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PCT > Respiratory Lecture 1 > Flashcards

Respiratory Lecture 1 Flashcards

ventilation, diffusion, perfusion, Oxy Hgb dissociation curve, V/Q mismatch, pathophysiology

1
Q

Where does Canada stand as far as resp compromise in comparison to other developed countries

A

considered mid-range

  • 2.5 - 3 million have asthma
  • 750 000 - 1 million have COPD
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2
Q

What is anatomical dead space

A

-total vol of the conducting airways from the nose to terminal bronchioles that fills with air that is exhaled again before gas exchange can occur. ~ 150 ml

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3
Q

What is minute volume respiration

A

vol of gas inhaled or exhaled from lungs in a minute

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4
Q

What is tidal volume

A

normal vol of air displaced during normal inhalation and exhalation

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5
Q

What is residual volume

A

vol of air still in lungs after most forceful expiration possible
-aka residual air

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6
Q

What is inspiratory reserve volume

A

max amount of additional air that can be inspired after normal inspiration

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7
Q

What is expiratory reserve volume

A

max amount of air that can be forcefully expired after normal expiration

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8
Q

What is total lung capacity

A

amount of gas in lungs after maximum inhalation

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9
Q

What is vital capacity

A

max vol of air that can be expelled from lungs after taking the deepest inspiration possible

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10
Q

What is functional residual capacity

A

Vol of air in lungs after normal expiration

-ERV + RV

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11
Q

What is inspiratory capacity

A

vol of gas that can be taken in on a full inhalation

-TV + IRV

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12
Q

What is forced expiratory volume

A

measures how much air can be exhaled during a forced breath

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13
Q

What are intrinsic factors

A

Factors that are within or influence by PT system.

-out of PT control

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14
Q

Examples of intrinsic factors

A
  • genetic predisposition
  • COPD, asthma, lung CA
  • cardiac or circulatory conditions
  • stress
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15
Q

What are extrinsic factors

A

Factors that are external to PT
-environmental
-Lifestyle
-

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16
Q

Examples of extrinsic factors

A
  • smoking (cigarettes, vape, pot)

- enviro pollutants and toxins

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17
Q

What is the physiological process of repiratory system

A
  • it is to exchange gases with the environment
  • O2 diffuses into blood for use in cell metabolism
  • CO2 (waste product) eliminated from body
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18
Q

What is the process that allows gas exchange to occur

A
  • ventilation
  • Diffusion
  • Perfusion
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19
Q

What is ventilation

A

Mechanical process of moving air in and out of the lungs

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20
Q

What are the 2 phases of ventilation

A
  • Inspiration

- Expiration

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21
Q

What 4 body structures must be intact for ventilation to occur

A
  • chest wall
  • nerve pathways & brainstem
  • Diaphragm
  • Pleural cavity
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22
Q

What is Diffusion

A

Movement of molecules through a membrane from an area of high concentration to an area of low concentration

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23
Q

gases move btw what two structures in diffusion

A

alveoli and pulmonary capillaries

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24
Q

What is the PO2 in alveoli

A

104mmHG

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25
Q

What is PO2 in pulmonary capillaries before gas exchange

A

40mmHg

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26
Q

What is movement of O2 in lungs

A

Moves from high concentration in alveoli to low concentration in RBC’s moving through capillaries

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27
Q

What is PCO2 in pulmonary capillaries

A

45mmHg

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28
Q

What is PCO2 in alveoli

A

40mmHg

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29
Q

What would increase the amount of O2 moved from alveoli into blood

A

a greater difference in concentration (increase concentration gradient)

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30
Q

What structures must be intact for adequate diffuion to occur

A
  • alveoli (no damage/collapse)
  • Resp membrane (thickness .5 - 1 micrometer)
  • Interstitial space (no increase as you see w/ pulmonary edema or pneumonia)
  • endothelial lining of capillaries
  • no fluid accumulation of inflammation
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31
Q

What is perfusion

A

the circulation of blood through the capillaries

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32
Q

What are 4 conditions perfusion is dependant on

A
  • adequate blood vol
  • intact pulmonary capillaries
  • efficient pumping of blood by heart
  • concentration of Hb
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33
Q

What are the 2 ways O2 in transported

A
  • 98% by Hb

- 2% dissolved in plasma (PO2)

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34
Q

What is Hemoglobin (Hb)

A

the transport protein that carries O2 in blood

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35
Q

What is structure of Hb

A
  • 4 Heme molecules containing iron - where O2 binds and is transported
  • 1 globin portion containing protein
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36
Q

How does O2 binding change the overall structure of Hb

A
  • causes it to more readily bing to other O2 molecules

- forms oxyhemoglobin (HbO2)

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37
Q

What happens once Hb begins to release O2

A

it will more rapidly shed additional O2 as well

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38
Q

What happens when PO2 is >70 mmHg

A

saturation is essentially 100% and additional O2 will not make a significant difference

