Alteration of Pulmonary Function

Question 1

What is dyspnea? Name the two types.

Answer 1

Dyspnea is an experience of breathing discomfort.

The two types are Orthopnea (laying flat out pressure on the diaphragm) and Paraoxysmal nocturnal dyspnea (PND) (wake up in the middle of the night gasping for air).

Question 2

Name the severe signs of dyspnea.

Answer 2

Flaring nostrils and the use of accessory muscles for respiration

Question 3

What condition are those with an inability to effectively cough more at risk of developing?

Answer 3

Pneumonia because they cannot remove the microbes that infect the lungs.

Question 4

Compare acute and chronic cough

Answer 4

Acute cough: lasts 2-3 weeks or until the underlying condition is treated. It is caused by upper/lower respiratory disease, allergic rhinitis, acute bronchitis, pneumonia, congestive heart failure, pulmonary embolus, or aspiration.

Chronic cough: is persistent. In smokers it can be caused by bronchitis. In non-smokers it can be caused by post nasal drainage, asthma, and bronchitis.

Question 5

What is hemoptysis and what does it mean?

Answer 5

Hemoptysis is when a pt is coughing up blood or bloody secretions. It indicates that the pt has an infection/inflammation that had damaged the bronchi or lung parenchyma

Question 6

Describe Kussmaul respirations and what may cause them

Answer 6

Kussmaul respirations are max inhalation followed by max exhalation. This can be caused by strenuous exercise or metabolic acidosis (the decrease of pH and the increase of H+ because of the decreased amount of CO2 coming into the body).

Question 7

Describe a large airway obstruction

Answer 7

SLOW ventilators rate, LARGE tidal volume, increased effort, wheezing sounds

Question 8

Describe a small airway obstruction

Answer 8

RAPID ventilators rate, SMALL tidal volume, increased effort, wheezing sounds, prolonged expiration

Question 9

Describe restricted breathing and an illness associated with this kind of breathing

Answer 9

RAPID ventilatory rate, SMALL tidal volume.

Pulmonary fibrosis

Question 10

Describe Cheyne-strokes breathing and when does it occur?

Answer 10

Patterned breathing: increased, decrease, 15-60 second apnea, increase, decrease

This occurs when there is reduced blood flow to the brain resulting in slow impulses to the respiratory center of the brain. (For example: neurological impairment)

Question 11

What is hypoventilation and what happens to the CO2 levels?

Answer 11

Hypoventilation is when alveolar ventilation cannot keep up with metabolic demands so the CO2 isn’t being put out as fast as it is being made. Causing an increased level of PaCO2 in the body. This causes hypercapnia and decreases the pH levels in the blood causing respiratory acidosis.

Question 12

Why is hypoventilation often overlooked?

Answer 12

The breathing pattern can appear normal and changes in tidal volume are difficult to detect.

Question 13

What is hyperventilation and what does this do to the CO2 levels?

Answer 13

Hyperventilation is when are we all are ventilation surpasses metabolic demands which means that the lungs are removing CO2 faster than the cells are able to make it causing hypocapnia. The decreased level of PACO2, decreased H+ and increased PH make the body go into respiratory alkalosis.

Question 14

Describe peripheral cynosis and its cause

Answer 14

Peripheral cyanosis is due to poor circulation; slow circulation in fingers and toes. It can be due to cold environments, heart disease, and intense peripheral vasoconstriction. This is often seen in nail beds.

Question 15

Describe central sygnnois and its cause

Answer 15

Central cyanosis is the decreased arterial oxygenation. It is caused by decreased inspired CO2 (for example in high altitudes), CNS disorders, pulmonary disease, and cardiac disease. It can often be seen in buccal mucous membranes and the lips.

Question 16

Why doesn’t a lack of cyanosis indicate that oxygenation is normal? Give an example of a condition where this happens.

Answer 16

The lack of cyanosis does not indicate that oxygenation is normal because in adult cyanosis is not evident until severe hypoxemia is present. Severe anemia and carbon monoxide poisoning can cause inadequate oxygenation without causing cyanosis. Cyanosis must be interpreted in relation to the underlying conditions.

Question 17

What is clubbing and what disease process can it usually be found?

Answer 17

Clubbing is the bulbous enlargement of the distal end of a finger or toe. (For example the end of the finger might look like it goes inward and outward towards the end of the nail.) clubbing can usually be found in patients that have chronic hypoxia. For example cystic fibrosis and lung abscesses.

Question 18

What is a pleural friction rub, what causes it, and what makes the pain worse?

Answer 18

A plural friction rub is a unique breath sound. Infection/inflammation of the pleura causes pain when stretched during inspiration. The pain can be made worse when the patient is laughing and/or coughing. It is described as a sharp and stabbing pain.

Question 19

What is hypercapnia and how is it diagnosed?

Answer 19

Hypercapnia is the increased CO2 concentration level in the blood. (This also means an increased PaCO2). Hypoventilation is a symptom of hypercapnia but hyperventilation is easily overlooked so to a diagnose hypercapnia you must obtain a blood gas analysis or capnography to determine the severity of the illness.

