Patho Quiz 2 (VENTILATION)

Treating Impaired Ventilation

1. remove obstructions
2. restore integrity of chest wall 7 LUNGS
3. decrease inflammation & mucus
4. open & maintain integrity of airway
5. provide O2
6. control infection process
7. use mechanical ventilation if needed

What is Pneumonia?

* **causes inflammation of the lungs**
* occurs commonly in the bronchioles, interstitial lung tissue & alveoli
* **products of inflammation accumulate & cause consolidation**
* infectious process
* droplet spread

Pneumonia Clinical Mani’s

* **sudden onset fever**
* **sputum production**
* tachypnea
* **crackles in lungs**
* chills
* loss of appetite
* **tachycardia**
* fatigue
* dyspnea
* pleuritic pain (consolidation impacts lung’s ability to move)

Diagnosing Pneumonia

* HX & Physical Exam
* CT scan
* ABG
* CBC
* Gram stain
* Pulse ox
* Chest x-ray
* culture & sensitivity

Pneumonia Treatment

* restore optimal ventilation & diffusion
* identify pathogen & target w/ proper pharm treatment
* supplemental O2
* incentive spirometry

What is Emphysema?

* Irreversible enlargement of the air spaces beyond terminal bronchioles
* destruction of the alveolar walls
* obstruction of airflow
* chronic smoking is most common implicated

Emphysema Clinical Mani’s

* persistent cough
*
* dyspnea
* wheezing
* **pursed lip breathing**

Diagnosing Emphysema?

* HX & Physical exam
* Chest X-ray
* pulmonary function tests
* hypercapnia/hypoxemia

Emphysema Treatment

* maintain optimal lung function in order to allow individual to preform ADL’s

What is Chronic Bronchitis?

persistent/productive cough lasting ≥3 weeks for 2 or more consecutive years

What results from Chronic Bronchitis?

* chronic inflammation & edema of airways
* hyperplasia of bronchial mucous glands & smooth muscle
* destruction of cilia
* squamous cell metaplasia
* bronchial wall thickening → fibrosis development

Chronic Bronchitis Clinical Mani’s

* productive cough
* dyspnea
* hypoxemia & hypercapnia
* adventitious lung sounds
* cyanosis
* purulent sputum

Diagnosing Chronic Bronchitis

* HX & Physical Exam
* ABG
* Pulmonary function tests
* Pulse Ox
* Sputum analysis

Chronic Bronchitis Treatment

* STOP SMOKING
* Pulmonary Rehabilitation
* Pharmacologic Therapy
* bronchodilators
* steroidal anti-inflammatory drugs
* Mucolytic agents
* Supplemental O2

What is Asthma?

airway obstructions due to:

* bronchial hyper-responsiveness
* chronic inflammation
* broncho-construction
* excess mucous production

Asthma Clinical Mani’s

* wheezing
* tachypnea/dyspnea
* coughing
* chest tightness
* anxiety
* excessive sputum production

Asthma Treatment

* Monitor lung function
* control environmental triggers
* Pharm Treatment
* PT education

Cystic Fibrosis (CF)

Autosomal recessive disorder of electrolyte & water transport

* mutation of the CF gene
* more prone to infection
* excessive mucous production

Where does Cystic Fibrosis affect

the epithelial lining of

* respiratory/digestive/reproductive

Cystic Fibrosis Clinical Mani’s

* Respiratory

* infections
* chronic cough
* purulent sputum
* tachypnea
* wheezing/crackles
* hemoptysis
* dyspnea on exertion
* chest pain

Cystic Fibrosis Clinical Mani’s

* GI

* intestinal obstruction
* large greasy stool
* abdominal pain

Diagnosing Cystic Fibrosis

* HX & Physical Exam
* Sweat test
* Genetic testing
* Chest X-ray
* Sputum analysis

Cystic Fibrosis Treatment

* Respiratory

* Chest Physiotherapy (PT)
* Pharmacological agents
* Lung transplant

Cystic Fibrosis Treatment

* GI

* optimal nutrition
* pancreatic enzymes

What is Acute Respiratory Distress Syndrome

progression from lung injury to respiratory distress within 24-48hrs

Acute Respiratory Distress Syndrome Clinical Mani’s

* tachypnea
* dyspnea
* retractions
* crackles
* restlessness
* anxiety
* **PT gets rly sick rly fast**

Acute Respiratory Distress Syndrome (ARDS) Treatment

* remove causative factors
* administer 100% O2
* Mechanical ventilation

What is Ventilation?

breathing in & out (acquiring O2 & removing CO2 from blood)

* neuronal impulse are directed by lung receptors

What is Impaired Ventilation?

a problem of blocking airflow in & out of the lungs

What are the two major mechanism implicated w/ Impaired Ventilation?