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39
Q

Why is Oxygen dissociation curve helpful

A

for understanding how the body carries and release O2

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40
Q

What does oxygen dissociation curve tell you

A
  • relates O2 saturation (SO2) & PO2 in blood

- shows how eagerly Hb binds and releases O2 molecules into surrounding fluid

41
Q

When does oxygen bind easily to Hb

A

in area of high O2 pressure like lungs

42
Q

When does Hb release O2 more readily

A

-in area of low O2 pressure like the tissues

43
Q

What happens when Hb releases O2

A

CO2 starts binding to it

44
Q

When do you get and upward left shift on O2 dissociation curve

A

when increased affinity for O2

45
Q

When do you get downward right shift on O2 dissociation curve

A

when you have decreased affinity for O2

46
Q

What causes changes in O2 dissociation curve

A
  • body temp
  • blood PH
  • PCO2
47
Q

What are the 3 ways CO2 is transported from cells to lungs

A
  • mostly as bicarbonate ions
  • bound to globin part of Hb molecule
  • dissolved in plasma PCO2
48
Q

How is CO2 transported as bicarbonate ion

A

CO2 released into capillaries

  • enters RBCs
  • the enzyme carbonic anhydrase causes CO2 + H2O to become 2 hydrogen ions and bicarbonate (HCO3)
  • the HCO3 can now leave RBC to enter plasma and be transported to lungs and be release as CO2 in gas exchange
49
Q

What would cause the O2 dissociation curve to shift up and left

A
  • increase in PH
  • decrease in PCO2
  • decrease in temp
50
Q

What would cause the O2 dissociation curve to shift up and right

A
  • decrease in PH
  • increase in PCO2
  • increase in temp
51
Q

What structures must be intact for adequate perfusion

A
  • pulmonary capillaries must be open/ not occluded (so no pulmonary emboli)
  • heart must pump efficiently through pulmonary capillaries (ex. acute pulmonary edema)
52
Q

What is respiration

A

the exchange of gases btw a living organism and its environment
-pulmonary respiration

53
Q

Where does pulmonary respiration occur

A
  • in the lungs

- gases exchanged btw alveoli and the RBCs in pulmonary capillaries through membranes

54
Q

What is cellular respiration and where does it occur

A
  • exchange of gases btw RBCs & various tissues

- occurs in peripheral capillaries

55
Q

What does the V and Q stand for in V/Q mismatch

A 
V= ventilation
Q= Perfusion
56
Q

When does V/Q mismatch occur

A
  • when anything increases / decreases ventilation of the lungs or perfusion of the lungs
  • Anything that interferes with ability of fresh air to get to alveoli or prevents blood flow to the capillaries
57
Q

What are the 7 possible causes of V/Q mismatch

A
  1. Decreased ambient O2 supply
  2. Mechanical Ventilations
  3. Perfusion mismatch
  4. Decreased surface area
  5. Cardiac output
  6. Hb issues
  7. Histotoxin
58
Q

What is decreased ambient O2 supply

A

Inadequate O2 available in atmospheric air

  • CO poisoning
  • Altitude
  • Confined space
  • Drowning
  • Noxious exposure
59
Q

What are mechanical ventilations

A

Breathing mechanics are interrupted which interferes with process of bringing in the air

  • foreign body airway obstr.
  • CNS disruption
  • chest wall injury
  • lung injury
  • neuromuscular diseases interfering w/ muscle action (MS, MD)
60
Q

What is perfusion mismatch

A

Blood isnt getting to alveolar surface to pick up O2

  • Hypovolemic shock
  • Pulmonary embolism
  • dehydration
61
Q

What is decreased surface area

A

Total area O2 can come across has been reduced

  • decrease in surfactant (=atelectasis)
  • emphysema
  • lung CA
  • aspiration
62
Q

What is cardiac output (re: V/Q mismatch)

A

Heart is not pumping out the blood to get it to the lungs, cant get to destination for gas exchange

  • AMI
  • Overdose
  • shock
  • valve failure
  • pericarditis
  • cardiac tamponade
  • dysrhythmia
  • cardiac arrest
63
Q

What are the Hb issues re: v/q mismatch

A

Hb not functioning properly or malformed or absent

  • sickle cell anemia
  • anemia
  • hemorrhage
  • iron deficiency
  • CO poisoning
64
Q

What is histotoxin

A

the actual cells cannot use the O2 that is delivered to them because of cellular damage

  • cyanide poisoning
  • Smoke inhalation of household fires during the burning of rubber and plastic predominantly
  • Cyanide inhibits mitochondrial cytochrome oxidase
  • Blocks electron transport, resulting in decreased oxidative metabolism and oxygen utilization.
65
Q

Respiratory disease limits the body’s ability to do what

A

get rid of waste products

-results in disruption of ventilation, diffusion, perfusion

66
Q

What 3 areas can cause disruption in ventilation

A
  • upper/lower respiratory tract
  • Chest wall & Diaphragm
  • Nervous sytem
67
Q

What can cause obstructed air flow in upper/ lower resp tract

A
  • trauma (bleeding, swelling)
  • infections (epiglottitis, tonsillitis, abscess)
  • foreign body aspiration
  • mucous accumulation (asthma)
  • smooth muscle constriction (COPD, asthma)
  • airway edema (inf, burns)
68
Q

