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Fundamentals Of Respiratory Care > 1110 FINAL (FRC) > Flashcards

1110 FINAL (FRC) Flashcards

1
Q

Ventilation?

A

Ventilation is the process of gas exchange, moving gases in and out of the lungs.

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2
Q

Transrespiratory Pressure? (PTR)

A

Everything that exists between pressure measured at airway opening (PAO) and pressure measured at body surface (PBS)

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3
Q

Transrespiratory Pressure formula?

A

PTR=PAO-PBS

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4
Q

Transrespiratory Pressure is responsible for?

A

This gradient causes gas flow in and out of the lungs (alveoli) during breathing.

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5
Q

Transpulmonary Pressure Difference (PTP)?

A

Pulmonary system (airways and alveolar region)
Established by opposing lung and thorax recoil and is responsible for maintaining alveolar inflation.

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6
Q

Transpulmonary Pressure difference formula?

A

PTP=PAO-PPL

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7
Q

Transthoracic pressure difference (PTT)?

A

Total pressure required to expand or contract the lungs and chest wall together.

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8
Q

Transthoracic Pressure difference formula?

A

PTT=PA-PBS

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9
Q

What are the forces that must overcome to allow inspiration?

A

Movement of tissues
Elasticity forces
Airway Resistance (RAW)
-RAW: The impedance to ventilation caused by the movement of gas through the conducting airways to the lungs.
Surface tension forces

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10
Q

Why does lung recoil occur?

A

Due to tissue elasticity and surface tension.

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11
Q

What is pulmonary surfactant?

A

Pulmonary surfactant reduces lung surface tension in the alveoli.

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12
Q

What are the factors that make up pulmonary surfactant?

A

Produced in alveolar type II pneumocytes.
Surfactant stabilizes alveoli by preventing collapse.
When surface area decreases, ability of pulmonary surfactant to lower surface tension increases.

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13
Q

Pulmonary pathology alters ___?

A

Lung compliance. (CL)

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14
Q

What diseases increase lung compliance?

A

Emphysema, obstructive lung diseases increases lung compliance. (Loss elastic tissue fibers, lungs less distensible, termed hyperinflation.)
Large changes in volume for small pressure changes.

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15
Q

Fibrosis, restrictive lung diseases__?

A

Decreases CL (gain elastic tissue, lungs less distensible, termed hypoinflation.
Small volume change for any change in pressure.
Stiffer lungs, usually with reduced volume.

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16
Q

Airway Resistance.

A

Impedance to ventilation caused by the movement of gas though the conducting systems of the lungs.

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17
Q

R=🔺P/🔺V

A

Change in pressure/Change in flow

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18
Q

Approximately how much of the resistance to gas flow occurs in the nose, mouth, and large airways, where flow is mainly turbulent?

A

Approximately 80% of the resistance to gas flow occurs in the nose, mouth, and large airways, where flow is mainly turbulent.

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19
Q

Approximately how much of the total resistance to flow is attributable to airways smaller than 2mm in diameter?

A

Approximately 20% of the total resistance to flow is attributable to airways smaller than 2mm in diameter and flow is mainly laminar.

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20
Q

In healthy lungs ___?

A

Neither ventilation (V) or perfusion (Q) are distributed evenly.

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21
Q

Ventilation and perfusion are matched best at?

A

In upright lung, ventilation and perfusion (V/Q) are matched best at bases (dependent area)

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22
Q

Regional factors affecting the distribution of gas in the normal lung result in ??

A

More ventilation going to the bases and lung periphery.

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23
Q

Apical alveoli are larger but harder to ventilate compared to those at bases.

A

During normal inspiration alveoli at the apexes expand less than those at the bases.
Gravity pulls more blood to bases.

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24
Q

What is anatomic dead space?

A

Gas left in conducting airways after inspiration.

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25
Q

What is alveolar dead space?

A

Alveoli that are ventilated but have no perfusion.

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26
Q

Physiologic dead space= __?

A

Physiologic dead space= sum of anatomic and alveolar dead space.
The larger the dead space, the less efficient the tidal volume will be in eliminating CO2.

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27
Q

What is alveolar ventilation?

A

Amount of fresh gas reaching alveoli per minute.
It is determined by VT, dead space, fB (RR).

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28
Q

What is Deadspace ventilation?

