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Fundamentals Of Respiratory Care > 1110 FINAL (FRC) > Flashcards

1110 FINAL (FRC) Flashcards

1
Q

Ventilation?

A

Ventilation is the process of gas exchange, moving gases in and out of the lungs.

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2
Q

Transrespiratory Pressure? (PTR)

A

Everything that exists between pressure measured at airway opening (PAO) and pressure measured at body surface (PBS)

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3
Q

Transrespiratory Pressure formula?

A

PTR=PAO-PBS

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4
Q

Transrespiratory Pressure is responsible for?

A

This gradient causes gas flow in and out of the lungs (alveoli) during breathing.

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5
Q

Transpulmonary Pressure Difference (PTP)?

A

Pulmonary system (airways and alveolar region)
Established by opposing lung and thorax recoil and is responsible for maintaining alveolar inflation.

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6
Q

Transpulmonary Pressure difference formula?

A

PTP=PAO-PPL

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7
Q

Transthoracic pressure difference (PTT)?

A

Total pressure required to expand or contract the lungs and chest wall together.

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8
Q

Transthoracic Pressure difference formula?

A

PTT=PA-PBS

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9
Q

What are the forces that must overcome to allow inspiration?

A

Movement of tissues
Elasticity forces
Airway Resistance (RAW)
-RAW: The impedance to ventilation caused by the movement of gas through the conducting airways to the lungs.
Surface tension forces

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10
Q

Why does lung recoil occur?

A

Due to tissue elasticity and surface tension.

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11
Q

What is pulmonary surfactant?

A

Pulmonary surfactant reduces lung surface tension in the alveoli.

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12
Q

What are the factors that make up pulmonary surfactant?

A

Produced in alveolar type II pneumocytes.
Surfactant stabilizes alveoli by preventing collapse.
When surface area decreases, ability of pulmonary surfactant to lower surface tension increases.

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13
Q

Pulmonary pathology alters ___?

A

Lung compliance. (CL)

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14
Q

What diseases increase lung compliance?

A

Emphysema, obstructive lung diseases increases lung compliance. (Loss elastic tissue fibers, lungs less distensible, termed hyperinflation.)
Large changes in volume for small pressure changes.

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15
Q

Fibrosis, restrictive lung diseases__?

A

Decreases CL (gain elastic tissue, lungs less distensible, termed hypoinflation.
Small volume change for any change in pressure.
Stiffer lungs, usually with reduced volume.

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16
Q

Airway Resistance.

A

Impedance to ventilation caused by the movement of gas though the conducting systems of the lungs.

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17
Q

R=🔺P/🔺V

A

Change in pressure/Change in flow

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18
Q

Approximately how much of the resistance to gas flow occurs in the nose, mouth, and large airways, where flow is mainly turbulent?

A

Approximately 80% of the resistance to gas flow occurs in the nose, mouth, and large airways, where flow is mainly turbulent.

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19
Q

Approximately how much of the total resistance to flow is attributable to airways smaller than 2mm in diameter?

A

Approximately 20% of the total resistance to flow is attributable to airways smaller than 2mm in diameter and flow is mainly laminar.

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20
Q

In healthy lungs ___?

A

Neither ventilation (V) or perfusion (Q) are distributed evenly.

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21
Q

Ventilation and perfusion are matched best at?

A

In upright lung, ventilation and perfusion (V/Q) are matched best at bases (dependent area)

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22
Q

Regional factors affecting the distribution of gas in the normal lung result in ??

A

More ventilation going to the bases and lung periphery.

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23
Q

Apical alveoli are larger but harder to ventilate compared to those at bases.

A

During normal inspiration alveoli at the apexes expand less than those at the bases.
Gravity pulls more blood to bases.

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24
Q

What is anatomic dead space?

A

Gas left in conducting airways after inspiration.

