Term
| A schematic of the respiratory control system. Information from the various peripheral sensors is fed to a central control mechanism, the output of which goes to the effector muscles. By changing ventilation, the respiratory muscles reduce perturbations of the sensors (negative feedback). |
|
Definition
|
|
Term
|
Definition
- Central brainstem chemoreceptors
- Peripheral arterial chemoreceptors
- Intrapulmonary receptors
- Chest wall and muscle mechanoreceptors |
|
|
Term
| What are the main peripheral arterial chemoreceptors? |
|
Definition
- carotid bodies at bifurcation of internal and external carotids
- aortic bodies |
|
|
Term
| The carotid bodies respond to __ and __. The greatest response is seen with __, especially when the __ falls below ___. |
|
Definition
- PaO2 and H+
- hypoxemia
- PaO2
- 70mmHg |
|
|
Term
| The carotid body has a high arterial blood supply, thus its oxygen needs are met by __ __ in the blood. This means it is insensitive to conditions that lower arterial oxygen content but exert little or no change on __, such as __ and __ __ __. |
|
Definition
- dissolved oxygen in the blood
- little or no change on PaO2
- anemia and carbon monoxide poisoning |
|
|
Term
| WITH CARBON MONOXIDE POISONING, CO IS DISPLACING THE OXYGEN FROM HEMOGLOBIN, |
|
Definition
|
|
Term
| Each carotid body is a few mm in size and has the highest blood flow per tissue of weight of any organ in the body. |
|
Definition
|
|
Term
| Afferent nerve fibers of the __ __ join with the __ ___ before entering the __ __. |
|
Definition
- cartoid bodies
- sinus nerve
- glossopharyngeal nerve |
|
|
Term
| A decrease in carotid body blood flow results in cellular __, ___, and __ pH that all lead to an __ in receptor firing. |
|
Definition
- hypoxia, hypercapnia, and decreased pH
- increase in receptor firing |
|
|
Term
| Thresholds for PO2, PCO2, and pH that result in carotid body firing: |
|
Definition
- PO2 80mmHg or less
- PCO2 greater than 40mmHg
- pH below 7.4 |
|
|
Term
|
Definition
|
|
Term
| Carotid Sinus Pressure aka a carotid massage involves stimulation of the ___ __ __ resulting in ___ heart rate and __ cardiac workload. |
|
Definition
- parasympathetic nervous system
- reduced heart rate
- reduced cardiac workload |
|
|
Term
| Central chemoreceptors are on the __ surface of the __ __. These respond to the __ of the CSF. They sense __ and __. |
|
Definition
- ventral surface of the medulla oblongata
- acidity of CSF
- pCO2 and H+ |
|
|
Term
| Intrapulmonary receptors are __ receptors in the lungs and chest wall. If the lungs become overinflated, they signal the respiratory centers to __ and __ __ This mechanism prevents damage to the lungs. |
|
Definition
- stretch receptors
- exhale and inhibit inspiration |
|
|
Term
| If lungs expand too much you are at risk for __. |
|
Definition
|
|
Term
| What three things stimulate ventilation in humans? |
|
Definition
- hypoxemia
- hypercapnia
- acidemia |
|
|
Term
The cough reflex represents a primary defensive mechanism for airway protection in a variety of mammalian species.
Excessive and inappropriate coughing can emerge as a primary presenting symptom of many airway diseases. |
|
Definition
|
|
Term
Cough disorders are characterized by a reduction in the threshold for reflex initiation and, as a consequence, the occurrence of cough in response to stimuli that are normally innocuous in nature.
The current therapeutic strategies for the treatment of cough disorders are only moderately effective.
This relates in part to limitations in our understanding of the neural components comprising the cough reflex pathway. |
|
Definition
|
|
Term
| Reflux causes cough for what two reasons? |
|
Definition
- stimulates vagus nerve in lower esophagus
- aspiration of gastric contents (HCl) |
|
|
Term
|
Definition
| removing plaque from the carotid artery |
|
|
Term
| People with COPD retain ___, this is classic for them. |
|
Definition
|
|
Term
| possible complications of an endarterectomy: |
|
Definition
| - denervation of carotid body> CO2 narcosis |
|
|
Term
| normal arterial blood pH: |
|
Definition
|
|
Term
| Acid base balance is the regulation of __ __. |
|
Definition
|
|
Term
| Most important buffer system in the body: |
|
Definition
- Bicarbonate-Carbonic Acid buffer system (blood buffer systems act immediately and thus are they body's first line of defense against acid-base imbalance)
CO2 + H2O >< H2CO3> |
|
|
Term
|
Definition
|
|
Term
| The lungs help regulate acid/base balance by eliminating or retaining __ __. pH may be regulated by altering the __ and __ of respirations. Changes in pH are rapid and occur in minutes. |
|
Definition
- carbon dioxide
- rate and depth |
|
|
Term
| An Arterial Blood Gas (ABG) test measures the ___ and levels of __ and __ __ in the blood stream from an artery. This is used to test how well your lungs move oxygen into the blood and remove carbon dioxide from the blood. |
