RCP_200_final_study_guide.pdf

1. Sensory input to the dorsal respiratory neurons from the lungs, airways, and peripheral chemoreceptors is provided via ----- ------ nerves? Homework 5 Glossopharyngeal; vagus 2. The pneumotaxic center controls --------------? Homework 5 When inspiration switches off (the inspiratory time) 3. What...

1. Sensory input to the dorsal respiratory neurons from the lungs, airways, and peripheral chemoreceptors is provided via ----- ------ nerves? Homework 5 Glossopharyngeal; vagus 2. The pneumotaxic center controls --------------? Homework 5 When inspiration switches off (the inspiratory time) 3. What stimulates the Hering-Breuer inflation reflex? Homework 5 The stretch receptors at high lung volumes 4. What receptors are associated with causing coughing, sneezing, and tachypnea when stimulated? Homework 5 Irritant receptors 5. What receptors cause a rapid shallow breathing pattern when stimulated by pulmonary disease? Homework 5 J receptors 6. What group of nerve cells senses and responds to changes in the chemical composition of its fluid environment? Homework 5 Chemorecpetors 7. Where are the peripheral chemoreceptors located? Homework 5 In the arch of the aorta; in the bifurcations of carotid arteries 8. --------- levels is indirectly responsible for minute-to-minute control of breathing. Homework 5 CO2 levels 9. Alveolar ventilation (V): is the amount of air that reaches alveoli in the lungs, measured in :--? Homework 5 Liters/minute (L/min) 10. The flow of air and blood is the highest with ventilation of around 0.8 L/min, and perfusion of around 1.3 L/min; generating a V/Q ratio of 0.6, In Zone ------? Homework 5 Zone 3 11. In ----------- : Ventilation is equal to perfusion, generating a V/Q ratio of about 1. Homework 5 Zone 2 12. J-receptor is located in the ---------Alveoli 13. picture A shows ----------picture B shows ------------ homework 5 question 19 a. ventilation b. perfusion 14. What (DRG) stand for ? Homework 5 Dorsal Respiratory groups 15. there is ----------when perfusion is cut off, V/Q goes to infinity. Homework 5 Dead space 16. The V/Q increased when --------------? Homework 5 Blood flow is low with respect to ventilation 17. In -----------, a normal V, but a low Q, which means that V/Q is high. Homework 5 Pulmonary embolism 18. ----------- (Q) : is the pulmonary blood flow, or cardiac output, that reaches the arteries, and specifically the capillaries, surrounding the alveoli, also measured in L/min. Homework 5 Perfusion 19. To compensate the Shunt the arterial O2 should be ---------- and decrease ----------. Homework 5 The arterial O2 should be dropped and decrease PaO2 20. To compensate the Dead space the alveolar CO2 should be -------- (decrease ---------) homework 5 The alveolar CO2 should be dropped (decrease PACO2) 21. To compensate the Dead space the alveolar duct will :---------? Homework 5 Constrict 22. The ---------- in smooth muscle of large and small airways inhibit inspiration via vagal impulses to DRG homework 5 Stretch receptors 23. Overall, the V/Q ratio progressively ------ from zone 1 to zone 2 and finally to zone 3. homework 5 decreases 24. because zone ------ has about 19 times more blood flowing through per minute, it ends up accounting for more of the overall gas exchange. Homework 5 Zone 3 25. The picture shows ------------ homework 5 question 34 Strecth sensitive muscle spindle 26. The lung receptors are:------, ----- , --------? Homework 5 J receptors, stretch receptors, irritant receptors 27. -----------Breathing is a cycles of gradual increase in rate and volume followed by gradual decrease to complete apnea. Homework 5 Cheyne stokes breathing 28. -------is characterized by deep, rapid, and labored breathing. Homework 5 Kussmaul breathing 29. Medullary chemoreceptors, aortic bodies