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exam 3 > Oxygenation and Tissue Perfusion evolve > Flashcards

Oxygenation and Tissue Perfusion evolve Flashcards

1
Q

Human tissues require oxygen to

A

meet metabolic requirements

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2
Q

The purpose of respiration is

A

deliver oxygen to the cells and remove carbon dioxide

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3
Q

The cardiovascular system moves

A

oxygen from the lungs to the tissues and carbon dioxide from the tissues back to the lungs, where it can be expired

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4
Q

Respiration is controlled by

A

neural and chemical changes that direct the depth and rate of respirations

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5
Q

The heart is ____ _____-_____ shaped organ

A

hollow, cone-shaped

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6
Q

the center area of the chest, known as

A

mediastinum

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7
Q

The size of the heart is

A

varies but usually is about 9 cm wide, 12 cm long, and 6 cm deep

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8
Q

The heart is composed of _____ chambers

A

4

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9
Q

the chamber on top of the heart are the

A

atria

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10
Q

The lower chambers of the heart are the

A

ventricles

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11
Q

The wall of the heart is composed of three layers which are

A

serous pericardium outer layer

myocardium

endocardium innermost layer

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12
Q

serous pericardium does what

A

protects the heart and secretes serous fluid

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13
Q

myocardium does what

A

thick layer of contractile muscle that contracts to push the blood out of the heart chambers

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14
Q

endocardium does what

A

provides a protective lining in the chambers and valves of the heart as well as the blood vessels

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15
Q

Cardiac output is calculated by

A

multiplying the heart rate in beats per minute times stroke volume in liters per beat

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16
Q

Preload is

A

the amount of blood and pressure in the ventricle at the end of diastole

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17
Q

Afterload is

A

is the resistance that has to be exceeded for the ventricle to eject the blood during systole

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18
Q

The respiratory system is divided into

A

the upper respiratory tract and the lower respiratory tract

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19
Q

The upper respiratory tract includes

A

nose,
nasal cavity,
sinuses
pharynx

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20
Q

The sinuses located in

A

skull

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21
Q

The sinuses are

A

air filled

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22
Q

The lower respiratory tract contains

A

larynx where the vocal cords are located
trachea

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23
Q

trachea is

A

flexible tube about 2.5 cm in diameter and 11 cm long that transports air from the larynx to the lungs

where it branches into right and left bronchi

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24
Q

These main stem bronchi and their subdivisions form

A

bronchial tree

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25
Q

Each bronchus divides repeatedly into increasingly smaller tubes, forming a network of bronchioles and alveolar ducts that

A

terminate in alveoli

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26
Q

Movement of air into the lungs is known as

A

Inspiration (inhalation)

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27
Q

The reversal of air movement is called

A

expiration

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28
Q

Inspiration begins with

A

impulses from the respiratory center in the brain that travel through the phrenic and intercostal nerves and stimulate the diaphragm to move downward and the chest cavity to expand. The resulting expanded lung volume decreases the intraalveolar pressure. Atmospheric pressure is then higher than the intraalveolar pressure, causing air to move into the respiratory tract and the lungs to fill with air.

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29
Q

During expiration (exhalation)

A

the diaphragm relaxes, the elastic tissues of the chest and lungs recoil, and intraalveolar pressures increase, causing air to be forced out of the lungs

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30
Q

The ability to inspire oxygen from the atmosphere depends on

A

intact lung structure

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31
Q

Alteration of lung tissue may

A

decrease delivery of oxygen to the alveoli

impede transfer of oxygen from alveoli to the bloodstream

hinder expulsion of carbon dioxide.

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32
Q

The heart functions as

A

a pump and pushes the oxygenated blood from the lungs to body tissues, where oxygen is used by the cells

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33
Q

A weakened or diseased heart

A

cannot pump correctly, decreasing the supply of oxygen to tissues.

