Quiz 8 respiratory Flashcards
A patient has hypoxia, dyspnea and lack of breath sounds on one side. Chest x-ray shows a mediastinal shift. You suspect which of the following has occurred?
Pneumonia
, Not Selected
Correct answer:
Pneumothorax
Pleural Effusion
, Not Selected
Pulmonary Embolism
Pneumothorax
“Clinical signs and symptoms of a pneumothorax include chest pain, dyspnea, and increased respiratory rate… auscultation may reveal a lack of breath sounds on the affected side…. A mediastinal shift toward the contralateral, undamaged lung may be apparent…. Pulse oximetry and ABG analysis demonstrate hypoxemia”
In patients with pneumonia, why does excess mucus in the alveoli reduce gas exchange?
Correct answer:
the alveolar-capillary interface is widened
alveolar walls will begin to stick together
, Not Selected
mucolytic enzymes destroy alveolar macrophages
, Not Selected
mucus binds with the oxygen that enters the alveoli
the alveolar-capillary interface is widened
mucous and exudative edema accumulate between the alveoli and capillaries. The alveoli attempt to open and close against the purulent exudate; however, some cannot open…. A layer of edema and infectious exudate at the capillary-alveoli interface hinders optimal gas exchange. The patient can become hypoxic and hypercapnic, with obstructed exchange of O2 and CO2 at the pulmonary capillaries.” (Capriotti, 2nd Ed., Pg. 484) Note: Also see the normal alveolar-capillary interface as shown in Figure 20-2 on page 473. This is where the above problem occurs in the person with pneumonia!
W hen a patient has a history of left ventricular heart failure, this increases their risk of developing which of the following?
Pneumothorax
, Not Selected
Pneumonia
, Not Selected
Asthma
, Not Selected
Correct answer:
Pulmonary Edema
Pulmonary Edema
“The most common cause of pulmonary edema is left ventricular heart failure (LVF)… as a result, hydrostatic pressure builds backward… the high hydrostatic pressure within the pulmonary capillaries causes fluid from the blood to diffuse into the interstitial tissues.”
___________________________________ causes the expanded anterior-posterior chest diameter in emphysema that results in a barrel-chest appearance.
asignificant carbon dioxide retention
, Not Selected
Correct answer:
chronic air trapping with hyperinflation
markedly narrowed bronchial lumens
, Not Selected
chronic destruction of alveolar walls
chronic air trapping with hyperinflation
“A barrel-shaped chest is commonly present in emphysema; this is a shape that has an equal diameter of the width and depth of the chest. In healthy persons the width of the chest should be double the depth of the chest. In emphysema, there is an accumulation of air in the alveoli, which over time increases the width and depth of the thoracic cage.” (Capriotti, 2nd Ed., Pg. 506) Also see Figure 21-3 on page 499!
Why can excessive supplemental oxygen administration to COPD patients be detrimental?
Correct answer:
low oxygen levels are their primary stimulus to breathe
oxygen washes out the inert gases and causes alveolar collapse
, Not Selected
high oxygen levels can trigger an acute hypertensive crisis
, Not Selected
increased CO2 causes a metabolic alkalosis condition
low oxygen levels are their primary stimulus to breathe
“The healthy person is stimulated to breathe when CO2 accumulates in the bloodstream and activates the respiratory center in the brain.” “In persons who develop long-term chronic hypercapnia, the respiratory center becomes insensitive to accumulation of CO2 as a stimulus for breathing. The body changes its respiratory stimulus to low oxygen levels (hypoxia), instead of high CO2 levels. This often occurs in person with long-term COPD.” (Administering “excessive supplemental oxygen” to THIS person can remove their drive to breathe!) (Capriotti, 2nd Ed., Pg. 497)
What is the best description of the disease known as cor pulmonale?
whole heart failure due to shunting of blood through the pulmonary circulation
, Not Selected
Correct answer:
right-sided heart failure due to pulmonary hypertension
right-sided heart failoure due to blood shunting to the lungs during shock states
, Not Selected
left-sided heart failure due to increased systemic vascular resistance
right-sided heart failure due to pulmonary hypertension
“Chronic pulmonary disease is the leading cause of RVF (right ventricular failure). When pulmonary disease is the etiology of RVF, the condition is referred to as cor pulmonale. In cor pulmonale, the initiating event of heart failure is a lung disease that causes chronic hypoxia. The heart starts out in good health until a lung disease exerts detrimental effects on the right ventricle.”