and Carotid bodies response to-----? Homework 5 Increase CO2 (hypercapnia) 30. Where the respiratory chemoreceptors are located? Homework 5 Medulla oblongata and in the carotid artery and in the aortic artery 31. Neural impulses for ventilation originate in -------------? Homework 5 Medulla oblongata 32. The overall ratio is an average of the three zones and works out to be ---? Homework 5 0.8 33. Which reflex prevents the lungs from over-inflating with inspired air? Hering Breuer inflation reflex 34. Pa ---- is the primary mediator of the minute-to-minute breathing drive in humans. Homework 5 PaCO2 35. ------- will be seen in the arterial blood gas values of a patient with acute ventilatory failure? Quiz 6 Acidic pH, near normal bicarbonate level, high carbon dioxide level 36. What is the normal arterial carbon dioxide pressure (PaCO2) in a healthy individual? Quiz 6 35-45 37. What an anion gap of 17 would indicate ? quiz 6 Metabolic acidosis 38. What are the common causes of metabolic acidosis? Homework 6 Diabetic ketoacidosis; prolonged diarrhea, lactic acidosis, renal failure 39. Common causes of metabolic alkalosis include: homework 6 Prolonged vomiting, nasogastric drainagen, hypokalemia 40. If ABG results (pH=7.21; PaCO2 =68; HCO3= 26; PaO2= 51) what would strongly indicate the need for? 41. A results show a pH and PaO2 that seem unreasonably high, while the PaCO2 seems unreasonably low. What most likely causes these erroneous results? Homework 6 Air bubble in the sample 42. Calculate the anion gap using the following data: Na+: 140 mEq/L K+ 4.1 mEq/L Cl-: 105 mEq/L HCO3-: 24 mEq/L Use the following equation. Na-(CL+HCO3) 140-(105-24)= 11 mEq/L 43. The primary goal of acid-base homeostasis is to maintain ----? Homework 6 Normal pH 44. Which system is primarily responsible for the buffering of fixed alkaline? 45. Which system is primarily responsible for the buffering of fixed acids? Homework 6 HCO3 46. Which organ systems assist in acid excretion? Homework 6 Kidneys and lungs 47. Which organ system excretes H+ from the body? Homework 6 Kidneys 48. If the blood PCO2 is high, the kidneys will Excrete more --------- and reabsorb more ------. Excrete more H+ and reabsorb more HCO3 49. What is the primary chemical event in respiratory acidosis? Homework 6 Increase in blood CO2 levels 50. What is the primary chemical event in metabolic alkalosis? Homework 6 Increase in blood HCO3 levels 51. What is a normal response of the body to a failure in one component of the acid-base regulatory mechanism? Homework 6 Compensation 52. Compensation for respiratory acidosis occurs through ------------? Homework 6 Increase in blood HCO3 levels 53. Compensation for metabolic acidosis occurs through ------------------? Homework 6 Decrease in blood CO2 levels 54. Kidneys take hours to days to compensate for respiratory disorders (True/False) False 55. An increase in the H+ ion concentration [H+] of the blood due only to an increase in the arterial PCO2 (hypercapnia) best describes the ? Homework 6 Respiratory acidosis 56. An ABG result shows the pH to be 7.56 and the HCO3– to be 23 mEq/L. What is the disorder? 57. An ABG result shows pH of 7.35, PaCO2 of 30 mm Hg, and HCO3– of 18 mEq/L. What is the disorder? 58. What are the clinical findings would you expect in a fully compensated respiratory acidosis? Homework 6 Elevated HCO3. PH between 7.35-7.39 59. In the face of uncompensated respiratory acidosis, what abnormalities would you see in blood ? Homework 6 Decreased pH, Increased PCO2 60. How is acute respiratory acidosis accomplished? Homework 6 By increasing alveolar ventilation 61. A decrease in the H+ ion concentration [H+] of the blood caused by a low PaCO2 best describes as___________? HW 6 Respiratory alkalosis 62. What are the causes of respiratory alkalosis? Homework 