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Respiratory P1 Flashcards

1
Q

Potential Space Makeup

A

parietal pleura
visceral pleura
pleural cavity

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2
Q

Conducting zone makeup

A

trachea
primary bronchus
bronchial tree
terminal bronchioles

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3
Q

Path of air

A

Nose/Mouth
Pharynx
Glottis
Trachea
Primary bronchi
bronchial tree
respiratory bronchioles
alveolar sacs
alveoli

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4
Q

Makeup of respiratory zone

A

respiratory bronchioles
alveolar sacs
alveoli

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5
Q

Aspiration

A

when anything besides air goes down the trachea

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6
Q

Carina

A

inferior termination of trachea into R and L mainstem bronchi
at level of sternal angle

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7
Q

Which lung is more common to experience pneumonia?

A

Right
the bronchi on the right side are straighter and wider vs the left, allowing more to enter the lungs

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8
Q

Functions of conducting zone

A
  1. conducts air to respiratory zone
  2. warms and humidifies inspired air
  3. filters and cleans the inspired air
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9
Q

Mucociliary Escalator

A

-cilia on epithelial cells lines the conducting zones
-they beat in unilateral and coordinated way to move mucus toward pharynx
-leads germs to be either swallowed or expectorated

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10
Q

What is something that paralyzes cilia?

A

smoking

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11
Q

Functions of respiratory zone

A

Region of gas exchange between air and blood
Gas exchange occurs by diffusion from alveolus to capillary

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12
Q

Respiration steps

A

Ventilation
Gas Exchange
O2 utilization

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13
Q

Ventilation

A

-mechanical process of moving air in and out of lungs
-O2 is greater in air vs O2 in blood, so it follows a gradient, moving from air to blood
-CO2 in blood is greater than in lungs, goes from blood to lungs

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14
Q

Gas Exchange

A

-occurs entirely by diffusion through lung tissue
-diffusion is very rapid because of the large surface area and small diffusion distance
-occurs between air/blood/lungs/other tissues

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15
Q

Alveoli

A

very thin
have alveolar type 1 (structural), alveolar type 2 (secrete surfactant)

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16
Q

Lungs and and thoracic cavity

A

-during breathing, lungs remain in contact with chest wall
-vacuum keeps them together
-lungs expand and contract with thoracic cavity

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17
Q

Intrapulmonary pressure

A

pressure inside the alveoli

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18
Q

Intrapleural pressure

A

pressure inside intrapleural space

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19
Q

Intrapulmonary pressure and ventilation

A

Inspiration = less than atmospheric pressure (about 3 mmHg)
Expiration = greater than atmospheric pressure (about 3 mmHg)

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20
Q

Boyle’s gas

A

pressure of gas is inversely proportional to its volume
1. increase in lung volume decreases intrapulmonary pressure (air moves in).
2. decrease in lung volume raises intrapulmonary pressure above atmosphere (air moves out)

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21
Q

Transpulmonary Pressure

A

pressure difference across the wall of the lung

Intrapulmonary pressure - intrapleural pressure = transpulmonary pressure

in healthy adults, this pressure will be positive because pressure within alveoli is greater than pressure outside of alveoli

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22
Q

Atelectasis

A

partial or whole lung collapse
due to interference w/forces that promote lung expansion

treatment includes deep breathing, mobility

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23
Q

Pneumothorax

A

partial or whole lung collapse
due to collection of air or gas in intrapleural space, so pressure outside is greater than inside

chest tube is the treatment

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24
Q

Chest tube

A

tube placed between the ribs and into the intrapleural space to drain air/blood to allow the lungs to re-inflate