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25
What is alveolar dead space?
Alveoli that are ventilated but have no perfusion.
26
Physiologic dead space= __?
Physiologic dead space= sum of anatomic and alveolar dead space. The larger the dead space, the less efficient the tidal volume will be in eliminating CO2.
27
What is alveolar ventilation?
Amount of fresh gas reaching alveoli per minute. It is determined by VT, dead space, fB (RR).
28
What is Deadspace ventilation?
Gas that is wasted during normal ventilation.
29
Alveolar ventilation equation?
VA=(VT-VD)xfb
30
1lb of IBW= __?
1ml of anatomic Dead-space.
31
Normal VD/VT ratio is _?
30% (range of 0.2-0.4) Normal physiologic deadspace is approximately 1/3 of the Vt.
32
Hyperventilation occurs?
Hyperventilation occurs when ventilation exceeds metabolic need,hyperventilation is defined as a decrease in blood carbon dioxide levels PaCO2<35mmHg
33
Hypoventilation occurs when?
Hypoventilation occurs when ventilation is insufficient to meet metabolic needs, Hypoventilation is defined as a elevated blood carbon dioxide level PaCO2>45mmHg.
34
What is the best indicator of adequate effective ventilation? 😮‍💨🤌🏽
The best indicator of adequate effective ventilation is PaCO2, which is the particle pressure of arterial CO2 or arterial CO2 gas tension.
35
What is the normal range for PaCO2?
35-45mmHg (40) is dead normal.
36
What does the medullary respiratory center make up?
These form dorsal and ventral respiratory groups.
37
What is the Dorsal respiratory groups neurons (DRG)?
Composed mainly of inspiratory neurons located bilaterally in the medulla. These neurons send impulses to motor nerves of the diaphragm and external intercostal muscles.
38
Which nerves bring sensory impulses to the DRG neurons?
Vagus and glossopharyngeal nerves bring sensory impulses to DRG from lungs, airways, peripheral chemoreceptors, and joint proprioceptors. -Input modifies breathing pattern.
39
What is the ventral respiratory group neurons? (VRG)
VRG neurons contain both inspiratory and expiratory neurons located bilaterally in the medulla.
40
Where does the VRG neurons send inspiratory impulses to?
Laryngeal and pharyngeal muscles. Diaphragm and external intercostals.
41
Where does the VRG neurons send expiratory impulses to?
Other VRG neurons send expiratory signals to the abdominal muscles and internal intercostals.
42
Pons modify what?
Pons modifies output of medullary centers that are located in the pons of the brain stem.
43
What are the two pontine centers?
Apneustic and pneumotaxic.
44
What is the apneustic center?
Functions only identified by cutting connection to medullary centers.
45
What is apneustic breathing?
Characterized by long, gasping inspirations interrupted by occasional expirations.
46
What is the pneumotaxic center?
Controls “switch-off“, so it controls the inspiratory time (IT).
47
What is the Hering-Breuer inflation reflex?
Lung distention causes stretch receptors to send inhibitory signals to DRG, stopping further inspiration. Regulates rate and depth of breathing during moderate to strenuous exercise. In adults active only o large Vt >800ml (high lung volumes).
48
What is the deflation reflex?
Sudden lung collapse results in hyperpnea as seen in pneumothoraces, causes a strong inspiratory effort.
49
Irritant receptors?
Cause bronchospasm, cough, sneeze, tachypnea, and narrowing of glottis.
50
J-receptors are stimulated by?
Pneumonia, CHF, and pulmonary edema.
51
What are Peripheral proprioreceptors?
Found in muscles, tendons, joints, and pain receptors. Movement stimulates hypernea. Moving limbs, pain, and cold water all stimulate breathing in patients with respiratory depression.
52
Where are the Peripheral chemoreceptors located?
