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Respiratory Care Year 1 > Study Guide 3 cardiopulmonary > Flashcards

Study Guide 3 cardiopulmonary Flashcards

1
Q

What is the vasomotor center that sends sympathetic impulses to the blood?

A

Medulla Oblongota

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2
Q

Where are the baroreceptors located?

A

Carotid sinus and aortic arch (in the aorta)

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3
Q

What is the function of the baroreceptors?

A

Regulate arterial blood pressure.

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4
Q

Describe the baroreceptors reflex

A

BP drops: baroreceptors decrease impulse to medulla. Medulla increases signals which cause vasoconstriction, which cause heart rate to go up and BP to increase

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5
Q

Normal systolic/diastolic
Systemic
Pulmonary

A

Systemic: 120/80
Pulmonary: 25/8

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6
Q

Calculate driving pressure if given the mean pressure of various heart and blood vessel structures

A

Subtract from one another

Ex: 100-4=96

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7
Q

What is stroke volume

A

Volume of blood ejected from the ventricle during each contraction.
Normal is 40-80ml

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8
Q

What is cardiac output?

How do you calculate it?

A

Total volume of blood ejected from the ventricles per minute

CO=SV x HR

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9
Q

What happens to the blood pressure if the heart rate or stroke volume increases?

A

BP increases

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10
Q

What is the blood volume in an adult?

systemic, pulmonary, heart, veins, arteries, capillary beds

A 
5L.
systemic-75%
pulmonary- 10%
heart 15%
veins 60%
arteries 10%
capillary 75ml
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11
Q

Where is perfusion better when the patient is in the following: supine, prone, side, upside down

A

supine-posterior
side- lateral
prone- anterior
upside down- upper lobes

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12
Q

Stroke volume is determined by 3 things. Name them:

A

ventricular preload
ventricular afterload
myocardial contractility

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13
Q

What is the ventricular preload

A

How much the myocardial is stretched prior to contraction

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14
Q

What is ventricular afterload and what is it determined by?

A

force against which the ventricles must work to pump blood.

Determined by viscosity (how thick the blood is. How open the blood vessels are)

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15
Q

What is myocardial contractility

A

force generated by the myocardium when the heart contracts

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16
Q

an increase in myocardial contractility is known as

A

positive inotropism

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17
Q

a decrease in myocardial contractility is known as

A

negative inotropism

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18
Q

what is vascular resistance

A

resistance to flow that has to be overcome to push blood through the circulatory system

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19
Q

what happens when vascular resistance increases? Decreases?

A 
BP increases (goes up)
BP decreases (goes down)
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20
Q

what are active mechanisms that change vascular resistance

A 
pharmacological stimulation (drugs)-epi, dopamine (constriction) O2 (dilates)
pathological conditions- different diseases
Abnormal ABG- decrease PaO2, increase PaCO2= Increase PVR
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21
Q

What are passive mechanisms that change vascular resistance?

A 
pulmonary arterial pressure changes
left arterial pressure changes
alveolar vessel resistance
extra alveolar vessels
blood volume changes
blood viscosity changes
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22
Q

What are the causes of increased pulmonary vascular resistance?
Acute, chronic

A

Acute: hypoxia, acidosis, drugs, hypercapnia
Chronic: pathological conditions

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23
Q

What are normal arterial blood gas values?

A

pH 7.35-7.45
PCO2 35-45mmHg
PO2 80-100mHg
HCO3- 22-26mEq/l

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24
Q

Which blood gas values are actual determined by blood gas machines? Which are calculated?

A

PaO2, pH, PaCO2

SaO2, HCO3-

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25
Q

Oxygen is carried in 2 forms. Name them

A

dissolved O2 in plasma

chemically bound to Hb

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26
Q

Determine the amount of O2 carried in the plasma (dissolved O2)

A

PaO2 x 0.003

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27
Q

Determine the amount of O2 chemically bound the Hb (combined O2)

A

Hb x 1.34 x SaO2

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28
Q

Hb saturation is normally 97% due to:

A

Anatomical shunts

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29
Q

A decrease in affinity of Hb for O2 causes

A

increase unload of O2

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30
Q

What is p50?

What is the normal p50?

A

normal: 27mmHg

partial pressure at which the Hb is 50% saturated with O2

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31
Q

What are the factors that cause a right shift of O2 dissociation curve?

A

decrease pH
increase PaCO2
increase temperature
increase DPG (2,3)

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32
Q

What does a shift to the right of the O2 dissociation curve result in?

A

decrease Hb affinity for O2
decrease pH
increase unloading of O2
Hb saturation for a given PO2 falls

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33
Q

What are the factors that cause a left shift of the O2 dissociation curve?

A 
increase pH
decrease PaCO2
decrease temperature
decrease DPG (2,3)
COhb,MetHb, HbF
34
Q

What does a shift to the left of the O2 dissociation curve result in?

A

increase Hb affinity of O2
decrease unloading of O2
Hb saturation for given PO2 rises

35
Q

The effect of pH on the Hb affinity for O2 is known as

A

Bohr effect

36
Q

O2 transport studies are indicators of

A

cardiac output and ventilation

37
Q

What is total O2 delivery? What must you take into account when determining it?

