6B: RLD II

Question 1

What are some toxins that can lead to reduced lung compliance and volume?

Answer 1

Silicosis, BPD, lung cancer, pulmonary fibrosis, inhalation injury, radiation therapy, lobectomy, asbestosis, TB, sarcoidosis

Question 2

What is pleural effusion?

Answer 2

Inflammation and fluid accumulation in the pleural space

Question 3

What are causes of pleural effusion?

Answer 3

Infection, trauma, CHF, cirrhosis, pericardial disease that alters V/Q mismatch

Question 4

What is the pathophysiology of the effects of pleural effusion?

Answer 4

Fluid and inflammation put pressure on the lungs and decrease the ability to inflate

Question 5

What happens to lung volumes with pleural effusion?

Answer 5

Decrease

Question 6

What happens to activity tolerance with pleural effusion?

Answer 6

Decrease

Question 7

Is there pain associated with pleural effusion?

Answer 7

May have pain with inspiration

Question 8

What are the four symptoms of pleural effusion?

Answer 8

1. SOB and difficulty with deep breathing
2. Decreased expansion on x-ray
3. Bronchial or decreased breath sounds
4. Decreased activity tolerance

Question 9

What are the five causes of pulmonary edema?

Answer 9

1. Increased pulmonary capillary pressure
2. Increased negativity or interstitial pressure
3. Altered alveolar/capillary membrane permeability
4. Lymphatic insufficiency
5. Unknown

Question 10

How does fluid build up and cause edema?

Answer 10

Factors cause fluid to leak from the pulmonary and lymphatic system interstitially and into the alveoli

Question 11

What does the build up of interstitial fluid cause?

Answer 11

Creates a barrier that makes gas exchange between the capillaries and the alveoli difficult

Question 12

What is the effect of pulmonary edema on the heart?

Answer 12

Heart has to work much harder to gain sufficient levels of oxygen

Question 13

Are O2 or CO2 levels affected more by pulmonary edema, and why?

Answer 13

O2 levels because CO2 is more soluble

Question 14

What are key symptoms of pulmonary edema?

Answer 14

• SOB
• Increased RR
• Decreased lung volumes

Question 15

What happens to PaO2 with pulmonary edema?

Answer 15

Decreased due to the V/Q mismatch

Question 16

What will you see on x-ray with pulmonary edema?

Answer 16

Fluid accumulation

Question 17

What heart symptoms will someone with pulmonary edema present with?

Answer 17

Signs of CHF

Question 18

When auscultating, what sounds might you hear if someone has pulmonary edema?

Answer 18

Crackles or rhonchi

Question 19

ARDS is the result of what?

Answer 19

Trauma, aspiration, overdose, inhaled toxin, shock, metabolic reasons, severe infection

Question 20

What happens with ARDS?

Answer 20

Fluid fills in the alveoli

Question 21

What are the five pulmonary effects of ARDS?

Answer 21

1. Decreased lung volume
2. Increased work of breathing
3. Decreased surfactant
4. Decreased breath sounds
5. Wheezes or rhonchi

Question 22

What are the three pulmonary effects of COVID?

Answer 22

1. Fluid leaks into alveoli
2. Inflammation of bronchial walls
3. Fluid blocks smaller airways

Question 23

What are the pulmonary symptoms of COVID?

Answer 23

• SOB and difficulty breathing
• Fluid in lungs
• Dry cough and sore throat

Question 24

What will a chest x-ray look like with COVID?

Answer 24

Ground glass

Question 25

What would require intubation with COVID?

Answer 25

Severe presentation, cytokine storm

Question 26

What is the effect of rib fractures on the pulmonary system?

Answer 26

- Decreased respiratory depth - Muscular splinting - Decreased chest wall motion

Question 27

What is a lung contusion?

Answer 27

Localized damage causing RBC and plasma to move into the alveoli that results in V/Q mismatch

Question 28

What are the three clinical sings of rib fractures?

Answer 28

1. Decreased rib excursion and lung volumes 2. Pain with inspiration, weak cough 3. Decreased breath sounds and ventilation

Question 29

What clinical signs indicate are present with lung contusion?

Answer 29

- Decreased lung volumes - Decreased breath sounds - Poor ventilation, possibly visible clotted area on x-ray

Question 30

What are interventions for lung contusion?

Answer 30

- Ventilation - Deep breathing and positioning to increase PO2 - Mobility - Observation of fluid volumes

Question 31

What is atelectasis?

Answer 31

Air sac collapse, partial lung collapse

Question 32

What happens with V/Q in the lung segment with atelectasis?

Answer 32

Decreased

Question 33

What are some causes of atelectasis?

Answer 33

Phrenic nerve injury, SCI, post-surgical, trauma, muscular and bony changes

Question 34

What are the five signs of atelectasis?

Answer 34

1. Decreased breath sounds 2. Decreased lung ventilation 3. SOB 4. Decreased rib excursion 5. Decreased activity tolerance