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Chapter 35 McCance Patho
Terms in this set (69)
Presence of pus in the pleural cavity
collapse of alveoli
bluish discoloration of the skin caused by desturation of hemoglobin
PaO2 below normal
coughing up bloody sputum
passage of fluid and/or solid particles into the lungs
presence of fluid in the pleural space
Severe kyphoscoliosis causes
Decreased lung compliance
aspiration of gastric acids is most likely to cause this
-DULLNESS to percussion over lung bases
-Pink frothy sputum
** excess water in the lungs caused by disturbances of capillary hydrostatic pressure, capillary oncotic pressure or capillary permeability. Common cause is L. sided HF that increases hydrostatic pressure in the pulmonary circulation.
Exudative pleural effusion
process that increases capillary permeability can cause this
Transudative pleural effusion
Processes that increase capillary HYDROSTATIC pressure can cause this
tachypnea, non-productive cough, use of accessory muscles, low-grade fever and hypoxemia
-inflammatory obstruction of small airways. Most common in children.
a RESTRICTIVE respiratory disease
an OBSTRUCTIVE respiratory disease
* chronic inflammatory disorder of the bronchial mucosa that causes hyperresonance, mucosal edema, airway constriction, and variable obstruction to airflow. Obstruction is from episodic attacks of bronchospasm, bronchial inflammation, mucosal edema and increased mucus production.
what individuals with obstructive respiratory disease have a hard time with
Clubbing of fingers
A response to CHRONIC hypoxemia
-most common cause is cigarette smoking
-early lung cancer has vague signs and symptoms
-Response to severe hypoxemia
-Reduced firing of neurons to respiratory muscles
-Respiratory muscle weakness
-Response to severe hypoxemia
-Reduced compliance of chest wall
ARDS development sequence
a. Pneumonia or other condition causes Acute Lung Injury (ALI)
b. Proinflammatory cytokines are released
c.Neutrophils, macrophages, and platelets accumulate in the lungs
d. Neutrophils release inflammatory mediators and activate complement.
e.Cell damage disrupts alveolocapillary membrane
f.pulmonary edema occurs from exudation
g.fibroblasts and other lung cells proliferate and form membranes
h. fibrosis destroys the aleveoli and bronchioles
i. Acute respiratory failure occurs with hypoxemia, hypercapnia and acidosis
**acute, diffuse injury to the alveolocapillary membrane and decreased surfactant production...increases membrane permeability and causes edema/atelectasis
Alternating periods of deep and shallow breathing with apnea episodes
Restricted breathing pattern
Increased ventilatory rate, small tidal volume
Rhythmic and effortless with normal tidal volume
Irregular, quick inspirations with an expiratory pause.
Obstructed breathing pattern
Increased ventilatory rate, small tidal volume, increased effort, prolonged expiration, wheezing
Increased ventilatory rate, very large tidal volume, no expiratory pause
mediated by IgE that binds to mast cells which degranulate producing inflammation, bronchoconstriction and increased mucous production.
-IgE is produced by B lymphocytes that are committed to a specific antigen.
Dyspnea vs Orthopnea
Dyspnea is feeling short of breath but orthopnea is feeling short of breath when laying flat.
Stridor vs wheezing
-Stridor is high pitched during inspiration
-wheezing is a whistling during expiration.
Absorption atelectasis is alveolar collapse caused by gases being absorbed from obstructed alveoli.
Compression atelectasis is alveolar collapse caused by external pressure on the alveoli.
Tension pneumothorax is when the pressure of the air in the pleural space is more than the barometric pressure - air enters during inspiration but cannot exit during expiration.
(Open) Communicating pneumothorax
Communicating pneumothorax is when there is air in the pleural space that is the same pressure as the barometric pressure-air is drawn into the pleural space during inspiration and out during expiration.
Paroxsymal nocturnal dyspnea
waking up with dyspnea during the night and needing to sit upright or stand and breathe is called this...
When rib fractures disrupt the mechanics of breathing and cause a portion of the chest wall to collapse during inspiration
Persistent abnormal dilations of the bronchi and a chronic cough that produces large amounts of purulent sputum
-abnormal dilation that is often secondary to another pulmonary disorder such as inflammation or infection
Noxious gases & prolonged exposure to high concentrations of oxygen
Can damage the bronchial mucosa or alveolocapillary membrane...causes inflammation or acute respiratory failure.
An excessive amount of connective tissue in the lungs and causes decreased lung compliance.
In asthma, long-term airway damage that is irreversible is known as airway remodeling.
Acute Asthma Episode
Inflammatory mediators cause inflammation, hypersecretion of mucous and bronchial smooth muscle is constricted.
An asthma episode that does not resolve with usual treatment
Alpha 1 antitrypsin
A genetic deficiency of this causes early onset emphysema because the enzyme normally inhibits the action of proteolytic enzymes
Chronic Bronchitis-persistent hypersecretion of mucous with a chronic productive cough-obstruction is from bronchial smooth muscle hypertrophy and production of thick, tenacious mucus.
