Respiratory System Flashcards
1
Q
Function of pulmonary ventilation
A
Breathing. Promotes air movement in and out of the lungs.
2
Q
Function of external respiration
A
Gas exchange at the alveoli and pulmonary capillary interface. Loading of O2, unloading of CO2.
3
Q
Process of respiratory gas transport
A
O2 and CO2 transportation from and to the lungs and body cells via blood in the circulatory system.
4
Q
Process of internal respiration
A
Gas exchange at the interface between systemic capillaries and tissue cells.
5
Q
Definition of Type I respiratory failure. SpO2 and SpCO2 values
A
Hypoxaemia with normocapnia
(PaO2 low, PaCO2 normal/low)
Causing an increased alveolar gradient
6
Q
Definition of Type II respiratory failure, SpO2 and SpCO2 values. Target SpO2.
A
Hypoxaemia with hypercapnia (Low PaO2 with high PaCO2) Normal alveolar gradient Decreased pH. SpO2 88-92%.
7
Q
Tachypnoea definition
A
RR >20rpm.
8
Q
Bradypnoea definition
A
RR <12rpm.
9
Q
Apnoea definition
A
Absence of respiration
10
Q
Cyanosis definition
A
Lack of oxygen in the blood that causes bluish discolouration of skin and mucous membranes
11
Q
Hypoxia definition
A
Inadequate oxygen supply to the tissues
12
Q
Dyspnoea definition
A
Difficult, laboured breathing
13
Q
Hypoxaemia definition and value
A
Reduced arterial blood PaO2 <8kPa, with or without increased arterial PaO2.
14
Q
Hypercapnia definition and value
A
Increased arterial PaCO2 >6kPa.
15
Q
Definition of SaO2
A
Percentage of haemoglobin saturated with oxygen. Arterial SaO2 very similar to capillary SpO2 measures
16
Q
SpO2 definition and target value.
A
Peripheral capillary blood haemoglobin oxygen saturation (not a measure of effective ventilation). SpO2 94-98%
17
Q
PaO2 definition and normal values
A
Partial pressure of oxygen in the arterial system. Normal values 11-13kPa
18
Q
Normal haemoglobin value
A
11.5-18.0g/dL
19
Q
Arterial blood gas (ABG) analysis normal values with unit of measure: pH PaO2 PaCO2 HCO3- BE SaO2 Lactate
A
pH: 7.35-7.45 PaO2: 11-13.3kPa PaCO2: 4.8-6.0kPa HCO3-: 21-28mmol/L BE: -2 to +2 SaO2: 95-100% Lactate: 0.5-1mmol/L
20
Q
PaCO2 normal values
A
4.6-6.0kPa
21
Q
What occurs in respiratory acidosis
A
Increasing PaCO2 with decrease PaO2 causing decrease in pH
22
Q
Compensatory mechanisms for respiratory acidosis
A
Increased respiratory rate. Depletion of HCO3- store/increase in circulating HCO3-
23
Q
What is pink throthy sputum a sign of
A
Cardiac failure
24
Q
Definition of chenye-stokes respiration
A
Irregular breathing pattern with periods of apnoea associated with brain stem death.
25
What is Kussmal breathing and what is it associated with? What may cause it?
Deep and rapid breathing associated with metabolic acidosis. Caused by sepsis, uraemia or diabetic ketoacidosis
26
Flail chest
Breaking of ribs away from chest wall, preventing normal mechanics of breathing from occurring efficiently.
27
Surgical emphysema
Air under the surface of the skin on the chest from the lungs, feels like bubble wrap.
28
What can an X-ray of the chest help to diagnose in relation to the respiratory system
Pneumothorax, pleural fluid, pulmonary oedema, infection, lung fibrosis.
29
What occurs in respiratory alkalosis?
Decrease CO2
| Increase in pH
30
What is base excess?
Provides a numerical value for the the degree of acid base imbalance.
31
What does a BE of +2 mean?
