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N5315 / N5315 Advanced Pathophysiology Module 6 Study Guide (Latest Update) - University of Texas at Arlington

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N5315 Advanced Pathophysiology Module 6 Study Guide Pulmonary and Shock Core Concepts and Objectives with Advanced Organizers Age related Difference in pulmonary anatomy and physiology 1. Descri... be the age-related changes which occur in the alveoli, chest wall, and gas exchange. o Neonate:  Surfactant produced by 20-24 wks gestation; secreted into fetal airways by 30 wks gestation • Surfactant deficiency seen in premature infants  respiratory distress syndrome (hyaline membrane disease)  Immature respiratory control  ↓ response to hypoxia/hypercapnia  ↑ risk for apnea/hypoxia o Infant:  ↑ chest wall compliance (esp. premature infants)  ↑ metabolic rate  ↑ O2 consumption o Children:  Alveoli ↑ until 5-8 yrs old o Older Adults:  ↓ elastic recoil  Chest wall stiffening  Changes in gas exchange  ↑ flow resistance  ↓ alveolar wall tissue  ↓ alveolar surface available for gas diffusion  ↓ gas diffusion  Joint stiffening/rib ossification  ↓ compliance  ↓ respiratory endurance (20%) by 70 yrs old  ↓ vital capacity    ↑ residual volume  ↓ V/Q ratio  ↓ compensatory response to hypercapnia/hypoxemia  ↓ PaO2 2. Explain the structure and physiologic differences of the pulmonary system in the infant and child. o Infant:  Smaller airway than adults  ↑ obstructive episodes from mucosal edema or secretion accumulation  ↑ tonsil size  swelling  obstruction  Nose breathers until 2-3 mos old  congestion  obstruction  Immature respiratory control  ↓ response to hypoxia/hypercapnia  ↑ risk for apnea/hypoxia o Children:  Smaller airway than adults  ↑ obstructive episodes from mucosal edema or secretion accumulation  Diaphragmatic breathing at rest  pulmonary compromise  intercostal retractions or retractions of supraclavicular spaces  ↓ glycogen reserve  ↓ effectiveness of accessory muscles  fatigue & lactic acidosis may occur quickly 3. Examine the process of ventilation, gas exchange and transport. o Ventilation:  Movement of air in & out of lungs  Controlled by respiratory center in brain stem • Dorsal Respiratory Group (DRG): o located in medulla o control breathing pattern • Central chemoreceptors: o Located near respiratory center o Monitor arterial blood  maintain pH, PaCO2, & PaO2  ↑ H+ concentration  trigger receptors  stimulate respiratory center  ↑ ventilation  ↑ CO2 exhaled  ↓ H+ concentration • Peripheral chemoreceptors: o Located in aorta & carotid arteries o Monitor pH & PaO2  ↓ PaO2  triggers receptors  stimulate respiratory center  ↑ ventilation • These receptors do not kick in until PaO2 <60 mmHg  Alveolar ventilation measured by PaCO2  Mechanics of breathing: • Inspiration: o Diaphragm is major muscle of inspiration & is innervated by phrenic nerve  Contraction  flattens out  ↑ negative pressure in lungs  draws air in  Diaphragm contraction  external intercostal muscles contract  ↑ A/P diameter  ↑ air drawn into lungs o Accessory muscles: sternocleidomastoid & scalene muscles  ↑ A/P diameter  Assist w/ ventilation when minute volume ↑ (e.g. respiratory distress or strenuous exercise [Show More]

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