Cardio Exam 1

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Cardio Exam 1
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  1. Disablement Model
    -Pathology/pathophysiology (disease, disorder,or condition) in the following systems ( cardiovascular, multiple systems)

    -Impairments in the following categories ( circulation, ventilation and respiration/gas exchange)

    -Functional limitations in the ability to perform actions,tasks, and activities in the following categories (self care, home management)

    -Disability – the inability or the restricted ability toperform actions, tasks, or activities within theindividual’s sociocultural context – in the following categories ( self-care, home management)
  2. Lobes of lungs
    3 right ( upper, middle, lower)

    2 left (upper, lower)- lingual

    lower lobe is most of posterior view
  3. nose
    air enters and filters

    warms it, humidify it
  4. pharynx
    musculomembraneous tube

    • 3 parts:
    • -nasopharynx
    • -oropharynx
    • -laryngopharynx
  5. larynx
    cartilaginous framework 

    composed of the thyroid, cricoid,and the epiglottis cartilages

    Extends anteriorly from thelaryngopharynx between thegreat vessels of the neckdownward to the trachea
  6. trachea
    Tube about 4 inches long and aninch in diameter consisting ofcartilaginous rings
  7. carina
    Point of bifurcation into right andleft mainstem bronchi

    "Y-shaped" split
  8. Bronchi
    the right mainstembronchi is most direct–

    Right is wider andshorter than the leftmainstem bronchi.
  9. alveoli
    where the actualexchange of gases (O2and CO2) occurs
  10. Ribs
    – True Ribs (1-8)

    – False Ribs (9-10)

    – Floating  Ribs (11-12)
  11. 2 main categories of pulmonary pathophysiology
    obstructive dysfunction

    restrictive dysfunction

    number of diseases can be both
  12. Obstructive dysfunction
    If the flow of air is impeded, the defect is obstructive

    bronchi, tracheae,bronchus, etc.cold, bronchitis
  13. Restrictive dysfunction
    If the volume of air or gas is reduced, the defect is restrictive 

    gas exchange
  14. Restrictive Lung Disease
    Restriction of the lung parenchyma (lung tissue) characterized by stiffness or reducedcompliance

    Reduced lung volume

    abnormal pulmonary ventilation

    • dec. chest wall compliance
    • dec. lung volumes
    • incr. respiratory rate
  15. Classic Clinical Manifestationsof RLD
    • Hallmark symptoms include:
    • – Dyspnea – shortness of breath
    • – Wasted, emaciated appearance
    • Pulmonary fibrosis is most commonly associated with RLD

    V/Q ratio is low

    • Cough, usually dry-sounding and nonproductive
    • Tachypnea – fast rate of breathing

    Hypoxemia


    Corpulmonale- right sided heart failure
  16. Abnormalities in Fetal LungDevelopment
    • Respiratory Distress Syndrome (RDS) orhyaline membrane disease (HMD)
    • – a disorder of prematurity or lack of complete lung maturity.
    • Infants of less than 36 weeks gestation often exhibit  ( surfactant - developed at 36 weeks- keeps alvelois open- not from collapsing)

    Ventilatory dependent infants can alsodevelop RLD. ( higher risk for developing fibrotic lungs if on ventilators too long)
  17. Pleural effusions
    accumulation of fluidwithin the pleural space

    in lung lining
  18. Pulmonary edema
    an increase in theamount of fluid within the lung. First the fluidis in the interstitium, then the alveoli

    in lung tissue
  19. Pulmonary emboli
    severe back/upper thoracic pain
  20. PT Treatment of RLD
    • Bronchial hygiene techniques
    • – Breathing exercises
    • – Coughing techniques
    • – Respiratory muscle training
    • – Chest mobility,
    • posture exercises
    • – Exercise training
  21. Chronic obstructive lung diseases
    obstruction to airflow

    This affects both the mechanical function and gas exchangingcapability of the lungs.- poor difussion
  22. Physical symptoms characteristic of COPD include
    • Chronic, productive cough–
    • Wheezing (expiratory sound)
    • – Dyspnea on exertion (DOE)

    cilia are dying
  23. Important markers for COPD
    expiratory flow rates ( FEV1)- increase

     residual volume (RV)- increase
  24. Pathological changes seen in most COPD
    • Increased mucus production (or impairment of mucusclearance)
    • – Inflammation of the mucosal lining of the bronchi andbronchioles
    • – Changes decrease the size of bronchial lumen and increaseresistance to airflow.
    • – Loss of normal elastic recoil of lung tissue
    • – Tendency of bronchial walls to collapse and trap air
    • – Over time, entire lung becomes hyper-inflated.
  25. Chronic Bronchitis
    • Long-term irritation of lining of the tracheobronchial tree
    • -Inflammation of the lining
    • – Hypersecretion of mucous and destruction of cilia
    • Chronic productive cough.
    • – Smoke irritation of airways produces bronchoconstriction.
    • – Hypoxia _ pulmonary vasoconstriction _ increased pulmonarypressures _ increased workload of RV _RV hypertrophy (RVH)
  26. Emphysema
    • • Repeated inflammation ofthe bronchial tubes or airpassages
    • • edema, inflammation, andbronchial dilation
    • • destruction of respiratorybronchioles and alveolarwalls
    • • bronchiolar collapse duringexpiration.