Located in the aortic arch and bifurcations of common carotid arteries.
53
Peripheral chemoreceptors respond to?
Increased PaCO2 and (H+)
54
Whole-body diffusion gradients?
Gas moves across system by simple diffusion or gaseous diffusion. This is the movement of gases between the lungs and the body tissue.
55
What is alveolar carbo dioxide? (PACO2)
The alveolar partial pressure of CO2 (=PACO2) varies directly proportional to whole-body’s production of CO2 (VCO2) and not directly proportional to alveolar ventilation . (VA)
56
What can lead to an increased PACO2?
An increase in dead space, the portion of inspired air that is exhaled without being exposed to perfumed alveoli, can also lead to an increased PACO2.
57
How does PACO2 decrease?
If CO2 production decreases of alveolar ventilation increases.
58
What is alveolar oxygen tensions? (PAO2)
PiO2 is primarily determinant for PAO2 PiO2 is the partial pressure of inspired oxygenated gas.
59
Normal Alveolar Gas Tensions PAO2=_?
100mmHg
60
Normal alveolar gas tensions PACO2=_?
40mmHg
61
Normal alveolar gas tensions PAH20=_?
47 mmHg
62
Normal alveolar gas tensions PAN2=_?
573mmHg
63
Normal alveolar gas tensions AGT=_?
760 mmHg (AGT and atmospheric pressures both equal 760 mmHg)
64
What are the only changes that will be seen in O2 and CO2?
Constant FiO2, PAO2 varies inversely with PACO2 if there is a rise in CO2 it will cause a fail in O2 equally. Prime determinants of PACO2 is VA (alveolar ventilation).
65
The sum of PAO2, and PACO2 equals?
140 mmHg on (RA) and at sea level (760 mmHg)
66
An increase in VA will ?
Decrease PACO2and increase PAO2 equally.
67
A pt on RA (FiO2 21%) at sea level cannot have a ?
PaO2 > (greater than) 120 mmHg (Normal range 110-120 mmHg)
68
A pt on FiO2 at sea level can have a ?
PaO2 level of approximately 670 mmHg.
69
PaO2 normally 5-10 mmHg less than PAO2 due to ?
Anatomic shunts or diffusion defects in a young healthy adult breathing room air.
70
When ventilation is increased in the lung bases what happens to the alveoli at the apexes?
Causing alveoli at the apexes to expand less than those at the bases.
71
What happens at the bases of the lung?
Blood flow is greater than ventilation. Resulting in a lower PO2 and slightly higher PCO2. Causing the V/Q to be lower than average.
72
How are most O2 transported?
In chemical combination with Hb in the erythrocytes. (RBC)
73
(HB) Hemoglobin is the most?
Important component in the transport system.
74
What are the normal values for SaO2?
95%-100%
75
What is the total content of blood?
Equals the sum of O2 dissolved in plasma and chemically combined/bound to the Hb.
76
What is the normal values for total oxygen content of blood?
16-20ml/dl
77
Increased affinity
Increases pH (alkalosis) Decreases PCO2 Decreases body temperature Decreases 2,3 DPG levels
78
Decreased affinity
Decreases pH (acidosis) Increases PCO2 Increases body temperature Increases 2,3 DPG levels
79
Without 2,3 DPG ?
Hb affinity is so great that O2 cannot unload
80
When 2,3 DPG level curve to the right?
Promotes O2 unload.
81
When 2,3 DPG curves to the left?
Promotes unloading.
82
What is P50?
P50 is the partial pressure of O2 at which the Hb is 50% saturated, standardized to a pH level of 7.40.
83
What is the normal value for P50?
26.6 mmHg
84
Increased p50=?
Decreases in Hb affinity for O2 (shifts the HbO2 curve to the right.)
85
Decreased P50=?
Increase in Hb affinity for O2. (Shifts the HbO2 to the left)
86
PaO2 (Hypoxemia) 80-100mmHg
Normal
87
PaO2 (Hypoxemia) 60-79 mmHg
Mild Hypoxemia
88
PaO2 (Hypoxemia) 40-59 mmHg
Moderate hypoxemia
89
PaO2 (Hypoxemia) <40 mmHg
Severe Hypoxemia
90
CaO2 (Hypoxemia) 16-20 ml/do or vol %
Normal
91
CaO2 (Hypoxemia) 14-15.9 ml/dl vol %
Mild Hypoxemia
