Oxygenation ch. 40 Flashcards
what is the amount of air inspired and expired with each breath, in milliliters, and is usually set by the patient’s ideal body weight (5 to 8 mL/kg).
tidal volume
what is the purpose of using the incentive spirometer.
helps minimize the chance of fluid build-up in the lungs and to help reduce the incidence of postoperative pulmonary atelectasis.The patient breathes in from the device as slowly and as deeply as possible, then holds his/her breath for 2-6 seconds. This provides back pressure which pops open alveoli.
what structures create a negative pleural pressure and increase the size of the thorax for inspiration.
the contraction of the diaphragm and external intercostal muscles.
what acid-base status increases the ability of hemoglobin to release oxygen to the tissues
acidemia
what acid-base status decreases the ability of hemoglobin to release oxygen to the tissues.
Alkalemia
what are some Causes of hypoxia include
1) a decreased hemoglobin level and lowered oxygen-carrying capacity of the blood; (2) a diminished concentration of inspired oxygen, which occurs at high altitudes; (3) the inability of the tissues to extract oxygen from the blood, as with cyanide poisoning or alkalemia; (4) decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia or atelectasis; (5) poor tissue perfusion with oxygenated blood, as with shock,; and (6) impaired ventilation, as with multiple rib fractures or chest trauma.
why will administering high levels of oxygen extinguish the stimulus to breathe in COPD.
In these patients it is the change in the oxygen level that stimulates changes in ventilation as opposed to In a healthy person’s lungs, the chemoreceptors are sensitive to small changes in carbon dioxide levels instead.
what nerve controls the function of the diaphragm
phrenic nerve
where does the phrenic nerve exit on the spinal cord.
at the fourth cervical vertebra
The major inspiratory muscle of respiration is what
diaphragm
what is surfactant
is the chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing
patients with COPD,especially emphysema, frequently use what muscles to increase lung volume.
Accessory muscles.
what is compliance
is the ability of the lungs to distend or expand in response to increased intraalveolar pressure.
in what kinds of diseases would you see decreased compliance in?
Pulmonary edema, interstitial and pleural fibrosis, and congential or traumatic structural abnormalities such as kyphosis or fractured ribs.
what does expiration depend on?
the elastic recoil properties of the lungs.
How does advanced COPD affect respirations?
It causes loss of the elastic recoil of the lungs and thorax.
what is Atelectasis?
it is the collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide.
patients with certain pulmonary diseases have decreased production of what chemical from the lungs and this sometimes develops into what adverse condition
surfactant, and atelectasis.
what are normal lung values determined by?
age, gender, and height.
what does the elevation of the patient’s clavicles during inspiration indicate
use of accessory muscles, ventilation fatigue, air hunger, or decreased lung expansion.
what is the term for maximum amount of air that can be removed from the lungs during forced expiration.
forced vital capacity
the thickness of the alveoli affects the rate of what
diffusion of respiratory gases.
why does increased thickness of the alveolar membrane impedes diffusion?
Because gases take longer to transfer across the membrane.
what types of respiratory conditions cause thickened alveolar membranes.
pulmonary edema, pulmonary infiltrates (pneumonia) or pulmonary effusion.
what are the three things that influences the capacity of the blood to carry oxygen.
- The amount of the dissolved oxygen in the plasma, 2. The amount of hemoglobin, 3. and the tendency of hemoglobin to bind with oxygen.
the more stretch on the ventricular muscle, the greater the contraction and the greater the stoke volume.
Frank-starling law of the heart.
when does starling law not apply
in the diseased heart (cardiomyopathy, or MI)
During ventricular diastole what valves open and cause blood flow from the higher pressure atria into the ventricles,
Mitral and tricuspid.
what happens to the valves during ventricular systole
ventricular pressure rises and closes the mitral and tricuspid valves. semilunar valves open (aortic and pulmonic) valves open,and blood flows form the ventricles into the aorta and pulmonary artery.
which coronary artery has the most abundant supply and feeds the more muscular left ventricular myocardium.
