WEEK 3 STUDY GUIDE
Alterations IN Pulmonary Function
(Edapt slides with rationals)
Key Concepts
, lOMoARcPSD|51648332
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?
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Decreased diffusing capacity
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
pH 7.56
PaCO2 30 mmHg
HCO3‾ 24 mEq /L
PO2 82 mmHg
O2 saturation 87%
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
pH 7.35–7.45 7.56 ↑ (alkalosis)
PaCO2 35–45 mmHg 30 ↓ (respiratory)
HCO3– 22–26 mEq/L 24 24 (normal)
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
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)
Other: Clients with altered levels of consciousness, neurological disorders,
tracheal intubation, bed rest, or immobilization
Acute or Chronic Disease
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
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 area of the lung that decreases areas of
gas exchange (e.g., emphysema). As a result, inflammatory processes destroy the
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
lung’s elasticity, decreasing recoil and lung compliance. Common obstructive lung
diseases include the following:
asthma
chronic obstructive pulmonary disease (COPD) (a combination of chronic
bronchitis and emphysema)
respiratory tract infections (acute bronchitis or pneumonia)
abscess formation
pulmonary vascular disease (pulmonary embolism)
pulmonary hypertension
cor pulmonale
malignancies of the respiratory tract
Ventilation Perfusion Mismatch
Regardless of the cause of the obstruction, there is an increased respiratory effort,
which requires more energy and effort to breathe. This results in a
ventilation/perfusion (V/Q) mismatch. A V/Q mismatch is the imbalance between
the air that enters the alveoli and the amount of perfusing blood, preventing the
lungs from optimally delivering oxygenated blood throughout the body. A V/Q
mismatch is a cause of hypoxemia. Clinical manifestations of acute hypoxemia can
include cyanosis, confusion, tachycardia, edema, and decreased renal output.
For example, clients with chronic obstructive pulmonary disease (COPD) have a V/Q
mismatch due to exposure to chronic allergens. The allergens destroy the lung’s
elastic tissue (e.g., via chronic hypersensitivity reactions). The lung is infiltrated
with inflammatory cells that release cytokines, contributing to airway damage and
mucus production. When elastin is destroyed, the lung loses its ability to recoil and
impairs gas exchange. Decreased oxygenation also reduces cerebral perfusion and
places clients at risk for falls and other safety considerations.
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Prioritization of Care
The nurse practitioner (NP) is reviewing triage assessments. Which two (2) clients
should the NP prioritize to assess? Select two.
An adolescent with a history of asthma and wheezing after the use of their inhaler
An older adult with seasonal allergies with red, swollen eyes and clear nasal
drainage
A young adult with a nonproductive cough and a history of allergic rhinitis
An older adult with confusion who fell and has a history of chronic obstructive
pulmonary disease (COPD)
An older adult with pneumonia is experiencing pain in the lower chest wall while
coughing
The client with chronic obstructive pulmonary disease (COPD) should be seen right
away because of their neurological state (confusion) and their fall, which suggests
poor cerebral oxygenation. The adolescent's worsening asthma and wheezing not
relieved with inhaler use should also be assessed by the NP right away as their
airway is compromised.
The other clients’ needs are not urgent, as each has a patent airway and is
breathing without difficulty.
Pathophysiology of Restrictive Lung
Diseases
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Image Transcript
Restrictive lung diseases are characterized by the inability to expand the lungs
during inspiration and lung volume reduction. The lung tissue is “stiff” or has
decreased compliance to stretch to support oxygenation and gas exchange needs.
Clients who experience decreased lung compliance have common clinical
manifestations of dyspnea, tachypnea, and decreased tidal volume (TV).
Remember, TV is the volume of air that moves in or out of the lungs with each
respiratory cycle.
