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Pulmonary Gas Exchange
N/A
66
Nursing
Undergraduate 4
09/09/2012

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Term
Ventilation
Definition
movement of gases from atmosphere to alveoli (and visa versa)
Term
Diffusion
Definition
Mechanism by which o2 moves across the alveoli and into pulmonary capillary
Term
Perfusion
Definition
02 leaves alveoli to combine with Hgb or dissolve in blood Pa02 to be carried to the left side of the heart
Term
How do Central Chemoreceptors work and where are they located?
Definition
medulla of the brain: work depending on the quantity of hydrogen ions. To high of hydrogen ions will cause the body to increase respirations in order to try to correct the quantity of hydrogen.
Term
How do peripheral chemoreceptors work and where are they located?
Definition
aortic arch and carotid: decreased Pa02 (partial pressure or oxygen that is within the blood) causes increased ventilation, high PaC02, high hydrogen ions causes increased ventilation.
Term
Pardoxical chest wall motion
Definition
one side of the chest is going up while the other side is going down, commonly happens with pneumothorax
Term
Three values that indicate a patient is in respiratory distress
Definition
PaCO2 > =50
Pa02 < =60
Ph<= 7.30
Term
Type 1 alveolar epithelial cells
Definition
90% total alveolar surface in lungs. very susceptible to injury and inflammation
Term
Type II alveolar epithelial cells
Definition
produce, store secrete pulmonary surfactant: without surfactant alveoli would collapse and stick together
Term
Recruitment
Definition
when you regain surfactant
Term
What does surfactant do
Definition
lowers surface tension in the lungs, stabilizes alveoli to increase pulmonary compliance
Term
Macrophages: what do they do in alveoli
Definition
release H202 to kill bacterial. if there are no bacteria but still macrophage response, this can deteriorate lung and cause pneumothorax.
Term
Three factors affecting diffusion of gas across alveolar capillary membrane
Definition
pressure gradient (driving pressure): differences in pressure concentration
surface area
thickness
Term
Increased surface area for diffusion causes
Definition
increased amount of gas that can diffuse
Term
four interventions to increase surface area
Definition
incentive spirometer
turn cough deep breath
sigh/yawn
PEEP
Term
what happens when you exercise to allow an improvement of gas exchange
Definition
body increases CO which increases pulmonary pressure so you can move more blood through your body at a faster rate, constriction of vasculature, increases pulmonary artery pressure which increases surface area by making it more swollen to improve gas exchange. this works in healthy people and doesn't work in unhealthy people.
Term
How does the thickness of the alveolar cap membrane affect rate of diffusion
Definition
the thicker the alveolar capillary membrane, the slower the rate of diffusion
Term
Three conditions that increase alveolar capillary membrane thickness
Definition
ARDS
pulmonary edema
pulmonary fibrosis
Term
Two ways 02 is transported in blood
Definition
bound to hemoglobin
dissolved in blood (pa02)
Term
Normal PH in blood
Definition
7.35-7.45
increase is alkalosis
decreased is acidosis
Term
Normal CO2 values in blood?
Definition
35-45
RESPIRATORY
increase= acidosis
decreased =alkalosis
Term
normal pa02
Definition
80-100
Term
normal Sa02
Definition
92-100
decreased = hypoxia
Term
normal HCO3
Definition
Metabolic; produced by kidenys
22-26
increased = alkalosis
decreased =acidosis
Term
Respiratory Acidosis
Definition
excessive retention of C02 due to hypoventilation leading to a decrease in PH below 7.35
Term
5 Causes of respiratory acidosis
Definition
COPD
pneumonia
atelectasis
neuromuscular Dz
post-op narcotics
Term
Metabolic acidosis
Definition
decreased HC03 and decrease in PH below 7.35
Term
causes of metabolic acidosis
Definition
diabetic acidosis
starvation
impending shock
ASA OD
Diarrhea
Term
Respiratory alkalosis
Definition
low PCO2 due to hyperventilation (excess CO2 exhaled) and ph above 7.45
Term
Causes of respiratory alkalosis
Definition
hysteria
anxiety
head injury
pain
fever if your hot your breathing faster blowing off more CO2
ventilation
Term
Metabolic Alkalosis
Definition
Increased HC03 and increase in PH above 7.45
Term
Causes of metabolic Alkalosis
Definition
diuretics
prolonged NG suction w/o electrolyte replacement
excessive vomiting
overuse of antacids
diuretics
Term
distribution of perfusion is dependent on what?
Definition
gravity: this means perfusion is more dense at the base of the lungs because gravity has pulled alveoli down towards the bottom of the lungs.
Term
What happens if you turn your patient and they desaturate then what do you do?