Increase in bicarbonate due to metabolic alkalosis causing compensatory respiratory acidosis to try and bring pH back within range
32
What does a BE of -2 mean?
Reduced bicarbonate due to metabolic acidosis causing compensatory respiratory alkalosis to bring pH back within range.
33
What type of process is inspiration/expiration
```
Inspiration= active process
Expiration= passive
```
34
What determines airway resistance?
Diameter of airway
35
What is lung compliance?
Ability of lungs to stretch and expand easily.
36
What is the name of the membrane that covers the lung and chest wall?
Pleura (visceral and parietal)
37
What keeps the visceral and parietal pleura together?
Negative pressure within the inter plueural space that constantly pulls the two membranes together.
38
What is the costal angle?
Space/angle between the two sides of the rib cage by the diaphragm.
39
What is the function of bronchial circulation?
Supply oxygen and nutrients to the lung parenchyma, airways, pulmonary arteries/veins and pleura
40
What is the lung parenchyma and its function?
Portion of the lung involved in gas transfer.
| The alveoli, alveolar ducts and respiratory bronchioles
41
What is the normal volume for expectoration?
100mls
42
What is haemoptysis?
Coughing up of blood
43
Where are the cough receptors located?
Receptors in the pharynx, larynx and bronchi
44
What is a lower airway cough associated with?
Sputum production
45
What is phlegm rather than sputum an indication of?
Inflammation and infection
46
What does white grey sputum indicate?
Chronic irritation
47
What colour may the sputum of someone with pneumonia be?
Rusty
48
What does pink throthy sputum indicate?
Pulmonary oedema
49
What is haemoptysis a sign of?
Serious lung disease
50
How to tell if blood is from the stomach or lungs in haemoptysis?
Dark red= lung
| Bright red= stomach
51
Which structures of the lung have no pain receptors?
Lungs and visceral pleura
52
Which structures of the lung have pain receptors?
Parietal pleura, chest wall and medistinal structures
53
What are the symptoms of pleurtric pain? Such as in the case of pleural effusion
Sharp, stabbing, worse on deep inspiration and coughing
54
What type of pain indicates muscle strain or rib fracture?
Chest wall pain.
| Pain worse on turning or twisting n bed.
55
What is stridor?
Harsh inspiratory and expiratory noise
56
Where is the respiratory centre located in the brain?
The medulla oblongata of the brain stem.
57
What are the names of the nerves that coordinate the respiratory movement?
Phrenic and intercostal nerves
58
Which nervous system controls airway tone?
Autonomic nervous system
59
Is it noradrenaline or adrenaline that stimulates bronchodilation?
Noradrenaline
60
What is the name of the group of drugs that cause bronchodilation?
Beta androgenreceptor agonists
61
What can inhaling smoke, dust or cold air stimulate and result in?
Stimulate cough receptors triggering brochoconstriction via vagus parasympathetic activity.
62
What are the 4 factors that cause change in respiration?
Conscious change in rate/depth
Limb receptors in response to exercise
Pulmonary receptors in response to stretch/irritation
Chest wall muscle receptors
63
What are the 3 chemical stimulants for breathing?
Rise in PaCO2
Metabolic acidosis- remove CO2
Fall in PaO2/increase in H+ conc detected by receptors in carotid and aortic bodies
64
What 2 factors influence efficient gaseous exchange?
Adequate ventilation and capillary perfusion.
65
Which 2 factors lead to ineffective gaseous exchange?
Inadequate perfusion or ventilation at the alveoli
66
Which 3 factors determine effective gaseous exchange?
Airway resistance - diameter
Lung compliance - ease of expansion
Elasticity - stretch and recoil
67
What is the definition of type 1 respiratory failure?
Insufficient O2 availability at alveoli-capillary interface decreasing arterial oxygen level
68
What is the definition of type 2 respiratory failure?
Insufficient arterial O2 with increased CO2 (hypercapnia)
69
What are the 3 main diseases included in COPD?
chronic bronchitis
emphysema
chronic asthma
70
What is chronic bronchitis?
