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Cardio A&P exam 1
Terms in this set (87)
Where is the pleural space located?
Between the visceral and parietal pleura
Normally, how much air (gas) is in the plural space?
Discuss the role of pleural fluid in the potential pleural
The fluid functions as a lubricant to allow the two layers of the pleura to glide smoothly past each other during respiration.
What is the medical name of abnormal friction between the two pleural membranes that is caused by an inadequate amount of pleural fluid?
what are the 3 pressures in the chest, the location of each pressure?
1. the intra-pulmonary pressure. This is also called the alveolar pressure.
2. the inter-pleural pressure. Located In the potential space.
3. the atmospheric/barometric pressure. 760 mmHg at sea level or 15 psi-- the weight of the atmosphere/air
At rest, no inspiration or expiration, the pause in between, what are the pressure difference?
760/0 at the mouth and alveoli. There is no gas pressure difference (or gradient). There is no gas movement at rest. The pressure in the pleural cavity is 756 or -4.
explain the 4 reasons why the inter-pleural pressure is negative
1. Elasticity of the lung
2. Surface tension in the alveoli
3. The elasticity of the chest wall.
4. Gravity has an effect (pressures are different in different places within the potential space)
what is the role of elasticity of the chest wall?
The overall structure of the chest wall is designed to push the chest wall outward. parietal pleura and the visceral pleura would pull apart if not held together by the pleural fluid
Discuss the concept of "potential space
The "potential" increase in volume causes a negative pressure to be created in the potential pleural space. This negative pressure stops the lungs from collapsing when the lungs are "still"
the removal of excess pleural fluid
Lymphatic vessels will drain any excess fluid.
How is pleural fluid moved around in the pleural space?
What is the medical name of a buildup of pleural fluid?
what are the two muscle groups that create inspiration?
1. The external intercostals - Mid to lower ribs, skeletal muscle.
2. The pulmonary diaphragm
Both the external intercostals and the diaphragm can initiate an inspiration via which nervous system?
cortical control" - (Think about it)
what is the source of your voluntary control?
which nervous system center has involuntary control?
Inspiration can be controlled automatically or you can voluntarily control when you want to take a breath. (T/F)
Which bones of the thoracic cage are pulled up and out during inspiration?
The middle to lower ribs.
The external intercostals receive autonomic signals from the "ventral respiratory group" (VRG). (T/F)
Where do the nerves branch off of the spine that causes the external intercostals to start inspiration?
T1 - T11
The autonomic signals that are sent to the diaphragm are via the phrenic nerve. (T/F)
explain the pressure changes in "quiet" breath of an adult at rest.
The increase in the inter-pulmonary pressure causes the intra-pulmonary pressure (alveolar) to become a pressure of -1 to -2, (758 to 759) The gas flow continues until the -1 to -2 of negative pressure (758 to 759) equals the atmospheric pressure
What is a normal Vt for an adult at rest
400 - 700 mLs
State the intra-pulmonary pressure and atmospheric pressure when inspiration ends
The -1 of pressure in the lungs/alveoli/intra-pulmonary pressure (759) continues until the intra-pulmonary pressure becomes equal to the atmospheric pressure (760 or 0) and inspirations ends.
the nervous system that can initiate a forced inspiration?
2. autonomic nervous system (CNS)--common protective maneuver: cough, yawn, sigh, or sneeze. (Involuntary)
Name two groups of muscles used for a forced inspiration
1) diaphragm and external intercostals
2)The accessory muscles of inspiration: SCM, scalenes, pectoralis minor
Name all of the muscles that are normally contracted during a quiet-breathing expiration
discuss the purpose of a stretch receptor
To slow down/limit inspiration.
-The stretch receptors will send signals to the pneumotaxic center only if the volume of air during inspiration is greater than 800 mLs.
Which phase of breathing is inhibited by the stretch receptors?
At what Vt will the pneumotaxic center send signals to the apneustic center to slow down inspiration?
800 ml or more
Which gas law explains the volume/pressure changes that cause the expiratory phase of breathing?
The intra-pulmonary pressure is -1 during inspiration and +1 during expiration. (T/F)
*intra-pulmonary pressure that was -1 during inspiration (759) now becomes 761 mmHg (+1)
what is the flow rate of the air leaving the lungs when the intra-pulmonary pressure is 760 and the atmospheric pressure is 760?
There is no flow
a forced expiration can start at TLC, the end of a normal Vt expiration, or anywhere in between. (T or F)
As the abdominal muscles contract, the intra-abdominal volume goes down (is compressed) and intra-abdominal pressure goes up. This positive pressure physically pushes the diaphragm in and upwards and helps to create a forced expiration. (T/F)
which accessory muscles involved in FORCED expiration?
1. The abdominal muscles
2. The internal intercostals
Which set of expiratory accessory muscles are located over the ventral abdomen?
The abdominal muscles
Define and describe a "Valsalva" maneuver
Take in a deeper breath than normal and forced expiration against a closed glottis.
what type of pressure level is present in the lungs (intra-pulmonary/alveolar pressure) during a maximal forced inspiration and breath-hold?
what does the brainstem control?
1. the resp. rate
2. the depth of Vt
3. coordination of the anatomical structures involved in swallowing, talking, airway protection
The brainstem controls many anatomical structures that coordinate upper airway movements ( T or F)
-This control is automatic ... but can be initiated by voluntary higher brain cognition (thinking) Also called "cerebral" control.
