Exam 3 Concept Review: Chapter 13

Question 1

What is orthopnea? and how is it relieved?

Answer 1

Condition where someone has difficulty breathing when lying down

it is relieved by sitting and standing

Question 2

What happens in hypercapnia?

Answer 2

when carbon dioxide levels in the blood increase.

Question 3

What happens when carbon dioxide easily diffuses into Cerebrospinal fluid (CSF)?

Answer 3

Lowers pH (acidic) and stimulates respiratory center (stimulates breathing)

Increased rate and depth of respirations (hyperventilation)

Causes respiratory acidosis—nervous system depression

Question 4

What is hypoxemia?

Answer 4

A marked decrease in oxygen

Question 5

What happens when there is a marked decrease in oxygen?

Answer 5

chemoreceptors in the carotid arteries respond

Question 6

What is the important control mechanism in individuals with chronic lung disease?

Answer 6

Individuals with chronic lungs disease is going to have high CO2 levels all the time because their breathing is impaired – what is going to happen? They going to move to the hypoxic drive where they going to rely on low oxygen to stimulate breathing

Question 7

What are the factors affecting diffusion of gases?

Answer 7

Partial pressure gradient
Everything is on a pressure and the body wants it to be balanced in terms of the pressure gradient

Thickness of the respiratory membrane
Fluid accumulation in alveoli or interstitial tissue impairs gas exchange – make it a thicker membrane for air flow to get across.
In other words, there is a barrier for gas exchange
Manifestations: shortness of breath (the patient is not diffusing gases correctly)

Total surface area available for diffusion
If part of alveolar wall is destroyed, surface area is reduced, so less exchange
Alveolar wall can destroyed by significant lung disease or atelectasis (crumbled up – fraction of the alveoli)

Ventilation-perfusion ratio
Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange.

Question 8

What are Kussmaul’s Respirations?

Answer 8

Deep rapid respirations—typical for acidosis; may follow strenuous exercise
The respiratory will kick in and the patient will breath a little faster to blow off the acid or CO2 (air hunger)

Question 9

What happens when emphysema patients progressively have difficulty breathing with expiration?

Answer 9

Air trapping in alveoli and increased residual volume (air leftover after expire leading to “barrel chest”

Question 10

What happens when the emphysema advances?

Answer 10

Adjacent damaged alveoli coalesce, forming large air spaces.

Pneumothorax (lung collapse)
Occurs when pleural membrane surrounding large blebs ruptures

Hypercapnia becomes marked.
Higher levels of CO2 due to the body holding on to CO2 (all the air)

Hypoxia becomes driving force of respiration
These kinds of patients always have high CO2 so the chemoreceptors in the medulla have to revert hypoxia drive because the body always have high CO2 (the body becomes desensitized to it so they are relying on the chemoreceptors in the carotid bodies that are sensitive to low oxygen which becomes the drive for breathing)
This is why nurse don’t give emphysema patients oxygen because if they give the patients too much oxygen, it will knock their drive for breathing

Frequent infections

Pulmonary hypertension (pressure in the airways) and cor pulmonale (right-sided failure due to lung problems) may develop in late stage.

Question 11

What happens when there is a breakdown of alveolar wall in emphysema patients?

Answer 11

Loss of surface area for gas exchange

Loss of pulmonary capillaries

Loss of elastic fibers

Altered ventilation-perfusion ratio

Decreased support for other structures

Question 12

What are the risk factors for tuberculosis?

Answer 12

People living in crowded conditions (MOST IMPORTANT)
Ex: nursing homes, homeless shelters

Immunodeficiency (MOST IMPORTANT)

Malnutrition

Alcoholism

Conditions of war

Chronic disease

HIV infection
Due to the immunodeficiency that the patient has meaning they can get infection easily.

Question 13

What are secondary infections?

Answer 13

Someone already exposed but they have some kind of problem that makes their resistance go down like stress or infection which forces them to be reinfected

Question 14

What is secondary or re-infection of Tuberculosis (TB)?

Answer 14

THIS IS WHEN THE BACILLI IS STILL WALLED OFF AND CALCIFIED BUT THE PATIENT IS FACING SOME KIND OF STRESS ON THE BODY SUCH AS THE IMMUNE SYSTEM, MALNUTRITION, AGE, AND THIS CAUSES THE CELL-MEDIATED IMMUNITY TO BECOME IMPAIRED WHICH RESULT IN THE BACILLI TO REPRODUCE AND EFFECT THE PERSON AND BECOME ACTIVE “TB”.

