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Portage Pathophysiology Module 5- Pulmonary System Disorders, Exams of Nursing

Walden University Nursing

Portage Pathophysiology Module 5- Pulmonary System Disorders Portage Pathophysiology Module 5- Pulmonary System Disorders Portage Pathophysiology Module 5- Pulmonary System Disorders

Typology: Exams

2022/2023

Available from 08/10/2023

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Portage Pathophysiology Module 5-

Pulmonary System Disorders

ABG Arterial Blood Gas Normal Ranges: - pH=acid

or base 7.35-7.45

PCO2=partial pressure of carbon

dioxide 35-45 mm Hg

HCO3=bicarbona

te 22-26 mEq/L

PO2=partial pressure of

oxygen 80-100 mmHg

Acute respiratory distress syndrome (ARDS - - can be caused by several

different conditions, all lead to similar pathologic lung changes.:

Aspiration:

- Near drowning, aspirating gastric contents

Drugs, Toxins, and Therapeutic Agents

- Free-base cocaine smoking, heroin,

inhaled gases (smoke, ammonia),

breathing high concentrations of

oxygen, radiation

Infection

- Septicemia

Trauma and Shock

- Burns, fat embolism, chest trauma

Disseminated intravascular coagulation

Multiple blood transfusions

affinity (of the hemoglobin molecule) - - the degree to which it is able to bind

oxygen.

Each hemoglobin molecule can bind up to four molecules of oxygen when

fully saturated. After the first oxygen is bound, it changes shape to make

each consecutive oxygen molecule easier to bind. Therefore, the affinity of

hemoglobin for oxygen increases with hemoglobin saturation. As hemoglobin

must not only bind but also release oxygen into the surrounding tissues, the

affinity must decrease. Opposite to the binding sequence, the affinity

decreases with each passing release of oxygen.

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Portage Pathophysiology Module 5-

Pulmonary System Disorders

ABG Arterial Blood Gas Normal Ranges: - pH=acid or base 7.35-7. PCO2=partial pressure of carbon dioxide 35-45 mm Hg HCO3=bicarbona te 22-26 mEq/L PO2=partial pressure of oxygen 80-100 mmHg Acute respiratory distress syndrome (ARDS - - can be caused by several different conditions, all lead to similar pathologic lung changes.: Aspiration:

Near drowning, aspirating gastric contents Drugs, Toxins, and Therapeutic Agents
Free-base cocaine smoking, heroin, inhaled gases (smoke, ammonia), breathing high concentrations of oxygen, radiation Infection
Septicemia Trauma and Shock
Burns, fat embolism, chest trauma Disseminated intravascular coagulation Multiple blood transfusions affinity (of the hemoglobin molecule) - - the degree to which it is able to bind oxygen. Each hemoglobin molecule can bind up to four molecules of oxygen when fully saturated. After the first oxygen is bound, it changes shape to make each consecutive oxygen molecule easier to bind. Therefore, the affinity of hemoglobin for oxygen increases with hemoglobin saturation. As hemoglobin must not only bind but also release oxygen into the surrounding tissues, the affinity must decrease. Opposite to the binding sequence, the affinity decreases with each passing release of oxygen.

Airway inflammation - - caused by bronchial hyper-responsiveness to stimuli and recurrent episodes of respiratory symptoms which are usually associated with reversible airflow obstruction.

three components:

Airway inflammation (primary event)
Airway hyperresponsiveness (secondary event)
Airflow obstruction (secondary event Airway inflammation causes - - Inflammation results from complex interactions among many inflammatory cells and mediators, including eosinophil recruitment and airway edema. As such, inflammation is a direct response of the immune system to a trigger. At cellular level:

caused by multiple inflammatory cells, including eosinophils, lymphocytes, and mast cells. Secreted by many of these cell types, cytokines also play a role in the chronic inflammatory response. Recent studies further suggest the T-helper 2 (T2H) cell response is exaggerated when children have frequent viral infections. When T2H cells are released, more IgE is produced, further predisposing the airways for an allergic reaction.
Contact with a trigger stimulates the cascade of neutrophils, eosinophils, lymphocytes, and mast cells which causes epithelial injury. This causes airway inflammation, which further increases hyperresponsiveness and decreased airflow. As mast cells release histamine and leukotrienes, this causes major bronchoconstriction, inflammation, and mucus secretion. Mast cells can trigger multiple cytokine release, which causes even more airway inflammation. The contraction of the airways and subsequent swelling leads to further airway obstruction. Airway narrowing - - due to many factors.
As the airway walls thicken due to these inflammatory reactions, the amount of airway narrowing produced by a given amount of smooth muscle contraction in asthma is much greater than it is in a normal airway. Thus, even a small contraction of bronchial smooth muscle can lead to dramatic increases in airway resistance when the bronchial walls are already thickened from the actions of inflammatory cells and airway edema. airway remodeling - - refers to the development of specific structural changes in the airway wall in asthma accompanying long-standing and severe airway inflammation. Airway remodeling and fibrosis may be the cause of "fixed" airflow obstruction in asthma that is not reversible with steroids, bronchodilators, or both.
Histologically, one will see hypertrophy of bronchial smooth muscle and deposition of subepithelial collagen. There is a thickening of the basement membrane of the bronchial epithelium. There is also edema and inflammatory infiltrate in the bronchial walls, with a prominence of eosinophils and mast cells.

