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1) discuss the pathophysiology underlying

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1) discuss the pathophysiology underlying

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COPD is characterized by a limitation in air entry to lungs that is not fully reversible and is normally progressive but is treatable. COPD is the name associated to a variety of lung conditions. The cause of COPD is an enhanced inflammatory response in air way and lungs to particles or gases; which can be the result of family history of COPD, frequent lung infections and or smoking history. The clinical manifestations of COPD may include conditions that cause air obstruction such as emphysema. Symptoms of COPD are shortness of breath and cough; coughs are long lasting and contain mucus. Dyspnea is also a symptom that may worsen with progression and effect an individual’s activity tolerance and food intake. In COPD accessory muscles are used to breathe; increasing risk for respiratory infection and respiratory failure. As COPD progresses the symptoms or number of symptoms progress as well. Airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. The inflammatory response occurs throughout the airways. Due to chronic inflammation and the body’s attempts to repair it, narrowing occurs in the small peripheral airways. Over time, this injury-and-repair process causes scar tissue formation and
narrowing of the airway.

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2. What clinical findings are likely in RS as consequence of his bronchitic COPD? How would these differ from those of emphysematous COPD? What are the similarities and differences between emphysema and chronic bronchitis?

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2. What clinical findings are likely in RS as consequence of his bronchitic COPD? How would these differ from those of emphysematous COPD? What are the similarities and differences between emphysema and chronic bronchitis?

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a) Dyspnea, hypersecretion, mucous is thicker than usual, chronic productive cough.

b) Not as much secretions, the impairment of gas exchange is d/t damaged airway walls, clubbed fingers are present, CHF could be present.

c) Similarities: dyspnea, cough, airway obstruction, hypoxemia.
Differences: Bronchitis - +++ secretions, obstruction is d/t secretions
Emphysema: Obstruction is d/t damage to airway walls and loss of elasticity. Because of the loss of elasticity, there is an increase in residual volume and an over inflated lung

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3. Interpret RS laboratory results, How would his acid base disorder be classified- what does the Hct indicate- what is the most likely cause of his RBC alteration 

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3. Interpret RS laboratory results, How would his acid base disorder be classified- what does the Hct indicate- what is the most likely cause of his RBC alteration 

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Respiratory acidosis, his hematocrit is low due to low oxygenation due to high carbon dioxide within the body because of COPD

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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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Hypoxemia: after 5 minutes r/t impaired gas exchange. ⬇ Oxygen RR =36/min, SpO2 =91% (low tissue perfusion).

Dyspnea = Intercostal muscle use, nasal flaring, retraction + thrashing.

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Severe Pulmonary Edema.
MANIFESTATIONS

•Dyspnea

•Crackles on auscultation and dullness on percussion d/t fluid in lung interstitial tissue

•Hypoxemia

•Severe edema = pink, frothy sputum

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

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

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Inability to remove excess fluid build up (r/t anesthetic) ➙ causes fluid in interstitial space = Pulmonary edema.

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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 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 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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Pt has Absorption Atelectasis - the collapse of lung tissue r/t impaired removal of air from aveoli from the anesthetic.

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4) RS is admitted with his third exacerbation of dyspnea and a respiratory infection this year. His family is very concerned and do not understand what is causing his dyspnea and recurrent. infections what would you tell them?

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4) RS is admitted with his third exacerbation of dyspnea and a respiratory infection this year. His family is very concerned and do not understand what is causing his dyspnea and recurrent. infections what would you tell them?

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Dyspnea (SOB) is common with COPD as COPD enhances the inflammatory response to particles and gasses.  Infection are also common with COPD they have difficulty clearing their lungs of bacteria, dusts and other pollutants in the air. This makes them at risk for lung infections that may cause further damage to the lungs.

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1. What is the most likely cause of JC's m/f?

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1. What is the most likely cause of JC's m/f?

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The most likely cause of her manifestations are pneumothorax, or collapsed lung (i.e. increase in respirations but absent breath sounds)

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5. In what position would RS have the worst ventilation-perfusion matching 

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5. In what position would RS have the worst ventilation-perfusion matching 

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Lying on the right side

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2. Explain the pathophysiology and m/f underlying this cause. Discuss the different types.

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2. Explain the pathophysiology and m/f underlying this cause. Discuss the different types.

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- The presence of air or gas in pleural space caused by a rupture in the visceral pleural (which surrounds the lungs) or the parietal pleura and chest wall (can occur from an external or internal buildup of air)

- Loss of negative pressure → Collapse of all or part of a lung that occurs when air or another gas enters the pleural space surrounding the lungs

Manifestations:

Bluish skin

Chest pain

Coughing

Fatigue

Fast breathing

Fast heartbeat

Shortness of breath

Types:
1. Open pneumothorax
2. Tension pneumothorax
3. Spontaneous pneumothorax
4. Secondary pneumothorax

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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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Infect the lungs through inhalation of aerosolized bacterial or more commonly by aspiration of colonized oropharyngeal secretions. They have several virulence factors:

-Capsules that make phagocytosis by alveolar macrophages difficult and release toxins

-Intense inflammatory response is initiates with release of TNF-Alpha and IL-1

-Neutrophils and inflammatory exudates cause alveolar edema

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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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it is often a sign of old blood in mucus. Usually caused by Streptococcus pneumonia.
Other manifestations: fever, chest pain, SOB, cough, drowsiness, and shaking.