92
CaO2 (Hypoxemia) 12-13.9 ml/do or vol %
Moderate hypoxemia
93
CaO2 (Hypoxemia) <12 ml/dl vol %
Severe hypoxemia
94
How is CO2 normally carried in the blood?
44-55 ml/dl 1. Dissolved in blood ~8% 2. Chemically combined with protein ~12% 3. Ionized as bicarbonate ~80%
95
When DO2 is inadequate (Impaired oxygen delivery) ?
Tissue Hypoxia occurs Caused by decreases in arterial PO2 Decreased available Hb or decrease in cardiac output (shock or ischemia)
96
What is hypoxia?
Occurs when O2 delivery is inadequate for cellular needs in the tissues.
97
What is hypoxemia?
Defined as low arterial blood oxygen. (PaO2)
98
Impaired CO2 removal?
Increases dead space ventilation.
99
Increased Deadspace ventilation is caused by?
1. Decreased Vt as in rapid shall breathing or 2. Increased physiologic dead space as in pulmonary embolus.
100
Where do hydrogen ions come from?
Hydrogen Ions form in the body come from either volatile or fixed (nonvolatile) acids.
101
Acid excretion is done by?
The lungs and the kidneys.
102
Lungs effect the ?
Changes in PaCO2. While lungs can alter (CO2) in seconds.
103
Kidneys effect changes?
In the HCO3-. Physically remove H+ from body by excretion, secretion, and reabsorption. Kidneys require hours or days to change HCO3 and affect pH.
104
The body’s buffer system?
The lungs, and the kidneys work together to maintain acid-base homeostasis under various conditions.
105
Primary Respiratory Disturbances?
PaCO2 is controlled by the lung; changes in pH caused by the PaCO2 are considered respiratory disturbances.
106
Hyperventilation?
Decreases PaCO2 which increases pH; referred to as RESPIRATORY ALKALOSIS.
107
Hypoventilation?
Increases PaCO2 which decreases pH; referred to as RESPIRATORY ACIDOSIS.
108
Primary metabolic disturbances?
Involve gain or loss of fixed acids or HCO3-. Both appear as changes in HCO3- because changes in fixed acids will alter amount of HCO3- used in buffering.
109
Primary metabolic disturbances pt. 2?
Decreases in HCO3- which decreases pH results in metabolic ACIDOSIS. Increases in HCO3- which increases pH results in metabolic ALKALOSIS.
110
Any primary disturbance immediately triggers a compensatory response.
Any respiratory disorder will be compensated for by kidneys. Any metabolic disorder will be compensated for by lungs.
111
Three primary states of matter?
Solids, liquids, and gases.
112
Solids?
1. Have high degree of internal order 2. Fixed volume or shape 3. Strong mutual attractive force between atoms 4. Molecules have the shortest distance to travel before collision -The jiggle.
113
Liquids?
1. Have fixed volume, but adapt to shape of their container. 2. Atoms exhibit less degree of mutual attraction compared with solids. - Shape is determined by numerous internal and external forces.
114
Gases?
1. Gas molecules in constant motion exhibit rapid, random motion with frequent collisions. 2. Exhibit the phenomenon of flow, to fill their container, and have minimal forces of attraction.
115
What is heat transfer?
When two objects of different temperature coexist heat will move from hotter to cooler object until both are equal.
116
How can heat transfer occur?
Conduction Convection Radiation Evaporation Condensation
117
Conduction
Is the transfer of heat by the direct interaction of atoms or molecules in a hot area with atoms or molecules in a cooler area, requires direct contact between two substances.
118
Convection
Involves the mixing of either liquid or gas molecules (fluids) at different temperatures, requires direct contact between two substances.
119
Radiation
Requires no direct contact between the warmer and cooler substances.

Fundamentals Of Respiratory Care (8 decks)

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