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Ch 19 Patho
Respiratory Disorders
Question | Answer | Answer | Answer | Answer | Answer | Answer | Answer | Answer |
---|---|---|---|---|---|---|---|---|
The Lower Respiratory is considered? | Sterile | |||||||
The nasal cavities job is to? | Warm and moisten incoming air and trap foreign material by mucus secretions | |||||||
The nasopharynx is the site for? | Pharyngeal tonsils in posterior wall | |||||||
Palatine tonsils are made up of and found? | Lymphoid tissue in posterior portion of the oral cavity | |||||||
The Oropharynx is considered? | The Common passageway for air and food | |||||||
The Epiglottis? | protects opening into larynx. | Closes over glottis at swallowing to prevent aspiration | ||||||
The Larynx holds? | Two pairs of vocal cords | |||||||
Process of inspiration and expiration is determned by? | Airflow depends on pressure gradient from high to low area | |||||||
Inspiration is? | Atmospheric pressure higher than pressure in alveoli | air moves from atmosphere into lungs | ||||||
Expiration is? | Pressure in alveoli higher than in atmosphere | air moves from lungs into atmosphere | ||||||
Tidal volume is | the amount of air exchanged with quiet inspiration and expiration | |||||||
Residual volume is | Volume of air remaining in lungs after maximum respiration | |||||||
Vital capacity is? | Maximal amount of air that can be moved in and out of the lungs with a single forced inspiration and expiration | |||||||
Primary control centers for breathing are located where? | Located in the medulla and pons | |||||||
Chemoreceptors detect changes in? | carbon dioxide levels, hydrogen ions, and oxygen in blood or cerebrospinal fluid (CSF) | |||||||
Central chemoreceptors are found? | In the medulla | |||||||
Peripheral chemoreceptors are found? | in the carotid bodies | |||||||
Hypoxemia is? | Marked decrease in oxygen in which Chemoreceptors respond | |||||||
Important control mechanism in individuals with chronic lung disease? | move to hypoxic drive | |||||||
Hypocapnia | Caused by low carbon dioxide concentration in blood | May be caused by hyperventilation | Causes respiratory alkalosis | |||||
Factors Affecting Diffusion of Gases | Thickness of the respiratory membrane | Total surface area available for diffusion | Ventilation-perfusion ratio need to match | |||||
Oxygen is? | About 1% is dissolved in plasma | Most is bound (reversibly) to hemoglobin | ||||||
Binding/release of oxygen to hemoglobin depends on | PO2 | PCO2 | Temperature | Plasma ph | ||||
Carbon dioxideis? | Waste product from cellular metabolism | About 7% dissolved in plasma | About 20% reversibly bound to hemoglobin | Most diffuses into red blood cells | ||||
Sputum is? | Yellowish-green, cloudy, thick mucus | Often indication of a bacterial infection | ||||||
Rusty or dark-colored sputum is a sign of? | pneumococcal pneumonia | |||||||
Very large amounts of purulent sputum with foul odor is? | bronchiectasis | |||||||
Thick, tenacious mucus is caused by? | Asthma or cystic fibrosis | |||||||
Hemoptysis is? | Blood-tinged (bright red) frothy sputum | associated with pulmonary edema | ||||||
Kussmaul respiration is? | Deep rapid respiration | typical for acidosis | may follow strenuous exercise | |||||
Labored respiration or prolonged inspiration or expiration cause? | obstruction of airways | |||||||
Wheezing or whistling sounds indicates? | obstruction in small airways | |||||||
Stridor is? | High-pitched crowing noise | indicates upper airway obstruction | ||||||
Rales breathing is? | Light bubbly or crackling sounds with serous secrteions | |||||||
Rhonchi breathing is? | Deeper or harsher sounds from thicker mucus | |||||||
Absence breathing is? | Nonaeration or collapse of lungs | |||||||
Dyspnea is? | Subjective feeling of discomfort | May be due to increased carbon dioxide or hypoxemia | Often noted on exertions such as climbing stairs | |||||
Severe dyspnea indicative of respiratory distress are? | Flaring of nostrils | Use of accessory respiratory muscles | Retraction of muscles between or above ribs | |||||
Orrthopnea is? | Occurs when lying down | Usually due to pulmonary congestion | ||||||
Paroxysmal nocturnal dyspnea is? | Sudden acute type of dyspnea | Common in patients with left-sided congestive heart failure | ||||||
Cyanosis is? | Bluish coloring of skin and mucous membranes | Result of large amounts of unoxygenated hemoglobin in blood | ||||||
Friction rub is? | Soft sound produced as rough inflamed or scarred pleural move against each other | |||||||
