Pulmonary disease can results from...(3)
1) inadequate ventilation
2) abnormalities of gas exchange in the lungs
3) abnormalities in transport from the lungs to the peripheral tissues
The most fundamental test of pulmonary performance are determinations of...
Blood PO2, PCO2, pH
*should be measured rapidly for acute resp. distress or acute abnormalities of acid-base balance
The simplest test of lung function...
Pt takes deepest inhale, then most forceful exhale
*Total lung Capacity (TLC) to Residual Vol. (RV)
On average the expiratory rate does not go above ____ L/min at a lung volume of ___ L.
400 L/min at 5 L
Important concept of the expiratory flow curve
expiratory rate reaches a maximum value that cannot be passed without additional effort
The desending portion of the expiratory rate curve representing the maximum expiratory flow is...
effort-independent
Explain how the chest cage compresses during expiratory flow
Compressed both the alveoli and bronchiole so that the flow of air to the exterior is controlled (steadily decreases after max flow)
To determine is your Pt has obstructive or restrictive lung disease, what graph is useful to reference?
Normal maximum flow-volume curve
Pt has interstitial fibrosis this is a
___ lung disease, with ___ lung volume and ___ ___ expiratory flow rate at lung volumes
#NAME?
Pt has chronic bronchitis a ___ lung disease with ___ lung volumes and ___ than normal expiratory flow rates.
#NAME?
Pt with an expiratory flow-volume curve that looks "scooped-out" has an ____ lung disease.
obstructive lung disease
Restrictive vs. Obstructive lung disease
___ lung volume
____ expiratory flow at lung volumes
Restrictive/Obstructive
Lung vol: low/high
Exp flow: slightly high/lower
Obstructive lung disease is characterized by
increased resistance to airflow and high lung volume
Pt finds it easier to breath high lung volumes. Obstructive or Restrictive lung disease? Why?
Obstructive, breathing high volumes increases the caliber of the airways (by increasing radial traction) and thus reduces resistance to airflow
Pt has an obstructive lung disease, what are the three possible mechanisms (associated conditions)?
1) Airway lumen obstructed by secretions (chronic bronchitis), edema fluid, or aspiration of foods/fluids
2) Airway wall smooth m- contracted (asthma), thickened from inflammation (asthma, bronchitis), or mucous glands hypertrophy (chronic bronchitis)
3)
Restrictive lung disease is characterized by
low lung volumes
Pt finds it easier to breathe a low lung volumes...obstructive or restrictive lung disease? Why?
Restrictive, because it's difficult to fully expand lung
What conditions cause abnormalities of the lung parenchyma for your Pt with a restrictive lung disease?
pulmonary fibrosis, silicosis, asbestosis, tuberculosis
What conditions cause problems with the pleura for your Pt with a restrictive lung disease?
pneumothorax and pleural effusion
What conditions cause neuromuscular problems for your Pt with a restrictive lung disease?
polio and myasthenia gravis
What does "pulmonary emphysema" mean...what about "chronic pulmonary emphysema" hot shot.
Pul emy-excess air in lungs
Chronic- complex obstructive and destructive process of lungs (long-term smokers)
Why does your Pt with chronic pulmonary emphysema find it especially difficult to expire?
destruction of the alveolar walls obstructs the airway, entraps air in alveoli and stretches them
Chronic pulmonary emphysema generally progresses...
slowly over many years *but can extremely vary
List four changes that can occur with Chronic Pulmonary Emphysema.
1) Increasing airway resistance
2) Decreased diffusing capacity
3) Abnormal ventilation-perfusion ratio
4) Increased pulmonary vascular resistance
Regarding Chronic Pulmonary emphysema, how does the increasing airway resistance occur? *Effect?
bronchiolar obstruction
*expiration is difficult due to further compression of bronchioles
Regarding Chronic Pulmonary emphysema, how does the decreased diffusing capacity occur? *Effect?
loss of alveolar walls
*reduces lungs ability to bring O2 in and CO2 out
Regarding Chronic Pulmonary emphysema, how does the Abnormal ventilation-perfusion ratio happen? *Effects on various parts within the lung?
