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2010-10-20 14:57:16
Pulmonary System

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  1. Pulmonary Disease:
    • Acute or Chronic
    • Obstructive or Restrictive
    • Infectious or Noninfectious
  2. Lung disease:
    is greatly influenced by conditions of the environment, occupation, and personal and/or social habits
  3. Signs/Symptoms of Pulmonary Disease:
    • Dyspnea
    • Abnormal Breathing Patterns
    • Hypoventilation
    • Hyperventilation
    • Cough
    • Hemoptysis
    • Cyanosis
    • Pain
    • Clubbing
  4. Dyspnea as a s/s of Pulmonary Disease:
    • SOB; air hunger
    • Can be dyspnea on exertion; orthopnea (lying down); paroxysmal nocturnal dyspnea
  5. Abnormal Breathing Patterns as s/s of Pulmonary Disease:
    • Kussmaul respirations (hyperpnea-breathe too quickly)
    • Cheyne-Stokes Repirations (time breaks between breathing)
  6. Hypoventialtion as s/s of Pulmonary Disease:
    • hypercapnia-too much CO2
    • (not breathing enough)
  7. Hyperventilation as s/s of Pulmonary Disease:
    • Paper bag
    • Hypocapnia
    • too little CO2
  8. Cough as s/s of Pulmonary Disease:
    • reproductive reflex
    • acute or chronic
  9. Hemoptysis as s/s of Pulmonary Disease
    • Coughing up bloody sputum
    • not same as vomiting blood
    • (ex-TB, chronic bronchitis)
  10. Cyanosis as s/s of Pulmonary Disease:
    • Turning blue
    • blood doesn't have enough oxygen
  11. Pain as s/s of Pulmonary disease:
    • friction rub
    • pleural effusion
    • chest tube
  12. Clubbing as a s/s of Pulmonary Disease:
    • painless
    • chronic oxygen loss
    • COPD
  13. Conditions cause by Pulmonary Disease or Injury:
    • Hypercapnia
    • Hypoxemia
    • Acute Respiratory Failure
    • Pulmonary Edema
    • Hypoxia
  14. Hypercapnia:
    increased CO2
  15. Pulmonary Edema:
    • excess water in lungs
    • Hypoxemia versus hypoxia
  16. Hypoxemia:
    • reduced arterial blood
    • PaO2 (amount of O2 in alveoli)
    • caused by respiratory alterations
  17. Hypoxia:
    • decreased oxygen in tissues
    • can be caused by hypoxemia
    • decreased cardiac output, cyanide poisoning
  18. Pulmonary Edema:
    • Excess water in lungs
    • most common cause is heart disease
    • Left ventricle fails-pressures on left side of heart fail-fluid from capillaries in lung pushed back into lungs
  19. Maifestations of Pulmonary Edema:
    • Tumors
    • Edema
    • Fibrotic tissue
  20. Signs and Symptoms of Pulmonary Edema:
    • Drowning feeling
    • Dyspnea
    • Inspiratory crackles (alveoli stuck together, breathe in "pop")
    • Pink frothy sputum (if severe)
  21. Acute Respiratory Failure
    • inadequate gas exchange leading to tissue hypoxia and hypoxemia
    • PaO2 less than 60 mmHg or PaCO2 greater than 50 with pH less than 7.25
  22. Aspiration:
    the passage of fluid and solid foods into the lungs
  23. Atelectasis:
    • collapse of lung tissue
    • -OR-
    • incomplete expansion of a lung
  24. Causes of Atelectasis:
    • Airway Obstruction- most common
    • Lung compression (pneumothorax)
    • Pleural Effusion
  25. Manifestations of Atelectasis:
    • tachypnea
    • tachycardia
    • dyspnea
    • cyanosis
    • signs of hypoxemia
    • diminished chest expansion
    • absence of breathe sounds
  26. Atelectasis can be cause by:
    a thrombus obstructing flow to upper lobe
  27. Croup:
    (child disorder)
    • aka Acute Laryngotracheobronchitis
    • common in children 6 months to 5 years
    • commonly cause by virus (parainfluenza, flu A or RSV)
    • caused by subglottic edema
    • usually occurs after an episode of rhinorrhea, dore throat or fever
  28. Signs and Symptoms of Croup:
    • Seal-like barking cough
    • nasal flaring indicates worsening of symptoms
    • presence of inspiratory stridor or respiratory ditress-severe croup
  29. Manifestations of Severe Croup:
    • deep retractions
    • stridor
    • aditation
    • tachycardia
    • pallor or cyanosis
  30. Spasmodic Croup:
    • similar hoarseness, cough and stridor to croup
    • usually in older children
    • sudden onset, usually at night, and with no previoius viral illness
    • resolves quickly
  31. Acute Epligottitis:
    • sever, rapidly progressive, LIFE-THREATENING infection of the epiglottis and surrounding area
    • death can occur in a few hours
    • Children 2 to 7 years old
  32. Causes of Acute Epiglottitis:
    • historically caused by Haemophilius influenzae type B
    • decreased incidence due to HIB vaccination
    • current cases caused primarily by group A strep
