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1

Which Bronchus will likely be where a kid gets something stuck?

Right Bronchus

***The right main bronchus is wider, shorter, and more vertical than the left main bronchus.

2

What are the 3 steps of Gas Exchange?

Step 1 = Ventilation

Step 2 = Respiration

Step 3 = Transport of Gases into the Circulation

3

Gas Exchange:

The process of moving air between atmosphere and the lung alveoli and distributing air within the lungs to maintain appropriate concentrations of Oxygen and Carbon Dioxide in the alveoli.

Ventilation

***exchange between AIR and LUNG

4

Gas Exchange:

The process by which alveolar air gasses are moved across the alveolar-capillary membrane to the pulmonary capillary bed.

Respiration

***exchange of O2 and CO2 at ALVEOLAR LEVEL

5

Which type of Alveoli are squamous and used for gas exchange?

Type I

6

Which type of Alveoli are secretory and make surfactant?

Type II

7

What are the factors that determine Diffusion of O2?

Surface area available

Integrity of Alveoli-Capillary Membrane

Amount of Hgb

Diffusion of co-efficient of gas (amount of contact time)

Driving Pressures

8

What is a normal V:Q Ratio?

Ventilation (V): 4 L/min
Perfusion (Q): 5 L/min

V:Q = 4:5 = 0.8 ratio

***More perfusion than ventilation

9

What does it mean that a normal V:Q Ratio is 4:5 (0.8)?

not all alveoli are working 100% during each inspiration

***more air is coming in than is passing into the blood

10

What does a V:Q Ratio of LESS THAN 0.8 indicate?

decrease in ventilation in relation to perfusion

more deoxygenated blood is returning to left heart

11

What does a V:Q Ratio of MORE THAN 0.8 indicate?

decrease in perfusion in relation to ventilation

**PE
**Cardiogenic Shock

12

Which V:Q Ratio would indicate a likely PE?

greater than 0.8

***oxygen is getting all the way to alveoli, but the blood flow is block at the capillary level

13

What is PaO2?

Amount of oxygen dissolved in plasma

***Normal value is 3%

14

What is oxygen that is bound to Hemoglobin called?

SaO2 (Oxygen Saturation)

***Normal value is around 97%)

15

Oxyhemoglobin Disassociation Curve:

What does the bottom axis measure?

What does the vertical axis measure?

PaO2

SaO2

16

Oxyhemoglobin Disassociation Curve:

What are factors that will shift the curve left (decreasing SaO2)?

Increase pH

Decrease PCO2

Decrease Temp

Decrease 2, 3-DGP

Carboxyhemoglobin

Hgb Ranier

Hgb Hiroshima

Hgb San Francisco

17

Oxyhemoglobin Disassociation Curve:

What are factors that will shift the curve right (increasing SaO2)?

Decrease pH

Increase PCO2

Increase Temp

Increase 2, 3-DGP

Hgb Kansas

Hgb Seattle

18

What is the purpose of the Oxyhemoglobin Disassociation Curve?

describes the ability of Hgb to bind to oxygen at normal arterial O2 tension levels and release it at lower PO2 levels

19

Oxyhemoglobin Disassociation Curve:

What is the benefit of the UPPER FLAT PORTION?

arterial association which protects the body by enabling Hgb to load O2, despite large decreases in PaO2

ex:
PaO2 is 100 mm Hg yields SaO2 of 98%

PaO2 is 60 mm Hg yields SaO2 of 89%

20

Oxyhemoglobin Disassociation Curve:

What is the benefit of the LOWER STEEP PORTION?

Venous dissociation portion that protects the body by allowing the tissues to withdraw large amounts of O2

ex:
PaO2 is 50 mm Hg yields SaO2 of 80%

PaO2 is 40 mm Hg yields SaO2 of 70%

21

Oxyhemoglobin Disassociation Curve:

What is a SHIFT TO THE RIGHT?

Enhances oxygen delivery to tissues

Hgb has LESS affinity for Oxygen, which means it releases it more readily to tissues

R's

Right shift

Release O2 more Readily

22

Oxyhemoglobin Disassociation Curve:

What are some causes of the SHIFT TO THE RIGHT?

R's

- Reduced pH (acidosis)
- hypeRcapnia (PCO2 increase)
- feveR
- incRease levels of 2,3-DPG

23

Oxyhemoglobin Disassociation Curve:

What is a SHIFT TO THE LEFT?

O2 not dissociated from Hgb until tissue and capillary O2 are very low, decreasing O2 delivery to tissue

Hgb has MORE affinity for O2, decreasing delivery to tissue

L's = Left

Hgb hoLds O2

24

Oxyhemoglobin Disassociation Curve:

What are some causes of SHIFT TO THE LEFT?

L's

- alkaLosis (pH increase)

- Low CO2

- coLd

- Low levels of 2,3-DPG

- increased Level of carbon monoxide poisoning

25

What is 2,3-DPG?

