Pulmonary Normal Physiology, Response to Exercise & Abnormal Physiology

Question 1

Normal SpO2 =
Normal PaO2 =
Normal Respiratory Rate =

Answer 1

95-100%
80-100 mmHg
12-18 breaths/min

Question 2

SpO2:
– percentage of ____ bound to O2
– how do you measure?
– measures:
– exact/not exact measurement?

Answer 2

– Hgb
– pulse ox –> non invasive
– how much O2 is being delivered to tissues
– not as exact

Question 3

PaO2:
– partial pressure of dissolved ____ in arterial blood
– how do you measure?
– reflective of:
– exact/not exact measurement?

Answer 3

– O2
– requires arterial blood gas lab draw
– the balance of O2 delievery and consumption
– most accurate way to determine effectiveness of blood oxygenation

Question 4

true or false. normal respiratory rate has regular rhythm with non-labored effort, tidal volume is ~500 mL and no audible sounds are heard.

Answer 4

true

Question 5

what is eupnea?

Answer 5

normal breathing rate and pattern

Question 6

cardiac biomarkers:
– lab value is ____
– normal value:
– indication?

Answer 6

– BNP
– < 100 pg/mL
– released in response to ventricular stretch or worsening heart failure

Question 7

CBC:
– lab value used in pulmonary:
– normal range:
– indication:

Answer 7

– hemoglobin (Hgb)
– M: 14-18 ; F: 12-16
– Transports O2

Question 8

arterial blood gases:
– pH normal:
– PaO2 normal:
– PaCO2 normal:
– HCO3:
– indication for drawing blood gases?

Answer 8

– 7.35-7.45
– 80-100 mmHg
– 35-45 mmHg
– 22-26 mEq/L
– all portions that control normal blood chemistry for optimal physiologic function

Question 9

what is normal SpO2 response during exercise?

Answer 9

initially: transient drop when exercise starts –>
with increasing workload: increase in respiratory rate brings SpO2 back to stable/normal levels

Question 10

what may happen to SpO2 with long duration exercise once steady state is reached?

Answer 10

SpO2 may increase

Question 11

should SpO2 fluctuate greatly with a normal response to exercise?

Answer 11

no

Question 12

what is normal respiratory rate response to exercise?

Answer 12

gradual increase with increased workload
rapid rise after anaerobic threshold is reached (VT2)

Question 13

does respiratory rate fluctuate during exercise once steady state has been reached?

Answer 13

no - minimal change should happen

Question 14

what is normal lung volume response to exercise?

Answer 14

increases linearly with increasing workload

Question 15

tidal volume ___(increases/decreases)___ to meet demands of exercise and can approach _______ volumes

Answer 15

increases ; vital capacity (VC)

Question 16

*** normal progression of respiration due to exercise **

Question 17

Abnormal SpO2 =
Abnormal RR =
Abnormal HR =
Abnormal BP =

Answer 17

< 90% at rest, acute change in O2 demand/device
< 10 or > 30 / min. at rest ; unable to maintain conversation
< 50 or > 120 at rest ; uncontrolled/new arrhythmia
> 180/90 or < 90/60 or MAP < 60

Question 18

what could cause hypoxemia/hypoxia in a patient?

Answer 18

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

Question 19

what is Hypoxemia?

Answer 19

low blood O2 levels measured by SpO2 or PaO2

Question 20

symptoms of hypoxemia?

Answer 20

headache
dyspnea
tachycardia
coughing
wheezing
confusion, AMS
Cyanosis of fingers or lips

Question 21

what is hypoxia?

Answer 21

under-oxygenation of tissues that impair cellular metabolism

Question 22

symptoms of hypoxia?

Answer 22

restlessness
headache
confusion, AMS
tachycardia
anxiety
tachypnea, dyspnea

Question 23

symptoms of severe hypoxia?

