Respiratory System and Disorders- Notes from Slideshow (quiz 3) PART 1 Flashcards
1
Q
Decreased levels of oxygen in the tissues
A
Hypoxia
2
Q
Decreased levels of oxygen in the arterial blood
A
Hypoxemia
3
Q
Increased levels of CO2 in the blood
A
Hypercapnia
4
Q
Decreased levels of CO2 in the blood
A
Hypocapnia
5
Q
Difficulty breathing
A
Dyspnea
6
Q
Rapid rate of breathing
A
Tachypnea
7
Q
Bluish discoloration of skin and mucous membranes due to poor oxygenation of the blood
A
Cyanosis
8
Q
Blood in the sputum
A
Hemoptysis
9
Q
The incomplete expansion of the lungs
A
Atelectasis
10
Q
characteristic of atelectasis
A
Collapsed alveoli
11
Q
Etiology of Atelectasis
A
- Lack of mobility
- Pneumonia
- Radiation disease
- Granulomatous disease (such as lupus)
12
Q
irreversible condition causing atelectasis
A
Pulmonary Fibrosis
13
Q
Reversible condition causing atelectasis
A
Pneumonia
14
Q
Another word for Pulmonary ventilation
A
Breathing
15
Q
The process of air flowing into the lungs during inspiration & out during expiration.
A
Pulmonary ventilation
16
Q
Why does air flow?
A
Due to pressure differences b/w the atmosphere & the gases inside the lungs
17
Q
SEE PICTURE FOR BASIC ANATOMY OF THE RESPIRTORY SYSTEM
A
ON SLIDE ONE
18
Q
Is transportations of gases an efficient process?
A
Yes, very.
19
Q
What carries O2?
A
Hemoglobin
20
Q
Why is Hgb the carrier of O2?
A
it has great affinity for O2
21
Q
How many molecules of O2 bind to each Hgb?
A
4
22
Q
What happens to O2 that is picked up by Hgb?
A
It is transported by the blood to various tissues
23
Q
In what form are CO2 molecules transported?
A
Dissolved form-in our blood
24
Q
Why is CO2 transported in the dissolved form and O2 transported in Hgb?
A
CO2 is more soluble in water than O2
25
Is all CO2 formed expelled from the body?
No
26
Why is some CO2 not expelled and instead retained?
It reacts with water to form compounds useful for life processes
27
This is used when the human body knows when to increase the supply of O2 & when to reduce it
adaptation
28
Regulatory system that tells the body when to increase the supply of O2 & when to reduce it
medulla
29
What is the respiratory system very sensitive to?
the concentration of CO2 in the arterial blood
30
What symptoms occur when there is a decrease or increase in CO2 in the arterial blood?
-acceleration or slowing down of respiration activity --change in rate & depth of breathing.
31
Where does gas exchange occur?
At the alveolar capillary membrane
32
1. Blood low in O2 and high in CO2 is in artery before alveolar
2. Gases dissolve in moist lining
3. CO2 diffuses from blood into alveolar to be exhaled
4. Oxygen diffuses into blood
5. Oxygen is transported around body by RBCs
6. Blood low in CO2 and high in O2 leaves the alveolar
Steps of Gas Exchange at the alveolar capillary membrane
33
Steps of Gas Exchange at the alveolar capillary membrane
1. Blood low in O2 and high in CO2 is in artery before alveolar
2. Gases dissolve in moist lining
3. CO2 diffuses from blood into alveolar to be exhaled
4. Oxygen diffuses into blood
5. Oxygen is transported around body by RBCs
6. Blood low in CO2 and high in O2 leaves the alveolar
34
What occurs in the respiratory system in some C Spine injuries?
Medulla and respiratory center of brain can be affected and they may not be able to breath
35
Why might you find yourself unintentionally breathing faster or slower?
The body is trying to achieve equilibrium because it is always working towards homeostasis
36
What is an example of a disorder that causes the exchange of gases to be impaired?
