Oxygenation and Tissue Perfusion evolve Flashcards
Human tissues require oxygen to
meet metabolic requirements
The purpose of respiration is
deliver oxygen to the cells and remove carbon dioxide
The cardiovascular system moves
oxygen from the lungs to the tissues and carbon dioxide from the tissues back to the lungs, where it can be expired
Respiration is controlled by
neural and chemical changes that direct the depth and rate of respirations
The heart is ____ _____-_____ shaped organ
hollow, cone-shaped
the center area of the chest, known as
mediastinum
The size of the heart is
varies but usually is about 9 cm wide, 12 cm long, and 6 cm deep
The heart is composed of _____ chambers
4
the chamber on top of the heart are the
atria
The lower chambers of the heart are the
ventricles
The wall of the heart is composed of three layers which are
serous pericardium outer layer
myocardium
endocardium innermost layer
serous pericardium does what
protects the heart and secretes serous fluid
myocardium does what
thick layer of contractile muscle that contracts to push the blood out of the heart chambers
endocardium does what
provides a protective lining in the chambers and valves of the heart as well as the blood vessels
Cardiac output is calculated by
multiplying the heart rate in beats per minute times stroke volume in liters per beat
Preload is
the amount of blood and pressure in the ventricle at the end of diastole
Afterload is
is the resistance that has to be exceeded for the ventricle to eject the blood during systole
The respiratory system is divided into
the upper respiratory tract and the lower respiratory tract
The upper respiratory tract includes
nose,
nasal cavity,
sinuses
pharynx
The sinuses located in
skull
The sinuses are
air filled
The lower respiratory tract contains
larynx where the vocal cords are located
trachea
trachea is
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
These main stem bronchi and their subdivisions form
bronchial tree
Each bronchus divides repeatedly into increasingly smaller tubes, forming a network of bronchioles and alveolar ducts that
terminate in alveoli
Movement of air into the lungs is known as
Inspiration (inhalation)
The reversal of air movement is called
expiration
Inspiration begins with
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.
During expiration (exhalation)
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
The ability to inspire oxygen from the atmosphere depends on
intact lung structure
Alteration of lung tissue may
decrease delivery of oxygen to the alveoli
impede transfer of oxygen from alveoli to the bloodstream
hinder expulsion of carbon dioxide.
The heart functions as
a pump and pushes the oxygenated blood from the lungs to body tissues, where oxygen is used by the cells
A weakened or diseased heart
cannot pump correctly, decreasing the supply of oxygen to tissues.
coordinated beating of the heart begins with
organized impulse generation
The pacemaker of the heart is located in
right atrium and normally generates an impulse that produces a pulse that is 60 to 100 beats/min and regular
When the heart beats too slowly, too fast, or irregularly
ability to pump oxygen to cells can be interrupted.
Interruption of blood flow to the myocardium (heart muscle) can result from
narrowing of the arteries by atherosclerosis
spasms
congenital malformations
resulting in coronary artery disease
what causes a myocardial infarction (MI)
Blood clot formation or buildup of plaque in the coronary arteries may totally block blood flow to a portion of the myocardium
The clinical manifestations of an MI include
pain or discomfort between the neck and navel
associated dyspnea
diaphoresis
nausea
vomiting
Other cardiac irregularities may be associated with
decreased blood flow
interrupted electrical impulses
electrolyte disturbances
decreased blood flow
interrupted electrical impulses
electrolyte disturbances
signs
irregular heartbeat
difficulty breathing
dizziness with possible loss of consciousness
The heart may develop cardiac failure which causes
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
Causes of heart failure
damage to a heart valve
pressure around the heart
deficiency of the B vitamins
damage to blood vessels
the symptoms that warrant a call to the PCP in patient who had heart failure include
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
Chronic obstructive pulmonary disease (COPD) is
general term used for a group of disorders characterized by impaired airflow in the lungs
Emphysema is characterized by
enlargement of gas-exchange airways and damage to the alveolar walls in the lungs
its part of copd
Emphysema causes
Due to the loss of elasticity, expiration is difficult and air becomes trapped in the lungs, causing hyperinflation of the chest
The major contributing factors to emphysema is
cigarette smoking (main)
Exposure to pollution
family history of the disease
childhood respiratory tract infections
Chronic bronchitis is characterized by
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
what increases the risk for chronic bronchitis
Environmental exposures, including smoking, pollutants in many settings, and secondhand smoke
bronchitis is part of
copd
Smoking and frequent bronchopulmonary infections may
contribute to COPD
other disorders that cause respiratory disease
Pulmonary insufficiency, chronic pulmonary emphysema, pneumonia, atelectasis, asthma, and tuberculosis
Asthma is
chronic disorder that causes inflammation and constriction of the airways
Asthma produces symptoms
dyspnea
intermittent cough
chest tightness
exertional wheezing heard on auscultation
prolonged expiration
Asthma causes
genetics
allergies
The symptoms of asthma are caused by
airway spasms
bronchial narrowing or obstruction
mucous accumulation
airway inflammation
Asthma symptoms are often a response to
irritants, allergens, pollutants, exercise, or cold air.
