PATHOPHYSIOLOGIC RESPONSE
TO
RESPIRATORY DYSFUNCTION
A. Hypoxia
1. Hypoxia refers to inadequate cellular oxygena-
tion.
2. It may result from;
a. Insufficient oxygen intake
b. Insufficient perfusion of oxygen in the
pulmonary system or the peripheral or-
gans and tissues
c. Inability of blood to transport oxygen
d. Insufficient oxygen-carrying capacity of
the blood, which would occur with low
levels of hemoglobin
B. Cyanosis: a bluish discoloration of the skin indicat-
ing hypoxia; it result when oxygenation does not oc-
cur and carbon dioxide does not leave the blood.
C. Dyspnea: difficult breathing. May occur as the need
for oxygen exceeds the supply.
D. Increased work of breathing: occurs when energy
expenditure for respirations is excessive and great ef-
fort is required for breathing.
E. Tachypnea: rapid breathing with respiratory rates
higher than 24 to 26 breaths per minute.
F. Cough:
a. An effective cough allows the body to expel
excessive mucus, keeping the airway clear.
b. An effective cough compromises airway
clearance by preventing mucus from being
expelled.
c. Along with the mucocilliary system, cough
is a defensive mechanism of the respiratory
system.
G. Adventitious breath sounds
a. As fluid and mucus accumulate, abnor-
mal breath sounds can be heard.
b. Fluid is heard as rales (crackles); mucus is
heard as rhonchi (gurgles).
H. Clubbing of fingers
a. Clubbing is an increase in the normal angle
between the nail and its base (from 160° to
180° or more).
b. It usually is accompanied by a softening of
the nail base.
I. Fatigue: feelings of tiredness and exhaustion that
usually result when energy requirements for breath-
ing become excessive.
J. Pain
a. May or may not present
b. Pain due to rib-cage injury, infection, or
chest surgery may cause hypoventilation.
K. Hypoventilation
a. Hypoventilation refers to a ventilation
rate that is insufficient to meet the body’s
metabolic needs.
b. It may result in respiratory acidosis because
the acid (carbon dioxide) is not removed
when ventilation is decreased.
L. Hyperventilation
a. Hyperventilation refers to a ventilation
rate that exceeds the body’s metabolic
needs.
b. It may result in respiratory alkalosis because
acids (carbon dioxide) are eliminated in ex-
cessive amounts, leaving excess base (bicar-
bonate) in the blood.
M. Respiratory acidosis
a. This condition is commonly caused by hy-
poventilation, which reduces elimination
of carbon dioxide (CO2), leaving too much
acid in the serum, revealing a low pH.
b. The renal system tries to compensate by re-
taining HCO3 to buffer the acid, moving the
pH toward neutral; this occurs over a period
of many hours to days.
c. Arterial blood gas (ABG) values reveal a
low pH, a high CO2, and a normal HCO3
when renal compensatory mechanisms are
not in place.
N. Respiratory alkalosis
a. This condition is commonly caused by hy-
perventilation, which increases the re-
moval of carbon dioxide, leaving too
much base (HCO3) in the serum, reveal-
ing a high pH.
b. The renal system tries to compensate by in-
creasing HCO3 elimination in order to main-
tain the balance of HCO3 to CO2, thus mov-
ing th pH toward neutral; this occurs over a
period of many hours to days.
c. ABG values reveal a high pH, a low Co2 and
a normal to high HCO3 when renal com-
pensatory mechanisms are not in place.
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