Test 1-Pulmonary Pathologies Flashcards
1
Q
Pathology Def:
An acute inflammation of the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli of the lungs. The inflammation may either be unilateral or bilateral and involve all or portions of the affected lung.
Etiology: May be caused by micro organisms such as bacteria, viruses, fungus, or protozoans. The disease also may arise secondary to other systemic diseases or induced by a variety of non-infectious agents such as chemicals and dust. Most microbial and non-infectious agents that cause this disease are either inhaled from the air or aspirated from the naso- and oropharynx.
S&S-Coughing, sputum production, stabbing chest pain, shaking chills, high or low grade fever.
A
Pneumonia
*primary tx- antibiotic therapy
2
Q
Def: Normal respiratory rate, normal breathing
A
Eupnea
3
Q
Def: Rapid, deep breathing
A
Hyperventilation
4
Q
Def: Slow and shallow breathing
A
Hypoventilation
5
Q
Def: Labored or difficult breathing
A
Dyspnea
6
Q
Def.: Normal breathing in an upright position
A
Orthopnea
7
Q
Def: Breathing stops completely for a brief period
A
Apnea
8
Q
Def: Occurs in critical diseases such as CHF, brain injuries, or brain tumors, or even drug overdose. *Type of respiration with Cycles of alternating apnea and hyperventilation.
Often happens at the end of life.
A
Cheyne-stokes respirations
9
Q
Def: Failure to resume breathing
A
Respiratory arrest
10
Q
What three terms describe the intensity of a breath sound?
A
Vesicular, bronchial, and decreased
Ves- Inhalation produces a soft rustling sound; exhalation is normally silent
Bronchial-Louder, more hollow, and echoing sound
Decreased-Breath sounds are very quiet and barely audible
11
Q
Def: Previously termed rails and rhonchi, Sound like the rustling of cellophane.
(CHF, pulmonary fibrosis, emphysema)
A
Crackles
12
Q
Def: High-pitched, course, whistling sounds. Heard during inspiration and expiration indicating compressed or narrowed airway
(Bronchitis, asthma, pneumonia)
A
Wheezes
13
Q
Def: Harsh, high pitched crowing sound indicating upper airway obstruction
(Tracheal stenosis, presence of foreign body)
A
Stridor
14
Q
Def: Study of disease;
Study of basic structural and functional changes associated with disease, and includes the study of causes that lead to the structural and functional changes and the manifestations that result from them.
A
Pathology
15
Q
Pathologies are also concerned with the sequence of events that lead from cause to structural and functional abnormalities and finally to manifestations; the sequence is referred to as ______ of disease.
_______(same as other blank) Is the development of unhealthy conditions or disease; it is the cellular events and reactions and other pathologic mechanisms that occur in the development of disease.
A
Pathogenesis
16
Q
Def: The study of disease causes, but is used commonly to refer to the cause of a disease
A
Etiology
17
Q
Def: The process of assigning a name to the patient’s condition
A
Diagnosis
18
Q
Def: Diseases that last a short period of time, usually a few days to a few weeks. Usually has a rapid onset.
A
Acute
19
Q
Def: Diseases that last a long time, often for a patient’s lifetime
A
Chronic
20
Q
Def: When the signs and symptoms of the disease subsides for a period of time
A
Remission
21
Q
Def: The period of time when the signs and symptoms recur in all their severity
A
Exacerbation
22
Q
Def: The aftermath of a disease
A
Sequela
23
Q
Def: Objective evidence of disease observed on physical examination, such as abnormal pulse, fever and pallor
A
Signs
24
Q
Def: Indication of the disease perceived by the patient, such as pain, dizziness, and itching
A
Symptoms
25
Def: The perception and response of the person to not being well
Illness
26
Def: Used to describe a biomedical condition that is substantiated by objective data, such as elevated temperature or presence of infection
Disease
27
Def: changes in the structure of genes; occur when the normal sequence of DNA is disrupted
Mutations
28
Classifications of hereditary disease (3)
Chromosomal (Down’s syndrome)
Mutation (cystic fibrosis)
Polygenic (RA, gout)
29
Def: The invasion and multiplication of pathogenic microorganisms in the body
Infection
30
The leading cause of death in the US for persons under 40. It is the third leading cause of death following cardiovascular and cancer in those over 40.
