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NURS 319: Pulmonary
Chapters 20 & 21: Pulmonary and Respiratory Systems
| Question | Answer |
|---|---|
| what parts of the body are involved with breathing? | diaphragm, abdominal muscles, lungs, throat |
| what is inhaled in breathing? | oxygen |
| what is exhaled in breathing? | carbon dioxide |
| what innervates the diaphragm? | C3, C4, C5 |
| what does it mean for the ability to breathe if there is damage to the spinal cord? | it can be severely impacted and even cause death |
| protective mechanism in the lungs that traps inhaled particles and moves them up to the upper airway to be coughed out | mucociliary apparatus |
| what impacts the mucociliary apparatus and how? | respiratory infections and smoking; increased viscosity of mucus |
| what are retractions? | pulling inward of soft tissues between ribs upon inhalation |
| what are adventitious breath sounds? | superimposed over normal breath sounds; crackles, wheezes, rhonchi, friction rub |
| how is breathing controlled? | automatic, controlled by respiratory center in base of brain |
| process of diffusion in the airways | oxygen in and carbon dioxide out, acid-base balance, ATP to mitochondria |
| where does gas exchange occur? | alveoli |
| SaO2 | oxygen saturation of hemoglobin |
| oxyhemoglobin | Hgb with attached O2 |
| erythropoietin | secreted by kidneys when BP is low |
| airway resistance | resistance in respiratory tract to airflow during exhalation and inhalation |
| compliance of the lungs | elasticity, expandability, distendibility |
| dyspnea | difficulty breathing |
| expectoration | expulsion of mucus, sputum, or fluids from the respiratory tract by coughing or clearing one's throat |
| hemoptysis | coughing up blood (from lower respiratory) |
| ventilation | breathing and its track; expiration: breathing/ pushing out |
| perfusion | flow of blood around alveoli through capillaries |
| hypoxia | low oxygen in blood |
| how does hypoxia affect the vessels? | pulmonary vasoconstriction |
| hypercapnia | higher levels of CO2 in blood |
| how does hypercapnia affect the vessels? | vasoconstriction |
| new stimulus to breathe when the body experiences chronic hypercapnia (allostatic overload) | hypoxia |
| atelectasis | collapse of small # of alveoli |
| common causes of atelectasis | sedation, shallow breathing, decreased respiratory rate, pneumonia |
| anoxia | no oxygen |
| carbon monoxide poisoning | hemoglobin has higher affinity for carbon dioxide than oxygen. hemoglobin picks up more co2 than o2. body does not get o2 to muscles, lungs, etc. and gets sick/ shuts down but hemoglobin will continue to carry co2 instead |
| why does a person with carbon monoxide poisoning stay pink in color? | formation of carboxyhemoglobin |
| respiratory failure | failure to oxygenate blood or remove carbon dioxide |
| what would cause a hypoxemic failure? | pulmonary edema, pneumonia PaO2 less than 60 mmHg |
| what would cause a hypercapnic failure? | COPD, asthma PaCO2 greater than 50 mmHg |
| chest X-rays | takes contrasting image of chest |
| pulse oximetry | measures level of O2 saturation |
| arterial blood gases | o2 and co2 levels in blood |
| CT scan and MRI | more detailed image |
| bronchoscopy | scope down to 2nd generation bronchioles |
| thoracentesis | remove fluid or air from around the lungs |
| sputum cultures | taking sample of patient mucus and running tests on it |
| V/Q scan | ventilation and perfusion |
| what does mismatch V/Q show? | air cannot flow into an alveolus or blood flow around alveolus is altered |
| what is the most common disorder that a V/Q mismatch indicate? | pulmonary embolus |
| pulmonary function test | spirometry + lung volumes and air flow |
| what is the difference between acute and chronic rhinitis? | length/frequency of inflammation acute: 2-4 days |
| symptom of bacterial rhinitis | antibiotics work, more gradual onset |
| symptom of viral rhinitis | antibiotics do not work, more rapid onset |
| rhinitis | inflammation of mucus membranes |
| sinus infection | inflamed sinuses that drain into membranes |
| what symptom of a sinus infection would be worrisome and why? (requires hospitalization) | altered mental status/ dizziness indicates that infection has spread to brain |
| usual causative agent for bacterial acute pharyngitis | group A beta hemolytic streptococcus |
| why do we worry about group A beta hemolytic streptococcus | can cause many life-threatening diseases affects heart, kidneys, lungs |
