NR I224 IExam I3 IStudy IGuide
Chapter 40 Oxygenation
I I
Oxygen
-Cardiac Iand Irespiratory Isystems Isupply Ithe Ioxygen Idemands Iof I the Ibody
-Blood Ioxygenated Ithrough I mechanisms I(ventilation, Iperfusion, Iand Itransport Iof Iresp. I gases)
Respiratory IPhysiology
-Exchange Iof Irespiratory I gases Ioccur Ibetween Ienvironment Iand Iblood
-Respiration I is Iexchange Iof Ioxygen Iand Icarbon Idioxide Iduring Icellular I metabolism
-Airways I in I lungs Itransfer Ioxygen I from Iatmosphere Ito Ialveoli-oxy. IIs Iexchanged I for Icarbon Idioxide.
Structure Iand IFunction
-Intrapleural Ipressure I is I negative/less Ithan Iatmospheric Ipressure I(760 I mmHg) Iat Iseal I level
-Air Iflow I into I lungs, I intrapleural Ipressure Ibecomes I more Inegative-sets Ipressure Igradient
IbetweenIatmosphere Iand Ialveoli
-Diaphragm Iand Iexternal I intercostal I muscles Icontract Ito Icreate I negative Ipleural Ipressure, I increase Isize
IofIthorax I for I inspiration
3 ISteps Iof IOxygenation I(Ventilation, IPerfusion, IDiffusion)
Ventilation: Iprocess Iof I moving I gases I into Iand Iout Iof Ithe I lungs.
-coordination Iof I lung Iand Ithorax
-major I inspiratory I muscle Iof I respiration I is Idiaphragm
-innervated Iby Iphrenic Inerve, Iexits I the Ispinal Icord Iat I4th Icervical I vertebra
Perfusion: Iability Iof Ithe Icardiovascular Isystem I to Ipump Ioxygenated Iblood Ito Itissues Iand
IreturnIdeoxygenated Iblood Ito I lungs
Diffusion: Iresponsible I for I moving I respiratory Igases I from Ione Iarea Ito Ianother Iby Iconcentration I gradients
-exchange Iof Irespiratory I gases I need Iorgan, I nerves, I muscles Ito Ibe I intact. ICentral I nervous
IsystemIneeds Ito I regulate Ithe Irespiratory Icycle
Work Iof IBreathing
-the Ieffort Irequired Ito Iexpand Iand Icontract Ithe I lungs
Inspiration: Ian Iactive Iprocess, Istimulated Iby Ichemical I receptors I in Iaorta
Expiration: Ipassive Iprocess, Idepends Ion Ithe Ielastic Irecoil Iproperties Iof I lungs
-requires I little Ior I no I muscle Iwork
Surfactant: Ichemical Iproduced I in I the I lungs Ito I maintain Ithe Isurface I tension Iof Ithe Ialveoli Iand Ikeep
IthemIfrom Icollapsing
-Patients Iwith ICOPD I lose Ithe Ielastic Irecoil Iof I the I lungs Iand Ithorax, IWOB Iincreases
Atelectasis: Icollapse Iof Ithe Ialveoli I that Iprevents I normal Iexchange Iof Ioxygen Iand Icarbon Idioxide
Compliance-the Iability Iof I the I lungs Ito Idistend Ior Iexpand I in Iresponse Ito I increased I intraalveolar Ipressure
-decreases I in Idiseases Isuch Ias Ipulmonary Iedema, I interstitial Iand Ipleural I fibrosis, Iand Icongenital
IorItraumatic Istructural Iabnormalities Isuch I as Ikyphosis Ior I fractured I ribs
,Airway Iresistance-increase I in Ipressure Ioccurs Ias Idiameter Iof Iairways Idecreases I from I mouth/nose
ItoIa lveoli
-Disease Icausing Iairway Iobstruction Isuch Ias Iasthma Iand Itracheal Iedema I increase Iairway Iresistance
-Airway Iresistance I increases, Iamount Iof Ioxygen Idelivered Ito Ialveoli Idecreases
Lung IVolumes
-Normal I lung I values Iare Idetermine Iby Iage, Igender, Iand Iheight
