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Pathophysiology > Respiratory- T2 > Flashcards

Respiratory- T2 Flashcards

1
Q

function of lungs and airway

A
  • gas exchanges btw alveoli
  • serves as reservoir for blood storage
  • produces heparin in the capillaries where small clots are trapped
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2
Q

ventiliation (pulmonary review: respiration)

A
  • movement of air (gas) into and out of the lungs

- doesnt mean we’re getting O2

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3
Q

gas exchange

A

the exchange of O2 and CO2 at the alveolar level

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4
Q

ventilation

A
  • movement of O2, nitrogen, CO2, and other gases btw the atmosphere and the lungs
  • air moves along pressure gradient (high pressure pushing air)
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5
Q

what is the muscle for ventilation to assist in air movement?

A

-diaphragm
-sterno-cleido -mastoid
- scalene
intercostals

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6
Q

nursing implications for the function of the lungs and airways

A

-premature babies dont have fully formed lungs so these functions, esp surfactant production may be impaired with severe consequences

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7
Q

nursing implications for diaphragm

A

assess accessory muscles for respiratory difficulty

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8
Q

what does air movement int the lungs depend on?

A

resistance of the airways and lung compliance

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9
Q

lungs are usually ____ under normal conditions but become ____ and _____ in conditions such as ARDS

A
  • elastic
  • stiff and noncompliance

(if they have COPD and are a smoker, the lungs cannot be elastic)

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10
Q

diaphragm

A

help expand and contract to maintain pressure higher and lower

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11
Q

nursing implications for ventilation

A

assess and listen to lungs carefully after surgery

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12
Q

What causes strong increase in intrathoracic pressure, impeded venous return to right atrium?

A

valsalva maneuver

Ex:Trying to get pt out of bed and they had abdominal surgery/ Their abs hurt and it hurt as they bare down, pushing, and holding their breath. → this is valsalva maneuver
(decreases venous return to atrium/cardiac output)

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13
Q

what is the atmosphere pressure?

A

760 mmHg (considered as 0)

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14
Q

where is gas measured?

A

arterial system

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15
Q

normal PO2

A

80-100%

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16
Q

normal PCO3

A

35-45% (arterial)

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17
Q

when we take a breath, diaphragm….

A

goes DOWN

  • allowing air to come in
  • air around intraplueral spaces also affected (anything that interrupts is abnormal)
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18
Q

inspiration

A

air moves btw the atmosphere and into the lungs bc of pressure differences; phyiscs dictates that air overs in a gradient from high to low

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19
Q

during inspirations, the chest…

A
  • chest expands
  • intrapulmonary pressure decreases and become more negative (spaces around the lung)
  • air enters the lungs
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20
Q

What happens to the chest cavity during expiration?

A

decreases in size

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21
Q

perfustion

A

movement of blood flow to the gas exchange portion of the lung

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22
Q

what happens when there is perfusion without ventilation?

A
  • result in shunting
  • is dead air space (air doesnt contribute to gas exchange)
  • therefore the amount of blood that is suppose to be O2 is going to decrease and exchange in the rest of the body
  • should happen in the LUNGS but affect the entire BODY
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23
Q

What results in ventilation-perfusion mismatch?

A

-disease that interfere with either ventilation or perfusion

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24
Q

2 methods of Oxygen transport

A
  • transported in chemical combination with hemoglobin –> called oxyhemoglobin (about 96-98%)
  • transported in dissolved state (about 2-4%: dissolved in the blood) and can diffuse into the tissue cells
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25
Q

what is oxygen saturation dependent on?

A

-amount of O2 bound to hemoglobin

measure by device that is clipped to fingers, toes, etc

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26
Q

What is the partial pressure of O2 dependent on?

A

-dissolved O2-pO

dissolve part-saturation –> in actual blood

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27
Q

hypoxemia

A

reduction in blood O2 (arterial) levels from respiratory disease, dysfunction of the neuro system, and/or alterations in circulations
- can lead to ventilation/perfusion mismatching

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28
Q

as PO2 level drops, what happens to the body?