Physical Trauma
31
Def: Bruise brain tissue and disrupt normal nerve function; may cause loss of consciousness, hemorrhage, and even death.
Cerebral contusions
32
_____ cause temporary neural dysfunction, but are not severe enough to cause a contusion.
Concussions
33
Def: New formation or growth
Neoplasia
*Tumors and neoplasms are generally used synonymously
34
Def: The spreading process of malignant tumors
Metastasis
35
Natural immunity: specific to a ____
_____ immunity: Body has developed the ability to defend itself against a specific agent.
Species
Acquired immunity
*we develop antibodies around 3-6 weeks of age
36
3 Classifications of immune system gone wrong:
1) ______: When the immune response is inappropriate
2) ______: When the immune response is misdirected
3) _____: When the immune response is inadequate
1) Allergy
2) Auto-immunity
3) Immunodeficiency
37
_____ is due to improper intake of foods and quantity as well as quality, malabsorption or poor utilization, increase need, impaired metabolism and food and drug interaction
Malnutrition
38
Def: Diseases that have no known cause
Idiopathic
39
Some diseases are ______; that is caused by treatment and its effect in patients. Seen in the treatment of some cancer patients where chemotherapy drugs may cause severe anemia.
Iatrogenic
40
In the process of inspiration the thorax ____ in size, the pressure _____ and air flows in from the atmosphere. The diaphragm and external intercostal muscles _____ and the thorax ____pulling the lungs with it. This is an ____ process whereas expiration is a ____ process caused by the elastic recoil of the lungs and thoracic muscles.
Thorax INCREASES in size
Pressure DECREASES
Contract
Thorax expands
Active (inspiration)
Passive (expiration)
41
The diaphragm ____ when it contracts during inspiration and moves ____ toward the ____ cavity. This makes the ____ cavity longer.
Flattens
Downward
Abdominal cavity
Chest cavity
42
Most important muscle of inspiration is the _____
Diaphragm
43
Expiratory muscles are the ____ intercostals and _____ muscles
Internal intercostals
Abdominal muscles
44
Def: The exchange of gases between the blood and alveolar air; occurs by diffusion
External respiration
45
Blood flowing into the lung capillaries is ___ in oxygen. Because alveolar air is rich in oxygen, diffusion causes movement of oxygen from the alveoli to the ____ blood.
Low in O2
Capillary blood
46
Normal pH is ___-___
pH represents hydrogen ion concentration in body fluid.
7.35-7.45
47
pH greater than 7.45 is _____
Alkalosis
48
pH less than 7.35 is considered ____
Acidosis
49
DECREASED pH——>INCREASED hydrogen = ________
Respiratory rate and depth increases so that the lungs can increase the breakdown of carbonic acid to CO2 and H2O and can then exhale both the carbon dioxide and hydrogen. Decreasing hydrogen concentration thusly corrects the problem.
Acidosis
50
INCREASED pH ——>DECREASED Hydrogen = ______
When the body pH is increased the body fluid becomes more alkaline (basic), respiratory rate and depth is decreased to retain carbon dioxide so more carbonic acid can be formed.
Alkalosis
51
Pathology def: Excessive acidity of body fluids due to inadequate removal of carbon dioxide by the lungs. As the CO2 levels in the blood rise so does the amount of CO2 that combines with water to form carbonic acid. Consequently the pH of blood decreases.
Etiology: Occurs when there is a sudden impairment of ventilation resulting from an airway obstruction. This may be due to a foreign object blocking the air way or the effects in certain drugs, neuromuscular diseases, or cardiac arrest
Respiratory Acidosis
*chronic respiratory acidosis is caused by pulmonary diseases that change the characteristics of lung tissue, impairing the ability to release CO2. Ex. Emphysema, bronchitis, COPD
52
Pathology def/etiology: Caused by acute or chronic hyperventilation. May result from hyperventilation induced by anxiety or psychological trauma, fever, pain, salicylate poisoning, excessive exercise, or excessive use of mechanical ventilators.
