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CABS2: Pulm > CABS: Regulation of respiration and drive and CLIN MED: PFT and ABG (incomplete) > Flashcards

CABS: Regulation of respiration and drive and CLIN MED: PFT and ABG (incomplete) Flashcards

1
Q

what determines pH

A

H+ concentration

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2
Q

what balances pH

A

CO2 and HCO3- concentrations

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3
Q

what is the calculation for pH

A

HCO3- / pCO2

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4
Q

how much CO2 do we produce per minute

A

200mL / Min

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5
Q

what triggers central chemoreceptors

A

CO2

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6
Q

how much more soluble than O2 is CO2

A

20x - will diffuse very quickly

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7
Q

what is the henderson hasselback equations

A

CO2 + H2O -> H2CO3 -> HCO3- + H+

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8
Q

what is the combination of CO2 + H20

A

carbonic acid (H2CO3)

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9
Q

what is the buffer of pH

A

bicarbonate

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10
Q

what controls the bicarbonate levels

A

kidneys

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11
Q

what is normal bicarb levels

A

24-26 mEq/L

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12
Q

what is the by-product of glucose and oxygen

A

carbon dioxide + water + ATP

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13
Q

what chemicals control involuntary breathing

A

CO2
H+
H2CO3
HCO3
pO2 - partial pressure O2

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14
Q

what are the different types of chemoreceptors

A

CO2 (periphery) and O2 receptors (peripherally and centrally located)

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15
Q

what occurs to the pH when the CO2 increases

A

pH will decrease (acidosis)

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16
Q

what is part of the respiratory center within the brain stem

A

Pons - pneumotaxic and apneustic center
Medulla - dorsal and ventral respiratory group

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17
Q

what is the pneumotaxic center

A

located in the pons
modify breathing rhythm that is set forth by the dorsal and ventral respiratory groups
helps with inspiration/expiration transition

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18
Q

what is the apneustic center

A

located in the pons
modify breathing rhythm that is set for by the dorsal and ventral respiratory groups
involved in inspiration
received input from stretch receptors

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19
Q

what the dorsal respiratory group (DRG)

A

primary control in respiratory drive
located in the medulla
chemical, mechanical and neural triggers
(at rest breathing)

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20
Q

what is the ventral respiratory group (VRG)

A

activated during times of increased effort
controls the rhythm of breathing
assists with inspiration and expiration

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21
Q

what signals initiate VRG

A

dopamine

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22
Q

at what point does O2 become the primary driver to influence respiratory rate

A

< 60

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23
Q

what do the chemoreceptors in the carotids detect

A

CO2 (and O2 if now) (and pH)

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24
Q

what are irritant receptors

A

react to noxious stimuli within the lung
located in the conducting airway epithelium
triggers cough reflex and bronchoconstriction

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25
Q

what is the function of the lung receptors

A

these will all send afferent stimuli to the dorsal respiratory group of the medulla

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26
Q

what are stretch receptors

A

lung receptors-assist with ventilatory rate/volume as the smooth muscles sense/react to over inflation/deflation
will stop continued inhalation to prevent barotrauma

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27
Q

what are J-receptors

A

lung receptors - sense pulmonary capillary pressure
react to pulmonary edema

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28
Q

what are j receptors most commonly associated with

A

left HF
- rapid/shallow breathing

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29
Q

what is the ANS inneration

A

determines the diameter of the airways (constriction and dilation)

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30
Q

what is the affect of the parasympathetic on the lungs

A

vagus nerve will cause constriction of the airways
irritants/inflammation can trigger

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31
Q

what is the sympathetic affect on the lungs

A

causes relaxation of the airways
- dilation occurs due to catecholamines
stress - b-agnoists

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32
Q

what is FiO2

A

% of oxygen they are getting in

33
Q

what is the PaO2 within the pulmonary artery

A

40mmHg

34
Q

what is the PaO2 within the pulmonary vein

A

100mmHg

35
Q

what is ABG

A

arterial blood gas

36
Q

what is the ABG a gold standard test for evaluating

A

acid-base balance
oxygenation
ventilation

37
Q

what are indications for ABG

A

critically ill, respiratory condition, metabolic disorder
ICU, ED never done in Primary care

38
Q

how is ABG obtained

A

radial arterial puncture - uncomfortable for patients

39
Q

what does the ABG tell us

A

pH
PaO2/PO2
PaCO2/PCO2
HCO3 concentration
degree of excess or deficit of base in the blood
O2 Sat

40
Q

What is an alternative to ABG

A

venous blood gas (VBG) - can assess oxygenation
provides venous pH and HCO3 concentrations
End-tidal CO2/Capnography - requires tight fitting mask or intubation