Tidal IVolume: Iamount Iof Iair Iexhaled Iafter Inormal I inspiration
Residual IVolume: Iamount Iof Iair I left I in Ithe Ialveoli Iafter Ia I full Iexpiration
Forced Ivital Icapacity: I maximum I amount Iof Iair Ithat Ican Ibe Iremoved I from I the I lungs Iduring
IforcedIe xpiration
Respiration IGas IExchange
-Thickness Iof I membrane Iaffects Irate Iof Idiffusion
-Increased Ithickness Iof I membrane I impedes Idiffusion, I gases Itake Ilonger Ito Itransfer Iacross I membrane
-Pulmonary IEdema, IPulmonary IInfiltrates, IPulmonary IEffusion Ihave Ithickened I membrane,
IresultsIin Islow Idiffusion, Islow Iexchange Iof Irespiratory I gases, Idecreased Idelivery Iof Ioxygen I to Itissues
OxygenITrans port
-Consists Iof I lungs Iand Icardiovascular Isystem
-Delivery Idepends Ion Iamount Iof Ioxygen Ientering I lungs I(ventilation), Iblood I flow Ito I lungs Iand
ItissuesI(perfusion), Irate Iof Idiffusion, Iand Ioxygen-carrying Icapacity
Three I things I influence Ithe Icapacity Iof Ithe Iblood I to Icarry Ioxygen: Iamount Iof Idissolved Ioxygen I in
Iplasma,Ia mount Iof Ihemoglobin, Itendency Iof Ihemoglobin Ito Ibind Iwith Ioxygen
Hemoglobin: Icarrier I for Ioxygen Iand Icarbon Idioxide
-transports I most Ioxygen I97%
-hemoglobin I molecule Icombines Iwith Ioxygen I to I form Ioxyhemoglobin
-oxyhemoglobin I is Ireversible, Iwhich I frees Ioxygen Ito Ienter Itissues
Carbon IDioxide ITrans port
-product Iof Icellular I metabolism, Idiffuse I into Ired Iblood Icells Iand I is Irapidly I hydrated I into Icarbonic
IacidI( H2CO3)
-Dissociates I into Ihydrogen Iand Ibicarbonate I ions IHCO-3
-Hemoglobin Ibuffers I hydrogen I ion Iand IHCO-3 Idiffuses I into Iplasma
-Venous Iblood Itransports I majority Iof Icarbon Idioxide Iback Ito Ithe I lungs Ito Ibe Iexhaled
Cardiovascular IPhysiology
-Cardiopulmonary Iphysiology Iinvolves Idelivery Iof Ideoxygenated Iblood I(high I in Icarbon/low I in Ioxy.) Ito
ItheIr ight Iside Iof I heart Iand I then Ito I lungs Iwhere I it I is Ioxygenated
-Oxygenated Iblood I(high I in Ioxygen/low I in Icarbon) Itravels I from I lungs Ito Ithe I left Iside Iof I heart Iand
ItheIt issues
Structure Iand IFunction
-Right I ventricle Ipumps Ideoxygenated Iblood Ithrough Ithe Ipulmonary Icirculation
-Left Iventricle Ipumps Ioxygenated Iblood Ithrough Ithe Isystemic Icirculation
, Myocardial IPump
-Pumping Iaction Iof I heart I is Iessential Ito Ioxygen Idelivery
-Four Icardiac Ichambers, Itwo Iatria, Itwo Iventricles
-Ventricles I fill Iduring Idiastole, Iempty Iduring Isystole
-Stroke Ivolume: I volume Iof Iblood Iejected I from Ithe I ventricles Iduring I systole
*Hemorrhage Iand Idehydration Icause Ia Idecrease I in Icirculating Iblood I volume Iand Ia Idecrease I in
IstrokeIvolume*
-Myocardial I fibers-have Icontractile Iproperties, Iallow Ithem Ito Istretch Iduring I filling
Frank-Starling I Law Iof I Hearts
-Myocardium I stretches, Ithe Istrength Iof Ithe Isubsequent Icontraction I increases
Pulmonary-left Iheart I failure
Systemic- Iright I heart I failure
Myocardial IBlood IFlow
