Exam 4- Oxygenation and Circulation Flashcards
A baby born at <35 weeks (premie) are at risk for (4)?
- Respiratory Distress
- Atelectasis
- Hyperapnea
- Hypoxemia
Why are premies at risk for Acute Respiratory Distress Syndrome (ARDS)?
Because premies don’t have surfactant producing cells to keep alveoli inflated.
A baby born @ 40 weeks (normal) are at risk for (3)?
- Respiratory Syncytial Virus (RSV)
- Apnea
- Decreased immune system- breast milk best for it’s antibodies
Why are babies at risk for Respiratory Syncytial Virus? RSV
because their CNS is immature and may not have regulation of breathing and leads to SIDS
Why are toddlers at risk for respiratory problems?
Because their tonsils are enlarged compared to an adult, and they’re always putting things in their mouth, AIRWAY OBSTRUCTION is a concern..DROWNING
What respiratory problems are school-aged children susceptible to?
- Croupe
2. Pneumonia
What risk factors are adolescents exposed to?
SMOKING because of peer pressure, social reasons, not as many dr. visits as before, smoking at a younger age.
What respiratory problem are young/middle adults at risk for and what’s the pathophys?
SMOKER’S LUNG- (at cellular level)- columnar epithelial cells turn into squamous epi cells due to SMOKING. Cilia may be paralyzed.
What may happen if a smoker quits smoking?
Cellular change is possible! Quitting is a benefit and can reverse bad cells/negative effects of smoking
What respiratory problem are elderly adults at risk for?
GERD- gastro esophageal reflux disease= increased risk for aspirations.
What physical changes are occurring in older adults that can cause respiratory problems?
- Decreased no. of cells
- Decreased lung expansion
- Decreased alveolar inflation (AEB diminished lung sounds)
- Inability to expel mucous or foreign materials
- less ventilation
- poorer immune response
- Heart muscle looses contractility strength
- Coughing- fluids end up going into lungs
What happens during the allergic reaction, Asthma?
Rxn in bronchioles caused by irritants: cold air, dust, mold, pets.
Causes: bronchoconstriction
bronchospasms
lower airway edema
What medication do you give to a pt with asthma and what does the medication do?
Albuterol- broncho dilator- give in mist form so med can get absorbed. If mask- turns high flow 02 into a mist with prescribed time (5 min)
What does an uncomplicated rib fracture do to a person?
PAINFUL and causes pt to take DEEP shallow BREATHS, be immobile and fluid accumulation= PNEUMONIA.
As a nurse what would you implement for a pt with an uncomplicated rib fracture?
- Take a pillow to chest/rib fracture to help with pain and splint themselves.
- Treat pain so pt can move around
What is flail chest?
trauma. Broken bone/segment of rib. Separated from chest wall r/t stress, falling, abuse, accident
What physiological changes happens to a pregnant pt in regards to their metabolism and blood volume?
15% increase in metabolism rate during 2nd half of pregnancy and mother compensates 30% blood volume
What does a pregnant pt require and why? What nursing interventions would you implement?
- ADDITIONAL IRON to meet fetal requirements.
2. Increase Fe in diet or supps and prenatal vitamin
What happens to a pt with a fever in regards to their respiratory function?
For every 1 F -> Increased 7% BMR which Increases Respirations and Increases Respiratory Workload
What are 4 alterations in Respiratory functioning?
- Hyperventilation
- Hypoventilation
- Hypoxia
- Hypoxemia
What is hypoxia?
inadequate tissue oxygenation cellular level
What is hypoxemia?
inadequate oxygenation of blood
What is hyperventilation?
tachypnea- increased respiratory rate, exhale too much C02- alkalosis
What is hypoventilation?
Bradypnea- inadequate ventilation to meet body’s demand. C02 build up- acidosis
What is atelectasis?
Collapse of the alveoli- anything that reduces lung sounds/function
What can cause atelectasis?
Tumor or obstructed airway
What are S and Sx of upper respiratory infections?
COLDS and FLUS- headache, fatigue, fever, mortality rates
What are examples of lower respiratory infections?
ACUTE, CHRONIC- bronchitis, RSV, pneumonia, TB
What are 6 different breathing patterns?