A

the body switches to anaerobic metabolism and lactic acid begins building up in the blood causing metabolic acidosis

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29
Q

mild hypoxemia (s/s)

A
  • INCREASE HEART RATE AND BP
  • change in mental status
  • hyperventilation
  • possible cyanosis
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30
Q

chronic hypoxia (s/s)

A
  • compensatory mechanisms may include…
    • increased ventilation
    • increased RBC production (have chronic acidosis and erthyrocytosis -increase production of RBC)
  • more than 3 months
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31
Q

severe hypoxemia (s/s)

A
  • PRONOUNCED INCREASED HEART RATE AND BP (just like mild)
  • restlessness, impaired judgement
  • delirium, stupor, coma
  • pronounced cyanosis
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32
Q

Hypoxia treatment

A
  • delivery of appropriate amount of O2 (if COPD, give LOW amount of O2 –> can cause ventilatory failure)
  • delivery of O2 thru appropriate device, cannula mask, or MV
  • intervene early and appropriately
  • PCO2 levels are increasing bc youre holding your breath to take in more O2
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33
Q

hypercapnia

A
  • INCREASE IN CO2 content of arterial blood (normal pCO2 is 35-45)
  • decreased pH, acidosis, compensation results in increased heart rate and RR
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34
Q

cause of hypercapnia

A
  • HYPOventilation
  • ventilation perfusion mismatch
  • increased metabolic rate
  • high CHO
  • diet
  • fever
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35
Q

cyanosis

A

bluish discoloration of the skin resulting from EXCESSIVE CONCENTRATION OF DEOXYGENATED HEMOGLOBIN in small vessels
-late sign of respiratory failure

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36
Q

where is cyanosis most evident?

A
  • central: tongue and lip

- peripheral: extremities and tip of nose and ears

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37
Q

respiratory pO2 is _____ than ___ and PCO2 is _____ than ____ for cyanosis

A

pO2 is LESS than 50 and PCO2 is GREATER than 50

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38
Q

dyspnea

A

-a subjective sensation of difficulty breathing

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39
Q

where does dyspnea occur?

A
  • people with pneumonia
  • asthma
  • emphysema
  • heart disease with pulmonary congestion
  • neuromuscular disease that affect respiratory muscle such as myasthenia Gravis
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40
Q

dyspnea nursing implications

A

several scales that can be used to measure dyspnea to evaluate progression

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41
Q

dyspnea- treatment

A

depends on the cause, the amount of anxiety it produces but includes anxiety reduction, energy conservation, breathing retraining

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42
Q

cough reflex

A
  • a protective mechanism
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43
Q

what interferes with cough reflex?

A

-when muscle strength is impaired

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44
Q

cough reflex - nursing implications

A

bedrest impairs the expansion of the chest, limits amount of air, making for a weak, ineffective cough

  • best to have pt sit up for coughing and deep breathing such as after surgery unless otherwise contraindicated
  • NASOGASTRIC TUBES interfere with cough reflex by preventing closure of upper airway structure
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45
Q

what are pulmonary diseases?

A
  • obstructive disease
  • disorders of lung infection
  • respiratory tract infection
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46
Q

obstructive diseases (pulmonary disease)

A

disoeders that limit EXPIRATORY airflow

- Ex: asthma, COPD,

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47
Q

disorders of lung infection (pulmonary disease)

A
  • disorders that decreases (restrict) EXPANSION of lung
  • Ex: atelectasis, pneumothorax
  • trauma
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48
Q

respiratory tract infection (pulmonary disease)

A
  • pneumonia
  • influenza
  • common cold
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49
Q

Asthma characteristics

A
  • airway obstruction thats usually reversible
  • airway inflammation
  • increased airway responsiveness due to stimuli (usually allergens)
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50
Q

what causes asthma

A

hypersensitivity reactions to a number of allergens

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51
Q

asthma patho

A

-exaggerated hypersensitivity response to variety of stimuli, including allergens, drugs, cold, or exercise

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52
Q

in asthma, after the exposure to the inciting factors, what happens?

