Exam 2 Flashcards
1
Q
ventilation refers to
A
air moving in and out of the lungs
2
Q
portion of tidal volume that remains in the conducting airways
A
anatomical deadspace (VD)2
3
Q
list examples of deadspace
A
nose, mouth, pharynx, larynx, trachea, bronchi, and bronchioles
4
Q
Dead air space does not participate in
A
gas exchange
5
Q
Amt of anatomical dead space is usually equal to ones
A
weight
6
Q
Tidal volume is usually 500 ml, but the amt that participates in gas exchange is usually
A
350 ml
7
Q
Bc anatomical deadspace reflects the size of the conducting airways, what are some things that can effect this
A
decreased radius (smoking, mucus, or asthma) or length of airway (ex on a vent)
8
Q
Refers to the anatomic dead space plus any other areas that don’t exchange gases (alveolar dead space).
A
physiological dead space
9
Q
Physiological dead space is usually ___% of tv
A
30
10
Q
having ventilation but no perfusion, or having perfusion but no ventilation could be an issue with what type of dead space
A
physiological
11
Q
give an ex of when you can have vent without perfusion
A
when capillary is blocked, but air is still getting in
12
Q
give an ex of when you can have perfusion without ventilation
A
asthma (air cant really get in/out, but perfusion capability still exists)
13
Q
If you have more physiological dead space, you have to take in more air to compensate. You would do this by
A
increasing TV
14
Q
More air goes into which side (which lung)
A
right
15
Q
Which recieves more air, independent or dependent alveoli
A
dependent (eventhough they are smaller)
16
Q
where does air “gather” when inspired
A
air will go where gravity takes it (sitting it goes inf or to the base of lungs, supine it goes posterior)
17
Q
breathing at low volumes closes airways where (dependent or independent alveoli)
A
dependent
18
Q
What must be present near alveoli for gas exchange to occur
A
capillary
19
Q
Blood flow is ____ dependent
A
gravity
20
Q
Where is blood flow greater, the apex or the base of the lungs
A
base
21
Q
explain the 3 zone model in relation to blood flow in the pulm sx
A
Zone 1 is least gravity dependent and receives basically no blood flow, Zone 2 is the intermediate zone and receives intermittent blood flow (flow is based on difference between pulmonary arterial and alveolar pressures) Zone 3 is most gravity dependent and receives basically all blood flow
22
Q
How can pulm blood flow help to aid in recovery when it comes to positioning our pts
A
we can alter position of our pts to increase or decrease blood flow
23
Q
An increase in SV increases arterial pressure. This causes which zone to extend farther up the lung
A
3
24
Q
What does V/Q mean
A
ventilation perfusion ratio
25
what is ventilation perfusion
Describes the relationship between factors that affect alveolar gas flow (V) and pulmonary capillary blood flow (Q)
26
What is the typical V/Q
4 = ventilation
5= blood flow
which is 4/5 = .8
27
amount of effort needed to inspire and expire is known as
work of breathing
28
normal WOB requires __% of O2 consumption
5
29
If elastic recoil is compromised, WOB increases or decreases
increases
30
What is elastic recoil
ability of lungs to return to original shape
31
What is compliance
ease with which lungs are inflated during inspiration
32
walls of the thorax are lined with ___ pleura
pariatel
33
the lungs are lined with ___ pleura
visceral
34
what is between both of the pleura
small amt of fluid
35
If compliance is low, what needs to occur to compensate in order to inflate the lungs (increase vol)
the lower the compliance, the greater the pressure change needed to change the size of the lung.
