lOMoAR cPSD| 67691079
ALTERATIONS IN PULMONARY FUNCTION
OBSTRUCTIVE AND RESTRICTIVE LUNG
FUNCTION, PART 1 OF 4
Introduction to Obstructive and Restrictive Lung
Diseases
Obstructive and restrictive lung diseases disturb normal pathophysiological processes to support
normal cellular regulation and homeostasis. Lung diseases impair gas exchange due to an inconsistent
oxygen supply and subsequent removal of by-product waste (carbon dioxide). Interdependent
interactions between our neurological, respiratory, and cardiovascular systems are also required to
support gas exchange.
When gas exchange is compromised from pulmonary disease, oxygenation is reduced or ceases,
affecting the cells and triggering a cascade of physiological problems across and between systems.
There are also variations in client care needs based on context. For example, is impaired gas exchange a
result of a primary diagnosis of chronic obstructive pulmonary disease (COPD) or secondary due to a
myocardial infarction? Regardless of the underlying cause, client care needs to support gas exchange
are prioritized for ventilation, oxygen transport, and perfusion of oxygen-rich blood throughout the
circulatory system.
This learning module focuses on the disease process of obstructive and restrictive lung diseases and
enables you to meet the following course outcomes:
• CO 1: Analyze pathophysiologic mechanisms associated with selected disease states across the
lifespan.
• CO 2: Examine the way in which homeostatic, adaptive, and compensatory physiological
mechanisms can be supported and/or altered through specific therapeutic interventions across
the lifespan.
• CO 3: Distinguish risk factors associated with selected disease states across the lifespan.
• CO 4: Integrate advanced pathophysiological concepts in the diagnosis and treatment of health
problems in selected populations.
Chronic Bronchitis
The nurse practitioner (NP) is seeing a client with chronic bronchitis that needs spirometry on today’s
visit. What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic
bronchitis?
Decreased diffusing capacity
, lOMoAR cPSD| 67691079
Decreased total lung capacity (TLC)
Decreased lung compliance
Decreased forced expiratory flow (FEV1)
Chronic bronchitis is an obstructive disease. Therefore, the client will have decreased expiratory flow
rates. The FEV1 will be decreased.
Air trapping is also common in obstructive disease which will cause an increased TLC. A decreased
diffusing capacity typically only occurs in emphysema, not chronic bronchitis. In chronic bronchitis, lung
compliance is increased slightly, not decreased.
Arterial Blood Gas
The nurse practitioner (NP) assesses a client with a history of heart failure and
Arterial Blood Gas Results
PaCO2 30 mmHg
‾
24 mEq /L
PO2 82 mmHg
pulmonary edema. Based on the arterial blood gas (ABG) result below, which clinical condition does the
NP suspect?
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
The client has uncompensated respiratory alkalosis.
Arterial Blood Gas
Normal Values Results Problem
7.35–7.45 7.56 ↑ (alkalosis)
, lOMoAR cPSD| 67691079
PaCO2 35–45 mmHg 30 ↓ (respiratory)
HCO3– 22–26 mEq/L 24 (normal)
Arterial Blood Gas
Normal Values Results Problem
PO2 80–100 mmHg 82 82 (normal)
O2 saturation 95%–100% 87% 95 (normal)
---------------------
Characteristics of Lung Disease
Complete the following sentence by choosing from the list of options.
Lung diseases that have (increased lung volume\ increased lung capacity\ reduced lung volume) are
characterized as restrictive, whereas diseases with (increased airflow\ reduced airflow\ normal airflow)
are characterized as obstructive.
Risk Factors of Lung Disease
An individual is at risk based on age, individual factors, and underlying clinical conditions. Click each
section below to learn more about the risk factors of lung disease.
Age
• Infants and young children have less alveolar surface area for gas exchange; therefore,
airways can be easily obstructed by mucus, edema, or foreign objects.
• Older adults have anatomical and physiological changes expected with advanced age.
