Pathology for Exam 3

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  1. Burns
    Injuries that result from direct contact with or exposure to a thermal, chemical, electrical or radiant source
  2. The severity of the burn injury is related to... (3 things)
    • Source of the energy
    • Temperature of the source
    • Duration of exposure
  3. Any burn injury causes an _________ _________ _______ and a release of ___________ ____________ resulting in a major fluid fluid shift, edema & decreased blood volume.
    • acute inflammatory response
    • Chemical Mediators
  4. 4 Types of Thermal Burns
    • Flames
    • Hot Liquids
    • Steam
    • Semi Solids
  5. 3 Types of Chemical Burns
    • Contact
    • Ingestion
    • Inhalation
  6. 3 Types of Electrical Burns
    • Electric shock from faulty wires
    • Lightening
    • High Voltage Wires
  7. 2 Types of Radiation Burns
    • Exposure to Radioactive Source
    • Sunburn
  8. Where do the majority of burns (which are accidental) happenen?
    At Home
  9. Which age groups are at highest risk for burns?
    • Young Children under 3
    • Senior Adults over 70
  10. What education would be involved with helping parents reduce the risk of burns at home?
    • Decrease water temperature
    • Easy to handle handles at sinks/tubs
    • Adequate supervision near heating sources
    • Reduced clutter near heat sources
    • Don't Smoke
    • Smoke and fire detectors in place
  11. Superficial Partial-Thickness Burn
    -Skin layers involved
    -also called which type
    -how does it heal
    • 1st Degree Burn
    • Involves the epidermis & part of the dermis
    • Little, if any blister formation
    • Usually heals well w/o scar tissue
    • Sunburn or other minor burns (examples)
  12. Deep Partial-Thickness Burn
    -also called which type of burn
    -which skin layers involved
    -how does it look & feel
    -what is necessary w/ large areas?
    • 2nd Degree Burn
    • Involved the epidermis & part of the dermis
    • Blister Formation
    • Painful & swollen
    • Large areas require grafting
    • May result in scarring
    • High risk of infection
  13. Full-Thickness Burn
    -also called which types of burns
    -which body structures are involved
    • 3rd & 4th Degree Burns
    • Destruction of all skin layers & often underlying tissues
    • Appears hard & dry at the surface (eschar)
    • Usually requires significant surgical repairs including skin grafts (may be completed in stages)
    • Many burns are at mixed levels of injury
  14. 2 Methods of Determining the Size of a Burn
    • Rule of Nines
    • Lund-Browder Method
  15. What is the purpose of determining the percentage of a burn?
    --which method of burn size is used to do this initially?
    For treatment purposes-- to know amount of fluid loss and which burn center the patient should be transferred to--Rule of Nines
  16. What is the Rule of Nines and describe how it works
    • Easy & Quick method for calculating the size & extent of burn injuries
    • The body is divided by sections. Each section is considered to be 9% of the body surface area.
    • Used easily by emergency personnel
  17. Lund-Browder Method (LBM)
    Modifies the percentage of the Rule of Nines for more specific calculation (gender, size, age)
  18. 6 Effects of Burn Injury (both local & systemic)
    • Dehydration & Edema
    • Shock
    • Respiratory Problems
    • Pain
    • Infection
    • Increased Metabolic Needs for healing
  19. Shock
    -what sets this apart from other burn injury complications & why?
    -what does this result from?
    -which organ is effected?
    -how are patients treated?
    • Most serious of the systemic effects
    • Results from massive fluid & protein shifts
    • Electrolyte imbalances may lead to kidney dysfunction
    • Patients require fluid and electrolyte replacement as well as plasma infusions
    • Multiple organ system response may result in failure or death
  20. Respiratory Concerns of Burn Injuries (4 bullets)
    • Inhalation of toxic or irritating fumes may interfere with the transport of hemoglobin
    • Damage to the lining or the trachea
    • supplemental O2 for a period of time for healing
    • Lung infections are a significant risk
  21. What is a pharmacological method used to help patients deal with the tremendous pain of burns?
    Medically induced coma (high doses of narcotics to keep patients in a stupor to deal with pain)
  22. Hypermetabolism
    increased metabolic needs
  23. How do burns effect metabolic needs?
    • hypermetabolism to maintain body temperature
    • May need hyperalimentation by infusion
  24. Hyperalimentation
    • Being fed through a feeding tube
    • Used for people who require 10-15,000 calories a day
  25. Treatment for Burn Injuries (systemic & life threatening effects)
    • Fluid Balance
    • Respiratory and airway challenges (breathing machine)--remember how Cargon Monoxide poisening happens
    • Hemodynamics (blood volume)
    • Wound Care
  26. Treatment for Burn Injuries: Surgical procedures involved with the healing of large/deep wounds
    • Removal of non-viable tissue by debridement
    • Covering of wounds by grafting (TransCyte, Integra)
  27. Treatment for Burn Injuries
    -What do we worry about concerning the joints due to burns?
    -What is a concern for burn patients even after their wound has improved?
    Prevention of hypertrophic (thick) scaring and contractures is a critical component of burn recovery and rehabilitation (compression helps tissue grow in a flat manner & exercise to improve ROM)
  28. Basal Cell Carcinoma
    • Skin tumor originating in the epidermis
    • Non-invasive and does not metastisize
    • Very common Especially w/ high sun exposure
    • Most lesions are small & easily excised
    • May recurr locally (not spreading)
    • Mohs' Surgery common to improve appearance & resolve carcinoma
  29. Mohs' Surgery
    • Most common treatment approach for Basal Cell Carcinoma
    • Results in the best cosmetic appearance along w/ resolution of the carcinoma
  30. Squamous Cell Carcinoma
    • Slightly less common than Basal
    • May in insitu (local) or invasive (grow large)
    • Usually seen in the high risk exposure population
    • May have slightly worse cosmetic outcomes due to local invasive process
  31. Squamous Cell Carcinoma
    -what is it
    -where is it found
    • Painless, malignant tumor of the epidermis
    • Lesions most commonly found on exposed areas of the skin, but also in oral cavity. (Face, neck, base of tongue)
    • Excellent prognosis when lesion is removed w/in resonable time
  32. Malignant Melanoma
    • Arises from the melanocytes (melanin in skin--skin color)
    • Arise from nevi (multi-colored, ireegular border)
    • ~5% of cancers (rate increasing)
    • Spreads quickly &insiduously to underlying tissue & adjacent lymphatic
    • More serious than other skin cancer, because it may result in DISTANT METASTASIS)
  33. ABCD of Melanoma
    • Change in APPEARANCE
    • Change in BORDER
    • Change in COLOR
    • Increase in DIAMETER
  34. Risk Factors of Malignant Melanoma
    -What increases the risk (2 things)
    -How can prognosis be improved
    -What are 2 methods of treatment
    • Genetic links to Celtic/Scandinavian ancestry
    • Artificial exposure to UVA
    • Early diagnosis results in improved surgical outcome (may require chemo/radiation depending on lesion depth)
  35. What is the function of the cardiovascular system?
    Coordinate w/ the pulmonary system to circulate oxygenated blood through the arterial system to all cells & also collect deoxygenated blood through the venous system and return it to the lungs for oxygenation.