Alveolar epithelium consists of - type I and type II alveolar cells, as well as macrophages. alveoli - the actual sites of gas exchange between the air and blood.

Oxygen from the alveoli diffuses into the blood, and carbon dioxide from the blood diffuses into the alveoli. alveolus - a sac that fills with oxygenated air when one breathes in and allows that air to pass across a membrane into a blood vessel (alveolar capillary). The alveolus contracts back down like a deflating balloon to let carbon dioxide out and to begin the cycle again. Within this space, capillaries are abundant, allowing blood and air to constantly mix. Anatomic dead air space - the volume of air taken in that does not undergo gas exchange. This air would be found in the conducting airways to the terminal bronchioles.
Dead air space has ventilation without perfusion, resulting in a high ventilation- perfusion ratio. This would occur with a pulmonary embolism which restricts blood flow to a part of the lung. Some diseases have both impaired ventilation and perfusion, a prime example being chronic obstructive lung disease. ARDS: Clinical Presentation - ARDS presents with a rapid onset of respiratory distress (usually within 12-18 hours of triggering event), increased respiratory rate, and signs of respiratory failure. Hypoxemia occurs and is coupled with multiple organ failure. ARDS: Diagnosis and Treatment - A chest x-ray will show diffuse bilateral infiltrates of the lungs from fluid ("white-out"), with normal cardiac function. Treatment focuses on supportive care of oxygen and ventilator support until the lungs heal and the underlying cause is addressed. Recovery may be complicated by lung scarring and fibrosis. Asthma - - a chronic respiratory disease characterized by airway obstruction, bronchial hyperresponsiveness, airway inflammation, and in some cases, airway remodeling.
It is the most common chronic respiratory disorder among all age groups. Although prevalence is higher among racial and ethnic minorities, a more valid relationship may exist between socioeconomic status and increased asthma prevalence. Sixty to seventy-eight percent of people with asthma also suffer from allergic rhinitis. More than 25 million Americans have asthma. Asthma risk factors - - family history of asthma, allergies (including dust mites, pollen, mold, cockroaches, stings, or bites), antenatal exposure to tobacco smoke and pollution, gastroesophageal reflux disease, exercise, cold air, and being of African American or Puerto Rican descent.
Small subsets of people with hypersensitivity have a triad of asthma, chronic rhinosinusitis, and nasal polyps.

They also tend to have asthma attacks in response to taking aspirin and other NSAIDs.

compression by fluid (pleural effusion from congestive heart failure), tumor mass (cancer), exudate,

or anything else causing obstruction. It can affect portions of the alveoli, lung segments, or an entire lung lobe Risk:

The risk of obstructive atelectasis is increased following surgery. Anesthesia, pain and pain medications, and immobility promote retention of bronchial secretions. Patients are encouraged to frequently cough, deep breathe, change positions, hydrate adequately, and ambulate early to prevent atelectasis. Atelectasis: Clinical Presentation - Symptoms of atelectasis include tachypnea (rapid breathing), tachycardia, dyspnea, cyanosis, signs of hypoxemia, diminished chest expansion, decreased breath sounds, and intercostal retractions. If the collapsed area is large, the mediastinum and trachea shift to the affected side. In compression atelectasis, the mediastinum shifts away from the affected lung. Atelectasis: Diagnosis and Treatment - Atelectasis is diagnosed by signs and symptoms and chest x-ray and/or chest CT scan. Treatment depends on the cause and extent of lung involvement. If possible, treatment will reduce the airway obstruction or lung compression, and re- inflate the collapsed area of the lung. Oxygen administration, ambulation, deep breathing, and body positions that favor increased lung expansion are helpful treatments Atopy - - 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.
IgE is the antibody responsible for causing allergic reaction and inflammation. barrel chest - - As air becomes trapped in the alveoli and lungs, the anteroposterior dimension of the chest becomes bigger
Patients may have a prolonged expiratory phase because of the obstruction to expiration. Breath sounds may have wheezing or be diminished throughout, and the patient becomes prone to diaphragmatic fatigue and acute respiratory failure. Blue bloater - - also used to differentiate emphysema from chronic bronchitis.
term used to describe those with chronic bronchitis.
It refers to cyanosis and fluid retention common with right-sided heart failure.
Clinically, the differentiation between the two diseases is difficult, as most people have some degree of both emphysema and chronic bronchitis. Branching levels: - The first 16 generations (Z) make up the conducting airways. Generations 17 to 23 make up the respiratory airways. Throughout childhood, the airways increase in diameter and length. The number and size of the alveoli increase until adolescence when respiratory development

