Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
280 Cards in this Set
- Front
- Back
Purpose of respiratory system |
transport oxygen from the air into the blood and for removing carbon dioxide from the blood
|
|
Element essential for cell metabolism
|
oxygen
|
|
Waste material resulting from cell metabolism. What is that material's purpose?
|
carbon dioxide
influences the acid-base balance in body fluids |
|
Upper respiratory tract
|
made up of passageways that conduct air between the atmosphere and the lungs
|
|
Lower respiratory tract components and role
|
trachea, bronchial tree and lungs
where gas exchange takes place |
|
pH
|
potential of hydrogen, a measure of the acidity or alkalinity of a solution
|
|
Acid
|
a substance that releases hydrogen into a solution
|
|
Alkali
|
a substance that removes hydrogen into a solution
|
|
Acidosis
|
low serum pH (below 7.4), increased H+
|
|
Alkalosis
|
high serum pH (above 7.4), decreased H+
|
|
List the paranasal sinuses and and its function
|
ethmoid, sphenoid, frontal, maxillary sinuses
reduce the weight of the facial bones and adds resonance to the voice |
|
Respiratory mucosa
|
pseudostratified columnar epithelium which includes mucus-secreting goblet cells and cilia
|
|
What activity impairs the function of the cilia?
|
smoking
|
|
The pharyngeal tonsils or adenoids are responsible for what disorder? Explain
|
mouth breathing
the tonsils become enlarged due to infection, thus obstructing the nasopharynx |
|
Creates a predisposition to the spread of infection from the upper respiratory tract
|
the continuation of the respiratory mucosa into the sinuses and the middle ear
|
|
Location of pharynx and its function
|
where the nasopharynx joins the oropharynx
serves as a common passage for air and food |
|
Largest thyroid cartilage
|
adam's apple
|
|
List the structures of the vocal chords
|
upper or false pair
lower or true vocal chords |
|
Glottis refers to ____
|
the true vocal chords and the space between them
|
|
Function of the vocal chords
|
prevents food from entering the trachea and the lungs
|
|
What is the function importance of the tracheal cartilage's open side in regards to its location? What is its role?
|
the open side on the posterior surface allows for esophageal expansion.
supports the wall of the airway, preventing its collapse |
|
Which bronchus is straighter and larger? Why?
|
right bronchus (3 lobes), therefore it is the more likely for aspirated material.
due to the position of the heart |
|
Describe the flow of air through the lower respiratory tract
|
bronchus-->bronchi-->bronchioles--> alevolar duct/alevoli
|
|
Point at which the bronchus enters the lung
|
hilum
|
|
Cause of bronchodilation
|
results when sympathetic stimulation (increases heart rate and contractilty) relaxes the smooth muscle
|
|
Function of the alevoli
|
promotes diffusion of gases in to the blood (the end point of inspired air)
*contains macrophage |
|
Explain the respiratory membrane and its function
|
combined alveolar and capillary wall, a very thin membrane in which gas exchange takes place
|
|
Inside surfaces of alevoli are covered with surfactant. What does this do?
|
has a detergent action that reduces surface tension (the tendency for fluid to reduce its surface area), facilitating inspiration and preventing total collapse of the alveoli during expiration
|
|
Structures contained in the mediastinum
|
heart
major blood vessels esophagus trachea |
|
Each lung is covered by_____
|
its own double walled sac- pleural membrane
|
|
Function of the pleural fluid
|
provides lubrication during respiratory movements as well as cohesion
|
|
Explain the structure of the ribs
|
1-7= true ribs
8-10= false ribs 11-12= floating ribs (false) |
|
Airflow during inspiration and expiration is dependent on _______
|
pressure gradient
high pressure to low pressure |
|
Inspiration
|
air moves from the atmosphere into the lungs
|
|
Boyle's law
|
as the size of the thoracic cavity decreases, pressure inside the cavity increases
|
|
Compliance
|
the ability of the lungs to expand
|
|
What two activities cause changes in ventilation?
