EXAM 1 RC 111

EXAM 1 RC 111

INTRAUTERINE FETAL LUNGS

FETAL LUNG FLUID IS CONSTANTLY RENWED AND REPLACED

THIS CONSTANT MOVEMENT OF FLUID (NEW VS OLD) HELPS TO KEEP THE LUNGS INFLATED

Positive intrapulmonary pressure the continuous secretion. If fluid creates a mild + pressure inside the lungs and keep them inflated

Fetal lungs have a high vascular resistance

WHAT IS THE BACK PRESSURE TO STENT AIRWAYS OPEN IN INFANTS IS CALLED

LARYNGEAL BRAKING

is a mechanism that maintains airway patency during breathing by creating a pressure differential.

LUNG COMPLIANCE

The ability of the lungs to stretch and expand during breathing, reflecting the elasticity and distensibility of lung tissue.

WHAT ARE PERIMETERS FOR HYPOTENSION

WHEN BP FALLS BELOWS 90/60

NORMAL TIDAL VOLUME

500 ML

7-9 ML/KG

WHAT IS NORMAL VALUES LUNG COMPLIANCE

150-200 ML PER H20

HOW DOES LUNG COMPLIANCE AFFECT TIDAL VOLUME

IT DETREMINES HOW MUCH THE LUNGS CAN EXPAND FOR A GIVEN Change IN PRESSURE

HOW DOES AIRWAY RESISTANCE IMPACT TIDAL VOLUME

INCREASES AIRWAY RESISTANCE DIRECTLY reduces tidal volume due to increased effort required for breathing.

DULL SOUND

CONSOLIDATION, FLUID

HYPER RESONANCE

EXCESS AIR

HOW ARE INFANT NERVES INVOLVED IN LARYGNEAL BRAKING

BY REGULATING the airway and preventing collapse during breathing.

MAJPR MUSCLES OF RESPIRATION

DIAGRAPHM AND INTERCOSTALS

ACCESSORY MUSCLES

WHAT ARE THE ACCESSORY MUSCLES OF INSIRATION

SCALENES

,STERNOCLEIDOMASTOID,

PECTORALIS MAJOR.

TRAPEZIUS

WHAT ARE THE ACCESSORY MUSCLES OF EXPIRATION

RECTUS ABDOMINS

EXTERNAL OBLIQUE

INTERNAL OBLIQUE

TRANSVERSUS ABDOMINUS

WHEN DO ACCESSORY MUSCLES COME INTO USE

DURING INCREASED LUNG VOL MAY USE ACCESSORY MUSCLES TO COMPENSATE BY ENLARGING THE THORAX

LESS EFFICIENT BREATHING WHEN LUNG VOLUME REQUIRES EXTRA EFFORT

WHAT IS THE PARIETAL PLEURA

THE INNER LAYER OF THE THORACIC WALL IN CONTACT WITH THE LUNGS IS LINED WITH SEROUS MEMBRANE

WHAT IS THE VISCERAL PLEURA

COVERS THE OUTER SURFACE OF THE LUNGS and is also lined with serous membrane.

WHAT IS THE PLEURAL SPACE

The space between the parietal and visceral pleura, filled with pleural fluid that reduces friction during breathing.

HOW MANY LOBES OF

RIGHT LUNG

LEFT LUNG

RIGHT LUNG HAS 3 LOBES

RIGHT UPPER, MIDDLE AND LOWER

LEFT HAS 2 LOBES

LEFT UPPER AND LOWER

WHAT ARE THE AREAS OF AUSCULATION

WHAT IS DIFFERENCE BETWEEN SPUTUM AND PHLEGM

SPUTUM EXITS THE ORAL CAVITY AND COUGHED UP

PHELGM IS UNCONTAMINATED BY ORAL SECRETIONS

HOW TO CALCULATE PACK YEARS

FOR EX.

