Patho
The upper respiratory tract (upper airway) consists of____________
the nose, mouth, sinuses, pharynx (upper section of the throat), epiglottis, and larynx (voice box).
The lower respiratory tract consists of
the trachea (windpipe), bronchial tubes, and lungs.
Which is the cause of most pulmonary emboli?
A blood clot in the deep veins of the leg
What can cause shortness of breath in someone with anemia?
A lack of hemoglobin
Which of the following are risk factors for chronic obstructive pulmonary disease (COPD)? Select all that apply.
A rural area family using a wood-burning stove for heating Adult female with a genetic predisposition to lung disease A construction worker in an urban area Food server working in a bar where smoking is allowed A college student who uses a vape
Which are common risk factors for pulmonary emboli (PE)? Select all that apply.
A two-day trip on a train in coach seating Bedrest after surgery Sitting in a chair all day watching television
Diagnostic Testing for Chronic Obstructive Pulmonary Disease
Bedside Spirometry Chest Radiograph Oxygen Saturation Blood Tests Arterial Blood Gases
Which statement best describes anemia?
Below normal concentrations in the blood
Gas exchange occurs in the _______________, but does not occur in the trachea, bronchioles, or diaphragm.
Alveoli
Where in the lungs does pneumonia attack?
Alveoli
Which preventive measures will reduce the risk of this young adult's anemia in the future? Select all that apply.
Always wearing a seatbelt in a vehicle Treatment for alcohol misuse
Which of the following reduces the risk of pneumonia? Select all that apply.
Air filtration Handwashing Vaccination against known microorganisms
Which of the following causes wheezing during an asthma attack?
Air passing through narrowed bronchioles and mucus during exhalation
Parasitic
Ascaris Toxoplasmosis
Aspiration Pneumonia
Aspiration pneumonia is usually caused by streptococcus pneumoniae, haemophilus influenza, staphylococcus aureus, and gram-negative bacteria found in the oral pharynx. This is caused when food gets caught in the lung due to dysphagia and grows these common bacteria.Those at risk: clients experiencing dysphagia due to stroke, neurological disease, or facial trauma
common symptoms of anemia
fatigue loss of skin color low temperature dizziness shortness of breath chest pain
Treatments for impaired gas exchange
Avoid inhaling irritants and maintain good ventilation Reduces inflammation and infection Current immunizations Prevents infection Humidify air Moist mucosa resists damage Thins and removes secretions Moderate exercise Improves lung function and circulation Breathing and coughing Improves lung expansion and removes secretions Chest physiotherapy Removes thick secretions and reduces infections Oxygen Improves oxygen supply to all body cells
Prevention Strategies for Chronic Obstructive Pulmonary Disease
Avoiding Smoke and Pollution Regular Exercise Treatment Vaccination
Which actions will help prevent gas exchange problems in the future? Select all that apply.
Avoiding high levels of outdoor air pollution Getting vaccinated against COVID-19 Learning to swim Smoking cessation Using an air purifier indoors
Which of the following can cause alterations in gas exchange? Select all that apply.
Blockage of air traveling into the lung Inability for carbon dioxide to diffuse across capillaries and into the alveoli Inability for air to be exhaled from the lung Blockage in the blood traveling away from the lung Inability for oxygen to diffuse across the capillaries and into the red blood cell
Pulmonary emboli
Blood clots in the capillaries or veins
Arterial Blood Gases (ABG)s
Blood is drawn from an artery and oxygen, carbon dioxide, and other items are measured.
Perfusion problem: Anything stopping oxygen from getting to the cells through the blood is a perfusion problem.
Blood loss: Lack of hemoglobin causes a lack of oxygen transported to tissues. Carbon monoxide poisoning: Carbon monoxide can bind to hemoglobin strongly, especially when there is a large amount of it. Sickle cell disease: A deformed red blood cell cannot carry oxygen to tissue.
Fungal pneumonia testing
Blood testing for immunoglobulins
Parasitic pneumonia testing
Blood, sputum, stool, or other bodily fluid culture
Which of the following pathophysiologic changes occur with advanced chronic obstructive pulmonary disease (COPD)? Select all that apply.