Left anterior descending coronary artery.
what is the normal cardiac output in the healthy adult at rest
4 to 6 L/min
what factors affect stroke volume
The amount of blood in the left ventricle at the end of diastole (preload), the resistance to left ventricular ejection (afterload), and myocardial contractility.
what is a good clinical measure of afterload
the diastolic aortic pressure.
what is the process of transporting carbon dioxide out of the body.
1.carbon dioxide diffuses into red blood cells and is rapidly hydrated into carbonic acid. 2. The carbonic acid then dissociates into hydrogen and bicarbonate ions. 3. Hemoglobin buffers the hydrogen ion, and the Bicarb diffuses into the plasma. 4. reduced hemoglobin (Deoxyhemoglobin) combines with carbon dioxide, and the venous blood transports the majority of carbon dioxide back to the lungs to be exhaled.
What is preload?
It is the end-diastolic volume
what is afterload?
Is the resistance to left ventricular ejection. the heart works harder to overcome the resistance so blood can be fully ejected from the left ventricle.
what does hypertension do to afterload
increases it. increasing cardiac workload.
what three conditions cause extracellular fluid loss and reduced stroke volume. and what would the medical term be for describing decreased fluid volume be called.
hemorrhaging, shock, dehydration (hypovolemia)
what is the primary pathological factor in right sided- heart failure and what happens during it.
elevated pulmonary vascular resistance as a result from pulmonary diseases. As the PVR continues to rise, the right ventricle works harder, and the oxygen demand of the heart increases. As the failure continues, the amount of blood ejected from the right ventricle declines, and blood beings to “back up” in the systemic circulation.
what causes S1 sounds
closure of mitral and tricuspid valves
what causes S2 sounds
closure of semilunar valves (aorta and pulmonic)
how does heart rate affect cardiac output
because of the relationship between rate and diastolic filling time.
what will a sustained heart rate greater than 160 beat/min affect cardiac output
diastolic filling time decreases, decreasing stoke volume and cardiac output.
what part of the nervous system influences the rate of impulse generation and the speed of transmission through the conductive pathway and the strength of atrial and ventricular contractions.
the autonomic nervous system.
what nerve fibers increase the rate of impulse generation and speed of transmission.
sympathetic
What nerve fibers originating from the vagus nerve decrease the rate of the heart.
Parasympathetic
what does the AV node do
It assists atrial empty by delaying the impulse before transmitting it through the bundle of his and the ventricular purkinje fibers.
what does the qt interval indicate
it represents the time needed for ventricular depolarization and repolarization.
what is the normal QT interval?
0.12 to 0.42 this interval varies inversely with changes in heart rate.
what changes in electrolyte values increase the QT interval
hypocalcemia
what kinds of drugs increase the QT interval
Disopyramide (norpace) or amiodarone (Cordarone)
shortening of the QT interval occurs when?
With digitalis therapy, hyperkalemia, and hypercalcemia.
respiratory disorders usually include what three conditions
hyperventilation, hypoventilation, and hypoxia.
Cardiac disorders include what conditions?
disturbances in conduction (arrhythmias, heart blocks) impaired valvular function, myocardial hypoxia, cardiomyopathic conditions, and peripheral tissue hypoxia.
what two conditions decrease the oxygen carrying capacity of blood by reducing the amount of available hemoglobin to transport oxygen
anemia and toxic substances.
what is anemia the result of
Decreased hemoglobin production( such as aplastic anemia or iron deficiency anemia), increased red blood cell destruction (hemolysis), and/or blood loss (hemorrhage).
what are the symptoms of anemia
fatigue, decreased activity tolerance, increased breathlessness, increased heart rate (to compensate for the lack of oxygen circulating), and pallor (especially seen in the conjunctiva of the eye).
what is the physiological response to chronic hypoxemia (low oxygen in the blood).
is the development of increased red blood cells (polycythemia). This is a adaptive response of the body to increase the amount of hemoglobin and the available oxygen-binding sites.
what is the most common toxic inhalant decreasing the oxygen-carrying capacity of blood?
Carbon monoxide
why does carbon monoxide decrease the oxygen-carrying capacity of the blood.
