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NURS 350 patho resp

Pathophys - respiratory system, alterations

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