Breakdown of elastic fibers by elastase causes alveoli to permanently inflate. High pressure in the pulmonary system develops over time. Thickening of the bronchial walls leads to narrowed airways.
Gas Exchange Process
Breathe in (O2 in)/Breathe out (CO2 leaves) O2 rich blood transported to cells Gases exchanged: O2 enters cells, CO2 leaves cells CO2 rich blood transported to the lungs
Testing for a pulmonary embolus (PE) is completed in one of the following ways:
Computed Tomographic (CT) Angiogram: This test involves injecting a radio-opaque dye into the venous system and taking image pictures as the dye flows through the circulation. Ventilation and Perfusion (VQ scan): In this test, radioactive material is injected, and the sensors watch as the material is absorbed into the lung. Areas in which gas exchange takes place are highlighted, while other areas in which there is blockage do not show the gas exchange. Arterial Blood Gases (ABGs): This test involves drawing blood from an artery and measuring the gases within the artery. While not specific to a pulmonary embolus, the test will show poor gas exchange.
Which signs and symptoms may indicate that someone has a pulmonary embolus? Select all that apply.
Chest pain Cough with blood-tinged sputum Loss of skin color
Advanced Pneumonia Treatment
Chest physiotherapy: a process by which tapping on the back and sides of someone helps loosen secretions for easier removal with coughing Small volume nebulizer (SVN): a way of delivering medication deeper into the lung Proning: repositioning someone on their stomach for a period of time to allow for better oxygenation of the upper lungs High-flow oxygen: oxygen delivery using a higher flow rate Artificial ventilation: using a separate machine to deliver premeasured breaths, pushing them directly into the lung Extracorporeal membrane oxygenation (ECMO): bypassing the lungs by pulling blood from the body, oxygenating the blood, then returning it to the body
Symptoms of COPD
Chronic cough Shortness of breath Excessive mucus production Easily fatigued Frequent respiratory infections Orthopnea (difficulty breathing lying flat)
Which condition can result in normocytic normochromic anemia? Select all that apply.
Chronic illness End stage renal disease Decreased iron in diet
Which of the following suggests that hospitalization may be necessary to decrease the morbidity or mortality of pneumonia? Select all that apply.
Client at age 68 Respiratory rate of 34 breaths per minute Heart rate of 122 beats per minute
Which of the following is the most effective prevention strategy for Sally?
Closing the window before the lawn is mowed
Fungal
Coccidiomycosis Histoplasmosis
Diagnostic Tests
Common tests include the following: Spirometry-pulmonary function testing (PFT) is used to test pulmonary volumes, measuring volume and airflow times. Arterial blood gas determinations are used to check oxygen, carbon dioxide, and bicarbonate levels as well as serum pH. Oximeters measure O2 saturation. Exercise tolerance testing is useful in patients with chronic pulmonary disease for diagnosis and monitoring of the patient's progress. Radiography may be helpful in evaluating tumors or infections such as pneumonia or tuberculosis. Bronchoscopy may be used in performing a biopsy or in checking for the site of a lesion or bleeding. Culture and sensitivity tests on exudates from the upper respiratory tract or sputum specimens can identify pathogens and assist in determining the appropriate therapy.
Community-Acquired Pneumonia (CAP)
Community-acquired pneumonia (CAP) is widespread and most likely from people interacting in the community. People without other risk factors for specific types of pneumonia are most likely to have whatever the local health departments identify is spreading within the community. Pneumonia caused by streptococcus pneumoniae is the most common bacterial infection.Those at risk: immunocompromised including the elderly, children, and those with chronic illnesses
Which of the following suggests a gas exchange problem? Select all that apply.
