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128 Cards in this Set
- Front
- Back
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What is the primary function of the respiratory system?
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-gas exchange via ventilation, perfusion & diffusion
-O2 from environment w/delivery to cells & CO2 from the cells w/delivery to environment |
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What are the characteristics of the alveolar-capillary surface?
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grape-like configuration creates a large surface area for gas exchange.
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Since the respiratory moves O2 & CO2 in and out of the lungs what does that maintain?
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-acid base balance
-fluid balance |
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What is normal systemic circulation pressure?
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120/80 mmHg
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What is normal pulmonary circulation pressure?
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25/8 mmHg
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What are the parts of the upper respiratory tract?
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-nose
-nasal cavity -paranasal sinuses -pharynx -larynx |
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What are the parts of the lower respiratory tract?
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-trachea
-right & left bronchial tube -bronchioles -lungs |
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How many lobes are in the right lung?
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3
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How many lobes are in the left lung?
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2
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What protects the respiratory tract?
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-mucocilliary system
-alveolar macrophages |
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What are the components that protect the respiratory tract?
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-nasal cavity hairs
-pseudostratified ciliated columnar epithelium -goblet cells -cilia |
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What happens if the PSNS is stimulated what happens to the bronchioles?
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bronchoconstrict
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What happens if the SNS is stimulated what happens to the bronchioles?
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bronchodilation (think running from the bear)
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What does PAO2 or PACO2 mean?
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partial pressure exerted by O2 & CO2 in the alveoli
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What does PaO2 or PaCO2 mean?
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partial pressure exerted by O2 & CO2 in the blood
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How is fluid balance maintained in the pulmonary capillaries?
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-hydrostatic pressure
-colloid osmotic pressure -capillary permeability |
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How do capillaries lower pulmonary vascular resistance in response to increased vascular pressure?
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-recruitment: opening capillaries
-distention:widening of capillaries |
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What is it called when you breath in air?
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ventilation
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What is the driving force behind movement of O2 into the blood from the alveoli?
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-breath air in
-lungs fill with air -equalize pressure -greater pressure of O2 in lungs allows O2 to diffuse to the alveoli -O2 then attaches to Hgb on RBCs |
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What is the relationship between PAO2 and PaO2?
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alveolar tension vs. arterial tension
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What does it mean if PAO2 and PaO2 is mismatched?
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gas exchange problem
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Describe the physical mechanics of breathing with diaphragmatic involvement.
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-inspiration the diaphragm moves down
-exhalation the diaphragm moves up |
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Where is the respiratory center?
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Medulla oblongata/pons
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Neurologic control of breathing: Where are the central chemoreceptors? What do they respond to?
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-brain
-respond to changes in pH and CO2 |
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Neurologic control of breathing: Where are the peripheral chemoreceptors? What do they respond to?
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-aortic arch/carotid
-respond to decrease in arterial O2, pH & increase PaCO2 |
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How do the lungs adjust for increased PaCO2?
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-high PaCO2/low PaO2
-chemoreceptors sense decrease in pH (high H+) -sends signal to respiratoy rate -Hgb's affinity lessens for O2 -right shift -more O2 can be delivered to tissues |
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How do the lungs participate in adjustment of low pH?
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-pH is low (acidic)
-increased RR -excrete H+ -hyperventilation |
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How do the lungs participate in adjustment of high pH?
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-pH is high (alkalosis)
-decreased RR -preserve H+ -hypoventilation |
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What is perfusion?
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the distribution of blood. capillary network allows blood to perfuse through lungs to exchange O2 & CO2
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What are the zones of perfusion?
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-zone 1 (upper/apical)
-zone 2 (middle) -zone 3 (base) |
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Where is optimal perfusion achieved?
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base
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Why is optimal perfusion reached in the base?
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alveolis are smaller int he base. this allows for greater capillary expansion & greater blood flow
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What does the V/Q ratio tell us?
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comparison of alveolar air to pulmonary capillary blood flow.
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What is normal V/Q?
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0.8
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Will a low V/Q caused by hypoxemia?
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yes
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What is hypoxic vasoconstriction?
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when blood is diverted to better ventilated areas in the lungs
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What is diffusion?
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O2 has to diffuse across membrane to cross over capillary to get to RBCs
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Describe the movement of O2.
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O2 moves from higher concentration to lower concentration
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Name the 6 barriers O2 must pass in order to reach the RBC.
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-surfactant
-alveolar membrane -interstitial fluid -capillary membrane -plasma -RBC membrane |
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What is Oxyhemoglobin Dissociation and why do we care?
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-relationship between PaO2 and hemoglobin saturation.
-it tells us how much O2 is reaching the tissues |
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Describe the term "shift to the left" in terms of oxyhemoglobin dissociation - what is the affinity for O2?
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-everything is decreased
H+ PaCO2 temperature 2,3-DPG therefore a higer affinity of Hgb for O2. not much O2 will be released to tissues (smokers) |
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Describe the term " shift to the right" in terms of oxyhemoglobin dissociation - what is the affinity for O2?