    increased airway resistance and decreased lung elastic recoil

    decreased elastic recoil of lungs
  27. Clinical manifestations of emphysema
    • Dyspnea
    • • Cough
    • • Diminished nutritionalstatus,
    • weight loss
    • • Possible spontaneouspursed-lip breathing
    • • Distant breath sounds, especially at bases
    • • Prolonged expiration
    • • Possible end expiratory wheeze, especially on forcedexpiration.
    • • Later: signs and symptoms of cor pulmonale
    • • “pink puffers” due to increased work of breathing tomaintain relatively normal ABGs.
  28. Asthma
    • Increased airwayresistance
    • • increased WOB
    • • increased V/Qmismatching
    • • Possibility of respiratorymuscle fatigue
    • • respiratory failure
  29. Cystic fibrosis (CF)
    The most common lethal genetic disease in children

    • Characterized by exocrine gland dysfunction
    • – involving almost every body system
    • – thick, excessive secretions
    • – abnormal ciliary function
    • – GI (pancreatic enzyme deficiency)
    • – integumentary (increased secretion of highly ionized sweat) systems
    • – poor growth and weight gain

    develop chronic obstructive lung disease
  30. Bronchopulmonary Dysplasia
    A chronic lung disease of infancy- destroy lung tissue b/c air being forced into lungs on ventilator is too fast and too strong

    oxygen dependency lasting beyond 1 month of age
  31. pneumonia
    • Obstructive-Restrictive disorder
    • • Inflammation of the lungparenchyma
    • • Caused by– Bacteria– Viruses– Damage to the lungs (rare)
    • • Creates an immune response
  32. Bronchiectasis
    • Bronchial obstruction
    • • bronchial dilationwith inflammation
    • • increasedintrathoracicpressure required to
    • over come increased resistance
    • • dilation of airway
    • • eventual atelectasis ( alveolar collapse)

    • increased hypoxia
    • prolonged bronchial obstruction
  33. with moderate to severe COPD

    x-ray will show
    • – widening intercostal spaces
    • – flattening of the diaphragm,
    • – squared off costophrenic angles
    • – rib angles that approach 90 degree angles
  34. MRI
    Indications:– individuals with abnormal chest x-rays shownodule or mass

    May show: an enhanced picture of the massprior to surgical resection or biopsy.

    May help to distinguish between a fibrosisand nodule.
  35. Bronchography
    study of abnormal variationsin anatomy, or grosspathological changes in thebronchial wall and lumen

    indications:evaluation of congenitalanomalies, bronchiectasis
  36. Bronchoscopy
    inspectionof the interior of thetracheobronchial treethrough a bronchoscope
  37. ABG 

    Inverse relationship between PaCO2 and pH
    PaC02 decreases- Respiratory Alkalosis


    PaC02 increases- Respiratory Acidosis
  38. ABG

    direct relationship between HCO3 and pH
    metabolic involvement
  39. Tracheal Deviation
    • Tracheas shifts away from affected side
    • Pneumothorax (fluid/air in part of lung)• Tumor• Pleural Effusion


    • Toward the affected side:
    • • Atelectasis (collapse lung)
  40. Pharmacokinetics
    • Absorption
    • – Distribution
    • – Metabolism
    • – Elimination
  41. Pharmacodynamics
    • mechanism of action
    • drug concentraion

    drug effect- cellular, systemic
  42. Median effective dose
    50% of the populationresponds in the expectedway
  43. Median Toxic dose
    dose where 50% of thepopulation exhibit toxiceffects
  44. Dose response curves
    Range of effectiveness– Potency
  45. Bronchoconstriction process
    Within the (ANS), there aretwo nucleotides associatedwith smooth muscle tone - cAMP, cGMP
  46. cAMP
    – responsible for smooth musclerelaxation or bronchodilation

    – as well as inhibition of mastcell
  47. cGMP
    – increase in cGMP causes smooth muscle contraction or bronchoconstriction