ARDS
37
Why does ARDS causes the exchange of gases to be impaired?
Fluid in the alveolar blocks the exchange of gases
38
The build-up of excess fluid between the layers of the pleura outside the lungs
Pleural effusion (PE)
39
Where can fluid in PE be visualized on a scan?
at the bottom of one of the lungs (looks like a fluid sac)
40
Most common Etiologies of PE
- Malignancy
| - HF
41
Etiology of Pleural Effusion
- Heart failure
- Kidney failure
- Pulmonary embolism
- Hypoalbuminemia
- Infection
- Malignancy
42
- Heart failure
- Kidney failure
- Infection
- Malignancy
- Pulmonary embolism
- Hypoalbuminemia
Etiology of Pleural Effusion
43
What would a pt with Hypoalbuminemia present with?
- critically ill
- sick
- nutritional status compromised
- at risk for PE
44
Common Symptoms of PE
- Chest pain
- Difficulty breathing
- Painful breathing (pleurisy)
- Cough (dry or productive)
- Deep breathing typically increases pain.
- Fever, chills, & loss of appetite
45
- Chest pain
- Difficulty breathing
- Painful breathing (pleurisy)
- Cough (dry or productive)
- Deep breathing typically increases pain.
- Fever, chills, & loss of appetite
Common Symptoms of PE
46
Why do Fever, chills, & loss of appetite often accompany pleural effusions?
Because the PE is caused by infectious agents
47
Differential Diagnoses
When a practitioner differentiates between two or more conditions that could be behind a person's symptoms
48
Differential Diagnoses vs Diagnosis. What's the difference?
Differential Diagnoses- more than one possible diagnosis
| Diagnosis- one single theory
49
When diagnosing a pt it is important to
Consider all possible etiologies
50
Example of Differential Diagnoses: You have a client that has a chest x-ray. It shows the pleural effusion. What must a practitioner consider?
That pleural effusion has many etiologies and all possibilities must be considered or ruled out
51
Example of Differential Diagnoses: A pt has a cough. What must a practitioner consider?
That a cough can be caused by many things such as a common cold or lung cancer.
52
What type of fluid builds up in PE?
- Can be clear
- Could be an exudate
- Can be all different substances
53
In what case would exudate build up in PE?
In case of infective process
54
In what case would all different substances build up in PE?
In case of malignancy
55
Main Symptoms of Infectious Pneumonia: Systemic
- high fever
| - chills
56
- high fever
| - chills
Main Symptoms of Infectious Pneumonia: Systemic
57
Main Symptoms of Infectious Pneumonia: Central NS
- Headaches
- Loss of appetite
- mood swings
58
- Headaches
- Loss of appetite
- mood swings
Main Symptoms of Infectious Pneumonia: Central NS
59
Main Symptoms of Infectious Pneumonia: Skin
- clamminess
| - blueness
60
- clamminess
| - blueness
Main Symptoms of Infectious Pneumonia: Skin
61
Main Symptoms of Infectious Pneumonia: Vascular
-low BP
62
-low BP
Main Symptoms of Infectious Pneumonia: Vascular
63
Main Symptoms of Infectious Pneumonia: Lungs
- cough with sputum or phlegm
- SOB
- pleuritic chest pain
- hemoptysis
64
- cough with sputum or phlegm
- SOB
- pleuritic chest pain
- hemoptysis
Main Symptoms of Infectious Pneumonia: Lungs
65
Main Symptom of Infectious Pneumonia: Heart
- High HR
66
- High HR
Main Symptoms of Infectious Pneumonia: Heart
67
Main Symptoms of Infectious Pneumonia: Gastric
- N and V
68
- N and V
Main Symptoms of Infectious Pneumonia: Gastric
69
Main Symptoms of Infectious Pneumonia: Muscular
- fatigue
| - aches
70
- fatigue
| - aches
Main Symptoms of Infectious Pneumonia: Muscular
71
Main Symptoms of Infectious Pneumonia: Joints
-pain
72
-pain
Main Symptoms of Infectious Pneumonia: Joints
73
What is occurring at the alveolar capillary level in pneumonia?
