Week 4 (ch. 13) Flashcards
1
Q
Respiratory system function
A
transport of o2 from air to blood and removal of co2 from the blood
2
Q
carbon dioxide
A
a waste product from metabolism and influences acid-base balance
3
Q
URT
A
passageway of air from atmosphere to lungs
- resident flora
4
Q
LRT
A
where gas exchange occurs
- sterile
5
Q
nasal cavity
A
warming and moistening of air, foriegn material trapped by mucous secretions
6
Q
nasopharynx
A
pharyngeal tonsils in posterior wall
7
Q
palatine tonsils
A
lymphoid tissue in posterior portion of the oral cavity
8
Q
oropharynx
A
common passage for air and food
9
Q
epiglottis
A
protects opening into larynx, closes over glottis at swallowing to prevent aspiration
10
Q
larynx
A
2 paid of vocal cords
11
Q
trachea
A
lined by pseudo-stratified ciliated epithelium, C-shaped rings of cartilage
12
Q
Trachea branches into what
A
Right and left primary bronchus
- right is larger and staighter and more likely a destination for aspiration material
secondary bronchi (from inverter bronchial tree)
bronchioles
alveolar ducts
alveoli
13
Q
Alveoli
A
lined by simple squamous epithelium and surfactant to reduce surface tension and maintain inflation
- end point for inspired air
- site of gas exchage
14
Q
how many lobes to the left and right lungs have
A
right = 3 left = 2
15
Q
what is each lung covered with?
A
pleural membrane
16
Q
thorax
A
provides a rigid protection wall for the lungs
- external and internal intercostal muscles move thoracic structures during ventilation
17
Q
ventilation depends on what
A
Pressure gradient (Boyle law) - air always moves from high pressure to low pressure
– atmospheric pressure higher than pressure in alveoli (inspiration)
– pressure in alveoli is higher than in atmosphere (expiration)
18
Q
pulmonary volumes is what
A
measure of ventilatory capacity
19
Q
tidal volume
A
amount of air exchanged with quiet inspiration and expiration
20
Q
residual volume
A
volume of air remaining in lungs after maximum respiration
21
Q
vital capacity
A
max. amount of air that can be moved in and out of lungs with a single forced inspiration and expiration
22
Q
where are the primary control centers for breathing location
A
medulla and pons
23
Q
what detect changes in carbon dioxide level, hydrogen ion, and o2 levels in blood or CSF
A
chemoreceptors
24
Q
central vs peripheral chemoreceptors
A
central - located in medulla
peripheral - located in carotid bodies
25
hypercapnia
co2 levels in blood increase
co2 can easily diffuse into CSF
-- lowers pH and stimulates respiratory center
-- increased rate of respirations (hyperventilation)
--causes respiratory acidosis
26
hypoxemia
decrease in o2
- chemoreceptors respond
- important control mechanism in individuals with chronic lung disease - move to hypoxic drive
27
hypocapnia
Caused by low co2 concentration (low partial pressure of co2)
- may be caused by hyperventilation (excessive amounts of co2 expired)
- causes respiratory alkalosis
28
external respiration
flow of gases between the alveolar air and blood
29
gas exchage depends on what
relative concentrations (partial pressure) of the gases
30
Po2 =
| Pco2 =
partial pressure of o2
| partial pressure of co2
31
Dalton law
each gas in a mixture moves along its partial pressure gradient, independent of other gases
32
pulmonary arteries
bring venous blood from right ventricles to be oxygenation
33
pulmonary capillaries
where diffusion or gas exhange occurs
34
pulmonary veins
return oxygenated blood to let atrium of heart
35
where do the left ventricle and left atrium lead to
into aorta out to systemic circulation
36
what factors influence the diffusion of gases?
