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90 Cards in this Set
- Front
- Back
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what is normally a reservoir for blood?
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the lungs
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what is secreted by the lungs to prevent clots?
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heparin
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what is the normal physiology of the lungs?
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inactivates bradykinin
converts angiotensin I to angiotensin II (by means of ACE) heparin secreting cells |
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what are the 3 parts of gas transport?
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ventilation
pulmonary perfusion diffusion |
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gas transport part 1
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air exchange between lungs and atmosphere (breathe)
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what are the 2 types of ventilation?
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pulmonary ventilation
alveolar ventilation |
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gas transport part 2
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flow of blood through capillaries surrounding alveoli
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gas transport part 3
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movement of gas across the membrane into circulating blood
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slow diffusion
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w/ mucous filled, think alveoli/capillaries, scar tissue
decreased gas pressure |
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fast diffusion
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increased alveoli size
increase surface area gets more O2 |
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shunting
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mvmt of blood, bypassing the lungs, therefore does not pick up O2
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how does CO2 travel? (3)
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in venous blood
as bicarb (most) bound to proteins |
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which moves faster CO2 or O2
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CO2, 20 X faster across alveolar/ capillary membrane
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VQ Scan purpose
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r/o PE, determine lung function
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V=
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ventillation, gas flow (4L/min)
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Q=
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perfusion
capillary blood flow (5L/min) |
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normal v/Q ratio?
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0.8
4000ml air/ 5000ml blood |
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low v/q ratio
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< 0.8
not enough gas but plenty of blood flow d/t pulmonary edema, pneumonia, asthma tx FiO2 |
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ver low v/q ratio
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blocked gas but good blood flow
d/t acute resp. distress syndrom RDS of newborns does not respond to FiO2 b/c airway blocked use PEEP to keep alveoli open |
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high v/q ratio
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well ventilated but poor blood flow
d/t vasoconstriction of BVs embolus |
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lack of O2 (hypoxia) does what to BVs
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constricts because they are trying to pump out as much blood as possible
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what can cause hypoxia
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dec O2 inspired
hypoventilation diffusion abnormalities V/Q mismatch |
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hypoxemia vs hypoxia
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hypoxemia- low amounts of O2 in the blood, measure by ABG, normal 80-100
hypoxia- poor oxygenation of tissues/cells, measured by pulse ox, normal 93-100 |
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ODC?
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oxyhemoglobin dissociation curve
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ODC Left shift
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good, means can tolerate lower O2 levels
less O2 to the ext tissues |
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causes of ODC Left Shift
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hypothermia
alkalemia hypocapnia decrease levels of 2, 3 DPG |
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ODC Left shift people will be in
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respiratory alkalosis
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ODC Right shift
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bad, can drop off curve really fast
more O2 to the tissues "right to the tissues" |
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causes of ODC Right shift
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fever
hypercapnia acidemia normal or increased 2, 3 DPG |
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Resp complaints of hypoxia
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dyspnea
hypoventilation hyperventilation cough hemoptysis cyanosis clubbing |
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Pain complaints of hypoxia
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angina
worse w/ respirations: pleural pain (localized) pulmonary pain costochondritis (inflam. of bones and cartilage) |
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atelectasis
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collapsed alveoli, no gas exchange
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what can cause atelectasis
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alveoli underinflated
smoking post op anasthesia surgery close to diaphram |
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nonobstructive atelectasis?
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relaxation or passive
adhesive cicatrization |
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obstructive atelectasis?
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mucus plug
tumor foreign body |
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S&S of obstructive atelectasis
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cough
tachypnea and dyspnea hypoxemia dec breath sounds and chest wall expansion crackles fever CXR - mediastinum shift |
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patho of obstructive atelectasis
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airway obstructed, blood removes all the gases, airless alveoli perfused, blood shunting through w/o gas exchange, alveoli collapse or fill with fluid, surrounding lung spreads out and takes over the space
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type 1 alveolar cells
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gas exchange
pores of Kohn |
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type 2 alveolar cells
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produce, store and secrete surfactant
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pore of Kohn
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allow air to travel b/w cells
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normal surfactant
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lubricates
lowers surface tension prevents alveoli collapse stabilizes alveoli increase lung compliance eases work of breathing |
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deficient surfactant
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alveolar instability
atelectasis impairs gas exchange (preemies) |
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why does anesthesia cause post op atelectasis?
