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198 Cards in this Set
- Front
- Back
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Surfactant
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Lipoprotein that lowers surface tension in the alveoli
Decreases the tendency of the alveoli to collapse |
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Atelectasis
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When alveoli collapse and are airless
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Ventilation
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Involves inspiration and expiration
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Inspiration
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Movement of air into the lungs through contraction of the diaphragm
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Expiration
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Movement of air out of the lungs passively
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How does gas flow?
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From an area of higher concentration to an area of lower concentration
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Compliance (Distensibility)
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A measure of the ease of expansion of the lungs
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Elastic Recoil
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The tendency for the lungs to recoil or reduce in volume after being stretched or expanded
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Conditions that increase fluid in the lungs
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Pulmonary edema, ARDS, pneumonia
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Conditions that makes lung tissue less elastic or distensible
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Pulmonary fibrosis, sarcoidosis
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Condition that restricts lung movement
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Pleural effusion
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When is compliance increased?
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When there is destruction of alveolar walls and loss of tissue elasticity, as in emphysema
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Empyema
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Purulent pleural fluid with bacterial infection
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Diffusion
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The way oxygen and carbon dioxide move back and forth across the aveolar-capillary membrane
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PaO2
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The amount of oxygen dissolved in plasma
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SaO2
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The amount of oxygen bound to hemoglobin in comparison with the amount of oxygen the hemoglobin can carry
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Oxygen-Hemoglobin Dissociation Curve
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Describes the affinity of hemoglobin for oxygen
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Oxygen delivery to tissues depends on what?
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The amount of oxygen that can be picked up in the lungs and the ease at which the hemoglobin gives up oxygen once it reaches the tissues
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What two methods are used to assess the effiency of gas transfer in the lung
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Arterial Blood Gas (ABGs) and oximetry
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Arterial Blood Gas
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Measured to determine oxygenation and acid-base balance
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ABG analysis includes what?
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Measurement of PaO2, PaCO2, acidity, and HCO3
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How are ABGs obtained?
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Invasively: arterial catheter in the radial or femoral artery or arterial puncture
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Mixed Venous Blood Gases
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Consist of venous blood that has returned to the heart from all tissue beds and "mixed" in the right ventricle
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How are Mixed Venous obtained?
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Pulmonary artery Catheter
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Oximetry
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Measures arterial oxygen saturation
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How does oximetry work?
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It emits red and infrared lights. Well oxgenated blood absorbs more light
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At what value is oximetry less accurate?
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Less than 70%
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Partial Pressure
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Pressure exerted independently by a gas in a mixture of gasses. A measure of how much of that gas is present in the blood
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Lung Volumes
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Inspiratory Reserve Volume (IRV) = 3 L
Tidal volume (TV) = 0.5 L (volume of quiet breathing) Expiratory Reserve Volume (ERV) = 1 L Residual Volume (RV) = 1.2 L (volume remaining in lungs after maximal expiration) TOTAL LUNG CAPACITY (TLC) = 4L (female) to 5.7 L (male) |
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Control of respiration
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Respiratory center in brainstem medulla responds to a change in chemical and mechanical signals from the body. Impulses are sent down spinal cord and phrenic nerve to respiratory muscles
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Chemoreceptors
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Receptors that responds to a change in the chemical composition of the fluid around it
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Central chemoreceptors
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Located in the medulla and responds to a change in hydrogen ion concentration
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Peripheral chemoreceptors
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Located in the carotid bodies and the aortic bodies and respond to the decrease in PaO2 and pH and to increases in PaCO2
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Mechanical Receptors
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Stimulated by irritants, muscle stretching, and aveolar wall distortion.
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Mechanical Receptors are located where?
