The Pathophysiologic Basis for Common Clinical Manifestation Ch.3

Question 1

An individual’s normal breathing pattern is composed of

Answer 1

tidal volume (Vt), ventilatory rate, and inspiration- to- expiration (I/E ratio)

Question 2

In a normal adult Vt is about ______ or ____ to ____

Answer 2

500mL (7 to 9 mL/kg)

Question 3

Ventilatory rate is

Answer 3

12-20

Question 4

I/E is about

Answer 4

1:2

Question 5

_________ is defined as the “breathlessness” or “SOB” or the labored/ difficult breathing felt and described ONLY by the patient

Answer 5

Dyspnea

Question 6

Common types of dyspnea include

Answer 6

1. positional dyspnea
2. cardiac dyspnea
3. exertional dyspnea
4. paroxysmal nocturnal dyspnea
5. renal dyspnea

Question 7

Positional dyspnea occurs only when pt is

Answer 7

in the reclining position; orthopnea

Question 8

Cardiac dyspnea is_________ breathing, caused by _______ disease

Answer 8

labored breathing caused by heart disease (CHF)

Question 9

Exertional dyspnea is provoked by

Answer 9

physical exercise

Question 10

Paroxysmal nocturnal dyspnea is a form of respiratory distress related to

Answer 10

posture (especially reeling while sleeping).

Question 11

Proxymal nocturnal dyspnea is associated with what diseases?

Answer 11

CHF with pulmonary edema

Question 12

Renal dyspnea is difficulty in breathing as a result of

Answer 12

kidney disease

Question 13

During normal periods of eupnea, the individual has no sensation of difficult breathing. What matches?

Answer 13

Demand- to- breath matches capability- to- breath

Question 14

During periods of significant exercise, normal individual’s capability - to- breathe may be challenged to meet the
As ____________ consumption increases

Answer 14

increased demand- to -breath as oxygen consumption increases

Question 15

Modified Medical Research Council (mMRC) Questionnaire is used for?

Answer 15

Accessing the Severity of Breathlessness in those who can speak

Question 16

The Borg Dyspnea Scale is used in patients who

Answer 16

cannot communicate b/c of mouthpiece, ET tubes, tracheotomies

Question 17

Abnormal ventilatory patterns happens when

Answer 17

1. the anatomic alterations of the lungs associated w/ a specific disorder
2. the pathophysiologic mechanism that develop b/c of the anatomic alterations

Question 18

To evaluate and asses the various abnormal ventilatory patterns, the following ventilatory must first be understood (5)

Answer 18

-Lung compliance
-airway resistance
-peripheral chemoreceptors
-central chemoreceptors
-pulmonary reflexes

Question 19

The ease with which the elastic forces of the lungs accept a volume of inspired air is known as

Answer 19

lung compliance

Question 20

Compliance determines

Answer 20

how much air in liters the lungs will accommodate for each centimeter of water pressure change in distending pressure

Question 21

Lung compliance can either

Answer 21

increase or decrease

Question 22

Increased lung compliance is good except in

Answer 22

emphysema

Question 23

Emphysema is when lungs have lost all

Answer 23

elasticity (hyperinflation)

Question 24

Normal lung compliance is

Answer 24

0.1 L/cm H20

Question 25

CL=

Answer 25

change in volume (L)/ change in pressure (cmH20)

Question 26

Decreased lungs compliance means lungs are

Answer 26

stiff and cannot expand

Question 27

Decreased lung compliance is seen in

Answer 27

asthma attacks, pulmonary fibrosis, ARDS, pulmonary edema, PNA

Question 28

The pressure difference between the mouth and the alveoli divided by the flow rate

Answer 28

Airway resistance (Raw)

Question 29

The rate at which a certain volume of gas flow through the airways is a function of...

Answer 29

pressure gradient and resistance created by the airways to the flow of gas

Question 30

Raw =

Answer 30

change in pressure( cm H20)/ V(L/s)

Question 31

Normal Raw in TB tree is about

Answer 31

1.0 to 2.0 cm H20/ L/ s

Question 32

Decreased resistance is _____ Increased resistance is _____

Answer 32

good/ bad

Question 33

What can also increase Raw?

