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lecture final Flashcards

1
Q

What is the normal value for CaO2 and the equation for it

A

20 vol%
(1.34xHbxSaO2) + (PaO2x0.003)

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2
Q

what is the normal value for CvO2 and the equation for it

A

15vol%
(1.34xHbxSvO2)+(PvO2x0.003)

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3
Q

what is PAO2 normal value and the equation for it

A

100mmHg
[(Pb-H2O)xFiO2]-(PaCO2x1.25) PaO2 cannot be higher than PAO2

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4
Q

what is the equation for Qs/Qt

A

CcO2-CaO2/CcO2-CvO2

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5
Q

how do you find BH%

A

44mmHg - content/ saturated capacity x 100

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6
Q

where is the SA node and how many BPM

A

the SA node is located in the upper right atrium and produces 60-100 BPM

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7
Q

where is the AV node and how many BPM

A

the AV node is located in the lower portion of the right atrium and produces 40-60 BPM

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8
Q

what takes over when the SA and AV node fails and how many BPM

A

the pacemaker cells, bundle of His, and Purkinje fibers take over and produce 20-40 BPM

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9
Q

what is Hypercapnia

A

High CO2 levels in the blood resulting in increased depth of breathing w/ or w/o increased frequency

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10
Q

what is tachycardia

A

rapid HR >100 BPM

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11
Q

what is diffusion

A

process of gas molecules passively moving from an area of high concentrations to low concentrations

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12
Q

what is a true shunt

A

cardiac output that enters the left side of the heart w/o exchanging gases w/ alveolar gases. perfusion w/o ventilation (causes severe hypoxemia and cannot be helped with/ oxygen therapy)

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13
Q

what is deadspace

A

the volume of inspired air that does not reach the alveoli in the conducting zones. * ventilation w/o perfusion* (causes hypercapnia and can be helped with oxygen therapy)

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14
Q

what are the normal PaO2 values

A

80-100 mmHg

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15
Q

what are the normal values for PvO2

A

35-45 mmHg

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16
Q

Know the different ranges for hypoxemia

A

PaO2: 60-79 mild hypoxemia
PaO2: 40-59 moderate hypoxemia
PaO2: <40 severe hypoxemia

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17
Q

know the different ranges for hypoxemia with oxygen therapy

A

PaO2: <60 uncorrected hypoxemia
PaO2: 60-100 corrected hypoxemia
PaO2: >100 is overcorrected hypoxemia

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18
Q

what is anatomic deadspace

A

the volume of gas that only makes it to the conducting airways (nose to terminal bronchioles) no gas exchange occurs (1ml/lb of BW)

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19
Q

what is physiologic deadspace

A

sum of anatomic deadspace and alveolar deadspace

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20
Q

what is alveolar deadspace

A

oxygen that makes it to the alveoli but does not participate in gas exchange

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21
Q

given PFT values to be able to determine diagnosis of normal obstructive or restrictive

A

FEV1/FVC=FVC1% OVER 70% may be restrictive or normal under 70% will be obstructive
less than 80% FVC is abnormal <80% is restrictive >80% normal

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22
Q

what are the characteristics of the pore of kohn

A

small holes in intra-alveolar septa, permit gas movement between adjacent alveoli.
Formed by movement of macrophages, death of epithelial cells due to disease, and normal degeneration of cells due to aging.

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23
Q

Zone 1

A

least gravity dependent, up by the apex. Alveolar pressure is greater than arterial and venous pressure.

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24
Q

Zone 2

A

Middle part of the lobe, arterial pressure is greater than alveolar pressure but alveolar pressure is greater than venous pressure

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25
Q

Zone 3

A

Base of the lobe, most gravity dependent. Arterial pressure and venous pressure are greater than alveolar pressure.

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26
Q

understand the changes in intrapleural pressure in normal upright lungs

A
  1. intrapleural pressure is negative at all tines, without negative pressure the lungs would collapse.
  2. actual volume changes during inspiration is least in the upper lung
  3. natural intrpleural pressure gradient exist from the upper lung to the lower.
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27
Q

what are the anatomic differences between the right and the left mainstream bronchus

A

right: 25 degrees and is shorter/wider than left
Left: is 40-60 degree angle

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28
Q

what are the concentrations of atmospheric gases

A

PO2: 21%
PN2: 78%
1% other gases
atmospheric pressure:760 mmHG
water vapor: 47 mmHg

