Respiratory- Part 2 Flashcards by Johannah Crumpton

What are the two reasons that blood will never be at 100% O2 saturation? What system is this associated with?

amixture of deoxy and oxygenated blood

Ventilation Perfusion mismatch

High pressure/Low flow- 120/80

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Describe the Low Pressure/ High flow circulation. Where does it empty?

Right side of the heart, very thin, does not pump under very high pressure- 25/8

All of the blood needs to go to the lungs to get oxy aka HIGH FLOW

5000ml of blood

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Describe the High pressure/Low flow circulation

Straight out of the aorta, going to tissues of the lungs, supplies lungs with nutrition, empties into the left atrium, 2% of cardiac output, amixture of deoxy and oxygenated blood

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What does FEV1 demonstrate?

the amount of air that a person can exhale in the first second of exhalation. Measured in Liters a second

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What is used to determine if a person has an obstructive lung disease? What would it look like?

Looking at their FEV1- (think flow)

The amount of air expelled would decrease

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What is restrictive lung disease?

the inability of the alveoli in the lungs to expand

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What does forced vital capacity (FVC) measure?

The total amount of air (think volume)

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**A person with restrictive lung disease, what test do you look at?

Forced vital capacity (volume)

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**Of the air you are breathing in, you should get ____% out in the first second- (This is a magic number)

How is this number calculated? - Need the formula

80%

FEV1/FVC * 100

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What are the common types COPD. Are these problems with (inhalation/exhalation)?

Asthma, bronchitis and emphysema

Exhalation

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Vocal cord disfunction and laryngeal spasms are problems with (inhalation/exhalation)?

inhalation

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How do blood gases travel in the body?

through simple diffusion

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What are the two blood gases?

Oxygen and CO2

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Does Oxygen or CO2 diffuse faster through the bilipid layer?

CO2

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Name some factors that determine how fast things cross the bilipid layer?

-Solubility of the gas
-Cross sectional area of the fluid
- Distance through which the gas must diffuse
- molecular weight
- Temperature

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***For a patient that has fibrosis (increased thickness in the alveolar membrane) will FEV1 or FVC be negatively impacted?

FVC, because the thickness of the membrane makes it harder for the alveolar to expand, forced vital capacity

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Name some factors that affect the rate of gas diffusion through the respiratory membrane

-thickness of the membrane
- surface area of the membrane
- diffusion coefficient of the gas
- partial pressure difference

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Describe some things that are associated with emphysema. What enzyme can cause it?

-patients have decreased surface area but the alveoli in the lungs coalesce into one big ball instead of a cluster of grapes

-Elastase

-hard to exhale due to collapsed terminal airways

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Give 2 reasons why the partial pressure can change

high altitude

supplemental oxygen

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***____% of oxygen in the atmostphere

20.93%

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What % is Nitrogen in the atmosphere?

79.03%

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What percent is CO2 in the atmosphere?

0.04% CO2

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Define partial pressure

the pressure exerted by any 1 gas in a gas mixture

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At higher altitudes is there (more/less) pressure?

LESS pressure

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What is the partial pressure of Oxygen

159mmHg

What is the partial pressure of nitrogen

600mmHg

What is the partial pressure of Carbon Dioxide?

1mmHg

Be able to draw this picture

memorize and be able to draw this picture

When the V/Q is normal, How much are you breathing?

Breathing just enough to keep the partial pressure of oxygen at 100

Is it more important to keep the Oxygen or CO2 at its normal level in the blood.

Keeping the CO2 @ 40 is more important than keeping the Oxygen @100

In a physiologic shunt, what happens to the VA/Q ratio?

VA/Q ratio is BELOW normal

The bottom part of the lung (less/more) ventilated

Less ventilated

Physiological shunt is due to....

- poor ventilation - does not fully oxygenate the blood flowing through the alveolar capillaries - some venous blood passes to the pulmonary capillaries that are NOT oxygenated

In a physiologic dead space, what happens to the VA/Q ratio?

The VA/Q is GREATER than normal

Physiologic shunt is due to poor (ventilation or perfusion). Name some examples. What does it do to the ratio?

Poor ventilation but there is adequate blood flow COPD Emphysema- sometimes caused by smoking V/Q ratio decreases

Physiological dead space is due to poor (ventilation or perfusion). Name some examples. What does it do to the ratio?

Poor perfusion In areas of the lung where alveolar walls have been destroyed but some ventilation is occurring High V/Q ratio

What is wasteful breathing?

having to breath lots of air to get rid of the CO2

The ideal lung has ????

lowest alveolar ventilation for a given VCO2

At rest, what the physiological dead space is about _____ of the tidal volume

1/3

During exercise, what the physiological dead space is about _____ of the tidal volume

1/5

What is the normal A-a difference?

normal is 5-10mmHg

What does "A" stand for?

A= Alveoli

What does "a" stand for?

a= arterial

If there is a problem with the alveoli/lung tissue, what happens to the A to a difference?

difference will be large

Name some things that cause inefficient breathing?

Kyphosis Brain not telling your muscles to breathe

**In order for 1 Liter of CO2 to be expelled, you need ____ liters of air

25 Liters of air

What does it tell you if it takes a patient MORE than 25 Liters of air to exhale 1 liter of CO2

That their breathing is inefficient

What two things is hemoglobin made from? What does it form?

