Advanced Pathophysiology Respiratory

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

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


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