• Loss of elastic recoil of the chest and decreased lung volume capacity (tidal volume)
• Weaker respiratory muscles, reducing the effort to cough (risk for aspiration)
• Dilation of alveoli, decreased surface area
Individual Factors
• Nonmodifiable: Age, congenital abnormalities, or environmental concerns (air pollution, for
example)
• Modifiable: Tobacco use (inhaled smoke) or second-hand exposure to air pollutants; vaccinations
to prevent pulmonary disease (COVID, influenza, pneumococcal, Tdap)
, lOMoAR cPSD| 67691079
• Other: Clients with altered levels of consciousness, neurological disorders, tracheal intubation,
bed rest, or immobilization
Acute or Chronic Disease
• Accumulation of mucus and fluid accumulation in airways (cystic fibrosis, pulmonary edema,
chronic obstructive pulmonary disease [COPD])
• Diseases that reduce oxygen-carrying capacity (e.g., anemia)
• Hypersensitivity reactions (e.g., allergies) can exacerbate obstructive or reactive lung disease
At-Risk Clients
Which clients are at high risk for obstructive and restrictive lung disease? Select all that apply.
An 11-year-old child living with a parent who smokes cigarettes
A 54-year-old client with a diagnosis of iron deficiency anemia
A 34-year-old client with chronic urinary tract infections
A 45-year-old client with an acute exacerbation of asthma
A 74-year-old client who is immobile living in an assisted living facility
Inhaled smoke from tobacco products (firsthand or secondhand), asthma
(allergens), anemia (decreased oxygen-carrying capacity), and immobility (age and decreased lung
capacity) are risk factors for lung disease.
A client with chronic urinary tract infections is not at risk because this disease process does not directly
pose any threat to the airways that can cause a chronic inflammatory response.
Pathophysiology of Obstructive Lung Diseases
Obstructive lung diseases are characterized by obstruction to airflow during expiration. This can be
related to conditions that increase mucus production (e.g., chronic bronchitis) or the loss of surface
ALTERATIONS IN PULMONARY FUNCTION
OBSTRUCTIVE AND RESTRICTIVE LUNG
FUNCTION, PART 1 OF 4
Introduction to Obstructive and Restrictive Lung
Diseases
Obstructive and restrictive lung diseases disturb normal pathophysiological processes to support
normal cellular regulation and homeostasis. Lung diseases impair gas exchange due to an inconsistent
oxygen supply and subsequent removal of by-product waste (carbon dioxide). Interdependent
interactions between our neurological, respiratory, and cardiovascular systems are also required to
support gas exchange.
When gas exchange is compromised from pulmonary disease, oxygenation is reduced or ceases,
affecting the cells and triggering a cascade of physiological problems across and between systems.
There are also variations in client care needs based on context. For example, is impaired gas exchange a
result of a primary diagnosis of chronic obstructive pulmonary disease (COPD) or secondary due to a
myocardial infarction? Regardless of the underlying cause, client care needs to support gas exchange
are prioritized for ventilation, oxygen transport, and perfusion of oxygen-rich blood throughout the
circulatory system.
This learning module focuses on the disease process of obstructive and restrictive lung diseases and
enables you to meet the following course outcomes:
• CO 1: Analyze pathophysiologic mechanisms associated with selected disease states across the
lifespan.
• CO 2: Examine the way in which homeostatic, adaptive, and compensatory physiological
mechanisms can be supported and/or altered through specific therapeutic interventions across
the lifespan.
• CO 3: Distinguish risk factors associated with selected disease states across the lifespan.
• CO 4: Integrate advanced pathophysiological concepts in the diagnosis and treatment of health
problems in selected populations.
Chronic Bronchitis
The nurse practitioner (NP) is seeing a client with chronic bronchitis that needs spirometry on today’s
visit. What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic
bronchitis?
