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170 Cards in this Set
- Front
- Back
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the mechanical movement of gas or air into and out of the lungs
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ventilation
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circulation of blood through the tissues
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perfusion
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the tendency of molecules of a substance to move from high concentration to lower concentration
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diffusion
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What is the normal pH of arterial blood?
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7.35 - 7.45
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What is the normal pCO2 of arterial blood?
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35 - 45 mm Hg
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What is the normal pO2 of arterial blood?
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80 - 100 mm Hg
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What is the normal HCO3 level of arterial blood?
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22 - 26 mEq/L
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What is the normal O2 sat of arterial blood?
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96 - 98%
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inadequate gas exchange (hypoxemia) where PaO2 is less than or equal to 50 mm Hg or where PaCO2 is greater than or equal to 50 mm Hg with a pH of less than or equal to 7.25
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acute respiratory failure
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What causes acute respiratory failure?
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direct injury or indirect injury to the lungs, airways or chest wall
most pulmonary diseases can cause acute respiratory failure occurs frequently in patients who are mechanically ventilated in the ICU |
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How is acute respiratory failure treated?
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immunomodulators
antibiotics |
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excess water in the lung
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pulmonary edema
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What are some predisposing factors for pulmonary edema?
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heart disease
acute respiratory distress syndrome (ARDS) inhalation of toxic gases Can also result from obstruction of the lymphatic system by CHF, edema, or tumors |
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What are some clinical manifestations of pulmonary edema?
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dyspnea
hypoxemia crackles on inspiration frothy sputum increased PaCo2 |
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How is pulmonary edema treated?
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first, get rid of the fluid
then, treat the cause |
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the passage of fluid and solid particles (foreign substances) into the lung
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aspiration
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What are some predisposing factors for aspiration?
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altered level of consciousness
seizure disorders cerebrovascular accident myasthenia gravis Guillain-Barre syndrome (inflammation of nerves) |
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What are the clinical manifestations of aspiration?
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choking
cough vomiting dyspnea wheezing |
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How is aspiration treated?
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antibiotics (it can quickly turn into pneumonia)
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collapse of lung tissue
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atelectasis
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What are the 2 types of atelectasis?
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compression (caused by external pressure from tumor, fluid, or air or by abdominal distension pressing on a portion of lung)
absorption (results from removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated oxygen or anesthetic agents) |
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What are the clinical manifestations of atelectasis?
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dyspnea
cough fever leukocytosis |
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When does atelectasis tend to occur?
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after surgery
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How can atelectasis be prevented?
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deep breathing exercises
turning patients who are bed bound |
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persistent abnormal dilation of the bronchi from another disease process
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bronchiectasis
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What can cause bronchiectasis?
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obstruction of the airway
atelectasis infection cystic fibrosis TB weakness of the bronchial wall |
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What is bronchiectasis often associated with?
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bronchitis (inflammation of the bronchi)
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What are the clinical manifestations of bronchiectasis?
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large volume of sputum
recurrent infections decreased vital capacity |
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an inflammatory obstruction of the small airways or bronchioles, occurring most commonly in children
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bronchiolitis
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What causes bronchiolitis?
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chronic bronchitis
infection inhalation of toxic gases **usually preceded by an upper respiratory infection |
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What are the clinical manifestations of bronchiolitis?
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rapid ventilatory rate
marked use of accessory muscles low-grade fever dry/nonproductive cough hyperinflated chest |
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How is bronchiolitis treated?
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antibiotics
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the presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which surrounds the lungs) or the parietal pleura and chest wall
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pneumothorax
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What are the 3 types of pneumothorax?
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open
tension spontaneous |
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How does open pneumothorax occur?
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from a pentrating wound through the chest to the pleural space
(air drawn in to the pleural space through inspiration is forced back out during expiration) |
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How does tension pneumothorax occur?
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the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration
Compresses and displaces the heart and great vessels |
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What are the clinical manifestations of tension pneumothorax?
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severe hypoxemia
dyspnea decreased blood pressure decreased heart rate |
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How is any kind of pneumothorax treated?
