RCP 200 - Airways and Alveoli + Lungs and Chest Wall Flashcards

Main Functions of the Nose

Air-conditioning and filtering

What size particles do not gain entry to the lower airways due to the filtering capacity of the nose?

Particles larger than 5 micrometers

Nasal Function Lost with Endotracheal Tube

Air conditioning

Complications of Lack of Humidification with Artificial Airways

Airway mucus thickens, hindering ciliary motion and potentially causing airway plugging and atelectasis

Goals of Humidification in Mechanical Ventilation

32°C to 34°C and 100% RH

Reflexes Preventing Aspiration

Pharyngeal and Laryngeal reflexes

Tracheal Tube Seal

Inflatable cuff

Ventilator-Associated Pneumonia (VAP)

Lung infection associated with endotracheal intubation

Tongue

Most Common Threat to Upper Airway Patency in Unconscious Patient

Sniffing Position

An extended head aligning the oral cavity and pharynx with the trachea, opening the airway and facilitating intubation

Vallecula

Small space between the epiglottis and tongue

Apnea-Hypopnea Index (AHI)

Number of apneas (absent airflow) and hypopneas (reduced airflow) that occur per hour of sleep; AHI of 20 or more requires treatment, however an AHI of only 5 might still require treatment if the patient has heart failure and complains of daytime sleepiness and fatigue

Continuous Positive Airway Pressure (CPAP)

Device that blows air under pressure into the nostrils holding the pharyngeal airway open; CPAP pressure mostly ranges from 6 to 12 cm H2O 

Epiglottitis

Inflammation of the epiglottis, requiring immediate placement of an artificial airway

Narrowest Portion of Infant Airway

Cricoid cartilage of the Larynx

Emergency Airway Incision Site

Cricothyroid Membrane

Glottis

Narrowest Space of Adult Larynx for Endotracheal Tube

Stridor

Sound associated with high-velocity air flowing through a narrowed glottis

X-Ray Thumb Sign

Epiglottitis

X-Ray Steeple Sign

Swelling of the Larynx

Laryngospasm

Causes the vocal cords inside the larynx to close the trachea opening.

Adult Trachea Length

12.0 cm.

Carina

Point of tracheal division

Purpose of Tracheal Cartilages

Keeps the trachea open, opening of C shape makes space for the esophagus to swallow

Right Mainstem Bronchi Angle

20 to 30 degree angle; more direct continuation of the trachea

Left Mainstem Bronchi Angle

45 to 55 degree angle

If an endotracheal tube is inserted too far in the process of intubation, listening to the lungs will reveal diminished breath sounds on the _____

Right side

Anatomical Dead Space

A volume of gas that is approximately 150 mL in the average adult and does not participate in gas exchange

Conditions Associated with Neutrophilic Infiltration of the Airways

Allergic asthma

Columnar, ciliated pseudostratified epithelial cells

Cells of the mucosal epithelium of the trachea and bronchi

Goblet cells

Mucus secreting cells

Submucosal glands

Mucus secreting cells that contribute greater volume of mucus

Clara cells

Nonciliated secretory cells bulging upward into the airway lumen

Gel Layer

Cilia reach up into this mucous layer during the forward propulsive stroke.

Sol Layer

Cilia withdraw and retract in this less viscous mucous layer

Eosinophils

Produce inflammatory substances known as granule proteins, and along with neutrophils and macrophages, they produce protease enzymes and reactive oxygen species. All these substances injure the airway epithelium and damage the lung’s extracellular matrix.

Proteolytic Enzymes (Antiproteases)

Destroy bacteria and other microorganisms that might be present in the airway; however, when it is chronically present, it can degrade major structural components of healthy lungs

Type I Cells

Constitute most of the alveolar surface and are extremely flat

Type II Cells

Compact, polygonal-shaped cells protruding into the alveolar airspace; Source of alveolar surfactant

Cells in the lung containing the lamellar bodies

Alveolar Type II Cells

Alveolar Macrophages

Large migratory phagocytes wandering freely throughout the alveolar airspaces and interstitium; Main function is to engulf and digest microorganisms and foreign material

Mediastinum

The space between the lungs containing the heart, aorta, esophagus, greater veins, trachea, and mainstem bronchi

Cardiac Notch

Located along the anterior border of the left lung, which makes room for the heart’s protrusion into the left half of the thoracic cavity

Diaphragm

Where the lung bases rest upon and is the major muscle of ventilation, consisting of two distinct, separately innervated muscles – the left and right hemidiaphragms

Hilum

Where arteries, veins, and the main bronchi penetrate the lung’s mediastinal surfaces

Lingula

Tongue-shaped anatomical counterpart of the middle lobe of the right lung formed by a thin anterior portion of the upper lobe of the left lung overlapping the heart and continues downwards

Costophrenic Recess (Costophrenic Angles)

Where the lowest margin of the diaphragm meets the chest wall

Visceral Pleura

Membrane attached to the lung’s surface

Parietal Pleura

Membrane that covers the inner chest wall surface

Function of Pleural Fluid

Lubricates the pleural membranes, allowing nearly frictionless movement as they slide over one another during breathing

Pleural Effusion

Fluid formed in the pleural space.

