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RCP 110 Exam 4
| Term | Definition |
|---|---|
| Normal pH range | 7.35-7.45 |
| Acidic pH | <7.35 |
| Alkalotic pH | >7.45 |
| Normal PaCO2 range | 35-45 |
| Acidic PaCO2 | >45 |
| Alkalotic PaCO2 | <35 |
| Normal HCO3 range | 22-26 |
| Acidic HCO3 | <22 |
| Alkalotic HCO3 | >26 |
| Uncompensated | pH is abnormal, and the PaCO2 or HCO3 is abnormal, but one is normal |
| Compensated | Normal pH and BOTH PaCO2 and HCO3 are abnormal |
| Partially compensated | Abnormal pH with an abnormal PaCO2 and HCO3 |
| Combined | Abnormal pH and both PaCO2 and HCO3 are causing the same issue (acidic or basic) |
| Cyanosis characterisitics | Blue-gray or purplish discoloration seen on mucous membranes, fingertips, and toes |
| When does cyanosis occur? | Occurs when hypoxemia is severe (<40), will occur much earlier because of reduced hemoglobin, is often greater than 5g% |
| Venous admixture | Mixing of non-reoxygenated blood w/reoxygenated blood distal to the alveoli is the end result of pulmonary shunting |
| End result of a venous admixture | Blood mixture that has a higher PaO2 and O2 content than the original shunted, non-reoxygenated blood but lower PaO2 than the original reoxygenated |
| Absolute shunt (true shunt) | Exists when blood flows from the right side of the heart to the left side w/out coming into contact w/an alveolus for gas exchanges |
| Relative shunt (shunt like effect) | Pulmonary capillary perfusion is in excess of alveolar ventilation |
| What is the normal anatomic shunt value | 3% |
| What are the causes of relative shunts? | Hypoventilation, V/Q mismatch, alveolar capillary diffusion defects |
| What are the causes of absolute shunts? | Congenital heart disease, intrapulmonary fistula, vascular lung tumors, capillary shunt |
| <10% intrapulmonary shunt | Normal |
| 10-20% intrapulmonary shunt | Indicates intrapulmonary abnormality but usually fixes itself |
| 20-30% intrapulmonary shunt | Significant intrapulmonary disease and needs to be addressed quickly |
| >30% intrapulmonary shunt | Potentially life threatening and needs aggressive care |
| Shunt equation | Qs/Qt= CcO2 -CaO2 / CcO2 – CvO2 |
| Hypoxia | Inadequate level of tissue oxygenation |
| Hypoxemia hypoxia | Inadequate O2 at the tissue cells caused by low arterial O2 tension (PaO2) Caused by: Hypoventilation, high altitude, diffusion impairment, V/Q mismatch, pulmonary shunting |
| Anemic hypoxia | Normal PaO2 but O2 carrying capacity of hemoglobin is inadequate. Caused by: decreased hemoglobin |
| Circulatory hypoxia | Blood flow to tissue cells is inadequate so O2 is not adequate to meet tissue needs Caused by: Slow/stagnant peripheral blood flow and arterial venous shunts |
| Histotoxic hypoxia | Impaired ability of tissue to metabolize O2 Caused by: Cyanide poisoning |
| Hypoxemia | Abnormally low arterial O2 tension in the blood |
| Causes of hypoxemia | Hypoventilation, high altitude, diffusion impairment, V/Q mismatch, pulmonary shunting |
| HbO2 | Amount of O2 on the hemoglobin or hemoglobin bound with oxygen |
| PaO2 normal for venous blood | 40 |
| Normal V/Q ratio | 0.8 |
| Calculate V/Q ratio | VCO2/VO2 = 200 mL CO2/min / 250 mL O2/min = 0.8 |
| V/Q ratio in a healthy upright lung | 0.8 (>0.8 in upper lung) |
| Describe ventilation and blood flow in these regions | Alveoli in the apices receive moderate ventilation and blood flow, alveolar ventilation is moderately increased and blood flow is greatly increased in the lower lung |
| What determines PAO2 | amount of O2 entering the alveoli (ventilation) and removal by capillary blood flow (A/C membrane |
| hat determines PACO2 | amount of CO2 that diffuses into the alveoli from the capillary blood and its removal from the alveoli by means of ventilation |
| with an increased V/Q ratio, what happens to PAO2 | rises because it does not diffuse into the blood stream as it enters the alveoli because PACO2 decreases which allows PAO2 to move closer to the partial pressure of atm O2 |
| with an increased V/Q ratio, what happens to PACO2 | falls because it is washed out of the alveoli faster than it is replaced |
| with an decreased V/Q ratio, what happens to PAO2 | falls because O2 moves out of the alveolus and into the pulmonary capillary blood faster than is replenished |
| with an decreased V/Q ratio, what happens to PACO2 | rises because it moves out of the capillary blood and into the alveolus faster than is washed out |
| Internal respiration | gas exchange between the systemic capillaries and the cells |
| R value (respiratory quotient) | ratio between the volume of O2 consumed and the volume of CO2 produced |
| Ho much O2 is consumed in 1 minute | 250 mL/min |
| Ho much CO2 is consumed in 1 minute | 200 mL/min |
| Disorders that increase V/Q ratio | Pulmonary emboli, partial or complete obstruction in the pulmonary artery (atherosclerosis), Extrinsic pressure on pulmonary vessels (Pneumothorax, hydrothorax, presence of a tumor), Emphysema, decreased cardiac output |
| Disorders that decrease V/Q ratio | Obstructive lung disorders (emphysema, bronchitis, asthma), restrictive lung disorders (pneumonia, silicosis, pulmonary fibrosis), hypoventilation from any cause |
| Shunt | PAO2= 40 PACO2= 46 |
| Dead space | PAO2= 150 PACO2= 0 |
| PaO2 normal | 80-100 |
| PaO2 mild hypoxemia | 60-80 |
| PaO2 moderate hypoxemia | 40-60 |
| PaO2 severe hypoxemia | <40 |
Created by:
K.Moskowitz
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