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Ministry of Public Health of Ukraine M. Gorky Donetsk National Medical University




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Ministry of Public Health of Ukraine

M. Gorky Donetsk National Medical University


BASIS STAGES OF BREATHING. MECHANISMS OF INSPIRATION AND EXPIRATION. PROCESSES OF GAS EXCHANGE IN THE LUNGS AND TISSUES.


Methodical instructions for students


Donetsk


2009


BASIS STAGES OF BREATHING. MECHANISMS OF INSPIRATION AND EXPIRATION. PROCESSES OF GAS EXCHANGE IN THE LUNGS AND TISSUES.


Actuality of subject: Importance of studying gas exchange and transport of gases consists in the understanding physiological processes absorption by the organism of O2 and excretion of CO2, which is gas exchange. This processes is based on the aerobic oxidation, which provides energy metabolism in the organism. Respiration happens by way of interaction between respiratory organs system, cardiovascular system and blood, which forms functional systems. Impairment pulmonary ventilation can lead to different pathologic states (for example, hypoxia, hypoxemia, hypercapnia) and diseases. The knowledge of ventilation mechanism of lung and gas exchange is necessary for further use in therapeutic clinic.

Common purpose: To be able to interpret the mechanisms of lungs ventilation, to base the importance of gas exchange and of gases transfer in organism for further use in clinic of internal diseases.

^ Specific purposes Purposes of initial level of knowledge

To be able to:


1. Interpret mechanisms of pulmonary ventilation: the role of breathing muscles, stretch and length of the lungs, pressure in pleural cavity, role of the surfactant.

2. Determine mechanisms of gas exchange between blood and tissues, the role of hemoglobin in gas transport.

3. Interpret notion about hypoxia, hypo- and hypercapnia.

  1. Recognize morphology and microsrtucture of different parts and organs of respiratory system. (Histology Department)

  2. Value role of some muscles groups in movement of chest (Anatomy Department).

3. Explain action of surface tension and their importance in origin stretch pull of the lungs (Biophysics Department).

You must decide some tests in order to reveal your initial level of knowledge-skill:

^

Tasks for control of initial level of knowledge



Task # 1. During examination under microscope the respiratory tracts preparation segmental epithelium with a large quantity of ciliary and goblet cells was determined. What was the basic function of these cells?

  1. Incretory.

  2. Cooling of air.

  3. Clearance of air.

  4. Heating of air.

  5. Gas exchange.


Task # 2. In consequence of the disease a patient has indurations of all the costal joints. What occurs with breathing?

  1. It becomes surface.

  2. It doesn’t change.

  3. It stops.

  4. It becomes quick.

  5. It becomes quick, and then becomes slow.


Task # 3. During the experiment one rat’s lung was treated by elastase, which destroyed elastic fibers. How does change the elastic draught of lung?

  1. It falls.

  2. It falls and then rises.

  3. It doesn’t change.

  4. It rises.

  5. It rises and then falls.


If you decide previous tests then you must decide following tests independently.


Task # 4. A 44 year old man is the thickness of alveolo-capillary membrane increased. Change of which index of breathing did this lead to?

  1. Expiratory reserve volume.

  2. Minute respiratory volume.

  3. Alveolary pulmonary ventilation.

  4. Dead volume.

  5. Inspiratory reserve volume.


Task # 5. During the experiment at examination of human respiratory muscles state, rhythmic, intensive contraction of abdominal wall muscles was revealed. Which phase of breathing did this correspond?

  1. Deep breath.

  2. Quiet breath.

  3. Deep expiration.

  4. Quiet expiration.

  5. Breath is holding.


Task # 6. During open pneumothorax at an old age, as compared with young age, the degree of alveoli collapse decreases. What does explain such age peculiarity?

  1. An increase in surface tension.

  2. An increase in elasticity of alveoli.

  3. Fall of surface tension.

  4. Fall of elasticity of alveoli.

  5. Stop of alveolar bloodstream.

Basic theoretical questions.

