CHSO 404 Exam 2 with Complete
Solutions (Graded A+)
pneumothorax interventions - Answer--use of chest tube to monitor for latency, sterility
-monitoring of shock, respirations, oximetry
-provision of analgesics and positioning (semi Fowler) to make patient comfortable
pleural effusion - Answer--abnormal collection of fluid in pleural cavity
-transudate - hydrothorax
-exudate - empyema
-blood - hemothorax
-chyle (a milky fluid in lymph from GI tract) - chylothorax
hydrothorax - Answer--accumulation of transudate or fluid coming from different cells
-Seen in people with congestive heart failure, renal failure, nephrosis, liver failure
-Possibly caused by loss of albumin that changes osmotic pressure and leads to a
collection of fluids
empyema - Answer--exudate that comes from inflammatory processes or immune
responses
-Seen in infections, malignancies, rheumatoid arthritis, lupus
hemothorax - Answer--blood pooling into the pleural cavity
-Seen in chest injury, surgery, malignancies, vessel rupture
chylothorax - Answer--lymph fluid coming into pleural cavity
-Obstructed lymph return to blood
-Seen in trauma, infection, malignant infiltration
pleural effusion - causes - Answer--Increased capillary pressure
-Increased capillary permeability
-Decreased colloidal osmotic pressure
-Increased intrapleural negative pressure
-Impaired lymphatic drainage
All of these can contribute to changes in fluid, osmosis, or drainage of substances into
the pleural cavity.
,pleural effusion - consequences - Answer--Decreased lung volumes on affected side
-Diminished breath sounds, dullness, or flatness to percussion
-Dyspnea, pleuritic pain, constant discomfort
atelectasis - Answer--collapse of previously expanded lung tissue (adult) or incomplete
expansion of lungs at birth
-primary atelectasis - lung tissue remains uninflated at birth
-often due to insufficient surfactant
-often seen in premature births
-treated with exogenous surfactant to help open airways and allow for good gas
exchange
-secondary atelectasis - lung that have previously been inflated collapse
-airway obstruction (tumors, mucus plug, exudate)
-lung compression (pneumothorax or pleural effusion)
-increased lung recoil (decreased surfactant)
atelectasis - mechanisms - Answer--There is increased risk after surgery:
-Anesthesia (nitrogen wash-out)
-Narcotics
-Immobility (increased secretions, increased risk of obstruction)
-Surfactant needs to be constantly replenished by normal ventilation.
-Help patients after surgery do deep breathing and reestablish the surfactant secretion.
-Ineffective cough reflex results in poor alveolar expansion and obstruction.
-Increased viscosity of sputum leads to obstruction.
atelectasis - s/s - Answer-Severity of signs and symptoms depends upon amount of
lung tissue affected:
-Crackles and gurgles from accumulating secretions
-Diminished breath sounds at site of collapse
-Progressive dyspnea and tachycardia
-Progressive cough due to loss of secretions
-Hypoxemia
atelectasis - interventions - Answer--administration of o2, antibiotics, hydration
-monitoring breath sounds, temperature, spirometry
-frequent repositioning
-encouragement to cough and breathe deeply
obstructive lung disorders - Answer--increased airway resistance
-best indicated by FEV1 and FVC values on a pulmonary function test
,-FEV1/FVC ratio is decreased in obstructive lung disorders.
-The ratio is a forced expiratory value in one second.
-chronic bronchitis
-asthma
-emphysema
airway flow and resistance - Answer--air moves by a bulk flow process due to a
pressure gradient, but there is resistance to this flow
-Flow is defined by differences between atmospheric pressure and alveolar pressure
relative to resistance:
Patm−Palv
-----------
R
-resistance is defined by Poiseuille's law
R= 8nl
------
r^4
-The smaller the radius (r), the larger the resistance.
-Viscosity (η) and length (l) of airway can also increase resistance.
-Airway resistance is usually low.
-Disease states can alter airway resistance and compromise ventilation.
-Examples include asthma and bronchitis.
asthma - Answer--Is a chronic inflammatory disorder of airways
-Causes recurrent episodes of wheezing, breathlessness, chest tightness, and
coughing, resulting in airflow obstruction
-Has underlying pathophysiology that involves IgE and mast cell degranulation, causing
inflammatory mediators to be released, and leading to smooth muscle contraction,
increased secretions, etc.
-Used to be classified as extrinsic or intrinsic based on source of triggers
-Is currently classified based upon clinical severity
-Correlates better with management choices and clinical outcomes
-Includes mild intermittent, mild persistent, moderate persistent, and severe persistent
-treated based on severity
bronchitis - Answer--Bronchitis is inflammation of bronchi.