Why does a pulmonary embolus cause hypoxia to develop?
blood leaks into the alveolar spaces block gas transfer
, Not Selected
inspired air cannot reach the affected lung section
, Not Selected
Correct answer:
blocked blood supply causes an area of the lungs to not be perfused
the blood clot causes bronchospasms in surrounding lung tissues
, Not Selected
blocked blood supply causes an area of the lungs to not be perfused
A Pulmonary Embolus (PE) is when a clot has “traveled to the pulmonary arterial circulation and caused obstruction of arterial blood flow through the lungs”. This, as a result, leads to inadequate arterial blood flow and gas exchange in the area of the PE
What typically results from chronic hypoxia? (Select 3 that apply)
,
Bluish color of the sclera
Polycythemia
Clubbing of the fingers
Pulmonary hypertension
,
Purple discoloration in the ankles
Polycythemia
Clubbing of the fingers
Pulmonary hypertension
“The body compensates for hypoxia by increasing ventilation, stimulating pulmonary arteriole vasoconstriction, and having the kidney release erythropoietin…. Erythropoietin stimulates the bone marrow to synthesize red blood cells (RBCs)….Chronic hypoxia causes constant synthesis of RBCs, a condition called erythropoiesis…Chronic hypoxia also causes pulmonary arterial vasoconstriction; this leads to pulmonary hypertension, a condition of high blood pressure within the pulmonary arterial system.” (Capriotti, 2nd Ed., Pg. 497) “Clubbing of fingers occurs in chronic hypoxia.” (Figure 21-2, Pg. 499) “Polycythemia is an overabundance of RBCs. p. 297
A patient presents with high fever, fatigue and dyspnea. Upon assessment you find tachycardia and tachypnea, labs show leukocytosis and X-ray shows consolidation in the lung. What disease process do you suspect the patient has?
Correct answer:
pneumonia
chronic bronchitis
, Not Selected
pneumothorax
, Not Selected
pulmonary effusion
pneumonia
The person with pneumonia can have many signs/symptoms, including: cough, fever, chills, pleuritic chest pains with deep breaths, dyspnea, decreased exercise tolerance, fatigue, myalgias (achiness), tachypnea, use of accessory muscles for breathing, tachycardia, and crackles in lungs. (See “Clinical Presentation”, Capriotti, 2nd Ed., Pg. 485) “A chest x-ray is the most important diagnostic study in the diagnosis of pneumonia (see Figure 20-6). (Consolidation is seen as white areas on the chest x-ray, showing that air has been replaced by fluid or other.) CBC with differential will suggest either a bacterial or viral infection.” (Capriotti, 2nd Ed., Pg. 485) Leukocytosis is an elevated WBC count in the blood (Normal WBCs=4,000-10,000 cells/mL).
What pulmonary disorder is spread by droplets and presents with weight loss, night sweats, cough with purulent sputum and low grade fever?
asthma
, Not Selected
Correct answer:
tuberculosis
Community-acquired pneumonia
, Not Selected
sleep apnea
, Not Selected
tuberculosis
“TB (Tuberculosis) is spread by the inhalation of airborne droplets containing M. tuberculosis bacteria.” Clinical presentation of a person with active TB include “chronic cough, which produces purulent sputum; hemoptysis; weight loss; anorexia; chest pain; and a low-grade fever with night sweats”. (Capriotti, 2nd Ed., Pgs. 487 & 488)
