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Consider T.V.'s history, what is most likely the cause of her respiratory distress? 

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Consider T.V.'s history, what is most likely the cause of her respiratory distress? 

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Pulmonary embolism because DVT is a risk for PE if the clot travels to the lungs. The symptoms include: dyspnea (sudden onset).

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R.S is a long-time smoker who developed bronchitic chronic obstructive pulmonary disease (COPD). He also has a history of Coronary artery disease and peripheral vascular disease. His arterial blood gas (ABG) values are pH= 7.32, PaCO2= 60 mm Hg, PaO2= 50 mm Hg, HCO3-= 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is taking an inhaled B agonist and theophylline to manage his respiratory condition. At his clinic visit, it is noted that R.S has an area of consolidation in his right lower lobe thought to be consistent with pneumonia. 

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R.S is a long-time smoker who developed bronchitic chronic obstructive pulmonary disease (COPD). He also has a history of Coronary artery disease and peripheral vascular disease. His arterial blood gas (ABG) values are pH= 7.32, PaCO2= 60 mm Hg, PaO2= 50 mm Hg, HCO3-= 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is taking an inhaled B agonist and theophylline to manage his respiratory condition. At his clinic visit, it is noted that R.S has an area of consolidation in his right lower lobe thought to be consistent with pneumonia. 

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What risk factors, clinical and diagnostic findings would help confirm this diagnosis?

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What risk factors, clinical and diagnostic findings would help confirm this diagnosis?

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90% of pulmonary embolisms are caused by DVT. Other causes of this include; hypercoagulation and, injuries to endothelial cells that line the vessels.
Diagnostic findings:
- low pulse oximetry
- arterial blood gas
- chest x-ray
- VQ scan
- pulmonary angiogram
- echogram

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1. Discuss the pathophysiology underlying COPD 

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1. Discuss the pathophysiology underlying COPD 

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This process initially affects only the largest bronchi, but eventually all airways are involved. The thick mucus and hypertrophied bronchial smooth muscle constrict the airways and lead to obstruction, particularly during expiration when the airways are narrowed. Obstruction eventually leads to ventilation-perfusion mismatch with hypoxemia. The airways collapse early in expiration trapping gas in the distal portions of the lung. Air trapping expands the thorax and positions the respiratory muscles at a mechanical disadvantage. This air  trapping leads to decreased tidal volume, hypoventilation and hypercapnia.

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What do her ABGs reveal? What is the pathogenesis of the hypoxemia in this disorder?

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What do her ABGs reveal? What is the pathogenesis of the hypoxemia in this disorder?

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Respiratory alkalosis because of high pH, low CO2 and, low PO2.
Initial hypoxemia at acute PE is caused by an altered distribution of ventilation to perfusion.

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1. What is the underlying mechanism of R.J's asthma? What are three airway responses that occur during an asthma episode?

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1. What is the underlying mechanism of R.J's asthma? What are three airway responses that occur during an asthma episode?

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A)
1) Bronchoconstriction
2) Mucosal edema
3) Hypersecretion of mucous

B) What mechanisms cause obstruction in asthma?
- Bronchoconstriction
- Obstruction of airflow by intraluminal mucous
- Inflammation and remodelling of airway wall

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what is the most likely cause of JC's manifestations

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what is the most likely cause of JC's manifestations

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tension pneumothorax from the motor vehicle accident

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explain the pathophysiology and manifestations underlying this cause. Discuss the different types

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explain the pathophysiology and manifestations underlying this cause. Discuss the different types

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Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Air continues to get into the pleural space but cannot exit. Without appropriate treatment, the impaired venous return can cause systemic hypotension and respiratory and cardiac arrest (pulseless electrical activity) within minutes. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration

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1. State the cause of pneumonia and describe how it affects the lungs. 

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1. State the cause of pneumonia and describe how it affects the lungs. 

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the cause of pneumonia is commonly caused by aspiration of colonized oropharyngeal secretions, factors include; capsules that make phagocytosis by alveolar macrophages difficult and release toxins, and inflammatory response.
Neutrophils and inflammatory exudates cause alveolar edema.
Most common is bacterial.

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the patient is at risk for severe hypoxemia. What is hypoxemia? Explain why this is a possible complication for this patient?

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the patient is at risk for severe hypoxemia. What is hypoxemia? Explain why this is a possible complication for this patient?

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Hypoxemia is an abnormally low concentration of oxygen in the blood. The patient t risk for this complication because of the diminished or altered oxygen exchange

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2. D.P. reports rust colour sputum. what does this information reveal? Explain D.P.s other manifestations. 

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2. D.P. reports rust colour sputum. what does this information reveal? Explain D.P.s other manifestations. 

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Rust colour sputum reveals blood and pus which means Streptococcus pneumonia.
other manifestations: fever, cough, chest pain, SOB, drowsiness, cyanotic nail beds

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How does pneumothorax differ from pleural effusion?

