# T2 - Pulmonary System (Josh) Flashcards

1
Q

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

A

Right Bronchus

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

2
Q

What are the 3 steps of Gas Exchange?

A

Step 1 = Ventilation

Step 2 = Respiration

Step 3 = Transport of Gases into the Circulation

3
Q

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.

A

Ventilation

***exchange between AIR and LUNG

4
Q

Gas Exchange:

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

A

Respiration

***exchange of O2 and CO2 at ALVEOLAR LEVEL

5
Q

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

A

Type I

6
Q

Which type of Alveoli are secretory and make surfactant?

A

Type II

7
Q

What are the factors that determine Diffusion of O2?

A

Surface area available

Integrity of Alveoli-Capillary Membrane

Amount of Hgb

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

Driving Pressures

8
Q

What is a normal V:Q Ratio?

A

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

V:Q = 4:5 = 0.8 ratio

***More perfusion than ventilation

9
Q

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

A

not all alveoli are working 100% during each inspiration

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

10
Q

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

A

decrease in ventilation in relation to perfusion

more deoxygenated blood is returning to left heart

11
Q

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

A

decrease in perfusion in relation to ventilation

• *PE
• *Cardiogenic Shock
12
Q

Which V:Q Ratio would indicate a likely PE?

A

greater than 0.8

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

13
Q

What is PaO2?

A

Amount of oxygen dissolved in plasma

***Normal value is 3%

14
Q

What is oxygen that is bound to Hemoglobin called?

A

SaO2 (Oxygen Saturation)

***Normal value is around 97%)

15
Q

Oxyhemoglobin Disassociation Curve:

What does the bottom axis measure?

What does the vertical axis measure?

A

PaO2

SaO2

16
Q

Oxyhemoglobin Disassociation Curve:

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

A

Increase pH

Decrease PCO2

Decrease Temp

Decrease 2, 3-DGP

Carboxyhemoglobin

Hgb Ranier

Hgb Hiroshima

Hgb San Francisco

17
Q

Oxyhemoglobin Disassociation Curve:

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

A

Decrease pH

Increase PCO2

Increase Temp

Increase 2, 3-DGP

Hgb Kansas

Hgb Seattle

18
Q

What is the purpose of the Oxyhemoglobin Disassociation Curve?

A

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

19
Q

Oxyhemoglobin Disassociation Curve:

What is the benefit of the UPPER FLAT PORTION?

A

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
Q

Oxyhemoglobin Disassociation Curve:

What is the benefit of the LOWER STEEP PORTION?

A

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
Q

Oxyhemoglobin Disassociation Curve:

What is a SHIFT TO THE RIGHT?

A

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
Q

Oxyhemoglobin Disassociation Curve:

What are some causes of the SHIFT TO THE RIGHT?

A

R’s

• Reduced pH (acidosis)
• hypeRcapnia (PCO2 increase)
• feveR
• incRease levels of 2,3-DPG
23
Q

Oxyhemoglobin Disassociation Curve:

What is a SHIFT TO THE LEFT?

A

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
Q

Oxyhemoglobin Disassociation Curve:

What are some causes of SHIFT TO THE LEFT?

A

L’s

• alkaLosis (pH increase)
• Low CO2
• coLd
• Low levels of 2,3-DPG
• increased Level of carbon monoxide poisoning
25
Q

What is 2,3-DPG?

A

2, 3-Diphosphoglycerate

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

26
Q

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

Decrease?

A

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
Q

What stimulates the production of 2,3-DPG?

A

Tissue hypoxia

28
Q

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

A

Shunting

***increasing FiO2 does NOT help

29
Q

What are some causes of shunts?

A

AVMs

ARDS

Atelectasis

Pneumonia

PE

Pulmonary Embolus

Vascular Long Tumors

Intracardiac Right to Left Shunts

30
Q

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

A

PCO2

increasing RR

31
Q

If they’re oxygen saturation is low and unrelieved by FiO2, it is likely a —

A

shunting problem

32
Q

What is an Intrapulmonary Shunt?

A

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
Q

An Intropulmonary Shunt greater than — is life threatening.

A

30%

34
Q

What are ways that Shunting is Estimated?

A

PaO2 / PAO2 ratio

Aleolar - arterial Gradient

PaO2 / FiO2 ratio

• **a = arterial
• **A = Alveoli
35
Q

What is an A-a Gradient?

A

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
Q

What is a normal range?

A

10-20 mmHg

**increases as patient ages

37
Q

What is the purpose of this?

A

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

38
Q

What does a Large A-a Gradient suggest?

A

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

39
Q

PaO2 / FiO2:

What is a normal value?

A

greater than 286

40
Q

PaO2 / FiO2:

What does the lower the number indicate?

A

the worse the lung function

41
Q

PaO2 / FiO2:

What is FiO2?

A

fraction of inspired oxygen

ex: if inspired 50%, then FiO2 is 0.5

42
Q

PaO2 / FiO2:

Why is this a good measure?

A

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
Q

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

A

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

44
Q

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

A

Increased

45
Q

What would you teach client before a Pulmonary Function Test?

A

No smoking 6-8 hrs prior

Bronchodilators held 5=4-6 hrs prior

46
Q

What is PETCO2?

A

Partial Pressure of End Tidal CO2

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

***normal is 20-40 mmHG

47
Q

What is Tidal Volume?

A

amount of air someone takes in one inspiration

48
Q

What VENTILATION FACTORS would Increase PETCO2?

A

Hypoventilation

Bronchial Intubation

Partial Airway Obstruction

Rebreathing Asthma

COPD

49
Q

What METABOLISM FACTORS would increase PETCO2?

A

Fever

Recovery from sedation / paralysis

Sodium Bicarb

Tourniquet Release

Malignant Hyperpyrexia

50
Q

What CIRCULATION FACTORS would increase PETCO2?

A

Increased CO

Increased BP

51
Q

What VENTILATION FACTORS would decrease PETCO2?

A

Hyperventilation

Apnea

Total Airway Obstruction

Partial Airway Obstruction

Accidental Tracheal Extubation

PE

Intrapulmonary Shunt

52
Q

What METABOLISM FACTORS would decrease PETCO2?

A

Hypothermia

Sedation

Sleep

Cooling

53
Q

What CIRCULATION FACTORS would decrease PETCO2?

A

Reduced CO

Hypotension

Hypovolemia

PE

Cardiac Arrest

54
Q

What important teaching factor before a Bronchoscopy?

A

NPO 8 hrs prior to prevent aspiration

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

55
Q

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

A

Thoracentesis

***limit to 1000mL

56
Q

Complications from Thoracentesis

A

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

Pneumothorax

Bleeding

Infection

Subq Empysema (crackles under skin)

57
Q

Follow-up care for Lung Biopsy:

A

Assess vitals, breath sounds q4hrs for 24hrs

Assess for resp. distress

Monitor for Hemoptysis