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Chapter 41 Oxygenation Notes
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Terms in this set (120)
How is blood oxygenated?
through mechanisms of ventilation, perfusion, & transport of respiratory gases
The airway of the lung tranfers?
oxygen from the atmosphere to the alveoli, where the oxygen is exchanged for CO2
What allows air to escape from the lungs?
relaxation of the diaphragm and contractions of the intercostal muscles
What is ventilation?
is the process of the moving gases into and out of the lungs with air flowing into the lungs during inhalation and out of the lungs during exhalation
What is the major inspiratory?
What is perfusion?
ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
What is diffusion?
responsible for moving the respiratory gases from one area to another by concentration
What are conditions or disease that change the structure and function of the pulmonary system?
COPD (chronic obstructive pulmonary disease), asthma, lung cancer, and cystic fibrosis
Working of breathing (WOB)
effort required to expand required to expand and contact the lungs
active process, stimulated by chemical receptors in the aorta
passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work
chemical produced in the lungs to maintain the surface tension of the alveoli and keep from collapsing
Who typically doesn't have enough Surfactant?
-babies who are born prematurely
-patients with pulmonary disease and sometime develop atelectasis
Patients with advanced COPD lose?
elastic recoil of the lungs and thorax
collapse of the alveoli that prevents normal exchange of O2 and CO2
What determines lung volumes?
age and height
amount of air exhaled following a normal respiration
amount of the air left in the alveoli after a full expiration
maximum amount of air left in the alveoli after a full expiration
Variation in tidal volume and other lungs are associated with?
-alterations in a patient's health status or activity
-pregnancy, exercise, obesity or obstructive and restrictive conditions of the lungs
What is the primary function of the pulmonary circulation?
move blood to and from the alveolar capillary membrane for gas exchange
Where does pulmonary circulation begin? What does it do?
-begins at the pulmonary artery
-receive poorly oxygenated mixed venous blood from the right ventricle
Flow continuous from _____________ through the ______________ to the ______________, where blood comes in contact with the ___________________ and the __________ of ____________________ occurs
-alveolar capillary membrane
-exchange of respiratory gases occurs
The _____________________ then circulates through the __________________ and ________________________, returning to the _____________
-oxygen rich blood
Respiratory gas exchange
diffusion is the process for the exchange of respiratory gases in the alveoli of the lungs and the capillaries of the body tissues
Diffusion of respiratory gases occur where?
alveolar capillary membrane
What affects the rate of diffusion?
thickness of the membrane
How does increased thickness of the membrane impede diffusion?
gases take longer to transfer across the membrane
Patients with pulmonary edema, pulmonary infiltrates, or pulmonary effusion have thickened membranes resulting in?
slow diffusion, slow exchange of respiratory gases, and decreased delivery of oxygen to tissues
What do chronic decease, acute disease, and surgical process often alter? (emphysema, pneumothorax, lobectomy)
the amount of alveolar capillary membrane surface
Oxygen transport systems consists of?
lungs and cardiovascular system
Delivery of the oxygen transports depends on?
amount of oxygen entering the lungs (ventilation), blood flow to the lungs and tissues (perfusion), rate of diffusion, and oxygen-carrying capacity.
What are the three things that influence the capacity of blood to carry oxygen?
-amount dissolved oxygen in the plasma
-amount of hemoglobin
-ability of hemoglobin to bind to oxygen
What is the carrier for oxygen and CO2?
When hemoglobin molecules combines with oxygen, what does it form?
The hemoglobin molecule combines with oxyhemoglobin is easily reversible, thus allowing for?
hemoglobin and oxygen to dissociate (deoxyhemoglobin, which frees oxygen to enter tissues
Cardiovascular Physiology: What does the cardiac system deliver?
oxygen, nutrients, and other substances to the tissues and facilitates the removal of cellular metabolism waste products by way of blood flow through other body systems such as respiratory digestive and renal
removal of part of a lung
What is the normal hemoglobin men and woman range?
12 and 16
Pumping action of the heart is essential for?
How many cardiac chambers does the heart have?
-two atria and two ventricles
How do the ventricles work?
fill with blood during diastole and empty during systole
Hemorrhage and dehydration cause?
decrease in circulating blood volume;
decrease in stroke volume
Myocardial fibers have what properties? What does it allow?