-Bronchiectasis: persistent abnormal dilation of the bronchi that is frequently associated
with bronchitis
-Bronchiolitis: inflammatory obstruction of the bronchioles
-Inflammatory responses impair airflow.
-Chronic bronchitis gives rise to chronic obstructive pulmonary disease (COPD)
-chronic bronchitis causes increased fluid secretions
, emphysema - Answer--Abnormal permanent enlargement of gas exchange airways
accompanied by destruction of alveolar walls:
-Primary emphysema:(1 to 2%) results from inherited deficiency of α1-antitrypsin that
inhibits the action of proteolytic enzymes
-Proteolytic enzymes chew elastin.
-Destruction of elastin gives rise to emphysemic state.
-Secondary emphysema: caused by inability of body to inhibit proteolytic enzymes in
lung (from exposure to toxins or cigarette smoke)
-can be restrictive as well as obstructive
restrictive lung disorders - Answer--Characterized by lungs that are difficult to inflate
-Decreased compliance is best indicator of a restrictive disorder.
-Tidal volume and vital capacity are correspondingly decreased.
-Generally a problem with the lung tissue itself rather than airways (though
extraparenchymal damage impedes lung inflation)
-Pulmonary fibrosis: excessive collagen
-Pulmonary edema and pneumonia: fluid accumulation that restricts expansion
FEV1/FVC Ratio - Answer--Restrictive disorders are characterized by a decrease in the
forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC).
-The FEV1/FVC ratio may be normal or even increased.
-Obstructive disorders: reduced ratio
-Restrictive disorders: increased or normal ratio
The values for residual volume and total lung capacity are generally decreased in
restrictive lung disease.
pulmonary fibrosis - Answer--Condition characterized by excess connective tissue,
particularly elastin in the lungs
-Symptoms: shortness of breath, cough, fatigue, weakness, chest discomfort, loss of
appetite, and rapid weight loss
-May have a history of progressive shortness of breath (dyspnea) on exertion
-Causes: may be secondary to other diseases involving autoimmunity, infection, or
injury to the lung, or may be idiopathic
-Direct causes include exposure to environmental pollutants such as asbestos.
-Cigarette smoking often exacerbates illness.
-Mechanics
-Gradual exchange of parenchymal tissue with fibrotic tissue
-Increased thickness of the respiratory membrane and reduced efficiency of gas
exchange
Solutions (Graded A+)
pneumothorax interventions - Answer--use of chest tube to monitor for latency, sterility
-monitoring of shock, respirations, oximetry
-provision of analgesics and positioning (semi Fowler) to make patient comfortable
pleural effusion - Answer--abnormal collection of fluid in pleural cavity
-transudate - hydrothorax
-exudate - empyema
-blood - hemothorax
-chyle (a milky fluid in lymph from GI tract) - chylothorax
hydrothorax - Answer--accumulation of transudate or fluid coming from different cells
-Seen in people with congestive heart failure, renal failure, nephrosis, liver failure
-Possibly caused by loss of albumin that changes osmotic pressure and leads to a
collection of fluids
empyema - Answer--exudate that comes from inflammatory processes or immune
responses
-Seen in infections, malignancies, rheumatoid arthritis, lupus
hemothorax - Answer--blood pooling into the pleural cavity
-Seen in chest injury, surgery, malignancies, vessel rupture
chylothorax - Answer--lymph fluid coming into pleural cavity
-Obstructed lymph return to blood
-Seen in trauma, infection, malignant infiltration
pleural effusion - causes - Answer--Increased capillary pressure
-Increased capillary permeability
-Decreased colloidal osmotic pressure
-Increased intrapleural negative pressure
-Impaired lymphatic drainage
All of these can contribute to changes in fluid, osmosis, or drainage of substances into
the pleural cavity.
,pleural effusion - consequences - Answer--Decreased lung volumes on affected side
-Diminished breath sounds, dullness, or flatness to percussion
-Dyspnea, pleuritic pain, constant discomfort
atelectasis - Answer--collapse of previously expanded lung tissue (adult) or incomplete
expansion of lungs at birth
-primary atelectasis - lung tissue remains uninflated at birth
-often due to insufficient surfactant
-often seen in premature births
-treated with exogenous surfactant to help open airways and allow for good gas
exchange
-secondary atelectasis - lung that have previously been inflated collapse
-airway obstruction (tumors, mucus plug, exudate)
-lung compression (pneumothorax or pleural effusion)
-increased lung recoil (decreased surfactant)
atelectasis - mechanisms - Answer--There is increased risk after surgery:
-Anesthesia (nitrogen wash-out)
-Narcotics
-Immobility (increased secretions, increased risk of obstruction)
-Surfactant needs to be constantly replenished by normal ventilation.
