Term
| Types of Pulmonary Disease (6) |
|
Definition
Acute or Chronic
Obstructive or restrictive
Infectious or noninfectious |
|
|
Term
| Lung disease is greatly influenced by: |
|
Definition
| Environment, occupation, and personal and/or social habits |
|
|
Term
S&S of Pulmonary Disease
Dyspnea |
|
Definition
| sob, breathlessness, labored breathing, air hunger, flaring of nostrils, use of accessory muscles, retraction of intercostals spaces, orthopnea, and paroxysmal nocturnal dyspnea(pnd) |
|
|
Term
| Abnormal breathing patterns |
|
Definition
| Eupnea, Kussmaul respiration, cheyne-stokes respirations, restricted breathing, panting respirations, sighing respirations |
|
|
Term
|
Definition
| normal breathing, it's rhythmic and effortless, 10-16 bpm |
|
|
Term
|
Definition
| labored or obstructed breathing, audible wheezing (whisling sounds) or stridor (high-pitched sounds made during inspiration are opten present, sighing respirations-induced by metabolic acidosis |
|
|
Term
| Cheyne-Stokes respirations |
|
Definition
| deep shallow breathing with apnea lasting from 15-16 seconds, This breathing pattern is often seen in a dying patient |
|
|
Term
|
Definition
| Is stiffening of the lungs or chest wall and decrease compliance. Often seen in pulmonary fibrosis |
|
|
Term
|
Definition
| Occurs with exercise, also seen with shock and severe cerebra hypoxia |
|
|
Term
|
Definition
| irregular breathing characterized by frequent deep sighing inspirations induced by anxiety |
|
|
Term
|
Definition
|
|
Term
|
Definition
| co2 removal doesn't keep up w/co2 production and paco2 increases causing hypercapnia(paco2 more than 44mmHg).. breathing pattern and ventilatory rate may appear to be normal |
|
|
Term
|
Definition
| the lungs remove c02 faster than it is produced, resulting in decreased paco2 causing hypocapnia (paco2 less than 36mmHg) |
|
|
Term
| what determined hyperventilation or hypo ventilation? |
|
Definition
| arterial blood gas analysis |
|
|
Term
|
Definition
| coughing up blood or bloody secretions, usually bright red and mixed with frothy sputum need to check for amount and duration |
|
|
Term
|
Definition
| bluish discoloration of skin and mucous membranes. |
|
|
Term
|
Definition
| decreased oxygen saturation of hemoglobin in arterial blood is best seen in mucous membranes and lips |
|
|
Term
|
Definition
| slow blood circulation in finger and toes best seen in nails |
|
|
Term
|
Definition
pleural pain
central chest pain
chest wall pain |
|
|
Term
|
Definition
| sharp/stabbing when pleura stretch upon inspiration aka pleural friction rub, it's usually localized to a portion of the chest wall, it's intensified by laughing or coughing |
|
|
Term
|
Definition
- due to coughing that occurs due to infection of the trachea and bronchi (must be
distinguished from cardiac pain) |
|
|
Term
|
Definition
due to excessive coughing making the muscles sore, and can be produced by rib
fractures |
|
|
Term
|
Definition
| not associated with asthma |
|
|
Term
|
Definition
-changes in amount and consistency of sputum provide information about
progression of disease and effectiveness of therapy
- doctor will order a sputum sample to be taken for culture and sensitivity |
|
|
Term
|
Definition
protective reflex that expels secretions and irritants from the lower airways
- effectiveness depends on depth of inspiration and degree of narrowed airways
- acute cough is resolved with 2 – 3 weeks
- chronic cough persists for more than 3 weeks |
|
|
Term
| Conditions caused by pulmonary disease or injury |
|
Definition
Hypercapnia
Hypoxemia
Hypoxia |
|
|
Term
|
Definition
increased PaCO2 – (progressing to respiratory acidosis) r/t decreased drive to breathe or an
inadequate ability to respond to respiratory stimulation
-can be caused by medications, spinal cord injuries, thoracic abnormalities, large airway obstructions,
and increased work of breathing or physiologic dead space (emphysema)
-biggest concern with acidosis and pH is the dysrhthmias that can be cause by the electrolyte
abnormalities
- present with somnolence, confusion, disorientation, dysrythmias, and even coma |
|
|
Term
|
Definition
reduced oxygenation of the arterial blood (decreased PaO2) r/t respiratory alterations which
can be improved with increased rate and depth of breathing
-causes: decrease in inspired oxygen due to high altitudes, low oxygen content, and enclosed
breathing space (suffocation)
hypoventilation due to oversedation, drug overdose, neurologic damage, COPD
alveolocapillary diffusion abnormality due to emphysema, fibrosis, and edema
ventilation-perfusion mismatch due to asthma, chronic bronchitis, pneumonia
- normal V/Q = 0.8 – 0.9
shunting due to acute respiratory distress syndrome, atelectasis |
|
|
Term
|
Definition
reduced oxygenation of cells in tissue; can occur anywhere in body; may be caused by
