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Pathophysiology & Pharmacology > Respiratory System Pathology > Flashcards

Respiratory System Pathology Flashcards

1
Q

Anatomy Overview: Trachea, Bronchi, Bronchioles, and Alveoli

A
  • Trachea
    ~ Carries air from the pharynx to the
    bronchi.
  • Bronchi
    ~ Carries air from the trachea to the
    bronchioles.
  • Bronchioles
    ~ Carries air from the bronchi to the
    alveoli.
  • Alveoli
    ~ Thin sacs lined wth capillaries.
    ~ Site of gas exchange between the
    environment and the body
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2
Q

Function of the Respiratory System

A
  • Ventilation
    ~ Mechanically move air in and out of
    the system (inspiration/expiration)
    > Moving volume
  • Respiration
    ~ Exchange of gas between the
    environment and the body with the
    Alveoli
    ~ Exchange of gas between blood and
    the cells
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3
Q

Mechanisms for Ventilation: Inspiration

A
  • Active!
  • Due to increased volume of thoracic cavity.
    ~ Contraction of External Intercostals
    ~ Contraction of Diaphragm
    ~ Contraction of Scalenes
    > Expands lungs and airways
    > Creates negative pressure inside
    cavity
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4
Q

Mechanisms for Ventilation: Expiration

A
  • Passive!
  • Due to decreased volume of thoracic cavity.
    ~ Relaxation of Muscles
    ~ Contraction of Internal/Innermost
    Intercostals (forced expiration):
    blowing candles for example
    > Lungs and airways return to
    normal size
    > Creates positive pressure inside
    cavity
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5
Q

What Drives Respiration?

A
  • Diffusion
    ~ Driven by partial pressure gradient
    > PO2 in alveoli higher than in the
    pulmonary capillaries.
    • O2 moves into capillaries.
    > PCO2 in the alveoli lower than in
    the pulmonary capillaries.
    • CO2 moves out of capillaries.
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6
Q

Test for Ventilation

A
  • Spirometry
    ~ Vital Capacity
    > Maximum volume of air that can
    be expelled after deep inspiration.
    ~ FEV1 (one second forced expiratory
    volume)
    > Max volume of air that can be
    expelled after deep inspiration in
    the first second
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7
Q

Test for Respiration

A
  • Pulse O2/CO2
    ~ Persons with poor gas exchange
    would have reduced O2 and elevated
    CO2 in the blood
    ~ Normal Pulse 02 = 95-100%
    saturation.
    > Numbers are an estimate.
    > 92% is a concern.
    ~ Some evidence that those with darker
    skin have more inaccurate estimates.
    > 95% is more like 92% in some
    persons.
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8
Q

Signs of Normal Respiratory Function

A
  • Unlabored
  • Shallow
  • Rate = 12-20 breaths per minute
  • Equal Expansion
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9
Q

What drives changes in ventilatory rate?

A
  • Levels of CO2 and 02 in the blood.
    ~ Chemoreceptors for CO2 located in
    the medulla.
    ~ Chemoreceptors for 02 and CO2 in
    the carotid artery and aorta.
    ~ Body is more sensitive to changes in
    CO2 than O2.
    > Fluctuations in CO2 have greater
    effect on body’s pH levels
    • If CO2 is too high, alters pH =
    body is more acidic
    > Ex.: Hyperventilation and breath
    holding
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10
Q

General Signs and Symptoms of Respiratory Conditions

A
  • Dyspnea
    ~ Shortness of Breath
    ~ Often due to interference of gas
    exchange in the lungs.
  • Cough
    ~ Body’s mechanism for clearing
    material from the respiratory system.
    ~ Causes
    > Environmental/Allergen Irritation
    > Increased Mucus Production -
    Infection/ Allergen
  • Cyanosis
    ~ Bluish tint to skin, nails, and lips
    ~ Result of poor O2 saturation of the
    blood
  • Abnormal Breathing Pattern
    ~ Increased Rate and Depth
    > Indicates low O2 levels
    > Indicates high CO2 levels
    ~ Decreased Rate and Depth
    > Can indicate CNS injury
    > Opioid overdose
  • Thorax Pain with or without referred pain to the neck and/or shoulders.
  • Increased Heart Rate
  • Increased Blood Pressure
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11
Q

Asthma and its triggers

A
  • Partial blockage of the bronchi/bronchioles
    ~ Often some degree of blockage is
    present even when asymptomatic.
  • Triggers: Cause inflammatory response.
    ~ Allergens
    ~ Infection
    ~ Air Temperature
    ~ Emotional State
    ~ Exercise (Exercise Induced
    Bronchospasm)
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12
Q

Asthma: S&S and Management

A
  • S&S
    ~ Dyspnea
    ~ Tight Chest
    ~ Fatigue
    ~ Wheezing
    ~ Prolonged Expiration
    ~ Cyanosis
    ~ Coughing
    ~ Tachypnea
  • Management
    ~ Assess Airway
    ~ Victim should rest in a position of
    comfort.
    ~ Reassure Victim
    ~ Administer rescue medication (inhaler)
    ~ If victim doesn’t improve, quickly
    activate EMS!
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13
Q

Prevention of Exercise Induced Asthma

A
  • Warm-up followed by exercise for 10-15 minutes to induce small attack.
  • After attack there’s usually a refractory period when the person can exercise at desired levels without another attack
  • Refractory period can last a few hours
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14
Q

