Pathophys - respiratory alterations
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| s/s of respiratory alterations | dyspnea (subjective - uncomfortable breathing)---breathlessness, air hunger, SOB etc.
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| normal breathing data | 8-16 rpm---Tv=600-800mL----sighs 10-12 times/HOUR
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| kassmaul breathing vs Cheyne-Stokes | rapid, deep ---- reduced blood flow to brain stem intermittent/apnea
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| hypoventilation | inadequate alveoloar ventilation---paC02 > 44 -----normal PaC02=40
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| hyperventilaiton | alveolar ventilation exceeds metabolic demands----PaC02 < 36mmHg-----normal PaC02 = 40
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| hemoptysis | blood in sputum/pulmonary secretions bwo ----inf---pulm edema---PE (pulmonary embolism) or infarction---cancer
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| cyanosis | bluish skin/mucus membranes bwo desaturated or not enough Hb
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| s/s of hypoxia or dyspnea or cyanosis or respiratory alterations in general . . .(not sure which-gen idea here) | pain upon breathing ---clubbing---abnormal sputum
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| clubbing | increase in angle of nail bed, soft nails, nail curves like upside down spoon---associated with chronic hypoxic conditions such as ---lung ca---congenital heart disease---bronchiECTASIS
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| hypercapnia is caused by pulmonary disease | increased PaC02 measured in arterial blood
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| shunting | when blood flow (Q) is OK, but we have DECREASED ventilation-----caused by any disorder causing flooding or collapse of alveoli such as -----pulm edema---pneumonia---atelectasis
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| hypoxemia is | reduced oxygenation of arterial blood caused by 5 issues
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| hypoxemia caused by #1 | decreased oxygen in inspired air----high altitude, low 02 content in gas mixture, enclosed breating space
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| hyoxemia caused by #2 | hypoventilation bwo ---lack of neuro stimulation
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| hypoxemia caused by #3 | alveolocapillary diffusion problem bwo ----emphysema---fibrosis---pulm edema
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| hypoxemia caused by #4 | V/Q mismatch bwo ---asthma---chronic bronchitis---pneoumonia
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| hypoxemia caused by #5 | pulmonary right-to-left shunt bwo -----ARDs-----respiratory distress of newborn=hyaline disease---ateclectasis
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| what is a V/Q shift? |
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| what manifestion do ALL V/Q shifts cause | hypoxemia is end result
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| a low V/Q is less than 0.8 and indicates | IMPAIRED ventilation, somewhat deflated alveolus-----bwo---focal pneumonia---mucus
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| a very low V/Q indicates | BLOCKED venilation, collapsed alveolus bwo-----shunting---pneumothorax---ARDs---large area atelectasis
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| a HIGH V/Q over 0.8 indicates | impaired PERFUSION resulting in alveolar dead space bwo ---pulmonary emb---extensive emphysema
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| wikipedia's definition of pulmonary shunting | A pulmonary shunt is a physiological condition which results when the alveoli of the lung are perfused with blood as normal, but ventilation fails to supply the perfused region. VQ ratio is zero
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| What is acute respiratory failure | inadequate gas exchange----indicated by hypoxemia with Pa02 < 50----or---with PaC02 > 50 with pH < 7.25 acidotic
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| pulmonary edema | increase in interstitial fluid in lungs bwo capillary injury or failure of lymph to remove excess fluid.