    – the release of histamines andother mediators may also beenhanced by increasing cGMPbronchoconstriction
  48. Adganergic receptors
    • Beta 1- heart
    • Beta 2- lungs, if stimulated increase cAMP- increase bronchodilation
    • Alpha- if stimulated- decrease cAMP and inc cGMP- increase brochoconstricion
  49. Stimulation of alpha receptors
    causes contraction of bronchial smooth muscle and the myocardium
  50. Stimulation of beta 1
    receptors stimulatecardiac tissue
  51. Stimulation beta 2 receptors
    cause relaxation of bronchial smooth muscle
  52. Bronchodilator Therapy Drugs
    • – have no alpha-receptor activity
    • – more specific beta 2 receptor activity

    both are sympathomymemtic- mimic sympatheticnervous system
  53. Beta 2-specific agents
    • – produce bronchiolardilation by relaxing bronchial smooth muscle
    • – dilating effects of increased cAMP levels.

    both are sympathomymemtic- mimic sympatheticnervous system
  54. Bronchodilators
    • Medication is inhaled
    • increases the diameter of the lumen of a bronchus
    • side effects are less severe

    • Positive effects on exercise:
    • -Bronchodilation, increased strength of diaphragm, decreased dyspnea, improved exercise tolerance, improved ventilation

    • Negative effects on exercise:
    • -Tachycardia, chest pain, palpitations

    improves quality of life not survival rate
  55. Anticholinergics
    • Bronchodilator
    • Competitive inhibition of muscarinic cholinergic receptors
    • Blocks acetylcholine at parasympathetic sites in bronchial smooth muscle
    • May block reflex bronchoconstriction
    • Side Effects: headache, nervousness, nausea, dry mouth, cough, nasal dryness
  56. Sympathomimetics
    Drugs that stimulate the sympathetic receptors

    • Response varies depending on
    • -the intensity of the receptor reaction, the route of administration, the dosage 

    Epinephrine and ephedrine- stimulates alpha, beta 1 and beta 2 receptors
  57. Beta 2 agonists
    Mediate bronchodilation & vasodilation

    Bronchodilation of smooth muscle of the airways

    Increases cAMP- results in smooth muscle relaxation, mast cell stabilization
  58. Alpha sympatholytics
    Reduce vasoconstriction and bronchoconstriction

    Inhibit the decrease of cAMP
  59. parasympatholytics
    work to inhibit parasympathetic stimulation-preventing an increase in cGMP, thus producing an increase in cAMP

    Bronchodilation
  60. Bronchodilators- LABD
    act by suppressing the immune system

    More for preventive measures

    No effect for immediate relief of asthma attack
  61. Methylzanthines
    • LABD
    • Intracellular level of cAMP enhanced by inhibiting its degradation process
    • Blocks inactivation of cAMP
    • Inhibits prostaglandins, adenosine receptor blockade
    • Enhances of endogenous catecholamine levels
    • Inhibit cGMP and enhancement
    • Improved diaphragmatic contractility & ↓ diaphragmatic fatigue
  62. Glucocorticoids (corticosteroids)
    • SABD
    • Mechanism of Action (Hypothesized)-Suppresses the process of IgE-mediated bronchoconstriction- Blocks or inhibit many mediator substances.

    Considered the drug of choice during an acute attack

    methyprednisolone-usually administered intravenously-severe episodes

    Oral (prednisone) or inhaled route- prolonged used, fewer side effects
  63. Leukotriene Inhibitors - LABD
    Leukotriene: strong inflammatory mediators

    • induce bronchoconstriction
    • increase airway hyper-responsiveness
    • cause smooth muscle hypertrophy
    • mucus hypersecretion
    • influx of eosinophils into airway tissues

    inhibition of the action of leukotrienes

    • taken orally and are combined with other drugs
    • Side effects: hepatic impairment, headaches, fatigue, nausea, and vomiting
  64. Decongestants
    • Reduce edema and discharge in upper respiratory tract
    • Stimulate vasoconstriction
    • Positive effects on exercise
    • Allow for increased respiratory ability
    • Negative effects on exercise
    • Hypertension, palpitations
  65. Antihistamines
    • Treat allergic responses caused by seasonal allergies
    • Decrease mucosal congestion, irritation and discharge
    • Positive effects on exercise
    • Improved air flow to and from the lungs
    • Negative effects on exercise
    • Fatigue, loss of coordination
  66. Antitussives
    • Decrease ineffective, hacking cough
    • -blocks receptors in the brain that control cough
    • Positive effects on exercise
    • -Allow for breathing with decreased irritation, therefore and increased ability to exercise
    • Negative effects on exercise
    • -Decreased motivation for physical activity
  67. Mucoactive
    Increase movement and removal of lung secretions

    • Positive effects on exercise
    • -Less mucus in lungs-therefore increased surface area

    • Negative effects on exercise
    • -Bronchospasms▪decrease the flow of air to and from the lungs
    • -Coughing▪limiting a person’s activity level
  68. Respiratory Stimulants
    Increase output of central respiratory centers

    Analeptics

    Positive effects on exercise- Increase available oxygen to body

    Negative effects on exercise-May cause hyperventilation-decreased respiratory capacity-convulsions

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