  36. Where is the heart located?
    • Mediastinum b/t the lungs in pericardial sac (double-layered w/ small amt. of fluid b/t layers)
    • --Fluid subjective to infection & inflammation
  37. What is the actual muscle of the heart called & what are it's 2 important characteristics?
    Myocardium (striated & involuntary)
  38. What divides the atria of the heart
  39. Atrioventricular Valves
    • Separate the atria from the ventricles
    • Right: Tricuspic Valve
    • Left: Mitral/Bicuspid Valve
  40. Semilunar Valves
    • Located at the entry to the large arteries from the ventricles
    • Aortic Valve (systemic)
    • Pulmonary Valve (lungs)
  41. Conduction
    -what is responsible for cardiac contractions
    -what is the rate of contraction & how is it altered?
    • Cardiac contractions are initiated & controlled by the sinoatrial node (SA node) located in the wall of the R. Atrium
    • SA node generates impulses for contraction at ~70 beats/min.
    • --altered by presence of hormones or ANS
  42. Pathway of Conduction
    SA node--> atria contract-->AV node-->AV bundle/bundle of His-->Terminal Purkinje fibers--> ventricles contract
  43. How do we monitor the pattern of conduction?
    Electrocardiogram (EKG or ECG)
  44. What is the control center of the heart?
    • Medulla Oblongata (brain stem in the back of the head)
    • --controls rate & force of contraction
  45. Heart Control (4 things)
    • Cardia Cotrol Center-- Medulla Oblongata
    • Baroreceptors
    • Sympathetic Stimulation (cardiac accelerator nerve)
    • Parasympathetic Stimulation (CN X vagus nerve)
  46. What do Baroreceptors do & where are they located?
    • Detect changes in BP
    • Located in the aorta and internal carotid arteries.
  47. Sympathetic Stimulation
    -which nerve
    -what effect does it have on the heart
    • Cardica Accelerator Nerve
    • Increases HR (tachycardia)
  48. Parasympathetic Stimulation
    -which nerve
    -what effect does it have on the heart
    • CN X Vagus Nerve
    • Decrease HR (bradycardia)
  49. Factors that increase HR (8)
    • Increased thyroid production of epinephrine
    • Increased body temp. (fever)
    • Increased environmental temp. (high humidity)
    • Exertion/Exercise
    • Smoking
    • Stress Response (scary movie)
    • Pregnancy
    • Pain
  50. Coronary Circulation
    -what composes the coronary circulation
    -what does it supply (which organ)
    -what is a risk of valve obstruction?
    • R & L Coronary arteries (branch of the aorta immeidately distal to aortic valve, part of systemic circulation)
    • Many small branches extend from these arteries to supply the myocardium and endocardium
    • Collateral circulation is limited
  51. Divisions of the Left Coronary Artery
    • Left anterior descending/Interventricular artery
    • Left circumflex artery
  52. Divisions of the Right Coronary Artery
    • Right marginal artery
    • Posterior Interventricular artery
  53. Components of the Cardiac Cycle (2 basic things)
    • Diastole: relaxation of myocardium required for filling chambers
    • Systole: Contraction of myocardium provides increase in pressure to eject blood
  54. Path of Cardiac Cycle
    Atria relaxed, filling w/ blood-->AV valves open--blood flows into ventricles--atria contract, remaining blood forced into ventricles-- atria relax-->ventricles contract--AV valves close--> semilunar valves open-- blood into aorta and pulmonary artery-- ventricles relax
  55. Systolic Pressure
    • Exerted when blood is ejected from ventricles (high)
    • Heart is Pumping
  56. Diastolic Pressure
    • Sustained pressure when ventricles relax (lower than systolic)
    • Heart is at rest
  57. How is BP altered
    • Cardiac output
    • Blood Volume
    • Peripheral Resistance to Blood Flow
  58. ECG
    Useful in the initial diagnosis and monitoring of dysrhythmias, myocardia infarction, infection, & pericarditis
  59. Ausculation
    Detection of valvular abnormalities or abnormal shunts of blood that cause murmors
  60. Echocardiography
    used to record teh heart valve movement, blood flow, and cardiac output
  61. Exercise Stress Tests
    • To assess general cardiovascular function
    • --EKG continues while heart is working & in increased demand
  62. Chest x-ray films
    used to show shape and size of the heart (nuclear imaging, tomographic studies)
  63. Cardiac Catheterization
    Measures pressure and assess valve and heart function through femoral artery (invasive)
  64. Angiography
    Visualization of blood flow in the coronary arteries
  65. Arteriorsclerosis
    • General term for all types of arterial changes
    • Degenerative changes in small arteries and arterioles
    • Loss of elasticity
    • Lumen gradually narrows and may become obstructed
    • Cause of increased BP
  66. Atherosclerosis
    • Presence of atheromas in large arteries
    • Plaques consisting of lipids, calcium, and possible clots
    • Related to diet, exercise & stress
  67. Coronary Artery disease
    -2 conditions it consists of
    -what is it caused by
    -why are we so concerned with this disease?
    • Angina Pectoris & Myocardial infarction (insufficient oxygen for metabolic needs of the heart muscle)
    • Leading cause of death in both men and women in the US
    • 1 in 5 deaths result from CAD
    • 13-14 million people in the US are living with some degree of CAD
  68. Angina Pectoris
    • Not enough O2 to meet myocardial needs
    • Chest pain in 3 different pattters (classic/exertional, variant, unstable)
  69. Classic/Exertional Angina Pectoris
    -what is it
    -when does it occur
    -which drugs is used as treatment
    • Occurs when active (running up the stairs)--sudden burst of energy where body cannot produce enough oxygen as what is being used
    • Nitroglycerine (vasodilator used to quickly dilate blood vessels)
  70. Variant Angina
    Vasospasm occurs at rest
  71. Unstable Angina (5 bullets)
    -describe the pain a patient would have
    -describe the occurence of attacks
    -how is it relieved? drug used?
    • Prolonged pain at rest (may precede myocardial infarction)
    • Recurrent, intermittent brief episodes of substernal chest pain
    • Triggered by physical or emotional stress
    • Attacks vary in severity and duration but become more frequent and longer as disease progresses
    • Relieved by rest and administration of coronary vasodilators (nitroglycerine-acts on reduction of systemic resistance, decreasing the demand for oxygen)
  72. Emergency Treatment for Angina
    -non-pharmaceutical & pharmaceutical ways
    -Difference b/t if we know the patient has angina and if they don't have a history of it
    • Rest, stop activity
    • Sit in upright position
    • Administration of nitroglycerine (sublingual)
    • Checking pulse and respiration
    • Administration of oxygen if necessary
    • If patient is known to have angina, take 2nd dose of nitroglycerine
    • If patient doens't have angina history, emergency medical aid
  73. Myocardial Infarction
    -when does it occur
    -with which artery is it associted
    -what is the most common cause
    -what is the less common cause
    -how is damage determined
    • Occurs when Coronary artery is totally obstructed (possibly due to a thrombus)
    • Atherosclerosis is most common cause
    • Vasospasm- small % of causes
    • Size & Location of infarct determine the damage
  74. What are the 5 warning signs of a Heart Attack? (symptoms people notice)
    • Feeling of pressure, heaviness, or burning in chest (especially w/ increased activity)
    • Sudden SOB, waeakness, fatigue
    • Nausea, indegestion
    • Anxiety & fear
    • Pain may occur that is substernal, crushing, radiating
  75. What are the 3 characteristics associated with Pain that could be a warning sign of a heart attack?
    • Substernal
    • Crushing
    • Radiating
  76. How to Detect a Myocardial Infarction
    -diagnostic tests
    -what may be indicative of severe cases?