|
pregnancy and aging
|
|
Pulmonary volumes
|
measure of ventilatory capacity because they measure the air moving and out of the lungs with normal or forced inspiration and expiration
|
|
Effect of impaired expiration
|
increase in residual volume, and therefore and increase in CO2 levels in body fluid
|
|
Residual volume (RV)
|
amount of air remaining in the lungs after forced/max. respiration
1200mL |
|
Vital Capacity
|
max. amount of air expired following a maximal inspiration
4600 mL |
|
Dead space
|
areas where gas exchange can not take place
*first filled by newly inspired air |
|
Areas of dead space
|
bronchi and bronchioles
|
|
How can dead space be increased?
|
obstruction in the passageways or collapse of alveoli
|
|
Control centers for breathing
|
medulla and pons
|
|
List factors that can modify the rate and depth of breathing
|
-drugs
-activity of the hypothalamus (emotions) -stretch receptors in lungs -Hering-Breuer reflex (prevents excessive lung expansion, or voluntarily controlled as required when singing) |
|
What is the general role of chemoreceptors?
|
sense changes in the levels of carbon dioxide, hydrogen ions, and oxygen in CSF
|
|
Location and role of central chemoreceptors
|
medulla
respond quickly to slight elevations in PCO2 (from a normal 40 mmHg to 43 mmHg) OR a decrease in pH (increased H+) of the CSF |
|
Location and role of peripheral chemoreceptors
|
located in the carotid bodies at the bifurcation of the common carotid arteries and in the aortic body in the aortic arch
sensitive to decreased oxygen levels in arterial blood and low PH |
|
An marked decrease in oxygen level (from 105mmHg to 60 mmHg) is required before the chemoreceptors respond to what disorder?
|
hyoxemia
|
|
What should you do in regards to oxygen intake in patients with chronic lung disease?
|
these patients adapt to sustained elevation of PCO2 (moving to a hypoxic drive). Thus, they need low levels of oxygen.
|
|
Hypercapnia
|
increase in carbon dioxide levels in the blood
|
|
Effects of hypercapnia
|
-lowering of pH thus stimulating the respiratory center resulting in hyperventilation
-respiratory acidosis which depresses the nervous system |
|
Hypocapnia
|
decrease in carbon dioxide, caused by hyperventilation after excessive amounts of CO2 have been expired.
-causes respiratory alkalosis |
|
Gas exchange/external respiration
|
flow of gases between the alveolar air and the blood in the pulmonary circulation
|
|
Diffusion of oxygen and carbon dioxide in the lungs depends on _______
|
the relative concentrations/partial pressures of the gases
|
|
Dalton's law
|
each gas in a mixture moves or diffuses according to its own partial pressure gradient and independent of other gases.
|
|
Pulmonary circulation
|
brings venous blood (dark blue-red in color) from the right side of the heart to be oxygenated
|
|
Where does diffusion/gas exchange occur specifically?
|
pulmonary capillaries
|
|
Pulmonary veins
|
return oxygenated blood (bright red) to the left side of the heart, which then pumps into the systematic circulation
|
|
Effect of extra fluid in the alveoli
|
impedes blood flow through the pulmonary capillaries and increases surface tension in the alveoli constricting expansion of the lung
|
|
2 disorders that involve destruction of the alveolar wall
|
emphysema or fibrils in the lungs
|
|
Components of air
|
oxygen, carbon dioxide, nitrogen, and water
|
|
Ventilation Perfusion Ratio (Va/Q)
|
imbalance of ventilation
|
|
Name an autoregulatory mechanism of the respiratory system
|
in PO2 is low because of poor ventilation in an area, vasoconstriction occurs in the pulmonary arterioles shunting the blood to other areas of the lungs where ventilation may be better.
|
|
What percent of oxygen is dissolved in plasma?
|
1% because oxygen is relatively insoluble
*the dissolved form of the gas is that which diffuses from the alveolar are into the blood in the pulmonary capillaries as well as the interstitial fluid |
|
Oxyhemoglobin
|
How oxygen is mostly transported- bound to hemoglobin by Fe+ molecules
|
|
fully saturated
|
When all four molecules in hemoglobin have taken up oxygen the hemoglobin is said to be fully saturated
|
|
What happens when oxygen diffuses out of the blood into the interstitial fluid and the cells?
|
hemoglobin releases oxygen to replace it
|
|
The rate at which hemoglobin binds or releases oxygen is dependent on which factors?
|
-PO2 (partial pressure of dissolved oxygen)
-temp -plasma pH |
|
How much oxygen is released into the cells for metabolism? How much is retained?
