Nurs 497 Respiratory System Pathologies

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Questions and Answers

What is the primary function of alveoli in the respiratory system?

  • To facilitate gas exchange between air and blood. (correct)
  • To humidify air before it reaches the bronchi.
  • To produce mucus that traps foreign particles.
  • To filter air entering the lungs.

Which condition involves alveolar sacs filling with fluid, pus, or blood?

  • Asthma
  • Emphysema
  • Pneumonia (correct)
  • Pulmonary fibrosis

A patient's pulmonary function tests reveal significant difficulty exhaling. Which type of lung disease is most likely?

  • Obstructive lung disease. (correct)
  • Vascular lung disease.
  • Restrictive lung disease.
  • Infectious lung disease.

In restrictive lung disease, what change is typically observed in total lung capacity (TLC)?

<p>Decreased TLC (B)</p> Signup and view all the answers

A patient with a V/Q ratio of 1.2 likely has a problem with:

<p>Perfusion (C)</p> Signup and view all the answers

What does an arterial blood gas (ABG) with a pH of 7.32, PaCO2 of 52, HCO3- of 29, and PaO2 of 68 indicate in a COPD patient?

<p>Respiratory acidosis. (D)</p> Signup and view all the answers

What is a key factor in the development of Bronchopulmonary Dysplasia (BPD) in premature infants?

<p>Underdevelopment of lungs in premature infants. (B)</p> Signup and view all the answers

A premature infant requires mechanical ventilation and supplemental oxygen for several weeks. At 36 weeks gestational age, the infant still needs oxygen. Based on this information, what condition is the infant likely to be diagnosed with?

<p>Bronchopulmonary dysplasia (BPD). (D)</p> Signup and view all the answers

A baby with Bronchopulmonary Dysplasia (BPD) is likely to have which of the following clinical manifestations?

<p>Hypoxemia. (A)</p> Signup and view all the answers

Which genetic inheritance pattern is associated with Cystic Fibrosis (CF)?

<p>Autosomal recessive. (B)</p> Signup and view all the answers

What is the primary defect in Cystic Fibrosis (CF) that leads to the disease's various manifestations?

<p>Abnormal transport of chloride ions across cell membranes. (D)</p> Signup and view all the answers

A newborn screening suggests possible Cystic Fibrosis (CF). What is the standard test to confirm the diagnosis?

<p>Sweat chloride test. (B)</p> Signup and view all the answers

What is a common respiratory pathogen that colonizes the airways of individuals with Cystic Fibrosis (CF)?

<p>Pseudomonas aeruginosa. (C)</p> Signup and view all the answers

A child with Cystic Fibrosis has recurrent respiratory infections and greasy, foul-smelling stools. Which of the following is the most likely cause of the stool characteristics?

<p>Pancreatic enzyme insufficiency. (D)</p> Signup and view all the answers

Which of the following genitourinary manifestations is most commonly associated with Cystic Fibrosis (CF) in males?

<p>Congenital absence of the vas deferens. (A)</p> Signup and view all the answers

A patient presents with chronic cough, failure to thrive, and salty skin. Which condition does this presentation suggest?

<p>Cystic Fibrosis. (D)</p> Signup and view all the answers

What characterizes Idiopathic Pulmonary Fibrosis (IPF)?

<p>Chronic, progressive scarring of the lungs (C)</p> Signup and view all the answers

Which of the following is a common risk factor for developing Idiopathic Pulmonary Fibrosis?

<p>Cigarette smoking (D)</p> Signup and view all the answers

A patient with Idiopathic Pulmonary Fibrosis (IPF) is likely to have which finding on physical examination?

<p>Velcro-like crackles. (D)</p> Signup and view all the answers

What is the typical prognosis for a patient diagnosed with Idiopathic Pulmonary Fibrosis (IPF)?

<p>Around 3 years. (C)</p> Signup and view all the answers

Exposure to which of the following substances is least likely to cause COPD?