    -which measurements are helpful in evaluating ventricular function?
    • ECG Changes
    • Serum enzymes & isoenzymes released from necrotic cardiac cells
    • Leukocytosis, elevated CRP & ESR common
    • Arterial blood gas measurements may be altered in severe cases
    • Pulmonary artery pressure measurements helpful in evaluating ventricular function
  77. Most Common Complications of Myocardial Infarction (3)
    • Sudden Death (arrythmias in 1st hr. following MI--cocaine users)
    • Cardiogenic Shock
    • Congestive Heart Failure
  78. What causes Cardiogenic Shock in patients who have had a MI
    Reduced pumping capacity of left ventricle
  79. What causes CHF in patients w/ MI?
    Reduced contractility of ventricles and decreased cardiac output.
  80. What are the more rare complications of MI (2)
    • Rupture of necrotic heart tissue/cardiac tamponade
    • Thromboembolism causing CVA (w/ left ventricular MI)
  81. Treatment for MI (7 bullets)
    -what type of drugs/medications
    -other types of therapy
    • Reduce cardiac demand w/ moderate rest
    • Oxygen Therapy
    • Analgesics
    • Anticoagulants
    • Thrombolytic agents
    • Tissue plasminogen activator
    • Medication to treat dysrhythmias, hypertension, & CHF--cardiac rehabilitation begins immediately
  82. Why isn't bed rest used as a treatment for MI?
    Risk of development of a DVT
  83. What are Cardiac Dysrhythmias (Arrhythmias)?
    • Deviations from normal cardiac rate/rhythm
    • Reduction of the efficiency of the heart's pumping cycle
  84. What may cause the deviations from normal cardicate rate/rhythm of Cardiac Dysrhythmias (arryhthmias)?
    --& how are these deviations detected??
    • Electrolyte abnormalities
    • Fever
    • Hypoxia
    • Stress
    • Infection
    • Drug Toxicity
    • --ECG used to monitor the conductions system to detect abnormalities--
  85. Holter Monitor
    • Portible ECG
    • Warn for 24 hours
    • Used for people w/ arrythmias (people record arrythmias in journal. When it happens, what they were doing ect.)
  86. Sinoatrial Node (SA node)
    -what is it?
    -What are the 3 abnormalities associated w/ it?
    • --PACEMAKER of the heart--
    • Bradycardia (reg. slow HR)
    • Tachycardia (reg. fast HR)
    • Sick Sinus Syndrome: altering bradycardia & tachycardia--often requires mechanical pacemaker
  87. Atrial Conduction Abnormalities (3)
    --These are more common than ventricular--
    • Premature Atrial Contractions/Beats (PAC/PAB)
    • Atrial Flutter
    • Atrial Fibrillation (most common)
  88. Premature Atrial Contractions or beats (PAC/PAB)
    Irritable atrial muscle cells outside conductions pathway leads to extra contraction or ectopic beats
  89. Atrial Flutter
    Atrial Heart rate of 160-350 beats/min (AV node delays conduction, ventricular rate is slower)
  90. Atrial Fibrillation
    • Rate over 350 beats/min
    • Causes pooling of blood in the atria
    • Thrombus formation is a risk
    • Most common type of arrhythmia
    • --Blood pooling/thickening-->Clot formation--> stroke--
  91. Heart Blocks
    -What is it?
    -which part of the heart is affected?
    -name & describe the 3 types
    • Conduction is excessively delayed or sopped at AV node or bundle of His (hence an Atrioventricular node abnormality)
    • First Degree: conduction delay b/t atrial & ventricular contractions
    • Second Degree: Every 2nd to 3rd atrial beat is dropped at AV node
    • Third Degree: No transmission from atria to ventricles
  92. Ventricular Conduction Abnormalities (4)
    -which are most common?
    • Bundle Branch Block
    • Ventricular Tachycardia--common
    • Ventricular Fibrillation
    • Premature Ventricular Contractions (PVC's)--common
  93. Bundle Branch Block
    Interferance w/ conduction in one of the bundle branches
  94. Ventricular Tachycardia
    • Likely to reduce cardiac output as reduced diastole occurs
    • Common
  95. Ventricular Fibrillation
    • Random ventricular contraction
    • Muscle fibers conract independently & rapidly
    • Cardiac standstill occurs if not treated immediately
  96. Premature Ventricular Contractions (PVCs)
    Additional beats from ventricular muscle cell or ectopic pacemaker. May lead to ventricular fibrillation.
  97. Bradycardia (conduction change & effect)
    • Rate regular, <60 beats/min
    • Stroke volume increased, possible reduced cardiac output
  98. Tachycardia (conduction change & effect)
    • Rate reg., fast 100-160 beats/min
    • possible reduced cardiac output
  99. Atrial flutter (conduction change & effect)
    • rate 160-350 beats/min
    • Less filling time, often reduced cardiac output
  100. Fibrillation (conduction change & effect)
    • Rate over 300 beats/min uncoordinated muscle contractions
    • No filling, no output--cardiac standstill
  101. Premature Ventricular Contractions (PVCs) (conduction change & effect)
    • Additional ectopic beats
    • May induce fibrillation
  102. Bundle Branch Block (conduction chage & effect)
    • Deayed conduction in one bundle branch, wide QRS wave
    • No effect
  103. Heart Block 1o (Partial) (conduction change & effect)
    • Delays conduction in AV node, prolongs PR interval
    • No effect
  104. Heart Block 2o (partial) (conduction change & effect)
    • Delays conduction in AV node, gradually increasing PR untill one contraction missed
    • Periodic decrease in output
  105. Total Heart Block (conduction change & effect)
    • No conduction in AV node, ventricles slowly contract independent of atrial contraction
    • Marked decrease in output, causing syncope
  106. How are dysrhythmias treated concerning the SA node or a Total Heart Block?
  107. Treatment of Cardiac Dysrhythmias used for conversion of ventricular fibrillation?
  108. Before treatment of Cardiac Dysrythmias, the _______ must be determined.
  109. Drugs used to treat Cardia Dysrhythmias are called....
    ANTIDYSRHYTHMIC DRUGS (effective in many cases)
  110. What is Cardiac Arrest
    Cessation of all heart activity (no conduction of impulses, flat ECG)
  111. What are some causes of a Cardiac Arrest (7)
    • Excessive vagal nerve stimulation
    • Potassium imbalance
    • Cardiogenic shock
    • Drug Toxicity
    • Insufficient Oxygen
    • Respiratory Arrest
    • Blow to Heart
  112. Congestive Heart Failure (CHF)
    -what is it
    -which side of the heart is affected
    -secondary condition to?