Question 15

when does secondary or re-infection of Tuberculosis occur?

Answer 15

Occurs when client’s cell-mediated immunity is impaired because of:
	Stress
	Malnutrition
	HIV infection
	Age

Question 16

What happens to mycobacteria in secondary or re-infection of Tuberculosis (TB)?

Answer 16

Mycobacteria begin to reproduce and infect lung.

Question 17

What does it mean when someone becomes “Active TB”?

Answer 17

They can spread the infection to others

Question 18

DIAGNOSITIC TESTS FOR TUBERCULOSIS:

What is the best tests for a patient that hasn’t be exposed or vaccinated?

Answer 18

Skin test

Question 19

DIAGNOSITIC TESTS FOR TUBERCULOSIS:

Why wouldn’t the skin test be the best for a patient that has been exposed or vaccinated?

Answer 19

It won’t be effective for someone that’s had the vaccine or has been exposed in the past because it is always going to show positive

Question 20

DIAGNOSITIC TESTS FOR TUBERCULOSIS:

What should the nurse do other the skin test when their patient tested positive because they’ve been vaccinated or exposed?

Answer 20

Chest x-rays

Question 21

What does a positive tuberculin (skin) test results mean?

Answer 21

First exposure or primary infection

BUT THIS DOES NOT MEAN THE PATIENT IS ACTIVELY ILL

Question 22

DIAGNOSITIC TESTS FOR TUBERCULOSIS:

What is the best test that the nurse can do for positive TB? and What is the nurse looking for?

Answer 22

Sputum

The nurse is looking for an Acid Fast Bacilli

Question 23

TUBERCULOSIS:

What does cavitation do to the lungs?

Answer 23

CAVITATION PUTS HOLES IN THE LUNGS, ALLOWING FOR THE BACILLI TO TRAVEL TO OTHER AREAS OF THE BODY MUCH EASIER

Question 24

TUBERCULOSIS:

What kind of sputum is produced when the patient starts coughing?

Answer 24

A lung with a cough comes with hemoptysis, bloody sputum, because it starts to erode like the bronchi and vessel

Question 25

What is the color of the alveoli of an emphysema patient?

Answer 25

Pink puffer = emphysema

Question 26

CYSTIC FIBROSIS: What body systems do cystic fibrosis impact?

Answer 26

Digestive tract (both pancreas, bile ducts, salivary glands, ducts) Reproductive tract Obstruction of vas deferens (male) Obstruction of cervix (female) Sweat glands Sweat has high sodium chloride content.

Question 27

CYSTIC FIBROSIS: How does cystic fibrosis affect the digestive system?

Answer 27

Meconium ileus in newborns Meconium is the first stool they pass as a baby Intestine is blocked by the mucus so the baby can pass the meconium ileus (a blockage) Blockage of pancreatic ducts Causes a deficit of pancreatic enzymes leading to malabsorption and malnutrition The body needs pancreatic enzymes to absorb nutrients from food Obstruction of bile ducts Salivary glands often mildly affected Increased sodium secretions (ton of sodium in sweat) NOTE: BACKING UP THE PANCREAS CAN LEAD TO DIABETES

Question 28

What is sleep apnea?

Answer 28

Result of pharyngeal tissue collapse during sleep (can occur when a patient is super sedated – they are not responding to oxygen)

Question 29

What does CPAP do to help?

Answer 29

Continuous positive airway pressure pump (CPAP machine) – keeps airway open When sleep apnea is happening and the tissue is collapsing, the CPAP will help keep airway open

Question 30

What does sleep apnea lead to?

Answer 30

Leads to repeated and momentary cessation (pauses) of breathing

Question 31

Who are more effected by sleep apnea?

Answer 31

Men are affected more often than women.

Question 32

PULMONARY EDEMA: What causes Pulmonary Edema?

Answer 32

Inflammation in lungs is present. Increases permeability of capillaries Plasma protein levels are low. Decreases osmotic pressure of plasma Pulmonary hypertension develops.

Question 33

PULMONARY EDEMA What can fluid in the alveoli and interstitial fluid result from?

Answer 33

Can result from many primary conditions Reduces amount of oxygen diffusing into blood Interferes with lung expansion

Question 34

PULMONARY EMBOLISM: What are the manifestations of pulmonary embolism?

