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Unit 6 - Test 3

Respiratory system

Too much carbon dioxide in the blood (caused by a problem with ventilation) Hypercapnia
low oxygen in the blood hypoxemia
low oxygen in the tissue (caused by a problem with perfusion) hypoxia
What are some indicators of sever hypoxia -Tripod position -Use of accessory muscle -Cyanosis
Measure of oxygen in the blood PaO2
How do you obtain a PaO2 level painful needle into an artery to obtain arterial blood sample
Sa02 measures what? Pulse oximeter reading of ____ tissue perfusion. greater than 95%
Pa02 measures _______. SaO2 measures ________. Hypoxemia, hypoxia
How do you obtain a Sa02 measurement? from an oxygen saturation measurement (probe applied to finger, toe, earlobe, ect)
T or F - The lung has the capacity to compensate for mismatches in ventilation and perfusion? True
If ventilation is greater than perfusion, the Arterioles ________ and the Bronchioles _________, increasing perfusion while reducing ventilation. dilate, constrict
If ventilation is less than perfusion the _____ constrict while the ______ dilate to correct the imbalance. Arterioles, Bronchioles
What is the abbreviation for ventilation/perfusion? V/Q
This is done to evaluate the lung function (example: after a P.E) V/Q Scan
In a V/Q scan the ventilation part of the test looks at the the ________________________, while the perfusion part evaluates ________________________. ability of air to reach all parts of the lungs, how well blood circulates withing the lungs.
If Air Flow is disrupted it is a ________ problem. If Blood flow is disrupted it is a _______ problem. Ventilation, Perfusion
Blood clots, tachycardia, bradycardia, heart blocks and heart failure are some example that could cause what? Ventilation or perfusion Perfusion
hyperventilation, asthma, pneumonia, tumors and obstructions could cause what? ventilation or perfusion? Ventilation
What is the first indicator of hypoxia? Why? Change in LOC (restlessness, confusion and anxiety) --- Low oxygen is registered in the brain first.
T or F - The primary regulator of respiration is oxygen. False - Primary regulator is C02
What is the incomplete expansion of a part of the lungs (alveolie cannot fill with air) Atelectasis
What are 3 cause of Atelectasis? 1. Blockage of air passages (bronchus/bronchioles) 2. Pressure on the outside of the lung 3. Surfactant failure
_____________ is common soon after surgery or in patients who have limited mobility in the hospital (secretions build up in the lungs due to immobility) Atelectasis
__________ can develop quickly after atelectasis starts in the affected part of the lungs. pneumonia
In adults small areas of atelectasis are usually not life threatening but large areas can be life threatening, especially in who? babies or small children or someone who has another lung disease of illness
What are the S/S for atelectasis and what is the Tx? s/s - dyspnea, chest pain and cough Tx - Incentive spirometry and TCDB (turn, cough and deep breath)
Why do we have patients turn cough and deep breath when they have atelectasis? the actions are intended to keep the alveoli open and prevent further lung collapse
List 8 risk factors for developing atelectasis (LF STAMPP) L - Lung disease F- Foreign object in airway S- shallow breathing T-Tumor that block airway A - Anesthesia M - Mucus that plugs airway P - Prolonged rest with few change in position P- Pressure on lungs caused by pleural effusion
________ ________________ is when Alveoli cannot expand b/c the airways are blocked and air cannot get into the air sac, or there is no nitrogen in the air sac to keep it open. Absorption Atelecasis
Explain the 3 steps that lead to post-op atelectasis (absorption atelectasis) 1. Oxygen (given in general anesthesia) pushes CO2 and Nitrogen gases out of the alveoli. 2. Oxygen then leaves the alveoli too as it gets absorbed into the capillaries. 3. No gas is left in the alveoli to keep it open.
___________ __________ is cause by outside pressure pushing on the alveoli and collapsing it - such as a space -occupying tumor or a pocket of pleural effusion. Compression Atelectasis
A collapsed lung Pneumothorax
A collapsed lung that occurs without any cause spontaneous pneumothorax
Air blisters that break open can result from what. mechanical ventilator is set to high or without warning to people with weakened alveoli
What are some lung disease that can increase the chance of a pneumothorax? Asthma, COPD, Cystic fibrosis, Tuberculosis and whooping cough
Inflammation of the lining of the lungs and chest (the pleura) that causes chest pain when taking a breath or coughing. The normally smooth surfaces lining the the lungs (the pleura) becomes rough. Pleuritis/Pleurisy
What is friction rub When the smooth surfaces of the lung become rough and rub together with each breath resulting in a rough grating sound.
What is a P.E Pulmonary embolism - arteries in the lungs become blocked by a clot.
P.Es restrict blood flow to a portion of the lungs causing a ___________ that can result in lung death. Perfusion Mismatch
Most of the time P.Es are caused by what? blood clots that travel from the leg (DVT)
What are some high risk for developing a P.E? birth control pills, large bone fractures, smoking, atrial fibrillation, Post-operative (especially orthopedic)
Why are large bone fractures a risk for P.E.? release of fatty emoli causing Fat Embolism syndrome.
