Term
|
Definition
| movement of gases from atmosphere to alveoli (and visa versa) |
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Term
|
Definition
| Mechanism by which o2 moves across the alveoli and into pulmonary capillary |
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Term
|
Definition
| 02 leaves alveoli to combine with Hgb or dissolve in blood Pa02 to be carried to the left side of the heart |
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Term
| How do Central Chemoreceptors work and where are they located? |
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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. |
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Term
| How do peripheral chemoreceptors work and where are they located? |
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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. |
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Term
| Pardoxical chest wall motion |
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Definition
| one side of the chest is going up while the other side is going down, commonly happens with pneumothorax |
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Term
| Three values that indicate a patient is in respiratory distress |
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Definition
PaCO2 > =50
Pa02 < =60
Ph<= 7.30 |
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Term
| Type 1 alveolar epithelial cells |
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Definition
| 90% total alveolar surface in lungs. very susceptible to injury and inflammation |
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Term
| Type II alveolar epithelial cells |
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Definition
| produce, store secrete pulmonary surfactant: without surfactant alveoli would collapse and stick together |
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Term
|
Definition
| when you regain surfactant |
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Term
|
Definition
| lowers surface tension in the lungs, stabilizes alveoli to increase pulmonary compliance |
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Term
| Macrophages: what do they do in alveoli |
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Definition
| release H202 to kill bacterial. if there are no bacteria but still macrophage response, this can deteriorate lung and cause pneumothorax. |
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Term
| Three factors affecting diffusion of gas across alveolar capillary membrane |
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Definition
pressure gradient (driving pressure): differences in pressure concentration
surface area
thickness |
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Term
| Increased surface area for diffusion causes |
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Definition
| increased amount of gas that can diffuse |
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Term
| four interventions to increase surface area |
|
Definition
incentive spirometer
turn cough deep breath
sigh/yawn
PEEP |
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Term
| what happens when you exercise to allow an improvement of gas exchange |
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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. |
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Term
| How does the thickness of the alveolar cap membrane affect rate of diffusion |
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Definition
| the thicker the alveolar capillary membrane, the slower the rate of diffusion |
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Term
| Three conditions that increase alveolar capillary membrane thickness |
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Definition
ARDS
pulmonary edema
pulmonary fibrosis |
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Term
| Two ways 02 is transported in blood |
|
Definition
bound to hemoglobin
dissolved in blood (pa02) |
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Term
|
Definition
7.35-7.45
increase is alkalosis
decreased is acidosis |
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Term
| Normal CO2 values in blood? |
|
Definition
35-45
RESPIRATORY
increase= acidosis
decreased =alkalosis |
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Term
|
Definition
|
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Term
|
Definition
92-100
decreased = hypoxia |
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Term
|
Definition
Metabolic; produced by kidenys
22-26
increased = alkalosis
decreased =acidosis |
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Term
|
Definition
| excessive retention of C02 due to hypoventilation leading to a decrease in PH below 7.35 |
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Term
| 5 Causes of respiratory acidosis |
|
Definition
COPD
pneumonia
atelectasis
neuromuscular Dz
post-op narcotics |
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Term
|
Definition
| decreased HC03 and decrease in PH below 7.35 |
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Term
| causes of metabolic acidosis |
|
Definition
diabetic acidosis
starvation
impending shock
ASA OD
Diarrhea |
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Term
|
Definition
| low PCO2 due to hyperventilation (excess CO2 exhaled) and ph above 7.45 |
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|
Term
| Causes of respiratory alkalosis |
|
Definition
hysteria
anxiety
head injury
pain
fever if your hot your breathing faster blowing off more CO2
ventilation |
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Term
|
Definition
| Increased HC03 and increase in PH above 7.45 |
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|
Term
| Causes of metabolic Alkalosis |
|
Definition
diuretics
prolonged NG suction w/o electrolyte replacement
excessive vomiting
overuse of antacids
diuretics |
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|
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. |
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Term
| What happens if you turn your patient and they desaturate then what do you do? |
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Definition
|
|
Term
| normal alveolar ventilation |
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Definition
|
|
Term
| what is pulmonary capillary perfusion and what is normal |
|
Definition
amount of blood going through cap blood and returning
5l/min |
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|
Term
| normal ventilation/persuion |
|
Definition
|
|
Term
|
Definition
| ventilation exceeds perfusion |
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Term
|
Definition
| VQ imbalance caused by poor ventilation. |
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Term
|
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 |
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Term
|
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. |
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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. |
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Term
|
Definition
| combined anatomic and capillary shunt |
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|
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. |
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Term
|
Definition
| you have perfusion but not ventilation, disease processes increase such high pressure you have no more perfusion. |
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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. |
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Term
|
Definition
| combined amount of anatomic dead space and alveolar dead space. |
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Term
|
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) |
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|
Term
| four diseases that are considered obstructive lung disease |
|
Definition
COPD
Asthma
Bronchiectasis
cystic fibrosis |
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Term
|
Definition
| people cannot full fill lungs with air, lungs are restricted from fully expanding, |
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|
Term
| four signs of impaired gas exchange |
|
Definition
tachypnea
anxiety
crackles
confusion |
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|
Term
| AbG of someone with impaired oxygenation |
|
Definition
| decreased Pa02 decreased Sa02 |
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Term
|
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. |
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|
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 |
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|
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) |
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|
Term
|
Definition
|
|
Term
| ARDS deaths are commonly due to two things |
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Definition
|
|
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
|
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 |
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|
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
|
|
Term
| what does pursed lip breathing do? |
|
Definition
| regains surfactant, by increasing PEEP which recruits alveoli |
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