Patho Test # 3 Respiratory

Front 1

What is the major function of the respiratory system

Back 1

gas exchange..air goes in the body and travels to lungs, oxygen replaces C02 in the blood and C02 is exhaled

Front 2

name the 4 parts of the upper airway

Back 2

nose mouth pharynx larynx
it allows air in and out of lungs/warms, humidifies, and filters inspired air/protects lower airway from foreign matter

Front 3

name 4 parts of the lower airway

Back 3

trachea lft/rght mainstream bronchi 5 secondary bronchi bronchioles.... this is where gas exchange occurs/aveoli are the main units for gas exchange

Front 4

what is and what happens in diffusion

Back 4

it is the passage of gas molecules thru respiratory membrane; 02 is is passed to the blood for circulation for body while at the same time C02 is collected from the blood for disposal out of the lungs

Front 5

What is surfactant

Back 5

a liquid substance that coats the alveoli..it allows the alveoli to expand fully during inspiration and prevents collapse during expiration of aveoli

Front 6

How much 02 and c02 trade places in the aveoli?

Back 6

depends on ventilation( air) and perfusion(amount of blood in the pulmonary cappilaries)..

Front 7

what 3 things can happen in ineffective gas exchange

Back 7

shunting-reduced air to lung
dead space vntilation- reduced perfusion to a lung
silent unit- combo of both

Front 8

what happens in normal ventilation and perfusion?

Back 8

when they are matched, unoxygenated blood from the veins returns to the right ventricle then thru the pulmonary artery then to the lungs CARRYING CARBON DIOXIDE, aerteries branch into aveolar capillaries and gas exchange occurs

Front 9

The amount of air that reaches the lungs depends on what three things

Back 9

lung volume/capacity
compliance
resistance to air flow

Front 10

airway resistance is increased in what diseases

Back 10

asthma, chronic bronchitis, emphsyema...has to work harder to breathe, especially in expiration to compensate for narrowed airways and diminished gas exchange

Front 11

where is the respiratory center located in the brain

Back 11

lateral medulla oblongata of the brain stem

Front 12

Name 3 things the chemoreceptors respond to

Back 12

ion concentration in the blood-PH
partial pressure of c02
partial presssure of o2
they respond indirectly to arterial blood by sensing changes in the PH of cerebrospinal fluid

Front 13

what helps regulate ventilation by impacting the ph of CSF

Back 13

PaC02

Front 14

what would happen to the rr if the Pac02 is high

Back 14

increases

Front 15

if the rr is decreasing what is going on with Pac02

Back 15

it is low

Front 16

what happens in ARDS

Back 16

fluid builds up in the interstitum, alveolar spaces, and small airways causing the lungs to stiffen. impaired ventilation and oxygen of pulmonary capillary blood

Front 17

Explain ARDS in detail

Back 17

1. reduced blood flow=platlet aggregation that release serotonin,bradykinin, histamine that inflame and damage alvelor membrane =capillary permeability
2. fluids shift into interstitial spaces
3. as cap permability increases proteins and more fluids leak out causing pulmonary edema
4. fluid in aveoli decrease surfactant=reduces aveoli to make more=impaired gas exchange and alveoli collapse
5. increase rr, not enough 02 can cross avelcapillary membrane and c02 is lost more quickly..02 and c02 are both decresed
6. pulmonary edema worsens, fibrosis, hypoxemia = metabolic acidosis

Front 18

what is asthma

Back 18

a chronic obstructive reactive airway disorder causing airway obstruction from bronchospasms, mucous secretions, mucosal edema

Front 19

Details of what happens in asthma

Back 19

1. bronchial linings overreact to certain stimuli causing episodic smooth muscle spasms that severly constrict the airways

Front 20

what is COPD

Back 20

refers to long term pulmonary disorders depicted by airflow resistance.Asthma/Chronic bronchitis/ Emphysema/

Front 21

Why does smoking predispose one to COPD

Back 21

it impairs ciliary action and macrophage function causing inflammation in the airway, increased mucous production, alveolar destruction, fibrosis