6 question 28 NOT: extreme obesity 63. Compensation for respiratory alkalosis occurs through renal ______of ____? Homework 6 Renal excretion of HCO3 64. In partially compensated respiratory alkalosis, HCO3–is _______, PCO2 is ____, pH is ___? Homework 6 Decreased HCO3, Decreased PCO2, Increased pH 65. What is a normal anion gap range? Quiz 6 9 to 14 mEq/L 66. What is the main compensatory mechanism for metabolic acidosis? Homework 6 Hyperventilation 67. Patient with Kussmaul’s respirations, what acid-base disturbance would you expect to see? Quiz 6 Metabolic acidosis 68. What is the treatment may be indicated. for metabolic acidosis? Quiz 6 NaHCO3 infusion 69. What compensates for a metabolic alkalosis? Quiz 6 Hypoventilation 70. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.43, PCO2 = 39 mm Hg, HCO3– = 25.1 mEq/L 71. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.62, PCO2 = 41 mm Hg, HCO3– = 40.9 mEq/L 72. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.43, PCO2 = 20 mm Hg, HCO3– = 12.6 mEq/L 73. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 6.89, PCO2 = 24 mm Hg, HCO3– = 4.7 mEq/L 74. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.08, PCO2 = 39 mm Hg, HCO3– = 11.8 mEq/L 75. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.28, PCO2 = 53 mm Hg, HCO3– = 25.8 mEq/L 76. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.38, PCO2 = 21 mm Hg, HCO3– = 11.7 mEq/L 77. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.35, PCO2 = 68 mm Hg, HCO3– = 34.3 mEq/L 78. What is the normal range for BE? Quiz 6 +2 mEq/L 79. In acute respiratory acidosis, what would you expect the BE range to be? Quiz 6 +2 to –2 mEq/L 80. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.62, PCO2 = 32 mm Hg, HCO3– = 29 mEq/L 81. Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.01, PCO2 = 71 mm Hg, HCO3– = 16.3 mEq/L 82. What is the level of PaO2 set as a goal for oxygen therapy in healthy adults? Quiz 6 Atleast 60 mmHg; SaO2=90% 83. On which conditions is oxygen therapy effective? quiz 6 V/Q mismatch, diffusion effects, and general hypoventilation 84. What type of oxygen device should be recommended for a patient with hypercapnic COPD? Quiz 6 High flow 85. What is the most recommended position for a patient in the immediate postsurgical period to improve the PaO2? Quiz 6 upright 86. How should patients with unilateral lung disease be positioned to optimize oxygenation? Quiz 6 With healthy lung down 87. In ARDS PaO2/FIO2 ________ than _____ mm Hg quiz 6 Lower than 300 mmHg 88. The major difference between CPAP and PEEP is that the airway pressure does not rise during inspiration with _______. Quiz 6 Airway pressure does not rise during inspiration with PEEP 89. What are considered mechanisms of ventilator-induced lung injuries? quiz 6 Volutrauma, Barotrauma, atelectrauma, and biotrauma 90. The concept of “open lung” ventilation refers to _______? Quiz 6 Preventing repetitive opening and closing of alveoli (Atelectrauma) 91. When has full acid-base compensation occurred, the pH is _______? Quiz 6 Restored to the normal range 92. What is occurring when either PaCO2 or HCO3- is also abnormal in a way that brings the pH back toward the normal range? 93. What is the interpretation of the following blood gas: pH is 7.36, PaCO2 is 80 mm Hg, and HCO3- is 44 mEq/L? 94. What is the interpretation of the following blood gas: pH is 7.36, PaCO2 is 80 mm Hg, and HCO3- is 44 mEq/L? 95. What is the interpretation of the following blood gas: pH is 7.15, PaCO2 is 80 mm Hg, and HCO3- is 26 mEq/L? 96. What is the most common clinical condition associated with respiratory acidosis? Quiz 6 COPD 97. Central nervous system ( CNS) depression causes ___________? quiz 6 Respiratory acidosis 98. When does renal compensation begin? Quiz 6 As soon as PaCO2 rises 99. When is