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CRNA Adv. A&P > Pulmonary Pt2 > Flashcards

Pulmonary Pt2 Flashcards

1
Q

Where does the normal automatic process of breathing originate from?

A

The Brainstem

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2
Q

Neurons in which part of the brain control unconscious breathing?

A

Neurons in the medulla and pons in the brainstem

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3
Q

If voluntary control of breathing is needed, which part of the brain can override the medulla and pons?

A

The cortex

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4
Q

The automatic rhythm of breathing is controlled by neurons located where?

A

In the Respiratory nuclei of the medulla rhthymicity center.

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5
Q

inspiratory center

A

-(dorsal respiratory group)
•frequent signals, you inhale deeply
•signals of longer duration, breath is prolonged

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6
Q

expiratory center

A

(ventral respiratory group)

•involved in forced respiration

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7
Q

rate and depth control

A

Pons

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8
Q

pneumotaxic center (pons)

A

•sends inhibitory impulses to inspiratory center, as impulse frequency rises, breaths shorter, faster and shallower (turns of inspiration to prevent overinflation of lungs)

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9
Q

_______ is the reticular formation of the medulla beneath the floor of the fourth ventricle

A

medullary respiratory center

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10
Q

apneustic center (pons)

A

•promotes maximal lung inflation and long, deep breaths of Inspiration and expiration (turns off the pneumotaxic

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11
Q

Dorsal Respiratory Group (medullary resp center)

A

sets the basic respiratory rhythm

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12
Q

Ventral Respiratory Group (medullary resp center)

A

associated with forced respiration

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13
Q

Dorsal and Ventral Respiratory Groups’ cells have/responsible

A

•intrinsic periodic firing abilities and are responsible for basic rhythm of ventilation

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14
Q

Pre-Botzinger Complex (medullary resp center)

A

-(part of Ventral Group) = essential for generation of the respiratory rhythm

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15
Q

T/F Dorsal and Ventral Respiratory Groups’ cells, even when all afferent stimuli is abolished, these cells generate repetitive action potentials that send impulses to the diaphragm and other respiratory muscles

A

True

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16
Q

pneumotaxic center location/inhibits/limits

A
  • located in upper pons
  • inhibits inspiration
  • limits the burst of action potentials in the phrenic nerve, effectively decrease the tidal volume and regulating the respiratory rate
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17
Q

Impulses from ____ and _____ modulate the output of inspiratory cells

A

the Vagus (X) and Glossopharyngeal (IX)

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18
Q

Input to Respiratory Centers from limbic system and hypothalamus

A

resp effects of pain and emotion

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19
Q

Input to Respiratory Centers from chemoreceptors

A

Resp effects of blood pH, CO2 and O2 levels

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20
Q

•Rate and depth of breathing adjusted to maintain levels of:

A
  • pH
  • Pco2
  • Po2
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21
Q

what can exist in absence of pneumotaxic center

A

-“Fine tuning” of respiratory rhythm because a normal rhythm can exist in the absence of this center

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22
Q

primary stimulus for central chemoreceptors

A

pH of CSF

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23
Q

Apneustic center location/impulse/promotes/sends

A
  • located in the lower pons
  • Impulses have an excitatory effect on the Dorsal Respiratory Group in the medulla
  • Promotes inspiration
  • Sends signals to the Dorsal Respiratory Group in the medulla to delay the “switch off” signal provided by the pneumotaxic center
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24
Q

CO2 easily crosses

A

BBB

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25
Q

in CSF the CO2 reacts with water and releases

A

H+

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26
Q

the cycle of inspiration:

A

-Crescendo of action potentials leading to a ramp of strengthening inspiratory muscles
-
-Inspiration action potentials cease and inspiratory muscle tone falls
-
-Expiration occurs due to elastic recoil of lung tissues and chest wall

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27
Q

central chemoreceptors strongly stimulate

A

inspiratory center

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28
Q

“blowing off” CO2 pushes reaction to the

A

left

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29
Q

Input to Respiratory Centers from airways and lungs

A

and lungs
-irritant receptors in respiratory mucosa
•stimulate vagal signals to medulla, result in bronchoconstriction / coughing
-stretch receptors in airways - inflation reflex
•excessive inflation triggers stop of inspiration
•J-receptors - juxtapulmonary capillary receptors - increase rapid, shallow breathing

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30
Q

hypoventilation pushes reaction to the

A

right

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31
Q

ketoacidosis may be compensated for by _____ respirations

A

Kussmaul

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32
Q

peripheral chemoreceptors

A

-found in major blood vessels
>aortic bodies (signals medulla via C.N. X)
>carotid bodies (signal medulla by C.N. IX)

