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TL Respiratory

Respiratory A&P review (LAG)

What are the functions of the respiratory system? (GE, D, R, S, M, D) gas exchange, Delivery of O2 to tissues, Removal of CO2, synthesis of surfactant and other chemicals, metabolism and detoxification of drugs and toxins, defense against infection
What are the major organs housed in the thorax? Lungs, mediastinum – heart and major vessels
What’s unique to the first 7 ribs? true ribs – attached to sternum and vertebral column
How do ribs 8-10 attach? to the rib above
How do ribs 11&12 attach? only at the vertebra, no anterior attachment
What is the name of the spaces between ribs? intercostals spaces
What is the name of the angle between the xyphoid process of the sternum and the costal cartilages? Costal angle
What muscle is the major muscle of respiration? the diaphragm
What does contraction of the diaphragm do? Contraction of the diaphragm promotes inhalation by flattening the dome shaped muscle downward toward the abdomen causing expansion in the lungs thus a decrease in pressure resulting the rushing in of air
What does contraction of the external intercostals muscles do? expand the rib cage anterioposteriorly
What does contraction of the internal intercostals muscles do? Accessory muscles for expiration
What does natural compliance mean when referring to the thorax? Means it wants to spring outward and expand
Describe the features of the right lung. thicker, wider, shorter (liver), 3 lobes- upper, middle, lower, 10 segments
Describe the features of the left lung. narrower(mediastinum), longer, 2 lobes – upper, lower, 8 segments
What’s a lingula? area between left upper and lower lobes
What’s an Apex? the top pointy area of the lung
What makes up the pleural space? The two layers of serous membrane surrounding the lungs- visceral pleura and parietal pleura and 5-15mL of fluid to facilitate smooth movement between the layers
Name the 3 sections of the pharynx. nasopharynx, oropharynx, laryngopharynx (or hypopharynx)
Name two structures located in the nasopharynx. adenoids and openings to Eustachian tubes
Name two structures in the laryngopharynx. epiglottis and larynx (voice box)
Describe the cartilage of the trachea. 16-20 C shaped with open side to back
About where do the right and left bronchi divide? about the second or third intercostals space
What is the cartilage called where the left and right bronchi devide? carina
Define the area included in the term airway. from the nose to the terminal bronchioles
What structures make up the upper airway? nasal cavity, sinuses, mouth, pharynx, and larynx
Describe the components of atmospheric air. 21% Oxygen, 78% nitrogen, some other stuff
List the primary functions of the nasal cavity. warm/cool, filter, humidify inspired air
Why is aspirated fluid more likely to go in the right lung? Why is it that ETT displacement more commonly happens in the right bronchus? the right bronchus is shorter, wider, less bent – straight angle off main bronchus
Name the descending parts of the tracheobronchial tree. trachea, main stem bronchi to lobar branches to segmental bronchi to subsegmental bronchi to bronchioles to terminal airways
What are airways less than 2mm in diameter? bronchioles
Define anatomical deadspace. normal passages for air (airways) where no gas exchange takes place – nose to conducting airways
Define alveolar deadspace. Areas in aveoli where gas exchange does not occur
Define physiologic deadspace. alveolar dead space + anatomical dead space
Define mucociliary escalator. specialized mucous membrane lining the lower respiratory tract; composed of pseudostratified columnar epithelium; lined with cilia that work like an escalator to carry mucous trapped debris to the pharynx for expectoration or swallowing
Name several substances that inhibit/paralyze the cilia of the lower respiratory tract. smoke, pollutants, alcohol, anesthesia, high O2, dehydration
What structure of the respiratory tract marks the transition to the respiratory zone? the bronchioles