Respiratory Alkalosis
53
Pathology def: A collapsed or airless condition of all or part of a lung that allows unoxygenated blood to pass unchanged through the area, and this produces hypoxia. This condition may be produced secondary to obstruction of the lung by foreign matter, mucous plugs or excessive secretion.
S&S: Dyspnea, cyanosis, tachycardia, anxiety
Tx: Frequent coughing and deep breathing are advised, postural drainage, chest percussion
Atelectasis
54
Pathology def: Not a specific disease but a collection of disorders that decreases the ability of the lungs and bronchi to perform the function of ventilation. It is characterized by permanent changes in the structure of the lungs and bronchi.
Diseases that may lead to this include emphysema, Chronic bronchitis, chronic asthma, pulmonary tuberculosis.
*In all forms, narrowing of airways obstruct airflow to and from the lungs. The obstruction increases the resistance to airflow. The trapped air hinders gas exchange in causes distention of alveoli.
Chronic obstructive pulmonary disease (COPD)
* Problem of getting air out
* Tx: Bronchodilators-Albuterol; Corticosteroids; SaO2 therapy
55
```
IRV-
ERV-
VC-
TV-
RV-
FRC-
```
Inspiratory reserve volume-Amount of air a person can inhale forcefully at the end of normal inhalation
Expiratory reserve volume-Amount of air a person can exhale forcefully at the end of normal exhalation
Vital capacity-Greatest volume of air that can be expelled from lungs after taking the deepest breath possible
Tidal volume-Amount of air that moves in or out of lungs during each respiratory cycle
Residual volume-Amount of air that remains in the lungs at the end of forced expiration
Functional residual capacity- Volume of air present in the lungs at the end of passive expiration
56
Pathology def: Inflammation of the bronchial mucous membranes. Characterized by a hypertrophy and hyperplasia of bronchial mucous glands, damage to bronchial cilia and narrowing of the bronchial airways.
Etiology: Associated with long-term heavy cigarette smoking
S&S: A chronic cough with sputum production is the classic symptom.
*A clinical diagnosis requires that a productive cough be present on most days for a minimum of three months in the year and at least two consecutive years
Chronic Bronchitis
57
Pathology def: An inflammation of the trachea and bronchi that is self-limiting and short term with minimal pulmonary signs
Etiology: Chemical irritants, viral infections, measles, chickenpox, or whooping cough
S&S: Mild fever, malaise, back and muscle pain, sore throat, productive cough, followed by wheezing and possible laryngitis
Acute Bronchitis
58
Def: Removal of a lung
Pneumonectomy
59
Def: Removal of one lobe of the lung
Lobectomy
60
Def: Removal of one or more lung segments
Segmental resection
61
Def: Removal of pie shaped section from surface of lung
Wedge resection
62
Def: Surgery performed to confirm a suspected diagnosis of lung or chest disease. The ribs are spread to get the best possible exposure of the lung and hemithorax. The pleura is entered and the lung is explored, a biopsy is usually done. A chest tube and closed drainage system is necessary bc the pleura space was entered.
Thorocotomy
63
All patients who have re-sectional surgery of the lung will require drainage of pleural spaces by one or two ____ _____. The closed drainage system must remain ____ the level of the chest.
Chest tubes
Below level of chest
64
Def: Localized in the substernal or chest region over involved lung fields that may include the anterior chest, side or back. The pain may radiate to neck, upper trapezius, costal margins, thoracic back, scapulae, or shoulder area
(Not a pathology)
Pulmonary pain pattern
65
The organs of the respiratory system are designed to perform 2 basic functions:
1)
2)
The primary function of the respiratory system is to:
1) Serve as air distributors
2) Gas exchangers of the body
Primary function of the respiratory system is to supply oxygen to cells and remove carbon dioxide
66
In addition to air distribution and gas exchange, the respiratory system also ___, _____, and ____ the air we breathe.
Respiration means -
Filters, warms, and humidifies
Respiration means exchange of gases between a living organism and its environment
67
Breathing consists of 2 processes
1) Def: The movement of air from outside the body to alveolar of the lungs
2) Def: The process of oxygen uptake and carbon dioxide elimination between the body and outside environment
Ventilation
Respiration
68
The two major sensors in the body that detect need to breathe are:
1) _____ ______: Located near the medulla. These respond to increases in carbon dioxide and decreases in pH in cerebrospinal fluid.
