Cadriopulm mgmt Session 1 Flashcards
What are the components of the oxygen transport system
- Inspired oxygen and quality of air
- Airways
- Lungs and chest wall
- Diffusion
- Perfusion
- Myocardial function
- Peripheral Circulation
- Tissue extraction and utilization of oxygen
- Return of partially desaturated blood and CO2 to lungs
- Oxygen Delivery - DO2
- Oxygen consumption - VO2
- Oxygen extraction ratio - OER (23% at rest)
What regulates DO2?
Demand of tissues
At rest, how may times more is the supply of DO2 vs the demand?
3-4x
What determines hemoglobin’s affinity for O2?
pH and temperature
Why is the balance of intravascular and extravascular fluid important?
An imbalance can impact the electrolytes and lead to impaired organ function
What is the % nitrogen and % oxygen in the air?
Nitrogen- 79%
Oxygen- 21%
Why is poor air quality a problem for the lungs?
Poor air quality interferes with the respiratory tract filtering and leads to inflammation of alveolar capillary
Why is humidity important for inspiration?
Dry environments cause a loss of mucus covering which can lead to erosion and infection; alveoli need moisture to help with gas exchange
What are the components of the upper and lower respiratory tracts?
Upper: Nasal cavity, pharynx, larynx
Lower: Trachea, primary bronchi, lungs
What is the role of cilia in the respiratory tract?
Catch cilia and help push it back out
How does the diaphragm regulate inspiration?
When the diaphragm contracts, a negative space is created in the lungs and air flow in (inhalation). In expiration, the diaphragm relaxes and causes a positive pressure, causing air to flow out.
What problem is caused when the lungs don’t expand symmetrically?
The lesser moving side pools mucus and causes pneumonia
What muscles are involved in inspiration?
External intercostals - elevate ribs
Diaphragm - depresses the inferior wall of the thoracic cavity
What muscles are involved in active expiration (typically expiration is a passive process)
Internal intercostals - compress and lower ribs
Abdominals - Compress abdominal cavity which elevates the abdominal organs and passively elevates the diaphragm
Define diffusion
The transfer of oxygen from alveolar sacs to pulmonary circulation
List 5 factors that affect diffusion
- SA of alveolar capillary membrane
- Diffusing capacity of alveolar- capillary membrane (thick vs thin membrane)
- Pulmonary capillary blood volume (more blood = more oxygen)
- Ventilation/ perfusion ratio (Vol O2 breathed in vs % O2 used)
- Transit time of blood in alveolar capillary
Define perfusion
Blood flow
Describe perfusion changes throughout the lungs
Upper lungs (apical): low perfusion :( alveoli fully expanded :)
Lung bases: perfusion increased due to gravity :) enlarged vessels compress alveoli
Midle lungs: OPTIMAL PERFUSION
Optimal myocardial function depends on synchronized coupling of electrical _______ and mechanical _________
Conduction; contraction
What are two measures of myocardial function impairment?
Heart rate, ejection fraction
What are 4 measures of cardiac output
Preload, force and rate of contraction, after load
Large vessels have _______ & _________ tissue, medium to small vessels have more ___________ muscle
elastic; connective; smooth
Peripheral circulation is regulated by what 2 pressures?
Hydrostatic, oncotic
Where in the peripheral circulation is partial pressure of oxygen highest?
Venous (vs arterial)
Myocardial infarction affects which step of oxygen transport?
- Myocardial function
Pneumothorax from stab wound affects which step of oxygen transport?
- Lungs and chest wall
Asthma affects which step of oxygen transport?
- Airways
4. Diffusion?
Pulmonary embolism affects which step of oxygen transport?
- Perfusion
Hypertension affects which step of oxygen transport?
- Peripheral circulation
Anemia affects which step of oxygen transport? (low iron and hemoglobin)
- Tissue extraction and utilization of O2
What 3 aspects of oxygen transport are affected by exercise?
- Ventilation
- Cardiac output
- Tissue utilization
Why is early mobility important?
- Impact cardiac output and VO2
- Impact OER
- Bedrest changes fluid distribution, reduces muscle activity, aerobic deconditioning
Describe the astronaut syndrome of “bird legs and puffy face”
Gravity keeps fluids where they should be. In lack of gravity (or bed rest), fluid shifts to thorax/ head
What are symptoms of overall poor health?
Weight gain/ loss, fatigue/ weakness/ malaise, fever/ chills, sweats/ night sweats
What are symptoms of poor skin?
Excessive dryness or moisture, itching, excessive bruising, lesion or rash
What are symptoms of poor respiratory system?
Hx of lung dz, chest pain with breathing, wheezing, SOB, cough, odd sputum color or amount, hemoptysis (bloody sputum), medications
What are symptoms of poor CV system?
Heart pain, palpitation, cyanosis, dyspnea on exertion, orthopnea (SOB when laying down), edema, hx of heart murmur/ HTN/ CAD or anemia, meds
What are symptoms of poor peripheral vascular system?
Coldness, numbness, tingling of legs; swelling of legs; discoloration of hands and feet; varicose veins; intermittent claudication; thrombophlebitis; ulcers; meds
What are symptoms of poor hematologic system?
bleeding in skin or mucus membranes; excessive bruising; lymph node swelling; blood transfusion and reaction; meds
What are symptoms of poor endocrine?
Hx of diabetes; hx of thyroid dz; change in skin texture; excessive sweating; relationship between appetite and weight; nervousness, tremors
What are symptoms of poor O2 transport?
External: Pale, cold cyanotic skin; SOB; Diaphoresis
Internal: Vital signs, respiratory pattern, hypoxia/ low pulse, poor peripheral circulation, decreased capillary refill (>3 sec)
