CP Exam 3- Spring 13
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| What is the name given to Phase 1? | Acute Phase
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| At what location does it take place? | Hospital Setting
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| How many days does it last? | 3-5 days
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| Phase I Goals | Get out of bed, ADL, UE/LE ex's, Supervised ambulation
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| Time/Session | 20-30 mins
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| Frequency per day | 2-3x/day
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| Intensity Level | 2-3 METs
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| Progression of time/frequency/intensity | 30-45 minutes, 1-2x/day, 3-5 METs
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| Phase I RPE? | Light
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| Phase I HR restrictions | Never increase 10-20 bpm from rest
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| HEP: ambulation time & frequency | 20-30 min, 1-2x/day, 4-6x/week
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| HEP: UE & LE | ROM, Flexion/Extension
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| Phase 2 is called? | Sub-Acute phase
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| Most payers allow for how many visits? | 36, usually 3x/week for 12 weeks
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| Phase 2 time of exercise | 30-60 in with 5-10 min warm-up & cool-down
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| What MET for exit point? | 9 METs
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| When to begin strength training for phase 2? | 3 week in cardiac rehab; 5 wk post-MI; 8 wk post-CABG
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| Where do phase 3 activities occur? | Community center, YMCA, Clinical facilities
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| Phase 3 entry level criteria | Functional capacity of 5 METs; Clinically stable angina; Medically controlled arrhythmias during exercise
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| Phase 3 progression | 50-85% functional capacity; 3-4x/week; 45 minutes or more
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| Phase 3 D/C | 6-12 months
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| 2 Main functions of the conducting zone? | Warming & Humidifying inspired air; Filtration & Cleaning of inspired air
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| Functions of Ciliated Cells? | Propel mucus blanket up to opening b/t larynx & pharynx where mucus content can either be coughed up or swallowed
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| Functions of clara cells? | Synthesize & secrete proteins ("antibodies" & lysosymes to detox harmful substances); Differentiate into ciliated cells to regenerate bronchiolar epithelium
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| Functions of basal cells? | Thought to be bronchial stem cells & can differentiate into either clara cells or ciliated cells
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| Functions of goblet cells? | Mucus from goblet cells mix with other secretions of mucus blanket that serves to trap small particles in the inspired air & thereby performs a filtration function
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| Functions of submucosal glands? | Secrete mucins, antimicrobial substances, & copious amounts of fluid that add to the liquid that composes the mucociliary blanket
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| 4 components of respiratory zone? | Respiratory bronchioles; Alveolar ducts; Alveoli sacs; Alveoli
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| 2 serous membrane layers that surround the lungs? "Space" b/t membranes? | Parietal Pleura- lines inside of thoracic wall & covers diaphragm; Visceral Pleura; surface of the lungs; Pleural cavity is between 2 layers
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| At the end of expiration what is the net mvmt of air & why? | No net mvmt at end of expiration b/c there's no difference in pressure b/t atmospheric pressure & intrapulmonary pressure
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| During inspiration what is the net mvmt of air & why? | Air into the airways b/c decrease in intrapleural pressure causes a decrease in intrapulmonary pressure, causing negative pressure difference b/t atmospheric pressure & intrapulmonary pressure
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| At the end of inspiration what is the net mvmt of air & why? | No net mvmt at end of inspiration b/c atmospheric pressure & intrapulmonary pressure equalizes
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| During expiration what is net mvmt of air mvmt of air & why? | Chest cavity returns to resting position (inward & down) & diaphragm returns to bell shape position; This creates + pressure difference causing air to move out of airways
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| Lung Compliance | Ease at which the lung can be expanded during inspiration
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| Lung Elasticity | Ease at which the lung can return or "recoil" back to the resting state
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| What controls the resistance to air flow through the conducting system? | The radius of the airways
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| What controls surface tension? | Thin film of surfactant containing fluid that lines the components of the respiratory zone
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| Compliance of lungs if a drop of 6 mmHg in intrapleural pressure results in mvmt of 400 mL of air into lungs? | 400/6 = 66.7
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| Compare ease at which lung A & lung B expand if A has compliance=100 & B has compliance=80 | Lower compliance=harder to inspire air; Lung B has lower compliance so it takes more work to bring air into lung B
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| What components within the lungs provide the ability for the lungs to return to their initial size after being distended during inspiration? | High content of elastic fibers & elastin proteins within the septa or walls of the lung provide elastic recoil that enables lungs to return to resting position after inspiration
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| Alveolus A & B have a surface tension of 50, but A has a radius of 1 & B a radius of 1.5. Using Laplace formula what is pressure in each alveoli? | A = 2 x 50/1 = 100/1 = 100;
B = 2 x 50/1.5 = 100/1.5 = 66.7
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| If both lungs were connected which one would expand & which would collapse? | Air flows from high pressure to low pressure; therefore, air would flow from alveolus A to alveolus B, thus alveolus A would collapse
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| Taken by themselves, which one would be easier to expand (ie need least pressure to expand)? | Smaller the radius of the alveolus, the more pressure it takes to expand the sphere; therefore, alveolus A would be harder to expand
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| How does surfactant reduce surface tension? | Surfactant "fits" in b/t water molecules, reducing surface tension; Higher concentration of surfactant, lower surface tension
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| Alv. C & D are situated in healthy lung & have normal surfactant. If C has radius 1 & D radius 2, which one has the greatest concentration of surfactant molecules per unit of surface area in order to prevent one collapsing into the other? | The smaller the radius of an alveoli the higher the concentration of surfactant. Therefore, Alveolus C would have the higher concentration of surfactant.