Name the structures that make up the respiratory zone. terminal bronchioles, alveolar ducts, alveolar sacs, and alveoi
Where does gas exchange take place? in the alveoli
How many alveoli are there in the adult lung? about 300 million
What structures surround the alveoli? pulmonary capillaries
What kinds of cells make up the epithelium of the alveoli? Type I – pneumocytes line most of the alveolar surface, type II pneumocytes produce surfactant, Alveolar macrophages phagocytize bacteria and foreign particles
What is the function of surfactant? reduces surface tension and prevents collapse
Where is the interstitium of the alveoli and what is it made of? lies between alveoli – made up of capillaries, lymphatic channels, nerves and elastic tissue which gives the lungs their elastic recoil
What are two properties of the lungs that contribute to their function? recoil and compliance
Define recoil. Ability to return to resting position after stretching
Define compliance. Ability to expand
Explain the connection between recoil and the pathophysiology of emphysema. Ephysema results in loss of recoil due to alveolar wall breakdown resulting in hyperinflation
Describe the relationship between compliance and pulmonary fibrosis. In pulmonary fibrosis connective tissue is replaced with scar tissue resulting in stiff, noncompliant lungs
Define ventilation. movement of air in and out of the respiratory tract
What is required to achieve effective ventilation? air reaches the alveoli so that gas exchange can take place; requires patent airway; working parts of respiration, thoracic cage, lungs, and muscles must be intact and functioning
Define respiration, internal and external. respiration is the exchange of gases; internal - tissue level; external – lungs
What is required to have effective respiration? adequate ventilation
Explain Boyles law. The pressure gas exerts is inversely related to volume so that when volume goes up (as in expanding thoracic cavity) pressure goes down; When volume goes down (such as in smaller area in the thoracic cavity during expiration) pressure goes up
How many mmHg is atmospheric pressure? 760 mmHg
Discuss the relationship of atmospheric pressure to intrathoracic/intraplueral pressure. intrathoracic/intrapleural pressure is always slightly below atmospheric pressure
Describe how the receptors that regulate ventilation in the Medulla work. Medulla/respiratory center has receptors sensitive to CO2 and H+ ions with arterial CO2 being the main stimulus for increased ventilation/decreased O2 is a lesser stimulus for increased ventilation
Describe how the peripheral chemoreceptors located in the carotid and aortic bodies work to control ventilation. they are sensitive to decreased O2 mainly but also increased CO2 and decreased PH.
What pressure activates the carotid and aortic bodies? PO2 below the normal of 100mmHg, but maximal response to PO2 below 50-60mmHg
Name the receptors in the lung that help regulate ventilation. Pulmonary stretch receptors, Irritant receptors, J receptors
What is the function of Pulmonary stretch receptors? prevent overinflation -say we’ve just had a nice stretch, that’s enough now,make more surfactant – Hering-Breuer Reflex
What is the function of Irritant receptors. Create urge to cough
What do J receptors do? increase respiratory rate (and possibly involved in the subjective feeling of dyspnea) in response to barotrauma like pneumonia, pulmonary embolism, pulmonary edema
What type of movement facilitates the exchange of O2 for Co2 in the alveoli? Diffusion
Define diffusion. the movement of substances from a place of higher concentration to lower concentration
Explain why O2 moves from the alveoli to the pulmonary capillary bed and why CO2 moves out. Alveolar pressure of O2 is about 100mmHg, Venous pressure is about 40mmHg
Define ventilation/perfusion matching. ventilation is the air being carried to the aveoli and perfusion adequate flow of blood to pick up oxygen; matching means That the amount of oxygen delivered is the amount that the body needs and the blood is able to pick it up and deliver it.
