Test 3: Breathing System Flashcards

1
Q

Laminar flow is _______ flow

A

Linear

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2
Q

In laminar flow the flow is the highest in the _____ of the tube.
Why?

A

Middle
Because of less friction being present

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3
Q

A larger tube for gas to flow through will allow more or less gas to flow?

A

More

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4
Q

Wha this Hagen-Posieuille Law for Laminar flow?

A

Change in pressure= (Lx v x V) r4

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5
Q

What is turbulent flow?

A

Flow going in multiple directions, not parallel.

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6
Q

In turbulent flow, the flow can be ______ or _____.

A

Localized or generalized

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7
Q

The more resistance, will do what to gas delivery?

A

Slow it down

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8
Q

With turbulent flow, the flow will be _______ throughout.

A

Constant

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9
Q

Laminar-turbulent flow will need more ________ to overcome the resistance.

A

Pressure

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10
Q

What will increase the resistance on breathing circuits?

A

Bends
Lengthy tubing
Changes in diameter (going smaller)

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11
Q

What causes generalized turbulence?

A

exceeding the critical flow rate

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12
Q

what causes localized turbulent flow?

A

when gas flow is below the critical flow rate but encounters constrictions, curves, or valves an area of localized turbulence occurs

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13
Q

what is the nature of laminar flow? particles move how?

A

the nature of the flow is smooth and orderly,

particles move parallel to the walls of the tube

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14
Q
A
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15
Q

describe the nature of turbulent flow?

A

flow is going in multiple directions, no longer parallel

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16
Q

turbulent flow can be ________ or ________.

A

localized or generalized

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17
Q

the more resistance will do what to the flow?

A

slow it down

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18
Q

the flow rate of turbulent flow is what across the diameter of the tube?

A

the same

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19
Q

describe the flow rate across the diameter of the tube for laminar flow?

A

the flow is the greatest in the middle

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20
Q

what is the Hagen-Posieulle Law for Turbulent flow?

A

change in pressure is equal to Lxflow rate (V) x K (constant that includes gavity, friction, and gas density and viscosity)/ r5

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21
Q

resistance imposes what on the patient?

A

a strain

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22
Q

changes in breathing tend to parallel changes in?

A

work of breathing

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23
Q

_______ ________ is typically greater source of resistance compared to the breathing circuit.

A

tracheal tube (smaller diameter and exposed to secretions and could be bite down on and such)

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24
Q

list five ways the anesthesia provider could limit resistance?

A

short length

limit turns

limit valves

limit kinks

ensure largest internal diameter

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25
Q

when does resistance become excessive?

A

when the patient cannot overcome it

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26
Q

flow volume loops can show changes in?

A

resistance

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27
Q

pressure volume loops can show changes in?

A

compliance

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28
Q

compliance is a change in ________ over a change in __________.

A

change in volume over a change in pressure

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29
Q

in the breathing system what is the most distensible components?

A

reservoir bag

breathing tube

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30
Q

compliance places a role in determination of?

A

tidal volume

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31
Q

compliance is a measure of?

A

distensiability

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32
Q

A higher compliance is equal to what volume and pressure?

A

larger volume

less pressure

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33
Q

lower compliance equals what volume and pressure?

A

less volume

more pressure

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34
Q

the more compliant your system is the less __________

A

resistance

easier to distend

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35
Q

the purpose of all types of anesthesia breathing circuits is to deliver? and eliminate?

A

oxygen and anesthetic

carbon dioxide

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36
Q

what does rebreathing mean?

A

to inhale previously respired gases from carbon dioxide which may or may not have been removed.

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37
Q

rebreathing is ______ as the fresh gas flow is decreased.

A

increased

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38
Q

name the three factors that influence rebreathing?

A

fresh gas flow

mechanical dead space

breathing system design

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39
Q

if the volume of FGF supplied per minute is equal to or greater than the patient’s minute volume, is there rebreathing?

A

no

as long as provision is made for unimpeded exhaust to the atmosphere or to a scavenging system at the point close to the patient respiratory tract

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40
Q

what is dead space?

A

ventilation without perfusion

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41
Q

how do you minimize mechanical dead space?

A

seperate the inspiratory and expiratory gas streams as close to the patient as possible

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42
Q

what is mechanical dead space?

A

the volume in a breathing system occupied by gases that are rebreathed without any change in composition

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43
Q

with no rebreathing, the composition of inspired gas is identical to?

