Pulmonary Flashcards
whats the difference btwn ventilation and respiration?
respiration is gas exchange at alveoli and ventilation can be seen as in and out flow, a component of respiration
How many bronchiole branches are their before you reach the lungs?
26
Pt has 1:1 chest ratio. what might they have?
barrel chest - Emphysema
what is boyles law?
Inverse Relationship Between Volume and Pressure When Temperature Constant
an Increase or Decrease in Lung Volume Results in Inspiration and Expiration
what happens in the pleural cavity during inhalation?
diaphragm flattens
thoracic cavity increases
intrapulmonary volume increases, intrapulmonary pressure drops (-1)
air flows into lungs down its pressure gradient until intrapulmonary pressure is 0
Expiration is passive or active
passive
what happens to the diaphragm during expiration?
rises
what happens to alveoli pressure during expiration?
decreases
what two muscles are involved in forceful expiration?
Abdominals Contract and Intercostals Relax
what happens during expiration?
Elastic recoil of Diaphragm
Alveolar Pressure Rises �
Thoracic cavity volume decreases
Intrapulmonary pressure rises (by +1 mm Hg)
Air flows out of lungs down pressure gradient until pressure is 0�
what is the formula for airflow?
change in pressure / resistance
what affects lung compliance?
lung distensibility
thoracic cage distensibility
surface tension
whats the difference between having lower or greater compliance?
The lower the compliance → the more exertion required for expansion
The greater the compliance → the less exertion required
what disorders affects compliance?
Emphysema
Respiratory distress syndrome
Conditions affecting the joints of the ribs or spinal cord (scoliosis)
Compare good compliance and poor compliance?
Good Compliance
Normal breathing at rest
Supply and demand for muscle work balanced
Poor Compliance Normal breathing at rest Use of accessory muscles Increased demand for energy Just breathing leads to exhaustion
What creates the alveolar-capillary membrane?
Alveolus + pulmonary capillary
Describe the position/ location of the alveolus and pulmonary capillaries?
Each alveolus surrounded by pulmonary capillary while pulmonary capillaries cover external surfaces of alveoli
What is the function of the alveolar-capillary membrane?
Alveolar-capillary membrane provides interface between respiratory and cardiovascular systems (blood)
Enhances gas exchange
Each adult has how many alveoli? how large is the surface area?
Adults have 300–600 million alveoli &
50-100 m2 surface area for O2 diffusion into about 280 billion capillaries
what are the layers of the capillary membrane?
1st layer - Phospholipid surfactant layer
2nd layer - tissue
3rd layer - interstitial space
4th layer - capillary endothelium
what produces surfactant?
granular pneumocytes (type 2)
what does surfactant do?
Lowers surface tension of alveolar walls
Keeps alveolar walls from collapsing with exhalation
Surface tension draws fluid from adjacent capillaries to alveoli (making them wet)
what is the tissue layer comprised of?
type 1 and type 2
Describe type 1 cells?
Squamous pneumocytes
Make up (95%) of alveolar surface
Thin pancake-like cells
Allow easy movement of gas molecules
describe type 2 cells?
Plump granular pneumocytes
Aid in cellular repair
Produce surfactant for the 1st layer of membrane
Development of surfactant significant factor in premature birth survival
what is surfactant composed of?
Detergent-like phospholipoprotein substance
Sphingomyelin
Lecithin (more)
Describe the formation of surfactant’?
Hydrophobic heads facing air
Hydrophilic tails in the water
what layer manages the movement of gases?
tissue layer - squamous pneumocytes (type 1)
what affect does lecithin have?
it makes surfactant more affective
Why are premies born with immature lungs at risk for infant respiratory distress syndrome?
The pulmonary system isnt fully developed since it’s the last of the fetal systems to functionally/structurally mature
how can surfactant in premis be measured?
-
What is partial pressure?
-
what happens when plasma CO2 concentration increases?
ventilation has decreased causing pH to go down = respiratory acidosis –> compensated by hyperventilation
A patients respiration
-
what compensates for increased ventilation?
hypoventilation
what drives ventilation in normal ppl?
CO2 levels
whats the normal blood ph?
7.35-7.45
whats the normal partial oxygen pressure?
