Advanced Pathophysiology Respiratory
The pressure in the pleural space ranges from ______ mmHg to _______mmHg.
-4 to -10
Pulmonary circulation pressure is ______ mmHg Systemic circulation pressure is _______ mmHg
18 90
Normal ventilation is _____L/min Normal perfusion is _______L/min
4 5
A normal V/Q ratio.
4/5 0.8
In this respiratory illness there is a non-productive cough that is aggravated by cold, dry or dusty air.
Acute bronchitis
What is pneumococcal pneumonia?
Acute lung infection that results in inflammatory cytokines and causes alveolar edema
Characterized by hypoxemia, hypercapnia and a decreased pH.
Acute respiratory failure
Primary emphysema is an inherited deficiency of what?
Alpha-1 antitrypsin
Pneumonia
An infection of the lower respiratory tract
What are the 4 major routes of infection for pneumonia?
Aspiration Inhalation ET tubes Low respiratory defenses
These receptors are found mostly in the lungs.
Beta 2
Acyanotic defects will present with symptoms of ________?
CHF
This is the 3rd leading cause of death in the US?
COPD
What are the 4 phases of pneumococcal pneumonia?
Consolidation Red hepatization gray hepatization Resolution
This is an autosomal recessive lung disease that results in abnormal secretions that lead to obstructive problems with in the respiratory, digestive and reproductive tracts.
Cystic fibrosis
The most common cause of PE.
DVT
When the stretch receptor in the bronchiolar and bronchial tree send inhibitory impulses to brain stem to limit excessive inspiration.
Hering-breuer inflation reflex
Respiratory alkalosis occurs with what type of ventilation?
Hyperventilation
In restrictive lung disease, it is difficult to get air_______?
IN
Asthma starts with the release of ______ that leads to mast cell degranulation.
IgE
Characterized by an increased ventilatory rate with a very large tidal volume.
Kussmaul respirations
Most common cause of pulmonary edema is?
Left sided heart disease
In obstructive lung disease it is difficult to get air _______.
OUT
The graph representing hemoglobin saturation and desaturation.
Oxyhemoglobin dissociation curve
In this respiratory disease there will be an increase in the V/Q ratio.
PE
What disease results in widespread hypoxic vasoconstriction?
PE
What part of the ABG would you look at for alveolar ventilation?
PaCO2
This disease is responsible for more disease and death than any other infection.
Pneumonia
This is a rare life threatening complication that can occur after relief of an upper airway obstruction?
Postobstructive pulmonary edema
Caseous necrosis are cheesecake material found in what disease?
TB
This disease may remain dormant for life or cause active disease?
TB
This respiratory disease is the leading cause of death from a curable infection in the world.
TB
The partial pressure of gas is the driving force of diffusion.
The Haldane Effect
This is where the right and left bronchi enter the lungs along with blood and lymph vessels.
The Hila
Bronchioles, alveolar ducts, alveoli
The acinus
The ridge where the trachea divides into the right and left bronchi.
The carina
These provide the structure of the alveoli.
Type 1 alveolar cells
Surfactant is produced by?
Type 2 alveolar cells
Viral pneumonia is usually preceded by what kind of illness?
Upper respiratory infection
The most common cause of hypoxemia?
V/Q mismatch
This respiratory disease is seasonal and usually mild?
Viral pneumonia
A patient is in the ER displaying with a sudden onset of pleuritic chest pain along with dyspnea, tachypnea, tachycardia and an unexplained anxiety. What is likely going on with this person?
a PE
What is an abscess?
a circumscribed area of suppuration and destruction of lung parenchyma
The hallmark finding in obstructive lung disease?
a decreased FEV1/FCV ratio
Why must a nurse take care not to correct respiratory acidosis too quickly?
a rapid reduction in CO2 could cause respiratory alkalosis with seizures and death
Acidosis, hypercapnia, low pH would cause what kind of shift on the oxyhemoglobin dissociation curve?
a shift to the right
A PE is usually caused by what?
a thrombus
acute bronchitis usually follows what?
a viral illness
________ follows lung consolidation, in which inflammation causes alveoli to fill with fluid and pus
abscess
Hypoventilation leads to respiratory ____________ d/t __________.
acidosis hypercapnia
In the early asthmatic response, what contributes to bronchial hyper-responsiveness?
activation of eosinophils
In which respiratory illness will there be a negative chest X-ray even though there is disease?
acute bronchitis
What is acute bronchitis?
acute infection or inflammation of the airways
Caused by a decrease in elastic recoil during expiration that results in collapse of the airways.
air trapping
TB is transmitted how?
