Obstructive Lung Disorders

What is the problem in obstructive lung disorder?

A. Problem in diffusion

B. Problem in inhalation

C. Problem in exhalation

C. Problem in exhalation

A group of diseases including Emphysema and Bronchitis which is characterized by airflow limitation and is not fully reversible.

A. Asthma

B. CABG

C. Pleural Effusion

D. COPD

D. COPD

These are risk factors for COPD except:

A. Tobacco smoking

B. Allergens

C. Environmental and Occupational pollutants

D. Genetic predispositions

B. Allergens

All of these are detrimental effects of smoking: SATA

1. Depresses activity of ciliary cleaning and scavenger cells

2. Irritates goblet cells leading to accumulations of mucus and secretions

3. Forms carboxyHgb

4. Lowers the levels of Alpha 1-Antitrypsin

A. All of the above

B. All except 4

C. 1,2,3

D. 1,3,4

B. All except 4

When ciliary cleaning and scavenger cells action are depressed, this results in obstruction of airflow leading to CO2 Air trapping behind obstruction. This then results in? SATA

1. Carboxyhemoglobin in blood

2. Diminished lung capacity

3. Alveolar distention

4. Irritation and damage to lungs

A. All of the above

B. 1,2,3

C. 2,3

D. 1,2,4

C. 2,3

Smoking also irritates Goblet cells that is found in epithelial cells and contains/regulates mucus. When irritated, what happens? Explain its pathophysiology. :P

Irritated goblet cells ---> Increased accumulation of mucus and secretions ---> Further irritation causing infection and damage to lungs.

Patients at risk for developing COPD in terms of genetic predisposition have Alpha-1 antitrypsin deficiency in which it protects lungs, liver and counteracts destruction of lung tissue. This protease inhibitor is produced where?

A. Liver

B. Lungs

C. Thyroid

D. Pituitary

A. Liver

COPD is a progressive disease, thus clinical manifestations are simplified into 3 primary symptoms, what are those?

1. Chronic cough

2. Sputum production

3. Dyspnea on exertion

Note: chronic cough and sputum production(not all manifest sputum) occurs first before dyspnea as these two limits airflow.

What are the complications of COPD?

1. Severe dyspnea

2. Weight loss -because of energy depletion

3. Breathing increases overtime -body will use secondary muscles

Partial pressure of O2 (PaO2) normal range for people with COPD

A. 50-55 mmHg

B. 80-100 mmHg

C. 60-65 mmHg

D. 95-100 mmHg

C. 60-65 mmHg

An O2 Saturation of a patient with COPD should also be within normal limits as those of people without, this is because too much oxygen results in what? Explain its patterns. :P

Too much O2 ---> Retention of CO2 in lungs ---> Disruption of respiratory drive (suppression of CO2 chemoreceptor) ---> Disrupted perfusion and ventilation = Dyspnea, DOB, Shock, Respiratory arrest (possible).

You are a nurse in the ICU, and you noticed that one of your patient is having DOB, you immediately get the materials for O2 administration. O2 administration is a dependent nursing intervention, however, in emergency situations, the normal amount of oxygen to be administered independently is?

A. 2-4 L/Min

B. 1-3 L/Min

C. 2-3 L/Min

D. 3-4 L/Min

C. 2-3 L/Min

This is a type of lung disease under COPD that is associated by problems in the Alveoli. The air spaces become distended leading to destruction of alveolar walls due to impaired exchange of O2 and CO2.

A. Pneumonia

B. Pleural Effusion

C. Bronchitis

D. Emphysema

D. Emphysema

These are clinical manifestations (internally) of Emphysema

A. Destroyed elastic fibers of alveoli

B. Decreased alveolar recoil and atelectasis

C. Air trapping

D. Lost alveolar recoil

Yes, AOTB

Destroyed elastic fibers of the alveoli results in decreased alveolar recoil, this condition leads to?

Atelectasis (collapse of alveoli)

Why is Emphysema called "Pink puffer?"

A. Because patient tries to breathe in

B. Because patient tries to breathe out

C. Because of retained CO2 in the body

D. Because the patient is pink panther

B. Because patient tries to breathe out

An increased pressure of CO2 in the arterial blood refers to?

Hypercapnia

Impaired CO2 elimination leads to later stage of Emphysema. Tap the card to see the later stage of Emphysema.

Hypercapnia ---> Increased CO2 in A. Blood = Co2 in lungs ---> Increase resistance to pulmonary blood flow ---> High RV pressure because blood is not pushed in the pulmonary = Pulmonary Hypertension ---> Increased pressure in pulmonary circulation and artery = Cor Pulmonale (Emphysema) ---> Back up of blood in venous circulation = RSHF.

One of the diagnostic procedure of an Emphysema is Chest X-Ray. What findings should we anticipate for a patient with suspected Emphysema?

Hyperinflated lungs because of trapped air

Flattened diaphragm because of decreased alveolar recoil

This diagnostic tool is used to determine patient's response to treatment of bronchodilators. Patient with suspected emphysema has reduced force expiratory volume (FEV).