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| Why do premature babies have a high risk for respiratory distress syndrome? | Failure of type II alveolar cells to produce sufficient levels of surfactant (type II alveolar cells aren't "mature")
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| Tidal Volume (Vt) | Volume of air moved into & out of the lungs during quiet breathing
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| Vital Capacity (VC) | Volume of air equal to toal lung capacity minus residual volume (TLC-RV)
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| Total Lung Capacity (TLC) | Volume in the lungs at max inflation
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| Residual Volume (RV) | Volume of air remaining in lungs after a max exhalation (can't be measured by spirometry)
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| A= FVC 5 L & FEV1 3 L; B= FVC 4 L & FEV1 3 L What are FEV1/FVC ratios? Which likely smokes cigarettes? | A ratio - 3/5 = .6
B ratio - 3/4 = .75
Healthy adult ratio should be 75-80%, so person A probably smokes
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| Given the following locations in the lungs, which would have the highest PO2 & which would have the lowest: trachea, bronchi, alveoli? Why? | Trachea would have highest PO2 & alveoli the lowest. Reason for decline as one descends airway b/t: Mixing of "fresh" incoming air mixed w/ "stale" air from last expiration in "dead space" of trachea, bronchi & terminal bronchioles; & Humidification
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| PaO2 at rest & at Peak Exercise | No matter how active a healthy person is, even at peak exercise, PaO2 should stay at ~97 mmHg (at sea level)
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| PaCO2 at rest & at Peak Exercise | For a healthy person, no matter the level of activity, all the excess CO2 in the blood entering the lungs should be "blown off", keeping the arterial PCO2 at 40 mmHg
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| PAO2 | 100 mmHg
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| PACO2 | 40 mmHg
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| PvO2 at rest | 40 mmHg
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| PvCO2 at rest | 46 mmHg
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| In a healthy person, oxygen saturation of arterial blood is mainly determined by what? | Arterial O2 saturation determined by PaO2
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| What 2 components of blood determine the O2 carrying capacity of blood? | CaO2 = Hb (gm/dl) x 1.34 mL Ox/gm Hb x SaO2, O2 carrying capacity of blood is determined by the hemoglobin concentration & SaO2
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| A person has a hemoglobin content of 14 gms/dl & a SaO2 of 80. What is the oxygen carrying capacity? | CaO2 = 14 x 1.34 X .80 = 15.0 mL/dl
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| What relationship is represented by the oxyhemoglobin dissociation curve? | Relationship b/t available oxygen & amount of oxygen carried by hemoglobin
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| What range of the oxyhemoglobin dissociation curve represents PAO2? | Partial pressure of oxygen will remain at the "flat" end of the curve or above 60 mmHg unless one ventures to extremely high altitudes; this end of curve insures O2 sat of at least 90%. <90% is hypoxemia
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| When considering % oxyhemoglobin O2 saturation, what is unique about this range? | At the "flat end" the drop of partial pressure from 100 mmHg to 60 mmHg only causes a slight drop in O2 sat from 98-99% to 90%
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| What range of oxyhemoglobin dissociation curve represents the tissue PO2 that surrounds systemic capillary beds? | At rest PAO2 is ~40 mmHg which beings at "steep" part of curve; Blood entering cap bed with PAO2 40 mmHg will leave tissue at ~75% saturation;
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| What is unique about this range? | Blood leaving at around 55% saturation thus releasing more O2 to the tissue. In this way, the blood can match the needs of the tissue
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| In what direction does increasing temperature in the capillary bed shift the oxyhemoglobin dissociation curve? | Right
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| In what direction does decreasing temperature in the capillary bed shift the oxyhemoglobin dissociation curve? | Left