- inflamed, thickened alveolar wall
| - alveolus filled with fluid
74
How do the changes on the alveolar capillary level affect the body in pneumonia?
Gases are unable to perfuse through fluid and inflammation
75
What happens to someone who gets pneumonia who also has underlying respiratory disease?
Makes things more complicated for them than someone who doesn't have underlying disease
76
What lab value indicatshypoxemia?
low PaO2
77
What level of PaO2 is normal?
80-100 mmHg
78
What test is conducted to find out PaO2?
blood gas
79
Most Common Pneumonias: Viral
- Influenza A & B
| - RSV
80
Most Common Pneumonias: Bacterial
- Strep
- Mycoplasma
- Staph
- Klebsiella
- Chlamydia
81
Which category of pathogens is are the most common bacterial pneumonias?
community acquired
82
Which common bacterial pneumonia is atypical?
Chlamydia
83
Which common bacterial pneumonia is typical?
- Strep
- Staph
- H. Flu
84
Who gets RSV?
infants and children
85
Where is viral pneumonia visualized on a scan?
mid lung, midline, attached to inside walls
86
Where is bacterial pneumonia visualized on a scan?
mid lung streaching across from inside wall to outside wall
87
How are bacterial and viral pneumonia treated
they have different treatments
88
Types of pneumonias
- Aspiration
- Community-Acquired Acute
- Community-Acquired Atypical
- Chronic
- Nosocomial
- Necrotizing & lung abscess
- In immunocompromised
89
- Community-Acquired Acute
- Community-Acquired Atypical
- Nosocomial
- Aspiration
- Chronic
- Necrotizing & lung abscess
- In immunocompromised
Types of pneumonias
90
Pathogens Causing Pneumonias (OVERALL): Community-Acquired Acute
*MOST IMPORTANT TO KNOW*
- Step
- H. flu
- Staph aureus
- Klebsiella
* MOST IMPORTANT TO KNOW*
91
- Step
- H. flu
- Staph aureus
- Klebsiella
*MOST IMPORTANT TO KNOW*
Pathogens Causing Pneumonias: Community-Acquired Acute
*MOST IMPORTANT TO KNOW*
92
Pathogens Causing Pneumonias: Community-Acquired Atypical
- Mycoplasma
- Chlamydia
- SARS
93
- Mycoplasma
- Chlamydia
- SARS
Pathogens Causing Pneumonias: Community-Acquired Atypical
94
Pathogens Causing Pneumonias: Nosocomial
- Klebsiella spp
- Serratia
- E. Coli
95
- Klebsiella spp
- Serratia
- E. Coli
Pathogens Causing Pneumonias: Nosocomial
96
Pathogens Causing Pneumonias: Aspiration
-Anaerobic oral flora (Bacteroides)
97
-Anaerobic oral flora (Bacteroides)
Pathogens Causing Pneumonias: Aspiration
98
Pathogens Causing Pneumonias: Chronic
- Nocardia
- Actinomyces
- TB
- Atypical mycobacteria
- Fungal
99
- Nocardia
- Actinomyces
- TB
- Atypical mycobacteria
- Fungal
Pathogens Causing Pneumonias: Chronic
100
Pathogens Causing Pneumonias: Necrotizing & lung abscess
- Anaerobic bacteria (foreign body, tumor)
101
- Anaerobic bacteria (foreign body, tumor)
Pathogens Causing Pneumonias: Necrotizing & lung abscess
102
Pathogens Causing Pneumonias: In immunocompromised
- CMV
- Pnumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
103
- CMV
- Pnumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
Pathogens Causing Pneumonias: In immunocompromised
104
Most common pathogen (s) causing pneumonia (OVERALL): Community-Acquired Acute
*MOST IMPORTANT TO KNOW*
- Step
- H. flu
- Staph aureus
*MOST IMPORTANT TO KNOW*
105
Most common pathogen(s) causing pneumonia (OVERALL): Community-Acquired Atypical
None
106
Most common pathogen(s) causing pneumonia(OVERALL): Nosocomial
E. Coli
107
Most common pathogen(s) causing pneumonia: Aspiration
Anaerobic oral flora (Bacteroides)
108
Most common pathogen(s) causing pneumonia (OVERALL) : Chronic
- Actinomyces
- Atypical mycobacteria
- TB
- Fungal
109
Most common pathogen(s) causing pneumonia(OVERALL): Necrotizing & lung abscess
None
110
Most common pathogen(s) causing pneumonia(OVERALL): In immunocompromised
- CMV
- Pneumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
111
What are all the most common pathogens causing pneumonias?