80-100mmHg
whats the normal partial CO2 pressure?
35-45 mmHg
what is normal bicarb found in the blood?
22-26mEq/L
what does ABG consist of?
pH, PCO2, PO2, HCO3
What is the 3rd Alveolar-Capillary Membrane known as?
Interstitial space
What is found between the basement membrane of alveolar epithelium from basement membrane of capillary endothelium?
interstitial fluid
What is interstitial edema?
When too much fluid gets into interstitial space -> Space will separate → Making gas exchange more difficult
What is the 4th capillary membrane?
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capillary endothelium
What is found in the 4th layer?
wandering macrophages
Wangering macrophages are also known as?
Type III cells
What are pores of Kohn? What do they do?
Small holes between alveoli
Allow movement of macrophages from one alveolus to another
What is it called when CO2 accumulates in the plasma? and is the ph high or low?
hypercapnia aka Respiratory Acidosis
What caused hypercapnia?
from hypoventilation
which system of the body requires continuous stimulation from the brainstem?
respiratory
what stimulates inspiratory drive in respiration?
pons
what controls the regulation of respiration?
medullary center
what part of the brain controls voluntary breathing?
cerebral cortex
What is the chemical receptor site?
peripheral and central chemoreceptors
What chemicals influence central chemoreceptors?
just increase CO2 and H+
What chemicals influence peripheral chemoreceptors?
decrease in O2 increase CO2 and H+
What respiratory centers in the medulla are stimulated if a pt has respiratory acidosis?
peripheral chemoreceptors
central receptors
which is the only chemoreceptor in the medulla that responds to low oxygen?
peripheral chemoreceptors
which chemoreceptor stimulates the most response?
central chemoreceptors
How does emotional stimuli and pain affect respiration (what part of the brain)?
positive/ negative in the hypothalamus
Name the only positive respiratory centers in the medulla
peripheral, central, receptors in muscles and joints
Name the only negative respiratory centers in the medulla
stretching of the lung, irritant receptors
Name the respiratory centers in the medulla respond to both positive and negative stimuli
hypothalamus and cerebral cortex
What kind of impulse did the medullary respiratory center cause?
efferent impulse
where are afferent impulses received?
medullary respiratory centers
How does the negative feedback mechanism regulate ventilation?
central and peripheral chemoreceptor respond to increased PCO2/pH and then the medullary respiratory centers send impulses to the respiratory muscles increases ventilation
What responds to increased PCO2 and decreased pH in cerebral spinal fluid?
central chemoreceptors
How can you determine long standing hypoxia?
looking at the digits and measuring sing the angle of clubbing to measure if it’s early middle or serve
What are the two forms of cyanosis?
Peripheral or central
What is peripheral cyanosis related to? Give an example.
Related to grams of hemoglobin
Ex: Lupus
What is an indication of central cyanosis?
finger extremities and the lips
A pt is cyanotic what would you see on a CBC to confirm this diagnosis?
5g of desaturated hemoglobin or more (less oxygen bound hemoglobin)
what other reasons could a patient be cyanotic?
blood loss
Pt has Polycythemia Vera with 6g of desaturated hemoglobin. Would you consider this patient in trouble/hypoxia? Why?
No the pt has more then enough RBC to compensate for the 6g of desaturated hemoglobin
what does cyanosis typically indicate?
severe hypoxia
What does the spirometery test evaluate?
Diagnostic spirometer used to evaluate patient’s ability to ventilate during a maximum forced exhale
What is vital capacity?
Amount of air exhaled after maximum inspiration
What is forced vital capacity (FVC)?
Volume expired with maximal force
What is forced expiratory volume-1 (FEV1)?
Amount of air exhaled during the first second of the FVC test
What Measures patient’s ability to move air into and out of the lungs?
Peak flow meter
What can the flow volume loop show?
restrictive or obstructive (ex: COPD)
how do you determine a child’s personal best?
reviewing the recorded measurements 2-3x a day for 2-3 weeks
What does a peak flow meter measure?
Measures patient’s ability to move air into and out of the lungs
Describe what PEFR is and what the 3 levels indicate?