Question 20

What causes hypercapnia?

Answer 20

Hypercapnia is caused by hypoventilation of the alveoli. The alveoli are not pushing out enough CO2, which increases the concentration of CO2 within the body. Increasing the concentration of PaCO2.

Question 21

What mechanisms cause hypoxemia?

Answer 21

Hypoxemia can be caused by issues with O2 delivery to the alveoli, issues with diffusion of O2 from the alveoli into the blood, issues with perfusion of the pulmonary system.

Question 22

How can hypoxemia lead to hypoxia?

Answer 22

Hypoxemia decreases the levels of O2 in the blood. The blood delivers O2 to the cells. If there is decreased O2 levels in the blood, it will also decrease the level of O2 in the cells.

Question 23

What is respiratory failure?

Answer 23

Then adequate gas exchange. Otherwise known as not enough of what is being inhaled is being exhaled and vice versa

Question 24

What other body systems can be involved in respiratory failure?

Answer 24

The brain, the spinal cord, and the heart.

Question 25

How does chest wall restriction affect ventilation?

Answer 25

Chest wall restriction makes it more difficult for the patients to take a breath. This decreases the title volume. (A.k.a. the amount of O2 coming into the body.)

Question 26

What is a pneumothorax? Name the three types.

Answer 26

A pneumothorax is the presence of air or gas in the pleural space caused by a rupture in the visceral pleura or the parietal pleura and chest wall.

Primary pneumothorax, secondary pneumothorax, and latrogenic pneumothorax.

Question 27

Describe a primary pneumothorax and its symptoms

Answer 27

This happens unexpectedly in healthy individuals usually between 20-40 years of age. It is caused by spontaneous rupture of blebs (blisters) on the visceral pleura.

The clinical manifestations are sudden plural pain, tachypnea, and dyspnea.

Question 28

Describe a secondary pneumothorax and it’s symptoms.

Answer 28

Occurs as a result of chest trauma, blood rupture or bulla (a large vesicle), mechanical ventilation.

The symptoms include pleural pain, tachypnea, and dyspnea.

Question 29

Describe a latrogenic pneumothorax and its symptoms.

Answer 29

This occurs because of a transthoracic needle aspiration procedure.

It’s symptoms include sudden pleural pain, tachypnea, and dyspnea.

Question 30

What is the treatment for a pneumothorax?

Answer 30

The treatment for a pneumothorax is aspiration via a chest tube attached to a waterseal drainage system with suction. When the pneumothorax is removed and the plural rupture has healed the chest tube will be removed.

Question 31

What is plural effusion, what causes plural effusion and what are the symptoms?

Answer 31

A plural effusion is the presence of fluid in the pleural space. A plural effusion is caused by the fluid coming from blood vessels and lymphatic vessels underneath the pleural space.

The symptoms are impaired ventilation, pleural pain, decreased breath sounds, and pleural friction rub.

Question 32

Name the different types of plural effusion.

Answer 32

Transudate (watery), exudate (high concentration of white blood cells and proteins), Puss (microorganisms and debris of infection), blood (hemorrhage), chyle (milky fluid containing lymph and fat).

Question 33

What are the treatments for plural effusion?

Answer 33

Treat the underlying condition, identify the type of effusion and provide symptomatic relief, and a large effusion requires chest to placement and or surgery to prevent reoccurrence.

Question 34

What is emphysema, what causes emphysema, and what are the symptoms and treatment?

Answer 34

Emphysema is the abnormal permanent enlargement of gas exchange airways causing the permanent damage of alveolar walls.

The causes of emphysema include: deficiency of a-antitrypsin, cigarettes, air pollution, occupational hazards, childhood respiratory tract infections.

The symptoms include a productive cough, dyspnea, wheezing, prolonged expiration, and barrel chest.

Emphysema can be treated with bronchodilators and corticosteroids.

Question 35

What are the symptoms of restrictive lung disease?

Answer 35

Cough, trouble breathing, pain, unusual breathing patterns, fever, an elevated heart rate

Question 36

What factors may lead to aspiration and what are the clinical manifestations?

Answer 36

Factors that lead to aspiration are: impaired swallowing and coughing mechanisms, an altered level of consciousness, dysphasia, and feeding through a nasogastric tube.

The clinical manifestations include choking, intractable cough with or without vomit, fever, dyspnea, and wheezing

Question 37

How is aspiration treated?

Answer 37

Administration of oxygen with possible mechanical ventilation and administration of corticosteroids.

Restrict fluid intake.

Question 38

What is atelectasis and what are the three types?

Answer 38

Atelectasis is the collapse of lung tissue. Air does not reach the alveoli preventing the exchange of O2 and CO2.

The three types are compression atelectasis, obstructive atelectasis, and surfact impairment atelectasis.

Question 39

What are the clinical manifestations and treatment of atelectasis?

