Nursing 280: Pathophysiology Examination

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Nursing 280 PathophysiologyExamination
7Module VII Alterations in Ventilation and
Oxygen Exchange Part II Pathophysiologic
Processes

• Presented by
• Ronda M. Overdiek M.S.N., R.N.

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Part IIPathophysiologic Processes

• Objectives 6-8
• Chapter 26

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Part II Objectives

• Objective 6 Describe conditions resulting from
  pulmonary alterations.
• Objective 7 Correlate pathophysiology and
  clinical manifestations of selected pulmonary
  disorders.
• Objective 8 Recognize common respiratory tract
  infections.

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The Normal Lung
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Objective 6Describe conditions resulting from
pulmonary alterations.

• Hypoxemia
• Reduced oxygenation of arterial blood (PaO2)
• Caused by respiratory alterations
• Hypoxemia can lead to hypoxia
• Causes
• Decreased oxygen content of inspired gas
• Hypoventilation
• Diffusion abnormalities
• Abnormal ventilation-perfusion ratios
• Pulmonary right to left shunt

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Objective 6Describe conditions resulting from
pulmonary alterations.

• Pulmonary Edema
• Excess water in the lung
• Clinical Manifestations
• Dyspnea, hypoxemia, increased work of breathing,
  inspiratory crackles (rales), frothy sputum,
  PaCO2 increases.
• Treatment
• Dependent on cause. Diuretics, vasodilators,
  ventilation, supplemental oxygen.

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Objective 6Describe conditions resulting from
pulmonary alterations.
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Objective 6Describe conditions resulting from
pulmonary alterations.
Pulmonary Edema Pathogenesis Figure 26-3 Page 756
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Objective 6Describe conditions resulting from
pulmonary alterations.

• Atelectasis
• Collapse of lung tissue
• Clinical Manifestations
• Dyspnea, cough, fever, leukocytosis
• Nursing Pointers
• Atelectasis tends to occur postoperatively.
• Cough, deep breathing, frequent position changes,
  early ambulation

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Objective 6Describe conditions resulting from
pulmonary alterations.

• Bronchiectasis
• Persistent abnormal dilation of the bronchi.
• Occurs in conjunction w/other resp. conditions
• Clinical Manifestations
• Recurrent lower resp. infections, expectoration
  of voluminous amounts of purulent sputum (odor),
  hemoptysis, clubbing fingers. Eventually lead to
  hypoxemia and cor pulmonale.

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Objective 6Describe conditions resulting from
pulmonary alterations.

• Bronchiolitis
• Inflammatory obstruction of the small airways
• Often proceeded by URI
• Clinical Manifestations
• Tachypnea, marked use of accessory muscles,
  fever, dry nonproductive cough, hyperinflated
  chest.
• Treatment antibiotics, steroids, chest physical
  therapy (humidified air, coughing/deep breathing,
  postural drainage).

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Objective 6Describe conditions resulting from
pulmonary alterations.

• Pneumothorax
• Presence of air in the pleural space separating
  the visceral and parietal pleurae.
• The air that enters the pleural space destroys
  the negative pressure, disrupting the elastic
  recoil forces of the lung and chest wall.
• Tension pneumothorax (life-threatening)
• Air pressure pushes against the lung, displacing
  and compressing the heart and great vessels.
• Clinical manifestations
• Hypoxemia, dyspnea, hypotension, shock,
  bradycardia, and ACUTE decompensation.
• Treatment Evacuation of air, chest tube.

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Objective 6Describe conditions resulting from
pulmonary alterations.
Pneumothorax Figure 26-5 Page 758
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Objective 6Describe conditions resulting from
pulmonary alterations.
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Objective 6Describe conditions resulting from
pulmonary alterations.
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Objective 6Describe conditions resulting from
pulmonary alterations.
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Objective 6Describe conditions resulting from
pulmonary alterations
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Objective 6Describe conditions resulting from
pulmonary alterations.

• Pleural Effusion
• Presence of fluid (abscess, blood, lymph) in the
  pleural space.
• Cause compression atelectasis and displace
  mediastinal contents.
• Clinical manifestations
• Dyspnea, impaired ventilation, mediastinal shift,
  pain, pleural friction rub.

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Objective 6Describe conditions resulting from
pulmonary alterations
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Objective 6Describe conditions resulting from
pulmonary alterations.

• Empyema
• Infected pleural effusion, the presence of pus in
  the pleural space.
• Cause
• Pulmonary lymphatics become blocked
• Clinical Manifestations
• Cyanosis, fever, tachycardia, cough, pleural
  pain.
• Treatment
• Antibiotics, thoracentesis, chest tube.