36
fibrosis or alveolar edema would do what to compliance
decrease
37
age or emphysema does what to compliance
increases it (expands too much)
38
with increased compliance, lungs can expand very easy, even when pressure changes are
very insignificant or low
39
with increased compliance, the lungs expand easy (even when pressure change is low) but this is bad why
bc getting air out is difficult
40
increased compliance, difficulty getting air out describes what disease
emphysema
41
Decreased compliance makes it more difficult to expand the lungs. Greater pressure changes are required to bring in the same amt of air (almost having to suck in air). This describes what disease
restrictive lung disease
42
Restrictive lung disease can lead to (increased or decreased) TV
deccreased
43
Surface tension exists where in the lungs
inside of the lining of the lungs (bc alveoli are covered by thin liquid)
44
explain how surface tension CAN exist in the lungs
water molecules become more attracted to one another (more than the air molecules)
45
The more fluid present, the (more or less) compliant the lung
less
46
What 2 things help lungs return to original shape
recoil, surface tension
47
What offsets surface tension (dt decreasing the attraction btwn water molecules)
surfactant
48
What cell type produces surfactant
type 2 alveolar cells
49
Surfactant increases or decreases the amt of muscle tension needed to expand the lungs
decreases
50
So essentially, surfactant makes the lungs more or less compliant
more
51
What is RDS
respiratory distress syndrome. premie babies before 26-28 weeks are born without surfactant
52
What does Q= changeP/R mean
air flow is equal to the change in pressure over resistance in the airways
53
biggest factor in controlling air flow is ___
resistance, which is determined by the radius of the airway
54
Parasympathetic system (via acetylcholine and muscarinic receptor) causes ___
bronchoconstriction
55
sympathetic system causes
bronchodilation
56
Losing TV does what to resp rate
increases
57
If a person gets fatigued or to exerted, what happens to TV
decreases
58
decreasing TV, as a result of increased WOB, does what to gas exchange
decreases the amt of O2 at level of alveoli/capillary level
59
If decreased TV can lead to decreased gas exchange, the person might have to go on supplemental O2, does this increase TV
no, just increases O2 sat
60
what is one way to have a very clear cut understanding as to a pts perfusion abilitiy
Ventilation/Perfusion Scan
61
pulmonary embolism would be an example of this on a ventilation/perfusion scan
ventilated but not perfused
62
COPD and pneumonia would be an example of this on a vent/perfusion scan
neither vent or perfused
63
Control center for respiration/HR is located where
medulla
64
peripheral chemoreceptors fire in response to
low O2 levels
65
min to min control mechanism for respiration is what
central chemoreceptors
66
central chemoreceptors are found where and respond to what
found in the medulla, respond directly to H and indirectly to CO2
67
What does exercise do to CO2 levels
increase them
68
Peripheral chemoreceptors normally don't play a role in normal breathing processes, however, they will if a person is ill. If a person's _____ gets very low they will inact.
PO2 (blood O2)
69
What does SaO2 mean
saturation of O2 on the hemoglobin
70
What is PaO2
how much O2 is in the blood
71
Think about the V/Q ratio, if something is ventilated and not perfused, what is the ratio, if something is perfused and not ventilated what is the ratio
V/Q
If there is vent but not perf = 4/0 infinity
if there is perf but no vent = 0/5
either way it's bad
72
if PaO2 is 60 then SaO2 (sat) would be
90%
73
diabetic ketoacidosis leads to more acidic pH, what cascade of homeostasis follows
Decreased pH fires off the peripheral chemoreceptors increasing ventilation and blowing off the excess acid. Trying to decrease H by exhaling CO2
74
2 types of sleep apnea
central and obstructive
75
which type of sleep apnea Results from failure of the respiratory center, resulting from encephalistis, brainstem infarction, and bulbar poliomyelitis
central
76
idiopathic central sleep apena, results in a conscious effort to control ventilation
ondine's curse
77
which type of sleep apnea may explain sids
central
78
this type of sleep apnea is related to relaxed or collapse of structures, or obesity
obstructive
79
obstructive apnea is aka
pickwickians syndrome
80
receptors Located in the smooth muscle that shut off inspiration to keep lungs from continuing to expand too much.
Hering-Breuer Reflex
81
for hering breuer reflex, Tidal volume has to reach about _____ before they fire.
1.5 liters
82
Located within the alveolar walls near pulmonary capillaries (“justa near” the pulmonary capillaries). these Sense increased fluid or pressure within the capillaries or interstitial space. result is rapid shallow breathing (high RR).
Juxtacapillary (J) Receptors
83
normal breathing is known as
eupnea
84
eupnea rate is
12-20
85
tachypnea is more than
20 per min
86
bradypnea is less than
12 / min
87
anatomical dead space is a reflection of the
size of the conducting airways
88
Chene stokes is an indication that
person isn't getting good blood to brain- is a control center prob
89
What is one pathology that can result in cheyne stokes
if pt doesn't have proper functioning left side of heart, the brain doesn't get sufficient O2
90
Cheyne stokes often indicates impeding
death
91
explain the rate/way in which cheyne stokes breathing occurs
Gradual increase in rate and depth of breathing, then slower with alternate periods of apnea (may last up to 30 seconds)
92
the other control center caused breathing pattern
biots
93
explain biots pattern
fast and deep with sudden pause
94
biots is usually the result of
increased pressure (intracranial)
95
what type of breathing might you see in a diabetic ketoacidosis pt
kaussmauls
96
when might you see frog breathing
person with high SCI, if they were on a vent
97
With cardiac AP, the Na channels are (fast or slow)
fast
98
while standing, which portion of the lung will be preferentially perfused
since blood goes where gravity takes it, it will be the lower (zone 3)
99
mismatching of V/Q creates
more deadspace
100
cardiac AP plataue is due to
Ca coming in
101
what causes depolarization in the AP in cardiac muscle
Ca in
102
what causes repolarization in the AP in cardiac muscle
K out
103
cardiac muscle doesn't have a well defined SR so it gets Ca from
ECF
104
The Ca channels in cardiac muscle are (fast or slow)
slow
105
In cardiac muscle, what determines the amt of cross bridging (which determines strength of contraction)
Ca in ECF
106
Each time the heart beats (via SA node firing), it sets up a series of events that ultimately leads to ventricular contraction and the sending of blood to the lungs and body. this is called a
cardiac cycle
107
blood flows due to
pressure changes
108
diastole is aka
relaxation
109
during vent diastole, pressure in the left atrium is greater than pressure in the left ventricle, therefore the_____is open.
