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Hypoventilation
–Leads to hypercapnia and hypoxemia
–Caused by certain drugs, disorders such as obesity, myasthenia gravis, chest wall damage, or paralysis of respiratory muscles
the delivery of air to the alveoli is insufficient this deficieny leads to hypercapnia (increase CO2 in blood) and hypoemia (decrease in O2 in blood)
Your not blowing out CO2 so it builds up the increase in alveolar CO2 displaces the O2, contributed to obesity
Myasthenia gravis: a breakdown of the motor end plate of the muscle is gone lossing muscle control causeing hypoventilation
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Hyperventilation
–Leads to hypocapnia
–Caused by hypoxia, pain, fever, or anxiety
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Hypoxemia
decrease O2 in blood
–Caused by high altitude, hypoventilation, and airway obstruction
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Hypoxia
decreased O2 in tissues
–Caused by high altitude, hypoventilation, and airway obstruction
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Acute Respriatory Failure
–Disturbed gas exchange resulting in abnormal arterial blood gas levels
–Hypoxemia develops because of mismatched perfusion and ventilation
- –Hypercapnia develops due to
- inadequate alveolar ventilation
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Manifestations of Acute respiratory failure
pt becomes confuesed not enough o2 to brain, dizziness, depressed conciousness, tremors, pt will attempt to take in O2 àtachypnea, increased HR, whenever you have decreased O2 tension àvasodilation àhypotension
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Pulmonary hypertension
occurs with any condition that increases the resistance of the pulmonary vasulature also related to cardio genic
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Primary pulmonary Hypertension
Idopathic not sure what causes it but associated with it are serosis of the liver, appetite supresive drugs, seen in HIV, rapid progression and prognosis poor, more common in women
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Secondary Pulmonary Hypertension
Most commonly due to increased airway resistance, as in chronic bronchitis and advanced emphysema
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Pulmonary Venous Thromboembolism
coming from DVT and increase in pulmonary pressure -->right sided HF
- PE: pts will presetn with tachycardia and pnea, severe chest pain may or may not occuring with very large PE,
- SOB -->very anxious and restlessness, symptoms of RHF (kussmals sign-disteneded superficial jugular vein, peripheral edema, spleenomeglia)
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Four major types of carcinomas
- Squamous cell carcinomas
- Adenocarcinoma
- Large cell carcinoma
- Smalle cell carcinoma
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Squamous cell carcinoma
Metastasizes to regional lymph nodes
- common can b detected by ctyological examination of
- sputum. Propensity to mestastisize to regional lymph nodes
develop in bronchial tree
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Adenocarcinoma
Metastasis occurs in distant organs
located in the perphery of the lungs no easily detected
causes increased sputum
develops in parenchyma
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Large cell carcinoma
Metastasis occurs in distant organs
develops in parenchyma
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small Cell carcinoma
worst type and resistant to treatment, grows rapidly
widespread metastasis is common
mutates a lot causing more and more resistance to the intervention used
develops in the bronchial tree
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Obstructive Pulmonary disorder
Obstruction from conditions of the wall of the lumen
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Asthma
Most common chronic disease in childhood
Lung disease characterized by
-Airway obstruction, usually reversible
-Airway inflammation
-Increased airway responsiveness to stimuli
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Exercise induced asthma
common in children often related to heat loss and water loss more common in winter lack of humidity
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Drug induced Asthma
associated with aspirin (affects the cygooxynase cycle so that gets kicked out to ipooxygenase pathwayà increase din leukitrine production, NSAIDs,
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Asthma episode may range in severity from
mild to life threatening depending on the degree of airway obstruction
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Acute Bronchitis
- Acute inflammation of trachea and bronchi, typically caused by viruses (influenza virus A or B, parainfluenza virus, rhinovirus, etc.) and bacteria (Streptococcus
- pneumoniae, Haemophilus influenza, etc.)