Cough Chest pain Smoker Shortness of breath
Bacterial pneumonia testing
Culture and sensitivity (C&S) testing
Drugs for impaired gas exchange
Decongestants Vasoconstriction in nasal mucosa, reduces edema Expectorants Thins respiratory secretions for easier removal Antitussives Reduces cough reflex Antihistamines Blocks H1 receptors to reduce allergic response Analgesics Reduces pain Antimicrobials Prophylaxis and treatment of infection (sputum culture and sensitivity) Bronchodilators Stimulates beta-2 adrenergic receptors to open bronchioles Glucocorticoids Antiinflammatory, antiallergenic
Which are age-related changes that can alter gas exchange? Select all that apply.
Decrease in the volume of air inhaled Less elasticity in the alveoli
Signs of COPD
Decreased lung sounds Increased anterior to posterior chest size Clubbing of the nails Use of accessory muscles Pursed-lip breathing Wheezing
What is the primary source of pulmonary emboli?
Deep vein thrombosis, primarily in the legs
Risk Factors for Anemia
Genetics Diet Low in Iron Alcoholism Vitamin Deficiency Surgery Medications Chronic Disease Trauma
There are some great strategies that can prevent or reduce the likelihood of a gas exchange problem.
Do not smoke and, if you do, stop. Do at least 20 to 30 minutes of aerobic exercise three to five times per week. Get vaccinated against respiratory illnesses (e.g., pneumococcal pneumonia, COVID-19, and influenza). Avoid exposure to high levels of indoor and outdoor pollution. Use safety equipment and follow safety guidelines when working with hazardous chemicals (e.g., cleaning products and insecticides). If you have asthma or allergies, see your healthcare provider to obtain treatment. Learn to swim and do not swim alone. Always take small bites and chew your food completely.
Which of the following strategies helps to prevent complications of chronic obstructive pulmonary disease (COPD)? Select all that apply.
Education on pursed-lip breathing Avoiding air pollution
A healthcare provider saw a client in the office with symptoms that suggested pneumonia. Immediately, the healthcare provider prescribed an antibiotic. This is an example of which type of treatment?
Empiric treatment
Aplastic Anemia
Etiology: Bone marrow damage or failure Pathophysiology: Impairment or failure of bone marrow that leads to stem cell loss which decreases numbers of erythorocytes, leukocytes and platelets. Signs and Symptoms: Pallor, weakness, dyspnea, leukopenia, thrombocytopenia
Iron Deficiency Anemia
Etiology: Decreased dietary intake, malabsorption, blood loss Pathophysiology: Insufficient iron intake decreases hemoglobin synthesis which reduces oxygen transportation in the blood. Signs and Symptoms: Pallor, fatigue, lethargy, cold intolerance, irritability, degenerative changes, stomatitis, glossitis, menstrual irregularities, delayed healing, tachycardia, heart palpitations, dyspnea
Pernicious Anemia
Etiology: Deficit of intrinsic factor owing to immune reaction Pathophysiology: Malabsorption of Vitamin B12 and a lack of intrinsic factor needed to bind with the vitamin. The RBCs are very large and are destroyed prematurely, resulting in low erythrocyte count. Lack of B12 also causes demyelination of peripheral nerves and the spinal cord which interferes with nerve impulse conduction. Signs and Symptoms: Enlarged, red, sore tongue, decreased gastric acid, nausea and diarrhea, neurologic effects of paresthesia or loss of coordination
Thalassemia
Etiology: Gene mutations with one or more genes for hemoglobin are missing or variant Pathophysiology: Results from a genetic defect where one or more genes for hemoglobin are missing or variant. Interference with productions of the globin chains and the amount of hemoglobin synthesized and the number of RBC's are reduced. Signs and Symptoms: Pallor, weakness, dyspnea
Sickle Cell Anemia
Etiology: Recessive inheritance Pathophysiology: Inherited characteristic leads to abnormal hemoglobin formation. This changes the shape of the RBS to a crescent shape. Cells have a much shorter life span. Signs and Symptoms: Symptoms occur at around 1 year old. Pallor, weakness, tachycardia, dyspnea, hyperbilirubinemia, splenomegaly, delayed growth and development, CHF, frequent infections
Which of the following could trigger or make an asthma attack worse? Select all that apply.