A

Gas that is wasted during normal ventilation.

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29
Q

Alveolar ventilation equation?

A

VA=(VT-VD)xfb

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30
Q

1lb of IBW= __?

A

1ml of anatomic Dead-space.

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31
Q

Normal VD/VT ratio is _?

A

30% (range of 0.2-0.4)
Normal physiologic deadspace is approximately 1/3 of the Vt.

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32
Q

Hyperventilation occurs?

A

Hyperventilation occurs when ventilation exceeds metabolic need,hyperventilation is defined as a decrease in blood carbon dioxide levels PaCO2<35mmHg

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33
Q

Hypoventilation occurs when?

A

Hypoventilation occurs when ventilation is insufficient to meet metabolic needs, Hypoventilation is defined as a elevated blood carbon dioxide level PaCO2>45mmHg.

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34
Q

What is the best indicator of adequate effective ventilation? 😮‍💨🤌🏽

A

The best indicator of adequate effective ventilation is PaCO2, which is the particle pressure of arterial CO2 or arterial CO2 gas tension.

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35
Q

What is the normal range for PaCO2?

A

35-45mmHg (40) is dead normal.

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36
Q

What does the medullary respiratory center make up?

A

These form dorsal and ventral respiratory groups.

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37
Q

What is the Dorsal respiratory groups neurons (DRG)?

A

Composed mainly of inspiratory neurons located bilaterally in the medulla.
These neurons send impulses to motor nerves of the diaphragm and external intercostal muscles.

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38
Q

Which nerves bring sensory impulses to the DRG neurons?

A

Vagus and glossopharyngeal nerves bring sensory impulses to DRG from lungs, airways, peripheral chemoreceptors, and joint proprioceptors.
-Input modifies breathing pattern.

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39
Q

What is the ventral respiratory group neurons? (VRG)

A

VRG neurons contain both inspiratory and expiratory neurons located bilaterally in the medulla.

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40
Q

Where does the VRG neurons send inspiratory impulses to?

A

Laryngeal and pharyngeal muscles.
Diaphragm and external intercostals.

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41
Q

Where does the VRG neurons send expiratory impulses to?

A

Other VRG neurons send expiratory signals to the abdominal muscles and internal intercostals.

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42
Q

Pons modify what?

A

Pons modifies output of medullary centers that are located in the pons of the brain stem.

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43
Q

What are the two pontine centers?

A

Apneustic and pneumotaxic.

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44
Q

What is the apneustic center?

A

Functions only identified by cutting connection to medullary centers.

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45
Q

What is apneustic breathing?

A

Characterized by long, gasping inspirations interrupted by occasional expirations.

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46
Q

What is the pneumotaxic center?

A

Controls “switch-off“, so it controls the inspiratory time (IT).

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47
Q

What is the Hering-Breuer inflation reflex?

A

Lung distention causes stretch receptors to send inhibitory signals to DRG, stopping further inspiration. Regulates rate and depth of breathing during moderate to strenuous exercise.
In adults active only o large Vt >800ml (high lung volumes).

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48
Q

What is the deflation reflex?

A

Sudden lung collapse results in hyperpnea as seen in pneumothoraces, causes a strong inspiratory effort.

49
Q

Irritant receptors?

A

Cause bronchospasm, cough, sneeze, tachypnea, and narrowing of glottis.

50
Q

J-receptors are stimulated by?

A

Pneumonia, CHF, and pulmonary edema.

51
Q

What are Peripheral proprioreceptors?

A

Found in muscles, tendons, joints, and pain receptors.
Movement stimulates hypernea.
Moving limbs, pain, and cold water all stimulate breathing in patients with respiratory depression.

52
Q

Where are the Peripheral chemoreceptors located?

A

Located in the aortic arch and bifurcations of common carotid arteries.

53
Q

Peripheral chemoreceptors respond to?

A

Increased PaCO2 and (H+)

54
Q

Whole-body diffusion gradients?

A

Gas moves across system by simple diffusion or gaseous diffusion.
This is the movement of gases between the lungs and the body tissue.

55
Q

What is alveolar carbo dioxide? (PACO2)

A

The alveolar partial pressure of CO2 (=PACO2) varies directly proportional to whole-body’s production of CO2 (VCO2) and not directly proportional to alveolar ventilation . (VA)

56
Q

What can lead to an increased PACO2?

