Oxygenation- cardiopulmonary Flashcards
Inspiration
Diaphragm and intercostals contract.
Intrapulmonary pressure decreases below atmospheric pressure.
Tidal volume
Volume of both inspired and expired breath and one normal breath.
Approximately 500 ml
Hemoglobin
Component of RBC’s.
Carries oxygen from lungs to tissues and CO2 from tissues to lungs.
Contains iron.
Hypoventilation
Alveolar disturbance
Either not enough oxygen is filtered through alveoli to meet metabolic needs of the body for the oxygen
or there is a buildup of carbon dioxide in the alveoli that can back up into the blood.
Hypercapnia
Too much carbon dioxide in blood
Atelectasis
Alveoli collapse and a partial or total collapse of the lung occurs
Hypoxia
Symptoms
More advanced state of hypoventilation.
Anxiety, restlessness, dizziness, increase in rate and depth of respirations followed by tachypnea, tachycardia, increase or decrease in blood pressure.
Severe hypoxia: Cyanosis, bradycardia, dyspnea and changes in level of consciousness.
Dyspnea
Extreme SOB
Oxygenation related to COPD
Severe hypoxia can result if too much oxygen is given as a treatment for COPD.
Have higher than normal CO2 in blood. Increased CO2 triggers response to breathe.
If too much O2, can prevent trigger and can arrest or decrease respirations.
Hyperventilation
Increased rate of respiration to rid the body of excess carbon dioxide.
A cause could be metabolic acidosis which can be a complication of uncontrolled diabetes.
Can also be prompted by anxiety or high fever.
Kussmaul breathing
Breathing that is very deep and rapid associated with metabolic acidosis or diabetic keto acidosis.
Circumoral parasthesia
Tingling around the mouth
Bradypnea
Slow breathing
Can result from drug overdose or brain injuries
Tachypnea
Rapid respiration rate
can because by strong emotions such as fear and pain or high fevers
Cheyne- Stokes breathing
Breathing pattern marked by apnea lasting 10 to 60 seconds followed by gradually increasing depth and frequency of respirations-hyperventilation.
Drug overdoses or any disease process that increases Cranial pressure
Biot’s breathing
Caused by intracranial pressure
Characterized by several short breaths followed by long and irregular periods of apnea
CHF
Ventricles can’t pump blood sufficiently.
Can be caused by MI, other cardiac disease, fluid overload.
Pulmonary edema
When left ventricle is unable to pump blood effectively, blood can back up into pulmonary system.
Accumulation of fluid in lungs with swelling or stretching of pulm blood vessels.
Ischemia
Lack of Blood supply
CVA or TIA
CVA- Blood flow severely compromised to any portion of the brain.
TIA- periodic episodes of ischemia
Angina pectoris
Transient narrowing of coronary blood vessels.
Substernal chest pain. Unlike an MI, angina can be relieved by nitro.
Nitro dilates blood vessels.
Higher BP, especially diastolic can be indicative of what?
Narrowed blood vessels due to atherosclerosis.
Vital capacity
Amount of air inhaled then exhaled forcibly with one breath
Orthopnea
Difficulty breathing while lying down
Rales
Crackling
Caused by fluid or secretions.
usually located in the lower lobes of the lungs
Rhonchi
Low pitched, gurgling and moaning sound.
Caused by secretions or narrow air passages
usually in the trachea and bronchi
Pleural friction rub
Creaking sound, like in an unoiled hinge.
Caused by plural services of lungs inflamed and rub together.
Usually located in the front and side of the chest just below the rib cage.
Bronchial wheeze
High-pitched, squeaky sound. Caused by bronchi narrowing from secretions.
can be found in all lobes of the lungs.
What does absence of breath sounds mean?
Collapsed lung
Fremitus
Vibrations when both hands are placed on posterior chest wall over lobes of lungs. Patient is encouraged to speak a word, like “one” several times.
Increased fremitus could indicate pneumonia.
Absence of fremitus might indicate a collapsed lung.
Hemoglobin and Hematocrit definitions
Hemoglobin measures Blood’s oxygen carrying capacity in RBC’s.
Hematocrit measures % of RBC’s in total blood volume.
Hemoglobin normal values
Female: 12-16 grams/ ml
Male: 14-18 grams/ml
Children slightly lower
Hematocrit values
Females: 37-47
Males: 40-54
WBC’s
Done to determine if there is any bacterial infection.
