ABSN Exam 3 Objectives - Spring 2025 - Respiratory & Cardiovascular Key Terms PDF

**[Respiratory Key Terms]** Acute respiratory distress syndrome (ARDS) Life-threatening lung condition that causes severe difficulty breathing. Occurs when fluid builds up in the alveoli of the lungs, preventing the exchange of oxygen and CO2. Diffusion The process of moving and exchanging the o...

**[Respiratory Key Terms]** Acute respiratory distress syndrome (ARDS) Life-threatening lung condition that causes severe difficulty breathing. Occurs when fluid builds up in the alveoli of the lungs, preventing the exchange of oxygen and CO2. Diffusion The process of moving and exchanging the oxygen acquired during ventilation with carbon dioxide waste across the alveolar-capillary membranes. Peripheral cyanosis Bluish discoloration of the skin on the extremities, like the hands, fingers, toes, caused by poor blood circulation and a lack of oxygen-rich blood reaching those areas. Adventitious breath sounds Abnormal lung sounds that are heard in addition to the usual breath sounds. Dyspnea Shortness of breath or difficulty breathing. Phlegm Thick mucus produced by the lungs and upper airways that can be coughed up. Air trapping Abnormal condition where the lungs are unable to fully exhale air. Causes excess build-up of air within lung tissue that leads to shortness of breath and chest tightness Emphysema Chronic lung disease that damages the air sacs (alveoli) in the lungs. Causes alveoli to lose their elasticity and become enlarged, making it difficult to breathe Pleural effusion Condition where an abnormal amount of fluid builds up in the space between the lungs and chest wall. (aka pleural space) Airway remodeling Persistent structural changes in the airways that occur in response to chronic inflammation and injury Exercise-induced asthma (EIA) A condition that causes the airways to narrow during physical activity. Pleural friction rub Rough, grating sound in the chest that indicates inflammation of the pleura, the tissue lining the lungs. Alpha-1 antitrypsin (AAT) Protein that is produced primarily in the liver and plays a crucial role in protecting the lungs. Expectorate To eject mucus, sputum, or fluids from the respiratory tract by coughing or clearing throat. Pneumonia Infection of the lungs that causes inflammation of the air sacs (alveoli) Leads to accumulation of fluid and pus in the lungs, which can make breathing difficult. Anoxia An abnormal condition characterized by the total lack of oxygen Expiration Exhalation of breath Pneumothorax Condition where air enters the space between the lung and chest wall. Trapped air puts pressure on the lung, preventing it from expanding properly. Aspiration The accidental inhalation of foreign materials, such as food, liquids, or saliva into the lungs Fibrosis Condition where excessive fibrous connective tissue (scar tissue) builds up in an organ or tissue Pulmonary edema Condition where excess fluid accumulates in the lungs, making it difficult to breathe Aspiration pneumonia A type of lung infection that occurs when food, liquid, or vomit enters the lungs instead of the stomach. Forced expiratory volume in 1 second (FEV1) The amount of air a person can forcefully exhale in the first second during a lung function test. Pulmonary embolus Condition where a blood clot (embolus) travels to and blocks one or more arteries in the lungs. Asthma Chronic lung condition that causes inflammation and narrowing of the airways making it difficult to breathe. Forced vital capacity (FVC) The maximum amount of air a person can forcefully exhale from their lungs after taking the deepest breath possible. Pulsus paradoxus Abnormally large drop in the systolic blood pressure that occurs during inhalation. Typically indicates serious heart or lung condition. Atelectasis Partial of complete collapse of the lung Gastroesophageal reflux (GER) When stomach content moves up in the esophagus. (heartburn) Pursed lip breathing Breathing technique where you inhale slowly through nose and exhale slowly through pursed lips (blowing out candle) Atopic Genetic predisposition towards the development of hypersensitivity or an allergic reaction to common environmental allergens. Hemoptysis The coughing up of blood or bloody mucus from the respiratory tract, which includes the lungs and throat. Residual volume (RV) The amount of air that remains in the lungs after a maximum forceful exhalation. Atypical pneumonia A type of lung infection caused by bacteria or viruses that are different from the more common bacteria that cause typical pneumonia Hepatization Process that occurs in the lungs when lung tissue is converted into a solid, liver-like substance Resistance Opposition to airflow through the airways, essentially the friction encountered by air as it moves in and out of the lungs. Auscultation Method used to listen to the sounds of the body during a physical examination by using a stethoscope. Hyaline membrane Layer of dead cells and proteins that lines the alveoli of the lungs. Respiration The exchange of oxygen and carbon dioxide (breathing) Barrel chest Abnormal rounding of chest cavity. Ribs become fixed in an expanded position. Hypercapnia A condition in which there is an excessive amount of carbon dioxide in the bloodstream Respiratory failure Condition where lungs are unable to get enough oxygen into your blood and remove enough carbon dioxide. Bronchiectasis Damage to the bronchial tubes due to inflammation Hypoxemia Condition where there are low levels of oxygen in the blood. Retractions The inward pulling of the skin and soft tissues between the ribs or in the neck during inhalation. Indicates struggle to breathe. Capillary refill A clinical measurement that assesses how quickly blood returns to the capillaries after pressure is applied. Hypoxia Condition where the body tissues do not receive enough oxygen Sepsis Life-threatening conditions occur when the body's immune system overreacts to an infection. Central cyanosis Generalized bluish discoloration of the body and visible mucous membranes Impaired diffusion Condition that occurs when the exchange of gases in the lungs is not efficient Sputum Thick, sticky fluid that is produced in the lungs and airways Centriacinar emphysema Chronic lung disease that damages the respiratory passageways in the upper lobes of the lungs. Insidiously Any disease that comes on slowly and does not have obvious symptoms at first. Status asthmaticus Severe, life-threatening asthma attack that doesn't respond to standard treatments. Causes significant difficulty breathing and requires immediate med attention. Chemoreceptors Specialized sensory cells that detect chemical changes in the body or environment. Inspiration Inhalation of breath Surfactant Chemical compound produced by type II alveolar cells in the lungs. Reduces surface tension between two substances. Chronic bronchitis Long-term lung condition that causes inflammation in the airways of the lungs. Mechanical ventilation Use of a ventilator to assist or fully take over the process of breathing when one is able to breathe adequately on their own. Systemic inflammatory response syndrome (SIRS) Body-wide inflammatory response triggered by a harmful stressor like infection, trauma, surgery, or acute inflammation. Chronic obstructive pulmonary disease (COPD) Ongoing lung condition caused by damage to the lungs that results in difficulty breathing. Characterized by ongoing inflammation and narrowing of the airways. (\#1 cause=smoking) Mucus plugs Mucus that accumulates in the lungs can plug up or reduce airflow in the larger or smaller airways. Tidal volume (TV) The amount of air that moves into and out of lungs during a breath. Clubbing Physical sign that causes the ends of the fingers or toes to enlarge and appear bulbous. Nosocomial Healthcare associated infections (HAI) or Infection