Answer 23

bradycardia
extreme restlessness
cyanosis
passing out

Question 24

abnormal breathing patterns:
bradypnea =
tachypnea =
apnea =
hyperpnea =
cheyne-stokes =
agonal =

Answer 24

– dec. RR
– inc. RR
– absence of breathing
– normal rate but deep respirations
– gradual increase and decrease in respirations with periods of apnea
– apnea with periods of inconsistent respirations

Question 25

causes of abnormal breathing patterns:
bradypnea =
tachypnea =
apnea =
hyperpnea =
cheyne-stokes =
agonal =

Answer 25

– sleep, drugs, metabolic disorder, CVA/ABI
– fever, anxiety, shock, exercise, pathology
– not alive
– emotional stress, diabetic ketoacidosis
– inc. intracranial pressure, brainstem injury
– actively dying, severe CVA/ABI

Question 26

what is restrictive lung volume?

Answer 26

decreased vital capacity and total lung capacity

Question 27

with restrictive lung volume, what are the biggest limitations to functional endurance?

Answer 27

dec. inspiratory reserve volume (IRV - breath in) and dec. expiratory reserve volume (ERV - breath out)

Question 28

what is obstructive lung volume?

Answer 28

increased vital capacity and total lung capacity

Question 29

with obstructive lung volume, what are the biggest limitations to functional endurance?

Answer 29

increased ERV and residual volume (RV)

Question 30

what is an abnormal SpO2 response to exercise?

Answer 30

persistent and/or ongoing drop in O2 with increasing workload
AND
increasing supplemental O2 delivery to maintain homeostasis

Question 31

what is the physiologic implication of drop in O2 with increasing workload?

Answer 31

ischemia to muscles that need to be working while performing exercise

Question 32

what is important to know before making clinical decisions to stop activity or reduce intensity?

Answer 32

individual patient O2 goals

Question 33

what is an abnormal RR response to exercise?

Answer 33

drop in RR –> there are no normal scenarios that RR drops with increasing workload
AND
rapid increase in RR that does not match intensity of workload

Question 34

how do you monitor how close your patient is to their VT2?

Answer 34

maintain ongoing conversation

Question 35

what are basic principles of O2 delivery?
- supplementing ____
- observe:
- maintain:
- awareness in ability to __

Answer 35

• 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 patient during mobility
• awareness of PT role in ability to titrate/adjust O2

Question 36

what is:
– flow rate?
– concentration?

Answer 36

– how fast air is being delivered, expressed in L/min
– FiO2 of O2, expressed in % (how much of that air is O2)
—> the faster the FiO2, the faster it needs to be delivered

Question 37

what is FiO2?
– what is atmospheric air FiO2?

Answer 37

fraction of inspired oxygen (FiO2) = percentage of inhaled air that is O2
– 21%

Question 38

how do we determine how much oxygen our patient is on?

Answer 38

every 1 L/min above room air adds ~4% FiO2
ex: pt on 2 L O2 –> 2x4% = 8% + 20% = 28%
** 20% is atmospheric air

Question 39

Nasal cannula:
– amount
– requires humidification??
– can only change ____

Answer 39

– 1-6 L/min “low flow”
– does not require added
– flow rate

Question 40

face mask:
– amount:
– requires humidification??
– can only change ____

Answer 40

– 6-12 L/min
– does not
– flow rate

Question 41

high flow nasal cannula:
– amount?
– requires ___
– how do we ensure it reaches the pt?

Answer 41

– 6-15 L/min for some types
– humidification added since air is moving faster
– inner lumen of cannula is patterned to direct high air flow

Question 42

heated high flow nasal cannula:
– amount?
– what helps protect airways and keep secretions thin?

Answer 42

– up to 60 L/min and 100% FiO2
– heated humidifications

Question 43

venturi mask:
– amount?
– sets flow based on ____
– can only titrate:

Answer 43

– up to 60% FiO2
– FiO2
– FiO2

Question 44

Non-Rebreather device:
– amount?
– how does oxygen get delivered?

Answer 44

– 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