520 exam 2

effects on O2 binding to hemoglobin

pH, temperature, pCO2, BPG

Bohr effect

active tissues generate H+, bind to Hb and stabilize T state, release of O2 from Hb

pH effect

lower pH, less binding

temperature effect

gas solubility based on temperature, higher temperature, less binding

pCO2

formation of carbonate lowers pHmore CO2, less binding

BPG

negatively charged molecule present in RBC that have greater binding affinity to Hbmore BPG, less binding

2 wavelengths

940 and 660

940 nm

oxyhemoglobin

660

deoxyhemoglobin

Modes of pulse oximetry

transmittance and reflectance

AC components

fluctuation of light absorption due to pulsatile volume of arterial blood

DC component

stable lines due to constant absorption due to non-pulsatile blood, venous blood, tissue and bone

limitations of pulse oximetry

calibration, optical interference, signal artifacts

A pulse oximeter is an instrument that estimates and displays the __________

arterial saturation of oxygen

Pulse oximetry is an _______ measurement of oxygen saturation in tissues

optical

One hemoglobin moleculeis composed of four hemoglobin chains bound looselytogether.

The quaternary structure

arterial saturation of oxygen

ratio of oxyhemoglobin concentration to thetotal concentration of arterial hemoglobin available for reversible oxygen binding.

henry's law

temperature increases, solubility decreases

boyles law

pressure of air in thorax has to be lower than atmospheric pressure for air to enter thorax

exhalation

lung volume decreases, air pressure increases, thoracic above atm

inhalation

lung volume increases, air pressure decreasesthoracic below atm

what principle governed pulmonary ventilation

P1V1 = P2V2

what is pulmonary ventilation affected by

airway resistancealveolar surface tensionlung compliance

airway resistance

increased resistance, decreased airflow

alveolar suface tension

surfactants decrease surface tension and open alveoli

lung compliance

ability of lungs to expand as transpulmonary pressure increases

intrapulmonary pressure

within lung, around atm

Intraplural pressure (Ppl)

within plural cavity, negative pressure

transpulmonary

difference betweeen intrapulmonary and intrapleural

blood flow

deoxy: right AV, pulmonary artery, lungslungs: pulmonary capillaries, gas exchange in alveolioxy: pulmonary veins, left heart, aorta

role of respiratory system

gas exchangeregulation of blood phvoice productionolfactionprotection

how is blood ph regulated

changing blood co2 levels

spirometry

assess lung function by measuring volume and flow of air that can be expelled

vital capacity

total amount of air that can be inhaled/exhaled with max effort

Inpsiratory Capacity

max amount of air that can be inhaled after tidal expiration

function residual capacity

air remaining in lungs after tidal expiration

total lung capcity

max amount of air lungs can contain

forced expiratory volume

% of VC that can be exhaled in time interval

peak flow

max speed of expiration

minute respiratory volume

amount of air inhaled per minute

maximum voluntary ventilation

MRV during heavy exercise

alveolar ventilation

volume of air exchanged between atmosphere and alveoli per minute

pulmonary blood flow

approximately equal to alveolar ventilation

negative pressure ventilation

creates negative pressure around chest and sucks into lungs

positive pressure ventilation

increase pressure in airway, forces air into lungs

mechanical ventilators

instrument that replaces or assists spontaneous breathing

The _______ and ________ accomplish this

diaphragm and intercostal muscle

biofluids compartments

ECF and ICF

ECF subcompartment

intravascular fluid, plasma, transcellullar fluid
interstital fluid

renal function mechanism

capillary exchange, regulates water and electrolyte balance and excretes waste

bowman's capsule

filters fluid from blood, fluid converted to urine

kidney process

glomerular filtrationtubular reabsorptiontubular secretionwater conservation

Glomelular Filtration

creates filtrate of blood

tubular reabsorption

removes solutes from filtrate and returns to blood

tubular secretion

removes waste from blood and adds to filtrate

water conservation

removes water from urine and returns to blood

how is kidney funciton assessed

blood tests, urinalysis, biopsy, ultrasound, x-rays

dialysis

waste removed as it moves across membrane

Ultrafiltration

excess fluid removed by water molecules moving across membrane due to pressure gradient

convection

dissolved solute dragged along with moving water molecules

diffusion

higher to lower concentration

osmosis

water moves from low to high solute concentration

sensors

conductivitytemperatureblood air flow pressure

conductivity sensor

verifies composition of diasylate

temperature sensor

diaslysate temp outside of normal range causes complications

blood sensor

checks for blood leakage by transmitting light through dialysate

air sensor

uses ultrasound to detect air bubbles

determining GFR

kf(hydrostatic-colloid)

dialyzer

device that separates substances in solution through unequal diffusion through semipermeable membrane

hemodialysis delivery system

instrument that enables blood to be safely dialyzed of waste

Renal circulation receives _____ % of cardiac output under normal conditions

20-25

Over 200 waste products excreted but only _______and ______ are used for clinical assessment.

blood urea nitrogen, creatinine

what is urea composed of

ammonia, creatine, phosphates

nephron is connected to

renal artery/vein and ureter

hydrostatic pressure

pushes filtrate into tubule

colloid osmotic pressure

result of non-filterable proteins

hormone

substances secreted from endocrine glands or gonad and transported through blood to site of action, control tubular reabsorption to regulate body fluid volumes & solute concentrations

The majority of ______ patients are given _______

end stage renal failure, renal replacement therapy

renal replacement therapy composed of

dialysisultrafiltrationconvection

solute removal

passive diffusion

what is ultrafiltration influenced by

osmosis and hyraulic pressure

vascular access

AV shunt, fistula, graftvenous catheter

artherosclerosis

fatty deposits build up on arterial walls and lead to diminished arterial perfusion

Types of atherosclerosis

peripheral artery diseasecoronary artery diseasecarotid artery disease

peripheral artery disease

arteries in limbs

coronary artery disease

prevents oxygen transport to myocardium & leads to heart attack

carotid artery disease

prevents oxygen transport to brain and leads to stroke

aneurysms

dilation of artery

most common type of aneurysm

abdominal aortic aneurysm

Steps of percutaneous transluminal coronary angioplasty

coronary angiographytransluminal angioplasty

coronary angiography

inject dye into arteries and capture image with x-ray

transluminal angioplasty

use catheters to open blocked arteries seen during angiography

bare metal stent

uses expandable mesh to keep vessel open

types of grafts

vinyon clothsynthetic grafts

vinyon cloth

fine mesh cloth stops blood leakage by forming fibrin plugs

types of synthetic grafts

dacron, goretex

how do synthetic grafts work

heal via ingrowth of endothelium and MSCs, allow weakened wall to be replaced

key features of engineering

no leakage under pressureelastic recoilmicroscopic porositybiocompatibilityin vivo clinical study

tunica intima

endothelium that lines lumen

tunica media

SMCs and elastic fibers