Cardio Exam 1

-Pathology/pathophysiology (disease, disorder,or condition) in the following systems ( cardiovascular, multiple systems)

-Impairments in the following categories ( circulation, ventilation and respiration/gas exchange)

-Functional limitations in the ability to perform actions,tasks, and activities in the following categories (self care, home management)

-Disability – the inability or the restricted ability toperform actions, tasks, or activities within theindividual’s sociocultural context – in the following categories ( self-care, home management)

3 right ( upper, middle, lower)

2 left (upper, lower)- lingual

lower lobe is most of posterior view

air enters and filters

warms it, humidify it

musculomembraneous tube

• 3 parts:
• -nasopharynx
• -oropharynx
• -laryngopharynx

cartilaginous framework 

composed of the thyroid, cricoid,and the epiglottis cartilages

Extends anteriorly from thelaryngopharynx between thegreat vessels of the neckdownward to the trachea

Tube about 4 inches long and aninch in diameter consisting ofcartilaginous rings

Point of bifurcation into right andleft mainstem bronchi

"Y-shaped" split

the right mainstembronchi is most direct–

Right is wider andshorter than the leftmainstem bronchi.

where the actualexchange of gases (O2and CO2) occurs

– True Ribs (1-8)

– False Ribs (9-10)

– Floating  Ribs (11-12)

obstructive dysfunction

restrictive dysfunction

number of diseases can be both

If the flow of air is impeded, the defect is obstructive

bronchi, tracheae,bronchus, etc.cold, bronchitis

If the volume of air or gas is reduced, the defect is restrictive 

gas exchange

Restriction of the lung parenchyma (lung tissue) characterized by stiffness or reducedcompliance

Reduced lung volume

abnormal pulmonary ventilation

• dec. chest wall compliance
• dec. lung volumes
• incr. respiratory rate

• Hallmark symptoms include:
• – Dyspnea – shortness of breath
• – Wasted, emaciated appearance
• Pulmonary fibrosis is most commonly associated with RLD

V/Q ratio is low

• Cough, usually dry-sounding and nonproductive
• Tachypnea – fast rate of breathing

Hypoxemia


Corpulmonale- right sided heart failure

• Respiratory Distress Syndrome (RDS) orhyaline membrane disease (HMD)
• – a disorder of prematurity or lack of complete lung maturity.
• Infants of less than 36 weeks gestation often exhibit  ( surfactant - developed at 36 weeks- keeps alvelois open- not from collapsing)

Ventilatory dependent infants can alsodevelop RLD. ( higher risk for developing fibrotic lungs if on ventilators too long)

accumulation of fluidwithin the pleural space

in lung lining

an increase in theamount of fluid within the lung. First the fluidis in the interstitium, then the alveoli

in lung tissue

severe back/upper thoracic pain

• Bronchial hygiene techniques
• – Breathing exercises
• – Coughing techniques
• – Respiratory muscle training
• – Chest mobility,
• posture exercises
• – Exercise training

obstruction to airflow

This affects both the mechanical function and gas exchangingcapability of the lungs.- poor difussion

• Chronic, productive cough–
• Wheezing (expiratory sound)
• – Dyspnea on exertion (DOE)

cilia are dying

expiratory flow rates ( FEV1)- increase

 residual volume (RV)- increase

• Increased mucus production (or impairment of mucusclearance)
• – Inflammation of the mucosal lining of the bronchi andbronchioles
• – Changes decrease the size of bronchial lumen and increaseresistance to airflow.
• – Loss of normal elastic recoil of lung tissue
• – Tendency of bronchial walls to collapse and trap air
• – Over time, entire lung becomes hyper-inflated.

• Long-term irritation of lining of the tracheobronchial tree
• -Inflammation of the lining
• – Hypersecretion of mucous and destruction of cilia
• Chronic productive cough.
• – Smoke irritation of airways produces bronchoconstriction.
• – Hypoxia _ pulmonary vasoconstriction _ increased pulmonarypressures _ increased workload of RV _RV hypertrophy (RVH)

• • Repeated inflammation ofthe bronchial tubes or airpassages
• • edema, inflammation, andbronchial dilation
• • destruction of respiratorybronchioles and alveolarwalls
• • bronchiolar collapse duringexpiration.

increased airway resistance and decreased lung elastic recoil

decreased elastic recoil of lungs

• Dyspnea
• • Cough
• • Diminished nutritionalstatus,
• weight loss
• • Possible spontaneouspursed-lip breathing
• • Distant breath sounds, especially at bases
• • Prolonged expiration
• • Possible end expiratory wheeze, especially on forcedexpiration.
• • Later: signs and symptoms of cor pulmonale
• • “pink puffers” due to increased work of breathing tomaintain relatively normal ABGs.

• Increased airwayresistance
• • increased WOB
• • increased V/Qmismatching
• • Possibility of respiratorymuscle fatigue
• • respiratory failure

The most common lethal genetic disease in children

• Characterized by exocrine gland dysfunction
• – involving almost every body system
• – thick, excessive secretions
• – abnormal ciliary function
• – GI (pancreatic enzyme deficiency)
• – integumentary (increased secretion of highly ionized sweat) systems
• – poor growth and weight gain

develop chronic obstructive lung disease

A chronic lung disease of infancy- destroy lung tissue b/c air being forced into lungs on ventilator is too fast and too strong

oxygen dependency lasting beyond 1 month of age

• Obstructive-Restrictive disorder
• • Inflammation of the lungparenchyma
• • Caused by– Bacteria– Viruses– Damage to the lungs (rare)
• • Creates an immune response

• Bronchial obstruction
• • bronchial dilationwith inflammation
• • increasedintrathoracicpressure required to
• over come increased resistance
• • dilation of airway
• • eventual atelectasis ( alveolar collapse)

• increased hypoxia
• prolonged bronchial obstruction

• – widening intercostal spaces
• – flattening of the diaphragm,
• – squared off costophrenic angles
• – rib angles that approach 90 degree angles

Indications:– individuals with abnormal chest x-rays shownodule or mass

May show: an enhanced picture of the massprior to surgical resection or biopsy.

