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NURS366
Pulmonary Lecture
62
Nursing
Undergraduate 3
02/04/2012

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Term
The process of pulmonary gas exchange
Definition
inspiration and delivery of 02 from environment ---> alveoli, diffusion across alveolar capillary membrane --> attaches to Hb, dissolves in blood --> left heart
Term
Ventilation
Definition
movement of gases from atmosphere to alveoli (and visa versa)
Term
Diffusion
Definition
mechanism by which 02 moves across the alveoli and into the pulmonary capillary
Term
Perfusion
Definition
02 leaves alveoli to combine with Hgb (Hb02) or dissolve in blood (Pa02) to be carried to left side fo the heart.
Term
Five factors that ventilation depends on...
Definition
-Conducting airway (airway diameter)
-Ventilatory Muscles (diaphram, intercostals must have both muscles in order to breath)
-Thorax (flexibility of rib cage)
-Elasticity of the lungs
-Nervous system/ regulators (autnomic pattern)

(DECREASING FUNCTION OF ANY OF THESE IMPAIRS VENTILATION)
Term
Controller of the regulation of ventilation
Definition
Central nervous system (brainstem, cerebral cortex, neurons in spinal cord)
also, group of effectors (muscles) that work in a coordinated factors.
Term
Initiation of breathing
Definition
central chemoreceptors in medulla (increase H+ --> increase ventilation
Peripheral chemoreceptors in aortic arch, carotids: decrease Pa02 in order to increase ventilation
also, increases PaC02, H+ will increase ventilation

