Pathophys Exam 2

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Rx2013
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46349
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Pathophys Exam 2
Updated:
2010-10-31 21:34:20
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Respiratory Disorders
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Respiratory Disorders
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  1. Pores of Kohn
    mixes air between alveoli sacs
  2. Number of alveoli in in the adult lung
    300 million
  3. Type I alveolar cells
    • makes up most of the surface area of the alveoli
    • does not divide
  4. Type II alveolar cells
    secrete 5% of surfactant
  5. Inspiration uses
    external intercostals
  6. expiration involves
    internal intercostals contract
  7. volume of air moved with each breath
    Tidal volume
  8. volume of air left in the lungs after maximal expiration
    Residule volume
  9. volume of air remaining in the lungs at the end of expiration (sum of RV and ERV)
    functional residual capacity
  10. measures pulmonary function. Pt breathes out as hard as they can.
    spirometry
  11. maximum amount of air that can be rapidly and forecully exhaled from the lungs after full inspiration
    forced vital capacity (FVC)
  12. volume of air expired in the first second of FVC
    forced expiratory volume (FEV1)
  13. volume of air expired in the first second expressed as a percentage of the FVC
    FEV1/FVC ratio
  14. Arterial blood gases
    • PO2 >80 mmHg
    • PCO2 35-45 mmHg
    • usually taken from the femeral artery
  15. amount of oxygen bound and dissolved oxygen in the blood
    • normal 97-100%
    • goal for COPD pt. >92%
  16. Restrictive lung disease
    lungs cannot expand the way they should
  17. Obstructive lung disease
    tumor, clot or other space occupying lesion
  18. Diagnosis of Asthma
    • must have 3 of the following:
    • airflow obstruction
    • ronchial hyper-responsiveness
    • underlying inflammation
  19. americans that had an asthma attack in 2005
    22.2 million
  20. adults with asthma diagnosis
    400,000
  21. children with asthma diagnosis
    111,000
  22. ED visits related to asthma in 2005
    30,000
  23. hospital days related to asthma care
    25,000
  24. Extrinsic (atopic) asthma
    • induced by exposure to an allergen
    • developes in 10-20 minutes of exposure
    • early and late phase reactions
  25. Early phase reaction
    • antigen binds IgE receptor on mast cell
    • cytokines attract other inflammatory cells cause bronchoconstricion leading to bronchospasm
    • increased mucus and edema in the lungs
  26. Late phase
    • recruited cells drive the response (4-8 hrs later)
    • airway epithelial cells also release eotaxin (recruits eosinophils)
    • epithelial cell injury and bronchoconstricion
    • increased airway responsiveness = prolonged asthma symptoms
  27. Intrinsic Asthma triggers
    • respiratory tract infections
    • excercise, stress, laughter
    • Aspirin, NSAIDS, B Blockers
  28. Clinical presentation of asthma
    • cough, wheezing, dyspnea
    • chest tightness
    • tachypnea & tachycardia
    • hypoxemia
  29. Used for short term monitoring of asthma control. Based on pt. personal best value.
    • peak flow meter
    • used when standing up
  30. >80% peak flow zone
    • no asthma symptoms
    • take meds as usual
  31. 50-80% peak flow zone
    • use short acting beta 2 agonist
    • check about changing or increasing dose
  32. <50% peak flow zone
    • short acting inhaled beta 2 agonist
    • emergency medical alert
  33. best peak exp flow is 550 L/min. peak flow is now 300 L/min. what zone is this?
    yellow
  34. Symptoms of Mild Intermittent asthma occur
    < 2 days/week
  35. nighttime awakenings with mild intermittent asthma
    < 2x/month
  36. Beta-agonist use for mild intermittent asthma
    < 2d/week
  37. Interference with activity with mild intermittent asthma
    none
  38. Lung function with mild intermittent asthma
    FEV1 normal between exacerbations
  39. symptoms with mild persistent asthma
    > 2 days/week, not daily
  40. Nighttime awakenings with mild persistent asthma
    3-4x/month
  41. Beta-agonist use with mild persistent asthma
    >2d/week but not daily
  42. interference with activity with mild persistent asthma
    minor limitation
  43. Lung function with mild persistent asthma
    • FEV1 > 80% predicted
    • FEV1/FVC normal
  44. Symptoms of moderate persistent asthma
    daily
  45. nighttime awakenings with moderate persistent asthma
    > 1x/week, not nightly
  46. Beta agonist use with moderate persistent asthma
    daily
  47. moderate persistent asthma interference with activity
    some limitation
  48. Lung function with moderate persistent asthma
    • FEV1 >60% but >80%
    • ratio reduced by 5%
  49. Symptoms with severe persistent asthma
    throughout the day
  50. nighttime awakenings with severe persistent asthma
    often nightly
  51. beta agonist used in severe persistent asthma
    several times per day
  52. severe persistent asthma interference with activity
    extreme limitation
  53. lung function with severe persistent asthma
    fev1 < 60% predicted
  54. Asthma goals (6)
    • 1. prevent symptoms
    • 2. decrease use of SABA (2 days/week)
    • 3. maintain normal pulmonary function
    • 4. maintain normal activity
    • 5. meet care expectations
    • 6. optimal therapy with minimal expectations
  55. risk factors for asthma related death
    • history of severe exacerbations
    • > 2 hospitalizations for asthma in the past year
    • > 3 ED visits for asthma in the past year
    • using > 2 SABA per month
    • current oral steroid use
    • low socioeconomic status
  56. cough for 3 month in each of two successive years in a patient in whom other causes of chronic cough have been excluded.
