Question Answer
sinuses air-filled cavities in the bones of the skull which communicate with the nasal cavity (make head “lighter”)
Palatine Tonsils back of the oral pharynx between the palatopharygeal arch and the palatoglossal arch (visible when looking in the mouth)
Lingual Tonsils back of the tongue (lumpy bumps)
Pharyngeal Tonsils aka Adenoids, back of the nasopharynx; if inflamed or swollen, they may block passage of air between the nose and throat
Upper-Airway 1) Nose – filter, warm and humidify 2) Oral Cavity 3) Pharynx- a)nasopharynx b)oropharynx c)laryngopharynx 4) Layrnx
Epiglottis prevents aspiration of foods or liquids by covering the larynx opening while swallowing
Glottis narrowest passageway in an adult (Trachea)
Cricoid Cartilage the only cartialigious ring that goes all the way around the trachea; narrowest passageway on an infant
Circothyroid Ligament site where the trachea is punctured if you can’t breathe through your mouth
Alveolar Sacs where most gas exchange occurs (part of the Respiratory Zone) O2 goes in blood; CO2 goes out of blood
Pores of Kohn where over ventilated go to under ventilated via small pore (PoK)
Canals of Lambert opening that allows going back and forth
Pendulum Effect going from one lung to another
Pulmonary Artery only 1 – pumps blood to lungs (low in O2) (all other arteries are high in O2)
Pulmonary Vein 4 of them – come from lungs to heart with oxygenated blood (all other veins are low in O2)
Lymphatic System Primary function is to remove excess fluid and protein molecules that leak out of the pulmonary capillaries (break “junk” down)
Pneumothorax a collection of air or gas in the pleural space, causing the lung to collapse (air goes in but can’t get out; pushes to the infected side)
Phrenic Nerve innervates the diaphragm
Vagus Nerve innervates throat, rectum, back of the throat (openings) (more sensitive on babies)
Muscles of Ventilation (Inspiration) Using Muscles: Active -scalene (neck) -sternocleidomastoid (sides of neck) -pectoralis major (upper chest) -trapezius (upper back/back of neck) -external intercoastal (between ribs)
Muscles of Ventilation (Expiration) Not using Muscles: Passive -Rectus -External Abdominius -Internal Abdominius -Transverse (Internal Intercoastal) All in the Abdomen
Laplace’s Law The distending pressure of a liquid sphere is: 1)directly proportional to the surface tension of the liquid 2)inversely proportional to the radius of the sphere
Pulmonary Surfactant a phopholipd substance important in controlling the surface tension of the air liquid emulsion lining the alveoli
Poiseuille’s Law the speed of the flow of a fluid through a tube is directly proportional to the square of the diameter of the tube, the pressure upon the fluid and indirectly to the viscosity of the fluid and the length of the tube
Diffusion the movement of gas molecules from an area of relatively high concentration of gas to one of low concentration
C dyn Dynamic Compliance = Vt/MIP-EEP
C static Static Compliance = Vt/SPR-EEP Normal = males-40-50; females- 35-45
Raw Raw = MIP-SPR/Flow *must convert cm/min to L/sec by diving by 60
Lung Compliance “Stiffness” of the lungs or “ease of filling”; tells how much pressure will develop in the lungs for a given volume of air (pushed in)
Compliance is GOOD!! The BIGGER the BETTER
Resistance is BAD!! THE smaller THE BETTER
Alveolar Dead Space some alveoli are ventilated but not perfused with pulmonary blood (unpredictable)
Anatomic Dead Space volume of gas in conducting airways normal – 1 ml/lb or 2.2 ml/kg
Physiologic Dead Space the sum of the alveolar and anatomic dead space
Airway Resistance pressure difference between the mouth and the alveioli divided by the inspiratory flow rate *normal = 1-2 cm H2O/L/Sec (Resistance against air flow)
Apnea complete absence of breathing
Eupnea normal breathing
Biot’s Breathing short rapid, deep breaths followed but 10-30 secs of apnea
Hypernea increased depth (volume) of breathing
Hyperventilation pulmonary ventilation rate greater than metabollically necessary *need blood gas test (wrist); decrease in CO2 (not normal)
Tachypnea rapid rate of breathing
Cheyne-Stokes Breathing 10-30 secs of apnea followed by gradual increase in volume, then decrease until more apnea
Kussmaul Breathing deep and very rapid breathing (Not too small!)