Answer 34

Transient chest pain, cough, dyspnea (shortness of breath)—small emboli Larger emboli—increased chest pain with coughing or deep breathing; tachypnea and dyspnea develop suddenly. Later—hemoptysis ( and fever Hypoxia—causes anxiety, restlessness, pallor, tachycardia Massive emboli Severe crushing chest pain, low blood pressure, rapid weak pulse, loss of consciousness PATIENT LYING DOWN CAN PUT THEM AT RISK FOR PULMONARY EMBOLUS BECAUSE IT CAUSE STASIS OF THE BLOOD (THE BLOOD IS SLUGISH)

Question 35

ASTHMA: When does bronchial construction occur?

Answer 35

Occurs in persons with hypersensitive or hyperresponsive airways

Question 36

PATHO OF ASTHMA: What are the pathophysiological changes of bronchi and bronchioles?

Answer 36

Inflammation of the mucosa with edema (narrow airway) Bronchoconstriction Caused by contraction of smooth muscle (airway constrict, smaller) Increased secretion of thick mucus In airways

Question 37

TREATMENT ASTHMA: What does a patient use for the bronchoconstriction?

Answer 37

Bronchodilators (rescue inhalers) – ALWAYS IN HAND | Help exchange air (allows patient to breath easier)

Question 38

What are the general manifestations of respiratory disease?

Answer 38

Yellowish-green, cloudy, thick mucus Often indication of a bacterial infection Rusty or dark-colored sputum Usually sign of pneumococcal pneumonia Thick, tenacious mucus Asthma or cystic fibrosis, blood-tinged sputum—may result from chronic cough; may also be sign of tumor or tuberculosis Hemoptysis Blood-tinged (bright red) frothy sputum, usually associated with pulmonary edema THESE ARE ALL ABNORMAL SPUTUMS (A NORMAL SPUTUM IS THIN, CLEAR, OR CREAM COLOR)

Question 39

PULMONARY EDEMA: What is another sputum associated with pulmonary edema?

Answer 39

Pink frothy sputum is associated with pulmonary edema

Question 40

What is the difference between forced and quiet/passive inspiration?

Answer 40

Quiet/passive inspiration – when the person is not aware of their breathing (it happens naturally) There is no effort put into Forced inspiration – require additional energy and muscle activity (takes an action)

Question 41

What is an Alveoli?

Answer 41

Alveoli- end point for inspired air; site of gas exchange (there are millions of alveoli) Blood and respiratory system oxygenates the blood

Question 42

What is the difference between Central and Peripheral Chemoreceptors?

Answer 42

Central chemoreceptors Located in the medulla Respond to slight elevations in CO2 or a decrease in pH Peripheral chemoreceptors Located in the carotid bodies Is sensitive to low O2 (oxygen levels in the blood get too low)

Question 43

Describe the chemoreceptors

Answer 43

Though, both chemoreceptors do the same job, they are sensitive to different things. This can come in handy when discussing patients with chronic issues with breathing - why drive of breathing can switch to a different drive; this depends on what the chemoreceptors are sensitive to and how they respond

Question 44

What is the normal respiratory response in a healthy person?

Answer 44

(a normal or healthy person respiratory wise, control of breathing is responding to CO2 – they rely on high levels of CO2 to stimulate or have drive for taking breath)

Question 45

What is the normal cycle for respiratory control?

Answer 45

1. When the person starts breathing, CO2 increases in the blood and cerebrospinal fluid (CSF) 2. The increase of CO2 and CSF stimulates the central chemoreceptors in the medulla 3. Central Chemoreceptors realize there is too much CO2 and forces the body to take a breath Stimulates inspiratory muscles to inspire air 4. These inspiratory muscles increases the respiratory rate 5. As the respiratory increase, more CO2 is removed from the body 6. As result, the PCO2 level decreases 7. The decrease of PCO2 causes a decrease in the chemoreceptor stimulation 8. Slow respirations 9. Retain more CO2

Question 46

What are the role of surfactants?

Answer 46

Surfactant, is lubrication (so when the alveoli is exchanging air, the surfactant is reducing friction)

Question 47

CYSTIC FIBROSIS: What happens to the body systems due to cystic fibrosis?

Answer 47

ELECTROLYTE IMBLANCE AND DEHYDRATION DUE TO THE EXCESS SODIUM CONTENT IN THE SWEAT GLANDS BLOCKAGE OF THE REPRODUCTIVE TRACT LEADS TO INFERTILITY OBSTRUCIVE PANCREA DUCTS LEADS TO MALABSORPTION OR MALNURITION

Question 48

TREATMENT FOR CYSTIC FIBROSIS: What is the nurse trying to ensure with the treatment of cystic fibrosis?