    chronic bronchitis
  57. abnormal permanent enlargement of airspaces distal to the terminal bronchioles accompanied by destruction of their walls.
    emphysema
  58. 4th leading cause of death in america claiming the lives of 123,000 in 2004
    COPD
  59. approximately ____ COPD cases caused by smoking
    80-85%
  60. Asthma as compared to COPD
    • mostly reversible/intermittent
    • associated with allergies
    • CD4
  61. COPD compared to asthma
    • Not reversible
    • gets progressively worse
    • neutrophils involved
    • CD8 and macrophages
  62. Hereditary component of COPD
    • alpha 1 antitrypsin
    • protective enzymes against protease
  63. Chemotactic factors of COPD
    • attracts neutrophils and CD8 cells
    • Leukotriene B4
    • Interleukin-8
  64. Proinflammatory cytokines in COPD
    • Tumor necrosis factor alpha
    • Interleukin-6
  65. Growth factors in COPD
    • fibrosis of small airways
    • Transforming growth factor beta
  66. ventilation and perfusion in COPD
    • perfusion without ventilation
    • ventilation without perfusion
  67. Consequences of smoking
    • more neutrophils and macrophages in alveoli
    • increased release of elastase from neutrophils
    • oxidants and free radicles inhibit alpha 1 antitrypsin
  68. increased inflammation in the alveoli results in
    decreased air out
  69. hyperinflation of the alveoli results in
    decreased air in
  70. Dysfunction of alveoli results in
    • hypoxemia
    • pulmonary vasoconstriction
    • hypercapnia (high CO2 in the blood)
  71. Pink puffers
    • use of accessory muscles
    • pursed lip breathing
    • tripod position
    • barrel chest
    • prolonged expiration
  72. Blue bloaters
    • cyanosis
    • right sided heart failure
    • fluid retention
    • prolonged expiration
  73. Grade 1 COPD
    no breathlessness except during strenuos exercise
  74. grade 2 COPD
    short of breath when hurrying or walking up a slight hill
  75. grade 3 COPD
    walks slower than people of same age or has to stop when walking at own pace due to breathlessness
  76. grade 4 COPD
    stops for breath after walking for a few minutes on level ground
  77. grade 5 copd
    too breathless to leave the house or breathless when dressing or undressing
  78. Stage 1 Mild COPD
    • ratio < 70%
    • FEV1 > 80% predicted
  79. Stage 2 Moderate COPD
    • ratio < 70%
    • FEV1 between 50 and 80 %
  80. Stage 3 Severe COPD
    • ratio < 70%
    • FEV1 30 and 50%
  81. Stage 4 Very Severe COPD
    • ratio <70%
    • FEV1 < 30%
    • predicted <50%
  82. 3 cardinal symptoms of COPD exacerbation
    • increased dyspnea
    • increased sputum purulence
    • increased sputum volume
  83. mild exacerbation
    1 symptom
  84. moderate exacerbation
    2 symptoms
  85. 3 symptoms
    severe exacerbation
  86. Utilize antibiotics when?
    two or more cardinal symptoms
  87. Goal for oxygen therapy
    90-29%
  88. cor pulmonale
    • right handed heart failure
    • increased resistance to flow in the pulmonary artery
  89. clinical manifestation of cor pulmonale
    • RV hypertrophy
    • Peripheral edema
    • SOB
    • Decreased exercise tolerance
  90. Polycythemia Vera
    • Kidneys sense chronic hypoxemia which results in increased erythropoietin = more RBCs produced
    • increased risk of blood clots
  91. Oxygen therapy indicated in patients
    • with O2 saturation < 88% and
    • polycythemia, pulmonary HTN or signs of right sided heart failure.
  92. Oxygen therapy must be used....
    at least 15 hrs/day for mortality benefit

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