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102 Cards in this Set

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IMPAIRED VENTILATION:What 2 major mechanisms implicated?
Problem of blocking airflow in and out of lungs . v/q, diffusion
IMPAIRED VENTILATION-PERFUSION (V/Q) MATCHING 1)Areas of the lung are ventilated but not perfused or the lung is perfused but not ventilated. Or 2)The process of restricting the transfer of oxygen or carbon dioxide across the alveolar capillary junction
1.
IMPAIRED DIFFUSION: 1)Areas of the lung are ventilated but not perfused or the lung is perfused but not ventilated. Or 2)The process of restricting the transfer of oxygen or carbon dioxide across the alveolar capillary junction
2)The process of restricting the transfer of oxygen or carbon dioxide across the alveolar capillary junction
Effects of impaired ventilation and diffusion: What 3 effects result from ↓ O2 presence or utilization or retention of CO2 (either the body can't take in enough O2 or release enough O2?
Hypoxemia, Hypoxia, Hypercapnia
Barrel Chest is caused by what?
a-hypertrophy
b-hyperventilation
c-trapped air
d-hypercapnia
c-trapped air and Use of Accessory Muscles
Cough, excess mucus production, hemoptysis, dyspnea, orthopnea, use of accessory muscles, chest pain, barrel chest, adventitious or altered breath sounds (wheezing, crackles) are S&S of what?
Impaired ventilation and diffusion
V/Q stands for what?
Ventilation-PERFUSION
Atelectasis is defined as the lack of
gas exchange within alveoli, due to alveolar collapse or fluid consolidation.
Perfusion means? fluid/blood getting to the tissue Whereas ventilation means?
Getting O2 to the tissue. So inadequate perfusion is not enough blood and inadequate ventilation is not enough oxygen.
cyanotic mucus membranes, changes in ABG's, mental staus changes, finger clubbing are are S&S of what 3 things.
Systemic S&S that result from hypoxemia, hypoxia, hypercapnia.
______the associated respiratory acidosis result in electrolyte abnormalities that may cause dysrhythmias.-may present w/ somnolence, -even coma from changes in ICP
associated w/ ↑ levels of arterial CO2 which causes cerebral vasodilation.
Alveolar hypoventilation w/ ↑ alveolar CCO2 limits the amount of oxygen available for diffusion into the blood, thereby leading to 2ndary hypoxemia.
a-hypocapnia
b-Hypercapnia
c-hypoxia
d-hypoxemia
b-hypercapnia
Cyanosis is a bluish discoloration of skin and mucous membranes caused by what?
Increasing amounts of desaturated or reduced hemoglobin in the blood. It generally develops when 5 g of hemoglobin is desaturated regardless of hemoglobin concentration.
In adults cyanosis is not evident until when?
severe hypoxemia is present and is therefore an insensitive indication of respiratory failure.
Severe anemia and carbon monoxide poisoning can cause inad. Oxygenation of tissue w/o causing what?
cyanosis.
Central cyanosis- vs Peripheral cyanosis
central decreased oxygen sat of hemoglobin in arterial blood is best seen in buccal mucous membranes and lips whereas Peripheral cyanosis (slow blood circulating in fingers and toes) is been seen in nail beds.
↓ arterial oxygenation (low PO2), pulmonary or cardiac right-to-left shunts, ↓ cardiac output, cold environ, or anxiety are causes of which?
a-hypoxia
b-hypoxemia
c-cyanosis
d-hypercapnia
c-cyanosis
Individuals w/ polycythemia (abnorm ↑ of RBC) hay have cyanosis even when what is adequate?
oxygenation is adequate.
key to diagnosis Pneumonia
Inflamed alveoli fill with exudate and other products of inflammation leads to consolidation – a solid mass in the lung tissue – evident on x-ray
Oxygen diffusion is greatly impaired, -Hypoxia, -Dehydration due to fever, -Respiratory failure can occur if not treated
a-asthma
b-cb
c-pneumonia
d-emphysema
c-pneumonia
Pneumonia is spread how?
a-respiratory droplets
b-airborne droplets
c-sexual contact
d-blood borne pathogens
a-spread-respiratory droplets.
streptococcus, mycoplasma pneumoniae, influenza virus cause which hospital or community pneumonia?