|
Definition
- pH
- oxygen
- carbon dioxide |
|
|
Term
| The 6 steps to ABG analysis: |
|
Definition
1. Analyze the pH
2. Analyze the CO2
3. Analyze the HCO3
4. Match the CO2 or HCO3 with the pH
5. Does the CO2 or HCO3 go the opposite direction of the pH?
6. Analyze the pO2 and O2 saturation |
|
|
Term
| If the blood pH falls below ___ it is acidic. If it goes above ___ it is alkalotic. |
|
Definition
- below 7.35= acidic
- above7.45= alkalotic |
|
|
Term
| When analyzing the CO2, below __ is ___ and above __ is ___. |
|
Definition
- below 35 is basic
- above 45 is acidic |
|
|
Term
| Normal HCO3 is between __ and __ mEq/L. If the HCO3 is below ___ the pt is ___. If it is above __ the pt is ___. |
|
Definition
- 22 and 26
- below 22 the pt is acidic
- aboce 26 the pt is basic |
|
|
Term
| A ___ CO2 or a ___ HCO3 means the pt is acidic. |
|
Definition
|
|
Term
| A __ CO2 or __ HCO3 means the patient is basic. |
|
Definition
|
|
Term
| If the pH matches the ___, the issue is with the respiratory system. If the pH matches the ___, the issue is with the metabolic (renal) system. |
|
Definition
- CO2> respiratory
- HCO3> metabolic |
|
|
Term
| What does it mean if either the CO2 or HCO3 is going the opposite direction of the pH, what is going on? |
|
Definition
|
|
Term
| The pH is acidotic, the CO2 is acidotic, and the HCO3 is basic. What is going on? |
|
Definition
| - respiratory acidosis with metabolic compensation |
|
|
Term
| 3 organs involved in acid-base homeostasis: |
|
Definition
|
|
Term
| Causes of respiratory acidosis: |
|
Definition
- Respiratory center depression
- Neuromuscular disorders
- Chest wall restriction
- Lung restriction
- Pulmonary parenchymal diseases
- Airway obstruction
- Late ARDS
- Sepsis
- Burns
- Inadequate mechanical ventilation
- excess CHO intake
- COPD |
|
|
Term
| drugs that may depress the respiratory control centers resulting in respiratory acidosis: |
|
Definition
- anesthetics
- opiates
- sedatives |
|
|
Term
| Neuromuscular d/os that may depress respiratory control centers resulting in respiratory acidosis: |
|
Definition
Spinal cord injury
Phrenic nerve injury
Poliomyelitis, Guillain-Barré syndrome, etc.
Botulism, tetanus
Myasthenia gravis
Administration of curarelike drugs
Diseases affecting the respiratory muscles |
|
|
Term
| Conditions that cause chest wall restriction resulting in respiratory acidosis: |
|
Definition
- kyphoscoliosis
- pulmonary fibrosis
- sarcoidosis
- pneumothorax
- pleural effusions
- extreme obesity |
|
|
Term
| Pulmonary parenchymal disorders that result in respiratory acidosis: |
|
Definition
- pneumonia
- pulmonary edema |
|
|
Term
| Airway obstruction conditions that result in airway obstruction: |
|
Definition
- COPD
- Upper airway obstruction |
|
|
Term
| Mechanism of respiratory acidosis: |
|
Definition
- hypoventilation
- excess CO2 production |
|
|
Term
| Respiratory acidosis symptoms: |
|
Definition
- dyspnea
- disorientation
- coma
- dysrhythmias
- pH < 7.35
- PaCO2 > 45 mmHg
- Hyperkalemia
- Hyoxemia |
|
|
Term
| Hyperkalemia may be associated with __ __. |
|
Definition
|
|
Term
| Respiratory acidosis treatment: |
|
Definition
- treat underlying cause
- support ventilation
- correct electrolyte imbalance
- IV Sodium Bicarbonate |
|
|
Term
| IV Sodium Bicarbonate is used to treat __ __. |
|
Definition
|
|
Term
| Common causes of respiratory alkalosis: |
|
Definition
- CNS issues
- Drugs/hormones
- Bacteremias
- Fever
- Pulmonary disease
- Over mechanical ventilation
- Hypoxia due to high altitude |
|
|
Term
| Detailed list of causes of respiratory alkalosis: |
|
Definition
Central nervous system
Anxiety
Hyperventilation syndrome
Inflammation (encephalitis, meningitis)
Cerebrovascular disease
Tumors
Drugs or hormones
Salicylates
Progesterone
Bacteremias, fever
Pulmonary diseases
Acute asthma
Pulmonary vascular diseases (pulmonary embolism)
Overventilation with mechanical ventilators
Hypoxia; high altitude |
|
|
Term
| ASA and progesterone may cause __ __. |
|
Definition
|
|
Term
| Acute asthma and PE may cause __ __. |
|
Definition
|
|
Term
| Anxiety, hyperventilation, a CNS tumor, cerebrovascular disease, encephalitis, and meningitis all may cause __ __. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Emphysema and pneumonia may cuase: |
|
Definition
|
|
Term
| Symptoms of respiratory alkalosis: |
|
Definition
- Tachypnea/Hyperpnea
- SOB
- chest pain
- light headedness
- syncope
- seizures
- coma
- numbness and tingling in extremities
- difficulty concentrating
- blurred vision
- weaknes
- paresthesias
- tetany |
|
|
Term
pH above 7.45
CO2 less than 35 |
|
Definition
|
|
Term
| respiratory alkalosis treatment: |
|
Definition
- monitors VS and ABGs
- treat underlying disease
- assist client to breathe more slowly
- paper bag breathing
- breathing mask
- sedation |
|
|
Term
| Metabolic acidosis causes (general): |
|
Definition
- ingested drugs/toxic substances
- loss of bicarbonate ions
- lactic acidosis
- ketoacidosis
- inability to excrete hydrogen ions |
|
|
Term
| Drugs/toxic substances that may cause metabolic acidosis: |
|
Definition
- methanol
- ethanol
- salicylates (ASA)
- ethyelene glycol
- ammonium chloride |
|
|
Term
| ASA may cause respiratory __ and/or metabolic __. |
|
Definition
- respiratory alkalosis
- metabolic acidosis |
|
|
Term
| Specific causes of metabolic acidosis: |
|
Definition
Ingested drugs or toxic substances
Methanol
Ethanol
Salicylates
Ethylene glycol
Ammonium chloride
Loss of bicarbonate ions
Diarrhea
Pancreatic fistulas
Renal dysfunction
Lactic acidosis
Hypoxemia
Anemia, carbon monoxide
Shock (hypovolemic, cardiogenic, septic, etc.)
