Acid Base disorders Flashcards
How many lobes does the right lung have?
3
The left lung has ____lobes
2
The _______ and ______ are the major muscles of inspiration
diaphragm and external intercostals
What is perfusion?
Blood flow second to ventilation, distribution of blood flow at the alveolar level to allow exchange
of O2 and CO2
What is diffusion?
ventilation, moving air into the lungs and distributing air within the lungs to gas exchange units (alveoli) for maintaining of O2 and removal of CO2
The _______ and ______ are the accessary muscles of inspiration
sternocleidomastoid and scalene muscles
What are the accessary muscles of expiration?
abdominal and internal intercostal muscles
What is Total lung capacity?
how much air you can inhale in maximum inspiration effort
What is vital capacity?
amount of air that can be expelled in resting state (exhale)
What is functional residual capacity/ volume?
after exhalation, how much air left in alveoli to keep them open
What is inspiratory capacity?
volume of gas that can be taken in in a full inhale
What are the neurological controls of ventilation?
respiratory center (medulla-primary and pons-secondary)
What are the chemical controls of ventilation?
pH, O2, CO2
What are the mechanical controls of ventilation?
stretch receptors in bronchi, irritant receptors throughout the epithelium, temperature
What is the V/Q ratio?
Ventilation/ Perfusion ratio, matching adequate volume of air in alveoli to adequate pulmonary blood flow
What would a V/Q of 80% mean?
normal/ideal: 4L/ minute of alveoli ventilation to 5L/ min of capillary blood flow in the lungs
What effet does standing have on the V/Q ratio?
increases V and thus increases V/Q
What effet does lying down have on the V/Q ratio?
increases perfusion and this decreases V/Q ratio
What might cause a low V/Q?
Chronic bronchitis, low V
What might cause a very low V/Q?
a shunt or hole in the heart that is bypassing ventilation
What might cause a high V/Q?
Low perfusion, COPD
What might cause shifting in oxyhemoglobin dissociation curve?
CADET: CO2 changes, Acidosis Condition, DPG- measure of eurthrocytes, Exercise, Temperature
Would you rather see a left or right side shift in the oxyhemoglobin dissociation curve? Why?
Right, if there is a left shift it means that Hg has a high affinity to O2 and is reluctant to let it go to the tissues
What is resperatory insufficiency?
gas exchange maintained at an acceptable level with increased work from the cardiopulmonary system.
What might cause resperatory insufficiency?
emphasema, asthma flare up, COPD at terminal stage
What might cause respiratory failure?
COPD with severe pneumonia
What could the etiology of a decreased CNS drive to breath be?
narcotics, head/neck trauma, sleep apnea
What could the etiology of impaired ventilation d/t obstruction be?
bronchial edema, obstructed airway, pneumothorax, popped lung
What could casue impaired ventilation/perfusion?
COPD, restricted lung disease, atelectasis, pneumonias, pulmonary edema, anemias
What is the difference between hypoxia and hypoxemia?
Hypoxia-lack of O2 hypoxemia- result of severe low O2 , no blood perfussion, at rist for tissue necrosis
What is hypoxemia a direct consequence of?
respiratory failure
How does hypoxemia effect the CNS?
restlessness, agitation, incordination, coma and death
What are the clinical presentations of respiratory distress?
tachycardia, coolness, diaphoresis, pallor-cyanosis, initial increases in BP, HR, failed hypotension, bradycardia
What is hypercapnea?
increased level of CO2 in blood, direct vasodilator (cerebral vessels leading to headache, flushed skin, conjunctiva- hyperemia)
How does the neumonic ROME help us to understand acid base balance?
Respiratory Opposite Metebolic Equal CO2 increases and pH is low then it is respiratory acidosis (opposite) HCO3 is high and pH is high then it is metabolic alkalosis (they go in the same direction)
What is the normal value for pH?
7.35-7.45
What is the normal value for CO2?
35-45
What is the normal value for HCO3?
22-26
What is the normal value for arterial O2?
80-100 mmHg
What is the normal value for O2 sat?
96-100%
What does metabolic acidosis cause?
hyperkalemia, drowsiness, confusion, coma, decreased BP, dysrhythmia, dilation, abd pain, increased resp (compensation)
What can cause metabolic acidosis?
retaining lactic acid, chronic renal failure
What does metabolic alkalosis cause?
hypokalemia, dizziness, irritability, nervous, confusion, increased HR, NV, anorexia, tetany, tremor,decreased respirations (compensation)
What can cause metabolic alkylosis?
severe vommiting
What can cause respiratory acidosis?
hypoventilation due to use of narcotics, COPD
What can cause respiratory alkalosis?
hyperventilation
What would complete compensation look like?
both CO2 and HCO3 are abnormal in the same direction and pH is within normal range
What does partial compensation look like?
both CO2 and HCO3 are abnormal in the sane direction and pH is still outside the normal range
Can combined acidosis and alkalosis be compensated?
NO!
