Respiratory Flashcards
Ventilation is the movement of ______ in/out of the _______
Respiration is the movement of ___ between _______ in the lungs and the ________
Ventilation is the movement of AIR in/out of the LUNGS
Respiration is the movement of GASES between ALVEOLI in the lungs and the BLOOD
What are the four components that make up the pulmonary system?
Thorax
Respiratory tract
Pulmonary blood
Lymph supply
What makes up the thorax?
Everything between neck and abdomen
Includes scapula, ribs, sternum, vertebral bones + intercostal muscles
LUNGS:
Parenchyma - _______ supportive tissue that surrounds and attaches to airways
How many lobes does each lung have?
How far down the ribs do the lungs expand?
What is the pleural membrane?
What is the pleural cavity?
LUNGS:
Parenchyma - ELASTIC supportive tissue that surrounds and attaches to airways
How many lobes does each lung have? - The right lung has 2 lobes and the left lung has 3 lobes
How far down the ribs do the lungs expand? - to the 7th and 8th rib
What is the pleural membrane? - covering over the lungs that prevents lungs from collapsing
What is the pleural cavity? - space between the pleural membrane
What is part of the upper resp airway?
What is part of the lower resp airway?
Upper: Nose, mouth, pharynx, larynx, epiglottis
Lower: Trachea, bronchi, bronchioles, alveoli
What are the conducting airways?
What are the respiratory airways?
Conducting = no gas exchange
(nose, mouth, pharynx, larynx, trachea, bronchi, terminal bronchioles)
Respiratory = gas exchange
(respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli)
Cilia
Propels mucus
Bronchi
Where _______ and ______ fluids end up. Cause a deep _______ when stimulated. Lots of _____ helps to keep it patent.
Bronchi
Where FOREIGN PARTICLES and ASPIRATED fluids end up. Cause a deep COUGH REFLEX when stimulated. Lots of CARTILAGE helps to keep it patent.
Terminal Bronchioles
Respiratory Bronchioles
Terminal bronchioles mark the end of the conducting division of airflow in the respiratory system while respiratory bronchioles are the beginning of the respiratory division where gas exchange takes place.
Some alveoli present in respiratory bronchioles = some gas exchange
Alveoli - where ________ occurs
Surfactant: helps decrease surface ______ from alveoli, preventing ______, and protect lung compliance
Alveolar macrophages: remove _______ materials. They are the main ______ beyond the terminal bronchioles.
Alveoli - where GAS EXCHANGE occurs
Surfactant: helps decrease surface TENSION from alveoli, preventing COLLAPSE, and protect lung compliance
Alveolar macrophages: remove FOREIGN materials. They are the main CLEARANCE SYSTEM beyond the terminal bronchioles.
Lymphatic Circulation:
Two main roles in the body:
(1) reabsorb ______ that was filtered out capillaries into the ________ fluid to maintain _____ balance in the lungs
(2) Remove bacteria, foreign materials, cell debris via lymph fluid
Lymphatic Circulation:
Two main roles in the body:
(1) reabsorb PLASMA that was filtered out capillaries into the INTERSTITIAL fluid to maintain FLUID balance in the lungs
(2) Remove bacteria, foreign materials, and cell debris via lymph fluid
Bronchial circulation: supplies _____ tissue with blood and does not participate in _______ exchange
Pulmonary circulation: participates in _____ exchange
Bronchial circulation: supplies LUNG tissue with blood and does not participate in GAS exchange
Pulmonary circulation: participates in GAS exchange
Respiration and Ventilation:
Respiration = ____ exchange
- ________: movement of gas between air spaces in lung and bloodstream
- __________: movement of blood into and out of the capillary beds of the lungs to the body organs and tissues
Ventilation = ___ movement in/out of lungs
- Inspiration: air enters
- Expiration: air exits
Respiration and Ventilation:
Respiration = GAS exchange
- DIFFUSION: movement of gas between air spaces in lung and bloodstream
- PERFUSION: movement of blood into and out of the capillary beds of the lungs to the body organs and tissues
Ventilation = AIR movement in/out of lungs
- Inspiration: air enters
- Expiration: air exits
How does nervous regulation control the respiratory system?
Medulla oblongata and pons + sense CO2
Pressure and Volume:
Pressure and volume ______ related.
Air flows from area of ______ pressure to ______ pressure.
Pressure and Volume:
Pressure and volume are INVERSELY related.
Air flows from an area of HIGH pressure to LOW pressure.