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Lungs
Upper airway Chest wall Diaphragm |
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Stretch receptors
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Aid in the control of respiration
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HeringBreuer reflex
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Stretch receptors activate the inspiratory center to inhibit further lung expansion as the lungs inflate preventing overdistention
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Juxtacapillary receptors
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Causes the rapid respiration (tachypnea) seen in pulmonary edema. Stimulated by fluid entering the pulmonary interstitial space
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Cardinal S & S of Pulmonary Disease
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Cough
Sputum Hemoptysis Dyspnea (SOB, DOE) Chest pain Clubbing Cyanosis |
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Eupnea
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normal, unlaboured ventilation, sometimes known as quiet breathing or resting respiration
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Bradypnea
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slow respiration
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Tachypnea
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fast respiration
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Hyperventilation
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the state of breathing faster and/or deeper than necessary, bringing about lightheadedness and other undesirable symptoms often associated with panic attacks. Hyperventilation can also be a response to metabolic acidosis
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Cheyne-stokes
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Alternating periods of apnea and deep, rapid breathing. Usually seen as a person nears death
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Kussmaul
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Deep, rapid breathing
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Biot's Respiration
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Abrupt and irregularly alternating periods of apnea with periods of breathing that are consistent in rate and depth, often the result of increased intracranial pressure
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Ataxic
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an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea
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Acidity
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Increase in hydrogen ions
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Alkalinity
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Decrease in hydrogen ions
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Normal pH
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7.35-7.45
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Acid
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CO2; Donor of hydrogen ion
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Acidemia
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An arterial blood pH of less than 7.35
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Alkalemia
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An arterial blood pH of more than 7.45
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Alkalosis
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Process that adds base or eliminates acid from body fluids
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Acidosis
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Process that adds acid or eliminates base from body fluids
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Anion Gap
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Reflection of normally unmeasured anions in the plasma; helpful in differential diagnosis of acidosis
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Base
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HCO3; Acceptor of hydrogen ions
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Buffer
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Substance that reacts to an acid or base to prevent a large change in pH
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pH
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Negative logarithm of the hydrogen ion concentration
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Buffer system
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Fastest acting system in the body. Turns strong acid into weak one or bind acids to neutralize their effect
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Buffers in the body
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Carbonic Acid-Bicarbonate, Monohydrogen-dihydrogen phosphate, intracellular/plasma protein and hemoglobin buffers
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Acid-base regulation: Respiratory system
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The lungs help maintain a normal pH by excreting CO2 and water
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Acid-base regulation: Renal system
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Secretes H+, combines H+ with ammonia, excretes weak acid and hold onto HCO3
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Three types of Acid-base regulation
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Buffer system
Respiratory system Renal system |
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Respiratory Acidosis
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CO2 excess
Hypoventilation pH < 7.35, CO2>45 |
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Respiratory Alkalosis
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CO2 deficit
Hyperventilation pH >7.45, CO2 <35 |
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Metabolic Acidosis
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HCO3 deficit
DKA, diarrhea, renal disease pH <7.35, HCO3 <22 Kussmauls Resps. |
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Metabolic Alkalosis
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HCO3 excess
Vomiting, suctioning pH >7.45, HCO3 >26 |
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Causes of Respiratory Acidosis
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COPD
Barbiturate or Sedative Overdose Chest wall abnormality Severe PNA Atelectasis Resp. Muscle Weakness Mechanical hypovent |
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Causes of Metabolic Acidosis
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DKA
Lactic Acidosis Starvation Severe diarrhea Renal tubular acidosis Renal failure GI fistula Shock |
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Causes of Respiratory Alkalosis
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Hyperventilation
Stimulated Respiratory Center Mechanical Hyperventilation |
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Causes of Metabolic Alkalosis
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Severe vomiting
Excess GI suction Diuretics K+ deficit Excess NaHCO3 intake Excessive mineralocorticoids |
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Neuro Manifestations of Respiratory Alkalosis
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Lethargy
Light-headedness Confusion |
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CV Manifestations of Respiratory Alkalosis
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Tachycardia
Dysrhythmias |
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GI Manifestations of Respiratory Alkalosis
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N/V
Epigastric pain |
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Neuromuscular Manifestations of Respiratory Alkalosis
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Tetany
Numbness Tingling of the extremities Hyperreflexia Seizures |
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Respiratory Manifestations of Respiratory Alkalosis
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Hyperventilation
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How does alkalosis effect calcium in the body
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It increases calcium binding to protein, leading to decreased ionized calcium
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PaCO2:
Respiratory Alkalosis OR Compensated Metabolic Acidosis |
Less than 35
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PaCO2:
Normal or Compensated |
35-45
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PaCO2:
Respiratory Acidosis OR Compensated Metabolic |
Greater than or equal to 45
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HCO3:
Metabolic Acidosis |
Less than 22
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HCO3:
Normal or Compensated |
22-26
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HCO3:
Metabolic Alkalosis |
Greater than 26
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Hypercapnia
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From the Greek
“hyper” above “kapnos” smoke A condition where there is too much carbon dioxide (CO2) in the blood |
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Causes of Hypercapnia
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Hypoventilation
Lung disease Diminished consciousness Exposure |
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Early manifestations of Hypercapnia
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Flushing, full pulse, muscle twitching, hand flapping, increased BP
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Late manifestations of Hypercapnia
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Panic, hyperventilation, convulsions, unconsciousness, death
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Hypoxia
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Body as a whole or an area of the body is deprived of oxygen supply
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Hypoxemia
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Insufficient oxygenation of arterial blood
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Acute Respiratory Failure
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Not a disease; condition that occurs as a result of one or more diseases involving the lungs or other body systems
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Types of Respiratory Failure
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Hypoxemic
Hypercapnic |
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Hypoxemic Failure is refered to as what?
