Read the attached case study concerning the respiratory system and answer the associated questions. Be sure to cite all references used.
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Chapter 22: The Respiratory System
Case Story Summary
Cari, a 47-year-old female with a 20-year history of pack-a-day smoking and chronic bronchitis,
presents at the clinic complaining of a cold and potential sinus infection. She describes general
muscle aches, fatigue, sore throat, hoarseness of voice, and has a temperature of 101.2 and a
history of several weeks of flu-like symptoms.
Upon examination it is found that her respiratory rate is elevated and she has a low oxygen
saturation level. Her lung sounds are abnormal. A follow up chest x-ray reveals fluid infiltrate
within the lungs. A Grams stain reveals the presence of bacteria, resulting in a diagnosis of
Cari is initially unresponsive to the antibiotic therapy, but makes a full recovery after changing
therapies. Like many smokers, Cari has a hard decision to make: Continue smoking and risk
further infections, loss of respiratory function, emphysema, cancer, and chronic obstructive
lung disease, or quit.
Pneumonia may be caused by a variety of organisms including viruses, bacteria and
even fungi. Pneumococcal pneumonia is caused by streptococcus pneumoniae, a type
of bacteria. Typical symptoms include high fever, cough, shortness of breath, rapid
breathing and chest pains. Sometimes, nausea headache, and general muscle
soreness and fatigue may be present also. Pleural effusion may be seen on chest xrays and typically a culture of the patients sputum is obtained. See the DVD
accompanying the textbook for more information on smoking.
The mortality rate for this type of pneumonia is around 10%. Treatment may consist of
penicillin for non-resistant bacterial strains. Many resistant strains do exist however. In
these cases quinolone antibiotics may be administered (levofloxacin). Oxygen may be
administered to improve blood oxygen saturation levels. Constant and regular
monitoring of lung sounds is important and follow-up chest x-rays are usually advised
Chapter 22: The Respiratory System
Answers to Case Questions
1. How could an infection in Caris nasal passages and pharynx spread into the sinuses?
2. What sinuses lie over Caris eyes? (Hint: see paranasal sinuses on page 837)?
3. Which cells found within Caris mucous membranes are producing excess
amounts of mucus?
4. What is the cough reflex?
5. How might Caris hoarse voice be related to the upper respiratory tract infection? Which
structures found in the terminal bronchioles and alveoli normally would protect Caris
lungs from infectious pathogens and particulate matter?
6. Where is the base of Caris lung that the nurse is listening to?
7. What accessory muscles of respiration must Cari use to forcefully inspire air?
8. How would Caris the resistance of Caris airways be affected by the excess mucus and
fluid in her lung?
9. How would Caris lung compliance (the effort required to expand the lungs) be altered
as her alveoli fill with fluid due to pneumonia?
10. Caris respiratory rate is elevated; how does this alter her minute ventilation?
11. Cari has been given pure oxygen to breath; why would increasing the oxygen
concentration in the air she is breathing help Cari?
12. Normal blood oxygen saturation levels are greater than 94%; Caris blood oxygen
saturation level was 90% at the time of her exam and an initial arterial blood gas
analysis done when she was admitted to the hospital revealed her arterial PO 2 was 54
mm Hg. How would these clinical findings relate to internal respiration in Caris body?
The fluid in Caris lungs decreases her functional alveolar surface area; how is this
affecting Caris external respiration?
13. Which of the symptoms that Cari has described are due to lack of oxygen and reduced
oxygen exchange at her tissues?.
14. Why would Caris increased respiratory rate cause her to lose more CO2 than gain
15. Cari has been put on an artificial ventilation machine and she is still receiving oxygen;
how would increasing her PO2 assist hemoglobin in oxygen transport?.
16. As Caris PCO2 rose, how was the oxygen-carrying capacity of hemoglobin affected?
17. Caris fever is subsiding; how might her elevated body temperature have altered oxygen
transport in her body?
18. How would you have expected Caris decreased PCO2 and alkaline blood pH to have
affected her breathing?.
19. Why would a decrease in bicarbonate have caused Caris blood pH to rise?
20. How would administration of oxygen enhance Caris central drive to breath? Severe
oxygen deficiency depresses the activity of central chemoreceptors in the inspiratory
21. What is another name for Caris low blood PCO2 ? Hypocapnia.
22. Which anatomic structures in Caris respiratory system were initially involved?
23. Why was Cari plagued with a chronic smokers cough?
24. Which damaging effects of tobacco smoke led to Caris impaired respiratory defense
25. How did pneumonia affect Caris lung function?
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