Exposure to an asthma trigger Wait for 12 to 24 hours to see if the attack subsides
Based on their risk factors, which of the following would you recommend for this participant to reduce their risk of COPD? Select all that apply.
Follow-up with your healthcare provider about treating your asthma Obtain influenza vaccine yearly Stop smoking
Which are homeostatic mechanisms used by the body when there is a gas exchange problem? Select all that apply.
Forcing respiratory muscles to work harder Changing the pH of the blood Increasing respiratory rate
Pneumonia Prevention
Frequent hand washing: It reduces the transfer of microorganisms at an entry point in the body. This is the most effective prevention strategy for any infection. Social distance: It reduces the possible spread of microorganisms. Vaccines: These include pneumococcal, COVID, and flu immunizations. Other vaccines depend on risk, community spread, and current health department guidelines. Good air filtration: Some organisms can spread in poor air circulation or air systems. Personal protective equipment (PPE) when appropriate: Depending on how a microorganism may spread, protective equipment is required in areas where community spread may be high, or when there is a high risk of exposure.
Which actions can reduce the risk and impact of pneumonia in an immunocompromised client? Select all that apply.
Frequent handwashing by anyone in contact with them Administration of vaccinations for the client and anyone in frequent contact with them Ordering groceries for delivery
Based on the risk factors, which could have been done to prevent a pulmonary embolus (PE)? Select all that apply.
Frequent standing and moving while on the plane Wear support stockings Smoking cessation
Risk Factors for Gas Exchange
Gas exchange can be impacted by many external things. High Altitude Less oxygen and less pressure. Results in lower rate of gas exchange. The higher the altitude, the less oxygen and the less pressure there is to promote oxygen/carbon dioxide gas exchange. Supplemental oxygen is often used when we are at high altitude, OR pressure is added to our vehicle to compensate (i.e., airplane). Pollution 21% of the air has oxygen. Particulates impair oxygen flow to blood. Pollution is another thing that can impact gas exchange. Only 21% of our air has oxygen. When particulates are inhaled, hey can "clog the filter" and impair the movement of oxygen into the blood. Lifestyle Smoking causes tar buildup in lungs. That leads to altered gas exchange. Lifestyle is also an important factor that could affect gas exchange. Cigarette smokers routinely inhale thousands of chemicals within smoke, causing a buildup of tar and other elements within the lung tissue, leading to altered gas exchange. Diet Affects gas exchange. Low iron means insufficient oxygen carbon dioxide exchange. Diet affects gas exchange as well. People who have low iron intake lack enough iron to transport the exchanged oxygen from the lungs or carbon dioxide from the body. In addition, there are some genetic conditions that cause chronic anemia (low or abnormal red blood cell counts) which can cause further problems transporting gases.
Which best describes the way oxygen and carbon dioxide move between the alveoli and capillaries?
Gases move from a high pressure and concentration to a low pressure and concentration.
A total or partial airway obstruction during an asthma attack may lead to which condition?
Hypoxia
Hospital-Acquired Pneumonia (HAP)
Hospital-acquired pneumonia (HAP), also known as nosocomial pneumonia, is found in clients who acquired pneumonia while being in the hospital. VAP is a subset of HAP. The most common bacteria in HAP include staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]) in addition to VAP causes.Those at risk: hospitalized clients
What happens when air is trapped in the body as a result of asthma?
Hyperinflation of the lungs
Prevention of Asthma Attacks
Identify and avoid asthma triggers Get regular exercise Create and follow a plan of what to do if an attack does occur Take the regular asthma medications as prescribed Recognize and treat an attack early Notice a progressive increase in "rescue" inhaler use and follow-up with a health care provider Get vaccinated to prevent infections that may make asthma worse
Which are risk factors for increased pulmonary emboli in older adults? Select all that apply.
