NR 507 Pathophysiology
Oxygen transportation step 1 - answer Air is inhaled through the process of ventilation
(mechanical movement of gas or air into or out of the lungs)
Oxygen transportation step 2 - answer oxygen diffused from the alveoli into pulmonary
capillaries, moving oxygen from the pulmonary veins to the left side of the heart to the
aorta into systemic arterial circulation
Oxygen transportation step 3 - answer Perfusion (exchange of O2 and CO2 in the blood
stream, which occurs via the alveoli and pulm capillaries) of the systemic capillaries with
oxygenated blood
Oxygen transportation step 4 - answer oxygen is diffused from the systemic capillaries
to each and every cell
Gas CO2 transport step 1 - answer Diffusion of blood (deoxygenated) from cells into
systemic capillaries
Gas CO2 transport step 2 - answer Perfusion of the systemic capillaries with
deoxygenated blood through the venous circulation, to the vena cava into the right side
of the heart, to the pulmonary arteries (ART carry deoxygenated blood)
Gas CO2 transport step 3 - answerDiffusion of the CO2 from pulmonary arteries into
alveoli through pulmonary capillaries
Gas CO2 transport step 4 - answerExhalation of air by ventilation of lungs from removal
of CO2
What are bronchioles? - answersmallest of the conducting airways, branch out from the
alveoli and connect to the alveoli
What are the three layers of the bronchioles? - answerEpithelial layer (inner layer)
mucous containing goblet cells, and ciliated cells.
Connective tissue (middle layer) lamina propia- cartilage and WBC's
Smooth muscle layer (outer layer) outer layer to constrict and dilate
What are the bronchioles controlled by? - answerThe autonomic nervous system
Parasympathetic stimulation- mediated via vagus nerve--- release neurotransmitter
acetylcholine binds to cholinergic receptors-- leading to bronchial constriction
(decreased air flow). Dominates to limit exposure to external substances
Sympathetic stimulation- stimulation of neurotransmitter epinephrine-- binds to beta 2-
adrenergic receptors-- leading to bronchial dilation
,What is asthma? - answerchronic inflammatory disorder of the bronchial mucosa
caused by bronchial hyper-responsiveness, construction of airways, and variable airflow
obstruction that is reversible.
Asthma signs and symptoms - answerThose are asymptomatic between attacks.
Beginning of attacks--chest constriction, expiratory wheezing, dyspnea, nonproductive
coughing, prolonged expiration, tachypnea, and tachycardia
Severe attacks-- use of accessory muscles of respiration, wheezing during both
inspiration/expiration, pulsus paradoxus- decrease in SBP during inspiration
Anti-cholingeric drugs for asthma - answerTiotropium and Ipratropium- these drugs
block acetylcholine binding--- leading to bronchodilation through decrease in the
parasympathetic response
What causes bronchitis and associated pathogenesis? - answeracute causes- infection
or inflammation
chronic causes- usually caused by viruses with a nonproductive cough
Chronic bronchitis - answerInflammation of the bronchi persisting over a long time.
Productive cough that continues for at least three months for a year for 2 years
consecutive years. Enhanced chronic inflammatory response in the airways to noxious
particles or gases.
Inspired irritants-- bronchial inflammation-- bronchial edema increase in mucous glands
and goblet ells in airway, smooth muscle hypertrophy with fibrosis, narrowing of airways
Hypersecretion of thick muscus and cannot be cleared due to impaired ciliary function--
increasing susceptibility to infection contributing to airway injury and ineffective repair.
Initially only affects larger bronchi-- eventually all airways involved
Chronic bronchitis and acid/base disturbances - answernarrowed airway--obstruction--
ventilation-perfusion mismatch with hypoxemia
Hypercapnia develops as air trapping worsens and the work of breathing increase
Reduced tidal volumes-hypoventilation-- respiratory acidosis
Polycythemia vera - answerchronic neoplastic, nonmalignant condition that is
characterized by overproduction of red blood cells (often with an increase levels of WBC
and platelets) and splenomegaly
chronic bronchitis (marked hypoxemia) leads to ... - answerpolycythemia and cyanosis
what is an essential component of polycythemia vera - answerErythrocytosis; clonal
proliferation of erythoid progenitors occurs in the bone marrow independent of
erythropoietin, even though the cells express a normal erythropoietin receptor
alveolar hyperinflation with asthma - answerairway obstruction increases airflow
resistance and decreases flow rate---
, impaired expiration causes air trapping, hyperinflation distal to obstruction and
increased work of breathing--
continued air trapping increase intrapleural pressure and alveolar gas pressures--
decreased alveolar perfusion--
hyperventilation is triggered in response to increased lung volume and obstruction (early
hypoxemia without Co2 retention and respiratory alkalosis)--
With progressive obstruction of expiratory airflow, airflow trapping more air leading to
lungs and thorax hyperexanded, decrease respiratory muscles resulting in a decrease
tidal volume and increase in CO2 retention-- causing respiratory acidosis
Blood flow between heart and lungs - answerThe superior and inferior vena cava carry
systemic DEoxygenated blood to the right atrium-- the tricuspid valve opens to allow for
blood flow into the right ventricle-- the pulmonary semilunar valve opens to allow blood
flow into the pulmonary truck; a large blood vessel that divides to form the left and right
pulmonary arteries that carry blood to the lungs and eventually into the alveolar
capillaries where gas exchange occurs-- The pulmonary veins return oxygenated blood
to the left atrium-- the bicuspid valve opens to allow blood flow into the left ventricle--
the aortic semilunar valve opens to allow blood flow into the aorta; a large blood vessel
that divides into brachiocephalic, left common carotid and subclavian arteries that will
further branch to carry blood to the rest of the body.