Pneumonia is
an infection in the lungs
Pneumonia is caused by
bacteria, viruses, or fungi
The clinical manifestations of pneumonia include
fever
cough
increased secretions
difficulty breathing
sometimes the flu could cause
pneumonia
Key points for nursing management of pneumonia are
monitoring gas exchange and maintaining a patent airway
If aspiration is determined to be a contributing cause, swallow precautions are implemented
swallow precautions are
thickened liquids and keeping the patient in an upright position for feeding and drinking
Atelectasis results from
blockage or collapse of air passages in at least one lobe of the lungs
hypoventilation causes
Anesthesia, prolonged bed rest, and shallow breathing can decrease movement of the diaphragm and chest wall
Patients who have had abdominal or chest surgery are at risk for
hypoventilation and atelectasis
Untreated chronic lung disease may result in
respiratory failure
Respiratory failure occurs when
body is unable to maintain sufficient oxygenation to tissues because of disease or injury to the lungs
Symptoms of covid 19
fever or chills
cough
shortness of breath or difficulty breathing
fatigue
congestion or runny nose
diarrhea
loss of taste and smell
risk factors for COVID-19
prior stroke
diabetes
chronic lung disease
chronic kidney disease
Measures taken to prevent spread of covid 19 include
immunization
good hand hygiene
social distancing
wearing masks in public
Health Assessment Questions
Cardiovascular Focus
- 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?
Health Assessment Questions Pulmonary Focus
- 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?
A focused cardiopulmonary assessment is performed for any patient with symptoms of
decreased oxygenation
shortness of breath
activity intolerance
history of cardiac or respiratory problems
focused cardiopulmonary assessment in order
obtaining a set of vital signs and then performs a cardiac
respiratory
peripheral vascular assessment
in cardiopulmonary assessment Vital signs are obtained that include the blood pressure taken in three positions
lying, sitting, and standing
respiratory rate, and an apical and peripheral pulse
The apical and peripheral pulses are compared to
determine whether a pulse deficit exists
barrel-shaped chest may indicate
air trapping, which accompanies COPD
The use of accessory muscles may indicate
respiratory distress
Left ventricular hypertrophy may cause
the chest wall to move with each heartbeat
Palpation over the precordium for cardiac function assesses
cardiac enlargement or abnormal vibrations from turbulent blood flow due to hyperactivity or valve disease
thrill is
Abnormal vibration over the heart
During auscultation and hearing thrill, the vibration may be heard and is referred to as a
murmur
Auscultation of the lungs is completed on the
anterior, lateral, and posterior of the chest
Cough may be caused by
inflammation or by mechanical or chemical stimulation of the cough receptors in the lung
The nurse determines…… of the cough
duration and timing of the cough
whether the patient has a fever or wheezing
amount and characteristics of sputum
Hemoptysis is
the presence of blood in the sputum
Hemoptysis characteristics of the blood
flecks or streaks or frank bleeding
Edema may result from
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
Peripheral vascular assessment includes
evaluation of peripheral pulses
skin color and texture
capillary refill in the fingers and toes
Patients with cardiopulmonary problems may have
thready or absent peripheral pulses
changes in skin color and texture
slow capillary refill
Laboratory assessments determine
chemical imbalances or abnormal substances in the blood
blood counts, lipids, and cardiac enzymes
Noninvasive assessment includes
12-lead electrocardiogram (ECG)
chest x-ray
echocardiogram
pulmonary function tests
physical assessment
Forced vital capacity (FVC) is
the amount of air that can be forcefully expelled or exhaled after the lungs are maximally inflated
Forced vital capacity (FVC) normal amound
