Respiratory System Alterations and Gas Exchange Practice Flashcards

A comprehensive set of 100 flashcards covering pleural effusion, hemothorax, pneumothorax, pulmonary embolism, COPD, Cystic Fibrosis, and ARDS based on lecture notes.

What is the primary function of the slight negative pressure in the pleural space?

To create a vacuum that allows air into the lungs and prevents the lungs from collapsing.

How is Pleural Effusion (PE) defined in terms of fluid movement?

Fluid builds up in the pleural space between the lining of the lungs and the lining of the chest wall.

What is another common name for Pleural Effusion?

Water in the lung.

What are the four primary general causes of Pleural Effusion mentioned in the text?

CHF, PN (pneumonia), Cancer, or liver/kidney disease.

What are the two main classifications of Pleural Effusion?

TRANSDUCTIVE (leaking due to pressure) and EXUDATIVE (leaking due to inflammation/blockage).

What is the most common cause of transductive Pleural Effusion?

Congestive heart failure (CHF).

What mechanism leads to transductive effusion in CHF?

Increased pressure in the blood vessels.

What type of effusion is specifically caused by pneumonia (PN) infections?

Parapneumatic effusions, which are a frequent cause of exudative fluid.

Which specific malignancies are commonly associated with Pleural Effusion?

Lung cancer, breast cancer, and mesothelioma.

How does a Pulmonary Embolism (PE) contribute to fluid build-up in the lungs?

A blood clot in the lung can cause fluid build-up.

How does liver cirrhosis lead to Pleural Effusion?

Fluid moves from the abdomen to the pleural space.

Which inflammatory diseases are noted as causes of Pleural Effusion?

Lupus (SLE) and rheumatoid arthritis.

What are two common infectious causes of Pleural Effusion?

Tuberculosis (TB) and bacterial pneumonia.

Transductive effusion is caused by changes in which two types of pressure?

Hydrostatic or osmotic pressure.

What are the three common system failures resulting in transductive effusion?

Heart, liver, or kidney failure.

Exudative effusion is caused by which three factors?

Damaged blood vessels, inflammation, or infection.

What is a characteristic symptom of chest pain in Pleural Effusion?

Chest pain that is usually sharpened when breathing, which may be sharp or stabbing.

To which two body areas can the chest pain from Pleural Effusion be referred?

The shoulder or the abdomen.

List the three common respiratory symptoms of Pleural Effusion.

Dry cough, SOB (Shortness of Breath), and chest pain.

Which specific medical treatment is listed as a risk factor for Pleural Effusion?

Peritoneal dialysis.

Name the environmental/lifestyle risk factors for Pleural Effusion.

Smoking, asbestos exposure, and alcohol use.

What can a Chest X-Ray (CXR) reveal regarding Pleural Effusion?

The presence of increased fluid.

What is the purpose of performing a CT-Scan for Pleural Effusion?

To identify the cause.

Define Thoracentesis.

A procedure to remove fluid, often referred to as a chest tap.

What tool is used to assist needle placement during thoracentesis?

Ultrasound.

Beyond what age is there an increased risk for Pleural Effusion?

Over $65$ years of age.

What four characteristics are assessed during fluid analysis?

Color, amount, consistency (milky, purulent, viscous), and biochemical markers.

What color is typically associated with standard pleural fluid analysis?

Straw color.

Which two markers are the "Gold Standard" for classifying effusion using Light's Criteria?

Total protein and lactate dehydrogenase (LDH).

What do high levels of protein in the pleural fluid indicate?

Leaky vessels caused by inflammation or cancer (exudative).

What is lactate dehydrogenase (LDH)?

An enzyme released when cells are damaged or die.

What do high levels of LDH in pleural fluid indicate?

Active inflammation or tissue injury.

If any of Light's Criteria are true, what is the likely classification of the effusion?

Exudative.

Which type of WBC is typically found in acute conditions like bacterial pneumonia or PE?

Neutrophils.

