Patho/Pharm II - Respiratory

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Patho/Pharm II - Respiratory
2012-09-04 18:12:46
Patho Pharm II Test

Patho/Pharm II - Test 1--- Respiratory
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  1. Dyspnea
    Subjective sensation of breathlessness
  2. Tachypnea
    Increased respiratory rate
  3. Orthopnea
    Dyspnea while lying flat
  4. PND
    • Paroxysmal "attack or spasm"
    • Nocturnal "PM"
    • Dyspnea "SOB"
    • = Wake up at night with dyspnea
  5. Apnea
    the cessation of breathing
  6. Abnormal Breathing patterns
    • 1. Kussmaul Respirations
    • 2. Obstructed Breathing
    • 3. Restrictive Breathing
    • 4. Cheyne-Stokes Respirations
    • 5. Hypoventilation 
    • 6. Hyperventilation
  7. Slightly increased ventilatory rate, very large effortlest Vt
    Kussmaul Respirations
  8. Slow ventilatory rate, large Vt, increased effort
    Obstructed Breathing
  9. Caused by disorders that stiffen the lungs
  10. Restrictive Breathing
  11. Alternating patterns of deep and shallow breathing and apnea
    Cheyne-Stokes Respirations
  12. Inadequate alveolar ventilation in relation to metabolic demands
    • Hypoventilation
    • **Increased Co2, metabolic acidosis
  13. Alveolar ventilation that exceeds metabolic demands.
    • Hyperventilation
    • ** decreased CO2, metabolic alkalosis
  14. Define cough

    What does the effectiveness depend on?
    • An explosive expiration that cleanses the lower airways
    • The effectiveness depends on the depth of the inspiration and the degree to which the airways narrow which increases the velocity of expiratory gas.
  15. Abnormal Sputum could be signs of...
    Infection, inflammation, or cancer.
  16. Hemoptysis
    Coughing up of bright red blood. 
  17. Cyanosis
    Bluish discoloration of the skin caused by decreased oxygenation of blood. Usually a late symptom.
  18. Clubbing
    • The painless, selective enlargement of distal segement of the digits (ie fingertips)
    • Caused by chronic disease of the heart or lungs.
  19. What is the most common type of pain caused by pulmonary disorders?
    Pleural pain

    *Infection and inflammation cause pleura to stretch during inspiration causing pain
  20. Pain in the chest wall is usually due to ____ _____.
    excessive coughing
  21. Define hypoxemia. 
    • Inadequate oxygenation of blood caused by 
  22. List the 5 causes of hypoxemia
    • 1. Decreased oxygen inspiration - suffocation, high altitude
    • 2. Hypoventilation- decreased LOC
    • 3. Diffusion abnormalities- edema, fibrosis, emphysema
    • 4. Abnormal ventialtion/perfusion rates- Most common asthma, bronchitis, pneumonia
    • 5. Pulmonary right to left shunts- ARDS, atelectasis
  23. Hypercapnia
    • Increased carbon dioxide
    • CO2>45
    • leads to respiratory acidosis pH<7.35
  24. Pulmonary Edema
    • accumulation of fluid in the lungs
    • **Classic symptom= pink, frothy sputum
  25. Aspiration
    Passage osolid particles into the lung

    -Right lung is more susceptible.
  26. Ateclectasis
    • Collapse of the lung. 
    • O2<50 , CO2>45
  27. Bronchiectasis
    dilation and loss of elasticity of the walls of bronchi from chronic inflammation and degeneration
  28. Bronchiolitis
    • An inflammatory obstruction of the small airways or bronchioles.   
    • Common in children. Treated with antibiotics and steroids.
  29. Abscess Formation and Cavitation
    • Lung Abscess: pus-filled cavity in the lung surrounded by inflammed tissue and caused by an infection. 
    • Usually abscesses rupture into an airway, producing a lot of sputum that gets coughed up. A ruptured abscess leaves a cavity in the lung that is filled with fluid and air.
    • Staph or Klebsiella common causes of infection.
  30. Chest Wall Restriction
    Work of breathing is increased and ventilation is compromised if the chest wall is deformed, immobilized, or made heavy by fat. 
  31. Flail Chest
    Multiple rib fractures cause the ribs to be unstable leading to paradoxical movement on inspirationa and expiration. 