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diaphram impairment because you are relaxed, and pain from surgery
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S and S of post op atelectasis
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incisions close to diaphram
shallow breathing dec breath sounds pain hypoxemia CXR-opacity |
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how do you treat atelectasis
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intermittent positive pressure breathing
mech ventil chest PT O2 therapy analgesics bronchodilators mucolytics cough and deep breathing IS positioning early ambulation |
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what produces mucus?
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goblet cells
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what does heat (fever, dehydration, smoking) do to airway?
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dries membranes, thick secretions which will slow down or paralyze cilia
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typical pneumonia?
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has pus
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atypical pneumonia
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does not have pus
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community acquired pneumonia
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can be prentable with vaccine
gram positive bacteria (streptococcus pneumoniae & mycoplasma pneumoniae) |
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what type of pneumonia does streptococcus pneumoniae cause?
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typical (most common)
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what type of pneumonia does mycoplasma pneumoniae cause?
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atypical
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what is legionaires disease?
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form of bronchopneumonia
get from standing warm water |
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hospital acquired pneumonia?
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gram negative bacteria
e coli klebsiella pneumoniae pseudomonas aeroginosa |
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how do you get an invasion of lower resp tract
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aspiration
inhalation bloodstream trauma intubation |
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who does typical pneumonia usually affect?
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healthy ppl
pus inflammation diminished breath sounds dull percussion |
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who does atypical pneumonia usually affect?
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ill
young elderly no pus chest cold sore throat |
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sequelae of pneumonia
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ARF
Septicemia death |
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lobar s and s
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inspiratory crackles
sudden onset fever up to 106 chills |
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bronchopneumonia s and s
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slow onset
expiratory crackles green or yellow sputum |
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tuberculosis affects what part of lobes
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upper
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what is caseous necrosis
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cheese like substance in lungs
in TB |
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what immunity does TB test test
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cell mediated
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what is inherent anergy?
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when immune system is not enough to give a positive test
AIDS |
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TB primary infection
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bacilli in lungs
phagocytes transport to lymph system macrophages can't kill bacilli **** form granuloma, becomes calcified +PPD without active disease |
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TB secondary infection
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reactivation of infection
increase # granulomas extensive tissue necrosis, bacilli spread systematically get s/sx |
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tb s/sx
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fever, malaise, fatigure, night sweats, wt loss, cough
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what is pleural effusion?
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pleural fluid accumulation b/w viseral and parietal pleura
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causes of pleural effusion
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neoplasms
infections thrombo-emboli cardiovascular defects immunologic defects |
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patho pleural effusion
increased negative intrapleural pressure? |
atelectasis
things start collapsing due to negative pressure |
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increased capillary pressure
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CHF
fluid backup |
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increased cap permeability
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inflammation process
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decreased colloidal osmotic pressure d/t
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low albumin
can't pull back fluid into capillaries |
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impaired lympahtic drainage
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carcinoma
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what is empyema
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pus (abscess)
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hydrothorax
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serous fluid (CHF)
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chylothorax
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chyle (lymph backup)
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hemothorax
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blood (injury)
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"sucking chest wound"
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open chest wound
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tension pneumothorax s/sx
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tracheal deviation towards effected side
diminished or absent breath sounds on affected side CO significantly decreased |
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scalene elevates
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top 2 ribs
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sternocleidomastoid elevates
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sternum
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abdominal wall muscles used in
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expiration
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what nerve innervates the diaphram
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phrenic nerve at 4th cervical disc
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what in the blood regulates respiration?
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CO2
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apneustic center?
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excitatory effect
prolongs inspiration |
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pneumotaxic center?
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turns inpsiration off
controls RR and inspiratory volume |
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increased compliance
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easy to inflate
difficult to exhale overstretched |
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decreased compliance
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stiff
difficult to inhale |
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during inspiration air moves from
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area of greater pressure to less pressure
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