Chapter 40: Respiratory & Oxygentation Cliff Notes

Question 1

The ______ and _______ systems supply the oxygen demands of the body. _______ is oxygenated through the mechanisms of ventilation, perfusion, and transport of respiratory gases. ______ and _______ regulators control the rate and depth of respiration in response to changing tissue oxygen demands. The cardiovascular system provides the _____ mechanisms to distribute oxygen to cells and tissues of the body.

Answer 1

Cardiac and Respiratory
Blood
Neural and chemical
Transport

Question 2

Respiration is the exchange of oxygen and carbon dioxide during _______. The airways of the lung transfer oxygen from the atmosphere to the alveoli, where the oxygen is __________ for carbon dioxide. Through the _____________, oxygen transfers to the blood, and carbon dioxide transfers from the blood to the alveoli. There are three steps in the process of oxygenation. What are the three steps?

Answer 2

Cellular Metabolism
Exchanged
Alveolar Capillary Membrane
Ventilation, Perfusion, and Diffusion

Question 3

The respiratory muscles, pleural space, lungs, and alveoli are essential for ventilation, perfusion, and exchange of respiratory gases. Gases move into and out of the lungs through ________ changes. __________ pressure is negative, or less than atmospheric pressure, which is _______mm/Hg at sea level. For air to flow into the lungs, intrapleural pressure becomes more negative, setting up a __________ between the atmosphere and the alveoli. The diaphragm and external intercostal muscles contract to create ________ pleural pressure and increase the size of the thorax for inspiration. _______ of the diaphragm and __________ of the internal intercostal muscles allow air to escape from the lungs.

Answer 3

Pressure
Intrapleural
760 mm/Hg
Pressure Gradient
Negative
Relaxation
Contraction

Question 4

This requires coordination of the muscular and elastic properties of the lung and thorax. The major inspiratory muscle of respiration is the diaphragm. It is innervated by the phrenic nerve, which exits the spinal cord at the fourth cervical vertebra. What is this defined as?

Answer 4

Ventilation

Question 5

This is the effort required to expand and contract the lungs. In the healthy individual breathing is quiet and accomplished with minimal effort. The amount of energy expended on breathing depends on the rate and depth of breathing, the ease in which the lungs can be expanded (compliance), and airway resistance. What is this defined as?

Answer 5

Work of breathing (WOB)

Question 6

This muscle used during respiration can increase lung volume during inspiration. Patients with COPD, especially emphysema, frequently use these muscles to increase lung volume. Prolonged use of these muscles does not promote effective ventilation and causes fatigue. What is this defined as?
During assessment observe for elevation of the patient’s ______ during inspiration, which can indicate ventilatory fatigue, air hunger, or decreased lung expansion.

Answer 6

Accessory muscles

Clavicles

Question 7

This is the ability of the lungs to distend or expand in response to increased intraalveolar pressure. What is this defined as?
This decreases in diseases such as _________, interstitial and pleural __________, and congenital or traumatic structural abnormalities such as __________ or fractured ribs.

Answer 7

Compliance
Pulmonary Edema
Fibrosis
Kyphosis

Question 8

This is the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli. Any further decrease in airway diameter by bronchoconstriction can increase this. What is this defined as?

Answer 8

Airway Resistance

Question 9

Decreased lung ________, increased airway resistance, and the increased use of accessory muscles increases the WOB, resulting in increased __________. Therefore the body increases its ___________ and the need for more oxygen. The need for elimination of __________ also increases. This sequence is a vicious cycle for a patient with ____________, causing further deterioration of respiratory status and the ability to oxygenate adequately.

Answer 9

Compliance
Energy Expenditure
Metabolic Rate
Carbon Dioxide
Impaired Ventilation

Question 10

__________ is the amount of air exhaled after normal inspiration.

Answer 10

Tidal Volume

Question 11

Diseases causing airway obstruction such as asthma and tracheal edema ___________ airway resistance.
When airway resistance increases, the amount of oxygen delivered to the alveoli ____________.

