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C/P Test 3

CP Exam 3- Spring 13

What is the name given to Phase 1? Acute Phase
At what location does it take place? Hospital Setting
How many days does it last? 3-5 days
Phase I Goals Get out of bed, ADL, UE/LE ex's, Supervised ambulation
Time/Session 20-30 mins
Frequency per day 2-3x/day
Intensity Level 2-3 METs
Progression of time/frequency/intensity 30-45 minutes, 1-2x/day, 3-5 METs
Phase I RPE? Light
Phase I HR restrictions Never increase 10-20 bpm from rest
HEP: ambulation time & frequency 20-30 min, 1-2x/day, 4-6x/week
HEP: UE & LE ROM, Flexion/Extension
Phase 2 is called? Sub-Acute phase
Most payers allow for how many visits? 36, usually 3x/week for 12 weeks
Phase 2 time of exercise 30-60 in with 5-10 min warm-up & cool-down
What MET for exit point? 9 METs
When to begin strength training for phase 2? 3 week in cardiac rehab; 5 wk post-MI; 8 wk post-CABG
Where do phase 3 activities occur? Community center, YMCA, Clinical facilities
Phase 3 entry level criteria Functional capacity of 5 METs; Clinically stable angina; Medically controlled arrhythmias during exercise
Phase 3 progression 50-85% functional capacity; 3-4x/week; 45 minutes or more
Phase 3 D/C 6-12 months
2 Main functions of the conducting zone? Warming & Humidifying inspired air; Filtration & Cleaning of inspired air
Functions of Ciliated Cells? Propel mucus blanket up to opening b/t larynx & pharynx where mucus content can either be coughed up or swallowed
Functions of clara cells? Synthesize & secrete proteins ("antibodies" & lysosymes to detox harmful substances); Differentiate into ciliated cells to regenerate bronchiolar epithelium
Functions of basal cells? Thought to be bronchial stem cells & can differentiate into either clara cells or ciliated cells
Functions of goblet cells? Mucus from goblet cells mix with other secretions of mucus blanket that serves to trap small particles in the inspired air & thereby performs a filtration function
Functions of submucosal glands? Secrete mucins, antimicrobial substances, & copious amounts of fluid that add to the liquid that composes the mucociliary blanket
4 components of respiratory zone? Respiratory bronchioles; Alveolar ducts; Alveoli sacs; Alveoli
2 serous membrane layers that surround the lungs? "Space" b/t membranes? Parietal Pleura- lines inside of thoracic wall & covers diaphragm; Visceral Pleura; surface of the lungs; Pleural cavity is between 2 layers
At the end of expiration what is the net mvmt of air & why? No net mvmt at end of expiration b/c there's no difference in pressure b/t atmospheric pressure & intrapulmonary pressure
During inspiration what is the net mvmt of air & why? Air into the airways b/c decrease in intrapleural pressure causes a decrease in intrapulmonary pressure, causing negative pressure difference b/t atmospheric pressure & intrapulmonary pressure
At the end of inspiration what is the net mvmt of air & why? No net mvmt at end of inspiration b/c atmospheric pressure & intrapulmonary pressure equalizes
During expiration what is net mvmt of air mvmt of air & why? Chest cavity returns to resting position (inward & down) & diaphragm returns to bell shape position; This creates + pressure difference causing air to move out of airways
Lung Compliance Ease at which the lung can be expanded during inspiration
Lung Elasticity Ease at which the lung can return or "recoil" back to the resting state
What controls the resistance to air flow through the conducting system? The radius of the airways
What controls surface tension? Thin film of surfactant containing fluid that lines the components of the respiratory zone
Compliance of lungs if a drop of 6 mmHg in intrapleural pressure results in mvmt of 400 mL of air into lungs? 400/6 = 66.7
Compare ease at which lung A & lung B expand if A has compliance=100 & B has compliance=80 Lower compliance=harder to inspire air; Lung B has lower compliance so it takes more work to bring air into lung B
What components within the lungs provide the ability for the lungs to return to their initial size after being distended during inspiration? High content of elastic fibers & elastin proteins within the septa or walls of the lung provide elastic recoil that enables lungs to return to resting position after inspiration
Alveolus A & B have a surface tension of 50, but A has a radius of 1 & B a radius of 1.5. Using Laplace formula what is pressure in each alveoli? A = 2 x 50/1 = 100/1 = 100; B = 2 x 50/1.5 = 100/1.5 = 66.7
If both lungs were connected which one would expand & which would collapse? Air flows from high pressure to low pressure; therefore, air would flow from alveolus A to alveolus B, thus alveolus A would collapse
Taken by themselves, which one would be easier to expand (ie need least pressure to expand)? Smaller the radius of the alveolus, the more pressure it takes to expand the sphere; therefore, alveolus A would be harder to expand
How does surfactant reduce surface tension? Surfactant "fits" in b/t water molecules, reducing surface tension; Higher concentration of surfactant, lower surface tension
Alv. C & D are situated in healthy lung & have normal surfactant. If C has radius 1 & D radius 2, which one has the greatest concentration of surfactant molecules per unit of surface area in order to prevent one collapsing into the other? The smaller the radius of an alveoli the higher the concentration of surfactant. Therefore, Alveolus C would have the higher concentration of surfactant.