Common restrictive lung diseases include the following:
aspiration
atelectasis
bronchiectasis
bronchiolitis
pulmonary fibrosis
pulmonary edema
pneumoconiosis
allergic alveolitis
interstitial lung disease (ILD)
acute respiratory distress syndrome (ARDS)
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Obstructive and Restrictive Lung
Diseases Clinical Manifestations
Clients with obstructive or restrictive lung disease(s) face multifaceted care needs.
Diagnosis and management vary based on assessment, which includes diagnostic
criteria and underlying disease pathology. Clinical management includes goals to
optimize gas exchange by prioritizing airway patency, ventilation, perfusion, and
acid-base balance.
Assessing a client experiencing an obstructive or restrictive lung disease begins
with a health history and prioritizing problem-based needs, symptom analysis, and
diagnostic testing. Common clinical manifestations of pulmonary disease include,
but are not limited to, the following:
dyspnea
cough
shortness of breath
abnormal sputum
abnormal breathing patterns
hypo/hyperventilation
chest pain with breathing
clubbing
cyanosis
Also, lung diseases are not self-limiting. They can be obstructive (limited airflow),
restrictive (limited lung volume), or both. For example, a client may have a history
of asthma (obstructive) and then be diagnosed with pneumonia. Pneumonia can
cause acute lung inflammation, injury, and hypoxemia. If the client’s condition
worsens, it could lead to acute respiratory distress syndrome (ARDS), a restrictive
condition.
For a client with a history of COPD who is diagnosed with pneumonia, they may
present with a mixed obstructive/restrictive disorder. Obstruction includes airway
narrowing from COPD and restrictive includes alveolar filling and reduced lung
compliance from pneumonia.
Clinical Assessment
A 68-year-old client presents to the emergency department from an assisted care
facility with fever, shivering, dyspnea, crackles, and poor response to oxygen
therapy. Three days before arrival, the client was diagnosed with bacterial
pneumonia and treated with fluids, intravenous antibiotics, and supportive oxygen
therapy. The client has a history of chronic obstructive pulmonary disease (COPD)
and obstructive sleep apnea (OSA).
Downloaded by Benjamin Luca ()
Alterations IN Pulmonary Function
(Edapt slides with rationals)
Key Concepts
, lOMoARcPSD|51648332
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?
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Decreased diffusing capacity
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
pH 7.56
PaCO2 30 mmHg
HCO3‾ 24 mEq /L
PO2 82 mmHg
O2 saturation 87%
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
pH 7.35–7.45 7.56 ↑ (alkalosis)
PaCO2 35–45 mmHg 30 ↓ (respiratory)
HCO3– 22–26 mEq/L 24 24 (normal)
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
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)
Other: Clients with altered levels of consciousness, neurological disorders,
tracheal intubation, bed rest, or immobilization
Acute or Chronic Disease
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
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 area of the lung that decreases areas of
gas exchange (e.g., emphysema). As a result, inflammatory processes destroy the
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
lung’s elasticity, decreasing recoil and lung compliance. Common obstructive lung
diseases include the following:
asthma
chronic obstructive pulmonary disease (COPD) (a combination of chronic
bronchitis and emphysema)
respiratory tract infections (acute bronchitis or pneumonia)
abscess formation
pulmonary vascular disease (pulmonary embolism)
pulmonary hypertension
cor pulmonale
malignancies of the respiratory tract
Ventilation Perfusion Mismatch
Regardless of the cause of the obstruction, there is an increased respiratory effort,
which requires more energy and effort to breathe. This results in a
ventilation/perfusion (V/Q) mismatch. A V/Q mismatch is the imbalance between
the air that enters the alveoli and the amount of perfusing blood, preventing the
lungs from optimally delivering oxygenated blood throughout the body. A V/Q
mismatch is a cause of hypoxemia. Clinical manifestations of acute hypoxemia can
include cyanosis, confusion, tachycardia, edema, and decreased renal output.
