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47 Cards in this Set

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VC vital capacity on the quiz*************************************************
Pt takes a big breath and blows into a spirometer. Values set by age, body build, weight, gender. Most will exhale 80% in one sec. Vital Capacity performed w/ a maximally fourced expiratory effort (this vp is often reduced in COPD b/c or air trapping
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FEV functional expiratory Volume
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volume of air exhaled in the specified time during the performance of forced vital capacity; FEV is vol. exhaled in 1 second (usually 80% called FEV1a) All of it forced out in 3 secs. (FEV3). (a clue to severity of expiratory airway obstruction)
would aging affect lung compliance?
air flow resistence,airways are stiffer
cilia function decreased
loss of elastion, an increase in chest wall stiffness
muscle loss
whole vent system decreases by 25% b/t ages of 20-80. 1/4 is lost by the time your 80. aeorobic exercise will increase our VC so normal consecensces of aging aren't so severe.
so complicate the aging process with disease of heart and lungs and you really have a problem with oxigenation. can't cough as effectivily so what?
an increase chance for pneumonia. SO, you don't have the stamina and energy as a 20 year old
ventilation is the contraction and relaxation of the lungs, air moving in and out, this is NOT respiration. so w/ COPD, empysema, asthma issues and the expiratory part of ventilation, what is happening?
the expiratory part becomes labored.
what is important in the expiratory phase, a passive mechanical function in the chest?
the elastic recoil of the chest wall and lungs are important.
what is the substance in the lungs that helps the aveoli to open up again what once they are collapsed they
surfactant, a big issue with peds patients and premmies. People w/ cystic fibrosus have real sticky muccuos so this makes ventilation difficult. they need chest percussion to clear this stuff out.
what is air trapping with people w/ lung disease?
Air trapping refers to the abnormal retention of gas within the lung following expiration.
what are chemo receptors?
chemoreceptors detect levels of CO in the BLOOD. They monitor concentrations of hydrogen ions in the blood, which decrease pH of the blood, as a direct consequence of the raised CO concentrations.
this CO level is called partial pressure. the air we breathe is nitrogen 78%, O2 20% and CO 0.04%, water vapor 0.05%, and some helium and argon. THE atmospheric pressure is 760 mm Hg. What is partial pressure?
partial pressure = pressure exerted by each of these gases in a mixture of gases. So, partial pressure of a gas is porportional to that the concentration of that gas in a mixture. the total pressure = sum of the partial pressures. This is about the pH of arterial blood which reads the partial pressure all the time I think
what do you get when you mix CO and water?
carbonic acid this happens every time you breathe and exhale. so if you retain CO after exhaling, you would be more acidic b/c it gives it more time to hang around, mix w/ water and make carbonic ACID
what is the body's signal to breathe?
body looks at its CO2 partial pressure and that level signals the body to breathe.
so emphsema causes this partial pressure monitoring of CO shuts down. The chemorecptors b/c ...
the body quits listening to chemorecptors scream about CO2 levels and starts instead monitoring the partial pressure of O2 levels instead.
so if you crank these COPD pts up from 2 liters to 4 liters , what happens then?
the body says 'Hea, I got enough O2, I can quit breathing now!" and the pt will quit breathing by turning off the brain.
So gas exchange happens:
diffusion thru alveolar capillary membranes. What things make this happen? the avalibility of O2 to cells?
how much hemoglobin Hgb
how much regional blood flow
arterial o2 content
cardiac outtput (bad heart won't put out as well. a clot will plug up a vessel in lung that prevents gas exhange. no blood flow, no gas exhange. the alveola bag works but no gas exhange b/c no blood flow
remember CO2 is normally not in your body tissue BUT if it IS in your tissue your ...
hypoxic
your actually hypercapnia. This is CO2 snow removal doesn't keep up with CO2 snow fall. This causes respiratory ACIDOSIS
7.35-7.45 is normal pH in blood. 7.35 is more acidodic, the low end. Remember pH is on a log scale so a small rise here is alot. So if pt retains CO2 are they acidodic?
yes. CO2 retention makes you acidodic. WHEN SHE SAYS pH IS GOING DOWN, THIS MEANS your GETTING ACIDIC. 8 to 7 is pH going down, getting more acidic.
lungs can't excrete the acid. so pH will or will not go down. what is the job of the kidneys?