Severe exercise
Acute respiratory distress syndrome (ARDS)
Ketoacidosis
Diabetes mellitus
Alcoholism
Starvation
Inability to excrete hydrogen ions
Renal dysfunction |
|
|
Term
| Anemia, CO poisoning, intense exercise, shock, and ARDs cause __ __ which causes __ __. |
|
Definition
lactic acidosis
metabolic acidosis |
|
|
Term
| Specific conditions that cause metabolic acidosis: |
|
Definition
- renal failure
- diabetic ketoacidosis (DKA)
- starvation
- lactic acidosis
- prolonged diarrhea
- antifreeze
- aspirin
- carbonic anhydrase inhibitors (Diamox) |
|
|
Term
| Metabolic acidosis symptoms: |
|
Definition
- Kussmaul's respirations
- Lethargy
- Confusion
- Headache
- Weakness
- Nausea
- Vomiting |
|
|
Term
|
Definition
treat underlying cause
monitor ABG, I&O, VS, LOC Sodium Bicarb? |
|
|
Term
| General common causes of metabolic alkalosis: |
|
Definition
- loss of hydrogen ions
- ingestion of excess bicarb/bases |
|
|
Term
| Specific causes of metabolic alkalosis: |
|
Definition
- loss of hydrogen ions: vomiting, gastric fistulas, diuretic therapy, steriods
- excess antacids or IV bicarbonate |
|
|
Term
| diarrhea causes metabolic __, vomiting causes metabolic __. |
|
Definition
- diarrhea> metabolic acidosis
- vomiting> metabolic alkalosis |
|
|
Term
| Loss of potassium from __ or ___ causes metabolic __. |
|
Definition
- steroids or diuretics
- metabolic alkalosis |
|
|
Term
| Kidney failure causes metabolic __. |
|
Definition
|
|
Term
| Metabolic alkalosis symptoms: |
|
Definition
- compensatory hypoventilation
- dysrhythmias
- dizziness
- paresthesias
- numbness
- tingling of extremities
- hypertonic muscles
- tetany |
|
|
Term
| Good easy treatment for metabolic alkalosis: |
|
Definition
|
|
Term
pH above 7.45
Bicarb above 26 |
|
Definition
|
|
Term
| with metabolic alkalosis, what would be the compensation? |
|
Definition
| - respiratory hypoventilation to increase CO2 to increase H+ and decrease pH |
|
|
Term
| metabolic alkalosis treatment: |
|
Definition
I&O, VS, LOC
give potassium
treat underlying cause |
|
|
Term
| Normal arterial blood gases: |
|
Definition
pH 7.35-7.45
PaCO2 35-45 mm Hg
PaO2 80-95 mm Hg
HCO3 22-26 mEq/L
O2 Saturation 95-99% |
|
|
Term
| If the nonprimary system is in the normal range (CO2 35 to 45) (HCO3 22-26), then that system is not compensating for the primary. |
|
Definition
|
|
Term
| Lungs as a pulmonary defense mechanism: |
|
Definition
Abrupt changes in direction of airflow in the nasal passages can trap potential pathogens.
The epiglottis and cough reflex prevent introduction of particulate matter in the lower airway.
The ciliated respiratory epithelium propels the overlying mucous layer (right) upward toward the mouth.