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How does pneumothorax differ from pleural effusion?

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Pleural effusion is a result of excess fluid that accumulates in the pleural cavity, the fluid- filled space that surrounds the lungs. Pneumothorax is the accumulation of air in the plural space- "collapsed lung".

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How should R.J's current problem be managed? What parameters should be assessed to monitor response to therapy?

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How should R.J's current problem be managed? What parameters should be assessed to monitor response to therapy?

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He should still be using his albuterol inhaler as needed, incorporating some pharmacotherapy such as bronchodilators, corticosteroids and anti-inflammatory bronchodilators to reduce bronchospasm are used for controlling sudden attacks; they cause the muscles around the airway to relax. Spirometry measures both how much and how fast air moves through your lungs. The results are expressed as FEV, forced expiratory volume. peak flow meters would be useful.

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3. Describe the normal mechanisms that defend against infection in the respiratory tract.

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3. Describe the normal mechanisms that defend against infection in the respiratory tract.

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Cilla - hair like projections that line the respiratory tract
Mucous layer - trap pathogens
Alveolar macrophages - type pf WBC on the surface of alveoli

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4. What precautions could you take as nurses to reduce the risk of respiratory infection for yourself, your colleagues, and your patients?

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4. What precautions could you take as nurses to reduce the risk of respiratory infection for yourself, your colleagues, and your patients?

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-stay current on vaccinations
-proper hand hygiene
-appropriate PPE
-proper ventilation

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1. Explain what is happening with T.R. Explain the manifestations.

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1. Explain what is happening with T.R. Explain the manifestations.

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hypoventilation - causes an increase in CO2, which will lead to a decreased SpO2 even with being on O2 at 15L/min.

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2. a) Which clinical findings are likely in RS as a consequence of his bronchitic COPD. b) How would these differ from emphysematous COPD?

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2. a) Which clinical findings are likely in RS as a consequence of his bronchitic COPD. b) How would these differ from emphysematous COPD?

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a) Bronchitic COPD:

Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. Continual bronchial inflammation causes bronchial edema, an increase in the size and number of mucous glands and goblet cells in the airway epithelium, smooth muscle hypertrophy with fibrosis, and narrowing of airway. Thick, tenacious mucus is produced and cannot be cleared because of impaired ciliary function. The lungs defence mechanisms are therefore compromised increasing susceptibility to pulmonary infection and injury and ineffective repair.

Emphysematous COPD:

Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. Continual bronchial inflammation causes bronchial edema, an increase in the size and number of mucous glands and goblet cells in the airway epithelium, smooth muscle hypertrophy with fibrosis, and narrowing of airway. Thick, tenacious mucus is produced and cannot be cleared because of impaired ciliary function. The lungs defence mechanisms are therefore compromised increasing susceptibility to pulmonary infection and injury and ineffective repair.

b) Both emphysema and chronic bronchitis are long term conditions 90% of time associated with smoking. both are part of COPD. Emphysema main symptom is SOB and fatigue. no/little cough normally. chronic bronchitic main symptoms is frequent cough with mucous, and fever.

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severe pulmonary edema

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3. Describe the pathophysiologic mechanism contributing to T.R.'s problem in #2.

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3. Describe the pathophysiologic mechanism contributing to T.R.'s problem in #2.

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fluid in the alveoli

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4. Later that day, the nurse reports decreased air entry to the right medial lobe and T.R. reports dyspnea with RR of 28 breaths per minute and shallow. A CXR is ordered and reveals an area of atelectasis. T.R. asks what that means.

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4. Later that day, the nurse reports decreased air entry to the right medial lobe and T.R. reports dyspnea with RR of 28 breaths per minute and shallow. A CXR is ordered and reveals an area of atelectasis. T.R. asks what that means.

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- collapse of lung tissue
- hypoventilation of the lung d/t obstruction or removal of air from the alveoli - inhalation of gas (e.g. anesthetic) -> the pt is shallow breathing so there is no anesthetic being removed from the bases of the lungs
- inadequate effect at breathing post-op

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Explain R.Js manifestations and ABG results 

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Explain R.Js manifestations and ABG results 

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- Metabolic acidosis + respiratory alkalosis ( mixed acid- base disorder)?
-  Asthma attack; AEB tightness of chest, hypersecretion of sputum, dyspnea, expiratory wheezing, use of accessory muscles, and chest retraction; uncompensated.

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3. Interpret R.S's laboratory results. a) How would his acid-base disorder be classified? b) What does the Hct indicate? c) What is the most likely cause of this RBC alteration? 

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3. Interpret R.S's laboratory results. a) How would his acid-base disorder be classified? b) What does the Hct indicate? c) What is the most likely cause of this RBC alteration? 

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a) Partially compensated respiratory acidosis.
b) The hematocrit indicated the volume of RBC in the blood. For men the average is 48% to 54% therefore, R.S is within normal range, which indicates he is not anemic.
c)