What are tests of pulmonary function?
spirometry, diffustion capacity, residual volume, FRC, Total lung capacity, arterial blood gas analysis, chest radiographs
What are primary pulmonary symptoms?
Dyspnea, cough, hemoptysis (cough up blood), clubbing, abmornal spetum, paroxysmal nocternal dyspnea, orthopnea
What are obstructive lung diseases?
COPD, Asthma
What are restrictive lung diseases?
Pneumonia, Pneumothorax, pleural effusion
What are pulmonary infections?
TB, pneumonia, influenza
A patient presents with difficulty exhaling, use of accessory musles on exhalation, and a decreased FEV1 and FEV1/FVC. This would be an example of ______________ lung disease
obstructive
A patient presents with difficulty inhaling, decreased FVC, but has no problem breathing while asleep. This would be an example of __________ lung disease.
Restrictive
COPD refers to a combination of which 3 diseases?
Chronic bronchitis, emphysema, asthma
COPD stands for:
Chronic Obstructive Pulmonary Disease
T or F: COPD refers to a category of respiratory disorders that obstruct the pathway of normal alveolar ventilation either by spasm of the airways, mucus secretions, or changes in airway and/or alveoli
TRUE
_________________ is bronchial inflammation with hypertrophy and hypersectretion of the bronchial mucous glands
chronic bronchitis
List 4 causes of chronic bronchitis:
tobacco smoke, smog, occupational hazards, viral/bacterial infection
To get diagnosed with chronic bronchits one must:
have a productive cough for 3 months per year for 2 consecutive years
A slang term for a person with chronic bronchitis is:
“blue bloater”
In a person with emphysema, terminal airways collapse during: inspiration or expiration?
expiration
List 2 causes of emphysema:
inhalation of irritants (tobacco smoke), genetic (rare)
The slang term for a person with emphysema is:
“pink puffers”
A person who comes in complaining of a productive cough, incresed work load of breathing, and dyspnea most likely has:
chronic bronchitis
A patient complaining of dyspnea, barrel chest, non-productive cough most likley has:
emphysema
To manage chronic bronchitis and emphysema the three main points are:
1 improve ventilation (bronchodilators, breathing exercises) 2 promote secretion removal (hydration, humidification) 3 prevent complications
___________ is defined as Intermittent airway obstruction d/t bronchospasm and increased mucous sectretions and a hyper-responsiveness of airways after exposure to irritating stimuli
asthma
The 5 main reasons to use respiratory therapy is:
1 improve ventilation 2 raise PO2 3 Increase humidification 4 mobilize secretions 5 prevent complications
The 5 Main purposes of respiratory drugs are to:
1 dilate bronchi 2 increase of LIQUIFY secretions 3 decrease secretions 4 treat infection and inflammation 5 decrease cough
skipping categories of drugs
bronchodilators, anti-inflammatory
________ is defined as alveoli fill up with exudate (RBC’s, WBC’s, fluid, and debris) and consolidate lungs
pneumonia
What are the 4 main causes of Pneumonia?
aspiration, bacteria, virus, toxin
Community-aquired pneumonia (CAP) is commonly cause by which 2 microorganisms?
S. pneumoniae and H. influenzae
A person complaining o fa combination of fever, chills, productive or dry cough, malaise, pleural pain, dyspnea, hemoptysis, leukocytosis, or anxiety may have:
pneumonia
What is an issue with sputum and blood cultures when testing for pneumonia?
There are many false negatives
What is a treatment for pneumonia?
rest, hydration, antibiotics for bacterial, vitamin C, decongestants, cough suppressants
___________ is described as an infectious, communicable process that is caused by mycobacterium. It may effect any part of the body but is most common in the lungs
Pulmonary tuberculosis
T or F: Tubercle bacilli (cause TB) can live in dried sputum in dark places and are destroyed by direct sunlight or UV rays.
TRUE
Describe the three steps of how TB develops in the lungs
- TB enters lung and body fights with phagocytosis 2. Gray masses form if phagocytosis fails 3. Cavitation occurs and then erodes=air filled cavity
What are some common clinical manisfestations of TB?
cough, sputum production, dyspnea, hemoptysis, pleuritic pain, fatigue, irritability, night sweats, low grade fever in late afternoon, tachycardia, weight loss
What are 3 current treatments for TB?
Drug therapy, limited activity, dry, sunny, well ventilated living environment
Smoking, industrial pollutants, race/socio-economic status, and geography are all risk factors for:
lung cancer
A patient comes to the clinic complaining of chest pain, dysphagia, fatigue, recurrent URI’s, and has had a persistent cough that recently worsened. This patient may have ___________
lung cancer
3 common complications from lung cancer include:
pleural effusions, resp. insufficiency, and CV
T or F: A danger of lung cancer is it’s potential for metastasis to the brain, bone, and liver.
TRUE
List 4 possible treatment options for lung cancer:
chemotherapy, radiation, surgery, compassionate care
When assessing a patient Always pay attention to:
pateint history, vital signs, symptoms and physical findings, lab values
When assessing a patient Always ask:
What is causing the abn. Finding? What can be done to fix it?
