Exam 2: 7,9, and 10 Flashcards
What is pathophysiology?
study of how disease processes affect the function of the body
What is the sodium potassium pump?
responsible for moving ions back and forth across cell membrane using ATp and this movement of ions leads to the generation of an electrical charge leading to depolarization stimulating muscle contraction.
What is metabolism?
the cellular function of converting nutrients into energy by water, glucose and oxygen
What is electrolyte?
a substance that, when dissolved in water, separates into charged particles with their movement enabling electrical functions of cells such as nerve transmisisona nd cardiac muscle depolarization including potassium, sodium, and magnesium
What is aerobic metabolism?
the cellular process in which oxygen is used to metabolize glucose. energy is produced in an efficient manner with minial waste products
What is anaerobic metabolism?
the cellular process in which glucose is metabolized into energy without oxygen. energy is produced in an inefficient manner with many more waste products (which affect hemoglobin binding
What is FiO2?
fraction of inspired oxygen, concentraton of oxygen in the air we breathe
What is perfusion?
delivering oxygenated blood to body cells
What is patent?
open and clear airway; free from obstruction above trachea most common obstructions occur
What is tidal volume?
the volume of air moved in one cycle of breathing
amount of air moved in one breath ex. less than 94% oxygen is bad
What is minute volume?
the amount of air breathed in during each respiration multiplied by the number of breaths per minute problems with this elad to respiratory dysfunction
ex. average adult breathes 12-20 breaths per minute with under 8 is concerning and over 30. it is about depth, how they look.
What is dead air space?
air that occupies the space between the mouth and alveoli but that does not actually reach the area of gas exchange
150 mL not available at alveolar ventile keeping bronchiole and pharynx open, alveolar volume is tidal volume minus dead space volume
What is medulla oblongata?
part of brain controlling repiration can be affected by stroke, infection, narcotics,
What is inhalation?
active process, diaphragm contracts, muscles of chest expand and negative pressure is created in the chest cavity and lungs and this negative pressure pulls air in through trachea
What is exhalation?
muscles relax passive process creating positive pressure pushing air out relying on contact with the chest compartment. bleeding In pleural space between chest walls and lungs can cause them to collapse
What is heart failure and sepsis?
changes ability of alveloli to transfer gases across membranes. permeability of thin walla that separates form capillary changes impairing diffusion causing hypoxia and hypercapnia (high carbon dioxide)
What is chemoreceptors?
chemical sensors in the brain and blood vessels that identify changing levels of oxygen and carbon dioxide by increasing or decreasing breathing based on concentration in blood
What is dyspnea?
shortness of breath resuls form need for gas exchange that cannot be met by current breathing levels (minute ventialiation
What is blood plasma?
liquid portion of blood, dissolving oxygen and carbon dioxide, contains large proteins attract water from area around cells into bloodstream
What is plasma osmotic pressure?
the pull exerted by large proteins in the plasma portion of blood that tends to pull water form the body into the bloodstream.
What is hydrostatic pressure?
the pressure within a blod vessel that tends to push water out of the vessel when the heart contracts
What is liver failure?
swelling in patient as fluid accumulates outside bloodstream and dehydration of blood because liver doenst produce enough albumin which would pull water into blood stream so water leaves bloodstream accumulates around body cells and cavities.
What is anemia?
decrease in the number of red blood cells and loosing oxygen in blood changing amount delivered
What is sympathetic nervous system (SNS)?
in its fight or flight response stimulates blood vessels to constrict and the parasympathetic nervous system stimulates blood vessels to relax.
What is sepsis?
causes uncontrolled dilation of the body vessels increases in capillary permeability leading to volume loss form blood stream restricting airflow
What is stretch receptors?
sensors in blood vessels that identify internal pressure
What is systemic vascular resistance?
(SVR) the pressure in the peripheral blood vessels that the heart must overcome to pump blood into the system
What is stroke volume?
the amount of blood ejected form the heart in one contraction average 70 mL =per contraction with more forceful contractions increasing stroke volume, greater the pressure in the systemic system lower stroke volume pumping blood fast decreases stroke volume as not enough blood gets back to heart.