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immediate and life-saving needle decompression or chest tube placement
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How does spontaneous pneumothorax occur?
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unexpectedly in healthly individuals (usually men age 20-40)
caused by the spontaneous rupture of blebs (blister-like formations) on the visceral pleura |
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What are the clinical manifestations of spontaneous pneumothorax?
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sudden pleural pain
increased respiratory rate dyspnea decreased breath sounds |
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the presence of fluid in the pleural space
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pleural effusion
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the presence of pus in the pleural space
infection of the pleural space |
empyema
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How does empyema develop?
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Pulmonary lymphatics become blocked, leading to an outpouring of contaminated lymphatic fluid into the pleural space
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What are the clinical manifestations of empyema?
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those of toxicity:
cyanosis fever tachycardia cough pleural pain |
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How is empyema treated?
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antibiotics
thoracentesis |
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inflammation of the pleura
preceded by an upper respiratory infection |
pleurisy
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What are the signs/symptoms of pleurisy?
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fever
chills pain on inspiration *Often, a pleural friction rub can be heard over the affected area |
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How is pleurisy treated?
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antibiotics
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a circumscribed area of pus and destruction of lung tissue
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abscess
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What is the most common cause of abscess?
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aspiration pneumonia
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What are the clinical manifestations of abscess?
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fever
cough chills sputum production pleural pain |
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How is abscess treated?
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antibiotics
chest physiotherapy bronchoscopy |
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an excessive amount of fibrous or connective tissue in the lung
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pulmonary fibrosis
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What leads to pulmonary fibrosis?
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healing after another disease
inflation of harmful substances |
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How is pulmonary fibrosis treated?
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treatment is difficult
prevention is key! |
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results from the fracture of several consecutive ribs in more than one place or the fracture of the sternum plus several consecutive ribs
these multiple fractures result in instability of a portion of the chest wall, causing paradoxic movement of the chest with breathing |
flail chest
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What are the clinical manifestations of flail chest?
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pain
dyspnea unequal chest expansion hypoventilation hypoxemia |
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How is flail chest treated?
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mechanical ventilation until healing can occur
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severe inflammation of the airways, alveolar and capillary damage, and pulmonary edema
initial symptoms include burning of the eyes, nose, and throat, coughing, chest tightness, and dyspnea |
toxic gas exposure
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any change in the lung caused by inhalation of inorganic dust particles, usually in the workplace
most commonly caused by silica, asbestos, and coal clinical manifestations include cough, chronic bronchitis, dyspnea, decreased lung volumes, and hypoxemia |
pneumoconiosis
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an allergic inflammatory response caused by grains, silage, bird droppings/feathers, wood dust, etc
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allergic alveolitis
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form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury with noncardiogenic pulmonary edema
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acute respiratory distress syndrome (ARDS)
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What causes ARDS?
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injury to the lung from various diseases/conditions
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What are the clinical manifestations of ARDS?
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rapid/shallow breathing
dyspnea decreased lung compliance hypoxemia unresponsive to oxygen therapy diffuse alveolar infiltrates decreased blood pressure death |
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How is ARDS treated?
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mechanical ventilation
prophylactic immunotherapy antibiotics *Prevention is key in patients with aspiration or pneumonia |
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a chronic inflammatory disorder of the airways in which many cells and cellular elements (mast cells, eosinophils, T cells, macrophages, neutrophils, etc.) play a role; can be allergic in nature or exercise induced
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asthma
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What are the clinical manifestations of asthma?
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asymptomatic during remission periods
during attacks: dyspnea wheezing nonproductive cough prolonged expiration tachycardia tachypnea |
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What is the life-threatening form of asthma called?
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status asthmaticus
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How is asthma treated?
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Avoidance of allergens
Use inhalers prior to exercise Inhalers and Beta 2 agonists Immunotherapy |
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pathologic lung changes consistent with emphysema or chronic bronchitis and is a syndrome characterized by abnormal tests of expiratory airflow that do not change markedly over time, nor exhibit major reversibility in response to pharmacologic agents; a disease state characterized by airflow limitation that is not fully reversible—the airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases
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chronic obstructive pulmonary disease (COPD)
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What is the primary cause of COPD?