acquired in a hospital or healthcare setting while receiving care. Total lung capacity (TLC) The maximum volume of air that the lungs can hold after a full inhalation. Compliance The ability of the lungs and chest wall to stretch and expand, or their distensibility. Orthopnea Shortness of breath that occurs when lying down or reclining. Relieved by sitting up. Type I alveolar cells Flat, thin, squamous cells that line the lungs alveoli and are responsible for gas exchange. Consolidation When the normal, air-filled spaces of the lungs (alveoli) become filled with products of disease. (fluid, pus, blood) Oxygen saturation (SaO~2~) The percentage of hemoglobin in the blood that is bound to oxygen. How much oxygen the blood is carrying. Type II alveolar cells Cells found in the alveoli of the lungs play a vital role in lung function and repair. Responsible for producing and secreting surfactant. Cor pulmonale Medical condition that causes the right side of heart to enlarge and fail. AKA right-sided heart failure or pulmonary heart disease. Oxyhemoglobin (HbO~2~) A molecule in the blood that is formed when oxygen fully binds to hemoglobin. Typical pneumonia Lung infection that causes inflammation of the alveoli which can fill up with fluid or pus. Include cough with phlegm, fever, chills, and difficulty breathing Costochondritis Inflammation of the cartilage that connects the ribs to the breastbone (sternum) PaO~2~ A measurement of the pressure of oxygen in the blood. How well oxygen is able to move from the lungs to the blood. Ventilation The process of moving air in and out of the trachea, bronchi, and lungs. Crackles Short, explosive, discontinuous lung sounds that are often associated with pulmonary disorders. (short interrupted breath sounds) PaCO~2~ Partial pressure of carbon dioxide evaluates carbon dioxide levels in the blood. Ventilation-perfusion (V/Q) mismatching Situation where the amount of air reaching the alveoli doesn't match the amount of blood flowing through the capillaries surrounding the alveoli. This results in inefficient gas exchange and potentially low blood oxygen levels. (hypoxemia) Cyanosis Bluish-purple discoloration of the skin, lips, or nail beds caused by a lack of oxygen in the blood. Panacinar emphysema A type of emphysema that destroys the air sacs in the lungs, causing the air spaces to enlarge. Vital capacity (VC) The maximum amount of air that a person can exhale from their lungs after taking a deep breath. Cystic Fibrosis (CF) Genetic disorder that affects the body's mucous producing glands. This causes the body to produce thick, sticky mucus that clogs the airways, pancreas, and other organs. Partial pressure The pressure exerted by oxygen molecules within a mixture of gases. Diffusing capacity A measure of how well the lungs move gas from the air into the blood Perfusion The process of supplying oxygenated blood to the lungs and organ systems via the blood vessels. **[Respiratory Objectives (Chapters 29-31)]** 1. **Define ventilation, diffusion, perfusion, and respiration.** - **Ventilation:** The process of moving air into and out of the trachea, bronchi, and lungs - **Diffusion:** The process of moving and exchanging the oxygen acquired during ventilation with carbon dioxide waste across the alveolar-capillary membranes. - **Perfusion:** The process of supplying oxygenated blood to the lungs and organ systems via the blood vessels. - **Respiration:** The process in which cells throughout the body use oxygen aerobically to make energy. 2. **Identify the defense mechanisms designed to protect the lungs from environmental injury.** - **Protective structures:** - Hairs and turbinates (shell-shaped) structures in the nose - Cilia in the upper and lower airways -- trap and remove foreign particles from the air - **Mucosal Lining:** - Upper and lower airways -- warms and humidifies air - **Irritant receptors:** - Throughout the nose and airways -- recognize injurious agents and respond by triggering a sneeze or cough reflex to remove foreign particles. - **Immune protections** - Such as the immune coating in the respiratory tract mucosa and macrophages in the alveoli -- ingest and remove bacteria and other foreign materials via phagocytosis - **Intercostal muscles and ribs** - Surround the lungs -- providing protection against injury. 3. **Explain the role of ventilation and diffusion in oxygen/carbon dioxide gas exchange.** - Ventilation is the process of acquiring oxygen through inspiration and removing carbon dioxide through expiration from the blood. - Chemoreceptors help control the amount of oxygen and CO2 during ventilation. If blood is more acidic, respiratory center increases rate and depth to blow off excess CO2. If blood is more alkaline, respiratory center decreases rate and depth of breathing to retain CO2. - Diffusion is how oxygen and CO2 are exchanged at the alveolar-capillary junctions. Two major processes occurring simultaneously during diffusion: - Oxygen is trying to get to all cells - CO2 is trying to escape the body through the lungs 4. **Explain the process of inspiration and expiration and their purpose.** - Inspiration = the process of acquiring oxygen - Expiration = the process of removing CO2 5. **Identify the measurements of ventilation that can determine the effectiveness of inspiration and expiration (tidal volume, vital capacity, forced vital capacity, forced expiratory volume in 1 second, residual volume, total lung capacity).** - **Tidal volume (TV):** amount of air that is exhaled after a passive inspiration. This is the volume of air going in and out of the lungs AT REST. (Adults approx. 500mL) - **Vital Capacity (VC):** Maximum amount of air that can be moved in and out of the lungs with forced inhalation and exhalation. - **Forced Vital Capacity (FVC):** Maximum amount of air that is exhaled from the lungs during a forced exhalation. - **Forced Expiratory Volume in 1 second (FEV1):** The maximum amount of air that can be expired from the lungs in one second. - **Residual Volume (RV):** Volume of air that remains in the lungs after maximum expiration. - **Total Lung Capacity (TLC):** Total amount of air in the lungs when they are maximally expanded and is the sum of the VC and RV. 6. **Explain the role of diffusion, including partial pressure, oxygen diffusion and transport, carbon dioxide diffusion and transport, and diffusing capacity.** - Diffusion is the process of oxygen and carbon dioxide being exchanged at the alveolar-capillary junctions. - There are two major processes that occur simultaneously during diffusion: - Oxygen is trying to get to all cells - Carbon Dioxide is trying to escape the body through the lungs - Effectiveness of Diffusion depends on: - **Pressure**: Amt of partial pressure of Oxygen and CO2 in the blood. - **Solubility:** CO2 is much more soluble than oxygen; therefore, CO2 can diffuse at a greater rate than oxygen. - Membranes: The thickness and surface area of the alveolar and capillary membranes - **[Partial Pressure]**: Oxygen and CO2 particles are in constant collision. The force of these collisions results in the formation of pressure. - 1-3% of oxygen in blood as dissolved gas in plasma, creating pressure in plasma (aka PaO2) - Since there is no direct method to measure oxygen concentrations in the body, PaO2 gives a reasonable estimate of the presence of oxygen in blood based off pressure exerted by gas. - PaO2 and PaCO2 measured via ABG - **[Oxygen Diffusion and Transport]** - As PaO2 increases, oxygen dissociates from the plasma and connects with hemoglobin molecules in red blood cells. - Oxyhemoglobin (HbO2) = oxygen-hemoglobin combination - Iron is the magnet that pulls oxygen into the hemoglobin molecule - Binding by attraction continues until the hemoglobin molecules are completely saturated with oxygen - **[Carbon Dioxide Diffusion and Transport]** - One mechanism for ridding the body of excess acid is to free the CO2 into the bloodstream where it can travel to the alveoli and through the lungs for exhalation - CO2 moves easily across the alveolar-capillary membranes and diffuses more readily than oxygen - Transported in 3 different ways - Dissolved in Plasma (10%) - Bound to hemoglobin (10-30%) - Diffused into the red blood cells as bicarbonate (60-70%) - **[Diffusion Capacity:]** The measure of Carbon monoxide, oxygen, or nitric oxide transfer from inspired gas to pulmonary capillary blood and reflects the volume of a gas that diffuses through the alveolar-capillary membrane each minute. - The ability of the alveolar-capillary junction to exchange oxygen and carbon dioxide between the atmosphere and the blood 7. **Describe the processes that can impair ventilation and diffusion.