Exam 2 Flashcards

1
Q

ventilation refers to

A

air moving in and out of the lungs

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2
Q

portion of tidal volume that remains in the conducting airways

A

anatomical deadspace (VD)2

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3
Q

list examples of deadspace

A

nose, mouth, pharynx, larynx, trachea, bronchi, and bronchioles

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4
Q

Dead air space does not participate in

A

gas exchange

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5
Q

Amt of anatomical dead space is usually equal to ones

A

weight

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6
Q

Tidal volume is usually 500 ml, but the amt that participates in gas exchange is usually

A

350 ml

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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)
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8
Q

Refers to the anatomic dead space plus any other areas that don’t exchange gases (alveolar dead space).

A

physiological dead space

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9
Q

Physiological dead space is usually ___% of tv

A

30

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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

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11
Q

give an ex of when you can have vent without perfusion

A

when capillary is blocked, but air is still getting in

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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)

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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

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14
Q

More air goes into which side (which lung)

A

right

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15
Q

Which recieves more air, independent or dependent alveoli

A

dependent (eventhough they are smaller)

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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)

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17
Q

breathing at low volumes closes airways where (dependent or independent alveoli)

A

dependent

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18
Q

What must be present near alveoli for gas exchange to occur

A

capillary

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19
Q

Blood flow is ____ dependent

A

gravity

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20
Q

Where is blood flow greater, the apex or the base of the lungs

A

base

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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

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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

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23
Q

An increase in SV increases arterial pressure. This causes which zone to extend farther up the lung

A

3

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24
Q

What does V/Q mean

A

ventilation perfusion ratio

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25
Q

what is ventilation perfusion

A

Describes the relationship between factors that affect alveolar gas flow (V) and pulmonary capillary blood flow (Q)

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26
Q

What is the typical V/Q

A

4 = ventilation
5= blood flow
which is 4/5 = .8

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27
Q

amount of effort needed to inspire and expire is known as

A

work of breathing

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28
Q

normal WOB requires __% of O2 consumption

A

5

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29
Q

If elastic recoil is compromised, WOB increases or decreases

A

increases

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30
Q

What is elastic recoil

A

ability of lungs to return to original shape

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31
Q

What is compliance

A

ease with which lungs are inflated during inspiration

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32
Q

walls of the thorax are lined with ___ pleura

A

pariatel

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33
Q

the lungs are lined with ___ pleura

A

visceral

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34
Q

what is between both of the pleura

A

small amt of fluid

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35
Q

If compliance is low, what needs to occur to compensate in order to inflate the lungs (increase vol)

A

the lower the compliance, the greater the pressure change needed to change the size of the lung.

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36
Q

fibrosis or alveolar edema would do what to compliance

A

decrease

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37
Q

age or emphysema does what to compliance

A

increases it (expands too much)

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38
Q

with increased compliance, lungs can expand very easy, even when pressure changes are

A

very insignificant or low

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39
Q

with increased compliance, the lungs expand easy (even when pressure change is low) but this is bad why

A

bc getting air out is difficult

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40
Q

increased compliance, difficulty getting air out describes what disease

A

emphysema

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41
Q

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

A

restrictive lung disease

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42
Q

Restrictive lung disease can lead to (increased or decreased) TV

A

deccreased

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43
Q

Surface tension exists where in the lungs

A

inside of the lining of the lungs (bc alveoli are covered by thin liquid)

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44
Q

explain how surface tension CAN exist in the lungs

A

water molecules become more attracted to one another (more than the air molecules)

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45
Q

The more fluid present, the (more or less) compliant the lung

A

less

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46
Q

What 2 things help lungs return to original shape

A

recoil, surface tension

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47
Q

What offsets surface tension (dt decreasing the attraction btwn water molecules)

A

surfactant

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48
Q

What cell type produces surfactant

A

type 2 alveolar cells

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49
Q

Surfactant increases or decreases the amt of muscle tension needed to expand the lungs

A

decreases

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50
Q

So essentially, surfactant makes the lungs more or less compliant

A

more

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51
Q

What is RDS

A

respiratory distress syndrome. premie babies before 26-28 weeks are born without surfactant