Clubbed digits results from? | chronic hypoxia associated with respiratory or cardiovascular diseases | |||||||
Changes in arterial blood gases cause? | Hypoxemia | Hypercapnea | ||||||
Sinusitis is? | Usually bacterial infection | Analgesics for headache and pain | Course of antibiotics often required to eradicate infection | |||||
Laryngotracheobronchitis (croup)is? | Common viral infection, particularly in children | Parainfluenza viruses and adenoviruses causitive organisms | Infection usually self-limited | |||||
Epiglottitis is? | Acute infection Common in children ages 3 to 7 | Usually caused by H. influenzae type B | Rapid onset; fever and sore throat | Child sits in tripod position | Drooling and difficulty swallowing | Heightened anxiety | Swelling | Treatment Oxygen and antimicrobial therapy |
Influenza treatment include what? | Symptomatic and supportive | Antiviral drugs | Vaccination | |||||
Type A H1N1 Influenza is? | This virus contains genes from pig, bird, and human flu strains. | More commonly affects children and teens under age 20 | Healthy young adults also at high risk | High mortality rate due to acute respiratory syndrome | ||||
Bronchiolitis is? | Caused by the respiratory syncytial virus (RSV) | Transmitted by oral droplet | Virus causes necrosis and inflammation in small bronchi and bronchioles. | Signs Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise | Treatment Supportive and symptomatic | |||
Pneumonia is? | Causative agent Viral, bacterial, fungal | Throughout both lungs, or consolidated in one lobe | Changes in interstitial tissue, alveolar septae, or alveoli | Nosocomial (hospital-acquired) | Community-acquired | |||
Lobar pneumonia – bacterial pneumonia is? | Community-based, often in healthy young adults | Usually caused by Streptococcus pneumoniae | Infection localized in one or more lobes | Infection may spread to pleural cavity – empyema | ||||
Manifestations of Lobar Pneumonia? | Sudden onset | High fever with chills, fatigue, leukocytosis | Dyspnea, tachypnea, tachycardia | Pleural pain | Rales | Confusion and disorientation | ||
Bronchopneumonia is? | Diffuse pattern of infection in both lungs | Several species of microorganisms may be the cause | Inflammatory exudate forms in alveoli | Onset tends to be insidious | Antibacterial treatments | |||
Legionnaires’ disease is? | Caused by Legionella pneumophila | Thrives in warm, moist environments | Often nosocomial infection | Difficult to identify – requires special culture medium | ||||
Untreated Legionnaires’ disease causes? | Cause severe congestion and consolidation | Necrosis in the lung | Possibly fatal | |||||
Primary atypical pneumonia is? | Mycoplasma pneumoniae – bacterial | Viral form caused by influenza A or B, adenoviruses, and RSV | ||||||
Tuberculosis Etiology? | M. tuberculosis transmitted by oral droplets from persons with active infection | People living in crowded conditions, immunodeficiency, malnutrition, alcoholism, conditions of war, chronic disease, HIV infection | ||||||
Usual cause M. tuberculosis? | Somewhat resistant to drying and many disinfectants | Can survive in dried sputum for weeks | Destroyed by ultraviolet light, heat, alcohol, glutaraldehyde, formaldehyde | Normal neutrophil response does not occur | Primarily affects lungs; other organs may be invaded, too | |||
Primary infection of TB? | Engulfed by macrophages – local inflammation | If cell-mediated immunity is inadequate: Mycobacteria reproduce and begin to destroy lung tissue | This form of disease is contagious | |||||
Secondary or reinfection TB is? | cell-mediated immunity is impaired due to: Stress Malnutrition HIV infection Age | Mycobacteria begin to reproduce and infect lung | ||||||
Active TB (either primary or secondary) is? | Organisms multiply, forming large areas of necrosis | Cavitation promotes spreading into other parts of lung | Cough, positive sputum, radiograph showing cavitation | |||||
Treatment of TB? | Long-term treatment with a combination of drugs | Length of treatment varies from 6 months to 1 year | ||||||
Histoplasmosis is? | Fungal infection Caused by Histoplasma capsulatum | Granuloma formation and necrosis | Cough, fatigue, fever, night sweats | Treatment – antifungal agents | ||||
Cystic Fibrosis? | Inherited (genetic) disorder Gene located on chromosome seven | Tenacious mucus from exocrine glands | Primary effects seen in lungs and pancreas | Mucus obstructs airflow in bronchioles and small bronchi | Permanent damage to bronchial walls | Infections are common | ||
