Upper & Lower Respiratory Flashcards
primary functions of respiratory system
gas transport
gas exchange
acid-base balance
secondary functions of respiratory system
air conditioning
defense against pathogens
what does the upper respiratory do to air
filters
warms
humidifies
purifies
what kind of breathers were we designed to be?
nose breathers
difference between infant/child anatomy & adults
large tongue
small mouth
elevated pharynx
swollen epiglottis is a huge problem
who has a more horizontal eustachian tube?
infants –> more ear infxns
who are obligate nose breathers?
infants
when do infants become better mouth breathers?
6 months
how can parents help their children with stuffiness?
bulb syringe & saline nasal drops
air pathway through nose
nose > conchae > nasopharynx > oropharynx > laryngopharyx
air pathway through mouth
mouth > teeth > oral cavity > hard & soft palates > epiglottis > larynx > vocal folds > thyroid cartilage > cricoid cartilage > trachea > bronchus > bronchioles > alveoli
one of the most common birth defects in US
cleft palate
difficulties with cleft palate
feeding, talking, ear infections, hearing loss
what folds on top to protect trachea?
epiglottis
what consists of the vocal folds, thyroid cartilage, cricoid cartilage & trachea
larynx
emergency airway
cricoidthyrotomy
what kind of cells surround trachea?
ciliated pseudostratified columnar epithelial cells
what do the ciliated pseudostratified columnar cells of the trachea contain?
secretory glands & cilia
which way does cilia beat?
toward pharynx
what is the mechanism of cilia?
continuous transport of contaminant out of lungs
what happens with damaged or paralyzed cilia?
increased risk of infections
pneumonia
bronchiectasis
most common cause of damaged or paralyzed cilia
smoking
can cilia regrow?
yes, with quitting of smoking
what coats the alveolar epithelial surface?
surfactant
how does surfactant work?
decreases surface tension allowing expansion of alveoli with inspiration
what would happen without surfactant?
alveoli would collapse during expiration
atelectasis overview
diminished volume affecting part or all of the lung caused by a collapsed or airless state of the alveoli
is atelectasis acute or chronic?
either
two types of atelectasis
obstructive
non-obstructive
most common type of atelectasis
obstructive
what is obstructive atelectasis caused by?
mucous
tumor
foreign body
what can obstructive atelectasis cause
infection
what happens if obstruction causing atelectasis is removed?
infection can subside, returns to normal
what happens if obstruction causing atelectasis is persistent?
fibrosis or bronchiectasis
loss of contact between visceral and parietal pleura
non-obstructive pleural effusion or pneumothorax
when does IRDS occur in kids?
when infants are born <37 weeks
lack of surfactant (adhesive) disorders
ARDS
radiation pneumonitis
IRDS
when else can atelectasis occur?
post-op (after thoracic or upper abdominal surgery and diaphragm is irritated by anaesthesia)
signs and symptoms of atelectasis
dyspnea
chest pain
cough
low-grade fever
what are the lungs innervated by?
ANS
sympathetic affect on lungs
pulmonary vasoconstriction
inhibition of secretion
bronchial smooth muscle relaxation
parasympathetic effect on lungs
pulmonary vasodilation
mucous gland secretion
bronchial smooth muscle constriction
things that cause bronchoconstriction
allergens
cold air
viral infection
things that cause bronchodilation
exercise
epinephrine
norepinephrine
what monitors O2 and CO2 concentration in blood?
specialized nerve cells in aorta and carotid bodies
what happens when O2 decreases?
increased respiratory rate & depth
what happens when CO2 increases?
increased respiratory rate & depth
what exclusively monitors CO2 in CSF
chemoreceptors in the medulla
what happens when CSF is acidotic?
increase respiratory rate & depth
what happens when pH is high?
decease respiratory rate & depth
where are stretch receptors located?
lungs & chest wall
what happens when lungs are over-inflated?
signal to respiratory centers to exhale and inhibit inspiration
what happens with respirations with pain and strong emotions?
increased respirations
what tells the respiratory center to speed up, slow down, or stop?
nerve centers in the cortex
result of chemical irritants
contraction of respiratory muscles causing you to sneeze or cough
whats the main function of the respiratory system
gas transport
how is over 98% of the oxygen carried in the blood?
by attachment to hemoglobin
what does oxygen + hemoglobin form
oxyhemoglobin
how many oxygen molecules can each hemoglobin molecule bind?
