Chapter 35 - Oxygenation (Week 4 quiz) Flashcards
memory tips for heart and lungs:
Tri = right (three lobes/tricuspid valve) Bi = left (two lobes/bicuspid valve)
apex is opposite (Heart bottom, lung top)
:)
The pulmonary, cardiovascular , mucsoskeletal and neurological systems work together to achieve _______
oxygenation
Type II alveolar cells produce ________, a lipoprotein that lowers the surface tension within alveoli to allow them to inflate during breathing
surfactant
Two major processes occur in the pulmonary system. ______ which is the movement of air into/out of the lungs
__________ is the exchange of oxygen/carbon dioxide
Alveolar capillary/capillary cell membrane
Ventilation (physical)
Movement of air into/out of the lungs which is called inhalation/exhalation
Respiration (chemical)
Exchange of oxygen/carbon dioxide
takes place in Alveolar capillary/capillary cell membrane
During _______ the diaphragm contracts, causing expansion of chest cavity (intercostals pull up and out) and lungs (creates negative pressure-and air is drawn in).
______ occurs when the diaphragm and intercostals relax, chest returns to normal resting size.
inhalation
exhalation
In vital signs we covered repisratory rate, depth, hyperventillation, hypoxemia, hypoventilation. Describe each!
Respiratory rate (# of times a person breathe in a full minute; count for full minute is new pt and to ensure accuracy vs for 15-30)
depth (tidal volume is the amt of air taken in on inspiration) - can be deep, shallow, or normal
rhythm-regular or irregular (cheyne stokes in the dying, Biot’s, kussmauls)
effort-effortless, dyspnea (labored breathing), orthopnea (inability to breath lying down), bradypnea, tachypnea
hyperventillation is rapid and deep breathing resulting in excess loss of CO2 (hypocapnea). Too much carbon monoxide can cause this. Pt may complain of feeling light-headed and tingly HYPOXEMIA is a mild form og hyperventillation except it is when there is a low level of oxygen in the blood. EMIA!!!
hypoventillation is when the rate and depth of respirations are decreased (small amount) and CO2 is retained. Can result in hypoxia (O2 def to tissues)
_______ _____ refers to the ease of lung inflation. It can be reduced by conditions that cause elastin fibers to be replaced with scar tissues, edema or loss of surfactant.
lung compliance
__________ _________ refers to tendency of elastin fibers to return to their original position (like a rubber band stretched and then snapped). This causes it to lose recoil over time. Lung can inflate easily but not deflate, leaving air trapped in alveoli
Lung elasticity
Usually _____ ____ is minimal. HOwever, during bronchospasm, the slightest reduction in diameter can cause trouble.
airway resistance
Which diagnostic test/exam would best measure a client’s level of hypoxemia?
a. chest x-ray b. pulse oximeter reading c. ABG d. peak expiratory flow rate
Correct answer: C
The term “hypoxemia” means low levels of oxygen in the blood. Arterial blood gas sampling is the most direct way in which the level of oxygen in the blood can be measured.
What is the difference between internal and external respiration?
External takes place between alveoli and capillary (will touch the external world as some point going in and out)
Internal takes place between the capillary and tissue (cell membrane)
(takes place soley inside capillaries/cells)
http://www.youtube.com/watch?v=qM1A4O3urGE
AP2: RESPIRATORY SYSTEM: EXTERNAL & INTERNAL RESPIRATION
Breathing is controlled by _________ located int he medulla, brainstem, carotid arteries and the aorta which detect changes in pH, O2, CO2.
Normally, the blood CO2 level provides the primary stimulus to breathe.
In addition, lung ______ located in the lung and chest wall are sensitive to breathing patterns/lung expansion/compliance/airway resistance/and respiratory irritants. Resp ctr uses feedback from these to adjust ventillation.
chemoreceptors
What allows us to control breathing in order to talk?
voluntary control of breathing via motor cortex
What factors infuence pulmonary function?