-stretch during cardiac filling
Stretch is proportionally related to?
strength of contraction
What is Starling's Law?
strength of the subsequent contraction increases
Does starlings law apply on a diseased heart (cardiomyopathy)? Explain:
No, increased stretch of the myocardium is beyond the physiological limits of the heart
How does a subsequent contractile occur? What does it do?
-insufficient stroke volume
-blood begins to back up in the pulmonary (left heart failure) or systemic (right heart failure) circulation
To maintain adequate blood flow to the pulmonary and systemic circulation, what must happen?
myocardial blood flow must supply sufficient oxygen and nutrients to the myocardium itself
T/F blood flow through the heart changes direction.
false, its unidirectional
What does the atrioventricular valve do during ventricular diastole?
open and blood flows from the higher pressure atria into relaxed ventricels
As systole begins, ventricular pressure?
rises and the mitral and tricuspid valves close
What causes S1?
During systolic phase the semilunar (aortic and pulmonic) valves?
open and blood flows from the ventricles into the aorta and pulmonary artery
During systole, what does the mitral and tricuspid valve do?
stay closed so that all of the blood is moved forward into the pulmonary valves
Valve closure causes?
second heart sound (S2)
What causes a murmur?
patients with valvular disease have backflow or regurgitation of blood through an incompetent valve
Is the branch of the systemic circulation that supplies the myocardium with oxygen and nutrients and removes waste
What happens to the coronary arteries during diastole?
The left coronary artery has how much blood and what does it do?
abundant blood supply and feeds the muscular left ventricular myocardium
-does most of the work of the heart
Which side of the heart does the most work?
What is the purpose of the arteries in the systemic circulation?
deliver nutrients and oxygen to tissues and the vein removes waste from tissues. (goin out into our body)
Which path does the oxygenated blood flow? and then?
left ventricle through the aorta and into large systemic arteries
-These arteries branch into smaller arteries; then arterioles; and finally into the smallest vessels which are the capillaries
Where does the exchange of respiratory gases occur?
at the capillary level where the irises are oxygenated
Where do waste products exit?
capillary network through the venules that join to form the veins
-the amount of blood ejected from the left ventricle each minute
-The normal cardiac output is 4 to 8 L/min in a healthy adult at rest
Circulating volume of the blood changes according to?
oxygen and metabolic needs of the body
-Example: cardiac output increases during exercise, pregnancy, and fever, however it decreases during sleep
What is CO=SV*HR?
cardiac output= stroke volume* heart rate
the amount of blood ejected from the ventricle with each contraction
What affects stroke volume?
Preload, afterload, and myocardial contractility
(end diastolic volume) is the amount of blood in the left ventricle at the end of the diastole, before the next contraction
The more stretch on the ventricular muscle, the?
the greater the contraction and the greater the stroke volume (starling's law)
How does certain medical treatment and stroke volume get altered?
changing the amount of circulation of the blood volume
-Maybe due to kidneys not excreting enough fluid, heart not pumping hard enough which causes a retain in fluid, IV running too fast which needs to be slowed down by the provider
What happens if volume is not replaced?
preload, stroke volume and the subsequent cardiac output decrease
is the the resistance to the ejection of blood flow from the left ventricle
What occurs to the arteries if bp is high all the time?
arteries become stiff and lose the elasticity
hardening of the arteries
Why does the heart work harder to overcome resistance?
blood flow can be ejected from the left ventricle
What occurs during hypertension?
afterload increases causing an increase in cardiac workload
What is myocardial contractility?
ability of the heart to squeeze blood from the ventricles
-It also affects stroke volume and cardiac output
What does poor ventricular contraction do to the blood?
decrease to the amount of blood ejected
What does CHF due to the elasticity of the heart?
since its not pumping correctly it causes loss of elasticity
is the rhythmic relaxation and contraction of the atria and ventricles depend on continuous, organized transmission of electrical impulses
Conduction system of the heart generates
impulses needed to initiate the electrical chain of events for a normal heart beat
-SA is sinoatrial and AV is atrioventricular
increase the rate of impulse generation and speed of transmission
Where does the conduction system originate?
SA node which is the pacemaker of the heart
Impulses are initiated at the?
-intrinsic rate of 60 to 100 cardiac action potentials per minute in an adult at rest .