A

inflammatory mediators released by T-lymphocytes, activated macrophages, eosinophils, mast cells, and basophils induce broncho-constriction

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53
Q

bronchial (larger airway) asthma

A

chronic inflammatory disease of the airways involving recurring symptoms of airflow obstruction and bronchial hyperresponsiveness

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54
Q

Asthma-symptoms

A
  • wheezing
  • tightness of chest
  • dyspnea
  • cough
  • increased sputum production
  • tachycardia
  • tachypnea
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55
Q

asthma in children

A
  • leading cause of chronic illness with 80% being symptomatic by 6 years of age
  • more frequent in black children
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56
Q

what is the first symptoms for asthma in children?

A

-may be a cold that progresses on very rapidly and ends in a trip to the ER

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57
Q

diagnosis of asthma

A
  • history/physical exam

- spirometer measurements of FVC, FEV, PEF, tidal volume, inspiratory and expiratory reserve volume

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58
Q

intrinsic (nonatopic) asthma are triggered by what?

A
  • respiratory tract infection
  • exercise
  • hyperventilation
  • cold air
  • drugs and chemicals
  • hormonal changes
  • airborne pollutants
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59
Q

What does respiratory infection stimulate? (intrinsic asthma)

A

production of IgE antibodies

-increases airway responsiveness to other triggers that may last for weeks

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60
Q

What induce broncho-spasm?

A

inhaled irritants such as smoke

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61
Q

extrinsic (atopic) asthma

A

-initiated by type I hypersensitivity reaction induced by exposure to extrinsic antigen or allergen, usually begins in childhood or adolescence

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62
Q

extrinsic (atopic) asthma - what are other things they experience?

A

hay fever, urticaria, and eczema

-attacks related to specific allergen

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63
Q

how many phases of mechanisms of response are there for extrinsic asthma?

A

2

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64
Q

what is the 2 main goal for extrinsic asthma?

A
  1. prevention and control of triggers and effects

2. medications

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65
Q

treatment of extrinsic asthma

A
  • decrease exposure to allergens
  • educate pt and family about triggers and appropriate treatment
  • relaxation techniques
  • allergens immunotherapy
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66
Q

COPD (chronic obstructive pulmonary disease)

A
  • an umbrealla tern that encompasses 2 chronic, progressive disease processes that involve obstruction of the airway
  • no early symptoms
  • 4th leading cause of death in U.S
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67
Q

examples of COPD

A
  • emphysema

- chronic bronchitis

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68
Q

COPD risk factors

A
  • direct inhalation of tabacco smoke
  • second and exposure to cigarette smoke
  • genetics
  • occupational exposure to various dusts/chemicals
  • indoor air pollution involving biomass fuels used for heating and cooking in poorly ventilated dwellings
  • severe respiratory infections
  • maternal smoking during pregnancy
69
Q

COPD symptoms

A
  • SIT IN TRIPOD POSITION
  • fatigue
  • exercise intolerance
  • AM productive cough
  • barrel chest
  • SOB
70
Q

cyanosis, fluid retention, RIGHT heart failure

A

COPD BLUE BLOATERS

71
Q

-hypoxemia can cause polychythemia (increase in RBC)

A

COPD BLUE BLOATERS

72
Q

chronic bronchitis

A

COPD Blue bloaters

73
Q

-no cyanosis, air trapping, increase in antero-posterior dimension of chest –> causing barrel

A

COPD Pink Puffers

74
Q

predominant emphysema

A

pink puffers copd

75
Q

Decreased PaO2 <65 and increased PCO2>55

A

pink puffers COPD

76
Q

how does emphysema happen?