Developmental stage:
Less than 35 wk gestational - do not have full developed alveolar surfactant system/at risk for RDS (atelectasis - alveoli collapse), hypoxemia/hypercarbia; apnea;
Infants - susceptible to nfection
TOddlers put toys in their mouths - ingesting germs; possibly choking; drowning
Adolescents - start using tobacco
Young/middle/older adults - lack of exercise, smoking; organ decline; reduced lung expansion; difficulty expelling mucus, declining immune response, GERD
Environment: stress allergies air quality altitude
lifestyle:
pregnancy - O2 demand increases; limited diaphragm movement
occupational hazards - chemicals, fine particles, etc
nutrition
obesity - causes sleep apnea AND fat preses upward on diaphragm, preventing chest expansion which leads to hypovent.dyspnea;increase risk of lung infection
exercise
smoking
substance abuse
Medications - that depress CNS (anesthesia/opioids/antianxiety med/diazepam (valium), neuromuscular bloicking agents.
pathophysiological conditions - prob with gas exchange, resp infections, pulmonary system/circulation , cns and neuromuscular abnormalties,
Difference between hypoxia and hypoxemia?
hypoxia - inadequate O2 in tissues/organs
hypoxemia - low arterial blood O2 levels
The location!
What is the difference between hypercarbia and hypercapnia?
Nothing. The mean the same thing - excess of dissolved CO2 in the blood.
T or F: Hypocarbia (aka hypocapnia) is a low level of dissolved CO2 in the blood. In most cases (except high altitude) blood O2 levels remain normal. Caused by hyperventilation.
True
What is the differences in symptoms of URI vs Flu
Flu has the symptoms of URI (colds) BUT are more severe AND cause headache, fatigue, weakness, exhaustion and HIGH FEVER.
What are some pulmonary system abnormalties?
structural - broken rib, pneumothorax, fluid
airway inflammation/obstruction - astham / swollen tonsils
alveolar-capillary membrane disorders - alveoli become stiff and diffcult to ventiliate/gas exchange impaired
Atelectasis - alveolar collaps
What is a pulmonary embolus?
obstruction of pulmonary artery circulation due to clot/air/fat
_________ ________ is elevated pressure in the pulmonary artery system. High pressure causes the heart to have to work harder and eventually leads to right-sided heart failure, w/reduced amt of blood pumped into circulation.
pulmonary hypertension
Any CONDITION that alters CNS Function can interfere with the regulation of breathing. What are some common conditions?
Trauma
Stroke
Medications
Know what these are: eupnea dyspnea orthopnea bradypnea/tachypnea kussmaul's breathing Biot's breathing Cheyne-Stokes
eupnea 9normal breathing)
dyspnea (labored breathing),
orthopnea (inability to breath lying down),
bradypnea/tachypnea (slow/fast)
kussmaul’s breathing (youtube this! http://www.youtube.com/watch?v=TG0vpKae3Js )
Biot’s breathing https://www.youtube.com/watch?v=FpKdq-_ZvsI
Cheyne-Stokes ( note: may be alarming! https://www.youtube.com/watch?v=6_kxzDyV6J8 )
What is the best way to assess a cough?
OLDCART +
Is the cough dry,productive or hacking?
_____ ____ is a noninvasivce est. or arterial blood O2 saturation (SaO2). SaO2 relfects % of hgb carrying oxygen. Normal is 95-100%
pulse oximetry
hgb = iron contraining pigment of red blood cells
SaO2 - saturation of Oxygen that is actually bound to hemoglobin
There are two methods for measuring O2 and CO2 levels in the body. What are they? Which is most reliable?
ABG (Most reliable) - measure PAO2/PC02/Bicarbonate
Pulse ox - measures )2 saturation with a light beam
Def:
P02 (pp of O2 in blood) - amt of O2 availble to combine wih hgb to make Oxyhemoglobin; normal 80-100mmHg n arterty/40mg in vein
PC02 (pp of CO2),
Bicarbonate - blood pH
Capnography is used to measure ventilation and indirectly measure the partial pressure of CO2. Name some situations when this is used…
- when pt receiving opioids
- during general anesthesia
- monitoring infants w/resp distress
- for adjusting parameter settings in mechanically ventilated patients
- for validating ET placement (if wrong little or no CO2 will be present.
