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1002 1-5 Flashcards

1
Q

in pulmonary system, describe the bronchi

A

bronchi is conducting airways of lungs

  • right main bronchus more vertical 

  • progressive branching increases
  • progressive thinner walls 

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2
Q

describe alveoli

A

Alveoli is the primary gas exchange unit


  • pores of Kohn : allow air to pass from alveolus to 
 alveolus

  • approx. 300 million in adult

  • 2 types of epithelial cells:
 Type I – structural
 Type II – secrete surfactant
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3
Q

what is the main driver of breathing

A

CO2

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4
Q

describe chest wall and pleura

A

ribs and intercostal muscles

Pleura 3 types
visceral pleura- the membrane covering the lungs
parietal pleura- membrane living the thoracic cavity
pleural cavity- thin or cavity allowing the two surfaces to slide with breathing.

Muscle
major- diaphragm and external intercostal muscles.
accessory- sternocleidomastoid and scalene muscles - increase A/P

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5
Q

explain about respiratory physiology

A

respiration

central controller - pons, medulla other parts of brain 
- (output)
effectors 
respiratory muscles
- 
sensors 
chemoreceptors, lung and other receptors 
- (input)
central controller
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6
Q

how brainstem is involved in control of breathing

A

complex process controlled from brainstem
- control centre+
afferent + efferent pathways

Respiratory centres in medulla : autonomic control regulated by afferents

  • Medullary rhythmicity area
  • Pontine respiratory centre
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7
Q

what is afferent

A

chemoreceptors

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8
Q

what are the 3 types of receptors of LUNG

A

3 type of receptors:

Irritant: proximal larger airways

Stretch: smooth muscle of airways

J-receptors: near capillaries, pressure sensitive

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9
Q

what are the ions needed in breathing

A

CO2 - main driver of breathing
CO2 + H2O = H2CO3
H2CO3 = Carbonic Acid
H+ + HCO2 (Carbonate)

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10
Q

describe how efferents are involved in breathing

A

Efferents:
respiratory centre to diaphragm, intercostal muscles + accessory muscles

phrenic nerve arise from spinal nerves, C3, 4 + 5

intercostal nerves leave spinal cord between T 1+ T 12

inspiration is active + expiration is passive

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11
Q

what is the mechanic of breathing

A

Mechanics of breathing

  1. Major and accessory muscles
  2. Elastic properties of lung and chest
  3. Resistance to airflow
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12
Q

what is dead space

A

Dead Space is the parts of the airway that takes no part in gas exchange

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13
Q

what is tidal volume

A

Tidal Volume is the amount of gas that is inhaled and then exhaled in one breath

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14
Q

how to calculate minute ventilation

A

Minute Ventilation = (Tidal Volume – Dead Space) X Respiratory Rate

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15
Q

describe Minute Ventilation

A

The amount of gas that is inspired and exhaled in one minute.

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16
Q

what are the alterations in MV? (the causes of unconsciousness) and why they happen?

A 
Causes of unconsciousness
A	- Anoxia or alcohol
E	- Epilepsy
I	- Insulin (diabetes mellitus)
O 	- Overdose
U	- Ureamia
T	- Trauma
I	- Infection
P	- Psychiatric/ psychosomatic
S	- Shock
Trauma to brainstem – brain death
Spinal cord injury
Nervous system 
MS, Guillain Barrè Syndrome, Myasthenia gravis
Airway – burns, trauma, tumors, foreign objects, inflammation
Thoracic chest wall injury
# ribs, flail chest
Pleural disease or injury
Pleural Effusion, pneumothorax, haemothorax
Lung disease or injury
Asthma
Chronic Obstructive Pulmonary Disease
Pneumonia
Pulmonary Oedema
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17
Q

what is the subjective data of Health history and the examples?

A

the symptoms that can be seen, observed or gained from patients or their family.
Cough
Onset, how often, time of day, productive (sputum), Haemoptysis.
Shortness of breath – timing, on exertion
Orthopnoea – SOB whilst supine
Paroxysmal nocturnal dyspnoea – awakening at night with SOB
Chest pain with breathing
History of respiratory infections and lung disease
Smoking history
Environmental exposure

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18
Q

what is the scale that can check measure breathlessness?

A

Borg category-ratio scale – How short of breath are you right now?

0 (nothing at all)- 10( maximal)

19
Q

what the normal chests look like?

A

posterior chest

  • should be in a straight line
  • Symmetrical (even) , in an elliptical shape with ribs in a 45o angle to spine.

anterior chest

Ribs are sloping downwards with symmetrical interspaces
Inspect
Airways – foreign object, swelling, signs of burns, tumors
Note:
facial expressions
Skin colour and condition – cyanosis is a late indication of low oxygen
Respirations
Accessory muscles
Bulging intercostals
Abdominal recession - paradoxical breathing

20
Q

what is palpation

A

Using fingers palpate the entire chest wall

-Palpate trachea for position – normally midline

The results are:

Crepitus

Course crackling sensation – subcutaneous emphysema
Caused by air in subcutaneous tissue

Fremitus

Vibration of the chest wall due to vocalization of “99”.
Increased fremitus – lungs become filled with fluid or more dense
Pneumonia, tumors & pleural effusions
Decreased – lung hyperinflated – barrel chest
Absent – Pneumothorax and lung alveolar collapse (Atelectasis)

21
Q

what are the assessment of respiration?

