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What is Atrial Septal Defect? What direction is the shunt?
An opening between the right and left atria
Causes a left to right shunt that can be reversable
Well tolerated but leads to to PHTN
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What is the most common congenital heart defect?
Ventricular Septal Defect
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What is VSD? What direction is the shunt?
Ventricular septal defect; an opening between the left and right ventricle.
Causes a left to right shunt with frequent reversal
Leads to progressive PHTN and is mroe likely to need surgical correction
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Why is it serious when the shunt reverses with a VSD?
Because deoxygenated blood is sent out the aorta which leads to hypoxia.
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What is Patent Ductus Arteriosis? What direction is the shunt?
A connection between the pulmonary a. and the aorta
A left to right shunt (aorta to pulmonary) which doesn't reverse
Leads to PHTN and requires surgical correction
Oxygenated blood mixes with deoxygenated blood
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(T or F) All defects can lead to congestive heart failure.
All defects can lead to CHF
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What is CHF?
Congestive heart failure; heart is unable to eject all the blood delivered to it
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What can cause l. heart failure?
Systemic hypertension
MV/AV disease
Ischemic heart disease
Myocardiopathy
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What can cause r. heart failure?
L. heart failure
Lung disease
PV/TV disease
L. to r. shunts
PHTN
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What are 3 compensatory mechanisms for CHF?
- Increased SNS activity (positive inotropic affect; epinephrine)
- Increased HR
- Hypertrophy of myocardium
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What happens if the compensation for CHF isn't enough?
Increased EDV which causes the heart to dilate
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What is Frank-Starling's Law?
When the ventricles dilate, m. fibers intially contract forcibly to increase CO
If dilation continues contractions becomes weaker progressively decreasing CO
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How does compensated CHF relate to Frank - Starling's Law?
Mild vent. dilation lead to forcible contraction and increased CO
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How does Decompensated CHF relate to Frank - Starling's Law?
Greatly increased EDV (leading to ventricle dilation) leads to weaker contractions and decreased CO
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Where does blood back up during l. heart failure?
From the l. vent to the l. atrium to the lungs
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What is PHTN?
Pulmonary hypertension; increase in hydrostatic pressure of pulmonary vessels
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What is pulmonary edema?
Leakage of fluid in the interstitial spaces of the pulmonary vessels (and eventually into the alveoli)
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What are common results of l. heart failure?
PHTN
Pulmonary edema
R. heart failure
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What is the most common cause of r. heart failure?
L. heart failure
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What are common results of r. heart failure?
Venous congestion
Soft tissue edema
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What are clinical signs of r. heart failure?
Distended neck veins
Splenomegaly leading to ascites (stomach edema)
DVT and PE
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How does CHF affect the kidneys?
Decompensated CHF leads to decreased renal perfusion
Renin-angiotensin cycle activate, water is retained
Heart unable to pump increased fluid volume leads to venous pooling
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What should the first treatment be to protect the kidneys from CHF?
Diuretics.
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Describe the bronchial tree
Trachea: C- shaped cartilage
Bronchi: Transition from cartilage to smooth m.
Bronchioles: no cartilage, all smooth m.
Alveoli: exchange surface closely associated w/ capillaries
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What is the major function of the lungs?
Excrete carbon dioxide while obtaining oxygen
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Where does diffusion between blood and air occur?
The alveoli
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Describe intrathoracic pressure during inspiration
The diaphragm moves down while the ribs move up and out
Chest volume increases while pressure inside the chest decreases
Air moves into the chest
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Describe intrathoracic pressure during expiration
Diaphragm moves up and ribs move down and in
Chest volume decreases, pressure inside the chest increases
Air moves out of the chest
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What is dyspnea?
Difficulty breathing (SOB)
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What is orthopnea?
Difficulty breathing while laying down
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What is exertional dyspnea?
Difficulty breathing while excercising
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What is hypoventilation?
Inadequate alveolar ventilation in relation to metabolic demands
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What is hyperventilation?
Alveolar ventilation exceeds metabolic demands
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Cough's can be either _____ or non - ______.
Coughing can either be productive (wet) or non-productive (dry).
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What are the 2 types of productive coughing?
Purulent sputum: infection
Non-purulent: nonspecific irritation
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What are the 2 types of cough medicines?
Expectorants (productive coughs)
Suppressants (Non-prodcuctive; can lead to pneumonia if used with productive cough)
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What is cyanosis?
Bluish skin discoloration caused by increased unoxygenated hemoglobin
Tx with supplemental oxygen
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What is hemoptysis?
Coughing up bloody/bloody secretions
Coughed blood: high pH, bright red
Thrown up blood: low pH, dark red
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WHat are 3 mechanisms of pulmonary edema?
L. heart failure
Inflammation of alveoli
Blockage of lymphatic vessel
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What is pleural effusion? What are the 2 types?
Fluid in pleural space
Transudate (hydrothorax, serous effusion): fluid w/ little fluid; yellowish; low specific gravity
Exudate: high protein; cloudy; high specific gravity
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What are the 3 types of exudates in pleural effusion?
Empyema (pus)
Hemothorax (serosanguinous; blood)
Chlyothorax (Chyle; lymph fluid)
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What is atelectasis?
Loss of lung volume due to inadequate expansion of airspaces
Results in poorly oxygenated blood
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What are the common symptoms of resp. disease?
Dyspnea
Hypo/hyperventilation
Cough
Cyanosis
Hemoptysis
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What are the different types of atelectasis?
Resoption
Compression
Micratelectasis
Contraction
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What is resoption atelectasis?
Occurs when an obstruction prevents air from reaching distal airways
Air already present gradually becomes absorbed
Tumor, foreign body,mucous plug
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What is compression atelectasis?
Occurs w. accumulation of fluid, blood, or air in pleural cavity
Pleural effusion (fluid), pneumothorax (air)
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What is pneumothorax?
Presences of air/gas in pleural space
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What are the 3 types of pneumothorax?
Tension: increased pressure
Open: pressure equal with outside environment (e.g. stab wound)
Iatrogenic: occurs with open chest surgery
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What is microatelectasis?
Generalized loss of lung expansion
Decreased surfactant
Neonatal resp. distress syndrome
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What is contraction atelectasis?
Occurs with fibrotic changes (wound healing) in the lung/pleura and make expansion difficult
Not reversible!
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What is aspiration?
Passage of fluid and/or solid particles into the lung.
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Where to particles typically lodge with aspiration?
Lower lobe of r. lung if upright.
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What are some predispositions for aspiration?
Impaired swallowing mechanism
Impaired cough reflex
Alt. level of consciousness
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What are the different types of aspiration?
Foreign body
Large food particles
Acidic gastric fluid
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What is the complication associated with aspiration?
Aspiration pneumonia
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What are 4 different chest wall restrictions?
Obesity
Skeletal disorders (kyphoscoliosis)
Neuromuscular disease ( myasthenia gravis, muscular dystrophy, spinal cord trauma)
Flail chest
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