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cigarette smoke
(other risks include occupational exposures and air pollution) |
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How is COPD treated?
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the same as asthma management:
Avoid allergens Inhalers and Beta 2 agonists Immunotherapy |
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an abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar walls; obstruction results from changes in lung tissue; air can get in but cannot get out; the major mechanism of air flow limitation is loss of elastic recoil
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emphysema
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What causes emphysema?
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can be genetic (rare) but mainly caused by cigarette smoking
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What are the clinical manifestations of emphysema?
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marked dyspnea
no cough early but later tachypnea with prolonged expiration accessory muscles used for ventilation barrel chest normal or elevated hematocrit late cor pulmonale |
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How is emphysema treated?
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smoking cessation
bronchodilating drugs nutrition breathing retraining relaxation exercises antibiotics for acute infections |
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form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury with noncardiogenic pulmonary edema
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acute respiratory distress syndrome (ARDS)
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What causes ARDS?
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injury to the lung from various diseases/conditions
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What are the clinical manifestations of ARDS?
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rapid/shallow breathing
dyspnea decreased lung compliance hypoxemia unresponsive to oxygen therapy diffuse alveolar infiltrates decreased blood pressure death |
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How is ARDS treated?
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mechanical ventilation
prophylactic immunotherapy antibiotics *Prevention is key in patients with aspiration or pneumonia |
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a chronic inflammatory disorder of the airways in which many cells and cellular elements (mast cells, eosinophils, T cells, macrophages, neutrophils, etc.) play a role; can be allergic in nature or exercise induced
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asthma
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What are the clinical manifestations of asthma?
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asymptomatic during remission periods
during attacks: dyspnea wheezing nonproductive cough prolonged expiration tachycardia tachypnea |
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What is the life-threatening form of asthma called?
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status asthmaticus
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How is asthma treated?
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Avoidance of allergens
Use inhalers prior to exercise Inhalers and Beta 2 agonists Immunotherapy |
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pathologic lung changes consistent with emphysema or chronic bronchitis and is a syndrome characterized by abnormal tests of expiratory airflow that do not change markedly over time, nor exhibit major reversibility in response to pharmacologic agents; a disease state characterized by airflow limitation that is not fully reversible—the airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases
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chronic obstructive pulmonary disease (COPD)
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What is the primary cause of COPD?
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cigarette smoke
(other risks include occupational exposures and air pollution) |
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How is COPD treated?
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the same as asthma management:
Avoid allergens Inhalers and Beta 2 agonists Immunotherapy |
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an abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar walls; obstruction results from changes in lung tissue; air can get in but cannot get out; the major mechanism of air flow limitation is loss of elastic recoil
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emphysema
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What causes emphysema?
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can be genetic (rare) but mainly caused by cigarette smoking
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What are the clinical manifestations of emphysema?
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marked dyspnea
no cough early but later tachypnea with prolonged expiration accessory muscles used for ventilation barrel chest normal or elevated hematocrit late cor pulmonale |
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How is emphysema treated?
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smoking cessation
bronchodilating drugs nutrition breathing retraining relaxation exercises antibiotics for acute infections |
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hypersecretion of mucus and chronic productive cough for at least 3 months of the year for at least 2 consecutive years; incidence is increased in people who smoke and even more so in workers exposed to air pollution; major health problem for elderly people
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chronic bronchitis
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What are the clinical manifestations for chronic bronchitis?
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exercise intolerance
late dyspnea wheezing productive cough marked hypoxemia leading to polycythemia and cyanosis early cor pulmonale CHF |
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How is chronic bronchitis treated?
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The best treatment is prevention b/c pathologic changes are not reversible.
Bronchodilators, expectorants, and chest physical therapy may be used. |
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acute infection of the lower respiratory tract caused by bacteria, fungi, protozoa, or parasites. It is the 6th leading cause of death in the U.S. Risk factors include advanced age, lung disease, alcoholism, smoking, malnutrition, and immobilization. It can be community acquired or hospital acquired.