-Must Isupply Isufficient Ioxygen Iand Inutrients Ito Ithe I myocardium I itself
-Valvular IDisease: Ibackflow Ior Iregurgitation Iof Iblood Ithrough Ithe I incompetent I valve, Icausing Ia
ImurmurIthat I you Ican I hear Ion Iauscultation
Coronary IArtery ICirculation
-Branch Iof Isystemic Icirculation, Isupplies Ithe I myocardium Iwith Ioxygen Iand I nutrients Iand Iremoves I waste
Systemic ICirculation
-Deliver I nutrients Iand Ioxygen I to Itissues Iand I veins Iremove Iwaste I from I tissues
-Oxygenated Iblood I flows I from Ithe I left I ventricle Ithrough Ithe Iaorta Iand I into I large Isystemic Iarteries
-Exchange Iof Irespiratory I gases Ioccurs Iat Icapillary I level, Itissues Iare Ioxygenated
-Waste Iexit Icapillary Inetwork Ithrough I venules, Ijoin Ito I form I veins
-Veins Ibecome I larger, I form Ivena Icava, Icarry Ideoxygenated Iblood Ito Iright Iside Iof Iheart, Ireturns
ItoIpulmonary Icirculation
Blood IFlow IRegulation
Cardiac IOutput: Iamount Iof Iblood Iejected I from Ithe I left I ventricle Ieach I minute
-Normal Icardiac Ioutput I is I4-6 IL/min
-Cardiac Ioutput I increases Iduring Iexercise, Ipregnancy, Iand I fever
-Decreases Iduring Isleep
-FORMULA: IStroke IVolume I(SV) IX IHeart IRate I(HR)
Preload: Iblood I left I in I left I ventricle Iat Ithe Iend Iof Idiastole I(preload)
-More Istretch Ion Iventricular I muscle, Igreater Ithe Icontraction, Igreater Ithe Istroke Ivolume
Afterload: IResistance Ito I left Iventricular Iejection
-Heart Iworks Iharder Ito Iovercome Iresistance, Iblood Ican Ibe I fully Iejected I from I left I ventricle
-Diastolic Iaortic Ipressure I is Ia I good Iclinical I measure Iof Iafterload
-Hypertension-afterload I increases I making Icardiac Iworkload Ialso I increase
Myocardial IContractility
-affects Istroke Ivolume Iand Icardiac Ioutput
-poor Iventricular Icontraction Idecreases Iamount Iof Iblood Iejected
-injury Ito Imyocardial I muscle, Iacute IMI Icauses Idecrease I in I myocardial Icontractility
Chapter 40 Oxygenation
I I
Oxygen
-Cardiac Iand Irespiratory Isystems Isupply Ithe Ioxygen Idemands Iof I the Ibody
-Blood Ioxygenated Ithrough I mechanisms I(ventilation, Iperfusion, Iand Itransport Iof Iresp. I gases)
Respiratory IPhysiology
-Exchange Iof Irespiratory I gases Ioccur Ibetween Ienvironment Iand Iblood
-Respiration I is Iexchange Iof Ioxygen Iand Icarbon Idioxide Iduring Icellular I metabolism
-Airways I in I lungs Itransfer Ioxygen I from Iatmosphere Ito Ialveoli-oxy. IIs Iexchanged I for Icarbon Idioxide.
Structure Iand IFunction
-Intrapleural Ipressure I is I negative/less Ithan Iatmospheric Ipressure I(760 I mmHg) Iat Iseal I level
-Air Iflow I into I lungs, I intrapleural Ipressure Ibecomes I more Inegative-sets Ipressure Igradient
IbetweenIatmosphere Iand Ialveoli
-Diaphragm Iand Iexternal I intercostal I muscles Icontract Ito Icreate I negative Ipleural Ipressure, I increase Isize
IofIthorax I for I inspiration
3 ISteps Iof IOxygenation I(Ventilation, IPerfusion, IDiffusion)
Ventilation: Iprocess Iof I moving I gases I into Iand Iout Iof Ithe I lungs.
