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Questions
Ventilation Process of inspiration and expiration through pulmonary airways. CORRECT ANSWER
Perfusion Movement of blood through pulmonary circulation, providing oxygen to the body
CORRECT ANSWER Ventilation-perfusion ratio (V-Q ratio) Ratio of air reaching alveoli to amount
of blood reaching alveoli. Ideal is equal.
-Shunt: area with no ventilation
-Dead space: no perfusion CORRECT ANSWER Oxygenation Gas exchange of carbon dioxide for
oxygen takes place in the alveoli to oxygenate the blood CORRECT ANSWER what is oxyhemoglobin
hemoglobin bound to oxygen. (each hemoglobin molecule can carry 4 oxygen molecules)
CORRECT ANSWER What is Erthyropoietin (EPO)? Explain its role in gas exchange: hormone
released by kidneys to stimulate erythropoiesis (RBC production)
-any condition that causes hypoxia will stimulate secretion of erythropoietin
-erythropoietin then stimulates the bone marrow to produce more RBCs
-hemoglobin w/n the RBCs bind to oxygen
-which then delivers more oxygen the tissues CORRECT ANSWER Summarize the role of RBCs, HGB,
and kidneys and their effect in gas exchange? -RBCs transport oxygen from the lungs to body tissues
and carbon dioxide from tissues back to the lungs
-hemoglobin is the molecule responsible for binding and releasing oxygen and carbon dioxide.
-The kidneys indirectly contribute to gas exchange by regulating erythropoiesis and acid-base balance to
ensure an adequate oxygen supply and pH balance in the blood. CORRECT ANSWER What is
ventilation-perfusion imbalance? -Air cannot flow into an alveolus
-Blood flow around an alveolus is altered
-Most common etiology (cause) is blood clot in the lung also known as pulmonary embolus. CORRECT
ANSWER Hypoxia stimulates pulmonary arterial:
a)vasoconstriction
b)vasodilation a)vasoconstriction
Patients with chronic hypoxia can develop chronic pulmonary vasoconstriction, which can result in
pulmonary hypertension. CORRECT ANSWER What role does hypercapnia and chemoreceptors play in
,gas exchange? -Central chemoreceptors located in the medulla sense changes in carbon dioxide and
blood pH
-An increase in CO2 (hypercapnia) or a decrease in pH (acidosis) stimulates the central chemoreceptors,
resulting in an increased rate of respirations CORRECT ANSWER what is chronic hypercapnia? High
level of CO2 in the body or bloodstream. Lungs can't fully expel CO2. A common finding in patients with
progressive hypoxic lung disease
Ideal PCO2: 35mmHg - 45mmHg.
D/t bradypnea. Signals brain's respiratory center (in medulla) to increase breathing rate
Causes: asphyxiation, aspiration, asthma, COPD, pneumonia, pulmonary edema, thoracic muscle
paralysis, opiate toxicity
Symptoms: headache, drowsiness, intellectual impairment, disorientation -> stupor and coma
** Distinct change in stimulus to breathe. Shifts from CO2 accumulation to hypoxia as stimulus.*
CORRECT ANSWER what is chronic hypoxia? Chronic lack of oxygen from respiratory dysfunction.
AKA Hypoxemia.
Ideal PO2: 90mmHg - 100mmHg.
Brain can handle hypoxia 5-6 min til brain cells die, kidney can sustain for 20 min before nephrons die.
Under 60 mmHg, cellular aerobic metabolism ceases and anaerobic takes over -> lactic acid At 60 mmHg
Hgb starts to release oxygen molecules, pt is in severe hypoxemia -> behavioral changes, restlessness,
uncoordinated movements, impaired judgment, delirium, stupor, coma
Compensation: increase ventilation, pulmonary arteriole vasoconstriction, kidneys release erythropoetin
-> pulmonary hypertension -> right ventricular hypertrophy -> right ventricular failure (cor pulmonale)
CORRECT ANSWER what is an obstructive disorder? restrictive?