Emphysema-barrel chest, dyspnea on exertion and at rest- destruction of alveoli leading to airway collapse and obstruction to gas flow during expiration and air trapping.
*is the coexistence of chronic bronchitis and emphysema.
ventricular enlargement caused by chronic pulmonary hypertension...associated with late stage chronic bronchitis
laryngeal cancer is characterized by this
occurs primarily in men and represents 2-3% of all cancers. ..comes from smoking and drinking ETOH...HPV, GERD are also risk factors
-carcinoma of the true vocal cords is common
-squamous cell carcinoma is the most common type-manifests as progressive hoarseness
primary lung cancer arising from cells that line the airways is called this
Small cell carcinoma
in the lung produces tumor-derived hormones
Pulmonary fibrosis types
-Pneumoconiosis is from exposure to inorganic materials like silica.
-Hypersensitivty pneumonitis is from organic materials like mold that cause scarring.
a protective reflex that expels secretions and irritants from the LOWER airway
increased PaCO2 caused by a decrease in minute volume (RR x TV).
Acute Respiratory Failure
inadequate gas exchange or ventilation (PaO2<50mmHg or PaCo2 > or = to 50mmgHg and pH > or = 7.25)
accumulation of fluid in the pleural space, usually resulting from disorders that promote transudation or exudation from capillaries underlying the pleura...occasionally from a blocked lymphatic vessel to drain into the pleural space
Caused by inhalation of dust particles in the workplace including coal dust, silica, and asbestos...can cause chronic inflammation, pulmonary fibrosis, and susceptibility to lower airway infection and tumor formation.
Centriacinar emphysema begins in the respiratory bronchioles and spreads peripherally. Also termed centrilobular emphysema, this form is associated with long-standing cigarette smoking and predominantly involves the upper half of the lungs.
Paraseptal emphysema, also known as distal acinar emphysema, preferentially involves the distal airway structures, alveolar ducts, and alveolar sacs. The process is localized around the septae of the lungs or pleura. Although airflow frequently is preserved, the apical bullae may lead to spontaneous pneumothorax. Giant bullae occasionally cause severe compression of adjacent lung tissue.
Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. Panacinar emphysema generally is observed in patients with homozygous alpha1-antitrypsin (AAT) deficiency. In people who smoke, focal panacinar emphysema at the lung bases may accompany centriacinar emphysema.
acute lung infection resulting in inflammatory response with four phases:
usually from the influenza virus...it is acute and self-limiting
Viral pneumonia can set the stage for a secondary bacterial infection, is seasonal, and is usually mild and self-limiting.
-TB inflammatory response isolates colonies of bacilli by enclosing them in tuburcles and surrounding them with scar tissue
-the bacilli can be dormant for life or if immune system becomes compromised
Pulmonary artery hypertension
PAH- caused by: N-5-10mmHG
a. elevated left ventricular pressure
b.increased blood flow through pulmonary circulation
c.obliteration/obstruction of the vascular bed
d.active constriction of the vascular bed produced by hxpoxemia or acidosis
What is the appropriate term for inadequate alveolar ventilation in relation to metabolic demands?
Hypoventilation is inadequate ventilation in relation to metabolic demands. Hyperpnea is rapid breathing. Orthopnea is difficulty breathing when an individual is lying flat. Dyspnea is difficulty breathing.
Clubbing is associated with
Cystic fibrosis is the disease associated with the bulbous enlargement of the distal segments of the fingers (clubbing). The enlargement of the distal segments of the fingers is also associated with bronchiectasis, pulmonary fibrosis, lung abscess, and congenital heart disease. Cystic fibrosis is not associated with the other options.
What is the most common cause of pulmonary edema?
A. inhalation of toxic gases
B. Heart disease
C. Pulmonary hypertension
-The most common cause of pulmonary edema is heart disease. Toxic gas inhalation, pulmonary hypertension, and ARDS are also causes of pulmonary edema but are not as common as pulmonary edema from heart disease.
Which statement is true about the pathophysiological process of asthma?
a. Inflammation results in airway hyperresponsiveness. - correct
b. Immunoglobulin A (IgA) is the major factor.
c.The inflammatory process is due to the loss of bronchial smooth muscle spasm.
d. Vascular permeability increases.
-Increased bronchial smooth muscle spasm and increased vascular permeability cause asthma. Asthma is an immunoglobulin E (IgE)-mediated response.
Which PNA is hospital acquired?
A. Streptococcus pneumoniae
B. Mycoplasma pneumoniae
C. Haemophilus influenzae
D. Pseudomonas aeruginosa
Pseudomonas aeruginosa is commonly acquired in hospitals or nursing homes. All of the other choices are community-acquired pneumonias.
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