A

destruction of alveoli by enzymes from neutrophils and macrophages

77
Q

smoking causes alveolar damage in 2 ways

A
  1. inflammation of the lung tissue

2. inactivates chemical that protects lung tissue

78
Q

loss of alveolar wall leads to…

A

emphysema

79
Q

loss of elastic tissue in lung leads to…

A

emphysema

80
Q

increases in airway pressure leads to..

A

emphysema

81
Q

decreases in airway outflow leads too…

A

emphysema

82
Q

air becomes trapped in alveoli leads to…

A

emphysema

83
Q

formation of bullae

A
  • common in emphysema
  • on alveoli and can rupture (When rupture, air is now escaping and if they’re near intrapleural space, it can go there and cause death) –> increase air causes pneumothorax
84
Q

s/s of pink puffers

A

emphysema

85
Q

s/s of decreased in PaO2 (60-80mmHg)

A

emphysema

86
Q

s/s of Increasing PCO2 with disease progression

A

emphysema

87
Q

what is emphysema?

A

destructive changes in the alveolar walls without fibrosis and abnormal enlargement of distal air sacs

  • frequently associated with chronic bronchitis
  • develops over a long period of time
88
Q

what causes emphysema?

A
  • associated with cigarette smoking
  • genetic predisposition
  • may follow bacterial infection
89
Q

history of emphysema

A
  • smoker
  • weight loss
  • usually after age 50
90
Q

chronic bronchitis

A

airway obstruction by inflammation of the major and small airways
-hypersecretion of bronchial mucous and a chronic recurrent cough of more than 3 months duration and occurring each year for 2 consecutive years

91
Q

how does chronic bronchitis happens

A
  • chronic inflammation and swelling of bronchial mucosa
  • increase numbers of bronchial mucous glands and goblet cells
  • increased bronchial wall thickness
  • )
92
Q

what is the scarring and increased fibrosis of bronchial mucous membrane

A

the cause of chonic bronchitis

93
Q

obstruction of airflow (inflammatory and fibrotic changes can extend into alveoli & mucous plugs can prevent proper oxygenation

A

cause of chronic bronchitis

94
Q

COPD: Oxygen thread

A
  • low flow only (1-2L/min) to prevent reduction of the ventilatory drive
  • normal person has ventilatory drive based on high CO2 levels
  • the person with COPD has ventilatory drive based on low O2
95
Q

examples of disorders of lungs

A
  • atelectasis

- pneumothorax

96
Q

pleural cavity

A
  • pleura

- pleural space

97
Q

pleura

A

double layered membrane that covers the lungs

98
Q

pleural space

A

space btw the 2 layers

99
Q

atelectasis

A

an incomplete expansion of the lung or portion of lung

- usually occur after surgery bc pt isnt taking deep breaths since it hurts

100
Q

tachypnea, tachycardia, and dyspnea are signs of what?

A

atelectasis

101
Q

cyanosis and hypoxemia are s/s of…?

A

atelectasis

102
Q

absent breath sounds and intercostal retraction are s/s of…?

A

atelectasis

103
Q

what is the cause of atelectasis

A
  • airway obstruction
  • compression of lung tissue
  • lack of surfacant
104
Q

pneumothorax

A

presence of air within pleural space resulting in partial or complete collapse of lung

105
Q

spontaneous pneumothorax

A
  • due to rupture of a bleb on the surface of the lung

- cause is unknown. Associated with tall young males and heavy smoker

106
Q

traumatic pneumothorax

A
  • due to injuries (penetrating or non-penetrating)

- Ex: getting shot or stabbed

107
Q

tension pneumothorax (aka closed)

A
  • intrapleural pressure exceeds atmospheric pressure
  • life threatening
  • Ex: bullet goes in and cant escape bc skin closes
108
Q

increased respiratory rate, dyspnea, decreased/absent heart rate, hypoxemia, asymmetrical chest expansion, mediastinal shift is the s/s of what?