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29
Q

what happens to FiO2 and PO2 when you go up or down in elevation

A

PO2 will change and FiO2 will always remain the same

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30
Q

what are the muscles of inspiration

A
  1. external intercostal muscles
  2. scalene muscles
  3. sternocleidomastoid
  4. pectoral major
  5. trapezius
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31
Q

is inhalation/exhalation active or passive

A

first 30% of exhalation is effort dependent last 70% is not
Inspiration is active
expiration is passive

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32
Q

what is transthoracic pressure

A

difference between alveolar pressure and body surface pressure
Ptt= Palv-Pbs

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33
Q

what is trans-pulmonary pressure

A

difference between alveolar pressure and pleural pressure
Ptp=Palv-Ppl

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34
Q

what is transairway pressure

A

difference between mouth and alveolar pressure
Pta=Pm-Palv

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35
Q

how does hemoglobin work and its normal O2 binding capacity

A

4 heme groups, each group combine with 1 oxygen molecul. (if all 4 heme groups bound to O2= 100% saturation, 3= 75% saturation) they consist of 2 alpha and 2 beta chains
male: 14-16 g%
female: 12-15g%

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36
Q

what is scoliosis

A

spine is curved from side to side (s curve)

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37
Q

what is lordosis

A

inward curve of lumbar and cervical vertebral column

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38
Q

kyphosis

A

round back or hunch over, curvature of the thoracic

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39
Q

kyphoscoliosis

A

combo of scoliosis and kyphosis

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40
Q

if bronchial tube size increases or decreases what happens to driving pressure/flow

A
  1. flow is proportional to change in pressure while radius is inversely proportional to length and gas viscosity
  2. decrease radius by 1/2= decrease in flow of 1/16 of original
  3. decrease radius by 16%= decrease in flow by 1/2
  4. pressure will increase with decrease in radius
  5. decreasing radius by 1/2 increases pressure bye 16x to keep flow constant
  6. decrease radius by 16%= pressure must increase 2x for flow to remain constant.
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41
Q

where is pulmonary surfactant produced

A

type II pneumocytes are the primary source of pulmonary surfactant

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42
Q

what are the 7 functions of pulmonary surfactant

A
  1. decrease inflation pressure
  2. improve lung compliance
  3. provide alveolar stability
  4. decrease work of breathing
  5. enhance alveolar fluid clearance
  6. enhances foreign particle clearance
  7. serves as protective layer for cell surfaces
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43
Q

what effects surfactant/surface tensions size

A

the DPPC molecule causes surface tension to decrease w/ decreased alveolar size.
as alveolar size increases, surfactant thins out across the alveoli.

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44
Q

what is cheyne-stokes breathing

A

10-30 seconds of apnea followed by a gradual increase in volume and frequency, followed by another gradual decrease with another period of apnea. (heart failure)

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45
Q

what is biot’s breathing

A

short episodes of rapid deep respirations followed by 10-30 seconds of apnea (neurological injury and meningitis)

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46
Q

what kussmauls breathing

A

Increased RR and depth of breathing. Resulting in decrease in PACO2 (ketoacidosis and renal failure)

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47
Q

what are the four lung volumes in order

A
  1. inspiratory reserve volume (IRV)
  2. tidal volume (Vt)
  3. expiratory reserve volume (ERV)
  4. Residual volume (RV)
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48
Q

What are the four lung capacities and there corresponding volumes

A
  1. inspiratory capacity (IC) - (IRV,VT)
  2. Function residual capacity (FRC)- (ERV,RV)
  3. Vital capacity (VC)- (IRV,VT,ERV)
  4. Total lung capacity (TLC)- (IC, FRC) or (IRV,VT,ERV,RV)
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49
Q

Define ficks law of diffusion

A
  1. gas diffusion is directly proportional to the difference in partial pressure of the gas across the membrane
  2. gas diffusion is inversely proportional to membrane thickness
  3. gas diffusion is directly proportional to the diffusion constant of the gas
  4. surface area when decreased, results in decreased diffusion of gases, causes collapsed alveoli and increased alveolar fluid
  5. P1-P2 when decreased results in decreased diffusion causing decreased altitude, alveolar hypoventilation
  6. thickness of the A-C membrane when increased results in decreased diffusion and causes alveolar fibrosis and alveolar edema
50
Q

what is a time constant and its equation

A

time constant- is the time necessary to inflate a particulate lung region to 60% of its potential filling capacity
TC=Raw x Cl

51
Q

long time constant/ short time constant

A

long time constant- increased lung compliance and/or increased airway resistance
short time constant- decreased lung compliance and/or decreased airway resistance

