PEDIATRIC AACN CCRN: Pulmonary (27
Questions and Answers.)
# of lobes in right lung
# of lobes in left lung -
\3
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
- 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
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
More H+ ions = high or low pH?
Less H+ ions = high or low pH? -
\LOW
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
PaO2 vs PaCO2 -
\PaO2: evaluation of oxygenation
Questions and Answers.)
# of lobes in right lung
# of lobes in left lung -
\3
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
- 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
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
More H+ ions = high or low pH?
Less H+ ions = high or low pH? -
\LOW
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
PaO2 vs PaCO2 -
\PaO2: evaluation of oxygenation