In the alveoli, cell-mediated immunity, humoral factors, and the inflammatory response defend against lower respiratory tract infections. (C, complement.) |
|
|
Term
Must be able to ventilate the lung tidally to freshen alveolar gas
Must provide for perfusion of the individual alveolus in a manner proportional to its ventilation
Must allow for adequate diffusion of respiratory gases between alveolar gas and capillary blood
Must be able to accommodate several fold increases in the demand for oxygen uptake or CO2 elimination imposed by metabolic needs or acid-base derangement |
|
Definition
|
|
Term
|
Definition
1. Respiration
2. Acid/Base balance
3. Phonation
4. Pulmonary defense mechanisms |
|
|
Term
| The right bronchus is __, __, and more __. The left bronchus is ___, __,and more ___. |
|
Definition
- right is shorter, wider, and more vertical
- left is narrower, longer, and more horizontal |
|
|
Term
Left and right lungs:
are in left and right pleural cavities, respectively
The base:
inferior portion of each lung rests on superior surface of diaphragm |
|
Definition
|
|
Term
| Serous membranes has two layers: the __ pleura adheres to the lungs, the ___ pleura lines the thoracic cavity. |
|
Definition
- visceral pleura adheres to the lungs
- parietal pleura lines the thoracic cavity |
|
|
Term
| The 2 pleural cavities are separated by the ___. |
|
Definition
|
|
Term
| Each pleural cavity holds a lung and is lined with the serous membrane. |
|
Definition
|
|
Term
Pleural fluid:
lubricates space between 2 layers |
|
Definition
|
|
Term
| The pleural cavity has two pleural layers that are continuous with each other at the __ of the lung and form a closed potential space with a small amount of pleural fluid. It is __ __ __. |
|
Definition
- root
- sub-atmospheric pressure |
|
|
Term
| There are _ lobes in the right lung and _ lobes in the left lung. |
|
Definition
- 3 on the right
- 2 on the left |
|
|
Term
| The right lung has 3 lobes, the __, __, and __. The lobes are separted by the ___ and __ fissures. |
|
Definition
- superior, middle, and inferior
- horizontal and oblique fissures |
|
|
Term
| The left lobe has the __ and ___ lobe. They are separated by the ___ fissure. |
|
Definition
- superior and inferior
- oblique fissure |
|
|
Term
| The apex of the lung is the top and extends through the __ __ __ into the root of the neck. It lies in close contact to the __ or __ of the pleura. The apex of the lung is crossed by the __ __ which produces a groove in the __ . |
|
Definition
- superior thoracic aperture
- dome or cupula of the pleura
- crossed by the subclavian artery
- mediastinal surface |
|
|
Term
| The base of the lung is the __ __ surface of the lung related to the __ of the __. The base of the __ lung rises to a more superior level. Its inferior border is thin and sharp where it enters the __ __. |
|
Definition
- concave diaphragmatic
- related to the dome of the diaphragm
- right lung
- costodiaphragmatic recess |
|
|
Term
| The __ of the lung serves as the attachment for the lung and is where structures enter and leave the lungs at the __. It connects the __ surface of the lung to the __ and __ and is surrounded by the reflection parietal to visceral pleura. |
|
Definition
- root
- hilum
- medial surface of the lung to the heart and trachea |
|
|
Term
| Where the root is attached to the lung is the __. |
|
Definition
|
|
Term
| The hilum contains the __ __, __ __, __ __, __ __, and __ entering and leaving the lung. The hilum is where the root attaches to the lungs. |
|
Definition
- main bronchus
- pulmonary vessels (one artery, 2 veins)
- bronchial vessels
- lymph vessels
- nerves |
|
|
Term
| The __ lung is heavier and larger but also short and wider. |
|
Definition
|
|
Term
| The anterior margin of the right lung is __, whereas the margin of the left lung has a __ __ __. |
|
Definition
- straight
- deep cardiac notch |
|
|
Term
| The anteriorinferior portion of the left lung has a small tongue like projection called the ___. |
|
Definition
|
|
Term
| The horizontal fissure of the right lung separates the __ and __ lobes. |
|
Definition
|
|
Term
| The oblique fissure of the rightlung separates the __ lobe from the __ and __ lobes. |
|
Definition
- inferior lobe
- middle and superior lobes |
|
|
Term
| The anterior border of the lungs is thin and sharp and overlaps the ___. The anterior border separates the __ surface from the __ surface. During inspiration, the lungs project into the __ __ of the pleura. |
|
Definition
- pericardium
- costal surface from the mediastinal surface
- costomediastinal recess of the pleura |
|
|
Term
| The posterior border of the lung is rounded and lies in the deep concavity at the side of the thoracic region of the vertebral column called the __ __. |
|
Definition
|
|
Term
Anterior Border of the Right Lung
This corresponds to the anterior border of the right pleura.
Between the level of the 2nd and 4th cartilages, its anterior border is near the median plane.
Inferior to the 4th costal cartilage, the surface of the right lung gradually diverges from this plane and leaves the sternum posterior to the 6th costal cartilage.
The Anterior Border of the Left Lung
This corresponds to the anterior border of the left pleura as far as the level of the 4th costal cartilage.
Here, the anterior border deviates laterally to a point about 2.5 cm lateral to the left edge of the sternum to form the cardiac notch.
It then turns inferiorly and slightly medially to the 6th costal cartilage.
The Inferior Borders of the Lungs
These are indicated by a line drawn from the inferior end of the line representing the anterior border that crosses the 6th rib at the midclavicular line, the 8th rib in the midaxillary line and the 10th rib in the midscapular line.
These borders end about 2.5 cm lateral to the spinous process of T10 vertebra.
They lie two ribs superior to the pleura on each of three vertical lines just mentioned.
Back to top
The Bronchi, Roots, and Bronchopulmonary Segments of the Lungs
The principal or main bronchus, one for each lung, passes inferolaterally from the bifurcation of the trachea.
The bronchus accompanies the pulmonary artery into the wedge-shaped hilum of the lung, where it subdivides.
The right main bronchus is wider, shorter and more vertical (significant in inhaled obstructions) than the left one.
It is about 2.5 cm long and passes directly into the root of the lung.
The left main bronchus is about 5 cm long and passes inferolaterally, inferior to the arch of aorta, and anterior to the oesophagus and the descending thoracic aorta.
Within each lung, the bronchi divide in a constant fashion and in constant directions so that each branch supplies a clearly defined sector of the lung.
Each main bronchus divides into secondary or lobar bronchi (two for left, three for right), each of which supplies a lobe of the lung.
Each lobar bronchus divides into tertiary or segmental bronchi, which supply specific segments of the lung, called bronchopulmonary segments.
