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RCP 110 Exam 3
| Term | Definition |
|---|---|
| What are the components of plasma? | 91% water, 7% proteins (albumin, globulins, fibrinogen), 2% other (electrolytes, nutrients, respiratory gases, waste, and regulatory substances) |
| What are the formed elements of the blood? | RBC, WBC, platelets |
| Average blood volume for men | 5-6L |
| Average blood volume for women | 4-5L |
| What are the functions of the blood? | Transportation of O2 to the tissue cells and CO2 to the lungs , Transport nutrients and waste products, processed molecules , hormones and enzymes, Regulate pH and osmosis, Maintain body temperature, Protect against foreign substances, Form clots |
| What is the function of red blood cells? | Transport O2 from lungs to tissues and CO2 from tissues to lungs |
| What is the normal range of red blood cells? | 4.2 - 6.2 million/mm3 |
| Hematocrit | Percentage of RBCs in relation to the total blood volume |
| Normal hematocrit volumes | Normal adult male: 45% Adult female: 42% Healthy newborn: 45-60% |
| Where are RBCs produced and destroyed | Produced in the bone marrow in spongy bone of cranium, vertebrae, ribs, sternum, humerus, and femur Destroyed in the spleen and liver |
| What is the average life span of an RBC | Approximately 120 days |
| What is the function of the hemoglobin? | To transport O2 within the blood |
| What is the function of the white blood cells? | Protect the body against invading microorganisms (viruses, parasites, toxins, and tumors) and work to remove dead cells and debris from body |
| What are the five different types of white blood cells? | Granulocytes: neutrophils, eosinophils, and basophils Agranulocytes: lymphocytes and monocytes |
| What is the normal range for white blood cells? | 5000-9000 cells/mm3 |
| Leukocytosis | overall increase in the number of WBCs (bacterial infection) |
| Leukopenia | overall decrease in the number of WBCs (viral infection) |
| How do you obtain a white blood cell count? | By obtaining a CBC |
| What is the most numerous white blood cell? | Neutrophils (65%) |
| What white blood cell is found in the airways? | Eosinophils (2-5%) |
| What white blood cell is increased with asthma? | Eosinophils |
| Basophils | Increase in number in both allergic and inflammatory reactions (histamine and heparin) |
| Function of monocytes | Phagocytize bacteria, dead cells, cell fragments, and viral infectiosn |
| What is the function of the platelets? | Prevents blood loss by forming platelet plugs (small blood vessels and blood clots (larger tears)) |
| What is the normal range of platelets? | 250,000-500,000/mm3 |
| How do the platelets control blood flow? | Contains serotonin which causes smooth muscle constriction and reduced blood flow |
| What side transports unoxygenated blood? | Ride side, propels blood to the lungs |
| What side transports oxygenated blood? | Left side, propels blood throughout the systemic circulation |
| What is the function of the pericardium? | Fibrous pericardium: protect heart, anchor heart to surrounding structures, prevent heart from overfilling Serous pericardium: fluid between two layers for friction free environment |
| Pericarditis | inflammation of the pericardium (trauma, MI, malignant neoplastic disease) pain radiates between back and chest |
| Cardiac tampandade | A large amount of blood collects in the pericardial sac. Fluid compresses the heart from the outside and the heart cannot fill adequately. PEA treated like a flatline. Cardiac output decreases, BP decreases |
| Epicardium | Outside layer |
| Myocardium | Thick middle layer |
| Endocardium | Inside layer (lines the heart chamber) |
| Arteries | vessels that carry blood away from the heart (strong, elastic, carry blood under high pressure) |
| Arterioles | arteries subdivide as they move away from the heart into these smaller vessels (play a major role in distribution and regulation of BP) |
| Capillaries | where gas exchange occurs External respiration: gas exchange between blood and air in pulmonary system Internal respiration: gas exchange between blood and tissues in systemic system |
| Venules | tiny veins continuous with the capillaries, empty into veins |