kidneys job is to excreate or retain bicarb. So a new COPD patient is not excreating CO2 from their lungs so the pH starts to go down, and the kidneys freak by saying TOO MUCH ACID. TOO MUCH ACID. So they hold on to the bicarb! to normalize the pH! to keep homeostatis. The kidneys COMPENSATED! COMPENSATION. But as the COPD progresses, the kidney's would be able to keep up. So, you'll look at a pt's blood gaes and see their pH is normal but their CO2 is high! And so will their bicarb will be elevated too! *****************************
so if a patient is blowing off too much CO2 if they are hyperventilating, (maybe they are stressed from a thrill ride)and blowing off too much CO2, thus not retaining enough CO2 to maintain acid so you will be what?
respiratory alcolosis,
blowing off too much acid
so the kidneys say, "WOW, gET rid of this sodium bicarb, we need to bring her back to homeostatis."
Think of a balance beam between carbonic acid and sodium bicarbon. The kidneys function here like your lungs do. If you have kidney failure that alters excretion of bicarb or retention of bicarb, what?
the respirations will increase or decrease to bring you back to metabolic balance.
so if you have too much bicarb would you breath faster or slower?
slower. too much bi carb? You will breathe slower.
why? b/c you want to retain the CO more the body to form acid! to bring you back in balance.
So gas exchange happens:
diffusion thru alveolar capillary membranes. What things make this happen? the avalibility of O2 to cells?
how much hemoglobin Hgb
how much regional blood flow
arterial o2 content
cardiac outtput (bad heart won't put out as well. a clot will plug up a vessel in lung that prevents gas exhange. no blood flow, no gas exhange. the alveola bag works but no gas exhange b/c no blood flow
remember CO2 is normally not in your body tissue BUT if it IS in your tissue your ...
hypoxic
your actually hypercapnia. This is CO2 snow removal doesn't keep up with CO2 snow fall. This causes respiratory ACIDOSIS
7.35-7.45 is normal pH in blood. 7.35 is more acidodic, the low end. Remember pH is on a log scale so a small rise here is alot. So if pt retains CO2 are they acidodic?
yes. CO2 retention makes you acidodic. WHEN SHE SAYS pH IS GOING DOWN, THIS MEANS your GETTING ACIDIC. 8 to 7 is pH going down, getting more acidic.
lungs can't excrete the acid. so pH will or will not go down. what is the job of the kidneys?
kidneys job is to excreate or retain bicarb. So a new COPD patient is not excreating CO2 from their lungs so the pH starts to go down, and the kidneys freak by saying TOO MUCH ACID. TOO MUCH ACID. So they hold on to the bicarb! to normalize the pH! to keep homeostatis. The kidneys COMPENSATED! COMPENSATION. But as the COPD progresses, the kidney's would be able to keep up. So, you'll look at a pt's blood gaes and see their pH is normal but their CO2 is high! And so will their bicarb will be elevated too! *****************************
so if a patient is blowing off too much CO2 if they are hyperventilating, (maybe they are stressed from a thrill ride)and blowing off too much CO2, thus not retaining enough CO2 to maintain acid so you will be what?
respiratory alcolosis,
blowing off too much acid
so the kidneys say, "WOW, gET rid of this sodium bicarb, we need to bring her back to homeostatis."
Acidosis and alcalosis
normal pH is 7.35-7.45
which is acidotic?
7.35 is acidodic,
the lower the pH the more acid it is!!!!
Remember this****************
water + CO2 = Carbonic Acid so if your lungs hold CO2, what might also be holding too?
Carbonic Acid b/c of the CO2
Acid is acid, a lower pH, so the acid from holding CO2 lowers the pH
So you think the pH in the lungs or Blood will now go down ... maybe ... but whats the job of the Kidneys?
to either retain or excreate bicarb !!! The Kidneys does this. SO ... DIG THIS ... The COPD guy has CO2 build up in his lungs, he then has Bicarb build up, his Acid goes up ... the kidneys freak out seeing the pH go down and they hold on to the bicarb and the pH normalizes! Homeostatis, thats COMPENSATION...But as COPD progresses, the kidneys can't keep up so in blood gases you'll see pH normal but the CO2 high! WHY? Look at the bicarb and it will be hi too.
So the pt is blowing off too much CO2 if they are hyperventilating or stressed from a head injury or some kind of trauma, YOur blowing off too much CO2 to maintain acid so what?
you can go into alkalosis from too much loss of acid, a respiratory alkalosis and your kidneys freak out and say, "Too much sodium bicarb, get rid of it!" and you go back to homeostatis.
so the lungs AND the kidneys are working to keep your pH blood gases in check. But if you have Kidney problems, then you will have to breathe one way or the other to what?
bring things back into balance
so too much bi carb and your lungs will compensate
hypoventilation not blowing off co2 and retaining it, the kidneys will
retain bicarb to balance it out. co2 creates acid so the kidneys will come up w/ the bicarb to balance it out
hyperventilation blowing off the acid, we have to ...
get rid of the bicarb
Aveola ventilation that exceeds metabolic demands is ...
hyperventalation
normal range pH is