A

An increase in dead space, the portion of inspired air that is exhaled without being exposed to perfumed alveoli, can also lead to an increased PACO2.

57
Q

How does PACO2 decrease?

A

If CO2 production decreases of alveolar ventilation increases.

58
Q

What is alveolar oxygen tensions? (PAO2)

A

PiO2 is primarily determinant for PAO2
PiO2 is the partial pressure of inspired oxygenated gas.

59
Q

Normal Alveolar Gas Tensions
PAO2=_?

A

100mmHg

60
Q

Normal alveolar gas tensions
PACO2=_?

A

40mmHg

61
Q

Normal alveolar gas tensions
PAH20=_?

A

47 mmHg

62
Q

Normal alveolar gas tensions
PAN2=_?

A

573mmHg

63
Q

Normal alveolar gas tensions
AGT=_?

A

760 mmHg
(AGT and atmospheric pressures both equal 760 mmHg)

64
Q

What are the only changes that will be seen in O2 and CO2?

A

Constant FiO2, PAO2 varies inversely with PACO2 if there is a rise in CO2 it will cause a fail in O2 equally. Prime determinants of PACO2 is VA (alveolar ventilation).

65
Q

The sum of PAO2, and PACO2 equals?

A

140 mmHg on (RA) and at sea level (760 mmHg)

66
Q

An increase in VA will ?

A

Decrease PACO2and increase PAO2 equally.

67
Q

A pt on RA (FiO2 21%) at sea level cannot have a ?

A

PaO2 > (greater than) 120 mmHg (Normal range 110-120 mmHg)

68
Q

A pt on FiO2 at sea level can have a ?

A

PaO2 level of approximately 670 mmHg.

69
Q

PaO2 normally 5-10 mmHg less than PAO2 due to ?

A

Anatomic shunts or diffusion defects in a young healthy adult breathing room air.

70
Q

When ventilation is increased in the lung bases what happens to the alveoli at the apexes?

A

Causing alveoli at the apexes to expand less than those at the bases.

71
Q

What happens at the bases of the lung?

A

Blood flow is greater than ventilation.
Resulting in a lower PO2 and slightly higher PCO2.
Causing the V/Q to be lower than average.

72
Q

How are most O2 transported?

A

In chemical combination with Hb in the erythrocytes. (RBC)

73
Q

(HB) Hemoglobin is the most?

A

Important component in the transport system.

74
Q

What are the normal values for SaO2?

A

95%-100%

75
Q

What is the total content of blood?

A

Equals the sum of O2 dissolved in plasma and chemically combined/bound to the Hb.

76
Q

What is the normal values for total oxygen content of blood?

A

16-20ml/dl

77
Q

Increased affinity

A

Increases pH (alkalosis)
Decreases PCO2
Decreases body temperature
Decreases 2,3 DPG levels

78
Q

Decreased affinity

A

Decreases pH (acidosis)
Increases PCO2
Increases body temperature
Increases 2,3 DPG levels

79
Q

Without 2,3 DPG ?

A

Hb affinity is so great that O2 cannot unload

80
Q

When 2,3 DPG level curve to the right?

A

Promotes O2 unload.

81
Q

When 2,3 DPG curves to the left?

A

Promotes unloading.

82
Q

What is P50?

A

P50 is the partial pressure of O2 at which the Hb is 50% saturated, standardized to a pH level of 7.40.

83
Q

What is the normal value for P50?

A

26.6 mmHg

84
Q

Increased p50=?

A

Decreases in Hb affinity for O2 (shifts the HbO2 curve to the right.)

85
Q

Decreased P50=?

A

Increase in Hb affinity for O2. (Shifts the HbO2 to the left)

86
Q

PaO2 (Hypoxemia)
80-100mmHg

A

Normal

87
Q

PaO2 (Hypoxemia)
60-79 mmHg

A

Mild Hypoxemia

88
Q

PaO2 (Hypoxemia)
40-59 mmHg

A

Moderate hypoxemia

89
Q

PaO2 (Hypoxemia)
<40 mmHg

A

Severe Hypoxemia

90
Q

CaO2 (Hypoxemia)
16-20 ml/do or vol %

A

Normal

91
Q

CaO2 (Hypoxemia)
14-15.9 ml/dl vol %

A

Mild Hypoxemia

92
Q

CaO2 (Hypoxemia)
12-13.9 ml/do or vol %

A

Moderate hypoxemia

93
Q

CaO2 (Hypoxemia)
<12 ml/dl vol %

A

Severe hypoxemia

94
Q

How is CO2 normally carried in the blood?