Pulmonary ventilation is dependent on 3 pressures:
Atmospheric
Intrapleural
Intrapulmonary
Structures that Effect Pressures:
(1) Lungs tend to ______
(2) Chest tends to ______
The chest walls tendency to ____ keeps the lungs from ______ and the lungs tendency to _____ keeps the chest from being overly ______
(3) At the end of expiration = ______ of pressures (no _______ movement)
Structures that Effect Pressures:
(1) Lungs tend to RECOIL
(2) Chest tends to EXPAND
The chest walls tendency to EXPAND keeps the lungs from COLLAPSING and the lungs tendency to RECOIL keeps the chest from being overly EXPANDED
(3) At the end of expiration = EQUILIBRIUM of pressures (no AIR movement)
Inspiration pressures:
Atmospheric pressure: 0
Intrapleural pressure: more ______
Intrapulmonary pressure: _______
Expiration pressures:
Atmospheric pressure: 0
Intrapleural pressure: ______
Intrapulmonary pressure: ______
Inspiration pressures:
Atmospheric pressure: 0
Intrapleural pressure: more negative
Intrapulmonary pressure: negative
Expiration pressures:
Atmospheric pressure: 0
Intrapleural pressure: negative
Intrapulmonary pressure: positive
2 factors affecting ventilation
Airway resistance and lung compliance (ease of lung stretch)
Dead space
Does not participate in gas exchange
Ventilation/Perfusion Mismatch:
Issue: NO __________ = ______
Issue: NO __________ = ______
Both result in _______
Ventilation/Perfusion Mismatch:
Issue: NO VENTILATION = SHUNT
Issue: NO PERFUSION = DEADSPACE
Both result in HYPOXIA
Oxygen Transport:
(1) Bound to ________ (______ & ______)
(2) Dissolved in _______ (_____)
Oxygen Transport:
(1) Bound to HGB (SaO2 & SpO2)
(2) Dissolved in PLASMA (PO2)
Oxygen delivery is dependent on two factors:
Oxygen content and CO
What is hypoxia? What are the 3 main causes?
What is hypoxemia? Ranges?
Hypoxia is low oxygen levels in the tissues. Caused by:
(1) Blood-related - decreased CO/perfusion
(2) Cell-related - tissues unable to uptake O2
(3) Content-related - low oxygen content in the blood
Hypoxemia is low oxygen levels in the blood.
PO2 < 60mmHg or SpO2 < 90% or below desirable range
Is a medical prescription required for oxygen therapy?
Yes, except for cases of medical emergencies
What is FiO2?
The fraction of inspired oxygen (FiO2) is the concentration of oxygen in the gas mixture.
The gas mixture at room air has a fraction of inspired oxygen of 21%, meaning that the concentration of oxygen at room air is 21%
Low-Flow Systems:
Provide a _____ amount of oxygen flow which is usually ______ than the patient’s _____ flow
A _____ FiO2 is provided to the patient based on their condition (RR, quality of breath, depth of breath), meaning the patient can breath _____ the FiO2 of device.
Ie - If a patient is receiving 2L O2 via NP, they are receiving 100% oxygen (via 2L) + RA (21%) - the FiO2 is being diluted with pt’s deep breaths since they are breathing over the FiO2 of the NP.
Low-Flow Systems:
Provide a FIXED amount of oxygen flow which is usually LOWER than the patient’s INSPIRATORY flow
A VARIABLE FiO2 is provided to the patient based on their condition (RR, quality of breath, depth of breath), meaning the patient can breath OVER the FiO2 of device.
Ie - If a patient is receiving 2L O2 via NP, they are receiving 100% oxygen (via 2L) + RA (21%) - the FiO2 is being diluted with pt’s deep breaths since they are breathing over the FiO2 of the NP.
