0
Q
Dyspnea
A
- Subjective experience of breathing discomfort that is comprised of qualitatively distinct sensations that vary in intensity.
- Feeling often described as breathlessness, air hunger, SOB
1
Q
Most Common Pulmonary Disease Symptoms
A
- Dyspnea & Cough
2
Q
Kussmaul Respirations
A
- Induced by strenuous exercise or metabolic acidosis
- Characterized by:
- Slightly increased ventilatory rate
- Very large tidal volumes & no expiratory pause
3
Q
Large Airway Obstruction
-Characteristics
A
- Slow ventilatory rate
- Large tidal volume
- Increased effort
- Prolonged inspiration and Expiration
- Stridor or audible wheezing
4
Q
Small Airway Obstruction
-Characteristics
A
(Asthma, COPD)
- Rapid Ventilatory rate
- Small tidal volume
- Increased effort
- Prolonged expiration
- Wheezing often present
5
Q
Peripheral Cyanosis
A
- Slow blood flow to the fingers and toes
- Most often results from intense peripheral vasoconstriction
- Observed in people with Raynaud’s disease
6
Q
Central Cyanosis
A
- Caused by decreased arterial oxygenation (Low Po2) from pulmonary disease or pulmonary or cardiac right-to-left shunts
7
Q
Clubbing
A
- Commonly associated w/ diseases that cause chronic hypoxemia, such as:
- Bronchiectasis
- Cystic Fibrosis
- Pulmonary fibrosis
- Lung Abscess
- CHF
8
Q
Hypercapnia
-Results from
A
- Decreased drive to breathe or inadequate ability to respond to stimulation
9
Q
Hypercapnia
-Causes
A
- Depression of respiratory center by drugs
- Disease of medulla (infection of CNS)
- Abnormal spinal conducting pathways
- Disease of the neuromuscular junction or of respiratory muscles
- Thoracic cage abnormalities
- Large airway obstruction
- Increased work of breathing
10
Q
Hypoxemia Vs Hypoxia
A
- Hypoxemia is reduced oxygenation of arterial blood caused by respiratory alterations
- Hypoxia is reduced oxygenation of cells in tissues, caused by alterations of other systems as well
11
Q
Hypoxemia
-Most common Cause
A
- Abnormal V/Q ratio is the most common cause of hypoxemia
12
Q
Shunting
A
- Inadequate ventilation of well-perfused areas of the lung that causes hypoxemia
- Occurs in:
- Atelactasis
- In asthma as a result of bronchoconstriction
- pulmonary edema
- Pneumonia when alveoli are filled w/ fluid
13
Q
Alveolar Dead Space
A
- An area where alveoli are ventilated but not perfused.
14
Q
Pg 682
A
Acute Respiratory Failure
-Start Making Notes here
15
Q
Respiratory Failure
A
- Inadequate gas exchange with PaO2 ≤50 mm Hg or
PaCo2 ≥50 mm Hg with pH ≤7.25
16
Q
Hypercapnic Respiratory Failure
A
- Result of inadequate alveolar ventilation and the individual must receive ventilatory support.
17
Q
Hypoxemic Respiratory Failure
A
- Result of inadequate exchange of oxygen between the alveoli and capillaries and the individual must receive supplemental oxygen therapy
18
Q
Respiratory Failure and Surgery
A
- Respiratory failure is an important potential complication of any major surgical procedure, especially those involving:
- CNS
- Thorax
- Upper Abdomen
19
Q
Most Common Post-op pulmonary problems
A
- Atelactasis
- Pneumonia
- Pulmonary edema
- Pulmonary emboli
20
Q
Flail Chest
A
- Results from the fracture of several consecutive ribs in more than one place or fracture of the sternum and several consecutive ribs
21
Q
Pneumothorax
A
- Presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which surrounds the lungs) or the parietal pleural and chest wall.