Front 22

what is emphysema

Back 22

the abnormal permanent enlargement of the acini accompanied by destruction of alveolar walls..obstruction occurs from tissue change. There is airflow limitation caused by lack of elastic recoil in the lungs

Front 23

Pulmonary edema

Back 23

is a common thing in cardiac disorders, accumulated fluid in the extravascular spaces of the lungs. Diminshed function of left ventricle causes blood to pool there and left atrium= blood backs up to pulmonary veins and capillaries, increasing cap hydrostatic pressure pushes fluid into interstial spaces and alveoli

Front 24

what is the role of the lungs

Back 24

provides a surface for gas exchange, moves 02 into blood, c02 is removed from blood, partners with cardio to support breathing

Front 25

name the 4 steps of respiration

Back 25

ventilation, oxygen diffusion, transportation, tissue extraction

Front 26

what happens to oxygen during gas exchange

Back 26

moves from aveolar air into blood

Front 27

what happens to C02 during gas exchange

Back 27

moves from blood into alveolar air

Front 28

what happens in hypoventilation

Back 28

there is decreased c02 blowoff= increases c02 in the blood and depression of repiratory system

Front 29

what are barriers to ventilation

Back 29

increased resistance and decreased compliance where lungs cant fully expand

Front 30

name all the restrictive diseases

Back 30

Pneumonia, atelectasis, edema, contusion, pnemothorax

Front 31

what are obstructive diseases

Back 31

emphysema, asthma, bronchitis, cystic fibrosis

Front 32

To give someone more air/ventilation what w0uld u do

Back 32

INCREASE COMPLIANCE BY: TCDB, spirometer, lasix, antibiotics, CPAP

Front 33

To decrease resistance and increase ventilation support what would u do

Back 33

suctioning, bronchdilators, TCDB

Front 34

Other airway support

Back 34

nutrition, mechanical assitant, diaphramtic rest

Front 35

what is this when oxygen and C02 are exchanged between the alveolus and RBC thru the capillary membrane

Back 35

diffusion

Front 36

This is a barrier to diffusion where there is good blood exchange but less air-alveolar problems..ex: pneumonia/ARDS/pulm edema

Back 36

pulmonary pathology

Front 37

cardio pathology

Back 37

less blood exchange and good alveolar change and is a barrier to diffusion

Front 38

oxygen therapy is given when

Back 38

1. hypoventilation in COPD pts
2. microatelectasis from nitrogen loss
3. SAFE IS 40% or less, unsafe is 60% or more

Front 39

dissolved in plasma and oxygen bound

Back 39

transportation

Front 40

two barriers to transportation and cause of hypoxia

Back 40

low hemoglobin and low cardiac output

Front 41

what is ventilation perfusion mismatching

Back 41

when blood goes to parts of the lungs that do not have oxygen to give it and blood does not go into parts of lungs that have oxygen

Front 42

Pulse ox

Back 42

Sp02 does not = Sa02
large changes can occur in Pa02 b4 Sp02 drops

Front 43

what is Extraction

Back 43

when 02 and c02 are exchanged btw the RBC and the tissues the cap membrane

Front 44

what are barriers to extraction

Back 44

edema, fibrosis, cellular dsyfunction

Front 45

1. S shape reflects hemoglobins affinity for oxygen based on 02 saturation
2. Hemos affinity for 02 should change with the needs of the tissues, therefore if there is a increased metabolic need in the tissues then hemo will have a lower affinity for 02 and give it up(shift to the right)

Back 45

02 hemoglobin dissociation curve

Front 46

To assess ventilation we look at what?

Back 46

PaC02

Front 47

To assess diffusion we look at what?

Back 47

Pa02

Front 48

Acid base assessment, we look at what ?

Back 48

ph,HC03,PaC02

Front 49

what are the 3 different types of respiratory diseases

Back 49

restricitve, obstructive, and vascular

Front 50

a normal ph is ---- and we use this to determine------- or -------

Back 50

7.35-7.45; acidosis or alkalosis

Front 51

PaC02 tells us the respiratory effect. what is normal? alka? acidosis?

