Respiratory Physiology Flashcards by Chavez Girls

respiration

gas exchange

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ventilation

air moving in/out of lung
-PT’s can enhance ventilation

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Diffiusion happens faster for: (CO2 or O2)

CO2

is influenced mostly by changes in ventilation

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inspiration

diaphragm contracts (depresses) → increase thoracic cavity volume

negative pressure gradient needed for air to enter lung

higher atmospheric pressure pushes air into airways

internal intercostals expand lungs

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expiration

diaphragm relaxes (elevates)
lungs recoil

external intercostal compress ribcage

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Minute Ventilation

RR x TV

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PT implication for minute volume

deep breaths → better alveolar ventilation due to less dead space → easier to respirate

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How do you know if you are pushing your patient too hard?

-SpO2 levels drop
-↓ TV, ↑ RR (shallow, rapid breathing) → produces dead space → ↓ ventilation
→ ↑ CO2 → acidosis

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how can lumbar pain cause difficulty breathing?

pain → diaphragm becomes a lumbar support muscle/muscles guard/tighten → difficulty breathing

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surfactant

chemical that reduces surface tension within the alveoli, preventing them from collapsing—especially during exhalation.

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lung compliance and associated conditions

lung stretches in response to pressure
↑ compliance: emphysema
↓ compliance: pulmonary fibrosis

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effect of increased lung compliance

↑ airway resistance of exhalation

↓ PaO2 / ↑ PCO2

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effect of decreased lung compliance

↑ work of breathing

restrictive lung disorders

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Which diaphram usually sits higher?

R side, it’s on top of the liver

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The parietal pleura is on the ______

the visceral pleura is on the __________

In between these layers is called the _____________

ribs

Lungs

Pleural space

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Intrapleural pressure is typically ________ than intrapulmonic pressure

Lower

Note: if it was higher it would restrict the lungs

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intrapleural pressure increases/decreases with inspiration and expiration

inspiration: decreases

exhalationL increases

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It’s better to have a ________ tidal volume w/ a _____ respiration rate

Higher

Lower

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Diffusion happens where?

Alveoli

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Why must RBC pass close to the alveoli-capillary wall?

because oxygen does not diffuse as readily as CO2

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What is FiO2 of room air?

21%

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Why should patients NOT use valsalva maneuver

There is less venous return w/ valsalva maneuver bc of increased intrabdominal pressure.

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Every time you take a deep breath you __________ venous return

increase

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The surface tension of the lungs is lowered by ___________, absence of it can cause a collapsed lung

Surfactant

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Intra-alveoli pressure: If the pressure is __________ that allows more air to get to the alveoli and diffuse into the bloodstream

Lower

Less pressure in alveoli + less pressure in pleural space = _______ tidal volume

More Tidal Volume

When a patient lies supine, the diaphram wants to move ___________

Superiorly This is why supine is a harder position to breathe in

How will obesity affect the diaphram position?

Push it upwards → ↓ ERV → harder to breathe

If your diaphram is pushed upwards, you have ________________ functional residiual capacity

decreased

How can you help patient's who have decreased functional residual capacity due to diaphram pushed upwards

Diaphramatic scoop positioning note: Cpap also helps push diaphram back down in patient's w/ obstructive sleep apnea

Inhalation requires work exhalation is a ________

passive process using elastic properties of lung Note: hypercompliance reduces the ability to exhale! Obstructive lung disease!

What is tidal volume

Amount that goes in and out w/ each breath

What is inspiratory reserve volume?

Maximum volume u can inspire above your normal tidal volume

What is expiratory reserve volume

maximum amount you can exhale above your tidal volume

What is residual volume

Volume of air left in lungs after maximum effort

Functional residual capacity

FRC = RV + ERV

Inspiratory capacity

IC = TV + IRV

Vital Capacity

VC = IRV + TV + ERV

Total Lung capacity

TLC= IRV + TV + ERV + RV

Patient's with obstructive lung volume have an __________ of residual lung volume overtime Patient's with restrictive lung volume have a __________

increase decrease

T or F: RV, FRC, and TLC can be measured w/ spirometery

False, because these all include residual volume, which you cannot measure since you can't breath that out.

Obstructive lung diseases cause a ___________ of TLC (Total lung capacity) Restrictive causes a _______ of TLC

Increase Decrease

FEV1

the volume of air expired in the 1st second important in classifying obstructive diseases

normal FEV1

> 80% predicted

FEV1 predictive value is based off of...