Nasal Prongs can deliver up to ___ oxygen
Nasal Prongs can deliver up to ____ oxygen
Simple Face Mask can deliver between ___ to ___ oxygen. Cannot be less than ___ or else the patient will begin breathing in ____
Simple Face Mask can deliver between 5 to 10L oxygen. Cannot be less than 5 or else the patient will begin breathing in CO2
High-Flow Systems:
Supply a ______ FiO2 ranging from ____ to ____ % regardless of the patient’s _________ demands. Flow is _____ or _____ patient’s _______ flow
Unable to breath in ___________ air
High-Flow Systems:
Supply a FIXED FiO2 ranging from 24 to 100% regardless of the patient’s INSPIRATORY demands. Flow is EQUAL or EXCEEDS patient’s INSPIRATORY flow
Unable to breath in ATMOSPHERIC air
Venti mask delivers up to ____ and FiO2 of ____
Optiflow can deliver up to _____ and FiO2 of _____
Venti mask delivers up to 15L and FiO2 of 60%
Optiflow can deliver up to 40L and FiO2 of 90%
Reservoir Systems:
Incorporates a mechanism for gathering and _______ oxygen between breaths
Reserve supply is used when ___________ flow exceeds O2 flow into the device
FiO2 can be __________
Reservoir Systems:
Incorporates a mechanism for gathering and STORING oxygen between breaths
Reserve supply is used when INSPIRATORY flow exceeds O2 flow into the device
FiO2 can be VARIABLE
Our normal peak inspiratory flow tends to range between ___ - ___ L/min. Our respiratory muscles are comfortable and do not tire when we breathe at a normal respiratory rate with this peak inspiratory flow
Our normal peak inspiratory flow tends to range between 20 - 30 L/min. Our respiratory muscles are comfortable and do not tire when we breathe at a normal respiratory rate with this peak inspiratory flow
Complications of Oxygen Therapy:
Oxygen Toxicity: production of oxygen ______-______ which can initiate inflammatory response
Depression of ventilation: occurs when _____ is the _____ to breathe. High oxygenation suppress the pt’s _______ to breathe
Absorption atelectasis: High concentrations of oxygen washes out the ____ that normally helps keep alveoli open = alveoli ______
Complications of Oxygen Therapy:
Oxygen Toxicity: production of oxygen FREE-RADICALS which can initiate inflammatory response
Depression of ventilation: occurs when HYPOXA is the DRIVE to breathe. High oxygenation suppresses the pt’s DRIVE to breathe
Absorption atelectasis: High concentrations of oxygen washes out the NITROGEN that normally helps keep alveoli open = alveoli COLLAPSE
Non-Invasive Ventilation: Provides _______ airway pressure meaning air is _____ into the airway as pt breathes
Two indications: ventilation and oxygenation
Ventilation: Pt’s who are _______ CO2 as they are unable to ventilate their lungs enough to facilitate diffusion of _____ out of the blood
Oxygenation: _____ helps keep alveoli open so they are available for _______ __________
BiPAP - ______ with patient’s breaths
CPAP - provides ____ level of pressure
Non-Invasive Ventilation: Provides POSITIVE airway pressure meaning air is PUSHED into the airway as pt breathes
Two indications: ventilation and oxygenation
Ventilation: Pt’s who are RETAINING CO2 as they are unable to ventilate their lungs enough to facilitate diffusion of CO2 out of the blood
Oxygenation: PP helps keep alveoli open so they are available for GAS EXCHANGE
BiPAP - SYNCHRONIZES with patient’s breaths
CPAP - provides CONTINUOUS level of pressure
pH is the concentration of ____ in the blood
H+ ions
What would you use to treat respiratory acidosis? (x4)
Improve ventilation:
Encourage deep breathing/coughing
Suctioning
Non-Invasive ventilation
Intubation
What is mixed acidosis and alkalosis?
Mixed acidosis: Resp + Metabolic acidosis (DKA + hypoventilation)
Mixed alkalosis: Resp + Metabolic alkalosis (severe vomiting + hyperventilation)
What are two types of obstructive respiratory disorders?