Left Lung
Superior (upper) lobe:
Apical
Posterior
Anterior
Superior lingular
Inferior lingular
Inferior (lower) lobe:
Superior (apical)
Medial basal
Anterior basal
Lateral basal
Posterior basal
Right Lung
Superior (upper) lobe:
Apical
Posterior
Anterior
Middle lobe
Lateral
Medial
Inferior (lower) lobe:
Superior (apical)
Medial basal
Anterior basal
Lateral basal
Posterior basal |
|
Definition
|
|
Term
| When auscultating, the anterior portion of the pts left chest is mostly the __ lobe of the left lung. |
|
Definition
|
|
Term
| On the pts right side you aremostly listening to the the right __ lobe, but if you move up you can hear the other lobes as well. |
|
Definition
|
|
Term
| When auscultating the pts left side, you are mostly listening to the left __ lobe. |
|
Definition
|
|
Term
| A primary bronchus branches to form ___ bronchi aka ___ bronchi. The secondary bronchus goes to each __. |
|
Definition
- secondary bronchi aka lobar bronchi
- secondary bronchus goes to each lobe |
|
|
Term
| Respiratory exchange does not start until the air reaches the respiratory ___. |
|
Definition
|
|
Term
| The walls of primary, secondary, and tertiary bronchi contain progressively less __ and more __ __ this increases muscular effects on airway constriction and resistance. |
|
Definition
- less cartilage
- more smooth muscle |
|
|
Term
| Human bronchial epithelium is made of __ ___ cells. The goblet cells secrete mucus. |
|
Definition
|
|
Term
| 2 types of blood flow to the lung: deoxygenated to get oxygen, and bronchial circulation supplying oxygen to lungs. |
|
Definition
|
|
Term
| The pulmonary vein carries __ blood back to the __ atrium of the heart. |
|
Definition
|
|
Term
| A __ __ drains each bronchopulmonary ___, usually on the ___ surface of each corresponding bronchus. |
|
Definition
- main vein
- segment
- anterior surface |
|
|
Term
| The right superior and left superior __ __ drain the __ and ___ lobes of the respective lungs. |
|
Definition
- pulmonary veins
- superior and middle |
|
|
Term
| The bronchial veins only drain the part of the blood delivered by the __ __ to the __ __. |
|
Definition
| - bronchial arteries to the bronchial tree |
|
|
Term
| bronchial arteries> bronchial tree> bronchial veins |
|
Definition
|
|
Term
| The right bronchial vein drains INTO the __ __. |
|
Definition
|
|
Term
| The left bronchial vein drains INTO the __ __ __ or the __ __ __ ___. |
|
Definition
- accessory hemizygous vein
- left superior intercostal vein |
|
|
Term
| The bronchial arteries are responsible for the majority of the ___ supply to the __ __. |
|
Definition
- oxygen supply
- lung parenchyma |
|
|
Term
| what supplies oxygen to the lung parenchyma? |
|
Definition
|
|
Term
| There is much variation in bronchial anatomy, but in most patients, there are two bronchial arteries on the left and one on the right. |
|
Definition
|
|
Term
| The lungs and pleura are innervated by the __ and __ __ __. |
|
Definition
| - anterior and posterior pulmonary plexuses- these are mixed vagal and sympathetic fibers |
|
|
Term
| The vagus (parasympathetic) efferent fibers are __ to the smooth muscle of the bronchial tree and cause ____. They inhibit pulmonary vessels and cause ___. They also cause gland __ from the bronchial tree. |
|
Definition
- motor to smooth muscle
- bronchoconstriction
- vasodilation
- secretion (secretomotor) |
|
|
Term
| Efferent vagus fibers to the lungs cause: |
|
Definition
- bronchoconstriction
- vasodilation
- secretomotor |
|
|
Term
| Afferent vagus fibers are ___ to the __ __ (touch and pain)and to the branches of the __ __ (stretch). |
|
Definition
- sensory
- respiratory epithelium
- bronchial tree |
|
|
Term
| Effects of sympathetic efferent fibers: |
|
Definition
- bronchodilation
- vasoconstriction
- inhibits gland secretion |
|
|
Term
Albuterol works on the sympathetics.
Atropium bromide works on the Parasymp
Drugs that work on the sympathetics tend to work better. |
|
Definition
|
|
Term
| Lower Respiratory Disorders: |
|
Definition
- signs and symptoms of respiratory disease
- pulmonary function tests
- atelectasis
- acute lung injury
- pulmonary infections
- vascular lung lesions
- restrictive lung diseases
- obstructive lung diseases
- lung tumors
- mediastinum disordres
- pleural disorders |
|
|
Term
| Symptoms and signs of respiratory disease: |
|
Definition
Symptoms: cough, dyspnea, hemoptysis
Signs: tachypnea, tracheal shift, vocal tactile fremitus, percussion changes, breath sounds |
|
|
Term
| sensation of difficult or uncomfortable breathing due to stimulation of J receptors causing decrease in full inspiration. |
|
Definition
|
|
Term
|
Definition
- decreased compliance (fibrosis)
- increased airway resistance
- chest bellows disease
- interstitial inflammation/fluid accumulation |
|
|
Term
J-receptors (juxtacapillary) are nerves innervating into the body of the lung. They are present in the alveolar interstitium and are innervated by fibers of the vagus nerve. J-receptors respond to events such as pulmonary edema, pulmonary emboli, pneumonia, and barotrauma, which cause a decrease in oxygenation and thus lead to an increase in ventilation/respiration. They may be also stimulated by hyperinflation of the lung as well as intravenous or intracardiac administration of chemicals.
