Study sets, textbooks, questions
Upgrade to remove ads
Chapter 23 Pathophysiology notes
Terms in this set (24)
involves the movement of air into the lungs.
the portion of ventilation that participates in gas exchange
driven by the partial pressure of the gases. oxygen moves from the alveoli, where the partial pressure of oxygen averages 104 mm Hg when breathing room air, to the blood in the pulmonary capillaries, where the average PO2 is only 40 mm Hg.
involves the movement of blood through the pulmonary circulation, including the pulmonary capillaries, where the gas exchange takes place.
refers to a reduction in the PO2 of the arterial blood. Can result from an inadequate amount of O2 in the air, disease of the respiratory system, dysfunction of the neurologic system, or alterations in cirulatory function.
the bluish discoloration of the skin and mucous membranes resulting from an excessive concentration of reduced or deoxygenated hemoglobin in the small blood vessels. is often a late sign. a deoxygenated hemoglobin concentration of appx 5 g/dL of deoxygenated hemoglobin is required in the circulating blood for cyanosis to occur.
Central cyanosis: is evident in the tongue and lips. is caused by an increased amount of deoxygenated hemoglobin in the arterial blood.
Peripheral cyanosis: occurs in the extremeties and on the tip of the nose or ears. is caused by slowing of blood flow to an area of the body, with increased extraction of oxygen from the blood. It results from vasoconstriction and diminished peripheral blood flow, as occurs with cold exposure, shock, heart failure, or peripheral vascular disease.
Manifestations of Hypoxemia
particularly in persons with chronic lung disease.
The body compensates for chronic hypoxemia with increased ventilation, pulmonary vessel vasoconstriction, and increased production of red blood cells.
Diagnosis of hypoxemia
based on clinical observation and diagnostic tests that measure PO2 levels. The analysis of arterial blood gases provides a direct measure of the ability of the lungs to oxygenate blood.
Treatment of hypoxemia
directed toward correcting the cause of the disorder and increasing the gradient for diffusion through the administration of supplemental oxygen. High vs Low concentration
the presence of air in the pleural space. Causes partial or complete collapse of the affected lung. Tension pneumothorax describes a life-threatening condition in which increased pressure within the pleural cavity impairs both respiratory and cardiac function.
Clinical features of Pneumothorax
Manifestations: depend on the size and integrity of the underlying lung. pg. 570 increase of respiratory rate and often accompanied by dyspnea. Asymmetry of the chest may occur. Hypoxemia usually occurs immediately after a large ptx followed by vasoconstriction.
Diagnosis: confirmed by chest radiograph, CT scan, or ultrasonography.
Treatment: in small only observation and follow-up chest radiographs are required. Supplemental oxygen may be used. in larger the air is removed by needle aspiration or a closed drainage system used with or without suction. Emergency treatment includes prompt insertion of a large-bore needle or chest tube into the affected side of the chest along with one-way valve drainage or continuous chest suction to aid in lung reexpansion.
is a chronic inflammatory disease of the airways involving recurring symptoms of airflow obstruction and bronchial hyper-responsiveness. Characterized by episodic wheezing, difficulty breathing, feeling of chest tightness, and a cough that often is worse at night and early morning.
extrinsic or allergic and intrinsic or non-atopic
after being exposed inflammatory mediators released by activated macrophages, eosinophils, mast cells, and basophils induce bronchoconstriction, increased vascular permeability, and mucus production.
initiated by type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen.
Early-phase response (acute phase response) develop within 10 to 20 minutes of exposure to the allergen are caused by the release of chemical mediators from presensitiezed IgE-coated mast cells.
Late-phase response develops 4 to 8 hours after exposure to an asthmatic trigger, involves inflammation and increased airway responsiveness that prolong the asthma attack ans set into motion a vicious cycle of exacerbations.
Manifestations of Asthma
S/S: wheezing, chest tightness
the airways narrow because of bronchospasm, edema of the bronchial mucosa, and mucus plugging.
Chronic Obstructive Pulmonary Disease
denotes a group of respiratory disorders characterized by chronic and recurrent obstruction of airflow in the pulmonary airways.
Most common cause of COPD is smoking. other causes include exposure to occupational dusts and chemicals, airway infections, and asthma or airway hyperresponsiveness.
loss of lung elasticity and abnormal enlargement of the air spaces distal to the terminal bronchioles with destruction of the alveolar walls and capillary beds.
Causes: smoking an dinherited deficiency of antitrypsin.
Centriacinar or centrilobular: affects the bronchioles in the central part of the respiratory lobule, with initial preservation of the alveolar ducts and sacs. is the most common type of emphysema and is seen predominantly in male smokers.
Panacnar: produces initial involvement of the peripheral alveoli and later extends to involve the more central bronchioles. is more common in persons with antitrypsin deficiency. found in smokers in association with centriacinar emphysema.
airway obstruction of the the major and smaller airways. is associated with chronic irritation from smoking and recurrent infections. more than three months in at least the past two consecutive years. Early feature is hypersecretion of mucus. viral and bacterial infections are common.