Cystic Fibrosis Digestive tract? | Meconium ileus in newborns | Blockage of pancreatic ducts | Obstruction of bile ducts | |||||
Cystic Fibrosis Reproductive tract? | Obstruction of vas deferens (male) | Obstruction of cervix (female) | ||||||
Cystic Fibrosis Sweat glands? | Sweat with high sodium chloride content | |||||||
Cystic Fibrosis Signs and symptoms? | Salty skin | Signs of malabsorption | Chronic cough and frequent respiratory infections | Failure to meet normal growth milestones | ||||
Cystic Fibrosis treatment? | Replacement therapy and well-balanced diet | Chest physiotherapy | ||||||
Aspiration | Passage of food, fluid, emesis, other foreign material into trachea and lungs | Common problem in young children or individuals laying down when eating/drinking | Obstruction Aspirate is a solid object | Inflammation and swelling Aspirate is an irritating liquid | Predisposition to pneumonia | |||
Aspiration signs and symptoms | Coughing and choking with dyspnea | Stridor and hoarseness | Tachycardia and tachypnea | Nasal flaring, chest retractions, hypoxia | Cardiac or respiratory arrest | |||
Asthma | Bronchial obstruction In persons with hypersensitive or hyperresponsive airways | May occur in childhood or have an adult onset | Often family history of allergic conditions | |||||
Extrinsic asthma | Acute episodes triggered by type I hypersensitivity reactions | |||||||
Intrinsic asthma | Onset during adulth | Hyperresponsive tissue in airway initiates attack | ||||||
Asthma Pathophysiologic changes of bronchi and bronchioles | Inflammation of the mucosa with edema | Bronchioconstriction | Increased secretion of thick mucus | Changes create obstructed airways, partially or totally | ||||
Asthma – Signs and Symptoms | Cough, marked dyspnea, tight feeling in chest | Wheezing | Rapid and labored breathing | Expulsion of thick or sticky mucus | Tachycardia | Hypoxia | ||
Asthma – Signs and Symptoms | Respiratory alkalosis | Respiratory acidosis | Severe respiratory distress | Respiratory Failure | ||||
Asthma – Acute Episode | Persistent severe attack of asthma | |||||||
Chronic Obstructive Pulmonary Disease | Group of chronic respiratory disorders | Causes irreversible and progressive damage to lungs | May lead to the development of cor pulmonale | Respiratory failure may occur | ||||
Emphysema | Destruction of alveolar walls and septae Leads to large, permanently inflated alveolar air spaces | Contributing factors Genetic deficiency Genetic tendency Cigarette smoking Pathogenic bacteria | ||||||
Breakdown of alveolar wall from Emphysema | Loss of surface area for gas exchange Loss of pulmonary capillaries Loss of elastic fibers Altered ventilation-perfusion ratio Decreased support for other structures | |||||||
Fibrosis from empysema | Narrowed airways Weakened walls Interference with passive expiratory airflow | |||||||
Emphysema | Progressive difficulty with expiration Air trapping and increased residual volume Overinflation of the lungs Fixation of ribs in an respiratory position, increased anterior-posterior diameter of thorax (barrel chest) Flattened diaphragm (on radiograph | |||||||
Emphysema signs and symptoms | Dyspnea | Hyperventilation with prolonged expiratory phase | Anorexia | Fatigue | Clubbed fingers | |||
Bronchiectasis | Irreversible abnormal dilation of the medium-sized bronchi | |||||||
Pulmonary Edema | Fluid collecting in alveoli and interstitial area | |||||||
Tension pneumothorax | Result of an opening through chest wall and parietal pleura or from a tear in the lung tissue and visceral pleura | Air entry into pleural cavity on inspiration but hole closes on expiration, trapping air > increased pleural pressure and atelectasis | ||||||
Upper Respiratory has | Resident Flora | |||||||
Hypercapnia | Carbon dioxide levels in the blood increase | Carbon dioxide easily diffuses into CSF | Lowers pH and stimulates respiratory center | Increased rate and depth of respirations (hyperventilation | Causes respiratory acidosis – nervous system depression | |||
Common cold (infectious rhinitis) | Viral infection | More than 100 possible causative agents | Spread through respiratory droplets | Handwashing and respiratory hygiene important in prevention | Symptomatic treatment | Secondary bacterial infections may occur | ||
Influenza (Flu) | Viral infection | Type A (most prevalent), types B and C | Viruses constantly mutate | Sudden, acute onset with fever, marked fatigue, aching pain in the body | May also cause viral pneumonia |