Chapter 23

Question 1

3 stages of breathing

Answer 1

1. Ventilation
2. Diffusion
3. perfusion

Question 2

Ventilation, perfusion, deffusion

Answer 2

V- movement of air into lungs
P- movement of O2 and CO2 into and out of circulation
D- movement of blood through the pulmonary circualtion.

Question 3

Decrease in amount of O2 in blood

Answer 3

Hypoxemia

Question 4

Hypoxemia

Answer 4

• effects are due to compensatory mechanisms of body
• SNS ^ = ^HR, ^BP, vasoconstriction
• ^ serum lactate from anaerobic respiration
• ^ respiratory rate, cyanosis, mental status changes
• ^ RBC production

Question 5

Hypercapnia

Answer 5

PCO2 greater than 50 mm Hg

too much CO2 in circulation

Question 6

causes of hypercapnia

Answer 6

hypoventilation
changes in metabolic rate
^ carbohydrate diet

Question 7

treatment for hypercapnia

Answer 7

• improvement of respiratory muscles (gas exchange)

- provide supplemental O2

Question 8

Hypercapnia (PCO2 ____)

Hypoxemia (PO2 ____)

Answer 8

PCO2 > 50 mm Hg

PO2 < 60 mm Hg

Question 9

Bronchia are surrounded by ___

Bronchioles are surrounded by ___

Answer 9

• cartilage & smooth muscle

- smooth muscle only

Question 10

Autonomic NS controls ___ in breathing
Parasympathetic ____
Sympathetic ___

Answer 10

smooth muscle

• Constriction- through vagus nerve (epi and norepi)
• Dilation- through B2 adrenergic receptor during sress and exercise

Question 11

Inflammatory disease that causes obstruction to flow of air in/out of lungs

Answer 11

asthma

Question 12

Asthma is caused by:

Answer 12

overreaction of the airways to irritants

Question 13

In Asthma, the irritant exposure triggers immune response by: (1st thing)

Answer 13

• Bronchoconstriction (^ inflammatory mediators do this)
• ^ vascular permeability
• ^ mucus production

Question 14

In Asthma, the irritant exposure triggers immune response by: (2nd thing)

Answer 14

• TH2 cell involvment-
• binds to allergen and triggers B cells to secrete IgE
• IgE binds to mast cells
• Mast cells initiate inflammatory response (mucus & asthma attack)

Question 15

Asthmatics have more ___ cells that increase their chance to pick up more potential allergens

Answer 15

Th2 cells

Question 16

Their are 2 types of Asthma:

Answer 16

1. Extrinsic (Atopic) Asthma- allergy

2. Intrinsic (Nonatopic) Asthma- Irritation

Question 17

Extrinsic (Atopic) Asthma

Answer 17

• Hypersensitivity to allergen

- initiated by allergic response

Question 18

Steps in Atopic Asthma

Answer 18

1. mast cells release inflammatory mediators
   
   • this causes an ACUTE response within (10-20 mins)
2. Bronchospasm, ^ vessel permeability, ^ mucus production.
3. WBC’s enter area, release more inflammatory med.
4. Airway inflammation causes LATE-PHASE response (4-8 h later)

Question 19

Intrinsic (Nonatopic) Asthma is caused by:

Answer 19

1. Respiratory Infections- epithelial damage, IgE produc
2. Exercise, Hyperventilation, cold air
3. Inhaled Irritants- inflammation, vagus reflex

Question 20

Their are 2 types of Chronic Obstructive Pulmonary Disorder, what are they?

Answer 20

1. Emphysema

2. Chronic Obstructive Bronchitis

Question 21

Emphysema is characterized by:

Answer 21

• destruction of alveoli and capillary beds
• Neutrophils in the alveoli secrete proteases (breaks down elastin)
• can have genetic defect in a1-antitrypsin

Question 22

a1-antitrypsin deactivates ____ which deactivates ____

Answer 22

elastase (which is used to breakdown elastin)
which deactivates
elastin which destroys alveoli ability to expand and contract

Question 23

Emphysema main symptoms:

Answer 23

1. barrel chested- air constantly getting trapped and can’t escape the lungs, so its distended
2. Pink Puffer- ppl purse lips to create more resistance in air so their airways don’t collapse

Question 24

Emphysema creates ___ of airways that then ___ on exhale. This contributes to the inability of a person to breathe fully.

