NURS 612 EXAM 1 MARYVILLE UNIVERSITY ADVANCED HEALTHASSESSMENT EXAM QUESTIONS AND ANSWERS, Exams of Nursing

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NURS 612 EXAM 1 MARYVILLE UNIVERSITY ADVANCED

HEALTHASSESSMENT EXAM QUESTIONS AND ANSWERS

Pathophysiology of respiratory system deals with Pathophysiologic mechanisms, physiologic basis of selected diagnostic tests and clinical manifestations of: Dyspena, hypoxemia, hypercapnea Disorders of inflation (pleural disorders, pneumonia, atelectasis) Obstructive diseases (asthma, COPD) Vascular diseases (PE) Upper airway structures Mouth Oropharynx Nasal pharynx Larynx Upper air way purpose: Purpose: Conduction Humidification Protection Lower airway structures

• Tracheobronchial tree
• Trachea-5th vertebre
• R+L main stem bronchi - Secondary and tertiary bronchus
• Bronchioles and terminal bronchioles
• Alveolar ducts
• Alveoli

Airway membranes: _________________ is in the bronchioles Cuboid epithelium in bronchioles Airway membranes: _________________ is in the alveoli Squamos epithelium in the alveoli Lobuole-functional unit consists of consists of:

• Branch of terminal bronchiole
• Arteriole: carry deoxygenated blood - Pulmonary capilaries - Venule: collects oxygenated blood - Gas exchanges in terminal broncioles, alveolar ducts, and alveoli Alveolar Structure cells - Type I Cells
• Type II Cells
• Macrophage-dust cells Type 1 Cells Type 1 Cells-> 90% of surface area flat, epithelial cells across which gas exchange takes place

Type II Cells Type II Cells->produce surfactant surface tension in alveoli prevent their collapse ease lung inflation prevent fluid accumulation Macrophage Macrophage-dust cells Scavengers: move around and phagocytize what reaches the Parasympathetic innervation in the respiratory system Parasympathetic (vagus) Bronchial Smooth Muscle constriction - > airway constriction Increase secretion of glands Atrovent-anticholinergic Sympathetic innervation in the respiratory system Sympathetic Bronchial Smooth Muscle relaxation - > airway relaxation Glandular secretion inhibition Xopenex, Albuterol- Beta2 agonist

Muscles of Inspiration Diaphragm External intercostal Accessory muscles Accessory muscles and they're functions Scalene raise first two ribs SCM raise sternum External intercostal External intercostal Increase AP diameter of the Rib C ________________ is the main muscle of inspiration Diaphragm Main muscle of inspiration Muscles of Expiration Accessory muscles: Abdominal Internal intercostals Expiration is a ______________ process due to... Expiration is a passive process due to recoil of muscles of inspiration Movement of rib cage and diaphragm on inspiration: Inspiration Diaphragm contracts, pulls lungs “down”, chest expands top to bottom creating more volume, more negative pressure sucks in air

Lung Compliance refers to “Ease” with which the lungs are inflated Compliance = Compliance = Δ volume/Δpressure Compliance is determined by: Compliance is determined by:

• Elastin and collagen fibers of lung
• Surface tension
• Compliance of the rib cage ___________ keep the airway open. Elastin fibers keep the airway open. _____________ is replaced with scar tissue in Pulmonary fibrosis, interstitial lung disease, and the lungs become ____________ and ____________.
• elastin fibers Very stiff, non-compliant When the lungs lose their elastic element, what happens? This is seen in what disease state? Lose the elastic element=Overstretching loss of elastic recoil. Easy to inflate, more difÏcult to deflate (emphysema) _______________ produce surfactant Type II alveolar cells produce surfactant surfactant is a complex _________________which exerts its effect mainly at the ____________________ preventing surfactant is a complex lipoproteine which

Type 2 cells mature after ____-___th week of gestation. What does this mean for premies? Type 2 cells (produce surfactant) mature after 26 - 28th week of gestation->premies have respiratory difÏculties → atelectasis, IRDS Maturation is accelerated by steroids Volume of air moving is directly related to________________________ and inversely related to

Volume of air moving is directly related to pressure differences and inversely related to resistance that the air encounters as it moves thru airways. Sum of the resistances in three types of airways, largely due to

Sum of the resistances in three types of airways, (large and medium bronchi, and bronchioles) largely due to resistance in large bronchi Poiseuille law Small Δ in caliber of airway→ large ∆ in airway resistance Poiseuille law R=1/r Ventilation-Airway Resistance is affected by bronchial smooth muscle via stimulation of