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pneumonia/acute bronchitis
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What are the clinical manifestations of pneumonia/acute bronchitis?
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fever
chills cough malaise pleural pain sometimes dyspnea and hemoptysis increased WBC counts |
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How is pneumonia/acute bronchitis treated?
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Identify the pathogen.
Treat with antibiotics. |
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infection caused by Mycobacterium tuberculosis
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tuberculosis (TB)
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How is TB transmitted?
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person to person in airborne droplets
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What are the clinical manifestations of TB?
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In many individuals, it is asymptomatic.
In others, symptoms appear gradually—fatigue, weight loss, lethargy, anorexia, night sweats, low-grade fever. Dyspnea, chest pain, and hemoptysis may occur as the disease progresses. |
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How is TB treated?
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antibiotic therapy for 6 to 12 months
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an occlusion of a portion of the pulmonary vascular bed by an embolus (blood, fat, or air)
the most common emboli are thrombi dislodged from the deep veins in the thigh |
pulmonary embolism
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What are the risk factors for developing a pulmonary embolism?
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disease/disorders that promote blood clotting as a result of venous stasis
hypercoaguability injury to the endothelial cells lining the vessel walls |
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What are the clinical manifestations of pulmonary embolism?
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Pulmonary embolism without infarction usually causes tachypnea, tachycardia, dyspnea, and unexplained anxiety.
Emboli that cause infarction usually present with pleural pain, dyspnea, pleural friction rub, pleural effusion, hemoptysis, fever, and leukocytosis. Massive occlusion causes profound shock, hypotension, and death. |
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Diagnosis of pulmonary embolism is made using elevated levels of _______ in the blood.
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D-dimer
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How is a pulmonary embolism treated?
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Ideal treatment is prevention through risk factor analysis and elimination of predisposing factors (leg elevation, bed exercises, position changes, calf compressions).
Anticoagulant therapy is the primary treatment for pulmonary embolism. |
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high blood pressure in the pulmonary arteries
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pulmonary hypertension
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What causes secondary pulmonary hypertension?
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any respiratory or cardiovascular disorder that increases the volume/pressure of blood entering the pulmonary arteries or that narrows/obstructs the pulmonary arteries
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What are the clinical manifestations of pulmonary hypertension?
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: Symptoms are often masked by primary pulmonary or cardiovascular disease.
First indication may be an abnormality seen on a chest x-ray or EKG that show right ventricular hypertrophy. Manifestations include fatigue, chest discomfort, tachypnea, dyspnea with exercise, and tricuspid murmur. |
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How is pulmonary hypertension diagnosed?
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right heart catheterization
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What is the only cure for pulmonary hypertension?
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heart or lung transplant
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What is the palliative treatment for pulmonary hypertension?
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vasodilators
anticoagulants diuretics digitalis (increases heart's contractility and decreases heart rate) |
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also called pulmonary heart disease
consists of right ventricular enlargement or dilation (or both) caused by primary or secondary pulmonary hypertension hypertension creates pressure on the RV resulting in RV failure clinical manifestations and treatment are the same as for pulmonary hypertension |
cor pulmonale
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long-term exposure to sun, wind, or cold predisposes you to this type of cancer
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lip cancer
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What is the most common type of lip cancer?
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exophytic (lower lip)
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Lip cancer is often preceded by a __________ that evolves into a ________________.
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blister
superficial ulceration |
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What is the treatment for lip cancer?
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Mohs micrographic surgery
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If treated, the prognosis for lip cancer is ___________.
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excellent
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the risk of this type of cancer is increased by the amount of tobacco smoked and further heightened with the combination of smoking and alcohol consumption
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laryngeal cancer
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What are the clinical manifestations of laryngeal cancer?
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progressive hoarseness
dyspnea cough |
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How is laryngeal cancer treated?
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radiation therapy
endoscopic laser total laryngectomy |
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What is the most common cause of lung cancer?
