant irritation from smoking or industrial pollution Irreversible and progressive Inflammation of mucous Hypertrophy of mucous glands: secretions are increased, increase in goblet cells Decreased ciliated epithelium Bronchial walls thicken, are fibrosed: leads to obstruction Secretions pool Low oxygen levels Episodes of coughing: may develop cyanosis

Chronic bronchitis

dyspnea, hyperventilation, over inflation- what you may call people with emphysema.

Pink puffer:

low oxygen level, cyanosis, edema- what you may call people with chronic bronchitis.

Blue boater

Cigarette smoking Industrial area Heavy smog

Etiology Chronic bronchitis

``` Chronic productive cough Tachypnea, SOB Cough more severe in morning Hypoxia, cyanosis, hypercapnia Polycythemia Severe weight loss Systemic edema ```

Signs and symptoms Chronic bronchitis

``` Reduce exposure to irritants Vaccines Expectorants, bronchodilators Chest therapy to remove mucous Low flow oxygen ```

Treatment Chronic bronchitis

Bluish color of skin and mucous membranes Results from large amounts of unoxygenated hemoglobin Peripheral or generalized Cardiovascular conditions or Respiratory disease Not a good early indicatory of hypoxia

Cyanosis

Respiratory system Flashcards

(62 cards)