    -downside of compensation mechanisms?
    -is this ACUTE or CHRONIC
    • Heart is unable to pump out sufficient blood to meet metabolic demands of the body (left side of heart is not effectively pumping)
    • Usually a condition secondary to cardiopulmonary dissorder
    • May involve a combo of factors (DUH!)--lung disease or CAD
    • Various compensation mechanisms to maintain cardiac output (may aggravate the condition)
    • CHRONIC DISSORDER--lifelong
  113. Congestive Heart Failure (CHF)
    -effects of decreased cardiac output/stroke volume (4 things)
    • Less blood reaches the various organs (kidneys back up to the heart)
    • Decreased cell function
    • Fatigue & lethargy
    • Mild acidosis develops
  114. Congestive Heart Failure (CHF)
    -Effects of backup and congestion as coronary demands for oxygen and glucose are NOT met
    • Output from ventricle is less than the inflow of blood
    • Congeston in venous circulation draining into the affected side of the heart
  115. Signs & symptoms of CHF
    -Forward effects (3)
    • Decreased blood supply to tissues, general hypoxia
    • Fatigue & weakness
    • Dyspnea and SOB
  116. Signs & Symptoms of CHF
    -Compensation mechanisms (3)
    • Tachycardia
    • Cutaneous & visceral vasocontriction
    • Daytime oliguria
  117. Signs & Symptoms of CHF
    -Backup effects of left-sided Failure
    • Related to pulmonary congestion
    • Dyspnea and orthopnea (develops as fluid accumulates in the lungs)
    • Cough (fluid irritating respiratory passages)
    • Paroxymal Nocturnal Dyspnea (acute pulmonary edema, develops during sleep, Excess fluid leads to infections like pneumonia)
  118. Signs & Symptoms of CHF
    -Backup effects of right-sided failure & systemic backup
    • Dependent edema in feet, legs, or buttocks
    • Increased pressure in jugular veins--> distention
    • Hepatomegaly and splenomegaly (digestive disturbances)
    • Ascites: distended abdomen from fluid accumulation in peritoneal cavity
    • Acute Right-sided Failure: Flushed face, distended neck veins, headache, visual disturbances
  119. CHF causes (right vs left sided)
    • Left: aortic valve stenosis, hypertension, hyperthyroidism
    • Right: Pulmonary valve stenosis, pulmonary disease
  120. Basic effects of CHF (left vs. right sided)
    • Left: decreased cardiac output, pulmonary congestion
    • Right: Decreased cardiac output, systemic congestion and edema of legs and abdomen
  121. Signs & Symptoms--Forward Effects (decreased output) of CHF (L vs. R sided)
    BOTH: Fatigue, weakness, dyspnea, exercise intolerance, cold intolerance
  122. Signs & Symptoms--Compensations of CHF (L vs. R sided)
    BOTH: Tachycardia and pallor, secondary polycythermia, daytime oliguria
  123. Signs & Symptoms of CHF--back up effects (L vs. R sided)
    • Left: Orthopnea, cough, SOB, paroxsmal nocturnal dyspnea, hemoptysis, rales
    • Right: Dependent edema in feet, hepatomegaly and splenomegaly, ascites, distended neck eins, headache, flushed face
  124. How would you recognize if a child had CHF
    -secondary to which disease?
    -what's the 1st sign?
    (5 others)
    • Secondary to heart disease
    • First sign--often feeding difficulties (failure to gain weight or meet developmental guidelines)
    • Short sleep periods
    • Tripod postion to play
    • Cough, rapid grunting respirations, flared nostrils, wheezing
    • Radiographs show cardiomegaly
    • Arterial blood gases used to measure hypoxia
  125. Congenital Heart Defects (2 types)
    --may be ___________ or ___________ depending on direction of shunting.
    • Cardiac Anomalies: Structural defects in the heart that develop during the first 8 weeks of embryonic life
    • Congenital Heart Disease: Valvular Defects, Septal defects, Detected by the pressence of Heart Murmurs, If untreated, child may develop heart failure
    • May be cyanotic or acyotic depending on direction of shunting
  126. Signs & Symptoms of Congenital Heart Defects (7)
    • Pallor
    • Tachycardia: very rapid sleeping pulse & frequent pulse deficit
    • Dyspnea on Exertion
    • Squatting Position to modify blood flow (more comfortable)
    • Clubbed Fingers
    • Intolerance for exercise and exposure to cold weather
    • Delayed growth and development
  127. When are Severe Congenital Heart Defects usually diagnosed?
    At birth, others may not be detected for some time
  128. Examination Tequniques for Congenital Heart Defects (5)
    • Radiography
    • Diagnostic Imaging
    • Cardiac Catherization
    • Echocardiogram
    • ECG
  129. Treatment for Congenital Heart Defects? (1)
    Surgical Repair
  130. Ventricular Septal Defect (VSD)
    • Most common congenital heart defect
    • Opening in the interventricular septum (may vary in size & location)
  131. What happens if a VSD is untreated? (3 bullets)
    • Pressure usually higher in the left ventricle
    • Shunt from left --> right
    • Blood pools in the right ventricle
  132. Valvular Defects
    -which valves are most commonly affected?
    -how is it classified?
    --abnormally enlarged & floppy valve leaflets<--what is this?
    -how are they repaired?
    • Most commonly affect aortic and pulmonary valves
    • Classified as Stenosis or Valvular Incompetence (failure of valve to close completely, blood regurgitates or leaks backwards)
    • Mitral Valve Prolapse: Abnomally enlarged and floppy valve leaflets
    • Surgical Replacement: Mechanical or animal (porcine) tissue
  133. Valvular Defects are most common in which 2 valves?
    Aortic & Pulmonary Valves
  134. Valvular Defects may be classified as Stenosis or Valvular Incompetence, which is...?
    • Failure of valve to close completely
    • Blood regurgitates or leaks backward
  135. Mitral Valve Prolapse
    • Abnormally enlarged and floppy leaflets
    • 10% of population are asymptomatic (many times discovered during pregnancy
  136. How are Valvular Defects treated??
    Surgical Replacement: Mechanical or animal (porcine) tissue
  137. Tetralogy of Fallot (8 bullets)
    -which type of shunt is this & what does that mean?
    -what else does this include besides the heart?
    -what changes about the aorta?