Answer 33

Secretions

Question 34

________ is defined as the force multiplied by the distanced move

Answer 34

work

Question 35

Work =

Answer 35

force x distance

Question 36

Peripheral chemoreceptors are activated by_______ and are triggered when Pa02 falls below ______

Answer 36

hypoxemia; 60

Question 37

A decreased arterial oxygen level (hypoxemia) is a result of decreased (3)

Answer 37

ventilation-perfusion ration (V/Q), pulmonary shunting, and venous admixture

Question 38

When the diaphragm becomes significantly depressed or comprised what is activated?

Answer 38

Accessory muscles of inspiration

Question 39

The major accessory muscles of inspiration are

Answer 39

- Scalenes - Sternocleidomastoids - Pectoralis major muscle groups - Trapezius muscle groups

Question 40

This is activated when Raw become significantly elevated

Answer 40

Accessory muscles of expiration

Question 41

The major accessory muscle of expiration are

Answer 41

- Rectus abdominus - External oblique - Internal oblique - Transversus abdominis

Question 42

_______-____ ___________ occurs in patients during the advanced stages of obstructive pulmonary disease

Answer 42

Pursed- lip breathing

Question 43

The positive pressure (back pressure) provides the airways w/ some stability which offsets

Answer 43

airway collapsed and air trapping

Question 44

This may be seen in patients with severe restrictive lung disease such as PNA and ARDS (mainly seen in infants)

Answer 44

substernal and intercostal retractions

Question 45

Intercostal is the

Answer 45

skin in between the ribs

Question 46

Substernal is

Answer 46

below the sternal

Question 47

Superclavicular is

Answer 47

above the clavicle

Question 48

Retractions mean

Answer 48

the skin sinks down into bony structures when trying to breathe

Question 49

Severe resistance to taking a deep breath is a symptom of pleuritic pain is called (❤️ pillow)

Answer 49

splinting

Question 50

Usually described as a sudden sharp or stabbing pain

Answer 50

pleuritic chest pain

Question 51

pleuritic chest pain happens in what diseases (5)

Answer 51

PNA pneumothorax lung cancer plueral effusion TB

Question 52

____ __________ _______ pain is described as constant pain that is usually located centrally

Answer 52

Nonpleuritic chest pain

Question 53

Nonpleuritic chest pain happens in (4)

Answer 53

myocardial ischemia pulmonary hypertension local trauma of chest cage, Esophagitis

Question 54

The inspection of the pt's extremities should include (4)

Answer 54

-Altered skin color (e.g cyanotic, pale, red, purple) - digital clubbing - peripheral edema - distended neck veins

Question 55

The termed is used to describe the blue-gry or purplish of the mucous membrane, finger tips and toes whenever the blood in these areas contains 5 g/dL of reduced hemoglobin.

Answer 55

Cyanosis

Question 56

Is characterized by bulbous swelling of the terminal phalanges of the fingers and toes.

Answer 56

Digital clubbing

Question 57

Peripheral edema is seen in pts with

Answer 57

CHF

Question 58

Flow from the major veins of the chest that returned blood to the right side of the heart may be compromised is called (neck)

Answer 58

Distended neck veins (Jugular venous distention)

Question 59

__________ _________ production is commonly seen in respiratory disease that cause an acute or chronic inflammation of the TB tree

Answer 59

Excessive sputum

Question 60

What should be assessed in sputum

Answer 60

Sputum volume, appearance, viscosity, and odor

Question 61

Acute sputum may be a cause of the

Answer 61

cold or flu

Question 62

Chronic sputum may be seen in

Answer 62

cystic fibrosis , COPDers

Question 63

Coughing up blood or blood tinged sputum from the TB tree is called

Answer 63

hemoptysis

Question 64

Vomitting blood is called

Answer 64

hematemesis

Question 65

A sudden audible explosion of air from the lungs is called

Answer 65

cough

Question 66

For a cough to be affective you need 3 things. What are they?

Answer 66

1. deep inspiration 2. partial closure of the glottis 3. forceful contraction of accessory muscle of expiration to expel air from the lungs

Question 67

What are some causes for a non productive cough?

Answer 67

- irritation of the airway -inflammation of the airways -mucous accumulation -tumors -irritation of the pleura

Question 68

For a productive cough the RT should access (3)

Answer 68

-Is the cough strong or weak - Is it a loud cough -Is sputum being coughed up? If so how much , color and odor

Question 69

What is the average total compliance of the lungs and chest wall combined?