IF PT HAS SMOKED FOR 20 YEARS

20 CIGARETTES PER PACK

HAS SMOKED 30 CIG

TAKE THE AMOUNT OF CIG SMOKED/THE NUMBER OF CIG IN A PACK X YEARS

30/20 X 20 =30 PACK YEARS

WHAT IS THE FUNCTION OF THE LARYNX

FACILTATING SOUND

PROTECTING THE AIRWAY

VALVE TO CONTROL AIRFLOW DURING BREATHING AND SWALLOWING

WHAT IMPAIRS OR INHIBITS CILIARY ACTIVITY

SMOKING

INFECTIONS

ENVIROMENTAL POLUUTANTS

THESE CAN LEAD TO A DECREASES MUCOCILIARY ESCALTOR ACTIVITY

WHAT ARE CONDUCTING AIRWAYS

The parts of the respiratory system that transport air to the lungs,

NO GAS EXCHANGE

WHAT IS ORTHOPNEA

A condition where a person has difficulty breathing while lying flat, often relieved by sitting up.

SEEN IN CHF

WHAT IS PLATYPNEA

A condition characterized by difficulty breathing when sitting or standing, often relieved by lying down.

It is less common than orthopnea and may be associated with certain medical conditions.

WHAT IS APNEA

CESSATION OF BREATHING

CAUSES OF PEDAL EDEMA

SWELLING IN LOWER EXTREMITIES

CAUSED BY THE HEARTS INABILITTY TO PUMP BLOOD EFFECTIVELY

THE INCREASE IN VENOUS HYDOSTATIC PRESSURE PUSHES FLUID INTO THE INTERSTIAL SPACE

CHF

, kidney disease, liver disease, or venous insufficiency.

NORMAL VALUES OF

BP

RR

SPO2

TEMP

HR

120/80

12-20

95-100

37 C (98.6 F)

60-100

COMMON CAUSES FOR HYPOTENSION

DEFINED AS:

1. A SYSTOLIC PRESSURE LESS THAN 90 MMHG

2. A MEAN ARTERIAL PRESSURE OF LESS THAN 65 MMHG

   1. A DECREASE IN SYSTOLIC OF 40 MMG HG FROM BASELINE

RETRATCTIONS

INWARD SINKING OF THE CHEST WALL DURING INSPIRATION

INSP MUSCLES CONTRACTIONS GENERATE LARGE NEGATIVE INTRATHORACIC PRESSURE

KUSSMAUL BREATHING

DEEP AND FAST RESPIRATIONS

is a deep, labored breathing pattern often associated with metabolic acidosis, particularly diabetic ketoacidosis.

BIOT BREATHING

CHAOTIC BREATHING PATTERN

DAMAGE TO MEDULLA CHARACTERIZED BY FREQUENT IRREGULARITY IN BOTH RATE AND TIDAL VOLUME

APNEUSTIC BREATHING

DEEP GASPING INSPIRATION WITH BRIEF PARTIAL EXPIRATION

WHAT CAN CAUSE DECREASED BREATH SOUNDS

PLUERAL EFFUSION

PNEUMOTHORAX, ATELECTASIS, OR OBSTRUCTION

WHAT IS HOOVER SIGN

A clinical sign indicating paradoxical movement of the abdomen during breathing, often associated with respiratory distress or diaphragm weakness.

WHAT IS TRACHEAL TUGGING

A clinical sign characterized by an inward movement of the trachea during inspiration, often indicating respiratory distress or airway obstruction.

WHAT IS THE DEAD SPACE VOLUME CALCULATION

WHAT IS DEAD SPACE VENTILATION

The portion of each breath that does not participate in gas exchange, which includes the anatomical and physiological dead space.

WHAT IS THE MEDIASTINUM

The central compartment of the thoracic cavity, located between the lungs, containing the heart, great vessels, trachea, esophagus, and other structures.

WHAT IS PERCUSSION

A physical examination technique used to assess the condition of the thoracic or abdominal organs by tapping on the surface and listening for sounds.

WHAT ARE THE CLINICAL IMPLICATIONS OF PERCUSSION

DIFFERENCE BETWEEN SIGNS AND SYMPTOMS

Signs are objective evidence of disease observed by a healthcare professional,

symptoms are subjective experiences reported by the patient.

BREATHLESSNESS

AN UMPLEASANT URGE TO BREATHE

COUGH

MOST COMMON YET NONSPECIFIC SYMPTOM OOBSERVED IN PATIENTS WITH PULM DIS.