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cigarette smoking
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The CM of this type of lung cancer are:
nonproductive cough sputum production airway obstruction |
squamous cell carcinoma (non-small cell)
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The CM of this type of lung cancer is:
pleural effusion |
adenocarcinoma (non-small cell)
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The CM of this type of lung cancer are:
chest wall pain pleural effusion cough sputum production hemoptysis airway obstruction caused by pneumonia |
large-cell carcinoma
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The CM of this type of lung cancer are:
airway obstruction caused by pneumonitis S/S of excessive hormone production |
small cell carcinoma
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The CM of this type of lung cancer are:
dyspnea pleuritic pain recurrent pleural effusions |
mesothelioma
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the mechanical movement of gas or air into and out of the lungs
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ventilation
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part of the brain stem that controls respiration by transmitting impulses to the respiratory muscles, causing them to contract and relax; is composed of several groups of neurons; the basic automatic rhythm of respiration is set by the dorsal respiratory group
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respiratory center
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the tendency for liquid molecules that are exposed to air to adhere to one another; occurs at any gas-liquid interface
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surface tension
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the tendency of the lungs to return to the resting state after inspiration; permits passive expiration, eliminating the need for major muscles of expiration
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elastic recoil
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the measure of lung and chest wall distensibility and is defined as volume change per unit of pressure change; represents the relative ease with which these structures can be stretched and is, therefore, the opposite of elasticity
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compliance
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similar to resistance to blood flow; is determined by the length, radius, and cross-sectional area of the airways and the density, viscosity, and velocity of the gas
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airway resistance
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the delivery of oxygen to the cells of the body and the removal of carbon dioxide from the cells of the body; has 4 steps: (1) ventilation of the lungs, (2) diffusion of oxygen from the alveoli into the capillary blood, (3) perfusion of systemic capillaries with oxygenated blood, (4) diffusion of oxygen from systemic capillaries into the cells; steps in the transport of carbon dioxide occur in reverse order
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gas transport
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the circulation of blood through the tissues
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perfusion
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type of lung receptor found in the epithelium of all conducting airways; sensitive to noxious vapors, gases, and particulate matter, which cause it to initiate the cough reflex; also causes bronchoconstriction and increased ventilatory rate when stimulated
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irritant receptor
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type of lung receptor located in the smooth muscles of airways; is sensitive to increases in the size or volume of the lungs; decreases ventilatory rate and volume when stimulated; active in adults only at high tidal volumes (such as with exercise) and may protect against excess lung inflation
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stretch receptor
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type of lung receptor located near the capillaries in the alveolar septa; sensitive to increased pulmonary capillary pressure, which stimulates it to initiate rapid, shallow breathing
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J-receptor (juxtapulmonary capillary receptor)
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monitors the pH, PaCO2, and PaO2 of arterial blood
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chemoreceptor
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located near the respiratory center and are sensitive to H+ ion concentration in the CSF—a decrease in pH will stimulate them to increase the depth and rate of ventilation to move CO2 out
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central chemoreceptors
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sensitive primarily to oxygen levels in arterial blood (PaO2); as PaO2 and pH decrease, they send signals to the respiratory center to increase ventilation; PaO2 must drop well below normal (to around 60 mm Hg) before they will have much influence on ventilation
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peripheral chemoreceptors
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the subjective sensation of uncomfortable breathing; the feeling of being unable to get enough air; can be caused by disturbances of ventilation or gas exchange or by increased work of breathing or by diseases that severely damage lung tissue
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dyspnea
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dyspnea when the individual is lying down; can be caused by pulmonary congestion—the horizontal position redistributes body water, causes the abdominal contents to exert pressure on the diaphragm, or decreases the efficiency of the respiratory muscles; generally is relieved by sitting up in a forward-leaning position or supporting the upper body on several pillows
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orthopnea
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seen in individuals with left ventricular failure who wake up at night gasping for air and have to sit up or stand to relieve the dyspnea; results from the redistribution of body water into the lungs while the individual is recumbent
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paroxysmal nocturnal dyspnea
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slow ventilatory rate
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bradypnea
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rapid ventilatory rate
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tachypnea
