Patho Chapter 15: Altered Ventilation & Diffusion PREPU
-"You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." Explanation: Atelectasis is characterized by incomplete lung expansion, and can often be prevented by deep breathing and coughing. Pleural effusion, not atelectasis, is associated with fluid accumulation between the lungs and their lining. Neither chest tube insertion nor bronchodilators are common treatments for atelectasis.
A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which teaching point by her nurse is most appropriate? -"Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often." -"You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." -"Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube." -"I'll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in."
-Supplementary oxygen therapy Explanation: Bronchiolitis necessitates supplementary oxygen therapy. Antibiotics are ineffective due to the viral etiology. Recovery usually occurs within several days, and tracheotomy is necessary only in the event of severe complications. Plasma transfusion is not a relevant treatment modality.
A 6-month-old infant has been hospitalized with acute bronchiolitis. Which treatment should be prioritized in the infant's care? -Supplementary oxygen therapy -Intravenous antibiotics -Transfusion of fresh frozen plasma -Tracheotomy
-Damage has occurred at the connection between the pneumotaxic and apneustic centers. Explanation: Brain injury, which damages the connections between the pneumotaxic and apneustic centers, results in an irregular breathing pattern that consists of prolonged inspiratory gasps interrupted by expiratory efforts. If the occipital lobe was not functioning, the client would have no respiratory effort and require mechanical ventilation. Leaking of spinal fluid would not cause these respiratory signs. If nerves were severed to the lungs, the client would not be able in inflate/deflate the lungs with mechanical ventilation.
A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiologic principle for these signs would include: -Damage has occurred at the connection between the pneumotaxic and apneustic centers. -The client's occipital lobe is no longer functioning. -The client must have a leak in the ventricles resulting in a decrease in spinal fluid. -The nerves innervating the lungs have been severed in the accident.
-Nosocomial hospital-acquired infection (HAI) Explanation: Hospital-acquired pneumonia is defined as a lower respiratory tract infection that was not present or incubating on admission to the hospital. Hospital-acquired pneumonia is the second most common cause of hospital-acquired infection and has a mortality rate of 20% to 50%. Most hospital-acquired infections are bacterial. The organisms are those present in the hospital environment and include P. aeruginosa, S. aureus, Enterobacter species, Klebsiella species, Escherichia coli, and Serratia species. The organisms that are responsible for hospital-acquired pneumonias are different from those responsible for community-acquired pneumonias, and many of them have acquired antibiotic resistance and are more difficult to treat.
A client hospitalized for 72 hours has developed symptoms of a lower respiratory tract infection. Sputum cultures reveal S. aureus as the infectious organism. The nurse explains to the client that the most likely cause of this infection is: -Nosocomial hospital-acquired infection (HAI) -Community-acquired infection -Opportunistic infection -Autoimmune disease
-Aspiration Explanation: In clients with GERD, aspiration is the most likely cause for the development of pneumonia because stomach acid can reflux back up into the throat and is then inhaled into the lungs causing an inflammatory process. Although an ineffective cough reflex could also contribute to the risk of aspiration pneumonia, in this question there is no reason to believe that the client has an ineffective cough reflex. It is more likely that the direct cause of the pneumonia is aspiration.
A client is suffering from severe gastroesophageal reflux disease (GERD) and has been admitted to the hospital with a diagnosis of pneumonia. Which of the following would be the most likely cause for the development of pneumonia? -Recent exposure to TB -Aspiration -Pertussis -Ineffective cough reflex
-Nosocomial pneumonia Explanation: Pneumonia can be classified according to the type of organism causing the infection (typical or atypical), location of the infection—lobar pneumonia or bronchopneumonia—and setting in which it occurs—community- or nosocomial/hospital-acquired pneumonia. Community-acquired pneumonia involves infections from organisms that are present more often in the community than in the hospital or nursing home. Hospital-acquired (nosocomial) pneumonia is defined as a lower respiratory tract infection occurring 48 hours or more after admission.
A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis. -Typical pneumonia -Community-acquired pneumonia -Nosocomial pneumonia -Antibiotic-resistant pneumonia
-380 mm Hg Explanation: The law of partial pressures states that the total pressure of a mixture of gases, as in the atmosphere, is equal to the sum of the partial pressures of the different gases in the mixture. If the concentration of oxygen at 760 mm Hg (1 atmosphere) is 50%, its partial pressure is 380 mm Hg (50.54 kPa). The equation to calculate is 760 × 0.50 = 380.