Answer 39

Dyspnea, cough, fever, and leukocytosis.

Treatments include deep breathing exercises (incentive spirometer), frequent position changes, and early ambulation.

Question 40

What is bronchiectasis, when does it occur, and what are the symptoms?

Answer 40

It is the inflammatory obstruction of the small airways/bronchios.

It occurs with chronic bronchitis, upper and lower respiratory tract viral infections, or inhalation of toxic gas.

The symptoms are a rapid ventilatory rate, use of accessory muscles, low-grade fever, and a non-productive cough.

Question 41

How is bronchiectasis treated?

Answer 41

It is treated with antibiotics, corticosteroids, immunosuppressive agent, and chest physical therapy.

Question 42

What is pulmonary fibrosis, what are its causes, and how is it treated?

Answer 42

Pulmonary fibrosis is the excess amount of fibrous or connective tissue in the lungs.

It’s causes can be idiopathic (unknown), caused by the formation of scar tissue after active pulmonary disease, autoimmune disorders, or the inhalation of harmful substances.

It is treated with oxygen, corticosteroids, anti-fibrotic/cytotoxic drugs, or lung transplants.

Question 43

What is pulmonary edema and what is the major cause?

Answer 43

Pulmonary edema is excess water in the lungs.

It’s major cause is left sided heart disease. (The left ventricle fails, pressure fills on the left side of the heart increasing pulmonary capillary hydrostatic pressure. Pulmonary edema develops when the fluid from the capillaries exceeds the lymphatic systems ability to remove it.)

Other causes are pulmonary capillary injury that increases capillary permeability and obstruction of the lymphatic system.

Question 44

What are the symptoms of pulmonary edema and how is it treated?

Answer 44

The symptoms of pulmonary edema are dyspnea, hypoxemia, and increased work for breathing.

What is treated with therapy to improve cardiac output, remove the offending agent and implement therapy to maintain ventilation and circulation, and treat the underlying condition.

In all treatments supplemental oxygen may be necessary.

Question 45

What is acute respiratory distress syndrome and what are its predisposing factors?

Answer 45

Acute lung inflammation.

The predisposing factors are sepsis and multiple trauma

Question 46

What is the pathophysiology behind ARDS?

Answer 46

There are three phases: the exudated phase, the proliferative phase, and the fibrotic phase.

In the exudated phase (24 hours after injury) there is damage of the capillary membranes allowing the leak of protein rich fluid into the intercisium and the alveoli sack causing pulmonary edema. There is a damage to the surfactant cells producing little to no surfactant which causes the patient to develop atelectasis causing decreased O2 levels. A hyaline membrane develops making the lungs less elastic and less compliant. An important hallmark is refractory hypoxemia. This means that even with the administration of high oxygen the patients readings are low

The proliferative phase (14 days after injury) includes the rapid growth and production of cells, the repairing of structure and reabsorption of fluids. But this causes the lung tissue to be dense and fibrous causing low lung compliance and hypoxemia worsening.

The fibrotic phase (3 weeks after injury) includes fibrous lung tissue and dead space. Not all patients reached this phase this is worst case scenario.

Question 47

What is the nemonic for ARDS?

Answer 47

Atelectasis
Refractory Hypoxemia
Deceased lung compliance
Surfactant cell damage

Question 48

Asthma is characterized by what chronic state?

Answer 48

Inflammation

Question 49

What causes the chronic state of inflammation in Asthma?

Answer 49

Bronchial responsiveness, airway constriction, variable airflow obstruction (reversible).

Question 50

What is status asthmaticus?

Answer 50

Another name for acute severe bronchospasm.

If continued, hypoxia worsens, expiratory flows and volume decreases more, and effective ventilation decreases. Acidosis develops because of the rising PaCO2 levels. A silent chest + > 70 mmHg PaCO2 will lead to impending death.

Question 51

How is an acute attack of asthma managed?

Answer 51

Administration of O2, inhaled B-agonist bronchodilator, and oral corticosteroids.

Question 52

What are the risk factors of COPD?

Answer 52

Tobacco smoke, occupational dust and chemicals, indoor and outdoor pollution, factors that affect lung growth rate during gestation or childhood.

Question 53

How is chronic bronchitis determined?

Answer 53

History of symptoms, physical examination, chest imaging, pulmonary function tests, and blood gas analysis.

Question 54

What are the hallmark pathogenic changes occurring in the body with chronic bronchitis?

Answer 54

Exposure to irritants and chemicals cause hypertrophy and hyperplasia to the bronchial mucous glands (in main bronchi) and goblet cells (in bronchioles). This causes an increased mucus production. Because the bronchioles are smaller and easier to obstruct. In smokers, for example, the cilia will become smaller making it harder to move mucus around which is why people with chronic bronchitis tend to have a nonproductive cough.

Question 55

How does obstruction occurred emphysema different from obstruction happening in chronic bronchitis?

Answer 55

In emphysema the damages to the alveoli. And chronic bronchitis the damages to the bronchioles.

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