52
Q

the effects of increased airway resistance or decreased lung compliance

A
  1. when lung compliance decreases, so does tidal volume and time constant, but RR increases
  2. When airway resistance increases, so does tidal volume and time constant but RR decreases (allowing more time for filling)
53
Q

ventilatory pattern definition and normal values

A

ventilatory pattern- RR and VT
normal; VT= 500ml and RR=15breaths per min
VE= RR x VT 15x.500=7.5L

54
Q

what does stimulation of the baroreceptor reflex cause

A
  1. located in the walls of the carotid arteries/aorta
  2. short term regulator for BP
    3.Responds instantly to BP changes and the medulla with increase sympathetic activity
  3. If changes last more than a few days they accept it as a new normal
55
Q

What is ventricular after load and what determines it

A

Ventricular after load- the force against which the ventricles must work to pump blood
determined by;
1. volume and viscosity of blood ejected
2. peripheral vascular resistance
3. total cross-sectional area of the vascular bed into which the blood is ejected
4. arterial BP reflects after load

56
Q

Ventricular preload

A

Ventricular preload- the degree of myocardial fiber stretch prior to ventricular contraction
Increased stretch= increased strength of contraction

57
Q

hypoxemic hypoxia

A

increased altitude, suffocation, drug overdose, lung disease, and neurological injury

58
Q

stagnant (circulatory) hypoxia

A

cardiac arrest and shock

59
Q

anemic hypoxia

A

anemia, blood loss, and carbon monoxide poisoning

60
Q

histotoxic hypoxia

A

cyanide poisoning

61
Q

alveolar minute volume (VAmin)

A

VAmin: tidal volume- deadspace x RR answer will be in liters

62
Q

Recall normal diaphragmatic excursions

A

at rest: excursion is 1.5 cm, pressure change is 3-6 cmH2O
deep breath or exercise: excursion is 6-10 cm pressure may drop 50 Pb

63
Q

Correctly interpret ABGs

A

PH: acidotic <7.35-7.45 >alkalotic
PaCO2: alkalemia < 35-45 >acidotic respiratory
HCO3: acidemia < 22-28 > alkalemia metabolism
alveolar air equation for O2- PaO2 [(Pb-H2O) x FiO2] - (PaCO2 x 1.25)

64
Q

acute vs. chronic for ABGS

A

Acute- only one of the PaCO2 or HCO3 will be abnormal
Chronic- one will be acidotic the other will be alkalotic as they attempt to compensate

65
Q

Factors that shift the oxyhemoglobin dissociation curve left and unloading of oxygen

A

Left shift: loading at the lungs, decreased unloading at the tissue
left shift with increased PH, decreased PCO2, and decreased temp

66
Q

Factors that shift the oxyhemoglobin dissociation curve right and unloading of oxygen

A

Right shift: decreased loading at the lungs, increased unloading at the tissues.
right shift with decreased PH, increased PCO2, and increased temp

67
Q

recall normal inspiration to exhalation ratio

A

I:E - 1:2
3 phases- inspiratory, expiratory, and pause phase

68
Q

how gas movement occurs at the level of the alveoli

A

diffusion- area of high concentration to move to areas of low concentration. Directly related to surface area and pressure gradient.

69
Q

normal CO2 production

A

200 ml/min of CO2 produced and 250 ml of O2 is consumed

70
Q

normal SaO2

A

97% measure of the proportion of available Hb that is carrying O2

71
Q

normal value for stroke volume

A

40-80 mL volume of blood ejected from the ventricle during each contraction

72
Q

normal CaO2

A

20vol% bound to Hb and dissolved in plasma

73
Q

normal CvO2

A

15vol% bound to Hb and dissolved in plasma

74
Q

normal value DO2

A

1000 ml O2/min CaO2xCO
delivery of O2 to the tissues

75
Q

normal value for CO

A

5 L/min
HR x SV
total volume of blood discharged from the ventricles per min

76
Q

normal value for O2ER

A

0.25 amount of O2 extracted by peripheral tissues divided by the amount of O2 delivered

77
Q

normal value for VO2

A

250 mL/min
the amount of O2 consumed per min

78
Q

restrictive disorders, anatomy, pathophysiology, and PFT measurements effected

A

anatomy- non-airways/ gas regions (thoracic pump, lung parenchyma)
Breathing phase difficulty- inspiration
pathophysiology- decreased lung or thoracic compliance
PFT measurement effected- volumes

79
Q

formula for compliance

A

Cl= triangle v/ triangle P

80
Q

formula for resistance

A

Raw= triangle p (cmH2O)/ V (L/sec)

