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Total lung capacity
the volume of air in the lungs upon the maximum effort of inspiration
Bronchodilation
expansion of the bronchial air passages
Bronchoconstriction
Constriction, or blockage, of the bronchi that lead from the trachea to the lungs.
Plueral membrane
Serous membrane that surrounds the lungs and lines the thoracic cavity
P02
partial pressure of oxygen measures the effectiveness of the lungs in pulling oxygen into the blood stream from the atmosphere.
In a healthy individual
the brainstem is stimulated to breathe by a rise in C02
The ideal PO2 ranges from
90 mm Hg to 100 mm Hg
Hypercapnia
occurs when the lungs cannot fully expel carbon dioxide Can develop due to: bradypnea, asphyxiation, aspiration, asthma, COPD, pneumonia, pulmonary edema, thoracic muscle paralysis
Chronic hypercapnia
Commonly seen with hypoxic lung disease
Over time, the central chemoreceptors become indifferent to an increase in C02 levels -> Peripheral chemoreceptors
Clinical symptoms: Headache, drowsiness, intellectual impairment and disorientation
Hypoxia
occurs when the lungs cannot ventilate or acquire oxygen Compensation: Increase respiratory rate Pulmonary artery vasoconstriction: High blood pressure in the pulmonary artery system-> Pulmonary hypertension -> Cor pulmonale Erythropoietin -> Erythropoiesis
Chronic hypoxia
Chronic lack of oxygen that occurs with respiratory dysfunction P02 falls below 60 mm Hg = CRITICAL Anaerobic metabolism -> Lactic acid HgB begins to release oxygen
Severe hypoxia
Behavioral changes, restlessness, uncoordinated movements, impaired judgement, delirium, stupor, coma
Pulmonary disorders can be categorized as
obstructive or restrictive disease
Obstructive disease
characterized by an increase in resistance to airflow from the trachea and larger bronchi to the terminal and respiratory bronchioles.
AIRFLOW BLOCKED, OBSTRUCTED
Types of Obstructive pulmonary disorders
Asthma, COPD (Chronic bronchitis & Emphysema), Obstructive Sleep Apnea
Asthma Background
Chronic inflammatory disorder that causes reversible airway constriction due to bronchial hyperreactivity> AIRWAY CONSTRICTS = BLOCKED AIR FLOW Allergies are the most common stimulus 80-85% of asthma attacks in children are preceded by viral infection Exercise- induced asthma
Asthma Pathophysiology
Episodes of spastic reactivity in thenbronchioles Allergens are a common stimulus Allergens trigger the immune system Immune system responses: Bronchoconstriction (Constriction of airway), Inflammation (Bronchial edema), Increase in the size and number of Goblet cells( mucus makers) (Increase thick, mucus Production)
Complications: Status asthmaticus: Persistent bronchoconstriction that endures despite attempts to treat with medications; medical emergency 911
Asthma
Chronic inflammatory disorder that causes reversible bronchospasm because of bronchial hyperreactivity.
Cause and triggers: pollution, smoking, bacteria and viruses, genetics, pets, household chemicals, or dust
Clinical Presentation: Wheezing, Cough, Dyspnea, Chest tightness
Severe attacks: Accessory muscle use, Distant breath sounds, Diaphoresis(sweating)
Respiratory failure: Inaudible(silent) breath sounds, Repetitive, hacking cough
Rhonchi may be present if the large bronchial airways are involved
Chronic Obstructive Pulmonary Disease (COPD): Background
Characterized by poorly reversible airflow limitation. 3rd leading cause of death in the US Leading cause of disability Smoking is the most common cause Commonly occurs in older individuals Includes chronic bronchitis and emphysema
Chronic obstructive pulmonary disease (COPD)
is a combination of chronic bronchitis, emphysema, and hyperreactive airway disease Complications: Peripheral chemoreceptors are dependent on hypoxia to trigger respirations
COPD Pathophysiology Chronic Bronchitis
Inflammation, edema and excess mucus production Hypersecretion of mucus in the large and small airways > Creates obstruction to inspiratory airflow > Inhibits oxygenation > Atelectasis (partial or completer collapsed lung) Diagnostic criteria: Cough for 3 months out of the year for 2 consecutive years Inflammatory changes cause permanent remodeling of the airway Severe: Persistent poor ventilation and hypoxia stimulates vasoconstriction
COPD Pathophysiology Emphysema
Overdistention of alveoli with trapped air >Creates obstruction to expiratory airflow, loss of elastic recoil and retention of C02 in the lungs
BOTH Chronic bronchitis and Emphysema
Airways are hypersensitive
Severe disease leads to chronic hypoxia and chronic hypercapnia
Pulmonary hypertension
Peripheral chemoreceptors
Clinical Presentation: Dyspnea, cough, wheezing Severe disease: Tachypnea, accessory muscle use
Pulmonary hypertension
High blood pressure in the pulmonary arteries. Primary: Genetic disorder Secondary: Result of another disease process. COPD, chronic hypoxia As pulmonary hypertension progresses, right ventricular failure worsensleading to diminished cardiac output. Clinical Presentation:Syncope, dyspnea on exertion, fatigue
Peripheral chemoreceptors
found in the aortic arch and bifurcation of the carotid artery (called carotid bodies), respond primarily to a decrease in arterial oxygen.