airborne droplet transmission
Hyperventilation leads to respiratory _____________ d/t _____________.
alkalosis hypocapnia
Gas exchange between the pulmonary system and the cardiovascular system occurs here?
alveolocapillary membrane
Hyperventilation leads to ____________ V/Q ratio.
an increased
This is a type of restrictive lung disease that is most frequently seen in the right lower lobe?
aspiration
What is the most common cause of abscess formation in the lungs?
aspiration
Pneumococcal pneumonia begins with?
aspiration of streptococcus
This is a type of reversible bronchoconstriction.
asthma
Vasodilation, increased capillary permeability, mucosal edema, bronchospasm, thick secretions, mucus plugs, increased work of breathing and hypoxemia are all seen with?
asthma
bronchial hyper-reactivity
asthma
In pulmonary artery hypertension (PAH) the mean pulmonary artery pressure is what?
at or above 25 mmHg
The collapse of lung tissue.
atelectasis
Why is it called red hepatization in pneumococcal pneumonia?
because red blood cells accumulate in the lungs
60% of venous CO2 is in what form?
bicarbonate
90% of CO2 in arterial blood is in what form?
bicarbonate
In emphysema the alveolar destruction causes what adjacent to the pleurae?
blebs
A chronic productive cough will be present with what respiratory disease?
bronchiectasis
Cystic fibrosis causes persistent chronic bronchial inflammation which also causes?
bronchiectasis
This is a type of restrictive lung disease that is d/t persistent dilation of the bronchi.
bronchiectasis
Restrictive lung disease normally seen in children
bronchiolitis
A late stage fibrotic disease of the airways that causes permanent scarring of lungs.
bronchiolitis obliterans
In emphysema, the alveolar destruction causes what in the lung parenchyma?
bullae
A type of cyanosis seen in the mucous membranes and lips.
central
What is the fundamental abnormality found in cystic fibrosis?
chloride ion transport
Characterized by hyper secretion of mucus with a chronic productive cough that last 3 months/year for 2 consecutive years.
chronic bronchitis
Clinical manifestations include: decreased exercise intolerance, wheezing, productive smoker's cough and a decreased FEV-1
chronic bronchitis
Clinical manifestations include: narrow airways, hypertrophied bronchial smooth muscle and bronchial edema.
chronic bronchitis
Exposure to an inhaled irritant such as cigarette smoke could start the pathology of what disease?
chronic bronchitis
Hypoxemia, hypercapnia, air-trapping and airway collapse early in expiration all occur with what?
chronic bronchitis
This lung disease has thick mucus that cannot be cleared out.
chronic bronchitis
The relative ease with which the lungs and chest wall can be stretched.
compliance
In pneumococcal pneumonia what happens to the involved lung?
consolidation
A nurse is treating a patient who presents with a decreased cardiac output with exercise, chest pain, but when at rest the heart appears normal. What is this patient likely experiencing?
cor pulmonale
What can pulmonary artery hypertension lead to that is so deadly?
cor pulmonale
In this disease, chronic inflammation leads to hyperplasia of the goblet cells, bronchiectasis, pneumonia, hypoxia and scarring?
cystic fibrosis
Hypoventilation leads to _________ V/Q ratio.
decreased
The NP recalls that cystic fibrosis is associated with?
defective epithelial chloride ion transport
what group sets the basic automatic rhythm of respirations?
dorsal
The risk factors for laryngeal cancer are increased by what 2 behaviors?
drinking and smoking
Presents with flaring nostrils, use of accessory muscles and retractions.
dyspnea
The most common subjective sign/symptom of a pulmonary disease is?
dyspnea
The negative pressure of the pleural space is a r/o?
elastic recoil
The tendency of the lungs and chest to return to their resting state after expiration.
elastic recoil
What are 3 causes of pulmonary artery hypertension?
elevated left ventricular pressure hypoxia acidosis
Clinical manifestations include very little coughing and sputum, prolonged expiration, pursed lipped breathing, and a barrel chest.
emphysema
In this debase there is a destruction of the alveoli due to a breakdown of elastin.
emphysema
In this disease, pts will often lean forward to increase lung capacity with arms braced on their knees.
emphysema
Loss of elastic recoil is seen in?
emphysema
In this disease there is pus in the pleural space that is usually r/t bacterial pneumonia.
empyema
The most common causes of pneumoconiosis?
exposure to asbestos coal silica
This type of effusion has less water and more WBCs and plasma proteins.
exudative
paradoxical movement of the chest wall
flail chest
These help propel foreign material upwards to enable it to be coughed up.
