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Respiration differs from ventilation in that respiration involves:
a. movement and exchange of oxygen in the alveoli.
b. supplying oxygenated blood to the lungs and organ systems.
c. the mechanical process of moving air in and out of the respiratory system.
d. all of the body's cells and the utilization of oxygen to make energy.

D

Ethan is sitting next to Ryan in class. Ethan has a cold and is coughing. Ryan is worried about catching a cold. You tell Ryan that the pulmonary system has defense mechanisms to help him stay healthy. These defense mechanisms include all of the following except:
a. macrophages in the alveoli.
b. chemoreceptors.
c. structural protections such as hair.
d. mucosal lining that has an immune coating.

B

Todd is competing in a 2K run for his track team. As Todd is completing his laps on the track, his body is regulating the rate and volume of his respirations. All of the following are important in this regulation except:
a. lung receptors
b. respiratory control center in the brain
c. diffusing capacity
d. chemoreceptors

C

After surgery, Myron needed to have the oxygen saturation in his blood monitored for potential hypoxemia. The method most likely used in monitoring Myron is called:
a. pulse oximetry
b. ventilation oximetry
c. respiration observation
d. diffusion oximetry

A

When the body cannot maintain homeostasis because of an alteration in ventilation and diffusion, all of the following will occur except:
a. hyperthermia
b. hypercapnia
c. hypoxia
d. hypoxemia

A

Andrea is sitting quietly reading in her chair. The amount of air that Andrea exhales after passive inspiration is called:
a. tidal volume
b. vital capacity
c. residual volume
d. total lung capacity

A

The lipoprotein that coats the inner portion of the alveolus and promotes ease of expansion is called:
a. Ghon complex
b. Surfactant
c. Atopic protein
d. Marfan protein

B

Marlyn has pneumonia. He has decreased oxygen in the arterial blood and a decrease in the partial pressure of oxygen. This decreased oxygen level is called:
a. Hypoxia
b. Hypercapnea
c. Hypoxemia
d. Aspiration

C

Because of Marlyn's pneumonia and the increased collection of fluid/pus in the alveoli, he will most likely experience impaired:
a. Inspiration
b. Expiration
c. Ventilation
d. Diffusion

D

Marlyn is experiencing a deprivation of adequate oxygen to his cells. This is called:
a. Hypoxia
b. Hypercapnea
c. Hypoxemia
d. Aspiration

A

Marlyn is admitted to the hospital because of his pneumonia. He has impaired diffusion and ventilation with an increased amount of carbon dioxide level in his blood. This increased level of carbon dioxide in the blood is called:
a. Hypoxia
b. Hypercapnea
c. Hypoxemia
d. Aspiration

B

Marlyn experienced many local manifestations related to impaired ventilation and diffusion. All of the following would be considered local manifestations except:
a. Fever
b. Cough
c. Dyspnea
d. Excess mucous production

A

Marlyn complains of increased difficulty breathing when he is in a supine position and he prefers to have the head of his bed elevated. This need to sit upright is called:
a. Dyspnea
b. Hypoxemia
c. Hyperventilation
d. Orthopnea

D

Anthony is experiencing an acute exacerbation of his asthma. When you observe his chest, you notice that he is using accessory muscles during respiration and observe a pulling of his intercostal muscles. You would describe this as:
a. Orthopnea
b. Subtractions
c. Retractions
d. Interactions

C

When you auscultate Anthony's lung sounds, you hear wheezing. Altered breath sounds such as this are called:
a. Cavitations
b. Inspiration
c. Adventitious
d. Ventilation

C

acute respiratory distress syndrome ARDS

a condition of severe acute inflammation and pulmonary edema without evidence of fluid overload or impaired cardiac function

adventitious

refers to an alteration in lung sounds, as with wheezing or crackles

air trapping

decreased effective O2 intake and especially CO2 release by retaining air within the alveoli because of loss of elasticity

anoxia

the absolute deprivation of oxygen

aspiration

a problem of inhaling a foreign substance into the lungs

asthma

a chronic inflammatory disorder of the airways resulting in intermittent or persistent airway obstruction caused by bronchial hyperresponsiveness, inflammation, bronchoconstriction, and excess mucous production

atelectasis

a condition of collapse and nonaeration of the alveoli

atopic

describes individuals having a genetic predisposition to developing hypsensitivities

bronchiectasis

the irreversible dilation and destruction of the bronchial tree most often caused by chronic obstruction or infection

caseous necrosis

a distinctive, yellow, pasty, cheese like necrosis of tuberculosis

cavitation

area of necrosis that erode surrounding structures of the lungs, including the bronchioles, bronchi, and surrounding blood vessels

chronic bronchitis

the presence of a persistent, productive cough that lasts for 3 months or longer for 2 or more consecutive years.