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-everything is increased
H+ PaCO2 temperature 2,3-DPG therefore lower affinity of Hgb for O2. more O2 gets to tissues |
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In the lungs, which shift occurs?
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right shift
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What are restrictive pulmonary disorders?
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associated with some problem preventing expansion of lungs either in lung tissue or pleura
-pneumonia -ARDS -TB -Pneumothorax -Scoliosis |
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What are obstructive pulmonary disorders?
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things that block or obstruct airways.
-pulmonary embolism -emphysema -asthma |
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Describe the role of histamine in respiratory alterations:
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-stored in basophils & mast cells
-response to allergen -lead to bronchoconstriction -histamine binds to H1 receptors |
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What happens to Arachidonic Acid when the pulmonary vasculature is inflammed?
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-cell membrane disrupted
-pathway makes it to prostaglandins E2 -vasodilation |
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What happens to PGE2 when the pulmonary vasculature is inflammed?
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-vasodilation
-increase vascular permeability |
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What happens to leukotrienes when the pulmonary vasculature is inflammed?
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-vasoconstriction
-bronchospasm |
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Describe the pathophysiologic mechanism of Asthma:
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-allergen
-cross link IgE -release mediators from mast cells -bronchoconstriction -bronchiohyperactivity |
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What part of the respiratory system do asthma target?
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airways
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What is intrinsic asthma?
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related to cold, exercise, stress, not things in the environment
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What is extrinsic asthma?
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from something in the environment
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What remodels over time with asthma?
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-hypertrophy mucus glands (secrete more mucus)
-hypertrophy of vessels |
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What happens to FEV1 in asthma?
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decreased in obstructive disease
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Describe wheezing as a clinical metric of the level of obstruction
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-wheezing is not a reliable indicator of blockage.
-wheezing means they are moving air. |
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How is TB transmitted?
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airborne droplets
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What is a Ghon Tubercle?
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nodule or swelling containing Mycobacterium tuberculosis
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What walls of TB in the lungs and prevents it from spreading?
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ghon tubercle
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What are the staining characteristics of mycobacterials?
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acid fast bacilli. they have protective waxy coating
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What is a negative pressure room?
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when door is opened to pt room air is sucked into room inside of out. prevent spread of germ (airborne)
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Who is at greater risk for TB?
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-HIV pt (immunocompromised)
-eldery -community living -IV drug users |
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What is the biggest problem with the return of TB?
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pt's not adhering to their medication regimen and developing multi-drug resistance TB
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What are the signs & symptoms of TB?
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-fatigue
-weakness -weight loss -low-grade fever -cough > 2 months -blood tinged sputum |
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How would TB look on a CXR?
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opaque areas usually in apices of lungs
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What is happening in pulmonary edema?
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fluid fills alveoli therefore they cannot fill with air
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What happens to lungs in cardiogenic shock?
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LV failure
-fluid builds in lungs -fluid gets into alveoli |
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What happens to lungs in noncardiogenic shock?
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-damage to capillary endothelium or blockage of lymphatic vessels
-helps fluid drain before getting to alveoli -capillary damage |
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What is Acute Respiratory Distress Syndrome (ARDS)?
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restrictive disorder (pulmonary edema)
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What is Chronic Obstructive Pulmonary Disease (COPD)?
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combination typically of chronic bronchitis and emphysema. irreversible airway obstruction. damage of perfusion
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What is chronic bronchitis?
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obstructive pulmonary disease
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What happens in the pulmonary system with chronic bronchitis?
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--increased sputum
-persistent cough -excessive mucus in bronchial tree -hyperplasia of goblet cells |
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What happens with emphysema?
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enlargement or/and destruction of the alveoli and loss of lung elasticity
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What do the alveoli's look like with emphysema and chronic bronchitis?
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hyperinflated
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What are signs & symptoms of chronic bronchitis?
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-SOE
-DOE -wheezing -productive cough -fatigue -hypoxemia -polycythemia -cyanosis |
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What is the FEVI in chronic bronchitis? (measure of expired air)
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low
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What do the neutrophils do in a emphysema pt?
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-called to scene due to inflammation
-phagocytose the tars -release elastase -elastase either destroys alveoli or elatic tissue in alveoli -decreases elastic recoil |
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What would a CXR look lime in someone with emphysema?
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-barrel chest
-increased AP diameter -hyperinflation of the lungs -flattening of diaphragm |
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What is ABG with emphysema?
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typically oxygen acidosis
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What is the phenotype of those born with a deficiency of alpha-1 anti-trypsin?
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non-smoker or someone younger than 35 yoa
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Who is at risk for pneumonia?
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-immunocompromised
-hospitalized -very young/very old -chronic illness -prolonged bed rest |
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What type of disorder is pneumonia? Why
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restrictive pulmonary disorder
the alveoli fill up with inflammatory exudate/edema. the lung becomes more non-compliant |
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What will you note on lung sounds of a pt with pneumonia?
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decreased breath sounds
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Why are lung sounds decreased in pneumonia?
