Discussion 12.1: Disorders of Ventilation and Gas Exchange Essay

Discussion 12.1: Disorders of Ventilation and Gas Exchange Essay

Discussion 12.1: Disorders of Ventilation and Gas Exchange Sample Essay

1. How would you describe to these clinicians the physiology that plays a vital role in the development of these diseases?

Cor pulmonale is described as alterations to the function and structure of the heart’s right ventricle that is caused by a main respiratory system disease that leads to pulmonary arterial hypertension (Creel-Bulos et al., 2020). On the other hand, a pulmonary embolism is a sudden obstruction of your pulmonary arteries, which are the blood vessels that carry blood to your lungs (Osakwe & B. Das, 2022). A severe pulmonary embolism is the most common cause of sudden cor pulmonale. When deep venous thrombosis progresses, loose clots may enter the pulmonary arteries and migrate through the circulatory system to the heart’s right side, partially or fully blocking one or more vessels. The severity of the effects depends on the size and quantity of emboli, the underlying lung function, the right ventricular function, and the capacity of the body’s intrinsic thrombolytic system to destroy the clots. A massive pulmonary embolism may resemble myocardial infarction with elevated troponins, ST abnormalities, chest pain, and breathlessness.    

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1. What factors do you think are most important for them to know as they treat patients? Can one contribute to the formation of the other?

Identification of patients with a high risk of pulmonary embolism and the reduction of the chance that any patient would develop cor pulmonale from a PE are two of the nurse’s most important responsibilities (Ali et al., 2020). It’s crucial to keep in mind that a large pulmonary embolism is the most common cause of sudden cor pulmonale.

The primary goal of treatment is to address the underlying problem; this is done by enhancing RV contractility and reducing pulmonary vasoconstriction, which improves oxygenation and function of the right ventricles. Oxygen treatment reduces hypoxemic pulmonary vascular constriction, which increases cardiac output, decreases sympathetic vasoconstriction, reduces tissue hypoxemia, and enhances renal perfusion  (Stein et al., 2020). In individuals with chronic cor pulmonale, diuretics are used to reduce the high right ventricular filling volume. The use of cardiac glycosides such as digitalis in individuals with cor pulmonale has so far been contentious, and the therapeutic impact of these medicines is not as clear as it is in patients with left heart failure. Nevertheless, investigations have proven that digitalis has little effect on the failing right ventricle in individuals with chronic cor pulmonale.

References

Ali, S., Mathew, S., & Pappachan, J. M. (2020). Acute cor pulmonale from saddle pulmonary embolism in a patient with previous COVID-19: should we prolong prophylactic anticoagulation? International Journal of Infectious Diseases, 97, 299–302. https://doi.org/10.1016/j.ijid.2020.06.039

Creel-Bulos, C., Hockstein, M., Amin, N., Melhem, S., Truong, A., & Sharifpour, M. (2020). Acute Cor Pulmonale in Critically Ill Patients with Covid-19. New England Journal of Medicine, e70. https://doi.org/10.1056/nejmc2010459

Osakwe, O., & B. Das, B. (2022). Successful Pulmonary Endarterectomy after Acute Pulmonary Embolism and Reversal of Acute Cor Pulmonale in an 11-Year-Old Boy with Nephrotic Syndrome. Children, 9(10), 1444. https://doi.org/10.3390/children9101444

Stein, P. D., Matta, F., & Hughes, M. J. (2020). Catheter-Directed Thrombolysis in Submassive Pulmonary Embolism and Acute Cor Pulmonale. The American Journal of Cardiology, 131, 109–114. https://doi.org/10.1016/j.amjcard.2020.06.048

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Introduction

You are the education coordinator at a local hospital. You have been asked to give a presentation to the hospital nurses on embolisms and cor pulmonale.

Discussion Guidelines

Initial Post

In your initial post, answer the following questions:

1. How would you describe to these clinicians the physiology that plays a vital role in the development of these diseases?
2. What factors do you think are most important for them to know as they treat patients? Can one contribute to the formation of the other?

Response Post(s)

Reply to at least two of your classmates’ initial posts by Sunday.

Submission

Post your initial and follow up responses and review full grading criteria on the Discussion 12.1: Disorders of Ventilation and Gas Exchange page.

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

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Pulmonary Review Presentation

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

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.

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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.

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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:

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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”