2) ____ ____: Located in the carotid body and aortic arch. These respond to low arterial blood oxygen, high carbon dioxide, low pH and are believed to function only in pathologic situations.
1) Central chemoreceptors
| 2) Peripheral sensors
69
Hey bitch, understand basic concepts..
If pH DECREASES that means CO2 _______
Increase or Decreases?
INCREASES
70
The alveoli produce _____ which keep the lungs from collapsing
Surfactant
71
Right lung has how many lobes?
How many lobes does the left lung have?
R lung: 3 lobes- upper, middle, lower
L lung: 2 lobes- upper and lower
72
The difference in ____ ____ causes the movement of air into and out of the lungs.
Air moves from areas of ____ pressure two areas of ___ pressure.
Air pressure
High to low
73
Pathology def: Often develops in patients with a long history of chronic bronchitis when the alveolar walls have been destroyed with the permanent distention of the air spaces. The air passages are obstructed and difficult expiration results due to the destruction of the walls between the alveoli, partial airway collapse, and loss of elastic recoil.
S&S: There is a reduction in the lungs elasticity with an increased effort to exhale trapped air, causing dyspnea on exertion leading to dyspnea at rest. Patient is usually thin, NO cough present, tachypnea with expiration. The patient often leans forward with arms on knees to support shoulders and chest for breathing. The size and shape of the patient’s chest often changes and can be referred to as barrel chest with increased expiratory effort.
Emphysema
*Teach pursed lip breathing; progressive walking is the most common form of exercise, but exercise will not improve pulmonary function just enhances cardiovascular fitness
74
Pursed lip breathing is helpful because it causes ____ to outflow and maintains _____ pressure which improves the mixing of ____ in the lungs.
Resistance
Intrabronchial
Gases
75
Pathology def: Respiratory condition marked by recurrent attacks of labored breathing accompanied by wheezing. It is the consequence of spasms of the bronchial tubes or swelling of their mucous membranes. Hyperventilation eventually occurs as lungs attempt to respond to the increase the volume and pressure.
Tx: Aerosol or bronchodilators and nasal decongestants
Asthma
* Prevention: avoid allergens and emotional distress
* Use diaphragmatic breathing
76
What are the two types of asthma?
1) _____ asthma: Bronchospasm is the result of an allergic response to environmental irritant. Most common in childhood.
2) ____ asthma: The patient suffers attack without allergic trigger. Most often begins in adulthood.
Extrinsic asthma
Intrinsic asthma
77
Pathology def: An area of necrotize lung tissue containing purulent (pus) material. More frequent in the lower dependent portion of the lungs and in the right lung which has more vertical bronchus.
Etiology: Caused by infectious organisms frequently arise as complication of pneumonia. May be produced by a septic embolism being carried to the lung in pulmonary circulation. Neoplasms, trauma from foreign objects lodged in lung tissue, or bronchial stenosis also may cause this to form.
S&S: Produce a cough accompanied by bloody, purulent, foul smelling sputum and breath. Chest pain, sweating, chills, headache, fever, and dyspnea often are present.
Lung Abscess
*Tx: antibiotic therapy or surgical resection
78
Pathology def: A slowly developing bacterial lung infection characterized by progressive necrosis of the lungs. The disease is transmitted in aerosol droplets exhaled by infected individuals by sneezing, coughing, speaking, singing, etc.
S&S: Pt. may be asymptomatic, advanced symptoms are wheezes, rales, and deviation of trachea
Tuberculosis
79
Pathology def: usually seen in immuno-compromised hosts. It is more difficult to diagnose and treat than other form of this disease.
Early S&S: Pain and stiffness. The lower thoracic and lumbar spine or commonly involved.
Extra-Pulmonary Tuberculosis
*Vertebral TB sometimes referred to as Potts disease
80
Pathology def: Unknown etiology, Characterized by excessive connective tissue deposition. The most common pulmonary manifestation of this disease is interstitial fibrosis.