Definition
turn to other side.
Term
normal alveolar ventilation
Definition
4L/min
Term
what is pulmonary capillary perfusion and what is normal
Definition
amount of blood going through cap blood and returning
5l/min
Term
normal ventilation/persuion
Definition
4:5 or 0.8
Term
when V/Q higher than 0.8
Definition
ventilation exceeds perfusion
Term
When v/Q < 0.8
Definition
VQ imbalance caused by poor ventilation.
Term
Anatomic Dead Space
Definition
ventilation that does not participate in gas exchange, this is the air in your trachea and bronchioles and all of the non conductive tissue that does not contain alveoli there is no oxygen exchange but they still get about 5% of oxygen
Term
Alveolar Dead Space
Definition
occurs in diseased spaces when alveolar spaces are provided with oxygen but no perfusion occurs,. could occur because of obstruction in alveoli could occur because of blood clot.
Term
Intrapulmonary Shunt (capillary Shunt)
Definition
perfusion without ventilation. (right to left shunt) blood shunted past poorly ventilated alveoli. this could occur with pneumonia, fludding alveoli but you have perfusion, so you have no gas exchange, blood flowing past ventilated alveoli, because there is no ventilation in that part of lung.
Term
absolute shunt
Definition
combined anatomic and capillary shunt
Term
physiologic shunt (true shunt)
Definition
anatomic left to right cardiac shutn, structural problem with heart happens when babies heart doesn't properly close so blood flows from left to right instead of right to left.
Term
alveolar dead space
Definition
you have perfusion but not ventilation, disease processes increase such high pressure you have no more perfusion.
Term
anatomic shunt( physiologic shunt)
Definition
mixing of venous blood from bronchial circulation and the veins which drain right coronary circulation with the oxygenated blood in the left atrium decreases the saturation of left atrail blood to a range between 96-99% normally this is approximately 2-5 percent of blood flow.
Term
physiologic dead space
Definition
combined amount of anatomic dead space and alveolar dead space.
Term
Obstructive lung disease
Definition
difficulty exhaling all of the air from your lungs, at the end of a full exhalation an abnormally high amount of air still lingers in the lungs (air trapping)
Term
four diseases that are considered obstructive lung disease
Definition
COPD
Asthma
Bronchiectasis
cystic fibrosis
Term
Restrictive Lung disease
Definition
people cannot full fill lungs with air, lungs are restricted from fully expanding,
Term
four signs of impaired gas exchange
Definition
tachypnea
anxiety
crackles
confusion
Term
AbG of someone with impaired oxygenation
Definition
decreased Pa02 decreased Sa02
Term
ABG impaired ventilation
Definition
increased paco2 decreased ph
Term
What is acute respiratory distress syndrome?
Definition
inflammatory syndrome, activation of immune response inflammatory response overcompensates causing disruption of alveolar capillary membrane.
Term
with ARDS what is the PAWP
Definition
PAWP < 18mmHg or no evidence of left ventricular failure
Term
with ARDS what is the Pa02/Fi02 ratio
Definition
<175 (nl >300) pa02/fi02 ratio below 300 is condisered acute lung injury and below 200 is considered acute respiratory distress syndrome
Term
two risk factors for developing ARDS
Definition
direct lung injury (pneumonia, aspiration, pulmonary trauma)
indirect lung injury (sepsis, severe trauma with shock, drug overdose)
Term
% mortality for ARDS
Definition
40-60%
Term
ARDS deaths are commonly due to two things
Definition
sepsis
MODS
Term
in survivors of ARDS when does pulmonary function return to normal
Definition
6-12 months they still have residual impairment but you are asymptomatic.
Term
pathophysiology overview of ARDS
Definition
initiation of inflammatory immune response
activation of neutrophils and macrophages
release of endotoxins
release of mediators.
Term
two ways to treat ARDS
Definition
treat underlying cause
promote pulmonary gas exchange.
Term
four ways to promote pulmonary gas exchange
Definition
-intubation and mechanical ventilation
-lowest possible Fi02 to maintain Sa02 > 90%
-PEEP to promote diffusion
-hIGH RR W/ LOW TV TO PREVENT BARO/VOLUTRAUMA
Term
Investigational therapies to treat ARDS? nitric oxide
Definition
Theory: inhaled no cause selective basodilation and improved arterial oxygenation in the lung, reduces pulmonary hypertension
Reality: only been proven effective in Pulmonary HTN patients.
Term
if someone is desaturating do you change respiratory rate of method of oxygenation?
Definition
method of oxygenation
Term
what does pursed lip breathing do?
Definition
regains surfactant, by increasing PEEP which recruits alveoli
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