1. Partial pressure gradient
2. Thickness of respiratory membrane
- - fluid accumulation in alveoli or interstitial tissue
3. Total surface area available for diffusion
- - if part of alveolar wall is destroyed, surface area is reduced --> less gas exchange
4. ventilation-perfusion ratio
- - ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exhange
37
Describe the transport of o2
About 1% is dissolved in plasma
| -- most is reversibly bound to hemoglobin by iron molecules
38
binding and release of o2 to hemoglobin is dependent on what?
Po2, Pco2, temp, plasma pH
39
describe the transport of co2
about 7% dissolved in plasma
about 20% reversibly bound to hemoglobin
most diffused into RBC - converted into bicarbonate ions
40
how does co2 play role in control of blood ph
through bicarbonate buffer system
41
Diagnostic test: Spirometry
Pulmonary function test (PFT)
| - test pulmonary volumes and airflow times
42
Diagnostic test: arterial blood gas determination
checks o2, co2, bicarbonate, serum pH
43
Diagnostic test: Oximetry
measures o2 saturation
44
Diagnostic test: exercise tolerance testing
for patients with chronic pulmonary disease
45
Diagnostic test: radiography
helpful in evaluating tumors and evaluate infections
46
What are some other diagnostic tests for respiratory function
```
Bronchoscopy
Biopsy
check site of lesion or bleeding
culture and sensitivity tests
sputum testing and presence of pathogens
Determine antimicrobial sensitivity of pathogen
```
47
Sneezing
Reflex response to irritation in URT
| -- assists in removing irritants, associated with inflammation or foreign material
48
coughing
irritation caused by nasal drainage, inflammation or foreign material LRT caused by inhaled irritants
49
Sputum: thin, clear colorless
normal
50
Sputum: yellowish, green, thick, cloudy
bacterial
51
Sputum: rusty or dark
pneumococcal pneumonia
52
Sputum: purulent (pus like), foul odor
bronchiectasis
53
Sputum: Thick, tenacious (sticky) mucus
asthma or cystic fibrosis patients
54
Sputum: hemoptysis; bright red blood tinged frothy sputum
= pulmonary edema
55
Breathing patterns and sounds: Eupnea
normal rate
56
Breathing patterns and sounds: Kussmaul Respirations
Deep rapid respirations - typical for acidosis; may follow strenuous exercise
57
Breathing patterns and sounds: labored respiration or prolonged inspiration or expiration
often associated with obstruction of airways
58
Breathing patterns and sounds: wheezing or whistling sounds
indicate obstruction in small airways
59
Breathing patterns and sounds: Stridor
high pitched crowing noise (usually indicate upper airway obstruction)
60
Breathing patterns and sounds: Rales
light, bubbly, or crackling sounds with serous secretion
61
Breathing patterns and sounds: Rhonchi
Deeper or harsher sounds from thicker mucus
62
Breathing patterns and sounds: Absence
non aeration or lung collapse
63
Dyspnea
feel like you cannot inhale enough air
- subjective feeling
- may be caused by co2 or hypoxemia, often noted on exertion, such as climbing stairs
64
How is severe dyspnea indicative of respiratory distress?
flaring of nostrils, use of accessory respiration muscles, retraction of muscles between or above ribs
65
orthopnea
trouble breathing when lying down
| - usually caused by pulmonary congestion
66
Paroxysmal nocturnal dyspnea
sudden acute type of dyspnea
| - common in patients with left-sided congestive heart failure
67
Cyanosis
bluish coloring of skin and mucous membranes
| - caused by large amounts of unoxygenated hemoglobin in blood
68
Pleural pain
results from inflammation or infection of parietal pleura
69
friction rub
soft sound produced as rought, inflamed or scarred pleural move against each other
70
Clubbed digits
painless, firm, fibrotic enlargement at the end of the digit
| - results from chronic hypoxia associated with respiratory or CV diseases
71
Hypoxemia vs hypercapnea
Hypoxemia - inadequate o2 in blood
| hypercapnea - increased co2 in blood
72
infectious diseases of the URT
```
common cold
sinusitis
epiglottitis
influenze
scarlet fever
```
73
URT: Common cold
Viral infection; spread through respiratory droplets
74
common cold symptoms
congestion, sore throat, headache, fever, malaise, cough, may see pharyngitits, laryngitis, or acute bronchitis
-- symptomatic treatment
75
what secondary bacterial infections may occur from a common cold
Usually caused by streptococci
Purulent exudate; systemic signs (fever)
Can lead to rheumatic fever or group A beta hemolytic Streptococcus pneumoniae
76
URT: Sinusitis
usually bacterial infectors
analgesics for headache and pain
course of antibiotics often required
77
URT: Laryngotracheobronchitis (croup)
common viral infection, particularily in children
- - common causative organism
- - parainfluenza viruses and adenoviruses
infection usually self limited
78
URT: Epiglottitis
Caused by Haemophilus influenzae type B
- age 3-7, rapid onset, fever and sore throat, drooling, refuse to swallow, heightened anxiety
- swelling of larynx, supraglottic area and epiglottis - may obstruct airways
- treatment: ox2, antimicrobial therapy, intubation
79
URT: Influenza (FLU): what is it?
