Respiratory introduction Flashcards
what is acute care?
- short term conditions with an immediate onset managed immediately in primary care
what does an acute episode need?
- specialist input
what are the three different hospital types?
- primary
- secondary
- community
what is primary care?
- immediate intervention from GP services
what is secondary care? what are some examples?
- split into different expertise of hospital e.g., district general, tertiary hospitals
what are tertiary hospitals specialised for?
- critical care, cardiac surgery, liver care, trauma
what are community hospitals? what patients may be sent here and why?
- deal with minor problems
- DGH or TH patients may be sent here for rehabilitation
how are chronic patients managed? what is an example?
- managed by specialists within the hospital as they may present with an acute episode
e.g., exacerbation or acutely unwell due to chronic disease, where they will be admitted to the hospital from clinic
what is the normal pathway of patients?
- A & E
- MAU
- OPAL or ward
what is a&e? what does it involve?
- accident and emergency
- medically stabilised is the 1st protocol
what is MAU and when do you go there? what assessment does it involve?
- medical assessment unit
- when in hospital for a few hours
- assessed by speciality team e.g., heart failure assessed by cardiology team
what are the two pathways after MAU?
- some may be stabilised or a few amendments made so they can leave
- others can be stable but community issues e.g., frequent falls, help required with daily living
what is OPAL? who reviews the patient?
- older person’s assessment and liaison
- MDT reviews patient
what are the two pathways from the OPAL?
- may need to go to a community hospital (can’t return home in current state as it may lead to readmission)
- may be sent home with additional equipment
where are patients requiring a period of care be sent to? what is the main goal?
- patients sent to a ward
- goal is to get the patient home
- may be via community services
what does the ward depend on?
- rehabilitation and care needs of patients
what are the 9 different types of wards?
- stroke
- respiratory
- neurology
- trauma and orthopaedic
- surgery
- cardiac
- critical care
- burns & plastics
- care of older people
what wards does respiratory play a role in?
- plays a role in all the wards
what is the respiratory role in a stroke ward?
- poor functioning on one side, muscle weakness, loss of swallowing so aspirate on food causing infection and pneumonia
- loss of respiratory muscle functioning= difficulty coughing leading to chest infection
what is the respiratory role in a neurology ward? how many times would you see these patients in a day?
- impact on respiratory muscle causing compromise e.g., motor neuron disease needs 3-4 sessions to clear chest
what is the role of respiratory in trauma and orthopaedic wards?
- in bed for prolonged duration
- rib fracture = loss of cardiorespiratory function so struggle to breath
what is the respiratory role in a critical care ward?
- ventilators to manage tracheostomies
what is the respiratory role in a burns and plastics ward? - give an example
- carbon monoxide poisoning e.g., black tar cleared off chest so need to be seen regularly
what are lungs made up of? how many on each side?
- lobes
- right side has 3 lobes whereas the left lobe has 2 lobes
why is the left lung smaller than the right lung?
- because it shares the side with the heart
what does trachea do? what does it divide into?
- carries air into the lungs
- divides into airways known as bronchi
what do bronchi do?
- bronchi branches into smaller and smaller airways
- at the end of these are alveolis
what is an alveoli?
- tiny air sac
what is there within alveoli walls?
- dense network of tiny blood vessels
what is the reason for the dense network of tiny blood vessels in the alveoli?
- acts as a thin barrier between the air and capillaries
- allows oxygen from the air you breath in to diffuse from the alveoli into the blood
what is carbon dioxide? how is it removed?
- C02 is a waste gas released into the bloodstream due to gaseous exchange
- body gets rid of C02 when you breath out
what happens to the oxygen rich blood? what does it go through?
- travels from your lungs to your heart where blood is pumped to the rest of the body
- lung to left atrium via pulmonary veins
what opens to send blood from the left atrium to the left ventricle?
- mitral valve
what happens when the left ventricle is full?
- it squeezes
- opens the aortic valve so blood sent to aorta where it flows to the rest of the body
what do capillaries connect?
- capillaries connect small artery branches to very small veins at each body part
what are the walls like in capillaries? what does this allow?
- very thin walls
- allows nutrients and oxygen to be delivered to the cells
what is brought into the capillaries? where is it delivered to?
- carbon dioxide brought into the capillaries, which lead into veins
- delivering the de-oxygenated blood to the right side of the heart
what happens to the blood after it enters the right side of the heart?
- it is pumped back into the lung to collect a fresh oxygen supply
what does disruptions to the pathway cause?
- catrostrophic consequences
what are the two main problems that may disrupt the blood pathway?
- not oxygenated enough
OR contains excessive carbon dioxide
what can you pinpoint when there is a disruption to the blood pathway?
- can pinpoint where in the system is being affected and what we can do for it
what does the upper respiratory system contain?
- it is from the nasal cavity to the trachea
nasal cavity, nasopharynx, oropharynx, larynx
what does the lower respiratory system contain?
