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82 Cards in this Set
- Front
- Back
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What is internal respiration?
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The utilization of O2 by cells to produce ATP with CO2 as a by product
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What is external respiration?
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all the different components of the respiratory system that is designed to deliver O2 to the site of metabolism and remove CO2
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What are the basic requirements for external resp to work?
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1. Ventilation
2. Gas Exchange 3. Gas transport 4. Tissue extraction/deposition |
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What type of air is needed for ventilation?
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air that contains at least normal atmospheric % of O2 = 21%
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How much air goes to dead space in ventilation?
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30%
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Where does gas exchange occur?
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At the respiratory bronchioles and alveolar sacs
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What is the requirement for gas exchange to occur?
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must have adequate V/Q
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What are the 2 compartments where gassess are held during transport?
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plasma and then on hemoglobin
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Any problem in the basic requirements for external respiration will cause what?
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Hypoxia
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Pulmonary disorders tend to be a problem with the ___ and ____ of the lungs?
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structure and function
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What is the environment of the lungs that allow for ventilation>?
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Subatmospheric
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If the pressure inside the lungs is allowed to equalize with the atmosphere, what will occur?
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abnormal ventilation and collapse of the lungs
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What is restrictive lung disease characterized by?
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decrease compliance of thye lungs. They are less elastic and harder to ventilate
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What is obstructive lung disease? What does it lead to?
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Airway narrowing and causes decreased ventilation
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What can affect gas exchange?
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Anything that causes damage to the structure of the alveolar sacs or the pulmonary capillaries or both
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What is adult repsiratory distress?
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acute condition that involves respiratory failure by acute lung inflammation and wide spread damage of the alveolar space and the capillaries.
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What can cause acute respiratory failure?
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the inhalation of damaging substances
Sepsis very severe pulmonary infection connected to widespread inflammation |
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Abnormal gas exchange can be caused by?
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1. Acute respiratory distress
2. Reduced atmospheric PO2 3. Pulmonary edema 3. Ventilation-perfusion mismatches |
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Where is most of our O2 carried in the body?
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On hemoglobin
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What happens to O2 supply if RBC are reduce?
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causes hypoxemia, specifically anemic hypoxemia
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What can cause abnormal gas transport?
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1. Decrease Hb
2. Presence of CO poisoning |
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Abnormal tissue extraction can be the result of what?
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Histotoxic hypoxia: cyanide poisoning.
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What mechanism does histotoxic hypoxia follow?
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uncoupling of the electron transport chain which is a component of aerobic metabolism
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The mechanism of breathing requires what in the intrapleural space?
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Intrapleural space must be full of fluid where its pressure is less than the outside environment, less than in the lungs and less than the abdominal space
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Why does the intrapleural space have less pressure?
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Because it has no air in it. It has fluid
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why are the lungs not collapsed in their natural state?
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Because the fluid in the intrapleural space has surface tension that allow for expansion and maintenance of shape
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Anything that compromises the pleural membrane will cause what to occur?
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will cause the pressure in the space to equilibrate and lose the pressure and the lungs will collapse
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What are the 2 things that occur in a traumatic pneumothorax?
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1. the chest expands on the side of the collapse
2. the lungs deflate |
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What happens when a person with a collapsed lung breathes in?
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The chest wall will expand and the unaffected lung will fill, but the affected lung will not. Air will move thorugh the puncture
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Describe a tension pneumothorax
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A traumatic wound with irregular edges allows air to move in through the wound, but cannot get out. Therefore air builds up with every breath
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A tension pneumothorax is treated how? What will occur if it is not treated?
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Must puncture the chest wall to release the pressure.
If not, the pressure will continue to rise until it deviates the heart and will cause cardiac arrest |
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A spontaneous pneumothorax is a ____ in the visceral pleura?
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Break
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Which people are more likely to have a spontaneous pneumorthorax?
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More in men than women
Usually athletic |
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Describe a pleural effusion
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Inappropriate or excess Fluid occupies pleural space and impinges on the lung space. Reduces the extent that the lungs can expand and how much ventilation can occur
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What can cause a pleural effusion?
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Lack of drainage of the fluid or increase in production of fluid.
Constant turnover of intrapleural fluid but the rate of the production ends up outweighing the rate of removal |
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What is a hemothorax?
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When blood accumulates in the intrapleural space and reduces the space for the lung to occupy
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How is pleural effusion and hemothorax treated?
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With a chest tube that can move air from the pleural space out, but does not allow air to get in
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The amount of gas exchange is equal to____? (equation)
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(surface area/thickness of diffusion barrier) x (parital pressure gradient)
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Anything that reduces the partial pressure gradient will do what to gas exchange?
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Reduce it
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What does pulmonary fibrosis do to gas exchange and why?
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It reduces it because it causes and increase in thickness of the diffusion barrier
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Any obstruction in perfusion will result in an elevation of what value?