Viral infection - 3 groups of influenza virus
- type A (common), b and c
- virus constantly mutate
80
URT: Influenza (FLU): s/s
sudden, acute onset with fever, fatigue, aching pain in the body
-- May also cause viral pneumonia, Mild case of influenza may be complicated by secondary bacterial pneumonia.
Commonly, deaths in flu epidemics result from pneumonia.
81
URT: Influenza (FLU): treatment
Symptomatic and supportive
- - Antiviral drugs – Amantadine, Zanamivir, Oseltamivir
- - Prevention highly recommended, vaccination
82
Scarlet Fever is caused by what
group A beta-hemolytic S. pyogenes
83
Scarlet fever symptoms
"strawberry tongue"
- fever, sore throat
- chills, vomiting, abdominal pain, malaise
84
scarlet fever treatment
antibiotics
85
Bronchiolitis: cause
caused by respiratory syncytial virus (RSV)
| - common in children 2-12 months
86
Bronchiolitis: transmitted
oral droplet
87
Bronchiolitis: s/s
Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise, can have severe cases`
88
Bronchiolitis: Treatment
Supportive and symptomatic
At risk population could have RSV immunoglobulin serum- palivizumab (synagis)
Expensive, given every 28 days through RSV season
89
Pneumonia: classification
Classification is based on:
- causative agent (bacteria, viral, fungal)
Anatomical location of infection
- through out both lungs, or one lobe
Pathophysiologic changes
- changes in interstitial tissue, alveolar septae, alveoli
Epidemiologic data
- nosocomial
- community acquired
90
Tuberculosis: causative agent
mycobacterium tuberculosis
91
tuberculosis: transmission
oral droplets
92
tuberculosis is common where
crowded living conditions, immunodeficiency, malnutrition, alcoholism, war, chronic disease, HIV/AIDS
93
Describe TB bacteria
acid-fast, slow growing bacillus
- somewhat resistance to drying and many disinfectants
- survive in dried sputum for weeks
- destroyed by UV lights, heat, alcohol, formaldehyde
- cell wall protects bacillus from body's normal defenses
- normal neutrophil response does not occur
94
TB: Primary infection
Bacteria first enter the lungs
Local inflammatory reaction
- engulfed by macrophages (local inflammation)
if cell mediated immunity is inadequate, mycobacteria reproduce and begin to destroy lung tissue (contagious). If it is adequate, it remains small and walled off, eventually calcifying lesions called Ghon complexes (chest x-ray)
patient may stay viable in dormant state for years
95
TB: Secondary or reinfection
Stage of active infection
- can be years after primary infection
- occurs when host resistance is decreased
- organisms multiple - tissue destruction - large area of necrosis; cavitation occurs
- spread to other parts of lung and expelled in sputum (contagious)
96
TB: s/s
Anorexia, Malaise, Fatigue, Wght loss, afternoon low-grade fever & night sweats, prolonged cough becomes productive (sputum producing), sputum contains blood
97
TB: diagnostics
Primary TB or latent- Mantoux skin test- false positive if person received vaccination for TB (BCG)
QuantiFeron-TB Gold test – newer blood test in place of Mantoux skin test
--> Common routine in health care workers, if x-ray needed then typically every 5 years
98
Active TB diagnostics
Sputum culture, Acid-fast sputum test, x-ray, & CT scan, Nucleic acid amplification (NAA) test
99
Why is TB becoming and increasinly serious problem