Immobility Medications Injury Surgery
Aging and Pulmonary Embolus
Immobility: At any age, someone can be immobile, however, the elderly are much more likely to experience immobility related to social and occupational situations. In addition, multiple illnesses can also increase the likelihood of immobility. Medications: Some medications used to treat cancer, and hormones that may be used to treat menopausal symptoms are associated with an increased risk of blood clots. Surgeries: The trauma of surgery can activate the clotting system and increase platelet activity. In addition, surgical recovery may require some immobility, which also increases blood clot risk. Injuries: Increased falls with age are common due to underlying balance and overall mobility issues
Risk Factors for Pulmonary Emboli
Immobility Trauma or leg surgery Childbirth Congestive heart failure Dehydration Increased blood coagulation Cancer
Aplastic anemia
Impairment or failure of bone marrow that leads to stem cell loss, which decreases numbers of erythorocytes, leukocytes, and platelets.
Which strategies will decrease an individual's risk for anemia? Select all that apply.
Increase intake of green leafy vegetables Wear respiratory protection when working with pesticides and other chemicals Reduce alcohol intake
The most common pathogens for pneumonia
Viral: SARS CoV-2 (COVID-19), influenza (flu), respiratory syncytial virus (RSV), human parainfluenza viruses (HPIVS) Bacterial: streptococcus pneumoniae, mycoplasma pneumoniae, legionella Fungal: pneumocystis pneumonia, coccidioidomycosis (Valley fever), histoplasmosis Parasitic: ascaris, toxoplasmosis
Julie has a high fever, chills, and malaise. Viral pneumonia is suspected. Which tests would best identify the cause? Select all that apply.
Influenza polymer reactive chain test COVID-19 polymer reactive chain test
Sickle cell anemia
Inherited characteristic leading to abnormal hemoglobin formation. This changes the shape of the RBS to a crescent shape. Cells have a much shorter life span.
Iron deficiency anemia
Insufficient iron intake decreases hemoglobin synthesis, which reduces oxygen transportation in the blood.
Which statements are true about a pulmonary embolus? Select all that apply.
It blocks the blood going to the lung capillaries. It reduces the exchange of gases in the capillaries and alveoli.
Ultrasound of the lower extremity
It uses sound waves to identify clots that may be forming in the legs, which could lead to a pulmonary embolus.
Which of the following can cause alterations in gas exchange? Select all that apply.
Loss of consciousness Low oxygen saturation Confusion
Which causes of anemia are primarily seen in older adults? Select all that apply.
Low dietary iron intake Vitamin B12 deficiency
Which of the following pathophysiological changes occurs in someone with chronic obstructive pulmonary disease (COPD)? Select all that apply
Low oxygen levels to body tissue High pressure in the pulmonary artery Inability to clear mucus from lower airways
Which are increased risk factors for an embolus? Select all that apply.
Lower extremity surgery Childbirth Blood clotting disorders Immobility Cancer
Pernicious anemia
Malabsorption of vitamin B12 and a lack of intrinsic factor needed to bind with the vitamin. The RBCs are very large and are destroyed prematurely, resulting in low erythrocyte count.
What factors contribute to a higher mortality rate as people with asthma get older? Select all that apply.
Medication side effects Normal physiological decrease in lung function Presence of other heart and lung conditions
Treatments for Chronic Obstructive Pulmonary Disease
Medications-Primarily inhaled formulations are used and include steroids (anti-inflammatory), antimuscarinics (reduce mucus production), expectorants (liquify secretions), and anticholinergics (dry up mucus). In addition, beta-agonists or other bronchodilators used for asthma are also given. Oxygen-When damage is so significant that the oxygen saturation goes below 90%, oxygen is used. Oxygen concentrators and portable oxygen tanks offer more independence for those with COPD, so they don't need to be hospitalized. Pulmonary Rehabilitation-These sessions help strengthen the lungs, increase muscle mass, and teach people with COPD techniques to help them improve. Some common techniques taught in pulmonary rehabilitation include purse-lipped breathing, energy conservation, frequent rest periods, increased protein intake, smoking cessation, and breathing exercises.
Which values are the standard range for hemoglobin in males and females?
Men 13.5-18 g/100 mL; women 12-16 g/100 mL
Pneumonia may develop from which of the following? Select all that apply.