Answer 69

0.1 L/cm H20

Question 70

When lung compliance decreases, what is normally seen?

Answer 70

- Tidal volume usually decreases - Ventilatory rate usually increases

Question 71

What is the normal airway resistance in the TB tree?

Answer 71

1.0 to 2.0 H2o/L/s

Question 72

When the systemic blood pressure increases, the aortic and carotid sinus baroreceptors initiate reflexes that causes what to decrease

Answer 72

- Decreased ventilatory - Decreased heart rate

Question 73

What is the anteroposterior- transverse chest diameter ratio in the normal adult?

Answer 73

1:2

Question 74

What muscles originate from the clavicle? (2)

Answer 74

- Sternocleidomastoid muscles - Pectoralis major muscles

Question 75

Which of the following is associated with digital clubbing?

Answer 75

- Chronic infection - Local hypoxemia - Circulating vasodilators - Arterial hypoxemia

Question 76

Which of the following is associated with pleuritic chest pain?

Answer 76

- Lung cancer - PNA - Tuberculosis

Question 77

Signs of dyspnea include

Answer 77

-labored breathing -hyperventilation -tachypnea -retractions of intercostal spaces -use of accessory muscles -distressed facial expression -flaring of the nostrils - paradoxical breathing -gasping

Question 78

Borg dyspnea scale

Answer 78

0. no SOB 0.5 slight SOB 1 2. Mild SOB 3. Moderate SOB 4 5.Strong or hard breathing 6 7. Sever breathing 8 9 10. SOB so severe I need to stop and rest

Question 79

Abnormal ventilatory patterns that occur suddenly (minutes to hours maximum) are classified as

Answer 79

acute onset conditions

Question 80

Abnormal ventilatory conditions that develop slowly (days to months to years) are classified as

Answer 80

chronic conditions

Question 81

__________ _______ pain intensifies during deep inspiration and coughing and diminished during breath holding and splinting

Answer 81

Pleuritic chest pain

Question 82

Is generally not worsened by deep inspiration

Answer 82

Nonpleuritic chest pain

Question 83

When lung compliance decreases ventilatory rate __________ and ________ ________ increases

Answer 83

decreases and tidal volume (vt)

Question 84

Common measurements that can be calculated from a single forced vital capacity (FVC)

Answer 84

FEVt FEV1/FVC ratio FEF2 200-1200 FEF 25%-75% PEFR

Question 85

A decreased DLCO is a hallmark clinical manifestation in

Answer 85

emphysema

Question 86

In obstructive DLCO is decreased only in _______ and normal in _________

Answer 86

emphysema; restrictive

Question 87

The ____________ ____________pressure the pt is able to generate against a closed airway and is recorded as a ________ number in either cmH20 or mm

Answer 87

The maximum inspiratory pressure (MIP) ; negative

Question 88

In a normal adult the MIP is

Answer 88

-80 to 100 cm H20

Question 89

A forceful expiratory effort against an occluded airway and is reordered as a _______ number in either cm h20 or mm

Answer 89

Maximum expiratory pressure (MEP); positive

Question 90

The adult normal MEP is greater than

Answer 90

100 cm h20 males 80 cm h20 in females

Question 91

What is the PEFR in the normal healthy woman 20-30 y/o

Answer 91

450 L/min

Question 92

A restive lung disorder is confirmed when the

Answer 92

- FEV1 is decreased - FEV1/FVC ratio is normal or increased

Question 93

In obstructive lung disorder

Answer 93

-RV is increased -VC is decreased

Question 94

Under normal conditions the average DLCO value for the resting man is

Answer 94

25 mL/min/mm hg

Question 95

What is the normal percentage of the total volume exhaled during an FEV1

Answer 95

83%

Question 96

Which can be obtained from a flow- volume loop? 1.FVC 2.PEFR 3.FEVt 4.FEF 25%-75%

Answer 96

1,2,3,4

Question 97

An obstructive lung disorder is confirmed when the: 1.FEV1 is decreased 2. FVC is increased 3. FEV1 is increased 4. FEV1/FVC ratio is decreased

Answer 97

1 and 4

Question 98

What Anatomic alterations of the lungs is or are associated w/. restricted lung disorder

Answer 98

Atelectasis Consolidation