cardiac cycle - answeratrial systole, atria contracts-- blood pushes through open
tricuspid and mitral valves into ventricles. Semilunar valves are closed-- Beginning of
ventricular systole, ventricular contract-- increased pressure in ventricles. Tricuspid and
Mitral valves close (1st heart sound).
As pressure rises, semilunar valves open when ventricles pressure-- atrial pressure--
blood pushed into aorta and pulmonary arteries.
Beginning of ventricular diastole, pressure in relaxing ventricles drop below that in the
arteries and semilunar valves close (2nd heart sound)
As pressure falls, blood flow from veins into relaxed atria. Tricuspid and mitral valves
open when pressure ventricle falls below atrial pressure.
atrioventricular (AV) node - answermitral (left AV valve) and tricuspid (right AV valve)
What happens during ventricular relaxation (systole) - answerthe two AV valves (mitral
and tricuspid) blood from the atria to the ventricles. Once pressure is high in the
ventricles the valves close to prevent from back flow into the atria as the ventricles
contract (S1- 1st heart sound)
What are the semilunar valves? - answerpulmonary (RV-- lung) and aortic (LV-- body)
what happens during ventricular contraction (Diastole) - answerThe pulmonary and
aortic valves open when there is pressure and blood flows out of the ventricle and into
the systemic and pulmonary circulation---after ventricular contraction and ejection the
pressure decreases and the semilunar valves close when pressure is in the ventricles--
the closure is to prevent back flow into the right and left ventricles (S2- 2nd heart sound)
Oxygen transportation step 1 - answer Air is inhaled through the process of ventilation
(mechanical movement of gas or air into or out of the lungs)
Oxygen transportation step 2 - answer oxygen diffused from the alveoli into pulmonary
capillaries, moving oxygen from the pulmonary veins to the left side of the heart to the
aorta into systemic arterial circulation
Oxygen transportation step 3 - answer Perfusion (exchange of O2 and CO2 in the blood
stream, which occurs via the alveoli and pulm capillaries) of the systemic capillaries with
oxygenated blood
Oxygen transportation step 4 - answer oxygen is diffused from the systemic capillaries
to each and every cell
Gas CO2 transport step 1 - answer Diffusion of blood (deoxygenated) from cells into
systemic capillaries
Gas CO2 transport step 2 - answer Perfusion of the systemic capillaries with
deoxygenated blood through the venous circulation, to the vena cava into the right side
of the heart, to the pulmonary arteries (ART carry deoxygenated blood)
Gas CO2 transport step 3 - answerDiffusion of the CO2 from pulmonary arteries into
alveoli through pulmonary capillaries
Gas CO2 transport step 4 - answerExhalation of air by ventilation of lungs from removal
of CO2
What are bronchioles? - answersmallest of the conducting airways, branch out from the
alveoli and connect to the alveoli
What are the three layers of the bronchioles? - answerEpithelial layer (inner layer)
mucous containing goblet cells, and ciliated cells.
Connective tissue (middle layer) lamina propia- cartilage and WBC's
Smooth muscle layer (outer layer) outer layer to constrict and dilate
What are the bronchioles controlled by? - answerThe autonomic nervous system
Parasympathetic stimulation- mediated via vagus nerve--- release neurotransmitter
acetylcholine binds to cholinergic receptors-- leading to bronchial constriction
(decreased air flow). Dominates to limit exposure to external substances
Sympathetic stimulation- stimulation of neurotransmitter epinephrine-- binds to beta 2-
adrenergic receptors-- leading to bronchial dilation
,What is asthma? - answerchronic inflammatory disorder of the bronchial mucosa
caused by bronchial hyper-responsiveness, construction of airways, and variable airflow
obstruction that is reversible.
Asthma signs and symptoms - answerThose are asymptomatic between attacks.
