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125 Cards in this Set
- Front
- Back
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Tidal volume (TV) |
Amount of air inhaled and exhaled during normal resting breathing |
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Residual volume (RV) |
Volume of air remaining in the lungs after max expiration |
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Expiratory reserve volume (ERV) |
Volume of air that can be forcefully expelled following a normal expiration |
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Inspiratory reserve volume (IRV) |
Volume of air that can be forcefully inhaled after a normal inspiration |
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Forced vital capacity (FVC) |
Amount of air that is under volitional control
FVC= IRV + ERV +TV |
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Forced expiratory volume (FEV1) |
Volume of air that can be forcefully expelled in one second following a full inspiration
Normally 70% of FVC is exhaled within first second FEV1/FVC x 100 |
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Total lung capacity |
Sum of the residual volume and forced vital capacity
TV + IRV + ERV + RV |
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Functional residual capacity |
Volume of air remaining in the lungs following a normal expiration
ERV + RV |
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Atelectasis:definition |
collapsed lung--- complete or partial
Often associated with infection
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Atelectasis:presentation |
Pain on affected side Dyspnea Cyanosis Drop in BP tachycardia Diminished or absent breath sounds Full or flat to percussion Fever Reduced chest excursion |
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Hyperventilation:definition |
Increased inspiration and expiration of air as result of an increase in rate/depth of breathing |
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Hyperventilation: effect on body |
Causes respiratory alkalosis---depletion of CO2
With decrease in BP, vasoconstriction, sometimes syncope, anxiety, wrist cramping
Treatment: breathe into paper bag until CO2 content of blood returns to normal |
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Orthopnea |
Difficulty breathing in supine |
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Orthostatic hypotension |
Decreased in BP upon standing
Can result in fainting |
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Percussion |
Use of fingertips to tap the body lightly but sharply to determine position, size, and consistency of an underlying structure and the presence of fluid or pus in a cavity
The pitch of sound emitted, vibration elicited, or resistance encountered determines possibility of underlying condition
Can be used as treatment--cupping-- to increase secretions |
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Perfusion |
Volume of blood that circulates through the lungs, gravity dependent |
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Perfusion positioning |
Treatment should occur with the involved side down (blood flow is gravity dependent) |
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Sputum |
Substance expelled by coughing or clearing the throat
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Foul smell sputum |
Anaerobic infection |
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Purulent (green or yellow) |
Infection |
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Frothy sputum |
Pulmonary edema |
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Mucoid sputum |
Clear, thick
Indicative of cystic fibrosis or conditions with chronic cough |
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Hemoptysis |
Blood in the sputum |
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angle of louis |
bony ridge between the manubrium and body point of anterior attachment of 2nd rib and trachea bifurcation |
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True ribs |
ribs 1-6 costosternal ribs single anterior costochondral attachment to stermun |
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False ribs |
ribs 7-10 costochondral ribs share costochondral attachments before attaching anteriorly to sternum |
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Ribs 11-12 |
floating ribs costovertebral ribs no anterior attachment |
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Respiratory unit |
respiratory bronchioles alveolar ducts alveolar sacs alveoli diffusion of gas occurs through these structures |
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Right lung |
3 lobes oblique and horizontal fissures 10 segments |
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Left lung |
2 lobes single oblique fissure 8 segments |
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Parietal pleura |
covers the inner surface of the thoracic cage, diaphragm, and mediastinal border of the lung |
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Visceral pleura |
wraps the outer surface of the lung, including fissure lines |
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Intrapleural space |
potential space between the 2 pleurae that maintains approximation of the rib cage and lungs allows forces to be transmitted |
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Primary muscle of inspiration |
Diaphragm portions of the intercostals |
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Where is the diaphragm at rest? Where is the diaphragm when it contracts? |
REST: arched high into thorax CONTRACTS: pulled down by the central tendon, flattening the dome Protrusion of the abdominal wall during inspiration |
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Accessory muscles of inspiration |
-used when more rapid or deeper inhalation scalenes and SCM--raise the first 2 ribs levator costarum and serratus--rest of the ribs by fixing the shoulder: trap, pecs, serratus |
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Expiratory muscles |
passive event |
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Accessory muscles of expiration |
-used when quicker or fuller expiration required QL, portions in the interostals, muscles of abdomen, and triangularis sterni |
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Breathing with lack of abdominal musculature....SCI. How is the diaphragm affected and what is the best position for breathing |
- have a lower resting position of diaphragm, increasing inspiratory reserve -the more upright body position, the lower the diaphragm--> the lower the inspiratory capacity SUPINE is the best body position for diaphragm abdominal binder may be helpful to provide support to viscera |
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Resting End Expiratory Pressure (REEP) |
point of equilibrium where forces are balanced occurs at end tidal expiration |