  1. Respiration and its stages. The importance of external respiration in support of gaseous constants of blood.

  2. Role of the respiratory system in gas exchange. Other functions of respiratory system.

  3. The mechanisms of lung ventilation. Changes of pressure in the pleural cavity at various phases of respiratory cycle. Pneumothorax. Surfactant and its functions.

  4. Static and dynamic indexes of external respiration, method of their examination.

  5. Factors, influencing gas exchange between the alveolar air, blood and tissues.

  6. The transport of gases by blood.

  7. The exchange of gases in tissues.

Literature


Textbook of medical physiology /Arthur C. Guyton, John E. Hall – 2001, 432-472;

Lectures;

Methodical recommendation for students.


The educational tasks.


Task # 1. In the puerperal room in the new-born the first cry didn’t arise and child dead. After death was revealed that the lungs didn’t smooth out but respiratory tracts was free. What was the cause of this?

  1. Lack of surfactant.

  2. An increase size of alveoli.

  3. Bronchostenosis.

  4. Break of bronchi.

  5. Thickening of pleura.


Task # 2. A patient arbitrary delayed breathing for 50 seconds. What changes took place in blood after such breath holding?

  1. Hypercapnia.

  2. Hypocapnia.

  3. Alkalosis.

  4. Hyperoxya.

  5. Acidosis.


Task # 3. It was determined that an important role in transportation of CO2 by blood took part carbonic angidrase. Where was situated this ferment?

  1. In erythrocytes.

  2. In plasma.



  3. In leucocytes.

  4. In thrombocytes.

  5. In plasma protein.


If you decide previous tests then you must decide following tests independently.


Task # 4. After the operation on abdominal cavity a 48 year old patient is at rest at a horizontal position. Contractions of which muscles provides inspiration in this position?

  1. Diaphragm and abdominal.

  2. External intercostals.

  3. Internal intercostals.

  4. Rhomboidal.

  5. Pectoralis major.


Task # 5. Some time a patient lived in mountainous place with low partial pressure of O2. What led to resistance increasing of this patient to conditions of the hypoxia?

  1. A change of red blood cells amount.

  2. A fall of nervous strain.

  3. Low temperature of medium.

  4. A fall of physical loading.

  5. A clean mountainous air.


Task # 6. During examination of the respiratory functions in 55 year old woman it was necessary to determine, what part of the alveolar air renewed during each breath? What index was necessary for determination of this function?

  1. Functional residual capacity.

  2. Minute respiratory volume.

  3. Vital capacity.

  4. Coefficient of pulmonary ventilation.

  5. Minute alveolar ventilation.


Approximate basic of work.

^

Laboratory work # 1. Pneumography.

Laboratory work # 2. Spirometry.


Spirometry is carried out with help of a dry spirometer. Before beginning the work a tip to be attached to the spirometer and disinfected by 96% ethyl alcohol. Turning the glass cover, put marks opposite zero mark on the dial-plate of scale.

Measuring of breathing volume (BV). The spirometer must be set to the initial position . Doing quiet breaths through the nose, do several quiet expirations through the mouth in to the spirometer. With the help of scale determine volume of expired air and divide it by the numbers of expirations. Find proper BV, use the tables for this, make conclusion.

^ Measuring of expiratory reserve volume (ERV). The spirometer to the initial position, after a quiet breath do in the spirometer as a deep expiration as possible. Take reading spirometer and subtract from of breathing volume exponent this index, find ERV, make conclusion.

Measuring of vital capacity (VC). Spirometer leads to point of departure. Do a maximum breath and, closing nose, do the deep most expiration in the spirometer, and fix index and compare it with the physiological index. Make conclusion.

^ Definition of inspiratory reserve volume (IRV). Inspiratory reserve volume can be calculated subtracting the sum of breathing volume and expiratory reserve volume from the value, determined during the definition of VC. Find proper index. Make conclusion.

