NURS 231 Pathophysiology Module 5: Respiratory System Questions and Answers, Exams of Pathophysiology

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Questions And Answers

The respiratory system can be divided into what 2 structures? - correct answer Conducting airways and respiratory tissues What are the levels of branching? - correct answer Trachea, bronchi, bronchioles, alveoli Where is the site of gas exchange? - correct answer Alveoli What cells are in the alveolar epithelium? - correct answer Type 1 and II alveolar cells, macrophages Describe what happens during inspiration and expiration: - correct answer During inspiration, air is drawn into the lungs as the respiratory muscles expand the chest cavity. During expiration, air moves out of the lungs as the chest muscles relax and the chest cavity becomes smaller. What occurs with the diaphragm during inspiration and expiration? - correct answer The diaphragm is the main muscle of inspiration. When the diaphragm contracts (inspiration), the chest expands. Upon expiration, the chest cavity decreases and pressure inside increases. What is lung compliance? What factors affect it? - correct answer Lung compliance is the ease with which lungs can be inflated. Elastin, collagen, elastic recoil, and surface tension can affect lung compliance.

Questions And Answers

Lung Volumes - correct answer The amount of air exchanged from a single event during ventilation (measure by a spirometer) Tidal Volume (Vt) - correct answer normal volume of air inhaled or exhaled with each breath Inspiratory Reserve Volume (IRV) - correct answer amount of air that can be forcefully inhaled after taking a normal breath Expiratory Reserve Volume (ERV) - correct answer Amount of air that can be forcefully exhaled after taking a normal breath Residual Volume (RV) - correct answer Air remaining in the lungs after forced expiration (cant be measured with spirometer) Vital Capacity (VC) - correct answer amount of air that can be exhaled after maximal inhalation. (VC=Vt + IRV + ERV) Inspiratory Capacity (IC) - correct answer Max amount of air that can be inhaled following a normal expiration (IC= Vt + IRV)

Questions And Answers

Functional Residual Capacity (FRC) - correct answer the amount of air that remains in the lungs after a normal expiration (FRC= RV + ERV) Total Lung Capacity (TLC) - correct answer sum of all lung volumes (TLC= IRV + Vt + ERV + RV) pulmonary function tests - correct answer Observe pulmonary flow in relation to time. Used to diagnose respiratory disease or to examine respiratory complaints. Or can be used as a pre op anesthesia or surgical risk evaluation Maximum voluntary ventilation - correct answer measures volume of air a person can move in and out of the lungs under max effort in 12-15 seconds (L/min) Forced Expiratory Volume (FEV) - correct answer measures volume of air that can be quickly and forcefully exhaled following full inspiration (to total lung capacity) Forced inspiratory vital flow (FIF) - correct answer measures respiratory response during rapid maximal inspiration

Questions And Answers

Ventilation - correct answer the movement of gases into and out of the lungs Perfusion - correct answer the process that allows blood flow to help facilitate gas exchange Diffusion - correct answer the movement of gases across the alveolar- capillary membrane. Shunt - correct answer when blood moves from pulmonary circulation (right side of heart) without being oxygenated This results in perfusion without ventilation—low ventilation-perfusion ratio Dead air space - correct answer ventilation without perfusion, resulting in high ventilation-perfusion ratio What is oxyhemoglobin? - correct answer Oxyhemoglobin is the term to describe when hemoglobin is bound with oxygen.

Questions And Answers

What is affinity? - correct answer The ability of the hemoglobin molecule to bind oxygen in the lungs and release it in the tissues depends on the affinity of the molecule. How is carbon dioxide transported in the blood? - correct answer As dissolved carbon dioxide, attached to hemoglobin, becomes bicarbonate How is breathing controlled? - correct answer The automatic regulation is controlled by both chemoreceptors and lung receptors. Chemoreceptors monitor blood levels of oxygen, carbon dioxide, and pH and adjusts ventilation accordingly. Lung receptors monitor breathing patterns and lung function. What are the characteristics of COPD? - correct answer The pathogenesis of COPD includes inflammation and fibrosis of the bronchial wall, hypertrophy of the submucosal glands and hypersecretion of mucus, and loss of elastic lung fibers and alveolar tissue. This airflow obstruction causes a mismatch in ventilation and perfusion. Alveolar tissue destruction leads to a decreased surface area for gas exchange. What is the leading risk factor for COPD? - correct answer Smoking

Questions And Answers

Be familiar with the disease pathology, clinical presentation, diagnosis, and treatment of COPD. - correct answer 1. Pathology: inflammation and fibrosis of the bronchial wall, hypertrophy of the submucosal glands and hypersecretion of mucus, and loss of elastic lung fibers and alveolar tissue. This airflow obstruction causes a mismatch in ventilation and perfusion. Alveolar tissue destruction leads to a decreased surface area for gas exchange.

2. Clinical presentation:

• fatigue, exercise intolerance, cough, sputum -Viral or bacterial infections, respiratory infections and chronic respiratory failure

3. diagnosis:
4. history, physical exam, PFTs, chest xray, lab tests
5. treatment

• stop smoking to slow disease progression
• pneumonia and flu vax
• inhaled short and long acting bronchodilators, to relax airway smooth muscle
• oxygen therapy when PCO2 levels drop below 55 mmHg

Questions And Answers

What are the characteristics of asthma? - correct answer Asthma is a chronic respiratory disease characterized by airway obstruction, bronchial hyperresponsiveness, airway inflammation, and in some cases, airway remodeling. chronic bronchitis and emphysema - correct answer -Chronic bronchitis is a clinical diagnosis: chronic cough productive of sputum for at least 3 months per year for at least 2 consecutive years. -Emphysema is a pathologic diagnosis: permanent enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar walls What is atopy? - correct answer Atopy is the genetic tendency for developing IgE-mediated hypersensitivity reactions in response to environmental allergens. It is one of the strongest predisposing factors for developing asthma. Be familiar with the risk factors, disease pathology, clinical presentation, diagnosis, and treatment of asthma. - correct answer 1. risk factors

1. atopy, family history of asthma, allergies, prenatal exposure to tobacco smoke and pollution, gastro-esophageal reflux disease, exercise, cold air, being African American or Puerto Rican decent.