Gas exchange occurs in the respiratory bronchioles as well as the alveolar ducts and sacs which are located in the lobules of the lungs. Deoxygenated blood enters the lungs through a pulmonary artery, and oxygenated blood exits through a pulmonary vein. Breathing chemoreceptors: - - specialized receptors (chemoreceptors) that monitor and respond to changes in CO2 and oxygen levels in the blood.

The two types of chemoreceptors are central and peripheral. Breathing is controlled by: - - automatic and voluntary mechanisms.
The automatic regulation is controlled by both chemoreceptors and lung receptors. Chemoreceptors monitor blood levels of oxygen, carbon dioxide, and pH and adjusts ventilation rates accordingly. Lung receptors monitor breathing patterns and lung function.
Voluntary regulation gives temporary control of breathing in response to various activities such as speaking, singing or holding breath while underwater. bronchi division: - - Upon entering the lungs, the main bronchi divide into secondary or lobular bronchi, supplying each lobe of the lungs
the right lung has 3 lobes, while the left lung only has 2 lobes because of the position of the heart.
The secondary bronchi then further divide to form the segmental bronchi. The segmental bronchi will further branch into smaller bronchi until they become terminal bronchi—the smallest structures within the conducting airways.
Notably, the structural composition of bronchi also changes as it branches and decreases in size.
Although initially composed primarily of cartilage, its composition is gradually replaced by smooth muscle and elastic tissue.
In fact, by the time the bronchi branches into bronchioles no cartilage is present.
Instead, the bronchioles are primarily composed of smooth muscle and elastic tissue. bronchiprotective methods against infectious agents: - - Recruitment of inflammatory cells from the bloodstream into the bronchial wall, where they directly attack the invading organisms and secrete inflammatory chemicals that are toxic to the organisms
Swelling of the bronchial wall
Mucus secretion
Constriction of the airway carbaminohemoglobin - -Carbon dioxide also reacts with hemoglobin to form carbaminohemoglobin.
This permits transport of CO2 from the tissues to the lungs, where it goes into the alveoli and back into the environment.

Carbon dioxide is transported in the blood in three forms: - As dissolved carbon dioxide (10%)

manifests with hypersecretion of mucus in the large airways, along with hypertrophy of the submucosal glands in the trachea and bronchi. Histologically, it reveals a large increase in goblet cells, excess mucus production with plugging of the airway lumen, inflammatory infiltration, and fibrosis of the bronchiolar wall. Viral and bacterial infections are a common issue and are regularly detected in this population. Chronic obstructive pulmonary disease (COPD) - - characterized by chronic and recurrent airflow obstruction.
COPD is the leading cause of morbidity and mortality worldwide. It is estimated that 12 million Americans have COPD, and another 12 million don't know they have it. The cost burden of the disease according to the National Heart, Lung, and Blood Institute in 2010 was $49.9 billion.
encompasses two disorders: emphysema and chronic bronchitis. People can have one or the other, but often these diseases overlap. Classification of Asthma Severity - Mild intermittent: Symptoms ≤ 2 times/wk Nighttime Symptoms: ≤2 times a month Lung Function: PEF ≥ 80% predicted Mild persistent: Symptoms ≥ 2 times/wk, but < time/day Nighttime Symptoms: > times a month Lung Function: PEF ≥ 80% predicted Moderate persistent: Daily symptoms Nighttime Symptoms: >1 time a week Lung Function: PEF>60%- <80% predicted Severe persistent: Continual symptoms Nighttime Symptoms: Frequent Lung Function: PEF ≤ 60% predicted collagen fibers - resist stretching and decrease lung compliance COPD diagnosis - - based on history, physical exam, PFTs, chest x-ray, and lab tests. The FVC is prolonged and decreased. FEV1 is decreased as well. Notably, a decreased FEV1/FVC ratio differentiates obstructive from restrictive diseases. RV and TLC are also increased. Spirometry is used to diagnose and stage disease severity. As the disease progresses, exercise tolerance, nutritional status, hemoglobin saturation, and arterial blood gases become important measurements.