S&S: Dyspnea on exertion, NONproductive cough. Pleural effusion may appear with orthopnea, edema, possible pneumothorax and congestive heart failure. Skin changes occur prior to visceral alterations.
Systemic sclerosis lung disease
| Scleroderma
81
Pathology def: Malignancy in the epithelium of the respiratory tract and may appear as various neoplasms that may be in the trachea, bronchi, or air sacs of the lungs.
Lung Cancer
82
Four major types of lung cancer:
1) Small cell carcinoma
2) Squamous cell
3) Adenocarcinoma - most cases
4) Large cell carcinoma
83
Where is the most frequent site of metastases from other types of cancer (besides lung cancer)?
Lungs
84
Pathology def: A congenital disorder of the exocrine glands characterized by the production of copious amounts of abnormally thick secretions of mucus, especially in the lungs and pancreas. Disease inherited as a recessive trait meaning both parents must be carriers.
S&S: May appear soon after birth or take some time and developing. Sweat glands exhibit in increased salt concentration in the sweat. Mothers often report their babies taste salty.
Respiratory symptoms may include wheezy respirations, a productive cough, dyspnea, tachypnea stemming from accumulations of thick secretions in the bronchioles and alveoli of the lungs. Gastrointestinal symptoms may include intestinal obstruction, vomiting, electrolyte imbalance, and the inability to absorb fats. pancreatic insufficiency can result characterized by insufficient insulin production.
Cystic fibrosis (genetic disease of the lung)
85
Def: permanent dilatation of bronchi due to destruction of the muscular and elastic properties of the lung. Airways full of purulent sputum. Usually associated with other underlying pulmonary diseases.
Clinical presentation: persistent production of large volumes of secretions, chronic productive cough, may have fever and finger nail clubbing
Bronchiectasis
86
Def: A mass of undissolved matter in the pulmonary artery or one of its branches. It’s an obstruction due to a displaced thrombus, air bubble, a fat globule, a clump of bacteria, amniotic fluid, vegetations on heart valves. Once freed, the obstruction travels to the lungs, presenting with shortness of breath tachypnea, tachycardia, and chest pain.
At high risk are individuals immobilized with chronic diseases, those in body casts, persons with congestive heart failure or neoplasm’s, or postoperative patients. Also pregnant women, people with varicose veins, people with diabetes mellitus
Pulmonary embolism
87
The most common cause of pulmonary embolism is ____ originating in the proximal deep venous system of the lower legs. The embolism causes an area of blockage, which results in localized _____ known as pulmonary infarction.
DVT
Ischemia
88
What are the three major risk factors of DVT?
1)
2)
3)
1) Blood stasis- Slowing/pooling of blood
2) Endothelial injury- Injury of endothelium in a blood vessel
3) Hypercoagulable states
89
Name some important preventative measures to prevent DVT:
1) Compression stockings, intermittent pneumatic compression pump
2) Exercise, early mobilization, ambulation, position changing
3) Elevating of the legs with caution to avoid severe flexion of the hips
4) IVC filter
5) Anticoagulants
**NO MASSAGE, NO RESTRICTIVE CLOTHING OR PROLONGED SITTING/STANDING
90
What can a positive Homan’s sign indicate? What does the test consist of?
Could indicate patient has DVT.
Test consists of calf pain on slow dorsiflexion of the foot or gentle squeezing of the affected calf.
*A positive sign is not always indicative of a DVT though
91
Pulmonary embolism can be fatal and is responsible for 10% to 20% of all hospital deaths. It is the leading cause of _____ related deaths.
_____ Can also result from embolization of a thrombus from the heart, aorta, or femoral artery.
What is the treatment of choice for acute DVT and PE?
Pregnancy related deaths
Gangrene
Heparin: it is given to reduce the chance of clot formations and to reduce further clot formation potential
92
Pathology def: Hyper trophy and failure of the right ventricle of the heart, due to pulmonary embolism. This can be either acute or chronic. It is an emergency situation arising from the sudden dilation of the right ventricle as a result of the PE.
Some specific disorders that may lead to this include COPD, chronic bronchitis, pulmonary hypertension, and emboli.