CAP-community acquired pneumonia
Which is most often caused by: pseudomonas aeruginosa, staphylococcus E coli? Hospital or community?
Hospital aka nosocomial pneumonia
fungi, respiratory viruses, protozoa, parasites that cause pneumonia affect who?
the immunosuppressed
phys exam, wbc is usually ↑ but may be ↓ in the immunosuppressed, chest x-ray, stains, cultures of respiratory secretions, blood culture, sputum characteristics: gram stain, color odor. dx of:
a-cb
b-tb
c-pneumonia
d-emphysema
c-pneumonia
if bacterial-antibiotics, viral-usually supportive therapy but may need antiviral. If opportunistic: multiple drugs and antifungals. For all adequate hydration, deep breathing, coughing, chest physical therapy. tx for
a-TB
b-pneumonia
c-asthma
d-emphysema
tx of pneumonia-
infections w/ candida albicans or pneumocystis carinii (fungi) indicate what?
immunosuppression or immunodeficiency.
Pneumonia normal defenses such as cough, mucociliary blanket and macrophages in the alveoli are inadequate. This then triggers what?
Inflammatory and immune response.
Inflamed alveoli fill what what? Which leads to what?
Exudate and other products of other products of inflammation leads to consolidation – a solid mass in the lung tissue
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, hyperpnea, hypercapnia, hyperventilation hypocapnia? The subjective sensation of uncomfortable breathing-feeling like unable to get enough air.
Dyspnea.
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, hyperpnea, hypercapnia, hyperventilation, hypocapnia? Dyspnea when lying down.
Orthopnea
dyspnea, orthopnea paroxysmal nocturnal dyspnea, hyperpnea, hypercapnia, hyperventilation, hypocapnia? Waking at night gasping for air and have to sit up or stand to relieve.
Nocturnal dyspnea.
dyspnea, orthopnea paroxysmal nocturnal dyspnea, hyperpnea, hypercapnia, hyperventilation, hypocapnia? Slightly increased ventilatory rate, vary large tidal volumes no expiratory pause.
Hyperpnea aka kaussmaul respiration
dyspnea, Orthopnea paroxysmal nocturnal dyspnea, hyperpnea, hypercapnia, hyperventilation, hypocapnia? PCO2 more than 44mmHg?
Hypercapnia
dyspnea, orthopnea paroxysmal nocturnal dyspnea, hyperpnea, hypercapnia, hyperventilation, hypocapnia? Alveolar ventilation exceeding metabolic demands.
Hyperventilation
dyspnea, orthopnea paroxysmal nocturnal dyspnea, hyperpnea, hypercapnia, hyperventilation, hypocapnia? PCOs less than 36mmHg.
Hypocapnia.
Clubbing is what? What is it associated w/?
The selective bulbous enlargement of the end of a digit (finger/toe). Associated w/ chronic hypoxemia.
A protective reflex that cleanses the lower airways by an explosive expiration is called what?
A cough
what is hemoptysis? whereas hematemesis is?
Coughing up blood or bloody secretions. Not to be confused w/ hematemesis which is puking up blood
Pain caused by pulmonary disorders originates in the which 3 places
pleurae, airways or chest wall.
Infection and inflammation of parietal pleura (pleurodynia) cause what type of pain? is located? what makes pain worse? what is pleural friction rub?
sharp or stabbing pain when the pleura stretches during inspiration.
Pain is usually localized to portion of the chest wall
where a unique breath sound called a pleural friction rub may be heard over the painful area.
Laughing or coughing makes it worse.
pulmonary pain is central chest pain that is pronounced after _____ and occurs in ind. w/ infection/inflammation of the trachea or ______. can be difficult to differentiate from what?
coughing bronchi. Can be difficult to differentiate from cardiac pain.
High bp in pulmonary circulation (pulmonary hypertension) can cause pain during
exercise that is often mistaken for cardiac pain
pain in the chest wall is muscle pain or rib pain. Excessive coughing and rib fractures produces such pain. Inflammation of costochondral junction can cause chest wall pain. Chest wall pain can often be reproduced by pressing
on the sternum or ribs.