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34
Q

coordinated beating of the heart begins with

A

organized impulse generation

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35
Q

The pacemaker of the heart is located in

A

right atrium and normally generates an impulse that produces a pulse that is 60 to 100 beats/min and regular

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36
Q

When the heart beats too slowly, too fast, or irregularly

A

ability to pump oxygen to cells can be interrupted.

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37
Q

Interruption of blood flow to the myocardium (heart muscle) can result from

A

narrowing of the arteries by atherosclerosis

spasms

congenital malformations

resulting in coronary artery disease

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38
Q

what causes a myocardial infarction (MI)

A

Blood clot formation or buildup of plaque in the coronary arteries may totally block blood flow to a portion of the myocardium

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39
Q

The clinical manifestations of an MI include

A

pain or discomfort between the neck and navel

associated dyspnea

diaphoresis

nausea

vomiting

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40
Q

Other cardiac irregularities may be associated with

A

decreased blood flow
interrupted electrical impulses
electrolyte disturbances

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41
Q

decreased blood flow
interrupted electrical impulses
electrolyte disturbances

signs

A

irregular heartbeat
difficulty breathing
dizziness with possible loss of consciousness

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42
Q

The heart may develop cardiac failure which causes

A

decreased contractility

impairs systolic function

leads to ventricular dilation

reduces the ability of the heart to meet the needs of the body tissues

ejection fraction is reduced

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43
Q

Causes of heart failure

A

damage to a heart valve
pressure around the heart
deficiency of the B vitamins
damage to blood vessels

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44
Q

the symptoms that warrant a call to the PCP in patient who had heart failure include

A

shortness of breath with exertion or when supine

weight gain of 2 to 3 pounds in 1 day or 5 pounds in 1 week

increased cough with pink-tinged sputum

new or increased swelling of the ankles, feet, or abdomen

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45
Q

Chronic obstructive pulmonary disease (COPD) is

A

general term used for a group of disorders characterized by impaired airflow in the lungs

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46
Q

Emphysema is characterized by

A

enlargement of gas-exchange airways and damage to the alveolar walls in the lungs

its part of copd

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47
Q

Emphysema causes

A

Due to the loss of elasticity, expiration is difficult and air becomes trapped in the lungs, causing hyperinflation of the chest

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48
Q

The major contributing factors to emphysema is

A

cigarette smoking (main)

Exposure to pollution

family history of the disease

childhood respiratory tract infections

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49
Q

Chronic bronchitis is characterized by

A

inflammation of the larger airways, increased production of mucus, and chronic cough

Eventually, the lining of the airways is damaged, increasing the difficulty of clearing mucus

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50
Q

what increases the risk for chronic bronchitis

A

Environmental exposures, including smoking, pollutants in many settings, and secondhand smoke

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51
Q

bronchitis is part of

A

copd

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52
Q

Smoking and frequent bronchopulmonary infections may

A

contribute to COPD

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53
Q

other disorders that cause respiratory disease

A

Pulmonary insufficiency, chronic pulmonary emphysema, pneumonia, atelectasis, asthma, and tuberculosis

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54
Q

Asthma is

A

chronic disorder that causes inflammation and constriction of the airways

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55
Q

Asthma produces symptoms

A

dyspnea
intermittent cough
chest tightness
exertional wheezing heard on auscultation
prolonged expiration

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56
Q

Asthma causes

A

genetics

allergies

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57
Q

The symptoms of asthma are caused by

A

airway spasms
bronchial narrowing or obstruction
mucous accumulation
airway inflammation

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58
Q

Asthma symptoms are often a response to

A

irritants, allergens, pollutants, exercise, or cold air.

