Pathophysiology Ch 18 Study Guide

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The term hemoptysis refers to?

blood-tinged (bright red) frothy sputum associated with pulmonary edema.

The term Orthopnea refers to?

dyspnea that occurs when a person is lying down. (Pulmonary Congestion)

Is Laryngotracheobronchitis (LTB) "viral" or "bacterial"?

viral

Laryngotracheobronchitis (LTB) is manifested in?

between 1 and 2 years of age, adults may also contract laryngitis, tracheitis, or bronchitis.

Common causative organisms of LTB?

parainfluenza viruses and adenovciruses.

Pathophysiology of (LTB)

Viral infection. In child, larynx and subglottic area become inflamed with swelling and exudate, leading to obstruction and medical emergency.

Treatment of LTB

If child has airway, breathing treatent with racemic epinephrine

What is acute sinusitis?

A bacterial infection secondary to a cold or allergic reaction that has obstructed the drainage of one or more of the paranasal sinuses into the nasal cavity. Patient has exudative material in the sinuses. (Pneumococci, streptococci, H. flu)

Signs and symptoms of sinusitis?

Pain may be confused by headache (ethmoid sinus) or toothache (maxillary sinus).Other signs, such as nasal congestion, fever, or sore throat.

Typical signs and symptoms of epiglottitis include?

Usually high fever, difficulty swallowing with increased drooling, appears ill, rapid respiratios and pulse.

What is epiglottitis?

Acute infection usually caused by bacteria H. flu. Common in children 3-7 years old. Swelling is in the supraglottic area, larynx and epiglottis. Epiglottis appears as a cherry red ball.

What is the most common cause of viral pneumonia?

Viral is often caused by influenza A or B, adenovirus or respiratory syncytial virus (RSV).

What is viral pneumonia?

Inflammation in lung with increased inflammation at the interstitial space. Usually self-limiting

Most common manifestations of Lobar pneumonia (pneumococcal pneumonia) include?

*Systemic signs of high fever with chills, marked fatigue
*Dyspnea, tachypnea, tachycardia

Rust-colored sputum in a patient with pneumonia usually indicates?

Lobar pneumonia? (The presence of RBC's in the exudate)

Tuberculosis is what type if bacillus and resistant to many disinfectants?

Myobacterium Tuberculosis

Primary tuberculosis is identified by what?

indicated by a positive tuberculin test result. (cavitation in the formation)

Active (secondary) infection by M. tuberculosis with tissue destruction occurs when?

May arise years after primary infection.(The bacilli, hidden in the tubercules is reactivated)

What is secondary infection tuberculosis?

new infection. Caviation occurs. Destruction of lung tissue and erosion into bronchi and blood vessels. Bacteria may be swallowed to infect the digestive tract.

The presence of active (reinfection) tuberculosis is confirmed by?

chest x-ray, acid-fast staining of sputum specimens, and sputum culture (a lengthy time required), or cavitation occurs.

Cystic fibrosis is transmitted as a:

common genetic disease. (Chromosome 7 defect - CFTR gene, relate to a protein involved in chloride ion transport in the cell membrane. Organisms causing infection are: P.aerugniosa and S.aureus)

Growth and development of a child with cystic fibrosis may be delayed because of:

blocked pancreas duct (meconium ileus - small intestine blocked at birth by mucus; deficit of pancreatic digestive enzymes leads to malabsorption and malnutrition)

Persistent thick mucus in the bronchioles of a child with CF may cause:

obstruction of bronchioles, causing air trapping or atelectasis with permanent damage to the bronchial walls. Infections are common and add to the progressive destruction of lung tissue. (Air becomes trapped causing atelectasis)

Early signs of brochogenic carcinoma include:

*those related to the direct effects of the tumor on the respiratory structures
*those representing the systemic effects of cancer
*those caused by associated paraneoplastic syndromes
*those resulting from metastatic tumors at other sites

Early signs related to respiratory involvement (brochogenic carcinoma) include:

* persistent productive cough, dyspnea, and wheezing
*Detection on a chest x-ray
*Hemoptysis (when tumors erode tissue)
*Pleural involvement (leads to pleural effusion, pneumothorax, or hemothorax)
*chest pain (with advanced tumors involving pleura)
*hoarseness
*facial or arm edema

Systemic signs of lung cancer include:

weight loss, anemia, and fatigue

Paraneoplastic syndrome is indicated by:

the signs of an endocrine disorder related to the specific hormone secreted

Cigarette smoking predisposes to malignant neoplasms because smoking:

(respiratory mucosa changes through metaplasia to dysplasia)

Total obstruction of the airway by aspirated material is manifested by:

when mucus plugs completely block the flow of air in the already narrowed air passages.(Creates a ball-vale effect) Atelectasis ensues, Oxygen levels deplete, respiratory failure results.

The basis for acute attacks of extrinsic asthma is (which type of hypersensitivity reaction):

type 1 hypersensitivity due to an inhaled antigen.

Postoperative aspiration consists of:

vomitus may be aspirated postoperatively (depression of cough due to pain reflex) from the effects of anasthetics or drugs.

During an acute asthma attack, respiratory obstruction occurs due to:

Type 1 hypersensitivity reaction to an inhaled antigen. (Mucus plugs completely block the flow of air)

Expanded A-P thoracic diameter (barrel chest) in patients with emphysema results from:

increased residual volume and overinflated lungs

Destruction of alveolar walls and septae is typical of:

Emphysema. The destruction of the alveolar walls and sepatae, which leads to large permanently inflated alveolar spaces.

Chronic bronchitis is caused by:

constant irritation.

Chronic bonchitis has what effect on the bronchial wall?

Chronic irritation and inflammation lead to fibrosis and thickening of bronchial wall. Secretions pool distal to obstructions and are difficult to remove

Common signs of cor pulmonale are?

systemic adema, acides

Frequent inhalation of irritating particles such as silica, causes:

Fibrosis and loss of lung compliance

Causes of pulmonary edema include:

left-sided congestive heart failure, back up of blood from the failing left ventricle hypoproteinemia increased permeability in lungsblocked lymphatic drainage. (osmottic pressure drops)

The common cause of pulmonary embolus is:

Usually from DVT's (deep vein thrombosis - deep veins, primarily in the legs) thrombi or blood clots in legs

A large-sized pulmonary embolus is likely to cause:

right-sided heart failure and decerased cardiac ouput (shock). Sudden death

Manifestations of atelectasis associated with airway obstructino include:

obstructive atelectasis leads to a potential low pressure "gap" or space on the affected side; therefore the mediastinum shifts toward it, and the other lung, compensated by overinflating.

A large pleural effusion would cause atelectasis because:

increases the pressure in the pleural cavity and causing separation of the pleural membranes (inspiration is affected), preventing their cohesion during inspiration. These effects prevent expansion of the lung, leading to atelectasis.

Flail chest occurs when:

(contusion w/edema, bleeding in lung tissue. During inspiration, broken section moves inward rather than out, inthathoracic pressure decreases. Prevents expansion of affected lung. On expiration, flail section pushes outward increasing inthoracic pressure moving it back and forth)

Define surfactant

lipids and proteins that is produced in the lungs. The inside of the alveolia are coated with a very small amount of fluid containing surfactant

Surfactant reduces:

tension in the alveoli and promotes expansion (Surfactant has a detergent action that reduces surface tension of the aveolar fluid, facilitating inspiration and preventing total collapse of the alveoli during expiration)

Surfactant is first produced?

between 28 and 36 weeks of gestation, depending on the maturity of the individual lung.

Surfactant can asses

infant lung maturity.

Describe how normal quiet inspiration takes place (how the diaphragm and intercostals work together)

* Contraction of the diaphragm
* Diaphragm flattens and descends - increasing the length of thoracic cavity
* External intercoastal muscles raise the ribs and sternum - increasing the transverse and antraposterior diameters of the thorax.

Where is the gene for CF located?

The gene for CF is located on the 7th chromosome and it is autosomal recessive. Much more common in whites.

Define hypercapnia

When carbon dioxide levels in blood increase

Define hypoxia

inadequate oxygen supply to the cells.