    • Most common cyanotic (R-->L Shunt) Congenital heart Condition
    • Cyanosis occurs because shunt bypasses pulmonary circulation
    • Alters pressures w/in heart and alters blood flow
    • Includes 4 Abnormalities
    • Involves heart as well as joints
    • VSD
    • Dextraposition of the aorta
    • Right Ventricular Hypertrophy
  138. What are the 4 Abnormalities associated with Tetralogy
    • Involves heart as well as joints
    • VSD
    • Dextraposition of the aorta
    • Right Ventricular Hypertrophy
  139. Arterial Diseases: HYPERTENSION
    • High Blood Pressure (common, may occur in any age group, more common in individuals of African ancestry)
    • Classified as systolic or diastolic
    • Primary, Secondary or Malignant/resistant Hypertension
  140. Primary Hypertension
    • Essential hypertension
    • Blood pressure consistently above 140/90 (may be adjusted for age)
    • Over long period of time: damage to arterial walls (decreased blood supply to area, ischemia & necrosis of tissues w/ loss of function)
  141. Secondary Hypertension
    • Results from renal or endocrine disease, pheochromocytoma (benign tumor of the adrenal medulla)--arteries narrowed
    • Underlying problem must be treated to reduce blood pressure
  142. Malignant/Resistant Hypertension (3 bullets)
    • Uncontrollable, severe, and rapidly progressive form w/ many complications
    • Diastolic pressure is extremely high
    • Cause of Death in surgery Patients
  143. Peripheral Vascular Disease: ATHEROSCLEROSIS
    -what is it?
    -what increases the incidence?
    • Disease in arteries outside the heart
    • Incrased incidence w/ diabetes
  144. Most common sites of Atherosclerosis (3)
    • Abdominal Aorta
    • Carotid Arteries
    • Femoral and Iliac arteries
  145. Diagnostic Tests for Atherosclerosis (2)
    • Blood flow assessed by Doppler studies and arteriography
    • Plethysmography measures the size of limbs and blood volume in organs or tissues
  146. Areas most frequently damaged by hypertension (4)
    --at risk for uncontrolled high BP
    • Kidneys
    • Heart
    • Brain
    • Retina
  147. Predisposing Factors for Hypertension (5 bullets)
    • Incidence increases w/ age
    • Men affected more frequently & severely
    • Incidence in women increases after middle age
    • Genetic factors
    • Sodium intake, excessive alcohol intake, obesity, smoking, prolonged or recurrent stress
  148. In early Stages, Hypertension is ___________. (has to do with symptoms)
    • Initial signs vague and non-specific (fatigue, malaise, sometimes morning occipital headache)
  149. Steps of Treating Essential Hypertension (5)
    • Lifestyle Change
    • Reduction of Sodium intake
    • Weight reduction
    • Reduction of Stress
    • Drugs (diuretics, ACE inhibitors, drug combinations)
  150. What is the Function of the Respiratory Tract?
    Provide the mechanisms necessary for transporting oxygen and for removing carbon dioxide from the blood
  151. The function of the Respiratory System Requires what 2 things?
    • Ventilation: The ability to move air in and out of the lungs on a pressure gradient
    • Respiration: The gas exchange that supplies oxygen and removes CO2
  152. Name the structures of the UPPER respiratory Tract (5)
    • Nasal Cavities
    • Sinuses
    • Pharynx
    • Tonsils
    • Larynx
  153. Name the Structures of the Lower Respiratory Tract (4)
    • Trachea
    • Bronchi & Bronchioles
    • Alveoli
  154. What is the function of the UPPER AIRWAY? (6 bullets)
    -what does it do to the incoming air
    -what part removes irritants from the air
    -what provides additional protection
    -Function of the larynx & trachea
    • Warm & Moisten incoming air
    • Cilia remove foreign irritants from air
    • Tonsils and other lymphoid tissues provide additional protection
    • Epiglottis protects the respiratory structures from aspiration of food
    • Larynx: Vocal Cords that vibrate with the expiration of air producing the sound of voice
    • Trachea: Windpipe that is composed of smooth muscle and elastic tissue that is supported by C-Shaped rings of cartilage
  155. Lower Respiratory Tract (Bronchial Tree) -6 bullets
    • Trachea branches into:
    • right and left Bronchi
    • Secondary Bronchi
    • Bronchioles
    • Alveolar Ducts
    • Alveoli (lined by simple squamous epithelium and surfactant to reduce surface tension and maintain inflation)--end point for inspired air, site of gas exchange
  156. Alveolar Sacs are lined with ___________ that reduces the surface tesnion and allows inspiration to occur w/o lungs collapsing
  157. Ventilation
    • Process of inspiration and expiration: airflow depends on pressure gradient (Boyle's Law)-air moves from high to low pressure along pressure gradient
    • Atmoshperic Pressure higher than pressure in alveoli: Inspiration- air moves from atmosphere into lungs
    • Pressure in Alveoli high than in atmosphere: Expiration- air moves from lungs into atmosphere
  158. Boyle's Law
    Air always moves from high pressure area to low presure area (depends of pressure gradient)
  159. When the atmospheric pressure is high tahn pressure in the alveoli ________ during which, what happens??
    Inspiration: air moves from atmosphere into lungs
  160. When the pressure in the alveoli is high than in the atmosphere _________ occurs. During which, what happens?
    Expiration: Air moves from the lungs into the atmosphere
  161. What are the 3 Pulmonary Volumes?
    • Tidal Volume: amount of air exchanged w/ quiet inspiration and expiration
    • Residual Volume: Volume of air remaining in lungs after max. respiration (important in some pathologies)
    • Vital Capacity: Max. amt. of air that can be moved in and out of the lungs with a single forced inspiration and expiration (pathologies and muskuloskeletal impacts vital copacity)
  162. Tidal Volume
    Amount of air exchanged with quiet inspiration and expiration
  163. Residual Volume
    • Volume of air remaining in lungs after max. Respiration
    • Important in some pathologies
  164. Vital Capacity
    • Maximal amount of air that can be moved in and out of the lungs with a single forced inspiration and expiration
    • Pathologies & Musculoskeletal Impacts Vital Capacity
  165. Control of Ventilation
    -where are the primary centers for breathing located?
    In the MEDULLA & PONS
  166. Chemoreceptors
    -what do they detect
    -what are the 2 types
    • Detect changes in CO2 levels, hydrogen ions, and oxygen in blood or cerebrospinal fluid (CSF)
    • Central & peripheral Chemoreceptors
  167. Where are Central Chemoreceptors located?
    In the medulla
  168. Where are Peripheral Chemoreceptors Located?
    In the Carotid Bodies
  169. What is the overall control of respiration dependent upon?
    The rise and fall of the pressure of PO2 and PCO2
  170. What happens to respiration rates when the pressure of PCO2 rises?
    Respiration rates increase, allowing the rapid reduction of CO2 in the blood stream
  171. Gas Exchange
    -what is it (b/t what & what)
    -what does it depend on?
    -how do gases move in a mixture? (Dalton's Law)
    • Flow of gases b/t the alveolar air and the blood (external respiration)
    • Gas Exchange Depends on the relative concentrations (partial pressures) of the gases (PO2 & PCO2)
    • Each Gas in a mixture moves along its partial pressure gradient, independent of other gases (Dalton's Law).
