Respiratory System: Disturbance in Oxygen Utilization

Comprehensive practice flashcards covering respiratory anatomy, COPD, asthma, acute and chronic bronchitis, emphysema, pleural effusion, thoracentesis, chest tube care, flail chest, pneumothorax types, lung resections, and ARDS.

What structure in the lower respiratory tract serves as the site of external respiration where gas exchange between air and blood capillaries occurs?

The alveoli (alveolar ducts and alveoli clusters surrounded by pulmonary capillary networks).

What is hemoptysis, and what common causes are associated with it?

Hemoptysis is the expectoration of blood from the respiratory tract. Potential causes include pulmonary infections, lung cancer ($\text{CA}$), abnormalities of the heart or blood vessels, pulmonary artery or vein abnormalities, and pulmonary embolism ($\text{PE}$) or infarction.

What physical assessment finding and clinical sign are demonstrated when the normal diamond-shaped window between opposing nail beds is obliterated?

Schamroth's sign, indicating clubbing of fingers (often associated with chronic hypoxemia).

How is Chronic Obstructive Pulmonary Disease ($\text{COPD}$) characterized?

A progressive lung disease that causes airflow limitation and breathing difficulties, characterized by chronic respiratory symptoms and airflow limitation.

Why is low-flow oxygen ($1\text{--}2\,\text{L/min}$ or $2\text{--}4\,\text{L/min}$ via nasal cannula, or up to $40\%$ via Venturi mask) administered to clients with $\text{COPD}$?

Low-flow $\text{O}_2$ is used because a low arterial oxygen level is the $\text{COPD}$ client's primary drive for breathing; excessive high-flow $\text{O}_2$ can eliminate their hypoxic drive.

What is cor pulmonale, and how does it develop in patients with chronic lung disease?

Cor pulmonale is right-sided heart failure caused by pulmonary disease; the right side of the heart enlarges and fails due to pulmonary hypertension resulting from alveolar hypoxia and vasoconstriction.

In the inflammatory cascade of asthma, what role do dendritic cells and T-helper 2 ($\text{Th2}$) cells play?

Allergens attach to the cell membrane of dendritic cells, which activate and attach the allergen to $\text{Th2}$ cells; the $\text{Th2}$ cells release cytokines ($\text{IL-4}$ and $\text{IL-5}$) to stimulate eosinophils, plasma cells, and mast cells.

What potent chemical mediators are discharged by mast cells during an asthmatic reaction?

Histamine and leukotrienes.

How is pulmonary function evaluated via spirometry in asthma testing?

Through a spirometer test calculating the $\text{FEV}_1/\text{FVC}$ ratio, which shows how much air a person can forcibly exhale in the first second of full exhalation.

What is the primary indication for Short-Acting Beta 2-Adrenergic Agonists ($\text{SABAs}$) compared to Long-Acting Beta-2 Adrenergic Agonists ($\text{LABAs}$) in asthma?

$\text{SABAs}$ (e.g., Albuterol, Levalbuterol, Pirbuterol) provide quick relief of acute symptoms and prevent exercise-induced asthma; $\text{LABAs}$ are long-acting control medications used alongside anti-inflammatory agents to control nocturnal asthma symptoms.

Why should antibiotics and antihistamines generally be avoided in uncomplicated acute bronchitis?

Antibiotics are unnecessary because acute bronchitis is primarily caused by viral infections; antihistamines dry up secretions and worsen the cough.

What is the clinical definition and diagnostic criterion for chronic bronchitis?

Prolonged inflammation of the bronchi accompanied by a chronic cough and excessive production of mucus for at least $3\,\text{months}$ each year for $2$ consecutive years.

Why are patients with chronic bronchitis clinically described as "Blue Bloaters"?

They develop cyanosis from severe hypoxemia, an overweight body habitus, peripheral edema from cor pulmonale (right heart failure), elevated hemoglobin (secondary polycythemia), wheezing, and rhonchi.

What underlying pathological changes define emphysema, and what nickname is given to these patients?

A chronic disease characterized by loss of lung elasticity, hyperinflation, and destruction of alveolar walls; clients are termed "Pink Puffers" due to severe exertional dyspnea, pursed-lip breathing, and a barrel chest.