Virus Fungus Bacteria
Myasthenia gravis
Muscles used to breathe are too weak
Ventilation problem: Anything stopping oxygen from getting into the lungs is a ventilation problem.
No air: If there is low or no oxygen in the surrounding air, then breathing is compromised. Muscle weakness: The diaphragm and chest muscles are responsible for ventilation. Tongue blocking airway: Blockage of an airway is a ventilation problem.
Which of the following may require emergency treatment? Select all that apply.
No rescue medications available Cyanosis Severe shortness of breath with no wheezing
Extrinsic and Intrinsic Asthma
Normal bronchiole: open airway Bronchiole during attack: constricted airways Extrinsic asthma is when acute episodes occur when type 1 hypersensitivity reactions occur due to an inhaled antigen. Hay fever and eczema often accompany this type. The onset typically occurs in childhood. Intrinsic asthma is when an attack is initiated through stimuli targeting hyper-responsive tissue in the airway. The stimuli may be respiratory infections, exercise, medications, cold weather, and smoke. The onset typically occurs in adulthood.
Anemia
Not enough hemoglobin to carry oxygen
Suffocation
Not enough oxygen in the environment
Which area of the lung is most affected by asthma?
Small bronchi or bronchioles
Oxygen Transportation
Oxygen in the alveoli moves to the red blood cells (RBCs) as carbon dioxide moves from the RBCs to the alveoli. The oxygen binds to the hemoglobin within the red blood cell until it reaches a capillary where it moves into the cells. As the oxygen enters the cells, the carbon dioxide leaves the cells and binds to hemoglobin for transport back to the alveoli.
What do we already know about oxygen? Select all that apply.
Oxygen is vital for cellular metabolism. Oxygen is exchanged for carbon dioxide in the lung alveoli. Hemoglobin is the transport vehicle for oxygen. Each hemoglobin molecule is limited by the amount of oxygen it can carry.
Choking
Partial or full blockage between the mouth and the alveoli
Which statement best describes asthma?
Periodic, severe, but reversible, bronchial obstructive episodes
Which vaccinations should someone with chronic obstructive pulmonary disease receive to reduce the risk of increased lung complications? Select all that apply.
Pneumonia, Coronavirus,Influenza
Viral pneumonia testing
Polymer chain reactive (PCR) testing
What is known as a blood clot or a mass of material that obstructs the pulmonary artery or a branch of it?
Pulmonary embolus
What is the leading cause of emphysema and chronic bronchitis?
Smoking
Computed Tomographic (CT) Angiogram
Radio-opaque dye is injected into the venous system and pictures are taken as it moves through the circulation.
Ventilation and Perfusion (VQ scan)
Radioactive material is injected, and sensors watch as the material is absorbed into the lung. Areas in which gas exchange takes place are highlighted, while other areas in which there is blockage do not show the gas exchange.
Which actions will help prevent gas exchange problems in the future? Select all that apply.
Reading the warnings and following them when using bleach Walking a mile at a fast pace Getting an influenza shot yearly
Which is an age-related cause of pernicious anemia in older adults?
Reduced intrinsic factor
Which of the following are risk factors for chronic obstructive pulmonary disease (COPD)? Select all that apply.
Some people with genetic variants with increased susceptibility Vaping Smoking Outside workers in urban environments
Which definition best fits chronic obstructive pulmonary disease?
Respiratory disorders that include progressive tissue degeneration and airway obstruction in the lungs
Which clients are at risk for a pulmonary embolus? Select all that apply.
Someone who sits for a prolonged period Someone who does not get out of bed Someone with trauma to an extremity Mothers during childbirth
some symptoms of asthma attack that need immediate attention
Shortness of breath with the inability to say more than one to two words between breaths Cyanosis (a bluish coloration to the lips and skin) may indicate severely low oxygen saturation No rescue medications are available History of asthma attacks with hospitalization (primarily if the person was placed on a ventilator to support breathing) Severe shortness of breath with no wheezing (indicates minimal air movement)
Which are common symptoms of anemia? Select all that apply.