A

fresh gas

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44
Q

When rebreathing occurs, the inpsired gas is composed of what?

A

part fresh gas and part rebreathed gas

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45
Q

what is the temperature and moisture content of fresh gas?

A

room temp and dry

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46
Q

what is the temperature and moisture content of exhaled gases?

A

warm and moist

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47
Q

rebreathing reduces what?

A

heat and moisture loss

cost from decreasing gas supply

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48
Q

the effects of rebreathing on inspired gas tensions will depended on?

A

the part of exhaled gas rebreathed and whether these pass to the alveoli or only to the anatomical dead space

49
Q

oxygen rebreathed alveolar gas will have a _____inspired oxygen tension

A

reduced

50
Q

rebreathing alveolar gas will _______ inductions and emergence.

A

prolong

51
Q

rebreathing alveolar gas will cause an increased inspired ______ _________ tension unless the gas passes through an _______ before being rebreathed.

A

absorbent

52
Q

rebreathing will allow normocarbia to be achieved despite _________.

A

hyperventilation

53
Q

name the four rebreathing advantages?

A

cost reduction

heat retention

moisture retention

decrease occupation exposure to trace gases

54
Q

does a face mask or ETT have more dead space?

A

face mask

55
Q

list the common components of breathing systems?

A

connectors

adaptors

breathing tubes

apl valve

peep valve

filters

56
Q

what is the purpose of a connector?

A

a fitting intended to join together two or more similar components

57
Q

what is the purpose of an adaptor?

A

a specialized connector that establishes functional continuity between otherwise disparate or incompatible components

58
Q

connector/adaptors can be distinguished by?

A

shape

component attached to

added features (nipple)

size/type of fitting at either end

59
Q

if positioned between the breathing system and the patient connectors add to?

A

dead space

60
Q

connector increase the number of locations at which what can occur?

A

disconnection

61
Q

reservoir bags must have a ______ mm _______ connector

A

22 mm female connector

62
Q

what is the purpose of the reservoir bag?

A

allows gas to accumulate during exhalation (permits rebreathing)

help assist or control ventilation

serve as a visual or tactile observation as a monitor of a patient’s spontaneous respiration

63
Q

what is the MOST distensible part of the breathing system? it protects the patient from what?

A

reservior bag

it protects the patient from excessive pressure in the breathing system

64
Q

minimal rise in pressur edespite added volume in the reservior bag occurs untile _______ capacity is reached

A

nominal

65
Q

once nomial capacity is reached, the pressure rises rapidly to a peak and then reaches a _________ . then as the bag distends further what happens?

A

plateau

as the bag distends further the pressure falls slightly

66
Q

ASTM for reservoir bags requires that bags of 1.5 L or smaller shall not be less thant ____ cm H20 or over _____ cm H20 when the bag is expanded 4 times its capacity

what is the values for bags larger than 1.5 L

A

30

50

35 and 60

67
Q

latex free reservior bags may allow _____ pressures to develop

A

higher

68
Q

new reservior bags develop ________ pressure when first over inflated vs. bags that have been overinflated several times or pre stretched.

A

higher

69
Q

traditional reservior bag for adults is?

A

3L

70
Q

when discussing reservior bags a spare bag should always be kept immediately available why?

A

in case the bag develops a leak or becomes lost

71
Q

what is the purpose of corrugations in the breathing tubes?

A

increase flexibility, help prevent kinking, and adds distensibility

72
Q

what does the APL valve do?

A

releases gases to a scavenging system to control pressure in the breathing system

73
Q

what is the STAndard about APL valve?

A

requires an arrow or marking indicate the direction of movement to close the valve

74
Q

what is the standard motion ot close the APL valve or increase pressure?

A

clockwise motion

75
Q

PEEP valves can be ______ or _________.

A

unidirectional or bidirectional

76
Q

what is the recommended type of PEEP valve for safety? Why?

A

bidirectional

if placed incorrectly, they will not obstruct flow just not add PEEP

77
Q

what is the major concern with unidirectional PEEP valves?

A

obstruction of airflow and barotrauma

78
Q

what must a fixed peep valve have on it?

A

arrow indicating the proper direction of gas flow/ or words inlet and outlet/ and the amount of PEEP that will be applied.

79
Q

after a clinician applied a fixed PEEP valve what should they do?

