Mid Term Study Guide NR 507

Mid Term Study Guide NR 507

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\