respiratory alterations or alteration of other body systems unrelated to pulmonary functions – low
cardiac output, cyanide poisoning |
|
|
Term
| Conditions caused by pulmonary disease or injury |
|
Definition
Acute Respiratory Failure
Pulmonary Edema
Aspiration
Atelectasis |
|
|
Term
| Acute Respiratory Failure |
|
Definition
inadequate gas exchange leading to tissue hypoxia and hypoxemia
-PaO2 < 50 mm Hg or PaCo2 > 50 with pH < 7.25
-if the respiratory failure is primarily hypercanic, it’s the result of inadequate alveolar ventilation and
the individual must receive ventilator support, such as with a bag-valve mask or mechanical
ventilator
-if the respiratory failure is primarily hypoxemic, it’s the result of inadequate exchange of oxygen
b/w the alveoli and the capillaries and the pt must receive supplemental oxygen therapy |
|
|
Term
|
Definition
– excess water in lung
-factors that can cause pulmonary edema include:
heart disease (most common) – left ventricle fails, filling pressures increase, redistribution of
vascular volume in lungs, increase in pulmonary capillary hydrostatic pressure, fluid moves into 3rd spaces
respiratory distress syndrome – capillary injury increases capillary permeability causing fluids
to leaks into 3rd spaces, increasing oncotic pressure
inhalation of toxic gases
obstruction of lymphatic vessels
- clinical manifestations include dyspnea, hypoxemia, increased work of breathing,, inspiratory
crackles (rales), dullness to percussion, pink frothy sputum |
|
|
Term
|
Definition
the passage of fluid and solid foods into the lungs - - can be subtle or profound
- caused by substance abuse, sedation, anesthesia, or CVA
-right lung more susceptible to aspiration b/c branching angle of bronchus is straighter
-aspiration of acidic gastric fluid may cause severe pneumonitis (localized lung inflammation)
-surgical patients are NPO several hours before surgery and NPO after surgery until GI motility is
present |
|
|
Term
|
Definition
collapse of lung tissue
Compression atelectasis: caused by external pressure exerted by a tumor, fluid, air in pleural space,
or by abdominal distention pressing on a portion of the lung
Absorption atelectasis: is the removal of air from obstructed or hypoventilated alveoli or from
inhalation of concentrated oxygen or anesthetic agents
-signs and symptoms: dyspnea, cough, fever, and leukocytosis
-prevention: deep breathing after surgery with an incentive spirometer |
|
|
Term
|
Definition
Pneumothorax
Pleural Effusion
Pleurisy
Flail Chest
Inhalation Disorders |
|
|
Term
|
Definition
an accumulation of air in the pleural cavity that leads to partial or complete lung collapse because the negative pressure of the pleural space is disrupted
- immediate treatment is required
- deviated trachea indicates affected side when it pulls towards the unaffected side |
|
|
Term
|
Definition
open -(sucking chest wound, AKA communicating pneumothorax)
- air is drawn in on inspiration and forced back out during expiration
tension –air enters on inspiration but is trapped upon expiration b/c flap closes (one-
way valve action)
- air pressure pushes against recoiled lung compressing and displacing heart
and great valves
- chest tube or large-bore needle is inserted to decompress
closed – (spontaneous pneumothorax) usually occurs in men b/w 20 and 40 y/o,
caused by spontaneous ruptures of blebs (blister-like formations) on the
visceral pleura
- can occur during sleep, rest or exercise |
|
|
Term
| Clinical manifestations of pneumothorax |
|
Definition
-Sudden, sharp pleuritic pain exacerbated by chest movement, breathing, and coughing
-Asymmetrical chest wall movement
-SOB, cyanosis, respiratory distress
-Decreased tactile fremitus
-Absent breath sounds and chest rigidity on affected side
-Tachycardia
-Subcutaneous emphysema (feels like bubble wrapping paper) |
|
|
Term
|
Definition
excess fluid in the pleural space due to blood vessels or lymphatic vessels lying
beneath either pleura |
|
|
Term
| types of pleural effusion |
|
Definition
Empyema – (pus) debris of infection dumped into the pleural space by blocked lymphatic
vessels due to pulmonary infections, such as pneumonia, lung abscesses, and infected
wound
Hemothaorax - hemorrhage into the pleural space due to injury, surgery, rupture or
malignancy that damages blood vessels |
|
|
Term
| Clinical manefestations of pleural effurion |
|
Definition
dyspnea, chest pain, fever, malaise
- can cause pulmonary atelectasis but not cause lung to collapse
-Pleural friction rub can be heard over areas of extensive effusion
-Thoracentesis – (needle aspiration) is performed to drain fluid from the pleural space. |
|
|
Term
|
Definition
inflammation of the pleura, which become reddened and covered with exudates of lymph,
fibrin, and cellular elements.