A

Respiratory Rate- Number of full inspiration/expirations in one minute (adult: 12-20 infant: 30-50)

Ventilatory Depth - Observing the degree of excursion or movement in the chest wall
Deep respiration, full expansion of the lungs with full exhalation
etc

Ventilatory Rhythm - Breathing pattern – regular or irregular
Men & children – diaphragmatic breathing, seen in lower chest and abdomen
Women – thoracic muscle, seen in upper chest

Ventilatory Sound - Audible by ear,
Stertor – snoring sound when secretions block the trachea or large bronchi
Stridor – inspiratory wheeze indicating upper airway obstruction
Wheezing – high pitch musical sound occurring on inspiration, indicating partial obstruction of small (lower) airways
Inspiratory grunt – babies – occluded airway

22
Q

what can you check though auscultation?

A

breath sounds

normal:
Bronchial: loud, high pitched

Bronchovesicular: medium pitched

Vesicular: soft, low pitched, gentle, rustling sounds

abnormal:
Nil

Wet – Crackles or Rales = pulmonary oedema

Noisy - Rhonchi: air passing past sputum = pneumonia

Wheeze: narrow airways = asthma

23
Q

how to do percussion?

A

Starting over the apices, percuss the interspaces at 5cm intervals moving from side to side for comparison.
Avoid dampening effect of bone (scapula and ribs)
Resonance – normal low-pitched, clear hollow sound over lungs
Hyperresonance – lower-pitched, booming sound – too much air as in Pneumothorax and Emphysema
Dull – abnormal density in lung as with pneumonia, pleural effusion, atelectasis or tumour
Percussion has a 5-7cm depth limit

24
Q

what is the pulmonary function test?

A

Peak expiratory flow meters :
Is the point of highest flow during maximal expiration
Serial monitoring
Intra-individual accuracy
Limited assessment of respiratory diseases
Peak expiratory flow (trend of lung function)

spirometry:
Gold standard
Diagnostic
High reliability

25
Q

what are the things to be checked in lung function tests?

A 
Four volumes:
tidal volume (VT): volume of inspired or expired air per breath

inspiratory reserve volume (IRV): volume that can be inspired above TV

expiratory reserve volume (ERV): volume that can be expelled at end of TV

residual volume (RV): volume of gas remaining in the lungs after maximal expiration

Four capacities:
inspiratory capacity (IC)
functional residual capacity (FRC)
vital capacity (VC)
total lung capacity (TLC):volume of gas in lungs after maximal inspiration
26
Q

what is use of pulse oximetry

A

pulse oximetry is for Relative measure of percentage of bound oxygen to haemoglobin

  • COPD patients n=64
  • Acute exacerbation
  • Comparison of oximeters
  • Significant hypoxia PaO2 < 60 mmHg
27
Q

describe Capnography

A

it is to confirm endotracheal tube placement during emergency airway management - > 2000 intubations.

28
Q

what are the 4 major components of respiratoration

A

Mechanical movement of gases into and out of lungs – (mechanism of breathing) – last week’s lecture
Gas exchange across alveolar membrane
Carriage of gasses to and from tissues
Metabolic processes of the cell to produce energy

29
Q

explain use of oxygen in cells?

A

Production of Adenosine Triphosphate (ATP) for energy requires delivery adequate level of Oxygen (O2) to cells
Electron transport system in mitochondria supplies 95% of cellular energy but uses 90% of DO2

This delivery of oxygen (DO2) is dependent on cardio-vascular sufficiency, the focus of future lectures

Without oxygen, cells die.

30
Q

why DO2 important ? (dissolved oxygen)

A

Inadequate DO2 will cause:
Pyruvic acid converts to lactic acid
Drop in intracellular pH
Diminished protein synthesis, denaturing of existing proteins
Free fatty acid accumulation, swelling of intracellular organelles
Sodium-potassium pump dysfunction
Tissue/organ failure

Without oxygen, cells die.

31
Q

what is the alteration of PaO2

A 
Decreased partial pressure of inspired oxygen
Altitude
Suffocation
Increase in other gasses in air eg carbon monoxide
Ventilation/perfusion (V/Q) mismatch
Decreased Ventilation - Shunting
Airway occlusion eg COPD
Fluid in lungs eg pulmonary oedema
Alveolar collapse
Decreased Perfusion – Dead Space
Decreased cardiac function
Decreased BP
Pulmonary emboli
32
Q

oxygen transport, why oxygen is carried in blood?

A 
O2 considerably less soluble than CO2
Due to ability to form carbonic acid where as O2 has no ability
Carbonic Acid (H2CO3) = H2O + CO2
Therefore most O2 carried attached to haemoglobin (about 97% of total)
Measured as SpO2 (peripheral monitor)
or SaO2 (arterial gas analysis)
The remainder 3% is dissolved in plasma
Measures as PaO2
33
Q

oxygen saturation?