  172. PO2
    Partial Pressure of Oxygen
  173. PCO2
    Partial Pressure of Carbon Dioxide
  174. Factors affecting Diffusion of Gases
    • Partial Pressure Gradient
    • Thickness of the respiratory membrane: Fluid accumulation in alveoli or interstitial tissue impairs gas exchange
    • Total surface area available for diffusion: If part of alveolar wall is destroyed , surface area is reduced (less exchange)
    • Ventilation-Perfusion Ratio: Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange
  175. Explain the Ventilation-Perfusion Ratio
    - what is most effective?
    Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange
  176. Transport of Oxygen
    -how much O2 is dissolved in plasma
    -most bound to what??
    -what is this binding depended on?
    • About 1% of oxygen is dissolved in plasma
    • Most is bound (reversibly) to hemoglobin
    • Binding/ release of oxygen to hemoglobin depends on PO2, PCO2, temperature, plasma pH
  177. Transport of CO2
    -CO2 is a waste product of what?
    -How much is dissolved in plasma
    -How much is bound to hemoglobin
    -most diffuses into _____.
    • Waste product from cellular metabolism
    • About 7% dissolved in plasma
    • About 20% reversibly bound to hemoglobin
    • Most diffuses into RBCs
  178. Signs and Symptoms of Pulmonary disease (9)
    • Persistant Cough
    • Dyspnea
    • Chest Pain
    • Cyanosis
    • Clubbing
    • Alteration in Arterial Blood Gases (ABGs)
    • Altered Breathing Patterns
    • Breathing Patterns and Characteristics
    • Breath Sounds
  179. Signs and Symptoms of Pulmonary Disease
    • Accompanied by secretions or blood
    • Thick secretions often indicate infection
    • Dark colored Sputum may be a sign of pneumonia
  180. Signs and Symptoms of Pulmonary Disease
    -what is it
    -what are some physical changes that would be noticed?
    • a subjective feeling of discomfort reported when a person feels unable to breath enough air
    • Flaring of the nares
    • Muscle retraction at the ribs and accessory muscle action in the neck or sholders
    • Orthopnea: dificulty breathing when lying down
  181. Signs and Symptoms of Pulmonary Disease
    --CHEST PAIN--
    -what type of pain is it?
    May radiate throughout the thorax (NOT a significant sign)
  182. Signs and Symptoms of Pulmonary Disease
    Bluish color of skin and membranes (lips)
  183. Signs and Symptoms of Pulmonary Disease
    -what is it
    -what does it indicate?
    • Widening and thickening of the terminal digits of the fingers
    • --Frequent sign of long standing and chronic lung disease--
    • Hump on the nail= endstage
  184. Signs and Symptoms of Pulmonary Disease
    --Alterations in Arterial Blood Gases (ABG's)--3 things associated w/ hypoxia
    • Hypoxia: low or inadequate levels of oxygen=
    • 1) decrease in hemoglobin available for binding
    • 2) Cardiac disease that results in impaired circulation
    • 3) Impaired Ventilation
  185. Signs & Symptoms of Pulmonary Disease
    --Altered Breathing Patterns--
    Many causes including those of NEUROMUSCULAR or MUSCULOSKELETAL Etiology
  186. Signs & Symptoms of Pulmonary Disease
    • Labored Respiration or prolonged inspirations or expiration: often associated with OBSTRUCTION of airways
    • Wheezing or Whistle Sounds: Indicate obstruction in SMALL airways
    • Stridor: High-Pitched crowing noise. Usually indiates upper airway obstruction
  187. Stridor Indicates...
    Upper airway obstruction
  188. Wheezing or Whistling Sounds Indicates...
    Obstruction in small airways
  189. Labored Respiration or prolonged inspiration or expirations is associated with
    Obstruction of airways
  190. Signs & Symptoms of Pulmonary Disease
    --BREATH SOUNDS-- (3)
    • Rales: Light bubbly or crackling sounds with serous secretions (Fluid in Lungs)
    • Rhonchi: Deeper or harsher sounds from thicker mucus (COPD)
    • Absence: Noaeration or collapse of lungs
  191. Rales
    • Light bubbly or crackling sounds w/ serous secretions
    • May indicate fluid in the lungs
  192. Rhonchi
    • Deep/harsh sounds from thick mucus
    • May indicate COPD
  193. Upper Respiratory Tract Infections (4)
    • Common Cold (Infectious Rhinitis)
    • Sinusitis
    • Laryngotracheobronchitis (croup)
    • Influenza (viral Infection)
  194. Upper Respiratory Tract Infection
    --Common Cold (Infectious Rhinitis)--
    -which type of infection is it
    -how many causative agents
    -how is it prevented
    • Viral Infection
    • More than 100 possible causative agents
    • Spread through respiratory droplets
    • Hand washing and respiratory hygiene imprtant in prevention
    • Symptomatic treatment
    • Secondary bacterial infections may occur (usually caused by streptococci, purulent exudate, systemic signs, i.e. fever)
  195. Upper Respiratory Tract Infections
    -what kind of infection
    -which type of medicine used to treat what symptoms
    • Usually bacterial Infection
    • Analgesics for heacache and pain
    • Course of antibiotics often required to eradicate infection
  196. Upper Respiratory Tract Infections
    -which type of infection
    -who get it most commonly
    -2 common causative organisms
    -one more bullet
    • Common Viral Infection, Particularly in children
    • Common causative organism: Parainfluenza viruses & Adenoviruses
    • Infection usually self-limited
  197. Upper Respiratory Tract Infections
    which type of infection
    -name the 3 groups, which is most common?
    -some symptoms
    -what is a common secondary infection? this could cause what?
    • Viral Infection (fever & cough)
    • Three Groups ( Type A-most prevalent, Type B & Type C) constantly mutating
    • Sudden, acute onset w/ fever, marked fatigue, aching pain in body
    • May cause viral pneumonia
    • Mild case of influenza may be complicated by secondary bacterial pneumonia
    • commonly, deaths in flu epidemics result from pneumonia
  198. How is Influenza Treated? (2 bullets)
    • Symptomatic and Supportive (unless bacterial infection develops secondarily
    • Antiviral Drugs (w/in 12 hours) may reduce symptoms and duration and risk of spreading to others
  199. Prevention of Influenza (2 things)
    • Respiratory Hygiene
    • Vaccination is recommended for most individuals
  200. Lower Respiratory Tract Infections (4)
    • Pneumonia based on causative agent
    • Legionnaire's Disease
    • SARS (Sever Acute Respiratory Syndrome)
    • Tuberculosis
  201. Lower Respiratory Tract Infections
    -how is it classified? (4 ways)
    • Causative agent (viral, bacterial, fungal)
    • Anatomic location of Infection (through out both lungs or just 1 lobe)
    • Pathophysiologic Changes (changes in interstitial tissue, alveolar septae, or alveoli)
    • Epidemiologic Data: Nosocomial (hospital-aquired), Community-aquired
  202. Lower Respiratory Tract Infections
    -what is it caused by? (which pathogen)
    -where does this pathogen thrive
    -what is required to diagnos this
    -complications if left untreated (4 things)
    • Caused by Leionella Pneumonophilia ( thrives in warm, moist environments... often nosocomial infection)
    • dificult to Identify, requires special culture medium
    • Untreated Infections cause severe congestion and consolidation, necrosis in the lung, possibly fatal
  203. Lower Respiratory Tract Infections
    --Sever Acute Respiratory Syndrome--
    -what is the causative agent
    -which type of transmission
    -what are the first signs
    -what are the later signs
    • Emerging Infection
    • Acute Respirator Infection
    • Causative microbe SARS- associated coronavirus
    • Transmission by respiratory droplets--close contact
    • First Signs: Fever, headache, myalgia, chills, anorexia, possibly diarrea
    • Later Signs: Effect on lungs evident: dry cough, marked dyspnea; areas of interstitial congestion, hypoxia, mechanical ventilation may be required
  204. How is SARS Treated? (2 things)
    • Antivirals, glucocorticoids
    • High fatality rate
  205. Prevention of SARS and how it's spread (4 bullets)
    • Risk Factors (monitored to prevent outbreaks)
    • Travel to areas where endemic or epidemic or Contact w/ such traveler
    • Presence of a cluster of undiagnosed atypical pneumonia cases
    • Employment involving close contact with the virus (active cases quratines until clear of infection)
  206. Lower Respiratory Tract Infections
    -what are the 3 types?