May help to distinguish between a fibrosisand nodule.

study of abnormal variationsin anatomy, or grosspathological changes in thebronchial wall and lumen

indications:evaluation of congenitalanomalies, bronchiectasis

inspectionof the interior of thetracheobronchial treethrough a bronchoscope

PaC02 decreases- Respiratory Alkalosis


PaC02 increases- Respiratory Acidosis

metabolic involvement

• Tracheas shifts away from affected side
• Pneumothorax (fluid/air in part of lung)• Tumor• Pleural Effusion

• Toward the affected side:
• • Atelectasis (collapse lung)

• Absorption
• – Distribution
• – Metabolism
• – Elimination

• mechanism of action
• drug concentraion

drug effect- cellular, systemic

50% of the populationresponds in the expectedway

dose where 50% of thepopulation exhibit toxiceffects

Range of effectiveness– Potency

Within the (ANS), there aretwo nucleotides associatedwith smooth muscle tone - cAMP, cGMP

– responsible for smooth musclerelaxation or bronchodilation

– as well as inhibition of mastcell

– increase in cGMP causes smooth muscle contraction or bronchoconstriction

– the release of histamines andother mediators may also beenhanced by increasing cGMPbronchoconstriction

• Beta 1- heart
• Beta 2- lungs, if stimulated increase cAMP- increase bronchodilation
• Alpha- if stimulated- decrease cAMP and inc cGMP- increase brochoconstricion

causes contraction of bronchial smooth muscle and the myocardium

receptors stimulatecardiac tissue

cause relaxation of bronchial smooth muscle

• – have no alpha-receptor activity
• – more specific beta 2 receptor activity

both are sympathomymemtic- mimic sympatheticnervous system

• – produce bronchiolardilation by relaxing bronchial smooth muscle
• – dilating effects of increased cAMP levels.

both are sympathomymemtic- mimic sympatheticnervous system

• Medication is inhaled
• increases the diameter of the lumen of a bronchus
• side effects are less severe

• Positive effects on exercise:
• -Bronchodilation, increased strength of diaphragm, decreased dyspnea, improved exercise tolerance, improved ventilation

• Negative effects on exercise:
• -Tachycardia, chest pain, palpitations

improves quality of life not survival rate

• Bronchodilator
• Competitive inhibition of muscarinic cholinergic receptors
• Blocks acetylcholine at parasympathetic sites in bronchial smooth muscle
• May block reflex bronchoconstriction
• Side Effects: headache, nervousness, nausea, dry mouth, cough, nasal dryness

Drugs that stimulate the sympathetic receptors

• Response varies depending on
• -the intensity of the receptor reaction, the route of administration, the dosage 

Epinephrine and ephedrine- stimulates alpha, beta 1 and beta 2 receptors

Mediate bronchodilation & vasodilation

Bronchodilation of smooth muscle of the airways

Increases cAMP- results in smooth muscle relaxation, mast cell stabilization

Reduce vasoconstriction and bronchoconstriction

Inhibit the decrease of cAMP

work to inhibit parasympathetic stimulation-preventing an increase in cGMP, thus producing an increase in cAMP

Bronchodilation

act by suppressing the immune system

More for preventive measures

No effect for immediate relief of asthma attack

• LABD
• Intracellular level of cAMP enhanced by inhibiting its degradation process
• Blocks inactivation of cAMP
• Inhibits prostaglandins, adenosine receptor blockade
• Enhances of endogenous catecholamine levels
• Inhibit cGMP and enhancement
• Improved diaphragmatic contractility & ↓ diaphragmatic fatigue

• SABD
• Mechanism of Action (Hypothesized)-Suppresses the process of IgE-mediated bronchoconstriction- Blocks or inhibit many mediator substances.

Considered the drug of choice during an acute attack

methyprednisolone-usually administered intravenously-severe episodes

Oral (prednisone) or inhaled route- prolonged used, fewer side effects

Leukotriene: strong inflammatory mediators

• induce bronchoconstriction
• increase airway hyper-responsiveness
• cause smooth muscle hypertrophy
• mucus hypersecretion
• influx of eosinophils into airway tissues

inhibition of the action of leukotrienes

• taken orally and are combined with other drugs
• Side effects: hepatic impairment, headaches, fatigue, nausea, and vomiting

• Reduce edema and discharge in upper respiratory tract
• Stimulate vasoconstriction
• Positive effects on exercise
• Allow for increased respiratory ability
• Negative effects on exercise
• Hypertension, palpitations

• Treat allergic responses caused by seasonal allergies
• Decrease mucosal congestion, irritation and discharge
• Positive effects on exercise
• Improved air flow to and from the lungs
• Negative effects on exercise
• Fatigue, loss of coordination

• Decrease ineffective, hacking cough
• -blocks receptors in the brain that control cough
• Positive effects on exercise
• -Allow for breathing with decreased irritation, therefore and increased ability to exercise
• Negative effects on exercise
• -Decreased motivation for physical activity

Increase movement and removal of lung secretions

• Positive effects on exercise
• -Less mucus in lungs-therefore increased surface area

• Negative effects on exercise
• -Bronchospasms▪decrease the flow of air to and from the lungs
• -Coughing▪limiting a person’s activity level

Increase output of central respiratory centers

Analeptics

Positive effects on exercise- Increase available oxygen to body

Negative effects on exercise-May cause hyperventilation-decreased respiratory capacity-convulsions