| Question | Answer |
| Diaphram is innervated by... | a branch of the phrenic nerve originating at C3-C5. |
| Diapram is... | -Primary muscle of inspiration
-Contracts and flattens during inspiration, increasing intrathoracic Volume
-responsible for 75% of TV during normal inspiration, quiet breathing
-Divided into left and right "leaves" |
| Intercostals... | -Important secondary muscles of inspiration
Elevates the ribs, increasing anterior-posterior diameter and volume of thorax
-Innervated by intercostal nerves which originate at T1-T11 |
| Scalenes and Sternocleidomastoid | -Accessory muscles of inspiration
-Lift sternum and ribs upward and out, increasing intrathoracic volume |
| Explain the passive act of inspiration: | The diaphram draws downward and this action |
| Explain the act of expiration: | Recoil of the chest decreases the intrathoracic volume and increase pressure. |
| Oxyhemoglobin dissociation curve: | Graphic (sigmoidal curve) representation of the relationship between Hb saturation and the partial pressure of O2 (PaO2).
- determined in "normal" blood with a pH of 7.4 and a temperature of 37c |
| Right shift:
-More O2 released from teh hemoglobin, resulting in greater O2 delivery to tissue
Right shift causes: | -Increase of PCO2
-Increased temperature
-Increased 2,3-DPG
-Decreased pH (acidosis) |
| Left shift:
-O2 released by the hemoglobin at significantly lower PO2 resulting in decreased O2 delivery to tissues
-Left shift causes: | -Decrease in PCO2
-Decreased temperature
-Decreased 2,3-DPG
-Increased pH (alkalosis)
Carbon monoxide poisoning |
| History and Physical Exam...pay particular to what? | Cardiac and respiratory histories |
| History and Physical Exam: Determine if the patient has ever required the following: | -Intubation
-Mechanical ventilation
-Hospitalization
-Home oxygen use |
| COPD defined clinically as the presence of a productive cough for: | for three months out of the year for two years in a row |
| Radiogragh:
-A/P and lateral films
-Hyperinflation...what will you see? | -Flattened, low diaphragm
-Hyperlucent lung fields
-Wide intercostals spaces
-Long, narrow heart shadow
-Dimished vascular markings
-dilated bronchioles
-Bullae, blebs |
| COPD and pulse oximetry... | -Cannot identify hypercapnia or acid based disturbances
-Useful and conveinient for assessing oxygenation and monitoring oxygen saturation during treatment
*Instant feedback on patient status
*<90% requires aggressive therapy |
| Chronic bronchitis: | is what? |
| Chronic bronchitis and pulse oximetry... | -Useful and conveinient for assessing oxygenation and monitoring oxygen saturation during treatment
*Instant feedback on patient status
*<90% requires aggressive therapy |
| Chronic bronchitis and EKG you would use to evaluate what? | to evaluate hypoxia-induced ischemia |
| Chronic bronchitis and blood glucose, you would see what possibly? | -Hyperglycemia secondary to:
*Stress
*Use of B-agonists, corticosteroids
-Hypoglycemia
*Increased work
*Poor stores |
| COPD treatment: | -Aimed at achieving
*PaO2 >60 mmHg
*SaO2 >90%
-monitor ABG to rule out developing hypercapnia secondary to O2 administration
-Humidified O2 to assist in the mobilization of secretions |
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