COPD (chronic bronchitis, emphysema) and Asthma
COPD: airways become ______ which leaves air _______ inside the lungs (___-_____)
(1) Emphysema: “____-______” - difficulty breathing, but well _________
- Barreled chest, muscle wasting, pursed lips
- Elastic fibres allow _____ to expand and recoil, but in emphysema, there is loss in ___ fibres = decreased surface area = _______ alveoli
(2) Chronic bronchitis: “_____ _____” - inflammation of the ______, smooth muscle ________ + increased ______ production
COPD: airways become OBSTRUCTED which leaves air TRAPPED inside the lungs (AIR-TRAPPING)
(1) Emphysema: “PINK-PUFFERS” - difficulty breathing, but well PERFUSED
- Barreled chest, muscle wasting, pursed lips
- Elastic fibres allow ALVEOLI to expand and recoil, but in emphysema, there is loss in ELASTIC fibres = decreased surface area = COLLAPSED alveoli
(2) Chronic bronchitis: “BLUE BLOATERS” - inflammation of the BRONCHIOLES, smooth muscle HYPERTROPHY + increased MUCUS production
Restrictive Respiratory Disorders:
Restricted lung ________
Difficulty taking air into lungs due to ____ inside lung tissue
Restrictive Respiratory Disorders:
Restricted lung EXPANSION
Difficulty taking air into lungs due to STIFFNESS inside lung tissue
Pulmonary Fibrosis:
Alveolar lining is damaged = alveolar epithelial cells (_________) overproliferate = more _______ production = thickened layers between alveoli and capillaries
Causes issues with _________
Causes lungs to become ____ making it hard for air to flow in and out
= fibrosis of _________
= ________ in total lung capacity
Pulmonary Fibrosis:
Alveolar lining is damaged = alveolar epithelial cells (PNEUMOCYTES) overproliferate = more COLLAGEN production = thickened layers between alveoli and capillaries
Causes issues with VENTILATION
Causes lungs to become STIFF making it hard for air to flow in and out
= fibrosis of INTERSTITIUM
= DECREASE in total lung capacity
Vascular Respiratory Disorders
Related _________ ___________
Vascular Respiratory Disorders
Related PULMONARY VASCULATURE
Pulmonary Embolism
_______ lodged in pulmonary artery blocking ______ to lung tissue
V/Q Mismatch: Alveoli are getting ________, but not being _________ = __________
Pulmonary Embolism
EMBOLISM lodged in pulmonary artery blocking BLOOD FLOW to lung tissue
V/Q Mismatch: Alveoli are getting VENTILATED, but not being PERFUSED = DEADSPACE
Pulmonary Edema
A buildup of _____ in the lungs making it hard for oxygen to cross over into the capillaries = hypoxia
Lungs are “swollen”
V/Q Mismatch: _________
Pulmonary Edema
A buildup of FLUID in the lungs making it hard for oxygen to cross over into the capillaries = hypoxia
Lungs are “swollen”
V/Q Mismatch: SHUNT
Pleural Effusion
Excess fluid in ______ space because either too much _______ or too little is ______ away
If large enough, it may ________ the lungs = alveoli ______
Pleural Effusion
Excess fluid in PLEURAL space because either too much PRODUCED or too little is DRAINED away
If large enough, it may COMPRESS the lungs = alveoli COLLAPSE
What is chylothorax?
Lymphatic fluid accumulates in pleural space
Pneumothorax: Air in _____ space
Closed: Air enters the pleural space from the _____
Open: Air _____ and ______ the pleural space on inspiration and expiration
Tension: Air enters the pleural space, but unable to leave = lung collapse + tracheal deviation to ________ side = _____ CO
V/Q Mismatch: ________
Pneumothorax: Air in PLEURAL space
Closed: Air enters the pleural space from the LUNGS
Open: Air ENTERS and LEAVES the pleural space on inspiration and expiration
Tension: Air enters the pleural space, but unable to leave = lung collapse + tracheal deviation to UNAFFECTED side = DECREASED CO
V/Q Mismatch: SHUNT
ARDS: widespread _______ in the lungs
Begins with _______ response –> ________ edema –> alveolar collapse –> worsened _______
Leads to _________ phase = scar tissue and fibrosis = _________ of lungs
ARDS: widespread INFLAMMATION in the lungs
Begins with INFLAMMATION response –> PULMONARY edema –> alveolar collapse –> worsened HYPOXIA
Leads to FIBROPROLIFERATIVE phase = scar tissue and fibrosis = STIFFENING of lungs
Zone 1
Zone 2
Zone 3
Closest to the ceiling
Middle
Closest to the floor
Zone 3 has the highest ______ and highest ______
Perfusion; ventilation
What is PF ratio?
Normal PF ratio?
What is it used for?
How well lungs absorb oxygen from the inspired air
300-500
Used to trend respiratory failure
Oxy-Hgb Dissociation Curve:
At 60mmHg, SpO2 90%
On left side of the curve, small change in PO2 has profound change on SpO2 (<60mmHg = big drops in saturation)
- increased _______ between hgb and oxygen
- hgb cannot readily _____ oxygen to cells
- hypothermia, alkalosis, decreased altitude
On right side of the curve, not much change in SpO2
- decreased _______ between hgb and oxygen
- hgb not found well to oxygen
- acidosis, increased altitude, hyperthermia
Oxy-Hgb Dissociation Curve:
At 60mmHg, SpO2 90%
On left side of the curve, small change in PO2 has profound change on SpO2 (<60mmHg = big drops in saturation)
- increased AFFINITY between hgb and oxygen
- hgb cannot readily RELEASE oxygen to cells
- hypothermia, alkalosis, decreased altitude
On right side of the curve, not much change in SpO2
- decreased AFFINITY between hgb and oxygen
- hgb not found well to oxygen
- acidosis, increased altitude, hyperthermia