What is cardiac output?
the amount of blood ejected form the heart in one minute (heart rate x stroke volume)
What is V/Q match?
ventilation perfusion match. implies that alveoli are supplied with enough air that the air in alveoli is matched with suffi]cient blood in the pulmonary capillaries to permit optimum exchange of oxygen and carbon dioxide
What is perfusion?
supply of oxygen to and removal of wastes form cells and tissues of body as a result of flow of blood through capillaries
regular delivery of oxygen and nutrient to cells and removal of waste products
What is hypoperfusion?
inability of the body to adequately circulate blood to the body’s cells to supply them with oxygen and nutrietns a life threateneing condition called shock. oerfusion is inadequate and leads to acidosis of blood as the cells relay only on anaerobic respiration. heart rate increases, blood vessels constrict breathing increases, compensated shock. ex. slightly changed mental status anxiety and feeling impending doom, delayed capillary refill time, pale skin diaphoresis, sweating leads to decompensated shock (altered mental status and decreased blood pressure) to irreversible shock (organs die)
pediatric patient can compensate until they absolutely cant anymore so it is important to treat it right away for worst possible outcome because adult usually has a progression that you can see. Na+/K+ when messed with it leads to misfiring
What is hypovolemic shock?
low blood volume blood is lost (blleding) or volume portion lost (dehydration), too little volume mean reduced pressure, heart difficulty with cells hypoperfused loosing oxygen-carrying capacity creating oxygen deficit in cells
breach in vessel you are leaking out with lacceration in internal or external, it can also be due to loosing vascular tone (distributive shock) cant costrict like they should and cant dilate (neurogenic shock)
What is distributive shock?
blood vessel tone lost, losing ability to maintain normal diameter (anaphylaxis or sepsis) normally constricted vessels to dilate reducing pressure in system diminishing blood flow
What is cardiogenic shock?
heart fails to pump (myocardial infarction or trauma), lead to electrical or mechanical problem damage to heart itself. pump fails and cardiac output suffers, heart can no longer maintain pressure in cardiovascular system and blood fails to be pumped to cells, may not allow heart rate to increase
What is obstructive shock?
blood physically prevented from flowing, large amounts of blood prevented from reaching essential organs and vital areas organs go without blood.
What is diaphoresis?
cool pale and moist/sweaty skin; sweating symptoms in shock
What is dehydration?
an abnormally low amount of water in the body
How much water is in the body?
60% of body made up of water. 70% is intracellular water inside cells, 5% is intravascular water in bloodstream, interstitial fluid 25% water found between cells and blood vessels.
What is trauma to the brain and what does it lead to?
blood or edema takes up space where brain tissue would otherwise be and presses on brain increasing intracranial pressure damaging things
What are strokes?
from clots in or dbleeding from arteries that perfuse the brain depriving these cells of oxygen and die
What are signs of neurological impairment?
altered mental status, seizures, inability to speak or difficulty speaking, visual or hearing disturbance, inability to walk or difficulty walking, paralysis or weakness (sometimes limited to one side), loss of sensation and pupil changes.
What is gastrointestinal bleeding?
hypovolemic shock from acute massive bleeding in form of rectal bleeding or vomiting blood. nausea dn vomiting can be a sign of acute myocardial infarciton and even strokes and brain injuries
What is hypersensitivity?
an exaggerated response by the immune system to a particular substance. rapid drop in blood pressure, distributive shock, dilation of blood pressure, blood vessel permability,
What is diffusion?
moves oxygen across thin membrane form alveoli to capllaires and within capilarries oxygen is loaded onto hemoglobin and transported to cells
how gases exchange from an area of high concentration to an area of low concentration
What is edema?
swelling associated with the movement of water into the interstitial space, when pressure is high fluid is moved out
fluid part pulled out of vascular systems and the volume is pushed into the interstitial space
What is airway?
the passageway by which air enters and leaves the body. the structures of the airway are the nose, mouth, pharynx, larynx, trachea, bronchi and lungs
What is trachea?
16 rings of cartilage preveting collapse top ring cricoid ringbranches at carina into bronchi
What is sniffling position?
when swelling obstructs upper airway patients sit bolt upright with head ptched forward but if they can talk they are not obstructed different sounds may
What happens to children with inadequate airway?
pulling in of muscles above clavicles and between and below ribs, nasal flaring widening of nostrils with respiration in infant and children
What happens in partially obstructed airways?
makes sounds of stridor (high pitched) severly narrowed passage, hoarseness- swelling is building, snoring- upper airway soft tissue creating impedance (partial obstruction), and gurgling (fluid obstruction of vomit or blood)
What is a patent airway?
an airway (passage form nore or mouth to lungs) that is open and clear and will remain open and clear without interference to the passage of air into and out fo the body
what is the best way to look at an airway?
on their back
What is bronchioconstriction?
he contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway and increased resitance to airflow
what is stridor?
a high-pitched sound generated from partially obstructed airflow in the upper airway.