|
25%
75% of the hemoglobin in the venous blood is being saturated with oxygen |
|
carbaminoglobin
|
the 20% of hemoglobin attached to an amino group on the globin portion (not the heme portion)
|
|
What happens to CO2 after cell metabolism?
|
it diffuses into the RBCs where, under the influence of carbonic anhydrase, transitions briefly as carbonic acid, and then is converted to bicarbonate ions
|
|
Ratio of bicarbonate ion to carbonic acid
|
20:1
|
|
Spirometry
|
used to treat pulmonary volumes, measuring volumes and airflow times
|
|
Oximeters
|
measures O2 saturations
|
|
Sneezing involves the upper or lower respiratory tract? Coughing?
|
sneezing- upper
coughing-lower |
|
The cough reflex is controlled by the _____
|
medulla
|
|
Explain the difference between a productive and nonproductive cough
|
unproductive cough interferes with sleep and uses resp. muscles excessively
productive cough occurs when secretions, inflammatory exudate from the lungs are expelled |
|
Treatment for coughs
|
-cough suppressants (codeine and dextromethorphan)
-increase fluid intake -expectorant -humidifier |
|
sputum
|
mucoid discharge
|
|
Characteristics of a normal secretion
|
thin, clear, and colorless or cream color
|
|
Yellowish-green, cloudy thick mucous indicates:
|
Bacterial infection
|
|
Rusty or dark-colored sputum indicates:
|
pneumococcal pneumonia
|
|
Large amounts of purulent (pus) with a foul odor indicates:
|
bronchiectasis
|
|
Thick, sticky mucus occurs in patients with what disorders?
|
asthma
cystic fibrosis |
|
Hemoptysis
|
blood-tinged (bright red) frothy sputum usually associated with pulmonary edema
|
|
Blood tinged secretions are indicative of what disorders?
|
TB
chronic cough |
|
Eupnea
|
normal breathing pattern of 10-18 inspirations per minute
|
|
Kussmaul's respriations
|
deep, rapid respirations or "air hunger" are typical of a state of acidosis
|
|
Cause of labored respirations
|
obstruction of the airways
|
|
Cause of wheezing or whistling sounds
|
obstruction in small airways
|
|
Stridor
|
high-pitched crowing noise that indicates upper airway obstruction
|
|
Rales
|
light bubbly or crackling sounds associated with serious secretions
|
|
Rhoncii
|
deeper or harsher sounds resulting from thicker mucus
|
|
Cause of absence of breath sounds
|
nonaeration or collapse of a lung (atelectasis)
|
|
Orthopnea
|
dyspnea that occurs when a person is lying down
|
|
Describe the process of orthopnea
|
blood pools in the lung when lying down pushing the abdominal contents upward against the lungs
|
|
Paroxysmal nocturnal dyspnea
|
a sudden acute type of dyspnea common in patients with left-sided CHF
|
|
Explain the process of PND
|
during sleep, the body fluid is redistributed leading to pulmonary edema, and the patient wakes up gasping for air and coughing
|
|
What is cyanosis and what is its cause?
|
bluish coloring of the skin and mucus membranes
large amounts of oxygenated hemoglobin in the blood |
|
Pleural pain
|
results from inflammation or infection of the parietal pleura
*pain increased with inspiration or coughing |
|
What is friction rub? What causes it?
|
a soft sound produced as the rough membranes move against eachother
lobar pneumonia or lung infarction |
|
Clubbed fingers occur as a result of what disorder?
|
chronic hypoxia associated with respiratory and cardiovascular diseases
|
|
Clubbing
|
painless, firm, fibrotic enlargement at the end of a digit
|
|
Changes in arterial blood gases includes:
|
Hypoxemia- inadequate oxygen in blood (PaO2)
Hypoxia- inadequate oxygen in cells |
|
5 causes of Hypoxemia and Hypoxia
|
-low RBCs and hemoglobin levels
-circulatory impairment -impaired respiratory function -carbon monoxide poisoning -excessive release of oxygen from RBCs |
|
Carbon monoxide poisoning
|
carbon monoxide binds with hemoglobin displacing oxygen
|
|
Signs of carbon monoxide poisoning
|
bright red coloring of the skin and mucosa with headache and drowsiness
|
|
Hypoxia effects ____ ________, reducing cell function. What does this lead to?
