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Critical Care Test 1 > Pulmonary Disorders lecture > Flashcards

Pulmonary Disorders lecture Flashcards

1
Q

Functions of the lungs

A
  • filtration by hair, mucus, cilia
  • warm air to 37 deg. C
  • humidify air to 100% saturation
  • metabolism
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2
Q

Functions of the lungs:

-what do the lungs metabolize

A
  • Histamine production
  • converts angiostensin 1–> angiostenstin 2 (vasoconstrict)
  • surfactant production
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3
Q

Thorax and Ribs function

A

rigid to protect & flexible to expand with inhalation

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4
Q

Lungs apex location

A

rises above clavicle

-risk for pneumothorax

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5
Q

Trachea anatomy

  • anterior view
  • posterior view
A

1) cartilage rings

2) smooth muscle

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6
Q

Conducting airways functions

A
  • passageway to respiratory regions of lung
  • NO AIR EXCHANGE
  • hinders foreign material into gas exchange
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7
Q

respiratory airways

- type I epithelial cells

A
  • 90% of space

- role in GAS EXHANGE

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8
Q

respiratory airways

-type II epithelial cells

A

produce, store, and secrete surfactant (reduces surface tension)

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9
Q

mechanics of breathing:

-what does 80% of WOB

A

diaphragm

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10
Q

mechanics of breathing:

-what muscles aid in WOB

A
  • intercostal
  • abdominal
  • accessory muscles
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11
Q

Mechanics of breathing:

-where does the medulla send impulses to?

A

-the diaphragm via the phrenic nerve

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12
Q

Mechanics of breathing:

  • where is the phrenic nerve located in the body?
  • why is this important to know?
A
  • C3-C5

- trauma to these areas cause severe respiratory problems

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13
Q

Mechanics of breathing:

-Compliance def.

A

the lungs ability to expand and ease of lung inflation

the more compliant, easier to bring air in

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14
Q

Mechanics of breathing:

- compliance in ARDS pts

A

decreased compliance

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15
Q

Mechanics of breathing:

-compliance in COPD pts

A

Increased compliance BUT cannot let air back out

-barrel chested (decr. elastic recoil)

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16
Q

How does the body prevent lungs from collapsing?

A

INTRAPLEURAL pressure found in the pleural space between the lungs is a negative pressure that acts as a vaccum

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17
Q

What happens if interapleural pressure and external (outside) pressure are equal?

A

pneumothorax

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18
Q

Physical law that describes how alveoli stay open?

A

LePlace’s law

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19
Q

What part of the body creates the negative pressure in the intrapleural space?

A

the lymphatic system

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20
Q

Mechanics of breathing:

- alveolar pressure during inspiration

A

the diaphragm pulls the lungs down creating NEGATIVE Pressure

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21
Q

Mechanics of breathing:

- alveolar pressure during expiration

A

POSITIVE pressure

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22
Q

atelectasis

A

complete or partial collapse of lungs

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23
Q

total lung volume

A

5500-6000 ml

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24
Q

Tidal volume

A

amount of air inhaled and exhaled with each breath

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25
Q

Inspiratory reserve volume

A

volume of air that can be inspired beyond tidal volume

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26
Q

Expiratory reserve volume

A

volume of air that can be expired by force after end of tidal expiration

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27
Q

residual volume

A

volume of air remaining in the lungs after a forceful expiration

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28
Q

Functional residual capacity (FRC)

A

air reserve (1000 ml)

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29
Q

why is intake of O2 important

A
  • for metabolism

- to remove CO2

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30
Q

External respiration

A

gas exchange in alveolar-capillary membrane in the lungs

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31
Q

Internal respiration

A

diffusion of gases in and out of the cells at the tissue level

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32
Q

Diffusion

A

O2 and CO2 move from high concentration to low concentration

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33
Q

which is more diffusible in plasma? CO2 or O2

A

CO2

- O2 needs the help of hgb

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34
Q

Ventilation (V) & Perfusion (Q) should be what ratio at capillary membrane

A

equally matched- 1:1

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35
Q

V/Q

-shunt

A

perfusion (Q) in excess of ventilation (V)

