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3 Cardiopulmonary > Respiratory P1 > Flashcards

Respiratory P1 Flashcards

1
Q

Potential Space Makeup

A

parietal pleura
visceral pleura
pleural cavity

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2
Q

Conducting zone makeup

A

trachea
primary bronchus
bronchial tree
terminal bronchioles

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3
Q

Path of air

A

Nose/Mouth
Pharynx
Glottis
Trachea
Primary bronchi
bronchial tree
respiratory bronchioles
alveolar sacs
alveoli

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4
Q

Makeup of respiratory zone

A

respiratory bronchioles
alveolar sacs
alveoli

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5
Q

Aspiration

A

when anything besides air goes down the trachea

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6
Q

Carina

A

inferior termination of trachea into R and L mainstem bronchi
at level of sternal angle

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7
Q

Which lung is more common to experience pneumonia?

A

Right
the bronchi on the right side are straighter and wider vs the left, allowing more to enter the lungs

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8
Q

Functions of conducting zone

A
  1. conducts air to respiratory zone
  2. warms and humidifies inspired air
  3. filters and cleans the inspired air
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9
Q

Mucociliary Escalator

A

-cilia on epithelial cells lines the conducting zones
-they beat in unilateral and coordinated way to move mucus toward pharynx
-leads germs to be either swallowed or expectorated

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10
Q

What is something that paralyzes cilia?

A

smoking

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11
Q

Functions of respiratory zone

A

Region of gas exchange between air and blood
Gas exchange occurs by diffusion from alveolus to capillary

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12
Q

Respiration steps

A

Ventilation
Gas Exchange
O2 utilization

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13
Q

Ventilation

A

-mechanical process of moving air in and out of lungs
-O2 is greater in air vs O2 in blood, so it follows a gradient, moving from air to blood
-CO2 in blood is greater than in lungs, goes from blood to lungs

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14
Q

Gas Exchange

A

-occurs entirely by diffusion through lung tissue
-diffusion is very rapid because of the large surface area and small diffusion distance
-occurs between air/blood/lungs/other tissues

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15
Q

Alveoli

A

very thin
have alveolar type 1 (structural), alveolar type 2 (secrete surfactant)

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16
Q

Lungs and and thoracic cavity

A

-during breathing, lungs remain in contact with chest wall
-vacuum keeps them together
-lungs expand and contract with thoracic cavity

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17
Q

Intrapulmonary pressure

A

pressure inside the alveoli

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18
Q

Intrapleural pressure

A

pressure inside intrapleural space

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19
Q

Intrapulmonary pressure and ventilation

A

Inspiration = less than atmospheric pressure (about 3 mmHg)
Expiration = greater than atmospheric pressure (about 3 mmHg)

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20
Q

Boyle’s gas

A

pressure of gas is inversely proportional to its volume
1. increase in lung volume decreases intrapulmonary pressure (air moves in).
2. decrease in lung volume raises intrapulmonary pressure above atmosphere (air moves out)

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21
Q

Transpulmonary Pressure

A

pressure difference across the wall of the lung

Intrapulmonary pressure - intrapleural pressure = transpulmonary pressure

in healthy adults, this pressure will be positive because pressure within alveoli is greater than pressure outside of alveoli

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22
Q

Atelectasis

A

partial or whole lung collapse
due to interference w/forces that promote lung expansion

treatment includes deep breathing, mobility

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23
Q

Pneumothorax

A

partial or whole lung collapse
due to collection of air or gas in intrapleural space, so pressure outside is greater than inside

chest tube is the treatment

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24
Q

Chest tube

A

tube placed between the ribs and into the intrapleural space to drain air/blood to allow the lungs to re-inflate

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25
Q

Physical aspects of ventilation

A

Compliance
Elasticity
Surface tension

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26
Q

Compliance

A
  1. measure of distensibility
  2. change in lung volume per change in transpulmonary pressure
  3. C = V/P or P = V/C
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27
Q