The stimulation of the J-receptors causes a reflex increase in breathing rate, and is also thought to be involved in the sensation of dyspnea, the subjective sensation of difficulty breathing. |
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Definition
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Term
| The chest bellows includes all those structures that make up the thoracic cage (muscles, bones, nerves, and connective tissue), plus the diaphragm muscles and the pleural membranes. |
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Definition
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Term
Cough - a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes
Cough receptors: located at bifurcations in airways, larynx, distal esophagus
Cough with a normal chest x-ray
Postnasal discharge is the most common cause
Nocturnal cough with:
GERD: due to acid reflux in tracheobronchial tree at night
Bronchial asthma: due to bronchoconstriction
Productive cough with:
Chronic bronchitis: due to smoking cigarettes
Typical bacterial pneumonia
Bronchiectasis
Drugs causing cough:
ACE inhibitors: inhibit degradation of bradykinin; causes mucosal swelling and irritation in tracheobronchial tree
Aspirin: causes an increase in LT C-D-E, (bronchoconstrictors) |
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Definition
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Term
| what two drugs can cause cough? |
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Definition
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Term
| Reflex cough occurs when subsets of airway __ nerves are activated. These provide modifying inputs to the brainstem neural elements controlling respiration. |
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Definition
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Term
| coughing up of blood tinged sputum: |
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Definition
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Term
| mechanisms of hemoptysis: |
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Definition
- parenchymal necrosis
- bronchial/pulmonary vessel damage |
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Term
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Definition
- chronic bronchitis (most common cause)
- pneumonia
- bronchogenic carcinoma
- TB
- bronchiectasis
- aspergilloma (fungus living in a cavity lesion) |
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Term
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Definition
| rapid shallow breathing, > 20 rpm |
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Term
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Definition
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Term
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Definition
- restrictive lung disease
- pleuritic chest pain
- pulmonary embolus with infarction
- fever
- exercise
- anemia |
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Term
| Normal breathing rates in peds: |
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Definition
- infant up to 1 year: 30-60 bpm
- toddler (1-3 yr): 24-40 bpm
- preschool (3-6 yr): 22-34 bpm
- school age (6-12 yr): 18-30 bpm
- adolescent (12-18 yr): 12-16 bpm |
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Term
| hallmark sign of life-threatening tension pneumothorax: |
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Definition
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Term
| Vocal tactile fremitus produces a __ __ or vibration transmitted through the chest wall when a patient says "E", "1,2,3", or "99". |
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Definition
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Term
| Decreased tactile fremitus may be caused by: |
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Definition
- emphysema
- asthma
- increased AP diameter |
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Term
| Absent vocal tactile fremitus may be caused by: |
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Definition
- atelectasis (collapse of airways)
- effusion
- pneumothorax (air in pleural space) |
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Term
| Increased tactile fremitus causes: |
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Definition
| - lobar pneumonia due to alveolar consolidation (sound travels well through consolidation) |
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Term
| causes of dull percussion: |
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Definition
- pleural effusion
- lung consolidation
- atelectasis (no air in the alveoli) |
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Term
| causes of lung hyperresonance to percussion: |
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Definition
- pneumothorax
- asthma
- emphysema |
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Term
| The origin for normal breath sounds is the __ |
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Definition
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Term
| Air velocity and turbulence induce vibrations in airway walls producing breath sounds. |
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Definition
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Term
| Sites modifying breath sound: terminal airway and alveolar disease modify breath sounds; sounds heard with the stethoscope are produced in more central (hilar) regions and are altered in intensity and tonal quality as they pass through pulmonary tissue to the periphery |
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Definition
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Term
| Site for normal airway resistance and turbulent air flow: |
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Definition
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Term
| Site for laminar air flow : |
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Definition
| - begins at terminal bronchioles |
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Term
| __ branching increases __ __ area of airways and converts __ flow to __ flow. |
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Definition
- Parallel branching
- increases cross-sectional area
- turbulent flow to laminar flow |
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Term
Effects of inflammation of small airways (e.g., asthma, chronic bronchitis): air
trapping, wheezing, increased airway resistance |
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Definition
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Term
| Bronchial breath sounds are present over the __ __ and heard over the body of the ___. These sounds are more tubular and __ pitched than vesicular sounds, but not as harsh as tracheal breath sounds. |
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Definition
- large airways
- sternum
- high pitched |
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Term
| Bronchovesicular sounds are heard on the __ chest between the __ and on the __ chest in the __ and __ intercostal spaces. These are __ pitched. |
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Definition
- posterior chest between the scapulae
- anterior chest in the first and second
- medium pitched |
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Term
| __ sounds are heard throughout most of the lung fields. These are __, __ pitched, or ___ sounds. |
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Definition
- Vesicular
- soft, low pitched, or rustling sounds
(inspiration is longer than expiration with no pause between them) |
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Term
| A good pulmonary function test: |
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Definition
| - Alveolar-arterial partial pressure oxygen pressure gradient |
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Term
| The Alveolar-arterial gradient is the measurement of the difference between the __ concentration of __ and the __ concentration of __. |
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Definition
- alveolar concentration of oxygen
- arterial concentration of oxygen |
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Term
| Alveolar-arterial gradient is obtained from the __ __ __. |
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Definition
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Term
Alveolar-arterial Partial Pressure Oxygen Gradient
(A-a gradient)
It can be used in diagnosing the source of hypoxemia… |
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Definition
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Term
| The only thing dividing alveolar air and the blood that would become arterial blood is a thin layer of epithelial cells of the alveolar wall, a very thin layer of interstitial potential space, and an equally thin layer of arterial endothelial lining. |
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Definition
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Term
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Definition
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Term
| An increased A-a gradient suggests __ of __ origin. |
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Definition
| hypoxemia of pulmonary origin |
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Term
| medically significant A-a gradient: |
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Definition
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Term
Medically significant A-a gradient > 30 mm Hg
Increased A-a gradient: hypoxemia of pulmonary origin
Normal A-a gradient: hypoxemia of extrapulmonary origin |
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Definition
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Term
Causes of hypoxemia with an increased A-a gradient
Ventilation defect
(1) Impaired O2- delivery to the alveoli for gas exchange
(2) Example—airway collapse due to the respiratory distress syndrome
Perfusion defect
(1)Decreased or absent blood flow to the alveoli
(2) Example—pulmonary embolus
Diffusion defect
(1) O2 cannot diffuse through the alveolar-capillary interface.