Back 51

35-45, less than 35 =alkalosisi, and higher than 45=acidosis

Front 52

assume ------ when respirtory is ruled out

Back 52

metabolic cause

Front 53

what is an ABG

Back 53

is an arterial blood measurement of the acid base status

Front 54

if your rr increase you are blowing off more c02 therefore decreasing the acid(c02 is an acid) then you would be

Back 54

alkalosis

Front 55

if your rr decrease you are retaining acid-c02, giving you more

Back 55

acidosis

Front 56

the kidneys rid the body of nonvilotile acids(hydrogen) and maintain a constant ------

Back 56

HC03 bicarbonate(base)

Front 57

what is this when u have excess H+ and decreased HC03

Back 57

decreased ph and acidosis
REASON: kidneys try to adjust by excreting H+ and holding HC03; respiratory system will try to compensate by blowing off more C02, increased rr

Front 58

You have Alkalosis when H+ decreases and you have excess (or increased) HCO3 (base).

Back 58

The Kidneys excrete HCO3 (base) and retain H+ to compensate.
The Respiratory System tries to compensate with hypoventilation to retain
CO2 (acid) to decrease the Alkalosis.

Front 59

PH is less than 7.35 and C02 is higher than 45

Back 59

respiratory acidosis

Front 60

a. Depression of the Respiratory Center (sedatives, narcotics, drug overdose, CVA, cardiac arrest, MI)
b. Respiratory muscle paralysis (spinal cord injury, Guillian-Barre, paralytics)
c. Chest wall disorders (flail chest, pneumothorax)
d. Disorders of the lung parenchyma (CHF, COPD, pneumonia, aspiration, ARDS)
e. Alteration in the function of the abdominal system (distention)

Back 60

causes of hypoventilation

Front 61

Respiratory Alkalosis pH > 7.45
CO2 < 35

Back 61

causes of resp alkalosis: Alveolar Hyperventilation

a. Psychogenic (fear, pain, anxiety)
b. CNS stimulation (brain injury, ETOH, early salicylate poisoning, brain tumor)
c. Hypermetabolic states (fever, thyrotoxicosis)
d. Hypoxia (high altitude, pneumonia, heart failure, pulmonary embolism)
e. Mechanical overventilation (ventilator rate too fast)

Front 62

Metabolic Acidosis pH < 7.35
HCO3 < 22 (normal = 22 – 26)

Back 62

Causes:

--Increased H+, excess loss of HCO3

a. Overproduction of organic acids (starvation, ketoacidosis, increased catabolism)
b. Impaired renal excretion of acid (Renal Failure)
c. Abnormal loss of HCO3 (diarrhea, biliary fistula, Diamox)
d. Ingestion of acid (salicylate overdose, oral anti-freeze)

Front 63

Metabolic Alkalosis pH > 7.45
HCO3 > 26

Back 63

Causes:

--Loss of H+ or increased HCO3

a. Large losses of gastric contents (vomiting, NG suction)
b. Loss of K+ (diarreah, vomiting)
c. Ingestion of large amounts of bicarbonate (antacids, resuscitation)
d. Prolonged use of diuretics (distal tubule lose ability to reabsorb Na+ and Cl- therefore Na+, Cl-, K+,
Ammonia are lost in the urine and these bind with H+)
(Note: al-K+-low-sis means K+ value is low when pt is alkalotic)

Front 64

1. The O2 tells us if the patient has HYPOXEMIA (decreased oxygen in the blood).
2. Normal PaO2 = 80-100. (Hypoxemia = PaO2<80)
3. PaO2 assesses Perfusion (gas exchange).
4. PaCo2 asseses the adequacy of Ventilation (breathing pattern).
5. The PaO2 is very important in determining your patient’s oxygen status and needs—but it is not necessary in determining the Big Four.

Back 64

what does Pa02 mean?

Front 65

1. SaO2 (oxygen saturation) measures the percent of oxygen bound to hemoglobin. This tells weather the patient has HYPOXIA (decreased O2 in the tissues).
2. Normal SaO2 = Greater that 95%
3. Acceptable SaO2 will vary between MDs; but PaO2 dramatically drops when it is less that 92%.
4. This is a noninvasive measurement via pulse oxymetry and can be less accurate due to hypothermia, hypotension, hypovolemia, or vasoactives.
5. Note: In Carbon Monoxide Poisoning—the HGB is saturated with Carbon Monoxide. Although the patient is hypoxemic because there is no room on the HGB for O2 to be carried—the Saturation looks good because it can’t distinguish between the two.