A

check for ventilation to ensure no obstructed flow

and check to ensure additional PEEP is being applied.

80
Q

what is the purpose of a filter?

A

protect the patient from microorganisms and airborne particulate matter and to protect anesthesia equipment and the environment from exhaled contaminants.

81
Q

when a filter is placed between the pt and breathing machine what may the filter do what?

A

increase inspired humidity

82
Q

however, with a filter resistance increases as what happens?

A

condensation accumulates or secretions

83
Q

additionally a filter between the patient and ypiece does what?

A

increases dead space

84
Q

during spontaneous ventilation the APL valve remains closed during ______ and open during _______.

A

inspiration

expiration

85
Q

during assisted ventilation the APL valve is ______ closed.

A

partially

86
Q

during mechanical ventilation the APL valve is?

A

isolated by the bag-ventilator switch

87
Q

minute ventilation is calculated by?

A

RR x TV

88
Q

name the four classifications of breathing circuits?

A

open

semi-open

semi-closed

close

89
Q

give examples of open breathing systems?

A

open drop

insufflation

nasal cannula or face mask

90
Q

give examples of semi-open systems?

A

mapleson circuits (non breathing circuits)

circle system with high FGF greater than minute ventilation

91
Q
A
92
Q

semi-closed system examples?

A

circle system with FGF less than minute ventilation

93
Q

closed circuit system examples?

A

circle system with extremely low FGF, with APL closed.

94
Q

Does open system have rebreathing or reserviors?

A

no

95
Q

does a semi open system have rebreathing or reserviors?

A

rebreathing no

reservior yes

96
Q

does a semi closed system have rebreathing or reserviors?

A

rebreathing yes (partial)

reservior yes

97
Q

does a closed system have rebreathing or reserviors?

A

rebreathing Yes (complete)

reservior (yes)

98
Q

describe insufflation?

A

blowing of gas across a patients face

99
Q

list the advantages of an open system?

A

easy to use

simple

noninvasive

100
Q

list the disadvantages of a open system

A

air pollution

unable to ventilate

cannot control amount of gas providing to patient (entrain room air)

cost (high fresh gas flows)

Will not be able to conserve heat or humidity

101
Q

describe draw over?

A

ambient air is the carrier gas that when the spontaneously breathing patient inspires (negative force) pulls air flow through the vaporizer which pulls some anesthetic to the patients lungs.

102
Q

does a draw over have a reservior bag?

A

no it is a self inflating bag

103
Q

list the components of the mapleson circuit?

A

face mask

breathing tubes

fresh gas inlet

adjustable pressure limiting valve

reservior bag

104
Q

what does maplesons lack?

A

unidirectional valves

CO2 absorbers

both and inspiratory and expiratory limb

105
Q

wha tis the best methods to determine the optimal fresh gas flow?

A

carbon dioxide monitoring.

106
Q

what determine the amount of rebreathing using a mapleson?

A

the fresh gas flow

107
Q

why is work of breathing and resistance low with mapleson circuits?

A

no unidirectional valves

108
Q

with higher FGF you have ______ rebreathing

A

less

109
Q

with lower FGF you have ________ rebreathing

A

more

110
Q

what is the breathing tube size on a mapelson circuit?

A

22 mm

111
Q

if a unidirectional valve gets stuck in a circle system what can happen?

A

barotrauma d/t obstruction

112
Q

if a unidirectional valve becomes incompetent in a circle system what can happen?

A

you will get rebreathings

113
Q

what is another name for a check valve?

A

unidirectional valves

114
Q

the y piece has one _____ mm ___ port and two ____ mm ____ ports

A

15 female port

22 mm male ports

115
Q

when is the apl suppose to be fully open?

A

spontaneously breathing

116
Q

compliance of the breathing tube will be reflective of what?

A

resistance.

117
Q

what are the components of the circle system?

A

fresh gas inlet

unidirectional valves

y-piece connector

apl valve

reservior bag

canister containing carbon dioxide absorbent

bag/vent selector switch

mechanical anesthesia ventilator

118
Q

a closed breathing system is present with the FGI into the circle system ______ mL/min satisfies the patient’s metabolic oxygen requirements _______ mL/min during aneshtesia and replace anesthetic gases lost by virtue of tissue uptake

A

150-500mL/min

150-250 mL/min

119
Q
A