Define internal respiration

metabolic process by which living cells absorb oxygen and release carbon dioxide

Define external respiration

gas exchange at the alveolar capillary membrane (between the lungs and blood)

Define waste product of aerobic cellular metabolism

carbon dioxide

Describe the sputum characteristics of pulmonary edema

frothy (owing to air mixed with the secretions), and blood-tinged (owing to ruptured capillaries in the lungs).

The common cold (infectious Rhinitis) is caused by?

viral infection of the upper respiratory tract usually Rhinovirus. Usually spread by droplet spread.

Manifestations of croup include

larynx and subglottic area become inflammed with swelling and exudate leads to barking cough (croup), hoarse voice and inspiratory stridor.

Manifestations of Epiglottis include?

drooling of saliva is apparent,
and inspiratory stridor is heard,
high fever, appears ill, rapid pulse

Bronchiolitis is caused by?

(RSV) respiratory syncytial virus.

Manifestations of pneumoccoccal pneumonia?

*systemic signs of high fever with chills, marked fatigue and leukocytosis.
*Dysnea, tachypnea, tachycardia
*Productive cough, with the typical rusty-colored sputum

Describe the causative agent for tuberculosis?

Myobacterium bovis - acid fast aerobic, slow growing bacillus, which infect cows.

Define mucoviscidosis

cystic fybrosis (characterized by production of abnormally viscous mucus by the affected glands resulting in chronic respiratory infections and impaired pancreatic function)

Why does cancer in the lung frequently develop?

Change in epithelial tissue associated with cigarette smoke and second hand smoke or chronic irritation

Ball-valve effect is

air is able to pass down the tract on inspiration but the passageway closes on expiration, leading to a build up of air distal to the obstruction.

COPD manifestations

cough, dyspnea (can't breath out, emphysema, barrel chest, bronchitis, asthma)

Restrictive disease manifestations

dyspnea developing first. (can't breath in, incomplete lung expansion and lung stiffness, respiratory muscle paralysis, muscular dystrophy)

A large sized pulmonary embolus is likely to cause

blocks all pulmonary circulation leading to shock and cardiac arrest

What effect will a 60% occlusion of pulmonary embolus create?

affect the cardiovascular system, causing right-sided heart failure and decreased cardiac output (shock) Sudden death

Define atelectasis

the non-aeration or collapse of a lung or part of a lung leading to decreased gas exhange and hypoxia (restrictive disorder - lungs cannot expand)

Describe the problem if the lecithin shingomyelin ratio is not appropriate in a neonate

malutrition of lung tissue. utero stress (infant respiratory distress syndrome) There may not be enough surfactant causing infant to be on a respirator.

ARDS is known as

Adult or Acute Respiratory Distress Syndrome (no air in lungs) shock lung, wet lung, stiff lung, postperfusion lung, DaNang lung. associated with multiple organ failure-usually occurs 1-2 days after an injury or other precipitating event.

Acute respiratory failure

can be the end result of many pulmonary disorders. Indicated when Pao2 is less then 50 mmHg (severe hypoxia) or Paco2 is greater than 50 mmHg (hypercapnia) and serum pH is decreasing (<7.3) respiratory acidosis. Interferes with nervous system function.

During inspiration there is usual decerase in pressure inside the lungs.

*the flail or broken section of ribs moves inward rather than outward as intrathoracic pressure is decreased
*this inward movement of the ribs prevents expansion of the affected lung.
*a large flail section can compress the adjacent lung tissue, pushing the air out of that section and up the bronchus.

Describe what happens during inspiration who has a flail chest?

Sucking sound is heard. Decrease pressure inside.

open pneumothorax refers to

atmospheric air entering the pleural cavity through an opening in the chest wall. This could result from trauma or surgery.

Describe what happens during an open pneumothorax

mediastinal flutter. Sucking chest wound.

COPD

chronic obstructive pulmonary disease. (can't breath out)
1.Asthma (killer/reversable)
2.Chronic bronchitis
3.CF
4.Bronchiectasis
5.Emphysema
6. Barrel Chest

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