Age gender race height

If a patient has COPD, if they're given a bronchodilator, will their FEV1 change?

Not very much Compare this to asthma where the bronchodilator fixes the issue

FEV1/FVC

the percentage of vital capped exhaled in the 1st second of forced exhalation

FEV1/FVC should be atleast a percentage of...

70%

dynamic airway resistance

airway resistance progressively increases with decreased lung volumes

conductance

amount of air that travels deep to lung

Why is taking deeper breaths important for patients?

deeper breaths → ↑ ventilation → ↑ conductance → ↓ airway resistance *be careful with obstructive because they struggle exhaling

dynamic airway resistance with obstructive vs. restrictive diseases

obstructive: ↑ lung volume, ↓ flow rate → **↑ dynamic airway resistance** (especially on exhale) restrictive: ↓ lung volume, ↑ flow rate → normal or ↓ airway resistance

What is normal V/Q?

.8 Ideal = 1

If ventilation is greater than perfusion, this is considered:

Deadspace

If ventilation is less than perfusion in an area of the lungs, what happens?

Shunting to areas with more ventilation

Increasing tidal volume vs increasing breathing rate

Increasing breathing rate increases alveoli ventilation AND deadspace Increasing tidal volume ONLY increases ventilation This is because ventilation distribution improves with greater tidal volumes

T or F, the base of the lungs has the highest absolute ventilation and perfusion

T due to them being larger, but the relative ratio of V/Q is not as great as in the upper lobes

What part of the lung has the most deadspace?

Upper lobes

What part of the lung has the most shunting

Lower Lobes

Distribution of perfusion throughout the lung improves with ___________

exercise

Restrictive disorders increase the _____________ between the RBC and capillaries/alveoli

distance

Diffusion issues can lead to oxygen levels in the lung dropping -> _________________ -> May cause pulmonary hypertension -> Right sided heart failure

Reflexive vasoconstriction to deliver oxygen to ventilated parts of the lung (Shunting)

How would you position your patient if your goal is to increase **perfusion** of the anterior vs. posterior portion of the lung?

anterior: prone posterior: supine *gravity "pools" blood → perfusion

How would you position your patient if your goal is to increase **ventilation** of the anterior vs. posterior portion of the lung?

anterior: supine posterior: prone

what is the significance of the partial pressures for O2 and CO2 in the alveoli?

PaO2 > PvO2 → drives O2 **out of** alveoli PaCO2 < PvO2 → drive CO2 **into** alveoli to be expired

what can disorders affect diffusion?

they INCREASE the distance between the alveolar membrane and the capillary

Disorders that affect DIFFUSION

bronchopulmonary dysplasia chronic fibrotic pulmonary disorders pulmonary edema/pneumonia ARDS/IRDS pulmonary hypertension

What is normal pulmonary BP and what is considered too high with exercise

20 normal 40 too high with exercise

Decreased O2, Increased CO2, and increased Acidity of the blood will shift the oxygen/hemoglobin disassociation curve to the ________

right

which way does COPD shift the oxygen/hemoglobin dissociation curve?

right *so does exercise

causes of high alveolar - arterial gradient

right to left shunt V/Q mismatch diffusion limitation

how does hypoventilation or low inspired PO2 affect AA gradient

normal AA gradient

examples of reduced PiO2

high altitude

Can supplemental oxygen help a patient with large dead-space ventilation or a large intrapulmonary shunt?

NO Because the oxygen can't get to these areas in the first place; shunting bypassing portion of the lung responsible for gas exchange

how does hypoxemia result in R CHF

hypoxemia → vasoconstriction → increase pulmonary arterial → R CHF

what provides the strongest stimulus for breathing?

increased levels of PaCO2 > decreased levels of PaO2

Respiratory control of ABG occurs __________ whereas metabolic control occurs _____________

Rapidly- minutes Slowily- days

How might the respiratory system attempt to raise PH?

Hyperventilation

How might the respiratory system attempt to lower PH?

Hypoventilation

How might the metabolic system reduce acidity? How might it increase acidity?

Kidnesy will excrete HCO3 ( lower PH) Kidneys will retain HCO3 (Increase PH)

Renal failure will cause respiratory metabolic ______________

Alkalosis (cannot excrete HCO3) Note: you will then have hypoventilation in an attempt to compensate.

Choking aspiration tends to happen on the _______ primary bronchi due to it being straighter than the other

Right side