Peak expiratory flow rate
Green- good take meds
Yellow- take meds see if it improves if not then get medical help
Red- Get medical help
what is a pulse oximeter?
Measures and records the oxygen (O2) saturation of the blood (SpO2)
How can injury to the capillary cause pulmonary edema?
Increases capillary permeability and disruption of surfactant
movement of fluid and plasma proteins from capillary to intertisial space
How can blockage of a lymphatic vessel cause pulmonary edema?
Accumulation of fluid
How can valvular dysfunction, CAD, or left ventricular dysfunction cause pulmonary edema?
it increases left atrial pressure –> increased pulmonary capillary hydrostatic pressure –> excess water in the lungs
what is Pulmonary edema?
- Excess water in the lungs
pt has increase hydrostatic pressure due to pulmonary edema. what underling condition do they have?
Left Ventricular Failure and obstructed lymph vessel
pt has pulmonary edema due to decreased vascular oncotic pressure, what caused this?
increased capillary permeability
what can cause a thrombus?
venous stasis, vessel injury, hyper coagulability
what is an embolism?
a dislodgment of a thrombus
what is a PE?
Occlusion of portion of pulmonary vasculature
what occurs from Occlusion of portion of pulmonary vasculature?
hypoxic vasoconstriction decreased surfactant release of neural humoral substances pulmonary edema Atelectasis
what is Atelectasis?
not the same as pnemothorax, due to collapse or closure of lung from lack of blood flow to the capillary
What is the V/Q ratio of a patient with impaired ventilation and hypoxemia?
low V/Q
What is the V/Q ratio of a patient with collapsed alveolus due to blocked ventilation and hypoxemia?
(very low) Shunt V/Q
What damage at the alveolar level will affect V/Q?
impaired ventilation
alveolar dead space
Impaired perfusion
what will cause high V/Q?
impaired perfusion
what may or may not be categorized by COPD?
asthma
what disease are considered COPD?
emphysema
chronic bronchitis
bronchiectasis
What disease characteristic should you expect with a pt with emphysema and chronic bronchitis?
Most patients retain CO2
↓ ↓
Hypoxic with respiratory acidosis
Dyspnea becomes progressively more severe
↓↓
Eventually develop respiratory failure
what is asthma? list 4 things
Chronic Inflammatory Disorder
Recurrent, reversible episodes of wheezing
Bronchial Hypersensitivity
Heredity component
what are the types of asthma?
Mild Intermittent-> Mild Persistent -> Moderate Persistent -> Severe Persistent
What happens during an allergen or irritant exposure?
IL-4, IgE production and mast cell degranulation
What mediators would respond to mast cell degranulation?
Vasoactive mediators
Chemotactic mediators
what would a vasoacitve mediator cause?
vasodilatation
what would a chemotactic mediator cause that leads to bronchial hyperresponsiveness? (3)
-89
what is Abnormal permanent enlargement of gas-exchange airways (Acini) known as?
emphysema
what disease is associated with chronic destructive in alveolar walls?
emphysema
why is emphysema known as pink puffers?
Patients use a large amount of energy to exhale and Cyanosis doesnt appear until late in the disease
what are the 4 major distinctive characteristics of emphysema?
Chronic destructive changes in alveolar walls
Airways collapse during expiration
Loss of Elastic Recoil (Irreversible enlargement of alveolar air spaces)
Chronic inflammation promotes lung fibrosis
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Physical appearance of COPD
barrel chest
What constitutes chronic bronchitis?
Pt has bronchitis at least three months of the year for two consecutive years
what is bronchitis?
Hypersecretion of mucus and chronic productive cough
Why do chronic bronchitis pt have severely inflamed lungs?
Trapped mucus in lower respiratory tract
T or F - The parietal layer is superficial to the visceral pleura.
true
Do crackles occur on inhalation or exhalation?
inhalation - this is when alveoli collapse and pop back opened
What are the functions of the respiratory system?
Gas exchange
Acid-base balance
Phonation
What is ventilation?
Movement of air in and out
What is respiration?
Exchange of gases at alveoli
Name the respiratory tree divisions (7)
Trachea
Primary bronchi
Secondary bronchi
Tertiary bronchi
Bronchiole
Terminal bronchiole
Alveoli
what does the alveoli branch off of?
alveolar duct
What does the fusion of alveolar and capillary walls allow?