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the filling with inflammatory products (fluid/pus)
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What are signs & symptoms of pneumonia?
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-decreased breath sounds
-dullness to percussion -increased tactile fremitus -V/Q mismatch -tachypnea -increased EBC -HA -chest pain -fatigue |
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What would a CBC show with pneumonia?
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leukocytosis
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What would be basic clinical indicators of pneumonia?
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-low O2 levels
-sputum culture -ABG status (hypoxia) -CXR (consolidation) |
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What is acute bronchitis?
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inflammation of the tracheobronchial tree
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What is the pathophysiology of acute bronchitis?
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-infected mucus membrane (virus/bacteria)
-inflammation (capillary dilation) -swelling from exudation of fluid -infiltration of inflammatory cells -increase mucus production -loss of ciliary function |
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What is pulmonary embolism (PE)?
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occlusion of one or more pulmonary vessels (blood clot)
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What is Virchow's Triad?
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3 conditions highly associated with a PE
-venous stasis (not walking) -injury to venous wall -hypercoaguability of blood |
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What are the types of emboli?
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-thrombotic
-fat -amniotic -air -tumor -foreign material -septic -parasitic |
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What is the pathophysiology of a PE?
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-mechanical obstruction
-pulmonary vasoconstriction -increased pulmonary arterial pressure -right HF -hypotension/low CO |
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What are the signs & symptoms of a PE?
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-mild dyspnea
-respiratory failure |
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What are the signs & symptoms of DVT (deep venous thrombi)??
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-red
-warm -swollen leg -positive homan test (dorsiflex foot, very painful) |
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What is pneumothorax?
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the pleural space is more negative in pressure than atmospheric pressure (lung collapse)
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How do we treat a pneumothorax?
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Chest tube to re-establish negative pressure and re-inflate lung.
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Why is kyphosis and scoliosis restrictive pulmonary disorders?
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the displacement leads to lung compression and a small lung volume. (hypoventilation)
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What type of disorder is cystic fibrosis?
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autosomal recessive disorder/obstructive pulmonary disorder
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What is the pathophysiology of cystic fibrosis?
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-disorder in Na+ and Cl- channels
-causes thick secretions -secretions obstruct airways |
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What does the acinus consist of?
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-bronchiles
-alveolar ducts -alveoli |
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What is carina?
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cough receptors
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What is the thyroid cartilage often referred to?
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adam's apple
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What is the angle of louis?
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between sternum & manubrium (2 ICS)
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What is the manubrium?
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upper part of the sternum
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What are the pores of kohn?
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collateral alveolar ventilation
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What are the canals of lambert?
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collateral alveolar ventilation
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What is oncotic pressure?
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"pulling" from protein within vessel. pulls fluid back to vessel
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What is capillary hydrostatic pressure?
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fluid moves from capillary to interstitium
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What is tidal volume?
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lung volume representing the normal volume of air displaced between normal inspiration and expiration when extra effort is not applied.
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What is FEV1?
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Calculated ratio used in the diagnosis of obstructive and restrictive lung disease. It is the measure of expired air
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What is V/Q ratio?
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Matching of alveolar air (Ventilation) to pulmonary capillary blood flow (perfusion).
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What is barometric pressure?
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Force that is exerted on objects by the weight of the atmosphere above them.
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What is hypoxia?
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region of body deprived of O2
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What is hypoxemia?
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decreased partial pressure of O2 in blood
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What is mycolic acid?
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outer coat which is waxy that protects mycobacterium (TB) from disinfectants and allows them to survive for long periods in the environment
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What is consolidation?
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a filling up of a lobe or part of a lobe with inflammatory products (fluid/pus)
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What is cor pulmonale?
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right HF
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What is barrel chest?
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increase in the AP diameter of the chest wall resembling the shape of a barrel.
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What is alpha-1 antitrypsin deficiency?
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Inherited enzymatic disorder in which this enzyme cannot be produced.
Lung tissue is degraded, destroying elastic recoil in the alveoli. |
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What is egophony?
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increased resonance of voice sounds heard when auscultating the lungs
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What is viral shedding?
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successful reproduction, expulsion, and host-cell infection caused by virus progeny.
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What is DVT?
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deep vein thrombosis. Formation of a blood clot in a deep vein inside a part of the body, usually the legs
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What is a IVC filter?
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inferior vena cava filter. Medical device implanted to prevent fatal PEs.
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What does a V/Q scan measure?
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ventilation/perfusion ratio. Perfusion is normally higher than ventilation. A normal V/Q is 0.8.
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What does a D-Dimer test tell us?
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Confirms that the patient has had a fibrin clot that has broken down (FDPs).
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What is a CXR
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chest x-ray
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What is a PPD?
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Purified Protein Derivative Skin Test
intradurmal injection of PPD of tubercle bacillus. Reaction of >5 mm in duration positive only if person has HIV or was exposed to TB. >10 mm positive if IV drug user or healthcare user. If someone known positive for TB we won't do arm test because Type IV hypersensitivity is so severe they could lose function in their arm. |