    paradoxical movement= part of chest goes out while other goes in. 
  32. List 3 commonly encountered toxic gases...
    • 1. smoke
    • 2. ammonia
    • 3. hydrogen chloride
  33. Pneumothorax
    • Presence of air in the pleural space.
    • Makes it difficult for lungs to expand properly
  34. Open Pneumothorax
    Allows air to enter and exit the pleural space through penetration of the chest wall.
  35. Closed Pnuemothorax
    • Air enters and exits the pleural space without penetration of the chest wall. 
    • 1. Spontaneous: emphysema, pneumonia
    • 2. Traumatic: fractured rib
    • 3. Iatrogenic: accidently induced by a physician/medical procedure-- chest Sx, mechanical ventilation
  36. Tension Pneumothorax
    • Air leaks into the pleural space, but cannot escape. 
    • Causes the affected lung to collapse ->mediastinal shift-> unaffected lung collapse-> severe respiratory and CV distress and death.
  37. Hemothorax
    Presence of blood in the pleural space.
  38. Pleural Effusion
    Presence of fluid in the pleural space. 

    usually a secondary problem
  39. Empyema
    • Presence of infected fluid in pleural space. 
    • - uncommon but serious disorder occurs mostly in debilitated pt
  40. Pleurisy
    • Inflammation of the pleura. 
    • characterized by sudden onset, painful and difficult respiration, and exudation of fluid or fibrinous material into the pleural cavity—called also pleuritis
  41. Interstitial Lung Disorders
    1. aka ___ or ____
    2. produce varying amounts of..... ___, ___, ___
    3. cause lungs to become... ___ & ___
    • 1. fibrotic or restrictive
    • 2. inflammation, fibroids (scars), and disability
    • 3. stiff and non-compliant
  42. What are the two types of Occupational Lung Disorders
    • 1. Pneumoconiosis - inhalation of inorganic materials like asbestosis, coal, talocosis, silicosis
    • 2. Hypersensitivity- inhalation of organic dusts 
    •          - Farmer's Lung: moldy hay
    •          - Pigeon breeder's lung: birds
  43. 3 patterns of lung dysfunction that the interstitial lung disorders share..
    • 1. diminished lung volume
    • 2. reduced diffusing capacity
    • 3. varying degrees of hypoxemia
  44. Treatment of interstitial lung disorders include....
    • 1. Identifying and removing the injurious agent
    • 2. Suppress the inflammatory response
    • 3. Preventing progression
    • 4. Providing supportive Tx for pt with advance disease
  45. Pulmonary Fibrosis
    • Excessive amount of fibrous or connective tissue in the lung. 
    • (Excessive Scar tissue in the lung)
  46. Sarcoidosis
    • Tiny grain-like bumps form (granulomas), clump together to form larger lumps that can attack other organs.
    • T-lymphocyte alteration is thought to contribute.
  47. ARF = 
    - Signs
    - ABGs

    • Acute Respiratory Failure = inadequate gas exchange
    • - Signs = increased respiratory rate, use of accessory muscles, flushed face, Dyspnea, late sign is cyanosis, hypotension
    • - ABGs= pH<7.30 , pO2<50, pCO2>50
  48. ARDS
    Acute Respiratory Distress Syndrome = a form of pulmonary insufficiency that develops in the aftermath of a shock or shock-like state. Life-threatening. 

    increase in permeability of lungs leading to lungs that are wet, heavy, congested, hemorrhagic and stiff.
  49. Clinical symptoms of ARDS
    • Early symptoms mistaken as Stress!
    • -Change in LOC, Dyspnea, Hypotension- late
    • -Tachycardia, Tachypnea
    • -Fever
    • -Cough
    • As syndrome progresses so will symptoms- labored breathing, cyanosis, grunting resp.
  50. Treatment of ARDS
    • ◦Treat the Hypoxia
    • ◦Monitoring Parameters
    • ◦Drug Therapy
    • ◦Fluid Management
    • ◦Psychosocial Support
  51. Of all the Precipitating Factors for ARDS which are the highest correlators?
    • ◦Sepsis
    • ◦Aspiration
    • ◦Multiple blood transfusions
    • ◦Bone Fx
    • ◦Prolonged hypotension
    • ◦Burns
    • ◦Pancreatitis
    • ◦Pneumonia
    • ◦Pulmonary Contusion
  52. What is the best treatment for ARDS?
    • PREVENTION of atelectasis
    • TCDB, early amb., etc. 
  53. What are some ways you can prevent atelectasis?
    • -T C DB
    • -Early Ambulation 
    • -Changes in position
    • -Elevate HOB
  54. What three lung diseases are grouped as COPD and what is COPD characterized by? 
    • Chronic Obstructive Pulmonary Disease
    • 1. Emphysema
    • 2. Bronchitis
    • 3. Asthma - more acute but can be chronic

