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Patho chap 20 & 21
Pulmonary System
| Question | Answer |
|---|---|
| what innervates the diaphragm? | phernic nerve (C4) |
| what does that mean to the ability to breathe if there is damage to the spinal cord above this? | it is extremely difficult or could be impossible to breathe if there is damage to the spinal cord |
| mucociliary apparatus | a protective mechanism in the lungs that traps inhaled particles and moves them up to the upper airway to be coughed out |
| retractions | use of intercostal muscles to breathe, sign of respiratory distress |
| adventitious breath sounds: crackles | rales, noncontinuous; occur when deflated alveoli open and close against fluid |
| examples of where you would find crackles | heart failure and pneumonia |
| adventitious breath sounds: wheezes | high- pitch, whistling sounds; constricted diameter of airways, inspiratory or expiratory |
| examples of where you would find wheezes | asthma and COPD |
| adventitious breath sounds: rhonchi | low pitched, snore like; inflamed bronchial airways |
| examples of where you would find rhonchi | COPD, and bronchitis |
| adventitious breath sounds: friction rub | grating, scratchy during inspiration and expiration with inflammation of pleural surfaces |
| examples of where you would find friction rub | pulmonary embolism, pleurisy |
| central chemoreceptor | medulla, changes in Co2 and pH hypercapnia or acidosis stimulate increased ventilation |
| peripheral chemoreceptors | aorta and carotids decreased arterial oxygen in primary signal hypoxic drive- decreased oxygen stimulates ventilation |
| SaO2 | percentage of saturation of hemoglobin with oxygen |
| oxyhemoglobin | hemoglobin with attached oxygen |
| airway resistance | resistance in respiratory tract to airflow during exhalation and inhalation |
| compliance of the lungs | measure of elasticity, expandability & distensibility of the lungs and thoracic structures |
| dyspnea | shortness of breath |
| expectoration | coughing up sputum |
| hemoptysis | bright red bleeding in sputum |
| ventilation | refers to the flow of air into and out of the alveoli |
| perfusion | refers to the flow of blood to alveolar capillaries |
| how does hypoxia affect the vessels | insufficient oxygen for needs |
| how does hypercapnia affect the vessels? | a buildup of carbon dioxide in your bloodstream |
| atelectasis | collapse of small number of alveoli |
| most common cause of atelectasis | postoperative due to the sedation, shallow breathing and decreased respiratory rate |
| anoxia | complete absence of oxygen |
| carbon monoxide poisoning | carbon monoxide poisoning is the CO displaces oxygen from hemoglobin leading to hypoxia. the carboxyhemoglobin in the blood causes the pink tho be pink |
| pulse oximetry | the red light on the pulse oximetry on the nail bed will be able to detect the blood cells |
| arterial blood gasses | test measures the oxygen and carbon dioxide levels in your blood as well as your blood's pH balance |
| bronchoscopy | visualize larynx, trachea, and bronchi |
| thoracentesis | removal of pleural fluid |
| sputum cultures | a test that checks for bacteria or another type of organism that may be causing an infection in your lungs or the airways leading to the lungs. |
| V/Q scan | ventilation/ perfusion there needs to be 4L of oxygen/ 5L of blood to grab it normal ratio is .80 |
| V/Q most common mismatch | pulmonary embolism |
| spirometry | test measures how much air you can breathe in and out of your lungs, as well as how easily and fast you can the blow the air out of your lungs |
| acute rhinitis | inflammation and irritation of the mucous membranes of the nose |
| acute rhinitis symptoms | local inflammatory response, nasal mucociliary transport, nasal mucosa and turbinates, nasal discharge |
| allergic rhinitis | acute rhinitis caused by allergies |
| symptoms of allergic rhinitis | resembles common cold, interior nasal mucosa and turbinates - gray, nasal discharge - clear, CBC high in eosinophils |
| acute sinusitis | infection of the sinus: mucus - lined cavities filled with air that drains into the nose |