Inflammation and swelling of airways, narrowing of airways, reduced airflow, reduced alveolar ventilation.
Hypertrophy and increase in goblet cells.
71
What is emphysema?
Dilation, permanent enlargement and destruction of alveoli. Meaning less surface area for gaseous exchange
72
What is chronic asthma?
Inflammation of the airways, constriction of airway smooth muscle
73
What drug via what route reverses bronchospasm?
Inhaled bronchodilators such as salbutamol.
74
What are the 2 initial clinical symptoms of COPD?
Increased sputum production and increasing dyspnoea
75
What does spirometry investigation measure?
Volume of air expelled from lungs after maximal inspiration of breath.
76
What are the 3 tests for airway function?
Peak flow
Spirometry
Flow loop volumes
77
In terms of respiration what is the classification of obstructive lung disease?
Increased resistance to airflow
78
In terms of respiration what is the classification of restrictive lung disease?
Expansion of the lung is restricted
79
What is the classification of vasular lung disease?
Disease of the lung vasculature
80
What is the classification of environmental lung disease?
Inhaled particles
81
What are the 5 stages that occur in the exacerbation of asthma?
```
Inhalation of irritants
Epithelial shedding
Inflamatory oedema
Smooth muscle contraction
Increased secretions
```
82
What is the acronym used to assess the severity of pneumonia?
CURB score
83
What does CURB stand for? And whats it used in the assessment of?
Confusion
Urea
Respiration rate
Blood pressure
84
What are the clinical signs of pneumonia?
```
Coughing up pussy sputum
Pleuritic pain
Fever
Breathlessness
May have cyanosis and tachypnoea
```
85
What is the normal volume of pleural fluid?
5mls
86
What causes a pleural effusion to occur?
Disruption in hydrostatic pressure causing fluid to accumulate
87
What can be observed in a pt with a pleural effusion?
SOB
| Tachypnoea
88
What occurs in a pneumothrax?
Air in pleural space, leaked from alveoli due to a gap in the visceral pleura
89
What are 2 diagnostic of pneumothorax?
Sudden onset of pleuritic pain
| Breathlessness
90
What determines the extent of the breathlessness experienced in pneumothorax?
Health of the lung
| Size of pneumothorax
91
What is a tension pneumothorax?
A flap valve forms allowing air to only enter the pleural space on inspiration
92
What are the general management interventions for respiratory conditions?
```
Oxygen therapy
ABG- identify T1RF/T2RF
Bronchodilators
Steroids
Antibiotics
Analgesia
Physiotherapy
```
93
What is the management for asthma?
Inhalers, dry powders, nebulisers
Anti-inflamatory agent i.e. steroids
Bronchodilators: short and longterm beta agonists
Magnesium sulphate
Oxygen
Sit up
Mechanical ventilation if trouble to breath and silent chest
94
What is the management for COPD?
Oxygen therapy and long term oxygen therapy
Abx
Physio therapy
Bronchodilators
Non invasive positive pressure ventilation
95
What is the management for chest infection?
```
O2 therapy
Analgesia
Optimum fluid balance
Abx- depending on presentation
Physiotherapy
Sputum samples
```
96
What is the management for pleural effusion?
Transudate effusions= control underlying problem, usually self-reabsorbing. Large effusions drained 1.5L max
Exudate effusions- treat underlying cause, repeated aspirations, irritate introduced to adhere the pleura together
97
What is pleurodesis?
Adhesion of pleural surfaces
98
What is the management for pneumothorax?
Passive absorption- repeat xrays to see progress
Aspiration of air from pleural space
Intercostal tube drain- cannulae into chest wall; wide bore tube to drain air; under water seal drain
Surgery
99
What is involved in the assessment of a chest drain?
```
Fluid level
Fluid swing
Bubbling
Pain
Respiratory rate, rhythm, depth
Positioning
```
