Respiratory

cough

irritants stimulates receptors in the airway

acute cough could be because of...

URT infection, allergic rhinitis, acute bronchitis, pneumonia, CHF, pulmonary edema, aspiration

chronic cough could be because of...

asthma, gastro-esophageal reflux, angiotensin coverting enzyme inhibitors, smoker's cough (chronic bronchitis)

hemoptysis

coughing up blood ~ usually bright red, alkaline pH

hematemesis

vomiting blood ~ usually dark red, acidic pH

normal tidal volume

400-800 mL

kussmauls respiration

hyperpnea ~ increased rate and depth of breathing

hyperventilation

increased rate and depth that exceeds metabolic demands and will lower CO2

large airway obstruction leads to...

slow ventilatory rate, large tidal volume, increased effort, prolonged inspiration and expiration, wheezing

small airway obstruction leads to...

rapid ventilatory rate, small tidal volume, increased effort, prolonged expiration and wheezing

pulmonary fibrosis

restricted breathing where there is stiffen lungs or chest wall ~ decreasing compliance

cheyne-stokes respiration

alternating periods of deep and shallow breathing; apnea for 15-60 secs...

what is cheyne-stokes respirations a result from

any condition that reduces blood flow to brain stem

what can hypoventilation cause

hypercapnia ~ leading to respiratory acidosis and can cause disorientation

what is the usual ventilation/perfusion ration at rest

0

if ventilation is obstructed... what happens V/Q ration

it decreases

if blood flow is obstructed... what happen to V/Q ration

it increases

hypercapnia happens due to...

anything that impairs the nervous system or mechanical work of breathing

what respiratory group in the brain stem sets automaticity of inspiration at rest

dorsal respiratory group

what respiratory group in the brain stem sets inspiration and expiration during exercise

ventral respiratory group

what are some cause of hyperventilation

severe anxiety, head injury, pain, conditions that cause insufficient oxygenation of tissues

respiratory alkalosis

high pH, low CO2 ~ PaCO2 < 36 mm Hg

cyanosis

bluish discoloration of skin and mucous membranes due to high amount of unsaturated hemoglobin

peripheral cyanosis

slow blood circulation in fingers and toes

central cyanosis

caused by decreased arterial oxygen

clubbing

selective bulbous enlargement of the end of a digit ~ chronic hypoxemia

clubbing happens by...

whole megakaryocytes are trapped in fingertips, release growth factor with increased fibroblasts and smooth muscle cells invading nail beds

pleurodynia

stabbing/sharp pain caused by pulmonary disorders originating in the pleurae, airways or chest walls

shunting

perfusion without ventilation ~ occurs in atelectasis (collapse lung) , asthma, pulmonary edema and pneumonia

when is diffusion impaired for the alveolocapillary membranes

if the membranes is thickened (fibrosis) or surface area available for diffusion is decreased (emphysema)

emphysema

damage of alveoli

how can meds lead to hypoventilation

they can depress the respiratory centers (DRG and VRG)

Cor Pulmonale

a change in structure and function of the right ventricle as a result of a respiratory disorder

what happens to the right ventricle during Cor Pulmonale

the right ventricle hypertrophies then leads to right-sided heart failure

acute respiratory failure

inability of the lungs to perform their ventilatory function

respiratory failure an result from...

direct injury or indirect injury (another body sytem)

if respiratory failure manifest as hypercapnia... patients will need

ventilatory support

if respiratory failure manifest as hypoxemia... patients will need

supplemental oxygen

what is prevention of acute respiratory failure

frequent turning and change of position, deep breathing exercise, and early ambulation

what is the most common cause of hospitalization for patient with chronic neuromuscular diseases is...

pulmonary issues ~ compromised chest wall with muscle weakness

flail chest

instability of a portion of the chest wall due to fracture of several consecutive ribs in more than one place or fx of sternum

paradoxic movement

chest wall moves in with inspiration and out with expiration

Pneumothorax

air accumulation within pleural cavity due to rupture in the visceral pleura or parietal pleura

what are the three types of pneumothorax

spontaneous, open (communicating), tension

spontaneous pneumothorax

unexpected rupture of visceral pleura and blebs have formed ~ "porous pleura, damaged alveoli"

open pneumothorax

air enters pleural cavity through chest wall during inspiration and exits during expiration ~ "air in/air out"

tension pneumothorax

air enters pleural cavity during inspiration but doesn't exit during expiration ~ "air in/air can't get out"

pleural effesion

fluid in pleural space ~ most commonly the migration of fluids and other components on the the blood

thoracentesis

surgical puncture to remove fluid from the pleural space

pulmonary edema

fluid in lung tissue itself ~ hear crackle (rales)

pneumonia

infection of lower respiratory tract

pneumococcal

lung infected through inhalation of aerosolized bacteria or by aspiration of colonized oropharyngeal secretions

neutrophils and inflammatory exudates during pneumococcal can cause...

alveolar edema

lobar pneumonia

affects larger areas of the lungs, often including one or more sections, or lobes, of a lung

what are the 4 progressions of lobar pneumonia

congestion

red hepatizations

grey hepatizations

resolution

when blood markers show low levels of pro-calcitonin or C-reactive protein then the pneumonia diagnoses is...

not bacterial infection

tuberculosis is caused by...

mycobacterium tuberculosis ~ transmitted via air droplets

with tuberculosis, phagocytes go in to...

engulf/isolate bacilli forming tubercles ~ leading to tissue necrosis (caseation necrosis)

secondary tuberculosis

the dormant, isolated bacilli is reactivated (ghon focus)

what is the single greatest risk factor of reactivating the dormant, isolated bacilli

HIV

military TB

a disseminated form of tuberculosis (TB) where the bacteria spread throughout the body through the bloodstream, forming small, millet seed-like lesions in various organs

some clinical manifestations of tuberculosis

fatigue, weight loss

low grade fever

cough with purulent that develops

hemoptysis

multidrug-resistant tuberculosis

resistance to isoniazid and refimpicin, with or without resistance to other first line drugs

extra drug resistant TB

resistance to at least isoniazid and rifampicin, and any fluroquinolone, and to any of the three second-line injectable drugs