- Destroys negative pressure and causes lung to recoil and collapse toward the hilum
22
Q
Primary (spontaneous) Pneumothorax
A
- Occurs unexpectedly in healthy individuals
- Usually in men between 20-40 yrs old
- Caused by spontaneous rupture of blebs (blister-like formations)
23
Q
Secondary Pneumothorax
A
- Caused by:
- Chest trauma
- Rib fracture
- Stab or bullet wounds that lead the pleura
- rupture of bleb or bulla
24
Open (Communicating) Pneumothorax
1. Air pressure in the pleural space equals barometric pressure because air that is drawn into the pleural space during inspiration is forced back out during expiration
25
Tension Pneumothorax
1. Site of pleural rupture acts as a one-way valve
- Air can enter on inspiration but is prevented from exiting on expiration
2. Air pressure pushes against recoiled lung
26
Tension Pneumothorax
| -Clinical Manifestations
1. Sudden pleural pain
2. Tachypnea
3. Dyspnea
4. May reveal absent or diminished breath sounds
27
Tension Pneumothorax
| -Treatment
1. Treated w/ insertion of a chest tube that is attached to a water-seal drainage system with suction
28
Pleural Effusion
1. Presence of fluid in the pleural space
29
Empyema
1. Presence of microorganisms and cellular debris (pus) in the pleural space
2. Occurs most commonly in older adults & children
3. Develops as complication of pneumonia, surgery, or trauma
30
Empyema
| -Clinical Presentation
1. Cyanosis
2. Fever
3. Tachycardia
4. cough & pleural pain
31
Bronchiectasis
1. Permanent dilation of the bronchus
2. Most commonly occur in women >60 yrs
3. Cystic fibrosis is the most common cause of bronchiectasis in children
32
Compression Atelectasis
1. Caused by external pressure exerted by a tumor, fluid, or air in pleural space
or by
2. Abdominal distention pressing on a portion of lung, causing alveoli to collapse
33
Absorption Atelectasis
1. Results from removal of air from obstructed or hypo-ventilated alveoli
Or From
2. Inhalation of concentrated oxygen or anesthetic agents
34
Surfactant Impairment Atelectasis
1. Results from decreased production or inactivation of surfactant
2. Surfactant impairment can occur because:
- Premature birth
- Acute respiratory distress syndrome
- Anesthesia induction
- Mechanical Ventilation
35
Atelectasis & Surgery
1. Atelectasis tends to develop after surgery and is estimated to occur in more than 90% of individuals administered a general anesthetic
36
Atelectasis
| -Clinical Manifestations
1. Dyspnea, Cough, & Fever
| 2. Leukocytosis
37
Paroxysmal Nocturnal Dyspnea **
1. Respiratory distress that awakens pt from sleep, r/t to posture
- especially reclining at night
2. Attributed to CHF w/ pulmonary edema or sometimes to Chronic pulmonary disease
38
Bronchiectasis
| -Primary Symptom
1. Chronic productive cough that may date back to a childhood illness or infection
39
Pulmonary Edema
| -Predisposing Factors
1. Heart Disease
2. Acute Respiratory distress syndrome
3. Inhalation of toxic gases
40
Pulmonary Edema
Excess water in the lung
41
Pulmonary Edema
| -3 Causes
1. Valvular dysfunction, CAD, Left Ventricular dysfunction
2. Injury to capillary endothelium
3. Blockage of lymphatic vessels
42
Pulmonary Edema
| -Most Common Cause
1. Left-sided heart disease
43
Severe Pulmonary Edema
| -Sign
1. Pink frothy sputum is expectorated and lung compliance decreases
44
Pulmonary Edema
| -Clinical Manifestations
1. Dyspnea & Increased work of breathing
| 2. Inspiratory crackles & dullness on percussion
45
Elderly & Aspiration
1. Elderly are more at risk for aspiration
46
Aspiration
| -Predisposing Factors
1. Altered Level of consciousness Caused by substance abuse
2. Sedation
3. Anesthesia
4. Seizure disorder
5. CVA
6. Neuromuscular disorders that cause dysphagia
47
Aspiration
| -Most Important Preventative Measures
1. Semi-recumbent position
2. Surveillance of enteral feeding
3. Pro-motility agents
4. Avoidance of excessive sedation
48
Aspiration
| -Clinical Manifestations
1. Sudden onset of choking
2. Coughing
3. Vomiting
4. Dyspnea & wheezing
49
Atelectasis
| -Treatment
1. Deep-breathing exercise
2. Frequent position changes
3. Early ambulation
50
Aspiration
| -Treatment
1. Supplemental O2
2. Mechanical ventilation w/ positive end-expiratory pressure
3. Fluid restriction
4. Administration of corticosteroids
5. Antibiotics if bacterial pneumonia develops
Pathophysiology Test 3
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