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What is Atrial Septal Defect? What direction is the shunt?
An opening between the right and left atria
Causes a left to right shunt that can be reversable
Well tolerated but leads to to PHTN
What is the most common congenital heart defect?
Ventricular Septal Defect
What is VSD? What direction is the shunt?
Ventricular septal defect; an opening between the left and right ventricle.
Causes a left to right shunt with frequent reversal
Leads to progressive PHTN and is mroe likely to need surgical correction
Why is it serious when the shunt reverses with a VSD?
Because deoxygenated blood is sent out the aorta which leads to hypoxia.
What is Patent Ductus Arteriosis? What direction is the shunt?
A connection between the pulmonary a. and the aorta
A left to right shunt (aorta to pulmonary) which doesn't reverse
Leads to PHTN and requires surgical correction
Oxygenated blood mixes with deoxygenated blood
(T or F) All defects can lead to congestive heart failure.
All defects can lead to CHF
What is CHF?
Congestive heart failure; heart is unable to eject all the blood delivered to it
What can cause l. heart failure?
Ischemic heart disease
What can cause r. heart failure?
L. heart failure
L. to r. shunts
What are 3 compensatory mechanisms for CHF?
- Increased SNS activity (positive inotropic affect; epinephrine)
- Increased HR
- Hypertrophy of myocardium
What happens if the compensation for CHF isn't enough?
Increased EDV which causes the heart to dilate
What is Frank-Starling's Law?
When the ventricles dilate, m. fibers intially contract forcibly to increase CO
If dilation continues contractions becomes weaker progressively decreasing CO
How does compensated CHF relate to Frank - Starling's Law?
Mild vent. dilation lead to forcible contraction and increased CO
How does Decompensated CHF relate to Frank - Starling's Law?
Greatly increased EDV (leading to ventricle dilation) leads to weaker contractions and decreased CO
Where does blood back up during l. heart failure?
From the l. vent to the l. atrium to the lungs
What is PHTN?
Pulmonary hypertension; increase in hydrostatic pressure of pulmonary vessels
What is pulmonary edema?
Leakage of fluid in the interstitial spaces of the pulmonary vessels (and eventually into the alveoli)
What are common results of l. heart failure?
R. heart failure
What is the most common cause of r. heart failure?
L. heart failure
What are common results of r. heart failure?
Soft tissue edema
What are clinical signs of r. heart failure?
Distended neck veins
Splenomegaly leading to ascites (stomach edema)
DVT and PE
How does CHF affect the kidneys?
Decompensated CHF leads to decreased renal perfusion
Renin-angiotensin cycle activate, water is retained
Heart unable to pump increased fluid volume leads to venous pooling
What should the first treatment be to protect the kidneys from CHF?
Describe the bronchial tree
Trachea: C- shaped cartilage
Bronchi: Transition from cartilage to smooth m.
Bronchioles: no cartilage, all smooth m.
Alveoli: exchange surface closely associated w/ capillaries
What is the major function of the lungs?
Excrete carbon dioxide while obtaining oxygen
Where does diffusion between blood and air occur?
Describe intrathoracic pressure during inspiration
The diaphragm moves down while the ribs move up and out
Chest volume increases while pressure inside the chest decreases
Air moves into the chest
Describe intrathoracic pressure during expiration
Diaphragm moves up and ribs move down and in
Chest volume decreases, pressure inside the chest increases
Air moves out of the chest
What is dyspnea?
Difficulty breathing (SOB)
What is orthopnea?
Difficulty breathing while laying down
What is exertional dyspnea?
Difficulty breathing while excercising
What is hypoventilation?
Inadequate alveolar ventilation in relation to metabolic demands
What is hyperventilation?
Alveolar ventilation exceeds metabolic demands
Cough's can be either _____ or non - ______.
Coughing can either be productive (wet) or non-productive (dry).
What are the 2 types of productive coughing?
Purulent sputum: infection
Non-purulent: nonspecific irritation
What are the 2 types of cough medicines?
Expectorants (productive coughs)
Suppressants (Non-prodcuctive; can lead to pneumonia if used with productive cough)
What is cyanosis?
Bluish skin discoloration caused by increased unoxygenated hemoglobin
Tx with supplemental oxygen
What is hemoptysis?
Coughing up bloody/bloody secretions
Coughed blood: high pH, bright red
Thrown up blood: low pH, dark red
WHat are 3 mechanisms of pulmonary edema?
L. heart failure
Inflammation of alveoli
Blockage of lymphatic vessel
What is pleural effusion? What are the 2 types?
Fluid in pleural space
Transudate (hydrothorax, serous effusion): fluid w/ little fluid; yellowish; low specific gravity
Exudate: high protein; cloudy; high specific gravity
What are the 3 types of exudates in pleural effusion?
Hemothorax (serosanguinous; blood)
Chlyothorax (Chyle; lymph fluid)
What is atelectasis?
Loss of lung volume due to inadequate expansion of airspaces
Results in poorly oxygenated blood
What are the common symptoms of resp. disease?
What are the different types of atelectasis?
What is resoption atelectasis?
Occurs when an obstruction prevents air from reaching distal airways
Air already present gradually becomes absorbed
Tumor, foreign body,mucous plug
What is compression atelectasis?
Occurs w. accumulation of fluid, blood, or air in pleural cavity
Pleural effusion (fluid), pneumothorax (air)
What is pneumothorax?
Presences of air/gas in pleural space
What are the 3 types of pneumothorax?
Tension: increased pressure
Open: pressure equal with outside environment (e.g. stab wound)
Iatrogenic: occurs with open chest surgery
What is microatelectasis?
Generalized loss of lung expansion
Neonatal resp. distress syndrome
What is contraction atelectasis?
Occurs with fibrotic changes (wound healing) in the lung/pleura and make expansion difficult
What is aspiration?
Passage of fluid and/or solid particles into the lung.
Where to particles typically lodge with aspiration?
Lower lobe of r. lung if upright.
What are some predispositions for aspiration?
Impaired swallowing mechanism
Impaired cough reflex
Alt. level of consciousness
What are the different types of aspiration?
Large food particles
Acidic gastric fluid
What is the complication associated with aspiration?
What are 4 different chest wall restrictions?
Skeletal disorders (kyphoscoliosis)
Neuromuscular disease ( myasthenia gravis, muscular dystrophy, spinal cord trauma)