<p>Radon (C)</p> Signup and view all the answers

In the pathogenesis of chronic bronchitis and emphysema, what is the role of inflammation in the airway epithelium?

<p>Airway obstruction and air trapping. (C)</p> Signup and view all the answers

Which assessment finding is most indicative of COPD?

<p>Use of pursed-lip breathing. (D)</p> Signup and view all the answers

Which of the following is a key characteristic that differentiates pulmonary arterial hypertension (PAH) from pulmonary venous hypertension?

<p>Abnormalities in pulmonary arterioles. (B)</p> Signup and view all the answers

A patient with pulmonary hypertension would likely experience which of the following physiological changes?

<p>Increased pulmonary artery pressure. (D)</p> Signup and view all the answers

Which of the following is a common cause of pulmonary arterial hypertension?

<p>Hypoxia (A)</p> Signup and view all the answers

A patient with long-standing pulmonary hypertension develops right ventricular enlargement. Which condition is most likely to develop as a result?

<p>Cor pulmonale. (A)</p> Signup and view all the answers

A nurse assessing a patient with suspected right heart failure would expect to find which of the following?

<p>Peripheral edema. (C)</p> Signup and view all the answers

What is a key diagnostic indicator for cor pulmonale?

<p>Elevated right ventricular pressure. (B)</p> Signup and view all the answers

What are the general requirements for patients to be considered a candidate for lung transplantation?

<p>Acceptable nutritional status. (A)</p> Signup and view all the answers

Which of the following represents a relative contraindication for lung transplantation?

<p>Significant alcohol use. (A)</p> Signup and view all the answers

Which type of lung transplant involves a single lobe from a living donor?

<p>Lobe transplant. (D)</p> Signup and view all the answers

What is a leading cause of death following lung transplantation?

<p>Graft failure. (D)</p> Signup and view all the answers

After a lung transplant, a patient experiences a gradual decline in pulmonary function with decreased spirometry readings. What complication is most likely occurring?

<p>Bronchiolitis obliterans syndrome (BOS). (D)</p> Signup and view all the answers

Which of the following is often asymptomatic following a lung transplant, and can only be detected with frequent PFTs?

<p>Rejection (D)</p> Signup and view all the answers

Which of the following is one of the two sources a lung can be harvested from for transplant?

<p>Cadaveric (B)</p> Signup and view all the answers

A right ventricular heave can be found in the later stages in a patient exhibiting signs of:

<p>Right heart failure (C)</p> Signup and view all the answers

Which of the following tools cannot be used during initial confirmation of exertion dyspnea?

<p>CT scan (D)</p> Signup and view all the answers

What is the standard age cut off for transplant qualification consideration?

<p>65 years old (C)</p> Signup and view all the answers

In alveolar sac pathology, what directly results from the sac's inability to fully deflate?

<p>Retention of carbon dioxide and blocking initiation of a new breathing cycle (D)</p> Signup and view all the answers

What would be expected in a patient with a restrictive lung disease?

<p>Decreased total lung capacity (A)</p> Signup and view all the answers

What characteristic ABG values would you expect to see in a patient who is alkalotic?

<p>Ph &gt;7.45 (A)</p> Signup and view all the answers

A premature infant is diagnosed with Bronchopulmonary Dysplasia (BPD). The characteristics of their alveoli will include:

<p>Fewer alveoli with thicker walls (C)</p> Signup and view all the answers

According to the diagnostic criteria, what signifies moderate Bronchopulmonary Dysplasia (BPD) in an infant born before 32 weeks gestational age?

<p>Need for &lt;30% oxygen at 36 weeks PMA or discharge, whichever comes first. (B)</p> Signup and view all the answers

What is the most common genitourinary manifestation of Cystic Fibrosis (CF) in males?

<p>Congenital absence of vas deferens (D)</p> Signup and view all the answers

A 1-month-old patient presents with meconium ileus. Which condition is most likely suspected?