What is caused by hypoventilation of the alveoli?
a-hypoxia
b-hypercapnia
c-hypoxemia
d-hypocapnia
b-Hypercapnia
_______ is caused by respiratory alterations, whereas _____ may be caused b y alterations of other systems as well.
a-hypoxemia, hypoxia
b-hypoxia, hypoxemia
c-hypercapnia, hypoxemia
d-hypercapnia, hypoxia
a-Hypoxemia, hypoxia
hypoxemia results from problems w/ one or more of the major mechanism of oxygenation
1-O2 delivery to the _____
2-diffusion of O2 from the aveoli into the _____
3-[perfusion or diffusion] of the pulmonary capillaries.
1- oxygen delivery to the alveoli
2- diffusion of oxygen from the alveoli into the blood
3-perfusion of pulmonary capillaries.
An abnormal ventilation-perfusion ratio V/Q is the most common cause of what?
a-hypoxia
b-hypoxemia
c-obstruction
d-infection
Hypoxemia.
The normal v/q is 0.8 to 0.9 v/q mismatch refers to
abnormal distribution of ventilation and perfusion.
hypoxemia can be caused by inadequate ventilation/but normal perfusion called
shunting occurs in atelectasis, in asthma as a result of bronchoconstriction and in pulmonary edema and pneumonia when alveoli are filled w/ fluid. Right to left shunt; decreased systemic PO2 and hypoxemia.
When ventilated but not perfused called what?, v/q is high or low? Cause?
a-dead space
b-shunting
a-alveolar dead space,
v/q is high,
cause pulmonary embolus that impairs blood flow to a segment of the lung
COPD is a general term describing all chronic obstructive lung disorders including what 3? but primary is used to denote the presence of both _____ and _______.
emphysema, chronic bronchitis, asthma. Emphysema & chronic bronchitis.
COPD is characterized by inflammatory processes in the ______ and _______.
alveoli and bronchi.
Is COPD reversible?
No
smoking is usually the cause of COPD but in what % have never smoked?
10-20%
symptoms may not become apparent until lung function is at what % or below?
50%
emphysema is irreversible (enlargement or decrease) of the alveoli?
Enlargement
what happens to the alveoli walls in emphysema which causes ______ air flow.
The walls are destroyed and the airflow is obstructed.
Obstructive lung disease is characterized by airway obstruction that is worse with which inhalation or expiration? What happens?
Expiration. More force is needed and/or emptying the lungs is slowed.
Which of these is increasing in prevalence? Asthma, emphysema, chronic bronchitis?
Asthma
which is more acute and intermittent? Asthma or COPD?
Asthma.
What 1 sign and what 1 symptom is the unifying one of the obstructive lung diseases?
Symptom:dyspnea sign: wheezing.
Pulsus paradoxus:decrease in_____ BP during inspiration of more then ___mmHg
systolic BP 10mmHg
what is status asthmaticus? is a severe _____ that is not reversed by normal measures and if it continues the _____ worsens and the effective ____ decreases.
bronchospasm, hypoxemia, ventilation
Asthma-If O2 saturation falls below 90% ABG's should be measured. Usual findings are what?
a-hypoxia w/respiratory alkalosis
b-hypoxia w/respiratory acidosis
c-hypoxemia w/ respiratory alkadosis
d-hypoxemia w/ respiratory acidosis
Hypoxemia w/ associated respiratory alkalosis.
Asthma is a chronic inflammatory disorder of airways resulting in intermittent or persistent airway obstruction because of bronchial ______, inflammation, broncho-_____ and excess _____.
bronchial hyperresponsiveness, inflammation, bronchoconstriction, and excess mucus production.
Asthma Often occurs in what?
childhood but can emerge at any poitn in lifetime.