A

% of oxyhaemoglobin in total (saturated and unsaturated) haemoglobin
Normal SaO2 = 98%
Normal SvO2 = 75%
Difference is a reasonable estimate of oxygen extraction by cells

34
Q

what is the oxygen consumption and oxygen extraction ration

A

Volume of oxygen consumed by the tissues per minute (VO2)
Reflects body cellular metabolism

Norm 3.5 ml/min/kg resting
At rest 250 ml/min
Exercise 3600 ml/min

\
Estimate of the balance between oxygen usage by cells and oxygen delivery
-VO2: DO2
- OER = 22-32%

35
Q

describe arterial blood gases

A 
Using an arterial blood sample we can measure:
pH – acidity or alkalinity
normally 7.35 – 7.45
<7.35 acid
>7.45 alkaline
PaO2 – partial pressure of oxygen in arterial blood
Normally 80-100 mmHg
PaCO2 – partial pressure of oxygen in arterial blood
Normally 35-45 mmHg
> 45 acid 
< 35 alkaline
Bicarbinate - normal 21-26mmol
Base Excess - -2 to +2 mmol/L
36
Q

describe the blood gas analysis

A

Simple steps
1. Determine whether the blood is acidic or alkaline by examining pH
2. Determine the primary cause of the pH
- Examine PaCO2 to determine respiratory cause of acidosis or alkalosis
- Examine Bicarbonate and 3. Base Excess to determine renal cause of acidosis or alkalosis
4. Determine if there is respiratory/renal compensation
Determine oxygen status by examining PaO2 and SaO2

37
Q

describe pulse oximetry (finger thing)

A

Relative measure of percentage of bound oxygen to haemoglobin
SaO2 = HbO2 / Total Hb
Two wavelengths – visible and infrared beams
Measure absorption in pulsatile element of blood flow between Hb and Hb02

Use of pulse oximetry
COPD patients n=64
Acute exacerbation 
Comparison of oximeters
Significant hypoxia PaO2 < 60 mmHg
38
Q

simply explain respiratory physiology

A

Three steps in the process of oxygenation:

  1. Ventilation (gas in and out of lungs)
  2. Diffusion (o2 and Co2 in the alveoli and capillaries of body tissue)
  3. Perfusion of lungs (move blood to and from the alveolocapillary membrane for gas exchange to occur)
  • The respiratory centre lies in the brainstem and controls respiration
  • Chemoreceptors respond to change in the chemical composition

• Central – detects changes in pH (adjust inspiration rate and depth)
• Peripheral – detect arterial O2 and CO2 Predominantly o2 therefore adjust
respiration in response to hypoxaemia (Craft, et al 2015)

39
Q

what are the factors effecting oxygenation

A
  1. Physiological
  2. Developmental
  3. Behavioural
  4. Environmental
40
Q

the alternations in respiratory functioning

and they contribute-

A

Alveolar hyperventilation
• Ventilation in excess of that required to eliminate carbon dioxide
produced by cellular metabolism • Alveolar hypoventilation
• Ventilation inadequate to meet the body’s oxygen demand or to eliminate sufficient carbon dioxide
• Atelectasis
• Collapse of the alveoli, preventing normal diffusion of oxygen
and carbon dioxide

and they contribute
- Ventilation/perfusion mismatch
• Diffusion impairment
• Alteration in membrane thickness and/or surface area which results in impaired gas exchange
• Hypoxia
• Inadequate tissue oxygenation at the cellular level
• Cyanosis
• Blue discoloration of the skin and mucous membranes, caused by the presence of desaturated haemoglobin in capillaries, is a late sign of hypoxia

41
Q

what are the signs and symptoms?

A 
CNS
Unexplained apprehension
Unexplained restlessness or irritability Unexplained confusion or lethargy
Combativeness
Coma
Respiratory
Tachypnoea
Dyspnoea on exertion
Dyspnoea at rest
Use of accessary muscles
Retraction of interspaces on inspiration
Pause for breath between sentences, words Cardiovascular
Tachycardia
Mild hypertension
Dysrhythmia’s (pre mature ventricular contraction) Hypotension
Cyanosis
Cool clammy skin
Other
Diaphoresis
Decreased urinary output
Unexplained fatigue
42
Q

respiratory assessment diagnostic test for different 4 parts?

A

Ventilation and oxygenation studies

  • Pulmonary function test spirometry
  • Peak expiratory flow
  • Arterial blood gas
  • Oximetry

Viewing structures of the respiratory system

  • Chest X-ray examination
  • Bronchoscopy
  • Lung scan (CT)
43
Q

what are the common asthmatic symptoms or signs? triggers? and risk?

A
  • Bronchoconstriction
  • Oedema of airways
  • Mucous hypersecretion
triggers:
allergens
drugs
aspirin 
cold air
stress

risks:
family history
history of allergies
age

n 2 (2 decks)

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