- V

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36
Q

what dz causes shunts

A
  • pneumonia
  • mucus plug
  • bad airflow but good blood flow
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37
Q

V/Q

-dead space

A

ventilation in excess of perfusion

  • V>Q
  • this is a HIGH ratio
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38
Q

what dz causes dead space

A

cardiogenic shock

* good airflow but bad blood flow

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39
Q

Two methods of oxygen transport

A

1) dissolved in plasma (PaO2)

2) chemically bound to hgb (SaO2)

40
Q

Oxyhemoglobin Dissociation Curve

A

relationship between dissolved oxygen and hgb-bound oxygen

41
Q

CRITICAL ZONE of oxy-hgb dissociation curve

A

when PO2

42
Q

Oxy-Hgb Dissociation Curve:

- strength of bond in lungs

A

strong bond so that hgb can pick up O2 more easily in the lungs

43
Q

Oxy-Hgb Dissociation Curve:

- strength of bond in tissues

A

weak bond so that hgb will let go of O2 and allow it to diffuse into the tissue

44
Q

Oxy-Hgb Dissociation Curve:

-association between O2 saturation levels and P02 levels

A

after 80% O2 saturation, the P02 levels begin to fall below the critical zone
-this is why it is important to keep O2 sats >90%

45
Q

Oxy-Hgb Dissociation Curve:

- what causes a shift to the LEFT

A
  • High pH
  • low PCO2
  • low temp
  • ALKALOSIS
46
Q

Oxy-Hgb Dissociation Curve:

- what causes a shift to the RIGHT

A
  • Low pH
  • High PCO2
  • high temp
  • ACIDOSIS
47
Q

Oxy-Hgb Dissociation Curve:

- Shift to the left patho

A

higher O2 saturation for any PaO2 & INCREASED hgb affinity

48
Q

Oxy-Hgb Dissociation Curve:

-shift to the right patho

A

lower O2 saturation for any PaO2 and DECREASED hgb affinity

49
Q

Control of breathing:

-what do the Pons & Medulla control ?

A

-AUTOMATIC ventilation

50
Q

Control of breathing:

- what does the Cerebral cortex control?

A

VOLUNTARY ventilation

51
Q

Central Chemoreceptors:

- where are they located

A

ventral surface of the medulla

52
Q

Central Chemoreceptors:

-what do they react to?

A

changes in H+ ion concentration and directly driven by PaCO2

53
Q

Central chemoreceptors:

- what happens when H+ ions increase

A

Ventilation increases

54
Q

Central chemoreceptors:

- what happens when H+ ions decrease

A

Ventilation decreases

55
Q

Central chemoreceptors:

-What is the most potent stimulus for breathing?

A

CO2

56
Q

How does CO2 cross the BBB?

A

conversion of CO2 with H+ allows it to cross

57
Q

where are peripheral cehmoreceptors located?

A

above and below the aortic arch

58
Q

1) CENTRAL: what drives breathing?

2) PERIPHERAL: what drives breathing?

A

1) CO2

2) low O2

59
Q

Why is it bad to give a COPD patient high levels of O2?

A

Their body is used to high levels of CO2. the low levels of O2 are the only mechanism that drives them to breath
* if high O2 is given to them, it may depress their breathing mechanisms

60
Q

Hypoxemia

A

inadequate levels of oxygen in the blood

61
Q

normal PaO2 levels in adults younger than 60

A

80-`100

62
Q

normal PaO2 levels in adults older than 60

A

80 - # of years over 60 =
- age 66

80-6= 74 PaO2 ok!