mitral valve
110
When atria is full, the valve is
open
111
as blood passively flows into the ventricle, the atria depolarizes (known as ___ wave)
P
112
as the atria becomes depolarized, it contracts, rushing a volume of blood to the
ventricle
113
break time
ok
114
systole is aka
contraction
115
as depolarization wave hits the ventricle during ventricular systole, this is the____ wave
qrs (ventricular contraction)
116
when does the mitral valve close
when pressure in ventricle is greater than in the atria
117
when will aortic valve open
when pressure in ventricle is greater than pressure in aorta
118
Valves will close when the pressure is greater on the 1st or 2nd side
2nd side
119
relaxed is (de or re polarized)
re polarized
120
Symp Nerv Sx causes pos ____ and pos ____ effects
chronotropic and ionotropic
121
Parasymp only has what effect
```
neg chronotropic (decreases HR)
Para symp has no effect on ventricles
```
122
When you think vasopressin, think
water
123
when you think aldosterone think
Na
124
When you think renin think
angiotensin
125
WHat is normal PaO2
80-100
126
What is normal PvO2
40
127
Again, what is SaO2
saturation of O2 to Hgb
128
What (roughly) is the formula for a-Vo2 diff
% sat artery - % sat vein
129
AvO2 difference reflects what exactly
how much O2 is being delivered to the tissues
130
What could occur in the body to cause the curve to shift to the right
fever, acidity, increase in Co2, exercise
131
If there is a shift to the right (on the curve) what does that do to AVO2 diff
AVO2 diff increases
132
so if AVO2 diff increases, does the O2 delivered to tissues increase or decrease
increase
133
The increase ventilatory needs for adults is usually obtained by what
increase in TV
134
So if there is a shift to the right, is there more or less o2 at level of tissues
MORE
135
If curve shifts to the right, is there an increase or decrease in saturation of O2 to Hgb
decrease
136
The curve is actually a representation of what 2 things
relationship between % saturation of oxygen and the partial pressure of oxygen.
137
If body temp decreases the Oxyhem curve shifts
left
138
As PaO2 decreases, curve shifts
left
139
does 2,3 dpg shift curve to right or left? what is it
right, its from anaerobic met
140
Roughly interpret how PaO2 effects SaO2
If PaO2 is high, the affinity for O2 to bind to hemoglobin is high = good O2 supply in blood
If PaO2 is low, the affinity for O2 to bind is lower (and other things will bind to the Hgb spots) so O2 in blood is lower
141
What nerves send sensory info to the NTS in the medulla
vagus and glossopharengeal
142
Explain the diff btwn central and peripheral chemoreceptors
Are the most important regulator of minute to minute ventilation and respond directly to changes in hydrogen, but indirectly respond to changes in CO2 levels. Peripheral chemoreceptors – not as significant. these play more of a role in diseased states (bc these are like a back up plan, only respond when we reach 60)
143
What does the term the "effectors" mean in regards to vessels (BP)
extrinsic vs intrinsic regulation
144
Extrinsic regulation is what
symp Nerv system
145
What is intrinsic regulation
local controls, small arterioles and capillarys
146
Main effect of extrinsic regulator (symp NS)
vasonstriction= gets blood back to heart
147
Main effect of intrinsic regulator
vasodialation
148
how is ventilation primarily controlled during submaximal exercise
higher brain centers, chemoreceptors
149
how is ventilation primarily controlled during maximal exercise
hydrogen balance
150
Normal PaO2 (Oxygen on arterial side)
800-100
151
Normal PaCO2 (CO2 on arterial side)
40
152
Normal O2 on venous side (PVO2)
40
153
PVCO2 normal is
46
154
Pa vs Pv
```
Pa = artery side
Pv = venous side
```
155
Expiration is a ___ process
passive
156
expiration is due to relaxation of
intercostals and diaphragm
157
with expiration, interthoracic pressure dec or inc
increases
158
in inspiration, the external intercostals ___
contract
159
Two main ways O2 is transported to tissues
dissolved or attached to Hgb
160
CO2 is transported back to lungs how (3 ways with one being the primary)
Dissolved in plasma
Attaching to hemoglobin
***Converted to bicarbonate **** here the reaction is in the RBC, and the transport is in the plasma
161
What are effectors in regards to respiration
diaphragm, intercostals
162