Chronic bronchitis Clinical Presentation
Problem: Cannot get 02 in
BLUE BLOATERS: chronic Hypoxia, cyanosis
Clubbing of the fingers
Edema due to heart failure
Severe: Signs of right-sided heart failure (cor pulmonale) due to pulmonary Hypertension.
JVD, ascites, hepatosplenomegaly, ankle edema
Emphysema Clinical Presentation
Problem: Cannot get C02 out PINK PUFFERS: Well-oxygenated until late Stage. Pursed-lip breathing Well oxygenated until the disease becomes severe Barrel-shaped chest: Width and depth are = Prolonged exhalation using pursed lip breathing
Apnea
Reduction in airflow by 90% for at least 10 seconds
Obstructive Sleep Apnea (OSA)
Upper airway obstruction caused by intermittent collapse of the upper airway tissues. Patients experience sleep disturbances, daytime sleepiness, and hypoxemia Risk Factor: Obesity is the most common risk factor
Obstructive Sleep Apnea (OSA) Clinical Presentation
Symptoms include snoring, choking or gasping in sleep, and unrestful sleep Diagnosis requires a sleep study Treatment: Use of continuous positive airway pressure (CPAP) while sleeping. This forces air through the nasal passages to keep airways from closing.
Restrictive disease
is characterized by reduced expansion of lung tissue with decreased total lung capacity. REDUCED EXPANSION Types of pulmonary restrictive disorders-Pneumothorax, Pleural effusion
Pleural cavity (AKA pleural space)
Space between the outer layer of the pleural membrane and the inner layer of the pleural membrane. Vacuum: Only thing in this space is surfactant. There should not be any other air or fluid. Negative intrathoracic pressure The pleural space
Pneumothorax
most common restrictive disease
Pathophysiology: The presence of air in the pleural cavity that causes collapse of a large section or whole lobe of lung tissue. Can be either spontaneous or caused by trauma.
Pneumothorax Complication- Tension pneumothorax Air continues to build up in the pleural cavity and causes compression of not only the lungs but also the trachea, cardiac structures and vena cava. Air can enter the pleural space but not exit.
Clinical Presentation: Hypoxemia, tracheal deviation Medical emergency!!
Pneumothorax Clinical presentation
Chest pain, dyspnea, tachypnea, accessory muscle use May be an obvious asymmetry of the chest Auscultation: Diminished or absent breath sounds on the affected side
Pleural Effusion Pathophysiology
Abnormal collection of fluid within the pleural cavity that compresses lung tissue and inhibits lung inflation. Commonly edematous fluid that accumulates because of heart failure, severe pulmonary infection or cancer. Fluid can be: Exudate (Thin, watery), Purulent: (Pus), Lymph, Sanguineous (Blood)
Pleural Effusion Clinical Presentation
Dyspnea, tachypnea, sharp pleuritic chest pain Auscultation: Diminished breath sounds on the affected side
Pulmonary Edema: Pathophysiology
Accumulation of fluid around the alveoli Fluid inhibits oxygen transfer Causes: Left- sided heart failure: Weakened left ventricle cannot eject all of the blood within the chamber causing blood to accumulate in the left ventricle. The pressure builds all the way back to the pulmonary capillaries causing fluid from the blood to diffuse into the interstitial tissues.
Pulmonary Edema Clinical Presentation
SEVERE respiratory distress: Pink, frothy sputum, Hypoxia, Auscultation: Coarse, loud crackles, Extreme shortness of breath
suffocation in own fluid
Medical emergency!!
Pulmonary Embolism (PE)
A blood clot that has traveled to the pulmonary arterial circulation > obstruction of blood flow in the lungs Clot commonly originates from a deep vein thrombosis (DVT) in an extremity Pulmonary Embolism (PE)
Clinical Presentation- Sudden shortness of breath, chestpain, tachycardia, death
leading cause of death
Medical emergency!!
Adult (Acute) Respiratory Distress Syndrome (ARDS)
Pulmonary dysfunction characterized by: Alveolar injury, Pulmonary capillary damage, Bilateral pulmonary infiltrates, Sudden, progressive pulmonary edema, Severe hypoxemia Sepsis is the most common risk factor
Adult (Acute) Respiratory Distress Syndrome (ARDS) Clinical Presentation
Acute onset of respiratory distress Severe hypoxemia: Decreased level of consciousness, tachycardia, diminished circulation, sweating, restlessness and anxiety. Auscultation: Crackles