(2) Examples—interstitial fibrosis, pulmonary edema
Right-to-left cardiac shunt
Example—tetralogy of Fallot |
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Definition
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Term
Causes of hypoxemia with a normal A-a gradient
Depression of the respiratory center in the medulla
Examples—barbiturates, brain injury
Upper airway obstruction
(1) Epiglottitis due to Haemophilus influenzae
(2) Croup due to parainfluenza virus
• Mucosal edema narrows the trachea.
Chest bellows (muscles of respiration) dysfunction
(1) Paralyzed diaphragm
(2) Amyotrophic lateral sclerosis with degeneration of anterior horn cells |
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Definition
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Term
| another pulmonary function test: |
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Definition
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Term
| Spirometry is useful in distinguishing __ lung disease from __ lung disease. |
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Definition
| - restrictive lung disease from obstructive lung disease |
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Term
Spirometry - Useful in distinguishing restrictive from obstructive lung disease
Functional residual capacity (FRC)
Total amount of air in the lungs at the end of a normal expiration
Total lung capacity (TLC)
Total amount of air in a fully expanded lung
Residual volume (RV)
Volume of air left over in the lung after maximal expiration
Tidal volume (TV)
Volume of air that enters or leaves the lungs during normal quiet respiration
Forced vital capacity (FVC)
Total amount of air expelled after a maximal inspiration
Forced expiratory volume in 1 second (FEVl)
Amount of air expelled from the lungs in 1 second after maximal inspiration
FEVl/FVC
Ratio of air expelled in first second compared to total effort
Expiratory reserve volume (ERV)
Amount of air forcibly expelled at the end of a normal expiration. |
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Definition
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Term
| LOOK AT SLIDE 121 AND WRITE DOWN IN REVIEW, WHAT CHANGES WITH RESTRICTIVE VS. OBSTRUCTIVE. |
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Definition
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Term
| loss of lung volume due to inadequate expansion of the airspaces or collapse is called ___. |
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Definition
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Term
| Resorptive atelectasis is airway __ by __ __ that prevent air from reaching the alveoli. |
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Definition
| - obstruction by thick secretions |
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Term
| Compression atelectasis occurs when __ or __ in the pleural cavity under increased pressures collapses the ___ airways beneath the pleura. |
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Definition
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Term
| Common causes of compression atelectasis: |
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Definition
- CHF
- Ascites
- Post-op patients |
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Term
| Contraction atelectasis is due to __ of scars in the lung or pleura. It is commonly seen with __, __ __, and __ __. |
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Definition
- contraction of scars
- TB
- chronic pleuritis
- pleural adhesions |
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Term
| Atelectasis can also be caused by a loss of ___. |
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Definition
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Term
Two days after surgery with general anesthesia for a coronary artery bypass, a 56 year old male experiences increasing respiratory difficulty with decreasing arterial oxygen saturations. His heart rate is regular at 78 beats per minute, and his hemoglobin concentration has remained unchanged since surgery at 13.7 g/dL. He is afebrile. After coughing up a large amount of mucoid sputum, his condition improves.
Most likely explanation? |
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Definition
| - Resorptive atelectasis b/c the mucopurulent sputum |
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Term
| Atelectasis (microatelectasis) can occur postoperatively, and in respiratory distress of the newborn from loss of surfactant. |
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Definition
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Term
| what is the most common cause of pulmonary edema? |
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Definition
| - left sided heart failure |
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Term
| Acute Respiratory Distress Syndrome (ARDS) is a __ pulmonary edema resulting from acute __ __ damage. |
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Definition
- non-cardiogenic pulmonary edema
- alveolar capillary damage |
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Term
| Patients at risk for ARDS: |
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Definition
- Gram negative sepsis (> 40% of cases)
- Gastric aspiration
- Severe trauma with shock
- Diffuse pulmonary infections
- Heroin
- Smoke inhalation
- Acute pancreatitis
- Cardiopulmonary bypass
- Disseminated intravascular coagulation
- Amniotic fluid embolism
- Fat embolism |
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Term
| Transudate pulmonary edema is due to alterations in __ ___, either ___ hydrostatic pressure in pulmonary capillaries, or ___ oncotic pressure. |
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Definition
- Starling pressure
- increased hydrostatic pressure
- decreased oncotic pressure |
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Term
| conditions that cause increased hydrostaic pressure resulting in transudate pulmonary edema: |
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Definition
- Left sided heart failure
- Volume overload
- Mitral Stenosis |
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Term
| Conditions resulting in decreased oncotic pressure resulting in transudate pulmonary edema: |
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Definition
- nephrotic syndrome
- cirrhosis |
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Term
| Exudate pulmonary edema is due to ___ damage or __ ___. |
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Definition
| - microvascular damage or alveolar injury |
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Term
| Conditions resulting in microvascular damage or alveolar injury and thus pulmonary exudate: |
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Definition
- Infections: sepsis, pneumonia
- Aspiration: drowning, gastric contents
- Drugs: heroin
- High altitude
- Acute Respiratory Distress Syndrome |
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Term
| Edema due to changes in starling forces: |
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Definition
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Term
| Edema due to microvascular or alveolar damage: |
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Definition
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Term
| URI may be of the __, __ __, or __. |
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Definition
- nares
- oral cavity
- pharynx (throat) |
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Term
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Definition
physical - sneezing; nasal hairs, turbinates and mucus (filtration), continual sloughing of epithelium, flushing of oral cavity and pharynx by saliva