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52
Q

What does Q= changeP/R mean

A

air flow is equal to the change in pressure over resistance in the airways

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53
Q

biggest factor in controlling air flow is ___

A

resistance, which is determined by the radius of the airway

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54
Q

Parasympathetic system (via acetylcholine and muscarinic receptor) causes ___

A

bronchoconstriction

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55
Q

sympathetic system causes

A

bronchodilation

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56
Q

Losing TV does what to resp rate

A

increases

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57
Q

If a person gets fatigued or to exerted, what happens to TV

A

decreases

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58
Q

decreasing TV, as a result of increased WOB, does what to gas exchange

A

decreases the amt of O2 at level of alveoli/capillary level

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59
Q

If decreased TV can lead to decreased gas exchange, the person might have to go on supplemental O2, does this increase TV

A

no, just increases O2 sat

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60
Q

what is one way to have a very clear cut understanding as to a pts perfusion abilitiy

A

Ventilation/Perfusion Scan

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61
Q

pulmonary embolism would be an example of this on a ventilation/perfusion scan

A

ventilated but not perfused

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62
Q

COPD and pneumonia would be an example of this on a vent/perfusion scan

A

neither vent or perfused

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63
Q

Control center for respiration/HR is located where

A

medulla

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64
Q

peripheral chemoreceptors fire in response to

A

low O2 levels

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65
Q

min to min control mechanism for respiration is what

A

central chemoreceptors

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66
Q

central chemoreceptors are found where and respond to what

A

found in the medulla, respond directly to H and indirectly to CO2

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67
Q

What does exercise do to CO2 levels

A

increase them

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68
Q

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.

A

PO2 (blood O2)

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69
Q

What does SaO2 mean

A

saturation of O2 on the hemoglobin

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70
Q

What is PaO2

A

how much O2 is in the blood

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71
Q

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

A

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

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72
Q

if PaO2 is 60 then SaO2 (sat) would be

A

90%

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73
Q

diabetic ketoacidosis leads to more acidic pH, what cascade of homeostasis follows

A

Decreased pH fires off the peripheral chemoreceptors increasing ventilation and blowing off the excess acid. Trying to decrease H by exhaling CO2

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74
Q

2 types of sleep apnea

A

central and obstructive

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75
Q

which type of sleep apnea Results from failure of the respiratory center, resulting from encephalistis, brainstem infarction, and bulbar poliomyelitis

A

central

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76
Q

idiopathic central sleep apena, results in a conscious effort to control ventilation

A

ondine’s curse

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77
Q

which type of sleep apnea may explain sids

A

central

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78
Q

this type of sleep apnea is related to relaxed or collapse of structures, or obesity

A

obstructive

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79
Q

obstructive apnea is aka

A

pickwickians syndrome

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80
Q

receptors Located in the smooth muscle that shut off inspiration to keep lungs from continuing to expand too much.

A

Hering-Breuer Reflex

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81
Q

for hering breuer reflex, Tidal volume has to reach about _____ before they fire.

A

1.5 liters

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82
Q

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).

A

Juxtacapillary (J) Receptors

83
Q

normal breathing is known as

A

eupnea

84
Q

eupnea rate is

A

12-20

85
Q

tachypnea is more than

A

20 per min

86
Q

bradypnea is less than

A

12 / min

87
Q

anatomical dead space is a reflection of the

A

size of the conducting airways

88
Q

Chene stokes is an indication that

A

person isn’t getting good blood to brain- is a control center prob

89
Q

What is one pathology that can result in cheyne stokes

A

if pt doesn’t have proper functioning left side of heart, the brain doesn’t get sufficient O2

90
Q

Cheyne stokes often indicates impeding

A

death

91
Q

explain the rate/way in which cheyne stokes breathing occurs

A

Gradual increase in rate and depth of breathing, then slower with alternate periods of apnea (may last up to 30 seconds)

92
Q

the other control center caused breathing pattern

A

biots

93
Q

explain biots pattern

A

fast and deep with sudden pause

94
Q

biots is usually the result of

A

increased pressure (intracranial)

95
Q

what type of breathing might you see in a diabetic ketoacidosis pt

A

kaussmauls

96
Q

when might you see frog breathing

A

person with high SCI, if they were on a vent

97
Q

With cardiac AP, the Na channels are (fast or slow)

A

fast

98
Q

while standing, which portion of the lung will be preferentially perfused

A

since blood goes where gravity takes it, it will be the lower (zone 3)

99
Q

mismatching of V/Q creates

A

more deadspace

100
Q

cardiac AP plataue is due to

A

Ca coming in

101
Q

what causes depolarization in the AP in cardiac muscle

A

Ca in

102
Q

what causes repolarization in the AP in cardiac muscle

A

K out

103
Q

cardiac muscle doesn’t have a well defined SR so it gets Ca from

A

ECF

104
Q

The Ca channels in cardiac muscle are (fast or slow)

A

slow

105
Q

In cardiac muscle, what determines the amt of cross bridging (which determines strength of contraction)

A

Ca in ECF

106
Q

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

A

cardiac cycle

107
Q

blood flows due to

A

pressure changes

108
Q

diastole is aka

A

relaxation

109
Q

during vent diastole, pressure in the left atrium is greater than pressure in the left ventricle, therefore the_____is open.