Exact cause of asthma unknown, but often due to
frequent exposure to allergens, such as smoke or dust mites. Inflammatory and immune response triggered thru exposure to allergen. Triggers can be dust, mold, animal hair, exercise, temperature extremes, and anxiety
airway edema and the formation of mucus plugs from exudate and cell debris occur, -Mucus plugs may take weeks to resolve, -Over time, this chronic inflammation leads to structural changes and airway remodeling, strongly affecting the irreversibility of the condition
a-asthma
b-chronic Bronchitis
c-emphysema
d-pneumonia
a-asthma
Depend on state of airway hyperreactivity and inflammation, -Wheezing, breathlessness, chest tightness, excessive sputum production, and coughing, -During acute episode, anxiety, tachypnea, and use of accessory muscles S&S of?
a-emphysema
b-CB
c-asthma
d-pneumonia
c-asthma
History and physical, -Wheezing, -Other allergic reactions (skin conditions that indicate hypersensitivity), -ABGs, -Differential with eosinophilia (indicating allergy) dx of
a- TB
b- CB
c-asthma
d-pneumonia
c-asthma
Tuberculosis (TB) Infection disease caused by rod-shaped bacillus –
mycobacterium tuberculosis, -Primary site of infection for TB?
Route of transmission for TB?
a-respiratory droplets
b-airborne droplets
c-sexual contact
d-blood borne pathogens
b-inhaling airborne droplet
In an attempt to destroy the bacilli, inflammatory and cellular immune responses are elicited leading to one of the following three possibilities
1-Containment 2-Multiplication and development of aggressive symptomatic disease (progressive primary TB)3-Dormancy with future multiplication or reinfection leading to aggressive, symptomatic disease (secondary TB) – AKA Postprimary TB
hint: Co times Do
TB type depend on these factors:
virulence, bacterial load. (hint: who gets sick)
age, immune status, virulence, and mycobacterial load.
Destruction or containment of TB depends on an effective ____
a-cell mediated immunity
b-humoral immunity
c-innate immunity
d-inflammation response
cell-mediated immune response
TB-However: -Bacilli are fast or slow? resistant or easily destroyed?
slow growing (good for us) but resistant to destruction;- (bad for us)
TB-Bacilli do or do not produce toxins?
Do not
TB damage to lung and other tissues is thruwhat?
a-destruction of tissue
b-hypersensitivity
c-hypoxia
d-hypercapnia
b- hypersensitivity reactions
TB-Initial containment and destruction of bacilli occurs thru a granulomatous inflammatory response – a granuloma or walled-off area of bacteria is called what?
Ghon Focus
Primary TB – initial exposure and growth of bacilli in individual with or without symptoms. Individuals with symptoms are believed to have an what?
aggressive and destructive from of disease termed active infection. Individuals without symptoms often have an effective immune response and a healed Ghon complex forms
Secondary TB – if immune response becomes compromised and bacilli proliferate (or reinfection occurs), infection becomes active and progression to secondary TB occurs.This can spread to other organs and is marked by aggressive, destructive Cavitations what are what?
(areas of necrosis that erode surrounding structures)
Based on stage of infection, extent of damage, and amount of Dead Space, -90% of individual with primary are asymptomatic, -Progressive primary S & Sx may include malaise, weight loss, fatigue, anorexia, low-grade fever, and night sweats,-With progression, chronic productive cough withhemoptysis,-Secondary ( ) - with spread – example spread to brain: headache, mental status changes, & coma
S&S of?
a-Pneumonia
b-TB
c-Asthma
d-chronic bronchitis
b-TB
skin tests (Mantoux test or purified protein derivative [PPD]), -Sputum culture – collected in AM over 3 consecutive days, -Fiberoptic bronchoscopy with washings, -Chest x-ray, -History and physical
a-pneumonia
b-TB
c-cb
d-asthma
Diagnosis of TB-
antibiotic tx to control active or dormant and prevent transmission. Combo crug tx for 3 mo. Isolation from community no longer needed. Often tx in the home is sufficient.
tx of
a-TB
b-pneumonia
c-cb
d-asthma
TB
Which type of emphysema? Panacinar or centriacinar?
tends to occurs in smokers and persons w/ CB.
Septal destruction occurs in respiratory bronchioles and alveolar ducts, causing inflammation in bronchioles. Sac is intact. stems/trunks of broccoli are too big/bulky.