Back 65

what is saturation

Front 66

the respiratory system consists of

Back 66

air passages and lungs

Front 67

The lungs are the functional structure of the respiratory system, what do they do

Back 67

function in gas exchange, inactivate vasoactive substances like bradykinin,convert angiotensisen 1 to 2, and is a reservoir for blood

Front 68

The lobes of the lungs consist of what

Back 68

bronchioles, alveoli, pulmonary capillaries. oxygen from the alveoli diffuses across alveoli capillary membrane into the blood, and C02 from blood diffuses into alveoli to be expired

Front 69

pulmonary circulation provides what

Back 69

gas exchange function of the lungs

Front 70

bronchial circulation distributes blood

Back 70

to conducting airways and supporting structures of the lungs

Front 71

Lung compliance

Back 71

is the ease with which the lungs can be inflated,elasticity of the lung tissue, and surface tension in alveoli. Surfactant reduces tension in the lungs which increase compliance.

Front 72

exchange of gases btw air in the alveoli and blood in pulmonary capillaries requires?

Back 72

a match of ventilation and perfusion

Front 73

Shunt refers to what

Back 73

when blood that moves from right to left circulation with out being oxygenated.

Front 74

Hemoglobin

Back 74

main vehicle for oxygen, binds oxygen as it passes thru the lungs and releases as it moves thru tissues

Front 75

How do you determine the amount of oxygen available to a patient

Back 75

it is the total amount of oxygen carried by the hemoglobin + the amount of oxygen that is carried in the dissolved state.

Front 76

what is the primary function of the lungs

Back 76

to provide oxygen to blood and remove C02

Front 77

movement of air in the atmosphere and lungs

Back 77

ventilation

Front 78

what 4 factors if diffusion influenced by

Back 78

1. the surface area
2. thickness of alveolar-cap membrane
3. diff in partial pressure of the gas on either side of membrane
4. characteristic of the gases

Front 79

the efficiency of gas exchange requires

Back 79

matching of ventilation and perfusion so that = amounts of air and blood enter the respiratory part of the lungs

Front 80

the automatic regulation of ventilation is controlled by

Back 80

lung receptors- protect respiratory structures
chemoreceptors- which monitor gas exchange functions of the lungs by by sensing changes in the blood levels of c02, ph, 02

Front 81

Pneumonia is

Back 81

an infection of the parenchymal tissues of the lungs. It is an obstruction of the bronchioles with decreased gas exchange, increase exudate

Front 82

Atelectasis

Back 82

refers to incomplete expansion of the lungs, can be from airway obsrtuction, tumor, exudate

Front 83

obsrtuctive airway disorders

Back 83

are airway obstruction and limitation in expiratory airflow

Front 84

asthma

Back 84

chronic inflammatory disorder of the airways, shown by airway hypersenitivity and episodic attacks of airway narrowing

Front 85

COPD

Back 85

is a group of conditions shown by obstruction to airflow in the lungs. Empysema, chronic bronchitis

Front 86

loss of lung elasticity,abnormal permanent enlargement of the air spaces distal to terminal bronchioles, hyperinflation of the lungs

Back 86

emphysema

Front 87

pulmonary embolism disorders are what

Back 87

pulmonary embolism, pul hypertension

Front 88

when does pulmoary embolism develops when

Back 88

blood borne substance lodges in a branch of the pulmonary artery and obstructs blood flow, it can be air,thrombus,fat,amniotic fluid

Front 89

ARDS is

Back 89

acute lung injury resulting from a number of serious localized and systemic disorders that damge the alveolar cap membrane of the lung.