goblet cells cilia
What does a shift to the right on the oxyhemoglobin dissociation curve mean?
hemoglobin has a decreased affinity for oxygen
A shift to the left on the oxyhemoglobin dissociation curve depicts what?
hemoglobins increased affinity for oxygen
Increased work of expiration is a r/o?
high compliance
Lungs are easy to inflate and some elastic recoil is lost.
high compliance
Bronchial circulation is a type of ________ circulation in the lungs?
high pressure low flow
This type of circulation in the bronchi supplies blood to the trachea, the bronchial tree, the bronchioles and the outer coats of the pulmonary arteries and veins.
high pressure low flow
In metabolic acidosis, _________ moves into the intracellular fluid and ___________ moves into the the extracellular fluid to maintain the balance.
hydrogen potassium
The increase in this type of pressure in the left side of the heart leads to pulmonary edema?
hydrostatic pressure
Respiratory acidosis occurs with alveolar _____________.
hypoventilation
How does the body compensate for metabolic alkalosis?
hypoventilation kidneys conserve hydrogen kidneys excrete bicarb
A decrease of oxygen in the arterial blood.
hypoxemia
Peripheral chemoreceptors are stimulated by?
hypoxemia PaO2
A decrease of oxygen to the cells and tissues
hypoxia
What 2 things will the body do to normalize the V/Q ratio?
hypoxic vasoconstriction bronchoconstriction
Needle aspiration causes....
iatrogenic pneumothorax
Retaining CO2 will cause you to what?
increase respirations
Central chemoreceptors do what?
increase the respiratory rate and depth
In hypoventilation, perfusion is ______ and ventilation is ________.
increased decreased
What is the pathophysiology of pneumococcal pneumonia?
inflammatory cytokines cause alveolar edema, which creates a medium for bacteria that leads to consolidation
What is the most common secondary bacterial infection seen with viral pneumonia?
influenza
What is the pathophysiology of TB?
isolation of bacilli by enclosing them in tubercles and then surrounding tubercles with scar tissue
Why is viral pneumonia problematic?
it can lead to a secondary bacterial infection
Why is edema so problematic in pneumococcal pneumonia?
it creates a medium for bacteria and helps spread infection into other lung lobes
The larger diameter of the pulmonary artery/arteries has what effect on the heart?
it helps accommodate the stroke volume of the right ventricle
Compensation for respiratory acidosis includes (2)?
kidneys conserve bicarb and eliminate hydrogen
How does the body compensate during respiratory alkalosis?
kidneys decrease hydrogen excretion kidneys decrease bicarb absorption
The diameters of the pulmonary artery/arteries are?
large
Clinical manifestations of this disease include increased hoarseness, dyspnea and cough.
laryngeal cancer
Alkalosis and hypocapnia will cause the oxyhemoglobin dissociation curve to shift?
left
In acute respiratory failure the PaO2 will be______ the PaCO2 will be _________ and the pH will be ___________
less than 50 greater than 50 less than 7.25
A low V/Q ratio means ________ ventilation and ________ perfusion?
low high
In a low V/Q ratio what would your PaO2 and PaCO2 be?
low PaO2 high PaCO2
What is the most important cause of pulmonary artery constriction?
low PaO2 (low alveolar partial pressure of oxygen)
Increased work of inspiration is a r/o?
low compliance
In this type of circulation, venous blood is supplied from all parts of the body and alveolar capillaries where oxygen is added and CO2 is removed.
low pressure high flow
Pulmonary circulation is a type of ________ circulation in the lungs?
low pressure high flow
Pulmonary circulation has a ________ pressure than _________ circulation?
lower systemic
this is the most frequent cause of cancer death in the US?
lung cancer
What are 2 functions of alveolar surfactant?
lung expansion prevent lung collapse
Supports the negative pressure in the lungs to keep the lungs from collapsing.
lymphatic vessels
This part of the brain modifies respiratory depth and rate.
medulla
The pressure in the pleural space is.....
negative
Small cell carcinomas are the most prevelent form of what kind of lung tumor?
neuroendocrine
Small cell carcinoma is also called what?
oat
Asthma, chronic bronchitis, emphysema and COPD are all what type of lung disease?
obstructive
Emptying of the lungs is slowed in what pulmonary disease?
obstructive lung disease
In a tension pneumothorax the site of the pleural rupture acts as a?
one-way valve
The type of pneumothorax where air is not trapped.
open
PaO2
oxygen in arterial blood
A restrictive lung disease that leads to a disruption of surfactant production.
oxygen toxicity
Bronchial circulation has _______ blood whereas the pulmonary circulation is 100% _________.
