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81 Cards in this Set
- Front
- Back
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normal respiratory function is dependent upon:
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-adequate O2
-patent airways -adequate alveolar-capillary exchange -functioning CNS |
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clinical states associated with respiratory dysfunction
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-hypercapnea
-hypoxemia |
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what is hypercapnea? and what is the measurement?
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elevated PaCO2 levels (>44mmHg)
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what is hypoxemia?
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reduced oxygenation of the arterial blood brought on by respiratory dysfunction
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causes of diffusion abnormalities
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-thickening of membrane
-reduction of surface area -membrane becomes coated |
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normal V/Q level
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.8-.9
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what is V/Q?
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ventilation perfusion mismatch
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when ventilation is the problem what will happen to the V/Q ratio?
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DECREASE
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when perfusion is the problem what will happen to the V/Q ratio?
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INCREASE
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what is shunting?
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when blood is shunted through the lung areas where there is no oxygen....blood is returned to the left side of the heart deoxygenated....low V/Q ratio
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what is alveolar dead space?
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poor perfusion of an area in the lung that is well ventilated......high V/Q ratio
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acute respiratory failure (ARF)
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-sudden life threatening deterioration of the gas exchange function of the lungs
-exchange of oxygen for carbon dioxide in the lungs cannot keep up with the rate of oxygen consumption and carbon dioxide production by the cells of the body |
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ABGs of Acute Respiratory Failure
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PaO2 <50mmHg
PaCO2 >50mmHg arterial Ph <7.35 |
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common causes of ARF
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-decrease respiratory drive
-dysfunction of the chest wall |
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S/S of ARF
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-restlessness
-fatigue -air hunger -headache -dyspnea -tachycardio -increased BP -use of accessory muscles -decreased breath sounds -altered mental status -tachypnea -central cyanosis -diaphoresis -respiratory arrest |
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what is Pulmonary Edema?
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movement of water outof the vascular system and into interstitial tissue of the lungs and into the alveolar spaces
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risk factors of Pulmonary Edema
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-heart disease***
-acute respiratory distress syndrome -inhalation of toxic gases |
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clinical manifestations of Pulmonary Edema
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-dyspnea
-orthopnea -inspiratory crackles -dull percussion -cardiomegaly -pink frothy sputum (SEVERE) |
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obstructive pulmonary disorders are characterized by what?
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-airway obstruction that is worse on EXPIRATION
-patient has to increase force to expire |
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Chronic Obstructive Pulmonary disease (COPD) is what?
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-syndrome of chronic pathologic changes that occue in the lungs due to either chronic bronchitis or emphysema
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what respiratory syndrome is the 4th leading cause of death?
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COPD
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what are the primary causes of COPD?
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-cigarette smoking
-air pollution -occupational exposures |
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ABGs with COPD
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-decreased pH
-elevated pCO2 -decreased pO2 -H&H are elevated -tachycardia -tachypnea |
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COPD patients 1st stimulus to breathe is what?
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elevated CO2 (80)
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COPD patients 2nd stimulus to breathe is what? and with this how should you practice safe nursing interventions?
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decreased O2
***CANNOT GIVE THEM TOO MUCH O2 OR THEY WILL STOP BREATHING....KEEP BETWEEN 1 - 3 L*** |
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what is Chronic Bronchitis?
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hypersecretion of mucus and chronic production of cough lasting for 3 consecutive months for 2 consecutive years
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at risk populations of Chronic Bronchitis
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-smokers
-occupational pollutants -elderly |
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pathophysiology of Chronic Bronchitis
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irritants cause hypertrophy, hyperplasia of mucus glands and goblet cells in airway epithelium and increase in mucus production -> mucus is thicker and difficult to clear due to impaired ciliary function -> chronic inflammation and infection further reduce cilia and thicken walls of bronchi affecting particularly EXPIRATION
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beginning clinical manifestations of COPD: Chronic Bronchitis
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-decreased tolerance for exertion
-wheezing -SOB -productive cough -decreased forced expiratory volume |
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progression of clinical manifestations of COPD: Chronic Bronchitis
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-infections
-changes in pulmonary function tests -increased PCO2 levels -hypoxemia -cyanosis -pulmonary hypertension |
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what is COPD: Emphysema?