|
cell metabolism
anaerobic metabolism and the development of metabolic acidosis |
|
Compensation mechanisms of hypoxia
|
-tachycardia and high blood pressure
-increased erythropoietin secretion giving rise to secondary polycythemia |
|
Respiratory acidosis
|
excess carbon dioxide (increased carbonic acid)
*results from impaired expiration |
|
When respiration is increased what occurs? What is the cause?
|
respiratory alkalosis
acute anxiety and excessive intake of aspirin |
|
What is the most common pathogen?
|
rhinovirus
|
|
The common cold is also known as ________ _______
|
infectious rhinitis
|
|
Why is the common cold so contagious?
|
the virus is shed in large numbers from the infected nasal mucosa
|
|
The common cold can spread to cause what three disorders?
|
pharyngitis (sore throat)
laryngitis (hoarse throat) acute bronchitis (cough) |
|
Treatment of the common cold
|
acetaminophen for fever and headache
decongestants (vasoconstrictors) antihistamines (reduce secretions) humidifiers (keep secretions liquid) |
|
Name the microbe responsible for the cause of pharyngitis (strep throat)
|
streptococcous
|
|
Sinusitis
|
bacterial infection secondary to cold or allergy that has obstructed drainage of one of the paranasal sinuses
|
|
Laryngotracheobronchitis is a common disorder particularity in children of what age? Explain this disorder
|
1 to 2 years of age
the larynx and subglottic area become inflamed with swelling and exudate leading to obstruction and "barking cough", hoarse voice, and inspiration stridor. more severe at night |
|
Name another name for laryngotracheobronchitis
|
croup
|
|
Epiglottitis is caused by what bacterial organism? Name the age group it mostly affects.
|
H. influenzae type B
3-7 years old *child refuses to swallow |
|
How does flu differ from the common cold?
|
It has a sudden, acute onset with fever, market fatigue, and aching pains in the body
|
|
What causes most death from the flu?
|
pneumonia
|
|
Incubation period for the flu? What kind of drugs (list names) and when they should be taken to get the greatest benefit.
|
1-4 days
amantadine, oseltamivir, and zanamir 2 days |
|
List predisposing factors of broncholitis (RSV infection)
|
familial history of asthma
cigarette smoking |
|
Effects of broncholitis
|
necrosis and inflammation in the small bronchi and bronchioles with edema, increased secretions and reflex bronchospasm
|
|
Categories of pneumonia are based on -
|
causative agent, anatomic location of infection, pathophysiologic changes and epidemiologic data
|
|
Specific cause of lobar pneumonia
|
streptoccoccous penumoniae
|
|
List the two stages of lobar pneumonia
|
first stage- congestion
second stage- fibrin accumulate in the alveolar exudate forming a solid mass in the lobe called a consolidation |
|
In lobar pneumonia, infections may spread into the pleural cavity giving rise to what disorder?
|
empyema causing adhesion between pleural membranes restricting ventilation
|
|
The filling of the alveoli with exudate in lobar pneumonia causes what effect?
|
reduces the diffusion of gases, decreasing blood flow through the affected lobe
|
|
In lobar pneumonia, why is hypoxia more marked? What does this lead to?
|
because the demand for oxygen increases with the higher metabolic rate associated with the infection.
metabolic acidosis |
|
Bronchopneumonia
|
occurs as a diffuse pattern of infection in both lungs, more often in the lower lobes
|
|
Legionnaire's disease is a nosocomial disease. Where is the microbe that causes the disease usually found?
|
inside pulmonary macrophages
|
|
How is Mcoplasma pneumonia transmitted? What age group is more likely to have the disease?
|
aerosol
older children and young adults |
|
This diseases occurs as an opportunistic and often fatal infection in patients with AIDS
|
Pneumocystis carnii pneumonia (PCP)
|
|
Name the causative microbe in SARS
|
coronavirus
|
|
In SARS, elevated c-reactive protein levels are indicator of what two disorders
|
lymphopenia
thrmobocytopenia |
|
Mortality rate of SARS
|
10%, increasing to 50% in patients over 60
|
|
Treatment of SARS
|
anitviral-ribarvin
gluccocorticoid- methylprednisolone |
|
Mycobacterium
|
acid-fast, slow growing bacillus resistant to drying and disinfectants
|
|
How is mycobacterium destroyed?