  33. Manifestations of Acute Epiglottitis:
    • sudden onset
    • fever
    • sore throat
    • inspiratory stridor
    • severe respiratory distress
    • muffled voice
    • drooling
  34. Treatment for Acute Epiglottitis:
    • keep child calm and undisturbed
    • do NOT attempt to examine throat
    • emergency airway and antibiotics
  35. Cystic Fibrosis:
    • autosomal recessive multisystem disease
    • exocrine or mucus-producing glands secrete abnormally thick mucus
    • obstructs airway
    • obstructs pancreatic and biliary ducts
    • Thick secretions obstruct the bronchioles and predispose the lungs to chronic infections
  36. Manifestations of Cystic Fibrosis:
    • High concentrations of NaCl in sweat
    • Less Na and water in respiratory mucus and in pancreatic secretions
    • Mucus is thicker
    • *Children are ar greater risk for salt depletion episodes
    • *chronic bronchiolitis and bronchitits are the initial lung manifestations
  37. SIDS (Sudden Infant Death Symdrome):
    • Disease of unknown cause
    • Incidence lower during first month of life, increases in the second month, and peaks at 3 to 4 months; more common in male infants
    • Unexplained sudden death of an infant under 1 year of age
    • Seasonal variation- higher in winter months
    • ----possible relationship to respiratory infections
    • ----wide range of risk factors
  38. Acute Respiratory Failure:
    inadequate gas exchange leading to tissue hypoxia and hypoxemia
  39. Aspiration:
    the passage of fluid and solid foods into the lungs
  40. Atelectasis:
    collapse of lung tissue or incomplete expansion of a lung
  41. Acute Respiratory Failure can result from:
    • direct injury to lungs, airways, or chestwall
    • indirect injury elsewhere- brain or spinal cord
  42. Most pulmonary diseases can cause episodes of:
    Acute Respiratory Failure
  43. Acute Respiratory Failure is a potential complication of any major surgical procedure. The most common postoperative pulomnary problems:
    • atelectasis
    • pneumonia
    • pulmonaary edema
    • pulmonary emboli
  44. Prevention techniques of postop respiratory failure:
    • frequent turning
    • deep breathing
    • early ambulation
    • humidified air (loosens secretions)
    • incentive spirometer
    • supplemental oxygen
    • antibiotics
  45. Aspiration:
    • passage of fluid and solid particles into the lungs
    • when normal swallowing mechanisms and cough reflexes impaired by CNS, PNS
  46. Problems of Aspiration:
    • Right lung more than Left lung--causes Obstruction
    • (the right is starighter)
  47. Clinical Manifestations of Aspiration:
    • choking
    • cough
    • vomiting
    • dyspnea
    • wheezing
  48. Aspiration Pneumonia:
    occurs after inhaling foreign matter into the lungs
  49. Gastric acid fluid is very damaging and can cause:
    • Bronchial damage-inflammation, loss of ciliary function, bronchospasm
    • Alveoli damage-alveolocapillary membrane damage; leads to hemorrhagic pneumonitis
  50. Preventive measures for patients at risk:
    • semirecumbent position
    • monitor patients on enteral tube feeding
    • use of promotility agents (speed digestion)
    • avoid excessive sedation
  51. Atelectasis:
    • Collapse of lung tissue
    • 2 types:
    • Compression-tumor, fluid, or air in pleural space, or abdominal distention
    • Absorption-removal of air from alveoli-(anesthesia or concentrated oxygen)
  52. S/S of Atelectasis:
    • tachypnea
    • tachycardia
    • dyspnea
    • cyanosis
    • signs of hypoxemia
    • diminished chest expansion
    • absence of breath sounds
    • dyspnea
    • cough
    • fever
    • leukocytosis
  53. Bronchiectasis
    persistent abnormal dilation of bronchi
  54. Obstruction of airway can be caused by:
    • plugs
    • atelectasis
    • aspiration of foreign body
    • infection
    • cystic fibrosis
    • TB
    • weakened immunity
    • bronchietasis
  55. Bronchiolitis:
    • obstruction of small airways
    • inflammatory obstruction of the small airways bronchioles
    • most common in children
    • Adults=seen with chronic bronchitis, viral infection, or with inhalation of toxic gases
  56. Pneumothorax:
    presence of air or gas in pleural space
  57. Pneumothorax is caused by:
    • rupture in parietal pleura or visceral pleura
    • Air seperates the visceral and parietal pleura
    • Can cause partial or complete collapse of the affected lung
  58. Kinds of Pneumothorax:
    • open pneumothorax
    • tension pneumothorax
    • spontaneous pneumothorax
    • secondary pneumothorax (trauma)
  59. Tension Pneumothorax:
