An 18-year-old high school football player sustained a torn anterior cruciate ligament (ACL) in the state playoffs. After undergoing repair, he found it difficult to ambulate with the knee brace. Weighing close to 140 kg (~300 pounds), the athlete found it difficult to stand and balance on one leg. His mother was unable to support him by herself. After 1 week, the young man began to have increased pain and swelling in the calf of his affected leg. In the middle of the night, the teen called out to his mother, complaining of a shortness of breath and unexplained anxiety. His mother called 9-1-1, and he was taken to a local hospital. In the emergency department, he was diagnosed with a deep vein thrombosis and a pulmonary embolism. Oxygen and low-molecular-weight heparin were administered, and the young man was admitted to the intensive care unit. The patient is evaluated for multiple Pulmonary emboli. What risk factors and clinical findings are commonly associated with Pulmonary Emboli?
Required Textbook Readings
McCance, K.L., Huether, S.E., Brashers, V.L., Rote, N.S. (2019) Pathophysiology: The biologic basis for disease in adults and children. (8th ed.). Maryland Heights, MO: Mosby Elsevier
Please use apa7 citations and current information, and references
heres a chapter overview
Chapter 35: Structure and Function of the Pulmonary System Chapter Summary Review
Structures of the Pulmonary System
1. The pulmonary system consists of the two lungs, upper and lower airways, chest wall, diaphragm, and pulmonary and bronchial circulations.
2. Air is inspired and expired through the conducting airways, which include the nasopharynx, oropharynx, trachea, bronchi, and bronchioles to the sixteenth division.
3. Gas exchange occurs in structures beyond the sixteenth division: the respiratory bronchioles, alveolar ducts, and alveoli. Together these structures comprise the acinus.
4. The chief gas-exchange units of the lungs are the alveoli. The membrane that surrounds each alveolus and contains the pulmonary capillaries is called the alveolocapillary membrane.
5. The gas-exchange airways are served by the pulmonary circulation, a separate division of the circulatory system. The bronchi and other lung structures are served by a branch of the systemic circulation called the bronchial circulation.
6. The pulmonary circulation is innervated by the ANS, but vasodilation and vasoconstriction are controlled mainly by local and humoral factors, particularly arterial oxygenation and acid-base status.
7. Vasoconstriction of the pulmonary arterial system is caused by alveolar hypoxia, acidemia, and inflammatory mediators (histamine, serotonin, prostaglandins, and bradykinin).
8. The chest wall, which contains and protects the contents of the thoracic cavity, consists of the skin, ribs, and intercostal muscles, which lie between the ribs.
9. The chest wall is lined by a serous membrane called the parietal pleura; the lungs are encased in a separate membrane called the visceral pleura. The area where these two pleurae come into contact and slide over each another is called the pleural space.
Functions of the Pulmonary System
1. The pulmonary system enables oxygen to diffuse into the blood and CO2 to diffuse out of the blood.
2. Ventilation is the process by which air flows into and out of the gas-exchange airways.
3. Ventilation is involuntary most of the time. It is controlled by the respiratory center in the
brainstem and by the sympathetic and parasympathetic divisions of the ANS, which adjust airway caliber (by causing bronchial smooth muscle to contract or relax) and control the rate and depth of ventilation.
4. Neuroreceptors in the lungs (lung receptors) monitor the mechanical aspects of ventilation. Irritant receptors sense the need to expel unwanted substances and stretch receptors sense lung volume (lung expansion), and J-receptors sense alveolar size.
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Chapter Summary Review 35-2
5. Chemoreceptors in the circulatory system and brainstem sense the effectiveness of ventilation by monitoring the pH status of cerebrospinal fluid and the oxygen and carbon dioxide content of arterial blood (PaO2 and PaCO2).
6. Successful ventilation involves the mechanics of breathing: the interaction of forces and counterforces involving the muscles of inspiration and expiration, alveolar surface tension, elastic properties of the lungs and chest wall, and resistance to airflow.
7. The major muscle of inspiration is the diaphragm. When the diaphragm contracts, it moves downward in the thoracic cavity, creating a vacuum that causes air to flow into the lungs. There are no major muscles in expiration. Normal elastic recoil permits passive expiration.
8. The alveoli produce surfactant, created by type II alveolar cells. Surfactant is a lipoprotein that lines the alveoli. Surfactant reduces alveolar surface tension and permits the alveoli to expand more easily with air intake.
