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314 > Cardiopulmonary/Oxygenation > Flashcards

Cardiopulmonary/Oxygenation Flashcards

1
Q

pulmonary assessment subjective data

A
  • cough, sputum, SOB, pain
  • history of respiratory disease: childhood illnesses (asthma, croup, CF), adult illness (COPD, pneumonia, TB, HIV/AIDS
  • self care: immunizations
  • environmental exposure: occupation, travel, 2nd hand smoke, general environment
  • habits: smoking
  • injuries
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2
Q

pulmonary assessment objective data: anterior/posterior

A

inspect facial expression, LOC, ease of breathing, skin color and nail beds, use of accessory muscles, respiratory rate, sternal formation, shape and configuration (downward sloping ribs, muscle and skeletal structures, posture), AP diameter of chest 1:2

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3
Q

pectus carniatum

A

sternal protrusion

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4
Q

pectus excavatum

A

sternal concavity

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5
Q

pulmonary assessment objective: posterior

A
  • palpate posterior
  • symmetric expansion: thumbs along spinal processes, 2 in apart at 10th rib, palms resting lightly on lateral chest, tell patient to take several deep breaths, note bilateral outward movement of thumbs, should separate about 1.25-2 in
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6
Q

pulmonary assessment objective: palpation/percussion

A
  • assess for tenderness with percussion over kidneys: costal-vertebral angle
  • doesn’t assess respiratory status, but renal problems
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7
Q

pulmonary assessment objective: auscultate lung fields

A
  1. breath sounds: breathe through mouth
  2. ask to take slow deep breaths
  3. listen to entire and expiration at each position
  4. compare bilaterally
  5. start from top to bottom comparing sides, then compare laterally
  6. posterior: 8-10 positions
  7. lateral: 4-6 positions
  8. anterior: 8 positions
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8
Q

vesicular lung sound

A
  • soft, breezy, low pitched
  • small airways: periphery of lung
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9
Q

bronchovesicular lung sound

A
  • blowing, medium pitch/intensity
  • large airways: between scapulae, over bronchioles lateral to sternum
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10
Q

bronchial lung sound

A
  • loud, high pitched
  • trachea: head only over the trachea
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11
Q

adventitious sounds

A

atelectasis, crackles, wheezes, rhonchi, stridor, pleural friction rub, absent

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12
Q

atelectasis

A
  • collapsed alveoli: small area or large, usually unilateral
  • can be simply a collapse due to poor air exchange
  • obstruction can cause it: fluid, tumor, foreign object
  • minor = may not detect early
  • major = entire lobe/lung collapses
  • may cause wheezing, decreased/absent lung sounds
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13
Q

crackles

A
  • popping open of deflated alveoli on INSPIRATION
  • lower lobes usually where fluids collect
  • NOT cleared by cough
  • fine crackles are like the sound of a wood fireplace
  • coarse crackles: velcro separating/cellophane crumpled
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14
Q

wheeze

A
  • high velocity airflow through narrowed/obstructed airways
  • heard in all lung fields
  • coughing doesn’t change this
  • high pitched, continuous musical sound/squeaking
  • inspiration and/or expiration (usually louder on expiration)
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15
Q

rhonchi

A
  • spasm, fluid/mucus in airways = turbulence
  • mostly over trachea and bronchi with mucus present
  • clear after coughing usually/not always
  • loud, low-pitched, rumbling, continuous coarse sounds, snore
  • inspiration and/or expiration
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16
Q

stridor

A
  • air moving over partially obstructed airway/larynx
  • can become emergent
  • haled object, infection, throat swelling, laryngospasm frequent in children
  • throat, loud, no stethoscope needed
  • high pitch musical sound heard on INSPIRATION
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17
Q

pleural friction rub

A
  • inflamed pleura rubbing against the visceral pleura
  • dry, rubbing, or grating on inspiration AND expiration
  • heard over anterior lateral lung fields
  • does not clear with coughing
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18
Q