A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO2? -15.2 mm Hg -More data are needed -380 mm Hg -38,000 mm Hg
-"I'll ask you to breathe in as deeply as you can, and then blow out as much of that air as possible." Explanation: FVC involves full inspiration to total lung capacity followed by forceful maximal expiration.
A client with a history of chronic obstructive pulmonary disease (COPD) is undergoing pulmonary function testing. Which instructions should the technician provide to determine the client's forced vital capacity (FVC)? -"I'll ask you to breathe in as deeply as you can, and then blow out as much of that air as possible." -"I'd like you to take a deep breath, and then blow out as much air as you can during 1 second." -"I want you to breathe as normally as possible and I'm going to measure how much air goes in and out with each breath." -"Breathe normally, and then exhale as much as you possibly can when I tell you."
-Small cell lung cancer due to smoking history Explanation: Small cell lung cancer has the strongest association with cigarette smoking and is rarely observed in someone who has not smoked; brain metastasis is common. The earliest symptoms (of lung cancer) usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels. There is no indication the client has risk factors for TB. Pulmonary emboli result from blood clots traveling to the lungs. Pneumothorax would cause different symptoms and be an acute, abrupt onset.
A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which possible diagnosis? -Pneumothorax related to chronic lung infection weakening the alveoli -Small cell lung cancer due to smoking history -Pulmonary embolism due to blood in sputum -Tuberculosis due to long period of coughing
-Cor pulmonale Explanation: The term cor pulmonale refers to right-sided heart failure resulting from primary lung disease or pulmonary hypertension. The increased pressures and work result in hypertrophy and eventual failure of the right ventricle. The manifestations of cor pulmonale include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure. Primary hypertension is elevated blood pressure of unknown cause. Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space.
A client with primary lung disease has developed right heart failure. The health care provider would document this as: -Adult respiratory distress syndrome -Primary hypertension -Cor pulmonale -Cardiac tamponade
-Prepare for mechanical ventilation. Explanation: When alveolar ventilation is inadequate to maintain PO2 or PCO2 levels because of respiratory or neurologic failure, mechanical ventilation may be lifesaving. Usually a nasotracheal, orotracheal, or tracheotomy tube is inserted into the trachea to provide the client with the airway needed for mechanical ventilation.
A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support? -Increase oxygen level to 10 L/min. -Begin Bi-PAP. -Call respiratory therapy to suction the client. -Prepare for mechanical ventilation.
-stimulation of irritant receptors causes bronchoconstriction. Explanation: It is possible that irritant receptors are involved in the bronchoconstriction response that occurs in some persons with bronchial asthma when exposed to irritants such as tobacco, smoke, or perfume. A type III hypersensitivity reaction is an immune complex response, which does not exist in this case. Toxins do not normally compete with oxygen for binding sites. Artificial scents do not directly disrupt gas diffusion.
An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because: -a type III hypersensitivity reaction is caused. -stimulation of irritant receptors causes bronchoconstriction. -toxins can compete with oxygen for hemoglobin-binding sites. -certain chemicals in artificial scents disrupt gas diffusion
-"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?" Explanation: The causes of emphysema are smoking, which incites lung injury, and an inherited deficiency of alpha 1-antitrypsin, an antiprotease enzyme that protects the lung from injury.
An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement is the best response? -"Emphysema is a permanent dilation of the bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue as the result of infection and inflammation." -"This disease is seen most commonly in middle-aged men and is associated with chronic irritation from smoking and recurrent infections." -"There is no known cause for emphysema; however, it does seem to run in families. Has anyone in your family been diagnosed with this disease?" -"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"
-A subjective sensation felt when experiencing difficulty breathing Explanation: Dyspnea is described as a subjective sensation where a person feels that it is difficult to breathe. Cheyne-Stoke breathing involves waxing and waning of respiratory depth. Very rapid breathing explains tachypnea, while breathing that retains carbon dioxide describes hyperventilation.
Dyspnea can best be described by which of the following? -A subjective sensation felt when experiencing difficulty breathing -Breathing that is rhythmic waxing and waning of the depth of respiration -Very rapid respirations -Abnormally fast and deep breathing that results in retaining carbon dioxide
-Perfusion without ventilation Explanation: With shunt, there is perfusion without ventilation, resulting in a low ventilation-perfusion ratio. This occurs in conditions such as atelectasis in which there is airway obstruction. Ventilation without perfusion (dead air space) is a consequence of impaired pulmonary circulation. Hypoxemia will result in vasodilation, not vasoconstriction.