| Veins | carry blood toward the heart, capable of holding a large amount of blood with very little pressure exchange Approximately 60% of the body’s total blood volume is contained in the venous system |
| What controls the pulmonary arterioles and most of the arterioles in systemic circulation? | Sympathetic impulses |
| What does the vasomotor center control? | Controls constriction and dilation. In normal conditions the vasomotor center sends a continual stream of sympathetic impulses to the blood vessels maintaining the vessels in a moderate state of constriction all the time |
| Where is the vasomotor center located? | Located in medulla oblongata and controls the number of sympathetic impulses to the vascular system |
| What vascular beds are not controlled by the vasomotor center? | Arterioles of the heart, brain, and skeletal muscles |
| Where is the baroreceptor reflex located? | Specialized stretch receptors located in walls of carotid arteries and aorta. In the carotid arteries they are found in carotid sinuses located high in the neck. In the aorta they are located in the aortic arch. |
| What does the baroreceptor control? | Regulates arterial BP by initiating reflex adjustments to changes in BP. When BP decreases baroreceptor reflex causes increases in: heart rate, myocardial force contraction, arterial constriction, venous constriction |
| Systolic blood pressure | Maximum pressure generated during ventricular contraction |
| Diastolic blood pressure | Lowest pressure that remains in the arteries prior to the next ventricular contraction |
| Normal systemic blood pressure | 120/80 |
| Normal pulmonary blood pressure | 25/8 |
| Mean arterial blood pressure (MAP) | Average BP in an individual during a single cardiac cycle |
| Normal MAP | 80-100 |
| What are the major arterial pulse sites? | Carotid, Brachial, Radial, Femoral, Dorsalis pedis, Apical, Temporal, Facial, Popliteal, Posterior tibial |
| What causes the pulse we feel? | The alternating expansion and recoil of blood pumping through that area |
| Stroke Volume (SV) | The volume of blood ejected from the ventricle during each contraction 40-80 mL |
| Cardiac Output (CO) | Total volume of blood discharged from the ventricles per minute 4-8 L |
| Cardiac output equation | CO=SV/1000 x HR |
| In upright lung, what happens to blood flow | Blood flow progressively decreases from the base to the apex Gravity dependent |
| How would you position a patient based on the location of a lung pathology | Position them where maximal blood flow is needed |
| What happens in Zone 1 of the lungs | Least gravity dependent area, top of the lungs, decreased gas exchange. Alveolar pressure is sometimes greater than both the arterial and venous intraluminal pressures |
| What happens in Zone 2 of the lungs | Arterial pressure is greater than the alveolar pressure so pulmonary capillaries are perfused. From upper portion to lower portion of this zone, the flow of blood progressively increases. |
| What happens in Zone 3 of the lungs | Gravity dependent area. Both the arterial and venous pressures are greater than the alveolar pressure. Blood flow through this region is constant. |
| What three things determine stroke volume? | Ventricular preload, ventricular afterload, and myocardial contractility |
| Ventricular preload | Degree to which myocardial fiber is stretched prior to contraction (end-diastole) |
| Ventricular afterload | The resistance that must be overcome to push blood from the L ventricle out into the aorta and into the systemic system. Force against which ventricles must work to pump blood. |
| Myocardial contractility | Regarded as force generated by myocardium when ventricular muscle fibers shorten. When contractility of the heart increases or decreases |
| What happens to blood pressure when vascular resistance increases? | When vascular resistance increases, BP increases |
| Hypoxia | Decreased PaO2: Pulmonary vascular system constricts in response to decreased alveolar pressure. Redirects blood to the lung units that have higher PAO2. |
| Hypercapnia | Increase PaCO2: PVR increases in response to an acute increase in PaCO2 Increased PVR does not occur in high PaCO2 with compensated pH |
| Acidemia | Decreased pH: Develops in response to decreased pH whether metabolic or respiratory in origin |
| What drugs constrict pulmonary vessels? | Epinephrine, norepinephrine, dobutamine, dopamine, phenylephrine |