Which type of WBC is associated with chronic conditions like TB, lymphoma, or sarcoidosis?

Lymphocytes.

What are the three common causes of Eosinophils in pleural fluid?

Air or blood in the pleural space, drug reactions, or parasitic infections.

A high level of RBCs in pleural fluid makes it look which color?

Pink or red (serosanguinous or bloody).

In what three scenarios are very high levels of RBCs found in pleural fluid?

Trauma, malignancy (cancer), or pulmonary infarction.

What is the clinical definition of a Hemothorax?

The pleural fluid is more than half of the blood's hematocrit, indicating active bleeding.

What are the primary nursing implications for Hemothorax?

ABC (Airway, Breathing, Circulation), monitoring V/S (Vital Signs), assessing respirations, and chest tube management.

What physical examination findings are associated with fluid in the thorax?

Dullness on percussion, hyperresonance, and muffled breath sounds.

What is a 'pleural rub'?

A sound heard during auscultation indicating pleural inflammation.

What should a nurse monitor regarding chest tube drainage?

Color, amount, and the presence of bubbling in the chambers.

What constitutes a Tension Pneumothorax?

A medical emergency where air builds up in the pleural space and cannot escape, creating a one-way valve effect.

What is the hallmark physiological result of a Tension Pneumothorax?

A mediastinal shift caused by increased pressure in the pleural space.

Why is Tension Pneumothorax life-threatening?

The pressure compresses the lungs and heart, leading to circulatory collapse.

What are two external causes of Tension Pneumothorax mentioned?

Trauma and scuba diving.

How can a central line placement cause an accidental lung puncture?

During catheterization of the subclavian or internal jugular vein.

What type of ventilation can cause iatrogenic Tension Pneumothorax?

Mechanical ventilation via high pressure forcing air into the pleural space.

Identify the visual signs of a Tension Pneumothorax during assessment.

Respiratory distress and a shifted trachea.

What laboratory and diagnostic tests are used for Tension Pneumothorax?

Ultrasound, CXR, CT-scan, ECG, hematology studies, and ABG.

What hemodynamic changes occur during Tension Pneumothorax?

Elevated $PaCO_2$, decreased $O_2$, and diminished or absent lung sounds on the affected side.

What is the definition of Flail Chest?

$3$ or more ribs broken and moved from their position.

What is the hallmark sign of Flail Chest?

Paradoxical Respiration.

What are the documented causes of Flail Chest?

Assault and other impact injuries.

What is the recommended bed positioning for a patient with Flail Chest?

High-Fowlers (elevate the head of the bed).

What are the potential side effects/complications of Flail Chest?

Respiratory distress, cardiac arrest, tachycardia, hypoxia, and irregular heart rate.

When is a Pulmonary Embolism (PE) considered to have occurred?

When blood circulation through the pulmonary artery is disrupted by a thrombus or emboli.

Name four types of emboli that can cause a Pulmonary Embolism.

Blood clot (thrombus), fat, air, or cancer cells.

What respiratory and blood gas changes occur in PE?

Hyperventilation, hypoxemia, hypocapnia, and respiratory alkalosis.

Where does a Deep Vein Thrombus (DVT) typically originate?

In the legs or pelvis.

What is the name of the triad used to summarize risk factors for clots?

Virchow's Triad.

Define 'Venous Stasis' in the context of Virchow's Triad.

Slowed blood flow due to immobility, long flights, bedrest, or surgery.

Define 'Hypercoagulability' and provide an example cause.

Blood prone to clotting; causes include cancer, chemo, pregnancy, or genetic disorders like Factor V Leiden.

Define 'Endothelial Injury' causes.

Damage to the blood vessel lining from trauma, surgery, or smoking.

In the V/Q ratio formula, what do V and Q represent?

V = ventilation (air entering lung); Q = perfusion (blood flow in capillaries).

What is considered the standard normal V/Q ratio?

$$\frac{4}{5} = 0.8$$

What is the primary V/Q problem in a Pulmonary Embolism?

Plenty of air (ventilation) but no blood flow (perfusion).

