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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 shit 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