- Strep
- Staph aureus
- H. flu
- E. Coli
- Anaerobic oral flora (Bacteroides)
- Actinomyces
- Atypical mycobacteria
- TB
- Fungal
- CMV
- Pneumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
112
- Strep
- H. flu
- Staph aureus
- E. Coli
- Anaerobic oral flora (Bacteroides)
- Actinomyces
- TB
- Atypical mycobacteria
- Fungal
- CMV
- Pneumocystis
- Atypical mycobacteria
- Fungal (candida, aspergillus)
What are all the most common pathogens causing pneumonias?
113
What does nosocomial mean?
Pt that acquires pneumonia after being in a hospital or facility for 24 hrs
114
What are the two types of TB?
- Latent TB
| - TB Disease
115
Latent TB vs TB Disease: Is it live?
- Latent TB: yes
| - TB Disease: yes
116
Latent TB vs TB Disease: Does it grow?
- Latent TB: No
| - TB Disease: Active and growing in body
117
Latent TB vs TB Disease: Does it make a person sick and have symptoms?
- Latent TB: No
| - TB Disease: Yes
118
Latent TB vs TB Disease: Can it spread from person to person?
- Latent TB: No
| - TB Disease: Yes
119
Latent TB vs TB Disease: Can it worsen?
- Latent TB: Yes
| - TB Disease: Yes if left untreated
120
Latent TB vs TB Disease: What happens if it worsens?
- Latent TB: Can progress to TB disease
| - TB Disease: Can cause death left untreated
121
Types of TB
1. Primary Pulmonary
2. (Established) Pulmonary
3. Extrapulmonary
4. Return of Dormant
5. Military
6. Pleuritis
122
All possible NON SPECIFIC symptoms of TB
- poor appetite
- night sweats
- weakness
- fever
- dry cough
- weight loss
- GI symptoms
123
Symptoms of TB: (Established) Pulmonary
- productive cough
- weakness
- fever
- weight loss
124
- productive cough
- weakness
- fever
- weight loss
Symptoms of TB: (Established) Pulmonary
125
Symptoms of TB: Primary Pulmonary
- structural abnormalities
- night sweats
- poor appetite
- weakness
- fever
- dry cough
- weight loss
- GI symptoms
126
- structural abnormalities
- night sweats
- poor appetite
- weakness
- fever
- weight loss
- dry cough
- GI symptoms
Symptoms of TB: Primary Pulmonary
127
Symptoms of TB: Military
- poor appetite
- weakness
- fever
- weight loss
128
- poor appetite
- weakness
- fever
- weight loss
Symptoms of TB: Military
129
Symptoms of TB: Return of Dormant
- cough with increasing mucous
- coughing up blood
- night sweats
- poor appetite
- fever
- weight loss
130
- cough with increasing mucous
- coughing up blood
- night sweats
- poor appetite
- fever
- weight loss
Symptoms of TB: Return of Dormant
131
Symptoms of TB: Pleuritis
- chest pain
- fever
- dry cough
132
- chest pain
- fever
- dry cough
Symptoms of TB: Pleuritis
133
Symptoms of TB: Extrapulmonary
- Common sites: meninges, lymph nodes, bone and joints, genitourinary tract
- GI symptoms
134
- Common sites: meninges, lymph nodes, bone and joints, genitourinary tract
- GI symptoms
Symptoms of TB: Extrapulmonary
135
Symptoms specific to this type of TB: (Established) Pulmonary
- productive cough
136
Symptoms specific to this type of TB: Primary Pulmonary
- structural abnormalities
137
Symptoms specific to this type of TB: Military
-none
138
Symptoms specific to this type of TB: Return of Dormant
- cough with increasing mucous
| - coughing up blood
139
Symptoms specific to this type of TB: Pleuritis
-chest pain
140
Symptoms specific to this type of TB: Extrapulmonary
-Common sites: meninges, lymph nodes, bone and joints, genitourinary tract
141
Is TB eradicated in the US?