absent lung sounds

A
  • pneumothorax (collapsed lung)
  • no air movement in the identified area
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19
Q

cardiac assessment subjective data

A
  • HX of smoking/alcohol/caffeine
  • prescribed/OTC meds
  • HX of cardiac/vascular disease
  • family medical HX
  • reports of chest pain/discomfort
  • HX of cardiac procedures
  • reports: palpitations, fatigue, cough, dyspnea
  • reports peripheral symptoms: leg pain/cramps, edema, cyanosis, nocturia
  • reports of dizziness, SOB, orthopnea
  • other diagnoses: DM, lung, obesity
  • lifestyle: diet, salt, smoking, alcohol, drugs, exercise
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20
Q

cardiac assessment objective: anterior

A
  • inspect: skin (oxygenation/lesions), heave/lift at apical pulse
  • palpate: valves
  • palpate aortic, pulmonic, tricuspid, and mitral valves
  • apical pulse (mitral)
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21
Q

cardiac assessment objective: auscultate

A
  • aortic valve
  • pulmonic valve
  • Erb’s point
  • tricuspid valve
  • mitral valve
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22
Q

S1

A
  • lub
  • louder at apex
  • carotid pulsation and “r” wave in QRS
  • closure of AV valves
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23
Q

S2

A
  • dub
  • louder at base
  • closure of semilunar valves
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24
Q

neck vessels

A
  • inspect of obvious pulsation and bulging
25
Q

palpating carotid arteries

A
  • contour: smooth and amplitude
  • gently: do not massage vigorously
  • only one side at a time to prevent obstructed blood flow to the brain
  • equal bilaterally
26
Q

auscultate carotid arteries

A
  • good reflection of heart function
  • bell/hold breath briefly
  • normal = no sound
  • bruit = blowing, swishing sound (narrowing)
27
Q

carotid bruit

A
  • narrowed blood vessel: arteriosclerosis
  • creates turbulence
  • blowing/swishing sound
28
Q

jugular venous distension

A
  • noninvasive assessment of venous and right atrium pressures
  • place patient in supine position: jugular vein bulge/distension “normal” when torso flat
  • raise torso to 45 degrees: if JV still bulging, there is JVD so venous and right atrium pressure is elevated
  • heart failure or fluid overload
29
Q

peripheral arteries

A
  • assess elasticity, strength, and equality and symmetry
  • graded on a 4 point scale
    4+ = bounding, often visible
    3+ = full and brisk
    2+ = normal
    1+ = weak
    0 = absent
30
Q

modifiable risk factors for CV disease

A
  • hyperlipidemia
  • hypertension
  • excessive weight
  • physical inactivity
  • smoking
  • psychological stress
  • diabetes
31
Q

non-modifiable risk factors for CV disease

A
  • family history
  • genetics
32
Q

complete blood count (CBC)

A

numerous components

33
Q

lipids

A
  • risk of CAD
  • lipid panel
  • cholesterol
  • triglycerides
  • HDL = good
    = LDL = bad
34
Q

serum electrolytes

A
  • C-reactive protein: inflammation
  • peak 18+ hours
35
Q

BNP

A

elevated in heart failure

36
Q

creatine kinase

A
  • heart muscle injury: inexpensive
  • elevated in 4+ hours after injury
  • can pick up skeletal muscle injury
37
Q

troponin/myoglobin

A
  • evidence of cardiac damage
  • elevated in 3-4 hours
38
Q

murmurs

A
  • a blowing swishing sound from turbulent blood flow in the heart or great vessels
  • abnormal, but some people live with murmurs without symptoms
  • timing: systolic or diastolic murmurs possible
  • loudness: grade 1-6 soft to loud
  • pitch: high, medium, low
  • location
39
Q

cardiac assessment developmental considerations

A
  • infants: smaller diaphragm/bell, higher heart rates
  • children: extra cardiac signs of heart disease (clubbing of fingers, cyanosis, activity level, weight gain)
  • pregnancy: pulse increases, heart displaced to upper left and rotates, PMI is higher, increased blood volume, systolic murmurs
40
Q

