100 final

Respiratory Therapy Overview

• Role of Respiratory Therapist (RT)

  • RTs do not perform ambulation.

  • Importance of knowing correct answers, as tests are cumulative.

Licensing and Certification

• Regulatory Agency

• Respiratory Care Board: Responsible for licensing, revocation, and suspension.

• NBRC (National Board for Respiratory Care): Conducts certification examinations.

  • Pass the multiple-choice exam to obtain RRT (Registered Respiratory Therapist) or CRT (Certified Respiratory Therapist).

• California Specifics: CRTs cannot work unless grandfathered in; must achieve high cut score for RRT.

Professional Organizations

• AARC (American Association for Respiratory Care):

  • Provides clinical practice guidelines, scope of practice, advocacy for the profession, and code of ethics.

Neurotransmitters

• Acetylcholine:

  • Found in the parasympathetic nervous system; binds to M3 muscarinic receptors.

  • Causes bronchoconstriction.

  • Sympathetic Nervous System: Releases epinephrine.

Alveolar Cells

• Type I Alveolar Cells:

  • Cover over 93% of alveolar surface area.

• Type II Alveolar Cells:

  • Produce surfactant.

• Type III Alveolar Cells:

  • Alveolar macrophages.

Respiration Levels

• External Respiration:

  • Gas exchange between the atmosphere and blood.

• Internal Respiration:

  • Exchange between blood and tissues.

Respiratory System Functions

• Conduction of gases through the lower airways (anatomic dead space).

• Gross filtration of inhaled gases.

• Only specific numbered functions taught (1, 3, 4) pertain to respiratory functions.

Complications with Bronchi

• Bifurcation Angles:

  • Right main stem bronchus is straighter than the left, which can lead to:

    • Increased risk for aspiration on the right side.

    • Increased incidence of pneumonia and right main stem intubation.

• Bronchi Anatomy:

  • Right lung: 3 lobar bronchi.

  • Left lung: 2 lobar bronchi.

Breathing Mechanics

• Diaphragm:

  • Contracts during inhalation, causing intrapulmonary pressure to decrease.

• Pulmonary Vasculature:

  • Responds to hypoxia by vasoconstricting, redirecting blood to well-ventilated regions.

Documentation and Patient Autonomy

• Durable Power of Attorney:

  • Allows a patient to designate another individual to make health care decisions on their behalf.

Airway Mucus Function

• Acts to protect underlying tissues and trap contaminants.

• Production increases in response to infection.

Clinical Concepts

• Pleural Effusion:

  • Fluid in the pleural space.

• Hemothorax:

  • Blood in the pleural space.

• Pneumothorax:

  • Gas accumulation in the pleural space.

Breathing Patterns

• Kussmaul's Breathing:

  • Associated with diabetic ketoacidosis (DKA).

• Cheyne-Stokes Respiration:

  • Cyclic pattern of increasing depth followed by a decrease and apnea.

Summary of Physiological Responses

• Chemoreceptors:

• Peripheral: Monitor arterial pO2 located at the carotid bifurcations and aorta.

• Central: Respond primarily to pCO2 in the brainstem.

• Hypoxic Stimulation: Peripheral chemoreceptors respond specifically to pO2 decreases.

Treatment Considerations

• Oxygen Therapy for COPD:

  • Administer oxygen to maintain adequate oxygenation without exceeding recommended levels.

• Hypercapnia Response:

  • Acute rises in CO2 will stimulate a drive to breathe, while chronic conditions adapt.

Final Concepts

• Atelectasis:

  • Condition of collapsed lung tissue.

• Hypercapnia vs. Hypoxia:

  • Hypercapnia: high CO2 levels.

  • Hypoxia: low oxygen levels in tissues (hypoxemia refers to low oxygen in the blood).