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NR 507 EDAPT WEEK 3 Pulmonary System & Function Latest Update - 110 Questions with 100% Verified Correct Answers Guaranteed A+ Verified by Professor

*Associated with smokers

**Are the most common diagnosed - CORRECT ANSWER: *Associated with smokers

Pulmonary Langerhans cell histiocytosis*

**Are the most common diagnosed Hypersensitivity Pneumonitis** Pneumoconioses** Radiation pneumonitis** Idiopathic pulmonary fibrosis** Sarcoidosis**

80%

Rationale: The normal range for the FEV1/FVC is 80%. - CORRECT ANSWER: A patient with normal lungs should be able to exhale ___ of the forced vital capacity within the first second.

Abbreviations: - CORRECT ANSWER: -FVC / Forced Vital Capacity -FEV1 / Forced Expiratory Volume in One Second -TLC / Total Lung Capacity -RV / Residual Volume -DLCO / Diffusion Capacity for Carbon Monoxide 1 / 4

-BD / Bronchodilator

air trapping

Rationale:

Hyperresonance is the characteristic lung percussion finding when the chest

hyperinflated in COPD. - CORRECT ANSWER: Hyperresonance found on lung

percussion with a patient with COPD is primarily due to

Anatomical Changes with Chronic Bronchitis - CORRECT ANSWER: The anatomical

changes associated with chronic bronchitis are:

Smooth muscle constriction, bronchial wall inflammation and mucus plugs lead to alveolar hyperinflation.

Because of the anatomical changes in the bronchioles associated with chronic irritation, ventilation (includes inhalation and exhalation) is compromised, especially exhalation.Pressure differences during inhalation are high enough to force air into the alveoli.

During exhalation, however, the narrowing and collapse of the air passageways causes air to be trapped in the alveoli that results in alveolar hyperinflation leading to an expanded thorax. The inability to fully exhale leads to hypercapnia (CO2 retention) that leads to respiratory acidosis.

Anatomical Changes with Chronic Bronchitis: Chronic Low Oxygen - CORRECT

ANSWER: In response to the chronic low oxygen level of the blood, the kidneys

compensate by increasing secretion of erythropoietin, the primary hormone responsible for stimulating red blood cell (RBC) production. As a result of increased RBC production, patients with chronic bronchitis exhibit an elevated hematocrit and can develop secondary polycythemia vera. One might think that an increase in RBC to carry oxygen could be beneficial. That is not the case here. The increased blood volume causes additional strain on the pulmonary and cardiovascular systems. The increased blood volume combined with the vasoconstriction caused by chronic hypoxia leads to pulmonary hypertension. 2 / 4

This situation increases the workload of the right ventricle as it tries to pump deoxygenated blood into the lungs. Overtime, this results in cardiac hypertrophy and right-sided heart failure or cor pulmonale. The reduced ejection fraction from the right side of the heart causes blood to back up into the venous system causing venous distention and peripheral edema.

To diagnose chronic bronchitis, the NP must collect a through health history. The patient should be asked about chronic exposure to any inhaled irritants. Smoking history should also be obtained. The patient will also report chronic cough and sputum production.

Anatomical Changes with Chronic Bronchitis: Gas Exchange - CORRECT ANSWER: The high concentration of CO2 creates unfavorable conditions for gas exchange. There

is decreased oxygen exchange leading to a ventilation/perfusion (V/Q) mismatch:

Decreased perfusion of the pulmonary capillaries with oxygenated blood cells results in chronic pulmonary hypoxia and cyanosis. The term "blue bloater" is used to describe a patient with chronic bronchitis, with bloater referring to the expanded thorax that these individuals can develop as a result of alveolar hyperinflation.

Poor ventilation leads to decreased perfusion which causes right to left shunting. This is the phenomenon where deoxygenated blood passes from the right ventricle to the left ventricle with adequate perfusion (gas exchange).

Assessment and Diagnosis of ILD - CORRECT ANSWER: Assessment of ILD

Subjective and objective findings in patients with ILD include:

-Shortness of breath -Non-productive cough -Hypoxia -Fine crackles, especially during exertion 3 / 4

ILD should be considered in any patient presenting with subacute or chronic, progressive shortness of breath and/or a non-productive cough, especially if they have

a history of:

-Occupational or animal exposure, excluding dogs and cats -Connective tissue disease -Chest irradiation -Taking amiodarone, nitrofurantoin, or methotrexate

Assessment and Diagnosis of ILD - CORRECT ANSWER: Diagnosis of ILD

Diagnosis of ILD is made based on exposure history which includes the patient's current and past occupations as well as hobbies. Ask about exposure to animals, especially birds; medication history, including the use of illicit drugs (methamphetamines, marijuana, smoking crack cocaine and ask about any prior radiation treatment. A chest- x-ray will reveal a honey-comb pattern.

There are 4 key tests to definitively diagnose ILD:

• High resolution chest computed tomography
• Pulmonary function tests (normal or slightly low FEV1, low FVC, normal or elevated

FEV1/FVC ratio and reduced lung volumes); these values represent restrictive lung disease

• Bronchoalveolar lavage
• Lung biopsy

Asthma - CORRECT ANSWER: Asthma is a chronic (obstructive) disease which is

characterized by airway inflammation, bronchial hyperreactivity, and smooth muscle spasm that occurs intermittently and has a reversible obstructive airflow component.

Asthma is caused by complex interaction of genetic and environmental factors. As a matter of fact, over 100 different genetic mutations have been implicated as possible links to the development of asthma. Asthma results in excess mucus production and

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