pulmonary pathophysiology 2

Question 1

1. What are the mechanical barriers of the pulmonary defense mechanism?

Answer 1

Nose, mucociliary blanket, and cough

Question 2

2. What are the non-specific and immune mechanisms of the pulmonary defense mechanism?

Answer 2

Alveolar macrophages, neutrophils, and immune globulins

Question 3

3. Where are intermediate-size particles (3-5u) deposited in the respiratory tract?

Answer 3

The bronchi and bronchioles

Question 4

4. When small (<3u) particles reach the alveoli what happens to them?

Answer 4

The immune cells (alveolar macrophages)

Question 5

5. What mechanism are the cilia an important part of and what is their function?

Answer 5

They propel mucous out of the airway on the mucociliary escalator

Question 6

7. Describe the differences between acute bronchitis and bronchiolitis.

Answer 6

Acute bronchitis is an infection of the large airways that can be viral or bacterial, it more commonly occurs in adults and smokers. Acute bronchiolitis is an infection of the small airways that is mostly viral, and is typically seen in children.

Question 7

8. What is the pathophysiology of bronchitis?

Answer 7

Inflammation of the airways and sputum production

Question 8

9. Define pneumonia.

Answer 8

Infection of the pulmonary parenchyma (lung tissue) which can be caused by bacteria, viruses, fungi, and other organisms.

Question 9

10. What are the symptoms of pneumonia?

Answer 9

Fever, cough, sputum production, & chest pain

Question 10

11. What type of pneumonia can occur in healthy people but is commonly precipitated by a virus (like influenza)?

Answer 10

Bacterial pneumonia (strep pneumonia)

Question 11

12. What are the community acquired pneumonia pathogens?

Answer 11

Bacterial (streptococcus pneumonia, klebsiella pnemoniae, streptococcus pyogenes, staphylococcus aureus, and legionella pneumonphila), mycoplasma/chlamydia, viral (measles, varicella), and fungal (blastomycosis, histomycosis, and coccidiomycosis)

Question 12

13. What type of fungal pneumonia can occur in healthy individuals who visit wet, vegetative areas in the norther Midwest?

Answer 12

Blastomycosis

Question 13

14. How is the Blastomycosis (fungus) recognized on microscopy?

Answer 13

Broad, budding, yeasts

Question 14

15. Where do most community acquired pneumonia originate?

Answer 14

Colonization of the upper airways and aspiration of the organisms into the lungs

Question 15

16. What type of pneumonias occur in immunocompromised patients?

Answer 15

Viral (CMV and herpes), PCP, Fungi (aspergillosis), and nosocomial (anaerobes, gram negative rods, staph aureus)

Question 16

17. Where type of patients get nosocomial pneumonia?

Answer 16

Hospitalized patients

Question 17

18. What patients are at the highest risk for nosocomial pneumonia?

Answer 17

Intensive care patients on mechanical ventilators

Question 18

19. What organisms most often cause nosocomial pneumonia?

Answer 18

Gram negative rods and staph aureus and methyl resistant staph aureus (MRSA)

Question 19

20. As a future nurse what is the most important thing for you to provide your patients to prevent nosocomial pneumonia? Why?

Answer 19

Frequent and thorough oral care – especially when they are intubated! Most pneumonias originate in the mouth.

Question 20

21. Who gets opportunistic pneumonias? What are examples?

Answer 20

Patients who are immune compromised; pneumocystis pneumonia, and aspergillosis

Question 21

22. What is the therapy to prevent pneumocystis pneumonia?

Answer 21

TMP-Sulfa and monthly inhaled pentamidine

Question 22

23. What are the characteristics of invasive pulmonary aspergillosis?

Answer 22

Seen in severely neutropenic patients (chemotherapy, bone marrow transplants), invasion of pulmonary parenchyma and blood vessels, nodules and cavitations, can be fatal

Question 23

24. Who should receive the pneumonia vaccine?

Answer 23

Patients with chronic lung or heart disease, diabetes, lymphoma, alcoholism, asplenic patients, renal failure, and those aged 65 or greater should receive vaccine and/or booster

Question 24

25. Define ARDS.

Answer 24

Clinical syndrome of rapidly progressive respiratory failure, extensive radiologic opacities in both lungs and severe hypoxemia requiring mechanical ventilation

Question 25

26. What are the potential causes of ARDS?

Answer 25

Severe infections, multiple trauma, aspiration, pancreatitis, and shock

Question 26

27. What is the main pathologic finding of ARDS? Explain how it occurs.

Answer 26

Diffuse alveolar damage (DAD), which results from accumulation of inflammatory cells in the interstitial space, release of mediators, oxidants, and enzymes to destroy pathogens cause epithelial damage that results in loss of type I pneumocytes, denudation of basement membrane, and endothelial damage with causes leakage of protein rich plasma fluid causes alveolar edema

Question 27

28. Describe the phases of ARDS.

Answer 27

Exudative phase (week one): edema, inflammation, loss of type I cells. Organizing phase (week two): proliferation of type II cells and fibrosis. Resolution phase (after week 3): partial or complete resolution, patient is left with fibrotic lungs and varying degrees of long term respiratory damage