What is the head-tilt, chin-lift maneuver?
a means of correcting blockage of the airway by the tongue by tilting the head back and lifting the chin used when no trauma or injury is suspected until lower teeth touching upper teeth by moving the bone and lower lip but don’t put thumb in mouth. maintain even when having a device in.
What is the jaw thrust maneuver?
a means of correcting blockage of the airway by moving the jaw forward without tilting the head or neck. used when trauma, or injury, is suspected to open the airway without causing further injury to the spinal cord move jaw but steady rest of head retracting lower lip maintain even when having a device in
What are airway adjuncts?
oral- keep head-tilt, chin-lift when putting in and take out when person regains consciousness. to determine correct size measure device form cornor of patient’s mouth to tip of earlobe on same side of patient’s face if to large will put air into stomach. use tongue repressor to keep tongue down as you insert it along top of mouth and down their throat separate teeth on outside of mouth and rotate so tip is pointing down. or start with it pointed down and suction especially in children
What is a nasopharyngeal airway?
use when teeth clenched, intact gag reflex, or oral injuries soft flexible nasal airway, measure from nose to earlobe, lubricate non-water based, tube usually right nostril and points towards septum, do not use if clear fluid is coming from nose or ears (cerebrospinal fluid suggesting damage to skull)
a flexible breathing tube inserted through the patine’ts nostril into the pharynx to help maintain an open airway
What is an oropharyngeal airway?
curved device inserted through the patients mouth into the pharynx to help maintain an open airway only used on patients without a gag reflex such as when deeply unconscious but when regaining consciousness take it out
What is a gag reflex?
vomiting or retching that results when something is placed in the back of the pharynx this is tied ot the swallow reflex
What is suctioning?
use of a vacuum device to remove blood, vomitus, and other secretions or foreign materials from the airway. consists of suction source, continer material, tubing, suction tips or catheters. tubing- thick-walled nonkinking, wide-bore tubing don’t suction more than a ten seconds at a time if possible and if oxygen needed do it for a few second then switchand don’t lose the tip Yankaeur. Wear gloves, protective eyewear, and mask lay patient on side.
What is ventilation/
breathing in or out (inhalation and exhalation), or artificial provision of breaths
What is inhalation?
muscles of chest, intercostal muscles between ribs expanding at same time diaphragm contracts in a downward motion creating negative pressure
What is alveolar ventilation?
the amount of air that reaches the alveoli
What is diffusion?
a process by which molecules move from an area of high concentration to an area of low concentration
What is pulmonary respiration?
the exchange of oxygen and carbon dioxide between alveoli and circulating blood in the pulmonary capillaries
What is a stab wound?
when diaphragm moves down air is pulled into chest cavity through stab wound as well as normal drawing in of air through glottis opening, because of air rushing into chest through stab wound the negative pressure not created efficiently to pull into lungs
What happens when you lose nervous control in respiration?
cant transmit message through nerve tissue to innervate muscles of respiration from diseases such as multiple sclerosis
What is chest wall injuries/
pain and physical damage limiting chest wall movment
What are some airway problems?
air cannot move, no breathing astma and COPD decreasing in diameter with low oxygen levels in outside air in confined space with not enough oxygen to breath
What happens with diffusion problems in respiration?
congestive heart failure and COPD limit ability of alveoli to exchange oxygen and CO2 alveoli are not working.
What happens when there is not enough blood?
lost significant amounts of blood not enough circulating in alveoli
What are hemoglobin problems?
anemia with low hemoglobin or acidic body making hemoglobin difficiult to hold oxygen
What is cellular respiration?
exchange of oxygen and carbon dioxide between cells and circulating blood.