    • causes a mediastinal shift
    • heart, vessels, trachea are compressed and displaced from midline
    • Tx-chest tube
  60. Pleural Effusion:
    • presence of fluid in pleural space
    • fluids migrate through walls of capillaries bordering pleura
    • Transudative-watery
    • Exudative-WBCx, plasma proteins
  61. Sx of Pleural Effusion:
    • if large will see:
    • Dyspnea
    • Compression Atelectasis
    • Mediastinal shift
    • Pleural pain (if pleura inflammed)
  62. Names for kinds of pleural effusions
    • hydrothorax: serous fluid
    • empyema: pus, infection
    • chylothorax: lymph
    • hemothorax: blood
    • exam will reveal decreased breath sounds and pleural friction rub heard
    • DX: CXR
  63. Chest Wall Restriction:
    • compromised chest wall
    • deformation, immobilization, and obesity
  64. Flail Chest:
    • instability of a portion of the chest wall
    • (put on vent until they go to surgery)
  65. ARDS (Acute Respiratory Distress Syndrome)
    • acute lung inflammation
    • dyspnea
    • rapid shallow breathing
    • crackles on inspiration
    • unresponsive to oxygen therapy
    • Evaluation and tx: tests, oxygenation and ventilation, surfactant
  66. Postop Respiratory Failure:
    • atelectasis
    • pneumonia
    • pulmonary edema
    • pulmonary emboli
  67. Prevention of postop respiratory failure
    • frequent turning
    • deep breathing
    • early ambulation
    • air humidification
    • incentive spirometer
  68. Obstructive Lung Disease:
    • airwawy obstruction that is worse with expiration
    • common s/s: dyspnea and wheezing
  69. Common Obstructive Disorders:
    • asthma
    • emphysema
    • chronic bronchitis
  70. Manifestations of Asthma:
    • wheezing
    • chest tightness
    • breathlessness
    • coughing that is worse at night and in the early morning
  71. If asthma is severe then:
    • use of accessory muscles
    • distant breath sounds
    • loud wheezing
    • fatigue
    • anxiety
    • DEATH
  72. Etiology of Asthma
    unknown; although if other people in your family have asthma, you are more likely to develop it. Being exposed early in life to things like tobacco smoke, infections, and some allergens may also increase your chances of developing asthma. Some of the more common things that bring on asthma syptoms include exercise, allergens, irritants, and viral infections
  73. Hypersensitivity:
    responds to a variety of stimuli. Chronic inflammatory disease that affects airways causing them to become narrower allowing less air flow through the lungs
  74. Sx and Tx of Asthma:
    • Sx: expiratory wheezing, dyspnea, and tachypnea
    • Tx: peak flow meters, oral corticosteroids, inhaled beta-agonists, and anti-inflammatories used to treat
  75. Chronic Bronchitis:
    (Blue Bloaters)
    Hypersecretion of mucus and chronic productive cough that lasts 3 consecutive months for at least two consecutive years
  76. Risk factors for Chronic Bronchitis:
    • middle aged men
    • smokers
    • expose to air pollutants
    • mucus is thicker than normal
    • Tx: Bronchodilators, expectorants, and chest physical therapy used to treat
  77. Emphysema:
    abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis
  78. Emphysema (pink puffers)
    • loss of elastic recoil
    • obstruction occurs from changes in lung tissues rather than mucus production and inflammation
  79. risk factors, patho, and manifestations of Emphysema:
    • risk factors: smokers, inhaled irritants, elderly
    • patho: traps air, difficult to expel the trapped air due to less elasticity
    • manifests: dyspnea, thin, tachypnea, use of accessory muscles (barrel chest)
  80. Pneumonia:
    • infection of lower resp tract
    • causes: bacteria, virus, fungi, protozoa, and parasites
    • 6th leading cause of death in US
  81. Respiratory Tract Infections:
    • cause of TB= mycobacterium tuberculosis
    • acid faast bacillus
    • airborne transmission
    • tubercle formation
    • positive PPD
    • sputum
    • CXR
  82. Sx of TB:
    • fatigue
    • weight loss
    • lethargy
    • anorexia
    • night sweats
    • fever
    • cough
  83. DOT=
    • directly observed therapy
    • tx after you have been diagnosed with tb
  84. Pulmonary Embolism:
    • occlusion
    • lungs
    • thrombus
    • embolus
    • tissue fragment
    • lipids
    • air bubble
    • (can arise from the deep veins in the thigh)
  85. Pulmonary embolism manifestations and risk factors:
    • DEATH is imminent
    • sudden chest pain, dyspnea, and tachypnea
    • obese, immobile, ortho surgery, cancer, oral contraceptives, smokers