** - **[Impaired Ventilation]:** A problem of blocking airflow in and out of the lungs, thereby restricting oxygen intake and carbon dioxide removal from the body. - 2 Major mechanisms that cause impaired ventilation - Compression or narrowing of the airways - Disruption of the neural transmissions needed to stimulate the mechanisms of breathing - Mechanical ventilation moves air in and out of the lungs of clients who can't breathe on their own - **Invasive Mechanical Ventilation** - Endotracheal tube - Tracheostomy tube - **Non-invasive Mechanical Ventilation** - Nasal Plugs - Face Mask - Helmet - CPAP: Same amount of pressure - BIPAP: Different Pressures - Compression or narrowing of the airways - Could be caused by inflammation, Edema, and exudate accumulation from an infectious process or a structural narrowing of the passageways due to strangulation or presence of foreign body. - Disruption of the neural transmission needed to stimulate the mechanisms of breathing - Causes: oversedation, drug overdose, damage to respiratory centers of the brain, cervical or thoracic nerves that lead to unresponsive or ineffective breathing patterns. - **[Impaired diffusion:]** process of restricting the transfer of oxygen or CO2 across the alveolar-capillary membrane. - Rate of diffusion depends on the solubility and partial pressure of the gas, and on the surface area and thickness of the membrane; impaired gas exchange can happen with changes in any of these properties. 8. **Identify adaptations in breathing patterns, including their descriptions and reasons for occurrence.** - **Eupnea:** Expected pattern of breathing characterized by a rate between 10-20 breaths per minute. - Effective and responsive gas exchange - **Tachypnea:** Rapid and shallow breathing characterized by a rate of breathing above 24 breaths/min - The body needs to release excess carbon dioxide and responds by increasing the rate of breathing. Expected response to fever, fear, or exercise. Can also occur with respiratory insufficiency pneumonia, or injury to respiratory centers. - **Apnea**: Cessation of breathing for 10 seconds or longer, usually interspersed with another breathing pattern - Can result from brain injury, premature birth, or as an obstructive process during sleep. - **Hyperpnea (Kussmaul respirations), Hyperventilation:** Increase in the rate and depth of breathing - Excess carbon dioxide needs to be released. This can occur with extreme exertion, fear, or anxiety, or with diabetes ketoacidosis, aspirin overdose, or brain injury. Hyperventilation blows off excessive CO2 causing a decreased level in the blood. - **Bradypnea, Hypoventilation:** Slow breathing with regular depth and rate. Hypoventilation refers to a decrease in inadequate ventilation. - Drug-induced depression of the respiratory centers increased intracranial pressure, diabetic coma. - **Cheyne-Stokes:** A breathing pattern that alternates hyperpnea in a crescendo-decrescendo patterns and periods of apnea. - Increased intracranial pressure, bilateral damage to breathing areas in the cerebral hemisphere or diencephalon, drug induced respiratory depression, heart failure, and uremia. - **Ataxic breathing:** A breathing pattern of unpredictable irregularity. Can combine any or all breathing patterns above. - Severe head trauma and damage to respiratory centers, brain abscess, heat stroke, spinal meningitis, encephalitis - **Obstructive breathing:** Prolonged and incomplete expiration to overcome increased airway resistance and air trapping. - Chronic obstructive lung disease, asthma, chronic bronchitis 9. **Explain the concept of impaired ventilation-perfusion matching, and why ventilation and perfusion must be matched.** - **Impaired ventilation:** Inadequate oxygen comes into the lungs even though the blood flow is ready and able to carry the oxygen that is present. - **Impaired perfusion:** Blood flow to the lungs is restricted in one or more areas. Oxygen may be coming into the body but there is not blood flow to carry this away to other body cells - Perfusion = blood flow - Areas of the lung can be ventilated but not perfused or vice versa. If they are not even, this is V/Q - This can occur when total ventilation and total perfusion are normal but not matched throughout the lungs. - Doesn't occur throughout the whole lung usually, instead occurs in different sections of the lungs. - Any diseases that alter ventilation or perfusion can cause V/Q - 10. **Recognize the effects of impaired ventilation and diffusion. (hypoxemia, hypoxia, hypercapnia)** - **Hypoxemia:** A condition where the amount of oxygen in the blood is lower than normal. This can be caused by a number of conditions, including pneumonia, COPD, and congestive heart failure. (heart and brain damage) - **Hypoxia:** A condition where the body's tissues don't have enough oxygen. This can occur when blood with low oxygen levels travels to the body's tissues (respiratory failure) - **Hypercapnia:** A condition where the amount of carbon dioxide in the blood is higher than normal - General manifestations of Impaired ventilation and diffusion - Local manifestations = those triggered in airways and lung tissues, most often related to inflammatory processes in response to injury. - Injury triggers vasodilation, increased capillary permeability, exudate formation, and pain in the affected regions of the airways, lungs, or chest cavity. - Cough, excess mucus, hemoptysis (coughing up blood), dyspnea, chest pain, barrel chest, pleural pain, costochondritis (inflammation of one or more costal cartilages), adventitious breath sounds - Systemic Manifestations: - Cyanosis, central cyanosis, peripheral cyanosis 11. **Identify the common signs and symptoms of altered ventilation and diffusion.** - **Cough** = with or without sputum - Acute cough: Lasts 3 to 8 weeks (viral infection, seasonal allergies, aspiration) - Chronic cough: Lasts beyond 8 weeks (asthma, gastroesophageal reflux, chronic postnasal drainage) - **Sputum =** expectorated material - Expectorate: condition observed by having patient expectorate or spit mucus from throat/lungs - Phlegm: Large amounts of sputum expectorated from the oropharynx - **Hemoptysis:** Coughing up blood from the respiratory tract, defined by presence of red blood cells in sputum. - Often significant. Can be caused by heavy exertion when coughing, TB, a tumor, or severe trauma - **Dyspnea:** The subjective feeling of shortness of breath or the inability to get enough air - Based on presence of hypoxemia, hypercapnia, and reduction in pH - **Chest Pain:** Can originate in the visceral and parietal pleura, the airways, or the chest wall. - Pleural pain = inflammation in the pleura. Pain increases with deep inspiration and is often described as sharp or stabbing. - Auscultation = listening with a stethoscope will reveal grating, scratching sound (pleural friction rub) with inspiration. - Costochondritis = Inflammation of one or more costal cartilages. Pain occurs in the anterior chest wall and may be triggered by coughing. - **Barrel Chest:** Change in shape of the chest wall, can also occur with chronic lung disease. - **Adventitious breath sounds**: altered lung sounds resulting from airway constriction or fluid accumulation. - **Cyanosis:** caused by a greater proportion of desaturated hemoglobin in the blood which gives the blood a bluish hue. - **Central cyanosis:** problem of low oxygen saturation in the arterial blood, often presents as color changes in the skin and mucous membranes - **Peripheral cyanosis:** problem of sluggish blood flow in the fingers and toes, often present with sluggish capillary refill and a pale bluish hue in the nail beds. - **Clubbing:** enlargement and flattening of the tips of fingers or toes. 12. **Be able to describe the following adventitious lung sounds, and identify when they may be present: crackles, wheezing, rhonchi, stridor, diminished breath sounds, and absent breath sounds.