|
uv light, heat, alcohol, glutaraldehyde, and formaldehyde
|
|
Ghon complexes
|
lesions in the lungs and lymph nodes that cause necrosis
|
|
How long does the immune response in TB last?
|
6-8 weeks
|
|
What is the official name for the TB test called?
|
Mantoux test
|
|
Miliary tuberculosis
|
rapidly progressive form of TB in which multiple granulomas affect large areas of the lungs eventually affecting other tissues
|
|
Secondary/reinfection TB
|
stage of active infection
|
|
Cavitation
|
occurs with formation of a large open area in the lung and erosion into the bronchi and blood vessels
associated with hemoptysis |
|
How is mycobacterium transmitted?
|
oral droplets released from a person with active TB
|
|
Systematic signs and symptoms of primary TB
|
malaise, anorexia, fatigue and weight loss
*afternoon low-grade fever and night sweats develop |
|
First exposure or primary infection is indicated by a positive TB test. What does this mean?
|
no value, produces a false-positive result
|
|
This respiratory disorder is most common in persons with AIDS (not PCP)
|
Histoplasmosis
|
|
The causative agent of Histoplasmosis is found where?
|
fungus found in parasite macrophage
|
|
This test differentiates histoplasmosis from TB
|
skin test
|
|
Treatment for histoplasmosis
|
amphotericin B
|
|
Lung cancer rank in the US
|
3rd most common cancer
*90% related to smoking |
|
Why is metastatic cancer so frequent?
|
because the venous return and lymphatics bring tumor cells from many distant sites in the body to the heart and the the pulmonary circulation
|
|
Most common type of malignant lung tumor
|
bronchiogenic carcinoma from bronchial epithelium
|
|
Which two types of lung cancers are less symptomatic and why?
|
adenocarcinomas and bronchioalveolar cell carcinomas because they are found on the periphery of the lungs
|
|
Adenocarcinomas secrete _______
|
mucin
|
|
This cancer is rapidly growing, invasive and are often located near a major bronchus in the central part of the lung
|
"oat-cell" carcinoma
|
|
First change in the lungs? What is this associated with?
|
metaplasia
smoking and chronic irritation |
|
The prognosis of lung cancer is based on what classification?
|
tumor size-node involvement metastases (TNM) classification
|
|
Common sites of metastases
|
brain, bone, liver
|
|
Disorders common with tumors located on the lung periphery owing to inflammation or erosion of the pleural membrane
|
pleural effusion, hemothroax, pneumothorax
|
|
Besides smoking, what is the other major cause of lung cancer?
|
occupational or industrial exposure to the carcinogens silica, vinyl chloride, or asbestos
|
|
What specifically leads to lung cancer diagnosis?
|
metastatic tumor
|
|
Early signs related to respiratory involvement?
|
-persistent cough, dyspnea, wheezing
-detection on a chest x-ray when pneumonia develops -hemoptysis -pleural involvement -chest pain |
|
Systematic signs of lung cancer
|
-weight loss
-anemia -fatigue |
|
Diagnostic tests for lung cancer
|
-bronchoscopy
-mediatinscopy (lymph nodes) |
|
What is photodynamic therapy?
|
a chemical is injected and migrates to tumor cells where it is activated by laser light and destroys the cancer cells
|
|
Aspiration
|
passage of food or fluid into the lungs.
(usually in the right lower lung) |
|
ball-valve effect
|
air is able to pass down the tract on inspiration but the passageway totally closes on expiration
|
|
Aspiration pneumonia
|
material cause severe inflammation leading to narrow airways and increased secretions, which make the lungs more difficult to expand. Involves inflammation of alveoli.
|
|
Other complications of aspiration?
|
-respiratory distress syndrome
-pulmonary abscess (if microbes are in aspirate) |
|
Cafe coronary
|
combining eating with talking or social events
|
|
Treatment for total obstruction
|
trachectomy
|
|
Asthma
|
involves periodic episodes of severe but reversible bronchial obstruction in persons with hypersensitive or hyperrresponsive airways
|
|
In school children, in what month do asthma attacks most commonly occur?
|
September
|
|
Extrinsic asthma
|
acute episodes triggered by a type 1 hypersensitivity reaction to an inhaled antigen
|
|
Intrinsic asthma
|
onset during adulthood, other stimuli initiating an acute attack
|
|
Which immunglobin reacts with the antigen in intrinsic ashtma?
