Cardioresp - General Flashcards
Name the 4 functions of the upper airway.
- Conduct air to the lower airway
- Protective mechanism to prevent material getting into pulmonary tree
- Portion of anatomical deadspace
- Role in speech and smell
Eupnea
Normal breathing - occasional sigh
Tachypnea
Increased rate (not necessarily depth) - more than 20 Cause: anxiety, hyperventilation, high CO2
Hyperpnea
Increased TV (depth) with or without increase in rate
Bradypnea
Decreased RR (less than 12) Causes: alcohol, drugs, low CO2, neuro, sleep
Apnea
Period of no breathing
Causes: sleep, infant
Kussmaul’s Ventilation
Increase in RR and TV
Causes: diabetic acidosis (resp system compensation - blowing off CO2)
Cheyne Stokes
Ranges from hyperpnea to apnea
Causes: neuro insults
Biot’s Ventilation
Small breaths with apnea in between
Causes: neuro insult
Name 4 signs of respiratory distress
Increase RR, nasal flaring, intercostal indrawing, paradoxical breathing, leaned forward, wheezing, cyanosis
Name 3 possible reasons diaphragmatic excursion may be abnormal
Tumor, pneumothorax, damage to phrenic nerve
Name the 2 types of wheezes and their meaning.
High pitched = bronchospasm
Low pitched = secretions in the U/A
Name the 2 types of crackles and their meaning.
Coarse = pulmonary edema or secretions in the lower airway Fine = atelectasis or pulmonary fibrosis
Stridor
Upper airway obstruction
Pleural rub
Fluid in pleural space
Crunches
Subcutaneous emphysema
Name and describe the 3 forms of neural control of breathing.
- Medullary Neurons - center for generation of rhythm (spinal or propriobulbar) = bulbospinal (insp and exp); propriobulbar (transition between)
- Neurons of the Pons - not critical for generation of rhythm
- Upper cervical inspiratory neurons C1-C3
Nasal Irritant Reflex
Stimulated by water or chemical gases (results in deep insp and bronchoconstriction = sneezing)
Epipharyngeal Irritant Reflex
Receptors sensitive to mechanical deformation; powerful inspiratory efforts
Purpose = bring into esophagus or cough it up
Laryngeal Irritant Reflex
Sensitive to mechanical deformation or irritants = cough
Tracheal Irritant Reflex
Sensitive to mechanical deformation or irritants = cough
Lung Irritant Reflex
Receptors in epithelium of airways from trach to bronchioles; sensitive to mechanical deformation or chemical irritation
Causes: increase ventilation, bronchoconstriction, laryngeal constriction (prevents other substances from getting in)
J Receptors Irritant Reflex
Juxta pulmonary capillary receptors in alveolar wall
Stimulated by increased interstitial fluid between capillary endothelium and alveolar endothelium
= abnormal breathing pattern; bronchoconstriction and laryngeal muscle contraction
Stretch Reflexes
Info about lung volume to medullary neutrons (receptors in lung get stretched at certain points and stops insp)
Tidal Volume
Volume inspired or expired with each normal breath (500mL)
Inspiratory Reserve Volume
Max that can be inspired (on top of normal) (2-3L)
Expiratory Reserve Volume
Max volume that can be expired after tidal volume (1L)
Residual Volume
Volume that remains in the lungs after max expiration (1L)
Inspiratory Capacity
Volume of max inspiration (2.4-4L) IRV + TV
Functional Residual Capacity
Volume remaining in lung after normal expiration (2L) ERV + RV
Vital Capacity
Volume of max inspiration and expiration (3-4.5L) TLC - RV
Total Lung Capacity
Volume of air after max inspiration (4-6L) RV + TV + IRV + ERV
Dead Space (anatomic vs. physiologic)
Anatomic (150mL) - volume of conducting airways
Physiologic (150mL - greater with lung disease) - volume of lung that doesn’t participate in gas exchange
What are important considerations for patients using beta blockers?
Blunted HR and BP response (don’t use HRmax for exercise prescription - RPE instead); gradual warm up and cool down
What are the contraindications to spirometry?
MI in the last month, recent stroke/abdominal/thoracic surgery, uncontrolled HTN, recent pneumo
What are the differences between the obstructive and restrictive patterns for lung disease?
Obstructive = inc. lung volumes, dec. FVC, ++ dec. FEV1, dec. ratio Restrictive = dec. lung volumes, dec. FVC, dec. FEV1, ratio normal or increased
What are the precautions with an art line?
Infusion bag kept above insertion site; no hip flexion past 90 if femoral
What are the limitations post sternotomy?
No lifting anything more than 10lbs, no pushing, no pulling
What are the criteria for spirometry use?
Patient cooperative and motivated; FVC > 15mL/kg or IC > 12mL/kg; RR < 25
Name the precautions/contraindications for head down postural drainage positions?
Untreated pneumo, hemoptysis, unstable CV status, inc. ICP, esophageal anastomosis, aneurism, pulmonary edema or CHF, patient upset or agitated, PE, recent laminectomy, large pleural effusion