<p>Cystic Fibrosis (D)</p> Signup and view all the answers

A patient with Cystic Fibrosis (CF) experiences increased dysnpea and digital clubbing. What pulmonary manifestation is most likely occurring?

<p>Bronchiectasis (B)</p> Signup and view all the answers

Which dietary intervention is the most appropriate for individuals with Cystic Fibrosis (CF) to manage pancreatic insufficiency and malabsorption?

<p>High calorie, high protein diet (C)</p> Signup and view all the answers

What is thought to cause Idiopathic Pulmonary Fibrosis (IPF)?

<p>An unidentified injury to the lung. (D)</p> Signup and view all the answers

Which of the following represents a typical finding upon physical examination of a patient with Idiopathic Pulmonary Fibrosis (IPF)?

<p>Velcro-like crackles (A)</p> Signup and view all the answers

Which diagnostic method yields the most definitive information for confirming Idiopathic Pulmonary Fibrosis (IPF)?

<p>Lung Biopsy (B)</p> Signup and view all the answers

What is a significant physiological consequence of chronic bronchitis in the pathogenesis of COPD?

<p>Hypersecretion of mucus and bronchial edema (C)</p> Signup and view all the answers

A patient who uses pursed-lip breathing and has a "barrel" chest likely has which of the following?

<p>COPD (B)</p> Signup and view all the answers

What best describes the mechanism of pulmonary hypertension development related to chronic lung disease or hypoxemia?

<p>Pulmonary vasoconstriction (C)</p> Signup and view all the answers

A patient with pulmonary hypertension is likely to experience what?

<p>Ventricular Dilation (D)</p> Signup and view all the answers

When assessing for pulmonary hypertension, what would the results of right heart catheterization reveal?

<p>Right atrial pressure (C)</p> Signup and view all the answers

What is a key pathological process in the development of cor pulmonale secondary to pulmonary hypertension?

<p>Right ventricular dilation (A)</p> Signup and view all the answers

What is most likely to be found during assessment of a patient demonstrating signs of increased right ventricular pressure related to heart failure?

<p>Peripheral edema (B)</p> Signup and view all the answers

What is the significance of a declining oxygen saturation in a patient with dyspnea?

<p>A potential early or late sign of inadequate oxygenation (D)</p> Signup and view all the answers

Which condition is considered a qualification for potential lung transplant?

<p>Advanced COPD (B)</p> Signup and view all the answers

What would disqualify an individual from being a candidate for a lung transplant?

<p>A BMI &gt; 35 (A)</p> Signup and view all the answers

After a lung transplant, what does identification of infection signs suggest?

<p>Bacterial or viral contamination (A)</p> Signup and view all the answers

What is the clinical significance of monitoring spirometry findings in a patient post-lung transplant?

<p>Detecting initial asymptomatic signs of lung rejection (B)</p> Signup and view all the answers

Following a lung transplant, which of the following etiological agents are the suspected cause if the patient begins to have a productive cough, dyspnea at rest, and airway obstruction?

<p>Bronchiolitis Obliterans. (D)</p> Signup and view all the answers

Flashcards

What is an alveolus?

A sac that fills with air, enabling gas exchange in the lungs.

What is the airway?

Trachea, bronchi, and bronchioles that carry air to the alveoli.

What are alveolar membranes?

They allow oxygen to diffuse into the blood and carbon dioxide to exit.

What are pulmonary blood vessels?

They transport blood to the lungs for oxygen uptake and carbon dioxide release.

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What is restrictive lung disease?

Difficulty getting air IN to the lungs.

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What is obstructive lung disease?

Difficulty getting air OUT of the lungs.

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What happens during Obstruction?

Airways obstructed, alveoli can't contract, hard to get air out.

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What happens during Restriction?

Restricted airways/chest, alveoli can't expand, hard to get air in.

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What is residual volume?

The amount of air remaining in the lungs after a complete exhalation

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What is tidal volume?