9. Elastic recoil is the tendency of the lungs and chest wall to return to their resting states after inspiration. The elastic recoil forces of the lungs and chest wall are in opposition and pull on each other, creating the normally negative pressure of the pleural space.
10. Compliance is a measure of lung and chest wall distensibility during inspiration. Lung compliance is determined by the adequate production of surfactant and the elastic recoil of the lungs and chest wall.
11. Airway resistance is determined by the length, radius, and cross-sectional area of the airways and by the density, viscosity, and velocity of the gas. Airway resistance is normally very low because of the large cross-sectional area of the lungs.
12. The work of breathing is determined by the muscular effort (i.e., the energy required to achieve adequate oxygenation) necessary for ventilation.
13. Gas transport depends on ventilation of the alveoli, diffusion across the alveolocapillary membrane, perfusion of the pulmonary and systemic capillaries, and diffusion between systemic capillaries and tissue cells.
14. Efficient gas exchange depends on an even distribution of ventilation and perfusion within the lungs. Ventilation and perfusion are greatest in the bases of the lungs because the alveoli in the bases are more compliant, and perfusion is greater as a result of gravity.
15. Almost all of the oxygen that diffuses into pulmonary capillary blood is transported by hemoglobin, a protein contained within red blood cells. The remainder of the oxygen is transported dissolved in plasma.
16. Oxygen enters the body by diffusing down the concentration gradient, from high concentrations in the alveoli to lower concentrations in the capillaries. Diffusion ceases when alveolar and capillary oxygen pressures equilibrate.
17. Oxygen is loaded onto hemoglobin by the driving pressure exerted by PaO2 in the plasma. As pressure decreases at tissue level, oxygen dissociates from hemoglobin and enters tissue cells by diffusion, again down the concentration gradient.
18. CO2 is more soluble in plasma than oxygen is and diffuses readily from tissue cells into plasma. CO2 returns to the lungs dissolved in plasma, transported as bicarbonate, or combined with blood proteins to form carbamino compounds (e.g., bound to hemoglobin).
Tests of Pulmonary Function
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Chapter Summary Review 35-3
1. Spirometry measures the volume and flow rate of air during forced expiration.
2. The alveolar-arterial oxygen gradient is used to evaluate the cause of hypoxia.
3. Diffusing capacity is a measure of the gas diffusion rate at the alveolocapillary
membrane.
4. Arterial blood gas analysis can be used to determine pH and oxygen and CO2
concentrations.
5. Thoracic imaging techniques are used to detect pulmonary disease and tumors, and to
evaluate disease progression.
Aging and the Pulmonary System
1. Aging affects the mechanical aspects of ventilation by decreasing chest wall compliance and elastic recoil of the lungs. Changes in these elastic properties reduce ventilatory reserve.
2. Aging causes loss of alveolar wall tissue and alveolar enlargement, thus diminishing the surface area available for gas diffusion.
3. Aging can cause the PaO2 level to decrease but does not affect the PaCO2 level.
4. Vital capacity decreases and residual volume increases with age; however, total lung
capacity remains unchanged.
Chapter 36: Alterations of Pulmonary Function Chapter Summary Review
Clinical Manifestations of Pulmonary Alterations
1. Dyspnea is a feeling of breathlessness and increased respiratory effort; it is associated with respiratory and cardiac diseases and causes distress. Orthopnea is dyspnea when a person is in the recumbent position and is associated with heart failure. Paroxysmal nocturnal dyspnea occurs at night and requires the person to sit or stand for relief.
2. Coughing is a protective reflex that expels secretions and irritants from the lower airways; the cough reflex is mediated by the vagus nerve.
3. Abnormal sputum is a change in the amount, consistency, color, and odor of sputum.
4. Hemoptysis is expectoration of bloody mucus that can be caused by bronchitis, TB,
abscess, neoplasms, and other conditions that cause hemorrhage from damaged vessels.
5. Abnormal breathing patterns are adjustments made by the body to minimize the work of
respiratory muscles. They include Kussmaul, obstructed, restricted, gasping, and/or
Cheyne-Stokes respirations, and sighing.
6. Hypoventilation is decreased alveolar ventilation caused by airway obstruction, chest
wall restriction, or altered neurologic control of breathing. Hypoventilation causes
increased PaCO2.