Succinyl-CoA and glycine Pyrrol molecule

4 Pyrrols molecules combine to form ____

Protoporphyrin

Protoporphyrin combines with iron to form _____

Heme molecules

The heme component has how many types? Name them

2 Alpha and Beta

When hemoglobin changes shape, what does this affect? What is another name for it.

Changes its ability to hold on to and/or let oxygen go Affinity for oxygen

How many oxygens does it take to saturate a hemoglobin?

What is shunt blood?

Blood that went by the alveoli but did NOT get oxygenated

Oxygen dissociation curve: What does 20% Volumes represent

The amount of oxygen that can be carried for every 100mL of blood Oxygen carrying capacity Oxygen content of the arterial blood

Oxygen dissociation curve: What is the constant associated with ____mL/Hb

1.34

What does the a-VO2 difference represent?

The amount of oxygen extracted by the tissues

What is the a-VO2 difference for skeletal tissues?

5mL for every 100mL of blood

At the tissues, would you want a low or high oxygen affinity? Why.

low oxygen affinity because you want oxygen to be released into the tissues

At the lung, would you want a low or high oxygen affinity? Why.

high affinity

If the partial pressure decreases, what happens to the affinity?

the affinity decreases aka oxygen gets released easier

What does the steep part of the oxygen dissociation curve represent?

tissues are releasing more and more oxygen until the partial pressure increases

What 4 things can cause the oxygen dissociation curve to shift to the RIGHT:

1. Increase in hydrogen ions (becoming more acidic) 2. Increase CO2 3. Increase in temperature 4. Increased BPG

What does BPG promote?

hemoglobin transition from a high-oxygen-affinity state to a low-oxygen-affinity state

Give me an example of the Oxy Dissociation curve shifting to the right? Left?

Exercising - shifts right High altitude- shifts left

Be able to draw this curve, including being able to label everything

DO NOT FORGET, be able to draw and label this

**Anemic patient, would it affect the total oxygen carrying content of the blood or blood oxygen saturation? or both?

Anemic patient have less total number of RBC but the RBC they do have are completely saturated. Total oxygen carrying content would be less

___% of CO2 is transported by the same hemoglobin units that transport oxygen

23%

Once the oxygen has been dumped off hemoglobin, there is (more/less) affinity for CO2

More, the affinity for CO2 increases once oxygen has been dumped

CO2 has the ability to float around where? What is this expressing?

in your plasma the partial pressure

What is the main way CO2 is transported?

in the form of bicarbonate in the plasma

What enzyme is responsible for combining CO2 and water. What does it form?

Carbonic anhydrase Carbonic acid :H2CO3

Carbonic acid naturally wants to separate into what 2 things

Bicarb (HCO3) and H Ion

What happens when the bicarb leaves the RBC? What is it called?

bicarb leaves the RBC and goes into the plasma and Cl goes in Chloride shift

How did the CO2 get transported to the lungs?

as plasma bicarbonate

KNOW THIS EQUATION. If you take something away from the left side of the equation, what direction will it shift? How?

To the left, by breathing it out

To get the equation to go right, what do you add?

Tissues add CO2

To get the equation to go left, what do you need to do?

Lungs needs to blow off CO2

**Diabetic patient, that could not use carbs and was blowing off fats at way too high of a rate what would their body be producing?

Ketones, ketone acidosis

Ketone acidosis ____ H+ ions

liberates

What does lactic acid do in terms of this equation?

Lactic acid liberates H+ ions, adding H+ would shift the equation to the left, creates more water and CO2 which would increase your breathing in order to expel the increase in CO2

What is Dr. Sheppard's rule about CO2

treat CO2 as if it was acid

How much hydrogen ion is in your body?

VERY SMALL 0.00004 mEq/L

How is H+ regulated in your body?

very precisely by lots of enzymes

What 3 organ systems help regulate pH

1. Kidneys 2. Lungs 3. Breathing

If HCO3 increases what 2 things happen

- pH will rise - shift the acid-base balance towards alkalosis

HCO3 is mainly regulated by what organ?

Kidneys

PCO2 is mainly controlled by ______

rate of respiration

An increase in HCO3 will cause (Acidosis/Alkalosis)

Alkalosis- becoming more basic

An decrease in HCO3 will cause (Acidosis/Alkalosis)

Acidosis- becoming more acidic

An increase in PCO2 will cause (Acidosis/Alkalosis)

Acidosis

An decrease in PCO2 will cause (Acidosis/Alkalosis)

Alkalosis

**If there is a problem with metabolism, clinically you should look at (HCO3/PCO2)

HCO3

**If there is a problem with respiration, clinically you should look at (HCO3/PCO2)

PCO2

If in respiratory alkalosis/acidosis, ____ will make the adjustment

Kidneys

If you are having metabolic reason for acid/base mismatch, ____ will make the adjustment

Lungs

Give some clinical causes of acid-base disorders

-brain damage that effects the respiratory system -decrease in the lungs ability to eliminate CO2 due to COPD, Pneumonia, Emphysema

Name 2 causes of respiratory alkalosis

-High altitude -Psychoneurosis (hyperventilating due to anxiety)

_____ is the most likely cause of metabolic acidosis

diarrhea

Name some causes of metabolic alkalosis

-Diuretics -Excess aldosterone -Vomiting (due to loss of HCL-stomach acid) -Ingestion of alkaline drugs (Sodium bicarb and treatment of gastritis or peptic ulcers)