Answer 24

overextension of the airways that then collapses on exhale.

Question 25

Chronic bronchitis has 3 main characteristics:

Answer 25

1. Chronic irritation of airways * ^ mucous cells, ^ mucus hypersecretion 2. Productive cough- lasting at least 3 months 3. Blue Bloaters * can't ^ respiration enough to maintain O2 levels * cyanosis and polycthemia

Question 26

Chronic Bronchitis can be diagnosed from emphysema by it's distinctive: (3)

Answer 26

1. tripod position to use accessory muscles in breathing 2. wheezing and crackling in lungs 3. Productive cough

Question 27

Pulmonary Embolism signs and symptoms:

Answer 27

1. severe, crushing chest pain | 2. loss of consciousness

Question 28

How to diagnose pulmonary embolism:

Answer 28

* Pulmonary Angiography- passing of catheter directly into pulmonary arteries

Question 29

Most common causes of COPD:

Answer 29

1. Smoking 2. Exposure to occupational dusts and chemicals 3. Airway infections 4. Asthma 5. Airway hypersensitivity

Question 30

The term chronic obstructive pulmonary disease encompasses 2 types of obstructive airway disease:

Answer 30

1. Emphysema | 2. Chronic Obstructive Bronchitis

Question 31

Asthma

Answer 31

Enlargement of air spaces and destruction of lung tissue

Question 32

Chronic Obstructive Bronchitis

Answer 32

^ in mucus production, obstruction of small airways, chronic productive cough

Question 33

Emphysema is characterized by:

Answer 33

Loss of lung elasticity and abnormal enlargement of air spaces distal to the terminal bronchioles, with destruction of alveolar walls and capillary beds.

Question 34

2 causes of emphysema

Answer 34

1. Smoke- kills lung tissue | 2. Deficiency in a1-antitrypsin: antiprotease enzyme that protects the lung from injury

Question 35

Emphysema results from:

Answer 35

Breakdown of elastin and other alveolar wall components by an enzyme called proteases

Question 36

Mechanisms of COPD (4)

Answer 36

1. Inflammation and fibrosis of the bronchial wall 2. Hypertrophied mucous glands—- lead to excess mucus and obstructed airways 3. Loss of alveolar tissue—- decreased surface area for gas exchange 4. Loss of elastic lung fibers—- airway collapse, obstructed exhalation, air trapping

Question 37

Elastase

Answer 37

Breaks down fibers and elastin in lungs

Question 38

Antiprotease (alphatripsin)

Answer 38

Protects the lungs from protease ingestion but smoking and other irritants signal neutrophils to secrete more proteases, overpowering the antiprotease enzymes

Question 39

Asthmatics are called “pink puffers” because:

Answer 39

Lack of cyanosis Use of accessory muscles “pursed-lips” breathing -loss of lung elasticity and hyperinflation of the lungs causes airways to collapse during expiration because of pressure in the surrounding lung tissues exceeding airway pressure.

Question 40

Emphysema pt’s often have “barrell chest”, why?

Answer 40

-air becomes trapped in alveoli and lungs, producing an increase in the anteroposterior dimensions of the chest.

Question 41

Those with chronic bronchitis are called “blue bloaters”, why?

Answer 41

In reference to their cyanosis and fluid retention associated with R-sided heart failure.

Question 42

COPD symptoms for both emphysema and chronic bronchitis

Answer 42

- respiratory impairment on exhale - increased work of breathing but decreased effectiveness - exertional dyspnea - labored breathing even at rest - crackles and exploratory wheezing lung sounds - accessory muscle use (tripod stance)

Question 43

Pursed lips breathing does what for those with COPD

Answer 43

Enhances air flow bc it increases the resistance to the outflow of air and helps to prevent airway collapse by increasing airway pressure

Question 44

Pulmonary emboli originate from where?

Answer 44

Most arise from deep vein thrombosis int he large veins in the lower leg.

Question 45

A congenital defect in a1-antitrypsin in a patient who is also a long-term smoker is likely to lead to which of the following conditions:

Answer 45

emphysema