7. Hyperventilation is increased alveolar ventilation produced by anxiety, head injury, or
severe hypoxemia. Hyperventilation causes decreased PaCO2.
8. Cyanosis is a bluish discoloration of the skin caused by desaturation of hemoglobin,
polycythemia, or peripheral vasoconstriction.
9. Clubbing of the fingertips is associated with diseases that disrupt the normal pulmonary
circulation and cause chronic hypoxemia.
10. Chest pain can result from inflamed pleurae, the trachea, bronchi, or respiratory muscles.
11. Hypercapnia is an increased PaCO2 caused by a decrease in minute volume (respiratory
rate × tidal volume).
12. Hypoxemia is a reduced PaO2 caused by (a) decreased oxygen content of inspired gas, (b)
hypoventilation, (c) diffusion abnormality, (d) ventilation-perfusion mismatch, or (e)
shunting.
13. Acute respiratory failure is caused by inadequate gas exchange or ventilation (PaO2 ≤ 50
mmHg or PaCO2 ≥ 50 mmHg and pH ≥7.25).
Disorders of the Chest Wall and Pleura
1. If the chest wall is deformed, traumatized, immobilized, or made heavy by fat, the work of breathing is increased and ventilation is compromised by a decrease in tidal volume from compression of the lungs or impaired chest wall muscle function.
2. Flail chest results from rib or sternal fractures that disrupt the mechanics of breathing. Copyright © 2019, Elsevier Inc. All rights reserved.
Chapter Summary Review 36-2
3. Pneumothorax is the accumulation of air in the pleural space. It can be caused by spontaneous rupture of weakened areas of the pleura or can be secondary to pleural damage caused by disease, trauma, or mechanical ventilation.
4. Tension pneumothorax is a life-threatening condition caused by trapping of air in the pleural space.
5. Pleural effusion is the accumulation of fluid in the pleural space, usually resulting from disorders that promote transudation or exudation from capillaries underlying the pleura but occasionally resulting from blockage or injury that causes lymphatic vessels to drain into the pleural space.
6. Empyema is the presence of pus in the pleural space (infected pleural effusion). The source of the pus is usually lymphatic drainage from sites of bacterial pneumonia.
Pulmonary Disorders
1. Aspiration is passage of fluid and solid particles into the lung, usually from impaired swallowing and coughing. It frequently results in pneumonitis and pulmonary infection.
2. Atelectasis is the collapse of alveoli resulting from compression of the lung tissue, absorption of gas from obstructed alveoli, or impairment of surfactant.
3. Bronchiectasis is abnormal dilation of the bronchi usually secondary to another pulmonary disorder, usually infection or chronic inflammation.
4. Bronchiolitis is the inflammatory obstruction of small airways. It is most common in children.
5. Bronchiolitis obliterans organizing pneumonia is a complication of bronchiolitis obliterans in which the alveoli and bronchioles become filled with plugs of connective tissue.
6. Bronchiolitis obliterans syndrome is an inflammatory, fibrotic process that occurs as a complication of lung transplantation.
7. Pulmonary fibrosis is an excessive amount of connective tissue in the lung. It diminishes lung compliance and may be idiopathic or caused by disease; it results in decreased oxygen diffusion and hypoxemia.
8. Inhalation of noxious gases or prolonged exposure to high concentrations of oxygen can damage the bronchial mucosa or alveolocapillary membrane and cause inflammation or acute respiratory failure.
9. Pneumoconiosis is caused by inhalation of dust particles in the workplace, including coal dust (anthracosis), silica (silicosis), or asbestos. It causes chronic inflammation, pulmonary fibrosis, and susceptibility to lower airway infection and tumor formation.
10. Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is an allergic or hypersensitivity reaction to many allergens.
11. Pulmonary edema is the presence of excess water in the lung caused by disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability. A common cause is left-sided heart failure, which increases the hydrostatic pressure in the pulmonary circulation.
12. ALI/ARDS results from an acute, diffuse inflammatory injury to the alveolocapillary membrane and decreased surfactant production, which increases membrane permeability and causes pulmonary edema and atelectasis.
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Chapter Summary Review 36-3
13. Obstructive pulmonary disease is characterized by airway obstruction that causes difficult expiration. Obstructive disease can be acute or chronic and includes asthma, chronic bronchitis, and emphysema.