Patterns of destruction Centriacinar (centralobular)
Panacinar or centriacinar? associated with elderly and persons w/ a-antitrypsin deficiency. Involves entire acinus, damage more randomly distributed and involves lower lobes of lung. Whole broccoli looks funny/deformed both stems and ends
emphysema–Panacinar –
air trapping because of loss of elasticity is key in the pathophysiology emphysema, CB, Asthma or pneumonia?
emphysema
alpha1-antitrypsin AAT is what?
A major component in a-globulin a plasma protein
a1-antitrypsin inhibits proteolytic enzymes and so w/o it
proteolysis in not inhibited.
Emphysema, CB, Asthma or pneumonia?- expiration becomes difficult because loss of elastic recoil reduces the volume of air that can be expired passively and air is trapped in the lungs.
emphysema
Air trapping caused hyper-expansion of the chest which put the muscles of respiration at a mechanical disadvantage-this increases workload of breathing. Late in course of disease many develop what?
a-hyperventilation, hypercapnia
b-hypo-ventilation, hypercapnia
c-hyperventilation, hypocapnia
d- hypo-ventilation, hypocapnia
b-hypoventilation and hypercapnia.
Tx for emphysema-
similar to cb: smoking cessation, bronchodilating drugs, nutrition, breathing retraining, relaxation exercises, anti-inflammatory drugs, antibiotics for acute infections. Severe COPD may require use of steroids and oxygen. Severe emphysema-lung reduction or transplant.
Related to obstruction of small airways, chronic hypoxemia, and hypercapnia, -Most have smoked for over 20 years ,-Chronic cough – particularly in morning with production, Dyspnea, wheezing with minimal exertion,-Barrel chest due to chronic hyperinflation of lungs,-Pursed lip breathing
a-chronic bronchitis
b-asthma
c-emphysema
d-pneumonia
Clinical manifestations of emphysema-
-Hx & physical, -Pulmonary function tests (PFTs), -AAT levels in non-smokers (levels below normal of 85 to 213 mg/dl), -ABGs , -Chest x-ray
Diagnosis of emphysema
Chronic Bronchitis -Defined by presence of persistent, productive cough with excessive mucus production lasting for how long?
3 months or longer or longer for 2 or more consecutive years –, CB-Results in several changes in the bronchi and bronchioles in response to chronic injury, -These lead towhat?
inspired irritants result in airway inflammation w/ infiltration of neutrophils, macrophages, lymphocytes into bronchial wall. Continued inflammation leads to bronchial edema which ↑ the size and # of mucous glads and goblet cells in the airway epithelium. Impaired ciliary function can't clear mucus lungs defenses compromised. Frequent infection complicated by bronchospasms q/ dyspnea and productive cough. Initially affects larger bronchi but eventually all become narrowed. Expiratory airway obstruction traps gas in distal portion of lung which leads to v/q mismatch and hypoxemia occurs. hypoventilation and hypercapnia.
a-CB
b-emphysema
c-pneumonia
d-asthma
pathophysiology of CB
-Chronic productive cough, often with purulent sputum, -Dyspnea with minimal exertion. -Wheezing and crackles, -Hypoxemia, hypercapnia, and cyanosis
S&S of:
a-emphysema
b-chronic bronchitis
c-asthma
d-pneumonia
Clinical manifestations of chronic bronchitis
-History and physical, -History of smoking, -Recurrent respiratory infections, -ABGs , -Polycythemia may be seen on CBC due to chronic hypoxemia, -PFTs, -Chest x-ray
dx of:
a-emphysema
b-cb
c-asthma
d-pneumonia
b-Diagnosis of chronic bronchitis
Pink Puffers or blue bloater
(usually emphysema) -Increase respiration to maintain oxygen levels. -Dyspnea; increased ventilatory effort, -Use accessory muscles; pursed-lip breathing.
pink puffer
(usually bronchitis)-Cannot increase respiration enough to maintain oxygen levels, -Cyanosis and polycythemia, -Cor pulmonale
Pink Puffer or Blue bloaters?
blue bloater
emphysema obstruction results form
a-mucus production
b-changes in lung tissues
c-inflammation
b changes in lung tisse
Emphysema The major mechanism of air flow limitation is loss of ?
Elastic recoil.