Answer 11

Increase

Decreases

Question 12

The primary function of this is to move blood to and from the alveolar capillary membrane for gas exchange. This begins at the pulmonary artery, which receives poorly oxygenated mixed venous blood from the right ventricle. Blood flow through this system depends on the pumping ability of the right ventricle. The flow continues from the pulmonary artery through the pulmonary arterioles to the pulmonary capillaries, where blood comes in contact with the alveolar capillary membrane and the exchange of respiratory gases occurs. The oxygen-rich blood then circulates through the pulmonary venules and pulmonary veins, returning to the left atrium. What is this defined as?

Answer 12

Pulmonary Circulation

Question 13

___________ of respiratory gases occurs at the alveolar capillary membrane. The thickness of the membrane affects the rate of diffusion. Increased thickness of the membrane ________ diffusion because gases take longer to transfer across the membrane. Patients with ______, ________, and ________ have a thickened membrane, resulting in slow diffusion, slow exchange of respiratory gases, and decreased delivery of oxygen to tissues. What is this process defined as?

Answer 13

Diffusion
Slows
Pulmonary edema
Pulmonary infiltrates
Pulmonary effusion
Respiratory Gas Exchange

Question 14

The ____________ system consists of the lungs and cardiovascular system. Delivery depends on the amount of oxygen entering the lungs also known as _________, blood flow to the lungs and tissues also known as ________, rate of _______, and oxygen-carrying ________.

Answer 14

Oxygen Transport
Ventilation
Perfusion
Diffusion
Capacity

Question 15

This is a product of cellular metabolism, this product diffuses into red blood cells and is rapidly hydrated into carbonic acid (H2CO3). The carbonic acid then dissociates into hydrogen (H) and bicarbonate (HCO3−) ions. Hemoglobin buffers the hydrogen ion, and the (HCO3−) diffuses into the plasma. Reduced hemoglobin (deoxyhemoglobin) combines with this product, and the venous blood transports the majority of this product back to the lungs to be exhaled. What is this process defined as?

Answer 15

Carbon Dioxide Transport

Question 16

This is necessary to ensure sufficient oxygen intake and carbon dioxide elimination to meet the demands of the body (e.g., during exercise, infection, or pregnancy). What is this defined as?

________ and ________ regulators control the process of respiration.

Answer 16

Regulation of Respiration

Neural and Chemical

Question 17

Chronic diseases (e.g., ________), acute diseases (e.g., ________), and surgical processes (e.g.,______) often alter the amount of alveolar capillary membrane surface area.

Answer 17

Emphysema
Pneumothorax
Lobectomy

Question 18

The amount of dissolved oxygen in the plasma,
The amount of hemoglobin,
The tendency of hemoglobin to bind with oxygen. These three things influence what?

Answer 18

The capacity of the blood to carry oxygen.

Rationale: Hemoglobin, which is a carrier for oxygen and carbon dioxide, transports most oxygen (approximately 97%).

Question 19

This includes the central nervous system control of respiratory rate, depth, and rhythm. The cerebral cortex regulates the voluntary control of respiration by delivering impulses to the respiratory motor neurons by way of the spinal cord. What is this defined as?

Answer 19

Neural Regulation of Respirations

Question 20

This maintains the appropriate rate and depth of respirations based on changes in the carbon dioxide (CO2), oxygen (O2), and hydrogen ion (H+) concentration (pH) in the blood. Changes in chemical content of O2, CO2, and H (pH) stimulate the chemoreceptors located in the medulla, aortic body, and carotid body, which in turn stimulate neural regulators to adjust the rate and depth of ventilation to maintain normal arterial blood gas levels. What is this defined as?

Answer 20

Chemical Regulation of Respirations

Question 21

This involves delivery of deoxygenated blood (blood high in carbon dioxide and low in oxygen) to the right side of the heart and then to the lungs, where it is oxygenated. Oxygenated blood (blood high in oxygen and low in carbon dioxide) then travels from the lungs to the left side of the heart and the tissues. The cardiac system delivers oxygen, nutrients, and other substances to the tissues and facilitates the removal of cellular metabolism waste products by way of blood flow through other body systems such as respiratory, digestive, and renal. What is this defined as?

Answer 21

Cardiopulmonary physiology

Question 22

The right ventricle pumps deoxygenated blood through the pulmonary circulation . The left ventricle pumps oxygenated blood through the systemic circulation. As blood passes through the circulatory system, there is an exchange of respiratory gases, nutrients, and waste products between the blood and the tissues. what is this defined as?

