Advanced Pathophysiology NURS 5350 Exam 3

Advanced Pathophysiology NURS 5350 Exam 3 What is a cough? Protective reflex that helps clear the airways by an explosive expiration. Acute cough: 2-3 weeks Chronic cough: longer than 3 weeks. Causes: Post nasal drip, GERD, medications (ACE). Hypoventilation vs. Hyperventilation? Hypo: Alveolar ventilation is INADEQUATE: leads to RESPIRATORY ACIDOSIS. Hyper: Alveolar ventilation EXCEEDS metabolic demands: Leads to RESPIRATORY ALKALOSIS. What is clubbing? A painless enlargement of the terminal phalanges of the fingers and toes that develops over time due to chronic hypoxia (COPD, CF, Pulmonary fibrosis, CHD). What is Hypoxemia vs. Hypoxia? Hypoxemia is low arterial blood oxygen content. Hypoxia is inadequate oxygen level in the tissues/cells. What is pneomothorax? Presence of air or gas in pleural space. Open vs tension pneumothorax? Open: Air pressure in pleural space equals barometric pressure . Tension: Site of pleural rupture acts as one way valve permitting air to enter on inspiration but prevents its escape by closing during expiration. What is pleural effusion? Accumulation of fluid in the pleural space. Empyema: Pus What is Empyema? Pus in the pleural space. Treatment: Antimicrobial medications and DRAINAGE of pleural space with chest tube. What is bronchiectasis? Persistent abnormal dilation of the bronchi by DESTRUCTION OF THE ELASTIC OR MUSCULAR COMPONENTS OF THE BRONCHIAL WALL OR LUMEN OBSTRUCTION. What is Bronchitis? Inflammation of the bronchial tubes - usually caused by viruses. What is bronchiolitis? Diffuse inflammation of smallest airways or bronchioles (which are located on the most distal end of bronchi before the alveoli. What is asthma? How does genetics and environment play a role in childhood asthma?WHa Chronic inflammatory disorder of the bronchial mucosa. Causes bronchial hyper responsiveness, constriction of the airways and variable airflow obstruction that is reversible. Allergies are a key component as many attacks are due to allergic response. Childhood asthma: Genetics: genes that code for increased levels of immune and inflammatory mediators (IL-4, IL-5, IL-6, IL-13, IgE, and leukotrienes). What is COPD? Airflow limitation that is not fully reversible. Usually progressive and associated with chronic bronchitis and emphysema. Risk factors for COPD? Smoking, dusts, chemicals, indoor pollution, outdoor air pollution. What is Emphysema? Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis. What are the two types of emphysema? Centriacinar: Septal destruction occurs in bronchioles and alveolar ducts. Occurs in smokers with chronic bronchitis. Panacinar: Involbves the entire acinus. Involves lower lobes of the lung. What causes chronic bronchitis? Caused by viruses 90% of the time. What is a pulmonary embolism? Types or Origins? Risk factors? Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragments, lipids (fats), foreign body, air bubble, or amniotic fluid. Commonly (90%) arise from the deep veins in legs. Virchow Triad: Venous stasis, hyper coagulability, and injuries to the endothelial cells that line the vessels. Risk factors: Conditions that promote blood clotting (venous stasis: immobilization, heart failure), hypercoagulability (oral contreceptives, hormone replacement, pregnancy), genetic clotting disorders (factor V leiden mutation, etc). Cor Pulmonale? Secondary to PAH. Right ventricular enlargement. Pulmonary hypertension, creating chronic pressure overload in the right ventricle. Clinical manifestations: heart appears normal at rest. With exercise: decreased cardiac output and chest pain. What is pulmonary edema? Fluid in the lungs most commonly caused by left sides heart failure, or high altitudes. SS: Dyspnea, hypoxia, dullness to percussion over bases, inspiratory crackles, pink frothy sputum. Laryngeal Cancer? Risk factors? SS? Risk factors: tobacco smaoke, HPV, alcohol consumption with smoking. SS: Hoarseness, dyspnea, and cough. Patho: Laryngeal dysplasia has a high risk of progressing to malignancy. Metastasis develops by spreading to the draining lymph nodes. What is the most frequent cause of cancer death in the United States? Lung Cancer (bronchogenic carcinomas). How do you determine treatment for lung cancer? TNM classification system. T: Tumor (primary) extent. N: Nodule involvement. M: Metastasis extent. What is surfactant? Lipid-protein mix produced by alveolar type II cells which MAINTAINS ALVEOLAR EXPANSION. Produced by. 20-24 weeks gestation; is secreted into the fetal airways by 30 weeks gestation; therefore babies born before 30 weeks are at risk for inadequate surfactant in the lungs. What is croup? Acute laryngotracheobronchitis. Common in 6 months to 5 years of age. SS: seal-like barking cough, hoarse voice, and inspiratory stridor. What is the most common associated pathogen with brnchiolitis? RSV.