A

44-55 ml/dl
1. Dissolved in blood ~8%
2. Chemically combined with protein ~12%
3. Ionized as bicarbonate ~80%

95
Q

When DO2 is inadequate (Impaired oxygen delivery) ?

A

Tissue Hypoxia occurs
Caused by decreases in arterial PO2
Decreased available Hb or decrease in cardiac output (shock or ischemia)

96
Q

What is hypoxia?

A

Occurs when O2 delivery is inadequate for cellular needs in the tissues.

97
Q

What is hypoxemia?

A

Defined as low arterial blood oxygen. (PaO2)

98
Q

Impaired CO2 removal?

A

Increases dead space ventilation.

99
Q

Increased Deadspace ventilation is caused by?

A
  1. Decreased Vt as in rapid shall breathing or
  2. Increased physiologic dead space as in pulmonary embolus.
100
Q

Where do hydrogen ions come from?

A

Hydrogen Ions form in the body come from either volatile or fixed (nonvolatile) acids.

101
Q

Acid excretion is done by?

A

The lungs and the kidneys.

102
Q

Lungs effect the ?

A

Changes in PaCO2.
While lungs can alter (CO2) in seconds.

103
Q

Kidneys effect changes?

A

In the HCO3-.
Physically remove H+ from body by excretion, secretion, and reabsorption.
Kidneys require hours or days to change HCO3 and affect pH.

104
Q

The body’s buffer system?

A

The lungs, and the kidneys work together to maintain acid-base homeostasis under various conditions.

105
Q

Primary Respiratory Disturbances?

A

PaCO2 is controlled by the lung; changes in pH caused by the PaCO2 are considered respiratory disturbances.

106
Q

Hyperventilation?

A

Decreases PaCO2 which increases pH; referred to as RESPIRATORY ALKALOSIS.

107
Q

Hypoventilation?

A

Increases PaCO2 which decreases pH; referred to as RESPIRATORY ACIDOSIS.

108
Q

Primary metabolic disturbances?

A

Involve gain or loss of fixed acids or HCO3-.
Both appear as changes in HCO3- because changes in fixed acids will alter amount of HCO3- used in buffering.

109
Q

Primary metabolic disturbances pt. 2?

A

Decreases in HCO3- which decreases pH results in metabolic ACIDOSIS.
Increases in HCO3- which increases pH results in metabolic ALKALOSIS.

110
Q

Any primary disturbance immediately triggers a compensatory response.

A

Any respiratory disorder will be compensated for by kidneys.
Any metabolic disorder will be compensated for by lungs.

111
Q

Three primary states of matter?

A

Solids, liquids, and gases.

112
Q

Solids?

A
  1. Have high degree of internal order
  2. Fixed volume or shape
  3. Strong mutual attractive force between atoms
  4. Molecules have the shortest distance to travel before collision
    -The jiggle.
113
Q

Liquids?

A
  1. Have fixed volume, but adapt to shape of their container.
  2. Atoms exhibit less degree of mutual attraction compared with solids.
    - Shape is determined by numerous internal and external forces.
114
Q

Gases?

A
  1. Gas molecules in constant motion exhibit rapid, random motion with frequent collisions.
  2. Exhibit the phenomenon of flow, to fill their container, and have minimal forces of attraction.
115
Q

What is heat transfer?

A

When two objects of different temperature coexist heat will move from hotter to cooler object until both are equal.

116
Q

How can heat transfer occur?

A

Conduction
Convection
Radiation
Evaporation
Condensation

117
Q

Conduction

A

Is the transfer of heat by the direct interaction of atoms or molecules in a hot area with atoms or molecules in a cooler area, requires direct contact between two substances.

118
Q

Convection

A

Involves the mixing of either liquid or gas molecules (fluids) at different temperatures, requires direct contact between two substances.

119
Q

Radiation

A

Requires no direct contact between the warmer and cooler substances.

Fundamentals Of Respiratory Care (8 decks)

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