NR 507 Week 4 Midterm: Exam Specific Study Guide: Summer 2021

Pulmonary

1.      Concepts of anticholinergic drug and asthma:

Anticholinergic drugs: block acetylcholine binding (primarily in the lungs) -promotes bronchiole dilation through decrease in the parasympathetic response (tiotropium & ipratropium) is fast acting

2.      Bronchitis & associated pathogenesis:

Begins with an exposure to an irritant (tobacco smoke) – activates bronchiole smooth muscle constriction- mucus secretion- release of inflammatory mediators(histamine, prostaglandins & leukotrienes) normal response to occasional airborne site irritants- over bronchitis is over long term 3 months for over 2 consecutive years- = smooth muscle hypertrophy = increase bronchoconstriction, hypertrophy and hyperplasia of goblet cells= mucus hypersecretion, epithelia cell metaplasia = non-ciliated squamous cells, migration of more WBCs to site = inflammation and fibrosis in bronchial wall, thickening and rigidity of bronchial basement membrane= narrowing of bronchial passageways : Increased mucus production- inflammation process = weight loss, loss of appetite, muscle weakness (interleukin controls appetite) increases protease activity= breakdown of elastin in the connective tissues of the lung= destruction of the wall between the alveoli and lungs = large ineffective air sacs develop-elastic recoil of bronchial wall -destroys bronchi and cant dilate and they stay constricted =air trapping : Chronic bronchitis

=Dyspnea- air trapping increased mucus, increase WOB r/t chronic bronchoconstriction Cough- irritated and inflamed bronchial epithelia membrane Hypoxia & Hypercapnia -from impaired gas exchange

3.      Chronic bronchitis and related acid/base disturbance: Hypercapnia (CO2 retention) = Respiratory acidosis

r/t anatomical changes ventilation is compromised esp. exhalation = alveolar hyperinflation) expanded thorax) hypercapnia CO2 retention = respiratory acidosis\

4.      Perfusion:

the actual exchange of O2 and CO2 in the bloodstream occurs via the alveoli and pulmonary capillaries: the passage of fluid to an organ or a tissue usually referring to delivery of blood to an area

5.      Blood flow between the heart and lungs in chronic bronchitis:

Poor ventilation leads to r to l shunting to occur= deoxygenated blood passes from r ventricle to the lungs to the l ventricle without adequate perfusion (gas exchange) the kidneys respond by secreting erythropoietin increasing RBC production the increase in RBC increase O2 carrying capacity -the increase blood volume increases the workload of the pulmonary and cardiovascular systems increasing blood volume and vasoconstriction = pulmonary HTN= increase workload on the R ventricle =cardiac hypertrophy= R side HF or Cor Pulmonale

6.      Asthma signs and symptoms:

Coughing esp. at night, chest tightness, shortness of breath, wheezing on exhalation, and rapid breathing: Characteristics: airway inflammation, bronchial hyperactivity, smooth muscle spasms, = excessive mucus production, hypertrophy of bronchial smooth muscle -obstruction and decrease alveolar ventilation