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| What affect does shifting have on the unloading of O2 into the capillary bed? | Shifting right increases release of oxygen into the capillary bed while a shift left decreases the release of oxygen into the capillary bed
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| In what direction does increasing 2,3-DPGin the RBCs shift the oxyhemoglobin dissociation curve? | Increase would shift curve right & results in an increase in the release of O2 into all the systemic capillary beds
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| What 2 developments would cause a person's RBCs to increase its concentration of 2,3-DPG? | Any event that causes hypoxia (tissues of body deprived of an adequate supply of O2) will results in increased 2,3-DPG in blood (Ex: hypoxia as result of high altitude/COPD/Fe deficiency anemia)
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| What is the ventilation/perfusion ratio? | V/Q is defined at the ratio of the amount of air reaching the alveoli (VA) to the amount of blood reaching the alveoli (Q)
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| What affect would "shunting" have on the V/Q ratio & thus oxygenation of blood? | Given that the normal V/Q is ~0.8, shunting would reduce ratio below that toward 0
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| What disease conditions can cause shunting? | Shunting is blocking of airways due to airway edema, bronchoconstriction & increased mucus secretion as a result of asthma or bronchitis/bronchiolitis
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| What affect would a "dead space" have on the V/Q ratio & thus oxygenation of blood? | Dead space occurs whe perfusion to a ventilated airspace is blocked
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| What disease conditions can cause dead space? | Dead space increases as a result of a pulmonary thromboembolus or acute respiratory distress syndrome (ARDS)
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| What is the rhythmicity center & 2 types of neurons are found within it? | Medulla; I neurons (inspiratory neurons) that stimulate motor neurons that innervate respiratory mm & E neurons (expiratory neurons) that inhibit "I" neurons resulting in relaxation of respiratory mm
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| Where is the apneustic center & what is its function? | Pons; Stimulates the "I" neurons in the inspiratory center of the medulla
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| Where is the pneumotaxic center & what is its function? | Pons; Antagonizes apneustic center & inspiratory center to inhibit respiration
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| What are central chemoreceptors located? | Ventrolateral surface of medulla near the CSF of the 4th ventricle
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| How are central chemoreceptors stimulated? | Increased PaCO2 results in diffusion of CO2 into CSF. CO2 combines with H2O to form carbonic acid which dissociates into H+ & HCO3
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| Is it CO2 or H+ that directly stimulates central chemoreceptors? | H+
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| Where are peripheral chemoreceptors located? | Carotid & Aortic bodies
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| What directly stimulates peripheral chemoreceptors? | Rise in H+ concentration (decrease in pH); on stimulation ventilation rate increases
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| What effect does PO2 have on peripheral chemoreceptors? | Low PaO2 (</= 60 mmHg) is necessary to directly stimulate peripheral chemoreceptors; This degree of hypoxemia occurs in extremely severe environments
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| pH = 7.52 BE = +2.5 HCO3 = 24 mEq/L PCO2 = 30 mmHg | Respiratory Alkalosis
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| pH = 7.11 BE = -17 HCO3 = 12 mEq/L PCO2 = 40 mmHg | Metabolic Acidosis
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| pH = 7.57 BE = +13 HCO3 = 36 mEq/L PCO2 = 40 mmHg | Metabolic Acidosis
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| pH = 7.24 BE = -11 HCO3 = 15.5 mEq/L PCO2 = 38 mmHg | Metabolic Acidosis
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| pH = 7.36 BE = -2 HCO3 = 23 mEq/L PCO2 = 43 mmHg | Normal Blood Gases
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| pH = 7.23 BE = +2 HCO3 = 26 mEq/L PCO2 = 60 mmHg | Respiratory Acidosis
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