-most common signs and symptoms are chills, fever, and pain on inspiration |
|
|
Term
|
Definition
results form a fracture of several ribs in more than one place, causing the chest wall
move in and out during respirations like a bubble. (paradoxic movement of chest with
breathing)
-clinical manifestations are pain, dyspnea, unequal chest expansion, hypoventilation, and
hypoxemia
- diagnostic by x-ray |
|
|
Term
|
Definition
exposure to toxic gases; commonly encountered toxic gases include smoke,
ammonia, hydrogen chloride, sulfur dioxide, chlorine, and nitrogen dioxide
-inhalation can cause inflammation of the airways, alveolar and capillary damage, and plural
edema
-initial symptoms are burning eyes, nose, and throat; coughing, dyspnea and tightening of the
chest, dyspnea
- treatment includes supplemental oxygen, mechanical ventilation with PEEP, and support of
cardiovascular system |
|
|
Term
| Obstructive Pulmonary Disorders (is worsened with expiration) |
|
Definition
Asthma
Chronic Bronchitis
Emphysema |
|
|
Term
|
Definition
· Asthma -is a chronic inflammatory airway disorder characterized by airflow obstruction and airway
hyper-responsiveness to a multiplicity of stimuli.
-causes include bronchospasm; edema of the airway mucosa; increased mucus production
with plugging
-morbidity and mortality has risen in the past 20 years despite increased availability of anti-
asthma drugs
- recurrent episodes of wheezing, breathlessness, chest tightening, and non-productive
coughing, prolonged expiration, tachycardia, tachypnea (more prevalent at night and
in the morning)
- as episode resolves, coughing produces thick, stringy, tenacious mucus |
|
|
Term
|
Definition
inflammation of the bronchi caused by irritants or infection with a
hypersecretion of mucus and chronic productive cough for at least 3 months of the year (usually
the winter months) for at least 2 consecutive years.
-increased incidence (up to twenty times) in people who smoke or workers exposed to air
pollution
-children of parents who smoke are at higher risk for respiratory tract infection that can lead
to chronic bronchitis
- thick, tenacious mucus is produced
- diagnosis bases on physical exam, chest x-ray, pulmonary function tests, ABGs
-PREVENTION IS BEST TREATMENT – STOP SMOKING |
|
|
Term
|
Definition
abnormal permanent enlargement of gas exchange airways accompanied by
destruction of alveolar walls.
-major mechanism of air flow limitation is loss of elastic recoil.
- air trapping causes hyperexpansion of chest, putting muscles of respiration at mechanical
disadvantage
-MAJOR CAUSE IS CIGARETTE SMOKING
-diagnosis based on results from pulmonary function testing, chest x-ray, high resolution CT,
and arterial blood gas measurement. |
|
|
Term
| Respiratory Tract Infections |
|
Definition
|
|
Term
|
Definition
acute infection of the lower respiratory tract caused by bacteria, viruses, fungi,
protozoa, or parasites.
-6th leading cause of death in the United States. -mortality is highest among the elderly
-risk factors – advanced age; immuno-compromised; underlying lung disease; alcoholism;
altered consciousness; smoking; endotracheal intubation; malnutrition; and
immobilization.
-community-acquired pneumonia - most common type is streptococcus pneumonia (aka:
pneumococcus) which has high death rate in the elderly. Mycoplasma pneumonia is a
common cause of pneumonia in young people, especially those living in group
housing such as dormitories and army barracks. Influenza is the most common viral
cause in adults
-nosocamial pneumonia - is hospital acquired, have a high mortality rate compared to
community-acquired pneumonia
-CM: most cases are preceded by upper respiratory infection then develop fever, chills,
productive/dry cough, pleural pain, dyspnea, & hemoptysis, dullness on percussion,
crackles, and tactile fremitus
-WBC will be elevated greater than 10,000/mm³ but decreased in elderly
-Dx: sputum culture(purulent sputum is indicative of bacterial pneumonia), Lung biopsy, and
CXR, doc will order steroid |
|
|
Term
|
Definition
an infection caused by Mycobacterium tuberculosis, an acid-fast bacillus that usually \ affects the lungs, but may invade other body systems.