What is respiration?
the diffusion of oxygen and carbon dioxide between the alveoli and blood (pulmonary respiration) and between the blood and the cells (cellular respiration). also used to mean simply breathing when trying to make up for it if mental status and skin color is normal it is working
exchange of gases, o2 and co2, internal- at a cellular level, external- is in the lungs with the environment at the alveolus
What is hypoxia?
an insufficiency of oxygen in the body’s tissues cant tolerate for very long cause by fire, emphysema, overdose, heart attack, stroke, and shock
smoke inhalation, anaphylaxis, overdoses, emphysema, heart attack, stroke, trauma, seizure.
use positive pressure ventilation (positive pressure ventilation bag mask rest across chin and over nose, BiPAP (going with their respiration) , CPAP (continuous pressure)
Bad: gastric distention- (can decrease cardiac output, increase heart rate, cerebral pressure) air going into stomach don’t push on belly
know doing right- see chest rise and fall, for an adult every six seconds, 6
What is hypercapnia?
high levels of carbon dioxide the body can tolerate it for longer periods of time
What is respiratory distress?
increased work of breathing; a sensation of shortness of breath increasing heart rate to move more blood transporting more oxyen and CO2 constrict blood vessels
What is respiratory failure?
the reduction of breathing to the point where oxygen intake is not sufficient to support life
What is respiratory arrest?
when breathing completely stops. no breating/chest rise/ no air moved form mouth or nose/breath sounds/oxygen saturdation very low use use aritifical ventilation (pocket fask mask PFM, bag-valve mask (BVM), or flow-restricted, oxyen-powered ventilation device FROPVD) assiting ventlations at 10-12/minute for an adult or 20/ minute for a child or infant
What is inadequate breathing?
(respiratory failure)- rate of breathing or depth of breathing is outside normal ranges if the patient continues in this way they will undergo respiratory arrest and death. patient is moveing some air in and out, slow and shallow and not enough to leive, rate and/or depth outside normal, shallow ventilations, diminished or absent breath sounds, noises like crowing, stridor, snoring, gurgling or gasping, blue or gray skin color, decreased minute volume, oxygen saturation low so use assisted ventilation (air forced into lungs under pressure) with pocket face mask, bag-valve mask oR FROPVD
What do you do to some patient conditions?
to check look to see if chest is rising, listen for breath sounds or air leaving nose or mouth, feel for air moving out of nose or mouth
What is adequate breathing
speaking full sentences, alert and calm, rate and depth are adequate, no abnormal breath sounds, air moves freely in and out of chest, skin color normal, oxygen saturation normal but needs supplemental oxygen to a medical or traumatic condition use non breather mask or nasal cannula. adults- 12-20 per minute, childe 15-30 per minute, infant 25-50 per minute
What is inadequate breathing?
(respiratory failure)- rate of breathing or depth of breathing is outside normal ranges if the patient continues in this way they will undergo respiratory arrest and death. patient is moveing some air in and out, slow and shallow and not enough to leive, rate and/or depth outside normal, shallow ventilations, diminished or absent breath sounds, noises like crowing, stridor, snoring, gurgling or gasping, blue or gray skin color, decreased minute volume, oxygen saturation low so use assisted ventilation (air forced into lungs under pressure) with pocket face mask, bag-valve mask oR FROPVD
What is increasing respiratory distress?
visibly short of breath, speaking 3-4 word sentences, increasing anxiety use non breather mask or nasal cannula
What is severe respiratory distress?
speaking only 1-2 word sentences; very diaphoretic (sweaty); severe anxiety use assisted ventilations (pocket fask mask PFM, bag-valve mask (BVM), or flow-restricted, oxyen-powered ventilation device FROPVD) by assisting the patient’s own ventilations adjusting the rate for rapid or slow breathing continuing to deteriorate by sleeping with head-bobbing and becomes unarousable
What is cyanosis?
a blue or gray color resulting from lack of oxygen in body
What is artificial ventilation?
forcing air or oxygen into lungs when a patient has stopped breathing or has inadequate breathing, positive pressure ventilation.
What are negative side effects?
decreasing cardiac output/dropping blood pressure (use just enough volume to raise the chest), gastric distention- filling of stomach with air leading to vomiting, restriction of movement of diaphragm so use airway adjuncts maintain proper ventilation so body doestn vasoconstrictor
What are techniques of artificial ventilation?
(high concentration supplmenetal oxygen 15 liters/minute): mouth to make, two-rescuer bag valave mask BVM, flow restricted oxygen powered ventilation device, one=rescuer bag valve mask suction if vomited. do every 5 seconds for adult and every 3 for a child
