PEDIATRIC CCRN: Pulmonary questions
and answers
3 divisions of lungs - ANSWER>>1. Bronchi - cartilaginous
Bronchioles - membraneous
Alveoli - gas exchange units, lined by epithelial cells (2 types)
2 types of alveoli - ANSWER>>Type 1 - gas exchange
Type 2 - surfactant
Muscle of inspiration - ANSWER>>diaphragm
Part of brain that controls breathing - ANSWER>>medulla (phrenic nerve - C 3,4,5
keep you alive)
Compliance of lungs - ANSWER>>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 - ANSWER>>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 - ANSWER>>ETT (longer airway =
more resistance)
,Increased Resistance = Increase or Decreased tidal volume? -
ANSWER>>Decreased
Ventilation Perfusion Matching:
V/Q = 0.8 - ANSWER>>Ventilation (V): air ventilating the alveoli
Perfusion (Q): blood perfusion the alveoli
- usually more perfusion than ventilation
Low V/Q vs. High V/Q - ANSWER>>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 - ANSWER>>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? - ANSWER>>- decreased area
- CF
- ASD
- AVC flooding lungs
- polycythemia - thick blood
Different in Kids Lungs: - ANSWER>>- 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 - ANSWER>>- Total Lung Capacity
- Vital Capacity
- Functional Residual Capacity
- Residual Volume
Lung Tests and Monitoring: Total Lung Capacity - ANSWER>>volume in lungs at
max inspiration
Lung Tests and Monitoring: Vital Capacity - ANSWER>>maximum expired with
maximum expiration
Lung Tests and Monitoring: Functional Residual Capacity - ANSWER>>volume
remaining after normal expiration
Lung Tests and Monitoring: Residual Volume - ANSWER>>volume remaining after
forced expiration
Acid Base Balance: what keeps pH normal - ANSWER>>- 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? - ANSWER>>LOW
HIGH
(inverse relationship)
Normal Blood Gas Values: ARTERIAL - ANSWER>>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 - ANSWER>>pH: 7.31-7.41
PO2: 35-40
PCO2: 40-50
HCO3: 22-26
Base Excess: -2 to +2
Normal Blood Gas Values: CAPILLARY - ANSWER>>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 - ANSWER>>PaO2: evaluation of oxygenation
PaCO2: alveolar ventilation
1. pH: Acidosis vs Alkalosis
2. PCO2 and Bicard: SAME direction or DIFFERENT direction - ANSWER>>1. pH less
than 7.35 = acidosis; pH greater than 7.45 = alkalosis
2. SAME = metabolic; DIFFERENT = respiratory
ROME (respiratory opposite, metabolic equal)
and answers
3 divisions of lungs - ANSWER>>1. Bronchi - cartilaginous
Bronchioles - membraneous
Alveoli - gas exchange units, lined by epithelial cells (2 types)
2 types of alveoli - ANSWER>>Type 1 - gas exchange
Type 2 - surfactant
Muscle of inspiration - ANSWER>>diaphragm
Part of brain that controls breathing - ANSWER>>medulla (phrenic nerve - C 3,4,5
keep you alive)
Compliance of lungs - ANSWER>>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 - ANSWER>>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 - ANSWER>>ETT (longer airway =
more resistance)
,Increased Resistance = Increase or Decreased tidal volume? -
ANSWER>>Decreased
Ventilation Perfusion Matching:
V/Q = 0.8 - ANSWER>>Ventilation (V): air ventilating the alveoli
Perfusion (Q): blood perfusion the alveoli
- usually more perfusion than ventilation
Low V/Q vs. High V/Q - ANSWER>>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 - ANSWER>>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? - ANSWER>>- decreased area
- CF
- ASD
- AVC flooding lungs
- polycythemia - thick blood
Different in Kids Lungs: - ANSWER>>- 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 - ANSWER>>- Total Lung Capacity
- Vital Capacity
- Functional Residual Capacity
- Residual Volume
Lung Tests and Monitoring: Total Lung Capacity - ANSWER>>volume in lungs at
max inspiration
Lung Tests and Monitoring: Vital Capacity - ANSWER>>maximum expired with
maximum expiration
Lung Tests and Monitoring: Functional Residual Capacity - ANSWER>>volume
remaining after normal expiration
Lung Tests and Monitoring: Residual Volume - ANSWER>>volume remaining after
forced expiration
Acid Base Balance: what keeps pH normal - ANSWER>>- 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? - ANSWER>>LOW
HIGH
(inverse relationship)
Normal Blood Gas Values: ARTERIAL - ANSWER>>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 - ANSWER>>pH: 7.31-7.41
PO2: 35-40
PCO2: 40-50
HCO3: 22-26
Base Excess: -2 to +2
Normal Blood Gas Values: CAPILLARY - ANSWER>>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 - ANSWER>>PaO2: evaluation of oxygenation
PaCO2: alveolar ventilation
1. pH: Acidosis vs Alkalosis
2. PCO2 and Bicard: SAME direction or DIFFERENT direction - ANSWER>>1. pH less
than 7.35 = acidosis; pH greater than 7.45 = alkalosis
2. SAME = metabolic; DIFFERENT = respiratory
ROME (respiratory opposite, metabolic equal)