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“Oxygenation failure”
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Why is Hypoxemic Failure is refered to as “Oxygenation failure”?
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Because the primary problem is Inadequate 02 transfer in alveoli
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Hypoxemic Failure is defined as what?
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Pa02 of 60 mmHg or less when pt is receiving an inspired 02 of 60% or greater
60% is 3x that of room air |
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Two important concepts of Hypoxemic failure
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Pa02 level indicates 02 depleted hemoglobin
Pa02 level exists despite supplemental 02 |
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Hypercapnic Failure is refered to as what?
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“Ventilory failure”
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Why is Hypercapnic Failure is refered to as “Ventilory failure”?
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Because the primary problem is Insufficient CO2 removal
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Hypercapnic Failure is defined as what?
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PaC02 above normal (>45mmHg) with acidemia (pH<7.35)
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Three important concepts of Hypercapnic failure
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PaCO2 higher then normal
body unable to compensate for acidemia pH at level where further increase could lead to severe acid-base imbalance |
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Pathophysiology of Hypoxemic Failure
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(1) mismatch between ventilation (V) and perfusion (Q)
(2) shunt (3) diffusion limitation (4) hypoventilation |
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Pleurisy (pleuritis)
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An inflammation of the pleura
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Causes of Pleurisy
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Pneumonia
TB Chest Trauma Pulmonary infarction Neoplasms |
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Signs of Pleurisy
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Abrupt & sharp pain aggravated by inspiration
Shallow, rapid breathing Pleural friction rub |
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Pneumonia
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Acute inflammation of lung parenchyma caused by microbial agent
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Leading cause of death from infectious disease in the US?
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Pneumonia
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Pneumonia results when what?
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Defense mechanisms become incompetent or are overwhelmed by the virulence or quantity of infectious agents
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Pneumonia: Predisposing Factors
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Decreased consciousness
Tracheal intubation Mucociliary mechanism impairment Malnutrition Altered oropharyngeal flora |
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Pneumonia: Acquisition of organisms
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Aspiration
Inhalation Hematogenous spread |
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Types of Pneumonia
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Community Acquired
Hospital Acquired Fungal Aspiration Opportunistic |
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Community Acquired PNA
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A lower respiratory tract infection of the lung parenchyma with onset in the community or during the first 2 days of hospitalization
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Hospital Acquired PNA
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PNA occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization
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Fungal PNA
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Caused by fungi
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Aspiration PNA
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Sequelae occurring from abnormal entry of secretions or substances into the lower airway
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Opportunistic PNA
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PNA that occur because of altered immune responses in patient.
PCP CMV |
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Stages of PNA
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Congestion
Red Hepatization Gray Hepatization Resolution |
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PNA: Congestion
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Pneumococcus reach alveoli, fluid enters, oragnism multiply and damage host by interfering with lung function
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PNA: Red Hepatization
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Massive dilation in capillaries, and alveoli are filled with organisms, neutrophils, RBCs, and fibrin. Lung turns red and granular like liver
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PNA: Gray Hepatization
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Blood flow decreases, and leukocytes and fibrin consolidate in affected part of lung
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PNA: Resolution
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Healed if no complications
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PNA: Clinical Manifestations
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fever
shaking chills SOB cough productive with purulent sputum crackles |
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PNA: Complications
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Pleurisy
Plueral effusion Atelectasis Bacteremia Lung abscess Empyema Percarditis Meningitis Endocarditis |
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Tuberculosis
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Disease caused by Mycobacterium Tuberculosis, a gram-positive acid-fast bacillus.
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What part of the body does tuberculosis affect?
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Usually the lungs, but can disseminate throughout the body
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Factors that contribute to the resurgence of TB
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HIV
Multidrug-resistant strains |
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Who Gets TB?