THE EFFECTIVENESS OF A COUGH DEPENDS ON WHAT

1. THE ABILITY TO TAKE A DEEP BREATH

2. LUNG ELSATIC RECOIL

3. EXPIRATORY MUSCLE STRENGTH

4. LEVEL OF AIRWAY RESISTANCE

WHAT IS A CHRONIC COUGH

A cough lasting more than eight weeks, often indicative of underlying conditions such as asthma, bronchitis, or gastroesophageal reflux disease.

HEMOPYTSIS

COUGHING UP BLOOD OR BLOOD STAINED SPUTUM

HEMATOEMESIS

BLOOD VOMITED FROM GI TRACT

WHAT IS THE TRI-POD SIGN

A position assumed by patients with respiratory distress, where they lean forward with their arms braced on their knees or a surface to aid breathing.

PULSUS ALTERNAS

A condition characterized by alternating strong and weak pulses, often indicative of heart failure or other cardiac issues.

PULSUS PARADOXUS

IS A SIGNIFANCT DECREASE IN PULSE STRENGTH DURING SPONTANEOUS INSPIRATION

SYSTOLIC PRESSURE

The pressure in the arteries during the contraction of the heart muscles, specifically when the ventricles pump blood. It is the higher number recorded in a blood pressure reading.

DIASTOLIC PRESSURE

The pressure in the arteries when the heart is at rest between beats, specifically when the ventricles fill with blood. It is the lower number recorded in a blood pressure reading.

CENTRAL NEUROGENIC HYPERVENTILATION

CHARACTERIZED BY BY PERSISTENT HYPERVENTILATION DRIVEN BY ABNORMAL NEURAL STIMULI that affects the respiratory centers in the brain, often leading to respiratory alkalosis.

WHAT IS SUBCUTANEOUS EMPYSEMA

FINE AIR BUBBLES COLLECTING IN SUBCUTANEAOUS TISSUE PRODUCES A CRACKLING SOUND AND SENSATION WHEN PALPATED

It occurs when air leaks into the subcutaneous tissue, often due to trauma, surgical procedures, or infection.

BRONCHOPHONY

A clinical test used to assess lung function where the patient is asked to speak while the clinician listens to the lungs. Increased resonance of the voice indicates underlying lung pathology.

HOW ARE GASES CLASSIFIED

THERAPEUTIC

LABARATORY

ANESTHETIC

SIGNS AND SYMPTOMS OF HYPOXEMIA

include shortness of breath, confusion, cyanosis, and increased heart rate. These manifestations indicate insufficient oxygen levels in the blood.

CHEST XRAY PRESENT AFTER PROLONGED EXPOSURE TO HIGH FIO2

may show bilateral pulmonary infiltrates or signs of oxygen toxicity, indicating lung damage due to excessive oxygen exposure.

WHAT IS HYPOXIC DRIVE

A mechanism that stimulates breathing in response to low oxygen levels, rather than high carbon dioxide levels. This is particularly important in patients with chronic respiratory diseases.

HOW IS THE HYPOXIC DRIVE IN PT WITH HYPERCAPNIA

The hypoxic drive in patients with hypercapnia is often diminished, as their primary respiratory drive is based on elevated carbon dioxide levels. In such cases, low oxygen levels become the key stimulus for breathing.

WHAT IS THE DIFFERENCE BETWEEN LOW FLOW AND HIGH FLOW O2 DELIVERY SYSTEMS

Low flow systems provide oxygen mixed with room air, while high flow systems deliver a fixed concentration of oxygen regardless of the patient's breathing pattern. This distinction is crucial in determining the appropriate oxygen therapy for patients with varying respiratory needs.

NASAL CANNULA

1 TO 6 LPM

24% -44% FIO2

NON-REBREATHER

10-15 LPM

FIO2 -60%-80%

INVREASE LITER FLOW IF BAG DEFLATES MORE THAN 50%

BAG HAS A VALVE

that prevents exhaled air from entering the bag, ensuring a higher concentration of oxygen is delivered to the patient.

AIR ENTRAINMENT SYSTEM

2 TO 15 LPM

ALSO CALLED VENTURI

24% TO 50% FIO2

CAN’T GUARANTEE ABOVE 40% PER PT DEMAND

NO HUMIDITY NEEDED

USED FOR COPD PTS/CO2 RETAINERB

HBO SYSTEM

A system that delivers hyperbaric oxygen therapy, providing high concentrations of oxygen at elevated atmospheric pressure to treat various medical conditions.