- Apnea- none
- Eupnea- normal
- Bradypnea- slow
- Tachypnea- fast
- Dyspnea- (DOE) difficulty breathing on exertion
- Orthopnea- difficulty breathing while LYING DOWN
What are two common drugs given to ad contractility of the Heart?
- Digoxin
2. Nitroglycerin
What does Coumadin do?
ANTICOAGULANT- interferes with hepatic synthesis of vit. K- dependent clotting factors
Therapeutic efx: prevention of thrombo embolic events
What are nursing interventions for a pt on Coumadin?
assess for BLEEDING and hemorrhage.
Blood in stool, UA, NG aspirate
What is the #1 gas for breathing?
C02.
Low levels of 02 is separate way for air to get back into lungs.
External versus Internal Respiration
External-occurs in alveoli- alveolar capillary exchange
Internal- occurs in organs & tissues- capillary tissue exchange
What is the SA node’s duty for the heart?
PACEMAKER!
What happens if the SA node is blocked, i.e coronary artery disease?
AV NODE will take over. If both nodes blocked, PURKINJIE FIBERS will aid.
What are the therapeutic effects of Benzodiazepines?
Sedation, relief of ANXIETY
What are the therapeutic effects of Hyrdrocodone?
Suppression of involuntary cough, dry cough, and to treat hard gastric contents
What are the therapeutic effects of Guaifenesin?
mobilization and subsequent expectoration of mucous from coughs associated with upper resp. infections
What is melatonin good for?
Potential tx of insomnia, seasonal affective disorder, circadian rhythm, sleep disorder..(ST though, 3 months or less.)
What is Lunesta?
Sedative/hypnotic to improve sleep for INSOMNIA
What nursing intervention is crucial to improve airway patency?
BODY POSITIONING!
80-90 deg best way to sit up or haunched over
more upright allows lungs to expand better and improve oxygenation
Why is body positioning important for a COPD pt?
because COPD pt cannot lie flat, orthopnea. Reposition every 1-2 hrs. The more upright/haunched over the better
What are 2 things the nurse can implement to prevent atelectasis?
- Encourage DEEP BREATHING to prevent anything from decreasing lung sound/function
- ADEQUATE HYDRATION- to thin out secretions in order to spit em out! Thinner blood also increases circulation
Why combine antitusives with guaifenesin?
to get rid of involuntary cough thats irritating pt so pt can sleep and decrease involuntary coughs. While increasing secretions to come up via voluntary cough and spit out to get better.
What are the benefits of humidified air?
aid secretions to be thin and mobile. For decreased viscosity of secretions
To maintain a patent airway, what are 3 coughing techniques?
- Cascade- cough deeply, hold 1-4 sec & then forcefully cough out
- Huff- slow deep breaths, hold 3 sec- 4 huf huf huf with each breath
- Quad- parapalegic pt- do not have ability to cough, no reflexes to be able to physically cough..call resp therapist
What is CO and how much?
Amount of blood ejected from heart each minute= 4-6 L = 1.5 gallons
LA–>LV= O2 right blood to entire body= CO
What is SV?
amount of blood ejected from heart with each beat.
LV release
What is Preload?
at end of diastolic and stretch of myocardium under or overstretched
VOLUME
What does Left sided HF cause?
LUNG CONGESTION- able to hear crackles
What does Right sided HF cause?
PERIPHERAL EDEMA- fluid backs up to rest of body
Afterload?
Plaque build up= Increased Resistance becasue heart working harder to push CO to body.
e.g- pipes clogged, shit cannot flush=backed up!
What % of 02 is normal room air?
21% of 02
What is hypertrophy and where can it occur?
Heart can ENLARGE- occurs LEFT SIDED HF
What happens if a person is experiencing Right Sided HF?
blood back flows to peripheral parts of the body. you can visually see EDEMA at the first site= LEGS.
* Do daily weights
How many L at rest is CO?
6 L/min = 1.5 gallons
How would you asses for Left Sided HF?
Auscultate for crackles on L side a.k.a FLUID in the lungs..may lead to Pneumonia
What is intermittent claudication?
pain in calves because not enough circulation in legs. when pt gaits there is tightness in legs.
S and Sx for intermittent claudication/peripheral a. disease?
- decreased peripheral pulses
- pale skin color
- cool extermities
- decreased hair distribution
What is the most common cause of impaired blood flow to organs/tissue?
