1 - Cardiopulmonary Management Flashcards
What are the 3 key components of Cardiovascular Pulmonary Management (CVP)?
- Know
- Apply
- Manage
Of the 3 key components of CVP, what makes up Know?
Know
- Normal Physiology
- -Cardiac
- -Pulmonary
- -Vascular
(how is it supposed to work?)
Of the 3 key components of CVP, what makes up Apply?
Apply
- Pathology
- Disease Progression
- Pharmacology
(what makes the patient not typical? Is it going to get worse? Meds to deal with CVP?)
Of the 3 key components of CVP, what makes up Manage?
Manage
- Primary and Secondary Prevention
- -Primary = have impairment and directly addressing
- -Secondary = preventing any further complications
-Inpatient and Outpatient
How do you calculate Oxygen Delivery (DO2)?
DO2 = arterial O2 x cardiac output
How do you calculate Oxygen Consumption (VO2)?
VO2 = (arterial O2 - venous O2) x cardiac output
What might happen to VO2 is a severe cardiopulmonary dysfunction exists?
VO2 (oxygen consumption) may fall shor of demand
How do you calculate Oxygen Extraction Ratio (OER)?
OER = consumption / delivery = VO2 / DO2
If you have cardiopulmonary dysfunction, what does this mean in terms of the OER?
You are consuming more than you are delivering
What is DO2 dependent on?
the demands of the tissue
How does DO2 at rest compare with the consumption?
At rest, DO2 is 3-4 x greater than the actual consumption (can allow for wiggle room if not receiving oxygen you need)
How is 98% of oxygen in the body transported?
In combination with hemoglobin
What can cause the affinity between hemoglobin and O2 to change?
pH and temperature
What 4 main fluid problems can exist with blood?
Too much water
Not enough water
Too much Sodium
Not enough sodium (Hyponeutrmia)
What are the 9 steps in Oxygen Transport?
- Inspired Oxygen and Quality of Air
- Airways
- Lungs and Chest Wall
- Diffusion
- Perfusion
- Myocardial Function
- Peripheral Circulation
- Tissue Extraction and Utilization of Oxygen
- Return of Partially Saturated Blood and CO2 to Lungs
What is our air made of of in the atmosphere?
79% Nitrogen
21% O2
0.03% CO2
What role does the Nitrogen in the air in the atmosphere play in inspiring oxygen?
Nitrogen is not absorbed in the lungs but is important for keeping the alveoli in the lungs open.
What is the result of poor air quality on inspiring oxygen? (2)
- Interferes with respiratory tract filtering
2. Leads to inflammation of alvolar membrane (thickening of airways makes it harder for O2 to get in)
What three factors play into the Inspiration of oxygen?
- Atmospheric Air
- Air Quality
- Air Humidity
In the alveoli, inspired air is saturated with what?
water vapor
In dry environments, what can happen in the lungs?
Loss of mucus covering which can lead to erosion and infection. Want a fine balance of phlegm.
What is the purpose of cilia in the airway?
To catch debri and get it out. Can get burnt off if smoker.
When you breath in what is the diaphragm doing? What is happening to the negative pressure? Breathing out?
Contracting and moving down, this increases the negative pressure in the cavity drawing air in. When the diaphragm goes back this is a passive process.
Do we want symmetrical use of our lungs? Why or why not?
Mucous can pool in lungs and lead to infection. So when lying on back or even sitting up a bit your lungs are not fully symmetrically expanding.
Which 2 muscles are used during inspiration and how?
- External Intercostals
- elevate ribs and therefore increases the volume of pleural cavities - Diaphragm
- depress the inferior wall of thoracic cavity and, therefore increase the volume of the pleural cavities.
Which 2 muscles are using during expiration (normally a passive process; if mm used) and how?
- Internal Intercostals
- compress and lower the ribs and therefore decrease the volume of the pleural cavities - Abdominals
- compress the abdominal cavity which elevates the abdominal organs and passively elevates the diaphragm and, therefore, decreases the volume of the plural cavity.
Where does oxygen diffuse from to get into the blood stream?
Diffusion = transfer of oxygen from alveolar sacs to pulmonary circular (high to low concentration)
What 5 things does diffusion of oxygen from the alveoli to the pulmonary circular depend on?
- Surface area of alveolar capillary (larger surface area = more diffusion)
- Diffusing capacity of alveolar-capillary membrane (thicker membrane = diffuse more slowly)
- Pulmonary capillary blood volume (more blood = more oxygen)
- Ventilation / perfusion ratio (balance between how much is breathed in and how much blood flow)
- Transit time of blood in alveolar capillary membrane
Amount of oxygen that diffuses across alveolar-capillary membrane varies directly with ____ and inversely with ___.
Amount of oxygen that diffuses across alveolar-capillary membrane varies directly with SIZE (SURFACE AREA) and inversely with THICKNESS.
What result will a decrease in the surface area and increase in thickness of alveolar membrane have on amount of O2 in blood?
Decrease in the amount of O2 and blood.
As a PT, why is position and activity critical in care of patients in acute care?
Want to maximize the amount of ventilation and perfusion. Why we want upright to maximize this in lungs.
How do the Apical and Lung Bases differ in terms of perfusion and alveoli expansion?
Apical: Low perfusion and alveoli expand fully.
Bases: Perfusion increased due to gravity, enlarged vessels compress alveoli.
Where is the most optimal place for ventilation/perfusion in the lungs? Why?
Right in the middle, balance between perfusion from gravity vessel size and expansion of alveloi.[
Optimal function depends on synchronized coupling of ___ and ____ [of the heart.]
Optimal function depends on synchronized coupling of ELECTRICAL CONDUCTION and MECHANICAL CONTRACTION [of the heart.]
What result would messed up electrical excitation of the heart have on oxygen transport in the body?
Un-synchronized contraction of atria followed by ventricals won’t allow blood the flow properly through the body which is carrying oxygen.
Define Preload
left ventricular end diastolic pressure - determines how hard the ventricle will contract and push blood out to body. Amount ventricle stretches with blood. Synonymous the pressure water balloon feels when filled.
Define Afterload
Amount of resistance from periphery that blood or ventrical has to overcome in order to get to the body. Synonymous to the pressure from water on knot in balloon.
