NRS 313 Study Guide - Midterm Guide: Trachea, Pernicious Anemia, Anticoagulant
27 May 2018
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W5: Ventilation & Gas Exchange
• COPD: 80-92% SpO2
• Absorption adolectisis
o Too much O2 causes airways to collapse
• Oxyhemoglobin: association and dissociation
o Defined: how readily oxygen associates (bind with hgb. in the lungs) and
dissociates (releases from hgb. in the tissue).
o Association factors: (strength of binding / attraction)
▪ Left shift – alkaline pH, hypocapnia, low temperature.
▪ Alkaline: excess vomiting and diarrhea
▪ O2 will bind with heme group
▪ Low perfusion
▪ Warm them up, exercise, start IV with prewarmed bags, meds to inhibit
vomiting
o Dissociation factors: (ability to release)
▪ Right shift –hypercapnia, Acidotic pH, Exercise, elevated Temperature
▪ O2 will detach from heme group
▪ We want right shifts normally
• Anemia and O2 transport
o Causes of anemia include changes to:
▪ RBC size (end with “cytic” such as microcytic)
▪ hemoglobin content (end with “chromic” such as hypochromic)
▪ Anemia: decreased oxygen carrying capacity of the RBC
o Macrocytic-Normochromic anemia (Megaloblastic anemia)
▪ Large cells with normal hemoglobin (DNA synthesis is blocked or
delayed)
▪ Associated with Vit. B12 or Folate deficiency
▪ Premature death of macrocytic cell = decreased RBCs
▪ Example: Pernicious anemia
• Vit. B 12 deficiency secondary to lack of intrinsic factor (enzyme
from parietal cells) to absorb B12
• Classic anemia symptoms: fatigue, weakness, numbness in feet
and fingers
• Autoimmune disorder: antibodies attack the cell
▪ Example: Parietal cells. Stomach ulcer
• Stoamch cant make intrinsic factor. The stomach normally absorbs
vitamin b 12. This is critical for growth and development in RBC.
• B12 wants to be absorbed
• Macrocyte cells are created and die off early
• Microcytic-hypochromic anemia “blood loss anemia” Cont:
o Interpret the meaning of microcytic-hypochromic
find more resources at oneclass.com
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o Causes:
▪ Insufficient dietary intake of iron – iron depleted RBCs exiting the bone
marrow.
▪ Blood loss due to surgery, internal bleeding, slow GI bleeding (ulcers),
heavy menstrual bleeding.\
• Perimeopause
• Stomach ulcers
o Clinical manifestations
▪ Hgb level less than 12 g / dl (symptoms at 7 or 8 g/dl)
▪ Normal range 12 to 18 g / dl MEMORIZE
▪ Fatigue, weakness, SOB, paleness
▪ Additional labs
• Serum Iron
• CBC: total RBC, HCT, and Heme
• HCT: % of RBC in whole blood. 35%-50% MEMORIZE
o Hyochromatic: FE2+ disks are low
• Pulmonary problems
o Atelectasis: compressed alveoli/ collapsed. Leads to respiratory acidosis.
▪ Compression atelectasis: decreased O2 perfusion
• Immobility, DVT
▪ Absorption atelectasis: why we don’t give a high O2 over long periods of
time
▪ Surfactant impairment: inhaled anesthetics.
• Isoflorine is a degreasing agent for surfactant.
• Increase surface tension
• Alveoli can fill with H2O
o Risk factors: pressure on pleural space, anesthetics, inactivity, surgery, smoking
tobacco
▪ Worse with a BMI over 30
o CM: cough, dyspnea, fever, decreased SpO2, tachypnea, tachycardia, cyanosis,
decreased breath sounds and intercostal retraction
o Treatment:
▪ Mobility: Fowlers 45 degrees
▪ Turn, cough and deep breathing
▪ Incentive spirometer
• Pneumonia
o Inflammation in lower respiratory regions – bacterial (strep and staph), viral
(influenza) and nosocomial (pseudomonas) such as vent. associated pneumonia.
o Innate and adaptive immune response activated.
o CM: fever, productive cough, discolored sputum, dyspnea, inspiratory crackles,
pleural pain
o Treatment:
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
B12 or folate deficiency: premature death of macrocytic cell = decreased rbcs, example: pernicious anemia, vit. B 12 deficiency secondary to lack of intrinsic factor (enzyme from parietal cells) to absorb b12: classic anemia symptoms: fatigue, weakness, numbness in feet and fingers, autoimmune disorder: antibodies attack the cell, example: parietal cells. Stomach ulcer: stoamch cant make intrinsic factor. This is critical for growth and development in rbc: b12 wants to be absorbed, macrocyte cells are created and die off early, microcytic-hypochromic anemia blood loss anemia cont, interpret the meaning of microcytic-hypochromic, causes: 35%-50% memorize: hyochromatic: fe2+ disks are low, pulmonary problems, atelectasis: compressed alveoli/ collapsed. Leads to respiratory acidosis: compression atelectasis: decreased o2 perfusion. Immobility, dvt: absorption atelectasis: why we don"t give a high o2 over long periods of time, surfactant impairment: inhaled anesthetics. Inhibits the ability of the heart to pump: acute respiratory failure, sepsis most common cause of resp. failure, widespread.