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59
Q

Pneumonia is

A

an infection in the lungs

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60
Q

Pneumonia is caused by

A

bacteria, viruses, or fungi

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61
Q

The clinical manifestations of pneumonia include

A

fever
cough
increased secretions
difficulty breathing

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62
Q

sometimes the flu could cause

A

pneumonia

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63
Q

Key points for nursing management of pneumonia are

A

monitoring gas exchange and maintaining a patent airway

If aspiration is determined to be a contributing cause, swallow precautions are implemented

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64
Q

swallow precautions are

A

thickened liquids and keeping the patient in an upright position for feeding and drinking

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65
Q

Atelectasis results from

A

blockage or collapse of air passages in at least one lobe of the lungs

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66
Q

hypoventilation causes

A

Anesthesia, prolonged bed rest, and shallow breathing can decrease movement of the diaphragm and chest wall

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67
Q

Patients who have had abdominal or chest surgery are at risk for

A

hypoventilation and atelectasis

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68
Q

Untreated chronic lung disease may result in

A

respiratory failure

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69
Q

Respiratory failure occurs when

A

body is unable to maintain sufficient oxygenation to tissues because of disease or injury to the lungs

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70
Q

Symptoms of covid 19

A

fever or chills
cough
shortness of breath or difficulty breathing
fatigue
congestion or runny nose
diarrhea
loss of taste and smell

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71
Q

risk factors for COVID-19

A

prior stroke
diabetes
chronic lung disease
chronic kidney disease

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72
Q

Measures taken to prevent spread of covid 19 include

A

immunization
good hand hygiene
social distancing
wearing masks in public

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73
Q

Health Assessment Questions
Cardiovascular Focus

A
  • Are you having chest pain? If so, rate it on a scale of 0 to 10.
  • How long have you had the pain?
  • Is the pain located in one area or does it radiate to other areas?
  • Do activities or medications make it worse or better?
  • Are symptoms such as shortness of breath or sweating associated with the pain?
  • Do you have increased fatigue?
  • Have you had recent weight gain?
  • Have you had changes in skin texture, color, or temperature?
  • Do you take medications that prevent blood clots?
  • Have you had sores on your lower extremities that have not healed?
  • Have you had episodes of dizziness or loss of consciousness?
  • Do you have other chronic diseases?
74
Q

Health Assessment Questions Pulmonary Focus

A
  • Have you had breathing difficulties when you are exercising or at rest?
  • Have you had a loss of appetite, weight loss, or weakness?
  • Have you ever smoked?
  • If so, are you still smoking or did you quit smoking?
  • How many packs per day (ppd)?
  • Do you sleep on one or more pillows?
  • How much do you exercise?
  • Do you have wheezing, pain with breathing, or difficulty clearing your secretions?
  • Have you had asthma, bronchitis, or other lung diseases in the past?
  • Do you use oxygen at home?
  • What type of work have you done and were you exposed to hazardous materials?
  • Do you have anxiety related to your breathing condition?
  • Do you have a cough? For how long?
  • Are you coughing anything up? Color of sputum?
  • Is it worse when you lie down?
  • Have you had COVID-19? If so, when? Do you have increased fatigue, decreased energy, or shortness of breath?
  • Have you had immunizations for flu? Pneumonia? COVID-19? If so, when?
75
Q

A focused cardiopulmonary assessment is performed for any patient with symptoms of

A

decreased oxygenation
shortness of breath
activity intolerance
history of cardiac or respiratory problems

76
Q

focused cardiopulmonary assessment in order

A

obtaining a set of vital signs and then performs a cardiac
respiratory
peripheral vascular assessment

77
Q

in cardiopulmonary assessment Vital signs are obtained that include the blood pressure taken in three positions

A

lying, sitting, and standing

respiratory rate, and an apical and peripheral pulse

78
Q

The apical and peripheral pulses are compared to

A

determine whether a pulse deficit exists

79
Q

barrel-shaped chest may indicate

A

air trapping, which accompanies COPD

80
Q

The use of accessory muscles may indicate

A

respiratory distress

81
Q

Left ventricular hypertrophy may cause

A

the chest wall to move with each heartbeat

82
Q

Palpation over the precordium for cardiac function assesses

A

cardiac enlargement or abnormal vibrations from turbulent blood flow due to hyperactivity or valve disease

