Sample Answer for NUR-631 Topic 11 DQ 1 Included After Question

Answer both of the following questions for your discussion response using the “Discussion Forum Sample.”

Explain the differences between restrictive and obstructive respiratory disorders. Choose one disorder for each and explain the pathophysiological changes seen and alterations in pulmonary function tests that aid diagnosis.

Explain the manifestations of congenital pulmonary disorders seen in children.

A Sample Answer For the Assignment: NUR-631 Topic 11 DQ 1

Title: NUR-631 Topic 11 DQ 1

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Obstructive and restrictive lung diseases are two distinct respiratory disorders with different presentations and manifestations. Restrictive respiratory disorders are characterized by limited lung expansion, leading to impaired ventilation and decreased lung compliance (Krueter et al., 2021). One example of a restrictive lung disease is pulmonary fibrosis, which causes progressive scarring and hampers the ability of lung tissue to expand. This reduced expansion results in impaired ventilation and compromised gas exchange.

On the other hand, obstructive respiratory disorders arise from the narrowing of the airways, which also leads to impaired ventilation. Chronic obstructive pulmonary disease (COPD) is one example of an obstructive respiratory disorder. The airway narrowing in COPD can worsen over time and give rise to various complications necessitating medications and high levels of oxygen.

Pulmonary function tests (PFTs) play a crucial role in diagnosing and assessing the severity of these disorders. In obstructive disorders like COPD, PFTs typically reveal decreased expiratory volume due to airway narrowing, as well as reduced vital capacity (Koo et al., 2019). In pulmonary fibrosis, PFTs demonstrate reduced lung volumes and capacity, reflecting the limited ability of the lungs to expand appropriately.

Explain the manifestations of congenital pulmonary disorders seen in children.

There are various congenital pulmonary disorders that affect children, each with distinct presentations. The specific disorders and their severity determine the observed symptoms and required treatment. While some patients may exhibit symptoms from birth, the majority of these patients become symptomatic during their teenage years. Typical symptoms can range from respiratory distress with cyanosis, wheezing, cough, feeding difficulties, and failure to thrive. Common complications include pneumonia, spontaneous pneumothorax, and congenital emphysema (Nadeem et al., 2012). Congenital pulmonary disorders often require a multidisciplinary approach involving pediatric pulmonologists, pediatric surgeons, and other specialists to provide comprehensive care.

Koo, H. J., Lee, S. M., Seo, J. B., Lee, S. M., Kim, N., Oh, S. Y., Lee, J. S., & Oh, Y. M. (2019). Prediction of Pulmonary Function in Patients with Chronic Obstructive Pulmonary Disease: Correlation with Quantitative CT Parameters. Korean journal of radiology, 20(4), 683–692. https://doi.org/10.3348/kjr.2018.0391

Kreuter, M., Ladner, U. M., Costabel, U., Jonigk, D., & Heussel, C. P. (2021). The Diagnosis and Treatment of Pulmonary Fibrosis. Deutsches Arzteblatt international, 118(Forthcoming), 152–162. Advance online publication. https://doi.org/10.3238/arztebl.m2021.0018

Nadeem, M., Elnazir, B., & Greally, P. (2012). Congenital pulmonary malformation in children. Scientifica, 2012, 209896. https://doi.org/10.6064/2012/209896

When evaluating COPD patients, some of the presenting symptoms can give the practitioner clues to whether it is chronic bronchitis or emphysema. Productive cough tends to be a sign of chronic bronchitis, while it is a late sign of emphysema (McCance & Huether, 2018). Barrel chest is a classic sign of emphysema while cyanosis is common with chronic bronchitis. As practitioners, using these symptoms can be helpful in administering the most helpful treatment possible for our patients.

References

McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.

Barrel chest happens when the lungs become overfilled (hyperinflated) with air — like a balloon — as they work harder. This keeps the rib cage open or expanded for a long time. This happens most often because of a chronic lung condition, but other diseases and conditions may cause it as well

Restrictive Respiratory Disorders:

A restrictive respiratory disorder is characterized by a reduced ability of the lungs to expand and fill with air, thereby limiting the total lung capacity. It can be caused by various factors, such as lung tissue scarring, stiffness, or weakness of the respiratory muscles. As a result, the lungs are unable to adequately inflate and exchange gases.

Example Disorder: Idiopathic Pulmonary Fibrosis-

Pathophysiological Changes: Idiopathic Pulmonary Fibrosis is a chronic, progressive lung disease where the lung tissue becomes progressively scarred and stiff. This scarring is believed to be a result of abnormal healing responses to lung injuries, although the exact cause is unknown. Over time the scar tissue accumulates replacing healthy lung tissue and reducing the lung’s ability to expand.

Alterations in Pulmonary Function Tests: Pulmonary function tests (PFTs) help diagnose and assess restrictive respiratory disorders like IPF. In IPF, the key alterations observed in PFTs include: Reduced Total Lung Capacity (TLC): TLC measures the maximum amount of air the lungs can hold. In IPF, it is typically decreased due to reduced lung expansion.

Decreased Forced Vital Capacity (FVC): FVC is the maximum amount of air forcefully exhaled after a full inhalation. It is reduced in IPF due to the limited lung capacity.

Reduced Diffusing Capacity for Carbon Monoxide (DLCO). In IPF, DLCO is often reduced due to the destruction of the lung’s gas exchange surface area.

Obstructive Respiratory Disorders:

Obstructive respiratory disorders involve an obstruction or narrowing of the airways making it difficult to exhale air effectively. These conditions are often characterized by increased airway resistance, trapping of air, and hyperinflation of the lungs.

