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Flashcards in T2 - Pulmonary System (Josh) Deck (57)
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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