NSG 3850 Pathophysiology II Unit 3

Flashcards for alterations in oxygenation and pulmonary function, including obstructive and restrictive lung diseases, pleural space disorders, kyphoscoliosis, ankylosing spondylitis, disorders of obesity, pneumonia, and pulmonary tuberculosis.

Hypoventilation

Occurs when air delivered to alveoli is insufficient to provide O2 and remove CO2, resulting in ↑ PaCO2 and hypoxemia.

Hyperventilation

Increase of air entering the alveoli leads to hypocapnia (PaCO2 <35 mm Hg).

Hypoxia

Decrease in tissue oxygenation.

Hypoxemia

Deficient blood oxygen as measured by low arterial O2 and low hemoglobin saturation, which leads to hypoxia.

Early signs of Hypoxia

Restlessness, anxiety, tachycardia/tachypnea.

Late signs of Hypoxia

Bradycardia, extreme restlessness, dyspnea (severe).

Acute Bronchitis

Acute inflammation of the trachea and bronchi.

Pathogenesis of Acute Bronchitis

Airways become inflamed and narrowed from capillary dilation, swelling from fluid exudation, infiltration with inflammatory cells, increased mucus production, and loss of ciliary function.

Clinical Manifestations of Acute Bronchitis

Recent onset of cough, may have low-grade fever, substernal chest discomfort, sore throat, postnasal drip, and fatigue.

Emphysema

Destructive changes of the alveolar walls without fibrosis; damage is irreversible.

Pathogenesis of Emphysema

Smoking causes alveolar damage leading to inflammation and release of proteolytic enzymes, reduction in pulmonary capillary bed, loss of elastic tissue, air trapping, and bullae formation.

Clinical Manifestations of Emphysema

Progressive, exertional dyspnea, use of accessory muscles, minimal cough, thin/wasted appearance, decreased breath sounds, chronic morning cough, prolonged expiration, digital clubbing, barrel chest, hyperresonance, pursed-lip breathing, and wheezing.

Etiology of Chronic Bronchitis

Smoking (90%), repeated airway infections, genetic predisposition, inhalation of irritants, chronic or recurrent productive cough >3 months >2+ successive years.

Clinical Manifestations of Chronic Bronchitis

Typical patient is overweight, SOB on exertion, excessive sputum, chronic cough, edema, hypervolemia, cor pulmonale, cyanosis, secondary polycythemia.

Sarcoidosis

Acute or chronic systemic disease of unknown cause, likely with an immunologic basis involving activation of alveolar macrophages.

Pathogenesis of Sarcoidosis

Development of multiple, uniform, noncaseating epithelioid granulomas affecting multiple organs and abnormal T cell function.

Clinical Manifestations of Sarcoidosis

Malaise, fatigue, weight loss, fever, dyspnea with dry cough, erythema nodosum, macules, papules, hyperpigmentation, subcutaneous nodules, hepatosplenomegaly, lymphadenopathy.

Hypersensitivity Pneumonitis

Also known as extrinsic allergic alveolitis, a restrictive and occupational disease predominant in nonsmokers.

Pathogenesis of Hypersensitivity Pneumonitis

Antigen combines with serum antibody in alveolar walls, leading to type III hypersensitivity reaction, granulomatous inflammation, and diffuse pulmonary fibrosis in upper lobes.

Acute Clinical Manifestations of Hypersensitivity Pneumonitis

Symptoms start 4-6 hours after exposure and resolve in 18-24 hours; chills, sweating, myalgias, nausea, malaise, lethargy, headache, dyspnea, dry cough, tachypnea, chest discomfort, cyanosis, crackles.

Pleural Effusion

Pathologic collection of fluid or pus in pleural cavity due to another disease process, imbalance in pressure, or impaired lymphatic drainage.

Clinical Manifestations of Pleural Effusion

Dyspnea, decreased chest wall movement, pleuritic pain, dry cough, absence of breath sounds, dullness to percussion, decreased tactile fremitus, contralateral tracheal shift (massive effusion).

Etiology of Kyphoscoliosis

Neuromuscular issues, idiopathic causes, or congenital factors leading to bone deformity of the chest wall resulting from kyphosis and scoliosis.

Pathogenesis of Kyphoscoliosis

Bone deformity compresses lung volumes, leading to atelectasis, V/Q mismatch, hypoxemia.

Clinical Manifestations of Kyphoscoliosis

Dyspnea on exertion, rapid shallow breathing, chest wall deformity, ribs protruding/flaring/crowded, hypoxemia, CO2 retention (late).

Etiology of Ankylosing Spondylitis

More common in males; cause unknown; transient acute arthritis; chronic inflammation at ligamentous insertion into spine or sacroiliac joints; limited chest expansion and pulmonary fibrosis.

Pathogenesis of Ankylosing Spondylitis

Progressive, inflammatory disease with immobility of vertebral joints/fixation of ribs; inflammation affects articular processes/costovertebral joints/sacroiliac joints; fibrotic response.

Clinical Manifestations of Ankylosing Spondylitis

Low to mid back pain/stiffness increased with rest, decreased with exercise; restrictive lung dysfunction; rib cage movement reduction; chest wall muscular atrophy; breathing difficulty due to rib cage immobilization.

Etiology of Obesity

Excessive body fat (BMI > 30 kg/m2) resulting from excessive caloric intake and/or reduced caloric expenditure.

Obesity Hypoventilation Syndrome

Decrease in alveolar ventilation, somnolence, severe hypoxemia, polycythemia, and cor pulmonale.

25 to 29.9 kg/m2

Overweight is defined as a BMI of what?

greater than 30 kg/m2

Defined as excessive body fat, with a body mass index (BMI) of what?

Etiology of Pneumonia

Aspiration of oropharyngeal secretions, inhalation of contaminants, or contamination from the systemic circulation.

Pathogenesis of Pneumonia

Organisms enter lung, multiply, and trigger pulmonary inflammation; inflammatory cells invade alveolar septa; alveolar air spaces fill with exudative fluid and consolidate.

Clinical Manifestations of Pneumonia

Crackles and bronchial breath sounds over affected lung tissue, chills, fever, cough, purulent sputum.

Etiology of Pulmonary Tuberculosis

Mycobacterium tuberculosis infection via inhalation of small droplets.

Pathophysiology/Pathogenesis of Pulmonary Tuberculosis

Inhalation of droplets containing bacteria leads to localized infection; granuloma forms; tissue inside granuloma dies during caseous necrosis (Ghon focus).

Clinical Manifestations of Pulmonary Tuberculosis

History of contact with infected person, low-grade fever, chronic cough, night sweats, fatigue, weight loss, malaise, anorexia, apical crackles.

PRIMARY TUBERCULOSIS

This occurs when the macrophage attempts to phagocytize bacteria.