Answer 22

Normal Cardiovascular Function

Question 23

The pumping action of the heart is essential to _______ delivery. There are four cardiac chambers, two ____ and two ______. The ventricles fill with blood during diastole and empty during systole. The volume of blood ejected from the ventricles during systole is the ________. Hemorrhage and dehydration cause a _________ in circulating blood volume and a ________ in stroke volume. Myocardial fibers have ________ properties that allow them to stretch during filling. In a healthy heart this stretch is proportionally related to the strength of contraction. What law affects this?

Answer 23

Oxygen
Atria
Ventricles
Stroke Volume
Decrease
Decrease
Contractile
Frank Starling's Law of the Heart

Question 24

As the myocardium stretches, the strength of the subsequent contraction ________; this is known as the Frank-Starling (Starling’s) law of the heart. In the diseased heart (cardiomyopathy or myocardial infarction [MI]) Starling’s law _______ apply because the increased stretch of the myocardium is beyond the physiological limits of the heart. The subsequent contractile response results in _______ stroke volume, and blood begins to _______ in the pulmonary (left heart failure) or _______ (right heart failure) circulation.

Answer 24

Increases
Does Not
Insufficient
“back up”
Systemic

Question 25

The coronary circulation is the branch of the ________ circulation that supplies the myocardium with oxygen and nutrients and removes waste. The coronary arteries fill during ventricular diastole. The__________ has the most abundant blood supply and feeds the more muscular left ventricular myocardium, which does _____ of the work of the heart.

Answer 25

Systemic
Left Coronary Artery
Most

Question 26

Myocardial blood flow must supply sufficient oxygen and nutrients to the myocardium itself. Blood flow through the heart is __________. The four heart valves ensure this _______ blood flow. During ventricular diastole the atrioventricular (mitral and tricuspid) valves ______, and blood flows from the higher-pressure atria into the _______ ventricles. As systole begins, ventricular pressure ______ and closes the mitral and tricuspid valves. Valve closure causes the __________.

Answer 26

unidirectional
forward
open
relaxed
rises
first heart sound (S1)

Question 27

The amount of blood in the left ventricle at the end of diastole is called ________, the resistance to left ventricular ejection, and myocardial contractility all affect _________.

Answer 27

Preload

Stroke Volume

Question 28

For example, during treatment of a patient who is hemorrhaging, increased fluid therapy and replacement of blood increase circulating volume, thus increasing the ________ and _______, which increases ________. If volume is not replaced, preload, stroke volume and the subsequent cardiac output ________.

Answer 28

preload
stroke volume
cardiac output
decreases

Question 29

Myocardial _________ also affects stroke volume and cardiac output. Poor ventricular contraction decreases the amount of blood ________. Injury to the myocardial muscle such as an acute MI causes a decrease in myocardial contractility. The myocardium of the older adult is _______ with a slower ventricular filling rate and ___________ contraction time.

Answer 29

contractility
ejected
stiffer
prolonged

Question 30

Heart rate affects blood flow because of the relationship between rate and diastolic filling time. With a sustained heart rate greater than _____beats/min, diastolic filling time decreases, decreasing stroke volume and cardiac output. The heart rate of the older adult is _____ to increase under stress, but studies have found that this may be caused more by lack of conditioning than age. ________ is beneficial in maintaining function at any age.

Answer 30

160 beats/min
Slow
Exercise

Question 31

The ________ system of the heart generates the impulses needed to initiate the electrical chain of events for a ______ heartbeat. The ________ system influences the rate of impulse generation and the _______ of transmission through the conductive pathway and the _______ of atrial and ventricular contractions.

Answer 31

conduction
normal
autonomic nervous
speed
strength

Question 32

_______ and _______ nerve fibers innervate all parts of the atria and ventricles and the sinoatrial (SA) and atrioventricular (AV) nodes.

Answer 32

Sympathetic and parasympathetic

Question 33

The conduction system originates with the SA node, the __________ of the heart. The SA node is in the right atrium next to the entrance of the ________. Impulses are initiated at the SA node at an intrinsic rate of ___ cardiac action potentials per minute in an adult at rest.

Answer 33

“pacemaker”
superior vena cava
75

Question 34

The normal sequence on the ECG is defined as?