(PaC02 = partial arterial oxygen)
Term
Diffusion
Definition
movement of molecules from high concentration to low concentration. (mechanism by which 02 moves across alveoli and into blood stream)
Term
Type 1 alveolar epithelial cells
Definition
cover the entire surface of the lung, very susceptible to injury.
90% total alveolar surface within lungs
(highly susceptible to injury ---> inflammation)
Term
Type II alveolar epithelial cells
Definition
produce, store, secrete pulmonary surfactant (body produces this because it decreases the surface tension allowing alveoli to never stick together)
Term
Why do we have type 1 epithelial cells
Definition
they are able to keep warm moist atmosphere within the bronchial tree.
Term
What does Surfactant in alveoli do?
Definition
phospholoipid that lowers surface tension of the lungs. stabilizes alveoli, increases pulmonary compliance, eases WOB
Term
in disease, disruption of synthesis/ storage of surfactant -->
Definition
collapse of alveoli, impairment of pulmonary gas exchange
Term
Macrophages in alveoli
Definition
take on phagocytic role. they attack to small bacteria. they release enzymes (H202 or hydrogen peroxide) when killing microorganisms
Term
Diffusion of gas across alveolar capillary membrane is affected by 3 factors:
Definition
-Pressure gradient (driving pressure)
-Surface area
-Thickness
Term
factors that affect diffusion
Definition
PA02 ; PA02 Gradient
Surface Area
Thickness
Term
driving pressure
Definition
difference in pressure gradients (concentrations)
Term
increase surface area for diffusion --> ??
Definition
increases the amount of gas that can diffuse
Term
4 interventions to increase surface area
Definition
-incentive spirometer
-TCDB
-Sighs/ yawn
-Positive and expiratory pressure - pursed lip breathing.
Term
four conditions that increase alveolar capillary membrane thickness
Definition
-ARDs (adult respiratory distress syndrome)
-Pneumonia
-Pulmonary edema
-Pulmonary fibrosis
Term
how thickness of alveolar capillary membrane affects diffusion...
Definition
the thicker the alveolar capillary membrane, the slower the rate of diffusion.
Term
Two ways that 02 is transported in the blood
Definition
Bound to hemoglobin and suspended in bood plasma.
Term
HB02
Definition
oxyhemoglobin
Term
How much oxygen is transported via. hemoglobin and how much is transported in the plasma
Definition
97% on hemoglobin
3% in plasma
Term
Main cause of 90% of deaths from respiratory infection
Definition
Pneumonia
Term
6 risk factors for pneumonia
Definition
-absence of cough
-Prior viral infection (common cold)
-Cigarettes or second hand smoke
-Change in mental status (coma, drug)
-Systemic sepsis weakens immune responce
-dysfunctional mucocilliary bed (COPD)
Term
five signs and symptoms of pneumonia
Definition
-cough
-fever
-sputum production
-shortness of breath
-tachypnea/ tachycardia
Term
four ways to diagnose pneumonia
Definition
chest x-ray
sputum analysis
visual bronchoscopy
bronchial lavage
Term
6 treatments for pneumonia
Definition
appropriate antibiotics
oxygen support
bronchodilators
humidity with mist face tent
Percussion and postal drainage
hydration/ fever control/ nut. support
Term
cause of pulmonary embolism
Definition
blood clot in a deep vein, development of a deep vein thrombosis
Term
3 time you are at risk factors for pulmonary embolism
Definition
after some types of surgery
during a long trip in a care or airplane
if you stay in bed for an extended time
Term
4 symptoms of pulmonary embolism
Definition
shortness of breath
chest pain
cough
decreased oxygen saturations
(vary greatly depending on the clot and how much vasculature is affected)
Term
6 tests and diagnosis's for pulmonary embolism
Definition
chest x ray
ventilation perfusion scan
spiral computerized tomography scan
pulmonary angiogram
d-dimmer blood test
magnetic resonance imaging.
Term
2 treatments pulmomary embolism using medication
Definition
anticoagulants
thrombolytics
Term
2 treatments for pulmonary embolism using surgery
Definition
clot removal- threading a catheter through the vessels
vein filter - placing a filter into the inferior vena cava
Term
5 prevention steps to avoid pulmonary embolism
Definition
medications (heparin and warfarin)
compression stockings
pneumatic compression
physical activity
adequate fluid intake
Term
define COPD
Definition
chronic obstructive pulmonary disease
preventable and treatable disease.
airflow limitation associated with abnormal inflammatory responce of the lungs
Term
chronic bronchitis
Definition
defined as the presence of cough and sputum production for at least three months in each of the consecutive years, it is not necessarily associated with airflow limitation.
Term
Emphysema
Definition
lysis of lung tissue by proteolytic enzymes (macrophages releaseing hydrogen perodixde) from neutrophils and macrophages with abnormal permanent enlargement of the air space distal to the terminal bronchioles all the way down to the alveoli.
Term
Two types of emphysema
Definition
centrilobular
panlobular
Term
Centrilobular emphysema
Definition
central part of the lobule
respiratory bronchioles enlarge. walls are destroyed, associated with chronic bronchitis.
more common
Term
Panlobular emphysema
Definition
destruction of whole lobule.
affects bronchioles, alveolar ducts and sacs and alveoli, progressive loss of lung tissue
Term
pathophysiology of chronic bronchitis
Definition
hyperplasia of mucus- secreting glands in the trachea and bronchi
increase in goblet cells
disappearance of cilla
chronic inflammatory changes and narrowing of airways
altered function of alveolar macrophages leading to increased bronchial infections
Term
three clinical manifestations of emphysema
Definition
-dyspnea
-minimal coughing with little sputum
-barrow chest from over distention of alveoli
Term
atalectasis
Definition
alveoli that are filled up with fluid
Term
three mechanisms of bronchodilation
Definition
beta-agonists
anticholinergics
theophyllines
Term
action of beta2 andrenergic receptor agonists
Definition
act on b2andrenergic receptors around bronchioles causing smooth muscle relaxation resulting in dilation of bronchial passages and improved airflow
Term
mech of action anticholinergic drugs
Definition
act on many acetylcholine receptors around the bronchi reducing bronchspasms to prevent airway narrowin
Term
5 side effects of anticholinergic drugs
Definition
dry mouth
blurred vision
dry cough
difficulty urinating.
Term
*** no significant difference in exercise performance between drugs given by nebulizer and by spacer
Definition
Term
Theophylline/Aminophylline (methylxanines) mechanisms of action
Definition
bronchodilation
suppression of airway response to stimuli
anti-inflammatory effects
Term
corticosteroids suppress mediator production or secretion of...
Definition
histamine
eicosanoids
leukotrienes
cytokines
Term
cortiosteroids act on....
Definition
mast cells
lymphocytes
macrophages
ect.
act on these cells to inhibit inflammation...
Term
Combination therapy
Definition
combine short acting B agonist with short acting anticholinergic.
or
long acting B agonist wtih inhaled corticosteroids
Term
Hypoxic drive theory
Definition
patients oxygen level gets low enough, the patients brain will signal the patient to breathe
Term
NETT trial - Lung volume reduction surgery
Definition
removes 20-35 of space occupying lung tissue from each lung.
many risks
by reducing lung size the remaining lung and surrounding muscles (intercostals and diaphragm) are able to work more efficiently.
Term
four symptoms of asthma
Definition
coughing
wheezing
chest tightness
shortness of breath
Term
cure for asthma?
Definition
cannot be cured, can be controlled
Term
causes of asthma
Definition
genetic
immune
environmental factors
Term
asthma characterized by... (three things)
Definition
hyper responsiveness
chronic inflammation
airway remodeling
Term
7 symptoms of asthma
Definition
cough
shortness of breath
chest tightness
chest pain
wheezing
fatigue
behavior changes
Term
three pharmacologic therapies used with ashthma
Definition
beta agonists
anticholinergic
anti-inflammatory therapy
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