| acute sinusitis symptoms | URI, allergic reaction causes: viral, bacterial or both 5 to 7 days, bacterial up to 4 weeks |
| chronic sinusitis | inflammation of the sinuses for > 12 weeks |
| acute pharyngitis | if bacterial, the causative agent is Group A beta hemolytic streptococcus (GABHS) - streptococcus pyrogenes |
| acute pharyngitis symptoms | fever, malaise and sore throat, but typically no cough |
| acute pharyngitis diagnosis | rapid screening for streptococcal antigens, bacterial throat cultures, and heterophile blood test to rule out mono |
| acute tonsillitis cause | bacterial --GABHS viral -- epstein barr, adenovirus, herpes simplex and cytomegalovirus |
| acute tonsillitis symptoms | difficulty swallowing, swelling of tonsillar tissue and pharynx, quinsy (severe swelling of the tonsils with abscess), infectious mononucleosis - cervical lymphadenopathy is a characteristic sign of EBV tonsillitis |
| epiglottitis | the inflammation of the epiglottis and is a medical emergency |
| key symptoms of epiglottitis | inflamed, red, stiff and swollen epiglottis, steeple sign |
| what must you NOT do when you see a patient with symptoms of epiglottitis? | NEVER swab their throat |
| acute bronchitis | inflammation of bronchi and bronchioles |
| when do we most commonly see acute bronchitis? | most commonly seen in fall & winter months, low socioeconomic status families, and urban/ highly industrialized areas |
| patho of acute bronchitis | inflammatory response to pathogen or irritant |
| symptoms of acute bronchitis | sore throat, sputum may be clear, yellow, green or blood tinged persistent cough lasting 10- 20 days |
| chronic bronchitis | history bronchitis lasting for 3 months out of year for at least 2 years |
| pathology of pneumonia | pathogen exposure most commonly inhalation of droplets containing bacteria/ pathogen, inflammatory response, consolidation, decreased gas exchange mucus & exudative edema accumulate between alveoli & capillaries |
| symptoms of pneumonia | fever and chills, pleuritic chest pain, dyspnea, decreased exercise tolerance, myalgias, headache, earache |
| diagnoses of pneumonia | Chest x -ray, sputum culture |
| community acquired pneumonia | streptococcus pneumonia, myoplasma |
| hospital - associated pneumonia | infection contracted after 48 hours of hospital admission; staph aureus |
| ventilator associated pneumonia | MRSA |
| aspiration pneumonia | bacteria in oropharynx |
| mycoplasma - walking pneumonia | small bacteria - like organism mild pneumonia patient may not appear very ill persistent cough headache, earache |
| legionnaires disease pneumonia | water systems like AC and showers |
| active TB disease | the tubercle will rupture and symptoms will occur |
| latent TB infection | tubercle is built and you will form the tubercle in your lung |
| TB symptoms | chronic cough, hemoptysis, weight loss, night sweats |
| TB pathology (tubercle formation) | WBC's can't kill TB organism, scar tissue forms around tubercle, immune response to TB bacteria damages healthy lung tissue, once scar tissue grow around tubercle, bacilli become inactive |
| TB diagnosis | sputum cultures for acid - fast bacilli (stains positively in acid fast), chest x ray (tubercles), NAAT (nucleic acid amplification test for TB), mantoux (skin test with bubble indicated pos) |
| restrictive lung disease | reduced expansion of lung tissues, decreased total lung capacity |
| restrictive lung disease examples | pulmonary fibrosis, pneumoconiosis, thoracic cage deformities |
| obstructive lung disease | increased resistance to airflow |
| obstructive lung disease examples | emphysema, chronic bronchitis, bronchiectasis, asthma |
| what is the primary risk factor for lung disease? | smoking |
| what is another major risk factor for lung disease? | occupational and environmental exposures to harmful substances |
| what part of the nervous system causes bronchodilation | sympathetic nervous system specifically beta - 2 adrenergic receptors are responsible |