  55. Primary cause of COPD
  56. Emphysema
    • a condition characterized by air-filled expansions in interstitial or subcutaneous tissues
    • Tx= thin secretions, oxygen and bronchodialators
  57. Bronchitis
    • Hypersecretion of mucous and chronic productive cough. 
    • - Usually leads to emphysema
  58. Asthma
    • abnormal respoviveness of the air passages to a certain substance.
    • there are widespread narrowing of smaller airways in attacks that end spontaneously or with treatment.
    • ** there is a genetic tendency to developing asthma
  59. Sleep Apnea
    • =cessation of air flow during sleep for a period of 10 seconds or longer. 
    • (occurs 30 or more times over 7 hours of sleep)
  60. Obstructive Apnea
    • -caused by obstruction of upper airway
    • -common in obesity, middle aged men
    • - "Pickwickian syndrome": named after charles dickens book
  61. Central Apnea
    • cessation of respiratory drive so there is no movement of chest or abdomen
    • causes= encephalitis, brain stem infarction, polio
  62. Mixed Apnea
    mixture of central and obstructive apnea
  63. Cystic Fibrosis
    • = dysfunction of endocrine system to produce abnormally thick secretions of mucous
    • -Genetic
    • -Glands most effected = resp, pancreatic, sweat
    • - Can Dx prenatally through sweat test
  64. Pneumonia
    an acute, inflammatory infection of the lungs caused by bacteria, virus, fungi, protozoa or parasites
  65. Who is at risk of developing pneumonia?
    elderly, immunocompromised, alcoholics, smokers, decreased LOC, malnurished, immobilized, people with preexisting lung diseases
  66. What are the routes organisms use to enter the lungs?
    • 1. Aspiration - infected sneeze, cough, talk = airborn droplets
    • 2. Contaminated respiratory equipment
    • 3. Bacteria in blood spread to lungs
  67. What is the most common type of bacterial pneumonia?
    • Streptococcus pneumonia
    • accounts for 90% of all bacterial pneumonias
    • vaccine available
  68. What is the most common type of viral pneumonia?
    • Viral pneumonia influenza (Type A)
    • predisposes the patient to bacterial pneumonia
  69. Which type of pneumonia are school age children most likely to acquire?
    Mycoplasma pneumonia
  70. Which type of fatal pneumonia are AIDS patient most likely to develop?
    Pneumocystis Carcinii Pneumonia (PCP)
  71. Legionnaires Disease
    • = a serious type of bacterial pneumonia
    • Widely found in H2O. Discovered in 1976.

    • •Highest risk: chronic disease or impaired immune system
    • •Prognosis= 20-30% mortality rate in previously healthy individuals. Can be as high as 80% in immunosuppresed individuals
  72. TB
    Tuberculosis= A chronic infectious pulm./exo pulm disease that affects the lungs and can invade other body systems like kidneys, bones and lymph nodes
  73. How is active TB diagnosed?
    positive skin test (may also be positive with dormant TB), a sputum culture and a chest x-ray
  74. How might dormant TB become reactivated?
    • immune impaired through...
    • 1. poor nutrition
    • 2. diabetes
    • 3. steroid use
    • 4. chemotherapy
  75. How is TB transmitted?
    airborne droplets
  76. Treatment for TB
    • • Isolation precautions for active TB = private, negative pressure rooms 
    • •Antibiotic therapy to control active or dormant bacteria and prevent transmission. Drugs depend on the
    • individual, bacteria and the presence of the active disease. 
    • •In the past a combination of 2 drugs has been sufficient today combinations of 4
    • drugs may be used: INH, Rifampin, Pyrazinamide and either Streptomycin or Ethambutal.
  77. Clincal manifestations of TB include: 
    • - fatigue, lethargy
    • - weight loss, anorexia
    • - low grade fever in afternoon
    • - night sweats
  78. Pulmonary Embolism
    = Obstruction of pulmonary artery by a thrombus (DVT) that becomes dislodged and carried to lung
  79. Predisposing factors for developing PE
    • 1. venostasis-prolonged bedrest
    • 2. venous injury -surgery or fracture
    • 3. increased blood coaguability
    • 4. Disease- CHF, lung, MI
  80. BEST treatment of PE?
    and other ways to treat
    • - analgesic, bronchodilator, antibiotic, oxygen, sedative, bedrest
  81. What is Virchow's triad
    3 factors leading to thrombosis - stasis, hypercoaguability, intimal changes (injury or change in vessel)
  82. What are the risk factors of developing lung cancer?
    • -Smoking = LEAD
    • - evvironmental and occupational hazards
    • - family history
    • - reccurring pulm. inflam
    • - vitamin A deficiency
  83. NSCLC
    Best prognosis!
    metastisizes slow
    Squamous Cell Carcinoma
  84. "Oat Cell carcinoma" 
    -Strongest correalation to smoking
    -Grows rapidly, early and widely
    -Worst prognosis
    Small cell carcinoma
  85. NSCLC accts for 30-35%
    - arises from glands
    - weakest correalation to smoking
    - slow and unpredictable
  86. NSCLC accts for 10-15%
    -Grow to distort trachea and cause carina to widen
    -surgical treatment is limited
    Large Cell Carcinoma