Advanced Pathophysiology Exam 4 Exam Latest 2022

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Advanced Pathophysiology Exam 4 Exam Latest 2022 Normal Blood Gas Values - - pH: 7.35 - 7.45 PaO2: 80 - 100 mmHg PaCO2: 35 - 45 mmHg ventilation - - ability to clear CO2 oxygenation - - the proc... ess of delivering oxygen to the blood causes for CO2 increase - - -CO2 is being produced but not being exhaled quickly enough -increase in CO2 by increased metabolism like fever or exercise -PaCO2 in ABG is increased therefore pH decreases -as CO2 accumulates, peripheral and central chemoreceptors signal brain to increase RR -PaCO2 is influenced by alveolar minute ventilation and CO2 production -ventilation is influenced by alveolar minute ventilation and Co2 production -O2 sat decreases because increased CO2 pressure keeps O2 away alveolar minute ventilation - - alveolar volume x RR hypoxemia normal P (A-a) O2 (15-20) - - -lungs are working fine but there is problem above airways -altitude -nitrogen gas poisoning -fire smoke (O2 displacement) Alveolar hypoventilation increased P (A-a) O2 (>20) - - not getting enough ventilation into the alveoli, reducing oxygen -ex. OD antidepressants slowing RR fixed with O2 and increased ventilation causes of hypoxemia with increased P - - V/Q mismatch Shunt Diffusion Defect V/Q mismatch - - areas of our lungs that are receiving ventilation are not matched with perfused areas. when there is high CO2, pulmonary vessels selectively vasoconstirct so blood goes where best work is done low ventilation but normal perfusion because of airway secretions somewhat hypoxemic but not as severe as shunt shunt - - extreme VQ mismatch severe pneumonia ARDS when alveoli is filled with something that should not be there (fluid, blood, or infection) or alveoli is collapsed (atelectasis) Very hypoxemic diffusion defect - - conditions where there is a problem in O2 diffusing into the bloodstream: like with interstitial lung disease, some sort of irritation, body tries to restore damage, and fibroblasts lines up on the alveolar walls. other examples are pulmonary edema, hydrostatic pressure is too great, leaking into interstitial space work of breathing - resistance - - pressure that is required to overcome the resistance to gas flow through the airway during prespiration clinical conditions that increase airway resistance - - COPD mechanical obstruction infection asthma, bronchospasm work of breathing - compliance - - the ability of the lungs to expand is measured as the lung compliance. The volume change per unit of pressure when is more muscular effort for work of breathing is required? - - lung compliance is decreased (ex. pulmonary edema) chest wall compliance is decreased (spinal cord deformity or obesity) airways are obstructed by bronchospasm of mucous plugging (asthma, bronchitis) What 5 problems with oxygenation result in hypoxemia? - - -O2 concentration of FiO2 -ventilation of the alveoli (hypoventilation) -V/Q mismatch -Diffusion Defect -Shunt Examples of O2 content of FiO2 as a problem with O2 delivery to the alveoli - - high altitudes or oxygen displacement scenarios Examples of hypoventilation as a problem with O2 delivery to the alveoli - - unconciousness neurolgoic, muscular or bone diseases that restrict chest expansion COPD Examples of VQ mismatch as a problem with diffusion of O2 from the alveoli into the blood - - atelectasis asthma chronic bronchitis pneumonia ARDS PE Examples of diffusion defects as a problem with diffusion of O2 from the alveoli into the blood - - edema fibrosis emphysema examples of shunt as problem with perfusion of pulmonary capillaries - - blood flow bypassing lungs intracardiac defects intrapulmonary arteriovenous malformations DLCO - - diffusion capacity of the lung for carbon monoxide How is DLCO measured and preformed? - - inhale CO for 10 seconds and exhale measure how deep of breath and how much CO is left over diffusing capacity is a measure of the gas diffusion rate at the alveolocapillary membrane variables that affect DLCO - - Hb CoHb altitude PAO2 body position pulmonary capillary blood volume asthma obesity When is DLCO reduced - - pulmonary fibrosis pulmonary vascular disease restrictive lung diseases (loss of lung volume, fibrotic lung diseases) obstructive lung diseases (especially emphysema and others with V/Q mismatch) How does anemia cause a decrease in DLCO? - - there is less hemoglobin to pick up the carbon monoxide hemoglobin loves oxygen but it loves carbon monoxide more indications for DLCO - - -to monitor parenchymal lung diseases -evaluate pulmonary involvement in systemic diseases (RA, sarcoidosis, SLE, systemic sclerosis) -evaluate obstructive lung disease -evaluate cardiovascular diseases -quantify disability associated with interstitial lung disease COPD - - airflow limitations associated with chronic inflammatory response in the airway to noxious particles or gas. chronic irritant exposure recruits neutrophils macrophages and lymphocytes to lungs resulting in progressive damage from inflammation, oxidative stress, extracellular proteolysis apoptic and autophagic cell death chronic bronchitis - - inflammation and edema of the bronchials, increases size and number of mucous glands and goblet cells in airway, smooth muscle hypertrophy with fibrosis and narrowing airways. thick mucous can't be cleared r/t impaired cilia. bacteria also colonized (repeat infections) "blue bloater"..... 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