What are the s/s of P.E. shortness of breath (SOB), chest pain, s/s of hypoxia and cough
Dx for P.E. V/Q Scan, D-dimmer, and platelet count
A build up of fluid between the ribs and the lungs in the pleural space. Plueral Effusion
What are some of the fluid that can build up during plueral effusion? How can these fluids be removed? serous fluid, pus (empyema), lymph fluid or blood (hemothorax) - They can all be removed (aspirated) with a needle because it is in a cavity of the body.
A build up of fluid in the interstitial tissue of the the lung. Pulmonary edema
When does pulmonary edema occur? when the alveoli fill up with excess fluid seeped out of the blood vessels in the lung instead of air.
If large enough a pleural effusion can cause _________ __________. Compression atelectasis
Pulmonary Edema is commonly cause be what? what are some other cause. Commonly caused by left side heart failure. Other causes include kidney failure, sepsis or any lung failure.
How does Kidney failure cause Pulmonary edema? kidney does not remove excess body fluid
Difference between effusion and edema? - Pleural Effusion - Fluid in the Pleural cavity which can be drained out via thoracentesis. - Pulmonary edema - swelling of the interstitial lung tissue - Cannot be drained out.
What does ARDS stand for? Acute (adult) Respiratory Distress Syndrome
ARDS starts with an acute lung injury/insult (ALI) that cause what? Sever Lung inflammation or SIRS (systemic inflammatory response syndrome)
In response to lung injury the body release what? What do they cause? Chemical mediators, clotting factors, vasodilating agents - these cause further damage to the lungs. Particularly the alveoli and surrounding capillary beds.
What is the process for ARDS? Acute lung injury/insult ---> Systemic inflammatory response syndrome ---> body release chemical mediators, clotting factors, vasodilating agents causing more damage to lungs -->the lungs stop producing SURFACTANT ---->leads to atelectasis
What are the 5 stages of ARDS? First stage: Respiratory Alkalosis Intermediate Stage: Acidosis (respiratory and metabolic) Intermediate stage: Pulmonary Edema Intermediate stage: blood clotting late stage: respiratory failure
Explain the first stage of ARDS. Lungs initially try to compensate for hypoxia by breathing faster (tachypnea which will cause HYPERVENTILATION). This will result in RESPIRATORY ALKALOSIS to begin with because CO2 is being removed from the body.
Why does Acidosis happen in ARDS as hypoxia worsens? lungs cant keep up. Respiratory acidosis will develop as CO2 builds up.Metabolic acidosis develops as acid from CO2 & breakdown of cells increases K+. W/out enough O2 for metabolism, the body moves from aerobic to anaerobic metabolism & produces lactate,
In pulmonary edema stage of ARDS the combination of hypoxia and acidosis causes damage to the epithelial wall between the alveoli and the adjacent capillaries that forms the blood/air barrier. What does this lead to? fluid from blood is able to seep into the air sacs & drown the pt slowly (or rapidly in some cases of sepsis which adds to“leaky capillary” syndrome). Also, the damaged inflamed lining starts oozing thick exudate which cant be cleared from alveoli.
What happens in the intermediate state of ARDS? Blood Clots Platelets respond to the inflammation and tissue damage by making micro clots throughout the lung tissue. This adds to the problem by blocking perfusion, which in turn leads to worsening hypoxia.
In a person survives the late stage of ARDS (respiratory failure) what will be the result? they will have PERMANENT lung damage, as well as cognitive and psychological impairment due to the brain being deprived of adequate oxygen.
What are two of the most common COPD conditions? Emphysema and chronic bronchitis
Are asthma and cystic fibrosis considered COPD conditions? Yes - because they involve obstructive airways
COPD symptoms often do not appear until significant what has occurred? Lung damage
What is the most common cause of COPD? Smoking
What are 4 reason that air flow in impaired in a COPD situation? 1. airway and air sacs lose their elastic quality 2. walls between many of the air sacs are destroyed 3. walls of the airway become think and inflamed 4. airways make more mucus than usual and can clog
This is a chronic inflammatory disorder of the airway where inflammation results from hyperrepsonsiveness of the airway to any number of airborne irritants. Asthma aka Reactive Airway Disease
During Asthma the products of inflammation (chemical mediators such as histamines, bradykinins, and cytokines) go into mass production and over whelm the lungs. What is the result? This results in inflammation leading to constricted airways and the characteristic “wheezing” sounds. The inflammation makes the airway swollen and very sensitive. The airway tend to react strongly to certain inhaled substances.
This results in permanent damage to the lungs as a result of the inflammatory process. Emphysema
What is the result of emphysema. abnormal and permanent damage enlargement of the airways accompanied by destruction of alveolar walls without obvious fibrosis. the lung lose their ability to recoil after each respiration.
What is the characteristic sign of emphysema the patients chest goes from oval to round as a result of the body trying to adjust for extra work of breathing.
Patients with COPD live with persistently elevated CO2 levels therefore they dont responded to high PCO2 to stimulate respiration. What do they breath in response too? low O2 levels - consistent error signal of high CO2 causes the body to change what set point it relies on.