A

mitral valve

110
Q

When atria is full, the valve is

A

open

111
Q

as blood passively flows into the ventricle, the atria depolarizes (known as ___ wave)

A

P

112
Q

as the atria becomes depolarized, it contracts, rushing a volume of blood to the

A

ventricle

113
Q

break time

A

ok

114
Q

systole is aka

A

contraction

115
Q

as depolarization wave hits the ventricle during ventricular systole, this is the____ wave

A

qrs (ventricular contraction)

116
Q

when does the mitral valve close

A

when pressure in ventricle is greater than in the atria

117
Q

when will aortic valve open

A

when pressure in ventricle is greater than pressure in aorta

118
Q

Valves will close when the pressure is greater on the 1st or 2nd side

A

2nd side

119
Q

relaxed is (de or re polarized)

A

re polarized

120
Q

Symp Nerv Sx causes pos ____ and pos ____ effects

A

chronotropic and ionotropic

121
Q

Parasymp only has what effect

A
neg chronotropic (decreases HR)
Para symp has no effect on ventricles
122
Q

When you think vasopressin, think

A

water

123
Q

when you think aldosterone think

A

Na

124
Q

When you think renin think

A

angiotensin

125
Q

WHat is normal PaO2

A

80-100

126
Q

What is normal PvO2

A

40

127
Q

Again, what is SaO2

A

saturation of O2 to Hgb

128
Q

What (roughly) is the formula for a-Vo2 diff

A

% sat artery - % sat vein

129
Q

AvO2 difference reflects what exactly

A

how much O2 is being delivered to the tissues

130
Q

What could occur in the body to cause the curve to shift to the right

A

fever, acidity, increase in Co2, exercise

131
Q

If there is a shift to the right (on the curve) what does that do to AVO2 diff

A

AVO2 diff increases

132
Q

so if AVO2 diff increases, does the O2 delivered to tissues increase or decrease

A

increase

133
Q

The increase ventilatory needs for adults is usually obtained by what

A

increase in TV

134
Q

So if there is a shift to the right, is there more or less o2 at level of tissues

A

MORE

135
Q

If curve shifts to the right, is there an increase or decrease in saturation of O2 to Hgb

A

decrease

136
Q

The curve is actually a representation of what 2 things

A

relationship between % saturation of oxygen and the partial pressure of oxygen.

137
Q

If body temp decreases the Oxyhem curve shifts

A

left

138
Q

As PaO2 decreases, curve shifts

A

left

139
Q

does 2,3 dpg shift curve to right or left? what is it

A

right, its from anaerobic met

140
Q

Roughly interpret how PaO2 effects SaO2

A

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
Q

What nerves send sensory info to the NTS in the medulla

A

vagus and glossopharengeal

142
Q

Explain the diff btwn central and peripheral chemoreceptors

A

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
Q

What does the term the “effectors” mean in regards to vessels (BP)

A

extrinsic vs intrinsic regulation

144
Q

Extrinsic regulation is what

A

symp Nerv system

145
Q

What is intrinsic regulation

A

local controls, small arterioles and capillarys

146
Q

Main effect of extrinsic regulator (symp NS)

A

vasonstriction= gets blood back to heart

147
Q

Main effect of intrinsic regulator

A

vasodialation

148
Q

how is ventilation primarily controlled during submaximal exercise

A

higher brain centers, chemoreceptors

149
Q

how is ventilation primarily controlled during maximal exercise

A

hydrogen balance

150
Q

Normal PaO2 (Oxygen on arterial side)

A

800-100

151
Q

Normal PaCO2 (CO2 on arterial side)

A

40

152
Q

Normal O2 on venous side (PVO2)