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Poor
Underserved Homeless Inner-city neighborhoods Foreign born Elderly Institutionalized IVDA’s Immunosupressed Health Care workers |
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How is TB spread?
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Via airborne droplets when infected individual coughs, sneezes, speaks, or sings. TB is more commonly spread by repeated close contact (within 6 inches of the person's mouth)
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TB: Clinical Manifestations
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Cough that becomes white, frothy sputum
fatigue weight loss low-grade fever night sweats |
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TB: Complications
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Miliary TB
Pleural effusion PNA Organ involvement |
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Acute Bronchitis
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Inflammation of the bronchi in the lower respiratory tract, usually due to infection
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Causes of Acute Bronchitis
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Common causes are viral, but can be caused by bacteria also
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Acute Bronchitis: Clinical Manifestations
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Productive cough
h/a, fever, malaise, SOB Adventitious breath sounds |
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How do you differentiate between PNA and bronchitis
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With a chest x-ray because there is no evidence of consolidation or infiltrates on x-ray with bronchitis
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Pulmonary Embolism
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Complete or incomplete occlusion of the pulmonary arterial blood flow to parts of the lung by a thrombus, fat or air embolus, or tumor tissue
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What can cause a thromboembolism?
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Amniotic fluid, air, fat, bone marrow, foreign IV material
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Most common cause of Pulmonary Embolism
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DVT
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Pulmonary Embolism: Clinical Manifestations
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Anxiety
Unexplained dyspnea tachypnea tachycardia mild to moderate hypoxemia |
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Pulmonary Embolism: Complications
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Pulmonary infarction
Pulmonary hypertension |
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What is the most frequently used test to diagnose PE?
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Ventilation-perfusion lung scan
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Primary Pulmonary Hypertension
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Rare and potentially fatal disease. It is elevated pulmonary pressures resulting from an increase in pulmonary vascular resistance to blood flow
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Primary Pulmonary Hypertension is characterized by what?
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Mean pulmonary arterial pressure greater than 25 mm Hg at rest or greater than 30 with exercise
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Primary Pulmonary Hypertension: Cause
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Deficient release of vasodilator mediators, vasoconstriction, remodeling of walls of pulmonary vessels, and thrombosis in situ.
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PPH: Clinical Manifestations
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DOE
fatigue RVH |
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Secondary Pulmonary HTN
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Secondary to a primary disease that causes >PAP
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Anatomic changes that causes an increase in PVR
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Loss of capillaries from alveolar damage
Stiffening of pulmonary vasculature Obstruction of flow |
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Cor Pulmonale
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Enlargement of RIGHT ventricle due to diseases of the lung, thorax or pulmonary circulation (P HTN)
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Etiology & Patho of pulmonary HTN and cor pulmonale
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Genetics Unknown
Pulmonary endothelial injury Vasoconstriction Remodeling (wall thickening) Sustained hypertension RV hypertrophy Cor Pulmonale R HF |
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Most common cause of Cor Pulmonale
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COPD
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How can we tell if patient is in distress?
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Rapid or shallow breathing
Tripod positioning Pursed-lip breathing Orthopnea Retraction Paradoxic breathing Crackles/rhonchi |
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Pulmonary Edema
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Increased hydrostatic pressure increase or colloid oncotic pressure decrease causes fluid to leave capillary and enter interstitium
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When will interstitial edema progress to alveolar edema?
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When lymphatic drainage does not occur
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Pulmonary edema is most common in what?
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Left heart failure
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Aspiration
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Entry of gastric secretions, oropharygeal secretions or exogenous food or fluids into tracheobronchial passages
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Why is there a greater propensity for aspiration to right lung?
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The right bronchi is more vertical and has a somewhat larger lumen
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Bronchiectasis
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Permanent, abnormal dilation of one or more large bronchi resulting in destruction of the elastic and muscular structures supporting the bronchial wall
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Bronchiectasis is called what?
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Obstructive lung disease
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Bronchiectasis: Clinical Manifestations
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Paroxysmal cough
Copious sputum Crackles/rhonchi, wheezing Clubbing, cor pulmonale |
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Gold standard for Bronchiectasis diagnosis
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High-resolution CT scan of the chest
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Pneumothorax
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Air in pleural space resulting in complete or partial collapse of lung
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Pneumothorax should be suspected after what?