Better/easy diffusion
What supplies the alveoli with blood?
Cobweb of capillaries surrounding the lung
what helps maintain a sterile environment in the lungs?
Alveolar Macrophages + Ciliary Current = Sterile Membrane
What are some thing you would find surrounding the alveoli?
Smooth muscle
Elastic fibers
Capillaries
What are the two types of respiratory circulation?
Pulmonary circulation
Bronchiole circulation
what are the 4 layers of the respiratory membrane?
- surfactant
- tissue layer
- interstitial space
- capillary endothelium
What happens during inspiration?
Contraction of Diaphragm (falls), Intercostals
Alveolar Pressure Falls
Air flows into Lungs
is inspiration active or passive?
active
how much is inspired at rest?
500ml of Air Inspired
how much is inspired during deep breathing?
2-3 L (apx 5 in athletes)
when does the diaphragm move inferiorly?
inspiration
Name the sequence of events during inspiration
Contraction of inspiratory muscles
Thoracic cavity volume increase
Lungs stretch (intrapulmoary volume increases)
Intrapulmonary pulmonary drops -1mm Hg
Air/gases flow into lung (down pressure gradient) until intrapulmonary is equal to atm
Where does negative pressure need to be maintained?
within the pleural space
what is expiration?
Expiration is Normally Passive
Elastic recoil of Diaphragm
Alveolar Pressure Rises
what additional muscles are used during forceful respiration?
Forceful Expiration = Abdominals Contract and Intercostals Relax
what is lung compliance? what does it consist of?
= distensibility
surface tension
thoracic cage distensibility
lung distensibility
What does carbaaminohemoglobin do?
-
what percentage of carbon dioxide is transported throughout the body?
10% Dissolved in Plasma
20% Carbaminohemoglobin
70% Bicarbonate
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Pt has a lower respiratory tract mucosa becomes severely inflamed with mucus production what is a likely sequelae?
Risk of lung infection increases
Pneumonia is common
Pooled mucus due to chronic bronchitis impairs what?
Pooled mucus impairs ventilation/ gas exchange
Which COPD is related to lung fibrosis?
Emphysema
What could airways obstruction or air trapping result in?
Abnorm ventilation perfusion ratio
Hypoxemia
hypoventilation
right heart failure
What does alpha antitrypsin?
Breakdown of elastin in CT of lungs
Breakdown of elastin in CT of lungs
What is a COPD that is associated with with chronic bronchial inflammation caused by obstruction, infection, CF, and systemic disease such as AIDS?
bronchiectasis
What is bronchiectasis?
Persistent, abnormal dilation of bronchi, Elastic and muscular components destroyed
Which COPD is associated with chronic productive cough?
Bronchiectasis and chronic bronchitis
what is it called when you have too much fluid in the alveolar capillary membrane of the lungs?
interstitial edema
What causes a pnemothorax?
Outside air enters because of disruption of chest wall
How can you tell its a pleural effusion?
Xray and Thoracentesis (Thoracentesis will tell you if its blood or fluid)
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what are type III cells called and where are they located?
“Wandering macrophages” (Type III cells ) located in 4th layer
how do wandering macrophages get from alveolar to alveolar?
pores of kohn
What is pleural effusion?
Accumulation of fluid in pleural space reducing volume of the lung space
what types of fluid shift cause Pleural effusion?
Transudative or Exudative
whats the difference btwn Transudative or Exudative?
Transudative = watery, CHF Exudative = protein rich, infection or inflammation
what is hemothorax?
blood in pleural space
what is hydrothorax?
water in pleural space
what type of fluid shift would result from an infection or blocked blood/lymph vessels?
Exudative
what type of fluid shift would result from an increase in pressure of the blood vessels or low blood protein?
transuduative
What causes a pnemothorax?
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Outside air enters because of disruption of chest wall and parietal pleural or lung air enters because of disruption of visceral pleura�.
What is Dalton’s law?
In a mixture of gases, each gas exerts it’s own pressure as if the other gases are not present
What is partial pressure?
% of gas X total pressure
How do gasses move?
Gases move along Partial Pressure Gradient