|
IgE
|
|
Which nerve is stimulated during an asthma attack?
|
vagus nerve
|
|
Partial obstruction
|
small bronchi and bronchioles result in air trapping with hyperinflation of the lungs
|
|
What occurs in partial obstruction?
|
bronchial wall collapses due to forced expiration, residual volume increases as it becomes more difficult to inspire fresh air
|
|
What does total obstruction of the airway lead to?
|
atelectasis or nonaeration of the tissue distal to obstruction. the air diffuses out and is not replaced resulting in collapse of that section of the lung
|
|
What occurs as a result of severe respiratory impairment?
|
-respiratory and metabolic acidosis
-hypoxemia causing vasoconstriciton in the pulmonary blood vessels, reducing blood flow through the lungs and increasing the work load of the RIGHT side of the heart |
|
Pulse paradoxus
|
when the pulse differs on inspiration and expiration
taken during an ashtma attack. a gap of 10 mmHg before sounds of both inspiration and expiration are heard |
|
In asthma, hypoventilation leads to increasing___
|
hypoxemia and respiratory acidosis
|
|
Respiratory failure indicators
|
-decreasing responsiveness
-cyanosis -ABGs measurements indicating PaO2 of below 50mmHg or PaCO2 of above 50 mmHg |
|
Ventolin
|
beta-adrengic agent acts as receptors to relax bronchial smooth muscle
|
|
How are gluccococorticoids effective in asthma?
|
reduces the second stage of inflammation
|
|
Cromolyn sodium
|
prophylactic medication that is administered by inhalation on a regular basis that reduces hyperresponsiveness.
|
|
Chronic obstructive lung disease (COLD)
|
chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction of the airways and lungs
|
|
Examples of restrictive lung diseases? Why are they categorized this way?
|
silicosis, absteosis, and farmer's lung
the irritant causes interstitial inflammation and fibrosis, resulting in loss of compliance and "stiff lung" |
|
COPD leads to _______
|
cor pulmonale- right sided congestive failure due to lung disease
|
|
List the significant change in emphysema. What does this lead to?
|
destruction of the alveolar walls and septae, leading to large inflated alveoar spaces
|
|
A genetic deficiency of alpha-antitrypsin leads to the destruction of the alveoli. What is alpha-antitrypsin?
|
a protein normally present in tissues and body fluids that inhibit proteases (destructive enzymes released by neutrophils during inflammatory response)
|
|
What effect does smoking have on the alveoli?
|
it increases both the number of neutrophils in the alveoli and the release and activity of elatase. (decreases effects of alpha-antitrypsin) contributing to break down of the alveolar structures
|
|
The breakdown of alevolar walls results in:
|
-loss of surface area for gas exchange
-loss of pulmonary capillaries affecting diffusion of gases -loss of elastic fibers (affecting the ability of the lung to recoil on expiration) |
|
What results from chronic irritation and frequent infections associated with smoking and increased mucous production?
|
fibrosis and thickening of the bronchial walls
|
|
What disorder occurs as a result of advanced emphysema?
|
pneumothorax
|
|
Blood vessels are destroyed and hypoxia causes pulmonary vasoconstriction. What two disorders does this scenario lead to?
|
pulmonary hypertension and cor pulmonale
|
|
Increased pressure in the pulmonary circulation increases _____
|
resistance to the right ventricle
|
|
Barrel chest
|
hyperventilation with a prolonged expiratory phase
|
|
Pursed-lip breathing
|
partial closing of the lips that allow for slow expiration
|
|
How is COPD and chronic bronchitis differentiated?
|
significant changes in the bronchi resulting from the constant irritation from smoking or exposure to industrial pollution
|
|
In chronic bronchitis, what two conditions are associated with increased secretions, increased goblet cells secretion and decreased ciliated epithelium
|
hypertrophy and hyperplasia
|
|
"pink puffer"
|
the dyspnea, hyperventilation, and overinflation that maintain the oxygen levels in emphysema
|
|
"blue bloater"
|
low oxygen levels, cyanosis, amd edema in bronchitis
|
|
Signs and symptoms of chronic bronchitis
|
-constant productive cough
-tachypnea -shortness of breath |
|
What disorders specifically develop as vascular damage and pulmonary hypertension increases?