4
what is oxygen saturation a measure of?
a percentage of the hemoglobin saturated with oxygen
what has a higher affinity to Hgb than O2
CO
what helps report Hgb saturation with O2 and CO
pulse oximetry (but not accurate)
what is CO poisoning caused by
inhaling combustion fumes
what can produce CO
appliances fueled by wood, gas, or coal
signs & symptoms of CO poisoning
headache dizziness weakness nausea vomiting chest pain confusion
HbCO (carboxyhemoglobin) levels for
non-smoker 15%
treatment for CO poisoning
oxygen
hyperbaric chamber
what serves as a means for the body to exchange gases with the atmosphere via the blood?
respiration
what is greater, pO2 in air of alveolar spaces or pO2 in blood?
alveolar spaces
where is pCO2 higher?
blood
normal paO2
75-105mmHg
low paO2 means…
hypoxemia!
what value of paO2 is critical
<45mmHg
normal paCO2
33-45mmHg
abnormal paCO2
60mmHg
what are ABGs?
arterial blood gases
used to determine gas exchange levels in blood related to respiratory, metabolic, and renal function
what are ABGs indications
Check for severe breathing problems and lung dz, such as asthma, cystic fibrosis orchronic obstructive pulmonary disease (COPD).
Evaluate how well treatment for lung dzis working.
Find out if pt. needs extra oxygen or help with breathing (mechanical ventilation).
Find out if pt. is receiving the right amount of O2 while on O2 in the hospital.
patients you’d consider measuring the acid-base level
heart failure kidney failure uncontrolled diabetes sleep disorders severe infections drug overdose
divide the ABG process into 4 parts
- determine nature of pH of blood
- determine PaCO2 direction
- determine pH direction
- determine presense of compensation and which organ is compensating
ideal pH for the body
7.4 (7.35-7.45)
2 systems that regulate pH
lungs and kidneys
how do lungs regulate pCO2
respiratory rate
tidal volume
goal pCO2 (40mmHg)
goal HCO3 for the kidneys
24 mEq/L
low pH high CO2
respiratory acidosis
high pH low CO2
respiratory alkalosis
low pH low CO2
metabolic acidosis
high pH high CO2
metabolic alkalosis
acidosis and alkalosis limits
acidosis 7.46
what happens to pH when CO2 is dissolved in the blood
CO2 dissolved –> carbonic acid
normal 35-45mmHg
increase CO2 increase acid
respiratory acidosis and alkalosis limits
acidosis >46
alkalosis <34
what happens to pH when bicarbonate is dissloved into the blood
increased HCO3 makes it more basic
where is HCO3 made by?
metabolically by the kidneys
normal value for HCO3
22-26meq/L
metabolic acidosis and alkalosis limits for HCO3
acidosis< 21meq/L
alkalosis >27meq/L
tidal volume
relaxed, normal inspiration/ expiration
about 500ml
vital capacity
largest amount of air breathed out
TV + IRV + ERV
about 5700-6200 ml
expiratory reserve volume (ERV)
amount of air that can be forcibly exhaled after tidal volume
1000-1200ml
inspiratory reserve volume (IRV)
amount of air that can be forcibly inhaled over and above normal respiration
3000-3300ml
residual volume (RV)
leftover air after a forceful expiration
1200ml
measurement of lung size and represents volume of air in the lungs that can be exhaled following a deep inhalation
forced vital capacity (FVC)
a measure of how much air can be exhaled in one second following a deep inhalation
FEV1 (forced expiratory volume)
represents the percent of the lung size that can be exhaled in one second
FEV1/FVC
fastest flow rate reached at any time during the FVC
peak expiratory flow PEF
aka peak flow PF
when does PEF normally occur
in the begining of forcing breath out
what does self-monitorying of spirometry include
assessing the frequency and severity of symptoms
what is so important in monitoring spirometry
a baseline
what to look at when monitoring pts with obstructions
FEV1 and FEV1/FVC ratio
what is super important in interpreting spirometry numbers?
considering height, age, and sex
flow rate in the middle of a breath out
maximum mid-expiratory flow (MMEF) (FEF25-75)
what is a very sensitive measure of airflow obstruction in those with a mild disease?
MMEF
two types of lung function tests
spirometry
peak flow