Following surgery, a client had a chest x-ray that reported some opacities in the lung bases likely due to atelectasis. Which pathophysiologic process will result from this condition? -Compensatory vasoconstriction -Ventilation without perfusion -Dead air space -Perfusion without ventilation
-Pulmonary artery Explanation: Deoxygenated blood leaves the right heart through the pulmonary artery. Return of oxygenated blood to the heart occurs by way of the pulmonary vein, which empties into the left atrium.
Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via the vena cava, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system? -Pulmonary capillaries -Pulmonary artery -Pulmonary vein -Ductus arteriosus
-Corticosteroids Explanation: Corticosteroids are anti-inflammatory medications that are used to treat inflammation that impinges on ventilatory function such as with asthma. Humidification and decongestants are used in the presence of excessive, thick, or sticky mucus. Antitussives are used when a cough is excessive and interferes with sleep.
The emergency department nurse is caring for a client with an acute asthma attack. Which therapy should the nurse anticipate for this client? -Antitussives -Corticosteroids -Humidification -Decongestants
-Decreased tidal volume. Explanation: Tidal volume is the amount of air that a person brings in the lungs with one inhalation and exhalation. The pain caused by the fractured ribs will cause a decrease in the tidal volume, due to more shallow respirations, causing the feeling of shortness of breath because less air is entering and leaving the lungs.
The nurse caring for a client with bilateral rib fractures explains to the client that the pain causes him to take more shallow respirations, which will contribute to feeling short of breath due to a: -Increased vital capacity. -Decreased residual volume. -Increased total lung capacity. -Decreased tidal volume.
-Diabetic ketoacidosis Explanation: Diabetic ketoacidosis is an example of a condition resulting in Kussmaul respirations as an attempt by the client's body to correct metabolic acidosis. Heart failure is more likely to lead to Cheyne-Stokes respirations. Ataxic breathing may result from brain abscesses, and asthma results in obstructive breathing.
The nurse is caring for a client exhibiting Kussmaul respirations whose arterial blood gases testing showed a pH of 7.1. For which condition should the nurse anticipate treatment? -Brain abscess -Diabetic ketoacidosis -Asthma -Heart failure
-Mechanical ventilation Explanation: The nurse should anticipate mechanical ventilation, as a severed cervical nerve results in the cessation of spontaneous lung function. Antibiotics, arterial blood gases, and pulmonary function testing may be required later in the client's care.
The nurse is caring for a client exhibiting findings consistent with a severed cervical nerve. Which action should the nurse anticipate first? -Mechanical ventilation -Antibiotics -Pulmonary function testing -Arterial blood gases
-blood cultures -chest x-ray -oxygen to maintain SaO2> 90% -preparation for possible intubation Explanation: Due to the history of lung injury via aspiration and the rapid decrease in paO2 and increase in paCO2, the nurse should suspect acute respiratory distress syndrome (ARDS). In ARDS, ABGs often indicate early respiratory alkalosis which may quickly progress to hypercapnia and respiratory acidosis. The nurse should recommend blood cultures to detect sepsis, which is the most common cause of ARDS. The nurse also requests a chest x-ray and oxygen to maintain adequate saturation levels. Because ARDS can progress quickly, the nurse also ensures the team is aware of the need to be prepared for intubation for mechanical ventilation if needed. Mucolytics are indicated in conditions of excess or thickened sputum production and are not used as part of the treatment of ARDS.
The nurse is caring for a client who is diagnosed with aspiration pneumonia. The client's arterial blood gas (ABG) results from 4 hours ago indicated a paO2 of 80 mm Hg (10.64 kPa) and a paCO2 of 30 mm Hg (3.99 kPa). The nurse notes current ABG results of paO2 of 70 mm Hg (9.31 kPa) and a paCO2 of 50 mm Hg (6.66 kPa). When notifying the health care provider, which recommendations will the nurse make? Select all that apply. -blood cultures -chest x-ray -oxygen to maintain SaO2> 90% -preparation for possible intubation -STAT administration of mucolytics
-Macrophages in the alveoli A client who is immunosuppressed will have impaired immune protections, which include the presence and ability of macrophages in the alveoli to ingest and remove bacteria and other foreign materials via phagocytosis. Immunosuppression does not directly affect sneeze or cough reflex, signaling the respiratory control center, or warming and humidifying the air.