    • Primary Infection
    • Secondary or Re-Infection
    • Active TB (either primary or secondary)
  207. Tuberculosis: PRIMARY Infection
    -what happens when the organism first enters the lungs?
    -what happens if cell-mediated immunity is inadequate?
    • When organism first enters the lungs
    • Engulfed by macrophages=local inflammation
    • If cell-mediated immunity is inadequate: Mycobactyeria reproduce and begin to destroy lung tissue
    • This form of disease is CONTAGIOUS!
  208. Tuberculosis: If Cell Mediated Immunity IS adequate in PRIMARY Infection
    • Some bacilli migrate to lymph nodes-granuloma-formation of tubercle (contains live bacilli)-walled off and calcifying
    • Tubercle may be visible on chest rediograph
    • Bacilli may remain viable in a dormant stage for years
    • Individual's resistance and immune resposes high-bacilli remain walled off
    • Primary or latent infection: Individual has been exposed, infected, but does not have disease and is asymptomatic
    • Individual cannot transmit disease
  209. Tuberculosis: SECONDARY or Re-Infection
    -when does it occur
    -what impairs immunity
    • Occurs when client's cell-mediated immunity is imapired due to stress, malnutrition, HIV infection, Age
    • Mycobacteria begin to reproduce and infect lung
    • Active TB, which can be spread to others
  210. Active TB (primary or secondary)-4 bullets
    • Organisms multiply, forming large areas of necrosis: causes large open areas in lung (cavitation)
    • Cavitation promotes spreading into other parts of the lung: Infection may spread into pleural cavity
    • Cough, positive sputum, radiograph showing cavitation
    • Disease in this form is highly infectious when there is close personal contact over a period of time.
  211. What is cavitation? (associated w/ active TB)
    -what does it promote?
    • Large, open areas in lung
    • Promotes spreading into other parts of the lung (infection may spread to pleural cavity)
  212. Diagnostic Tests for Tuberculosis (2)
    • First exposure or primary Infection: indicated by positive tuberculin (skin) test results
    • Active Infections: Acid-fast sputum test, chest radiograph, sputum culture & sensitivity
  213. Diagnostic Tests for Tuberculosis: First Exposure or Primary Infection
    Indicated by positive tuberculin (skin) test results
  214. Diagnostic Tests for Tuberculosis: Active Infections (3 types)
    • Acid-fast sputum test
    • Chest readiograph
    • Sputum Culture & Sensitivity
  215. Tereatment for Tuberculosis (3 bullets)
    Long-term treatment
    how long does the treatment last
    what increases effectiveness of treatment (2 things)
    • Long-Term Treatment: combination of drugs
    • Length or treatment varies from 6 months to a year
    • Effective treatment requires monitoring and follow-up and is expensive
  216. Why is TB becoming an increasingly serious problem? (4 things)
    • Homelessness & crowding in shelter
    • HIV infection
    • Lack of health care
    • Multi-drug Resistant TB
  217. List the Obstructive Lung Diseases
    • Cystic Fibrosis
    • Lung Cancer
    • Obstructive Sleep Apnea
    • Asthma
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Emphysema
    • Chronic Bronchitis
  218. Cystic Fibrosis (3 bullets)
    • Inherited (genetic ) disorder: Gene Located in chromosome VII
    • Tenacious mucus from exocrine glands
    • Primary effects seen in lungs & pancreas
  219. Cystic Fibrosis: LUNGS (3 bullets)
    -how are the lungs affected
    -which pathogens cause infections here?
    • Mucus obstructs airflow in bronchioles and small bronchi
    • permanent damage to bronchial walls
    • Infections are common (caused by P. aeruginosa & S. aureus)
  220. Cystic Fibrosis: DIGESTIVE TRACT effects (4 things)
    • Meconium ileus in newborns
    • Blockage of pancreatic ducts
    • Obstruction of bile ducts
    • Salivary glands often mildly affected
  221. Cystic Fibrosis: REPRODUCTIVE TRACT
    male & female-- 1 each
    • Obstruction of vas deferens (male)
    • Obstruction of cervix (female)
  222. Cystic Fibrosis: SWEAT GLANDS
    Sweat with high sodium choloride content
  223. Cystic Fibrosis: SIGNS & SYMPTOMS (5 bullets)
    • Meconium ileus may occur at birth
    • Salty skin may lead to seat test and diagnosis of cystic fibrosis
    • Signs of malabsorption (steatorrhea, abdominal distention)
    • Chronic cough and frequent respiratory infections (tend to increase over time)
    • Failure to meet normal growth milestones
  224. cystic Fibrosis
    -How is it DIAGNOSED? (5 ways)
    • Genetic testing
    • Sweat test
    • Testing of stool
    • Radiographs, pulmonary function tests
    • blood gas analysis
  225. Cystic Fibrosis: TREATMENT
    Interdisciplinary Approach: replacement therapy and well-balanced diet, chest physiotherapy
  226. Lung Cancer (__% of cases are related to smoking?)
    -what are the 4 types?