Compliance is decreased by

A

factors that produce resistance to distension
pulmonary fibrosis, alveolar edema

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28
Q

Compliance is increased by

A

factors that decrease resistance to distension
aging, emphysema

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29
Q

elasticity

A
  1. tendency to return to initial size after distension
  2. high concentration of elastin protein allows for high elasticity and recoil ability
  3. tension increases during inspiration
  4. potential space helps lungs to not collapse
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30
Q

Emphysema

A

decreased elasticity, increased compliance. lungs lose recoil ability. barrel chest

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31
Q

Pneumothorax

A

unopposed elasticity
lung collapses in, thorax goes out

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32
Q

Surface tension

A

force that resists distension
exerted by a thin layer of fluid in each alveolus

surfactant helps to lower surface tension by decreasing attraction between H2O

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33
Q

Law of Laplace

A

pressure in alveoli is directly proportional to surface tension and inversely proportional to radius of alveoli

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34
Q

Tidal volume

A

how much you move in resting breath

35
Q

Diaphragm is the

A

resting muscle of inhalation

36
Q

muscles of inspiration

A

SCM
scalenes
external intercostals
diaphragm

37
Q

Muscles of expiration

A

no resting muscle of expiration, passive movement

internal intercostals
abdominal obliques
transversus abdominis
rectus abdominis

38
Q

Uses of accessory muscles

A

exercise
pathology (increased RR or TV)

39
Q

Bucket-handle motion

A

how lower ribs move as you breathe

40
Q

Quiet Inspiration, Active process

A

diaphragm contraction increases thoracic volume vertically
contraction of parasternal/external intercostals increases thoracic volume laterally

41
Q

Expiration, passive process

A

diaphragm, thoracic, thorax, lungs recoil after being stretched by contraction
decrease in lung volume raises pressure above atmosphere

42
Q

Expiration pressure changes

A

Intra-alveolar = -3 to +3
Intrapleural = -6 to -3
Transpulmonary = 3 - -3 = 6 mmHg

43
Q

Inspiration pressure changes

A

Intra-alveolar = 0 to -3
Intrapleural = -4 to -6
Transpulmonary = -3 - -6 = 3 mmHg

44
Q

Pulmonary function tests

A

assessed clinically by spirometry
measures how much and how quickly air can be exhaled by an individual

subject breathes into a closed system attached to spirometer, results displayed in spirograms

45
Q

Purposes of PFTs

A

screen for obstructive and restrictive diseases
document progression of disease
document effectiveness of intervention
evaluate prior to surgery
evaluate pt ability to be weaned from ventilator

46
Q

Tidal volume

A

amount of air expired with each breath during quiet breathing
about 500 mL

47
Q

Vital capacity

A

max amount of air that can be exhaled after max inhalation

48
Q

Lung volumes

A

Tidal volume
inspiratory reserve volume
expiratory reserve volume
residual volume

49
Q

Inspiratory reserve volume

A

additional air that can be inhaled after normal TV is inhaled

50
Q

Expiratory reserve volume

A

additional air that can be exhaled after normal TV is exhaled

51
Q

Residual volume

A

volume of air remaining in lungs after max expiration
cannot be directly measure w/spirometry

52
Q

Lung Capacities

A

Total lung capacity
vital capacity
inspiratory capacity
functional residual capacity

53
Q

Total lung capacity

A

total amount of air in lungs after max inspiration
cannot be directly measured with spirometry

54
Q

Inspiratory capacity

A

max amount of air that can be inspired after normal tidal expiration

55
Q

Functional residual capacity

A

amount of air remaining in lungs after normal tidal expiration
cannot be directly measured with spirometry

56
Q

PFTs variables are based on

A

age (increasing, PFT values decrease)
sex (males have larger PFT)
Body height/size (taller is larger PFT, obese is lower PFT)