| What drugs relax blood vessels? | Oxygen, isoproterenol, aminophylline, calcium channel blocking agents |
| When a patient is on oxygen what does it do to the pulmonary vessels? | Relaxes them |
| Vessel blockage or obstruction | Thrombus or embolus from blood clot, fat cell, air bubble, or tumor |
| Vessel wall disease | Sclerosis, polyarteritis, or scleroderma |
| Vessel destruction or obliteration | Emphysema or pulmonary interstitial fibrosis |
| Vessel compression | Pneumothorax, hemothorax, or tumor |
| Congestive heart failure | Left heart failure, inability of L ventricle to pump blood effectively, vascular system in the lungs becomes engorged with blood and causes pulmonary edema, patients are difficult to oxygenate, BiPAP, Lasix |
| Cor Pulmonale | Right heart failure, enlargement of the right ventricle caused by primary lung disease, eventually results in the inability of the R ventricle to pump blood effectively to the lungs, O2 therapy and blood thinners |
| What happens to PaO2 when there is a drop in SaO2 | PaO2 decreases |
| Know P50 and corresponding PaO2 | P50 is the PaO2 at which the Hb is 50% saturated Normal P50: 27 mmHg |
| Left shift PaO2 | 60 mmHg = 95% Hb saturation |
| Right shift PaO2 | 60 mmHg = 75% Hb saturation |
| What causes a left shift? | Alkalosis, hypocarbia, hypothermia, decreased DPG, COHb, Fetal Hb |
| What causes a right shift? | Acidosis, hypercarbia, hyperthermia, increased DPG |
| Which portion of the curve is considered the “safety zone” | The flat portion of the curve is considered the safety zone. It is where PaO2 can fall from 100 to 60 mmHg and Hb will remain 90% saturated. |
| Impact of steep portion of the curve on O2 delivery | As PaO2 increases O2 rapidly binds to Hb increasing O2 delivery, a reduction of PaO2 below 60 mmHg produces a rapid decrease in O2 bound to Hb reducing O2 delivery |
| Total oxygen content normal value | 17-20 vol% |
| Total oxygen content equation | (Hb x 1.34 x SaO2) + (PaO2 x 0.003) |
| Total oxygen delivery | (DO2) total amount of O2 delivered or transported to the peripheral tissues. Dependent on: body’s ability to oxygenate blood, Hb concentration, and cardiac output |
| Total oxygen delivery normal value | 1000 mL O2/min |
| Total oxygen delivery calculations | CO x (CaO2 x 10) |
| Arterial - venous O2 content difference normal value | 4-5 vol% |
| C(a-v)O2 calculations | CaO2 - CvO2 |
| Total oxygen content of mixed venous blood normal | 12-16 vol% |
| Total oxygen content of mixed venous blood calculation | (Hb x 1.34 x SvO2) + (PvO2 x 0.003) |
| PAO2 normal value | 100 mmHg |
| P(A-a)O2 normal value | 5-15 mmHg |
| Normal hemoglobin for men | 14-16 g/dL |
| Normal hemoglobin for women | 12-15 g/dL |
| Hemolytic anemia | BCs rupture or are destroyed at excessive rate (inherited defects, drugs, snake venom, artificial heart valves, autoimmune disease, or hemolytic disease of newborn) |
| Aplastic anemia | inability of bone marrow to produce RBCs (chemicals (benzene), drugs (certain anti chemo can cause this, some infections) Pernicious- chronic anemia caused by low B12 |
| Shape and characteristics of dissociation curve | S shaped curve with steep incline and plateau, Moving upward means rapid saturation of Hb, Moving downward means rapid desaturation of Hb |
| Majority of CO2 transported from tissues to the lungs via | 6 different mechanisms: 3 in plasma, 3 in red blood cells |
| CO2 production per minute | 200 mL/min |
| Methods of CO2 transport in plasma | Carbamino compound (bound to protein): 1% Bicarbonate: 5% Dissolved CO2: 5% |
| Methods of CO2 transport in RBCs | Dissolved CO2: 5% Carbamino-Hb: 21% Bicarbonate: 63% |
| Amount of CO2 transported dissolved in the plasma | 11% |
| Amount of CO2 carried as carbamino-Hb | 21% |
| Factors that increase VO2 | Exercise, seizures, shivering, hyperthermia |
| Factors that decrease VO2 | skeletal muscle relaxation (drugs), peripheral shunting (sepsis, trauma, etc), certain poisons (cyanide), hypothermia |
| Factors that increase O2 ER | seizures, shivering, anemia, decreased arterial oxygenation |
| Factors that decrease O2 ER | increased CO, peripheral shunting, certain poisons, hypothermia, increased Hb concentration |
Created by:
K.Moskowitz
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