Incorporate: -SABA
-LABA -characterized by an increase in resistance to airflow from the trachea and larger bronchi to the
terminal and respiratory bronchioles.
-characterized by reduced expansion of lung tissue, with decreased total lung capacity (TLC).
Short acting beta agonists: ex: Albuterol (used as rescue meds, work rapidly, usually within minutes, to
open the airways and provide relief during asthma attacks or other respiratory distress.)
Long acting beta agonists: ex: Salmeterol (used as part of combination therapy, especially when
combined with inhaled corticosteroids (ICS), to provide both bronchodilation and anti-inflammatory
,effects for the long-term management of respiratory conditions.) CORRECT ANSWER What are the
general risk factors for pulmonary disorders/diseases? -Smoking, including second hand smoke
-occupational exposure to toxic agents such as mineral dust, coal, silica, farming and landscaping
materials, and reactive chemicals such as toluene
-asbestos exposure CORRECT ANSWER what is orthopnea? Difficulty breathing when laying flat
CORRECT ANSWER what is clubbing? a painless enlargement of the terminal phalanges of the fingers
and toes that develops over time. (chronic hypoxia) CORRECT ANSWER What diseases would you hear
wheezes? Crackles? Wheezes and crackles:
-Pulmonary Edema
-COPD
-Pneumonia
-Bronchiectasis
Wheezing:
-Asthma CORRECT ANSWER What are the signs of lung pathophysiology? 1) Dyspnea
2) Cough
3) Hemoptysis
4) Atelectasis
5) Hypoxia
6) Impending Respiratory failure: Hypoxemic and Hypercapnic CORRECT ANSWER What is
hemoptysis? Causes? Blood containing sputum. Usually associated with infection, tumor or TB. Not
the same as hematemesis (contains dark, coffee colored blood) whereas hemoptysis contains bright red
blood. CORRECT ANSWER What is atelectasis? Causesthe collapse of a small number of alveoli
resulting in reduced gas exchange. Can occur because of a compressive force on the alveoli, or by an
obstruction of the bronchioles that inhibits the full inflation of alveoli.
*Most commonly post op because of sedation (shallow breathing -> alveoli don't fully inflate)
Treatment: cough and deep-breathe to open alveoli
Predisposition to pneumonia CORRECT ANSWER What is hypoxemic respiratory failure? Occurs
when the pressure of oxygen in arterial blood (PaO2) is lower than 60 mm Hg with normal arterial
carbon dioxide (PaCO2). CORRECT ANSWER What is hypercapnic respiratory failure? Occurs when
carbon dioxide in arterial blood (PaCO2) is greater than 50 mm Hg.
, Common causes of hypercapnia include COPD and asthma.
Hypoxemia commonly accompanies hypercapnic respiratory failure in persons who are breathing room
air. CORRECT ANSWER Patients who undergo long surgical procedures often develop_________.
Atelectasis.
It is important to advise postoperative patients to cough, deep-breathe, and use an incentive spirometer
to reverse atelectasis. CORRECT ANSWER Pneumonia/Types Lower respiratory tract infection that
causes inflammation of alveolar sacs, impairing gas exchange
-Cough, crackles, and fever are the characteristic signs of pneumonia.
-In older adult patients, hypothermia may present instead of fever.
-Hospital acquired
-Ventilator acquired
-Community acquired
-Aspiration
-Legionella
-Walking CORRECT ANSWER Risk factors for pneumonia/ Prevention/ Tx - Infection (common
cold)
-Males>Females
-Weak immune system (infants and elders at risk)
-HIV (immunosuppressants meds)
-Immobile (bedridden, stroke, change in neuro status)
-Lung problems (COPD, smoker)
-Post-opt (abdominal or chest surgery)
-Bronchiectasis
-alcohol or drug intoxication>aspiration
Prevention: Pneumococcal vaccine (older adults, infants, children with risk factors)