A

pneumothorax

109
Q

treatment for pneumothorax

A
  • chest tube

- pain control

110
Q

common cold

A

infection of respiratory tract

111
Q

rhinosinusitis

A

infection of respiratory tract

112
Q

influenza

A

infection of respiratory tract

113
Q

pneumonias

A

infection of respiratory tract

114
Q

tuberculosis

A

infection of respiratory tract

115
Q

fungal infections

A

infection of respiratory tract

116
Q

pollutants (asbestos, coal dusts)

A

infection of respiratory tract

117
Q

what is a common cold

A
  • a virus

- viral in origin, with kids being the main reservoir (adults have 2-3 yrs and children up to 12 yrs)

118
Q

what are secretions like for cold?

A

clear and watery

-mucous membes are reddened, swollen, sore throat, and hoarseness

119
Q

if they have a fever, is it a cold?

A

NO bc that is the FLU

120
Q

treatment of cold

A
  • rest and symptomatic treatment

- NO ANTIBIOTICS

121
Q

influenza

A

viral infection that is highly contagious and is the cause of about 36,000 deaths per years in mainly elderly

122
Q

s/s of influenza

A

Abrupt onset of FEVER and chills, malaise, muscle aching, headache, profuse watery discharge, nonproductive cough and sore throat. Malaise tends to be the distinguishing feature between common cold, sinusitis, and influenza.

123
Q

comorbidity for the flu

A

more disease, the higher the risk of them not recovering

124
Q

treatment for influenza

A
  • rest
  • fluids
  • ASA except in children for fever
  • antiviral such as amantadine which prevent replications of the DNA virus if used in 1st hours
125
Q

most important aspect of flu is…

A
  • prevention
  • Influenza vaccination which must be done annually since the formulation is made according to which viruses are believed to be causing the outbreak in a given year.
126
Q

pneumonia

A

inflammatory reaction in the alveoli & interstitium of the lung caused by INFECTIOUS OR NON-INFECTIOUS AGENT

  • can be viral or bacterial
  • 6th leading cause of death
127
Q

microbial agents enter the lung, mulitply, and trigger pulmonary inflammation

A

pneumonia

128
Q

what happens to the alvelar spaces with pneumonia

A

alveolar air spaces filled with EXUDATE

  • cant breathe if all those junks are in there
  • if pt isnt coughing up, it gets hard –> consolidation
129
Q

symptoms of pneumonia

A
  • hypoxemia

- exudate becomes consolidated and difficult to expectorate

130
Q

pneumonia is the complication of what?

A

-complication of influenza and immunicompromised

131
Q

categories of pneumonia

A
  • type of agent (typical vs aptypical)
  • distrubution with the lung (within the lobes or brinchi)
  • setting: community or hospital
132
Q

community acquired pneumonia

A
  • Lung infection with onset in the community or diagnosed within the first 2 days of hospitalization.
  • The individual has not lived in a long-term facility within 14 days prior to admission.
  • The most common culprits implicated in CAP include: S. pneumoniae, S. aureus, Mycoplasma pneumoniae, & Chlamydia. Viral causes include the influenza virus.
133
Q

hospital acquired pneumonia

A
  • occurs 48 hours or longer after hospital admission
  • not present upon admission
  • lower respiratory tract infection
  • difficult to treat due to resistance with antibiotics
  • Common organisms responsible for pneumonia include: Pseudomonas aeruginosa, S. aureus & E. coli
134
Q

pneumonia diagnosis

A
  • history
  • symptomatology
  • chest x-ray
  • sputum culture and sensitivity to determine infective organism and most appropriate antibiotics
135
Q

most common cause of bacterial pneumonia

A

pneumococcal pneumonia (S. pneumoniae

136
Q

4 stages of pneumonia

A
  • edema
  • red hepatization
  • gray hepatization
  • resolution
137
Q

edema

A

filling of alveoli with organisms

138
Q

red hepatization

A

massive leukocytes and RBC lost

139
Q

gray hepatization

A

arrival of macrophages

140
Q

resolution

A

removal of alveolar exudate

141
Q

prevention of pneumonia

A

Pneumococcal vaccine immunization is recommended for elderly over 65 and greater than two years of age if immunocompromised

142
Q

Watch for signs of rapid mental deterioration especially in winter months as a sign of pneumonia
-Supplemental oxygen may be needed for more severe cases.