homelessness (over crowding in shelters)
HIV infection
lack of health care
multidrug resisant TB
100
Treatment for Latent TB
Isoniazid (INH)
Rifapentine
Rifampin
101
Active TB treatment
```
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
Streptomycin
```
102
Cystic Fibrosis
inherited disorder -- gene located on chromosome 7
- -> tenacious mucus from enodocrine glands
- -> effets lung and pancrease
103
Cystic fibrosis: Lungs
mucus obstructs airflow and bronchioloes and small bronchi
| -- permanent damage to bronchial walls
104
Cystic fibrosis in the lungs is commonly caused by what
Pseudomonas aeruginosa and Staphylococcus aureus
105
cystic fribrosis: digestive trace
Meconium ileus in newborns
Blockage of pancreatic ducts
Obstruction of bile ducts
Salivary glands often mildly affected
106
Cystic Fibrosis: Reproductive tract
Obstruction of vas deferens (male)
| Obstruction of cervix (female)
107
Cystic Fibrosis: sweat glands
sweat has high sodium chloride content
108
Cystic Fibrosis: s/s
a. Meconium ileus may occur at birth.
b. Salty skin
c. Signs of malabsorption
d. Chronic cough and frequent respiratory infections
e. Failure to meet normal growth milestones
109
Cystic Fibrosis: Diagnosis
```
genetic testing
sweat test
testing of stool
radiography, pulmonary function
blood gas analysis
```
110
Cystic Fibrosis treatment
Replacement therapy and well-balanced diet
Chest physiotherapy – postural drainage, percussion, coughing techniques - Daily
111
Aspiration s/s
```
coughing and choking
loss of voice
stridor and horsness
wheezing
tachcardia and tachpnea
nasal flaring, chest retrations, hypoxia
cardiac or respiratory arrest
```
112
aspiration treatment
swallow study
| keep objects away from children
113
Asthma
Bronchial obstruction
| - occurs in persons with hypersensitive and hyperresponsive airways
114
Asthma pathophysiology
changes in bronchi and bronchioles
- inflammation of the mucosa with edema
- bronchoconstriction caused by contraction of smooth muscle
increased secretion of thick mucus in airways
115
extrinsic asthma
acute episodes triggered by type 1 hypersensitivity reactions
116
intrinsic asthma
onset during adulthood
| hyperresponsive tissue in airway initiates attact
117
asthma stimuli
Respiratory infections, Stress, Exposure to cold, Inhalation of irritants, Exercise, Drugs
118
asthma s/s
```
cough
dyspnea
tight feeling chest
wheezing
rapid and labored breathing
expulsion of thick / sticky mucus
tachycardia
hypoxia
```
119
respiratory alkalosis caused by
hyperventilation
120
respiratory acidosis cause
air trapping
121
severe respiratory distress leads to
hypoventilation leads to hyperoxemia and respiratory acidosis
122
respitatory failure indicated by what
decreasing responsiveness, cyanosis
123
chronic asthma attacks can lead to
chronic asthma and COPD
| - bronchial wall thickening and fibrous tissue
124
Asthma: Acute episode
Persistent severe attack of asthma
- - does not respond to usual therapy
- medical emergency
- may be fatal because of severe hypoxia and acidosis
125
Asthma treatment: general measures
```
Skin tests for allergic reactions
Avoidance of triggering factors
Good ventilation of environment
Swimming and walking
Use of maintenance inhalers or drugs
```
126
Asthma treatment: measure for acute attacks
controlled breathing tech.