Thoracentesis

Removal of abnormal fluid in the pleural space with a syringe and large-gauge needle.

Pneumothorax

Air in the pleural space/thorax; Treatment requires placement of a chest tube into the pleural space and application of suction to remove the air and reexpand the lung.

Bronchial Circulation

Lung’s systemic blood supply that arises from the aorta as bronchial arteries, which supply the airway walls from the major bronchi down to the respiratory bronchioles.

Pulmonary Circulation

Originates from the right ventricle of the heart as the pulmonary artery and carries oxygen-poor blood to the lungs to be reoxygenated.

Anatomic Shunt

Mixing of unoxygenated blood with oxygenated blood meaning systemic arterial blood can never have the same partial pressure of oxygen as alveolar gas.

P(A-a)O2

Alveolar-to-Arterial oxygen pressure difference

Vessels Carrying Oxygenated Blood

Arteries and Pulmonary Veins

Vessels Carrying Deoxygenated Blood

Veins and Pulmonary Arteries

Lymphatic System Imbalances

The body’s capillaries are porous and filter about 30 L of fluid per day out of the blood into interstitial spaces; they reabsorb only about 27 L back into the blood. If the extra 3 L of fluid remained in the interstitial spaces, fluid would accumulate and eventually flood the alveoli, causing pulmonary edema.

Motor innervation

Muscle stimulus originating from a nerve

Phrenic nerve

Stimulates the diaphragm

Intercostal nerves

Stimulates the muscles between the ribs

Autonomic Innervation of the Lungs

Stimulated entirely by autonomic sensory and motor nerves; no voluntary motor control over airway smooth muscle exists.

Sympathetic responses

Norepinephrine; This stimulation causes smooth airway muscle relaxation, which increases airway diameter (bronchodilation) and decreases resistance to airflow.

Parasympathetic response

Acetycholine; These impulses are the main cause of bronchoconstriction (bronchospasm)

Slowly adapting stretch receptors (Hering Breuer)

Stretch receptors in the smooth muscle of conducting airways. When stretched, as occurs in deep inspirations, they send inhibitory impulses via the vagus nerve to the respiratory centers in the brain, stopping further inspiration.

Rapidly adapting receptors (Irritant receptors)

Activated by various irritants and stimulation of these cause reflex bronchoconstriction, expiratory narrowing of the larynx, cough, deep inspiration and mucous secretion.

Juxtacapillary receptors (J-receptors)

C-fiber endings are located deep in the lung parenchyma near pulmonary capillaries and alveoli and are stimulated by alveolar inflammatory processes such as pneumonia and by the increased pulmonary capillary pressure and pulmonary edema as seen in patients with CHF.

Thorax

Cavity formed by the rib cage and its muscles (intercostal muscles), the vertebrae, sternum, and diaphragm; Can be subdivided into three cavities (left and right pleural cavities and the mediastinum)

Ribs

1 to 7 are true ribs, 8 to 10 are false ribs, 11 and 12 are floating ribs

Sternum

Manubrium (top), Body, and Xiphoid Process (bottom)

Sternal Angle (Angle of Loius)

Junction of the manubrium, body, and second rib that marks the level of the carina in the lung and is adjacent to the second rib

Primary Ventilatory Muscles

Diaphragm and, to a much smaller extent, the parasternal intercostal and scalene muscles are involved in quiet breathing

Accessory Ventilatory Muscles

Sternomastoids, pectoralis major, and abdominals; Only the abdominals are accessory muscles of expiration

Tripoding

Sitting in a chair or on the edge of a bed, leaning forward over a table or the back of a chair, spreading the arms and grasping the widest portion of the object associated with COPD

Diaphragm

Dome shaped when relaxed where only 1.5 cm of downward movement is responsible for a lung volume increase of about 500mL

Is the Diaphragm active during inhalation and passive during exhalation?

True

What can happen to the diaphragm if the lungs fail to empty completely during exhalation?

The retained volume keeps the diaphragm from recoiling fully to its bowed, resting position; as a result, the diaphragm is abnormally flattened at the end of exhalation. Then, when costal diaphragm fibers contract during inspiration, they are not in a good position to lift and expand the lower rib borders. Instead, their flattened position causes their contraction to pull the lower rib cage inward, decreasing lower thoracic dimensions

Intercostal Retractions

Strong inspiratory efforts may create enough subatmospheric pressure in the thoracic cavity to suck the intercostal muscles inward, clearly outlining the individual ribs; sign of intense respiratory efforts and reflect increased work of breathing and may be observed in patients with high resistance to airflow (e.g., asthma, croup) or stiff, noncompliant lungs