1
Q
Signs may include flaring nostrils, use of accessory muscles and retraction of ICS
A
Dyspnea
2
Q
The coughing up of bloody secretions
A
hemoptysis
3
Q
What does hemoptysis indication
A
- inflammation that damages the bronchi
- TB
4
Q
What are the results of hypoventilation
A
- respiratory acidosis
- sleepy/disoriented
5
Q
What are the results of hyperventilation?
A
- respiratory alkalosis
- anxiety, could be pneumonia
6
Q
This is caused by increased amounts of desaturated or reduced hemoglobin in the blood
A
cyanosis
7
Q
What diseases could clubbing be associated with?
A
- hypoexmiabronciestatis,
- cystic fibrosis,
- pulmonary fibrosis
8
Q
This is associated with increased ventilatory rate with no expratory pause. Usually caused by strenous exercise or metabolic acidosis?
A
Kussmaul Breathing
9
Q
This breathing pattern is caused by any condition that reduces blood flow to the brain stems
A
Cheyne Stokes
10
Q
The difference between hypoxia hypoxemia
A
- -oxia is associated w/ tissues, no lab values
- -emia is associated w/ blood pressure below normal lab value
11
Q
What is V/Q Ratio
A
- balance of ventilation/perfusion
12
Q
What is the “v” referring to?
A
air entering alveoli
13
Q
What is “q” referring to?
A
amount of blood perfusing the capillaries around the alveoli
14
Q
What is low v/q
A
- shunting
- inadequate ventilation
asthma, atelactasis, pulmonary edema
15
Q
What is high v/q
A
- poor **perfusion **of well ventilated lungs
PE
16
Q
What is the difference between V/Q mismatch and shunt when supplemental oxygen is administered?
A
V/Q mismatch will respond well but shunts (Qs/Qt) will not.
17
Q
How does obstruction/infection/fluid lead to compromised alveolar air exchange?
A
- limited ventilation 02 delivery to alveoli
- limited diffusion of 02 from alveoli to blood
- limited perfusion of capillaries
18
Q
What do chest wall disorders affect?
A
- affects tidal wave
- results in hypercapnia
19
Q
What do pleural diseases impact?
A
- ventilation
- oxygenation
20
Q
Define pneumothorax?
A
- air in the pleural space
- destroys neg pressure
- lung collapse
21
Q
Define Open Pneumothorax
A
- air pressure in the pleural space equals barometric pressure
- b/c air that is drawn into the pleural space during inspiration is forced back out during expiration
22
Q
indicates there was trauma to the chest resulting in the collapse of the lung
A
Secondary pneumothorax
23
Q
when constrictions and dilations destroy the bronchi.
A
Varicose
24
Q
Define Tension Pneumothorax?
A
- pleural rupture acts as a one way valve
- air ents on inspiration but preventing its escape by closing during expiration.
- air pressure exceeds barometric pressure
- life threatening
25
A 60 year old female with a history of cirrhosis presents with dyspnea, impaired ventilation, and pleural pain. a diagnosis of pleural effusion is made, and a watery fluid is drained. when giving report, the nurse will refer to this fluid as
transudative
26
What is empyema?
presence of microorganizms and cellular debris in pleural space
27
this is the collapse of lung tissue which tend to develop post op
Atelectasis
28
This is persisten abnormal dilation of the bronchi
Bronchiecstasis
29
Diseases associated w/ Bronchiectasis
* Cystic Fibrosis
* Obstructed Airway
* Atelectasis
* aspirative pneumonia
* TB
30
What are restrictive lung disorders assocated with?
* takes more effor to expand lung during inspiration
* Dyspnea
* Inc RR
* Decreased TV
* V/Q mismatch
31
a diffuse, inflammatory obstruction of the small airways or bronchioles
Bronchiolitis
32
This is an excessive amount of fibrosis tissue in the lung
pulmonary fibrosis
## Footnote
*ARDS TB*
33
This is when thick mucus gets secreted because of defective epithelial ion transport
Cystic Fibrosis
## Footnote
*autosomal recessive gene*
34
What does left sided heart failure cause?
* increases pulmonary cap hydrostatic presssure
* increases permeability
* ARDS
* inhalation of toxic gases
* blockage of lymphatic vessels
35
A 42 year old female presents with dyspnea, rapid, shallow breathing, inspiratory crackles, decreased lung compliance, and hypoxemia. tests reveal a fulminate form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury.