14. Asthma is a chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyperresponsiveness, mucosal edema, airway constriction, and variable obstruction to airflow that is reversible. Obstruction is caused by episodic airway epithelial exposure to antigen with attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased production of mucus.
15. COPD is the coexistence of two primary phenotypes, chronic bronchitis and emphysema, which frequently overlap each other.
16. The asthma-COPD overlap syndrome is a phenotype of chronic respiratory disease where there is an overlap of the clinical symptoms of asthma and COPD.
17. Chronic bronchitis is chronic inflammation of the bronchi that causes airway obstruction resulting from bronchial smooth muscle hypertrophy, increases in the size and number of epithelial mucous glands and goblet cells, and increased production of thick, tenacious mucus.
18. Emphysema results from destruction of elastin in the alveolar septa and loss of passive elastic recoil, leading to airway collapse, obstruction to gas flow during expiration, and air trapping.
19. Emphysema in which septal deterioration is caused by α1-antitrypsin deficiency or old age tends to be panacinar.
20. Emphysema in which septal deterioration results from smoking tends to be centriacinar.
21. Paraseptal emphysema is associated with large bullae formation.
22. Upper respiratory tract infections are the most common cause of short-term disability in
the United States and include rhinitis (the common cold), pharyngitis, and laryngitis.
23. Serious lower respiratory tract infections, which occur most often in older adults and
individuals with impaired immunity or underlying disease, include pneumonia and
tuberculosis.
24. Acute bronchitis is acute infection or inflammation of the large airways or bronchi; it is
usually self-limiting and caused by viruses.
25. Pneumonia is an infection of the lower respiratory tract and can be categorized as
community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), or
ventilator-associated (VAP).
26. Pneumococcal pneumonia is an acute lung infection resulting in an inflammatory
response with four phases: (a) consolidation, (b) red hepatization, (c) gray hepatization,
and (d) resolution.
27. Viral pneumonia is an acute, self-limiting lung infection usually caused by the influenza
virus.
28. TB is a lung infection caused by M. tuberculosis (tubercle bacillus) and can also invade
other organs. The bacterium is successful as a pathogen because it can survive within macrophages, resist lysosomal killing, multiply within the cell, and transit into a stage of dormancy rendering itself extremely resistant to host defense and drug treatment.
29. Bacilli may remain dormant within the tubercles for life; or if the immune system becomes compromised, they may cause recurrence of active disease.
30. Abscesses are circumscribed areas of destruction of lung parenchyma with suppuration usually resulting from aspiration pneumonia.
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Chapter Summary Review 36-4
31. Acute bronchitis is acute infection or inflammation of the airways or bronchi usually caused by a virus.
32. Pulmonary vascular diseases are caused by embolism or hypertension in the pulmonary circulation.
33. PE is occlusion of a portion of the pulmonary vascular bed by a thrombus (most common), a tissue fragment, or an air bubble. Depending on its size and location, the embolus can cause hypoxic vasoconstriction, pulmonary edema, atelectasis, pulmonary hypertension, shock, and even death.
34. Pulmonary artery hypertension (pulmonary artery pressure) is defined as a mean pulmonary artery pressure greater than 25 mmHg at rest. It is caused by (a) elevated left ventricular pressure, (b) increased blood flow through the pulmonary circulation, (c) obliteration or obstruction of the vascular bed, or (d) active constriction of the vascular bed produced by hypoxemia or acidosis.
35. Cor pulmonale is right ventricular enlargement caused by chronic pulmonary hypertension. Cor pulmonale progresses to right ventricular failure if the pulmonary hypertension is not reversed.
36. Laryngeal cancer occurs primarily in men and represents less than 1% of all cancers. Squamous cell carcinoma of the true vocal cords is most common and manifests with a clinical symptom of progressive hoarseness.
37. Lung cancer, the most frequent cause of cancer death in the United States, is commonly caused by smoking of cigarettes or tobacco.
38. Cancer cell types include non-small cell lung cancer (squamous cell carcinoma, adenocarcinoma, large cell undifferentiated carcinoma) and neuroendocrine tumors (small cell carcinoma and bronchial carcinoid tumors). Other tumors include small cell (oat cell) carcinoma, bronchial adenoma, adenocystic tumors (cylindromas), mucoepidermoid carcinomas (bronchial tumors), and mesothelioma. Each type arises in a characteristic site or type of tissue, causes distinctive clinical manifestations, and differs in likelihood of metastasis and prognosis.

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