chronic obstructive pulmonary diseases (COPD)

a generic term that describes all chronic obstructive lung problems including asthma, emphysema, and chronic bronchitis, separately or in combination

clubbing

a painless enlargement and flattening of the tips of fingers or toes due to chronic hypoxia

compliance

the expected distensibility, or expandibility, of the lung tissue and chest wall

consolidation

a solid mass in the lung tissue

cyanosis

a result of a greater proportion of desaturated hemoglobin in the blood, which gives the blood a bluish hue

auscultation

to listen with a stethoscope

cystic fibrosis (CF)

an autosomal recessive disorder of electrolytes and subsequently water transport that affects certain epithelial cells such as those lining the respiratory, digestive and reproductive tracts

dead space

an area where gas exchange cannot take place

diffusing capacity

a measurement of carbon monoxide (CO2), oxygen, or nitric oxide transfer from inspired gas to pulmonary capillary blood; is reflective of the volume of a gas that diffuses through the alveolar capillary membrane each minute

diffusion

movement of particles from an area of high to lower concentration

dyspnea

the subjective feeling of shortness of breath or the inability to get enough air

emphysema

an irreversible enlargement of the air spaces beyond the terminal bronchioles, most notable in the alveoli resulting in destruction of the alveolar walls and obstruction of airflow

expectorate

to spit out the mucus that is ejected during a cough

expiration

the process of removing carbon dioxide out of the body through the lungs

forced expiratory volume in 1 second (FEV1)

the maximal amount of air expired from the lungs in 1 second

forced vital capacity (FVC)

the maximal amount of air that is exhaled from the lungs during a forced exhalation

fully saturated

a state in which all the available seats for hemoglobin molecules are occupied on the red blood cell

Ghon complex

a combination of of the Ghon focus and additional granulomas that develop through the lymph channels in the lungs

Ghon focus

the formation of a granuloma, or walled off area of bacteria, which is considered the primary lung lesion in tuberculosis

hemoptysis

coughing up blood from the respiratory tract; defined by the presence of red blood cells in the sputum

hypercapnia

a state of increased carbon dioxide in the blood

hypoxemia

decreased oxygen in the arterial blood leading to a decrease in the partial pressure of oxygen (PaO2)

hypoxia

cellular deprivation of oxygen

inspiration

the process of breathing in to acquire oxygen

orthopnea

the physical need to sit in an upright or standing position to reduce respiratory effort

oxygen saturation (SaO2)

the amount of oxyhemoglobin; that is the amount of hemoglobin that is combined, or saturated with oxygn

oxyhemoglobin (HbO2)

the oxygen-hemoglobin combination within the red blood cells

PaCO2

the symbol for the partial pressure of carbon dioxide

PaO2

the symbol for the partial pressure of oxygen

partial pressure

the force exerted by gas molecules within a certain volume

perfusion

the process of forcing blood or other fluid to flow through a vessel and into the vascular bed of tissue for the purposes of providing oxygen and other nutrients

phlegm

large amounts of sputum expectorated from the oropharynx

pneumonia

inflammation of the lungs occurring commonly in the bronchioles,interstitial lung tissue or the alveoli

pneumothorax

the presence of air in the pleural space that causes the lung to collapse

pursed lip breathing

a process of holding the lips puckered tightly together while slowly exhaling to maintain positive airway pressure in the alveoli; this minimizes air trapping and promotes expiration of carbon dioxide

residual volume (RV)

the volume of air that remains in the lungs after maximal expiration

respiration

the process of oxygen use as a source of energy for the production of adenosine triphosphate (ATP) and release of metabolic products from the cell

respiratory failure

a life-threatening condition that can result from any problem that severely affects ventilation, ventilation-perfusion matching, or diffusion

retractions

the pulling in of accessory muscles usually in the intercostal, substernal, and supraclavicular spaces to promote more effective inspiration

sputum

expectorated material

status asthmaticus

a state of bronchospasm that is not reversed by by the patients medications or other measures