What affect does upper resp tract obstruction have on respiratory system

A
  • diseases that affect upper tract will obstruct air flow to lower structures
69
Q

What are mechanical components essential for normal ventilation

A

chest wall & diaphragm

70
Q

How do traumatic injuries disrupt mechanics of chest wall and diaphragm

A

Cause loss of neg pressure within pleural space = limited ability to expand thoracic cavity

  • pneumothorax
  • flail chest
  • diaphragmatic rupture
71
Q

How do infectious processes & inflammatory conditions disrupt mechanics of chest wall and diaphragm

A

simillar symptoms as traumatic - loss of pressur in pleural space reducing thoracic cavity ability to expand
-emphysema

72
Q

How do neuromuscular diseases disrupt mechanics of chest wall and diaphragm

A

they impair muscle function

73
Q

How can nervous system disrupt ventilation

A

any disease process that impairs nervous system’s regulation of breathing can alter ventilation

74
Q

What issues in nervous system can cause disruption to ventilation (examples)

A
  • CNS depressant (alcohol, benzodiazepines, barbiturates)
  • stroke, disease, injury to resp center in CNS
  • damage to major PNS that supply diaphragm (phrenic) & intercostal muscles (intercostal nerve): chest sx, penetrating trauma
75
Q

Describe Cheyne-strokes respirations

A

tidal volume progressively get deeper and more rapid then is followed by decline in volume and periods of complete apnea at end of expiration
- about 30 to 2 mins of dysrhythmic respirations followed by a period of apnea

76
Q

What are causes of cheyne-strokes respirations

A
  • older Pts with terminal illness

- Brain injuries

77
Q

Describe Kussmaul’s respirations

A

Deep, laboured, rapid breathing

-corrective measure against metabolic acedosis

78
Q

What are causes of Kaussmaul’s respirations

A
  • diabetic ketoacidosis (most common)

- renal failure

79
Q

Describe central neurogenic hyperventilation

A
  • deep & rapid breaths at a rate of at least 25 bpm
  • respiratory alkalosis often present
  • increasing irregularity of this respiratory rate generally is a sign the Pt will enter coma
80
Q

What causes central neurogenic hyperventilation

A
  • stroke

- injury to the brainstem

81
Q

Describe ataxic (Biot’s) respirations

A
  • repeated episodes of gasping ventilations, separated by periods of apnea
  • irregularly irregular breathing
82
Q

What causes Ataxic (Biot’s) respirations

A
  • damage to the medulla oblongata (stroke)

- increased intracranial pressure

83
Q

Describe apneustic respirations

A
  • deep, gasping inspirations w/ a pause at full inspiration followed by a brief insufficient release
  • seperated by periods of apnea
84
Q

what causes apneustic respirations

A
  • stroke

- CNS diseases

85
Q

What is hypoxia

A

a state in which insufficient O2 is available to meet the O2 requirements of the cell

86
Q

What causes hypoxia

A
  • any changes to concentration of O2 in alveoli (high altitude)
  • disease that affect # of usable alveoli (environmental pathogens, COPD, inhalation injury)
87
Q

How does alteration of thickness of respiratory membrane disrupt diffusion

A

Accumulation of fluid and inflammatory cells in the interstitial space create high pressure in pulmonary cap’s which pushes fluid out of the circulatory system

88
Q

What are the 2 cardiogenic causes that disrupt diffusion

A
  • L sided heart failure (increased venous pressure from poor L ventricle function)
  • Pulmonary hypertension (high resting pressure in pulmonary circulation causing R sided heart fail)
89
Q

How do non-cardiogenic genic causes disrupt diffusion

A

changes in permeability (leakiness) of pulmonary capillaries

90
Q

What are some non-cardiogenic causes for disruption in diffusion

A
  • adult respiratory distress syndrome
  • asbestos
  • environmental pathogens
  • near drowning
  • prolonged hypoxia
  • inhalation injury
91
Q

What conditions alter capillary endothelial lining (disrupting diffusion)

A

atherosclerosis

92
Q

Alterations in normal blood flow through pulmonary capillaries limits what?

A

normal gas exchange in lungs (disrupting perfusion)

93
Q

Problems reducing circulatory volume disrupt what process

A

perfusion

94
Q

What are some problems that cause a reduction in circulatory volume

A

= Hypovolemia

  • trauma
  • hemorrhage
  • dehydration
  • shock
95
Q

What would a reduction in normal circulating Hb disrupt

A

Perfusion

96
Q

What could cause anemia

A
  • acute blood loss
  • iron or vitamin deficiency
  • malnutrition
  • chronic disease
97
Q

What is pulmonary shunting

A

when an area of the lung is appropriately ventilated but no cap diffusion
-the available O2 is not moved into circulatory system

98
Q

What is a pulmonary embolism

A

-blood clot that develops in the body (often legs) and then travels to lung artery where it suddenly blocks blood flow

99
Q

How does pulmonary embolism disrupt perfusion

A
  • the blockage prevents perfusion of the lung segment supplied by that branch of the artery
  • there may be a significant shunt of unoxygenated blood to the pulmonary venous circulation

PCT (9 decks)

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