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Alterations of Pulmonary Function
Chapter 33 Patho
126
Science
Graduate
03/27/2012

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Term
Restrictive 
Definition
Any limitation to full lung expansion 
Term
Obstructive 
Definition
Any process that limits airflow 
Term
It is hard to do what when you have a restrictive disorder? 
Definition
Inhaling and expanding their lungs fully 
Term
It is hard to do what when you have and obstructive disorder? 
Definition
Exhale all the air out of the lungs 
Term
The most common causes of obstructive lung disease are:
Definition
  • Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis
  • Asthma
  • Bronchiectasis
  • Cystic fibrosis
Term
Conditions causing restrictive lung disease? 
Definition
  • Interstitial lung disease, such as idiopathic pulmonary fibrosis
  • Sarcoidosis
  • Obesity
  • Scoliosis
  • Neuromuscular disease, such as muscular dystrophy or amyotrophic lateral sclerosis (ALS)
Term
Clinical Manifestations of Restrictive and Obstructive Disorder? 
Definition

Cough

Dyspenea

Abnormal Breathing Patters

Hypoventilation 

Hyperventilation 

Cyanosis

Clubbing

Hemoptysis

Pain 

Term
What is a cough?
Definition

Serves as a protective mechanism 

Forced expiratory maneuver

Irritants stimulate airway receptors 

Term
What is an acute cough?
Definition

Resolves in less then 3 weeks

 

Term
Examples of things that cause an acute cough 
Definition

URI

Allergic rhinitis

Acute bronchitis

Pneumonia 

CHF

Pulmonary embolism

Aspiration 

Term
What is a Chronic cough? 
Definition
Persists longer then 3 weeks 
Term
Things that cause a chonic cough 
Definition

Smoking history r/t chronic bronchitis or lung caner  

Non smoking r/t asthma

Postnasal drainage

Gastro-esophageal reflux 

Term
What is Dyspnea?
Definition

SOB

Unable to take in air, feeling of breathlessness 

Term
What is DOE?
Definition
Dyspnea on exertion 
Term
What is Orthopnea? 
Definition
SOB when you are laying down 
Term
What is Paroxysmal nocturnal dyspnea? 
Definition
When a pt is woken up at night because they feel like they are being suffocated 
Term
Characteristics of Kussmaul Respirations 
Definition
  • Increased ventilatory rate
  • No expiratory pause
  • Hyperpnea 
  • R/t strenous exercise
  • Metabolic acidosis 
Term
Characteristics of Cheyne Stokes Respirations 
Definition
  • Alternating periods of deep and shallow breathing
  • Periods of apnea 
  • R/t decreased blood flow to brain stem 
Term
Hypoventilation 
Definition
Keeping too much CO2 
Term
What is happening to the alveoli in hypoventilation? 
Definition
Alveolar ventilation is less they metabolic demands 
Term
Hypoventilation leads to ...
Definition
Respiratory acidosis 
Term
Hypoventilation also leads to ...
Definition
hypercapnia - too much CO2
Term
Hyperventilation 
Definition
Blowing off too much CO2
Term
What is happening to the aveoli during hyperventilation? 
Definition
Alveolar ventilation exceeds metabolic demands 
Term
Hyperventilation leads to ... 
Definition
Respiratory Alkalosis 
Term
Hyperventilation also leads to ...
Definition
Hypocapnia - too little CO2 
Term
Characteristics of Cyanosis 
Definition
  • Bluish discoloration 
  • Desaturation
  • Evident with severe hypoxia 
Term
What is Clubbing?
Definition
Enlargement at end of the finger or toe 
Term
Hemoptysis 
Definition
Bloody Sputum 
Term
What is Pain?
Definition
  • Sharp
  • Caused by infection and inflammation 
Term
Things that cause pain? 
Definition