Volume of exhaled air after normal inspiration.

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What is V/Q?

Ratio of ventilation (V) to perfusion (Q) in the lungs.

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What is a normal V/Q ratio?

Normal is approximately 0.8.

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What are normal ABG ranges?

pH: 7.35-7.45, CO2: 35-45 mmol/L, HCO3: 22-26 mmol/L.

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What is Bronchopulmonary Dysplasia (BPD)?

Chronic neonatal lung disease in premature infants needing respiratory support.

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What increases the risk of BPD?

Prematurity, postnatal sepsis, male babies, genetics, ventilation, supplemental O2.

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What are manifestations of BPD?

Hypoxemia, hypercapnia, and increased work of breathing.

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What is Cystic Fibrosis (CF)?

Autosomal recessive disease causing thick mucus and multi-system illness.

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What is the major feature of CF?

Mutation of gene that regulates salt in and out of cells

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What happens during CF GI issues?

Thick secretions block ducts can cause pancreatic insufficiency.

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What type is caused by CF?

Large, bulky, loose, and foul-smelling stools (steatorrhea).

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What is Idiopathic Pulmonary Fibrosis (IPF)?

Chronic, progressive fibrosing disorder limited to the lungs with a poor prognosis.

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What are risk factors for IPF?

Cigarette smoking, viral infection, environmental pollutants

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What are the Signs and symptoms IPF?

Bilateral 'Velcro-like' crackles, clubbing, resting hypoxemia.

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What are the cause of COPD?

Pollution, Smoking, Age, Asthma, and AAT Deficiency

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What are features of chronic bronchitis?

Enlarged submucosal gland, mucus accumulation

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What defines Pulmonary Hypertension?

Mean pulmonary artery pressure > 25 mmHg at rest or > 30 mmHg with exercise.

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What happens in Pulmonary Arterial Hypertension (PAH)?

Pulmonary arteries are abnormal.

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What happens in Pulmonary Venous Hypertension (PVH)?

Left atrial pressure is higher than normal

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What are early symptoms of pulmonary hypertension?

Progressive exertional dyspnea and fatigue.

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What are later symptoms of pulmonary hypertension?

Jugular vein distension, peripheral edema, RV heave

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What is Cor Pulmonale?

Right ventricular failure due to pulmonary hypertension.

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What are Symptoms of Cor Pu?

When you start with exertional dyspnea.

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What is lung transplant?

Over the past 35 years, lung transplants have become a viable treatment

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What are Qualifications for Lung Transplantation?

Untreatable end-stage lung disease, substantial activity limitation, limited life expectancy.

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What are Contraindications for Lung Transplantation?

Concurrent illness such as heart failure; active infections, alcohol abuse.

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What are types of lung transplants??

Single-lung, double-lung, lobe

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What are things to look for in acute lung rejection?

Flu-like symptoms and fever

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What are things to look for in chronic lung rejection?

Bronchiolitis Obliterans Syndrome (BOS) and Restrictive allograft syndrome (RAS)

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If a patient has right side heart failure, what are the related signs/symptoms to look for?

Weight gain, tachycardia and confusion

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Study Notes

Respiratory System Overview

  • Potential areas for pathologies include the structures and function of the respiratory system.
  • Dysfunction in the respiratory system leads to various issues.
  • Common tests assess both pulmonary structure and function.
  • Obstructive and restrictive lung diseases differ, impacting airflow.

Bronchopulmonary Dysplasia (BPD)

  • BPD may arise from premature or low birth weight with respiratory issues.
  • Risk factors for BPD include prematurity, postnatal sepsis, and pulmonary hypoplasia.
  • Clinical manifestations of BPD include hypoxemia and increased work of breathing.
  • Diagnosis requires meeting specific gestational age criteria and treatment with supplemental oxygen.
  • Babies with BPD often have fewer and larger alveoli that are surrounded by thicker walls.
  • Diagnosing BPD occurs when babies struggle to wean from mechanical ventilation.