Laboratory work # 3. Determination of gas partial pressure by its percentage maintenance in alveolar air (with demonstration of Haldane gas analyzer).

Laboratory work # 4. Determination of breath holding in rest, after strained muscular work, after hyperventilation.

Laboratory work # 5. Determination of arterial blood saturation by oxygen with the help of oxyhemography method.


^ The task for the control of final level of knowledge


Task

It was known that in surface layer of liquid which covered alveolus, surfactant was contained .What functions did this substance carried out?

A. Preservation of straightened form of alveolus.

B. It improved gas exchange during deep breathing.

С.Periodical turn off part of alveolus.

D. Increasing of alveolus stretching.

E. Decreasing of evaporation with alveolus surface.


^ SHORT METHODICAL INSTRUCTIONS.


After organization part , in the beginning of study, after actualisation of topic pay attention to necessity to be able to interpret the mechanisms of pulmonary ventilation, gas exchange on the different stages of breathing for value of human functional possibilities.

After this the teacher ascertains initial level of knowledge-skill which received before.

After decision of teaching tasks students independent interpret physiologic properties of gas exchanging and pulmonary ventilation external breathing. During this students use table-train, graf logical structure of topic (addition 1).

After this students decide teaching tasks which they receive from teacher.

Students with teacher modulate situation tasks on these topics. Teacher corrects mistake students’ actions.

Students carry out laboratory works independent. For consolidate the topic students see education film.

After this students decide control tasks. Sum up of study and announcement marks.

^ TECHNOLOGICAL MAP OF THE STUDY



Stage

Time

Teaching aids

Place

Note







Min

Means of training

Equipment

of study




1.

Organization part. Actuality of subject. Purpose of study.

5







Classroom




2.

Control initial level of knowledge-skill with the help of tasks. Independent work of students with recommend models and scheme. Independent work of students with recommend teaching tasks. Model situation tasks and correct mistake action of students.

60

Tasks. Graf logical structure of topic. Table-train.




-//-




3.

Independent carry out laboratory works. Draw up minutes. Seeing of educational videofilm.

40

Instruction for laboratory works

Spirometer,oxyhemography. TV set

Classroom Videoroom




4.

The task for the control of final level of knowledge. Sum up of study . Announcement of marks.

15

Tasks

Computer

Computer room Classroom






Addition 1. Graf logical structure of topic

External respiration. Gas exchange and transport of gases”.


Gas exchange and transport of gases
^

Mechanisms of the gas exchange at blood


Carbohemoglobin

Transport of О2

Diffusion of О2 and СО2 through pulmonary capillary membrane

Area of alveolar surface


Thickness of pulmonary membrane
^

Heart work and vessels state


Diffusion coefficient for various gases

Transporte of СО2

Physical soluble О2

Oxyhemoglobin

Physical soluble

Factors which influence on gas transport form

рН

Т0

рСО2

Carbonic angidrase

2,3 DPG


^

Mechanism of gas exchange between alveolar air and blood

Factors which influence on this processes


Bicarbonate

Methods of examination

Oxyhemometry
Clinical tests

Interpret of organism physiological state for further use this knowledge in clinic


Addition 1. Graf logical structure of topic “ External respiration.

Gas exchange and transport of gases.


^

Mechanisms of inspiration and expiration


Factors which carry out inspiration

Respiratory movements of chest and diaphragm

Negative pressure of the pleural cavity

Methods of examination



Pneumography

Pneumotachometry

Spirometry

Spirography

External respiration stages


Full of alveolus by air


Gas diffusion between alveolus and blood


Transport of gases by blood


Gas diffusion between capillary blood and tissues

^

External respiration-the lungs ventilation


Factors which carry out expiration

Active


Passive

Surfactant

Damage of negative pressure

Pneumothorax

Traumatic

Therapeutic

Elastic lungs draught


Interpret of organism physiological state for further use this knowledge in clinic



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