83
Q

thrill is

A

Abnormal vibration over the heart

84
Q

During auscultation and hearing thrill, the vibration may be heard and is referred to as a

A

murmur

85
Q

Auscultation of the lungs is completed on the

A

anterior, lateral, and posterior of the chest

86
Q

Cough may be caused by

A

inflammation or by mechanical or chemical stimulation of the cough receptors in the lung

87
Q

The nurse determines…… of the cough

A

duration and timing of the cough

whether the patient has a fever or wheezing

amount and characteristics of sputum

88
Q

Hemoptysis is

A

the presence of blood in the sputum

89
Q

Hemoptysis characteristics of the blood

A

flecks or streaks or frank bleeding

90
Q

Edema may result from

A

excessive fluid in the vascular system that increases pressure in the capillaries and forces fluid out of the vessels and into the surrounding tissues

Poor venous return

damage to the lymphatic system

91
Q

Peripheral vascular assessment includes

A

evaluation of peripheral pulses

skin color and texture

capillary refill in the fingers and toes

92
Q

Patients with cardiopulmonary problems may have

A

thready or absent peripheral pulses

changes in skin color and texture

slow capillary refill

93
Q

Laboratory assessments determine

A

chemical imbalances or abnormal substances in the blood

blood counts, lipids, and cardiac enzymes

94
Q

Noninvasive assessment includes

A

12-lead electrocardiogram (ECG)
chest x-ray
echocardiogram
pulmonary function tests
physical assessment

95
Q

Forced vital capacity (FVC) is

A

the amount of air that can be forcefully expelled or exhaled after the lungs are maximally inflated

96
Q

Forced vital capacity (FVC) normal amound

A

varies by age and size of the patient but is approximately 4 L in an adult

97
Q

Forced expiratory volume in 1 second (FEV1) is

A

the volume of air expelled in 1 second from the beginning of the FVC

98
Q

Forced expiratory volume in 1 second (FEV1) normal finding

A

75% to 85%

99
Q

Forced expiratory flow (FEF) is

A

the maximal flow rate attained during the middle of the FVC maneuver

100
Q

Forced expiratory flow (FEF)

A

vary by body size

In cases of emphysema, the result is 25% of the predicted normal value for the patient’s size

101
Q

Residual volume (RV) is

A

the amount of air remaining in the lungs after forced expiration

102
Q

Residual volume (RV) expected finding

A

1 L

103
Q

Functional residual capacity (FRC) is

A

the volume of air that is left in the patient’s lung after normal expiration

104
Q

Functional residual capacity (FRC) predicted normal volume

A

2.3 L

In emphysema, it may be increased up to 200%

105
Q

RBC, hemoglobin, and hematocrit levels indicate

A

oxygen-carrying capacity

106
Q

The hemoglobin level may be decreased in patients with

A

heart failure

107
Q

hemoglobin increase with patients who have

A

COPD

108
Q

Elevation of the WBC level indicates

A

infection

109
Q

The basic metabolic panel is

A

series of blood tests

110
Q

basic metabolic panel assess a patient’s

A

renal function
glucose level
electrolytes

111
Q

basic metabolic panel patient with heart failure or hypertension may be on diuretics which cause

A

hypokalemia and hypomagnesemia

112
Q

electrolyte imbalances cause

A

cardiac arrhythmias

113
Q

Blood samples for arterial blood gas determinations are drawn from patients with

A

decreased oxygenation and a suspected acid-base imbalance

114
Q

Arterial Blood Gases: COPD causes

A

impaired gas exchange, leading to decreased oxygen levels and higher circulating levels of carbon dioxide

115
Q

A lipoprotein profile is used to diagnose

A

hyperlipidemia

116
Q

hyperlipidemia is a risk factor for

A

coronary heart disease

117
Q

lipoprotein profile usually measures four levels:

A

total cholesterol
low-density lipoprotein (LDL) cholesterol
high-density lipoprotein (HDL) cholesterol
triglycerides

118
Q

the primary lipid is

A

Cholesterol

119
Q

if the levels of Cholesterol are too high

A

atherosclerosis may develope

120
Q

The target value for HDL is

A

greater than 45 mg/dL for males
greater than 55 mg/dL for females

121
Q

The desired value for LDL is

A

less than 130 mg/dL

122
Q

The desired value for triglycerides is

A

less than 160 mg/dL for males
less than 135 mg/dL for females

123
Q

necrosis is

A

death of heart muscle cells

124
Q

Cardiac Enzymes: When a patient has MI symptoms

A

enzyme levels are evaluated to determine whether damage to the heart has occurred

125
Q

The cardiac troponin T and I proteins are

A

the most helpful biomarkers for determining whether an MI has occurred

126
Q

chest x-ray is performed to examine

A

lungs, heart, and bones of the chest

ensure proper location of certain devices

127
Q

chest x-ray Abnormal findings

A

fractures
tumors
pneumothorax
pneumonia
pleural effusion
pericardial effusion
enlarged heart and atelectasis

128
Q

pleural effusion is

A

excess fluid accumulation in the pleural cavity

129
Q

pericardial effusion is

A

fluid around the heart

130
Q

pneumothorax is

A

air in the pleural cavity

131
Q

An electrocardiogram is also called

A

ECG/ EKG

132
Q

electrocardiogram is

A

graphic representation of the electrical activity that occurs in the heart

133
Q

ECG is performed using

A

12-lead approach that gathers impulses from 12 areas

134
Q

electrocardiogram Test results are interpreted for

A

rate and rhythm of the heart
lack of blood supply
abnormalities of the conduction system
arrhythmias

135
Q

echocardiogram is

A

noninvasive ultrasound that uses sound waves to visualize the heart structure and evaluate the function of the heart

136
Q

echocardiogram test shows

A

movement of blood through the heart

it is used to measure cardiac output

137
Q

Echocardiograms are used to

A

evaluate congenital heart defects

pericardial effusion

disorders of the heart valves

heart size

effectiveness of cardiac output

blood flow

138
Q

Cardiac catheterization uses

A

contrast and a long, flexible catheter

139
Q

Cardiac catheterization visualize

A

heart chambers
coronary arteries
great vessels

140
Q

Cardiac catheterization is used to

A

evaluate chest pain

locate the region of coronary artery occlusion,

determine the effects of valvular heart disease

141
Q

Oxygen therapy for more than __ _____ per day has shown _______ _____ _____for patients with chronic respiratory failure and severe resting hypoxia

A

15 hours, survival rates

142
Q

oxygen therapy prescribed to individuals who have stable COPD with mild to moderate resting, nocturnal, or exercise-induced arterial desaturation has

A

not been shown to improve survival rates or decrease the amount of time to the first hospitalization

143
Q

The goal of long-term therapy is usually to have a baseline OF

A

PaO2 of 60 mm Hg at rest and an oxygen saturation level of more than 90%,

144
Q

Oxygen saturation may decrease during

A

exercise
sleep
deterioration of the respiratory status

145
Q

Oxygen concentration of room air is

A

21%

146
Q

The goal of oxygen therapy is to

A

decrease the symptoms related to low oxygen levels

decrease the workload on the cardiovascular system

147
Q

Oxygen Administration: Clinical practice guidelines for safe and effective patient care include