|
secondary polycythemia, severe weight loss, and signs of cor pulmonale (systematic edema)
|
|
Treatment of chronic bronchitis
|
expectorants, bronchodilators, and chest therapy
|
|
Bronchiectasis is a secondary problem of what disorders?
|
cystic fibrosis and COPD
|
|
Bronchiectasis
|
irreversible abnormal dilation or widening, primarily in the medium-sized bronchi
|
|
What does bronchiectasis lead to?
|
obstruction of the airways or weakening of the muscle and elastic fibers in the bronchial wall.
|
|
Effects of bronchiectasis
|
-loss of cilia and metaplasia in the epithelium,
-additional fibrosis -progressive construction |
|
Restrictive lung disorders
|
a group of diseases in which lung expansion is impaired and lung capacity is reduced
|
|
2 groups in restrictive lung disorders
|
-those in which lung disease impairs expansion
-those in which an abnormality of the chest wall limits expansion |
|
Idiopathic pulmonary fibrosis is an example of _____
|
a disease that has an immune basis
|
|
Pneumoconioses
|
chronic restrictive diseases resulting in from long-term exposure to irritating particles such as asbestos.
|
|
What aggravates pneumoconioses? List an example of a job in which penumoconioses is easily contactable?
|
smoking
mining |
|
Asbestos fibers have two additional effects. Name them
|
pleural fibrosis and it increases the risk of lung cancer
|
|
Pulmonary edema
|
fluid collecting in the alveoli and interstitial area
|
|
Effects of pulmonary edema
|
reduces the amount of oxygen diffusing into the blood and interferes with lung expansion, also reducing oxygenation of the blood
|
|
Excess fluid in the alveolar tissue may develop when: (3)
|
-inflammation occurs increasing capillary permeability
-plasma protein levels are low decreasing plasma osmotic pressure -pulmonary hypertension devlops |
|
With excessive amounts of fluid in the interstitial areas and alveoli comes what disorder?
|
hypoxemia
|
|
Left-sided congestive heart failure (in terms of pulmonary edema)
|
backup of blood from the failing left ventricle causes high pressure in the pulmonary circulation
|
|
Name a cause of pulmonary edema
|
pulmonary edema occurs as a result of hypoproteinemia due to kidney and liver disease
|
|
Signs of mild pulmonary edema
|
cough, orthopnea, and rales
|
|
Why is sputum in pulmonary edema blood-tinged and frothy?
|
air is mixed with the secretions- frothy
ruptured capillaries- blood tinged |
|
Name a distinctive sign of pulmonary edema
|
the patient feels as if they are drowing
|
|
What does acute congestive heart failure cause?
|
paroxysmal nocturnal dyspnea during a sleep period
|
|
After an episode of pulmonary edema, the patient is at an increased risk of what disorder? Why?
|
Pneumonia
because of the residual secretions |
|
Pulmonary embolus
|
blood clot or a mass of other material that obstructs the pulmonary artery or a branch of it, blocking blood flow through the lung tissue
|
|
Where do most pulmonary emboi originate from?
|
a leg vein
|
|
In pulmonary embolus, when does death occur?
|
within the first hour following symptoms
|
|
Why doesn't infarction follow obstruction of the pulmonary circulation? In what other circumstances may infarction occur?
|
because the tissue is supplied with oxygen and nutrients by the bronchial circulation
unless the general circulation is compromised or there is prior lung disease |
|
shower
|
multiple small emboli
|
|
What effect does an emboli have on moderate sized arteries?
|
respiratory impairment (because fluid and blood fill the alveoli of the involved area) and reflex vasoconstriction increasing the pressure in the blood vessels
|
|
Effect of large emboli
|
affects the cardiovascular system causing right-sided heart failure and decreased cardiac output (shocks)
|
|
What causes acute cor pulmonale in pulmonary embolus?
|
resistance (increased due to reflex vasoconstriction) to the output from the right ventricle
|
|
Saddle embolus
|
a large embolus lying across the bifurcation of the pulmonary artery
|
|
What two disorders cause pulmonary emboli to travel from the deep veins of the legs
|
thrombophlebitis and phlebothrombosis
|
|
Risk factors of emboli
|
-immobility
-trauma to the legs -childbirth -CHF -dehydration -cancer -increased coagulability of the blood |
|
Treatment of emboli
|
TEDS (thromboembolic) stockings
|
|
Fat emboli from the bone marrow results in ______
|
fracture of a large bone
|
|
Causes and effects of massive emboli
|
-severe crushing chest pain
-low BP -rapid weak pulse -loss of consciousness |
|
How are fat emboli distinguished?
