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What is ventilation? What is tidal volume?
what increases respiration?
What decreases it?
- Ventilation: Movement of air to the lungs to maintain oxyganation, and the removal of CO2.
- Tidal V: amt of air taken in (inspiration), amt of air going out (expiration).
- When CO2 increases or O2 and pH decrease = increase in respiration.
- when CO2 decrease, or increase in p = will decrease respiration.
What factor affect alveolar ventilation?
- Neurological control of ventilation (ponse and medula- Brain stem)
- Mechanical factors (the ability to inspiration and expiration).
- Deadspace and distribution of ventilation (everything that affects that alveoli ability to exchange gases)
What forces are included in the work of breathing (mechanics)?
- Elastic forces: Lung recoil due to elastin, collagen, fibrin.
- Surface forces: surface tension due to water-air interface.
- Airway Resistance: Primarily determined by airway radius.
What is anatomic dead space? Alveolar dead space? Physiologic dead space? Alveolar ventilation?
- Anatomic DS: Volume of gas not used in gas exchange.
- Alveolar DS: Ventilated, but underperfused or unperfused alveoli.
- Physiological dead space: the sum of anatomic and alveolar dead spaces.
- Alveolar ventilation: (tidal v - dead space) x rate.
What is ventilation and perfusion? what's there importance?
- V: amount of air move in and out of the lungs - amt of air that goes from the mouth to the alveoli.
- Q: Amt of blood flowing through the lungs - the ability for the heart to pump blood to the lungs.
- Importance: there must be adequate V/Q matching to oxygenated the blood.
What are ventilation-perfusion abnormalitites?
- Low V/Q: due to impaired ventilation.
- Shunt (very low) V/Q: blocked ventilation, collapsed alveolus.
- High V/Q: impaired perfusion (PE) alveolar dead space.
What's Hb affinity? What does a shirt to the right mean? shift to the Left? examples of what could cause them?
- Affinity: How easy does O2 hook up to Hb.
- Right shift: decreased O2-hb affinity. (low pH, high pCO2, high temp, etc)
- Left shift: increased O2-hb affinity. (high pH, low pCO2, low temp)
What are the alteration in pulmonary function?
- Hypoventilation: Insufficient air to the alveoli to provide O2 and remove CO2. It is influence by the rate and depth of respiration. -- high CO2 = increased respiration -- causes: opioids, surgery of thorax or abdomen, etc.
- hyperventilation: Low pCO2 (hypocapnia), blow off CO2 -- causes: pain, fever, anxiety, high altitude, obstructions, etc
Deficient blood O2, due to poor diffusio n at the alveoli or anemia wit low arterial O2 and low hb saturation.
Decrease tissue oxygenation. Four types:
- Hypoxic-hypoxia:PaO2 decreased despite normal carrying ability (high altitude)
- Anemic-hypoxia: Decreased O2 carrying capability, low Hb (sickle cell anemia)
- Cicularoty-hypoxia: Low cardiac output, O2 carrying capacity is normal, but blood flow is reduced. (blood loss, hemorrhaging)
- Histotoxic-hypoxia: toxic subtance leads to the inability of tissue to use available O2 (cyanide poisoning).
Acute respiratory failure: abnormal arterial blood gases, which is dx by an arterial stick. -- causes: quadriplegia, emboli, etc. -- CM: hyoxia, hypercapnia, confusion, decreased LOC (level of conscious), dizziness.
What are the types of pulmonary disorders?
- Vascula: Pulmonary HTN or embolism.
Pulmonary HTN? CM?
- It is the elevated P in the pulmonary arteries.
- 2 types: primary (rapidly progressing), secondary (result from known disease process)
- CM: exercise intolerane, fatigue, syncope, cor pulmonale (Rt sided failure), chest pain on exertion.
Pulmonary Embolus? Risks?
- It is an undissolved detached material (clot, fat emboli, eir, etc) that occlutes blood vessels. Usually come from deep veins in lower extremities.
- Risk: immobility, trauma, pregnancy, cancer, HF, and estrogen use.