| common symptoms of an infection caused by group A beta hemolytic streptococcus | red, swollen tonsils white exudate on tonsils enlarged lymph nodes |
| how do we diagnose bacterial pharyngitis | throat culture/ rapid screening |
| is there a difference between acute pharyngitis and acute tonsilitis | acute tonsilitis can be caused by EBV, adenovirus, Herpes simplex virus, cytomegalovirus |
| causes and symptoms of tonsilitis | sore throat, fever, difficulty swallowing, erythema, quinsy, swelling of pharynx |
| inflammation of the epiglottis | epiglottitis |
| key symptoms of acute epiglottitis | infection and inflammation, ABGs, steeple sign, inflamed/red/stiff/ swollen epiglottis |
| what must you NOT do when you see a patient with symptoms of acute epiglottitis | keep them calm and do NOT do a throat swab |
| what preventative measure can you take to avoid acquiring acute epiglottitis | getting antibiotics in system as soon as possible when sick |
| what is acute bronchitis | inflammation of bronchi + bronchioles |
| when do we commonly see acute bronchitis | fall and winter |
| symptoms for acute bronchitis | sore throat, nasal discharge, muscle aches, persistent cough, fever, sputum (clear, yellow, green, blood-tinged) |
| diagnostic criteria for chronic bronchitis | lasts longer than 3 months for 2 consecutive years or more |
| which part of the lung is predominately affected by bronchitis | bronchial tubes |
| pathophysiology of bronchitis | inflammatory response to pathogen or irritant |
| types of pneumonia + key characteristics | community acquired pneumonia: spread rapidly hospital acquired pneumonia: within 48 hours of admission aspiration pneumonia: bacteria in oropharynx mycoplasma pneumonia: walking pneumonia |
| pathophysiology of pneumonia | inhalation of droplets |
| symptoms of pneumonia | cough, fever/chills, dyspnea, chest pain, hemoptysis, myalgias |
| part of the lung predominately affected by pneumonia | lung tissue |
| how is pneumonia diagnosed | chest X-ray and sputum culture |
| difference between latent and active tuberculosis | latent: dormant active: showing symptoms |
| tuberculosis pathophysiology | inhalation of airborne droplets |
| how do you test for TB? | skin test + sputum culture |
| next test to verify positive TB? | chest X-ray |
| what other issues can TB cause? | scrofula, Pott's disease, Addison's disease |
| symptoms of active TB | cough, hemoptysis, weight loss, night sweats |
| mantoux test and positive looks | skin is viewed immediately then 72 hours later skin splotches bigger than 20mm |
| restrictive lung diseases + examples | decrease in total lung capacity pulmonary fibrosis, thoracic cage deformity |
| obstructive lung disease + examples | increased resistance to air flow emphysema, COPD, asthma |
| primary factor for lung disease | smoking |
| secondary (major) risk factor for lung disease | occupational and environmental exposures |
| when teaching a patient about lung diseases, what is a major focus of education? | try to stop smoking and avoid exposure if you can |
| bronchodilation | dilation of bronchi/ bronchioles |
| what part of the nervous system causes bronchodilation | sympathetic ANS |
| receptors responsible for bronchodilation | beta-2 adrenergic receptors |
| bronchoconstriction | constriction of bronchi/ bronchioles |
| what part of the nervous system causes bronchoconstriction | parasympathetic ANS |
| chemical mediators that lead to bronchoconstriction | leukotrienes histamine |
| where is the pleural membrane | lines chest cavity, envelopes lungs |
| why is the pleural membrane important | how lungs expand appropriately |
| the pleural membrane is under a ______ ______ pressure which allows the lungs to inflate easily | negative intrathoracic |
| accumulation of fluid in the pleural space | pleural effusion |
| accumulation of air in the pleural space | pneumothorax |
| how does chronic hypercapnia affect chemoreceptors in the brain | headache, drowsiness, intellectual impairment |
| what is the level of co2 that is considered hypercapnia | greater than 45 mmHg |
| when a patient has chronic hypoxia, what hormone is released to stimulate the production of red blood cells | erythropoietin |
| normal po2 level | 75 to 100 mmHg |
| po2 level that indicates blood is not perfusing tissues | less than 60 mmHg |
| less perfusion of blood to tissues = | increased ventilation |
| increased ventilation = | production of erythropoietin |
| production of erythropoietin = | pulmonary vasoconstriction |
