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Pulmonary
Patho. exam 3
67
Nursing
Undergraduate 3
10/24/2010

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Cards

Term
dererminant of oxygen delievery
Definition

cardiac output- arterial supply

hemoglobin- O2 carrying capacity of RBCs

dissolved O2 in arterial blood (PaO2)

Term
pulmonary secondary functions
Definition

acid base balance- by blowing off or retaining CO2

speech

fluid blance and heat balance- high temps respiratory rate increases, and helps to decrease heat

Term
ventilation
Definition
process of moving air between atmosphere and lung alveoli
Term
Upper airway
Definition

this airway;

warms/humidifies

cough/gag reflexes protect airway

 

Term
Lower airway
Definition

this airway includes alveoli and cells

  • smooth muscle
  • cilia
  • muscus secreting plays a role in immune system
  • alveoli
  • surfactant
Term

 

helps in bronco relaxation

Definition
what action does a beta agonist have?
Term
Alveoli
Definition
this is the basic unit of gas exchange and theres two types
Term
alveoli type one
Definition
this type is squamous cells
Term
alveoli type 2
Definition
this type is numocites that produce surfactant
Term
surfactant
Definition
this reduces surface tension, prevents alveolar collapse
Term
mediastinum
Definition
this is the middle that protects treachea and heart
Term
elastic and compliant
Definition
if the lungs are not this, can develop disease like COPD, emphysema, pulmonary edema
Term
pleural space
Definition
this is the space between the viseral pleura and partial pleura, pressure difference between the two
Term
respiratory center
Definition
this includes the brain stem and the cerebral
Term
Brain stem
Definition
this is involuntary, in medulla, people who have hdamage these patients usually need to be on a respirator
Term
cerebral
Definition
this is voluntary
Term
chemoreceptors
Definition
in aortic arch and carotid bodies, sensitive to change in blood levles of oxygen, carbon dioxide, and pH. they help correct changes that are occuring-- autonomic nervous system
Term
Alpha
Definition
this is constriction
Term
beta
Definition
this is dialation
Term
minute ventilation
Definition
tital volume x RR/min = minute ventilation
Term
Diffusion
Definition
this is a process fo gas exchange, passive movement from higher conc to lower conc
Term
97%
Definition
what percent of oxygen is carried by Hgb
Term
100%
Definition
when Hgb carries 4 oxygen molecules it is what percent saturated?
Term
3%
Definition

what percent of gas is dissolved in blood

(PaO2)?

Term
If PaO2 is low
Definition

when this is low; Hgb has low affinity for O2, the release oxygen at tissue level ( may not pick up as much O2 and release it right away)


No releasing in tissues

 

Term
If PaO2 is high
Definition
when this is high; Hgb has high affinity for O2 (lungs) picks up oxygen in lungs. ( Hgb doesnt bing to this as efficiently so tissues are not getting as much as they need
Term
Dyspnea
Definition
shortness of breath
Term
orthopnea
Definition
can breathe when there sitting up but not lying down
Term
Paroxysmal nocturnal dyspnea
Definition
may be cardiac involvement, comes and goes, usually know there short of breath, feel better sleeping in a chair
Term

Kussmaul respiration

(abnormal breathing)

Definition
hyperpnea- deep, increase rate (exercise metabolic acidosis)
Term
Cheyne stokes repiration
Definition
alternating perios of deep and shallow with periods of apnea, (death respirator pattern)
Term
Hemopotysis
Definition
blood in the sputum
Term
Cyanosis
Definition

 bluish discoloration of skin, hgb desaturated by 5g/dl

cause: low PaO2, pulmonary disease, cardiac disease, decreased cardiac output hypothermia, vasoconstruction

Term
1.34g
Definition
1g of Hgb is how many grams of oxygen?
Term

physical assessment

vital signs

Definition
respiratory rate, depth, pattern, spo2, color, including oral mucosa and nail beds
Term
labs for pulmonary diagnostics
Definition
ABGs, chest Xrays, pulmonary function test, tidal volume, bronchoscopy, CT, MRI, sputum culture
Term
what conditions increase oxygen demand?
Definition
these conditions increase what? exercise, revovery from surgery, disease, fever
Term
what are S/S of increased oxygen demand?
Definition
what do these s/s do? cyanosis, shortness of breath, clubbing, increased respiratory rate, increase pulse rate
Term
hypoxemia
Definition

low oxgen in blood

caused by low PaO2, hypoventilation, diffusion abnormalities, ventilation perfusion mismatch, shunting