For example, clients with chronic obstructive pulmonary disease (COPD) have a V/Q
mismatch due to exposure to chronic allergens. The allergens destroy the lung’s
elastic tissue (e.g., via chronic hypersensitivity reactions). The lung is infiltrated
with inflammatory cells that release cytokines, contributing to airway damage and
mucus production. When elastin is destroyed, the lung loses its ability to recoil and
impairs gas exchange. Decreased oxygenation also reduces cerebral perfusion and
places clients at risk for falls and other safety considerations.
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Prioritization of Care
The nurse practitioner (NP) is reviewing triage assessments. Which two (2) clients
should the NP prioritize to assess? Select two.
An adolescent with a history of asthma and wheezing after the use of their inhaler
An older adult with seasonal allergies with red, swollen eyes and clear nasal
drainage
A young adult with a nonproductive cough and a history of allergic rhinitis
An older adult with confusion who fell and has a history of chronic obstructive
pulmonary disease (COPD)
An older adult with pneumonia is experiencing pain in the lower chest wall while
coughing
The client with chronic obstructive pulmonary disease (COPD) should be seen right
away because of their neurological state (confusion) and their fall, which suggests
poor cerebral oxygenation. The adolescent's worsening asthma and wheezing not
relieved with inhaler use should also be assessed by the NP right away as their
airway is compromised.
The other clients’ needs are not urgent, as each has a patent airway and is
breathing without difficulty.
Pathophysiology of Restrictive Lung
Diseases
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Image Transcript
Restrictive lung diseases are characterized by the inability to expand the lungs
during inspiration and lung volume reduction. The lung tissue is “stiff” or has
decreased compliance to stretch to support oxygenation and gas exchange needs.
Clients who experience decreased lung compliance have common clinical
manifestations of dyspnea, tachypnea, and decreased tidal volume (TV).
Remember, TV is the volume of air that moves in or out of the lungs with each
respiratory cycle.
Common restrictive lung diseases include the following:
aspiration
atelectasis
bronchiectasis
bronchiolitis
pulmonary fibrosis
pulmonary edema
pneumoconiosis
allergic alveolitis
interstitial lung disease (ILD)
acute respiratory distress syndrome (ARDS)
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Obstructive and Restrictive Lung
Diseases Clinical Manifestations
Clients with obstructive or restrictive lung disease(s) face multifaceted care needs.
Diagnosis and management vary based on assessment, which includes diagnostic
criteria and underlying disease pathology. Clinical management includes goals to
optimize gas exchange by prioritizing airway patency, ventilation, perfusion, and
acid-base balance.
Assessing a client experiencing an obstructive or restrictive lung disease begins
with a health history and prioritizing problem-based needs, symptom analysis, and
diagnostic testing. Common clinical manifestations of pulmonary disease include,
but are not limited to, the following:
dyspnea
cough
shortness of breath
abnormal sputum
abnormal breathing patterns
hypo/hyperventilation
chest pain with breathing
clubbing
cyanosis
Also, lung diseases are not self-limiting. They can be obstructive (limited airflow),
restrictive (limited lung volume), or both. For example, a client may have a history
of asthma (obstructive) and then be diagnosed with pneumonia. Pneumonia can
cause acute lung inflammation, injury, and hypoxemia. If the client’s condition
worsens, it could lead to acute respiratory distress syndrome (ARDS), a restrictive
condition.
For a client with a history of COPD who is diagnosed with pneumonia, they may
present with a mixed obstructive/restrictive disorder. Obstruction includes airway
narrowing from COPD and restrictive includes alveolar filling and reduced lung
compliance from pneumonia.
Clinical Assessment
A 68-year-old client presents to the emergency department from an assisted care
facility with fever, shivering, dyspnea, crackles, and poor response to oxygen
therapy. Three days before arrival, the client was diagnosed with bacterial
pneumonia and treated with fluids, intravenous antibiotics, and supportive oxygen
therapy. The client has a history of chronic obstructive pulmonary disease (COPD)
and obstructive sleep apnea (OSA).
Downloaded by Benjamin Luca ()