Elevated WBC over 100,000 per cubic ml of whole blood indicate an acute infection.
Acid fast bacillus test (AFB)
Sputum test for tuberculosis
Sputum is collected over a 3 day period prior to breakfast.
Orthopneic position
Patient sits in chair or in bed.
Leans forward and places head on pillows on tray table.
COPD
3 primary classes of bronchodilators
Beta-agonists (albuterol)
Methylxanthines (theophylline)
Anticholinergics (ipratropium)
Used for asthma and copd
relaxes smooth muscle in resp system and pulm blood vessels
Glucocorticoids
Anti-inflammatory meds that decrease airway edema.
Can be po, IV or inhaler
Prednisone, beclomethasone(qvar)
Leukotriene inhibitors
Block effects of inflammatory mediators.
Montelukast
What does the QRS interval represent on ecg?
QRS complex indicates electrical activity of ventricles
Symptoms of left sided Heart failure
Pulmonary congestion Dyspnea DOE Orthopnea Bilateral crackles Mental confusion
Symptoms of right sided heart failure:
Jugular neck vein distention, peripheral edema,
Hepatomegaly
First step if Chest tube collection unit breaks open:
End of the chest tube should be quickly submerged in a container of sterile water to reestablish the seal.
Clamping the chest tube may result in a tension pneumothorax.
First step for ventricular fibrillation:
Prepare for CPR
variances in electrolyte values may cause what change in an ekg?
Increase QT interval.
Amiodarone and other meds can also can increase the QT interval.
How long does angina pain usually last?
1-15 minutes
What does pack-year history mean?
Packs of cigarettes per day X amount of years smoked
Example: smoke 2 packs per day for 20 years would be 40 pack-year history
If a question about orthopnea is asked, what is usually the answer?
Number of pillows used to assist laying more upright in bed
Or vice versa-
According to American Cancer Society, how much more likely is a smoker to develop lung cancer?
10 times more likely
Where should the obturator for tracheostomy be kept?
Taped to head of bed. It is a curved piece of plastic the guides the insertion of the trach. Should be close by and easy to find in case the trach comes out.
What is the first thing to do upon removal of a chest tube?
Close with the purse strings suture or cover with an occlusive dressing. Need to prevent air leakage into the chest cavity.
How does the nurse assess if a nasotracheal tube is still in place?
If the tube is in the correct position, the nurse should be able to hear equal bilateral breath sounds
What kind of croup is an emergency?
Epiglottitis
Requires antibiotics and airway support.
Never use tongue depressor to examine because it could cause complete obstruction. Only use tongue depressor if intubation can take place.
What is the earliest recognizable clinical manifestation of cystic fibrosis?
Meconium ilius-
Thicker than normal meconium. Causes obstruction.
Which tests aid in the diagnosis of cystic fibrosis?
Sweat chloride test,
stool for fat,
chest radiograph films
Difference between nursing diagnoses:
impaired gas exchange, ineffective airway clearance,
Ineffective breathing pattern
impaired gas exchange:
Must have SaO2 or Pao2 issue.
ineffective airway clearance:
Could be caused by secretions, lack of cough effort, pain
Ineffective breathing pattern:
Could be hyper ventilation or shallow breathing
What is the percent of oxygen in room air?
21%
What does heart valves becoming stiffer in older adults lead to?
Murmurs
After a heart attack when would you start seeing an increase in circulating myoglobin?
Within three hours
What is the intrinsic rate of the SA node versus the Av node.?
Vs bundle of his and perkinje fibers?
SA node 60 to 100
AV node 40 to 60
Bundle of His/ Perkinji 20-40
What is known as the pacemaker of the heart?
SA node
Where is edema in left sided heart failure versus right side?
Left-sided heart failure causes pulmonary edema.
Right sided heart failure causes Edema everywhere except lungs
What is the PMI and where can you find it?
PMI is “point of maximum intensity” on the heart.
Located at fifth intercostal space, mid clavicular line
What % of oxygen does each method supply?
Simple O2 mask:
Venturi O2 mask:
Non rebreather with reservoir:
Simple O2 mask: 30-60%
Venturi O2 mask:24-55%
Non rebreather with reservoir: 80-90%
With Excess of body fluid In intravascular compartment, should you expect elevated or decreased hematocrit?
Decreased hematocrit
