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Year 3: CardioPulm Rehab > Lecture 19: Normal and Abnormal Pulmonary Physiology > Flashcards

Lecture 19: Normal and Abnormal Pulmonary Physiology Flashcards

1
Q

normal SpO2 and PaO2

A

SpO2 = 95-100%

PaO2 = 80-100 mmHg

SpO2 of 90% correlates with PaO2 of 60 mmHg (minimum O2 concentration to prevent ischemia)

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2
Q

what is the saturation of peripheral O2 (SpO2)

A

% of Hgb bound to O2

non-invasive measurement

measures how much O2 is being delivered to tissue

not as exact a measurement

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3
Q

what is partial pressure of O2 (PaO2)

A

partial pressure of dissolved O2 in arterial blood

requires arterial blood gas draw lab

reflective of the balance of O2 delivery and consumption

most accurate way to determine effectiveness of blood oxygen saturation

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4
Q

normal respiratory rate

A

12-18 breaths per min at rest (some references say 12-20)

regular rhythm and non-labored effort

tidal volume ~500mL

no audible sounds

Eupnea = normal breathing rate and pattern

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5
Q

normal pulmonary vital signs

A

SpO2 = 95-100%

PaO2 = 80-100 mmHg

Respiratory Rate = 12-18 bpm

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6
Q

what is B type natriuretic peptide (BNP), normal ranges, and indication

A

a cardiac biomarker

normal <100 pg/mL

released in response to ventricular stretch or worsening heart failure

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7
Q

normal Hemoglobin (Hgb), lab category, and indication

A

a CBC value

normal (g/dL):

M = 14-18
F = 12-16

Hgb transports O2

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8
Q

normal blood gas values and indications

A

pH = 7.35-7.45

PaO2 = 80-100 mmHg

PaCO2 = 35-45 mmHg

HCO3 = 22-26 mEq/L

all portions that control normal blood chemistry for optimal physiological function

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9
Q

normal SpO2 response to exercise

A

initial transient drop when exercise starts

increase in respiratory rate brings back SpO2 back to stable/normal levels with increasing work load

SpO2 may increase with long duration tasks as steady state is reached

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10
Q

respiratory rate normal response to exercise

A

gradual increase with increased workload

maintains a steady state with minimal change at steady state exercise

rapid rise after/if anaerobic threshold (VT2) is reached

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11
Q

normal lung volume response to exercise

A

increases linearly with work

tidal volume increases to meet the demands of exercise and can approach vital capacity volumes

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12
Q

physiological progression that happens with respiration during exercise

A

mm cell respiration increases; more O2 is used; increase in CO2

brain detects increase in CO2; CNS signals lungs to increase RR

increased RR and volume of each breath; increase in gas exchange occurs

CNS signals heart to increase HR so more blood is pumped to the lungs for gas exchange

increased O2 gets sent to the mm to balance supply and demand

increased CO2 removed from blood and blown off via increased RR

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13
Q

vital signs that are concerning with a pulmonary patient

A

SpO2 <90% at rest or acute change in O2 demand/device

RR <10 or >30 at rest or unable to maintain conversation

HR <50 or >120 at rest or an uncontrolled/new arrhythmia

BP >180/90, <90/60, or MAP <60

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14
Q

what could potentially cause hypoxemia/hypoxia in a pt

A

heart/lung disease
hypoventilation
infection
anemia
carbon monoxide poisoning
PE
V/Q mismatch
sleep apnea
airway obstruction
high altitude

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15
Q

what is hypoxemia vs hypoxia

A

hypoxemia = low blood O2 levels measured by SpO2 or PaO2 (blood)

hypoxia = under oxygenation of tissues that impair cellular metabolism (cellular)

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16
Q

symptoms of hypoxemia

A

HA
dyspnea
tachycardia
coughing
wheezing
confusing, AMS
cyanosis of fingers, lips

17
Q

symptoms of hypoxia

A

restlessness
HA
confusion, AMS
tachycardia
anxiety
tachypnea
dyspnea

18
Q

symptoms of SEVERE hypoxia

A

bradycardia
extreme restlessness
cyanosis

19
Q

what is bradypnea

A

decreased RR

due to sleep, drugs, metabolic disorder, or CNA/ABI

20
Q

what is tachypnea

A

increased RR

due to fever, anxiety, shock, exercise, or pathology

21
Q

what is apnea

A

absence of breathing

due to death

22
Q

what is hyperapnea

A

normal rate but deep respirations

due to emotional stress or diabetic ketoacidosis

23
Q

what is cheyne-stokes breathing pattern

A

gradual increase and decrease in respirations with periods of apnea

due to increase in inter cranial pressure, brain stem injury

24
Q

what is atonal breathing pattern

A

apnea with periods of inconsistent respirations

due to actively dying, sever CVA/ABI

25
Q

what is a restrictive lung volume

A

decreased vital capacity (VC) and total lung capacity (TLC)

biggest limitations to functional endurance are decreased inspiratory reserve volume (IRV) and expiratory reserve volume (ERV)

26
Q

what is obstructive lung volume

A

increased vital capacity (VC) and total lung capacity (TLC)

biggest limitations to functional endurance are increased expiratory reserve volume (ERV) and residual volume (RV)

27
Q

abnormal SpO2 response to exercise

A

persistent or ongoing drop in O2 with increasing work load

increasing supplemental O2 delivery to maintain homeostasis

**important to know individual pt O2 goals before making clinical decision to top activity or reduce intensity

28
Q

abnormal RR response to exercise

A

drop in respiratory rate with work

rapid increase in RR that does not match intensity of workload

use ability to maintain ongoing conversation as a measure of how close the pt is to VT2

29
Q

basic principles of O2 delivery

A

supplementing hypoxemia with added O2 to keep SpO2 within safe limits

observe trends and amounts of supplemental O2

be able to maintain supplemental O2 for pt during mobility

awareness of PT role in ability to titrate/adjust O2

30
Q

flow rate vs concentration of O2

A

flow rate = how fast air is being delivered, expressed in L/min

concentration = the FiO2 of O2, expressed as %

the higher the FiO2, the faster it needs to be delivered

31
Q

what is FiO2

A

fraction of inspired oxygen

represents % of inhaled air that is O2

atmospheric air ~21% O2, so FiO2 is 21%

every 1 L/min above room air (RA) adds ~4% FiO2

FiO2 usually rounded down to 20% for ease

32
Q

list the flow rate in L/min corresponding to FiO2%

A

0 L/min = 20%
1 L/min = 24%
2 L/min = 28%
3 L/min = 32%
4 L/min = 36%
5 L/min = 40%
6 L/min = 44%

33
Q

describe a nasal cannula

A

delivers O2 1-6 L/min; “low flow”

does not require added humidification

can only change flow rate

34
Q

describe a face mask O2 delivery

A

can deliver 6-12 L/min

does not require humidification

can only change flow rate

35
Q

describe a high flow nasal cannula

A

can deliver 6-15 L/min for some types

requires humidification added since air is moving faster

inner lumen of cannula is patterned to direct high air flow to ensure it reaches pt

36
Q

describe heated high flow nasal cannula

A

up to 60 L/min and 100% FiO2

heated humidification helps protect airways and keep secretions thin

37
Q

describe a venturi mask

A

can provide up to 60% FiO2

adapter sets flow based on set FiO2

can only titrate FiO2

38
Q

describe a non-rebreather

A

1-15 L/min

mask covers nose and mouth to deliver very high O2 concentration

one way valves allow escape of exhaled CO2 to allow pure O2 on next inhalation

Year 3: CardioPulm Rehab (21 decks)

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