varies by age and size of the patient but is approximately 4 L in an adult
Forced expiratory volume in 1 second (FEV1) is
the volume of air expelled in 1 second from the beginning of the FVC
Forced expiratory volume in 1 second (FEV1) normal finding
75% to 85%
Forced expiratory flow (FEF) is
the maximal flow rate attained during the middle of the FVC maneuver
Forced expiratory flow (FEF)
vary by body size
In cases of emphysema, the result is 25% of the predicted normal value for the patient’s size
Residual volume (RV) is
the amount of air remaining in the lungs after forced expiration
Residual volume (RV) expected finding
1 L
Functional residual capacity (FRC) is
the volume of air that is left in the patient’s lung after normal expiration
Functional residual capacity (FRC) predicted normal volume
2.3 L
In emphysema, it may be increased up to 200%
RBC, hemoglobin, and hematocrit levels indicate
oxygen-carrying capacity
The hemoglobin level may be decreased in patients with
heart failure
hemoglobin increase with patients who have
COPD
Elevation of the WBC level indicates
infection
The basic metabolic panel is
series of blood tests
basic metabolic panel assess a patient’s
renal function
glucose level
electrolytes
basic metabolic panel patient with heart failure or hypertension may be on diuretics which cause
hypokalemia and hypomagnesemia
electrolyte imbalances cause
cardiac arrhythmias
Blood samples for arterial blood gas determinations are drawn from patients with
decreased oxygenation and a suspected acid-base imbalance
Arterial Blood Gases: COPD causes
impaired gas exchange, leading to decreased oxygen levels and higher circulating levels of carbon dioxide
A lipoprotein profile is used to diagnose
hyperlipidemia
hyperlipidemia is a risk factor for
coronary heart disease
lipoprotein profile usually measures four levels:
total cholesterol
low-density lipoprotein (LDL) cholesterol
high-density lipoprotein (HDL) cholesterol
triglycerides
the primary lipid is
Cholesterol
if the levels of Cholesterol are too high
atherosclerosis may develope
The target value for HDL is
greater than 45 mg/dL for males
greater than 55 mg/dL for females
The desired value for LDL is
less than 130 mg/dL
The desired value for triglycerides is
less than 160 mg/dL for males
less than 135 mg/dL for females
necrosis is
death of heart muscle cells
Cardiac Enzymes: When a patient has MI symptoms
enzyme levels are evaluated to determine whether damage to the heart has occurred
The cardiac troponin T and I proteins are
the most helpful biomarkers for determining whether an MI has occurred
chest x-ray is performed to examine
lungs, heart, and bones of the chest
ensure proper location of certain devices
chest x-ray Abnormal findings
fractures
tumors
pneumothorax
pneumonia
pleural effusion
pericardial effusion
enlarged heart and atelectasis
pleural effusion is
excess fluid accumulation in the pleural cavity
pericardial effusion is
fluid around the heart
pneumothorax is
air in the pleural cavity
An electrocardiogram is also called
ECG/ EKG
electrocardiogram is
graphic representation of the electrical activity that occurs in the heart
ECG is performed using
12-lead approach that gathers impulses from 12 areas
electrocardiogram Test results are interpreted for
rate and rhythm of the heart
lack of blood supply
abnormalities of the conduction system
arrhythmias
echocardiogram is
noninvasive ultrasound that uses sound waves to visualize the heart structure and evaluate the function of the heart
echocardiogram test shows
movement of blood through the heart
it is used to measure cardiac output
Echocardiograms are used to
evaluate congenital heart defects
pericardial effusion
disorders of the heart valves
heart size
effectiveness of cardiac output
blood flow
Cardiac catheterization uses
contrast and a long, flexible catheter
Cardiac catheterization visualize
heart chambers
coronary arteries
great vessels
Cardiac catheterization is used to
evaluate chest pain
locate the region of coronary artery occlusion,