What are the three anatomical classifications of emphysema shown in the diagram?

Panacinar (panlobar) emphysema, centriacinar (centrilobular) emphysema, and healthy alveoli (with paraseptal/distal acinar being the third variant).

What enzyme secreted by neutrophils breaks down elastin fibers in the alveoli during the pathogenesis of emphysema?

Elastase.

What key clinical differences distinguish the "Blue Bloater" (Chronic Bronchitis) from the "Pink Puffer" (Emphysema)?

"Blue Bloaters" exhibit cyanosis, an inflamed airway with increased sputum, obesity, crackles/wheezing, and cor pulmonale with peripheral edema; "Pink Puffers" present with a barrel chest, minimal cough, pursed-lip breathing, anxious facies, short jerky sentences, and exertional dyspnea.

What is a pleural effusion, and what is the normal volume of pleural fluid?

An abnormal collection of fluid between the visceral and parietal pleurae; the normal fluid volume is $5\text{--}15\,\text{mL}$.

How do transudative and exudative pleural effusions differ in their mechanisms?

Transudative effusions are protein-poor and cell-poor, caused by increased hydrostatic pressure or decreased oncotic pressure; exudative effusions are protein-rich, caused by increased capillary permeability from inflammation or disease.

What are the three essential chambers in a commercial chest drainage system (such as the Pleur-Evac)?

The drainage collection chamber, the water seal chamber, and the suction control chamber.

Under what conditions do fluctuations (tidaling) in the water-seal chamber of a chest tube stop?

Fluctuations cease when the lung has fully re-expanded, or pathologically if the chest tube is clogged with clots, the wall suction unit malfunctions, or a kink or dependent loop develops in the tubing.

What emergency nursing intervention is required if a break or major leak occurs in a chest drainage system?

The nurse must clamp the chest tube immediately with hemostats kept at the bedside and promptly notify the physician.

What patient positioning is recommended during and after a thoracentesis procedure?

During: sitting with arms and head resting forward on a padded table, or side-lying on the unaffected side. After: positioned on the unaffected side for at least $1\,\text{hour}$ and kept on bed rest for several hours.

What is bronchiectasis, and what characteristic sputum and radiographic signs are associated with it?

An abnormal and permanent dilatation of the bronchi and bronchioles characterized by chronic cough with copious, purulent, blood-streaked sputum worsening with position changes; chest X-ray reveals tram track opacities and ring shadows.

What paradoxical chest wall motion occurs in a patient with flail chest?

During inspiration, the fractured flail segment is drawn inward; during expiration, the flail segment bulges outward.

How does a tension pneumothorax differ mechanically from spontaneous and open pneumothoraces?

Tension pneumothorax involves a one-way valve effect where air enters the pleural space on inspiration but cannot escape, causing intrapleural pressure to remain positive throughout the entire respiratory cycle, leading to lung collapse and mediastinal shift.

What hallmark clinical sign on physical assessment indicates a tension pneumothorax with mediastinal shift?

Tracheal shift (deviation) toward the unaffected (opposite) side, accompanied by compression of the heart, great vessels, and contralateral lung.

What distinguishes wedge resection, segment resection, lobectomy, and pneumonectomy?

Wedge resection removes a small portion of a lobe; segment resection removes a larger portion/segment of a lobe; lobectomy removes an entire lobe; pneumonectomy removes the entire lung.

What is Acute Respiratory Distress Syndrome ($\text{ARDS}$), and how does it develop?

A form of acute lung injury ($\text{ALI}$) resulting from sepsis, major trauma, surgery, or critical illness; inflammatory mediators injure alveolar and capillary endothelial cells, causing increased permeability, noncardiogenic pulmonary edema, surfactant inactivation, alveolar collapse, and refractory hypoxemia.

What classic chest X-ray finding and ventilatory strategy are associated with Acute Respiratory Distress Syndrome ($\text{ARDS}$)?

Chest X-ray shows diffuse bilateral infiltrates producing a "whiteout"; collaborative ventilatory management requires low tidal volumes (to prevent barotrauma/lung injury), $\text{PEEP}$/$\text{CPAP}$, and prone positioning.