7.35 - 7.45
what is it if below 7.35?
below 7.35 is acidotic

above 7.45 is alkalotic
Pco2 (partial pressure of Co2)

35 to 45
below 35 is alkalotic

above 45 is acidotic
Po2 (partial pressure of o2)

80 to 100
Po2 dropping below around 70 ish is leaning toward hypoxia, or lack of o2
the job of the kidneys is to retain or excrete sodium bicarb. this is to balance what?
what is happening in the lungs so I have COPD and not excreting Co2 from my lungs and my kidneys hold on the sodium bicard to compensate for too much acid
co2 is the acid

sodium bicarb is the base

Ex a person is retaining too much bicarb will they breathe faster or slower to compensate?
they will breathe slower to retain co2 (acid) to balance the bi carb
HERE'S WHAT SHE'S SAYING

IF SOMEHOW YOUR THROWING AWAY AN ACID YOU HAVE TO ALSO THROW AWAY A BASE
IF YOU ARE RETAINING AN ACID YOU MUST ALSO THEN ...
RETAIN A BASE
AND THIS IS WHAT YOUR KIDYNEYS WILL DO IF YOUR LUNGS ARE THROWING AWAY TOO MUCH ACID (HYPERVENTILATING) YOUR KIDNEYS WILL DUMP BICARB TO COMPENSATE
THINK:

HYPOXIA REDUCED O2 IN TISSUES
AND USUALLY GOES HAND IN HAND W/ HYPERCAPNIA- WHY?
USUALLY IF YOU DON'T HAVE ENOUGH O2, YOU HAVE TOO MUCH CO2 AND THAT IS WHAT HYPERCAPNIA IS
THE BODY CAN EXPERIENCE HYPOXIA ALL OVER IT. YOUR CIRCULATION SYSTEM CAN HAVE HYPOXIA. YOUR BLOOD CAN BE HYPOXIC. YOUR TISSUES CAN HAVE HYPOXIA. WHAT IS TISSUE HYPOXIA CALLED?
HISTOTOXIC HYPOXIA IS TISSUE HYPOXIA
WHAT IS ANEMIC HYPOXIA?
HEMOGLOBIN AND IRON HYPOXIA
WHAT IS HYPOXEMIC HYPOXIA?
NOT ENOUGH O2 IN ARTERIAL BLOOD.. THIS IS WHAT IS HAPPENING IN EMPHAZEMIA PATIENTS
IRON ON THE HEMOGLOBON CARRIES OXYEGEN SO YOU DON'T HAVE ENOUGH HEMOGLOBIN THEN I WILL HAVE WHAT?
ANEMIA HYPOXIA
SO GOOD DIET IS IMPORTANT
HISTOTOXIC HYPOXIC WHATS THAT?
TISSUE ... SOMETHING IS WRONG AND O2 ISN'T GETTING TO THE TISSUES. YOU HAVE A BAD FURNICE AND YOU FEEL BAD, HEADACHE, YOU HAVE CARBON MONOXIDE POISONING, CARBON MONOXIDE TIGHTLY BINDS WITH THE O2 AND WON'T LET GO SO HEMOGLOBIN IS SATURATED W/ CARBON MONOXIDE SO YOUR HYPOXIC ALTHOUGH YOUR BRIGHT RED. THIS IS WHAT HAPPENS WITH CYINIDE! W/ ACUTE ALCOHOL INGESTION.
WHAT IS THE TERM THAT MEANS NOT ENOUGH O2 IN OUR ARTERIAL BLOOD?
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HYPOXEMIC HYPOXIA
THIS IS WHAT HAPPENS EMPHAZIMA PATIENTS OR COPD WHERE CIRCULATORY BED AND ALVOELA ARE SO DAMAGED THEY CANNOT GET ENOUGH O2 INTO THE BLOOD GOING OUT TO THE TISSUE
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EX: YOU WORK IN A MINE AND START BREATHING METHANE GAS, YOU WILL BECOME HYPOXEMIC AND DIE. BECAUSE YOUR ARTERIAL BLOOD BECAME LOW W/ OXYGEN