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Forced expiratory flow rate (FEF) |
- the slope of a line drawn between 25% and 75% of exhaled volume on a FVC exhalation curve this flow rate is more specific to the smaller airways shows a more dramatic change with disease then FEV1!!!!! |
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Arterial oxygenation |
ability of arterial blood to carry oxygen |
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Partial pressure of oxygen in atmosphere PaO2 |
barometric pressure x 21% 760 mm Hg x 21% 159.6 mm Hg |
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PaO2 in normal healthy adult |
95-100 mmHg |
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Hypoxemia |
PaO2 decreased with age in a young healthy individual, mild hypoxemia <90 |
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Fraction of oxygen in inspired air (FiO2) |
% of oxygen in air, based on a total of 1 FiO2 of room air is 21% oxygen |
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Supplemental oxygen |
increases the % (>21%) of patients atmosphere usually prescribed when PaO2 falls below 55 mmHg |
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Alveolar ventilation |
ability to remove CO2 from the pulmonary circulation and maintain pH |
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What does pH indicate? and what is normal range? |
the [] of free floating hydrogen ions within the body Normal pH: 7.35-7.45 |
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Normal PaCO2 in arterial blood |
35-45 mmHg |
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Hypocapnea |
PaCO2 < 35 mmHg |
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Hypercapnea |
PaCO2 >45 mmHg |
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What is the relationship to CO2 and pH |
INVERSE RELATIONSHIP |
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How does an increase in PaCO2 affect pH? |
DECREASES pH |
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How does a decrease in PaCO2 affect pH? |
INCREASES pH |
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Normal bicarbonate HCO3 level in blood |
22-26 |
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What is the relationship to bicarbonate levels and pH |
DIRECT RELATIONSHIP increase in HCO3 increased pH decrease in HCO3 decreases pH |
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Ventilation and perfusion |
optimal respiration occurs when ventilation and perfusion are matched perfusion=blood flow to lungs |
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Dead space |
a space that is well ventilated but in which no gas exchange occurs anatomical: conducting airways physiological: diseases--PE |
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Shunt |
no respiration occurs due to ventilation abnormality complete atelectasis of a respiratory unit allows the blood to travel through the pulmonary capillary without gas exchange |
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effects of body position on ventilation perfusion relationship |
gravity dependent |
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Upright position and perfusion |
more blood is found at the base of the lungs |
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upright position and ventilation |
at statis REEP, apical alveoli are more full than the base during inspiration, more air will be delivered to the bases, causing greater change in ventilation at the bases |
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Ventilation perfusion ratio (V/Q ratio) |
the ratio of pulmonary alveolar ventilation to pulmonary capillary perfusion upright position: apices (gravity independent): lowest Q (blood), still more air than blood, resulting in a high V/Q ratio (dead space) middle zone of lung: even ratio bases (gravity dependent): have the most Q, more blood than air, resulting in a low V/Q ratio (shunt) |
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Body positions and V/Q ratio |
every body position has 3 zones: gravity independent: acts as a dead space, high V/Q ratio middle: gravity dependent: acts as as a shunt, low V/Q ratio |
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Control centers of ventilation |
cortex pons medulla ANS |
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Normal heart rate |
adult: 60-100 bpm infant-120 bpm |
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Normal blood pressure |
adult: 120/80 infant: 75/50 |
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normal respiratory rate |
adult: 12-20 bpm infant:40 bpm |
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normal PaO2 |
adult: 80-100 mmHg infant: 75-80 mmHg |
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normal PaCO2 |
adult: 35-45 mmHg infant: 34-54 |
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normal pH |
adult 7.35-7.45 infant 7.26-7.41 |
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normal tidal volume |
adult 500 ml infant 20 ml |
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Peripheral edema seen in gravity dependent areas and jugular venous distention indicates |
possible heart failure |
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cyanosis indicates |
acute sign of hypoxemia bluish tinge to nail beds and areas around eyes and mouth |
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digital clubbing |
sign of chronic hypoxemia |
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A-P thorax dimension ratio |
1:2 with COPD, lung recoil force is decreased, resulting in a barreled chest and increased A-P dimension |
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Thoracic excusion |
measured at the base of the lungs from full inspiration and full expiration normal 2-3 inches |
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Auscultation: vesicular |
normal breath sound a soft rustling sound heard throughtout all of inspiration and the beginning of expiration |
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Auscultation:Bronchial |
a more hollow, echoing sound normally found only over the right superior anterior thorax this corresponds to an area over the right min stem bronchus all of inspiration and most of expiration are heard with bronchial breath sounds |
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Auscultation: Decreased breath sounds |
a very distant sound not normally heard allows only some of the inspiration to be heard associated with obstructive lung diseases |
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Adventitious breath sounds |
crackles and wheezes |
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Crackles |
aka rales a crackling sound heard usually during inspiration indicating--atelectasis, fibrosis, pulmonary edema |
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wheezes |