full renal compensation for respiratory acidosis expected to occur? Quiz 6 In several days 100. What is the interpretation of a blood gas that shows a high PaCO2, a high HCO3- and an acid pH still not quite in the normal range? Partially compensated respiratory acidosis 101. What is the most common cause of iatrogenic respiratory alkalosis? Quiz 6 Mechanical ventilation 102. What is the interpretation of a blood gas that shows a low PaCO2, a low HCO3- and an alkaline pH? Quiz 6 Partially compensated respiratory alkalosis 103. Which laboratory values is typically ignored in the calculation of the anion gap? Quiz 6 K+ 104. What is the interpretation of a blood gas that shows a pH of 7.10, a PaCO 2 of 50 mm Hg, and an HCO3- of 15 mEq/L? 105. How much should the PaO2 rise 50 mm Hg for every 10% increase in FIO2? Quiz 6 50 mmHg 106. ---- is the percentage of oxygen in the air mixture that is delivered to the patient. Quiz 6 FiO2 107. Natural air includes 21% oxygen, which is equivalent to FiO2 of -------- Quiz 6 0.21 108. FiO2 is maintained below ------ even with mechanical ventilation, to avoid oxygen toxicity. Quiz 6 0.5 109. Normal[HCO3-] = ----------- quiz 6 22-26mEq/L 110. PEEP ------ in diagnosed ARDS Prevent atelectrauma (closing-reopening injury) Homework 6 111. ARDS :Acute Respiratory Distress Syndrome lung injury characterized by ---? Quiz 6 Except increase lung compliance 112. Pulmonary arteries (carry Deoxygenated blood )begins with pulmonary trunk out of -------? Homework 7 Right ventricle 113. The ECG tracing appears as a flat line in ----------? Homework 7 Asystole 114. What a shift in the PMI indicates ? Homework 7 pneumothorax 115. GFR lower than 60 maybe an indication of -------- homework 7 Kidney disease 116. Pulmonary Artery Catheters (PAC) often referred to as a---------? Homework 7 Swanz ganz catheter 117. P wave refers to --------------? Homework 7 Atrial depolarization (atrial contraction) 118. What wave refers to ventricular depolarization (ventricular contraction)? Homework 7 QRS 119. In the process of inserting the PAC Catheter, the internal jugular vein provides a direct path to the ----------? Homework 7 Right atrium 120. In ECG which wave refers to ventricular repolarization (ventricular relaxation)? Homework 7 T Wave 121. A leaking which valve would lead to pulmonary edema? Homework 7 Mitral valve 122. What is the effect of the positive pressure ventilation on the urinary output? Homework 7 Decreases urinary output 123. Decrease in blood CO2 levels is a compensation for __________? 124. What is the single best indicator of the adequacy or effectiveness of alveolar ventilation? PaCO2 125. -----------is normal breathing, (500) ml of air is moved in/out of lungs with each breath. Tidal volume 126. At resting : Oxygen diffusion normally ceases after blood traverses one-third of the capillary distance within ---------? 0.25 127. The most common cause of acute alveolar hyperventilation is:_________ Hypoxemia 128. As VA increases, PACO2 -----decreases 129. The person with high lung compliance (low elastance) requires the ----- passive exhalation time 130. How would you describe a pH of 7.49 ? Alkalemia 131. What does VE mean ----------------? Total ventilation in a minute 132. Normal DLCO values is :_______? 20-30 mL/min/mmHg 133. Does pulmonary fibrosis disease affect WOB? True 134. what Does Low compliance mean? _________ 135. Normal tidal volume is ---------------------(mL/kg). 