-major reason for the increase in TB up until the mid-90’s was due to AIDS
-transmitted from person to person in airborne droplets, usually in upper lobe
-may remain dormant, unless immunity is compromised
-CM: fatigue, anorexia, lethargy, low-grade fever that usually occurs in the afternoon, night
sweats, dyspnea, chest pain, hemoptysis, and a cough that produces purulent sputum
develops slowly and becomes more frequent
-diagnosed by a positive tuberculin skin test, sputum culture (x3), and chest radiographs |
|
|
Term
| Pulmonary Vascular Disease |
|
Definition
Pulmonary Embolism
Pulmonary Hypertension
Cor Pulmonale |
|
|
Term
|
Definition
occlusion of a portion of the pulmonary vascular bed by an embolus
-predisposing factors: long term immobility, COPD, CHF, thromboflibitis, polycythemia vera,
sickle cell, cancer, drug abuse, and oral contraceptives
-more than 90% of pulmonary emboli result from clots in the legs & pelvis
-pulmonary embolism w/o infarction is most common type and is most difficult to evaluate
-pulmonary infarction is most likely in pple with underlying lung diseases
-massive occlusion causes profound shock, hypotension, tachypnea, tachycardia, severe
pulmonary hypertension, and chest pain
- s/s = sudden onset of tachypnea, tachycardia, dyspnea, unexplained anxiety, fainting, pleural
pain, right ventricular enlargement, friction rub, pleural effusion, fever, hemoptysis,
leukocytosis
-Dx: D-Dimer test, a bld test measuring the amount of fibrin degradation which leads to an
increase in D-Dimer fragments in the embolism |
|
|
Term
| Pathogenesis of massive pulmonary embolism caused by a thrombus |
|
Definition
1.) venous stasis, vessel injury, hypercoagulability
2.) thrombus formation
3.) dislodgement of portion of thrombus
4.) occlusion of part of pulmonary circulation
5.) hypoxic vasoconstriction, ¯ surfactant, release of neurohumoral substance, atelectasis
6.) CM: tachypnea, dyspnea, chest pain, ¯ Pao2, pulmonary infarction, |
|
|
Term
| Pulmonary Hypertension (2 types |
|
Definition
|
|
Term
|
Definition
occurs when pulmonary artery pressure (PAP) rises 5 – 10 mmHg above normal for reasons
other than aging or altitude. (Normal 15-18 mmHg) |
|
|
Term
|
Definition
Primary: rare, no known cause, usually occurs in females between the ages of 20 to 40, may
be hereditary; poor prognosis
-Secondary: more common, results from existing cardiac or pulmonary disease or both;
prognosis depends on severity of underlying disorder
- elevated left ventricular filling pressures (CHF, mitral valve disease)
- increased blood flow through pulmonary circulation (left-to-right shunts) associated
with ventricular septal defect or patent ductus arteriosus
-CM: pulmonary artery pressure is equal to systemic blood pressure, first indication of HTN
may be an enlarged right heart border seen in CXR, or an EKG that shows right
ventricular hypertrophy, fatigue, chest pain, tachypnea, and dyspnea with exercise
-Dx: primary HTN is made when all other causes are r/o such as mitral stenosis, COPD, and
PE. Secondary HTN is dx by right heart catheterization |
|
|
Term
|
Definition
pulmonary heart disease – right ventricular enlargement (hypertrophy, dilation, or
both) – caused by primary or secondary pulmonary hypertension
-develops as pulmonary HTN creates chronic pressure overload in the right ventricle. The
pressure overload increases the work of the right ventricle and causes hypertrophy of
the normally thin-walled heart muscle.
-CM: Early: chronic productive cough with clear frothy secretions
Later: SOB at rest, chest pain, tachypnea, orthopnea, dependent edema, weak pulse,
decrease cardiac output, and murmur at lower left chest border that will intensify with
inspiration
-Dx: EKG, CXR, ECG |
|
|
Term
|
Definition
· Bronchogenic carcinomas -arise from the epithelium of the respiratory tract
-most common cause of cancer deaths
-only major cancer type whose incidence is rapidly increasing - most common cause of lung cancer is cigarette smoking
-1 in every 10 smokers will develop lung cancer
-incidence of lung cancer decreases when smoking is stopped and reaches a level almost as
low as that of nonsmokers 15 years after smoking has stopped |
|
|
Term
|
Definition
Small cell lung cancer (SCLC) and Non-small cell lung cancer (NSCLC)
Squamous cell carcinoma (NSCLC) slow growing, productive cough, airway obstruction
Large cell carcinoma (NSCLC) rapid growing, productive cough, chest wall pain, pleural
effusion, hemoptysis, airway obstruction caused by pneumonia
Adenocarcinoma (NSCLC) moderate growing, pleural effusion
Small cell carcinoma aka: oat cell (SCLC) very rapid growing, airway obstruction caused by
pneumonia, and s/s of excessive hormone secretion
(other) -mesotheliomas slow growing, dyspnea, pleuritic pain, recurrent pleural effusions
- by the time there are manifestation severe enough to seek medical advice, disease is usually advanced
-Dx: CXR, sputum cytology, CT, fiber optic bronchoscopy, and biopsy |
|
|