Front 90

what are the results of ARDS

Back 90

interstitial edema in the lungs, increase in surface tension, inactivation of surfactant, collapse of the alveolar , stiff and noncompliant lung, and impaired diffusion of the repiratory gases with severe hypoxia that is resistant to oxygen therapy

Front 91

repiratory failure is

Back 91

is when the lungs fail to oxygenate the blood or prevent undue c02 retension. 02<50 C02>50

Front 92

COPD

Back 92

loss of aveolar surface area for gas exchange, progressive narrowing of bronchioles

Front 93

why would someone with ARDS not respond to oxygen therapy

Back 93

blood is shunted past alveoli with no ventilation,

Front 94

what is the last to develop in respiratory failure

Back 94

cyanosis

Front 95

why would you get dsypnea in COPD

Back 95

your airway open wider on inspiration and trap air on expiration..alveolar hyperinflation leads to rupture and loss of area for gas exchange

Front 96

your patient has ARDS what is the gas exchange impairment due to

Back 96

shunting of blood around nonventilated alveoli

Front 97

wheezes are heard

Back 97

when passageways are narrowed like asthma, crackles is where fluid is there

Front 98

what type of diseases are asthma, choking, anaphylasix schock

Back 98

obstructive diseases

Front 99

restrictive diseases refers more in the ------ and obstructive more ----

Back 99

lungs airways

Front 100

fluid builds up in lungs caused from bacteria and inflammatory process and immune system kicks in , decrease compliance and cant take deep breath, who am i ?

Back 100

pneumonia

Front 101

inflamm process kicks in, cant take deep breath, bruise, compliance is reduced, fluid shifts into tissue, who am i?

Back 101

contusion

Front 102

reduced surface area,cant get C02 out!, smoke breaks down alveoli, is restrictive. The alveoli start fusing into big alveoli and there is greater surface area with small ones=gas exchange is reduced. alveoli get overdistended cant get rid of C02 and there is not enough room to get out. Bronchitis is usually there also and cant blow enough air out. barrel chest is bc of large alveoli taking up so much room and there is decrease in compliance. who am i?

Back 102

Emphysema

Front 103

decrease size of airway, bronchitis, emphysema, CF, asthma,bronchitis

Back 103

obstructive diseases

Front 104

what is CPAP

Back 104

continuos positive airway pressure- force air in , keeps aveoli inflated and prevents atelectaisis

Front 105

TRANSPORTATION

Back 105

EACH RBC HAS 4-6 HEMOCLOBIN AND THEY HAVE 4 MOLECULES OF OXYGEN
LACK OF RBC CAN EFFECT OXYGEN
BLOOD AND HEART ISSUE
LOW HEMOGLOBIN- GIVE BLOOD
LOW CO- GIVE FLUIDS

Front 106

EDEMA BC IT CANT DIFFUSE ACROSS
TISSUE CANT USE IT BC OF DISFUNCTION...PH IS OFF BALANCE....CELL CANT FUNCTION
BALANCE OF SUPPLY AND DEMAND-----HYPOXIA,

Back 106

extraction

Front 107

if there is not a need in the tissue then it will keep hemoglobin...lower affinity
shift to the right
fever increase need for oxygen
left shift- more oxygen-
hypothermic- immerese in cold water- people with heart attack- they recover- and drop temp and reduces metabolic need for oxygen
look at ABG= for oxygen
know what obstructive vs restricitve vs vascular !!!!!!!

Back 107

affinity

Front 108

Students sometimes have trouble with the idea that pulmonary arterioles constrict in response to low O2 levels. This makes sense if you present it in an example in which the main idea is to keep the ventilation:perfusion ratio constant.
Learning Activity: Worksheet 20-1
In-Class Discussion Question (also on PowerPoint slides): A child has inhaled a peanut, blocking her left primary bronchus. How will the ventilation in her two lungs change?
Answer: Ventilation in the left lung will decrease. Ventilation in the right lung will increase to compensate.
How will the composition of the air in her two lungs differ?
Answer: The air in her left lung will have more CO2 and less O2.
Which lung should she send more blood to?
Answer: the right lung
How should her body alter perfusion of the lungs?
Answer: She must vasodilate the arterioles in the right lung and constrict the arterioles in the left lung.
 