Acute Respiratory Distress Syndrome (ARDS)
36
Describe Acute Respiratory Distress Syndrome
* inflammation of avelocapillary membrane
* severe pulm edema
* v/Q mismathc (shunting)
37
Major Disease associated with ARDS
* sepsis,
* multiple trauma,
* burns,
* pna,
* aspiration,
* drug od
38
What causes decrease breath sounds?
COPD & mucous
39
Why is expiration difficult in emphysema
because of loss of elastic recoil. Air gets trapped in the lungs
40
What is the difference for children vs adults with lymph nodes?
* enlarge in children
* atrophy in adults
41
What is this representative of?
Emphysema
42
This is chronic productive cough, hypersecretion of mucous and v/q mismath
* **Chronic Bronchitis**
* obstruction during expiration
* narrowing of arrows
43
Describe Emphysema
* Enlargement of the alveoli
* Loss of elastic recoil
* Air gets trapped in the lungs
* hyperexpansion of the chest
44
How can asthma lead to COPD
* permanent damage to lung tissue due to remodeling
45
Name the signs/symptoms of asthma
* chest constriciton
* expiratory wheezing
* dyspnia
* NON productive cough
* prolonged expiration
* tachycardia
* tachypnea
46
What is pneumonia
* infection of lower respiratory tract caused by bacterial infection
47
Name some things that could cause pneumonia
1. aspiration
2. inhalation of microorganisms
3. Bacteremia *(from blood to lungs)*
48
What damage can pneumonia do?
* lung damage
* sepsis
* accumulation of exudate leads to dyspnea and v/q mismatch
49
Causes of pulmonary hypertension
* secondary to lung respiratory disease, hypoxia
* secondary to chronic thromboembolic pulmonary htn
50
An 80 year old female is in the hospital for a bone fracture. while there she develops a large, nonlethal pulmonary embolus. What is the result of the obstruction of pulmonary blood flow\>
pulmonary hypertension
51
This happens as a result of diseased lungs or pulmonary blood vessels
Cor Pulmonale- right side
## Footnote
*excessive efor trying to overcome pulmonary htn*
52
Latent TB Infection is
* dont' feel sick
* They are infected with M. tuberculosis,
* Do not have disease
* positive skin test
* cannot spread disease
53
Airway hyper-responsiveness in asthma is related to
exposure to an allergen causing mast cell degranulation
54
A 53 year old male with a 20 year history of smoking is diagnosed with emphysema. Why the patient's airways are obstructed?
Loss of elastic recoil
55
A 42 year old female presents with dyspnea, rapid, shallow breathing, inspiratory crackles, decreased lung compliance, and hypoxemia. tests reveal a fulminate form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury.
Acute Respiratory Distress Syndrome (ARDS)
56
A yougn patient is admitted to the pediatric unit with cystic fibrosis (CF) exacerbation. the nurse monitors the patient closely because the main cause of death in a child with CF is
respiratory failure
57
What causes increased breath sounds
pneumonia
58
This is a loud low pitched bubbling & gurgling. Starts in early inspiration. Sounds like a velcro fastener. Inhaled air is colliding with secretions in the trachea and large bronchi.
* Crackles Course
* *pulmonary edema, pneumonia, depressed cough reflex*
59
Cigarette smoking produces:
* an increased LDL level
* thrombotic/inflammatory state
* decreased HDL
60
A 30 year old male prison inmate contracted tuberculosis during an outbreak. while planning interactions, the nurse realizes the patient can transmit this disease through
airborne droplets
61
Tb Disease
* Coughing for 3 weeks or longer
* Hemoptysis (coughing up blood)
* Chest pain
62
Major cause of hypercapnia
* supression of respiratory center
* chest wall deformities
* emphysema
* airway obstruction
63
Major cause of hypoxemia
v/q mismatch, respiratory inefficiency
64
Define Croup
* an acute laryngotracheobronchitis
* occurs in children between 6 months and 5 years of age, with a peak incidence at 2 years of age
* Almost always caused by a virus
65
What is epiglottis in children?