Term
cause of low VQ
Definition
pulmonary edema, ventilation is impaired but perfusion is okay
Term
High VQ
Definition
pulmonary embolus, perfusion is not okay but ventation is
Term
VQ (ventilation perfusion mismatch)
Definition
inadequate circulation or ventilation, normal rate  is 1.8-1
Term
what would interfere with gas passing across the alveolar capillary membrane?
Definition
happen if they interfere with what;   pulmonary edema, pumonary embolism, exudates for pneumonia
Term
Left heart failure
Definition

forward pump failure, fluid backs up into the lungs, cant sleep lying down, so they can have better diaphragm movment

classic S/S- orthopnea, crackles, productive cough

Term
Aspiration
Definition

loss of protective airway reflexes. left bronchi is narrower so you would turn them on there left side, right bronci is big

unconscious

emesis

acid contents of stomach are very irritating to elastic lung tissue--serious pneumonia

Term
Atelectasis
Definition
collapsed alveoli, loss of gas exchange, shunting of unoxygenated blood through lungs to heart (low VQ)
Term

Respiratory infection

(upper)

Definition

these are common in what kind of infection;

 

common cold, pharyngitis, laryngitis

Term

Respiratory infection

(lower)

Definition
pneumonia, virus bacteria, fungi, protozoa, parasites
Term
Pneumonia
Definition

risk factors: very young/very old, co-morbid conditions-- asthma, COPD, chronic bronchitis, diabetes.

Altered LOC, risk for aspiration,immobilization

vices: bad habits- smoking, alcohol, poor oral hygiene

 

Term
Bacterial
Definition

gram - (E coli, strep, mircoplasma, staph orius)

 

gram + ( need to know if gram - or + becuase it can show what you need to give them for treatment.)

Term
Community acquired
Definition
70% are Pneumoniae, < 5% mortality
Term
Nosocomial
Definition

E coli, P Aeruginosa, S aureus

 

50% mortaility, more likely to develop sepsis, lung necrosis

Term
Immunocompromised
Definition
(HIV, transplant) pneumocystis, carinii, mycobacterium tuberculosi, very difficult to treat high mortality
Term
Important lines of defense
Definition
intact cough/gag reflex, mucociliary clearance, alveolar macrophages
Term
Pneumonia
Definition

This is vasodilation-- redness, warmth

increase capillary permeability, interstitial edema

, leaks into alveoli, leaks into bronchioles, lung abscess, necrosis

Term
Systemic
Definition
fever, leukocytosis, plasma proteins
Term
Local inflammatory response
Definition
biochemical mediators damage bronchial mucous membranes, alveolocapillary membranes, causing the acini and terminal cronchioles to fill with infectious debris and exudates
Term
systemic response
Definition

release of endotoxins from gram bacteria increase capillary permeability, clotting cascade hypotension septic shock

 

Term

Pneumonia

clinical manifestations

Definition
fever, chills, elevated WBC > 10,000, pain-pleural, Sortness of breath, crackles, Low pO2, pCO2, respiratory alkalosis, tachypnea, tachycardia, hypoxia
Term
Hypoxia
Definition
impaired gas exchange poor O2 diffusion through consoildation, CO2 diffuses more redily
Term
S/Sof hypoxia
Definition

these are the S/S for?;

  • Rapid Breathing
  • Cyanosis
  • Poor Coordination
  • Lethargy/Lassitude
  • Executing Poor Judgment
  • Air Hunger
  • Dizziness
  • Headache
  • Mental and Muscle Fatigue
  • Nausea
  • Hot and Cold Flashes
  • Tingling
Term
Diagnositc and lab tests for pnemonia
Definition
sputum culture and sensitivity, stat gram stain, CXR, CBC with differential blood culture for T> 38.5C
Term
Treatment for Peumonia
Definition

Abx therapy, O2 therapy

RT- T, C, DB

incentive spirometer, CPT

rest, ambulate QID, hydration, assess- vital signs spO2 lung sounds

Term
evaluation of peumonia
Definition

improvement within 24 hours of ABx treatment

oxygenation status

Term
respiratory failure
Definition

paO2- < 50

PaCO2- > 50mmHg

pH- < 7.25

RR- >30 or <8

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