Shortness of breath Fatigue Pallor Chest pain
Bacterial
Streptococcus pneumoniae Mycoplasma pneumoniae
What are some ways to prevent venous stasis and deep vein thrombosis (DVT) development?
Support stockings: These socks squeeze the circumference of the leg, equalizing the pressure to all deep veins, ensuring the weaker ones can push blood towards the heart more effectively. Blood thinners: While these medications are used to treat blood clots, they are also used to prevent blood clots. These are given sometimes after surgery or to those who may be at high risk for developing blood clots. Anti-platelet medications: These medications, the most well-known being aspirin, reduce the likelihood of platelets breaking apart and thus reduce clotting. Smoking cessation: This behavior can significantly decrease the risk of blood clotting. Stopping cigarette use can go far to reduce the possibility of a clot traveling to the lung. Use alternatives to high-risk medications: Some medications can increase the risk of blood clots
During an asthma attack, which of the following best describes the pathophysiologic process?
The bronchioles are narrowed by an inflammatory response, making exhalation difficult.
Empiric treatment of pneumonia means which of the following?
The cause of pneumonia is predicted and the treatment is based on what is suspected.
Pathophysiology of Anemia
The pathology of anemia is a decrease in the oxygen-carrying capacity of blood and consequently a reduction in the amount of oxygen available to the cells. In some cases, when anemia develops slowly, the person usually adapts to the declining hemoglobin level and the clinical manifestations may not be as easily recognized.
D-dimer
This is a blood test to measure whether clotting is noted in the body. This test can be elevated for a pulmonary embolus or a deep vein thrombosis.
Surgical interventions for impaired gas exchange
ThoracentesisRemoval of excess fluid from the pleural cavity prevents atelectasisTracheotomyIncision into the trachea below the larynx to permit air intakeSurgeryRemoves tumor, abscess, or damaged tissue
In an extrinsic asthma exacerbation, which type of hypersensitivity reaction occurs?
Type 1
Testing for a thrombosis in the leg is done in the following ways:
Ultrasound of the lower extremity: This test uses sound waves to identify clots that may be forming in the legs, which could lead to a pulmonary embolus. D-dimer: This is a blood test to measure whether clotting is noted in the body. This test can be elevated for a pulmonary embolus or a deep vein thrombosis
Complications of Chronic Obstructive Pulmonary Disease
Upper respiratory infections-Excess mucus production Pneumonia-Inability to clear mucus from lower airways. Pneumothorax-High pressure in the chest. Confusion-Low oxygen levels to the brain. Fatigue-Low oxygen levels to body tissue. Dependent edema-High pressure in right ventricle and pulmonary artery. Arrythmias-Increased left atrial wall volume (from high lung pressure)
Which of the following strategies could prevent or reduce the likelihood of an asthma attack? Select all that apply.
Use your inhaler at the first sign of wheezing like your plan directs Get vaccinated for influenza Briskly walk a mile per day while able to talk in full sentences Avoid pollen from an olive tree, which is a known trigger for you
Which actions can prevent pneumonia? Select all that apply.
Vaccines Handwashing Air filtration
Ventilator-Acquired Pneumonia (VAP)
Ventilator-acquired pneumonia (VAP) is common in those who require mechanical ventilation. These can be clients who might temporarily require assistance to breathe or people with chronic conditions dependent upon a ventilator. The most common bacteria causing this type of pneumonia is pseudomonas aeruginosa, escherichia coli, and klebsiella pneumoniae.Those at risk: critically ill on mechanical ventilation
Which symptoms are expected findings in someone with chronic obstructive pulmonary disease? Select that all apply.
