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90 Cards in this Set

  • Front
  • Back
what is normally a reservoir for blood?
the lungs
what is secreted by the lungs to prevent clots?
heparin
what is the normal physiology of the lungs?
inactivates bradykinin
converts angiotensin I to angiotensin II (by means of ACE)
heparin secreting cells
what are the 3 parts of gas transport?
ventilation
pulmonary perfusion
diffusion
gas transport part 1
air exchange between lungs and atmosphere (breathe)
what are the 2 types of ventilation?
pulmonary ventilation
alveolar ventilation
gas transport part 2
flow of blood through capillaries surrounding alveoli
gas transport part 3
movement of gas across the membrane into circulating blood
slow diffusion
w/ mucous filled, think alveoli/capillaries, scar tissue
decreased gas pressure
fast diffusion
increased alveoli size
increase surface area
gets more O2
shunting
mvmt of blood, bypassing the lungs, therefore does not pick up O2
how does CO2 travel? (3)
in venous blood
as bicarb (most)
bound to proteins
which moves faster CO2 or O2
CO2, 20 X faster across alveolar/ capillary membrane
VQ Scan purpose
r/o PE, determine lung function
V=
ventillation, gas flow (4L/min)
Q=
perfusion
capillary blood flow (5L/min)
normal v/Q ratio?
0.8

4000ml air/ 5000ml blood
low v/q ratio
< 0.8
not enough gas but plenty of blood flow

d/t pulmonary edema, pneumonia, asthma

tx FiO2
ver low v/q ratio
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
high v/q ratio
well ventilated but poor blood flow

d/t
vasoconstriction of BVs
embolus
lack of O2 (hypoxia) does what to BVs
constricts because they are trying to pump out as much blood as possible
what can cause hypoxia
dec O2 inspired
hypoventilation
diffusion abnormalities
V/Q mismatch
hypoxemia vs hypoxia
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
ODC?
oxyhemoglobin dissociation curve
ODC Left shift
good, means can tolerate lower O2 levels

less O2 to the ext tissues
causes of ODC Left Shift
hypothermia
alkalemia
hypocapnia
decrease levels of 2, 3 DPG
ODC Left shift people will be in
respiratory alkalosis
ODC Right shift
bad, can drop off curve really fast
more O2 to the tissues "right to the tissues"
causes of ODC Right shift
fever
hypercapnia
acidemia
normal or increased 2, 3 DPG
Resp complaints of hypoxia
dyspnea
hypoventilation
hyperventilation
cough
hemoptysis
cyanosis
clubbing
Pain complaints of hypoxia
angina

worse w/ respirations:
pleural pain (localized)
pulmonary pain
costochondritis (inflam. of bones and cartilage)
atelectasis
collapsed alveoli, no gas exchange
what can cause atelectasis
alveoli underinflated
smoking
post op anasthesia
surgery close to diaphram
nonobstructive atelectasis?
relaxation or passive
adhesive
cicatrization
obstructive atelectasis?
mucus plug
tumor
foreign body
S&S of obstructive atelectasis
cough
tachypnea and dyspnea
hypoxemia
dec breath sounds and chest wall expansion
crackles
fever
CXR - mediastinum shift
patho of obstructive atelectasis
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
type 1 alveolar cells
gas exchange
pores of Kohn
type 2 alveolar cells
produce, store and secrete surfactant
pore of Kohn
allow air to travel b/w cells
normal surfactant
lubricates
lowers surface tension
prevents alveoli collapse
stabilizes alveoli
increase lung compliance
eases work of breathing
deficient surfactant
alveolar instability
atelectasis
impairs gas exchange (preemies)
why does anesthesia cause post op atelectasis?
diaphram impairment because you are relaxed, and pain from surgery
S and S of post op atelectasis
incisions close to diaphram
shallow breathing
dec breath sounds
pain
hypoxemia
CXR-opacity
how do you treat atelectasis
intermittent positive pressure breathing
mech ventil
chest PT
O2 therapy
analgesics
bronchodilators
mucolytics
cough and deep breathing
IS
positioning
early ambulation
what produces mucus?
goblet cells
what does heat (fever, dehydration, smoking) do to airway?
dries membranes, thick secretions which will slow down or paralyze cilia
typical pneumonia?
has pus
atypical pneumonia
does not have pus
community acquired pneumonia
can be prentable with vaccine
gram positive bacteria (streptococcus pneumoniae & mycoplasma pneumoniae)
what type of pneumonia does streptococcus pneumoniae cause?
typical (most common)
what type of pneumonia does mycoplasma pneumoniae cause?
atypical
what is legionaires disease?
form of bronchopneumonia

get from standing warm water
hospital acquired pneumonia?
gram negative bacteria

e coli
klebsiella pneumoniae
pseudomonas aeroginosa
how do you get an invasion of lower resp tract
aspiration
inhalation
bloodstream
trauma
intubation
who does typical pneumonia usually affect?
healthy ppl
pus
inflammation

diminished breath sounds
dull percussion
who does atypical pneumonia usually affect?
ill
young
elderly
no pus
chest cold
sore throat
sequelae of pneumonia
ARF
Septicemia
death
lobar s and s
inspiratory crackles
sudden onset
fever up to 106
chills
bronchopneumonia s and s
slow onset
expiratory crackles
green or yellow sputum
tuberculosis affects what part of lobes
upper
what is caseous necrosis
cheese like substance in lungs

in TB
what immunity does TB test test
cell mediated
what is inherent anergy?
when immune system is not enough to give a positive test

AIDS
TB primary infection
bacilli in lungs
phagocytes transport to lymph system
macrophages can't kill bacilli ****
form granuloma, becomes calcified
+PPD without active disease
TB secondary infection
reactivation of infection
increase # granulomas
extensive tissue necrosis, bacilli spread systematically
get s/sx
tb s/sx
fever, malaise, fatigure, night sweats, wt loss, cough
what is pleural effusion?
pleural fluid accumulation b/w viseral and parietal pleura
causes of pleural effusion
neoplasms
infections
thrombo-emboli
cardiovascular defects
immunologic defects
patho pleural effusion

increased negative intrapleural pressure?
atelectasis

things start collapsing due to negative pressure
increased capillary pressure
CHF

fluid backup
increased cap permeability
inflammation process
decreased colloidal osmotic pressure d/t
low albumin

can't pull back fluid into capillaries
impaired lympahtic drainage
carcinoma
what is empyema
pus (abscess)
hydrothorax
serous fluid (CHF)
chylothorax
chyle (lymph backup)
hemothorax
blood (injury)
"sucking chest wound"
open chest wound
tension pneumothorax s/sx
tracheal deviation towards effected side
diminished or absent breath sounds on affected side
CO significantly decreased
scalene elevates
top 2 ribs
sternocleidomastoid elevates
sternum
abdominal wall muscles used in
expiration
what nerve innervates the diaphram
phrenic nerve at 4th cervical disc
what in the blood regulates respiration?
CO2
apneustic center?
excitatory effect

prolongs inspiration
pneumotaxic center?
turns inpsiration off

controls RR and inspiratory volume
increased compliance
easy to inflate
difficult to exhale
overstretched
decreased compliance
stiff
difficult to inhale
during inspiration air moves from
area of greater pressure to less pressure