Heat, smoke inhalation, inhalation of irritant chemicals, and allergic reactions can also induce acute bronchitis
Cough and a low grade fever, bronchi and trachea bc obstructed complaining of dyspnea and chest pain
Considered more dangerous in children bc of the smallness of their airways and a smaller diameter but evquivelant response
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With Acute Bronchitis airways can be inflammed causing it bo become narrow in 4 diff ways
- 1. capillary dilation
- 2. increased exudation of fluid
- 3. increased mucus secreations
- 4. loss of mucilary cilliary esculator
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Chronic Bronchitis (Type B COPD)
- Presistent narrowing of the airways, due to chronic inflammation, excessicve mucsous production (lining
- the bronchi) leading to poor ventilation and poor gas defrusion
Major cause is cigarette smoking (paralyzing mucous cilliary esculator à> repeated airway infection
Remaining cause is inhalation of chemical irritants
Key is chronic obstruction
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Clincal manifestations of chronic bronchitis
- excess body fluid (edemal plethora)
- Chronic cough
- SOB on exertion
- increased sputum
- cyanosis (late sign)
"blue bloaters"
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Alveolar hypoxia leads to
generalized pulmonary vasoconstriciton, pulmonary hypertension and right ventrivular hypertrophy (cor pulmonale)
right sided HF may occur bc of the high pulmonary resistance
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Emphysema Type A COPD characterized by
by destructive changes of the alveolar walls and abnormal enlargement of the distant air sacs
Cigarette smoking is a major cause of emphysema
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emphysema develops over a ...
long period and is seen more frequently in persons older than 50
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Pathologic changes of emphysema are characterized by
alveolardestruction associated with the release of proteolytic enzymes from inflammatory cells (neutrophils and macrophages)
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Pathologic changes of emphysema are characterized by
alveolar destruction associated with the release of proteolytic enzymes from inflammatory cells (neutrophils and macrophages)
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With the loss of alveolar wall, in emphysema there is a marked
reduction in the pulmonary capillary bed and a decrease in overall gas exchange
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Emphysema is due to ...
due to alastic in alveolar walls in broken down when inhale there is no elastic in there to bring it back to normal size resulting in abnormal size in lungs
- Elsatic fibers also keep the small airways open, when lungs expand the lungs stretch and expands and the
- elastic fibers are pulled in all direction and small airways are collapsed à the obstruction is they cant get the air out staying in the lungs, lost radial traction and that’s what keeps the small airways open
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Clincal manifestations of Emphysema
- use of accessory muscles to breath
- pursed lip breathing
- minimal or absent cough
- leaning forward to breathe
- barrel chest
- digital clubbing
- dyspnea on exertion
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Bronchiectasis
Characterized by recurrent infection and inflammation of bronchial walls, leading to persistent dilation of medium-sized bronchi and bronchioles
recurrent infection inflammation --> a lot of purulent exudate (puss and foul smell yellow greenish)à airway obstruction
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Bronchiolotis
wide spread inflammation of bronchials, due to respiratory sincidial virus or influenza virus,
- what happens is the obstruction is due to inflammation associated with a inflammatory exudateà releaseing inflammatiory mediateorsà broncho constriction and
- fibrosis
- -obstruction typically takes place in the
- smallest broncials
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Cystic Fibrosis (CF)
Autosomal recessive disorder of exocrine glands
CF gene on chromosome 7, mutation in gene for transmembrane conductance regulator, which is involved in Chloride ion transport
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what does CF affect
- CF affects lungs (hypersecretion of thickened mucus), intestinal tract (excessive mucus secretions),
- sweat glands (high salt content in sweat) and pancreas (decreased production of pancreatic enzymes)
Heart-lung or lung transplantation is the only definitive treatment
first sign in children is said to have a salty kiss (bc chloride isnt working)
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Acute Tracheobroncial Obstruction
Requires immediate treatment
Causes include aspiration of a foreign body, laryngospasm, trauma, epiglottitis, swelling from smoke inhalation, etc.
can be complete or partial
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Acute tracheobronchial obstruction Complete happens in the
trachea or larnex
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Actue trachobronchial obstruction Partial or incomplete occurs in the
typically in bronchi usually one bronchi often times the right bronchus
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Epiglottitis
- Rapidly progressive cellulitis of the epiglottis
- and adjacent tissues
Typically caused by H. influenzae
Most often seen in children 2 to 4 years of age
Difficulty swallowing saliva with evidence of drooling is common
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Croup Syndrome
A number of acute viral inflammatory diseases of the larynx
Typically occur in late fall and early winter and affect children from 6 months to 3 years of age
typically present w/ a barking cough and stridor
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