Muscle Pain

Rib Fractures 

Term
What is hypercapnia? 
Definition
  • Too much PaCO2 in arterial blood
  • Alveoli hypoventilation 
Term
What causes hypercapnia? 
Definition
  • Drugs
  • CNS infections
  • Trauma
  • Spinal cord disruption 
  • Neuromuscular disorders
  • Sleep apnea
Term
What is Hypoxemia? 
Definition
  • Reduced oxygenation of arterial blood
  • Too little O2 
Term
What causes hypoxemia?
Definition
Respiratory Alterations 
Term
What is Hypoxia? 
Definition
Reduced O2 to the cells and tissues 
Term
What causes Hypoxia? 
Definition
  • Respiratory problems
  • Non respiratory problems 
  • Ventilation - perfusion abnormalities 
Term
What is acute respiratory failure? 
Definition
Inadequate gas exchange 
Term
What causes acute respiratory failure? 
Definition
  • Direct lung injury
  • Major surgical procedures
  • Atelectasis (collapse of lung)
  • Pneumonia 
  • Pulmonay edema (fluid)
  • Pulmonary emboli (clot)
Term
What is Atelectasis? 
Definition
Collapse of lung tissue
Term
What causes atelectasis? 
Definition
  • Compression - external pressure
  • Absorption - removal of air 
  • Most commonly a postoperative complication 
Term
What is the nursing management of a person with atelectasis? 
Definition
  • Frequent turning 
  • Deep breathing and incentive spirometry 
  • Early ambulation 
  • Air humidification 
Term
When is the best time of day to take a sputum sample? 
Definition
In the morning 
Term
Pulmonary edema results from excess what? 
Definition
Fluid overload 
Term
What is the most common cause of pulmonary edema? 
Definition
CHF
Term
3 Things that cause pulmonary edema
Definition
  • Heart problems
  • Injury to endothelium 
  • Blockage of lymphatic vessels 
Term
What is aspiration? 
Definition
It occurs when fluid and solid particles pass into the lungs 
Term
What causes aspiration? 
Definition
  • Impaired swallowing mechanisms
  • CNS of PNS abnormalities 
Term
Which lobe is the most frequent site of aspiration? 
Definition

Right side 

Usually middle and lower lobes 

Term
Why is this? 
Definition
Because the the right side branches to the lung slightly before the left side  
Term
What foods contribute to aspiration? 
Definition
  • Hot dogs
  • Grapes 
  • Small idems
  • Marbles 
Term
What is a pneumothorax? 
Definition
collapsed lung, or pneumothorax, is the collection of air in the space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath
Term
A pneumothorax can be 
Definition
Spontaneous or Secondary 
Term
What is an open pneumothorax? 
Definition
Where there is air or gas in the chest because of trauma or injury 
Term
Tension Pneumothorax
Definition
When spontaneous air gets into the chest and pressure build up 
Term
What are some clinical manifestations of a pneumothorax? 
Definition
  • Paradoxical breathing
  • Pain
  • You will hear no breath sounds on the effected side
Term
What is pleural effusion? 
Definition
Presence of fluid in pleural space 
Term
4 types of pleural effusion 
Definition
  • Transudative
  • Exudative
  • Hemothorax 
  • Empyema 
Term
What is Empyema? 
Definition

Infected pleural effusion 

Pus in pleural space

 

Term
What causes Empyema?
Definition
Obstruction in lymphatics 
Term
What is Flail Chest?
Definition
  • Occurs when the chest wall is separated from chest cage
  • Results from fracture of ribs of sternum 
  • Causes paradoxical breathing 
Term
What is paradoxical breathing? 
Definition


Paradoxical breathing is seen when inhalation results in a decreasing, or asymmetrical, chest movement rather than a normal chest expansion




Term
What causes inhalation disorders? 
Definition
Exposure to toxic gases 
Term
2 types of inhalation disorders 
Definition
  • Pneumoconiosis 
  • Allergic Alveolitis 
Term
Characteristics of Pneumoconiosis 
Definition
  • Causes by inhalation of inorganic dust particles
  • Silicosis
  • Coal worker (black lung)
  • Asbestosis 
Term
Characteristics of Allergic Alveolitis 
Definition
  • Inhalation of organic dust particles
  • Extrinsic allergic alveolitis - hypersensitivity pneumonitis 
Term

What is Acute Respiratory Distress Syndrome?

