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NURS 350 patho resp
Pathophys - respiratory system, alterations
| Question | Answer |
|---|---|
| resp systems delivers 02 and removes C02 by a coordinated process involving -3 | involving ventilation---diffusion---perfusion |
| what structure divides upper and lower respiratory tracts | the larynx |
| where is the transition between conducting airways and the respiratory airway units | the segmental bronchi/bronchioles - some are respiratory, some are not as they transition to alveolar ducts |
| gas exchanges where | walls of repiratory bronchiles and alveolar septa |
| alveolar septa contain what cells for gas exchange | epithelial layer (Type I, Type II cells), elastic basement membrane |
| Function of Type I and Type II alveolar cell lines | Type I = site of gas exchange-----Type II cells dispursed and secreat lipoprotein surfactant |
| role of surfactant | decreases surface tension allowing alveolar expansion. deficient in premature neonates |
| air moves down a pressure gradient during breathing - what are pressures for inspiration and expiration | inspiration Patm > Plungs------expiration Plung > Patm |
| Ventilary Rate = RR | number of times gas inspired/expired in 1 minute |
| Tidal Volume = Vt or TV | amount (L) of air inspired/expired per BREATH |
| Minute Ventilation = Ve | total amount of air inspired/expired in 1 min (L/min)----- Ve = RR x Vt |
| What is best way to determine adequate ventilation | by measuring PaC02 in arterial blood |
| What is normal PaC02---hypo and hyper ventilation are below/above this range | Normal is 35-45 mmHg |
| what is dead space = D | space that is ventilated, but NOT perfused. It is another way to evaluate ventilation----amount of air being exchanged = (Vt - D) x RR |
| RV = RESIDUAL (not reserve) volume | what remains in lung after maximal expiration. not measured by spirometry |
| ERV = expiratory reserve volume | amount expelled with maximal forced expiration |
| FRC = functional residual capacity = | =ERV + RV |
| TV or Vt = titdal volume again | amount inspired/expired per breath---can fluctuate depending upon demand to maxiumum inspiratory/expiratory levels |
| IRV = inspiratory reserve volume | as much as one can inhale |
| IC = inspiratory capacity = | = IRV + TV |
| VC = Vital capacity = | IRV + TV + ERV |
| Total lung capacity | the total amount of air the lungs can hold |
| surfactant molecules repel each other --> separate liquid molecules of alveolar fluid --> oppose surface tension --> prevent collaps of small alveoli. Name 2 diseases where surfactant is lacking | premature neonate ---emphysema (alveloli destroyed, can't produce surfactant) |
| elastic recoil allows lung to return to resting state after inspiration AND promotes passive outward air flow during ?expiration----name 2 states where there is a lost of elastic recoilalong with increased compliance | emphysema and normal aging process have loss of elastic recoil, increased compliance |
| compliance defn | how easily lung/chest wall stretch (ease of inflating balloon ---- C = change in V/ change in P -----amount of increase in lung volume PER uniti increase in airway pressure |
| increased compliance is like a balloon blowing up too easily - all stretched out ---what two disease states again? | emphysema and normal aging attributed to increased compliance |
| decreased compliance = stiffening of lung, which occurs with these 5 conditions/disease states | aging---ARDS---pneumonia---pulmonary edema---increased alveolar surface tension |
| the smaller the airway lumen, the greater the resistance to air flow. So the highest area of resistance in upper respiratory is nose---oropharnyx----larynx. What is airway of greatest resistance in lower respiratory | medium sized airways are site of greatesT airway resistance in LUNG |
| airway resistance occurse when there is edema---inflamm---obstruction---airway collapse---bronchocon. Name disorders assoc with increased airway resistance | chronic bronchitis---asthma---pneumonia---BRONCHIOLitis---cystic fibrosis |
| work of breathing defined as---and results in | muscular effort required for ventilation----results in increased 02 demand AND increased metabolic demand |
| inspiratory muscles | diaphragm, external intercostals----scalene/sternocleidomastoic only for forceful inspiration |
| expiratory muscles - used only during FORCED expiration | abdominal, internal intercostal |
| Boyle's Laws | at constant temp, pressure exerted by a gas varies INVERSELY with volume V=1/p |
| Intrapleural pressure always remains | negative, so that lung does not collaps. Is always about 5 mmHg les than pressure of the lung (rest, inspiration, expiriation) |
| delivery of 02 to cells is bwo of passive diffusion, and depends on these 4 factors | pressure gradients---distribution of ventilation (V) and perfusion (Q)---02 transport----C02 transport |
| define VQ ratio and normal value | relationship between ventilation and perfusion, expressed as a ratio where normal V/Q=0.8 |
| what region of the lung are ventilated/perfused the best | the most dependent portion, in base/zone III. This region gets most blood flow----can reposition patient to ensure proper V/Q depending on injury |
| about 97-99% of 02 delivered to cells is bound to Hb---the amount actually transported to cells is dependent upon 3 things | dependent upon --- Pa02 (driving pressure that loads Hb with 02)---Hb quantity---Hb affinity for 02 |
| what does 02 content measure (ml/dl) | measures the amount of 02 combined with Hb PLUS the amount of dissolved 92 in blood |
| what does Sa02 measure | measures 02 saturation or % of available Hb that is bound to 02 |
| what is clinically important about oxyhemoglobin dissociation curve, where x axis = Pa02 -----and y axis = Sa02 | when Pa02 drops below 50 mmHg then there is a SHARP drop in Sa02 (Hb losing its ability to bind/transport 02) |
| when there is a 'shift to the left' on 02-Hb curve, what does this mean | shift to the left means Hb has MORE affinity for 02---so LESS 02 being delivered to tissues |
| what factors contribute a shift-to-left on 02-Hb curve | Carbon monoxide poisoning---methemoblobinemia---both contribute to shift-to-left resulting in Hb HIGHER affinity for 02, LESS 02 being delivered to tissues |
| In terms of acid/base, under what conditions do we have a shift-to-left where Hb has higher affinity for 02 therefore less 02 delivered to tissues | acute ALKALOSIS----also dec pC02---dec temp |
| a shift to the right occurs resulting in Hb having LOWER affinity for 02, meaning MORE 02 being delivered to tissues. What 3 conditions contribute | anemia---chronic hypoxia---hemoglobinopathies----all contribute to right shift where Hb less affinity for 02, so more is delivered to tissues |
| what metabolic conditions contribute to shift-to-right | acute ACIDOSIS---inc PaC02---inc temp---abn Hb |
| Ideally, where do we want Pa02 to be | much higher than 50 mmHg so that Hb will bind/transport 02 ---normal 80-100mmHg |
| Children are obligate nose breathers with lower alveoli at birth, in addition to | having a more cartilagenous thoracic cage, greater 02 consumption and physioloc control of breathing |
| Elderly have loss of elastic recoil, dec compliance and stiffening of the chest wall--> reduced ventilatory reserve. This leads to | alterations in gas exchange, increads flow in resistance--> decreased vital capacity, increase in residual volume |
| true or false - 02 diffusion is affected by thicker bmem | true |
| true or false - a change in airway resistance effects ventilation | true - first will decrease tidal volume |
| true or false - Hb concentration can effect 02 diffusion | true - in anemias we have less RBCs or altered Hb |
| true or false- when oxy-Hb shifts to left under alkolotic conditions, 02 is more readily available to tissues | false - Hb hangs on to 02 under these conditions |
Created by:
lorrelaws
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