RCP 110 STUDY GUIDE EXAM 1.docx

**RCP 110 Anatomy and Physiology Exam I Study Guide** I. Upper airways a. Know the primary components and functions of the upper airways - The Nose, oral cavity, larynx, pharynx - Important areas of speech and smell, humidify and warm or cool inhaled air, conductor of air, prevents...

**RCP 110 Anatomy and Physiology Exam I Study Guide** I. Upper airways a. Know the primary components and functions of the upper airways - The Nose, oral cavity, larynx, pharynx - Important areas of speech and smell, humidify and warm or cool inhaled air, conductor of air, prevents foreign objects from entering the tracheobronchial tree b. Be able to define and identify conditions that cause nasal flaring - Widening of nostrils during resp. distress. Causes increased airway resistance for example asthma and upper airway obstruction. Another example is lungs stiffer than normal can be caused by pneumonia c. Be able to identify where an Endotracheal tube can end up if it is malpositioned (not located in the trachea) - During intubation, the ET tube can be inserted into the esophagus instead of the trachea d. Know the laryngeal cartilage responsible for preventing aspiration - Epiglottis flappy cartilaginous structure that prevents aspiration of food and liquids e. Understand the functions of the larynx - The passageway of air that connects the pharynx and trachea, prevents aspiration of solids and liquids, generates sounds for speech f. How is post-extubation laryngeal edema treated? - Post-extubation laryngeal edema is caused by trauma swelling at the vocal cords Treatment is aerosolized racemic epinephrine high humidification, (vaporized cool mist and steam inhalation, voice rest, cough meds, and antiseptic throat spray. g. Be able to identify and differentiate between epiglottitis and croup - Croup Viral infection caused by inflammation of the trachea and larynx - Epiglottitis is a bacterial infection causing swelling of the epiglottis and above glottis, airway obstruction. II. Lower Airways h. What function should patients avoid suppressing if the mucociliary transport mechanism is compromised? - Should avoid suppressing cough reflex only way to mobilize secretions i. Identify respiratory therapy modalities to mobilize and expectorate bronchial secretions - Chest physiotherapy, flutter of Capella, cough breathing exercises, suctioning j. Know the 3 layers of the tracheobronchial tree - Epitheal, lamia propria, and cartilaginous layer k. Know what occurs in the lamina propria and what physiologic response occurs when chemical mediators are released - In the lamina propria, there are mast cells that help in immunological mechanisms when activated release substances that alter the diameter of the bronchial airway. l. Identify the layers of the mucous blanket and the primary components - Primary components 95% water, 5% consist of glycoproteins, carbs, lipids, dna, some cellular debris - Gel layer: a viscous layer that lies closer to the lumenal surface. - Sol layer: a thinner layer that lies adjacent to the epithelial lining. m. Know the level of the tracheobronchial tree where cilia is absent - Terminal bronchioles between the 16^th^ and 19^th^ generations n. Understand the factors that alter the mucociliary transport mechanism Factors Affecting Mucociliary Escalator Function - Cigarette smoke: paralyzes the cilia, reducing their movement and effectiveness - Dehydration: reduces the function of cilia, leading to a vicious cycle of illness - Positive pressure ventilation: can damage cilia, especially at higher pressures - Endotracheal suctioning: can cause cilia damage - High FiO2: high levels of oxygen can paralyze cilia, making them less effective o. The cartilaginous airways are also known as - Conducting zone/airways p. How many segments does the right lung have and how many does the left lung have - There are 10 segmental bronchi in the right lung and 8 in the left lung. q. Which airways are considered non-cartilaginous - Bronchioles and terminal bronchioles r. What structures are nourished by bronchial arteries - The bronchial arteries nourish the lungs, providing oxygen to the tracheobronchial tree, lymph nodes, pulmonary nerves, and portions of the esophagus and pleura. s. Identify the different types of alveolar cells - Type 1 pneumocyte -Broad thin cells that make up 95% of the alveolar surface; **cannot reproduce** - Type 2 pneumocyte- 5% of the alveolar surface, Produces pulmonary surfactant **can reproduce itself** and type 1 cells. - Type 3 Alveolar macrophages-remove bacteria and foreign pathogens t. How many cm above the carina should the tip of an