Orhopnea when it is more comfortable for the patient to breathe in an upright position
Dyspnea shortness of breathe where the person is aware
pH (potential hydrogen) 7.35(acid) – 7.45 (alk)
PaCO2 partial pressure of arterial CO2 normal = 38-42 or 35-45 mmHg
HCO3 kidneys; normal = 22-26 mEq/L
PaO2 partial pressure of oxygen normal = 80-100 mmHg
Vt tidal volume = weight/2.2 x (7/9) then divide by 1000 normal = 7-9 ml/kg
Vtalv Alveolar Tidal Volume = Vt – DS (weight) volume giving benefit by getting rid of CO2
Dead Space wasted ventilation (usually weight)
MV Minute Volume = RR x Vt
MValv Alveolar Minute Volume = RR x Vtalv
AC Membrane under Alveolar sacs – thickening and widening edema is swelling between it and the alveolis
Boyle’s Law if the Temp is constant, pressure will vary inversely to volume (increase in volume means decrease in pressure)
Charles’ Law if Pressure is constant, volume and temp vary directly (increase in volume then increase in temp)
Gay-Lussac’s Law if volume is constant, pressure and temp vary directly (increase in pressure then increase in temp)
Ideal Gas Law incorporates pressure, volume and temperature in a mathematical equation
Dalton’s Law in a mixture of different gases, the total pressure is equal to the sum of the partial pressures of all the gases
Fick’s Law rate of gas transfer across a sheet of tissue is directly proportional to the surface area of the tissue to the diffusion constants (loss of tissue = loss of surface area)
Alveolar Air Equation Oxygen in the lungs PAO2 = [(Pb-PH2O)x FIO2] – PaCO2/.8
Pb 760 mmHg (if not given)
PH2O 47
PAO2 oxygen in lungs (Alveolar)
FIO2 .21 (if not given)
AaDO2 Difference of Oxygens: normal = 20 A – a (Alveolar – arterial)
Henry’s Law amount of gas that dissolves in a liquid at a given temp is proportional to the partial pressure of gas CO2 = .592 O2 = .244 CO2 is 24x more soluble than oxygen
Graham’s Law the rate of diffusion of a gas through a liquid is: 1)directly proportional to the solubility coefficient of the gas and 2)inversely proportional to the gram molecular weight (oxygen is lighter than 2 gases, moves faster than CO2)
Absolute Humidity actual amount of water vapor in gas (mg/L)
Relative Humidity actual amount of water vapor in a gas compared with the amount necessary to cause the gas to be fully saturate (%)
Body Humidity absolute humidity of inspired gas saturated at body temperature
Humidity Deficit difference between water vapor content of a gas at BTPS (Body Temperature Pressure Saturated) (mg/L)
Driving Pressure the difference between 2 points in a tube or vessel (P1>P2)
Transairway Pressure (Pta) the pressure difference between the mouth pressure (Pm)and the alveolar pressure (PAlv) Pta = Pm – PAlv
Transthoracic Pressure (Ptt) the pressure difference between the alveolar (PAlv) and the body surface pressure (Pbs) Ptt = PAlv – Pbs
Transpulmonary Pressure (Ptp) the pressure difference between the alveolar (PAlv) and the pleural pressure (Ppl)
Question Answer
Retinopathy of prematurity (ROP) is a potentially serious management problem mainly in the care of whom? Premature or low-birth-weight infants
A patient is receiving O2 through a nonrebreathing mask set at 8 L/min. You notice that the mask’s reservoir bag collapses completely before the end of each) inspiration. Which of the following actions is appropriate in this case? Increase the liter flow
A patient on a 40% air entrainment mask is brought dinner. In order to allow the patient to have her meal and still provide the approximate FIO2 of oxygen which of the following would you choose? Replace the mask with a 5 l/m nasal cannula during the meal