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V/Q Q becomes smaller
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What is a relative form perfusion obstruction causing decreased ventilation?
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Pulmonary embolus from DVT
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If the blood moves from the right side of the heart, to the lungs and then to the left side without oxygenation, what is this reffered to?
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Right/Left pulmonary shunt
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How do pulmonary arteries behave when they sense low O2? What does this cause?
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They constrict!
Increases the pressure of the pulmonary system causing pulmonary HTN. The R side of the heart will have to work harder RSHF |
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How does pulmonary edema cause impaired gas exchange?
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Reduces the surface area for gas exhange. Fluid in alveolar sacs
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What is the term for alveolar collapse?
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Atelectasis
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How is pulmonary edema like other forms of edema?
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In terms of bulk flow pressure, it is a result of excessive pulmonary capillary BP
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What can cause pulmonary edema?
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HTN, LSHF, FVE (chronic renal failure pts) * there will be questions on this in relation to the heart/lungs/kidney
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What are the 2 tests to see how well oxygenated our blood is?
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1. Blood gas analysis
2. Pulse Oximeter |
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If we see that our blood gas is normal, but our RBC count has gone down, what do we have?
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Anemic hypoxia
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Why is CO poisoning so life-threatening?
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CO bind with 200x the affinity to Hb in the same spot as O2 and is very difficult to remove. Irreversible
Hard to detect because ABGs will be normal since CO is not dissolved in plasma and pulse ox cannot distinguish between blood bound to O2 or CO |
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What are the symptoms of CO poisoning?
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N/V, loss of consciousness. Their O2 will be low, but they look overflushed!! Very red
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What are some examples of restrictive lung disease?
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1. Pulmonary fibrosis
2. infant respiratory distress syndrone |
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What is the hallmark sign of airway narrowing?
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Expiratory wheezing: due to forceful excape of air on a narrowed airway
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What are example of disorders that are characterized under obstructive Lung disease?
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Asthma, acute and chronic bronchitis, emphysema and COPD
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What is COPD based on?
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Having either chronic bronchitis, emphysema or both at the same time
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What is the common cause of COPD?
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SMOKING
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what does spirometry testing indicate?
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Test the volume of air you can move into and out of the lungs and the rate that you can move the air. Can measure total lung capacity
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What is tidal volume?
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volume of air moving in and out of the lungs during restful breathing
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If you ask a patient to breath in maximally, what value is this?
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Inspiratory capacity
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What is the reserve of breathing?
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The difference between the capacity and the tidal volume
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What is vital capacity?
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the maximal amount of air that you can breathe in and out
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Residual volume is?
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the small amount of air that cannot be expelled from the lungs. Can't be measure from spirometry testing
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How can you test residual volume?
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with gas delusion
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why do we have residual volume?
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Prevents the alveolar collapse that would occur under the pressure of maximal expiration
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What is the spirometry test?
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A forced expiratory test
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Describe forced vital capacity.
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Max inhaling and forcefully exhaling
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Forced vital capacity is (greater than or less than) normal vital capacity?
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LESS than
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What should the forced expiratory volume at 1 second be in relation to forced vital capacity?
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80%
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If you have more air trapping or if FEV < 80%, what does this mean?
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The airways are collapsing more readily than would be expected. HALLMARK sign of AIRWAY NARROWING!
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In restrictive lung disease, what happens to the values of FEV and FVC?
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They remain normal! Only changes are in the inspiratory capacities
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How does asthma manifest?
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As an airway hypersensitivity or hyperresponsiveness to an allergen
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What are the Tx options for asthma
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Bronchodilators for the spasms
Controllers: corticosteroids to reduce inflammation |
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What is chronic bronchitits?
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Chronic productive cough for about 3 months, usually duiring the winter and from smoking
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What does chronic bronchitis cause?
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hypersecretion of mucus that disables the airway ciliar and is a place for respiratory bacteria to fester and get chronic infections
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What is the Tx for chronic bronchitis?
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Expectorants: thin out the mucus
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What are the characteristics of emphysema?
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loss of lung tissue and an abnormal dilation of the alveolar sacs in the tree
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What occurs in functional narrowing of emphysema?
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Lose the liung tissue and the interdependence and connectivity in the lung. The lung cannot expand
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What is emphysema caused by? (2)
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Primary: deficiency of protein called inherited alpha 1 anti-tripsin. About 1% of the cases
Rest is due to smoking |
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What is inherited alpha 1 anti tripsin used for?
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Protein that blocks trypsin that breaks down protein. This helps regulate the rate of degredation and without it you get imbalanced lung breakdown.
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What is pulmonary fibrosis?
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the development of excess fibrous tissue in the lungs (scarring)
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What are the common causes of pulmonary fibrosis?
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1. Inhalation to environmental occupational pollutants
2. complications of certain disorders: scleroderma, lupus, RA 3. certain meds: amiodarone, methetrexate 4. repeated infections 5. radiation therapy to the chest |