surfactant

a lipoprotein that coats the inner portion of the alveolus and promotes ease of expansion and repels fluid accumulation

tidal volume (TV)

the amount of air that is exhaled after passive inspiration; this is the volume of air going in and out of the lungs at rest; in adults this volume is approximately 500ml

total lung capacity (TLC)

the total amount of air in the lungs when they are maximally expanded; is the sum of the vital capacity and residual volume

tuberculosis

an infectious disease caused by an aerobic, rod-shaped bacterium (bacillus) called Mycobacterium tuberculosis

ventilation

the movement of air into and out of the trachea, bronchi and lungs

vital capacity (VC)

the maximal amount of air that can be moved in and out of the lungs with forced inhalation and exhalation

conducting airways

Move air into lungs
Warm and humidify air
Trap inhaled particles

respiratory airways

Bronchioles
Alveoli
Gas is exchanged with the blood

ventilation

Involves both acquiring oxygen (inspiration) and removing carbon dioxide (expiration) from the blood
Neuronal impulses are directed by lung receptors, which map the current state of breathing and lung function
Uses the intercostal muscles, diaphragm, and sternocleidomastoid muscles

inspiration

Breathing in to acquire oxygen

Unidirectional from high pressure to low pressure.

Chest cavity size changes to alter the pressure gradient

expiration

Removing carbon dioxide out of the body through the lungs

The diaphragm and external intercostal muscles relax

Lungs compress and increase the pressure inside the airways

diffusion

Oxygen and carbon dioxide are exchanged at alveolar capillary junctions

Two major process occur:
Oxygen is trying to get to all the cells
Carbon dioxide is trying to escape the body through the lungs

gas exchange

Oxygen moves from alveolar air into blood
Carbon dioxide moves from blood into alveolar air

partial pressure

The collision of oxygen and carbon dioxide creates pressure
PaO2
PaCO2

blood gases- oxygen

Dissolved oxygen = PaO2 or PO2
Normal value >80 mm Hg
Oxygen bound to hemoglobin = oxyhemoglobin
Normal value 95% to 97% saturation
Below 90% needs oxygen

impaired ventilation

A problem of blocking airflow in and out of the lungs
Two major mechanisms implicated:
Compression or narrowing of the airways
Disruption of the neuronal transmissions needed to stimulate the mechanics of the airways

ventilation perfusion mismatching

Blood goes to parts of the lung that do not have oxygen to give it
Blood does not go to parts of the lung that have oxygen
Perfusion without ventilation is a blocked airway.
Ventilation without perfusion is a blocked capillary

impaired diffusion

Restricted transfer of oxygen and/or carbon dioxide across the alveolar capillary junction
Dependent upon:
solubility and partial pressure of the gas
surface area and thickness of the membrane

hypoxemia

PO2 <60 mm Hg
Cyanosis
Impaired function of vital centers
Agitated or combative behavior, euphoria, impaired judgment, convulsions, delirium, stupor, coma
Retinal hemorrhage
Hypotension and bradycardia
Activation of compensatory mechanisms
Sympathetic system activation
Measured with arterial blood gas

hypoxia

lack of oxygen at the tissue level. O2 Sat

hypercapnia

PCO2 >50 mm Hg
Respiratory acidosis
Increased respiration
Decreased nerve firing
Carbon dioxide narcosis
Disorientation, somnolence, coma
Decreased muscle contraction
Vasodilation
Headache; conjunctival hyperemia; warm, flushed skin

treating impaired ventilation and diffusion

Remove obstruction and restore physical integrity of airways, lung tissues
Decrease inflammation and mucus; treat infection
Supplemental oxygen
Mechanical ventilation

pneumonia patho

Infectious process
Respiratory droplet spread
Causes inflammation of the lungs
Occurs commonly in the bronchioles, interstitial lung tissue and/or the alveoli
Products of inflammation accumulate and cause consolidation

pneumonia manifestations

Sudden onset of fever
Chills
Cough
Sputum production
Fatigue
Loss of appetite
Dyspnea
Tachypnea
Tachycardia
Pleuritic pain
Crackles in lungs

pneumonia diagnostic criteria

History and physical examination
Complete blood cell count
Chest X-ray
Thoracic CT scan

pneumonia treatment

Restore optimal ventilation and diffusion
Identify pathogen and target with appropriate pharmacologic treatment
Supplemental oxygen