______ is used to measure air that moves into and out of the lungs.
Spirometry
T or F: DUe to fraction of inspired oxygen (Fio2=21%), if a pt receives 100% O2 for a few minutes, it is possible to have 500-600 mmgH (5-6 times higher than normal), while SaO2 remains at 100%
True!
Hemoglobin cannot be filled with more than 100% O2 (If there is 100 seats in a theatre (100 hgb), you cannot fill 101).
T or F: If gas exchange is impaired as a result of disease, Po2 and Sao2 levels will fall and there is no way to fix this.
False! Oxygen supplement will improve these levels!
What is the normal arterial Pco2?
35-45 mmHG
Fact: even in the face of obstacles, such as thickened membranes or alveolar fluid, CO2 readily diffuses. So unless there is a severe disorder, the level remains normal.
________ measures the amount of air that can be exhaled with forcible effort.. Expressed in liters. Asthma patients use this to measure daily during flare ups.
peak flow (PEFR - peak expiratory flow rate)
Steps to use:
- take deep breath and forcefully exhale into it. (use three readings and record highest)
- Teach pt to maintain/adjust med according to highest reading. (color coded system used)
What are the five A’s for treating tobacco use:
ASk - about tobacco use and document Advise - to quit. Assess - willingness to quit Assist - in quit attempt Arrange-arrange follow up or cessation classes
An —— or ——– position pulls abdominal organs down, allowing max diaphragm excursion and lung expanstion
upright or elevated
_______ promotes deep inhalation and forceful expulsion of secretions.
coughing
Interventions that help enhance coughing and mobilize secretions include deep breathing, coughing exercises and HYDRATION (matinain systemic hydration/humidify inhaled air - use humidifier or nebulizer)
______ _______ moves secretions to the large, central airway for expectoration or suctioning. It involves postural drainage, chest percussion and chest vibration.
chest physiotherapy
What is an O2 concentrator?
removes nitrogen from room air and concentrates O2.
Various devices are used to deliver O2 to the pt. They differ in amt of O2 they can deliver and the degree to which they enclose the pt. They are all capable of reaching 100% O2. What are some examples of low-flow devices? High-flow devices?
Low flow = nasal cannula, simple face masks, rebreather masks
High flow=venturi masks, aersol face masks, face tents, and tracheostomy collars.
Oxygen toxicity can develop when O2 concentrations of more than _____% are adminsitered for longer than ____ to ____ hours
50%
48-72 hours
If a person is unconscious, should you use an OPA (oropharyngeal airway) or NPA (nasopharyngeal airway)?
OPA. Can you use OPA on conscious? No because of gag reflex
Why do tracheostomy tubes requires a device to warm and humidify inhaled air?
because they bypass the upper airway (which normally warms/humidifes)
T or F: Even after the osotomy is well healed, the airway is at risk of collapsing.
False!
Once the ostomy is well healed, the airway will not collapse if the tracheostomy tube is dislodged.
T or F: Both a resp therapist and nurse are responsible for suctioning and trach care. You will need to collaborate with the resp therapist in managing the pt’s airway.
True
What is the biggest risk in using positive pressure ventilators?
drop in cardiac output as the positive pressure in the chest decreases venous return to the heart
VAP is associated with high mortality rates. What is VAP?
ventilator associated pneumonia
Normally there is neg. pressure in the pleural space and only a thin layer of fluid.
Accumulation of fluid and blood in the pleural space is called ________; it interferes with lung expansion, ventilation and gas exchange.
Air in the pleural space is called _______ and creates pos pressure, causing lung tissue to collapse.
hemothorax
pneumothorax
Chest tubes are used to remove air or fluid from the pleural space ( animation of it: https://www.youtube.com/watch?v=IMifvHjAKbE )
This is the sequence of?
ANS sends signal–>SA–>AV–>bundles of hiss–> left and right bundle branches–>purkinje fibers
electrical conduction
From KC’s:
Normal electrical impulses in the heart follow this path:
● The sinoatrial (SA) node initiates impulses that trigger each heart beat.
● Each impulse travels rapidly down the atrial conduction system so that both atria contract as a unit.
● There is a slight delay at the atrioventricular node (AV) node.
● From the AV node, impulses pass into the left and right bundles of His and into the Purkinje fibers.