Factors affecting diffusion and movement of oxygen and carbon dioxide between alveoli and pulmonary circulation
Change in pressure or resistance (radius is main factor)
163
what is the body’s acute response to low blood pressure
dec firing to NTS which allows SNS fires, vasoconstriction to arteries and inc venous tone leads to inc HR, inc SV, inc CO, inc BP
164
low blood pressure will result in the body doing what to blood vessels
if pressure is low, the body will compensate by vasoconstricting to increase the pressure. The constriction increases blood back to heart = increase SV, CO, HR
165
what is the body’s acute response to high blood pressure
inc firing from NTS (inhibits SNS) activates PNS, dec HR, dec CO, dec MAP
166
If bp is low, will the firing from the NTS Increase or decrease
decrease
167
Iv BP is high, will the sympathetic NS be activated or inhibited
inhibited
168
If BP is high, the PNS will be activated or inhibited
activated (there will be increased firing from NTS)
169
Vasopressin increases permeability of ___ which increases blood volume, increasing BP
water
170
Renin causes vasoconstriction which ___ BP
increases
171
Aldosterone increases the resorption of
Na
172
SNS has a pos chronotropic effect, what does this mean
increases HR
173
PNS has a neg ____only
chronotropic (no interaction with the ventricles)
174
If resistance is increased, what happens to CO
decreases
175
If pressure is increased, what happens to CO
increases
176
Ventricular diastole (or relaxation) is repolarization or depolarization
re
177
Amt of bld that flows into a ventricle during diastole
EDV, or LVEDV or RVEDV
178
__% of bld flowing into a ventricle is due to atrial contraction
30, 70 goes in passively
179
What condition might cause a lack of the 30% of bld people normally get from atrial contraction
atrial fib
180
What is the term when it is the period of time when both the mitral valve and the aortic valves are closed.
Mitral valve closed; aortic has yet to open
isovolumic systole
181
amt of blood ejected when ventricles contract
SV
182
Amt of bld that stays in the ventricles after systole
ESV
183
Period of time when both mitral and aortic valves are closed, aortic closed, mitral yet to open
Isovolumic diastole or isovolumic relaxation
184
How to find ejection fraction
you have to know the difference btwn isovolumic systole number and isovolumic diastole number
ex: 135-65 = 70 ml
Ejection fraction: 70/135 = should be approx. 55%
185
Factors effecting water moving in to capillary (moving water in)
water pressure in interstitial space (outside the capillary) pushing in, amt of protein in the capillary which brings water in
186
Factors effecting water moving out:
capillary water pressure (inside pushing out), interstitial proteins (outside) pulling water out
187
If pressure is greater outside the capillary, which way will water move
in
188
On the arterial side the net mvmt of water is going
OUT of the capillary (moving to cells)
189
On the venous side, the net mvmt of water is going
coming IN to the capillary
190
With CHF and right sided heart failure, water goes where
out of the capillary, into the interstitial space
191
With diabetes, water goes where
bc of proteins INSIDE, water goes in the capillary (which dehydrates tissue=polydipsia)
192
With histimine response, water goes where
out, into interstitial space
193
because overall, more goes out than comes back in (osmotic balance) what system is needed to help drain or clear the fluid
lymph
194
normally, right atrial pressure is (for central venous pressure test)
o
195
What disease process could increase CVP number
right sided heart failure (increases blood volume bc of the back up)
196
hemorrhages would do what to CVP
decrease it
197
explain JVD (jugular vein distension test)
tests right side of heart, incline a person to 45 degrees to see if jug vein distends
198
explain hepatojugular reflex
tests right side of heart, person is supine as you push on their right upper quadrant to see if jugular vein pops out and doesnt return quickly
199
which type of deadspace should do air exchange but doensn't
physiological
200
juxtacapillary receptors respond to fluid by
rapiid breathing = pump
201
SNS does what to BV and what to lungs
vasoconstrict
| bronchodilates
202
Para symp NS does what
vasodilates
| bronchoconstricts
203
ionotropic effect is on the
BV
204
chronotropic effect is on the
HR