COPD: Clinical Presentation - - manifests itself in the fifth or sixth decade of life, with fatigue, exercise intolerance, cough, sputum production, or shortness of breath.

original position after being stretched. With emphysema, the elastic components lose their recoil, making the lungs easy to inflate, but difficult to deflate.

Elastin fibers - - are easily stretched, making the lung tissue more compliant or easier to inflate Emphysema - - characterized by a decrease in lung elasticity, enlargement of the airspaces distal to the terminal bronchioles, and destruction of the alveolar walls and capillary beds

Enlargement of the airspaces leads to hyperinflation of the lungs, cau sing the total lung capacity (TLC) to increase.
Under the microscope, the lungs look like honeycombs: empty air spaces surrounded by alveolar membranes.
Two consequences are decreased elastic recoil of the alveoli, and bronchioles are more likely to collapse.
This leads to difficulty getting air out, which causes hyperinflation, air trapping, and less surface area for gas exchange. expiration - respiratory muscles relax, and as the thoracic cavity retracts a greater internal pressure relative to the outside atmosphere is created. The result of which causes the high-pressure air in the lung to be expelled from the body towards the area outside the body that is of lesser pressure four stages of asthma for children older than 12 years and adults. - - intermittent, mild persistent, moderate persistent, and severe persistent.
classification is used to determine treatment and identify people at high risk of life- threatening asthma attacks Functional residual capacity (FRC) - the amount of air that remains in the lungs after a normal expiration (VT), ~2400 mL. Thus, FRC = RV + ERV. fundamental defect in asthma - inflammatory actions occur in the bronchi when no serious infection, toxin, or other inhaled threat to the body exists. gas exchange function: - - ventilation and perfusion must match for it to work properly
depends on equal amounts of air and blood entering the lungs.
A mismatch of ventilation and perfusion occurs with dead air space and shunt Hemoglobin's affinity for oxygen is also influenced by : - - pH, carbon dioxide concentration, and body temperature.
It binds more readily to oxygen as the blood pH increases (> 7.45), and under conditions of decreased body temperature and CO2 concentration. Conversely, hemoglobin releases oxygen more readily in conditions of decreased pH (acidosis), increased CO2 concentration, and fever. hypoxemia - - Severe hypoxemia, with an arterial PO2 level below 55 mm Hg, causes reflex vasoconstriction of the pulmonary vessels.
It is more common in patients with chronic bronchitis type of COPD.

pressure to move air into a noncompliant lung than a compliant one. Lung compliance depends on multiple factors including overall water content and surface tension, as well as the amount of elastin and collagen fibers that are present. Lung volumes - refers to the amount of air exchanged from a single event during ventilation, either from inhaling or exhaling.

can be categorized into four main components (three can be directly measured using spirometer)

Tidal volume (VT) is the normal volume of air inhaled (or exhaled) with each breath, ~500 mL.
Inspiratory reserve volume (IRV) is the amount of air that can be forcibly inspired after taking in a normal breath (VT), ~3100 mL.
Expiratory reserve volume (ERV) is the amount of air that can be forcibly exhaled after letting out a normal breath (VT), ~1200 mL.
Residual volume (RV) is the air remaining in the lung after forced expiration, ~1200 mL. However, residual volume cannot be directly measured with a spirometer. Instead, RV can be calculated through indirect methods. main function of the respiratory system - gas exchange

primary goal is to get oxygen into the blood while also expelling carbon dioxide from the body. Oxyhemoglobin - - term used to describe when hemoglobin is bound with oxygen.
Ninety-eight to ninety-nine percent of oxygen in the blood is transported by hemoglobin
When blood leaves the left side of the heart, it is approximately 95-97% saturated with oxygen. In contrast, as blood returns to the right side of the heart in the venous system, the oxygen saturation has dropped to about 75%. The remaining 1-2% of oxygen is carried in the dissolved state. Importantly, only the dissolved form can diffuse through the cell membrane to be used in cell metabolism. paradoxical movement. - Paralysis of one side of the diaphragm causes the chest to move up on that side rather than down during inspiration because of the negative pressure in the chest.
Thus, people who sustain a spinal cord injury above C3 lose diaphragm function and require mechanical ventilation. 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

Portage Pathophysiology Module 5- Pulmonary System Disorders, Exams of Nursing

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Portage Pathophysiology Module 5-

Pulmonary System Disorders