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induced by strenuous exercise or metabolic acidosis; characterized by a slightly increased ventilatory rate, effortless tidal volumes, and no expiratory pause
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Kussmaul respirations (hyperpnea)
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characterized by alternating periods of deep and shallow breathing; apnea (cessation of breathing lasting from 15 to 60 seconds) is followed by increased ventilation, after which ventilation decreases again to apnea; these respirations occur in any condition that slows the blood flow to the brain stem or slows impulses to the respiratory centers of the brain stem
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Cheyne-Stoke respirations
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inhaling a slow normal breath through the nose, keeping the mouth closed; then, breathing out slowly and gently through your lips
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pursed lip breathing
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occurs if the airways are obstructed, as in chronic obstructive pulmonary disease; a slow ventilatory rate, large tidal volume, increased effort, and prolonged inspiration or expiration, depending on the site of obstruction, are typical; audible wheezing or stridor (high-pitched sounds made during inspiration) is often present
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labored (obstructed) breathing
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commonly caused by disorders such as pulmonary fibrosis that stiffen the lungs or chest wall and decrease compliance; small tidal volumes and tachypnea are characteristic
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restricted breathing
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occurs with exercise; shock and severe cerebral hypoxia contribute to gasping respirations that consist of irregular, quick inspirations with an expiratory pause
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panting
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inadequate alveolar ventilation in relation to metabolic demands caused by alterations in pulmonary mechanics or in the neurologic control of breathing
CO2 removal does not keep up with production and CO2 rises in the blood, causing hypercapnia this results in respiratory acidosis that can affect the function of many tissues throughout the body; |
hypoventilation
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alveolar ventilation that exceeds metabolic demands; the lungs remove CO2 faster than it is produced by cellular metabolism, resulting in hypocapnia; can be determined only by arterial blood gas analysis; occurs with severe anxiety, acute head injury, and conditions that cause insufficient oxygenation of the blood
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hyperventilation
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level of CO2 in the blood (less than 33 mm Hg)
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hypocapnia
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high level of CO2 in the blood (more than 44 mm Hg)
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hypercapnia
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a protective reflex that cleanses the lower airways by an explosive expiration that removes inhaled particles, accumulated mucus, or foreign bodies
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cough
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the coughing up or blood or bloody secretions; blood that is coughed up is usually bright red, has an alkaline pH, and is mixed with frothy sputum; indicates a localized abnormality, usually infection or inflammation that damages the bronchi or the lung parenchyma; other causes include cancer and pulmonary infarction; the amount and duration of bleeding provide important clues about its source
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hemoptysis
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– bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin (which is bluish) in the blood; can be caused by decreased arterial oxygenation (low PaO2), decreased cardiac output, cold environment, or anxiety
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cyanosis
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the selective bulbous enlargement of the end of a finger or toe; usually it is painless; commonly associated with diseases that interfere with oxygenation
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clubbing
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reduced oxygenation of arterial blood (reduced PaO2) caused by 5 different respiratory alterations: (1) decreased oxygen content (PO2) of inspired gas, (2) hypoventilation, (3) diffusion abnormalities, (4) abnormal ventilation-perfusion ratios, or (5) pulmonary right-to-left shunt
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hypoxemia
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reduced oxygenation of cells in tissues; may be caused by alterations of other systems besides the respiratory system, such as low cardiac output or cyanide poisoning
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hypoxia
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pulmonary test that looks at tidal volume and forced expiratory volume
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incentive spirometry
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nuclear medicine test that looks at oxygen diffusion in the lungs
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diffusing capacity
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assesses the functional status of the lungs as it relates to:
1. How much air volume can be moved in and out of the lungs 2. How fast the air in the lungs can be moved in and out 3. How stiff are the lungs and chest wall (compliance) Includes spirometry, diffusing capacity, and ABG's |
pulmonary function testing
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What does pulmonary function testing screen for?
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obstructive and restrictive pulmonary diseases
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radiological test used to evaluate the lungs
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chest x-ray
CT MRI |
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pulmonary test that looks for cancer
can take biopsies/washings, abnormalities, abcesses |
bronchoscopy
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treatment that involves pushing air through the airway passage at a high pressure
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CPAP (continuous positive airway pressure therapy)
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Who frequently receives CPAP therapy?
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sleep apnea patients
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