Cor Pulmonale
93
Pathology def: Inflammation of the visceral (inner) and parietal (outer) pleural membranes that envelop each lung.
There is primary and secondary.
S&S: chest pain (sudden, can be vague or intense stabbing sensations), cough, dyspnea (shortness of breath), fever and chills, tachypnea
Pleurisy
94
_____ Pleurisy: Caused by infection of the pleura by a bacteria or virus
_____ Pleurisy: May be due to pneumonia, tuberculosis, pulmonary infarction, neoplasm, chest trauma, RA, and systematic lupus erythematosus.
Primary Pleurisy
Secondary Pleurisy
95
Pathology def: A collection of air in the pleural cavity, typically resulting in the complete or partial collapse of the lung (atelectasis). One or both lungs can be affected. The condition can be spontaneous or secondary.
Pneumothorax
96
_____ pneumothorax: Caused by rupturing of small blebs along the surface of the lungs.
____ pneumothorax: Caused due to other lung diseases such as Asthma, emphysema, lung abscess, or lung cancer; or possibly due to chest trauma, perforated esophagus, or mechanical ventilators.
[Spontaneous or Secondary?]
Spontaneous
Secondary
97
In treating pneumothorax, bedrest, monitoring a vital signs, insertion of chest tube for drainage and to allow expansion of the collapsed lung or surgery.
_____ a surgical opening in chest cavity to explore or repair the state of origin of pneumothorax.
Thoracotomy
98
Def: Insufficient blood 02
Hypoxia
99
Def: Excessive blood CO2
Hypercapnia
*caused by HYPOventilation, lung dz/COPD
100
What happens with a restrictive lung pathology?
What is the most common restrictive lung disease?
The lungs aren’t expanding like they’re supposed to.
Pulmonary fibrosis
101
Pathology def: May be caused by radiation therapy, inhalation of noxious gases, O2 toxicity, asbestos exposure or idiopathic.
(a restrictive lung disease)
S&S: Rapid shallow breathing; limited chest expansion, digital clubbing, cyanosis, dyspnea, nonproductive cough. Life expectancy from time of diagnosis is approximately three years.
Pulmonary fibrosis
102
Acute or chronic pulmonary pathologies?
- PE
- Pneumonia
- ARDS (Acute respiratory distress syndrome)
- Pleural Effusion
Acute Pulmonary Pathologies
103
Def: Severe form of respiratory failure with significant impact on the morbidity and mortality of critical care patients. May be secondary to mechanical ventilation, pneumonia, lung contusion, near drowning, SEPSIS, inhalation injury, severe trauma
Considered a collection of symptoms rather than a disease.
Acute Respiratory Distress Syndrome (ARDS)
104
Def: Excessive collection of fluid within the plural space typically associated with heart, renal or liver failure, bacterial pneumonia or malnutrition.
S&S: Dyspnea, decreased chest expansion, diminished breath sounds
Pleural effusion
105
Def: Recurrent episodes of apnea during sleep lasting between 10 sec to > 1 minute
S&S: snoring and daytime somnolence (sleepiness)
Tx: weight loss, smoking cessation, CPAP (continuous positive airway pressure)
Obstructive Sleep Apnea
106
Exercise (physical therapy management)
- Mode: Sustained aerobic exercise (walking, cycling)
- Intensity: monitor HR, RPE
- Duration *how long?
- Frequency
- Exercise Progression *what is important to remember?*
- Activity Pacing: Break down component parts and intersperse rest periods (take a deep breath, on exhalation walk up 2 steps)
20-30 minutes recommended
First increase # of continuous minutes and decreasing rest breaks, then increase intensity.
107
What tool is used for ventilatory muscle training?
*Provides resistance to the inspiratory face, the expiratory phase, or both phases of ventilation to increase strength and endurance of these muscles
Spirometers
108
Postural drainage, percussion, vibration, cough Contraindications:
ICP> 20 mm Hg
Active hemorrhage
PE
Rib fx, surgical wound
Recent spinal surgery
109
Diaphragmatic breathing ____ your breathing rate and _____ oxygen demand.
Slows
Decreases
