Pulmonary Pathophysiology Exam Notes, Exams of Nursing

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Pulmonary Pathophysiology Spring 2023 Exam 1 1 Apnea is the cessation of airflow at the nose & mouth for > _______ seconds - Correct answer 10 2 Hypopnea is defined as a ______% reduction in airflow for ___ seconds that occurs _______ or more times per hour of sleep and is associated with snoring and a _______% decrease in O2 saturation. - Correct answer 50% 3 10 seconds 4 15+ times 5 4% 6 OSA is characterized by excessive episodes of ___________ and ___________ during sleep that are caused by __________________. - Correct answer apnea (10 seconds) 7 hypopnea 8 complete or partial upper airway obstruction. 9 What is the pathogenesis of OSA? - Correct answer multifactorial; airway obstruction in the pharynx 10 mechanical, neural, and structural factors contribute to upper airway collapse that eliminates ventilation → The intermittent closure/narrowing of the upper airway leads to: episodes of apnea-hypopnea → O2 desats → arousal 11 Since up to ______% to _____% of all patients with OSA are undiagnosed and untreated, the disorder will not be identified in the medical records of many patients who present for surgery. - Correct answer 80-95% 12 What is the STOP-bang tool? What is its sensitivity? - Correct answer a tool with 93% sensitivity used to evaluate for OSA 13 What is your inspiratory reserve volume? - Correct answer a max inspiratory effort, aka the EXTRA volume that can be inspired above tidal volume 14 What is your expiratory reserve volume? - Correct answer a max expiratory effort, aka the EXTRA volume that can be expired below tidal volume 15 What is your residual volume? - Correct answer Reserve volume or the volume remaining after maximum expiration 16 This is what we want to maximize in pts before intubation. 33 The dominant feature of COPD is ______________, as reflected by a decrease in ____________. - Correct answer progressive airflow obstruction 34 FEV1. (Less than 80% VC) 35 What is the etiology / pathophysiology of COPD? - Correct answer Airway narrowing is primarily related to a thickening of the airway walls, destruction of parenchyma, increased airway reactivity 36 In COPD, airway narrowing is primarily related to _______________, NOT an ________________ as is more prominently observed in asthma. - Correct answer a thickening of the airway walls 37 increase in smooth muscle tone (bronchoconstriction) 38 Between ______% and _____% of patients with COPD also have enhanced airway reactivity. - Correct answer 25%-50% 39 Explain the general changes of lung function from COPD? - Correct answer premature collapse of the airways from external pressure 40 increases poor distribution of inspired air. 41 exchange of CO2 and O2 between the blood and alveolar air is impeded. 42 Injury and inflammation of the bronchial tubes and alveoli increase the resistance to airflow during both inspiration and expiration. 43 Lung compliance increases with the tissue damage 44 The diaphragm may contract ineffectively, such that the abdomen moves inward rather than outward with each inspiration. 45 Because of the increased demands for work output placed on the respiratory muscles, the energy requirement of these muscles significantly increases. 46 What is a bullae? - Correct answer a manifestation of some forms of emphysema, are air-containing spaces greater than 1 cm in diameter that result from the destruction and dilation of air spaces distal to terminal bronchioles. 47 What is a bleb? - Correct answer collections of air within the layers of the visceral pleura. 48 They occur when air migrates from the lung parenchyma, and they usually form near the apices. 49 *not a form of emphysema because they do not involve functional lung units 50 Define asthma - Correct answer A chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular, mast cells, eosinophils, neutrophils, T lymphocytes, macrophages, and epithelial cells. 51 The pathogenesis of asthma involves chronic inflammation of the respiratory tract and the widespread propagation of inflammatory mediators, which is what primarily differentiates it from COPD 52 What is extrinsic asthma? - Correct answer (or allergic asthma) most commonly affects children and young adults and involves exacerbation by infectious, environmental, psychological, or physical factors. 53 What is intrinsic asthma? - Correct answer usually develops in middle age without specifically identifiable attack-provoking stimuli. 54 What is airway remodeling? - Correct answer Airway inflammation and a nonspecific hyperirritability of the tracheobronchial tree are now recognized as being central to the pathogenesis of even mild cases of asthma. 55 Permanent changes in airway anatomy, referred to as airway remodeling, magnify the inflammatory response. 56 What are the s/s of airway remodeling? (4) - Correct answer fibrosis 57 mucous hypersecretion 58 smooth muscle hypertrophy 59 angiogenesis. 74 ____________ asthma occurs in some predisposed individuals as a result of cyclooxygenase inhibition that drives arachidonic acid metabolism, with subsequent leukotriene production. 75 This peculiar response can also occur with the use of other nonsteroidal anti-inflammatory agents. - Correct answer Aspirin-induced asthma 76 Poorly controlled asthma (defined by _______ rescue inhaler use or ED visits within ______ days) is associated with an increase in respiratory complications, which affect overall surgical risk, hospital length of stay, and in-hospital mortality. - Correct answer frequent; 30 77 When is apnea considered obstructive? - Correct answer Apnea is obstructive if there is continued respiratory effort despite airflow cessation 78 Up to _____% of surgical patients are at risk of OSA - Correct answer 25% 79 OSA syndrome is diagnosed by _______________. - Correct answer polysomnography (PSG) using an apnea-hypopnea index (AHI) 80 In OSA, the site of upper airway obstruction is typically in the _________. - Correct answer pharynx 81 5+ clinically significant apneic episodes per hr or >30 episodes per night result in? (4) - Correct answer Hypoxia 82 Hypercapnia 83 Systemic & pulmonary HTN 84 Cardiac arrhythmias 85 In the STOP-bang tool, what number has a HIGH risk of OSA? - Correct answer yes to ≥ 3 items 86 In the STOP-bang tool, what number has a LOW risk of OSA? - Correct answer yes to ≤ 3 items 87 What is tidal volume? - Correct answer volume that enters and leaves with each breath, from a normal quiet inspiration to a normal quiet expiration 88 What are the clinical features of asthma? (4) - Correct answer Bronchoconstriction, Airway hyperresponsiveness, Mucous secretion, Airway edema 89 What is status asthmaticus? - Correct answer Severe obstruction that is refractory to bronchodilator therapy 90 can represent emergency situation 91 What is the treatment for status asthmaticus? - Correct answer administer ketamine or volatile anesthetics as part of the treatment for status asthmaticus. 92 During acute asthma attack, ___________ __________ tests may reflect _________ expiratory airflow obstruction (decreased forced expiratory flow [FEF______% to _____%]; ____________ FEV1:FVC). - Correct answer pulmonary function; acute 93 25%-75% 94 decreased 95 _____________ asthma may eventually lead to irreversible lung destruction, loss of lung elasticity, pulmonary hypertension, and lung hyperinflation. - Correct answer Chronic 96 Patients with increased airway resistance exhibit __________ FEV1 & FEV1/FVC ratios - Correct answer decreased 97 Obstructive: ______ FEV1 - Correct answer low 98 Restrictive: _______ FEV1, ______ VC, ________ FEV1/FVC ratio - Correct answer low; low; preserved 99 A normal FEF 25-75% value is > ______ - Correct answer 0.7 100 A normal FEF 25-75% of 4-5 L/sec _________ in pts with pulmonary disease - Correct answer decreases markedly 101 The pathologic changes in COPD are characterized by 2 specific disorders? - Correct answer Emphysema 102 Chronic bronchitis