Areas with bronchiolar obstruction have VERY LOW Va/Q (physiological shunt)
*poor aeration of blood
Areas with loss of alveolar walls VERY HIGH Va/Q (physiological dead space)
*Wasted ventilation
What does "pneumonia" includes (definition)
any inflammatory condition of the lung in which alveoli are filled with fluid and blood cells
Pt's left lung lobe is consolidated...what the F#CK does that mean?
filled with fluid and cellular debris
Pt arrives with an ateletasis, what is this and what are two common causes?
Collapsed lung
1) Airway obstruction- air trapped beyond bronchial obstruction = alveolar collapse
2) Lack of surfactant- Surface tension of alveolar fluid increases
If the lung cannot collapse, negative pressure develops in the alveoli causing...
edema fluid to collect
Hyaline membrane disease is also called
chronic pulmonary disease
Asthma is an _____ lung disease
obstructive
Asthma is usually caused by _____
Produces 1) 2)
-hypersensitivity of bronchioles to foreign substance
1) localized edema in walls of small bronchioles + mucus secretion into bronchiolar lumen
2) Spasm of bronchiolar smooth muscle
*both 1+2 increase airway resistance
How do you expect an asthmatic Pt to breath...
inspire adequately with great difficulty expiring
*dyspnea-"air hunger
what two lung volumes/capacities increase during an asthmatic attach?
#NAME?
The tubercle bacilli cause
tuberculosis
1) macrophages invade infected area
2) lesion is walled off by fibrous tissue
List five causes of hypoxia
1) Extrinsic factors cause Inadequate oxygenation of lungs
2) Pulmonary disease
3) Venous-to-Arterial shunt (R to L cardiac shunts)
4) Inadequate oxygen transport by blood to tissues
5) Inadequate tissue capability of using oxygen
What extrinsic factors cause inadequate oxygenation of lungs during hypoxia?
#NAME?
How does pulmonary disease cause hypoxia?
1) hypoventilation due to increased resistance or decreased pul compliance
2) Uneven alveolar ventilation-perfusion ratio
3) Diminished respiratory membrane diffusion
How does inadequate oxygen transport by the blood to the tissues cause hypoxia?
1) Anemia or abnormal hemoglobin
2) General circulatory deficiency
3) Localized ciruclatory deficit (peripheral, cerebral coronary vessels)
4) Tissue edema
How does inadequate tissue capability of using oxygen cause hypoxia?
1) poisoning of cellular enzymes (cyanide)
2) Diminished cellular metabolic capacity because of toxicity, vitamin deficiency, or other factors
____ therapy is of great value in certain types of hypoxia and nearly useless for others.
oxygen
Oxygen therapy can help what types of hypoxia? Less valuable to? Useless to?
1) Atmospheric hypoxia
2) Hypoventilation hypoxia
3) Hypoxia caused by impaired alveolar membrane diffusion
Less valuable
4) Hypoxia caused by oxygen transport deficient (anemia)
No help
5) Hypoxia caused by inadequate tissue use of oxygen
Pt's tissue are incapable of utilizing oxygen, you hear you attending say "GIVE OXYGEN THERAPY!" you...
think to yourself, well the tissue is incapable of utilizing oxygen you idiot, it's doubtful it will help.
Hypercapnia means?
excess CO2 in body fluids
Alveolar PCO2 from 60-75 mmHg, Pt will present
breathing as deeply and rapidly as possible (dyspnea)
At an alveolar PCO2 between 80-100 mmHg, Pt will
become lethargic, maybe semicomatose
Deoxygenated hemoglobin causes
cyanosis (bluish skin)
Definite cyanosis appears when arterial blood contains more than...?
5 g of deoxygenated Hb/100mL blood
Why can't an anemic become cyanotic?
Not enough Hb for 5g to be deoxygenated/100mL blood.
A polycythemia Pt will often become ____ due to the excess of Hb.
cyanotic (it takes 5g Deoxy Hb/100mL blood)