Affected by bronchial smooth muscle via stimulation of parasympathetic and sympathetic fibers

Laminar Laminar Streamlined, airflow occurs at low flow rates, airstream is parallel to sides of the airway, mainly in small airways Turbulent Turbulent Disorganized, molecules move laterally, collide Depends on radius of airways Accounts for breath sounds Minute Volume Amount of air exchange in one minute Determined by metabolic needs minute ventilation= Tidal volume x respiratory rate= minute ventilation

During inspiration, ventilation is greater at the ________________because____________________ During inspiration ventilation is greater at the base because the alveoli can expand more Work of Breathing determined by... Determined by amount of effort required to move air through conducting airway and by compliance of lung Increased Work of breathing during... and causes of increased WOB... Increases during exercise but it is not more than 3% of the total expenditure Causes of increased work of breathing: Increased airway resistance Decreased lung compliance Perfusion Requires constant flow Low velocity facilitates gas exchange Blood flows from high to low pressures Blood vessels thinner, more compliant, accommodate about 500 mL of blood Act as a reservoir for the left ventricle True or false? Lungs have a powerful fibrinolytic system. True. lungs have a powerful fibrinolytic system- can break down

clots pretty well Distribution of Blood Flow: apex Apex- less flow, alveoli bigger-less ventilationbad matching Distribution of Blood Flow: Base Base-more blood flow, alveoli smaller-more ventilation-better matching Ventilation/Perfusion Matching: Shunt causes - atelectasis

• pulmonary edema
• ARDS
• PNA Ventilation/Perfusion Matching: dead space causes PE Low CO excessive PEEP If you had a R sided PNA, how would you position the patient? on their left.

PaO2 Pa Dissolved, 3% 97% as Hb Oxyhemoglobin Dissociation Curve Represents the relationship between ________________ and _________________ Represents the relationship between HB saturation (HbO)2 and oxygen pressure (PaO2) Factors that affect Oxyhemoglobin Dissociation Curve Factors that affect ODC pH CO Temperature 2,3DPG In the Oxyhemoglobin Dissociation curve, the curve moves to the right in... exercises sepsis hyperthyroid In the Oxyhemoglobin Dissociation curve, the curve moves to the left in hypothermia hypothyroid C02 Transport (percentages) - 10% dissolved in plasma (20x more soluble in plasma than O2) - 30% attached to hemoglobincarbaminohemoglobin

• 60% as bicarbonate (HCO3-) Chloride shift

Breathing starts in the dorsal resp. center in the

breathing starts in the resp center in the medulla oblongata: like pacemaker cells The ________________ nerve innervates the diaphragm phrenic Control of Breathing - Dorsal respiratory center- pacemaker - Pneumotaxic centerswitches off inspiration - Apneustic centerexcites inspiration prolonging it prolonging it

• Axons in the phrenic and other muscles of respiration
• Reflexes are integrated in the level of the spinal cord Pneumotaxic center Pneumotaxic centerswitches off inspiration Apneustic center
• Apneustic centerexcites inspiration prolonging it

Lung receptors: stretch Stretch-in the airways. Respond to stretch by inhibiting inspiration Lung receptors: irrant Irritant-in epithelial cells. Respond to irritants by causing rapid shallow breathing Lung receptors: Juxtacapillary Juxtacapillary or J receptors-close to capillaries. Respond to lung congestion with tachypnea during pulmonary edema Voluntary control of respiration coordinates it with: Voluntary control of respiration coordinates it with voluntary acts like talking, eating, singing, blowing Dyspnea DifÏcult or labored breathing in which the subject is aware of shortness of breath: SUBJECTIVE ______________ is the general term for an increase in rate and/or depth of respiratory effort without the person feeling short of breath. ex: exercise Hyperpnea

____________is rapid, shallow breathing, that is not efÏcient Tachypnea mechanisms of cause for dyspnea Cause not completely understood but four mechanisms proposed:

1. Stimulation of lung receptors
2. Increased sensitivity to changes in ventilation capacity
3. Reduced ventilatory capacity (reserve)
4. Stimulation of neural receptors in intercostals, diaphragm dyspnea of Primary pulmonary dysfunction Primary pulmonary dysfunction Pneumonia, asthma, emphysema dyspnea of cardiac Cardiac dysfunction Pulmonary congestion