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Cardiopulmonary I > Pulmonary Normal Physiology, Response to Exercise & Abnormal Physiology > Flashcards

Pulmonary Normal Physiology, Response to Exercise & Abnormal Physiology Flashcards

1
Q

Normal SpO2 =
Normal PaO2 =
Normal Respiratory Rate =

A

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

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

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

A

true

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5
Q

what is eupnea?

A

normal breathing rate and pattern

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

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

A

– 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

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9
Q

what is normal SpO2 response during exercise?

A

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

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10
Q

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

A

SpO2 may increase

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11
Q

should SpO2 fluctuate greatly with a normal response to exercise?

A

no

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12
Q

what is normal respiratory rate response to exercise?

A

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

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13
Q

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

A

no - minimal change should happen

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14
Q

what is normal lung volume response to exercise?

A

increases linearly with increasing workload

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15
Q

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

A

increases ; vital capacity (VC)

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16
Q

describe the normal physiological progression of respiration due to exercise:

A

respiration increases –> more O2 used, increased CO2
brain detects increase in CO2 –>
CNS signals lungs to increase RR –>
inc. RR & lung volume leads to inc. gas exchange –>
CNS signals heart to inc HR –> so more blood is pumped to lungs for gas exchange –>
inc. O2 is sent to muscles to balance inc. demand –>
increased CO2 is blown off from inc. RR

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17
Q

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

A

< 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

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18
Q

what could cause hypoxemia/hypoxia in a patient?

A

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

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19
Q

what is Hypoxemia?

A

low blood O2 levels measured by SpO2 or PaO2
** low O2 in blood

20
Q

symptoms of hypoxemia?

A

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

21
Q

what is hypoxia?

A

under-oxygenation of tissues that impair cellular metabolism
** low O2 in tissues
** worse! Reg flag

22
Q

symptoms of hypoxia?

A

restlessness
headache
confusion, AMS
tachycardia
anxiety
tachypnea, dyspnea

23
Q

symptoms of severe hypoxia?

A

bradycardia
extreme restlessness
cyanosis
passing out

24
Q

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

A

– 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

25
Q

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

A

– 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

26
Q

what are abnormal restrictive lung volumes?

A

decreased vital capacity and total lung capacity

27
Q

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

A

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

28
Q

what are abnormal obstructive lung volumes?

A

increased vital capacity and total lung capacity

29
Q

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

A

increased ERV and residual volume (RV)

30
Q

what is an abnormal SpO2 response to exercise?

A

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

31
Q

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

A

ischemia to muscles that need to be working while performing exercise

32
Q

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

A

individual patient O2 goals

33
Q

what is an abnormal RR response to exercise?

A

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

34
Q

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

A

maintain ongoing conversation

35
Q

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

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 patient during mobility
  • awareness of PT role in ability to titrate/adjust O2
36
Q

is it within PT scope of practice to adjust supplemental O2?

A

no - O2 is considered a medication

37
Q

what is:
– flow rate?
– concentration?

A

– 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

38
Q

what is FiO2?
– what is atmospheric air FiO2?

A

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

39
Q

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

A

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

40
Q

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

A

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

41
Q

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

A

– 6-12 L/min
– does not
– flow rate

42
Q

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

A

– 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

43
Q

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

A

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

44
Q

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

A

– up to 60% FiO2
– FiO2
– FiO2

45
Q

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

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

Cardiopulmonary I (25 decks)

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