TB patho

Mycobacterium tuberculosis

Airborne droplet nuclei travel directly to the terminal bronchioles and alveoli of the lung

Inflammatory and immune responses
Containment- asymptomatic, granuloma may form
Multiplication- progressive primary TB
Dormancy-

tb manifestations

Many of those infected are symptomatic
In the presence of chronic inflammation:
Malaise
Weight loss
Fatigue
Anorexia
Low-grade fever
Possibly night sweats

tb diagnostic criteria

Tuberculin skin tests
Chest X-ray
Sputum culture
Sputum nucleic acid amplification

emphysema pathophysiology

Irreversible enlargement of the air spaces beyond terminal bronchioles
destruction of the alveolar walls
obstruction of airflow
Chronic smoking most often implicated

emphysema clinical manifestations

Persistent cough
Dyspnea
Wheezing
Barrel chest
Pursed lip breathing

emphysema diagnostic

History and physical examination
Pulmonary function tests
Chest x-ray
Hypercapnia/hypoxemia

emphysema treatment

Maintain optimal lung function in order to allow the individual to perform the desired activities of daily life
Smoking cessation
Pharmacologic therapy
Lung volume reduction or transplant

chronic bronchitis patho

Persistent, productive cough lasting three months or greater, for two or more consecutive years
Result of:
Chronic inflammation and edema of the airways
Hyperplasia of the bronchial mucous glands and smooth muscles
Destruction of cilia
Squamous cell metaplasia
Bronchial wall thickening and development of fibrosis

chronic bronchitis manifestations

Cough
Purulent sputum
Dyspnea
Adventitious lung sounds
Cyanosis

chronic bronchitis diagnostic criteria

History and physical examination
Arterial blood gases
Pulmonary function tests
Pulse oximetry
Sputum analysis

chronic bronchitis treatment

Smoking cessation
Pulmonary rehabilitation
Pharmacologic therapy
Supplemental oxygen

asthma patho

Intermittent or persistent airway obstruction due to:
Bronchial hyperresponsiveness
Chronic inflammation
Bronchoconstriction
Excess mucous production

asthma manifestations

Wheezing and tachypnea
Dyspnea and coughing
Chest tightness
Excessive sputum production
Anxiety

asthma diagnostic criteria

History and physical examination
Pulmonary function tests
Laboratory studies
Chest x-ray

asthma treatment

Monitor lung function
Control environmental triggers
Pharmacologic therapy
Patient and family education; action plan

cystic fibrosis patho

Autosomal recessive disorder of electrolyte and water transport affecting certain epithelial cells (respiratory, digestive, and reproductive lining)

Mutation of the CF gene

Associated with mucus plugging, inflammation, and infection in the lungs; also affects other body systems

Respiratory failure is most common cause of death

cf manifestations

Respiratory

Gastrointestinal

Reproductive

cf diagnostic criteria

History and physical examination
Sweat test
Genetic testing
Chest x-ray
Sputum analysis

cf treatment

Respiratory
Chest physiotherapy
Pharmacologic treatment
Lung transplant
Gastrointestinal
Optimal nutrition
Pancreatic enzymes

ARDS patho

Lung injury to respiratory distress within 24-48 hours
Severe acute inflammation and pulmonary edema without evidence of fluid overload or impaired cardiac function
Mortality rate 30%-40% from multi-system organ failure in those untreated

ARDS clinical manifestations

Tachypnea
Dyspnea
Retractions
Crackles due to fluid accumulation
Restlessness, anxiety

ARDS diagnostic criteria

History and physical examination
Laboratory studies
Imaging studies

ARDS treatment

Remove causative factors
Administration of 100% oxygen
Mechanical ventilation

pleural disorders decreased ventilation

Parietal pleura lines the thoracic wall and superior aspect of the diaphragm
Visceral pleura covers the lung
Pleural cavity or space between the two layers contains a thin layer of serous fluid

pneumothorax

Air enters the pleural cavity
Air takes up space, restricting lung expansion
Partial or complete collapse of the affected lung
Spontaneous: an air-filled blister on the lung ruptures
Traumatic: air enters through chest injuries
Tension: air enters pleural cavity through the wound on inhalation but cannot leave on exhalation
Open: air enters pleural cavity through the wound on inhalation and leaves on exhalation

open pneumothorax

lung collapse but air can still go in and out

tension pneumothorax

lung collase and air can go in but not out, not allowing the lung to expand.

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