Answer 48

FOR TREATMENT, THE NURSE WANTS TO TRY AND REPLACE THERAPY IN TERMS OF PANCREATIC ENZYMES AND ENSURE THEIR FLUID AND ELECTROLYTES ARE BALANCED AND DIET IS WELL-BALANCED

Question 49

LUNG CANCER: What are the lung tumor effects?

Answer 49

Obstruction of airflow into a bronchus (narrow the airway outside or obstruct it in the inside) Causes abnormal breath sounds and dyspnea Inflammation and bleeding surrounding the tumor (causes aggravation) Cough, hemoptysis, and secondary infections Pleural effusion, hemothorax, pneumothorax Fluid or blood build up in the lungs or collapse lungs Paraneoplastic syndrome Occurs when tumor cell secretes hormones or hormone-like substances Usual systemic effects of cancer Ex: weight gain, fatigue

Question 50

ASPIRATION: What is the most common area for aspiration or aspiration pneumonia?

Answer 50

THE RIGHT LOWER LOBE IS THE MOST COMMON AREA OF ASPIRATION OR ASPIRATION PNEUMONIA BECAUSE OF THE ANATOMY (IT GOES MORE STRAIGHT DOWN WHEREAS THE LEFT SIDE HAS A MORE SHARPER ANGLE SO IT TAKES THE PATH OF LEAST RESISTANCE)

Question 51

ASPIRATION: What is aspiration pneumonia?

Answer 51

Aspiration pneumonia | Inflammation—gas diffusion is impaired.

Question 52

ASPIRATION: What is Respiratory distress syndrome?

Answer 52

May develop if inflammation is widespread Or complete blockage where something solid was swallowed and there is no air exchange can cause a patient to go into respiratory distress

Question 53

PREVENTION OF PULMONARY EMBOLUS: How can a patient prevent pulmonary embolus?

Answer 53

Prevention Health teaching prior to surgery Antiembolic stockings are elasticated stockings designed to minimize the risk of blood pooling in your legs whilst you are ill and less able to move around than normal. Exercise to prevent thrombosis If applicable Use of anticoagulant drugs PATIENT LYING DOWN CAN PUT THEM AT RISK FOR PULMONARY EMBOLUS BECAUSE IT CAUSE STASIS OF THE BLOOD (THE BLOOD IS SLUGISH)

Question 54

TREATMENT OF PULMONARY EMBOLUS: What is the treatment for pulmonary embolus?

Answer 54

FOR PATIENTS WITH PULMONARY EMBOLUS, NURSE WOULD BE THEM ON BED REST AND HAVE THEM IN ANTIMOBLIC STOCKINGS

Question 55

What happens to the body as the result of Atelectasis?

Answer 55

Nonaeration or collapse of lung or part of a lung (MOST IMPORTANT) Leads to decreased gas exchange and hypoxia Alveoli become airless. (MOST IMPORTANT) Collapse and inflammation or atrophy occur. Process interferes with blood flow through the lung. Both ventilation and perfusion are altered. Affects oxygen diffusion

Question 56

What is Atelectasis?

Answer 56

ATELECTASIS IS A COMPLICATION OF A PRIMARY CONDITION (POST OP = OCCUR AFTER SURGERY) – NURSE WANT PATIENTS WALKING AS SOON AS POSSIBLE TO AVOID ATELECTASIS

Question 57

What is Pleural Effusion?

Answer 57

Presence of excessive fluid in the pleural cavity | LUNGS WON’T BE ABLE TO FULLY EXPAND

Question 58

Pneumothorax: What is the difference between tension, open, and closed pneumothorax?

Answer 58

IN CLOSED PNEUMOTHORAX, PART OF THE LUNG IS COLLASPING BECAUSE INTERNAL PROCESS (EX: PATIENTS WITH EMPHYESMA OR RESPIRATORY DISEASES ARE AT RISK FOR PNEUMOTHORAX BECAUSE THAT PART OF THE LUNG SURFACE CAN RUPTURE OR ERODED WHICH PUT A HOLE IN THE LUNG AND THE LUNGS ARE AT A NEGATIVE PRESSURE SO ONCE SOMETHING INTERFERES WITH THE PRESSURE, THE LUNGS WILL COLLAPSE) OPEN PNEUMOTHORAX, IS A PUCTURE THROUGH THE CHEST TENSION HAS A FLAB – AIR CAN GET IN BUT AIR CAN’T IN BECAUSE THE FLAB IS TRAPPING THE AIR WHICH CAUSES ISSUES WITH THE RESPIRATORY SYSTEM (MOST SERIOUS FORM)