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121 terms

Pathophysiology Chapter 13

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Respiration differs from ventilation in that respiration involves:
a. movement and exchange of oxygen in the alveoli.
b. supplying oxygenated blood to the lungs and organ systems.
c. the mechanical process of moving air in and out of the respiratory system.
d. all of the body's cells and the utilization of oxygen to make energy.
D
Ethan is sitting next to Ryan in class. Ethan has a cold and is coughing. Ryan is worried about catching a cold. You tell Ryan that the pulmonary system has defense mechanisms to help him stay healthy. These defense mechanisms include all of the following except:
a. macrophages in the alveoli.
b. chemoreceptors.
c. structural protections such as hair.
d. mucosal lining that has an immune coating.
B
Todd is competing in a 2K run for his track team. As Todd is completing his laps on the track, his body is regulating the rate and volume of his respirations. All of the following are important in this regulation except:
a. lung receptors
b. respiratory control center in the brain
c. diffusing capacity
d. chemoreceptors
C
After surgery, Myron needed to have the oxygen saturation in his blood monitored for potential hypoxemia. The method most likely used in monitoring Myron is called:
a. pulse oximetry
b. ventilation oximetry
c. respiration observation
d. diffusion oximetry
A
When the body cannot maintain homeostasis because of an alteration in ventilation and diffusion, all of the following will occur except:
a. hyperthermia
b. hypercapnia
c. hypoxia
d. hypoxemia
A
Andrea is sitting quietly reading in her chair. The amount of air that Andrea exhales after passive inspiration is called:
a. tidal volume
b. vital capacity
c. residual volume
d. total lung capacity
A
The lipoprotein that coats the inner portion of the alveolus and promotes ease of expansion is called:
a. Ghon complex
b. Surfactant
c. Atopic protein
d. Marfan protein
B
Marlyn has pneumonia. He has decreased oxygen in the arterial blood and a decrease in the partial pressure of oxygen. This decreased oxygen level is called:
a. Hypoxia
b. Hypercapnea
c. Hypoxemia
d. Aspiration
C
Because of Marlyn's pneumonia and the increased collection of fluid/pus in the alveoli, he will most likely experience impaired:
a. Inspiration
b. Expiration
c. Ventilation
d. Diffusion
D
Marlyn is experiencing a deprivation of adequate oxygen to his cells. This is called:
a. Hypoxia
b. Hypercapnea
c. Hypoxemia
d. Aspiration
A
Marlyn is admitted to the hospital because of his pneumonia. He has impaired diffusion and ventilation with an increased amount of carbon dioxide level in his blood. This increased level of carbon dioxide in the blood is called:
a. Hypoxia
b. Hypercapnea
c. Hypoxemia
d. Aspiration
B
Marlyn experienced many local manifestations related to impaired ventilation and diffusion. All of the following would be considered local manifestations except:
a. Fever
b. Cough
c. Dyspnea
d. Excess mucous production
A
Marlyn complains of increased difficulty breathing when he is in a supine position and he prefers to have the head of his bed elevated. This need to sit upright is called:
a. Dyspnea
b. Hypoxemia
c. Hyperventilation
d. Orthopnea
D
Anthony is experiencing an acute exacerbation of his asthma. When you observe his chest, you notice that he is using accessory muscles during respiration and observe a pulling of his intercostal muscles. You would describe this as:
a. Orthopnea
b. Subtractions
c. Retractions
d. Interactions
C
When you auscultate Anthony's lung sounds, you hear wheezing. Altered breath sounds such as this are called:
a. Cavitations
b. Inspiration
c. Adventitious
d. Ventilation
C
acute respiratory distress syndrome ARDS
a condition of severe acute inflammation and pulmonary edema without evidence of fluid overload or impaired cardiac function
adventitious
refers to an alteration in lung sounds, as with wheezing or crackles
air trapping
decreased effective O2 intake and especially CO2 release by retaining air within the alveoli because of loss of elasticity
anoxia
the absolute deprivation of oxygen
aspiration
a problem of inhaling a foreign substance into the lungs
asthma
a chronic inflammatory disorder of the airways resulting in intermittent or persistent airway obstruction caused by bronchial hyperresponsiveness, inflammation, bronchoconstriction, and excess mucous production
atelectasis
a condition of collapse and nonaeration of the alveoli
atopic
describes individuals having a genetic predisposition to developing hypsensitivities
bronchiectasis
the irreversible dilation and destruction of the bronchial tree most often caused by chronic obstruction or infection
caseous necrosis
a distinctive, yellow, pasty, cheese like necrosis of tuberculosis
cavitation
area of necrosis that erode surrounding structures of the lungs, including the bronchioles, bronchi, and surrounding blood vessels
chronic bronchitis
the presence of a persistent, productive cough that lasts for 3 months or longer for 2 or more consecutive years.
chronic obstructive pulmonary diseases (COPD)
a generic term that describes all chronic obstructive lung problems including asthma, emphysema, and chronic bronchitis, separately or in combination
clubbing
a painless enlargement and flattening of the tips of fingers or toes due to chronic hypoxia
compliance