Answer 34

Normal Sinus Rhythm

Question 35

This implies that the impulse originates at the SA node and follows the normal sequence through the conduction system. What is this defined as?
The P wave represents the electrical conduction through both _____. Atrial contraction follows the ___ wave. The PR interval represents the _______ from the SA node through the AV node, through the bundle of ___, and to the _____ fibers.

Answer 35

Normal Sinus rhythm
atria
P
impulse travel time
His
Purkinje

Question 36

The normal length for the PR interval is ____ to _____ second. An increase in the time greater than ____ second indicates a block in the impulse transmission through the ___ node; whereas a decrease, less than ___ second, indicates the initiation of the electrical impulse from a source other than the ___ node.

Answer 36

0.12 to 0.2
0.2
AV
0.12
SA

Question 37

The _____ complex indicates that the electrical impulse traveled through the ventricles. Normal QRS duration is _____ to _____ second. An increase in QRS duration indicates a ____ in conduction time through the ventricles. _________ contraction usually follows the QRS complex. The QT interval represents the time needed for ventricular _________ and __________.

Answer 37

QRS
0.06 to 0.1 
delay
Ventricular
Depolarization and Repolarization

Question 38

The normal QT interval is ____ to ______ second. This interval varies inversely with changes in _______. Changes in electrolyte values such as ________ or therapy with drugs such as ______ or _______ increase the QT interval. Shortening of the QT interval occurs with _____, ________, and _________.

Answer 38

0.12 to 0.42
heart rate
hypocalcemia
disopyramide (Norpace) or amiodarone (Cordarone)
digitalis therapy, hyperkalemia, and hypercalcemia

Question 39

Four factors that influence adequacy of circulation, ventilation, perfusion, and transport of respiratory gases to the tissues?

Answer 39

(1) physiological
(2) developmental
(3) lifestyle
(4) environmental

Question 40

Any condition affecting cardiopulmonary functioning directly affects the ability of the body to meet oxygen demands. Respiratory disorders include _______, _______, and ________. Cardiac disorders include disturbances in ________, impaired _______ function, myocardial ______, __________ conditions, and _______ tissue hypoxia.

Answer 40

hyperventilation, hypoventilation, and hypoxia
conduction
valvular
hypoxia
cardiomyopathic
peripheral

Question 41

Physiological processes affecting a patient’s oxygenation include alterations affecting the _______-carrying capacity of blood, decreased _____ oxygen concentration, increases in the ________ demand of the body, and alterations affecting ______ movement caused by musculoskeletal abnormalities or neuromuscular alterations.

Answer 41

oxygen
inspired
metabolic
chest wall

Question 42

Anemia (i.e., a lower-than-normal hemoglobin level) is a result of decreased hemoglobin production, increased red blood cell destruction, and/ or blood loss. Patients have fatigue, decreased activity tolerance, increased breathlessness, increased heart rate, and pallor (especially seen in the conjunctiva of the eye).

Answer 42

k

Question 43

Oxygenation decreases as a secondary effect with anemia. The physiological response to chronic hypoxemia is the development of increased red blood cells (poly- cythemia). This is the adaptive response of the body to increase the amount of hemoglobin and the available oxygen-binding sites. Carbon monoxide (CO) is the most common toxic inhalant decreasing the oxygen-carrying capacity of blood. In CO toxicity hemoglobin strongly binds with CO, creating a functional anemia. Because of the strength of the bond, CO does not easily dissociate from hemoglobin, making hemoglobin unavailable for oxygen transport.

Answer 43

k

Question 44

________ fibers increase the rate of impulse generation and speed of transmission in the heart.

Answer 44

Sympathetic

Question 45

The ___________ fibers originating from the vagus nerve decrease the heart rate.

Answer 45

Parasympathetic

Question 46

__________ is the amount of air left in the alveoli after a full expiration.

Answer 46

Residual Volume

Question 47

__________ is the maximum amount of air that can be removed from the lungs during forced expiration. _________ in tidal volume and other lung volumes are associated with alterations in patients’ health status or activity, such as pregnancy, exercise, obesity, or obstructive and restrictive conditions of the lungs.

Answer 47

Forced Vital Capacity

Variations