|
development of acute respiratory distress
-a petechial rash on the trunk -neuroligc signs such as confusion or disorentiation |
|
In patients with pulmonary embolus due to thrombus, what treatment is administered?
|
oxygen, and heparin or a fibrinolytic agent to prevent additional clots
|
|
Atelectasis
|
nonaeration or collapse of a lung or part of a lung leading to decreased gas exchange and hypoxia
|
|
What specifically occurs in atelectasis?
|
both ventilation and perfusion are altered, affecting oxygen diffusion
|
|
Obstructive or reabsorption atelectasis
|
total obstruction of the airway due to mucus or tumor leading to diffusion into the tissue of air distal to the obstruction
|
|
Compression atelectasis
|
a mass exerts pressure on a part of the lung and prevents air from entering that sectin of the lung
|
|
Contraction atelctasis
|
fibrotic tissue in the lungs or pleura
|
|
Postoperative atelctasis
|
occurs 24-72 hours following abdominal surgery
-restricted ventilation due to pain -slow shallow respiration due to analgesics -increased secretions due to the supine position -decreased cough effort |
|
Signs and symptoms of small and large atelectasis
|
small areas are asymptomatic
large areas cause dyspnea, increased heart and respiratory rates and chest pain |
|
Effect of compression atelectaisis
|
mediastinum shifts toward other unaffected side
|
|
Pleural effusion
|
the presence of excessive fluid in the pleural cavity
|
|
Pleurisy or pleuritis
|
follows pleural effusion, a condition in which the pleural membranes are inflamed, swollen, and rough often associated with lobar pneumonia
|
|
Effects of pleural effusion
|
large amounts of fluid increase the pressure of the pleural cavity causing separation of the pleural membranes preventing cohesion during inspiration
|
|
What do the effects of pleural effusion lead to?
|
prevents the expansion of the lung, leading to atelectasis
|
|
Exudative effusions
|
response to inflammation in which increased capillary permeability allows fluid containing protein and WBCs to leak into the pleural cavity
|
|
Transudates
|
watery effusions (hydrothorax) that results from increased hydrostatic pressure or osmotic pressure in the blood vessels, leading to a shift of fluid out of the blood vessels into the potential space into the pleural cavity |
|
Hemothorax
|
when fluid is blood, resulting from trauma, cancer or surgery
|
|
Trachel deviation and hypotension indicates ____
|
a massive effusion that interferes with both respiratory and circulatory function
|
|
Pleurisy is manifested by ______
|
cyclic pleuritic plain and friction rub
|
|
Needle aspiration
|
thoracocentesis removes fluid and relieves the pressure after an accumulation of fluid
|
|
List some predisposing conditions of Adult/Acute Respiratory Distress syndrome
|
-prolonged shock (because of ischemic damage in the lung tissue)
-systematic sepsis -burns -aspiration -smoke inhalation |
|
What causes stiffness and decreased compliance in ARDS?
|
hyaline membranes forming from protein-rich fluid in the alveloi and platelet aggregration, and microthrombi in the pulmonary circulation
|
|
Mortality rate of ARDS
|
80-90%
|
|
Acute respriatory failure (ARF)
|
end result of many pulmonary disorders, indicated when PaO2 is greater than 50 mmHg (hypercania) and serum ph is decreasing (less than 7.3)
|
|
Normal valves
|
80-100m Hg for oxygen
35-45mm Hg for CO2 |
|
Respiratory insufficiency
|
an interim state where blood gases are abnormal but cell function can continue
|
|
A primary problem may be complicated by
|
reflex pulmonary vascoconstriction due to hypoxia or acidosis, further impairing lung perfusion and increases cardiac workload
|
|
A chronic condition that leads to respiratory failure
|
emphysema
|
|
Acute respiratory disorders that lead to failure
|
-chest trauma
-pulmonary embolus -acute asthma |
|
Neuromuscular diseases that lead to failure
|
myasthenia gravis
amyotrophic lateral sclerosis muscular dystrophy |