Back 108

more stuff

Front 109

The easiest way I know to teach about hemoglobin’s role as a carrier of O2 and CO2 is to use candy. The students work in groups of four to six; each group represents a red blood cell, and each student a hemoglobin molecule. Then I throw small candies around the room. Each candy represents a molecule of O2. The candies that land on the floor represent the dissolved O2, or PO2. From those that land on the tables, each student can pick up as many as four candies. Because a hemoglobin molecule is 100% saturated when it has four molecules of O2, students should be able to calculate their individual O2 saturation, their “cell’s” O2 saturation, and the entire room’s O2 saturation.

Back 109

hemoglobin/02 sat

Front 110

More need in tissues= less affinity for hemoglobin, therefore it will give it up & vice versa

Right shift= fever, acidosis, increased CO2, anemia, heart failure

Left shift= decreased tissue metabolism such as alkalosis, hypothermia, decreased CO2

I explain affinity to students by telling them I have a high affinity for Patrick Swayze—that is, if I got hold of him I would not let go! It can also be demonstrated by offering the student something and then refusing to let go of it. The one of you with the highest affinity for the object will win, and this can demonstrate why fetal hemoglobin needs a higher oxygen affinity than does maternal hemoglobin.
To add carbon dioxide to the candy scenario, I throw a different kind of candy representing CO2. Students can pick these up, but for every molecule of CO2 they pick up, they must drop a molecule of O2. The CO2 has attached to the hemoglobins, creating carbaminohemoglobin, and reduced their oxygen affinity. In this way, an exercising tissue that releases CO2 w

Back 110

dissociation curve

Front 111

carbon dioxide and oxygen are exchanged what happens

Back 111

higher concentration of gas goes to lower; higher concentration of c02 in the hemoglobin moves across membrane into the alveoli and is expired by the lungs; high concentration of O2 in the alveoli crosses the membrane and attaches to the hemoglobin which is then distributed by the circulatory system thru the body

Front 112

lungs operate on ------ pressure

Back 112

negative

Front 113

what goes on in asthma

Back 113

airway becomes obstructed from either inflammation of lining of the airways or constrcition of the bronchial smooth muscles. Inflammatory response, increasing size of the bronchial lining=restriction

Front 114

why are rr increased in certain resp diseases

Back 114

the body is attempting to get more oxygen to the lungs, while tachcardia is due to the body trying to get more 02 to the tissues

Front 115

Atelectasis

Back 115

a portion of the lung does not expand completly which decreases the lung capacity to exchange gases which results in decreased 02 of blood.

Front 116

Atelectasis

Back 116

dyspnea-due to lack of expansion of part of the lung
tachcardia/tachypnea - trying to increase availble oxygen /body tries to availble 02

Front 117

Bronchitis

Back 117

increase mucous,infection and airborne irritants that block airways in the lungs, decreased ability to exchange gases.

Front 118

Emphysema

Back 118

chronic inflammation reduces the flexibility of the walls of alveoli=over distention of the alveolar walls, this causes air to be trapped in the lungs, impeding gas exchange.

Front 119

Signs of emphysema

Back 119

dyspnea-due to air trapping which retains C02 and reduces alveolar gas exchange, barrel chest

Front 120

Respiratory Acidosis

Back 120

hypoventilation, central nervous disorders, causes a disturbance in the acid balance resulting in hypercapnia, overtime the sustained c02 levels cause the kidneys to attempt to compensate by retaining bicarb/sodium and excreting hydrogen ions

Front 121

Pulmonary vascular diseases are conditions that affect the pulmonary circulation. Examples of these conditions are[citation needed]
Pulmonary embolism, a blood clot that forms in a vein, breaks free, travels through the heart and lodges in the lungs (thromboembolism). Large pulmonary emboli are fatal, causing sudden death. A number of other substances can also embolise to the lungs but they are much more rare: fat embolism (particularly after bony injury), amniotic fluid embolism (with complications of labour and delivery), air embolism (iatrogenic).
Pulmonary arterial hypertension, elevated pressure in the pulmonary arteries. It can be idiopathic or due to the effects of another disease, particularly COPD. This can lead to strain on the right side of the heart, a condition known as cor pulmonale.
Pulmonary edema, leakage of fluid from capillaries of the lung into the alveoli (or air spaces). It is usually due to congestive heart failure.
Pulmonary hemorrhage, inflammation and damage to capillaries in the lu

Back 121

vascular pulmonary