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25
Physical aspects of ventilation
Compliance Elasticity Surface tension
26
Compliance
1. measure of distensibility 2. change in lung volume per change in transpulmonary pressure 3. C = V/P or P = V/C
27
Compliance is decreased by
factors that produce resistance to distension pulmonary fibrosis, alveolar edema
28
Compliance is increased by
factors that decrease resistance to distension aging, emphysema
29
elasticity
1. tendency to return to initial size after distension 2. high concentration of elastin protein allows for high elasticity and recoil ability 3. tension increases during inspiration 4. potential space helps lungs to not collapse
30
Emphysema
decreased elasticity, increased compliance. lungs lose recoil ability. barrel chest
31
Pneumothorax
unopposed elasticity lung collapses in, thorax goes out
32
Surface tension
force that resists distension exerted by a thin layer of fluid in each alveolus surfactant helps to lower surface tension by decreasing attraction between H2O
33
Law of Laplace
pressure in alveoli is directly proportional to surface tension and inversely proportional to radius of alveoli
34
Tidal volume
how much you move in resting breath
35
Diaphragm is the
resting muscle of inhalation
36
muscles of inspiration
SCM scalenes external intercostals diaphragm
37
Muscles of expiration
no resting muscle of expiration, passive movement internal intercostals abdominal obliques transversus abdominis rectus abdominis
38
Uses of accessory muscles
exercise pathology (increased RR or TV)
39
Bucket-handle motion
how lower ribs move as you breathe
40
Quiet Inspiration, Active process
diaphragm contraction increases thoracic volume vertically contraction of parasternal/external intercostals increases thoracic volume laterally
41
Expiration, passive process
diaphragm, thoracic, thorax, lungs recoil after being stretched by contraction decrease in lung volume raises pressure above atmosphere
42
Expiration pressure changes
Intra-alveolar = -3 to +3 Intrapleural = -6 to -3 Transpulmonary = 3 - -3 = 6 mmHg
43
Inspiration pressure changes
Intra-alveolar = 0 to -3 Intrapleural = -4 to -6 Transpulmonary = -3 - -6 = 3 mmHg
44
Pulmonary function tests
assessed clinically by spirometry measures how much and how quickly air can be exhaled by an individual subject breathes into a closed system attached to spirometer, results displayed in spirograms
45
Purposes of PFTs
screen for obstructive and restrictive diseases document progression of disease document effectiveness of intervention evaluate prior to surgery evaluate pt ability to be weaned from ventilator
46
Tidal volume
amount of air expired with each breath during quiet breathing about 500 mL
47
Vital capacity
max amount of air that can be exhaled after max inhalation
48
Lung volumes
Tidal volume inspiratory reserve volume expiratory reserve volume residual volume
49
Inspiratory reserve volume
additional air that can be inhaled after normal TV is inhaled
50
Expiratory reserve volume
additional air that can be exhaled after normal TV is exhaled
51
Residual volume
volume of air remaining in lungs after max expiration cannot be directly measure w/spirometry
52
Lung Capacities
Total lung capacity vital capacity inspiratory capacity functional residual capacity
53
Total lung capacity
total amount of air in lungs after max inspiration cannot be directly measured with spirometry
54
Inspiratory capacity
max amount of air that can be inspired after normal tidal expiration
55
Functional residual capacity
amount of air remaining in lungs after normal tidal expiration cannot be directly measured with spirometry
56
PFTs variables are based on
age (increasing, PFT values decrease) sex (males have larger PFT) Body height/size (taller is larger PFT, obese is lower PFT)
57
FVC
forced vital capacity
58
FEV1
forced expiratory volume in 1 second
59
FEV1/FVC
% of FVC expelled from lungs in 1st second of forced exhalation
60
Restrictive Disorders
spirometry is required to make these broad diagnoses vital capacity is reduced flow rates are usually normal lobectomy and pulmonary fibrosis
61
Obstructive disorders
VC is normal decreased rates of expiration COPD, emphysema, asthma post bronchodilator FEV1/FVC <70% confirms the presence of persistent airflow limitation
62
Dead space
volume of airways and lungs that does not participate in gas exchange for those without pathology, dead space is anatomical
63
Anatomical dead space
about 150 mL stays constant conducting zone fresh air mixes with it volume of air in space remains the same, if you increase TV, % of fresh air increases that enters alveoli
64
Physiological dead space
parts of lungs not participating in gas exchange those with pathology will have larger ones
65
Alveolar ventilation
represents the actual removal and replacement of gas within alveoli, takes into account the dead space f x (TV - DS) (f is frequency of breathing)
66
Dalton's law
total pressure of a gas mixture is equal to the sum of the pressures that each gas in the mixture would exert independently total pressure of a gas mix = sum of partial pressures of constituent gases
67
Partial pressure
pressure that a particular gas in a mixture exerts independently partial pressure = total pressure X fraction of gas in mix
68
PO2 at sea level
760 mmHg x 21% (fraction of O2 in air) = 159 mmHg
69
PO2 at high altitudes
total pressure decreases, so PO2 decreases
70
Calculating PO2 in alveoli
air in alveoli is 100% saturated with water vapor, which contributes to partial pressure you have to subtract water vapor pressure in order to get pressure within alveoli about 150 mmHg dead air mixes with this, end up with about 105 mmHg
71
ways in which Oxygen is carried in blood
dissolved in plasma, 2% (only form that produces partial pressure) bound to hemoglobin, 98%
72
Hemoglobin
found within RBCs, produced by erthropoietin (produced in kidneys) 1 Hb can combine with 4 O2 pulse oximetry measures how much O2 is bound to Hb
73
Loading and unloading of Hb depends on
POs of environemnt affinity between Hb and O2
74
Unloading of Hb occurs
tissue capillaries
75
Loading of Hb occurs
in lung capillaries
76
PaO2 normal value at rest
100 mmHg
77
PO2 in systemic veins at rest
40 mmHg venous values are not clinically useful because they are much more variable
78
PO2 in veins during exercise
can drop to 20 mmHg
79
Oxygen content in blood depends on 3 things
PO2 Hemoglobin Hematocrit
80
Oxy-Hb dissociation curve
curve is steep and then flattens as Hb sat falls below 90%, PO2 drops rapidly
81
Right shift of Oxy-hb curve
hb has decreased affinity for O2, unloading is easier increase in PCO2 and decrease in pH increase in temp occurs during exercise, low pH
82
Left shift of oxy-Hb curve
Hb has increased affinity for O2, unloading is harder occurs with CO2 poisoning, high pH
83
SaO2
arterial oxy-hb saturation indicates how oxygenated arterial blood is catheter measures it
84
Pulse Ox and Pathology
performance of pulse ox deteriorates when SaO2 decreases below 80%, usually overestimation dyshemoglobins, low perfusion state, skin pigmentation, nail polish, excessive motion, anemia are all limitations. also has response delay

3 Cardiopulmonary (9 decks)

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