Assignment 12.1: Disorders of Ventilation and Gas Exchange Case Study

Assignment 12.1: Disorders of Ventilation and Gas Exchange Case Study

Assignment 12.1: Disorders of Ventilation and Gas Exchange Case Study

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Emmanuel and his mother live in an urban community housing complex. The building is worn down and dirty from the urban dust, cockroaches, and mold. Emmanuel is 5 years of age and has suffered from asthma for the last 2 years. One evening, his mother poured him some milk and put him to bed. Shortly afterward, Emmanuel woke up wheezing and coughing. As he gasped for air, he became more and more anxious. His mother ran for his inhaler, but he was too upset and restless to use it. Emmanuel’s skin became moist with sweat, and as he began to tire, his wheezing became quieter. His mother called 911 and waited anxiously for the ambulance to arrive.

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Student Name:

Emmanuel uses a corticosteroid inhaler for the management of his asthma. What is the mechanism of action of this drug? How is its action different from the β2-agonist inhalants?

Why does someone with severe asthma become physically fatigued during a prolonged attack? What are the physiological events that occur during an attack?

One of the complications of respiratory fatigue is the development of hypercapnia. How does the body compensate for an increase in CO2? What are the effects of hypercapnia on the central nervous system?

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Week 12: Respiratory Dysfunction

Welcome to Week 12. This week, we cover disorders of ventilation and gas exchange. In light of the large volume of content that you have had recently, this week should seem like a welcome relief. While some of this content is available in your textbook, the presented material follows the respiratory system and disorders associated with it, from anatomy through shunts and dead space, normal and abnormal breathing patterns, and signs and symptoms of pulmonary diseases.

Cellular hypoxia is reviewed, as well as whether O2 therapy is an effective treatment option. Alveolar to arterial gradients, and the disease states that lead to elevated alveolar to arterial gradients, are also reviewed. Finally, you should be able to describe and discuss other pulmonary conditions, including, but not limited to, edema, aspiration, atelectasis, bronchiectasis, bronchiolitis, pleural abnormalities (including pneumothorax and pleural effusion), and various obstructive and restrictive conditions. You should also be aware of the vascular, occupational, infectious, and suppurative diseases that affect the respiratory system.

Lesson 1: Disorders of Ventilation and Gas Exchange

The lengthy learning outcomes for this week follow directly from the presentation materials. You will learn pulmonary disease states concerning movement of air or blood flow (vascular diseases); inadequate lung, blood, or tissue oxygenation; as well as airway disorders and pleural abnormalities. Finally, you will need to be able to delineate obstructive and restrictive lung conditions.

Learning Outcomes

At the end of this lesson, you will be able to:

Disorders of Ventilation and Gas Exchange

Use your knowledge of the Fick equation to describe pathological conditions that reduce pulmonary diffusing capacity by increasing membrane thickness and decreasing surface area, or from disorders that alter ventilation

Understand the relationship between cardiac output and ventilation, and the relate these terms to the zonal distribution of ventilation (V) and blood flow (Q)

Shunts and Dead Space

Compare and contrast physiologic and anatomic shunts, and understand that cardiac defects can cause shunting of blood

Use your understanding of pulmonary volumes and capacities to describe clinically how pulmonary function tests can be used to diagnose obstructive or restrictive lung disorders

Compare and contrast anatomic, alveolar, and physiologic dead space, and understand how these may be altered in disease states

Breathing Patterns

Define a number of breathing patterns including eupnea, dyspnea, sigh breaths, Kussmaul respirations, labored breathing, restricted breathing, Cheyne-Stokes breathing, hypoventilation, and hyperventilation

Low Blood Oxygen or High Blood Carbon Dioxide levels

Define the terms hypoxemia and hypercapnia

List five generalized ways that hypoxemia can result (for example, decreased inspired oxygen). In addition, you should be able to describe conditions or diseases that produce each of the five ways that hypoxemia can occur

Describe the four ways that cellular hypoxia is produced

In each case of cellular hypoxia, the student should be able to determine if oxygen therapy would be useful as a treatment option

Pulmonary Disorders

Understand the clinical importance of the Alveolar (A) and arterial (a) gradients, and describe pathological conditions that result in elevated A-a gradients

Describe why carbon monoxide exposure causes significant pathological problems

Describe how pulmonary edema occurs, and how it is generally prevented

Compare and contrast bronchiectasis and bronchiolitis

Define the terms pleural effusion, empyema, and pleurisy

Compare and contrast open, tension, and spontaneous pneumothorax

Obstructive and Restrictive Pulmonary Disorders

Describe the three lung obstructive conditions, and realize that these conditions result in reducing oxygen diffusion by reducing airway diameter and/or surface area

List and understand the four causative conditions that lead to lung restrictive diseases, and understand that these conditions reduce gas exchange by increasing the diffusing distance by thickening the pulmonary membrane (interstitial fibrosis) or reducing the amount of air that can be brought into the lung (pneumothorax, scoliosis, multiple sclerosis)

Pulmonary Vascular Diseases

Describe the four conditions that are classified as pulmonary vascular diseases

Before attempting to complete your learning activities for this week, review the following learning materials:

Learning Materials

Read the following in your Porth’s Pathophysiology: Concepts of Altered Health States textbook:

Chapter 29, “Structure and Function of the Respiratory System”

Chapter 31, “Disorders of Ventilation and Gas Exchange”

Review the following presentation. Note: the video has no audio.

Pulmonary Review Presentation

Download the PowerPoint version of Pulmonary Review Presentation (PPT) if you require an accessible copy of the video.

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