57
Q

FVC

A

forced vital capacity

58
Q

FEV1

A

forced expiratory volume in 1 second

59
Q

FEV1/FVC

A

% of FVC expelled from lungs in 1st second of forced exhalation

60
Q

Restrictive Disorders

A

spirometry is required to make these broad diagnoses
vital capacity is reduced
flow rates are usually normal

lobectomy and pulmonary fibrosis

61
Q

Obstructive disorders

A

VC is normal
decreased rates of expiration
COPD, emphysema, asthma

post bronchodilator FEV1/FVC <70% confirms the presence of persistent airflow limitation

62
Q

Dead space

A

volume of airways and lungs that does not participate in gas exchange

for those without pathology, dead space is anatomical

63
Q

Anatomical dead space

A

about 150 mL
stays constant
conducting zone

fresh air mixes with it
volume of air in space remains the same, if you increase TV, % of fresh air increases that enters alveoli

64
Q

Physiological dead space

A

parts of lungs not participating in gas exchange
those with pathology will have larger ones

65
Q

Alveolar ventilation

A

represents the actual removal and replacement of gas within alveoli, takes into account the dead space

f x (TV - DS)
(f is frequency of breathing)

66
Q

Dalton’s law

A

total pressure of a gas mixture is equal to the sum of the pressures that each gas in the mixture would exert independently

total pressure of a gas mix = sum of partial pressures of constituent gases

67
Q

Partial pressure

A

pressure that a particular gas in a mixture exerts independently

partial pressure = total pressure X fraction of gas in mix

68
Q

PO2 at sea level

A

760 mmHg x 21% (fraction of O2 in air) = 159 mmHg

69
Q

PO2 at high altitudes

A

total pressure decreases, so PO2 decreases

70
Q

Calculating PO2 in alveoli

A

air in alveoli is 100% saturated with water vapor, which contributes to partial pressure

you have to subtract water vapor pressure in order to get pressure within alveoli

about 150 mmHg

dead air mixes with this, end up with about 105 mmHg

71
Q

ways in which Oxygen is carried in blood

A

dissolved in plasma, 2% (only form that produces partial pressure)
bound to hemoglobin, 98%

72
Q

Hemoglobin

A

found within RBCs, produced by erthropoietin (produced in kidneys)

1 Hb can combine with 4 O2
pulse oximetry measures how much O2 is bound to Hb

73
Q

Loading and unloading of Hb depends on

A

POs of environemnt
affinity between Hb and O2

74
Q

Unloading of Hb occurs

A

tissue capillaries

75
Q

Loading of Hb occurs

A

in lung capillaries

76
Q

PaO2 normal value at rest

A

100 mmHg

77
Q

PO2 in systemic veins at rest

A

40 mmHg
venous values are not clinically useful because they are much more variable

78
Q

PO2 in veins during exercise

A

can drop to 20 mmHg

79
Q

Oxygen content in blood depends on 3 things

A

PO2
Hemoglobin
Hematocrit

80
Q

Oxy-Hb dissociation curve

A

curve is steep and then flattens
as Hb sat falls below 90%, PO2 drops rapidly

81
Q

Right shift of Oxy-hb curve

A

hb has decreased affinity for O2, unloading is easier

increase in PCO2 and decrease in pH
increase in temp

occurs during exercise, low pH

82
Q

Left shift of oxy-Hb curve

A

Hb has increased affinity for O2, unloading is harder
occurs with CO2 poisoning, high pH

83
Q

SaO2

A

arterial oxy-hb saturation
indicates how oxygenated arterial blood is

catheter measures it

84
Q

Pulse Ox and Pathology

A

performance of pulse ox deteriorates when SaO2 decreases below 80%, usually overestimation

dyshemoglobins, low perfusion state, skin pigmentation, nail polish, excessive motion, anemia are all limitations. also has response delay

3 Cardiopulmonary (9 decks)

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