A

s/s of pneumonia

143
Q

two pneumonia vaccines

A
  • prevnar 13

- pneumovax 23

144
Q

prevnar 13

A

a pneumococcal CONJUGATE vaccine that protects against 13 types of pneumococcal bacteria

145
Q

pneumovax 23

A

a pneumococcal POLYSACCHARIDE VACCINE that protects against 23 types of pneumococcla bacteria

146
Q

tuberculosis

A

-#1 cause of death from a single organism worldwide (long decline of deaths when increase in cases occur bc of HIV)

147
Q

what is TB caused by?

A

mycobacterium tuberculosis- a rod shape, aerobic acid fast bacilli

148
Q

how is TB spread?

A
  • spread by airborne droplet, invisible particles

- thrive best in oxygen rich (lungs)

149
Q

how long does it take for TB mediated response to respond?

A

3-6 weeks and indicates the person has been exposed but NOT active
-on xray, a GHON focus can be seen

150
Q

TB is what type?

A

type IV hpersensitivity raction mediated by TH1 helper T-cells
-individualis INFECTED but not contagious

151
Q

symptoms of TB

A
  • weight loss
  • fatigue
  • night sweats
  • fever
  • once spread to SPUTUM, the person can pass it on to others
152
Q

diagnosis of TB

A

PPD skin test

  • chest X-ray
  • sputum test
153
Q

TB risk factors

A

-anything that causes your immune system to weaken (HIV/AIDS, foreign immigrants, small spaces, old age, chronic disease)

154
Q

TB treatment/ management

A
  • multiple drugs are mandatory (to prevent drug resistant and take 6+ months
  • use INDIVIDUALLY FITTED MASK when caring for person
155
Q

medications for TB

A
  • INH (isoniazide)
  • rifampin
  • pyrazinamide
  • ethambutol
  • streptomycin
156
Q

lung tumor

A

benign or malignant

157
Q

lung cancer

A 
LEADING cause (not common for men and women)
-main risk is cigarette smoking (15-20  delay btw smoking onset and cancer)
158
Q

lung cancer patho

A

-chemicals in cigarette smoke/tats bind and mutate DNA –> causing stepwise accumulation of over 20 GENETIC ABNORMALITIES that transform begign cells into malignant

159
Q

4 cells types of lung cancer

A
  • small cell
  • adenocarcinoma (MOST COMMON, MOST COMMON in women)
  • squamous cell (found in smoker)
  • large cells (tend to metastasize early and to brain)
160
Q

lung cancer s/s

A

-usually doesnt seek medical care until symptoms develop which is late (believes coughing is related to smoking)

161
Q

most common signs of lung cancer

A

-persistent coughing w/ or w/o coughing

162
Q

symptoms of Lung cancer

A

Recurrent bronchitis, dyspnea, chest pain, hoarseness, obstructive pneu`monia, fatigue, weight loss, paraneoplastic syndromes (production of hormone analogs which cause inappropriate neuroendocrine secretions)

163
Q

lung cancer diagnosis

A
  • usually by CT scan of lungs
  • bronchoscopy to get biopsy
  • thoracentesis to obtain cells from plural spaces
164
Q

stage I of thoracentesis

A

no meds, surgery

165
Q

stage II/III of thoracentesis

A

chemo, radiation, and surgery

166
Q

stage IV of thoracentesis

A

no surgery

167
Q

respiratory

A
  • decrease in ventilation

- causing an increase in pCO2

168
Q

metabolic

A

-addition or loss of acid/alkali from extracellular fluids cause alteration in the HCO3 levels (coming from kidney, have addition or losses of alkaline to change bicarbonate)

Pathophysiology (4 decks)

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