** - **Crackles:** snapping, popping, or bubbling sound emitted during inspiration and expiration and caused by fluid accumulation in the airways. - Fine crackles are higher pitched with shorter duration and signify fluid in smaller airways - Coarse crackles are louder and lower pitched and signify fluid in the larger airways. - **Wheezing:** continuous, high-pitched, whistling sound - Significant for obstruction or tightness in small airways - **Rhonchi:** low-pitched wheezing sounds with a snoring quality (sonorous wheezing) when the airway narrowing is in the larger airways and high-pitched wheezing sounds with a squeaking quality (sibilant wheezing) when the airway narrowing is in the smaller airways. - Occur when thick mucus partially blocks the airways - **Stridor:** Harsh, high-pitched, creaking sound - Significant for obstruction in the upper airways, especially of the trachea or larynx - **Diminished breath sounds:** Describes quieter breath sounds that are barely audible - Significant for complete obstruction in one or more airways - **Absent breath sounds:** no air movement through the lungs 13. Describe the diagnostic tests and treatments relevant to disordered ventilation and diffusion. - **Pulmonary Function Test (PFT):** Broad range of non-invasive tests including spirometry, lung volume measurements, and diffusion capacity that involve breathing into a tube that measures the pressure exerted during ventilation. Spirometry is useful in detecting obstructive lung disease by monitoring how well the lungs exhale. - **Arterial Blood Gas (ABG):** Determines presence of acid-base imbalances and degree of hypoxemia and hypercapnia from an arterial blood sample - **Pulse Oximetry:** Non-invasive test that measures oxygen saturation - **Bronchoscopy**: Direct visualization of bronchioles, can be used to take biopsy, take sputum samples, or remove foreign objects from the airway. - **Radiograph, CT, MRI:** Used to detect structural problems, presence of consolidation, obstruction, or cavitation in the airways and lung tissues. - **Nuclear (V/Q) lung scan:** Detects PE and lung disease such as emphysema and COPD by using a nuclear medicine camera and computer imaging to visualize the amount and distribution of minute amounts of radioactive materials inspired into the lungs (V) or injected into the vein (Q) that then flows to and perfuses the lung. - **Culture and Sensitivity test:** Determines presence and type of microorganisms in the blood and/or sputum. The results do not dictate the appropriate antibiotic treatment if indicated. - **Thoracentesis:** Determines the presence of a pleural effusion (excess fluid in the pleural space) by inserting a needle from the chest or back into the lung pleural space, the fluid is examined to determine the cellular and chemical composition, the presence of malignant cells, and the presence of microorganisms. 14. Identify the following treatment principles for altered ventilation and diffusion, and their appropriate uses (anti-inflammatory medications, humidification, decongestants, antitussives, bronchodilators, chest physiotherapy, antimicrobials, oxygen therapy, mechanical ventilation, surgery) - **Anti-inflammatory Medications:** - Reduces inflammatory response by acting on chemical mediators to decrease excess blood flow, swelling, heat, redness, and pain to affected area. - Appropriate Use: Inflammation that impinges on ventilatory function such as with asthma - **Humidification:** - Moistens and liquefies secretions to aid in expectoration - Appropriate Use: Use in the presence of excessive, thick, or sticky mucus. - **Decongestants:** - Decreases nasal congestion through vascular vasoconstriction, which decreases blood flow, reduces exudate, and shrinks swollen mucous membranes. - Appropriate Use: Use in the presence of excessive, thick, or sticky mucus - **Antitussives:** - Suppresses cough by inhibiting cough receptors in the medulla (some have local effects as well) - Appropriate Use: Use when cough is excessive and interferes with sleep - **Bronchodilators:** - Opens airways by relaxing bronchial smooth muscles - Appropriate Use: Conditions that cause bronchoconstriction: asthma, COPD - **Chest Physiotherapy:** - Using a pounding motion or vibration on the chest to physically loosen thick secretions - Appropriate Use: Conditions that result in thick, tenacious secretions such as cystic fibrosis - **Antimicrobials:** - Antibiotics have a range of mechanisms focused on destroying or reducing impact of bacteria; antivirals may also be prescribed as appropriate - Appropriate Use: Bacterial infection (antibiotics) such as bacterial pneumonia - **Oxygen Therapy:** - Provides direct oxygen supplementation - Appropriate Use: Hypoxia - **Mechanical Ventilation:** - Life support measure that provides the work of breathing - Appropriate Use: Respiratory Failure - **Surgery:** - Surgical removal of abnormal tissues or structures within the chest (thoracotomy) - Appropriate Use: confirmation of the diagnoses of lung disease, repair of lung, removal of lung tumor, removal of pus from pleural space (empyema) 15. Identify the pathophysiology, clinical manifestations, diagnostic criteria and treatment of Pneumonia. - **[Pneumonia:]** Inflammation of the lungs commonly in the bronchioles, interstitial lung tissue, or the alveoli. - Top 10 leading cause of death in the United States - Older and very young people, smokers, immunocompromised, and hospitalized people are most at risk to develop pneumonia - **[Patho:]** - Most common cause is microorganisms, including bacteria, viruses, and fungi spread by respiratory droplets. Most common viral pathogen to cause it is influenza virus - Often distinguished as nosocomial (hospital acquires) or community acquired - Inflamed alveili fill with exudate; RBCs, WBCs, and fibrin accumulate causing consolidation (solid mass in lung tissue) - Areas of consolidation can be seen on x-ray and often a feature of diagnosis of typical pneumonia - **[Patho of different types of pneumonia ]** - **Nosocomial:** Typically, more severe and leads to a less favourable prognosis (typ. Immunocompromised) - **Aspiration**: Pneumonia that occurs when inhaling items not intended for the lungs. (food, fluids, stomach contents) - **Typical**: Presence of another viral infection such as influenza, promotes attachment of the pneumococcal bacteria to the receptors on the respiratory system. - **Atypical:** Causes damage through immune-mediated mechanisms rather than direct damage caused by bacteria. Infection more likely to spread beyond the lobar boundaries and is often bilateral - **Hepatization:** Conversion of lung tissue into tissue that resembles liver tissue. Red, heavy, firm - **[Clinical Manifestations ]** - Sudden onset of fever - Chills - Cough - Sputum production - Fatigue - Loss of appetite - Dyspnea - Tachypnea - Tachycardia - Pleuritic Pain - Adventitious lung sounds (crackles) - Elderly -- headaches and confusion - **[Diagnostic Criteria]** - **CBC:** elevated EBC would indicate bacterial infection - **Chest x-ray or CT:** Identify lung tumors, heart failure, and areas of consolidation to rule out other diseases or complications. - Identify causative microorganism to guide treatment - Pleural fluid via thoracentesis if there is a pleural effusion (fluid in the pleural space) or empyema (lung abscess) - Monitor ventilation and perfusion status - **[Pneumonia Treatment ]** - Goal of treatment is to restore optimal ventilation and diffusion - Hospitalization if required - Antibiotic therapy - IV fluids - Chest physiotherapy, deep breathing and coughing - Fever management and comfort measures 16. Identify the pathophysiology, clinical manifestations, diagnostic criteria and treatment of Chronic Obstructive Pulmonary Disease (COPD) (Emphysema, Chronic bronchitis, asthma). - **COPD**: is the umbrella term for all chronic obstructive lung problems. (leading cause of death worldwide) - **Emphysema:** Irreversible enlargement of the air spaces beyond terminal bronchioles - **[Emphysema Pathophysiology ]** - Airway obstruction due to inflammation in the small airways - Patterns of alveolar destruction can occur in the respiratory bronchioles and spread peripherally termed Centriacinar, or uniformly destroy alveolus, termed Panacinar - Centriacinar Emphysema: associated with chronic smoking and primarily affects the upper half of the lungs. - Panacinar Emphysema occurs in those with AAT (alpha-1 antitrypsin) deficiency - **[Emphysema Clinical Manifestations ]** - Obstruction of small airways and alveoli, chronic hypoxemia, and hypercapnia - Heavy smokers = Productive cough - Dyspnea and wheezing - Barrel Chest as disease progresses - Pursed lip breathing - Tachypnea and respiratory distress in severe disease - **[Diagnostic Criteria Emphysema ]** - History and physical - AAT levels in nonsmokers - PFTs a prolonged forced respiratory rate greater than 6 seconds indicates severe disease - **[Treatment of Emphysema: ]** - Maintain optimal lung function to allow activities of daily living to continue life as normal - Smoking cessation - Drug therapy to increase AAT - Bronchodilators, steroids, antibiotics, and mucolytic agents to reduce thickness and promote clearance of sputum - Supplemental Oxygen - Lung Volume reduction or lung transplant are possible surgical treatments - **[Chronic Bronchitis]**: Defined by the presence of a persistent, productive cough with excessive mucus production that lasts for 3 months or longer for two or more consecutive years. - Most common cause: chronic smoking or exposure to environment pollutants that irritate airways - **[Chronic Bronchitis Pathophysiology: ]** - Results from several changes in the bronchi and bronchioles in response to chronic injury. - Chronic inflammation and Edema of the airways - Hyperplasia of bronchial mucous glands - Destruction on cilia - Squamous cell metaplasia - Bronchial wall thickening and development of fibrosis - **[Clinical Manifestations of Chronic Bronchitis]** - Many have both emphysema and chronic bronchitis simultaneously - Chronic productive cough with purulent sputum - Dyspnea - Prolonged expiratory phase with wheezing and crackles - Hypoxemia, hypercapnia, and cyanosis are common - **[Diagnostic Criteria of Chronic Bronchitis: ]** - Based on clinical presentation of persistent productive cough over a period of 3 months or more within 2 consecutive years. - Diagnosed after all other potential causes of chronic cough are excluded - History of smoking present - ABGs significant for hypoxemia and hypercapnia - Polycythemia vera as a compensatory measure to combat chronic hypoxemia - **[Treatment of chronic bronchitis ]** - Aimed at alleviating symptoms, improving airway and lung function, showing progression of disease, and improving quality of life. - Bronchodilators, steroids, antibiotics, and mucolytic agents (to reduce thickness and promote clearance of sputum.) - Supplemental oxygen - Pulmonary rehab - **[Asthma:]** Chronic inflammatory disorder of the airways that results in the intermittent or persistent airway obstruction because of bronchial hyperresponsiveness, inflammation, bronchoconstriction, and excess mucus production. - **[Asthma Pathophysiology: ]** - Exact cause is unknown, but astma is increased in individuals who are frequently exposed to environmental allergens, such as cigarette smoke and dust mites. - Combination of hypersensitivity reactions and inflammatory reactions - When exposed to trigger \--\> IgE-mediated hypersensitivity reaction is immediate - **Immediate inflammatory response** = increased edema, bronchoconstriction of airways, excessive mucus production in airways - **Late inflammatory response** = 6 to 24 hours after exposure; airway edema and mucus plugs - **Overtime =** cells of chronic inflammation cause destruction of respiratory epithelium, smooth muscle hyperplasia, and narrowing of airways. (structural changes known as airway remodelling) - **[Asthma Clinical Manifestations ]** - Depends on the state of airway hyperreactivity and inflammation - Periods of remission = symptom free - Exacerbation: patient may not notice any symptoms a exacerbation is emerging, although PFTs start to decline; as exacerbation continues, hyperactivity and inflammation in the airway causes wheezing, breathlessness, chest tightness, excessive sputum production, and coughing particularly at night and early morning. - **[Asthma Diagnostic Criteria]** - Evaluation of signs and symptoms and determination of triggers to determine the likelihood that symptoms are attributable to asthma - **Physical Findings:** - Evidence of respiratory distress - Pulus paradoxus (exaggerated decrease in systolic blood pressure during inspiration) - Wheezing breath sound - Prolonged expiratory phase - Atopic dermatitis, eczema, or other allergic skin conditions indicating hypersensitivities - **Lab findings:** eosinophilia, and ABG indicating hypoxemia and hypercapnia, spirometry trends - Chest x-ray: may demonstrate hyperinflation or infiltrates of the lung fields. - **[Treatment for Asthma: ]** - 4 Major Components - Monitoring lung function through peak flow testing - Controlling environmental triggers - Pharmacologic therapy to reduce inflammation, bronchoconstiction, and mucus secretion. - Patient education to facilitate adherence to the treatment plan - Status Asthmaticus or intractable Asthma: bronchospasms are not reversed by the patient's medications or other measures. Life threatening and requires emergency treatment 17. Be able to identify asthma classification and treatment based on severity. - **[Asthma Classifications: ]** - **Mild Intermittent:** symptoms occurring less than one week w/brief exacerbations, symptoms occur less than twice a month, no daily medication needed. - **Mild persistent:** Symptoms occurring more than once a week but less than once a day. Exacerbations affect activity and sleep. Inhaled anti-inflammatory 1-4 times per day and bronchodilator as needed - **Moderate Persistent:** Daily symptoms, exacerbations affect activity and sleep. Inhaled anti-inflammatory 1-4 times per day, long-acting bronchodilator especially for nighttime - **Severe persistent:** Continuous symptoms with frequent exacerbations. Physical activities limited by symptoms. Inhaled and oral anti-inflammatory, long-acting bronchodilator, and short-term bronchodilator as needed. 