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33
Q

central chemoreceptors

A

-in medulla
>primarily monitor pH of CSF
>inc H+ stimulates ventilation
>dec H+ inhibits it

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34
Q

central chemoreceptors mediate ___ % of ventilatory response

A

80%

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35
Q

peripheral chemoreceptors mediate ____ % of ventilatory response

A

20%

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36
Q

normal pH of CSF

A

7.33

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37
Q

CSF has much less buffering capacity compared to blood, resulting in:

A

greater change in pH with changes in PCO2

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38
Q

•With _______ disease, the hypoxic drive to ventilation becomes very important

A

severe lung disease

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39
Q

most important peripheral chemoreceptors

A

carotid bodies

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40
Q

carotid bodies afferent nerve

A

glossopharyngeal (C.N. IX)

41
Q

Carotid bodies respond to

A

decreases in arterial PO2 and pH, and increases in arterial PCO2

42
Q

carotid receptors respond to drop in ___ via ___ nerve

A

pH and C.N IX

43
Q

aortic receptors respond to ____ via ____ nerve

A

PCO2 and C.N. X

44
Q

ventilation receptors enhance by:

A

1) metabolic acidosis
2) low PO2 (<60 mmHg)
3) elevated temperature

45
Q

ventilation receptors suppressed by:

A

1) metabolic alkalosis
2) any CNS depressant
3) cold
4) narcotics

46
Q

•Changes can be compensated by ______ of HCO3- into the CSF

A
  • active transport
  • Example: A patient with chronic lung disease will have CO2 retention, but may have a near normal CSF pH and a resulting low ventilation for his or her PCO2 level
47
Q

Transitional flow

A

a mixture of laminar and turbulent flow and occurs at branch points in the airways

48
Q

The trachea and larger airways have either

A

•turbulent or transitional airflow

49
Q

peripheral chemoreceptors located

A

-Located in the carotid bodies at the bifurcation of the common carotid arteries, and in the aortic bodies above the aortic arch

50
Q

Laminar flow in

A

smallest airways

51
Q

Intrapleural Pressure

A

Pressure in the potential space between the parietal and visceral pleura is normally subatmospheric around -3 to -5 cm H2O

52
Q

T/F Not all alveoli are ventilated equally

A

True

53
Q

Alveoli in the lower lungs (base) receive

A

•receive more ventilation per breath than alveoli of the upper regions of the lungs in the awake, spontaneously breathing, upright patient.

54
Q

dependency

A

•The influence of gravity on a supported structure

-accounts for regional differences in alveolar ventilation (dependent vs. nondependent)

55
Q

difference in volume and compliance leads

A

leads to a difference in ventilation

56
Q

Effective gas exchange depends on

A

•depends on an approximately even distribution of gas (ventilation) and blood (perfusion) in all portions of the lungs (VQ).

57
Q

Ventilation and perfusion depend

A

body position

58
Q

Distribution of perfusion in the pulmonary circulation also is affected by

A

alveolar pressure (gas pressure in the alveoli)

59
Q

determine rate of diffusion of each gas and gas exchange between blood and alveolus

A

partial pressures (as well as solubility of gas)

60
Q

the volume remaining in the lungs at the end of a normal tidal expiration.

A

FRC (functional residual capacity)

61
Q

Elasticity

A

•the tendency of lung tissue to return to its original (or relaxed) position after an applied force has been removed.

62
Q

to keep the lungs inflated what is required and how is it provided

A
  • an opposing pressure

- Provided by the chest wall and the respiratory muscles (Compliance)

63
Q

end of expiration diaphragm is

A

relaxed

64
Q

inspiration diaphragm is

A

contracting

65
Q

end of inspiration diaphragm

A

contracted

66
Q

expiration diaphragm

A

relaxing

67
Q

Lungs do what with negative pressure in the thorax

A

expand

68
Q

small airway closure and trapping somewhat prevents air ____

A

loss

69
Q

West Lung Zones

A
  • PA = alveolar pressure
  • Pa = arterial pressure
  • Pv = venous pressure
  • Zone I: PA>Pa>Pv
  • Zone II: Pa>PA>Pv
  • Zone III: Pa>Pv>PA
  • Zone I = PA, compressed arterioles = V w/o Q = deadspace (usually only seen in mechanically ventilated pts)
70
Q

Airway collapse during forced expiration

A

in normal individuals this only occurs in very small airways overall result is that the lungs cannot be completely emptied

71
Q

compliance is the opposite of

A

elasticity

72
Q

compliance

A

it is a measure of the distensibility of the lung

73
Q

Minute Ventilation (VE) equation

A

Ve = Vt x f

VE = minute ventilation (volume per minute)
vT = tidal volume (volume per breath)
f = frequency or RR (Respiratory Rate)
Example:
VE = vT x f
= 500 x 10
= 5000 ml/min.
74
Q

anatomic ds =

A

conducting airway

75
Q

mechanical ds =

A

ventilator machine circuit, ET tube, etc

76
Q

alveolar ds =

A

nonperfused alveoli

77
Q

physiologic ds =

A

the sum of anatomic & alveolar ds

78
Q

•If you want to increase alveolar ventilation, should you increase respiratory rate or tidal volume?