It was then there was a resurgence
142
Why was there a resurgence of TB in the US?
Because these organisms change/evolve to become resistant to our medications
143
If you find out you have a pt with newly diagnosed TB what should you do?
Report it to the state. TB is reportable.
144
What happens if a pt is refusing their TB medications?
They will be incarcerated in some sort of facility while they are infected (according to our public health guideline)
145
What happens to homeless people who get TB and are non-compliant with medications?
They must show up daily to a clinic or a medical professional will go out to the street to find them and give them their medications
146
Daily productive cough for three months or more, in at least two consecutive years
Chronic Bronchitis
147
Permanent enlargement and destruction of airspaces distal to the terminal bronchiole
Emphysema
148
Bronchitis vs Emphysema: weight
Bronchitis: heavy
Emphysema: thin
149
Bronchitis vs Emphysema:
| coloring
Bronchitis: cyanotic
Emphysema: -
150
Bronchitis vs Emphysema:
| Hgb
Bronchitis: elevated
Emphysema: -
151
Bronchitis vs Emphysema:
| physical body changes too look for
Bronchitis: peripheral edema
Emphysema: barrel chest
152
Bronchitis vs Emphysema:
| chest sounds
Bronchitis: Ronchi
Emphysema: quiet
153
Bronchitis vs Emphysema:
| age
Bronchitis: -
Emphysema: old
154
Bronchitis vs Emphysema:
| breathing
Bronchitis: wheezing
Emphysema: severe dyspnea
155
What does emphysema look like on an x-ray?
hyperinflation with flattened diaphragms
156
What causes barrel chest?
Air trapping
157
Bronchitis vs Emphysema: lung characteristics
Bronchitis: inflammation, excess mucus, muscle constriction
Emphysema: alveolar membrane degraded
158
What is the number one cause of COPD?
Smoking
159
Imagine someone who has emphysema is having an acute exacerbation of COPD in the ER. O2 level is extremely low and they are not doing well, so we are going to put them on bypass.
Do we want to bring their 02 level up to the same level as someone who does not have COPD? Why?
1. No
2. the medulla will think they don't need to breathe as much because it is used to living at a low level of 02 to begin with
3. Used to living with CO2 retention
160
Normal O2 for regular person and normal 02 for COPD
Normal: 93-94+
COPD: 88-92
161
What class of medication is given for COPD?
antiinflammatories
162
What type of antinflammatories are given for COPD
Steroids
163
What happens to a pts blood sugar when we give them steroids?
Increases blood sugar
164
What would an APRN order for a pt on steroids for COPD?
Order finger stick BS
165
Why is high BS bad for COPD?
High blood sugar increases risk of infection
166
What should treatment of Asthma focus on?