-coordination Iof I lung Iand Ithorax
-major I inspiratory I muscle Iof I respiration I is Idiaphragm
-innervated Iby Iphrenic Inerve, Iexits I the Ispinal Icord Iat I4th Icervical I vertebra
Perfusion: Iability Iof Ithe Icardiovascular Isystem I to Ipump Ioxygenated Iblood Ito Itissues Iand
IreturnIdeoxygenated Iblood Ito I lungs
Diffusion: Iresponsible I for I moving I respiratory Igases I from Ione Iarea Ito Ianother Iby Iconcentration I gradients
-exchange Iof Irespiratory I gases I need Iorgan, I nerves, I muscles Ito Ibe I intact. ICentral I nervous
IsystemIneeds Ito I regulate Ithe Irespiratory Icycle
Work Iof IBreathing
-the Ieffort Irequired Ito Iexpand Iand Icontract Ithe I lungs
Inspiration: Ian Iactive Iprocess, Istimulated Iby Ichemical I receptors I in Iaorta
Expiration: Ipassive Iprocess, Idepends Ion Ithe Ielastic Irecoil Iproperties Iof I lungs
-requires I little Ior I no I muscle Iwork
Surfactant: Ichemical Iproduced I in I the I lungs Ito I maintain Ithe Isurface I tension Iof Ithe Ialveoli Iand Ikeep
IthemIfrom Icollapsing
-Patients Iwith ICOPD I lose Ithe Ielastic Irecoil Iof I the I lungs Iand Ithorax, IWOB Iincreases
Atelectasis: Icollapse Iof Ithe Ialveoli I that Iprevents I normal Iexchange Iof Ioxygen Iand Icarbon Idioxide
Compliance-the Iability Iof I the I lungs Ito Idistend Ior Iexpand I in Iresponse Ito I increased I intraalveolar Ipressure
-decreases I in Idiseases Isuch Ias Ipulmonary Iedema, I interstitial Iand Ipleural I fibrosis, Iand Icongenital
IorItraumatic Istructural Iabnormalities Isuch I as Ikyphosis Ior I fractured I ribs
,Airway Iresistance-increase I in Ipressure Ioccurs Ias Idiameter Iof Iairways Idecreases I from I mouth/nose
ItoIa lveoli
-Disease Icausing Iairway Iobstruction Isuch Ias Iasthma Iand Itracheal Iedema I increase Iairway Iresistance
-Airway Iresistance I increases, Iamount Iof Ioxygen Idelivered Ito Ialveoli Idecreases
Lung IVolumes
-Normal I lung I values Iare Idetermine Iby Iage, Igender, Iand Iheight
Tidal IVolume: Iamount Iof Iair Iexhaled Iafter Inormal I inspiration
Residual IVolume: Iamount Iof Iair I left I in Ithe Ialveoli Iafter Ia I full Iexpiration
Forced Ivital Icapacity: I maximum I amount Iof Iair Ithat Ican Ibe Iremoved I from I the I lungs Iduring
IforcedIe xpiration
Respiration IGas IExchange
-Thickness Iof I membrane Iaffects Irate Iof Idiffusion
-Increased Ithickness Iof I membrane I impedes Idiffusion, I gases Itake Ilonger Ito Itransfer Iacross I membrane
-Pulmonary IEdema, IPulmonary IInfiltrates, IPulmonary IEffusion Ihave Ithickened I membrane,
IresultsIin Islow Idiffusion, Islow Iexchange Iof Irespiratory I gases, Idecreased Idelivery Iof Ioxygen I to Itissues
OxygenITrans port
-Consists Iof I lungs Iand Icardiovascular Isystem
-Delivery Idepends Ion Iamount Iof Ioxygen Ientering I lungs I(ventilation), Iblood I flow Ito I lungs Iand
ItissuesI(perfusion), Irate Iof Idiffusion, Iand Ioxygen-carrying Icapacity
Three I things I influence Ithe Icapacity Iof Ithe Iblood I to Icarry Ioxygen: Iamount Iof Idissolved Ioxygen I in
Iplasma,Ia mount Iof Ihemoglobin, Itendency Iof Ihemoglobin Ito Ibind Iwith Ioxygen
Hemoglobin: Icarrier I for Ioxygen Iand Icarbon Idioxide
-transports I most Ioxygen I97%
-hemoglobin I molecule Icombines Iwith Ioxygen I to I form Ioxyhemoglobin
-oxyhemoglobin I is Ireversible, Iwhich I frees Ioxygen Ito Ienter Itissues
Carbon IDioxide ITrans port
-product Iof Icellular I metabolism, Idiffuse I into Ired Iblood Icells Iand I is Irapidly I hydrated I into Icarbonic
