Week 11- Emphysema

Question 1

PART 1

Answer 1

PART 1

Question 2

Emphysema:

• What is it?
• Is it a disease of inhalation or exhalation?
• Characterized by ___________ in the lungs.
• Causes an _______ in residual volume (RV) and total lung capacity (TLC), and a _______ is the FVC1/FVC ratio.
• Is it a progressive disease?

Answer 2

• Pathological accumulation of air in the lungs.
• Characterized by air trapping in lungs.
• INCREASE in RV/TLC, DECREASE in FVC1/FVC ratio
• Yes, it is progressive.

Question 3

What FVC1/FVC ratio is considered “bad news”?

Answer 3

<0.5 = BAD NEWS

Question 4

Describe the pathology of Emphysema. (3)

Answer 4

1. ) Creates hyperinflated lungs with enlarged alveoli (super alveoli).
2. ) Forced expiration causes smaller airways to collapse during expiration.
3. ) Leads to “air trapping” in the alveoli.

Question 5

Explain why hyperinflated alveoli explains the underlying pathology of emphysema. (3)

Answer 5

1. ) REDUCED lung elastic recoil.
2. ) INCREASED lung compliance.
3. ) INCREASED lung volumes with REDUCED maximal expiratory flow rates.

Question 6

Why are patients with emphysema typically thin? Why do they often have deformed chests?

Answer 6

Cachexia disease process causes muscle degradation. Chest deformities including barrel chest and larger accessory muscles due to inability to exhale trapped air.

Question 7

What is often the FIRST symptom of emphysema?

Answer 7

SOB at REST

Question 8

Do patients with emphysema often have R-sided HF? Why or why not?

Answer 8

Yes, often have accompanying CARDIAC problems (COR PULMONALE)

Question 9

What is the prognosis for emphysema and why?

Answer 9

• Poor prognosis due to it being a chronic, progressive, and debilitating disease.
• Also may present with lung cancer.

Question 10

Emphysema Treatment Benefits:

1. ) Reducing airway edema secondary to ______ and _______.
2. ) Facilitating the elimination of bronchial _________.
3. ) Preventing and treating respiratory ________.
4. ) Increasing exercise ___________.
5. ) Avoiding airway _______/________.
6. ) Relieving ________ and ___________.

Answer 10

1. ) inflammation and bronchospasms
2. ) secretions
3. ) infection
4. ) exercise tolerance
5. ) irritants/allergens
6. ) anxiety and depression

Question 11

The first heart sound is best heard under the distal sternal area. Hyper inflated lungs causes the heart to elongate, displacing the left ventricle _______ and ________.

Answer 11

downward and medially

Question 12

Patients with emphysema often assume unusual postures. Describe them.

Answer 12

• Professorial position

- Sitting up (laying down can limit breathing) or avoiding kyphosis to help lung volume

Question 13

What is Hypoxic Drive?

Answer 13

Form of respiratory drive in which the body uses O2 chemoreceptors instead of CO2 receptors to regulate respiratory cycle.

Question 14

How is normal respiration regulated? (4)

Answer 14

1. ) Driven mostly by levels of CO2 in the blood.
2. ) Those levels are detected by peripheral chemoreceptors.
3. ) An increase in arterial CO2 leads to an increase in respiration.
4. ) Dissolved O2 plays only a minor role in regulating respiration.

Question 15

Describe how respiration is different in those with emphysema.

Answer 15

1. ) The body begins to use paO2 to drive respiration rates (i.e. INCREASED RELIANCE on PaO2 to drive respiration).
2. ) Increases in PaO2 can have the effect of reducing respiratory rates.

Question 16

What may happen to a person with a chronic hypoxic drive (emphysema) if they enter ARDS? (2)

Answer 16

1. ) Healthcare providers who are unaware of condition may provide O2 therapy as initial treatment.
2. ) This, however, will only REDUCE respiration rates due to increasing PaO2 levels.

Question 17

PART 2: PHARMACOLOGY

Answer 17

PART 2: PHARMACOLOGY

Question 18

Metered-Dose Inhaler (MDI):

• User must take _____ (____s) breath while maintaining good seal AND pressing on the device.
• Important to evaluate for patient _________ use of MDI.

Answer 18

• slow (10s)

- correct use of MDI

Question 19

Why might a patient with emphysema be treated with a glucocorticoid?

Answer 19

Anti-inflammatory agent

Question 20

Are patients with emphysema treated with a beta-1 or beta-2 antagonist. What is the action of the drug and why might tit result in tachycardia and heart palpations
in these patients?

Answer 20

Beta-2 Antagonists

-Prevents smooth muscle contraction. Need air to “run away” which will also increase HR and contractility.

Question 21

What is an exacerbation of emphysema?

Answer 21

Upper respiratory infection