A

Total amount of O2 delivered or transported to the peripheral tissue
cardiac output and O2 content

38
Q

how do you determine the arterial-venous O2. content difference

A

CaO2-CvO2=

39
Q

What is the normal CaO2? Which is the normal CvO2?

A

20% volume

15% volume

40
Q

What is the normal difference

A

5% volume

41
Q

What is O2 consumption? What is this related to? What is the average?

A

amount of O2 extracted by the peripheral tissue during the period of 1 minute
Patient’s body surface area
Average is 125-165

42
Q

What is the O2 extraction ratio? What is normal O2 extraction ratio?

A

amount of O2 extracted by peripheral tissue divided by amount of O2 delivered in tissue
25% or 0.8

43
Q

What is the normal SvO2?

What is acceptable

A

75%

65%

44
Q

What does it mean when the SvO2 is decreased? What would you do to correct it?

A

tissue took out too much O2.
decreased cardiac output, periods of O2 consumption, exercise shivering, seizure hyperthermia
increase cardiac output with drugs

45
Q

Describe true shunt

A

blood flows from right heart to left heart without gas exchange

46
Q

An anatomical true shunt comprises __ of cardiac output

A

3-5%

47
Q

Name the abnormalities that cause true anatomic shunt

A

congenital heart disease, intrapulmonary fistula, vascular lung tumors, capillary shunts

48
Q

How do you usually correct a true shunt

A

surgery

49
Q

Descrive a shunt like effect how is it corrected?

A

pulmonary capillary perfusion is in excess of alveolar ventilation.

O2 therapy

50
Q

Name the causes of a shunt like effect

A

hypoventilation
V/Q mistmach
alveolar capillary diffusion

51
Q

_____ is the end result of venous shunting

A

venous admixture

52
Q

Ideal alveolar gas equation

A

[(Pb-47)FIO2] - (PaCO2 x 1.25)

53
Q

What is the normal pulmonary shunting?

A

less than 10%

54
Q

What percentage shows intrapulmonary abnormality

A

10-20%

55
Q

what percentage shows significant pulmonary disease

A

20-30%

56
Q

What percentage shows potentially life threatening condition

A

more than 30%

57
Q

Name 4 types of hypoxia and describe them

A

hypoxic- lower PaO2
anemic- low blood Hb or abnormal Hb
circulatory- not enough blood, bad heart
hisotoxic- inability to utilize O2

58
Q

types of hypoxic associated with

-overdose of nitric oxide therapy in NICU

A

hisotoxic, anemic

59
Q

types of hypoxia associated with

-patient with cardiomyopathy?

A

circulatory

60
Q

severe hemorrhage in MVA

A

circulatory/ anemic

61
Q

types of hypoxia associated with

-rookie mountain climber at 7k ft elevation

A

hypoxic

62
Q

What indicates a more life threatening condition, central or peripheral cyanosis? Why?

A

Central

Brain’s not getting enough air

63
Q

at rest, metabolizing tissue cells consume at __ ml of O2 and produce at ___ ml of CO2

A

250

200

64
Q

What is the end result of the adaptive mechanism to increase the O2 carrying capability of the blood in the patient with COPD

A

hypoxia -> polycythemia (makes more RBC) -> cor pulmonale (right heart failure)

65
Q

What are 3 ways CO2 is transported in the plasma

A

delivered CO2
HCO3-
Carbamino compound

66
Q

What are the 3 ways CO2 is transported in the RBC?

A

dissolved CO2
HCO3-
carbamino compound

67
Q

the majority of CO2 is carried __ in the __

A

bicarbonate

RBC

68
Q

The CO2 dissociation curve is ___

A

linear

69
Q

This means that there is a direct relationship between the __ and ___

A

partial pressure of CO2

amount of CO in the blood

70
Q

describe the Haldane effect

A

deoxygenated blood enhances the loading of CO2, oxygenated of blood enhances unloading of O2

71
Q

What is the average ventilation/perfusion ratio?

A

4:5 or 0.8

72
Q

in an increased V/Q ratio: the PAO2 __and the PaCO2__

A

rise

fall

73
Q

in a decreased V/Q ratio, the PAO2__ and the PaCo2___

A

falls

rises

74
Q

what is the respiratory quotient

A

internal respiration gas exchange between the systemic capillaries and cells
RQ= VCO2 / VO2

75
Q

What is the respiratory exchange ratio? (RR)

A

external respiration gas exchange between the systemic capillaries and cells

76
Q

if the V/Q ratio is increase what is happening?

A

perfusion decreasing

77
Q

Name the respiratory disorders that cause an increase V/Q ratio

A

pulmonary emboli, partial/complete obstruction in pulmonary arteries/arterioles, decrease cardiac output, extrinsic pressure on pulmonary vessels, destruction of capillaries

78
Q

if the V/Q is decreasing what is happening?

A

ventilation decreasing

79
Q

name the respirator disorders that cause a decrease in V/Q ratio

A

obstructive (CBABE)
restrictive- pneumonia, silicosis, pulmonary fibrosis
emphysema does both

80
Q

Be able to label ventilation/ perfusion sliding bar diagram

A 
Top bar (Vs anatomical, ventilation)
Bottom Bar (Q-perfusion, Qs anatomical)
81
Q

Total O2 delivery (DO2)

A

total amount of O2 delivered to the peripheral tissues

Respiratory Care Year 1 (1 decks)

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