a musically pitched sound usually heard during expiration , caused by airway obstruction asthma, COPD, foreign body aspiration |
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Vocal sounds |
normal transmission of vocal sounds loudest near the trachea and main stem bronchi words should be intelligible, softer and less clear at more distal areas |
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Abnormal transmission of vocal sounds |
fluid filled areas of consolidation, cavitation lesions or pleural effusions |
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Egophony |
a nasal or bleating sound "E" sounds are transmitted to sound like "A" |
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Bronchophony |
intense, clear, sound during auscultation, even at the lung bases |
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Whispered pectoriloquy |
whispered sounds are heard clearly during auscultation |
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Chest x-ray |
2-D to detect presence of abnormal materioal (exudate,blood), or change in pulmonary parenchyma (fibrosis, collapse) |
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V/Q scan |
to identify presence of pulmonary emboli |
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Fluoroscopy |
continuous x-ray beam observation of diaphragmatic excursion |
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Respiratory alkalosis |
increase pH decreased CO2 normal bicarbonate hyperventilation |
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Respiratory alkalosis signs and symptoms |
dizziness, syncope, tingling, numbness, early tetany |
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Respiratory acidosis |
decreased pH increased CO2 normal bicarbonate hypoventilation |
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Respiratory acidosis signs and symptoms |
early: anxiety, restlessness, dyspnea, headache late: confusion, somnolence, coma |
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Metabolic alkalosis |
increased pH normal CO2 increased bicarbonate bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease |
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Metabolic alkalosis signs and symptoms |
vague symptoms: weakness, mental dullness, possible early tetany |
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Metabolic acidosis |
decreased pH normal CO2 decreased bicarbonate diabetic, lactic, uremic acidosis, prolonged diarrhea |
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Metabolic acidosis signs ans symptoms |
secondary hyperventilation, nausea, lethargy, coma |
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Sputum: gram stains |
immediate identification of bacteria |
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Sputum: cytology |
reports presence of cancer cells |
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Pulmonary function test(PFT) |
evaluate lung volumes, capacities, and flow rates |
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Normal WBC count |
4000-11,000 |
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Normal hematocrit |
35-48% |
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normal hemoglobin |
12-16 g/dL |
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Exercise Tolerance Tests |
determines exercise-induced bronchospasm by testing pulmonary function---FEV1 before and after ETT analyze arterial blood gas values if blood sampling is not available--pulse oximetry can be used |
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Graded exercise test termination criteria |
max shortness of breath cardiac ischemia or arrhythmias symptoms of fatigue leg pain total fatigue signs of insufficient cardiac output reaching ventilatory max |
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Graded exercise test termination criteria--lab values |
fall in PaO2 of >20 mmHg or less than 55 mmHg a rise on PaCO2 of >10 mmHg or greater than 65 mmHg increase in DBP of 20mmHg SBP >250mmHg decrease in BP with increasing workloads |
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Classification of COPD by GOLD: stage 1 |
Mild-may be unaware lung function is abnormal vital capacity and FEV1 >80% |
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Classification of COPD by GOLD: stage 2 |
Moderate-typically seek medical attention vital capacity and FEV1 between 50-80% |
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Classification of COPD by GOLD: stage 3 |
Severe- greater SOB, reduced exercise capacity, fatigue, impact on QOL vital capacity and FEV1 between 30-50% |
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Classification of COPD by GOLD: stage 4 |
Very severe--QOL greatly affected, life threatening vital capacity and FEV1 <30 or <50 with chronic respiratory failure symptoms PaO2< 60 PaCO2 >50 cor pulmonale increased jugular distension |
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Mechanics of ventilation: inspiration |
ribs rise up DIAPHRAGM LOWERS intrapulmonic pressure DECREASE air flows into lungs |
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Mechanics of ventilation: expiration |
PASSIVE EVENT muscles relax, lungs recoil intrapulmonic pressure INCREASES air flows out of lungs |
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Automonic nervous system: sympathetic causes what |
bronchodilation and pulmonary arterial smooth muscle CONSTRICTION |
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autonomic nervous system : parasympathetic causes what |
bronchoconstriction and pulmonary arterial smooth muscle DILATION |
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Neural control of ventilation |
INVOLUNTARY--pons and medulla and various receptors vagus nerve |
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Neural control of ventilation: voluntary control |
from cerebral cortex corticospinal tract involuntary control is dominant |
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what does decreased in residual volume mean? |
restrictive lung disease, lung cancer, muscoloskeletal impairments |
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what does increased residual volume mean? |
hyperinflated lungs increased A-P diameter of chest wall and flattened diaphragm |
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when is total lung capacity increased? |
obstructive disease--emphysema due to hyperinflation |
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when is total lung capacity decreased? |
restrictive diseases obesity pregnancy |
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How is FEV1/FVC affected in restrictive lung disease? |
ratio is INCREASED due to elastic recoil and because TLC and FVC are decreased |
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How is FEV1/FVC affected in obstructive lung disease |
ratio is DECREASED due to trapped air TLC is increased and FVC in decreased |