chemical - enzymes in saliva, mucus
cellular - phagocytes (PMN), normal microbiota |
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Term
| A lower respiratory tract infection may be of the __, __, __, __, or __. |
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Definition
- epiglottis
- trachea
- bronchi
- bronchioles
- alveoli |
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Term
| Defenses against lower respiratory tract infections: |
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Definition
physical - coughing, ciliated mucosal epithelium ("mucus escalator")
chemical - mucus, enzymes
cellular - phagocytes (alveolar macrophages) |
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Term
| respiratory tract infection transmission: |
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Definition
- personal interaction
- respiratory droplets inhalation |
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Term
| Predisposing factors for respiratory tract infection: |
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Definition
- dry air
- low exercise level
- immunodeficiency |
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Term
| an important cause of death and pulmonary HTN: |
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Definition
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Term
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Definition
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Term
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Definition
A detached intravascular mass carried by the blood to a site in the body distant from its point of origin
Most emboli are thrombi – others include gas, fat, foreign bodies and tumor clumps |
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Term
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Definition
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Term
|
Definition
- sudden death
- severe chest pain
- dyspnea
- hemoptysis
- pulmonary infarction
- pulmonary hypertension
could also present just as an annoying cough |
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Term
| Pneumoconiosis is an __ __ lung disease caused by inhalation of __ often in mines. |
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Definition
- occupational restrictive
- dust |
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Term
| Restrictive lung disease: |
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Definition
A category of extrapulmonary, pleural, or parenchymal respiratory diseases that restrict lung expansion
Results in a decreased lung volume, an increased work of breathing, and inadequate ventilation and/or oxygenation.
Pulmonary function test demonstrates a decrease in the forced vital capacity. |
|
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Term
| decreased lung volume, decreased forced vital capacity, increased work of breathing: |
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Definition
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Term
| Restrictive lung disease causes: |
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Definition
- Intrinsic lung disease- change in lung parenchyma
- Extrinsic lung disease- disease of pleura, chest wall, or neuromuscular apparatus
- Pulmonary fibrosis
- Pneumoconiosis
- Sarcoidosis |
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Term
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Definition
Coal worker's pneumoconiosis
Silicosis
Asbestos-related disease
Berylliosis |
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Term
| Sarcodosis is a __ ___ disease of unknown etiology. |
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Definition
| - multisystem granulomatous |
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Term
| Easier to breathe with __ lung volumes than low lung volumes. |
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Definition
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Term
| If someone is choking, in 3-5 minutes they will experience __, __, and __ __. This does not occur instantly b/c we have a physiologic reserve of air in our lungs. If the pt had been breathing 100% oxygen for 2-3 minutes prior to choking, he would have 8-10 minutes before this occured. |
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Definition
| - hypoxia, bradycardia, and cardiac arrest |
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Term
| Functional residual capacity is the volume of gas __ in the __ at the __ of a __ __. |
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Definition
| - volume of gas remaining in the lungs at the end of a normal expiration |
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Term
| Gas exchange continues to occur throughout the respiratory cycle as blood is continuously passing through the lungs |
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Definition
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Term
| Functional residual capacity is determined by the __ of the lungs and chest wall. |
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Definition
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Term
| Compliance is the __ of change in __ in response to __. |
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Definition
| - rate of change in volume in response to pressure |
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Term
Anything that reduces the outward mobility of the chest wall reduces its compliance:
severe obesity or constrictive bandages.
Anything that reduces the volume of the lungs reduce their compliance, examples of this are pulmonary edema, fibrosis, consolidation or increased intra-abdominal pressure. |
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Definition
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Term
| Obstructive lung disease pts have trouble __ __ . |
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Definition
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Term
| Obstructive lung disease: |
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Definition
- emphysema
- chronic bronchitis |
|
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Term
| obstructive lung disease: |
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Definition
Physiological defects
Airflow limitation
Hyperinflation
Gas exchange disturbances |
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Term
| Emphysema is permanent __ of all parts of the respiratory unit includeing the __ __, __ __, and ___. |
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Definition
- enlargement
- respiratory bronchioles
- alveolar ducts
- alveoli |
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Term
|
Definition
- mucus hypersecretion and inflammation of the large airways (trachea and bronchus)
- peribronchiolar fibrosis
- airway obstruction |
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Term
|
Definition
| - Acinus (respiratory bronchiole, alveolar ducts, and alveoli)loss of elastic recoil |
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Term
| Obstructive lung disease with loss of elastic recoil: |
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Definition
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Term
| Pleural disorders to consider: |
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Definition
Infection--coccidioidomycosis
Drug effect--heroin, crack cocaine
Tobacco-associated: Langerhans' cell histiocytosis, respiratory bronchiolitis interstitial lung disease
Cryptogenic organizing pneumonia
Familial disease
Airways disease--bronchiolitis
Sarcoidosis |
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