A

evaluating the indications for oxygen therapy

taking necessary safety precautions

determining the need for oxygen

assessing the outcome of therapy

monitoring the patient on supplemental oxygen

148
Q

hypoxemia is

A

low level of oxygen in the blood

149
Q

how to check for hypoxemia

A

arterial blood gas analysis or measurement of hemoglobin oxygen saturation

150
Q

Hypoxemia may manifest as

A

high respiratory or heart rate

cyanosis

feeling of distress

151
Q

hypercapnia is

A

abnormally high level of carbon dioxide in the blood

> 45 mm Hg in arterial blood

152
Q

COPD patients keep the oxygen saturation above

A

88%

153
Q

Other complications of oxygen administration

A

high levels of oxygen pose a fire hazard

the moisture in humidifiers and nebulizers can become contaminated with bacteria

154
Q

Devices used to deliver oxygen are categorized as

A

low-flow systems
reservoir systems
high-flow systems

155
Q

commonly used low-flow system is

A

nasal cannula

156
Q

Cannulas are contraindicated for

A

newborns and infants with obstructed nasal passages

157
Q

reservoir masks is

A

valve system

158
Q

partial rebreather mask and nonrebreather mask have

A

1-L reservoir bag that is flexible and has an oxygen inlet

159
Q

bag-valve-mask (BVM) device uses one-way valve to

A

support, ventilate, and oxygenate a patient who needs ventilatory support

160
Q

who can use bvm

A

personnel who have been properly trained and certified

161
Q

Pharyngeal airways are needed most often when

A

patient has a decreased level of consciousness and loss of muscle tone

162
Q

Oropharyngeal airways are inserted

A

through the mouth

163
Q

nasopharyngeal airway is placed

A

nasally

164
Q

tracheal airways are

A

Airways that go beyond the pharynx and into the trachea

165
Q

Endotracheal tubes shape

A

semirigid curved tubes with a cuff at the distal end that seals

166
Q

Endotracheal tubes pros

A

prevent aspiration of gastric contents into the lung

allow positive pressure for ventilation

keep air from leaking out of the airway

167
Q

tracheostomy tube is placed

A

directly in the trachea to control the airway

168
Q

removable inner cannula has a standard __-mm adapter

A

15

169
Q

diet recommended for patients at risk for cardiopulmonary disease

A

high-fiber
low-fat

170
Q

Several medications are used for treating pulmonary diseases

A

Oral bronchodilators increase the diameter of the bronchi and bronchioles, which decreases wheezing and improves oxygenation.

Inhalation therapy bronchodilators increase the diameter of the bronchi, which decreases wheezing and improves oxygenation.

Anticholinergic agents decrease secretions, which improves airway clearance and decreases bronchospasm.

Corticosteroids decrease inflammation, which improves respiratory function.

Vaccines provide protection against communicable diseases, including influenza and pneumonia.

Antibiotics treat bacterial infections when they occur.

Mucolytic therapy decreases the thickness of secretions, which improves airway clearance.

Leukotriene modifiers decrease inflammation in the airways.

171
Q

Hypertension is treated with what meds

A

diuretics, such as thiazides, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, beta-blockers, calcium channel blockers, alpha-1 antagonists, alpha-2 agonists, and vasodilators

172
Q

Chest tubes help

A

drain fluid or blood (hemothorax) and excessive air (pneumothorax) from the pleural space

173
Q

Antiembolism hose are

A

elastic stockings used to promote venous blood return and prevent edema in the lower extremities, DVT, venous stasis, and PE

174
Q

Tracheostomy Care Purpose

A
  • To prevent skin breakdown at the tracheostomy site
  • To prevent infection
  • To maintain a patent airway
175
Q

Tracheostomy, Nasotracheal, Nasopharyngeal, Oropharyngeal, and Oral Suctioning purpose

A
  • To remove mucus from the respiratory tract
  • To assist the patient in clearing the airway
  • To obtain specimens for ordered tests
  • To prevent infections
176
Q

Care of Chest Tubes and Disposable Drainage Systems Purpose

A
  • To promote optimal respiratory functioning
  • To monitor drainage to ensure ultimate lung expansion
  • To monitor and prevent complications
177
Q

dyspena signs

A

its subjective

difficulty breathing

178
Q

apena signs

A

absence of breath

179
Q

tachypnea is

A

increased breathing

180
Q
A

exam 3 (12 decks)

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