cardiac changes with aging

A
  • harder to hear sound with increased AP diameter
  • cardiac valves degenerate (especially mitral and aortic)
  • conduction: pacemaker cells decrease in number (dysrhythmias and ectopic beats)
  • left ventricle: size increases and more fibrotic (decrease cardiac output)
  • aorta and large vessels thicken (increases systolic BP)
  • baroreceptors: become less sensitive (orthostatic hypotension)
41
Q

right side heart failure

A
  • right heart receives from the periphery
  • if the right side fails, the blood backs up into where it was coming from
  • decreased function of the R ventricle or increased pulmonary resistance
  • peripheral congestion/backup
42
Q

left side heart failure

A
  • left heart receives from the lungs
  • if the left side fails, the blood backs up into the lungs and it also circulates to everything, so everything gets less oxygen/nutrients
  • decreased function of L ventricle
  • decreased cardiac output (fatigue, dizziness, confusion)
  • pulmonary congestion (crackles, SOB, dyspnea, breathlessness)
43
Q

ventilation

A

process of moving gases into and out of the lungs during inhalation and exhalation

44
Q

perfusion

A

the ability of the CV system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs

45
Q

diffusion

A

responsible for moving the respiratory gases from one area to another by concentration gradients

46
Q

stroke volume

A

volume of blood ejected from the ventricles during systole

47
Q

cardiac output

A

the amount of blood ejected from the left ventricle each minute

48
Q

preload

A

the amount of blood in the left ventricle at the end of diastole before the next contraction

49
Q

afterload

A

resistance to the ejection of blood from the left ventricle

50
Q

alterations in respiratory function

A

hypoventilation, hyperventilation, anoxia (absence of oxygen

51
Q

physiologic factors affecting oxygenation

A

decreased O2 carrying capacity
- decreased O2 carrying capacity: low hemoglobin/anemia
- hypovolemia/decreased circulating blood volume
- oxygen concentration: airway obstruction, decreased environmental oxygen, hypoventilation
- increased metabolic rate: increases oxygen demand

chest wall movement
- pregnancy
- obesity
- musculoskeletal alterations in the thoracic region
- trauma
- neuromuscular
- central nervous system

52
Q

hypoxia

A
  • inadequate oxygenation of the tissue
  • not measurable at all, but comes as a result of hypoxemia
53
Q

hypoxemia

A
  • inadequate oxygenation of the blood
  • measurable (pulse ox, ABGs, other respiratory tests)
  • first signs: restlessness and confusion
54
Q

factors affecting oxygenation

A

alterations in cardiac function
- cardiac: conduction, altered cardiac output, valves, myocardial ischemia

lifestyle factors: nutrition, exercise, smoking, substance abuse, stress

environmental factors

55
Q

oxygenation developmental considerations in infants

A
  • count respiratory rate 1 full minute
  • irregular with some apnea normal
  • crackles are common in newborns
  • distress (nasal flaring, substernal and intercostal retractions)
56
Q

oxygenation developmental considerations in the elderly

A
  • increased AP diameter, especially with COPD
  • kyphosis
  • less mobile thorax
  • fatigue easily during auscultation
  • fragile bones
57
Q

clubbing

A
  • bulging of tissues at the nail base
  • caused by insufficient oxygenation at the periphery
  • emphysema and congenital heart disease are the most common causes
58
Q

oxygenation interventions

A
  • airway: coughing, suctioning, physiotherapy maintenance
  • hydration: humidifiers, fluid intake orally, through GI tubes, or intravenously
  • nebulizers: breathing treatments with medications added as well as humidity
  • cough/deep breathing: incentive spirometer
  • pursed lip breathing helps keep alveoli open longer
  • noninvasive ventilation
  • invasive mechanical ventilation
  • ambulation and positioning
  • chest tubes
    -oxygen therapies

314 (4 decks)

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