T or F: The heart has it’s own supply of blood
True - though coronary arteries.
Describe oxygenation and perfusion
● Oxygenation refers to how well cells, tissues, and organs are supplied with oxygen.
● Perfusion refers to the circulation of blood to all body regions.
What is the importance of diastole to perfusion of the heart?
Answer:
During diastole, the coronary arteries are the only arteries in the body that fill.
Knowledge Check 35-15
● How are oxygen and carbon dioxide transported in the blood?
Answer:
The gases are transported in the blood as follows:
● Oxygen (O2) is carried in the blood bound to hemoglobin (97%) or in a dissolved state (3%). At the tissue level, oxygen leaves the hemoglobin, becomes dissolved in the blood, and passes through the capillary membrane. Only the dissolved form of oxygen can pass through capillary membranes. Oxygen bound to hemoglobin serves as a reservoir, holding oxygen until it is needed in the dissolved state.
● Carbon dioxide (CO2) can be carried in the blood in three ways: a dissolved state, bound to hemoglobin, or as a bicarbonate ion. It leaves the cells by passing through the cellular–capillary membrane in the dissolved state. In the blood, about 7% remains dissolved in plasma, 23% attaches to hemoglobin, and 70% is converted into bicarbonate ions. At the alveolar–capillary membrane, dissolved carbon dioxide diffuses into the alveoli for exhalation from the lungs
Does poor peripheral perfusion increase risk for hypoxemia?
Answer:
No, poor peripheral perfusion increases the risk for tissue hypoxia.
What does stress do to the cardiovascular function?
Releases catecholamines - increased HR/contractility/vasoconstriction/inc tend to clot.
Supresses immune/inflammatory response
Release of cortisol - alters glucose, fat and protein metabolism.
Sustained stimulation of SNS can lead to cardiovascular disease.
What does heat and cold do to cardiovascular function?
Cold slows cell metabolsim, reducing O2 demand; causes vasoconstriction, slows HR
Heat causes vasodilation, increase Cardiac Output and oxygenation. Also increases metabolism. This is why people are sedentary when its hot
What does pregnancy do to cardiovascular function?
MOm’s blood incr. 30%
Requires addl iron to produce the blood and meet fetal requirements; failure to meet results in maternal anemia, reducing tissue oxygenation to mom and baby
Effects of calcium and potassium on heart
Not in reading… JIC
An excess of potassium ions in the extracellular environment markedly reduces the heart rate as well as the strength of contraction.
Excessive levels of sodium ions result in depression of cardiac function, which is thought to stem from their competition with calcium ions at some critical site during the contractile process.
an inadequate blood supply to an organ or part of the body, especially the heart muscles.
ischemia
How does carbon monoxide cause problems?
binds to hemoglobin at O2 receptor sites, making it impossible for hemoglobin to carry O2
How can you differentiate between pleuritis/rib fracture causing pain versus cardiac pain?
Cardiac pain usually in the ctr or on the left side of the chest and radiates to the left arm (at least in men); inhalation does not change the pain.
What is the purpose of ECG monitoring?
- ID pt baseline rhythm/rate
- Recog. sig. change in baseline
- Recog. lethal dysrhythmias (abnormal heart rhythm)
There are three parts of the cardiac cycle. What are they and what do they represent?
P wave - firing of SA node and impulse through atria (memory - PSA - public service announcement)
QRS complex- ventricular depolarization leading to contraction
T wave - return of ventricles to an electrical resting state
What is ectopy?
extra beat
What does it mean if a dysrhythmia is junctional?
means it is within the av node
What is the diff between thrombus and embolus?
thrombus is adhering to wall of vessel, embolus is traveling in the blood
T or F: Cardiovascular meds are used to enhance cardiac output, thus providing increased blood flow and oxygenation to organs and tissues.
True
T or F: Beta-adregeneric agents block stimulation of beta receptors, which are located primarily in heart/lungs/blood vessels. They decrease HR, slow conduction through AV, decrease myocardial oxygen demand by reducing myocardial contractility
true
Positive inotropes ____ cardiac contractility. Used to make heart a more effective pump.
increase
