Nur 265 – Respiratory UPDATED ACTUAL
Questions and CORRECT Answers
Chronic Obstructive Pulmonary Disease - CORRECT ANSWER - Characterized by
airflow obstruction resulting from chronic bronchitis and emphysema
• Cigarette smoking - causative factor in 90% of patients
• Environmental & genetic factors (alpha1-antirypsin deficiency)
• Second hand smoke, urban pollution, occupational exposure to toxins
COPD - Pathophysiology - CORRECT ANSWER - • Chronic Bronchitis - excessive
accumulation of mucous secretions block the airway, bronchospasm and inflammation of the
bronchi and bronchioles
• Emphysema - There is destruction of the walls of the overdistended alveoli which results in
impaired gas exchange
COPD - Smoking - CORRECT ANSWER - Interferes with cilliary cleansing mechanism
of respiratory tract; causing airflow to be obstructed. The aveoli become overdistened and there
is diminished lung capacity. Also irritates mucous glands, increasing mucous secretions. This all
causes protease release which breaks down the elastin in the aveoli.
COPD - Emphysema - CORRECT ANSWER - Some alveoli are destroyed and others
become large and flabby which decreases area for effective gas exchange trapping air in the
lungs. The hyper inflated lung flattens the diaphragm and increases the work of breathing
• The patient adjust by increasing respiratory rate. Carbon dioxide retention and respiratory
acidosis occur.
• In late stage emphysema, there is a low oxygen level because the oxygen has a hard time
moving from disease lung tissue into the bloodstream.
COPD - Symptoms - CORRECT ANSWER - • Dyspnea (even at rest in late stages),
cough, orthopnea
• Patient can't forcibly exhale air from lungs
• Risk for respiratory: infections, insufficiency and failure
, • FEV/FVC ratio <70% = COPD
• "Barrel Chest", air trapped in lungs(from Emphysema)
• Diminished breath sounds with expiration. Dry crackles and wheezes heard at base with forced
expiration
• Increased total lung capacity, functional residual capacity and residual volume due to trapped
air
• ABG's = high PCO2, low PO2
• Chest X-Ray: low flat diaphragm and hyperinflation
COPD - Typical Clinical Picture - CORRECT ANSWER - Increased RR, rapid shallow
respirations, use of accessory muscles (of abdomen and neck), limited diaphramatic excursion
(diaphragm is flattened)
• If the PO2 is chronically decreased: clubbing of fingers, cyanosis, delayed capillary refill
• Patient with an 8 pack a year history usually has obstructive changes but no manifestations
• Patient with a 20 pack history or longer often has early stage COPPD as found as changes in
pulmonary function test
COPD - Treatment - CORRECT ANSWER - • First intervention: improve gas exchange
and maintain patent airway
• Monitor COPD patient every 2 hours even if he is there for other reasons
• Deterioration of condition may require intubation and mechanical ventilation
Oxygen Therapy - CORRECT ANSWER - • ABGs are best means to determine need for
oxygen and its effectiveness
• Pulse Ox can be used to determine the oxygen needed
• Typical patient requires oxygen flow of 2-4 liters via nasal cannula or 40% Venturi mask
• Patients with low oxygen level and high CO2 level require 1-2 liters/min via nasal cannula
because low oxygen level is the patients's primary stimulus to breathe
COPD - Medulla Oblongata (MO) Respiratory Center (ANS) - CORRECT ANSWER -
Has 2 stimuli for respiration: the oxygen drive and carbon dioxide drive.
Questions and CORRECT Answers
Chronic Obstructive Pulmonary Disease - CORRECT ANSWER - Characterized by
airflow obstruction resulting from chronic bronchitis and emphysema
• Cigarette smoking - causative factor in 90% of patients
• Environmental & genetic factors (alpha1-antirypsin deficiency)
• Second hand smoke, urban pollution, occupational exposure to toxins
COPD - Pathophysiology - CORRECT ANSWER - • Chronic Bronchitis - excessive
accumulation of mucous secretions block the airway, bronchospasm and inflammation of the
bronchi and bronchioles
• Emphysema - There is destruction of the walls of the overdistended alveoli which results in
impaired gas exchange
COPD - Smoking - CORRECT ANSWER - Interferes with cilliary cleansing mechanism
of respiratory tract; causing airflow to be obstructed. The aveoli become overdistened and there
is diminished lung capacity. Also irritates mucous glands, increasing mucous secretions. This all
causes protease release which breaks down the elastin in the aveoli.
COPD - Emphysema - CORRECT ANSWER - Some alveoli are destroyed and others
become large and flabby which decreases area for effective gas exchange trapping air in the
lungs. The hyper inflated lung flattens the diaphragm and increases the work of breathing
• The patient adjust by increasing respiratory rate. Carbon dioxide retention and respiratory
acidosis occur.
• In late stage emphysema, there is a low oxygen level because the oxygen has a hard time
moving from disease lung tissue into the bloodstream.
COPD - Symptoms - CORRECT ANSWER - • Dyspnea (even at rest in late stages),
cough, orthopnea
• Patient can't forcibly exhale air from lungs
• Risk for respiratory: infections, insufficiency and failure
, • FEV/FVC ratio <70% = COPD
• "Barrel Chest", air trapped in lungs(from Emphysema)
• Diminished breath sounds with expiration. Dry crackles and wheezes heard at base with forced
expiration
• Increased total lung capacity, functional residual capacity and residual volume due to trapped
air
• ABG's = high PCO2, low PO2
• Chest X-Ray: low flat diaphragm and hyperinflation
COPD - Typical Clinical Picture - CORRECT ANSWER - Increased RR, rapid shallow
respirations, use of accessory muscles (of abdomen and neck), limited diaphramatic excursion
(diaphragm is flattened)
• If the PO2 is chronically decreased: clubbing of fingers, cyanosis, delayed capillary refill
• Patient with an 8 pack a year history usually has obstructive changes but no manifestations
• Patient with a 20 pack history or longer often has early stage COPPD as found as changes in
pulmonary function test
COPD - Treatment - CORRECT ANSWER - • First intervention: improve gas exchange
and maintain patent airway
• Monitor COPD patient every 2 hours even if he is there for other reasons
• Deterioration of condition may require intubation and mechanical ventilation
Oxygen Therapy - CORRECT ANSWER - • ABGs are best means to determine need for
oxygen and its effectiveness
• Pulse Ox can be used to determine the oxygen needed
• Typical patient requires oxygen flow of 2-4 liters via nasal cannula or 40% Venturi mask
• Patients with low oxygen level and high CO2 level require 1-2 liters/min via nasal cannula
because low oxygen level is the patients's primary stimulus to breathe
COPD - Medulla Oblongata (MO) Respiratory Center (ANS) - CORRECT ANSWER -
Has 2 stimuli for respiration: the oxygen drive and carbon dioxide drive.