Why do premature babies have a high risk for respiratory distress syndrome? Failure of type II alveolar cells to produce sufficient levels of surfactant (type II alveolar cells aren't "mature")
Tidal Volume (Vt) Volume of air moved into & out of the lungs during quiet breathing
Vital Capacity (VC) Volume of air equal to toal lung capacity minus residual volume (TLC-RV)
Total Lung Capacity (TLC) Volume in the lungs at max inflation
Residual Volume (RV) Volume of air remaining in lungs after a max exhalation (can't be measured by spirometry)
A= FVC 5 L & FEV1 3 L; B= FVC 4 L & FEV1 3 L What are FEV1/FVC ratios? Which likely smokes cigarettes? A ratio - 3/5 = .6 B ratio - 3/4 = .75 Healthy adult ratio should be 75-80%, so person A probably smokes
Given the following locations in the lungs, which would have the highest PO2 & which would have the lowest: trachea, bronchi, alveoli? Why? Trachea would have highest PO2 & alveoli the lowest. Reason for decline as one descends airway b/t: Mixing of "fresh" incoming air mixed w/ "stale" air from last expiration in "dead space" of trachea, bronchi & terminal bronchioles; & Humidification
PaO2 at rest & at Peak Exercise No matter how active a healthy person is, even at peak exercise, PaO2 should stay at ~97 mmHg (at sea level)
PaCO2 at rest & at Peak Exercise For a healthy person, no matter the level of activity, all the excess CO2 in the blood entering the lungs should be "blown off", keeping the arterial PCO2 at 40 mmHg
PAO2 100 mmHg
PACO2 40 mmHg
PvO2 at rest 40 mmHg
PvCO2 at rest 46 mmHg
In a healthy person, oxygen saturation of arterial blood is mainly determined by what? Arterial O2 saturation determined by PaO2
What 2 components of blood determine the O2 carrying capacity of blood? CaO2 = Hb (gm/dl) x 1.34 mL Ox/gm Hb x SaO2, O2 carrying capacity of blood is determined by the hemoglobin concentration & SaO2
A person has a hemoglobin content of 14 gms/dl & a SaO2 of 80. What is the oxygen carrying capacity? CaO2 = 14 x 1.34 X .80 = 15.0 mL/dl
What relationship is represented by the oxyhemoglobin dissociation curve? Relationship b/t available oxygen & amount of oxygen carried by hemoglobin
What range of the oxyhemoglobin dissociation curve represents PAO2? Partial pressure of oxygen will remain at the "flat" end of the curve or above 60 mmHg unless one ventures to extremely high altitudes; this end of curve insures O2 sat of at least 90%. <90% is hypoxemia
When considering % oxyhemoglobin O2 saturation, what is unique about this range? At the "flat end" the drop of partial pressure from 100 mmHg to 60 mmHg only causes a slight drop in O2 sat from 98-99% to 90%
What range of oxyhemoglobin dissociation curve represents the tissue PO2 that surrounds systemic capillary beds? At rest PAO2 is ~40 mmHg which beings at "steep" part of curve; Blood entering cap bed with PAO2 40 mmHg will leave tissue at ~75% saturation;
What is unique about this range? Blood leaving at around 55% saturation thus releasing more O2 to the tissue. In this way, the blood can match the needs of the tissue
In what direction does increasing temperature in the capillary bed shift the oxyhemoglobin dissociation curve? Right
In what direction does decreasing temperature in the capillary bed shift the oxyhemoglobin dissociation curve? Left