(ARDS)

Definition
  • Acute lung inflammation 
  • Life threatening condition that prevents O2 from getting into you blood 
Term
ARDS is causes by?
Definition
  • Diffuse alveolar capillary injury 
  • Injury to pulmonary capillary endothelium
  • Inflammation and platlet acivation 
  • Inability of cells to produce surfactant 
Term
ARDS results in 
Definition
Atelectasis 
Term
Atelectasis 
Definition

Decreased lung compliance 

Causes Ventilation-perfusion abnormalities 

Term
ARDS clinial manifestations 
Definition
  • Severe dyspnea
  • Rapid, shallow breathing
  • Respiratory alkalosis
  • Decreased lung compliance
  • Acute hypoxemia 
Term
ARDS can cause 
Definition
Severe pulmonary edema 
Term
Obstructive diseases 
Definition
  • Asthma 
  • Chronic Bronchitis
  • COPD
  • Emphysema 
  • Pneumococcal Pneumonia 
  • Absces
  • Pulmonary fibrosis
  • Chest wall restriction
  • Tuberculosis
  • Acute Bronchitis
  • Pulmonary Embolism  
Term
Remember obstructive is problems with ... 
Definition
expiration 
Term
Asthma characteristics 
Definition
  • Intermittent airway obstruction
  • sudden onset
  • Most common in US
  • Increasing prevalence 
Term
What happens when you have Chronic Bronchitis? 
Definition
  • You hypersecrete mucous
  • chronic productive cough
  • bronchial cells hypertrophy
Term
What does the body do when you inhale irritants? 
Definition
  • It increases mucous production
  • It increases size and number of mucous glands 
Term
What combination of 2 diseases cause COPD? 
Definition
  • Chronic bronchitis
  • Emphysema 
Term
What overall happens in emphysema? 
Definition
There are destructive changes in aveolar walls 
Term
What are some specific things that happen during emphysema?
Definition
  • Enlargement of gas exchange airways (but it is inadequate)
  • Increased lung compliance  (this is bad bc lungs get stretched out over time)
  • Decreased diffusion capacity
  • Increased airway resistance 
Term
Pulmonary Fibrosis
Definition
  • Excessive amount of fibrous or connective tissue in the lung
  • Hardening of the lung 
Term
What causes cheest wall restriction? 
Definition
  • Deformation
  • Immobilization
  • Obesity 
Term
Tuberculosis is caused by?
Definition
Infection of Mycobacterium tuberculosis, an acid fast bacillus 
Term
TB is transmitted by 
Definition
The air and saliva 
Term
How is TB diagnosed? 
Definition
  • Xray
  • Sputum culture 
Term
What is acute bronchitis? 
Definition
Acute infection or inflammation of airways or bronchi 
Term
Characteristics of acute bronchitis 
Definition
  • Usually self limiting
  • Commonly follows a viral illness
  • Symptoms similar to pneumonia except NO pulmonary consolidation and chest infiltrates 
Term
What is a pulmonary embolism?
Definition
  • Blockage in one or more arteries in your lungs 
  • Caused by blood clots that travel to your lungs from another part of your body 
Term
What types of clots cause PEs?
Definition
  • Thrombus
  • Embolus
  • Tissure fragment
  • Lipids
  • Air bubbles
Term
What is the most common source of PE?
Definition
DVT (made of fat) that travel to the lungs 
Term
Virchow's Triad
Definition
  • Vessel Wall Damage 
  • Venous stasis
  • Blood Coagulability 
Term
What are vein valves? 
Definition
Tiny bicuspid valves 
Term
Where do you see more vein valves? 
Definition
In the distal leg 
Term
Vein valves flow ... 
Definition
Unidirectional 
Term
What are 2 test that can show a clot? 
Definition
  • Venous Duplex
  • CT 
Term
Things that promote venous blood flow 
Definition
  • Gravity 
  • Valves
  • Skeletal contraction
  • Thoracic pressure
  • Abdominal pressure
  • Arterial flow
  • Right atrial pressure 
Term
What is pulmonary hypertension?
Definition
Above normal mean pulmonary artery pressure 
Term
What is a normal pulmonary arterial pressure? 
Definition
10-20 mmHg
Term
You are considered pulmonary hypertensive when?
Definition
  • You have even a slight increase in pressure
  • Anything greater then 20 mmHg
Term
Primary Pulmonary Hypertension is
Definition
  • Idiopathic
Term
Where do you see pathologic change in primary pulmonary hypertension? 
Definition
In precapillary pulmonary arteries 
Term
Secondary pulmonary hypertension is ...
Definition
The most common type 
Term
Secondary pulmonary hypertension results from
Definition
  • Respiratory diseases
  • Hypoxemia
  • Pulmonary arteriole vasoconstriction 
Term
Cor Pulmonale is AKA? 
Definition
Pulmonary heart disease 
Term
What happens during Cor Pulmonale or Pulmonary Heart Disease?
Definition
  • Right ventricular enlargement and failure 
  • This creates chronic pressure overload in the right ventricle 
Term
A patient has right ventricular enlargement secondary to pulmonary hypertension. What would be the most likely diagnosis?
Definition
Cor pulmonale 
Term
What is Cystic Fibrosis? 
Definition
  • A disease passed down through families
  • It causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body
Term
What causes Cystic Fibrosis? 
Definition
Defective epithelial chloride ion transport 
Term
Where has there been a cluster in Cystic Fibrosis? 
Definition
Northwest Ohio 
Term
Cystic Fibrosis is more common in? 
Definition

