Pediatric CCRN Pulmonary Exam | 200 Questions & Answers Study Guide

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PEDIATRIC CCRN: Pulmonary (200
Questions) & answers
✅-3
# of lobes in right lung
# of lobes in left lung -
2

3 divisions of lungs - 
-1. Bronchi - cartilaginous
2. Bronchioles - membraneous
3. Alveoli - gas exchange units, lined by epithelial cells (2 types)

2 types of alveoli - -Type 1 - gas exchange
Type 2 - surfactant

Muscle of inspiration - -diaphragm
Part of brain that controls breathing - -medulla (phrenic nerve - C 3,4,5 keep you
alive)

Compliance of lungs - 
-ability to stretch when there is a change in volume or
pressure
- how easily lungs stretch
- affected by surfactant and lung tissue elasticity
- greater compliance in young infants
- decreased by pulmonary edema, pneumothorax, atelectasis

Resistance of lungs - 
-factors that cause less air to reach alveoli
- inversely related to airway diameter (smaller airway = higher resistance)
- increased in asthma, CF, BPD, bronchiolitis, respiratory secreations

Which provides more resistance: ETT or TRACH - -ETT (longer airway = more
resistance)

Increased Resistance = Increase or Decreased tidal volume? - -Decreased

Ventilation Perfusion Matching:
V/Q = 0.8 - -Ventilation (V): air ventilating the alveoli
Perfusion (Q): blood perfusion the alveoli




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QUESTIONS
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- usually more perfusion than ventilation

Low V/Q vs. High V/Q - ✅-Low: decerase in ventilation compared to perfusion
- hypoxia
- pulmonary edema
(O2 doesn't help)

High: decrease in perfusion relative to ventilation
- shock

Pulmonary Vascular Resistance - 
-resistance that must be overcome to push
blood through the vasculature of the lungs

- RIGHT VENTRICLE pushes blood through PULMONARY ARTERY

What increases pulmonary vascular resistance? - -- decreased area
- CF
- ASD
- AVC flooding lungs
- polycythemia - thick blood

Different in Kids Lungs: - 
-- Smaller alveoli - more likely to collapse
- Lung volume increases 4 times in 1st year of life
- Chest shape: infant - cylindrical shape; AP > transverse diameter until 3 years of age
- Upper airway: elongated epiglottis - high in pharynx (obligatory nose bleeders until 6
months); pharynx is musculomembraneous tube; larynx - funnel shaped (connects
pharynx and trachea, thyroid cartilage, vocal cords, epiglottis, cricoid cartilage); trachea
- membraneous rigid thin walled tube
- Chest wall becomes less compliant as child ages: retractions d/t intercostal muscles
not strong enough to stabilize chest against stronger diaphragm contraction

* eligible for uncuffed ETT - cricoid cartilage is "natural cuff" if less than 24 kg or 8 years
of age

Lung Tests and Monitoring - -- Total Lung Capacity
- Vital Capacity
- Functional Residual Capacity
- Residual Volume




0monary
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Lung Tests and Monitoring: Total Lung Capacity - ✅-volume in lungs at max
inspiration

Lung Tests and Monitoring: Vital Capacity - -maximum expired with maximum
expiration

Lung Tests and Monitoring: Functional Residual Capacity - -volume remaining
after normal expiration

Lung Tests and Monitoring: Residual Volume - -volume remaining after forced
expiration

Acid Base Balance: what keeps pH normal - -- respiratory and renal buffering
- pH of blood changes and lungs/kidneys respond


-LOW
More H+ ions = high or low pH?
Less H+ ions = high or low pH? -
HIGH
(inverse relationship)

Normal Blood Gas Values: ARTERIAL - -pH: 7.35-7.45
PO2: 80-100
PCO2: 35-45
HCO3: 22-26
Base Excess: -2 to +2

Normal Blood Gas Values: MIXED VENOUS - -pH: 7.31-7.41
PO2: 35-40
PCO2: 40-50
HCO3: 22-26
Base Excess: -2 to +2

Normal Blood Gas Values: CAPILLARY - -pH: 7.35-7.45
PO2: less than arterial
PCO2: 35-45
HCO3: 22-26
Base Excess: -2 to +2

*NOT accurate if dehydrated




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