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abnormal, permanent enlargement of alveoli and gas exchange airways resulting in air obstruction from changes in lung tissue that leave the alveoli without any elasticity
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at risk populations for COPD: Emphysema
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-people with deficiency of alpha antitrypsin
-people whose bodies cannot inhibit the action of proteolytic enzymes bc of inhaled toxins |
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pathophysiology of Emphysema
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loss of alveolar elasticity/recoil -> airtrapping -> hyperinflation of alveoli/destruction -> expiration becomes difficult
-> increases O2 demands |
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clinical manifestations of Emphysema
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-dyspnea on exertion
-tachypnea -use of accessory muscles -acquired polycythemia -thin appearance (poor nutrition) -barrel chest -hyperresonance -tachycardia -dysrhythmias -cardiac complications (bc of compensation for tissue hypoxia) |
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ABGs of persons with Emphysema
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-elevated pCO2
-decreased pO2 -decreased pH |
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what is Chronic Bronchitis?
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hypersecretion of mucus and chronic production of cough lasting for 3 consecutive months for 2 consecutive years
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at risk populations of Chronic Bronchitis
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-smokers
-occupational pollutants -elderly |
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pathophysiology of Chronic Bronchitis
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irritants cause hypertrophy, hyperplasia of mucus glands and goblet cells in airway epithelium and increase in mucus production -> mucus is thicker and difficult to clear due to impaired ciliary function -> chronic inflammation and infection further reduce cilia and thicken walls of bronchi affecting particularly EXPIRATION
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beginning clinical manifestations of COPD: Chronic Bronchitis
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-decreased tolerance for exertion
-wheezing -SOB -productive cough -decreased forced expiratory volume |
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progression of clinical manifestations of COPD: Chronic Bronchitis
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-infections
-changes in pulmonary function tests -increased PCO2 levels -hypoxemia -cyanosis -pulmonary hypertension |
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what is COPD: Emphysema?
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abnormal, permanent enlargement of alveoli and gas exchange airways resulting in air obstruction from changes in lung tissue that leave the alveoli without any elasticity
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at risk populations for COPD: Emphysema
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-people with deficiency of alpha antitrypsin
-people whose bodies cannot inhibit the action of proteolytic enzymes bc of inhaled toxins |
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pathophysiology of Emphysema
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loss of alveolar elasticity/recoil -> airtrapping -> hyperinflation of alveoli/destruction -> expiration becomes difficult
-> increases O2 demands |
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clinical manifestations of Emphysema
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-dyspnea on exertion
-tachypnea -use of accessory muscles -acquired polycythemia -thin appearance (poor nutrition) -barrel chest -hyperresonance -tachycardia -dysrhythmias -cardiac complications (bc of compensation for tissue hypoxia) |
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ABGs of persons with Emphysema
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-elevated pCO2
-decreased pO2 -decreased pH |
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restrictive pulmonary disorders are defined as what?
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conditions in which the problem occurs in the inspiratory phase of respiration
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Acute Respiratory Distress Syndrome (ARDS) is characterized by what
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a sudden and progressive pulmonary edema, hypoxemia, reduced lung compliance
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pathophysiology of ARDS
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inflammatory trigger -> release of cellular and chemical mediators -> injury of the alveolar capillary membrane and leakage of fluids into the alveolar interstitial spaces -> alterations in the capillary bed -> V/Q mismatching (collapsing of alveoli, narrowed airways, and decreased lung compliance)
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S/S of ARDS
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-rapid onset of dyspnea
-anxiousness -labored breathing -tachypnea -intercostal retractions and crackles |
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characteristic feature of ARDS
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arterial hypoxemia that is unresponsive to supplemental oxygen
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what is Tuberculosis?