Incentive Spirometry

ABG studies are also used as a diagnostic tool in Emphysema. These are findings of ABG for a patient with suspected Emphysema. SATA

1. Respiratory acidosis

2. Carboxyhemoglobin

3. Respiratory alkalosis

4. Mild to moderate hypoxemia

A. 1,2

B. 1.3

C. 2,3

D. 1,4

D. 1,4

A type of lung disease that is characterized by problem in airway tract, especially in the bronchioles.

A. Pneumonia

B. Pleural Effusion

C. Chronic Bronchitis

D. Emphysema

C. Chronic Bronchitis

Chronic bronchitis is an obstructive disorder that is characterized by airway obstruction from what?

Hypertrophy of smooth muscle of airway

Hypersecretion of mucus

=Impaired O2 levels

One of the signs and symptoms of Chronic bronchitis is Cyanosis, therefore, Chronic bronchitis is also called?

A. Pink puffers

B. Blue puffers

C. Blue bloaters

D. Pink bloaters

C. Blue bloaters

Among the signs and symptoms of chronic bronchitis are dyspnea, productive cough, and wheezing. Patients may also manifest symptoms of?

A. RSHF

B. PAP

C. LSHF

D. COPD

A. RSHF

-Peripheral Edema, JVD, Overweight

Complications of C. Bronchitis SATA

1. Cor pulmonale

2. Pneumonia

3. Pneumothorax

4. RSHF

A. All of the above

B. 2,3,4

C. 1,2,4

D. 1,2,3

A. All of the above

T or F

The management of C. Bronchitis are:

1. Drink plenty of fluids (3000 ml/day if not contraindicated) to reduce mucus viscosity

2. Low flow O2 2-3L/min

3. Semi-fowlers or Orthopneic position

4. Pursed lip breathing

5. CPT

True

What is the rationale for administering O2 via Venturi Mask?

A. For aesthetic purposes

B. So patient cannot inhale toxic air

C. So patient can inhale O2 at a controlled concentration

D. To administer many O2 as many as possible

C. So patient can inhale O2 at a controlled concentration

Venturi Mask delivers about 40% of O2 concentration.

Diet management of people with C. Bronchitis are:

A. Low calorie, Low protein

B. High calorie, High protein

C. High calorie, Low protein

D. Low calorie, Low protein

B. High calorie, High protein

This condition refers to irreversible dilation of the bronchi and bronchioles caused by destruction of muscles and elastic connective tissues.

Bronchiectasis

These conditions heightens the risks for acquiring bronchiectasis: SATA

1. Recurrent RTI

2. Cystic Fibrosis

3. TB

4. Immunodeficiency disorders

A. All of the above

B. 2,3,4

C. 1,2,4

D. 1,2,3

A. All of the above

Tap to view the development of bronchiectasis :)

Inflammation damage to bronchial wall ---> Permanent distention & distortion of bronchial wall ---> Impaired mucociliary clearance ---> Affects most frequently lower lobes of lungs = Atelectasis.

Characteristics of symptoms (Bronchiectasis)

1. Chronic cough

2. Production of purulent sputum in copious amount

3. Hemoptysis

4.Crackles heard over affected lung segment (frequently in lower lobes)

5. Clubbing of fingers

6. Repeated pulmonary infections

A chronic, inflammatory lung condition that causes:

1. Airway hyperresponsiveness

2. Mucosal edema

3. Mucus production

Resulting in smaller airways

Bronchial Asthma

T or F

S/Sx of a patient with bronchial asthma comprises of a Triad:

1. Cough (productive or non)

2. Wheezing (occur first in expiration, possible in inspiration)

3. Dyspnea (Acute exacerbation of bronchial asthma)

True bes

Circadian variation affects the patterns of asthma attacking either at night or early in the morning. In patients with asthma, this changes level of what neurotransmitter and hormone that also acts as a defense against bronchoconstriction?

Epinephrine

Tap to view the pathophysiology of Bronchial Asthma :>

Airway inflammation ---> Narrowing of airways (Bronchoconstriction, Airway edema, Hyperresponsiveness) ---> Inflammatory cells (Mast, T-Lymphocytes, Macrophages, Neutrophils Eosinophils) ---> Releases several chemicals called Mediator cells (Histamines, Bradykinin, Prostanoids, Cytokines, Leukotrienes) = Perpetuates (worsens) inflammatory response ---> Increased blood flow, Vasoconstriction, Fluid leak, Mucus secretion = Bronchoconstriction

Predisposing factors of Bronchial Asthma:

1. Allergies (seasonal, perennial)

2. Airway irritants

3. Foods (shellfish, Nuts)

4. Exercise, stress, Hormonal Imbalance

5. MEDs, RTIs, GERD

Breathing exercises that may manage bronchial asthma attack

Diaphragmatic breathing

Pursed lip breathing

Nose breathing

The best way to manage bronchial asthma is to:

A. Have adequate rest and sleep

B. Administer bronchodilators

C. Breathing exercises

D. Keep away from allergens

D. Keep away from allergens