IacidI( H2CO3)
-Dissociates I into Ihydrogen Iand Ibicarbonate I ions IHCO-3
-Hemoglobin Ibuffers I hydrogen I ion Iand IHCO-3 Idiffuses I into Iplasma
-Venous Iblood Itransports I majority Iof Icarbon Idioxide Iback Ito Ithe I lungs Ito Ibe Iexhaled
Cardiovascular IPhysiology
-Cardiopulmonary Iphysiology Iinvolves Idelivery Iof Ideoxygenated Iblood I(high I in Icarbon/low I in Ioxy.) Ito
ItheIr ight Iside Iof I heart Iand I then Ito I lungs Iwhere I it I is Ioxygenated
-Oxygenated Iblood I(high I in Ioxygen/low I in Icarbon) Itravels I from I lungs Ito Ithe I left Iside Iof I heart Iand
ItheIt issues
Structure Iand IFunction
-Right I ventricle Ipumps Ideoxygenated Iblood Ithrough Ithe Ipulmonary Icirculation
-Left Iventricle Ipumps Ioxygenated Iblood Ithrough Ithe Isystemic Icirculation
, Myocardial IPump
-Pumping Iaction Iof I heart I is Iessential Ito Ioxygen Idelivery
-Four Icardiac Ichambers, Itwo Iatria, Itwo Iventricles
-Ventricles I fill Iduring Idiastole, Iempty Iduring Isystole
-Stroke Ivolume: I volume Iof Iblood Iejected I from Ithe I ventricles Iduring I systole
*Hemorrhage Iand Idehydration Icause Ia Idecrease I in Icirculating Iblood I volume Iand Ia Idecrease I in
IstrokeIvolume*
-Myocardial I fibers-have Icontractile Iproperties, Iallow Ithem Ito Istretch Iduring I filling
Frank-Starling I Law Iof I Hearts
-Myocardium I stretches, Ithe Istrength Iof Ithe Isubsequent Icontraction I increases
Pulmonary-left Iheart I failure
Systemic- Iright I heart I failure
Myocardial IBlood IFlow
-Must Isupply Isufficient Ioxygen Iand Inutrients Ito Ithe I myocardium I itself
-Valvular IDisease: Ibackflow Ior Iregurgitation Iof Iblood Ithrough Ithe I incompetent I valve, Icausing Ia
ImurmurIthat I you Ican I hear Ion Iauscultation
Coronary IArtery ICirculation
-Branch Iof Isystemic Icirculation, Isupplies Ithe I myocardium Iwith Ioxygen Iand I nutrients Iand Iremoves I waste
Systemic ICirculation
-Deliver I nutrients Iand Ioxygen I to Itissues Iand I veins Iremove Iwaste I from I tissues
-Oxygenated Iblood I flows I from Ithe I left I ventricle Ithrough Ithe Iaorta Iand I into I large Isystemic Iarteries
-Exchange Iof Irespiratory I gases Ioccurs Iat Icapillary I level, Itissues Iare Ioxygenated
-Waste Iexit Icapillary Inetwork Ithrough I venules, Ijoin Ito I form I veins
-Veins Ibecome I larger, I form Ivena Icava, Icarry Ideoxygenated Iblood Ito Iright Iside Iof Iheart, Ireturns
ItoIpulmonary Icirculation
Blood IFlow IRegulation
Cardiac IOutput: Iamount Iof Iblood Iejected I from Ithe I left I ventricle Ieach I minute
-Normal Icardiac Ioutput I is I4-6 IL/min
-Cardiac Ioutput I increases Iduring Iexercise, Ipregnancy, Iand I fever
-Decreases Iduring Isleep
-FORMULA: IStroke IVolume I(SV) IX IHeart IRate I(HR)
Preload: Iblood I left I in I left I ventricle Iat Ithe Iend Iof Idiastole I(preload)
-More Istretch Ion Iventricular I muscle, Igreater Ithe Icontraction, Igreater Ithe Istroke Ivolume
Afterload: IResistance Ito I left Iventricular Iejection
-Heart Iworks Iharder Ito Iovercome Iresistance, Iblood Ican Ibe I fully Iejected I from I left I ventricle
-Diastolic Iaortic Ipressure I is Ia I good Iclinical I measure Iof Iafterload
-Hypertension-afterload I increases I making Icardiac Iworkload Ialso I increase
Myocardial IContractility
-affects Istroke Ivolume Iand Icardiac Ioutput
-poor Iventricular Icontraction Idecreases Iamount Iof Iblood Iejected
-injury Ito Imyocardial I muscle, Iacute IMI Icauses Idecrease I in I myocardial Icontractility