Manifestations of COPD
usually have an insidious onset and persons characteristicaly seek medical attn in the fifth or sixth decade of life.
Late stages of COPD are characterized by recurrent respiratory infections and chronic respiratory failure. death usually occurs during an exacerbation of illness associated with infection and respiratory failure.
pink puffers: lack of cyanosis, the use of accessory muscles, and pursed-lip breathing. causes barrel chest.
blue boaters: usually labeled as this. cyanosis and fluid retention associated with right-sided heart failure.
obstruction of airflow is usually greater on expiration than inspiration. hypoxemia, hypercapna, and cyanosis develop. Severe hypoxemia arterial PO2 levels fall below 55 mm Hg.
increased work load on the right ventricle through the pulmonary artery
persons may develop right-sided heart failure with peripheral edema
is an inherited disorder involving fluid secretion by the exocrine glands in the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts.
Manifestation: pancreatic exocrine deficiency, chronic respiratory disease, and elevaton of sodium chloride in the sweat.
Etiology and pathogenesis:
caused by mutations in a single gene on the long arm of chromosome 7 that encodes for cystic fibrosis transmembrane regulator (CFTR). NaCl secreation and reabsorption is explained on pg. 584
Pseudomonas aeruginosa and Staphylococcus aureus
develops when a blood-borne substance lodges in a branch of the pulmonary artery and obstructs blood flow. May be caused by a thrombus, air that has accidentally been injected during intravenous infusion, fat that has been mobilized from the bone marrow after a fracture or from a traumatized fat deposit, or amniotic fluid that has entered the maternal circulation during childbirth.
Pathogenesis: most arise from deep vein thrombosis. causes bronchoconstriction in the affected area of the lung.
Manifestation: small are clinically silent.
moderate-sized: breathlessness accompanied by pleuratic pain, apprehension, slight fever, and cough productive of blood streaked sputum also tachycardia. Massive: present with sudden collapse, crushing substernal chest pain, shock and loss of consciousness. weak pulse and rapid, low BP, distended neck veins, and the skin is cyanotic and diaphoretic. often fatal.
right heart failure resulting from primary lung disease or pulmonary hypertension.
Manifestations: s/s primary lung disease and signs of right sided heart failure.
S of right sided heart failure include venous congestion peripeheral edema, shortness of breath, and productive cough. Plethora, cyanosis, warm moist skin may result form compensatory polycythemia and desturation of arterial blood that accompany chronic lung disease. drowsiness and altered consciousness can occur due to carbon dioxide retention.
Treatment of lung disease and heart failure. Low flow oxygen therapy can be used.
Acute Lung Injury/ Acute respiratory distress syndrome (ARDS)
ARDS: characterized by sever dyspnea of rapid onset, hypoxemia, and pulmonary infiltrates.
ALI: is less severe but can turn into ARDS
Both can result from aspiration of gastric contents, major trauma, sepsis secondary to pulmonary or nonpulmonary infections, acute pancreatitis, hematologic disorders, metabolic events, and reactions to drugs and toxins.
Include diffuse epithelial cell injury with increased permeability of the alveolar-capillary membrane. leads to accumulation of fluid surfactant inactivation, and formation of a hyaline membrane that is fibrous and impervious to gas exchange. Clinical features:
rapid onset (12-18 hours) of initiating event of respiratory distress, increase in respiratory rate, and signs of respiratory failure. Chest radiography is used to show diffusion of bilateral infiltrates of the lung tissue. Marked hypoxemia occurs that is refractory to treatment with supplemental oxygen therapy. many people have a systemic response that results in multiple organ failure, particularly of the renal, gi, cv, and cns.
treatment: supply oxygen to vital organs and provide supportive care until the condition causing the pathologic process has been reversed and the lungs have had a chance to heal. high concentrations of oxygen may be required to correct the hypoxemia. postive end-expiratory pressure breathing may be used. Smaller tidal volumes (6mL/kg) may be used to reduce barotrauma secondary to lower plateau pressures and optimal positive end expiratory pressure (PEEP) therapy prevents damage associated with the collapse and reinflation of alveoli.
What description is characteristic of the pathology of interstitial lung disease?
Airways become stiff and resist expansion, leading to hypoxemia
A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?
Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract.
Sets found in the same folder
ch 22 & 23 patho
Chapter 23: Disorders of Ventilation and Gas Excha…
Ch. 23 PrepU Quiz
Sets with similar terms
Chapter 23: Disorders of Ventilation and Gas Excha…
Chapter 23: Disorders of Ventilation and Gas Excha…
NUR 334: Exam 3 Terms List
Patho ch 26
Other sets by this creator
HLTHST 333 - Chapter 5 Vocab
HLTHST 333 Chapter 4 Vocab
HRM 305 Chapter 4 Vocab
HRM 305 Chapter 3 Vocab
Other Quizlet sets
MICRO NOVA FALL IMMUNOLOGY : B CELL DEVELOPMENT AC…
The System of Estates (Fee Simple, Life Estates, W…
What defines the severity of ARDS?
what is indicative of right sided heart failure?
What are the pain management options?
How can sleep apnea be treated?