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Any blunt trauma to the chest wall
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Types of Pneumothorax
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Closed
Open Tension Hemothorax Chylothorax |
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Closed Pneumothorax
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Has no associated external wound
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Open Pneumothorax
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Occurs when air enters the pleural space through an opening in the chest wall
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How should a Open Pneumothorax be covered
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With a vented dressing
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Tension Pneumothorax
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Rapid accumulation of air in the pleural space resulting in increase intrathoracic pressure and a shift of the mediastinum toward the unaffected side
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Hemothorax
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Accumulation of blood on the intrapleural space
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Chylothorax Pneumothorax
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Lymphatic fluid in the pleural space due to leak in the thoracic duct
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Pleural Effusion
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Collection of fluid in pleural space. It is not a disease but a sign of a disease
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Types of Pleural Effusion
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Transudative
exudative |
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Chronic Obstructive Pulmonary Diseases
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A preventable and treatable disease characterized by airflow limitation that is not fully reversible
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Leading cause of COPD
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Exposure to tobacco
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Types of Chronic Obstructive Pulmonary Diseases
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Emphysema
Chronic Bronchitis |
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Emphysema
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Abnormal PERMANENT enlargement of the air spaces distal to the terminal bronchioles accompanied by DESTRUCTION of walls with/without fibrosis
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Emphysema: Pathology
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Hyperinflation of alveoli
Destruction of alveolar walls Destruction of alveolar capillary walls Narrowed, twisted airways Loss of elasticity |
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COPD is characterized by what?
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Chronic inflammation found in the airways, lung parenchyma, and pulmonary vasculature
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Types of Emphysema
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Centrilobular
Panlobular |
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Centrilobular
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Involves dilation and destruction of the respiratory bronchioles and is the most commonly seen in upper lobes in mild disease
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Panlobular
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Involves destruction of the alveolar ducts, alveolar sacs, and respiratory bronchioles. It is most prominent in the lower lobes and is seen with A-antitrypsin defiency
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Emphysema:Clinical Manifestations
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Dyspnea
>AP diameter Flat diaphragm Accessory muscle use Underweight Scant sputum Blebs/bullae |
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Chronic Bronchitis
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Chronic productive cough for 3 months in each of 2 consecutive years in a pt who has been excluded from other reasons
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Chronic Bronchitis: Pathophysiology
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hyperplasia of mucous-secreting glands in trachea/bronchi
increase in goblet cells loss of cilia chronic inflammatory changes + narrowing of small airways altered function of alveolar macrophages |
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Chronic Bronchitis: Clinical Manifestations
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Obesity
Variable dyspnea Copious mucus Rhonchi, wheeze Frequent cor pulmonale |
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Pink Puffer
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a Pt with COPD and severe emphysema, who have a pink complexion and dyspnea
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Blue Bloater
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Pt with blueish color of the lips and skin commonly seen in severe Chronic Bronchitis
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Contributing Factors to COPD
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Cigarette smoking
Heredity Infection Aging |
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Complications of COPD
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Cor pulmonale:
Secondary to hypoxic vasoconstriction and increased pulmonary vascular resistance Acute exacerbations Acute respiratory failure Peptic ulcer disease Pneumonia |
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Asthma
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Chronic inflammatory disorder causing obstruction and hyperresponsiveness of airway. The clinical course is unpredictable
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Asthma Triggers
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Allergens
Exercise Respiratory Infections Nose/Sinus Problems Drugs and food additives GERD Emotions/Stress |
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Asthma: Clinical Manifestations
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wheezing
cough dyspnea chest tightness |
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Asthma: Complications
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Status asthmaticus
Rib fx Pneumo Atelectasis PNA |
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Lung Abscess
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Pus containing lesion of the lung parenchyma that gives rise to a cavity.
Cavity formed by necrosis of lung tissue |
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Pulmonary Fibrosis
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Scar tissue in the connective tissue of the lungs as a sequela to inflammation or irritation
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Pulmonary Fibrosis: Risk Factor
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Environmental or occupational inhalation
Cigarette smoking and chronic aspiration |
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Pulmonary Fibrosis: Clinical Manifestations
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Exertional dyspnea
Nonproductive cough Crackles |
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Flail Chest
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Multiple rib fractures causing instability of chest wall
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What prevents adequate ventilation and decreased compliance in Flail Chest?
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Paradoxical mvt. of affected area to intact portion of chest
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Flail Chest: Clinical Manifestations
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Rapid, shallow respirations
Tachycardia Visual Crepitus |
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Most important risk factor in developing lung cancer
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Cigarette smoking
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