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infectious disease caused by mycobacterium tuberculosis
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what is the leading cause of death from infectious diseases in the world?
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TB
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TB is transmitted how?
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AIRBORNE droplet from person to person
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S/S of TB
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-fatigue
-wt loss -anorexia -low grade fever -night sweats -cough with purulent sputum -dyspnea -chest pain |
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pathophysiology of TB
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droplets inspired into lungs and multiply -> lung inflammation -> activation of immune response -> bacilli isolated and tubercle is formed (granuloma) -> immunity develops
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what is Pneumonia?
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inflammation of the lung parenchyma that is caused by a microbial, viral or fungal agent
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what is the 6th leading cause of death in the US?
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Pneumonia
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pathophysiology of Pneumonia
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1. arises from normally present flora in a pt whose resistance has been altered
2. aspiration of flora present in the oropharynx 3. inhalation of flora that have been released into the air |
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risk factors for Pneumonia
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-cigarette smoking
-immunosuppresion -immobility -depressed cough reflex |
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strep pneumoniae is most common in who?
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most common pathogen in people <60 yrs without comorbidities & people >60 yrs with comorbidities
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viral pneumoniae is most common in who?
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most common in infants and children
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what is the most common viral pathogen for viral ppnemoniae?
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cytomegalovirus
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pulmonary vascular disorders are described as what?
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compromised blood flow through the lungs
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compromised blood flow through the lungs with pulmonary vascular disorders can be brough on by what 3 things?
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1. occlusion of vessels
2. destruction of vessels 3. increased pulmonary ressistance to vascular flow |
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what is a Pulmonary Embolism?
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occlusion of some part of the pulmonary vascular bed by an embolus or thrombus, lipids, tissue, or air fragment
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clinical manifestations of pulmonary emboli
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-sudden onset of chest pain
-dyspnea -tachypnea -tachycardia -anxiety - |
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croup is also known as what?
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laryngotracheobronchitis
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at risk groups of Croup
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6 months --> 5 years and males
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Croup is caused by what? and triggers what?
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viral infections; triggers the inflammatory and immune response
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pathophysiology of Croup
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1.inflammation and edema
2.upper airway obstruction 3.increased resistance to air flow 4.increased intrathoracic negative pressure 5.collapse of upper airway 6.respiratory failure |
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clinical manifestations of Croup
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-rhinorrhea
-sore throat -low grade fever -seal like barking cough -inspiratory stridor |
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what causes inspiratory stridor with Croup?
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laryngiospasms
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respiratory distress syndrome is also called what?
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hyaline Membrane disease
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what is the leading cause of death in newborns? (most often premature infants)
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respiratory distress syndrome
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at risk populations for respiratory distress syndrome
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-prematurity
-diabetic mother -cesarean delivery -males -whites |
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pathophysiology of respiratory distress syndrome
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1.surfactant deficiency in premature infant
2.atelectasis occurs 3.hypercapnea, hypoxiea, permeability from cellular injury leads to presence of fibrin and plasma protein film over alveoli 4. reducing O2 CO2 exchange 5.respiratory failure |
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clinical manifestations of respiratory distress syndrome
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-tachypnea
-nasal flaring -cyanosis -grunting -hypoxemia -dyspnea |
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what is Cystic Fibrosis?
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autosomal recessive inherited disease causing epithelial cell problems in the respiratory, digestive and reproductive system
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Cystic Fibrosis is a mutation of what chromosome resulting in what?
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Chromosome 7; results in abnormal CFTR
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pathophysiology of CF
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1.production of thick mucus leading to mucus plugging
2.inflammation/infection with microabcesses 3.bronchiectasis, fibrosis and cyst formation 4.reduction in functioning lung tissue |
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clinical manifestations of CF
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-persistent cough, wheezing, pneumonia
-barrel chest -clubbing -GI problems -pancreatic invovlement |