Questions And Answers

2. pathology swelling of bronchial wall, mucus secretion, airway constriction, airway inflammation, bronchial hyper-responsiveness, and airflow obstruction
3. clinical presentation

• asthma attacks- wheezing, breathlessness, chest tightness, cough that is typically worse at night and early morning.
• Lung sounds wheeze during expiration.

4. diagnosis:

• Pulmonary function tests, patient history and physical exam
• airway obstruction will show a reduced FEV1 and FEV1/FVC ratio of <70%
• Hallmark asthma: increase of FEV1 of > 11% after bronchodilator is a diagnostic hallmark of asthma. What is pneumothorax? - correct answer Pneumothorax is the presence of air in the pleural space that causes partial or complete collapse of the affected lung.

Questions And Answers

Be familiar with the risk factors, disease pathology, clinical presentation, diagnosis, and treatment of pneumothorax. - correct answer 1. Risk factors:

• spontaneous: tall boys between 10 and 30 due to difference in pleural pressure from top to bottom of lung. Lung disease, especially emphysema.

2. Disease pathology: Tension occurs when air enters pleural space but cant exit, such as penetrating chest wound. It can collapse the lung on affected side and compress mediastinal structures.
3. clinical presentation: -chest pain on affected side, increased rest rate and difficulty breathing.
4. diagnosis: chest x ray or CT scan
5. treatment: air removed by needle or closed drainage system w or wo suction.

Questions And Answers

What is atelectasis? - correct answer Atelectasis is an incomplete expansion of a lung, or portion of lung, caused by airway obstruction or lung compression. Be familiar with the risk factors, disease pathology, clinical presentation, diagnosis, and treatment of atelectasis. - correct answer 1. Risk factor and pathology

• newborns w respiratory distress syndrome (results form lung never been inflated or impaired lung expansion). -Adults: mucus plug in airway or compression by fluid, tumor mass, exudate, anything else.
• risk increased following surgery. Anesthesia, pain and pain meds, immobility

2. Clinical presentation

• rapid breathing (tachypnea), tachycardia, dyspnea, cyanosis, signs of hypoxemia, diminished chest expansion, decreased breath sounds.

Questions And Answers

3. Diagnosis:

• signs and symptoms and chest x ray or CT scan

4. treatment

• oxygen administration, ambulation (walking around), deep breathing What type of substance causes a pulmonary embolism? - correct answer The embolism may be a thrombus, air accidentally injected into an intravenous infusion, fat from the bone marrow after a fracture or trauma, or amniotic fluid that enters the maternal circulation after rupture of membranes. Be familiar with the disease pathology, clinical presentation, diagnosis, and treatment of pulmonary embolism. - correct answer 1. Path:
• substance lodges in branch of pulmonary artery and obstructs blood flow. It causes obstruction of blood flow which leads to impaired gas exchange and vasoconstriction in the lungs. Leads to pulmonary hypertension and right heart failure. VIRCHOW TRIAD: 3 factors that predispose to venous thrombosis

1. antithrombin III deficiency

Questions And Answers

2. protein c and s deficiency
3. factor V leiden Mutation
4. presentation

• chest pain, dyspnea, cough, increased respiratory rate

3. diagnosis

• medical history, ABGs (arterial blood gas analysis), lung scan, ECG,

4. treatment

• anticoagulant therapy (lovenox), thrombolytic therapy.
• compression stocking to prevent venous stasis Be familiar with the conditions that can cause ARDS in Table 5.3. - correct answer 1. Aspiration

2. drugs, toxins, therapeutic agents
3. infection
4. trauma and shock
5. disseminated intravascular coagulation
6. multiple blood transfusions

Questions And Answers

Be familiar with the disease pathology, clinical presentation, diagnosis, and treatment of ARDS. - correct answer 1. pathology

• due to pathologic lung changes the lungs stiffen and breathing becomes difficult

2. clinical presentation

• rapid onset of respiratory distress (12-15 hours after trigger event)
• increase respiratory rate, signs of respiratory failure
• hypoxemia occurs and with multiple organ failure.

3. diagnosis

• chest x ray shows lung "white out" from fluid with normal cardiac function.

4. treatment

• o2 and ventilator support Be familiar with the causes and manifestations of respiratory acidosis in Table 5.4. - correct answer 1. Causes:
• Depression of respiratory center
• lung disease
• airway obstruction

Questions And Answers

• disorders of chest wall and respiratory muscles
• breathing air with high CO2 content

2. Manifestations:

• Blood pH decrease,
• Partial pressure of CO2 increased ,
• Bicarbonate increase
• vasodilation, Headache, weakness, confusion, depression, paranoia, skin warm and flushed, acidic urine Be familiar with the clinical presentation, diagnosis, and treatment of respiratory acidosis. - correct answer Clinical presentation: since CO crosses blood brain barrier— it causes vasodilation and Headache, weakness, confusion, depression, paranoia, skin warm and flushed, acidic urine Diagnosis: pH below 7.35, and Partial pressure of CO2 above 45mmHg. Treatment: Aimed at improving ventilation