The brainstem contains structures that send and receive signals that regulate and control air movement in and out of the lungs. (T/F)
state the source of feed-back information that is sent to the neural control in the brainstem.
ventilation and the coordination of airway protective actions (Swallowing, Sneezing, gagging, vomiting) are usually automatic brainstem controlled or neural control. (T/F)
State and discuss the 3 components of control of ventilation.
1) central controller- pons, medulla (the brainstem)
2) effectors- resp. muscles
3) sensors- detect changes and send electrical signals to the brainstem
State the 3 chemical changes that are monitored by the chemoreceptors
1) oxygen- peripheral chemoreceptors
2) CO2- central and peripheral chemoreceptors
3) metabolic acids- peripheral
what chemical influence the pH of the cerebral spinal fluid (CSF) ?
PCO2 in the arterial blood
which center in the brainstem can prolong inspiration (influence the depth of Vt)?
which center in the brainstem coordinates all of the feed-back / stimuli from the sensors, and responsible for maintaining a regular, rhythmic, respiratory pattern?
There is no "stop inspiration" signal. Instead, the signals causing inspiration to "keep happening" stop. (T/F)
-The pneumotaxic center sends signals to the apneustic center that the inspiration should be slowed.
you can voluntarily control respiration, to talk, swallow, cough.
what happens in response to changes in the Hydrogen ion (H+) concentration of the CSF?
Ventilation is altered
If the pH of the CSF becomes more acidic, the body will increase ventilation. (T/F)
What does carbonic anhydrase do?
increase the disassociation of H2CO3 into H2O + CO2 by about 700 times
peripheral chemoreceptors respond to which 3 conditions?
and what is the response?
· Hypoxemia (PO2 < 60 mmHg)
· Hypercapnia (30% of the body's response)
· Metabolic Acidosis (three types)
increase Ve through signals to the medulla (brainstem)
These sensors become active to protect the lungs by limiting the size of Vt when the tidal volume exceeds 0.8 - 1.0 liter, what are these sensors?
Pulmonary Stretch Receptors or "Inflation Reflexes" or Hering-Breuer Inflation Reflex--located in visceral pleural and smooth muscles of the airway.
Where are irritant receptors located? and what triggers them?
beneath the bronchial epithelium.
1. A cough reflex
2. A sneeze reflex
3. Narrow the glottis to limit or block the entrance of the lungs.
(Dry drowning is possible)
4. Can trigger a rapid/shallow breathing pattern, (tachypnea).
What does J-receptor stimulation cause?
send signals to the brainstem in response to excess fluid in the alveolar/capillary area.
what is Vaso - Vagal response?
The blood vessels will dilate and the heart rate will decrease, fainting may occur.
ex: seeing blood, coughing, sudden immersion into cold water.
protection from the aspiration of a foreign substance. This reflex can cause a brief spasm that closes off the larynx.
Touching the carina can cause the heart rate to decrease (decrease blood pressure)
carinal reflex, part of vaso vagal
Joint & muscle receptors - proprio receptors
Movement of the limbs may stimulate ventilation during exercise
Temperature (exothermic receptors)
Fast changes in the temperature of the environment can cause hyperventilation. This reflex is sensed by the skin.
Emotions (fear / anger) receptors
located in the Limbic center of the brain. alter your breathing according to the emotional response. Increased RR and Vt
voluntary control of breathing
from the cerebral cortex to C3, C4, C5 and T1 - T11. This voluntary ability allows you to learn to talk, learn to whistle, learn to sing, learn social control of emotional expression
what is the most important factor in the control of ventilation under normal conditions?
When the COPD patient can no longer support the WOB needed to maintain a normal PCO2 in the body, the CO2 drive of breathing can diminish. (T/F)
-Increased WOB due to lung problems leads to a decreased stimulus to breath
a decreased CO2 will lead to a decrease in the stimulation to breath. So, if you voluntarily hyperventilate there will be no urge to breathe for a short time. (T/F)
With normal PCO2, PO2 can decrease to around 60 mmHg before there is any appreciable increase in ventilation. (T/F)
A decreased PO2 has NO effect on the central chemoreceptors. (T/F)
The central chemoreceptors only sense the changes in PCO2 (H+)
Arterial hypoxemia becomes the primary stimulus to breathe for a COPD chronic CO2 retainer. (T/F)
-The COPD patient breaths to maintains the PO2
If an RCP gives too high of an FIO2, the "CO2 retainer" may experience a dangerous decrease in ventilation and possible apnea. (T/F)
the low amount of oxygen will cause an anaerobic metabolism. The muscles will produce what type of acid?
will the body still make energy without glucose?
yes it will, the tissues will create ketone bodies.
The chief response to a large increase in metabolic acids and a decrease in pH is by which chemoreceptors?
Shortness of breath when lying flat (tripod position is preferred)
Orthopnea- The stomach, liver, and intestines will be pulled down by gravity. The pulmonary diaphragm will now have more room to move.
Normally, during quiet breathing, what percentage of each Vt is anatomical dead space?
20 to 40%
IBW is based on a person's height and gender. (T/F)
If his Vt is 450 mLs, the volume of anatomical dead space to Vt ratio would be 142 (IBW in lbs) divided by 450 = 31.5% (T/F)
The higher the Vt, the_______the percent of Vt is the anatomical deadspace
rate 12 - 20 bpm
sighs 6-7 /hour
rapid breathing over 25 bpm
shortness of breath
slow breathing < 10 bpm
- Decreased alveolar ventilation in relation to metabolic rate.
PaCO2> 45 mmHg
- Increased alveolar ventilation in relation to metabolic rate
- PaCO2 < 35 mmHg
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