    • About 90% of cases are related to smoking
    • Bronchogenic Carcinoma
    • Squamous cell Carcinoma
    • Adenocarcinomas & Bronchoalveolar Cell Carcinomas
  227. Lung Cancer: Bronchogenic Carcinoma
    • Most common type of primary malignant lung tumor
    • Arising from bronchial epithelium
  228. Lung Cancer: Squamous Cell Carcinoma
    Usually develops from epithelial lining of a bronchus
  229. Lung Cancer: Adenocarcinomas & Bronchoalveolar Cell Carcinomas
    Usually found on periphery of lung
  230. What are the effects of a Lung Tumor associated w/ lung cancer?
    • Obstruction of airflow into a bronchus: causes abnormal breath sounds and dyspnea
    • Inflammation and bleeding surrounding the tumor: cough, hemoptysis, and secondary infections
    • Pleural effusion, hemothorax, pneumothorax
    • Paraneoplastic syndrome: when tumor cell secretes hormones or hormone like substances
    • Usual systemic effects of cancer
  231. Lung Cancer: Paraneoplastic Syndrome
    When a tumor cell secretes hormones or hormone-like substances
  232. Early Signs of Lung Cancer (10)
    --if detected early, prognosis is pretty good--
    • Persistent productive cough
    • Detection on radiograph
    • Hemoptysis
    • Pleural Involvement
    • Chest pain
    • Hoarseness, facial or arm edema, heachache, dysphagia, or atelectasis
  233. Systemic Signs of Lung Cancer (3)-basic
    • Weight loss
    • Anemia
    • Fatigue
  234. Paraneoplastic Syndrome (2)
    • Indicated by signs of an endocrine dissorder
    • Related to the specific hormone secreted
  235. Signs of Metastases of Lung Cancer
    (3 things)
    • Bone Pain
    • Cognitive deficits, motor deficits
  236. diagnostic Tests of Lung Cancer (4)
    • Specialized CT scans & MRI
    • Chest Radiographs
    • Bronchoscopy
    • Biopsy
  237. Treatment of Lung Cancer (4 things)
    • Surgical resection or lobectomy
    • Chemotherapy and radiation
  238. Obstuctive Sleep Apnea
    -what is it
    -who is affected
    -what are 2 predisposing factors
    • Result of pharyngeal tissue collapse during sleep leads to repeated and momentary cessation of breathing
    • Men are more often affected than women
    • Obesity and aging are common predisposing factors
  239. Treatment for Obstructive Sleep Apnea (2 things)
    • Continuous positive airway pump (CPAP machine)
    • Oral appliances that reduce collapse of pharyngeal tissue
  240. Asthma (3 bullets)
    --who does this affect (what is different about their airways & which age groups)
    -which 2 things may influence occurence?
    • Bronchial Obstruction (in persons w/ hypersentive or hyperresponsive airways)
    • May occur in childhood or have an adult onset
    • Often family history or allergic conditions
  241. What are the 2 types of Asthma?
    • Extrinsic: Acute episodes triggered by type I hypersensitivity reactions-- allergic to something
    • Intrinsic: Onset during adulthood, hyperresponsive tissue in airways initiates attack (something inside of you is responding)
  242. 4 stimuli Associated with Intrinsic asthma
    • Respiratory infections; stress
    • Exposure to cold, inhalation of irritants
    • Exercise
    • Drugs
  243. Pathophysiologic changes of bronchi & brionchioles associated w/ Asthma (3 things)
    -what problems do these changes create?
    • Inflammation of the mucosa w/ edema
    • Broncioconstriction due to contraction of smooth muscle
    • Increased secretion of thick mucus in airways
    • Changes create obstructed airways, partially or totally
  244. Signs & Symptoms of Asthma (5 basic bullets, 2 other things)
    • Cough, marked dyspnea, tight feeling in chest
    • Wheezing (heard through stethoscope)
    • Rapid & labored breathing (increased respiratory rate)
    • Expulsion of thick or sticky mucus
    • Tachycardia
    • Hypoxia
    • Severe respiratory distress (Hypoventilation leads to hypoxemia & respiratory acidosis)
    • Respiratory Failure: indicated by decreasing responsiveness, cyanosis
  245. Asthma: Acute Episode
    --STATUS ASTHMATICUS-- 5 bullets
    • Persistent severe attack of asthma
    • Does not respond to usual therapy
    • Medical EMERGENCY!!
    • May be FATAL due to severe hypoxia and acidosis
  246. Treatment for Asthma (GENERAL MEASURES)
    -5 bullets
    • Skin test for allergic reactions
    • Avoidance of triggering factors
    • Good ventilation of environment
    • Swimming & walking (self-paces exercises improve aerobic cpacity)
    • Use of maintenance inhalers or drugs (small doses of steroids to maintain airway)
  247. Treatment of Asthma (ACUTE ATTACKS)-3
    • Controlled breathing techniques
    • Inhalers (bronchiodilators)
    • Glucocorticoids
  248. Common Asthma Medications (3)
    • Advair (inhaler)
    • Singulair (pill)
    • Pneumonex
  249. Advair
    • prevents the release of substances in the body that cause inflammation
    • Relaxes muscles in the airway to improve breathing
    • Used for asthma attacks, COPD, chronic bronchitis, & emphesema
  250. Singulair
    • Chewable tablet taken by mouth to prevent difficulty breathing, chest tightness, wheezing and coughing caused by asthma.
    • Also prevents bronchospasm during exercise, seasonal & perennial allergic rhinitis (sneezing, stuffy, itchy, runny nose)
  251. Chronic Obstructive Pulmonary Disease (COPD)
    (4 things)
    -what does it cause
    -how does it affect a person
    -what do we worry about happening (something very severe)
    • Group of chronic respiratory disorders
    • Causes irreversible and progressive damage to lungs
    • Debilitating conditions that may affect individual's ability to work
    • Respiratory failure may occur
  252. 2 types of COPD
    Emphysema & Chronic Bronchitis
  253. COPD: Emphysema
    -what is it?
    -what does it lead to?
    -how is it classified?
    • Destruction of alveolar walls and septae--> leads to large, permanentl inflated alveolar air spaces
    • Classified by specific location of changes
  254. Contributing Factors to Emphysema (4)
    • Genetic deficiency
    • Genetic tendency
    • Cigarette smoking
    • Pathogenic bacteria
  255. Emphysema: Breakdown of alveolar wall results in... (5)
    -these all lead to....? (1)
    • Loss of surface area for gas exchange
    • Loss of pulmonary capillaries
    • Loss of elastic fibers
    • Altered ventilation- perfusion ratio
    • Decreased support for other structures
  256. Emphysema
    • Narrowed airways
    • Weakened walls
    • Interference w/ passive expiratory airflow
  257. Emphysema (4 bullets)
    --Progressive difficulty w expiration--
    -what are some physical changes that contibute to difficulty?
    • Air trapping and increased residual volume
    • Over inflation of the lungs
    • Fixation of ribs in a respiratory position, increased anterior-posterior diameter of thorax (barrel chest)
    • Flattened diaphgragm (on radiographs)
  258. Signs & Symptoms of Emphysema (4 bullets)
    • Dyspnea: occurs first on exertion
    • Hyperventilation w/ prolonged expiratory phase: Development of "barrell chest"
    • Anorexia and faigue (weight loss)
    • Clubbed fingers
  259. Diagnostic Tests of Emphysema (1)
    Chest radiograph and pulmonary function tests
  260. Tretment for Emphysema
    • Avoidance of respiratory irritants
    • Immunization against influenza and pneumonia
    • Pulmonary rehabilitation
    • Appropriate breathing techniques
    • Adequate nutrition and hydration (improves evergy levels, resistance to infection
    • Bronchodilators, antibiotics, oxygen therapy as condition advances
Card Set:
Pathology for Exam 3

Burns, Skin Cancer, Heart & Heart Diseases, Upper & Lower Respiratory Tract Infections,
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