A 45-year-old patient with congestive heart failure is receiving O2 through a 35% air-entrainment mask. With an O2 input of 6 L/min, what is the total output gas flow? A) 16 L/min B) 24 L/min C) 28 L/min D) 34 L/min D) 34 L/min
You are to deliver a bronchodilator medication to a COPD patient via a SVN at 8 L/M. The patient is a known CO2 retainer, which of the following would be the most appropriate precaution to use. Use compressed air to deliver the breathing treatment
Specific clinical objectives of oxygen (O2) therapy include which of the following? I. Decrease the symptoms caused by chronic hypoxemia II. Decrease the workload hypoxemia imposes on the heart and lungs III. Correct documented arterial hypoxemia I. Decrease the symptoms caused by chronic hypoxemia II. Decrease the workload hypoxemia imposes on the heart and lungs III. Correct documented arterial hypoxemia
According to the National Institute of Standards and Technology of the U.S. Department of Commerce, a gas cylinder that is color-coded brown and green should contain which of the following? A) O2–N2 mixture B) O2–CO2 mixture C) CO2 D) O2–He mixture D) O2–He mixture
What key property of He makes it useful as a therapeutic gas? A) low solubility B) chemical inertness C) low cost D) low density D) low density
The pressure of O2 or air in a bulk supply system is reduced to what standard working pressure? A) 10 psig B) 14 psig C) 25 psig D) 50 psig D) 50 psig
Which of the following would indicate a need for O2 therapy for an adult or child? I. SaO2 less than 90% II. PaCO2 greater than 45 mm Hg III. PaO2 less than 60 mm Hg I. SaO2 less than 90% III. PaO2 less than 60 mm Hg
When used to control the flow of medical gases to a patient, how is a Thorpe tube classified? variable-orifice, constant-pressure flowmeter device
A physician orders 40% O2 through an air-entrainment nebulizer for a patient with a minute volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the prescribed FIO2? A) 8 L/min B) 10 L/min C) 12 L/min D) 14 L/min B) 10 L/min
What can properly applied O2 therapy decrease? I. Ventilatory demand II. Work of breathing III. Cardiac output I. Ventilatory demand II. Work of breathing III. Cardiac output
A COPD patient is being admitted to the ICU. The patient is a known CO2 retainer and is very lethargic with a pulse oximeter reading of 98% on a 50% air entrainment mask. What is the most appropriate course of action at this time. Decrease the oxygen until the pulse oximeter saturation is between 88 – 92%
Which of the following signs and symptoms are associated with the presence of hypoxemia? I. Tachypnea II. Tachycardia III. Cyanosis IV. Bradynea I. Tachypnea II. Tachycardia III. Cyanosis
You are planning a patient transport that will take about 1 1/2 hours. The patient requires manual ventilation with 10 L/min of O2. What is the minimum number of full E cylinders you would take with you? 2
You are transporting a patient to the ICU with an E cylinder using a bourdon gauge as a flowmeter. The O2 line leading to the patient’s mask is tangled and the flow to the patient is obstructed. What will the flow rate reading on the bourdon gauge do? B) The gauge will read higher then the flow delivered
What is the usual method of monitoring the remaining contents in a gas-filled cylinder? A) Weigh the cylinder. B) Read the pressure gauge. C) Compute the gas density. D) Read the cylinder label. B) Read the pressure gauge.