-Help patients after surgery do deep breathing and reestablish the surfactant secretion.
-Ineffective cough reflex results in poor alveolar expansion and obstruction.
-Increased viscosity of sputum leads to obstruction.
atelectasis - s/s - Answer-Severity of signs and symptoms depends upon amount of
lung tissue affected:
-Crackles and gurgles from accumulating secretions
-Diminished breath sounds at site of collapse
-Progressive dyspnea and tachycardia
-Progressive cough due to loss of secretions
-Hypoxemia
atelectasis - interventions - Answer--administration of o2, antibiotics, hydration
-monitoring breath sounds, temperature, spirometry
-frequent repositioning
-encouragement to cough and breathe deeply
obstructive lung disorders - Answer--increased airway resistance
-best indicated by FEV1 and FVC values on a pulmonary function test
,-FEV1/FVC ratio is decreased in obstructive lung disorders.
-The ratio is a forced expiratory value in one second.
-chronic bronchitis
-asthma
-emphysema
airway flow and resistance - Answer--air moves by a bulk flow process due to a
pressure gradient, but there is resistance to this flow
-Flow is defined by differences between atmospheric pressure and alveolar pressure
relative to resistance:
Patm−Palv
-----------
R
-resistance is defined by Poiseuille's law
R= 8nl
------
r^4
-The smaller the radius (r), the larger the resistance.
-Viscosity (η) and length (l) of airway can also increase resistance.
-Airway resistance is usually low.
-Disease states can alter airway resistance and compromise ventilation.
-Examples include asthma and bronchitis.
asthma - Answer--Is a chronic inflammatory disorder of airways
-Causes recurrent episodes of wheezing, breathlessness, chest tightness, and
coughing, resulting in airflow obstruction
-Has underlying pathophysiology that involves IgE and mast cell degranulation, causing
inflammatory mediators to be released, and leading to smooth muscle contraction,
increased secretions, etc.
-Used to be classified as extrinsic or intrinsic based on source of triggers
-Is currently classified based upon clinical severity
-Correlates better with management choices and clinical outcomes
-Includes mild intermittent, mild persistent, moderate persistent, and severe persistent
-treated based on severity
bronchitis - Answer--Bronchitis is inflammation of bronchi.
-Bronchiectasis: persistent abnormal dilation of the bronchi that is frequently associated
with bronchitis
-Bronchiolitis: inflammatory obstruction of the bronchioles
-Inflammatory responses impair airflow.
-Chronic bronchitis gives rise to chronic obstructive pulmonary disease (COPD)
-chronic bronchitis causes increased fluid secretions
, emphysema - Answer--Abnormal permanent enlargement of gas exchange airways
accompanied by destruction of alveolar walls:
-Primary emphysema:(1 to 2%) results from inherited deficiency of α1-antitrypsin that
inhibits the action of proteolytic enzymes
-Proteolytic enzymes chew elastin.
-Destruction of elastin gives rise to emphysemic state.
-Secondary emphysema: caused by inability of body to inhibit proteolytic enzymes in
lung (from exposure to toxins or cigarette smoke)
-can be restrictive as well as obstructive
restrictive lung disorders - Answer--Characterized by lungs that are difficult to inflate
-Decreased compliance is best indicator of a restrictive disorder.
-Tidal volume and vital capacity are correspondingly decreased.
-Generally a problem with the lung tissue itself rather than airways (though
extraparenchymal damage impedes lung inflation)
-Pulmonary fibrosis: excessive collagen
-Pulmonary edema and pneumonia: fluid accumulation that restricts expansion
FEV1/FVC Ratio - Answer--Restrictive disorders are characterized by a decrease in the
forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC).
-The FEV1/FVC ratio may be normal or even increased.
-Obstructive disorders: reduced ratio
-Restrictive disorders: increased or normal ratio
The values for residual volume and total lung capacity are generally decreased in
restrictive lung disease.
pulmonary fibrosis - Answer--Condition characterized by excess connective tissue,
particularly elastin in the lungs
-Symptoms: shortness of breath, cough, fatigue, weakness, chest discomfort, loss of
appetite, and rapid weight loss
-May have a history of progressive shortness of breath (dyspnea) on exertion
-Causes: may be secondary to other diseases involving autoimmunity, infection, or
injury to the lung, or may be idiopathic
-Direct causes include exposure to environmental pollutants such as asbestos.
-Cigarette smoking often exacerbates illness.
-Mechanics
-Gradual exchange of parenchymal tissue with fibrotic tissue
-Increased thickness of the respiratory membrane and reduced efficiency of gas
exchange