Whites

About 1 in 28 whites 

Term
When is a person usually diagnosed with Cystic Fibrosis? 
Definition
Between 6 months and 1 year
Term
Most common symptoms of Cystic Fibrosis 
Definition
  • Respiratory 
  • GI
  • Persistent cough
  • Wheezing
  • Reoccurring pneumonia 
Term
Life expectancy of a Cystic Fibrosis pt? 
Definition
  • Has increased to 40-50 years
  • With high health maintenance which includes medications and respiratory treatments 
Term
What causes death in a pt with Cystic Fibrosis?
Definition
  • Multi organ failure
  • but primarily effects on the lungs and respiratory failure 
Term
What types of problems do pt with cystic fibrosis have? 
Definition
  • Chronic inflammation
  • Mucous plugging
  • Chronic infection 
Term
What is used to diagnosis cystic fibrosis? 
Definition
  • Sweat Chloride Test (concentration in excess of 60mEq/L)
  • Genotyping 
Term
Lung Cancer is AKA?
Definition
Bronchogenic Carcinoma 
Term
Lung Cancer can be ... 
Definition
Primary or metastatic 
Term
Lung cancer is ...
Definition
The most common cause of cancer deaths 
Term
What causes lung cancer? 
Definition
  • Smoking 
  • Enviornmental 
  • Occupational
Term
Smoking is associated with what other cancers as well? 
Definition
  • Larynx
  • Oral cavity
  • Esophagus
  • Urinary Bladder 
Term
2 types of lung cancer
Definition
  • Non small cell carcinoma
  • Small cell carcinoma 
Term

Non small cell carcinoma

 

Definition
  • Better type
  • Squamous cell
  • "Large cell carcinoma"
Term
Most common type of non small cell? 
Definition
Adenocarcinoma - glandular 
Term
Small cell carcinoma
Definition
  • Really bad
  • Very rapid growth rate 
Term
What diseases case clubbing? 
Definition
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