Asthma Diagnosis

A
  • Favorable response to beta-agonist medications.
    ~ Stimulate beta-agonist receptors on
    the smooth muscle of the of the
    respiratory system.
    > Stimulation triggers relaxation of
    smooth muscle.
    • Bronchodilation
  • Spirometry
    ~ Measurement of forced expiratory
    volume within the first second (FEV1).
    > FEV1 improves beta-antagonist l
    meds
    > FEV1 diminished with Cholinergic
    meds
    • Cholinergics mimic
    acetylcholine action, smooth
    muscle contraction.
    *Causes Bronchoconstriction
    • Nothing will occur for people
    without asthma
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15
Q

Chronic Obstructive Pulmonary Disease (COPD)

A
  • Any condition which obstructs the flow of air in the bronchi and bronchioles during ventilation
  • Person can usually get air in, but have difficulty getting it out.
    ~ Does this make sense considering the
    mechanics of ventilation?
    > Yes, because the airway expands
    during inspiration and constricts
    during expiration
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16
Q

COPD - Chronic Bronchitis: Causes and Results

A
  • Inflammation of the bronchi
    ~ Symptoms for 3 months or more in at
    least 2 consecutive years
  • Causes
    ~ Recurrent Infection → trapped
    bacteria
    ~ Chemical Irritation → cigarettes
  • Results
    ~ Increased Mucus Production
    > Damaged Cilia
    ~ Narrowing of the Bronchi
    > Swelling
    > Bronchospasm
17
Q

COPD - Chronic Bronchitis: S&S and Management

A
  • S&S
    ~ Fever
    ~ Chronic Productive Cough
    ~ Cyanosis
    ~ Increased Ventilatory Rate
  • Management
    ~ Removal of Irritant/Treat Infection
    ~ Bronchodilator
    ~ Cough Suppressant? No because their
    cough is productive
18
Q

COPD - Emphysema: Cause

A
  • Excess mucus production block the bronchioles especially during expiration
  • Air is trapped in the alveoli.
  • Walls of the alveoli become damaged resulting in poor respiration at the lungs.
  • Causes
    ~ Heredity - Deficiency in protein
    responsible for preserving tissue
    elasticity.
    ~ Chemical Irritation
    ~ Infection
19
Q

COPD - Emphysema: S&S and Management

A
  • S&S
    ~ Dyspnea
    ~ Cough
    ~ “Barrel Chest”
    > Expansion of Alveoli causes a
    rounder shape to lungs
    ~ Increased Ventilatory Rate
  • Management
    ~ Removal of Irritant/Treat Infection
20
Q

Cystic Fibrosis: Cause

A
  • Congenital disorder of the exocrine glands characterized by the production of copious amounts (a lot) of abnormally thick mucus which accumulates in the bronchioles and alveoli
  • Cause: Recessive trait, both parents must be carriers.
    ~ 25% Chance
    ~ Most common in Caucasian
    population
    ~ 1 in every 2000
21
Q

Cystic Fibrosis: S&S and Management

A
  • S&S
    ~ Dyspnea
    ~ Productive Cough
    ~ Increased Breathing Rate
    ~ Mucous tends to trap bacteria and
    virus so pneumonia is common.
  • Management
    ~ Removal of Mucous
    ~ Bronchodilators
  • If pt dies, its usually due to pneumonia
22
Q

Pneumothorax: Cause

A
  • Accumulation of air in the chest cavity
    ~ Increased pressure in the chest cavity
    collapses the lung.
  • Cause
    ~ Lung Is punctured or damaged by an
    external force.
    ~ Doesn’t allow lung to expand due to
    pressure of air in the cavity
  • Pt will survive if they stay still
23
Q

Pneumothorax: S&S

A
  • Chest Pain
  • Dyspnea
  • Trachea may shift toward the side of the collapsed lung.
    ~ Decreased pressure in affected cavity
    causes a shift
  • Distended neck veins.
  • Uneven chest wall movement.
  • Reduced breath sounds heard in the affected side.
  • All signs and symptoms of shock.
    ~ Lack of O2 to brain
24
Q

Pneumothorax: Management

A
  • Treat for shock
  • Place victim lying with shoulders elevated or on side of injury
    ~ Gravity will help to expand affected
    lung
  • Emergency Referral
25
Q

Tension Pneumothorax

A
  • Air build up in the chest cavity due to traumatic pneumothorax puts pressure on the unaffected lung reducing its function
  • More serious
26
Q

Tension Pneumothorax: S&S

A
  • Same as traumatic pneumothorax except dyspnea progressively worsens
  • Trachea may shift away from the originally affected side
27
Q

Spontaneous Pneumothorax

A
  • Pneumothorax occurring during or immediately after activity
  • Lung tissue ruptures under heavy workload
28
Q

Hemothorax: Cause

A
  • Bleeding within chest cavity that interferes with normal expansion of the lungs
  • Cause
    ~ Lacerations of the chest cavity
    produced by penetrating objects or
    fractured ribs.
29
Q

Hemothorax: S&S and Management

A
  • S&S
    ~ Same signs and symptoms of
    pneumothorax except victim may
    cough up frothy red blood.
  • Management
    ~ Same as pneumothorax with
    attention to positioning
30
Q

Flail Chest

A
  • Fracture of more than one rib in more than one place
    ~ Chest wall is unable to expand
    during inspiration and contract during
    expiration in the area of the fractures
    > Opposite occurs
    ~ Reduces ventilation volumes
  • If there’s enough rib fractures, it’s like a pneumothorax
31
Q

Flail Chest: S&S and Management

A
  • S&S
    ~ Chest Pain
    ~ Difficulty Breathing
    ~ Abnormal chest wall movement with
    ventilation.
  • Management
    ~ Same as pneumothorax/hemothorax
    with attention to positioning

Pathophysiology & Pharmacology (20 decks)

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