What affect does shifting have on the unloading of O2 into the capillary bed? Shifting right increases release of oxygen into the capillary bed while a shift left decreases the release of oxygen into the capillary bed
In what direction does increasing 2,3-DPGin the RBCs shift the oxyhemoglobin dissociation curve? Increase would shift curve right & results in an increase in the release of O2 into all the systemic capillary beds
What 2 developments would cause a person's RBCs to increase its concentration of 2,3-DPG? Any event that causes hypoxia (tissues of body deprived of an adequate supply of O2) will results in increased 2,3-DPG in blood (Ex: hypoxia as result of high altitude/COPD/Fe deficiency anemia)
What is the ventilation/perfusion ratio? V/Q is defined at the ratio of the amount of air reaching the alveoli (VA) to the amount of blood reaching the alveoli (Q)
What affect would "shunting" have on the V/Q ratio & thus oxygenation of blood? Given that the normal V/Q is ~0.8, shunting would reduce ratio below that toward 0
What disease conditions can cause shunting? Shunting is blocking of airways due to airway edema, bronchoconstriction & increased mucus secretion as a result of asthma or bronchitis/bronchiolitis
What affect would a "dead space" have on the V/Q ratio & thus oxygenation of blood? Dead space occurs whe perfusion to a ventilated airspace is blocked
What disease conditions can cause dead space? Dead space increases as a result of a pulmonary thromboembolus or acute respiratory distress syndrome (ARDS)
What is the rhythmicity center & 2 types of neurons are found within it? Medulla; I neurons (inspiratory neurons) that stimulate motor neurons that innervate respiratory mm & E neurons (expiratory neurons) that inhibit "I" neurons resulting in relaxation of respiratory mm
Where is the apneustic center & what is its function? Pons; Stimulates the "I" neurons in the inspiratory center of the medulla
Where is the pneumotaxic center & what is its function? Pons; Antagonizes apneustic center & inspiratory center to inhibit respiration
What are central chemoreceptors located? Ventrolateral surface of medulla near the CSF of the 4th ventricle
How are central chemoreceptors stimulated? Increased PaCO2 results in diffusion of CO2 into CSF. CO2 combines with H2O to form carbonic acid which dissociates into H+ & HCO3
Is it CO2 or H+ that directly stimulates central chemoreceptors? H+
Where are peripheral chemoreceptors located? Carotid & Aortic bodies
What directly stimulates peripheral chemoreceptors? Rise in H+ concentration (decrease in pH); on stimulation ventilation rate increases
What effect does PO2 have on peripheral chemoreceptors? Low PaO2 (</= 60 mmHg) is necessary to directly stimulate peripheral chemoreceptors; This degree of hypoxemia occurs in extremely severe environments
pH = 7.52 BE = +2.5 HCO3 = 24 mEq/L PCO2 = 30 mmHg Respiratory Alkalosis
pH = 7.11 BE = -17 HCO3 = 12 mEq/L PCO2 = 40 mmHg Metabolic Acidosis
pH = 7.57 BE = +13 HCO3 = 36 mEq/L PCO2 = 40 mmHg Metabolic Acidosis
pH = 7.24 BE = -11 HCO3 = 15.5 mEq/L PCO2 = 38 mmHg Metabolic Acidosis
pH = 7.36 BE = -2 HCO3 = 23 mEq/L PCO2 = 43 mmHg Normal Blood Gases
pH = 7.23 BE = +2 HCO3 = 26 mEq/L PCO2 = 60 mmHg Respiratory Acidosis
Created by: 1190550002