* bacterial invasion,
* inflammation,
* edema,
* obstruction of airway
66
Signs/Symptoms of Epiglottis
* high fever
* irritability
* sore throa
* inspiratory stridor
* respiratory distress
* muffled voice
67
Which is the MOST common complication of an Acute Myocardial Infarcation (AMI)?
arrythmia
68
A young woman presents with pallor, numbness, and a sensation of cold temperature of her digits. Which condition is the most likely cause for these symptoms?
Raynauds Phenomenon
69
Define and embolus
detaches from the wall of a vessel and circulates within the vascular system until it reaches a vessel small enough for it to occlude
70
a thrombus formation occurring mainly in the lower extremities
Deep Vein Thrombosis
71
veins have pooled blood.
Varicose
72
a blood clot that remains attached to a vessel wall.
Thrombus
73
A 60 year old male undergoes surgery for a bone fracture. what nursing measure would be most effective for preventing pulmonary embolism (PE) in this patient?
prevent deep vein thrombosis
74
Arteriosclerosis plaque is caused by
collagen over a fatty streak that is composed of a large number of lipid-laden foam cells that deposit on the vessel wall.
75
This can lead to fibrosclerotic remodeling of the skin and ulceration
venous insufficiency
76
Persisten venous obstruction leads to
chronic venous insufficiency
77
What ar the 3 factors of the Virchow Triad (promote DVT)
1. *Venous stasis*
2. *venous endothelial damage* (trauma)
3. *Hypercoagulable state* (prego, hormones)
78
Defined as progressive occlusion of of SVC and leads to venous distention in the upper extremities
Superior Vena Cava Syndrome
79
What can superior vena cava syndrom cause?
1. headaches
2. visual distrubances
3. impaired consciousness
4. face/arm skin purple and taut
5. prolonged cap refill
80
Which is the MOST common complication of an Acute Myocardial Infarcation (AMI)?
arrythmia
81
Arteriosclerosis plaque is caused by
collagen over a fatty streak that is composed of a large number of lipid-laden foam cells that deposit on the vessel wall.
82
A 60 year old male undergoes surgery for a bone fracture. what nursing measure would be most effective for preventing pulmonary embolism (PE) in this patient?
prevent deep vein thrombosis
83
a blood clot that remains attached to a vessel wall.
Thrombus
84
veins have pooled blood.
Varicose
85
a thrombus formation occurring mainly in the lower extremities
Deep Vein Thrombosis
86
Define and embolus
detaches from the wall of a vessel and circulates within the vascular system until it reaches a vessel small enough for it to occlude
87
A young woman presents with pallor, numbness, and a sensation of cold temperature of her digits. Which condition is the most likely cause for these symptoms?
Raynauds Phenomenon
88
What happens in orthostatic hypotension?
* body fails to compensate, vessels dilate, heart rate drops
* pooling blood
* arterial pressure drops
## Footnote
*meds, hypovolemia, starvation, immobile*
89
Characteristic associated with hypertension?
1. Family history positive for hypertension
2. High dietary sodium
3. **Glucose intolerance**
4. Obesity
90
4 C's Complications of Hypertension
1. **C**oronary Artery Disease
2. **C**oronary Rheumatic Fever
3. **C**ongestive Heart Failure
4. **C**erebral Vascular Accident CVA)
91
What organs are affected by hypertension
* Eyes
* Heart
* Brain
* Kidney
92
What is the most common cause of arterial aneurysms
atherosclerosis
93
Define an Aneurysm
* localized dilation or outpouching of a vessel wall or cardiac chamber.
* Risk of rupture
94
Define a true aneurysm
weakening of all 3 layers of the arterial wall.
95
Risk Factors for Arterial Thrombosis
1. Surgery
2. Inflammation
3. Traumatic Injury
4. Infection
5. Low Blood Pressure
6. **Aneurysm**
7. Heart Valve Calcification
8. Obstructions/ Blood Stasis
96
What can lead to a clotting cascade?
inflammation and endothelium cells
97
What are the 2 threats that thrombi poses?
1. May grow large enough to occlude artery causion **ishchemia**
2. Thromboembolus if dislodged
98
an inflammatory disease of the peripheral arteries that tends to occur in young men who are heavy smokers
Thromboangiitis obliterans
99
This is what happens with thickening and **hardening** of the vessel walls. It perfuses the limbs, especially lower extremities.