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| lets say there are 3 things leading to pulmonary edema | increased left atrial pressure --- increased capillary perm/disruption of surfactant production---lymph obstruction/alteration
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| manifestations of pulmonary edema | dyspnea---hypoxemia---increased work of breathing---frothy sputum
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| aspiration commonly happens bwo | stroke pts aspirate food---kids inhale toys---ICU pts aspirate oropharyngeal contents
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| atelectasis | collapse of (alveoli) lung tissue caused by -----obesity---post op complication---endobronchial tumors---foreign body
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| bronchiectasis | is persistent dilation of bronchi--> easily collapse/obstruction most common and secondary to-----cystic fybrosis-----MOSTLY CAUSED BY mycobacterium avium
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| pneumothorax | gas or air trapped in pleural space bwo tear in visceral or parietal pleura
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| what can cause pneumothorz | chest wall trauma---inc airway pressure causing alveloi to rupture---spontaneous like ruptpure of COPD bleb, trauma
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| pleural effusion | shift of blood/fluid into pleura ---MOST OFTEN CAUSED BY CHF-----also nephrotic syndrome---cirrhosis---infections/pneumonia---cancer---PE
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| pleurisy | inflammation of pleural lining
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| what causes pleurisy | infection---inhaled chemical---collagen vascular disease---PE---trauma---pancreatitis/abd problems
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| ARDS = acute respiratory failure syndrome | sever form of failure with acute lung clincial lung injury----inflamm and diffuse alveolocapillary injury and NONCARDICAC PE
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| what is a very common cause of ARDs | severe aspiration of stomach contents, usually postop resp failure
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| obstructive pulmonary diseases | characterized by airway obstruction that makes it difficult to EXPIRE
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| examples of obstructive pulmonary diseases | asthma---chronic bronchitis---emphysema---
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| COPD | chronic obstructive pulmonary disease used to describe chronic BRONCHITIS AND EMPHYSEMA
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| asthma - chronic inflamm disorder of airways characterized by | bronchial hyperresponsiveness----episodic episodes of wheezing/breathlessness/chest tightness/coughing
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| pathophys of asthma | allergens---mast cells---release mediators---vasoactive cytokines increase cap perm---inflamm causes bronchial sm musc contr---vascular congestion/edema/mucus---mucociliary fxn impaired---epi cells damaged---airway walls thicken---obstruction
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| left untreated, asthma causes | causes irreversible airway damage
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| chronic bronchitis - can have seasonal cycles - defined as | hypersecretion of mucus and chronic/productive cough for at least 3 months for 2 consecutive years---higher incidence in smokers/high pollutants---repeaded infections a problem
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| pathophys bronchitis | irritant---inflamm cells---inc goblet cells---inc mucous can't be cleared---bronchospasm/dyspnea/cough---starts in lg airways, then smaller---airways close during expiration and trap air---V/Q mismatch---hypoxemia
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| take home on bronchitis | air can move in during INSPIRATION but during EXPIRATION, bronchial muscles relax, bronchial walls collapse around mucus----air cant escape---impaired ventilation leads to air trapping and increase in C02
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| emphysema | abn permanent enlargement of gas exchange airways accomp by DESTRUCTION of alveolar walls
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| in emphysema, what is obstruction caused by | caused by changes in lung tissue NOT BY mucus/inflamm
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| causes of emphysema | cig smoking---pollution ---childhood infection
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| what is the genetic component to emphysema | Alpha-1 antitrysin deficiency ---which inhibits many proteolytic enzymes. people lacking this enzyme, proteolysis of lung occurse --> homozygotes 75% chance of emphysema------smokers also deficient in alpha-1 antitrypsin
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| pathophys of emphysema | destruction of alveolar septa---destroys capillaries---increase volume of air in acinus---irritants may inhibit antiproteases---loss of elastic recoil/expiration.
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| what does hyperinflation in emphysema lead to | leads to air spaces (bullae) and blebs---then V/Q mismatch & hypoxia---air trapping---hypovent and hypercapnia late in dx
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| pulmonary hypertension = PAH | when pulmonary arterial pressure (PAP) exceeds 25 mmHg at rest, 30 exercising
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| pathophys of PAH | endothelial dysfunction --- xs vasoCONstrictors thromboxane/endothelin-----decreased vasoDILATORS NO/prostaglandin---fibrosis/thickening of vessel wall---lumen narrowing
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| PAH is associated with a ton of dxs | idiopathic--familial--CT dx--portal HTN---drugs/toxins---HF---thrombic/embolic dx---lung/hypoxia dxs
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| PAH clinical manifestations | often masked by u/l CV or pulm dx---dyspnea on exertion---fatigue---palpitations---chest pain
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| PE = pulmonary vascular disease-pulmonary embolus | occlusion by embolus---blood, fat, tissue, air
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| risk factos PE | conditions promoting clotting/venous stasis---hypercoagulability---endothelial injury
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| PE is 3rd leading cause of death in US | often bwo DVT - small emboli lodge in small bv---large occlude blood flow to lung = death
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