A

increasing tidal volume is more effective to increase VA than increasing breathing frequency

79
Q

Increasing frequency while maintaining a constant volume results in

A

§in proportional increase of both alveolar ventilation and dead space

80
Q

Increasing tidal volume while maintaining constant frequency results in

A

§no change to dead space but an increase in alveolar ventilation

81
Q

what is important for gas exchange between air in lungs and blood in capillaries

A

air-water interface

82
Q

Time required for gases to equilibrate

A

0.25 sec

83
Q

RBC transit time at rest

A

0.75 sec to pass through alveolar capillary

84
Q

•Reduced compliance is caused by:

A
  • Increased fibrous tissue (ex. pulmonary fibrosis)
  • Alveolar edema
  • If the lung remains unventilated for a long period with low volumes (atelectasis and increases in surface tension)
85
Q

RBC transit time with vigorous exercise

A
  • Diameter of airway
  • Flow (Laminar vs. Turbulent)
  • Density of gas (viscosity)
  • Governed by Poiseuille’s Law
  • Age or Pathologies that affect recoil (ex. Pulmonary fibrosis)
86
Q

% of O2 bound to hemoglobin

A

98.5%

87
Q

% of O2 dissolved

A

1.5%

88
Q

Alveolar minute ventilation equation

A

VA = (VT - VDS) x RR

VA = alveolar ventilation
VT = tidal volume
VDS = physiologic dead space ~ 1ml per pound ideal body wgt.
Example: 150 pound pt.
VA = (VT - vDS ) x RR
= (500 - 150) x 10
= 3500 ml/min.
89
Q

alveolar age effects

A

•Decreased alveolar elasticity and lung compliance, respiratory muscles weaken
•Higher Residual Volume and decreased maximal expiratory flow rates
-
•Loss of alveolar surface area
•Decreased pulmonary perfusion

90
Q

•Restrictive disorders

A 
- decrease compliance and vital capacity
•Pulmonary Fibrosis
•Sarcoidosis
•Interstitial Lung Disease
•Myasthenia gravis
•ALS
91
Q

•Obstructive disorders

A

-interfere with airflow, expiration requires more effort or is less complete
•Asthma
•COPD
•Emphysema

92
Q

Mixture of gases; each contributes its

A

•partial pressure

-at sea level 1 atm. of pressure = 760 mmHg
-nitrogen constitutes 78.6% of the atmosphere so
•PN2 = 78.6% x 760 mmHg = 597 mmHg
•PO2 = 159
•PH2O = 3.7
•PCO2 = + 0.3
•PN2 + PO2 + PH2O + PCO2 = 760 mmHg

93
Q

•Partial pressures (as well as solubility of gas) determine

A

-determine rate of diffusion of each gas and gas exchange between blood and alveolus

94
Q

alveolar air

A

-humidified, exchanges gases with blood, mixes with residual air
-contains:
•PN2 = 569
•PO2 = 104
•PH2O = 47
•PCO2 = 40 mmHg

95
Q

•Henry’s law

A

-amount of gas that dissolves in water is determined by its solubility in water and its partial pressure in air

96
Q

factors affecting gas exchange

A

•Concentration gradients of gases
-PO2 = 105 in alveolar air versus 40 in blood
-PCO2 = 45 in blood arriving versus 40 in alveolar air
•Gas solubility
-CO2 20 times as soluble as O2
•O2 has conc. gradient, CO2 has solubility
•Membrane thickness - only 0.5 mm thick
•Membrane surface area - 100 ml blood in alveolar capillaries, spread over 70 m2
•Ventilation-perfusion coupling - areas of good ventilation need good perfusion

97
Q

Oxygen concentration in arterial blood

A

-20 ml/dl

98
Q

•Oxyhemoglobin dissociation curve

A
  • relationship between hemoglobin saturation and PO2 is not a simple linear one
  • after binding with O2, hemoglobin changes shape to facilitate further uptake (positive feedback cycle)

CRNA Adv. A&P (8 decks)

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