Respiratory

Question 1

Peripheral chemoreceptors in the carotid bodies and aortic arch are sensitive to:

Answer 1

changes in arterial carbon dioxide, oxygen, and pH

Question 2

Central chemoreceptors in the medulla oblongata detect

Answer 2

changes in arterial PCO2, cause a change in breathing

Question 3

Major respiratory muscles

Answer 3

diaphragm and external intercostal

Question 4

Accessory muscles

Answer 4

sternocleidomastoid and scalene muscles

Question 5

Compliance of the lung

Answer 5

ability to stretch and expand

Question 6

Most important cause of pulmonary artery constriction is

Answer 6

low PaO2 (alveolar hypoxia -> hypoxic vasoconstriction)

Question 7

If low PaO2 is in one part of the lung

Answer 7

arterioles to that segment constrict, shunting blood to other, well-ventilated portions

Question 8

If all lung segments affected by low PaO2

Answer 8

pulmonary HTN

Question 9

Respiratory defense mechanisms

Answer 9

Mucociliary clearance system
- mucous
- IgA
- Cilia
- Cough reflex
- reflex bronchoconstriction
- alveolar macrophages

Question 10

Atelectasis

Answer 10

collapse of alveoli or lung tissue

Question 11

When is Atelectasis common?

Answer 11

after surgery (anesthetics can change breathing patterns)

Question 12

Nursing interventions for atelectasis

Answer 12

repositioning, mobilize, DB&C exercises, incentive spirometry, pain management, PT, suctioning

Question 13

Pneumonia

Answer 13

Acute inflammation of lung “parenchyma” (area used for gas exchange) caused by a microbial agent, usually associated with marked increase in interstitial fluid and alveolar fluid.

Question 14

Predisposing factors for Pneumonia

Answer 14

age, air pollution, dysphagia, altered LOC, prolonged immobility, chronic diseases, immunosuppressant drugs, inhalation or aspiration of noxious substances, intestinal or gastric feeding

Question 15

2 types of pneumonia

Answer 15

Lobar - consolidation of 1 lobe of 1 lung

Lobular or Bronchopneumonia - patchy consolidation throughout

Question 16

Clinical Manifestations of pneumonia

Answer 16

productive cough, fever, SOB, dyspnea, chills, sweats, fatigue

OA: confusion (lack of O2)

Question 17

Labs and Diagnostics for pneumonia

Answer 17

WBC, x-ray, C&S

Question 18

Nursing interventions for intake with Pneumonia Pts

Answer 18

1500 calories/day min
3L fluid/day

Question 19

Chronic Bronchitis

Answer 19

presence of a chronic productive cough that lasts at least three months a year for 2 consecutive years

Question 20

Emphysema

Answer 20

Abnormal and permanent enlargement of alveoli due to rupture and damage reducing the surface area for gas exchange

Question 21

COPD can present with both

Answer 21

emphysema and chronic bronchitis

Question 22

COPD

Answer 22

• caused largely by smoking
• progressive, partially reversible airway obstruction
• increasing frequency and severity of exacerbations
• chronic inflammation found in airways and lung parenchyma
• excess mucus production (chronic productive cough)

Question 23

5 Causes of COPD

Answer 23

1. Smoking
2. Occupational chemicals/dust
3. Infection
4. Heredity
5. Aging

Question 24

2 defining features of COPD

Answer 24

1. Limited airflow during forced EXHALATION d/t loss of elastic recoil of alveolus, not fully reversible, structural changes in the lungs
2. Airflow obstruction d/t mucus secretion, mucosal edema, and bronchospasm

Question 25

Systemic effects of COPD

Answer 25

• cachexia (loss of skeletal mass)
• weakness, exercise intolerance and deconditioning
• osteoporosis
• chronic anemia

Question 26

Clinical manifestations of COPD

Answer 26

1. cough
2. sputum
3. dyspnea on exertion, then dyspnea at rest
4. increased work of breathing
5. barrel chest (air trapping in lungs)
6. prolonged expiration and wheezes
7. weight loss and anorexia
8. fatigue

Question 27

diagnosis of COPD confirmed by

Answer 27

spirometry: FEV1/FVC ratio < 70%

FEV1 – Max air that can be expired by lung in one second
FVC - Max gas that can be expired by lung in one second

Question 28

Collaborative care for COPD

Answer 28

smoking cessation, pursed lip breathing, remove bronchial secretions, bronchodilators, long term O2 therapy, exercise, avoid high altitudes, surgery (lung volume reduction surgery, lung transplantation)

Question 29

COPD complication

Answer 29

Cor Pulmonale:

hypoxia → pulmonary vasoconstriction → pulmonary HTN → R ventricular hypertrophy → COR PULMONALE → R sided HF