List the flow of the conduction system of the heart in order:
1 SA node
2 AV node
3 Bundle of his
4 Right bundle branch
5 Purkinje fibers
On the ECG, what is the normal sequence called?
normal sinus rhythm (NSR)
Pneumonic for blood flow in the heart:
List the 14 steps of the circulation of the blood:
1 superior and inferior vena cava
2 right atrium
3 tricuspid valve
4 right ventricle
5 pulmonic valve
6 pulmonary arteries
8 pulmonic veins
9 left atrium
10 MITRAL or BICUSPID VALVE (same thing)
11 left ventricle
12 aortics valve
Left sided heart failure: Pulmonary edema
is accumulation of fluid or swelling in the lungs
-During auscultation you would hear crackles
-Patient will be SOB, will increased respiration in order to get more oxygen in, restless, confused
Left sided heart failure: Hemostasis
blood tinged sputum; they cough it up
Right sided heart failure: What is jugular vein distention or JV?
similar to how veins that stick out on the hand but it's on their neck
Right sided heart failure: Systemic Edema
usually in their lower extremities, weight gain; due to retention of fluid caused by the heart not pumping it out
Physiological Factors that affect oxygenation
Any conditions affecting cardiopulmonary functioning directly affects the ability of the body to meet oxygen demands.
Decreased Oxygen-Carrying Capacity: Hemoglobin
carries the majority of oxygen to tissues
Decreased Oxygen-Carrying Capacity: Anemia and inhalation of toxic substances cause?
decrease the oxygen carrying of blood by reducing the amount of available hemoglobin to transport oxygen
Decreased Oxygen-Carrying Capacity: CO is colorless, odorless gas that causes?
decreased oxygen carrying capacity of blood and also the most common form of toxicity
Decreased Oxygen-Carrying Capacity: How does CO toxicity affect hemogoblin?
it strongly binds with CO, creating a functional anemia
is a condition such as shock and severely dehydration cause extracellular fluid loss and reduced circulating blood volume
Reduced blood volume is?
Decreased circulating blood volume result in?
hypoxia to body tissues
What does the body try to do during significant fluid loss?
he body tires to adapt by peripheral vasoconstriction and by increasing the heart to increase the volume of blood returned to the heart, thus increasing the cardiac output
Increased Metabolic rate: How does it affect oxygen demand?
increases oxygen demand
Increased Metabolic rate: how does fever affect it?
increase the tissues' need for oxygen as a result, carbon dioxide production increase and declines the level of oxygen
How does oxygenation directly affect the lung disease?
it changes the interior posterior diameter of the chest wall
Type of chest that patients with COPD have and why?
barrel chest due to overuse of the accessory muscles in between our ribs, and it traps the air in the little airways.
Illnesses that affect the Alterations in Respiratory Functioning
affect ventilation or oxygen transport alter respiratory functioning
alveolar ventilation is inadequate to meet oxygen demand of the body or eliminate sufficient carbon dioxide
Signs and symptoms of hypoventilation:
mental status changes, dysrhythmias and potential cardiac arrest
state of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism.
Signs and symptoms of hyperventilation:
Severe anxiety, infection, drugs, or an acid base imbalance induced hyperventilation, rapid respiration, sigh breaths, numbness and tingling of the hands and feet, light headed or lose consciousness
inadequate tissue oxygenation at the cellular level
-results from a deficiency in oxygen delivery or oxygen use at the cellular level
Causes of hypoxia
decreased hemoglobin level and lowered oxygen
-carrying capacity of the blood
-decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia
-poor tissue perfusion with oxygenated blood as with shock
-impaired ventilation, as with multiple rib fractures or chest trauma
Clinical signs and symptoms of hypoxia:
apprehension restlessness, inability to concentrate, decreased level of consciousness, dizziness and behavioral changes
T/F a patient with hypoxia is able to lie flat and appear awake and relaxed
false, the patient with hypoxia is unable to lie flat and appears fatigued and agitated
blue discoloration of the skin and is a late sign of hypoxia
Where is central cyanosis obsereved?
tongue, soft palate, and conjunctive of the eye where blood flow is high, indicates hypoxemia
Where is peripheral cyanosis observed?
extremities, nail beds and earlobes, is often a result of vasoconstriction and stagnant blood flow
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