Decreased diffusing capacity
, lOMoAR cPSD| 67691079
Decreased total lung capacity (TLC)
Decreased lung compliance
Decreased forced expiratory flow (FEV1)
Chronic bronchitis is an obstructive disease. Therefore, the client will have decreased expiratory flow
rates. The FEV1 will be decreased.
Air trapping is also common in obstructive disease which will cause an increased TLC. A decreased
diffusing capacity typically only occurs in emphysema, not chronic bronchitis. In chronic bronchitis, lung
compliance is increased slightly, not decreased.
Arterial Blood Gas
The nurse practitioner (NP) assesses a client with a history of heart failure and
Arterial Blood Gas Results
PaCO2 30 mmHg
‾
24 mEq /L
PO2 82 mmHg
pulmonary edema. Based on the arterial blood gas (ABG) result below, which clinical condition does the
NP suspect?
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
The client has uncompensated respiratory alkalosis.
Arterial Blood Gas
Normal Values Results Problem
7.35–7.45 7.56 ↑ (alkalosis)
, lOMoAR cPSD| 67691079
PaCO2 35–45 mmHg 30 ↓ (respiratory)
HCO3– 22–26 mEq/L 24 (normal)
Arterial Blood Gas
Normal Values Results Problem
PO2 80–100 mmHg 82 82 (normal)
O2 saturation 95%–100% 87% 95 (normal)
---------------------
Characteristics of Lung Disease
Complete the following sentence by choosing from the list of options.
Lung diseases that have (increased lung volume\ increased lung capacity\ reduced lung volume) are
characterized as restrictive, whereas diseases with (increased airflow\ reduced airflow\ normal airflow)
are characterized as obstructive.
Risk Factors of Lung Disease
An individual is at risk based on age, individual factors, and underlying clinical conditions. Click each
section below to learn more about the risk factors of lung disease.
Age
• Infants and young children have less alveolar surface area for gas exchange; therefore,
airways can be easily obstructed by mucus, edema, or foreign objects.
• Older adults have anatomical and physiological changes expected with advanced age.
• Loss of elastic recoil of the chest and decreased lung volume capacity (tidal volume)
• Weaker respiratory muscles, reducing the effort to cough (risk for aspiration)
• Dilation of alveoli, decreased surface area
Individual Factors
• Nonmodifiable: Age, congenital abnormalities, or environmental concerns (air pollution, for
example)
• Modifiable: Tobacco use (inhaled smoke) or second-hand exposure to air pollutants; vaccinations
to prevent pulmonary disease (COVID, influenza, pneumococcal, Tdap)
, lOMoAR cPSD| 67691079
• Other: Clients with altered levels of consciousness, neurological disorders, tracheal intubation,
bed rest, or immobilization
Acute or Chronic Disease
• Accumulation of mucus and fluid accumulation in airways (cystic fibrosis, pulmonary edema,
chronic obstructive pulmonary disease [COPD])
• Diseases that reduce oxygen-carrying capacity (e.g., anemia)
• Hypersensitivity reactions (e.g., allergies) can exacerbate obstructive or reactive lung disease
At-Risk Clients
Which clients are at high risk for obstructive and restrictive lung disease? Select all that apply.
An 11-year-old child living with a parent who smokes cigarettes
A 54-year-old client with a diagnosis of iron deficiency anemia
A 34-year-old client with chronic urinary tract infections
A 45-year-old client with an acute exacerbation of asthma
A 74-year-old client who is immobile living in an assisted living facility
Inhaled smoke from tobacco products (firsthand or secondhand), asthma
(allergens), anemia (decreased oxygen-carrying capacity), and immobility (age and decreased lung
capacity) are risk factors for lung disease.
A client with chronic urinary tract infections is not at risk because this disease process does not directly
pose any threat to the airways that can cause a chronic inflammatory response.
Pathophysiology of Obstructive Lung Diseases
Obstructive lung diseases are characterized by obstruction to airflow during expiration. This can be
related to conditions that increase mucus production (e.g., chronic bronchitis) or the loss of surface