WHEN DO WE SUGGEST A HBO FOR A PT BASED ON CARBOXYHEMOGLOBIN

It is used to reduce the effects of carbon monoxide poisoning by displacing carbon monoxide from hemoglobin, thereby restoring the blood's oxygen-carrying capacity.

WHY ARE POST OP PTS MORE PRONE TO DEVELOP ATELECTASIS

as reduced lung volumes, shallow breathing, and pain that limits effective coughing, which can lead to the collapse of alveoli.

WHAT LUNG EXPANSION METHODS INCREASE TRANSPULMONARY PRESSURE GRADIENT

incentive spirometry, deep breathing exercises, and positive pressure ventilation increase the transpulmonary pressure gradient,

promoting lung expansion and preventing atelectasis.

IS

IPPB

CPAP

BIPAP

EZPAP

PEAK FLOWand other lung expansion techniques.

WHAT IS INCENTIVE SPIROMETRY

DECREASE PLEURAL PRESSURE

PTS DO 1O BREATHS PER HOUR

CK FOR BREATH SOUNDS

CAN ONLY BE DONE IN PTS WHO ARE ABLE TO FOLLOW THROUGH DIRECTIONS AND ARE SPONTANEOUSLY BREATHING

SLOW AND STEADY INHALE AND HOLD BREATH 5-10 SEC

USE PILLOW TO SPLINT

MEASUREMENT BASED ON AGE, HEIGHT, AND GENDER

CONTRAINDICTIONS OFR IPPB

include untreated pneumothorax, recent facial or skull surgery, and certain respiratory conditions that prevent effective ventilation.

WHAT ARE GOALS OF IPPB

To improve lung expansion, increase tidal volume, and enhance ventilation in patients who cannot take deep breaths effectively.

WHICH CLINICAL SIGNS INDICATE A PROBLEM WITH RETAINED SECRETIONS

Clinical signs include wheezing, decreased breath sounds, increased respiratory rate, and productive cough. These signs suggest airway obstruction or inadequate clearance of secretions.

WHAT IS MIE

MIE, or Mechanical Insufflation-Exsufflation, is a technique used to assist patients in clearing secretions from their airways through a combination of positive and negative pressure.

HOW DOES PEP WORK

Positive Expiratory Pressure (PEP) works by creating resistance during expiration, which helps keep airways open, promotes lung expansion, and aids in the clearance of secretions.

WHAT IS TOTAL FLOW CALCULATION

TOTAL FLOW =AIR TO O2 RATIO X O2 FLOW RATE

GIVEN FIO2 = 40%

O2 FLOW RATE - 10 L/MIN

AIR TO O2 RATIO = 3:1 = 4

TOTAL FLOW = 4 X10 = 40 L/MIN

SIMPLE MASK

5 TO 10 LPM

35% -50% FIO2

CAN’T USE ON LESS THAN 5 LBECAUSE CO2 WONT BE WASHED OUT

MASK WILL SERVE AS DEAD SPACE FOR EXHALED C02 IS RUN BELOW 5 LPM

PT CANT EAT OR DRINK

USED ON MOUTH BREATHERS

CAN’T USE HUMIDITY

BVM

A Bag-Valve-Mask (BVM) is a medical apparatus used to provide positive pressure ventilation to individuals who are not breathing or not breathing adequately. It consists of a self-expanding bag, a unidirectional valve, and a facial mask.