What are pulmonary malignancies? CM?
- Carcinomas - most common one being adenocarcinoma.
- High mortality, usually less than 1 yr.
- CM: 10 - 25 % cases are asymptomatic.
- Types: extra or intra-trhoracic.
obstructive pulmonary disorders? patho? etiologies?
- patho: it is caused by an increased in resistance as a result of changes in the radius of the airway.
- Etiologies: 1) Obstruction of the airway lumen, 2) wall of the lumen, 3) obstruction resulting from increase P around the outside of the airway lumen.
What are the pathologies in the obstruction of the airway lumen?
- Cystic Fibrosis.
- Acute tracheal obstruction.
- Croup syndrome.
What is bronchiectasis? Etiologies? Patho? CM? Tx?
- It is a recurrent inflammation of the bronchial walls, associated w infection and pus formation (foul smelling sputum). Usually seen in children and ppl w CF (cystic fibrosis)
- Etiology: dilation of the bronchial wall, obstruction of the wall formation, CF.
- Patho: (pathology of bronchioles) Recurrent inflammation, which causes destroction of the bronchial walls, which leads to loss of ciliated epithelium, which transforms into pus formation.
- CM: productive cough, w a foul-smell, green or yellow, hemoptysis.
- Tx: ABX, inhaled bronchodilators, hydration and exercise.
Bronchiolitis? etiologies? Patho? CM? Tx?
- wide spread inflammation of the bronchioles due to infection. Usually occurs from winter to spring.
- Etiology: Viral (RSV, influenza virus a,b,c) or bacerial (just abt anything)
- Patho: inflammation causes mucosal swelling, excessive mucous prodution, and bronchial muscle constriction that narrow the airway. usually seen in children <2, but also in adults who smoke, toxic fumes, or immunosuppresed.
- CM: it goes from mild to fatal, wheezing/bronchospasms, crackles, increased sputum.
- Tx: humidified O2, bronchodilators, abx, steroids.
acute tracheobrongial obstruction? Etiologies/causes? CM? Tx?
- etiology/causes: aspiration of foreign body (most often in the Lt lung), Malpositioned endotracheal tube, laryngospasm, spiglottitis.
- CM: inability to talk, nasal flaring, dyspnea -- requires emergency treatment.
- Tx: removal, heimlich, dusction, tracheostomy.
Epiglottitis? etiology? CM? tx?
- Etiology: inflammation of the epiglottis due to influenza B (usually) and happens to children 2 to 4yrs -- it is a medical emergency.
- CM: rapid onset of fever, pain, difficulty swallowing, and drooling.
- Tx: intubation, abx.
Croup?etiologies? pathogenesis? CM? tx:
- Viral inflammatory disease of the larynx, trachea, and bronchi. It is associated w upper respiratory infection.
- Etiology: para-influenza, pneumoniae, etc
- Pathogenesis: Infectious agent causes inflammation along entire airway, around the subglottic area. (below the epiglottis)
- CM: barking cough is the most common manifestation.
- Tx: Mist, hydration, steroids, O2
What are the obstructions from conditions in the wall of the lumen?
- Acute bronchitis.
- Chronic Bronchitis.
What is asthma? types? pathogenesis?CM?
- Its a lung disease characterized by airway obstruction and inflammation that is reversible, and brochoconstriction -- increased airway responsiveness to stimuli.
- 2 main types: Extrinsic (triggers) and Intrinsic (no history of allergies).
- Exercise-induced asthma: Bronchospasm after the end of exercise, usually resolves in 60 mins. It is caused by the loss of water and increase o heat. Common causes are running, joggin, and tennis.
- Occupational asthma: Often have positive test rxn to protein allergens in the work environment.
- Drug-induced asthma: Ranges from mild rhinorrhea to respiratory arrest, which requires mechanical ventilation.
- pathogenesis: No known single mechanism, bronchospasm, swelling, obstruction, hyperactivity of the bronchi.
- CM: Mild to severe attacks, Wheezing, productive cough, tick mucus, intermittent symptoms.
What is bronchitis? pathogenesis? CM? tx?