The nurse is caring for a client who is immunosuppressed. Which aspect of the client's pulmonary defense mechanism is affected? -Macrophages in the alveoli -Triggering a sneeze or cough reflex -Signaling the respiratory control center -Warming and humidifying the air
-deficiency of surfactant. Explanation: Surfactant is essential in supporting lung compliance by the reduction of surface tension, allowing a greater ease of lung inflation. Type II alveolar cells synthesize surfactant, which is composed of phospholipids, neutral lipids and proteins. Type II alveolar cells do not begin to mature until the 26th to 27th week of gestation; therefore, it is not unusual for premature infants to have insufficient levels of surfactant leading to alveolar collapse and respiratory distress. Mechanical ventilation helps to support the respiratory system.
The nurse is explaining to the parents of a 23-week premature infant the reason their baby needs to be on mechanical ventilation. The education is successful when the parents state that they understand their baby was born before the type II alveolar cells could mature, which has caused a: -deficiency of alveoli. -deficiency of type I alveolar cells. -deficiency of surfactant. -deficiency of conducting airways.
-Pleural effusion Explanation: Pleural effusion is used to describe an abnormal collection of fluid or exudates in the pleural cavity. Pleurisy in an inflammation in pleural space. Pneumothorax is an abnormal collection of air in pleural space.
The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is: -Pleurisy -Pleural effusion -Pneumothorax -Poor lung compliance
-Carbon dioxide -Oxygen -pH Explanation: Chemoreceptors monitor blood levels of oxygen, carbon dioxide, and pH and adjust ventilation to meet the changing metabolic needs of the body.
The nurse is monitoring trends in the client's arterial blood gases and recognizes that changes in ventilation will result from which of the following? Select all that apply. -Carbon dioxide -Oxygen -pH -Anion gap -Cerebrospinal fluid (CSF)
-Smaller airways create a susceptibility to changes in airway resistance and airflow. Explanation: Because the resistance to airflow is inversely related to the fourth power of the radius (resistance = 1/radius), relatively small amounts of mucus secretion, edema, or airway constriction can produce marked changes in airway resistance and airflow. Surfactant production is low early in life, and the respiratory center and chemoreceptors are present and functional in infants and children.
Which characteristic of the lungs of infants and small children creates an increased risk of respiratory disorders? -Smaller airways create a susceptibility to changes in airway resistance and airflow. -Type II alveoli in children may overproduce surfactant. -The pneumotaxic center in the pons is underdeveloped until 8 years of age. -There are fewer chemoreceptors in the young medulla.
-A school-aged child with severe asthma controlled by steroids admitted for an exacerbation -A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation -A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food Explanation: Persons requiring intubation and mechanical ventilation are particularly at risk, as are those with compromised immune function, chronic lung disease (like asthma), and airway instrumentation, such as endotracheal intubation or tracheotomy. Ventilator-associated pneumonia is pneumonia that develops in mechanically ventilated clients more than 48 hours after intubation. Neutropenia and impaired granulocyte function predispose to infections caused by S. aureus, Aspergillus, gram-negative bacilli, and Candida. Pneumonia in immunocompromised persons remains a major source of morbidity and mortality. The epithelial cells of critically and chronically ill persons are more receptive to binding microorganisms that cause pneumonia.
Which clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply. -A teenager who spends a lot of time at local coffee shops using Wi-Fi to chat with friends -A college female who is pregnant (unplanned) and who has been consuming alcohol prior to positive pregnancy test -A school-aged child with severe asthma controlled by steroids admitted for an exacerbation -A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation -A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food
-Intubation and mechanical ventilation. Explanation: The type II alveolar cells that produce surfactant do not begin to mature until 26-27th week of gestation; consequently, many premature infants have difficulty producing sufficient amounts of surfactant. This can lead to alveolar collapse and severe respiratory distress. The only answer to facilitate respiratory is mechanical ventilation. IV fluids and nutrition are important but not a priority of airway/breathing problems. There is no indication that the infant has increased ICP and would need an intraventricular catheter.
While working in the newborn ICU, the nurses receive a call that an infant, gestational age 23 weeks, is being air-flighted to their level three trauma nursery. The priority intervention for this infant would be: -Insertion of an umbilical line for fluids. -Intubation and mechanical ventilation. -Insertion of a feeding tube. -Insertion of an intraventricular catheter.
