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Undeleted > 3 Alteration in Gas Exchange > Flashcards

3 Alteration in Gas Exchange Flashcards

1
Q

alteration in gas exchange, definition

A

decrease in the exchange of O2 and CO2 between the blood and the lungs to meet cell’s oxygen needs
- results in imbalance between O2 supply and demand = cellular ischemia and necrosis

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2
Q

alveoli

A

the functional unit of gas exchange

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3
Q

right bronchi nota bene

A

straighter, wider, more likely site of aspiration

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4
Q

ventilation

A

moving gases through respiratory tract, moving air between atmosphere and alveoli

  • efficiency requires a V/Q match
    • ventilation (V) = alveoli that have air
    • perfusion (Q) = blood supply to alveolus
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5
Q

diffusion

A

gas exchange between alveoli and blood

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6
Q

perfusion

A

transport of O2 and CO2 in blood/body fluids to/from cells

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7
Q

room air O2 %

A

21%

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8
Q

1L nasal canula O2 %

A

24%

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9
Q

respiratory center in brain

A

medulla, pons

  • involuntary control
  • controls rate, depth, rhythm
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10
Q

central chemoreceptors of respiration

A

CO2 (major controller), pH

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11
Q

peripheral chemoreceptors of respiration

A

responds to changes in blood O2: pO2 <70

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12
Q

hypoxia

A

inadequate oxygen at cellular level

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13
Q

anoxia

A

absence of oxygen

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14
Q

hypoxemia

A

deficient oxygenation of the blood

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15
Q

hypercapnia

A

increased concentration of CO2 in the blood

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16
Q

hypocapnia

A

decreased concentration of CO2 in the blood

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17
Q

O2 in blood (x2)

A

bound to hemoglobin: 97%

free gas dissolved in plasma: 3%

18
Q

SaO2 + measurement method

A

saturation of O2 in arterial blood

measured by ABG (invasive!)

19
Q

SpO2 + measurement method

A

saturation of peripheral O2

measured by pulse oximetry (non-invasive!)
expected reading: >= 95%

20
Q

PaO2 + measurement method

A

partial pressure of oxygen in arterial blood (dissolved in plasma!)

measured by ABG
expected reading: 80-100 mmHg (with supplement > 100)

21
Q

oxygen saturation: hemoglobin

A

each has 4 heme groups (binding to O2) –> all or nothing affinity for O2

% is of ALL heme, not of ONE heme

22
Q

pulse oximetry results affected by

A 
P: oor peripheral perfusion s/t cold or hypotension
E: dema
L: ow cardiac output
V: asoconstriction
C: arbon monoxide poisoning

also technique/environment: shivering, high intensity lighting, dark nail polish, cold room, dirty sensor

23
Q

carbon dioxide in blood (x3)

A
  1. dissolved in plasma (7%) PaCO2 = 35 to 45 mm Hg
  2. combined with water as carbonic acid (70%)
    H2O + CO2 = H2CO3 = H+ + HCO3-
  3. coupled with hemoglobin in RBC (23%)
24
Q

*tidal volume

A

volume of air inspired/expired with each normal breath

500 ml

25
Q

*inspiratory volume

A

extra volume that can be inspired over and above tidal volume

3000 ml
key for incentive spirometry!

26
Q

expiratory reserve

A

extra volume that can be expired from forceful expiration at end of tidal expiration

1100 ml

27
Q

ventilation: what affects work of breathing?

A

increased muscular work itself leads to increased O2 demand

  • compliance
  • diameter of bronchi (airway resistance)
  • elastic recoil of lungs
  • alveoli surface tension (surfactant)
  • chest wall (bellows!)
28
Q

compliance

A

ease with which lungs expand

29
Q

factors effecting rate of diffusion (x3)

A
  1. pressure difference/concentration gradient
  2. distance (thickness of membrane)
  3. surface area (for gas exchange)
30
Q

factors effecting perfusion (x3)

A

blood flow, right? so…

  • movement of blood around alveoli
  • cardiac output
  • vessel patency, lumen size (vasoconstriction)
31
Q

perfusion labs

A

significant for understanding quality of blood

RBC, Hgb, HCT/PCV

also know about anemia or blood loss

32
Q
  • RBC typical
A

5 million/uL

33
Q
  • Hemoglobin (hgb) typical
A

15 g/dL

34
Q

*Hematocrit (HCT/PCV) typical

A

45%

35
Q

V/Q mismatch: V without Q

A

ventilation without perfusion

  • shock or PE
  • wasted air (air in alveoli, no blood flow)
36
Q

V/Q mismatch: Q without V

A

perfusion without ventilation

  • change in ventilation volume: shallow
  • atelectasis, pneumonia, airway obstruction

lungs compensate by pulmonary hypoxic vasoconstriction

37
Q

*pulmonary hypoxic vasoconstriction

A

redirection of blood flow around collapsed alveoli

- response to V/Q match (Q no V)

38
Q

factors affecting cell respiration

A
  • O2 consumption (related to cell BMR)
  • each organ/tissue = oxygen % according to need
  • availability/amount of O2 in blood
  • perfusion to cells
  • diffusion into cells (ex: edema increases distance for O2 to travel -> hypoxia)
39
Q

*increase in basal metabolic rate (BMR)… + causes

A

increases consumption of oxygen

  • agitation
  • fever & shivering
  • infection, sepsis, wound healing, burns
  • ADL, ambulation
  • stress
  • hyperthyroidism
  • seizures
  • increase work: tachypnea, tachycardia
40
Q

*hypoxia s/s

A
  • DECREASED MENTAL ACTIVITY OFTEN FIRST*
  • anxiety, restlessness, confusion, irritability, apprehension, headache, impaired judgment, decreased concentration/LOC

tachypnea, increased depth, dyspnea, adventitious sounds

tachycardia, dysrhythmia

fatigue of skeletal or cardiac muscles

cyanosis LATE SIGN

ischemia and death of cells, tissues, organs

41
Q

respiratory pathogens spread

A

> 5 feet

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