NR 283 Exam 2

NR 283 Exam 2

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Chamberlain University

NR-283: Pathophysiology

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Date

NR 283 Exam 2

A nurse notices a patient gasping for air in the middle of the night, needing to sit or stand to breathe. This condition is most likely Paroxysmal Nocturnal Dyspnea (PND). PND is a type of dyspnea that occurs suddenly at night due to fluid redistribution while lying down, typically linked to heart failure. When a patient has a PaCO2 level greater than normal due to inadequate expiration, the condition is termed Hypercapnia. Strenuous exercise can result in a breathing pattern characterized by an increased respiratory rate with large tidal volumes, known as Kussmaul Respirations. Unlike hypoxemia, which is low oxygen in the blood, hypoxemia causes may include damage to the alveolocapillary membrane, atelectasis, pulmonary embolus, or pneumonia.

When excess air in the pleural space develops into a “one-way valve,” it leads to a Tension Pneumothorax. Similarly, an excess amount of pus, cellular debris, and microorganisms in the pleural space defines Empyema, which differs from pulmonary edema or pneumonia. Acute Respiratory Distress Syndrome (ARDS), often caused by sepsis, leads to hypoxemia as the alveolocapillary membrane gets injured, allowing fluid and debris into the alveoli, thereby hindering gas exchange. The pathology of emphysema includes obstruction and air trapping caused by tissue changes rather than mucus production, with causes including cigarette smoke, air pollutants, or enzyme deficiency. Symptoms like fatigue, weight loss, anorexia, night sweats, and homelessness often point toward Tuberculosis.

Pulmonary embolism commonly arises from deep veins in the thigh. In Cor Pulmonale, also known as pulmonary heart disease, high pulmonary vascular pressure strains the right side of the heart. Oxygenated blood flows through pulmonary veins, and cardiac output (CO) is calculated as heart rate (HR) multiplied by stroke volume (SV). CO is affected by preload, afterload, contractility, and heart rate.

Chronic venous insufficiency can progress to varicose veins. Virchow’s Triad, which contributes to venous thrombosis, includes immobility, hypercoagulability (e.g., birth control pills), and endothelial damage. Unlike primary hypertension, malignant hypertension rapidly progresses, causing severe organ damage. Aneurysms, often symptomless, can result in false aneurysms due to hematoma formation. Reducing cholesterol levels may regress atherosclerotic lesions and improve vascular function. The progression of atherosclerosis involves foam cell formation, fatty streaks, fibrous plaques, and, eventually, complicated plaques.

Coronary artery disease reduces myocardial blood supply, causing ischemia, while vasospasms of coronary arteries cause Prinzmetal angina. Unstable angina is a sign of impending cardiac death. Constrictive pericarditis results in pericardial calcification, and the major concern in pericardial effusion is the development of tamponade. Among cardiomyopathies, dilated cardiomyopathy enlarges the ventricles. Mitral stenosis causes left atrial hypertrophy, while mitral valve regurgitation results in blood returning to the left ventricle. Valve vegetations in endocarditis can cause emboli. In left-sided heart failure, increased preload results in pulmonary manifestations such as dyspnea, orthopnea, and pulmonary edema due to fluid back-up.

NR 283 Exam 2

References

American Psychological Association. (2020). Publication Manual of the American Psychological Association (7th ed.). Washington, DC: American Psychological Association.

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