41
Q

what does protein breakdown yield

A

acids

42
Q

what is the normal pH of the blood

A

7.35 - 7.45

43
Q

what does pH =

A

-log (H+)
HCO3- (mEq/L) / pCO2 (mmHg)

44
Q

where is bicarbonate made

A

in the kidney to buffer acids -> more alkalotic

45
Q

where is bicarbonate reabsobed

A

by the proximal tubule

46
Q

why is pH important

A

metabolic functioning
protein structure
enzymatic functioning
cell wall integrity
…so many things

47
Q

how does acidosis affect metabolism

A

hyperkalemia

48
Q

how does alkalosis affect metabolism

A

decreased push of protons into the cell
this means that the calcium, mag, K are not getting pushed out of the cells so they can drop in ECF

49
Q

how does acidosis affect the respiratory system

A

tachypnea
can drop CO2 to about 10 at lowest point
Right shift

50
Q

how does alkalosis affect the respiratory system

A

low respiratory rate
left shift

51
Q

how does acidosis affect cardiovascular system

A

decreased cardiac output
vasodilation
increase ectopic rhythms from unstable cellular function
hyperkalemia

52
Q

how does alkalosis affect cardiovascular system

A

leads to excitability
ventricular tachyarrhythmias
SVT
hypokalemia

53
Q

how quickly do the lungs react to bicarbonate levels

A

within minutes

54
Q

how quickly do the kidneys react to bicarbonate

A

hours to days

55
Q

what is ionic shifts

A

H+ is exchanged for K+ (and others) across cellular membranes
occurs within hours

56
Q

what is an anion gap

A

AG = Na - (Cl + HCO3)

57
Q

what are acid base disorders

A

respiratory acidosis
respiratory alkalosis
metabolic acidosis
metabolic alkalosis

58
Q

what can cause respiratory acidosis

A

anything that impairs ventilation or oxygenation
asthma/COPD
obstruction
pneumonia (rare)
Head/chest trauma
respiratory depression (CNS lesions, drugs, sedation)

59
Q

what causes respiratory alkalosis

A

think anything that causes hyperventilation
pain/anxiety
CNS disorders
salicylate (ASA)
liver disease
sepsis

60
Q

what is respiratory acidosis hallmarked by

A

increase PaCO2

61
Q

what is respiratory alkalosis hallmarked by

A

decreased PaCO2

62
Q

what is metabolic acidosis

A

pH < 7.4 secondary to ‘metabolic’ disturbance
decreased acid excretion-> accumulation
increased acid load (ketones, lactate)
reduced level of base (HCO3)

63
Q

what is metabolic alkalosis

A

pH > 7.4 secondary to metabolic distrubance
excess acid excretion
increased level of base (HCO3)
hallmark is increased serum levels of HCO3

64
Q

What is the ROME criteria

A

Respiratory are Opposites, Metabolic is Equivalent

65
Q

what is a common way to measure and monitor arterial oxygen saturation

A

pulse oximetry
ration of oxygenated hemoglobin to total hemoglobin
expressed as percentage

66
Q

what are the different lung volume types

A

tidal volume
reserve volume (inspiratory, expiratory)
residual volume

67
Q

what are the different lung capacity types

A

inspiratory, expiratory, functional residual, vital capacity, total lung capacity

68
Q

what is the tidal volume

A

the amount of air that can be inhaled or exhaled in one respiratory cycle (normal breath)
will include volume to fill physiologic dead space
normal = 300-500mL

69
Q

what is the minute ventilation

A

tidal volume (TV) x Respiratory Rate (RR)

70
Q

what is inspiratory reserve volume

A

amount of air that can be forcibly inhaled after tidal volume (amount in a ‘deep breath’)
normal = 1900-3300 mL

71
Q

what is expiratory reserve volume

A

amount of air that can be forcibly exhaled beyond tidal volume (amount in ‘full exhale’)
normal = 700-1200mL

72
Q

what is residual volume

A

amount of air that remains in the lungs after full exhale
normal about 1200mL

73
Q

what is inspiratory capacity

A

total inspiratory volume
inspiratory reserve + TV

74
Q

what is total lung capacity

A

total volume of air the lungs can accommodate with maximal inspiration
Calculated (IRV + TV + ERV + RV)
normal about 4-6L

75
Q

what is vital capacity

A

total volume exhaled after full inhalation 4800mL

TV is only about 10% of vital capacity (VC)

76
Q

what is functional residual capacity (FRC)

A

air in the lung after a typical exhalation (non-forced)

77
Q

what is a PFT

A

pulmonary function tests
start with spirometry
if abnormal - repeat after bronchodilator

78
Q

what are PFTs utilized for

A

to diagnose restrictive and obstructive pulmonary disorders

CABS2: Pulm (7 decks)

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