2, 3-Diphosphoglycerate

***organic phosphate found in RBCs that has the ability to ALTER THE AFFINITY FOR O2

26

What does an increase in 2,3-DPG mean?

Decrease?

Increase = Hgb affinity for O2 decreases

Decrease = Hgb affinity for O2 increases

***turning it on releases O2 to the tissue

***turning it off keeps the O2 on the Hgb

27

What stimulates the production of 2,3-DPG?

Tissue hypoxia

28

What do we call it when a portion of venous blood does not participate in gas exchange?

Shunting

***increasing FiO2 does NOT help

29

What are some causes of shunts?

AVMs

ARDS

Atelectasis

Pneumonia

PE

Pulmonary Embolus

Vascular Long Tumors

Intracardiac Right to Left Shunts

30

In shunting, the --- usually stays the same, and the body compensates by --- ---

PCO2

increasing RR

31

If they're oxygen saturation is low and unrelieved by FiO2, it is likely a ---

shunting problem

32

What is an Intrapulmonary Shunt?

venous blood that flows thru the lungs without being oxygenated due to NONFUNCTIONING ALVEOLI

***greater than 10% is abnormal

***greater than 30% is life-threatening

33

An Intropulmonary Shunt greater than --- is life threatening.

30%

34

What are ways that Shunting is Estimated?

PaO2 / PAO2 ratio

Aleolar - arterial Gradient

PaO2 / FiO2 ratio


***a = arterial
***A = Alveoli

35

What is an A-a Gradient?

Difference between O2 pressure in Alveoli and in arteries (capillaries)

***always a positive number because you always have more O2 in lungs than tissue

36

A-a Gradient:

What is a normal range?

10-20 mmHg

**increases as patient ages

37

A-a Gradient:

What is the purpose of this?

provides an index on the efficiency of the lung in equilibrating pumonary capillary O2 and alveolar O2

38

A-a Gradient:

What does a Large A-a Gradient suggest?

lung is the site of dysfuntion (some prob in lung is causing arterial blood to NOT pick up the O2 like it should)

39

PaO2 / FiO2:

What is a normal value?

greater than 286

40

PaO2 / FiO2:

What does the lower the number indicate?

the worse the lung function

41

PaO2 / FiO2:

What is FiO2?

fraction of inspired oxygen

ex: if inspired 50%, then FiO2 is 0.5

42

PaO2 / FiO2:

Why is this a good measure?

because it can show that PaO2 is not always a good measure

ex: they can have a PaO2 of 100, but if FiO2 is 50% (0.5) then 100 divided by 0.5 is 200

200 is less than the normal value of greater than 286

43

What type of A-a Gradient would you see if hypoxemia is caused by Alveolar Hypoventilation?

Normal A-a gradient

***alveolar hypoventilation indicates that the disorder is int eh respiratory center and muscles of respiratory system

44

If Hypoxemia is caused by a V:Q Mismatch, what type of A-a Gradient would you see?

Increased

45

What would you teach client before a Pulmonary Function Test?

No smoking 6-8 hrs prior

Bronchodilators held 5=4-6 hrs prior

46

What is PETCO2?

Partial Pressure of End Tidal CO2

***partial pressure of amount of Carbon Dioxide in exhaled air

***normal is 20-40 mmHG

47

What is Tidal Volume?

amount of air someone takes in one inspiration

48

What VENTILATION FACTORS would Increase PETCO2?

Hypoventilation

Bronchial Intubation

Partial Airway Obstruction

Rebreathing Asthma

COPD

49

What METABOLISM FACTORS would increase PETCO2?

Fever

Recovery from sedation / paralysis

Sodium Bicarb

Tourniquet Release

Malignant Hyperpyrexia

50

What CIRCULATION FACTORS would increase PETCO2?

Increased CO

Increased BP

51

What VENTILATION FACTORS would decrease PETCO2?

Hyperventilation

Apnea

Total Airway Obstruction

Partial Airway Obstruction

Accidental Tracheal Extubation

PE

Intrapulmonary Shunt

52

What METABOLISM FACTORS would decrease PETCO2?

Hypothermia

Sedation

Sleep

Cooling

53

What CIRCULATION FACTORS would decrease PETCO2?

Reduced CO

Hypotension

Hypovolemia

PE

Cardiac Arrest

54

What important teaching factor before a Bronchoscopy?

NPO 8 hrs prior to prevent aspiration

**assess for cough and gag reflex before discontinuing NPO postop

55

--- is aspiration of pleural fluid or air from pleural space.

Thoracentesis

***limit to 1000mL

56

Complications from Thoracentesis

Mediastinal Shift (shift of pressures from the puncture of space)

Pneumothorax

Bleeding

Infection

Subq Empysema (crackles under skin)

57

Follow-up care for Lung Biopsy:

Assess vitals, breath sounds q4hrs for 24hrs

Assess for resp. distress

Monitor for Hemoptysis