oxygenated CO2
This type of emphysema involves the lower lobes.
panlobular
The amount of blood being sent to the lungs.
perfusion
A type of cyanosis seen in nail beds.
peripheral
In response to hypoxemia, what is responsible for the increased ventilation?
peripheral chemoreceptors
The most common type of pain found in respiratory disease?
pleural pain
Any change in lung caused by inhaling inorganic dust particles usually from work.
pneumoconiosis
Black lung is an example of what restrictive lung disease?
pneumoconiosis
Air in the pleural space
pneumothorax
Alveoli
primary gas exchange units
What is cavitation?
process of the abscess emptying and cavity formation
Gas-exchange airways are served by what circulation system?
pulmonary
Acyanotic defects will eventually lead to?
pulmonary HTN
This disease is often only seen when a chest X-ray shows an enlarged pulmonary artery or a EKG shows right ventricular hypertrophy.
pulmonary artery hypertension
What leads to cor pulmonate?
pulmonary artery hypertension
Burning of the eyes, nose and throat, cough and chest tightness are all clinical manifestations of?
pulmonary fibrosis
Exposure to ammonia, HCl, chlorine or other toxic gases can cause?
pulmonary fibrosis
In autonomic nervous system the sympathetic receptors in the upper thoracic and spinal cord cause the smooth muscle to?
relax dilate
In asthma, this leads to vasodilation, increased capillary permeability, mucosal edema, bronchospasm and thick secretions.
release of IgE
In what acid-base balance would a patient show signs of hypocalcemia?
respiratory alkalosis
What is the most common acid-base balance seen in critical care?
respiratory alkalosis
What is the usual cause of death with cystic fibrosis?
respiratory failure
Atelectasis is a type of what lung disease?
restrictive
FEV-1/FCV ratio is normal or increased in this lung disease?
restrictive
In this disease the lungs are good at getting air out but not letting it in.
restrictive lung disease
Where will the oxyhemoglobin curve shift with pulmonary edema?
right
If pulmonary artery hypertension is not treated and reversed what will this lead to?
right heart failure
What is cor pulmonale?
right ventricular enlargement
What would the nurse see in a patient with an abscess involving the bronchus? (3)
severe cough lots of foul-smelling sputum hemoptysis
What is a "tet spell?"
shortness of breath when crying
Perfusion without ventilation.
shunting
What are 2 ominous signs of impending death r/t asthma?
silent chest PaCO2 greater than 70
The diameter of the systemic arteries are?
small
This type of cancer has a worse prognosis but tends to be more responsive to chemotherapy?
small cell carcinoma
Centrilobular emphysema tends to occur in what population?
smokers with chronic bronchitis
Secondary emphysema is due to?
smoking
What are the 3 types of non-small-cell lung CA?
squamous cell adenocarcinoma large cell
Bronchospasm that is not reversed by the usual measures.
status asthmaticus
3 causes of restrictive lung disease?
stiff lungs stiff chest wall respiratory muscle weakness
This causes relaxation of smooth muscle or bronchodilaton.
stimulation of beta 2 receptors
What usually causes community acquired pneumonia?
streptococcus
Bronchial circulation is a branch of _________?
systemic circulation
Pulmonary circulation is separate from _________.
systemic circulation
In this pneumothorax, air is trapped.
tension
Hypoxemia, tracheal deviation away from the affected lung are both signs of what lung disorder?
tension pneumothorax
In this lung disease, the lungs eventually collapse causing a mediastinal shift.
tension pneumothorax
"tet spells" are seen with what congenital disorder?
tetralogy of fallot
What is Virchow's triad?
the 3 factors that can lead to a PE
The respiratory center is located in?
the brainstem
where do pulmonary emboli commonly arise from?
the deep veins of the thigh
The phrenic nerve innervates what respiratory muscle?
the diaphragm
In pan lobular emphysema were is the destruction?
the entire acinus
The pulmonary system acts as a blood reservoir for what?
the left ventricle
What is a pulmonary embolisim?
the occlusion of a portion of the pulmonary vascular bed by a thrombus or embolus
why would a chest X-ray be negative in acute bronchitis?
there is no consolidation or chest infiltrates
This type of effusion has water in the fluid.
transudative
Centrilobular emphysema has destruction where?
upper lobes
In pulmonary artery hypertension there is an overproduction of ________ and a decreased production of ___________
vasoconstrictors vasodilators
What are the 3 parts of virchow's triad?
venous stasis hypercoagulability damage to endothelial cells
The amount of air getting to the alveoli.
ventilation
What are the 2 unifying symptoms of obstructive lung disease?
wheezing dyspnea