| pulmonary vasoconstriction = | pulmonary hypertension |
| pulmonary hypertension = | cor pulmonale |
| symptoms you would expect to see in hypoxia | fatigue, clubbing, cyanosis |
| what is clubbing and what causes it | rounding of fingernails open ended capillaries from hypoxia |
| what is cyanosis and what causes it | blue discoloration of the skin + membranes; excessive concentration of deoxygenated hemoglobin |
| 3 characteristics to asthma | hyperreactive airway, reversible airway constriction, inflammatory changes |
| one thing about asthma that sets it apart from other respiratory illnesses | bronchial remodeling |
| how do chronic asthma attacks affect the tissues of the lungs | leads to swelling |
| which inflammatory cells play a role in asthma? | histamine, T cells, IgE, leukotrienes, eosinophils |
| symptoms of asthma | prolonged expiration, wheezing, cough, dyspnea, chest tightness |
| diagnostics of asthma | FVC/ FEV1 ratio diminishes |
| classifications of asthma | mild intermittent: flares mild persistent: 2x/wk, interferes with life, persistent bronchodilation despite reversal attempts moderate persistent: receptors saturated severe persistent: continuous symptoms |
| what part of the lung does chronic bronchitis affect? | mucus in bronchioles |
| chronic bronchitis main issue | hypoxia |
| why would a person with chronic bronchitis have elevated hemoglobin | body trying to increase oxygen delivery to lungs |
| chronic bronchitis symptoms | clubbing, cough, vasoconstriction, mucus + edema |
| what is "blue bloater" | cyanosis and inflammation |
| what part of the lung does emphysema affect | alveoli |
| emphysema main issue | hypercapnia |
| what is "pink puffer" | carbon monoxide overload thin and flat diaphragm |
| emphysema symptoms | barrel-shaped chest, prolonged exhalation |
| how can chronic bronchitis and emphysema lead to cor pulmonale | overworking right side of heart to compensate |
| how COPD can lead to a change in respiratory drive | body adapts to amount of oxygen available |
| what would happen if we give a patient too much oxygen and increase their oxygen saturation to 100% with FiO2? | reperfusion injury equivalent; body would be unable to handle it |
| pathology of bronchiectasis | bronchiole wall destroyed and replaced by fibrous tissues |
| apnea | reduction in airflow by 90% for at least 10 seconds |
| difference between obstructive sleep apnea and central sleep apnea | obstructive: upper airway tissues central: loss of respiratory drive from brainstem |
| symptoms of sleep apnea | loud snoring, choking/gasping during sleep, unrestful sleep, daytime sleepiness |
| sleep apnea diagnosis | sleep study |
| pneumothorax | air in pleural space |
| primary pneumothorax | tall, young men (30s) |
| secondary pneumothorax | long-term emphysema |
| traumatic pneumothorax | penetrating wound to ribcage |
| tension pneumothorax | compression |
| latrogenic pneumothorax | complication of medical procedures |
| symptoms of pneumothorax | chest pain, dyspnea, increased respiratory rate |
| diagnosis of pneumothorax | chest X-ray, CT scan, pulse oximetry + ABGs |
| pleural effusion | fluid in pleural cavity |
| pleural effusion symptoms | dyspnea, tachypnea, sharp chest pain, diminished breath sounds |
| pleural effusion diagnosis | chest X-ray |
| types of environmental lung disease | coal worker, asbestosis, silicosis |
| scoliosis | curvature of the spine (sideways) |
| kyphosis | curvature of the spine (hunchback) |
| how do scoliosis and kyphosis lead to restriction in the lungs | ribcage can shift and crush lungs |
| idiopathic pulmonary fibrosis | injury to lung tissue by an unidentified agent |
| pulmonary edema | build up of fluid + swelling |
| pulmonary edema symptoms | swelling, weight gain, anorexia |
| most common cause of pulmonary edema | left ventricular heart failure |
| how can a DVT lead to pulmonary embolism | DVT can break off and travel through bloodstream to lungs |
| how a V/Q mismatch occurs | perfusion or ventilation is hindered and now ratio does not match |
| how does pulmonary hypertension lead to cor pulmonale | R. ventricle hypertrophies and eventually fails because it is overworked |
| pathology of adult respiratory distress syndrome | sudden, progressive pulmonary edema |
| who do we see ARDS occur in? | critically ill patients |
| ARDS symptoms | hypoxemia that does not improve PO2 less than or equal to 50 mmHg PCO2 less than or equal to 50 mmHg |
Created by:
lcorlew1
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