What happens if we have ventilation but lack perfusion? No gas exchange
What is dead space? where no gas exchange takes place
Give some examples of condition that increase the amount of dead space. Emphysema and pulmonary embolism
Give some examples of conditions in which the blood flow to the aveoli is adequate but ventilation is inadequate. pneumonia, atelectasis, ARDs
Give 2 ways that O2 is delivered by the blood. 3% is dissolved and 97% is bound to Hgb
What does pulse oximetry tell us about? O2 bound to Hgb
How is CO2 carried in the blood? 70% in bicarbonate, 20% in doxygenated Hgb- carbaminohemoglobin, 10% dissolved – this value is what PCO2 measures in ABGs
What percentage of energy is used by a healthy person for breathing at rest? With exercise? 5%; up to 30% with exercise
Name two factors that affect the work of breathing. airway resistance (narrowed airways) and compliance (stretchiness)
Give 5 local manifestation of respiratory dysfunction. cough- lasting longer than 2-3 wks may = pulmonary disease; excessive nasal secretions; expectoration of sputum; Pain – pleuritic, intercostals, generalized; Dyspnea
What are some outward signs of dyspnea? (raLB, AM, FN, T, AE, G, C) rapid, audible, labored breathing; accessory muscles; flared nostrils; tachycardia; anxious expression; gasping; cyanosis
What’s the difference between hypoxia and hypoxemia? hypoxemia means decreased PaO2; Hypoxia means inadequate tissue oxygenation
Give 6 possible causes of hypoxemia/hypoxia. (VP, HA, IO, A, AH, CI) ventilation/perfusion mismatch (most common); High altitude; not enough O2 in inspired air; anemia; abnormal Hgb; Circulatory impairment like hypotension or low cardiac output
What values provide the most reliable indication of hypoxemia? ABGs
What are the early signs of hypoxia? (think Sympathetic nervous system) tachycardia, dilated pupils, tachypnea, irritability, unexplained apprehension
What are the later signs of hypoxia? combativeness, retractions, cyanosis, hypotension, HA and decreased LOC
When does hypoxemia become the main respiratory stimulus? in situations where CO2 retention and resulting acidosis are long standing such as in COPD
How does lack of oxygen result in acidosis? anaerobic metabolism results in lactic acid
Define hypercapnia/hypercarbia. increased CO2 in arterial blood
What causes hypercapnia/hypercarbia? Inadequate alveolar ventilation such as occurs in respiratory depressioin, pneumonia, pulmonary edema, and obstructive lung disease
Describe how excess CO2 leads to excess hydrogen or acidosis. CO2 and Water combine in the blood to form H2CO3 in greater than normal amounts(carbonic acid – weak acid) which dissociates into Hydrogen and bicarbonate
What is the normal balance/ratio between bicarbonate HCO3 and carbonic acid H2CO3? bicarbonate 20: carbonic acid 1
What signs are associated with acidosis resulting from increased CO2? tachycardia, hypertension, dizziness, HA, Mental cloudiness, LOC if severe
Define respiratory failure. Oxygenation and/or ventilation not working adequately
Briefly define the pathophysiology of respiratory failure. inability to supply the body with adequate oxygen (Oxygenation failure) and rid it of CO2 (ventilatory failure)
What PaO2 and PaCO2 levels define respiratory failure? PaO2 < 50 mmHg; PaCO2 > 50mmHg and pH < 7.25
What are the two classifications of respiratory failure? acute or chronic
Name some causes of Ventilatory failure (alveolar hypoventilation). upper airway obstruction, Depression of respiratory center (medulla); Problem with transmission of nerve impulse from respiratory center to muscles of respiration; Mechanical abnormailities of the chest wall or lung; Smokers (COPD)
What are some potential causes of depression of the respiratory center (medulla)? (O A H C) O.D., anesthesia, Head trauma, CVA
Give some examples of conditions that would interfere with impulse transmission from the respiratory center to the muscles of respiration. Lesion at the cervical level of the spinal cord; nerve or neuromuscular disorders like polio, Guillain-Barre, Myasthenia Gravis
Define Guillain-Barre. serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness; often starts with a minor infection like a lung/GI infection.
Define Myasthenia Gravis. chronic progressive disease characterized by chronic fatigue and muscular weakness (especially in the face and neck); caused by a deficiency of acetylcholine at the neuromuscular junctions.
Give some examples of mechanical abnormalities of the chest wall or lung. Pleural effusion, pneumothorax, hemothorax, flail chest
What are some causes of oxygenation failure? ventilation perfusion mismatch
Name some conditions that would lead to ventilation/perfusion mismatch. Pneumonia, ARDS, atelectasis, Severe Pulmonary edema, pulmonary embolism
What should be done in the case of respiratory failure? Provide O2, Ventilation or both; diagnose the underlying disorder