Endotracheal tube sit? - 2-5 cm above carina u. Define the carina - The carina of the trachea is part of the lowest part of the trachea cartilage which is placed between the orifices of the two bronchi. III. Lymphatic, vascular, pleura, etc. v. Know what happens when beta 2 receptors are stimulated in the lungs - Cause relaxation of the airways musculature, bronchodilation w. Be able to identify the structures in the mediastinum and identify the apex, base and hilum of the lung - Refer to book images book page 52 figures 1-49 and 1-50 x. Know the different abnormal conditions of the pleura - **Pleurisy**: Inflammation of the pleura, causing friction and pain - **Pleural effusion**: Fluid accumulation in the pleural cavity - **Empyema**: Infected fluid accumulation in the pleural cavity - **Pleural friction rub:** A grating sound caused by friction of parietal and visceral pleura rubbing against each other common in pleurisy. y. Know the accessory muscles of inspiration and expiration - Inspiration-Scalene, Sternocleidomastoid, external Intercostals, Trapezius - Expriation-Abdominal muscles, Internal intercostals z. Know the differences between pulmonary and systemic circulation with regard to oxygen and CO2 content **Pulmonary circulation** - Blood goes from the heart to the lungs to pick up oxygen and get rid of CO2. Then the blood goes back to the heart with more oxygen and less CO2. **Systemic circulation** - Blood goes from the heart to the body to give oxygen to the cells and collect CO2. After that blood returns to the heart low on oxygen and high on CO2. - pulmonary lungs=( get oxygen lose CO2) - systemic = body (give oxygen picking up CO2) f\. Define elastance and how it relates to lung compliance - Elastance is the measure of the stiffness of a structure, such as the blood vessels or lungs, which indicates that the lungs are stiff and difficult to inflate. - High Elastance means that a structure is stiff and resists stretching ( low compliance). - Low elastics means that a structure is more easily stretched or expanded parentheses (high compliance). a. Define ventilation - The process that moves gases between the external environment and the Alveoli. b. Know barometric pressure at sea level - 760 mm HG or 1033cm H2O c. Understand the pressure changes and the anatomical changes that occur during inspiration, end inspiration, expiration and end-expiration - Inspiration- pressure decreases diaphragm moves down - End of inspiration- intra-plural pressure holds at a level below that at rest and downward movement of diaphragm stops. - Expiration pressure increases and the diaphragm moves upward - End of expiration-pressure stays the same diaphragm upward movement stops Inspiration down in both pressure and diaphragm expiration up in both pressure and diaphragm. d. Understand the physiologic response to a tension pneumothorax (what happens to the patient's vital signs) - Increased HR, diminished absent BS, hyper resonant percussion, tracheal shift unaffected side, displaced heart sounds, an enlarged and immobile chest on the affected side, decreased cardiac output, and blood pressure. O2 sat decreased and RR increased. Confusion e. Define surface tension and understand surfactant (which cells produce surfactant, conditions that result in a surfactant deficiency) - Surface tension is the property of a liquid surface that allows it to resist an external force due to the cohesive forces between its molecules - Surfactant is produced and stored in the Alveoli type two cells. It's composed of phospholipids and protein. Conditions that result in surfactant deficiency include respiratory distress syndrome in infants and atelectasis, which is the collapse of the alveoli. f. Understand LaPlace's law and how it explains surface tension, radius, distending pressure, etc. - The places law shows that the distending pressure of a liquid sphere is one directly proportional to the surface tension of the liquid and two inversely proportional to the radius of the sphere. In other words, the numerator of the law shows that as the surface tension of the liquid bubble increases, the standing pressure necessary to hold the bubble open increases, or opposite the surface tension of the liquid bubble decreases the descending pressure of the bubble decreases when the surface tension of the liquid bubble decreases the descending pressure of the bubble decreases IV. Labeling g. Be able to label the visceral pleura, parietal pleura and pleural cavity/space h. Be able to identify the epiglottis, vocal cords, vestibular fold, larynx and esophagus  A diagram of the human lungs Description automatically generated