the expected distensibility, or expandibility, of the lung tissue and chest wall
consolidation
a solid mass in the lung tissue
cyanosis
a result of a greater proportion of desaturated hemoglobin in the blood, which gives the blood a bluish hue
auscultation
to listen with a stethoscope
cystic fibrosis (CF)
an autosomal recessive disorder of electrolytes and subsequently water transport that affects certain epithelial cells such as those lining the respiratory, digestive and reproductive tracts
dead space
an area where gas exchange cannot take place
diffusing capacity
a measurement of carbon monoxide (CO2), oxygen, or nitric oxide transfer from inspired gas to pulmonary capillary blood; is reflective of the volume of a gas that diffuses through the alveolar capillary membrane each minute
diffusion
movement of particles from an area of high to lower concentration
dyspnea
the subjective feeling of shortness of breath or the inability to get enough air
emphysema
an irreversible enlargement of the air spaces beyond the terminal bronchioles, most notable in the alveoli resulting in destruction of the alveolar walls and obstruction of airflow
expectorate
to spit out the mucus that is ejected during a cough
expiration
the process of removing carbon dioxide out of the body through the lungs
forced expiratory volume in 1 second (FEV1)
the maximal amount of air expired from the lungs in 1 second
forced vital capacity (FVC)
the maximal amount of air that is exhaled from the lungs during a forced exhalation
fully saturated
a state in which all the available seats for hemoglobin molecules are occupied on the red blood cell
Ghon complex
a combination of of the Ghon focus and additional granulomas that develop through the lymph channels in the lungs
Ghon focus
the formation of a granuloma, or walled off area of bacteria, which is considered the primary lung lesion in tuberculosis
hemoptysis
coughing up blood from the respiratory tract; defined by the presence of red blood cells in the sputum
hypercapnia
a state of increased carbon dioxide in the blood
hypoxemia
decreased oxygen in the arterial blood leading to a decrease in the partial pressure of oxygen (PaO2)
hypoxia
cellular deprivation of oxygen
inspiration
the process of breathing in to acquire oxygen
orthopnea
the physical need to sit in an upright or standing position to reduce respiratory effort
oxygen saturation (SaO2)
the amount of oxyhemoglobin; that is the amount of hemoglobin that is combined, or saturated with oxygn
oxyhemoglobin (HbO2)
the oxygen-hemoglobin combination within the red blood cells
PaCO2
the symbol for the partial pressure of carbon dioxide
PaO2
the symbol for the partial pressure of oxygen
partial pressure
the force exerted by gas molecules within a certain volume
perfusion
the process of forcing blood or other fluid to flow through a vessel and into the vascular bed of tissue for the purposes of providing oxygen and other nutrients
phlegm
large amounts of sputum expectorated from the oropharynx
pneumonia
inflammation of the lungs occurring commonly in the bronchioles,interstitial lung tissue or the alveoli
pneumothorax
the presence of air in the pleural space that causes the lung to collapse
pursed lip breathing
a process of holding the lips puckered tightly together while slowly exhaling to maintain positive airway pressure in the alveoli; this minimizes air trapping and promotes expiration of carbon dioxide
residual volume (RV)
the volume of air that remains in the lungs after maximal expiration
respiration
the process of oxygen use as a source of energy for the production of adenosine triphosphate (ATP) and release of metabolic products from the cell
respiratory failure
a life-threatening condition that can result from any problem that severely affects ventilation, ventilation-perfusion matching, or diffusion
retractions
the pulling in of accessory muscles usually in the intercostal, substernal, and supraclavicular spaces to promote more effective inspiration
sputum
expectorated material
status asthmaticus
a state of bronchospasm that is not reversed by by the patients medications or other measures
surfactant
a lipoprotein that coats the inner portion of the alveolus and promotes ease of expansion and repels fluid accumulation
tidal volume (TV)
the amount of air that is exhaled after passive inspiration; this is the volume of air going in and out of the lungs at rest; in adults this volume is approximately 500ml
total lung capacity (TLC)
the total amount of air in the lungs when they are maximally expanded; is the sum of the vital capacity and residual volume
tuberculosis
an infectious disease caused by an aerobic, rod-shaped bacterium (bacillus) called Mycobacterium tuberculosis
ventilation
the movement of air into and out of the trachea, bronchi and lungs
vital capacity (VC)
the maximal amount of air that can be moved in and out of the lungs with forced inhalation and exhalation
conducting airways
Move air into lungs
Warm and humidify air
Trap inhaled particles
respiratory airways
Bronchioles
Alveoli
Gas is exchanged with the blood
ventilation
Involves both acquiring oxygen (inspiration) and removing carbon dioxide (expiration) from the blood
Neuronal impulses are directed by lung receptors, which map the current state of breathing and lung function
Uses the intercostal muscles, diaphragm, and sternocleidomastoid muscles
inspiration
Breathing in to acquire oxygen

