chapter 21 - exam #2

compliance

lungs ability to expand and contract

bronchodilation

airways widen, sympathetic nervous system

bronchoconstriction

airways narrow, parasympathetic nervous system

b2 receptors in the bronchioles respond to

stress

cause bronchodilation

leukotrienes and histamine from inflammation cause

bronchoconstriction

pleural space

vacuum w/ no air or fluid

its good for lubrication

if air or fluid enter the pleural space, this results in …

lung collapse

pulmonary function tests identify

obstructive diseases → airflow from trach to bronchi

restrictive diseases → lungs can’t expand

pulmonary edema

patho: fluid build up around the alveoli which blocks oxygen exchange

main cause is LVF

sx: extreme sob, crackles, pink and frothy sputum, confusion

dx: clinical sx and PE, chest xray, ABG’s

pneumothorax

collapsed lung; air enters the pleural space and air pressure pushes against the lung

sx: sudden chest pain, sob, asymmetrical chest, decreased breath sounds, muscle retractions (muscles between ribs pull inward during inhalation)

primary spontaneous pneumothorax

occurs w/o lung disease or trauma

usually in tall, thin, young males

secondary spontaneous pneumothorax

occurs in people with lung disease like emphysema, TB, etc.

traumatic pneumothorax

caused by chest injury

tension pneumothorax

air gets in but can’t escape which compresses the heart and lungs - big emergency

latrogenic pneumothorax

caused by medical procedures

pulmonary hypertension (PH)

BP in pulmonary arteries

nml is about 25 mmHg

in PH its > 25mmHg at rest or > 30 mmHg w/ exercise

effects of pulmonary hypertension

• R ventricular hypertrophy → RV has to work harder to push blood to the lungs and overtime RV will become thicker and weaken

• R sided HF → R heart can’t keep up and blood backs up into body leading to JVD, edema, enlarged liver (hepatomegaly), fatigue and weakness

• low o2 → poor blood flow to lungs so o2 does not get into blood

pulmonary embolism

blood clot that travels to the lungs and blocks flow in the pulmonary arteries

clots can come from DVT, R heart, or in some cases, central venous caths

it can happen suddenly and be asymptomatic

dx: d-dimer, ct pulmonary angiography

asthma

aka hyperactive airway disease

airways in the lungs become inflamed and narrowed; its irreversible and recurrent attacks result in airway remodeling

asthma sx and dx

wheezing, coughing (especially at night), sob, trouble speaking during attacks

dx: pulmonary function test - increase of 12% or more after a short acting bronchodilator is a positive dx

covid

patho: spread via droplets

sx: fever, chills, sob, cough, nausea and vomiting, loss of tase and smell

dx: viral vs. antibody test, PCR w/ swab

COPD (chronic obstructive pulmonary disease)

chronic bronchitis, emphysema, hyperactive airway disease

smoking is a major cause

COPD - chronic bronchitis

“blue bloaters”

inflammation of the bronchi causing extra mucus to be produced which blocks airflow and causes a chronic, productive cough

COPD - chronic bronchitis - signs and sx

cyanotic

hypoxia

hypercapnia (elevated co2 bc no exhalation)

digital clubbing

respiratory acidosis

cardiac enlargement

bilateral pedal edema

JVD

leads to RHF

COPD - emphysema

“pink puffer”

alveoli in the lungs get damaged and loose stretch which makes it hard for oxygen to get into the blood and traps air in the lungs

COPD - emphysema - signs and sx

pink due to co2 retention

pursed lip breathing

barrel chest (from hyperinflated lungs)

hyperresonance on chest percussion

thin appearance

orthopneic

COPD dx

pulmonary function test

chest xray (if severe, diaphragm will be lower, hyperinflation of lung)

ECG

ABG’s