Peripheral Artery Disease
*prevalent in those with diabetes, bruits/pain*
100
What happens in thromboangitis obliterans?
* Formation of non atherosclerotic lesions.
* Obliterates small/medium sized arteries
101
What is Coronary Artery Disease
* A vascular disorder that narrows arteries
* deprives heart of oxygen
* may lead to myocardial ischemia
102
What is myocardial ischemia
* temporary deprivation of coronary blood supply
* Causes-
* **Angina, Pallor, Diaphoresis**
* **Pain radiates to jaw, left arm, neck**
103
What is prinzmental angina
* does not improve with rest
* spasms of coronary arteries
104
What can Myocardial Ischemia (angina) lead to..?
* Myocardial infarcation *(irreversible)*
* Unstable Angina (*reversible)*
105
What is a stemi?
**ST-elevation** myocardial infarction is caused by a sudden complete (100%) blockage of a heart artery.
106
How does Subendocardial Infarcation present itself on EKG?
* ST segment **depression**
* T wave **inversion**
107
What happens after 8-10 seconds after MI
* Myocardium cyanotic
* ischemia leads to release of catecholamines
* sympathetic responses
* dysrithmias
108
What is a Transmural Infarcation?
* STEMI- ST interval is elevated
* extends through the myocardiu to epicardium
109
Causes for Acute Pericarditis
* HIV
* Bacteria
* MI
* Trauma
* Surgery
* Idiopathic (no known cause)
110
20 Min after MI
* Temporary loss of contractile functioning
* RAAS, aldosterone
* myocardial remodeling
* Creatinine-Kinase triggered
## Footnote
*Hormones get triggered*
111
Complications of MI
* sudden cardiac arrest due to ischemia
* left ventricular dysfunction (failure)
* pericarditis
112
What are clinical manifestation of MI
1. chest discomfort
2. heart burn, pressure
3. feeling of impending doom
4. nausea, vomiting, pallor, diaphoresis
5. dyspnea
113
Signs and Symptoms of Acute Pericarditis? x5
1. fever
2. chest pain worsening w/ respiratory movement
3. pain radiates to the back
4. tachycardia
5. pericardial friction rub
114
What is chronic pericarditis
* pericardium is composed of scar tissue and calcifications
* *caused from TB or radiation exposure*
115
What are some causes for pericardial effusion?
fluid overload, heart failure hypoproteinemia
116
This is impaired systolic function leading to systolic heart failure
Dilated Cardiomyopathy
117
This has been the cause of more thatn 33 % of sudden deaths in athletes. Risks for ventricular dysrhythmias
Hypertrochic Obstructive Cardiomyopathy
118
This occurs due to increased resistance to ventricular ejection. Due to faulty **aortic valve...**
Hypertensive Hypertrophic Cardiomyopathy
119
Describe Restrictive Cardiomyopathy
* increased diastolic pressure
* normal systolic function
* **inadequate filling**
* **STIFF**
120
What can manifest because of heart disease?
1. Rhematic Fever
2. Rheumatic Heart Sisease
3. Infective Endocarditis
4. Dysrhthmias
5. Shock
121
This is an exaggerated immune response to pharyngeal infection by the group A beta hemolytic **streptococci**
Acute Rheumatic Fever- if left untreated can lead to rheumatic heart disease
122
What happens with rheumatic heart disease
* Inflammation of heart walls
* **Chronic mitral and aortic valves dysfunction**
123
This is a comlication of septic shock and is the failure of 2 or more organs?
Multiple organ dysfucntion syndrome (MODS)
124
This is when insterstitial fluid moves into vascular compartment, RAAs system is actived and releases ADH
Compensatory Mechanisms of shock
125
Causes for Cardiogenic Shock (decreased CO)
* MI
* Lef sided heart failure
* dysrhythmias
* valve dysfunction
126
This is due to extreme loss of blood volume, due to hemorrhage
hypovolemic shock
## Footnote
*symptoms start when 15% of loss*
127
This is due to parasympathetic overstimulation and sympathetic **under** stimulation?
Vasogenic Shock (widespread vasodilation)
## Footnote
*Anaphalactic Shock is similiar*
128
This can lead to a systemic inflammatory response syndrome (SIRS)
* **Septic Shock**
* *28-60% mortality*
* *MODS*
Nursing School Pt 1
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