* compression/narrowing of the airway (ex: asthma)
* disruption of the neuronal transmissions needed to stimulate breathing (ex: decreased LOC)

What are the 2 possible scenarios of Impaired Ventilation-Perfusion?

* Lung is ventilated, but NOT perfused
* Lung is perfused but NOT ventilated

What is the goal of Altered Ventilation

* acquire O2 needed for cellular metabolism
* remove CO2 needed to maintain pH & optimal cell function

What is Ventilation Altered by?

* obstruction/restriction of airflow
* inhibition of neuronal stimulation & mechanics of breathing
* which will lead to blocked airflow
* hypoxemia, hypoxia, hypercapnia
* acidosis
* CELL DEATH!!!!

What does blood do in the body? & what is it responsible for?

* primary transport system
* involved in all pathologic activities of all organs
* responsible for O2 transport
* responsible for carrying CO2 away from cells

What is Hematopoiesis?

BLOOD CELL PRODUCTION

* occurs in liver & spleen of fetus
* occurs in bone marrow after birth
* 2-stage process involving **Miotic division** (proliferation) & **maturation** (differentiation)

What happens when the number of circulating cells decrease?

blood cell have stem cells that undergo mitosis when stimulated by a specific biochemical agent

Pluripotential stem cells mature to…

* differentaited RBCs
* neutrophils
* eosinophils
* basophils
* monocytes
* PLTs

What causes Erythropoiesis?

decrease of hemoglobin levels = decreased tissue oxygen tension in the kidney

* in response to hypoxia erythropoietin is secreted
* bone marrow is stimulated to produce more cells

What is Erythropoiesis?

DEVELOPMENT of RBCs

* stimulated by erythropoietin (hormone in kidney)
* cell changes from a large nucleated cell to a reticulocyte b4 maturing to an erythrocyte

What is Hemoglobin?

O2 carrying protein in mature RBCs

* formed immature Red Cells (iron/proteins are required)
* Vitamins (B12, folic acid, B6, Vit E)
* Minerals
* Oxyhemoglobin

Mild Anemia

usually no clinical symptoms

* some elderly Pt’s w/ CV disease may have symptoms

Mild to Moderate Anemia

* fatigue
* generalized weakness
* tachycardia

Moderate to Severe Anemia

* tachypnea
* tachycardia
* headache
* lightheadedness
* BP drops w/position changes
* tinnitus

Gas Transport: Oxygen

97% of O2 in the blood is REVERSIBLY bound to hgb for transport in the blood

* SaO2 (95-100%)
* SvO2 (60-80%)
* PaO2 (80-100 mm/Hg)
* PvO2 (30-45 mm/Hg)

What is the affinity of hemoglobin for O2 is affected by

* **temp** (ex: FEVER: tissue needs more O2→body will alter affinity/pressure → hgb will let go of O2 & go to tissue)
* **acid-base balance**
* **CO2**

Anemia Clinical Mani’s

* reduced O2 carrying capacity ( not enough RBC)
* tissue hypoxia (not enough O2 circulating)
* Compensatory Mechanism Activated
* inc. pulmonary function (inc. RR)
* inc. cardiac function (inc. HR & CO)
* decreased affinity of hgb in tissues
* increased erythropoietin activity
* selective tissue perfusion provides shunting to vital organs

What is Anemia?

RBC deficit

* tissue hypoxia related to low O2 carrying capacity of RBCs

What is Relative Anemia?

Normal Total RBCs plasma volume is decreased

What is Absolute Anemia?

Decreased in the # of RBCs (dec. production = inc. destruction)

What is Polycythemia?

INCREASE IN RBCs

* increase in blood volume & viscosity

Anemia of Chronic Renal Failure

* impaired erythropoietin production
* dec. RBC & Low hgb/hct
* deformed RBCs
* Leukocyte count is NORMAL

What is MCV?

mean corpuscular volume

* avg size of RBCs

What is MCH?

mean corpuscular hemoglobin

* avg amt of hgb per RBC

What is MCHC?

mean corpuscular hemoglobin concentration

* avg. amt of ngb in a single RBC

What are Reticulocytes?

IMMATURE RBCs

* Hbg producing factory!!!
* Mature in 24-48hrs
* once mature it becomes am erythrocytes

What does it mean when you have an increased reticulocyte count?

this may indicate anemia due to RBCs being destroyed earlier than normal