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Objective 6Describe conditions resulting from
pulmonary alterations.

• Chest wall restriction
• Chest wall movement is restricted causing
  increased work of breathing and impaired
  ventilation due to decrease in tidal volume.
• Causes
• Obesity, deformity (kyphoscoliosis),
  neuromuscular diseases (myasthenia gravis,
  poliomyelitis, muscular dystrophy).

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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.

• Acute Respiratory Distress Syndrome (ARDS)
• Respiratory failure characterized by acute lung
  inflammation and diffuse alveolocapillary injury
  resulting in pulmonary edema, shunting,
  hypoxemia.
• Caused by injury to lung
• Sepsis, trauma, pneumonia, burns, aspiration,
  etc.
• Clinical Manifestations
• Rapid/shallow breathing, respiratory alkalosis,
  dyspnea, decreased lung compliance, hypoxemia.
• Treatment
• Early detection, supportive therapy, prevention
  of complications. Mechanical ventilation,
  antibiotics, surfactant replacement.

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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.
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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.

• Obstructive Pulmonary Disease
• Airway obstruction that is worse w/expiration.
• Diseases
• Asthma, chronic bronchitis, emphysema
• Chronic obstructive pulmonary disease (COPD)
• Chronic bronchitis emphysema
• Clinical Manifestations
• Dyspnea, wheezing, increased work of breathing
  V/Q mismatching, decreased forced expiration.

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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.

• Asthma
• Chronic inflammatory disorder of the airways
• Cause
• Familial disorder, genetics, environmental
  factors
• Classification is based on clinical severity
• Clinical Manifestations
• Asthma attack dyspnea, wheezing, decreased
  breath sounds, nonproductive coughing, prolonged
  expiration, tachycardia, tachypnea.
• Status Asthmaticus life threatening
• Treatment
• Avoidance of allergens/irritants, inhaled
  steroids, bronchodilators.
• Figure 26-9 Page 767

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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.

• Chronic Bronchitis
• Hypersecretion of mucus and chronic productive
  cough for at least 3 months of the year for at
  least 2 consecutive years.
• Cause
• Irritants resulting in airway inflammationgtgtedema
  gtgtincrease size/number of mucus glandsgtgt thick
  mucus produced gtgt frequent infections.
• Treatment
• Prevention, bronchodilators, expectorants, chest
  physical therapy, antibiotics, steroids,
  mechanical ventilation.

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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.

• Emphysema
• Abnormal permanent enlargement of gas exchange
  airways accompanied by destruction of alveolar
  walls w/loss of elastic recoil.
• Cause
• Smoking, air pollution, childhood respiratory
  infections, genetic.
• Clinical Manifestations
• Emphysema vs. bronchitis Table 26-4 page 770
• Treatment
• Smoking cessation, bronchodilators, nutrition,
  antibiotics, oxygen, lung reduction
  surgery/transplant.

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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.
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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.
Figure 26-8 Page 765
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Objective 7Correlate pathophysiology and
clinical manifestations of selected pulmonary
disorders.

• Pulmonary Embolism
• Occlusion of a portion of the pulmonary vascular
  bed by an embolus, thrombus, tissue fragment,
  lipids, air bubble.
• Risk factors
• Conditions/disorders that promote blood clotting,
  hypercoagulability, injuries to endothelial cells
  that line the vessels.
• Clinical Manifestations
• Tachypnea, tachycardia, dyspnea, unexplained
  anxiety, pain.
• Treatment
• Prevention, anticoagulant therapy.

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Objective 8Recognize common respiratory tract
infections.

• Pneumonia
• Acute infection of the lower respiratory tract
  caused by bacteria, viruses, fungi, protozoa,
  parasites.
• Cause
• Aspiration of oropharyngeal secretions,
  inhalation of microorganisms, spread from blood
  to lung.
• Clinical Manifestations
• Preceded by URI, fever, chills, productive/dry
  cough, pleural pain, dyspnea, hemoptysis.
• Treatment
• Antibiotics, supportive therapy, hydration,
  C.P.T., deep breathing, etc.

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Objective 8Recognize common respiratory tract
infections.

• Tuberculosis (TB)
• Infection caused by Mycobacterium tuberculosis.
• Immune response is mounted, colonies of bacilli
  are walled off forming a granulomatous lesion
  called a tubercle. Infected tissues within the
  lesion die resulting in scar tissue.
• Clinical Manifestations
• Fatigue, weight loss, lethargy, anorexia,
  low-grade fever, cough, nigh sweats, general
  anxiety, dyspnea, chest pain, hemoptysis.
• Treatment
• Antibiotic therapy (6 months).