- it is a temporary inflammation of the tracheobronchial tree. It could be viral, bacterial, fungal, heat, etc. -- Upper respiratory infection.
- Patho: Airways become inflamed and narroed from capillary dilation. fluid from fluid exudation, increased mucus production.
- CM: symptoms are due to narrowing of inflamed airways and increased mucus production. low-grade fever, sore throat, postnasal drip, substernal chest discomfort.
- Tx: no treatment for viral, antibiotics for bacterial, codeine-containing medications (for cough, at night).
What is chronic bronchitis? etiology?Patho? CM? tx:
- Inflammatory disorder of the airways associated with long term smoking. It is usually a chronic or recurrent productive cough > 3 months. It is irreversible when paired w emphysema!
- Chronic bronchitis is associated with COPD type B.
- etiology: cigarette smoking (90%), ppl w lots of infections (10%).
- Patho: Chronic inflammation and swelling of the bronchial mucosa resulting in scarring over time. -- CB can lead to pulmonary HTN, and eventually Rt CHF.
- CM: ppl that wake up coughing, cyonatic, commonly associated w emphysema, polycythemia (increased RBCs)
- Tx: smoking cessation, bronchodilator therapy, reduction to exposure of irritants.
what is emphysema? etiologies? patho? CM?
- It is the breakdown of the elastin and fiber network of the alveoli leading to alveolar destruction and formation of larger than normal air spaces. (COPD-type A). DAMAGE IS IRREVERSIBLE!
- Etiologies: smoking, Air pollution, occupations (welding, mining, asbestos)
- Patho: Alveolar destruction due to loss of elastic recoil which causes a decrease in surface area for gas exchange, and produces abnormal permanent enlargement of the airspaces.
- CM: pink puffer, Progressive exertional dyspnea and DOE, increased SOB over 3-4 yrs. Thin/weight loss, pursed-lip breathing, Minimal or absenct cough.
COPD-type A (emphysema) vs COPD-type-B (chronic bronchitis)
- L: pink puffer, thin/weight loss, mild hypoxemia, no hypercarbia, few secretions, not reversible,
- CB: blue bloater, obese, hypozemia and hypercarbia, increased hematocrit, lots of secretion, reversible.
What are the restrictive pulmonary disorders?
- Lung parenchyma disorders.
- Pleural space disorders.
- Chest wall disorders.
- Infection/inflammation of the lung.
Lung parenchyma disorders? types?
- Fibrotic: they cause fibrosis of the tissues of the lung.associated with occupations i.e black lung (coal), etc.
- Atelectatic: ARDS and IRDS.
- Adult respiratory disease syndrome (ARDS): profound hypozemia associated with trauma, sepsis or chock. Injury to the alveoli w changes in diameter (fluid).
- Infant respiratory disease syndrome (IRDS): most common in premature infants (lack of surfactant which is the way to measure the ability to breath, usually using the placenta)
What is pneumothorax? Hemothorax? types? CM? Tx?
- Accumulaltion of air in the pleural space, which results in complete or partial collapse of the affected lung.
- Hemothroax: when there is blood instead of air, usually fractured ribs.
- Types: spontaneous, traumatic, tension, and iatrogenic (cough hard enough)
- CM: Really SOB, absence of breath sounds when auscultating. cyanosis.
- Tx: chest tube w negative pressure. 3 to 5 days.
What is tension pneumothorax?
- results from buildup of air under pressure in the pleural space. Air enters the plural space but cannot escape during expiration.
- Lung on ipsilateral (same) side collapses and forces mediastinum towards contralateral side.
- Decrease venous return and CO.
- It is a medical emergency.
What is pleural effusion? Causes? CM?
- Fluid or pus in the pleural cavity as result of another disease process.
- Causes: Changes in the pleural cavity pressures (hydrostatic, colloid oncotic, and intrapleural)
- CM: dyspnea, pleuritic pain, dry cough, decreased tactile fremitus (pt says 99, or eeee)
What are the crest wall deformities?
- Ankylosing spondylitis
- flail chest