63
Q

Causes of hypoxemia

A
  • hypoventilation
  • Shunt (unventilated): blood reaches but no air
  • ventilation/perfusion inequalities: underventilation most common cause
64
Q

causes of hypoxia

A
  • low O2 in tissues
  • hypoxemia
  • abnormal hgb
  • low CO
  • Low BP
  • toxic substances
65
Q

Body systems response to hypoxia

A
  • tachycardia
  • tachypnea, SOB
  • decr. U.O : vasoconstrict
  • restless, confusion
  • ABGs
66
Q

Hypoxic pulmonary vasoconstriction (HPV)

A

when there is low O2 in the lungs, re-routes blood to adequate oxygenated alveoli to reduce the shunt

67
Q

S/S of ACUTE hypoxia

A
  • pulmonary edema
  • Cor pulmonale: R heart failure d/t pulmonary HTN
  • COPD only cure is O2
68
Q

Complications of oxygen therapy

A
  • dehydration and cracking of mucosa

* use humidified air

69
Q

Oxygen toxicity

A

breathing >50% for more than 24 hours causes severe gas exchange impairment with cough, dyspnea, and chest pain

70
Q

how many liters of air given via Nasal Canula

A

1-6 liters

71
Q 
FiO2's:
RA
NC 1 L
2L
3L
4L
5L
6L
A 
.21
.24
.28
.32
.36
.40
.44
72
Q

simple oxygen mask

  • components
  • liters of air
A
  • covers mouth a nose
  • vents for exhale
  • 5-8 L @ 40-60%
73
Q

non-rebreathing mask

A

short term therapy for acutely ill

  • 90-100 FiO2
  • valves open for inhalation and close exhalation
  • pt can only inhale fresh O2
74
Q

high flow devices

A
  • the O2 amount remains constant despite changes in ventilatory volume of the patient
  • filters out the upper airway & fills it with O2
75
Q

Normal values:

pH

A

7.35-745

76
Q

PaCO2

A

35-45

77
Q

HCO3

A

22-26

78
Q

PaO2

A

80-100

79
Q

SaO2

A

> 90

80
Q

How are VOLATILE acids excreted?

A

as a gas

81
Q

How are NON-VOLATILE acids excreted?

A

by the kidneys

-ex) lactic acid/keto acids

82
Q

Regulation of Plasma pH:

-chemical buffers

A
  • carbonic acid/bicard system: kidneys
  • phosphate system
  • proteinate system-most abundant b.c proteins in body
    • responds in seconds
83
Q

Regulation of Plasma pH:

- respiratory regulation

A

thru PaCO2 manipulation

*takes minutes

84
Q

Regulation of Plasma pH:

-renal regulation

A

thru HCO3 elimination or conservation

*takes hours or days

85
Q

Respiratory Alkalosis

  • cause
  • compensation
A
  • Low PCO2
  • d.t hyperventilation
  • kidneys will excrete bicarb and keep H+
86
Q

Metabolic Alkalosis

  • cause
  • compensation
A
  • High HCO3
  • d.t vomiting, diarrhea, NG suction, decr ventilation
  • kidneys keep H+ and excrete bicarb
87
Q

Respiratory Acidosis

  • cause
  • compensation
A
  • High PCO2
  • hypoventilation, mucus plug, obstruction
  • kidneys excrete H+ and retain bicrarb
88
Q

Metabolic Acidosis

  • cause
  • cpmpenstation
A
  • Low HCO3
  • d.t diarrhea, diabetic ketoacidosis, sepsis, low BP
  • CO2 eliminated, kidneys excrete H+ and retain bicarb
89
Q

S/S metabolic acidosis

A

pain, restless, chest pain, palpapitations, ALOC

-coma, low BP, tachycardia

90
Q

Treatment of Metabolic acidosis

A
  • fluids
  • insulin
  • dialysis
  • vasopressors
  • IV BICARB NOT A CURE
91
Q

Potassium effect:

1) Acidosis
2) Alkalosis

A

1) hyperkalemia

2) hypolkalemia

92
Q

Anion gap

A

difference between unmeasured cations and unmeasured anions

93
Q

Anion Gap formula

A

Na- (Cl+Bicarb) = 8-16 mEq/L

94
Q

what does an anion gap show?

A

severity of METABOLIC ACIDOSIS

95
Q

anion gap >16 means?

A

renal failure or DKA

96
Q

anion gap normal with acidosis means?

A

diarrhea

Critical Care Test 1 (13 decks)

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