81
Q

formula for elastance

A

triangle p/ triangle v

82
Q

time constant

A

TC= Raw x Cl

83
Q

what factors clinically modify clinical application of ficks law

A
  1. partial pressure
  2. alveolar surface area
  3. AC membrane T
84
Q

Normal ranges of PaO2, PaCO2, PvO2, and PvCO2

A

PaO2: 80-100mmHg
PaCO2: 35-35 mmHg
PvO2: 35-45 mmHg
PvCO2: 42-48 mmHg

85
Q

normal values for PAO2, PvO2, PaCO2, PvCO2, DO2, O2ER, QS/QT, VO2

A

PAO2: 100mmHg
PvO2: 40mmHg
PaCO2: 44mmHg
PvCO2: 46mmHg
DO2: 1000ml O2/min
O2ER: 0.25
QS/QT: normal <10%
VO2: 250 ml/min

86
Q

equation for CcO2

A

(1.34xHb)+(PAO2x0.003)

87
Q

VD/VT full equations

A

VD/VT ratio= PaCO2-PeCO2/ PaCO2
VD physiologic= VD/VT ratio x VT
VD alveolar= VD physiologic- VD anatomic (weight)

88
Q

VAmin equation

A

(VT- VD anatomic) x RR

89
Q

QS/QT equation

A

CcO2-CaO2/ Cco2- CvO2

90
Q

BH and RH equation

A

BH= 44- content/sat capacity x 100
RH= content/ saturated capacity x 100

91
Q

where is the pulmonary artery located and what else carries deoxygenated blood

A

the pulmonary artery is located in the right ventricle and carries deoxygenated blood, just like the veins do.

92
Q

in posterior view the lung extends to what rib?

A

the 11th rib

93
Q

where is intrapleural pressure more negative

A

at the apex

94
Q

with increased PcO2 what happens to PVR

A

PVR Increases

95
Q

what happens to PVR with a drop in PaO2

A

PVR will increase

96
Q

what happens to PVR if PH drops

A

PVR will increase

97
Q

where is perfusion better in the lungs

A

perfusion is better at the base of the lungs

98
Q

what will acute hypoventilation show on an ABG

A

it will show an increase in PaCO2 and a decrease in PH

99
Q

what happens to the time to fill when compliance is decreased

A

it will take less time to fill, and there will be a short time constant
increase RR, decrease Tidal volume

100
Q

in metabolic acidosis with compensation what will the patient have to do

A

hyperventilate

101
Q

what are the two conditions with increased CO2 levels in the blood

A

hypercapnia and hypercarbia

102
Q

what happens to PO2 in increased altitudes

A

PO2 decreases

103
Q

what describes gas movement at gas exchange units

A

molecular diffusion

104
Q

two factors that effect ventricular after load

A

blood volume and PVR

105
Q

what causes a decrease in PVR

A

recruitment and distention

106
Q

stroke volume is determined by what

A

ventricular preload
ventricular afterload
myocardial contractility

107
Q

what happens to driving pressure when a bronchial tube is reduced by 1/2

A

the driving pressure will increase 16x the original

108
Q

upon inspiration alveolar size increases what happens to the surface tension and the surfactant

A

surface tension will increase but surfactant will decrease to alveolar surface area

109
Q

ficks law is proportional and inversely proportional to what

A
  1. proportional to partial pressure of gas across membrane
  2. inversely proportional to membrane thickness
  3. directly proportional to the diffusion constant of a gas
110
Q

when airway resistance increases what happens to ventilatory rate and tidal volume

A

vent rate decreases and tidal volume increases

111
Q

what is 4800 ml in liters

112
Q

know what the shunt percentages mean

A

0-10%- normal shunt 10-20%- not clinically significant
20-30%- signs of intrapulmonary disease
>30%- life threatening

113
Q

formula for CcO2

A

(1.34xHb)+(PAO2 x 0.003)

114
Q

what will happen to flow if you decrease radius size by 1/2

A

it will decrease flow to 1/16 of original

115
Q

what will happen to flow if you decrease radius size by 16%

A

decreases flow by 1/2

116
Q

what happens to driving pressure if you decrease radius by 1/2

A

driving pressure will have to increase by 16x to keep flow constant

117
Q

what happens to driving pressure if you decrease radius by 16%

A

driving pressure must increase 2x for flow to remain constant

118
Q

where is the nasopharynx located

A

Nasopharynx- end of nasal cavity to the base of soft palate, posterior to nasal cavity and superior to soft palate.

119
Q

where is the oropharynx located

A

Oropharynx- base of soft palate to base of the tongue

120
Q

where is the laryngopharynx located

A

laryngopharynx- base of tongue to esophageal opening

respiratory therapy (3 decks)

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