Unidirectional from high pressure to low pressure.

Chest cavity size changes to alter the pressure gradient
expiration
Removing carbon dioxide out of the body through the lungs

The diaphragm and external intercostal muscles relax

Lungs compress and increase the pressure inside the airways
diffusion
Oxygen and carbon dioxide are exchanged at alveolar capillary junctions

Two major process occur:
Oxygen is trying to get to all the cells
Carbon dioxide is trying to escape the body through the lungs
gas exchange
Oxygen moves from alveolar air into blood
Carbon dioxide moves from blood into alveolar air
partial pressure
The collision of oxygen and carbon dioxide creates pressure
PaO2
PaCO2
blood gases- oxygen
Dissolved oxygen = PaO2 or PO2
Normal value >80 mm Hg
Oxygen bound to hemoglobin = oxyhemoglobin
Normal value 95% to 97% saturation
Below 90% needs oxygen
impaired ventilation
A problem of blocking airflow in and out of the lungs
Two major mechanisms implicated:
Compression or narrowing of the airways
Disruption of the neuronal transmissions needed to stimulate the mechanics of the airways
ventilation perfusion mismatching
Blood goes to parts of the lung that do not have oxygen to give it
Blood does not go to parts of the lung that have oxygen
Perfusion without ventilation is a blocked airway.
Ventilation without perfusion is a blocked capillary
impaired diffusion
Restricted transfer of oxygen and/or carbon dioxide across the alveolar capillary junction
Dependent upon:
solubility and partial pressure of the gas
surface area and thickness of the membrane
hypoxemia
PO2 <60 mm Hg
Cyanosis
Impaired function of vital centers
Agitated or combative behavior, euphoria, impaired judgment, convulsions, delirium, stupor, coma
Retinal hemorrhage
Hypotension and bradycardia
Activation of compensatory mechanisms
Sympathetic system activation
Measured with arterial blood gas
hypoxia
lack of oxygen at the tissue level. O2 Sat
hypercapnia
PCO2 >50 mm Hg
Respiratory acidosis
Increased respiration
Decreased nerve firing
Carbon dioxide narcosis
Disorientation, somnolence, coma
Decreased muscle contraction
Vasodilation
Headache; conjunctival hyperemia; warm, flushed skin
treating impaired ventilation and diffusion
Remove obstruction and restore physical integrity of airways, lung tissues
Decrease inflammation and mucus; treat infection
Supplemental oxygen
Mechanical ventilation
pneumonia patho
Infectious process
Respiratory droplet spread
Causes inflammation of the lungs
Occurs commonly in the bronchioles, interstitial lung tissue and/or the alveoli
Products of inflammation accumulate and cause consolidation
pneumonia manifestations
Sudden onset of fever
Chills
Cough
Sputum production
Fatigue
Loss of appetite
Dyspnea
Tachypnea
Tachycardia
Pleuritic pain
Crackles in lungs
pneumonia diagnostic criteria
History and physical examination
Complete blood cell count
Chest X-ray
Thoracic CT scan
pneumonia treatment
Restore optimal ventilation and diffusion
Identify pathogen and target with appropriate pharmacologic treatment
Supplemental oxygen
TB patho
Mycobacterium tuberculosis