18. Identify the pathophysiology, clinical manifestations, diagnostic criteria and treatment of Cystic Fibrosis. - **[Cystic Fibrosis]**: Autosomal recessive disorder of electrolyte and subsequently water transport that affects certain epithelial cells, such as those lining respiratory, digestive, and respiratory tracts - CF leads to production of excessive and thick exocrine secretions leading to obstruction. Inflammation, and infection. - Most affected individuals are diagnosed by 1 year of age, a small percentage are ot diagnosed until after the age of 10. - Median age of survival is 46 years, some live into their 50s. - **[Patho of Cystic Fibrosis: ]** - Caused by mutation of the CF gene located on the long arm of chromosome 7. - CF results when the cystic fibrosis transmembrane conductance regulator (CTFR) gene causes the CFTR protein to become dysfunctional. - CFTR gene mutation leads to impaired electrolyte transport across epithelial cells on mucosal surfaces. - CFTR mutations lead to impairment of cAMP regulated chloride transport across cells on mucosal surfaces, such as those lining the respiratory tract, pancreas, bile ducts, sweat glands, and vas deferens - The inability of these cells to conduct chloride and transport water across mucosal surfaces leads to thick secretions and obstruction in the respiratory tract, pancreas, GI tract, sweat glands, and other exocrine tissues. - CF is mostly associated with mucus plugging, inflammation, and infection in the lungs with respiratory failure as the most common cause of death. - Overtime, the airways and lung tissue in CF are characterized by air trapping, hyperinflation, abcess formation, lung tissue consolidation, persistent pneumonia, lung tissue fibrosis, and cyst formation (notably in pancreas) - Cystic Fibrosis Clinical Manifestations - Tenacious, thick secretions leading to respiratory and GI impairment. - Recurrent respiratory infections - Chronic cough - Tachypnea - Recurring wheezing or crackles - Hemoptysis - Dyspnea on exertion - Chest pain - Respiratory distress with chest retractions - Cyanosis - Barrel Chest - Recurrent Sinusitis - Development of nasal polyps - Newborns = intestinal obstruction at birth (meconium ileus) - Large, greasy, malodorous stools - Abdominal pain, distention, and poor absorption of fat-soluble vitamins - Sweat abnormalities and excessive salt depletion - Jaundice, GI bleeding, and rectal prolapse may occur - Males = frequently sterile - **[Cystic Fibrosis Diagnostic Criteria:]** - Diagnoses can be confirmed by a sweat test, which will reveal a sweat chloride concentration of 60mEq/L or greater - Genetic testing may be performed to detect certain CFRT mutations - The identification of 2 CFRT mutations with associated clinical symptoms is diagnostic - Newborn screening is now recommended in many developing countries - **[Cystic Fibrosis Treatment ]** - Maximizing ventilation, diffusion, and nutrition through: - Liquefying and clearing the airways of mucus - Avoiding and controlling respiratory infections - Reducing Inflammation and promoting bronchodilation in the airways - Providing or encouraging optimal nutrition using enzyme supplements to reduce malabsorption, multivitamin and mineral substances, and a high-calorie diet. - Managing disease complications such as diabetes mellitus, bowel obstruction, fatty liver, biliary cirrhosis, and portal hypertension. - Individuals with end-stage lung disease may consider lung transplantation 19. Identify the pathophysiology, clinical manifestations, diagnostic criteria and treatment of acute respiratory distress syndrome (ARDS). - **[ARDS:]** A condition of severe acute inflammation and pulmonary edema without evidence of fluid overload or impaired cardiac function. - **[ARDS Pathophysiology: ]** - Damage to the alveolar epithelium and vascular endothelium triggers the onset of severe inflammation. - Injury can result from inhalation of excessive smoke or toxic chemical, overwhelming lung infections, aspiration of gastric contents into the lungs, lung trauma, anaphylaxis, lack of pulmonary blood flow, and other conditions that impair the alveoli. - The presence of sepsis (bacterial infection of blood) and the systemic inflammatory response (SIRS) are clinical conditions that impair the alveoli. - Initially, oxygen diffusion is greatly impaired, but CO2 is still able to cross the alveolar-capillary junction to be expired. - As the process of alveolar impairment advances, a hyaline membrane forms, and CO2 release is disrupted. This leads to a state of impaired ventilation and diffusion, marked by poor lung expansion, hypoxemia, hypercapnia, and acidosis. - ARDS can be reversed if identified early - If untreated, death can ensue within 48 hours. - **[ARDS Clinical Manifestations ]** - Tachypnea - Dyspnea - Retractions - Crackles - Restlessness - Some patients may present in the course of disease without any signs or symptoms for mild tachypnea - Within 48 hours, severe respiratory distress is apparent - **[ARDS Diagnostic Criteria]** - ABG often depicts hypoxemia with early respiratory alkalosis, quickly progressing to hypercapnia and respiratory alkalosis. - Blood cultures may be needed to detect sepsis (most common cause of ARDS) - Chest X-ray - Often normal early in course of disease - Reveals bilateral diffuse infiltrates advancing to total opacity as the disease progresses - **[ARDS Treatment]** - Supportive and focused on removing causative factors triggering the inflammatory response - Administration of 100% oxygen to keep oxygen above 90% - Intubation with mechanical ventilation may be necessary 20. Identify the potential causes of atelectasis. **[Atelectasis:]** A condition of collapse and Non aeration of the alveoli Causes Include: - **Compression** - Compression of the alveoli by mass or fluid accumulation, such as tumor or pleural effusion, which exerts pressure on the lung and prevents air from entering alveoli - **Obstruction** - It prevents air from entering the airways and alveoli, existing air is reabsorbed into the tissues and the alveoli becomes empty. - **Destruction** - Destruction of surfactant, as with the inflammatory response, increased surface tension in the alveoli and promotes collapse - **Fibrosis** - Such as with emphysema, restricts alveolar expansion and promotes collapse +-----------------+-----------------+-----------------+-----------------+ | **[Cardiovascul | | | | | ar | | | | | Key | | | | | Terms]{.underli | | | | | ne}** | | | | +=================+=================+=================+=================+ | Aldosterone | Cor pulmonale | Infarction | 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| | | | pressure | failure | | Deficiency of | The process | | | | red blood cells | where heart | The average | Right=Rest of | | or hemoglobin, | cells release | arterial | body | | leading to | energy and | pressure | | | reduced | shift | throughout one | Condition where | | oxygen-carrying | electrical | cardiac cycle, | the right | | capacity in the | charge | systole, and | ventricle of | | blood. | distribution to | diastole. | the heart is | | | cause the | Crucial | unable to | | | heart's muscles | indicator of | effectively | | | to contract. | overall | pump blood to | | | | perfusion | lungs for | | | | pressure | oxygenation. | | | | driving blood | | | | | flow to body's | | | | | organs and | | | | | tissues | | +-----------------+-----------------+-----------------+-----------------+ | Aneurysms | Diastole | Mixed | Secondary | | | | systolic/diasto | hypertension | | Weakened and | Phase of the | lic | | | bulging section | heartbeat when | hypertension | High blood 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tissues. | | +-----------------+-----------------+-----------------+-----------------+ | Angiotensin I | Diastolic | Myocardial | Shock | | | failure | ischemia | | | Converts to | | | A condition of | | angiotensin II | The heart's | Condition where | circulatory | | by lungs | main pumping | the heart | failure and | | | chamber (left | muscle does not | impaired | | | ventricle) | receive enough | perfusion of | | | becomes stiff | oxygen due to | vital organs. | | | and unable to | reduced blood | | | | fill properly | flow. | Occurs when | | | with blood | | body does not | | | during | | receive enough | | | relaxation | | blood flow | | | phase. | | | +-----------------+-----------------+-----------------+-----------------+ | Angiotensin II | Diplopia | Myocardium | Shunting | | | | | | | A potent | Double vision | Thick muscular | The redirection | | circulating | | layer of heart | of fluid or | | vasoconstrictor | | | blood flow from | |. | | | one area of the | | Increases BP | | | body to | | and increases | | | another. | | production/secr | | | | | etion | | | | | of aldosterone. | | | | +-----------------+-----------------+-----------------+-----------------+ | Atherosclerosis | Disseminated | Nephrosclerosis | Sinoatrial (SA) | | | intravascular | | node | | Chronic disease | coagulation | Condition | | | that affects | (DIC) | characterized | Generates an | | the arteries, | | by the | electrical | | causing them to | Condition where | hardening and | signal that | | become narrowed | the body's | scarring of the | causes the | | and hardened. | blood clotting | kidneys, often | atria to | | | system becomes | caused by | contract. | | | overactive | hypertension. | | | | leading to | | Pacemaker of | | | widespread | | the heart | | | blood clots | | | | | throughout the | | | | | body. | | | +-----------------+-----------------+-----------------+-----------------+ | Atrial | Ecchymoses | Neurogenic | Stenosis | | fibrillation | | shock | | | | Blue or purple | | When heart | | Type of | discoloration | Typically | valve becomes | | irregular | that occurs as | caused by brain | narrowed, | | heartbeat that | a result of | or spinal cord | preventing it | | occurs when | rupture of | injury. Sudden | from fully | | atria beat too | blood vessels | drop in BP due | opening and | | fast and | under skin. | to damage to | restricting | | irregularly. | (bruising) | nervous system. | blood flow out | | | | | of heart. | | | | | Forcing the | | | | | heart to work | | | | | harder to pump | | | | | through body. | +-----------------+-----------------+-----------------+-----------------+ | Atrioventricula | Electrocardiogr | P wave | Stroke volume | | r | am | | (SV) | | (AV) node | (ECG, EKG) | Wave in EKG | | | | | that represents | The volume of | | Conducts | Non-invasive | electrical | blood pumped | | electrical | medical test | depolarization | out of the | | impulses from | that records | of the atria. | heart's left | | the atria to | the electrical | Shows the | ventricle | | the ventricles, | activity of the | contraction of | during each | | ensuring slight | heart. | the heart's | systolic | | delay to allow | | upper chambers. | cardiac | | atria to fully | | | contraction. | | contract before | | | | | ventricles pump | | | | | blood out. | | | | +-----------------+-----------------+-----------------+-----------------+ | Baroreceptors | | P-Q interval | Systemic | | | | | circulation | | Sensory nerve | | Period between | | | endings in | | the beginning | Supplies all | | blood vessels | | of the p wave | the other | | that monitor | | (atrial | tissues | | blood pressure | | depolarization) | throughout the | | and blood | | and the start | body | | volume. Located | | of the QRS | | | in blood | | complex | | | vessels near | | (ventricular | | | the heart. | | depolarization) | | +-----------------+-----------------+-----------------+-----------------+ | Bifurcations | Embolus | Patent | Systole | | | | | | | The branching | Blood clot or | Patent=open | Phase of the | | points in the | other substance | | cardiac cycle | | coronary | that breaks off | A patent artery | during which | | arteries where | and travels | is an artery | the heart | | a main artery | through the | that is open | muscle | | divides into 2 | blood stream | and | contracts and | | smaller | eventually | unobstructed | pumps blood out | | branches. | blocking blood | allowing blood | of the heart | | | flow in vessel | to flow | chamber into | | | | normally. | the arteries. | +-----------------+-----------------+-----------------+-----------------+ | Blood pressure | Endocardium | Percutaneous | Systolic blood | | | | coronary | pressure | | Force exerted | Inner lining of | intervention | | | by the blood | heart | (PCI) | Amount of | | against the | | | pressure | | walls of the | | Minimally | exerted during | | arteries as it | | invasive | contraction of | | is pumped by | | procedure that | the left | | the heart. | | opens blocked | ventricle and | | | | or narrowed | ejection of | | | | coronary | blood into the | | | | arteries. | aorta. | +-----------------+-----------------+-----------------+-----------------+ | C-reactive | Heart block | Percutaneous | Systolic | | protein (CRP) | | transluminal | failure | | | Condition where | coronary | | | A protein | the electrical | angioplasty | The heart\'s | | produced by the | signals that | (PTCA) | left ventricle | | liver in | control the | | is weakened and | | response to | heartbeat do | Minimally | unable to | | inflammation. | not travel | invasive | contract | | | properly | procedure that | forcefully | | CRP test can | through the | opens blocked | enough to pump | | show risk of | heart. | coronary | blood | | developing | | arteries to | effectively to | | coronary artery | | improve blood | the rest of the | | disease. | | flow to the | body. | | | | heart muscle. | | +-----------------+-----------------+-----------------+-----------------+ | Cardiac cycle | Heart failure | Perfusion | T wave | | | | | | | Used to | A condition | Passage of | Represents the | | describe the | where the heart | blood through | repolarization | | rhythmic | cannot pump | the blood | of the | | pumping action | enough blood to | vessels and | ventricles. | | of the heart. | meet the body's | natural | | | Divided into | needs. | channels in an | | | systole and | | organ and | | | diastole. | | tissue. | | +-----------------+-----------------+-----------------+-----------------+ | Cardiac | Heart rate (HR) | Pericardium | Thrombocythemia | | dysrhythmias | | | | | | Number of times | Outer covering | Condition where | | Irregular or | the heart beats | of heart | the bone marrow | | abnormal | per minute. | | produces | | heartbeats. | | | excessive | | (too fast, | | | number of | | slow, or | | | platelets, | | irregular | | | making it hard | | rhythm) | | | for blood to | | | | | clot normally. | +-----------------+-----------------+-----------------+-----------------+ | Cardiac output | Hematoma | Petechiae | Thromboembolism | | (CO) | | | | | | Pool of mostly | Small, red or | When blood clot | | The amount of | clotted blood | purple spots | breaks off and | | blood the heart | that forms in | caused by | travels through | | pumps in one | an organ tissue | bleeding into | the blood | | minute. | or body space | the skin. | stream, | | | | | blocking a | | | | | blood vessel. | +-----------------+-----------------+-----------------+-----------------+ | Cardiogenic | Hemorrhage | Plateau phase | Thrombosis | | shock | | | | | | Bleeding from a | In EKG | Blood clot | | Any cardiac | damaged blood | represents the | within blood | | condition that | vessel. | phase that | vessels that | | leads to | | membrane | limit the flow | | cardiac | | potential | of blood. | | insufficiency. | | remains almost | | | Results from | | constant. | | | inadequate or | | | | | ineffective | | | | | cardiac | | | | | pumping. | | | | +-----------------+-----------------+-----------------+-----------------+ | | Homans sign | Primary | U wave | | | | hypertension | | | | Clinical | | A small | | | finding where a | Type of high | positive | | | patient | blood pressure | deflection that | | | experiences | when there is | appears after | | | pain behind the | no clear, | the T wave and | | | knee when their | identifiable | represents the | | | foot is | cause. | final phase of | | | forcefully | | ventricular | | | dorsiflexed. | | repolarization. | +-----------------+-----------------+-----------------+-----------------+ | Chemoreceptors | Homocysteine | Pulmonary | Venous stasis | | | | circulation | | | Specialized | An amino acid. | | Blood flow in | | sensory cells | When there is | Moves blood | veins is slowed | | that detect | high level, | through the | (often in legs) | | chemical | there is an | lungs and | causing buildup | | changes in the | increased risk | creates a link | of blood and | | body or | of heart | with the gas | prevents blood | | environment. | disease. | exchange | from | | | | function of the | efficiently | | | | respiratory | returning to | | | | system. | heart. "pooled" | | | | | blood in veins | +-----------------+-----------------+-----------------+-----------------+ | Chordae | Hypercholestero | Pulmonary edema | Ventilation-per | | tendineae | lemia | | fusion | | | | Condition where | ratio | | Fibrous cords | Abnormally high | excess fluid | | | that connect | levels of | accumulates in | The | | papillary | cholesterol in | the lungs | relationship | | muscles to the | the blood. | making it | between | | AV valves in | | difficult to | ventilation and | | the heart. | | breathe. | perfusion. | | | | | Ventilation is | | | | | typically | | | | | slightly less | | | | | that perfusion | | | | | rate | +-----------------+-----------------+-----------------+-----------------+ | Circulation | Hypertension | Pulse pressure | Ventricular | | | | | fibrillation | | Continuous | High BP. Force | Systolic-diasto | | | movement of | of blood | lic | Heart arrythmia | | blood | against walls | = pulse | where | | throughout the | of arteries is | pressure | ventricles | | body | consistently | | quiver instead | | | too high. | Difference | of contracting | | | | between two | normally, | | | | pressures. | preventing | | | | | effective blood | | | | | flow. | +-----------------+-----------------+-----------------+-----------------+ | Collateral | | Purpura | | | circulation | | | | | | | Small, | | | Network of | | purple-red | | | smaller blood | | spots or | | | vessels that | | patches on skin | | | act as backup | | or mucous | | | and provide | | membranes | | | alternative | | caused by | | | routes for | | bleeding under | | | blood flow when | | the skin. | | | major artery or | | | | | vein becomes | | | | | blocked/damaged | | | | |. | | | | +-----------------+-----------------+-----------------+-----------------+ | Conduction | Hypotension | QRS complex | | | defects | | | | | | Low blood | Series of waves | | | Conduct | pressure. The | on EKG that | | | disturbances | force of blood | represent | | | that cause | pushing against | electrical | | | problems with | walls of | activity of | | | the heart's | arteries is | ventricles | | | electrical | lower than | during their | | | system. | normal. | contraction | | | | | phase. | | +-----------------+-----------------+-----------------+-----------------+ | Congestive | Hypovolemic | | | | heart failure | shock | | | | | | | | | The heart | Result of | | | | muscle is | inadequate | | | | weakened and | blood/plasma | | | | cannot pump | volume and | | | | blood | typically | | | | effectively. | occurs when | | | | This leads to | this volume is | | | | fluid build up | reduced by | | | | in lungs and | 15-20% | | | | other parts of | | | | | body. | | | | +-----------------+-----------------+-----------------+-----------------+ | Convergence | Infarct | | | | | | | | | Minimally | An area of dead | | | | invasive | tissue | | | | surgical | (necrosis) that | | | | technique used | occurs when | | | | to treat atrial | blood flows to | | | | fibrillation -- | an organ or | | | | a heart rhythm | tissue is | | | | disorder. | blocked. | | | +-----------------+-----------------+-----------------+-----------------+ **[Cardiovascular Objectives (Chapters 25-28)]** 1. Define and understand perfusion. - Forcing blood or other fluid to flow through a vessel and into a vascular bed of tissue to provide oxygen. - Requirements for effective perfusion: - Adequate ventilation and diffusion - Intact pulmonary circulation - Adequate blood volume and components - Adequate cardiac output - Intact cardiac control center - Intact receptors - Intact parasympathetic and sympathetic nervous system - Intact cardiac conduction - Intact coronary circulation - Adequate oxygen uptake in tissues 2. Describe the relationship between ventilation and perfusion. - Ventilation-Perfusion Ratio: The relationship between ventilation and perfusion - Typically, 0.8:0.9 - meaning the rate of ventilation is usually slightly less than the rate of perfusion. - Largest volume of ventilation and perfusion occurs in the lower lobes of the lungs due to the affects of gravity. 3. Understand the organization of the circulatory system. - **Functions of the circulatory system:** - Deliver oxygen and nutrients to the tissues - Carries waste products from cellular metabolism to the kidneys and other excretory organs. - Circulates electrolytes and hormones - Arteries = Away from the heart - Veins = To the heart - Helps regulate temperature - **Central circulation:** Blood that is in the heart and pulmonary circulation (coronary and pulmonary) - **Peripheral Circulation**: Blood that is outside the central circulation. (think extremities) 4. Describe the movement of blood through circulation. - **Pulmonary Circulation:** moves blood through the lungs and creates a link with the gas exchange function of the respiratory system. - **Systemic Circulation:** Supplies all the other tissues of the body - **Coronary Circulation:** Oxygen and nutrients are distributed to body. **[Components of Circulatory System: ]** - **Pulmonary Circulation** - Right Heart - Pulmonary arteries, capillaries, and veins - **Systemic Circulation** - Left Heart - Aorta and its branches - Capillaries supplying the brain and peripheral tissues - Systemic venous system and the vena cava - **Layers of the heart** - Pericardium: outer covering - Myocardium: thick muscular layer - Endocardium: Inner lining - **Chambers of heart** - Right and left atria - Right and left ventricles 5. Be able to identify dyslipidemia as a disorder of arterial blood flow, identify the classification of lipoproteins, and speak to hypercholesterolemia, and atherosclerosis. - **Dyslipidemia** is a condition of imbalance of the lipid components (triglycerides, phospholipids, and cholesterol) of the blood. - Hyperlipidemia: is elevated levels of on or all of triglycerides, phospholipids, and cholesterol - **Classification of Lipoproteins:** - **Chylomicrons** - Large lipoprotein particles that transport dietary fat from the small intestine to the bloodstrean - **Very-low density lipoprotein (VLDL)** - Carries large amounts of triglycerides - **Intermediate-density lipoprotein (IDL)** - **Low-Density Lipoprotein (LDL)** - Main carrier of cholesterol - Considered bad cholesterol because it builds and blocks - **High-density lipoprotein (HDL)** - 50% protein - Considered good cholesterol because it carries excess cholesterol back to liver to be excreted - **Hypercholesterolemia**: High levels of cholesterol in blood. - Serum cholesterol levels 240mg/dL or greater - Levels that could contribute to a heart attack, stroke, or other CV event associates with atherosclerosis. (Narrowed and hardened arteries.) - **Primary Hypercholesterolemia**: elevated cholesterol levels that develop independently of other health problems or due to lifestyle behaviors. - **Secondary Hypercholesterolemia:** Associated with other health problems and behaviors. - **[Atherosclerosis]**: Chronic condition characterized for hardening and narrowing of arteries. - **Major risk factors:** - Hypercholesterolemia - Cigarette smoking - Hypertension - Family history of premature CHD in a first-degree relative - Age: men \>45, women \>55 - HDL cholesterol \