A

40

153
Q

PVCO2 normal is

A

46

154
Q

Pa vs Pv

A
Pa = artery side
Pv = venous side
155
Q

Expiration is a ___ process

A

passive

156
Q

expiration is due to relaxation of

A

intercostals and diaphragm

157
Q

with expiration, interthoracic pressure dec or inc

A

increases

158
Q

in inspiration, the external intercostals ___

A

contract

159
Q

Two main ways O2 is transported to tissues

A

dissolved or attached to Hgb

160
Q

CO2 is transported back to lungs how (3 ways with one being the primary)

A

Dissolved in plasma
Attaching to hemoglobin
***Converted to bicarbonate ** here the reaction is in the RBC, and the transport is in the plasma

161
Q

What are effectors in regards to respiration

A

diaphragm, intercostals

162
Q

Factors affecting diffusion and movement of oxygen and carbon dioxide between alveoli and pulmonary circulation

A

Change in pressure or resistance (radius is main factor)

163
Q

what is the body’s acute response to low blood pressure

A

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
Q

low blood pressure will result in the body doing what to blood vessels

A

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
Q

what is the body’s acute response to high blood pressure

A

inc firing from NTS (inhibits SNS) activates PNS, dec HR, dec CO, dec MAP

166
Q

If bp is low, will the firing from the NTS Increase or decrease

A

decrease

167
Q

Iv BP is high, will the sympathetic NS be activated or inhibited

A

inhibited

168
Q

If BP is high, the PNS will be activated or inhibited

A

activated (there will be increased firing from NTS)

169
Q

Vasopressin increases permeability of ___ which increases blood volume, increasing BP

A

water

170
Q

Renin causes vasoconstriction which ___ BP

A

increases

171
Q

Aldosterone increases the resorption of

A

Na

172
Q

SNS has a pos chronotropic effect, what does this mean

A

increases HR

173
Q

PNS has a neg ____only

A

chronotropic (no interaction with the ventricles)

174
Q

If resistance is increased, what happens to CO

A

decreases

175
Q

If pressure is increased, what happens to CO

A

increases

176
Q

Ventricular diastole (or relaxation) is repolarization or depolarization

A

re

177
Q

Amt of bld that flows into a ventricle during diastole

A

EDV, or LVEDV or RVEDV

178
Q

__% of bld flowing into a ventricle is due to atrial contraction

A

30, 70 goes in passively

179
Q

What condition might cause a lack of the 30% of bld people normally get from atrial contraction

A

atrial fib

180
Q

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

A

isovolumic systole

181
Q

amt of blood ejected when ventricles contract

A

SV

182
Q

Amt of bld that stays in the ventricles after systole

A

ESV

183
Q

Period of time when both mitral and aortic valves are closed, aortic closed, mitral yet to open

A

Isovolumic diastole or isovolumic relaxation

184
Q

How to find ejection fraction

A

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
Q

Factors effecting water moving in to capillary (moving water in)

A

water pressure in interstitial space (outside the capillary) pushing in, amt of protein in the capillary which brings water in

186
Q

Factors effecting water moving out:

A

capillary water pressure (inside pushing out), interstitial proteins (outside) pulling water out

187
Q

If pressure is greater outside the capillary, which way will water move

A

in

188
Q

On the arterial side the net mvmt of water is going

A

OUT of the capillary (moving to cells)

189
Q

On the venous side, the net mvmt of water is going

A

coming IN to the capillary

190
Q

With CHF and right sided heart failure, water goes where

A

out of the capillary, into the interstitial space

191
Q

With diabetes, water goes where

A

bc of proteins INSIDE, water goes in the capillary (which dehydrates tissue=polydipsia)

192
Q

With histimine response, water goes where

A

out, into interstitial space

193
Q

because overall, more goes out than comes back in (osmotic balance) what system is needed to help drain or clear the fluid

A

lymph

194
Q

normally, right atrial pressure is (for central venous pressure test)

A

o

195
Q

What disease process could increase CVP number

A

right sided heart failure (increases blood volume bc of the back up)

196
Q

hemorrhages would do what to CVP

A

decrease it

197
Q

explain JVD (jugular vein distension test)

A

tests right side of heart, incline a person to 45 degrees to see if jug vein distends

198
Q

explain hepatojugular reflex

A

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
Q

which type of deadspace should do air exchange but doensn’t

A

physiological

200
Q

juxtacapillary receptors respond to fluid by

A

rapiid breathing = pump

201
Q

SNS does what to BV and what to lungs

A

vasoconstrict

bronchodilates

202
Q

Para symp NS does what

A

vasodilates

bronchoconstricts

203
Q

ionotropic effect is on the

A

BV

204
Q

chronotropic effect is on the

A

HR