- from the trachea to alveoli sacs & diaphragm
- lung, bronchus, bronchiole, respiratory bronchiole, alveolar duct, alveolar sac and diaphragm
how is the majority of breathing completed and why?
- completed via the nose
- as it humidifies the air and contains protective mechanisms (lined with cilia that catch debris)
what is breathing through the mouth like? what can it cause?
- breathing through the mouth is very dry
- can cause problems
where do bronchial trees come from?
- all come of in different directions
what do lobes further break down into?
- different sections
- apical, posterior, anterior, lateral, medial, anterior basal, etc
why are the different sections like anterior important to know?
- because during airway clearance you need to think about the direction to send it back up in
- positioning of secretions
when should the different sections of the lobe be kept in mind?
- kept in mind for chest infections as will be a specific division of the lobe
what are the two zones involved in the lungs?
- conducting zone
- respiratory zone
what happens in the conducting zone?
- air goes in and out
- no gas exchange in terminal bronchi
what happens in the respiratory zone?
- gaseous exchange occurs from respiratory bronchi and down
how many divisions are there in the lungs?
- 24 divisions
what happens to the diameter and number as you go down the divisions ?
- diameter reduces as you go down
- number increases as well as cross sectional area
what adaptation does the respiratory zone have and what for?
- large cross sectional area
- allows increased gas exchange
what is the pleural space?
- parietal and visceral pleura
- sits around the lungs
what is contained in the pleural space? what can happen there?
- pleural cavity
- where build- up of fluid can happen
what is pleural oedema? what does it cause?
- fluid build up on the outside of the lungs
- shortness of breath and difficulty breathing
what is pleural effusion? what does it cause?
- excessive collection of fluid in the cavity between a lung and the chest wall
- between layers of your pleura around lungs
- causes shortness of breath, coughing and chest pain
what is pneumothorax? when does it occur?
- collapsed lung
- occurs when air enters into the pleural cavity causing compression of the outside lung
what happens to the thoracic cavity and external intercostals in inspiration?
- thoracic cavity expands
- external intercostal muscles contract
what happens to the thoracic cavity and external intercostals in expiration?
- thoracic cavity reduces
- external intercostal muscles relax
what is the bucket handle movement?
- diaphragm flattens while the sternum and rib cage goes up and outwards to create low pressure in lungs
- air enters the lungs
what are the mechanics when breathing out?
- diaphragm contracts up creating a dome shape
- sternum and rib cage goes down creating high pressure in the lungs
what is boyles law?
- as volume increases, pressure inside decreases
what are the three important factors for gaseous exchange?
- concentration difference
- surface area
- distance travelled> membrane thickness
what is V/Q?
- rate of ventilation to perfusion in the lungs
what is a V/Q match?
- good amount of gas is required as well as blood flow
what is the normal V/Q ratio?
- normally 0.8
- perfusion exceeds ventilation
what is V/Q mismatch?
- imbalance between ventilation and perfusion
where do the lungs sit? what does this mean for the airways?
- lungs hang in the chest cavity
- different amount of opening in the airways of the lung like a slinky
- smaller airways at the bottom
how do the airways compare to a balloon?
- hard to open at the beginning then becomes easier due to pressure cuff
what does PEEP stand for?
- positive end- expiratory pressure
what is PEEP?
- positive pressure that will remain in the airways at the end of the respiratory cycle (end of exhalation)
how much water helps split the airways open?
- 5cm of watee
what is required in the compressed compartments?
- require a big breath in
what happens to the lobes in a normal breath?
- lower, middle and upper lobe open
what happens to the lungs in a deep breath?
- lower lung has an increased volume so opens up more
how does the upper lung differ from the middle lung?
- in the upper lung, open and shut smaller amounts whereas in the middle they have the capacity to go all the way up and down
what are the most open area of the airway? what does this mean?
- airways at the top are more open compare to the bottom of the lungs
- needs less pressure to open them
where is the optimal area of ventilation?
- middle of the lungs
where does optimal V/Q matching occur?
- in the middle
- maximal air in and out
what is effusion?
- abnormal collection of fluid in hollow spaces or between tissues of the body
what is the fluid of effusion like? where does it come from?
- more denser
- comes from a capillary network instead of lungs (gravity dependent)
where does optimal effusion sit?
- in the bases of the lungs
do you still get air in and out in areas other than the bases? what else contributes?
- still get air in and out
- capillaries push air in and out below and above optimal but less
what should you think about when positioning patients?
- think about optimal V/Q ratio
what is the relationship of pressure and volume?
- increased pressure= increased volume
what do you initially need to increase volume?
- initially require certain amount of pressure in order to achieve a raise in the volume of air
what are the two problems that may reduce air transport?
- blood clots
- airways blockages
what is blocked by blood clots? what is there sufficient volume of?
- blood supply blocked by blood clots
- but sufficient oxygen
what are airway blockages? - with examples
- can’t get air into the lungs
- plugged alveoli or full of secretions
e.g., mucus, bronchospasm
