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define dyspnea
subjective sensation of uncomfortable breathing
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subjective sensation of uncomfortable breathing when in horizontal position
orthopnea
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define paroxysmal nocturnal dyspnea
Wake up at night gasping for air and have to sit up or stand for relief
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paroxysmal nocturnal dyspnea is seen with what?
L ventricular failure
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increased ventilatory rate, very large tidal volumes, no expiratory pause.
kussmaul respirations (Hypernpnea)
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kussmaul respirations happen in
- strenuous exercise
- metabolic acidosis
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Hypoventilation
inadequate alveolar ventilation r/t metabolic demands
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hypercapnia
CO2 removal does not keep up with production and CO2 rises in blood
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Hyperventilation
alveolar ventilation that exceeds metabolic demands
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lungs remove C2 at a faster rate than it is produced; means low levels of CO2 in blood
hypocapnia
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hemoptysis
coughing up blood or bloddy secretions
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Cyanosis
decreased arterial oxygenation or decreased cardiac output
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bulbous enlargement of the end of the finger or toe
clubbing
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hypoxemia happens when?
- high altitude
- hypoventilation
- emphysema
- atelectasis
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________ caused by fracture of ribs or sternum
flail chest
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air or gas in pleural space collapses the lung partially or totally caused by rupture of pleura or spontaneous rupture of pleural bleb
pneumothorox
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collapse of lung tissue
atelectasis
caused by external pressure from tumor, fluid, or air in pleural space
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persistent abnormal dilation of bronchi
bronchiestasis
caused by obstruction of airway, atelectasis, infection
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fibrous tissue or nodule in lungs
pneumoconiosis
caused by silicosis, anthracosis (inhalation of coal dust), and asbestosis
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excess water in lungs
pulmonary edema
caused by heart disease that increases pulmonary capillary hydrostatic pressure, ARDS or inhalation of toxic gases that injure capillaries and increases permeability, or blockage of lymphatic vessels by CHF
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s&s of ARD
- Tachypnea
- Dyspnea
- Retractions
- Hypoxia
- Tachycardia
- decreased pulmonary compliance
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ABGs of ARDS
- decreased Po2
- Increased Dyspnea
(Pt is NOT getting better even with increased flow rate of oxygen)
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Causes of ARDS
- Trauma
- Pulmonary infection/aspiration
- Prolonged cardiopulmonary bypass
- Shock
- Fat emboli
- Sepsis
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What does ARDS look like?
white lung
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What is asthma
- acute
- intermittent bronchial inflammation
- smooth muscle spasm
- mucosal edema
- increased thick mucus production cause airway obstruction
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What is emphysema
- enlargement and destruction of alveoli
- loss of elasticity
- trapping of air during expiration causes airway obstruction
Risk factors: Alpha-1 antitrypsin deficiency and cigarette smoke
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Chronic bronchitis
inflamed and thick mucus membrane, impaired cilia
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Fungal
- infrequent
- can occur in immunosuppressed
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Community acquired
most common cause is strep pneumonia, lobar pneumonia
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Pneumonia
acute inflammation of lower respiratory tract caused by microorganisms
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Nosocomial pneumonia
staphylococcus aureus and Klebsiella pneumonia, usually in pts with other health problems such as COPD
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pneumococcal pneumonia
involved lobe has 4 phases of inflammatory response
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Phases of pneumococcle pneumonia
Phase 1- CONSOLIDATION: solidification of the tissue caused by filling with exudate
Phase 2: STAGE OF RED HEPATIZATION: alveoli fill with blood cells, fibrin, edematous fluid and pneumocci. Lungs look red
Phase 3: GRAY HEAPTIZATION: affected tissue becomes gray b/c of fibrin and neutrophils in consolidated alveoli. phagocytosis taking place
Phase 4: RESOLUTION: increasing numbers of machrphages appear in alveolar spaces, neutrophils degenerate, fibrin threads and bacteria digested. Removed lymphatic vessels
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Tuberculosis is caused by
- aerobic mycobacterium tuberculosis
- -acid-fast bacillus
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TB usually affects
lungs but may invade other body systems
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TB has ceseation necrosis, which is
infected tissues within the tubercle die and form a cheeselike material
collagenous scar then forms
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Pulmonary vascular diseases
Disrupt blood flow through the lungs by occluding blood vessels, increase pulmonary vascular resistance, or destroy vascular bed
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caused by blood-borne substances from venous stasis in legs, vessel injury, or hypercoagulation lodge in a branch of pulmonary artery and obstructs blood flow to lung parenchyma
embolism
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PA pressure elevated by increased Left atrial pressure, increased blood flow in pulmonary circulation
Pulmonary hypertention
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Pulmonary hypertension symptoms
- englarges PA and right ventricle hypertrophies on x-ray or EKG
- JVD
- Fatigue
- CP
- Tachypnea
- DOE
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COR pulmonale
- R heart failure b/c of primary
- pulmonary disease and long-standing pulmonary HTN
- secondary heart sound or closure of pulmonic valve accentuated
- tricuspid valve murmur
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Lip cancer
more prevalent in men exposed to sun, wind, cold over years
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Laryngeal cancer
increased risk by tobacco smoked, increased when combined with alcohol consumption
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Lung cancers or bronchogenic carcinomas arise from
epithelium of respiratory tract
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adrenocarcinoma
moderate growth rate, early metastasis
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squamous cell carcinoma
slow growth rate, late metastasis
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Large cell undifferentiated carcinoma
rapid growth rate, eartly and widespread metastasis
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Small cell (oat cell) carcinoma
very rapid growth rate, very early metastasis to mediastinum or distally to lung
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