Decrease/Eliminate Cause Factors
167
Asthma: Mild/Moderate vs Severe vs Life Threatening: SpO2
Mild/Moderate: >92%
Severe: <92%
Life Threatening: <92%
168
Asthma: Mild/Moderate vs Severe vs Life Threatening: RR/HR
```
Mild/Moderate:
<30 (over 5s)
<40 (over 5s)
Severe:
>30 (over 5s)
>40 (under 5s)
Increased HR
Life Threatening: -
```
169
Asthma: Mild/Moderate vs Severe vs Life Threatening:
| PEFR
Mild/Moderate: -
Severe: 33-50% predicted
Life Threatening:
170
Asthma: Mild/Moderate vs Severe vs Life Threatening:
| Chest sounds
Mild/Moderate: Wheeze (may only be audible with stethoscope
Severe: Audible wheeze
Life Threatening: Silent chest
171
Asthma: Mild/Moderate vs Severe vs Life Threatening:
| Accessory muscle use
Mild/Moderate: No/minimal use
Severe: Use of accessory muscles
Life Threatening: poor respiratory effort
172
Asthma: Mild/Moderate vs Severe vs Life Threatening:
| feeding/talking
Mild/Moderate: feeding and talking well
Severe: too breathless to feed or talk
Life Threatening: Altered consciousness, agitation, confusion, exhaustion, cyanosis
173
What causes respiratory distress in asthma?
Swelling and thickening mucous will not allow air through
174
Do people die from asthma exacerbations often?
Yes
175
What should pts with asthma have a home?
Pulse ox reader
176
What is a BAD sign in an asthma exacerbation? why?
1. No breath sounds or wheezing
| 2. No air can get through
177
Asthma Grading: Grade meaning
Grade 1: Intermittent/Mild
Grade 2: Chronic/persistent, mild
Grade 3: Chronic/persistent, moderate
Grade 4: Chronic/persistent, severe
178
Asthma Grading: Daytime Symptoms
Grade 1: 2 times per week or less
Grade 2: more than twice a week, but not daily
Grade 3: daily
Grade 4: continuous
179
Asthma Grading: Nighttime Symptoms
Grade 1: once a month or less
Grade 2: 2-4 times per month
Grade 3: more than once per week, but not nightly
Grade 4: frequent
180
Asthma Grading: Peak flow while exhaling
Grade 1: 80% or more of child's predicted best
Grade 2: 80% or more of child's predicted best
Grade 3: between 60-80% of child's predicted best
Grade 4: less than 60% of child's predicted best
181
What should we always teach our asthma pt?
1. Understanding/knowing about their oxygenation
2. Knowing when they need to see care
3. BE AWARE OF TRIGGERS
182
What is one way of finding out triggers?
skin testing
183
What happens to the bronchial tube in an asthma attack?
1. Tightened smooth muscle
2. Swelling
3. Mucus
184
A complication arising from DVT that results in a blood clot blocking the pulmonary branches
Pulmonary embolism (PE)
185
When part of your lung receives oxygen without blood flow or blood flow without oxygen
AV/Q mismatch
186
When does a VQ mismatch occur? Why?
1. PE
| 2. Because no perfusion (no blood) = no ventilation
187
Most common cause of PE
DVT
188
Where do DVTs most like occur?
Legs
189
Where can a thrombus lodge?
Anywhere (brain, heart, vessel, lungs)
190
Where does a PE embolus lodge?
lungs
191
What happens if a person does not die within the first couple of hours of pulmonary embolism?
They have a much greater chance of survival
192
How are PE pts treated?
1. Antithrombotic medications
| 2. Maybe stay overnight for observation then sent home
193
Term used for fluid in the alveoli
Pulmonary Edema
194
What occurs with Pulmonary Edema
VQ mismatch
195
Pulmonary Edema Etiology
1. Increased Capillary Permeability
2. Decreased plasma protein
3. Lymphatic Obstructions
4. Increased hydrostatic pressure
5. Decreased interstitial pressure
6. HEART FAILURE
196
How does HF cause pulmonary edema?
Heart isn't pumping well and end up retaining fluid and going into pulmonary edema