ARTHEROSCLEROSIS because of plaque build up, poor diet, decreased exercise
What is an emboli and what can it cause?
A clot on the move can occlude blood supply and the valve infracts and dies= acute pulmonary embolism
What can you do for a pt to prevent clotting issues/venous stasis?
- elevate LE above heart level
- Don’t sit/raise leg on table= poor venous stasis= thickening of blood.
- No pillows under knees while sitting.
- Recliners are better
- ROM leg exercises
- Birth control pills common with DVT
- Change position, promote ambulation
- Apply TED HOSE/ANTIEMBOLIC STOCKINGS to promote venous return.
- SCDs- sequential compression device
Fluid accumulation in the lungs is called? And what causes it?
Hypostatic Pneumonia caused by immobility
How to stimulate cough reflex?
Tell pt to take 3 deep breaths
Virchow’s Triad related to clot formation?
- Endothelial damage- skin tear-scab=clot
- Hypercoaguability- blood thickening
- Venous stasis- dehydration- thicker blood= decreased circulation
What pts are at highest risk to dev blood clots & what are their effects?
Female, smoker, birth control pills
Effects: Pain, larger extremity with blood clots therefore measure difference
What happens during orthostatic hypotension?
Get up too fast so blood shunts to brain, heart and lungs. Does not get blood flow resulting to CYNCOPAL EPISODE and pt becomes LIGHT HEADED and BP decreases
Deep vein thrombosis (DVT)- INR’s
0.75-1.25
Therapeutic for pt on blood thinner should be 2-3
Protine PT- pt on Coumadin- INR’s
PT lab value: 10-14 sec
Therapeutic (1.5-2x control): 15-28 sec
Partial Thromboplastine PTT ot on Heparin- INR’s
PTT lab value: 20-35 sec
Therapeutic: 30-70 sec
Normal BP range
140/90
HTN: >140/>90
Where does Myocardium (<3 muscle) get its blood supply from?
Right coronary a.
Left coronary a.
both typically to get blocked by plaque
What is Ischemia?
pain, discomfort, chest pain= can lead to MI, heart attack= DEATH
What artery is associated with the widow maker?
LEFT CORONARY ARTERY most common a to get obstructed
What is Nitroglycerin?
Vasodilator- if stable angina, able to open up blockage, increase blood flow, reduce myocardial 02 consumption.
Increase CO, Decrease BP
What is Digoxin?
ANTIARRHYTHMICS- to help increase force of myocardial contractions of heart therefore heart BEATS SLOWER, INCREASING FORCE making CO increase.
–> Decrease HF, Increase CO, decrease tachyarrhythmias
Nursing interventions for Digoxin?
Listen to apical HR for full min, hold med if HR is less than 60 bpm
What is Metoprolol?
BETA BLOCKERS- give more for Rate and Rhythm versus to decrease BP.
What is Cozzar?
ANGIOTENSIN II RECEPTOR ANTAGONIST- blocks vasoconstrictor and aldosterone- secreting efx of angiotensin II
What is Lisinopril?
ACE INHIBITOR- interrupts Razz system, prevents Angiotensin I to convert to II, from causing vasoconstriction to create HTN
Type I gas exchange cells
gas exchange cells lol
Type II gas exchange cells
SURFACTANT PROD CELLS- lipoprotein to reduce surface tension, allows inflation and deflation while you breathe. If not, ALVEOLI not inflating and deflating, no lung sound= ATELECTASIS!
What does incentive spirometry measure?
Sustained max inspiration.
Good for pt recovering from surgery to prevent risk for pneumonia from lying down and build up secretion.
What is PND- perioxsismol disopnea?
SUDDEN S.O.B wakes up from sleep assoc with HF happening b/c fluid can accum. peripherally lying down therefore fluid flows back into CV system causing PULMONARY EDEMA and fluid in lungs because of the Increased CO.
What is the most accurate way to check oxygenated blood?
ABGs because direct to source
Why isn’t a pulse ox not as accurate as ABGs?
movement on pt or pt has cold hands therefore not good blood flow going to pulse ox= not as accurate
What is a TIA and CVA?
Trans ischemic attack- mini strokes
Cerebral vascular attack= stroke