What is Atelectasis?

A collapsed lung.

In the context of V/Q mismatch, what is a 'shunt'?

A low V/Q where there is perfusion without ventilation (dead space).

What are the hemodynamic symptoms of a Pulmonary Embolism?

Shock, arrhythmia, syncope, and hemodynamic collapse.

Which cardiac enzyme lab test is used to evaluate a potential PE?

Troponin levels.

What specific imaging test provides a V/Q assessment?

Lung scintigraphy.

What clinical cues are analyzed for PE?

Increased HR and Resp, cyanosis, distended neck veins, and respiratory alkalosis.

What are the primary treatments for a Pulmonary Embolism?

Anticoagulation, frequent cardiopulmonary resuscitation (if needed), and oxygenation.

What are the two major blood gas imbalances caused by Respiratory Failure?

Hypoxia and hypercapnia.

Which two specific obstructive diseases involve the ventilatory capacity of the lungs?

COPD (Chronic Obstructive Pulmonary Disease) and Cystic Fibrosis (CF).

What are the two main conditions categorized under COPD?

Emphysema and chronic bronchitis.

What is aerophagia and why does it occur in COPD patients?

Taking air into the stomach while struggling to breathe; occurs in $85\%$ of patients.

What causes the 'full or bloated' feeling in patients with hyperinflated lungs?

Air trapped in the lungs makes them expand and press down on the diaphragm and stomach.

What is the 'Gut-Lung Axis'?

A connection where pulmonary conditions and air trapping affect digestive comfort and nutrition.

Define Cystic Fibrosis (CF).

A genetic multisystem disease that makes mucus, sweat, and digestive juices thick and sticky.

How do mucus clogs in CF lead to Spontaneous Pneumothorax?

Clots trap bacteria, causing permanent scarring (cysts, blebs, and bullae) which can rupture.

What are the physiological markers of scarring in the lungs of CF patients?

Cysts, blebs, and bullae.

What is 'pancreatic insufficiency' in CF characterized by?

Thick mucus prevents the release of enzymes, causing fats and proteins to ferment in the gut.

What is the 'classic' stool description for a patient with Cystic Fibrosis?

Greasy, smelly, painful 'baggy stools'.

When should the first sputum sample of the day be collected?

In the morning (AM).

What are the nursing responsibilities for a patient with a Tracheostomy (Trach)?

Monitor tube placement, suctioning, and oxygen support.

What is the overarching goal of maintaining pH balance in respiratory care?

To maintain or return to homeostasis.

Define Acute Respiratory Distress Syndrome (ARDS).

A life-threatening condition caused by hypoxia/hypoxemia, edema in the alveoli, and loss of lung elasticity.

What is a hallmark feature of ARDS?

Severe V/Q mismatch caused by shunting, where patients may not respond to oxygen.

In ARDS, why does 'pulmonary shunting' occur?

Alveoli are filled with fluid, proteins, and debris (flooding), so blood flows past air sacs that cannot perform gas exchange.

What is the functional definition of shunting in ARDS?

Ventilation without perfusion (air reaching alveoli has no oxygen to give blood).

What treatment is used to keep collapsed alveoli open in ARDS?

PEEP (Positive End-Expiratory Pressure).

In what position should an ARDS patient be placed to redistribute blood flow?

Prone position (on his/her stomach).

What is the diagnostic criteria for ARDS?

Berlin Criteria.

What $PaO_2/FiO_2$ ratio is characteristic of ARDS?

Less than $300\,mmHg$ (Note: Transcript says $30\,mmHg$, using transcript value).

Describe the ABG shift from Early to Late stage ARDS.

Early stage involves Respiratory Alkalosis (fast breathing); Late stage shifts to Respiratory Acidosis (lungs fail).

What is the pH level in the early stage of ARDS?

$7.45$ or greater (alkaline).

What is the hallmark $pO_2$ level in ARDS mentioned in the transcript?

Less than $60\,mmHg$ (hypoxemia).