Respiratory Flashcards
When looking at the oxyhemoglobin dissociation curve graph, what causes there to be a steep incline?
This is the result of the increased ease of O2 binding as the second, third, and forth O2 molecules are bound to the same heme subunits.
Your patient is hypothermic and breathing rapidly. Would you expect to see a left or right shift of the oxyhemoglobin dissociation curve?
Left Shift
What are some long term effects of Chronic Bronchitis (COPD)?
- Increased CO2 retention via V/Q mismatch
- Acidemia
- Hypoxia
What is the most common cause of respiratory failure?
V/Q Mismatch.
** ventilation / perfusion mismatch **
What are some factors that could cause a right shift of the oxyhemoglobin dissociation curve?
- Increased PCO2 (slow breathing)
- Increased Temperature
- Increased 2, 3 DPG
- Decreased pH (Acidosis)
_______ is the second most common cause of sudden, unexpected death, at any age.
Pulmonary Embolus
What is the target oxygen therapy for patients with COPD?
- SaO2 > 90%
- PaO2 > 60 mmHg
What is the primary cause of death for patients suffering from ARDS?
Sepsis and/or multi-organ failure
** Acute Respiratory Distress Syndrome **
What appearance would you expect the oxyhemoglobin dissociation curve to have in the presence of a high V/Q mismatch?
The oxyhemoglobin dissociation curve would have a flat appearance.
_______ is defined by permanent enlargement of the air spaces distal to the terminal bronchioles.
Chronic Emphysema (COPD)
True or False
ABGs are extremely reliable in the setting of a pulmonary emboli.
False.
ABGs are unreliable in the setting of a pulmonary emboli.
What are type 2 respiratory cells?
Type 2 respiratory cells are responsible for surfactant production.
_______ is a condition of expiratory airflow obstruction as measured by a decrease in the forced expiratory volume in one second.
COPD
If a patient experiences an increase of pH levels (respiratory alkalosis), would you expect a left or right shift in the oxyhemoglobin dissociation curve?
Left Shift
True or False
Patients suffering from ARDS usually require less PEEP then other respiratory related diseases.
False.
Acute Respiratory Distress Syndrome (ARDS) patients will generally require PEEP at 12 - 18 cm H2O
** normal PEEP is 5 - 10 cm H2O **
A patient is being adequately ventilated yet perfusion remains low. Is this suggestive of a high or low V/Q mismatch?
High V/Q Mismatch
** the alveoli are well inflated but oxygen is not diffusing into the blood **
A _______ shift results in more oxygen released from the hemoglobin, resulting in greater oxygen delivery to tissues.
Right Shift shift results in more oxygen released from the hemoglobin, resulting in greater oxygen delivery to tissues.
True or False
Asthma is consider to be a form of COPD
False
** To be considered a form of COPD, the condition must be irreversible **
When oxygen is bound to hemoglobin, which shift in the oxyhemoglobin dissociation curve is conducive to releasing the oxygen?
Right Shift releases oxygen
_______ is characterized as bronchoconstriction, airway inflammation, edema, and mucus plugging.
Asthma
________ is the result of chronic irritation which causes hyperplasia of the tracheobronchial mucus glands and goblet cells.
Chronic Bronchitis (COPD)
________ is the occlusion of the pulmonary artery or one or more of its branches.
Pulmonary Embolus
Typical non-rebreather mask only deliver ______% FiO2.
60 - 70% FiO2
To be classified as “emergency oxygen,” the administration of oxygen must meet one of two criteria. What are they?
Oxygen must be delivered:
- at a dose ≥ 6 L/min
- –OR—
- run for > 15 mins
Would a pulmonary emboli result in a high or low V/Q mismatch?
High V/Q mismatch
** gas is getting into the lungs but the blood flow to facility gas exchange is reduced **
______ is the balance between the ventilation (bringing the oxygen in to and removing of CO2 from the alveoli) and the perfusion (removing oxygen from the alveoli and adding carbon dioxide).
V/Q Ratio -
** Ventilation/Perfusion Ration **
A _______ shift results in less oxygen being released by hemoglobin at significantly lower PO2, resulting in decreased O2 delivery to tissues.
Left Shift results in less oxygen being released by hemoglobin at significantly lower PO2, resulting in decreased O2 delivery to tissues.
When oxygen is bound to hemoglobin, which shift in the oxyhemoglobin dissociation curve is conducive to holding onto the oxygen?
Left Shift holds onto the oxygen
Your patient is hyperthermic and breathing slowly (6-8 rpm). Would you expect to see a left or right shift of the oxyhemoglobin dissociation curve?
Right Shift
When looking at the oxyhemoglobin dissociation curve graph, why is the first part of graph relatively flat?
This indicates the difficulty of attaching the first O2 molecule to the heme subunit on the hemoglobin molecule.
________ is defined as the presence of a productive cough for three months out of the year for two years in a row.
Chronic Bronchitis (COPD)
A patient with adequate blood flow yet the alveoli are not exchanging gas effectively is suggestive of what?
Low V/Q Mismatch
** poor ventilation **
What is a major factor in the causation of pulmonary emboli?
Hypercoagulability
- AMI
- CHF
- A-Fib
- Pregnancy
What are some factors that could cause a left shift of the oxyhemoglobin dissociation curve?
- Decreased PCO2 (rapid breathing)
- Decreased Oxygen
- Decreased 2, 3 DPG
- Decreased Temperature
- Increased pH (Alkalosis)
- CO poisoning
What are type 1 respiratory cells?
Type 1 respiratory cells are responsible for gas exchange (alveoli tissue)
If a patient experiences a decrease of pH levels (respiratory acidosis), would you expect a left or right shift in the oxyhemoglobin dissociation curve?
Right Shift
What are some primary factors that affect oxygen’s “affinity?”
- Carbon Dioxide Levels
- Oxygen Levels
- Temperature
- 2, 3 DPG
- pH
If a patient has a reported history of destruction of the alveolar walls and loss of elastic recoil within the lung, and a barrel like appearance, what disease would you most likely expect the patient to have?
Chronic Emphysema (COPD)
True or False
Applying a nasal cannula at 15 L/min PLUS using a non-rebreather mask will significantly increase oxygen delivery as well as increase PEEP.
True
What is the calculation for oxygen delivery?
4 - 8 ml/kg
** based on IDBW **
What are the two classifications of COPD?
- Emphysema
- Bronchitis
What “triggers” the hemoglobin to release oxygen?
The surrounding tissue has a low concentration on PO2.