| what part of the nervous system causes bronchoconstriction | parasympathetic nervous system with the chemical receptors leukotrienes- secreted by WBCs & histamine - released by mast cells |
| where is the pleural membrane and why is it important | lines the chest cavity and envelops lungs & its a thin film of fluid lubricating membrane layers |
| what type of pressure is the pleural membrane | under a negative thoracic pressure which allow the lungs to inflate easily |
| what happens if air or fluid enters the pleural membrane | it causes lung expansion to be more difficult |
| pleural effusion | the accumulation of fluid in the pleural space |
| pneumothorax | the accumulation of air in the pleural space |
| pleural effusion and pneumothorax do to the lungs | both cause a compression on the lung tissue making it very difficult for lung expansion |
| hypercapnia | elevated carbon dioxide levels anything greater than 45 |
| how does chronic hypercapnia affect the chemoreceptors in the brain | prolonged, central chemoreceptors become insensitive to CO2 levels - stimulus for breathing shifts to the chemoreceptors in carotid and aorta |
| when a patient has chronic hypoxia, what hormone is released by the kidneys to stimulate the production of rbc's? | erythropoietin |
| what is a normal PO2 level? | 90 - 100 mmHg |
| a PO2 of < 60 mmHg means what? | the blood is not perfusion the tissue with oxygen = increased ventilation = production of erythropoietin to make more RBCs |
| pulmonary hypertension does what | will cause right sided heart failure because the right ventricle has to work harder to pump blood against the increased pressure |
| cor pulmonale | right sided heart failure |
| symptoms you expect to see in hypoxia? | clubbing of toes and fingers due to low oxygen levels and cyanosis |
| cyanosis | bluish discoloration of skin/ mucus membranes, excessive concentration of deoxygenated hemoglobin in small vessels |
| 3 characteristics to asthma | hyperactive air way disease of bronchioles, reversible airway constriction, each attack leads to inflammatory changes |
| what is the one thing about asthma that sets it apart from other respiratory illnesses? | asthma is reversible the other ones are not |
| name some causes of chronic attacks the tissues of the lungs | genetic allergies, occupation, exposure, exercise and GERD |
| which inflammatory cells play a role in asthma? | T cells, IgEs, leukotrienes, histamines, eosinophils |
| what are symptoms of asthma | prolonged expiration, wheezing, cough, dyspnea, chest tightness, use of accessory muscles |
| diagnostics of asthma | PFT, reassess ratio after bronchodilator use |
| classifications of asthma | mild intermittent, mild persistent, moderate persistent, severe persistent |
| mild intermittent of asthma | symptoms concur fever than 2 times a week and attacks are brief FEV1 greater than 80% during asthma attacks |
| mild persistent of asthma | symptoms are occuring more than 3x a week, but not as often as daily FEV1 greater or equal than 80% of normal during asthma attacks |
| moderate persistent of asthma | daily symptoms, quick- relief inhaler daily asthma attacks at least 2x per week FEV1: 60% -80% of normal, FEV1/ FVC ratio reduced by 5% |
| severe persistent of asthma | symptoms are basically continous FEV1 less than 60% of normal FEV1/FVC ratio reduced by greater than 5% |
| status asthmaticus | persistent bronchoconstriction despite attempts to reverse, decreased arterial oxygen and increased carbon dioxide |
| what part of the lung does chronic bronchitis affect | bronchial tubes |
| what is the main issue of bronchitis | hypoxia |
| why would a person with chronic bronchitis have elevated hemoglobin | because they have more carbon dioxide in their lungs they cannot get air into their lungs |
| what symptoms will a person with chronic bronchitis have? | cough, pulmonary arterial vasoconstriction, cyanosis, mucus and edema |
| chronic bronchitis will cause you to be a "blue bloater" | because chronic bronchitis can cause severe difficulty breathing and decreased oxygen in the body |
| what part of the lung does emphysema affect | alveoli |