By what means is oxygen for medical use in a hospital most commonly produced? A) chemical decomposition B) electrolysis C) fractional distillation D) physical separation C) fractional distillation
You design an air-entrainment system that mixes air with O2 at a fixed ratio of 1:7 (1 L air to 7 L O2). About what O2 will this device provide? A) 33% B) 40% C) 80% D) 90% D) 90%
What device is used to reduce the pressure and control the flow of a compressed medical gas? A) Bourdon gauge B) regulator C) flowmeter D) reducing valve B) regulator
What are some key patient considerations in selecting O2 therapy equipment? I. Type of airway (natural or artificial) II. Severity and cause of the hypoxemia III. Age group (infant, child, adult) IV. Stability of the minute ventilation I. Type of airway (natural or artificial)  II. Severity and cause of the hypoxemia III. Age group (infant, child, adult) IV. Stability of the minute ventilation
Which of the following statements is false about low-flow O2 delivery systems? A) The greater the patient’s inspiratory flow, the greater is the FIO2. B) All low-flow devices provide variable O2 concentrations. C) The O2 provided by a low-flow device i A) The greater the patient’s inspiratory flow, the greater is the FIO2.
Which of the following statements regarding O2 is false? A) It is only slightly soluble in water. B) It is odorless and transparent. C) It is flammable. D) It is heavier than air. C) It is flammable.
Low-flow O2 delivery systems used in respiratory care include all of the following except: A) nasal O2 cannula B) nasal O2 catheter. C) air-entrainment mask. D) transtracheal catheter. C) air-entrainment mask.
Question Answer
what is a Low flow system? It will only supply part of the patient’s inspired volume.
what is a High flow system? It will supply the patient’s entire inspired volume.
what are the different types of Low flow system 1.Cannula. 2. O2 conservation cannulas. 3.Transtracheal O2 catheters (TTO2). 4.Simple mask. 5.Partial re-breather mask.
what are the different types of High flow system 1.Non-rebreather mask. 2.Air entrainment mask / venturi mask. 3.Brigg’adapter (T-piece). 4.Aerosol mask,trach collar masks and face tents. 5.O2 hood. 6.Mist tent, O2 tent. Croupette. 7.CPAP mask. 8. Nasal CPAP mask. 9.ET CPAP
Cannula (Low flow system) FIO2: 24-45%. FLOW: 1-6 LPM. It is an appropriate O2 device for COPD pt.with stable RR and VT.
O2 Conservation Cannulas (Low flow system) 1.It is used in the homecare settings to reduce costs. 2. It is a reservoir cannula designed to maintain FIO2 at lower levels. 3. The flowrate may be reduced w/o affecting the FIOZ.
TTO2 (Low flow system) 1. this is a long term Low flow O2 therapy 2. This is done through a surgically implanted catheter. 3. It allows the upper airways and trachea to act as a reservoir for O2 during exhalation.
Hazards of TT02 (Low flow system) Bronchospasm, bleeding abscess, pneumothorax, airway obstruction, and subcutaneous emphysema.
What to do when pt becomes SOB or has increased wob with a TT02 device (Low flow system)? The catheter could be obstructed with secretions and you would need to flush the catheter.
Simple mask (Low flow system) FIO2: 40-50%. FLOW: 6-10 LPM. Flow must be always greater than 5LPM to flush out exhaled CO2.
Partial re=breather mask (Low flow system) FIO2: 60-65%. FLOW: 6-10 LPM. It does not have a one-way flap.
Non- rebreather mask (HIGH flow system) FIO2: 21-100%. It is used in Emergency: Pneumothorax, CO poisoning, CHF, burns. He/O2 mixtures and CO2/O2 mixtures. It has 3 one way valves.
Troubleshooting of Non-rebreather mask (HIGH flow system)? 1. If bag collapses then increase the flow. 2. If pt. inhales and the bag does not contract then a)seal the mask because it is not tight. b)or the non-breathing valve is stuck then replace the mask.
Air entrainment mask/ venturi mask (HIGH flow system) FIO2: 100% It is ideal for pt. with COPD who have irregular VT, RR and breathing patterns.