inhalers
glucocorticoids
127
Asthma treatment: measures for status Asthma asthmaticus
hospital care if no response to bronchodilator
128
Asthma treatment: prophylaxis and treatment for chronic asthma
Leukotriene receptor antagonist
- block inflammation response in presence of stimulus
- not effective for treatment f acute attacks
129
Asthma treatment: Cromolyn sodium
Prophylactic medication
Inhalation on a daily basis
Useful for athletes and sports enthusiasts
No value during an acute attack
130
COPD may lead to the development of what
corpulmonale (right sided heart failure)
131
What is COPD Emphysema
Destruction of alveolar walls and septae
| --> leads to large, permanent inflated alveolar air spaces
132
COPD Emphysema is classified by what
specific location of changes
133
COPD Emphysema contributing factors
genetic, gender, smoking, bacteria
134
COPD Emphysema: breakdown of alveolar wall results in what
loss of surface area for gas exchange.- loss of pulmonary capillaries.- loss of elastic fibers.- altered ventilation-perfusion ratio.- decreased support for other structures.
135
COPD emphysema: fibrosis
Narrowed airways, Weakened walls, Interference with passive expiratory airflow
136
COPD Emphysema: describe the progressive difficulty with expiration
a. Air trapping and increased residual volume
b. Overinflation of the lungs
c. Fixation of ribs in an respiratory position, increased anterior-posterior diameter of thorax (barrel chest)
d. Flattened diaphragm (on radiograph
137
COPD Emphysema: describe how advanced emphysema leads to loss of tissue
Adjacent damaged alveoli coalesce, forming large air spaces.
Pneumothorax
--> Occurs when pleural membrane surrounding large blebs ruptures
Hypercapnia becomes marked.
Hypoxia becomes driving force of respiration.
Frequent infections
Pulmonary hypertension and cor pulmonale
may develop in late stage
138
Emphysema s/s
Dyspnea (first on exertion and worsens with disease progression)
hyperventilation w prolonged expiratory phase (barrel chest)
Anorexia / fatigue
Clubbed fingers
139
Emphysema diagnosis
Chest radiography
| pulmonary function tests (PFT)
140
Emphysema treatment
- Avoid respiratory irritants
- Immunization
- Pulmonary rehabilitation
- Breathing techniques
- nutrition and hydration
- Bronchodilators, antibiotics, oxygen therapy as condition advances
- Lung reduction surgery
141
COPD chronic bronchitis
inflammation, obstruction, repeated infection, chronic coughing twice for 3 months or longer in 2 years
142
Patho of chronic bronchitis
Mucosa inflammed and swollen
hypertrophy and hyperplasia of mucous glands
fibrosis and thickening of bronchial walls
143
chronic bronchitis s/s
a. Constant productive cough
b. Tachypnea and shortness of breath
c. Frequent thick and purulent secretions
d. Cough and rhonchi more severe in the morning
e. Hypoxia, cyanosis, hypercapnia
f. Polycythemia, weight loss, signs of cor pulmonale possible
g. As vascular damage and pulmonary hypertension progress
144
Chronic bronchitis treatment
```
Stop smoking / irritant exposure
treat infection
vaccination
expectorants
bronchodilator
chest therapy
low-flow o2
nutritional supplements
```
145
Vascular disorders: pulmonary edema what is it
fluid collecting in alveoli and interstitial area
- results from primary conditions
- reduced amount of o2 diffusing into blood
- interferes with lung expansion
146
Vascular disorders: pulmonary edema may develop when
a. Inflammation in lungs is present.
- Increases permeability of capillaries
b. Plasma protein levels are low.
- Decreases osmotic pressure of plasma
c. Pulmonary hypertension develops.