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

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

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- IgE mediated (Hypersensitivity; allergy to cats and plant pollens); mast degranulation.
- Three airway responses: Constriction of airway (Bronchospasm), Airflow obstruction (mucus + constriction), Thickening / Edema
- Inflammation/constriction & mucus plug cause obstruction

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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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- Normal flora
- Respiratory epithelium
- Innate cells
- Mucous
- Physiologic reflexes (e.g., cough, sneeze, vomit)
- cilia

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2. Explain R.J's manifestations and ABG Results.

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2. Explain R.J's manifestations and ABG Results.

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- Wheezing, dyspneic, tachypnea (manifestations of asthma r/t above mechanisms)
- Second ABG: respiratory acidosis (Impending respiratory failure)

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

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

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Pulmonary embolism

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3. 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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3. 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 - An abnormally low level of oxygen in the blood due to problems with mechanisms of oxygen. Typically results in tissue dysfunction, or severe organ infarction.

JC is at risk for hypoxemia because of inadequate ventilation/perfusion imbalance from her collapsed lung. treatment is chest tubes to drain air or fluids.

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

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

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Aseptic techniques, wash your hands, mask, gown, gloves, proper PPE for pathogen (ex: influenza - droplet precautions, in separate room from others)

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

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

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Monitor peak flow meter readings
- Treatments: Anti-inflammatories, Corticosteroids, Inhaled beta-agonist, nebulizer

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

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

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DVT, bed rest, post-op pt. dyspnea, respiratory alkalosis

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5) Compare & contrast the path, cause, m/f, diagnostics, and treatment of viral and bacterial pneumonia, 

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5) Compare & contrast the path, cause, m/f, diagnostics, and treatment of viral and bacterial pneumonia, 

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1)    Viral Pneumonia:

-       Patho:

o   Set the stage for secondary bacterial infection by damaging ciliated epithelial cells

o   Destroy ciliated epithelial cells and invade the goblet cells and bronchial mucous glands

o   Seasonal and usually mild and self-limiting

-       Cause:

o   Virus (ex: flu, common cold)

-       m/f:

o   fever

o   cough

o   SOB

o   Shaking/chills

o   Muscle aches

o   Fatigue

o   Malaise

-       Diagnostic:
- chest X-ray
- ABG
- cultures of sputum

-       Treatment:

Bacterial Pneumonia:

-       Patho:

o   Infect the lungs through inhalation of aerosolized bacterial or more commonly by aspiration of colonized oropharyngeal secretions

o   They have several virulence factors:

-Capsules that make phagocytosis by alveolar macrophages difficult and release toxins
- Intense inflammatory response is initiates with release of TNF-Alpha and IL-1
-  Neutrophils and inflammatory exudates cause alveolar edema

-       Cause:

o   Bacteria – streptococcus pneumoniae

-       M/f:

o   Cough with yellow/green/blood-tinged mucus

o   Chest pain

o   Chills

o   fever

-       Diagnostic:

-       Treatment:

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3. What do her ABG's reveal? What is the pathogenesis of the hypoxemia in this disorder?

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3. What do her ABG's reveal? What is the pathogenesis of the hypoxemia in this disorder?

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Respiratory alkalosis
Hypoventilation to compensate for the respiratory alkalosis causes hypoxemia (reduced oxygenation arterial blood)

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4. How does pneumothorax differ from pleural effusion?

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4. How does pneumothorax differ from pleural effusion?

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Pneumothorax - Air or gas in the pleural space (lung collapse)
Pleural effusion - Fluid in the pleural space (no lung collapse - less oxygen exchange)

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- Respiratory acidosis  - uncompensated

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7. This disease process has developed into adult respiratory distress syndrome (ARDS). What are the hallmark signs of this disorder? 

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7. This disease process has developed into adult respiratory distress syndrome (ARDS). What are the hallmark signs of this disorder? 

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Tachypnea

Dyspnea

Retractions

Hypoxia

Tachycardia

Crackles
Atelectasis

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8. What is the most appropriate treatment for this pt?

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8. What is the most appropriate treatment for this pt?

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Antibiotic, NSAIDS (anti-inflammatory), cough suppressant medications, acetaminophen (reduce fever)

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8) What is the most appropriate treatment for this pt? 

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8) What is the most appropriate treatment for this pt? 

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- antibiotics
- will probably need to intubate