Example Disorder: Chronic Obstructive Pulmonary Disease (COPD)-

Pathophysiological Changes: COPD is typically caused by long-term exposure to irritating substances, such as cigarette smoke or occupational pollutants. The main pathophysiological changes in COPD include chronic inflammation, bronchoconstriction, and emphysema.

Alterations in Pulmonary Function Tests: Pulmonary function tests are crucial for diagnosing and monitoring COPD. The following changes are commonly observed:

Decreased Forced Expiratory Volume in 1 second (FEV1): FEV1 measures the maximum amount of air forcefully exhaled in the first second. In COPD, it is significantly reduced due to the obstruction of airways. Decreased FEV1/FVC Ratio: The ratio of FEV1 to Forced Vital Capacity (FVC) is decreased in COPD. This indicates difficulty in exhaling air rapidly, suggesting airway obstruction.

Increased Residual Volume (RV): RV is the amount of air remaining in the lungs after maximal exhalation. In COPD, RV is increased due to air trapping and difficulty in fully emptying the lungs.

Decreased Diffusing Capacity for Carbon Monoxide (DLCO): Similar to restrictive disorders, DLCO can be reduced in COPD due to emphysematous changes and destruction of the lung’s gas exchange surface area.

Congenital pulmonary disorders are a group of respiratory conditions that are present from birth and affect the structure and function of the lungs. These disorders can range from mild to severe and can have various manifestations in children. Here are some common congenital pulmonary disorders and their associated manifestations: Congenital Diaphragmatic Hernia (CDH):

CDH occurs when there is a hole or defect in the diaphragm, allowing abdominal organs to move into the chest cavity. This condition can lead to compression and underdevelopment of the lungs. Manifestations may include:

Respiratory distress: Infants with CDH often experience severe respiratory distress shortly after birth, characterized by rapid breathing, retractions, and cyanosis.

Scaphoid abdomen: Due to the presence of abdominal organs in the chest cavity, the abdomen may appear sunken or concave.

Unequal breath sounds: The affected side of the chest may have reduced breath sounds compared to the unaffected side.

Congenital Pulmonary Airway Malformation:

CPAM is a condition where abnormal lung tissue develops, leading to cystic or solid masses in the lung. The manifestations can vary depending on the size and location of the malformation. Some common manifestations include:

Respiratory distress: Infants with large CPAM lesions may experience respiratory distress shortly after birth, similar to CDH. Smaller lesions may be asymptomatic.

Recurrent respiratory infections: Children with CPAM may have a higher risk of developing respiratory infections, such as pneumonia, due to the presence of abnormal lung tissue.

Respiratory symptoms: Depending on the size and location of the lesion, children may experience symptoms like cough, wheezing, or recurrent respiratory symptoms.

Hi Joe. Another restrictiive lung disorder is atelectasis. This disorder tends to occur after surgery, especially in individuals under general anesthetics. Postoperative individuals are often in pain, breathe shallowly, are reluctant to change position, and produce viscous secretions that tend to pool in dependent portions of the lung, particularly those who have surgical procedures involving the thorax or upper abdomen. Atelectasis increases pulmonary shunt, decreases compliance, and may lead to perioperative hypoxemia (Brashers & Huether, 2019).

References:

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.

1.      Explain the differences between restrictive and obstructive respiratory disorders. Choose one disorder for each and explain the pathophysiological changes seen and alterations in pulmonary function tests that aid diagnosis.

Restrictive lung disorders are distinguished by decreased lung tissue compliance. These increases breathing labor because it takes more effort to inflate the lung during inspiration (McCance & Huether, 2019). Dyspnea increased respiratory rate, and increased tidal volume are all symptoms of restrictive lung illness (McCance & Huether, 2019). In pulmonary fibrosis, scarring in the lung tissue leads the lungs to “stiffen,” resulting in increasing and significant dyspnea with exertion. The spirometry findings show a decrease in both FEV1 and FVC, but the FEV1/FVC ratio is normal and over 70% due to no airway restriction. Restrictive lung volumes are also evident in situations where the chest wall is unable to expand normally, such as obesity, kyphoscoliosis, or conditions resulting in weak respiratory muscles, such as myasthenia gravis or muscular dystrophy.

Obstructive Lung Disease

Obstructive lung disease constricts the airways, making it difficult to exhale quickly and reducing the FEV1/FVC ratio. When a person with acute asthma is susceptible to specific inhalants, such as pollen, house dust mites, or pet dander, their airways can abruptly contract in response to a trigger, which may be temporary (Christenson et al., 2022). Long-term damage to the airways in chronic obstructive illnesses such as emphysema creates permanent and irreversible constriction that does not react well to inhaled therapy, resulting in long-term symptoms of dyspnea that increase with time. Symptoms may return to normal with the appropriate treatment. When the lungs expand or hyperinflate, the work of breathing rises.

2.      Explain the manifestations of congenital pulmonary disorders seen in children.

Congenital lung problems, also known as cystic lung disease or congenital lung deformities, develop while the infant is still in the womb of its mother. Prenatal ultrasounds are used to detect many congenital lung diseases. Approximately 10% of congenital lung diseases are diagnosed before birth, with the remaining 14% appearing by the age of 15. Congenital lung diseases are typically detected during routine prenatal ultrasounds. If your baby’s life is not in danger, doctors will use ultrasounds, MRIs, or echocardiograms to monitor her status in the womb(McCance & Huether, 2019)..

Christenson, S. A., Smith, B. M., Bafadhel, M., & Putcha, N. (2022). Chronic obstructive pulmonary disease. Lancet (London, England), 399(10342), 2227–2242. https://doi.org/10.1016/S0140-6736(22)00470-6

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier. 

Sample Answer for NUR-631 Topic 11 DQ 1 Included After Question

A Sample Answer For the Assignment: NUR-631 Topic 11 DQ 1

Title: NUR-631 Topic 11 DQ 1

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