5 to 7 mL/kg or (3 to 4 mL/lb) 136. Anatomic Dead Space is the Volume of gas in:___________ Airways 137. apices of the lungs rise to about the level of the--------- In the normal adult at end exhalation. First rib 138. Normal adult ventilatory rate --- to---- breaths per minute 12 to 20 139. Trapped air and pressure in the lung caused by inadequate expiratory time is called :--140. During Exhalation PA ------------- the Pao Increases above 141. During inspiration (inhalation) Intrapulmonary pressure is ------ than ------. Lower than atmospheric pressure 142. Lungs are covered with a(n) _______, which forms a sac enclosing the lung and continues as the lining of the thoracic cavity. Pleural membrane 143. The approximate length of the trachea, or windpipe, is _____ cm or ---- inch 11 cm 144. What does DLCO stands for? Diffusing capacity of the lungs for carbon monoxide 145. What is the name of the external landmark that identifies the point at which the trachea branches into the right and left main stem bronchi. Carina 146. If the blood PCO2 is high, what the kidneys will do? Excrete more H+ and reabsorb more HCO3 147. How much the volume of anatomic dead space is approximately equal to_______? 1 mL/lb (2.2 mL/kg) 148. The accumulation of fluid in the pleural cavity separates the visceral and parietal pleura. If untreated, the lung will Lung will collapse 149. what is the diagnosis with values (pH = 7.08, PCO2 = 39 mm Hg, HCO3– = 11.8 mEq/L) 150. ----: is a motor nerve that makes the innervation of --------, originate from C3 to C5. Injury from surgery, trauma, or disease may paralyze -----------, breathing is still possible if accessory nerves are intact. Phrenic Nerves? 151. Pulmonary ligament: Connects lung’s surface membrane with ------diaphraghm 152. Anatomical Shunt is : vascular connections between bronchial and pulmonary circulation 153. Pneumothorax, means ;______? 154. Which organ systems assist in acid excretion? Kidneys and lungs 155. an acinus: consists of all structures distal to a-----? Terminal bronchiole 156. During expiration (exhalation): Intrapulmonary pressure is greater than atmospheric pressure, about______? +1cmH2O 157. CO2 diffuses -------times faster than O2 across alveolar-capillary membrane because of its much greater solubility 20 times faster 158. Negative or sub atmospheric pressure (negative intrapleural pressure) normally exists between the------------? Parietal and visceral pleurae 159. What FIO2 refers ? Fraction of Inspired Oxygen 160. An ABG result shows the pH to be 7.56 and the HCO3– to be 23 mEq/L. What is the disorder? 161. What is a normal anion gap range? 9 to 14 mEq/L 162. What is the Normal Cardiac output (CO) ? 4-8 L/min 163. What is the Normal Mean pulmonary artery pressure (PAP)? 9-18 mmHg 164. What is the Normal Pulmonary capillary wedge pressure (PCWP)? 4-12 mmHg 165. What is the Normal Central venous pressure (CVP)? 0-8 mmHg 166. What is the Normal Stroke volume (SV)? 60-130mL 167. what does FiO2 =1.00 means 100% oxygen 168. What is the Normal BE = ? -2 to +2 mEq/L 169. properly set PEEP level prevents --------from collapsing at the end of ---------. Homework 6 Prevents alveoli from collapsing and the end of expiration 170. Whose Poor candidates for PEEP and CPAP? Homework 6 109 Unilateral disease and normal or high lung compliance 171. In ARDS mechanical assistance is required to ----------------- therapy, which reduces alveolar collapse, improves lung compliance, and eases the work of breathing. Homework 6 question 111 End expiratory pressure therapy 172. PCWP > 25 mm Hg = obvious evidence of --------------? Homework 7 Pulmonary edema 173. RA receives deoxygenated blood from superior --------, inferior --------, and coronary sinus. Homework 7 Superior vena cava; inferior vena cava 174. when extracellular fluids become too alkaline, kidneys excrete Sodium Bicarbonate into urine. And when extracellular fluids become too acidic, kidneys excrete H+ into urine. Homework 7 175. When patient develops metabolic acidosis, the lungs will _______hyperventilation____-ventilate. And when a patient develops metabolic alkalosis, the lung will ____hypoventilation_____-ventilate.