determine the effects of valvular heart disease
Oxygen therapy for more than __ _____ per day has shown _______ _____ _____for patients with chronic respiratory failure and severe resting hypoxia
15 hours, survival rates
oxygen therapy prescribed to individuals who have stable COPD with mild to moderate resting, nocturnal, or exercise-induced arterial desaturation has
not been shown to improve survival rates or decrease the amount of time to the first hospitalization
The goal of long-term therapy is usually to have a baseline OF
PaO2 of 60 mm Hg at rest and an oxygen saturation level of more than 90%,
Oxygen saturation may decrease during
exercise
sleep
deterioration of the respiratory status
Oxygen concentration of room air is
21%
The goal of oxygen therapy is to
decrease the symptoms related to low oxygen levels
decrease the workload on the cardiovascular system
Oxygen Administration: Clinical practice guidelines for safe and effective patient care include
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
hypoxemia is
low level of oxygen in the blood
how to check for hypoxemia
arterial blood gas analysis or measurement of hemoglobin oxygen saturation
Hypoxemia may manifest as
high respiratory or heart rate
cyanosis
feeling of distress
hypercapnia is
abnormally high level of carbon dioxide in the blood
> 45 mm Hg in arterial blood
COPD patients keep the oxygen saturation above
88%
Other complications of oxygen administration
high levels of oxygen pose a fire hazard
the moisture in humidifiers and nebulizers can become contaminated with bacteria
Devices used to deliver oxygen are categorized as
low-flow systems
reservoir systems
high-flow systems
commonly used low-flow system is
nasal cannula
Cannulas are contraindicated for
newborns and infants with obstructed nasal passages
reservoir masks is
valve system
partial rebreather mask and nonrebreather mask have
1-L reservoir bag that is flexible and has an oxygen inlet
bag-valve-mask (BVM) device uses one-way valve to
support, ventilate, and oxygenate a patient who needs ventilatory support
who can use bvm
personnel who have been properly trained and certified
Pharyngeal airways are needed most often when
patient has a decreased level of consciousness and loss of muscle tone
Oropharyngeal airways are inserted
through the mouth
nasopharyngeal airway is placed
nasally
tracheal airways are
Airways that go beyond the pharynx and into the trachea
Endotracheal tubes shape
semirigid curved tubes with a cuff at the distal end that seals
Endotracheal tubes pros
prevent aspiration of gastric contents into the lung
allow positive pressure for ventilation
keep air from leaking out of the airway
tracheostomy tube is placed
directly in the trachea to control the airway
removable inner cannula has a standard __-mm adapter
15
diet recommended for patients at risk for cardiopulmonary disease
high-fiber
low-fat
Several medications are used for treating pulmonary diseases
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.
Hypertension is treated with what meds
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
Chest tubes help
drain fluid or blood (hemothorax) and excessive air (pneumothorax) from the pleural space
Antiembolism hose are
elastic stockings used to promote venous blood return and prevent edema in the lower extremities, DVT, venous stasis, and PE
Tracheostomy Care Purpose
- To prevent skin breakdown at the tracheostomy site
- To prevent infection
- To maintain a patent airway
Tracheostomy, Nasotracheal, Nasopharyngeal, Oropharyngeal, and Oral Suctioning purpose
- To remove mucus from the respiratory tract
- To assist the patient in clearing the airway
- To obtain specimens for ordered tests
- To prevent infections
Care of Chest Tubes and Disposable Drainage Systems Purpose
- To promote optimal respiratory functioning
- To monitor drainage to ensure ultimate lung expansion
- To monitor and prevent complications
dyspena signs
its subjective
difficulty breathing
apena signs
absence of breath
tachypnea is
increased breathing