Should you give a COPD pts lots of oxygen to compensate for their high COPD levels? No - they response to low O2 levels to stimulate breathing - giving to much 02 removes respiratory drive and causes respiratory arrest.
This is a respiratory disease in which the mucus membrane in the lungs bronchial passages become inflamed. Bronchitis
Chronic bronchitis last at least ____ months of the year for ____ years in a row. 3 months, 2 years
T or F - Acute and chronic bronchitis are COPD conditions. False - Acute is not a COPD condition but chronic is.
This is a hyper-secretion of thick mucus and productive cough that last for at least 3 months of the year and for at least 2 consecutive years. Chronic Bronchitis
Chronic bronchitis usually presents in ________ patients emphysema patients
Once clogged with mucus, the lungs are then vulnerable to viral and bacterial infections, which over time distort and permanently damage the lungs' airways. This permanent condition is called ____ COPD
__________ is a common cause of bronchitis Smoking or second hand smoke
This is an autosomal recessive gene abnormality causing multisystem disease. Cystic Fibrosis
Cystic Fibrosis cause body wide what? body wide dehydration
What condition: impaired chloride and sodium reabsorption that alters vascular osmolarity and triggers sodium to shift from the secreting cells on glands and mucous membranes to the vascular space. Water follows NA+ leading to dehydration cystic fibrosis
Lung inflammation is called _________ if cause by a pathogen and ______ if caused by noninfectious agents. Pneumonia, Pneumonitis
This term describes inflammation of the parenchymal structures of the lungs (alveoli and bronchioles) Pneumonia
This is an airborne transmitted infection that can spread through the lymph nodes and blood stream to any organ in the body but primarily strikes the lungs. Tuberculosis
TB can be either ____ or _____. Active or latent
Explain the difference between active and latent TB. ACTIVE TB (infected, symptomatic AND contagious) or LATENT TB (infected but not symptomatic and not contagious). Latent TB can develop into active TB.
T of F - Some pts with TB have no symptoms. True
these are s/s of what - coughing with or without blood, fever, night sweats, chest pain, weight loss, tiredness TB
Who is at high risk for TB? People from underdeveloped countries, high density living conditions (long-term care, homeless shelters) and immunocompromised ( HIV, steroids, cancer, diabetes, kidney disease)
how do we test for TB? skin test and blood test
what are the contact precautions for a pts with TB? - Place pts in an isolated room (with negative pressure) as soon as TB is suspected - implement respiratory precautions (care provider N-95 masks) - have pts wear standard mask in public areas if they can tolerate it.
What is the top cancer in both men and women? Lung cancer
What is abnormal uncontrolled growth in on or both of the lungs Lung cancer
When do lung cancer s/s start to show well after the cancer has advanced (metastasized to distant parts of the body)
S/S of what: symptoms include coughing that is unrelieved with cough medicine, wheezing, shortness of breath, dyspnea, and bloody sputum. If the disease is far advanced, patients may experience unaccountable weight loss (cachexia). Lung cancer
Diagnosis for lung cancer is confirmed by what? tissue biopsy
Treatment for lung cancer? surgery, chemo, radiation
What are to two types of lung cancers? Non-small cell lung cancers and small cell lung cancers
the most common type of lung cancer (about 85%). Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of This non-small cell lung cancer
also called oat cell cancer. About 10%-15% of lung cancers. Highly malignant and Brain METASTASIS is common – poor prognosis; Chemo is usually the main treatment small cell lung cancer
Manifestations of lung cancer 1. change in organ funciton 2. Local effect of tumor- Compression of nerves or veins, 3. hormones secreated by tumor - low blood Na+ or high blood Ca+ levels. 4. nonspecific signs of tissue breakdown
What is the most common cause of Hemoptysis? TB
What are some diseases that may have hemoptysis TB, acute and chronic bronchitis, brochiectasis, lung cancer, pneumonia
What disease? The hemoptysis that results is usually mild to moderate and may be associated with other symptoms, including unexplained weight loss, cough, purulent sputum (thick, opaque, yellowish white discharge), and a history of mycobacterial exposure TB
What disease? very common cause of hemoptysis that results from recurrent coughing that irritates and eventually breaks down the mucosal lining of the airways. The hemoptysis is usually mild and often associated with a purulent sputum Acute or chronic bronchitis
chronic dilation and consequent infection of the bronchioles and bronchi that results from obstruction in the bronchi. The dilation results from damage to the surrounding supportive tissue and is usually a result of infection or fibrosis. Bronchiectasis
__________ is an example of the a disease that leads to bronchiectasis. Cystic fibrosis
________is a less common cause of hemoptysis than bronchitis or bronchiectasis but is an important one. Lung cancer (bronchogenic carcinoma)
Bleeds in Bronchogenic carinoma result form? 1. Necrosis of the tumor (death of the cells that make up the tumor) 2. The rupture of small blood vessels in the area 3. A tumor invading one of the pulmonary blood vessels --> major hemorrhage can result
What disease? As the lung tissue tries to protect itself, the lungs fill with liquid, blood, and pus. In addition to hemoptysis, other symptoms include a high fever, cough, and chest pain. Pneumonia
Created by: sbertelsen



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