C/E HOLD

DON’T PRESS MORE THAN 50% OF THE BAG 500 ML

HAS A BAG OR OR TUBE AS RESEVOIR

USED FOR PT WHO ARE NOT BREATHING OR INSUFFICIENT BREATHING

USE OPA OR NPA IF PT IS UNCONSCIOUS

PRESS BAG EVERY 6 SEC

HIGH FLOW NASAL CANNULA

FLOW RATE UP TO 50 LPM

FIO2 - 35% TO 90%

BRAND AIRVO

START WITH 40LPM AND TITRATE

TEMP 35-37 C

AVOIDING INTUBATION

USE STERILE WATER FOR INHALATION

METAL PLATE ATTACHED TO BLENDER FOR HEATING

BLENDER : TEMP AND FIO2

LVN

5-10 LPM

FI02 - 28%-98%

HAS A VENTURI DIAL TO ADJUST FLOW

BUBBLE HUMIDIFIER ATTACHED TO FLOW METER

USE 2 LARGE BORE TUBING

MDI

EXAMPLE ALBUTEROL

PRESET DOSE

SHAKE BEFORE USE

PRIME IF NEW

SLOW, STEADY INHALE

1 MIN GAP IN BETWEEN ACTUATION/PUFF

BAN

BREATH ACTUATED NEB

RUN AT 5 LPM

DELIVERS 0.5 -6 ML MEDICATIONS

AIR DRY ONCE DONE USING

HAS A DIAL THAT CONTROLS WHETHER THE PT IS SPONTANEOUSLY BREATHING

USE CONTINOUS SETTING = MASK

GREEN DIAPHRAGM INSIDE CONTROLS AEROSOL

MORE EXPENSIVE

WHAT IS Pa02

PARTIAL PRESSURE of oxygen in arterial blood, indicating oxygenation status.

CLINICAL OBJECTIVES FOR O2 THERAPY

MAINTAINS ADEQUATE TISSUE OXYGENATION

DECREASES THE WORKLOAD HYPOXEMIA IMPOSES ON THE CARDIOPULM SYSTEM

HOW DOES 02 THERAPY CORRECT HYPOXEMIA

INCREASING ALVEOLAR AND BLOOD LEVELS OF O2

RELIEVES DYSPNEA AND IMPORVES MENTAL FUNCTION

CARDIOPULMONARY SYSTEM COMPENSATES FOR DECREASED 02 BY

INCREASING VENT TO INCREASE CARDIAC OUTPUT

TO INCREASE 02 PERFUSION TO MEET METABOLIC 02 DEMANDS

HYPOXEMIA CAUSES

VASOCONSTRICTION

AND IF IT IS CHRONIC HYPOXEMIA IT CAN CAUSE PULM HYPERTENSION

INDICATIONS FOR 02 THERAPY

1. PAO2 LESS THAN 60 MM HG OR SPO2 LESS THAN 90% IN PT BREATHING ROOM AIR

2. ACUTE CARE SETTINGS IN WHICH HYPOXEMIA IS SUSPECTED

3. SEVERE TRTAUMA

4. ACUTE MI

5. SHORT TERM THERAPY OR SURGICAL INTERVENTIONS

WHAT IS THE RULE OF O2 TEHRAPY

TO GIVE JUST ENOUGH TO MEET THE SPECIFCATIONS , NOT EXCESSIVE

TITRATE DOWN AS SOON AS POSSIBLE

USE LEAST AMOUNT OF 02 TO GET TEHJOB DONE

FOR FIO2 GREATER THAN 50%

BE WORRIED ABOUT:

ABSORPTION ATELECTASIS

02 TOXICITY

OR DEPRESSION OF CILIARY OR LEUKOCYTE FUNCTION MAY OCCUR

EXUDATE

FLUID THAT OOZES FROM CELLS AND TISSUES USUALLY FROM IMFLAMMATION OR INJURY

A PAO2 GREATER THAN 80MMHG IN INFANTS MAY LEAD TO

RETINOPATHY OF PREMATURITY

O2 IS NOT FLAMMABLE BUT

PROMOTES A FIRE

WHAT IS O2 TOXICITY

IS DUE TO PAO2 AND EXPOSURE TIME

THE GREATER THE EXPOSURE TIME AND THE HIGHER THE PO2 (FIO2) THE GREATEST THE LIKLIHOOD OF DAMAGE

DURING O2 TOXICITY WHAT HAPPENS

OXYGEN FREE RADICALS DAMAGES CAPILLARY ENDOTHELIUM

TYPE 1 CELLS - DESTORYED

TYPE 2 CELLS - THICKEN

WHAT IS THE V/Q MISMATCH

A condition where the ventilation and perfusion of the lungs are not properly matched, leading to impaired gas exchange.

3 BASIC 02 DELIVERY SYSTEMS

LOW FLOW

HI FLOW

RESERVOIR

WHAT IS FIO2 FOR A NASAL CATHETER

22-45

USED SHORT TERM FOR SPECIFIC PROCEDURES