147
Vascular disorders: pulmonary edema s/s for mild and chronic
Mild: cough, orthopnea, rales
chronic:
- hemoptysis often occurs
- frothy sputum
- labored breathing
- hypoxemia increased
- cyanosis
148
Vascular disorders: pulmonary edema treatment
treat causative factors
supprtive care
possibly positive pressure mechanical care
keep upper body elevated
149
Pulmonary embolus treatment
```
Stockings
surgery
heparin or stretokinase
mechanical ventilation
embolectomy
```
150
pulmonary embolism diagnosis
Radiography
Lung scan
MRI
Pulmonary angiography
151
Pleural Effusion: what
Prescence of excessive fluid in pleural cavity
| -- causes increase pressure in pleural cavity and separation of pleural membrances
152
Pleural effusion: Exudate effusion
response to inflammation
153
Pleural effusion: transudate effusions
```
Watery effusions (hydrothorax)
- result of increased hydrostatic pressure or decreased osmotic pressure in blood vessles
```
154
Pleural effusion: s/s
Dyspnea
chest pain
increase RR and HR
usually dullness to percussion and absense of breath sounds over the affected area
tracheal deviation
hypotension
155
Pleural effusion: treatment
Remove underlying cause to treat respiratory impairment.
Analyze fluid to confirm cause
Chest drainage, thoracocentesis to remove fluid and relieve pressure
156
pneumothorax is what
air in pleural cavity
157
Describe a closed pneumothorax
air can enter pleural cavity from internal airways - no opening in chest well
158
closed pneumothorax: simple of spontaneous pneumothorax
tear on the surface of the lung
159
closed pneumothorax: secondary pneumothorax
associated with underlying respiratory disease
Rupture of an emphysematous bleb on lung surface or erosion by a tumor or tubercular cavitation
160
Open pneumothorax: what is it
Atmospheric air enters the pleural cavity through an opening in the chest wall
"sucking" wound -- large opening in chest wall
161
Open pneumothorax: tension pneumothorax
results of an opening through chest wall and parietal pleura or from a tear in the lung tissue and visceral pleura
- air enters pleural cavity on inspiration but hole closes on expiration
- trapping air leads to increase pleural pressure and atelectasis
- most serious
162
Pneumothorax s/s
```
Atelectasis
dyspnea
cough
chest pain
reduced breath sounds
unequal check expansion
hypoxia
interference with venous returne
```
163
pneumothorax treatment
Hospital ASAP
| MORE IN PPT
164
Infant respiratory syndrome usually results from what
premature birth
165
Infant respiratory syndrome what is it
lack of surfactant in alveoli
166
Infant respiratory syndrome pathophysiology for Poorly developed alveoli that are diff. to inflate
- - diffuse atelectasis results
| - - decrease pulm. blood flow, pulmonary vasoconstriction --> hypoxia
167
Infant respiratory syndrome pathophysiology for poor lung perfusion and lack of surfactant
Increased alveolar capillary permeability
| -- fluid and protein are leaking into the interstitial area and alveoli, hyaline membrane formation
168
Infant respiratory distress syndrom s/s
Respiratory difficulties at birth
Resp. = rapid and shallow
Frothy sputum
expiratory grunt
BP falls
cyanosis
peripheral edema
servere hypoxemia and decreased responsiveness
irregular respirations with periods of apnea
169
Infant respiratory distress syndrom diagnostic tests
arterial blood gas analysis
170
Infant respiratory distress syndrome treatment
Glucocorticoids for women in premature labor
Synthetic surfactant for high-risk neonate
CPAP
o2 therapy
171
Adult respiratory distress syndrome
results from injury to the alveolar wall and capillary membrane
172
what does Adult respiratory distress syndrome lead to
Release of chemical mediators
-- increased permability of alveolar capillary membranes
- increase fluid and protein in interstitial area and alveoli
- damage to surfactant producing cells
- diffuse necrosis and fibrosis if patient survives
173
Adult respiratory distress syndrome s/s
```
dyspnea
restlessness
rapid, shallow respirations
increase HR
combination of metabolic and resp. acidosis
```
174
Adult respiratory distress syndrome treatment
treat underlying cause
| supportive respiratory therapy