Cystic Fibrosis (CF)

  • CF results from an autosomal recessive gene, common among Caucasian populations, with a life expectancy of around 40 years.
  • It begins with a mutation that regulates salt transport in and out of cells producing abnormally thick secretions.
  • CFTR proteins malfunction or are insufficiently produced, causing a chloride buildup
  • CFTR gene mutations generate CFTR protein dysfunctions and affect the respiratory tract and pancreas.
  • Canada-wide newborn screenings include immunoreactive trypsinogen (IRT) protein level checks.
  • Cilia malfunction from thick mucus secretions, leading to poor bacterial clearance.
  • Diagnostic evaluation includes sweat chloride tests and genetic testing.

CF can lead to pneumothorax

  • Chronic inflammation causes a dilation and damage to the bronchi.
  • Cavitations or cysts, areas of bronchiolar consolidation, fibrosis and air-trapping develop in lung tissue.
  • Air-trapping increases pressure in alveolar tissue, compromising respiratory adequacy.
  • Inflammation weakens airway walls, leading to blebs and bullae in visceral pleura that leak into the pleural space.
  • Pulmonary Manifestations include recurrent wheezing and thick secretion.
  • GI issues include pancreatic insufficiency, biliary obstruction, and intestinal obstruction.
  • Manifestations include meconium ileus, large bulky stools, malnutrition.
  • Genitourinary effects include male infertility (blocked vas deferens) and female infertility (thick cervical secretions).
  • A high calorie, high protein diet is required to cope with the malnutrition.

Idiopathic Pulmonary Fibrosis (IPF)

  • IPF is a chronic, progressive fibrosing disorder limited to the lungs.
  • Median survival is 2-4 years after diagnosis, with typical onset at 50-70 years.
  • Common risk factors include smoking, viral infections, and environmental pollutants.
  • Clinical presentation includes exertional dyspnea, non-productive cough, and crackles.
  • The prognosis at diagnosis is approximately 3 years.

Chronic Obstructive Pulmonary Disease (COPD)

  • COPD causes include pollution, smoking, asthma, chemical exposure, and AAT deficiency.
  • Pathogenesis involves inflammation of the airway epithelium and protease activity.

Pulmonary Hypertension

  • Pulmonary hypertension is indicated by elevated pulmonary artery pressures (PAP) above 25 mmHg.
  • Pulmonary arterial hypertension (PAH) from pulmonary arteriole abnormalities.
  • Pulmonary venous hypertension (PVH) arises from increased left atrial pressure.
  • PAH is caused by idiopathic factors, left ventricular diseases/failure, chronic lung disease, and COPD.
  • Late symptoms also include jugular vein distention and tricuspid regurgitation murmur.
  • Diagnosis includes measuring right atrial and ventricular pressures via pulmonary artery catheterization.

Right Heart Failure (Cor Pulmonale)

  • Right heart failure can result from pulmonary hypertension increasing pressure on the RV.
  • Initial state includes symptoms of dyspnea or fatigue due to underlying lung disorder that occur with exercise when cardiac output falls.

Lung Transplants

  • Lung transplants have become a treatment option for patients with end-stage conditions like emphysema.
  • The first human lung transplant occurred in 1963, and emphysema in 1986 in Ontario.
  • In 2021, 352 lung transplants occurred in Canada.
  • Canada has four lung transplant centers: Vancouver, Edmonton, Toronto, Montreal.
  • Conditions include advanced COPD, CF, idiopathic pulmonary fibrosis, and hypertension.
  • Qualifications include untreatable end-stage lung disease and acceptable nutritional status for transplant.
  • Types of transplants include lobe, single-lung, double-lung, and heart-lung transplants.
  • Contraindications include chronic illness, infections, obesity, chest wall deformity, and substance use.
  • Post-transplant survival averages 4.6 years for single-lung and 6.6 years for double-lung transplants.

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