Beginning of attacks--chest constriction, expiratory wheezing, dyspnea, nonproductive
coughing, prolonged expiration, tachypnea, and tachycardia
Severe attacks-- use of accessory muscles of respiration, wheezing during both
inspiration/expiration, pulsus paradoxus- decrease in SBP during inspiration
Anti-cholingeric drugs for asthma - answerTiotropium and Ipratropium- these drugs
block acetylcholine binding--- leading to bronchodilation through decrease in the
parasympathetic response
What causes bronchitis and associated pathogenesis? - answeracute causes- infection
or inflammation
chronic causes- usually caused by viruses with a nonproductive cough
Chronic bronchitis - answerInflammation of the bronchi persisting over a long time.
Productive cough that continues for at least three months for a year for 2 years
consecutive years. Enhanced chronic inflammatory response in the airways to noxious
particles or gases.
Inspired irritants-- bronchial inflammation-- bronchial edema increase in mucous glands
and goblet ells in airway, smooth muscle hypertrophy with fibrosis, narrowing of airways
Hypersecretion of thick muscus and cannot be cleared due to impaired ciliary function--
increasing susceptibility to infection contributing to airway injury and ineffective repair.
Initially only affects larger bronchi-- eventually all airways involved
Chronic bronchitis and acid/base disturbances - answernarrowed airway--obstruction--
ventilation-perfusion mismatch with hypoxemia
Hypercapnia develops as air trapping worsens and the work of breathing increase
Reduced tidal volumes-hypoventilation-- respiratory acidosis
Polycythemia vera - answerchronic neoplastic, nonmalignant condition that is
characterized by overproduction of red blood cells (often with an increase levels of WBC
and platelets) and splenomegaly
chronic bronchitis (marked hypoxemia) leads to ... - answerpolycythemia and cyanosis
what is an essential component of polycythemia vera - answerErythrocytosis; clonal
proliferation of erythoid progenitors occurs in the bone marrow independent of
erythropoietin, even though the cells express a normal erythropoietin receptor
alveolar hyperinflation with asthma - answerairway obstruction increases airflow
resistance and decreases flow rate---
, impaired expiration causes air trapping, hyperinflation distal to obstruction and
increased work of breathing--
continued air trapping increase intrapleural pressure and alveolar gas pressures--
decreased alveolar perfusion--
hyperventilation is triggered in response to increased lung volume and obstruction (early
hypoxemia without Co2 retention and respiratory alkalosis)--
With progressive obstruction of expiratory airflow, airflow trapping more air leading to
lungs and thorax hyperexanded, decrease respiratory muscles resulting in a decrease
tidal volume and increase in CO2 retention-- causing respiratory acidosis
Blood flow between heart and lungs - answerThe superior and inferior vena cava carry
systemic DEoxygenated blood to the right atrium-- the tricuspid valve opens to allow for
blood flow into the right ventricle-- the pulmonary semilunar valve opens to allow blood
flow into the pulmonary truck; a large blood vessel that divides to form the left and right
pulmonary arteries that carry blood to the lungs and eventually into the alveolar
capillaries where gas exchange occurs-- The pulmonary veins return oxygenated blood
to the left atrium-- the bicuspid valve opens to allow blood flow into the left ventricle--
the aortic semilunar valve opens to allow blood flow into the aorta; a large blood vessel
that divides into brachiocephalic, left common carotid and subclavian arteries that will
further branch to carry blood to the rest of the body.
cardiac cycle - answeratrial systole, atria contracts-- blood pushes through open
tricuspid and mitral valves into ventricles. Semilunar valves are closed-- Beginning of
ventricular systole, ventricular contract-- increased pressure in ventricles. Tricuspid and
Mitral valves close (1st heart sound).
As pressure rises, semilunar valves open when ventricles pressure-- atrial pressure--
blood pushed into aorta and pulmonary arteries.
Beginning of ventricular diastole, pressure in relaxing ventricles drop below that in the
arteries and semilunar valves close (2nd heart sound)
As pressure falls, blood flow from veins into relaxed atria. Tricuspid and mitral valves
open when pressure ventricle falls below atrial pressure.
atrioventricular (AV) node - answermitral (left AV valve) and tricuspid (right AV valve)
What happens during ventricular relaxation (systole) - answerthe two AV valves (mitral
and tricuspid) blood from the atria to the ventricles. Once pressure is high in the
ventricles the valves close to prevent from back flow into the atria as the ventricles
contract (S1- 1st heart sound)
What are the semilunar valves? - answerpulmonary (RV-- lung) and aortic (LV-- body)
what happens during ventricular contraction (Diastole) - answerThe pulmonary and
aortic valves open when there is pressure and blood flows out of the ventricle and into
the systemic and pulmonary circulation---after ventricular contraction and ejection the
pressure decreases and the semilunar valves close when pressure is in the ventricles--
the closure is to prevent back flow into the right and left ventricles (S2- 2nd heart sound)