| what is the main issue of emphysema | hypercapnia |
| what symptoms will a person with emphysema have? | barrel shaped chest, diaphragm pushed downward |
| why are people with emphysema called pink puffers? | people have difficulty catching breath so the patient gasps or takes short, fast breathes. this causes them temporary redness or pink coloring on their cheeks and faces |
| describe how both emphysema and chronic bronchitis can lead to cor pulmonale | decreased oxygenation in lungs leads to pulmonary vasoconstriction, increased workload on RV may lead to right- sided heart failure, RV failure caused by pulmonary disease called cor pulmonale |
| describe how COPD can lead to change in respiratory drive (allostatic load) | in normal breathing stimulus there is increased CO2, but in severe COPD, CO2 levels are chronically elevated which then can cause those chemoreceptors to become insensitive to high CO2 |
| With the respiratory drive switching to hypoxia vs. hypercapnia, what do you think would happen if we give a patient too much oxygen and increase their oxygen saturation to 100% with FiO2 (oxygen)? | Giving high concentrations of oxygen to hypoxaemic patients with hypercapnia can result in individuals losing their hypoxic drive to breathe, with Co2 retention, respiratory acidosis and even death |
| describe pathology of bronchiectasis | untreated infections lead to chronic inflammation and dilation of bronchi |
| apnea | reduction of airflow by 90% for at least 10 seconds |
| obstructive sleep apnea | intermittent collapse of upper airway tissues |
| central sleep apnea | loss of respiratory drive from brainstem |
| symptoms of apnea | loud snoring, choking or gasping during sleep, un-restful sleep and daytime sleepiness |
| risks of apnea | obesity OSA- worsened by alcohol and sedative - hypnotic medications |
| diagnosis of apnea | sleep study |
| pneumothorax | a collapsed lung and air is in the pleural cavity causes collapse of a large section or whole lobe of lung tissue |
| primary spontaneous pneumothorax | risk: most common in tall, young men between ages 10-30 years unclear etiology, but ruptured alveoli are theorized to be the cause |
| secondary spontaneous pneumothorax | underlying pathological process in the lung, air enters the pleural space via ruptured blebs, at risk: patients with long term emphysema |
| traumatic pneumothorax | often due to penetrating wound of the thoracic cage pleural membrane |
| tension pneumothorax | escalating buildup of air within lung compresses the lung, bronchioles, cardiac structures, vena cava |
| iatrogenic pneumothorax | complication of medical procedures; often transthoracic needle aspiration |
| pleural effusion | an abnormal collection of fluid in pleural cavity |
| signs / symptoms of pleural effusion | dyspnea, tachypnea, sharp pleuritic chest pain, dullness to percussion, diminished breath sounds on the affect side, lack of breath sounds over area of effusion |
| environmental lung disease: pneumoconiosis | anthracosis black lung, gray sputum and wheezes can occur with exposure to air pollution |
| environmental lung disease: asbestosis | pulmonary fibrosis and cacincogen |
| environmental lung disease: silicosis | quartz crystal that if inhaled causes pulmonary fibrosis |
| scoliosis | twisting of thoracic vertebral column |
| kyphosis | curve of cervical spine |
| idiopathic pulmonary fibrosis | injury of lung disease tissue by an unidentified agent -repeated alveoli inflammation causes fibrotic changes (lung tissue stiffens) |
| virchow's triad | pulmonary stasis, vessel injury, hyper coagulation |
| primary pulmonary hypertension | abnormal structure of pulmonary vessels due to a genetic disorder |
| secondary pulmonary hypertension | increased pulmonary pressure results of other factors like hypoxemia |
| pathology of adult respiratory distress syndrome (ARDS) | sudden, progressive, pulmonary edema; arterial hypoxemia that does not improve with administration of oxygen, seen in critically ill patients, PO2 of 50 mmHg or less, PCO2 of 50 mmHg or more |
Created by:
sammy.e7
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