Airborne droplet nuclei travel directly to the terminal bronchioles and alveoli of the lung

Inflammatory and immune responses
Containment- asymptomatic, granuloma may form
Multiplication- progressive primary TB
Dormancy-
tb manifestations
Many of those infected are symptomatic
In the presence of chronic inflammation:
Malaise
Weight loss
Fatigue
Anorexia
Low-grade fever
Possibly night sweats
tb diagnostic criteria
Tuberculin skin tests
Chest X-ray
Sputum culture
Sputum nucleic acid amplification
emphysema pathophysiology
Irreversible enlargement of the air spaces beyond terminal bronchioles
destruction of the alveolar walls
obstruction of airflow
Chronic smoking most often implicated
emphysema clinical manifestations
Persistent cough
Dyspnea
Wheezing
Barrel chest
Pursed lip breathing
emphysema diagnostic
History and physical examination
Pulmonary function tests
Chest x-ray
Hypercapnia/hypoxemia
emphysema treatment
Maintain optimal lung function in order to allow the individual to perform the desired activities of daily life
Smoking cessation
Pharmacologic therapy
Lung volume reduction or transplant
chronic bronchitis patho
Persistent, productive cough lasting three months or greater, for two or more consecutive years
Result of:
Chronic inflammation and edema of the airways
Hyperplasia of the bronchial mucous glands and smooth muscles
Destruction of cilia
Squamous cell metaplasia
Bronchial wall thickening and development of fibrosis
chronic bronchitis manifestations
Cough
Purulent sputum
Dyspnea
Adventitious lung sounds
Cyanosis
chronic bronchitis diagnostic criteria
History and physical examination
Arterial blood gases
Pulmonary function tests
Pulse oximetry
Sputum analysis
chronic bronchitis treatment
Smoking cessation
Pulmonary rehabilitation
Pharmacologic therapy
Supplemental oxygen
asthma patho
Intermittent or persistent airway obstruction due to:
Bronchial hyperresponsiveness
Chronic inflammation
Bronchoconstriction
Excess mucous production
asthma manifestations
Wheezing and tachypnea
Dyspnea and coughing
Chest tightness
Excessive sputum production
Anxiety
asthma diagnostic criteria
History and physical examination
Pulmonary function tests
Laboratory studies
Chest x-ray
asthma treatment
Monitor lung function
Control environmental triggers
Pharmacologic therapy
Patient and family education; action plan
cystic fibrosis patho
Autosomal recessive disorder of electrolyte and water transport affecting certain epithelial cells (respiratory, digestive, and reproductive lining)

Mutation of the CF gene

Associated with mucus plugging, inflammation, and infection in the lungs; also affects other body systems

Respiratory failure is most common cause of death
cf manifestations
Respiratory

Gastrointestinal

Reproductive
cf diagnostic criteria
History and physical examination
Sweat test
Genetic testing
Chest x-ray
Sputum analysis
cf treatment
Respiratory
Chest physiotherapy
Pharmacologic treatment
Lung transplant
Gastrointestinal
Optimal nutrition
Pancreatic enzymes
ARDS patho
Lung injury to respiratory distress within 24-48 hours
Severe acute inflammation and pulmonary edema without evidence of fluid overload or impaired cardiac function
Mortality rate 30%-40% from multi-system organ failure in those untreated
ARDS clinical manifestations
Tachypnea
Dyspnea
Retractions
Crackles due to fluid accumulation
Restlessness, anxiety
ARDS diagnostic criteria
History and physical examination
Laboratory studies
Imaging studies
ARDS treatment
Remove causative factors
Administration of 100% oxygen
Mechanical ventilation
pleural disorders decreased ventilation
Parietal pleura lines the thoracic wall and superior aspect of the diaphragm
Visceral pleura covers the lung
Pleural cavity or space between the two layers contains a thin layer of serous fluid
pneumothorax
Air enters the pleural cavity
Air takes up space, restricting lung expansion
Partial or complete collapse of the affected lung
Spontaneous: an air-filled blister on the lung ruptures
Traumatic: air enters through chest injuries
Tension: air enters pleural cavity through the wound on inhalation but cannot leave on exhalation
Open: air enters pleural cavity through the wound on inhalation and leaves on exhalation
open pneumothorax
lung collapse but air can still go in and out
tension pneumothorax
lung collase and air can go in but not out, not allowing the lung to expand.