Wheezing Barrel shaped chest Shortness of breath Productive cough
A pulmonary embolus is a clot that breaks away from a vessel wall, travels through the circulation, and obstructs the _________flow in the________
blood/lung
Red blood cell production begins in the______________________
bone marrow
Chronic obstructive pulmonary disease is a(n) _________ disease that is_________
chronic/irreversible
Pneumonia Symptoms
cough (usually productive with a discolored sputum) shortness of breath sharp pain at the site of inflammation (chest or side) fever chills loss of energy or appetite not feeling well (malaise)
Pneumonia signs
decreased oxygen saturation fever increased pulse rate increased blood pressure abnormal chest x-ray abnormal lung sounds lymph node enlargement
Common symptoms of asthma include:
difficulty breathing (also called dyspnea) wheezing cough excess mucus production fatigue
To treat pneumonia, antibiotic, antiviral, or antifungal therapy
frequent deep breaths and coughing: every 1 to 2 hours to remove secretions increase fluid intake: liquify secretions symptom control medications: oral analgesics: for pain, muscle achesantipyretics: to control fever and inflammationantihistamines and decongestants: to reduce and clear secretionsantitussives: to reduce coughexpectorants: to make cough more productive by liquifying secretions
The body tries to maintain homeostasis by:
increasing the respiratory rate increasing the heart rate increasing the blood pressure changing the pH of the blood forcing respiratory muscles to work harder
Viral
influenza Respiratory syncytial virus
Microcytic normochromic anemia
is caused by chronic illnesses.
Normocytic normochromic anemia
is caused by iron deficiency (detected early), chronic illness (e.g., sepsis, tumor), acute blood loss, aplastic anemia, and renal disease.
Microcytic hypochromic anemia
is caused by iron deficiency (detected late), thalassemia, and lead poisoning
Macrocytic normochromic anemia
is caused by vitamin B12 or folic acid deficiency, phenytoin ingestion, chemotherapy, some myelodysplastic syndromes, myeloid leukemia, ethanol toxicity, and thyroid dysfunction.
Ventilation problem
limited or no oxygen in the environment (limited oxygen in surrounding environment) not enough pressure to pull the oxygen into the lungs (muscle weakness) something is blocking the airway (foreign object or tongue)
Empiric treatment
means to predict the cause, treat, and adapt based on client response or new information.
viral pneumonia sign and symptoms
muscle aches headache nausea and vomiting dry cough weakness
Perfusion problem
not enough hemoglobin to transport the oxygen to the body (anemia or blood loss) hemoglobin cannot carry enough oxygen (carbon monoxide poisoning) hemoglobin is unable to carry oxygen (deformed red blood cell) atherosclerosis or embolus decreasing blood flow
Many different things can impact gas exchange. Here are just a few to consider:
not enough oxygen in the environment (suffocation) too much carbon dioxide in the environment (carbon dioxide poisoning) partial or full blockage between the mouth and the alveoli (choking) blockage of gas exchange by another substance or chemical (drowning, infection) not enough hemoglobin to carry oxygen (anemia) blood clots in the capillaries or veins (pulmonary emboli) difficulty exhaling because of trapped air (asthma or chronic obstructive pulmonary disease) muscles used to breathe are too weak (spinal cord injury, myasthenia gravis)
Pneumonia and High Risk
older than 65 years of age declining or poor kidney function low blood pressure (systolic blood pressure below 90 mmHg) tachypnea (increased respiratory rate over 30 breaths per minute) hypothermic (low temperature) abnormal heart rate (heart rate below 50 or more than 100) needing assistance with breathing
Symptoms of Pulmonary Emboli
shortness of breath chest pain cough (with or without blood-tinged sputum) lightheadedness/dizziness rapid or irregular palpitations fever excessive sweating anxiety
With viral pneumonia, because it starts ________ symptoms more likely include________
systemically/muscle aches
Signs of Pulmonary Emboli
tachypnea (breaths per minute over 20) tachycardia (heart beats per minute over 100) elevated or low blood pressure (systolic blood pressure over 140 or under 90) decreased oxygen saturation (oxygen saturation below 90%) loss of skin color and/or cyanosis (pale or grey depending on the pigment) clear lung sounds (may have crackles in severe embolus)
3 main goals in treating anemia
Stop loss or destruction: Control bleeding and treat autoimmune conditions. Increase production: Stimulate bone marrow activity or replace depleted nutrients to increase the production and quality of red blood cells. Replace what is missing: Many different types of human and artificial blood products are available.