In CO toxicity hemoglobin strongly binds with CO, creating a functional anemia. Because of the the strength of the bond, CO does not easily dissociate from hemoglobin, making hemoglobin unavailable for oxygen transport.
how does the body adjust to significant fluid loss
peripheral constriction and increasing the heart rate to increase the volume of blood returned to the heart, thus increasing CO.
what happens in left sided heart failure
as the left ventricle begins to fail, blood beings to pool in the pulmonary circulation, causing pulmonary congestion and pulmonary edema.
What are the clinical findings include in left sided heart failure
crackles in the bases of the lungs on auscultation, hypoxia, SOB on exertion, cough, and paroxysmal nocturnal dyspnea.
what are the signs and symptoms of of left sided heart failure
Fatigue, breathlessness, dizziness, and confusion as a result of tissue hypoxia from the diminished cardiac output.
what are some Common causes of left-sided failure
Heart attack Chronic blockages of the heart arteries High blood pressure Excessive alcohol consumption impaired closure( causing regurgitation... murmurs) or stenotic (narrowing from hardening) heart valves Hypothyroidism Heart muscle infections(rheumatic fever)
what is the primary pathological factor in right sided- heart failure and what happens during it.
elevated pulmonary vascular resistance as a result from pulmonary diseases. As the PVR continues to rise, the right ventricle works harder, and the oxygen demand of the heart increases. As the failure continues, the amount of blood ejected from the right ventricle declines, and blood beings to “back up” in the systemic circulation.
what are the signs and symptoms of Right Sided heart failure
weight gain, distended neck veins (JVD), hepatomegaly and splenomegaly, and dependent peripheral edema.
what is angina pectoris
is the transient imbalance between myocardial oxygen supply and demand.
what are the signs and symptoms of angina pectoris
chest pain that is sharp, tingling, or burning or that feels like pressure. typically the chest pain is left sided or substernal and often radiates to the left or both arms, the jaw, neck, and back. sometimes it doesn’t radiate at all. it usually lasts from 3 to 5 minutes
what usually relieves the pain of angina pectoris
rest and coronary vasodilators, the most common being a nitroglycerin.
how long does it take cellular death (infarction) to occur from myocardial ischemia
20 minutes.
chest pain associated with MI in men is usually described as what
crushing, squeezing, or stabbing. The pain is often in the left chest and sternal area; may be felt in back; and radiates down the left arm to the neck, jaw, teeth, epigastric area, and back. Rest, position changes, or sublingual nitroglycerin doesn’t relieve the pain.
Women on average have what greater blood levels than men
cholesterol and triglyceride levels.
what are the most common symptoms of an MI for women
initially angina, but they also present with atypical symptoms such as fatigue, indigestion, SOB, and back or jaw pain.
during the teething process some infants develop what condition in their nose
nasal congestion
why is the tuberculin skin test an unreliable indicator of TB in older patient?
Because they frequently display false-positive or false negative skin test reactions.
the leading contributing factor for strokes in the older adult is from what heart condition
atrial fibrillation
mental status changes are the first signs of what problem in the older adult and often include what 2 signs
Respiratory problems. Forgetfulness and irritability
Older adults experience alterations in cardiac function as a result of what
calcification of the conduction system pathways, thicker and stiffer valves caused by lipid accumulation and fibrosis, and a decrease in the number of pacemaker cells in the SA node.
what causes a decrease in the effectiveness of the cough mechanism in older adults
reduced number of functional cilia.
morbidly obese patient’s body weight increases tissue oxygen demands, therefore, making them at risk for what condition.
anemia
COPD patient would be a candidate for what diet?
low carb diet
why would patient that have COPD need to be put on a low carb diet.
Diets high in carbohydrates play a role in increasing the carbon dioxide load for patients with carbon dioxide retention (COPD). as carbs are metabolized, an increased load of carbon dioxide is created from that metabolism and it’s excreted via the lungs.
diets high in what electrolyte prevent HTN and help improve control in patients with HTN
potassium
what does nicotine do to your blood vessels
it causes vasoconstriction of peripheral and coronary blood vessels, increasing blood pressure and decreasing blood flow to peripheral vessels.
women who take birth control pills and smoke cigs have an increased risk for what conditions
thrombophlebitis and pulmonary emboli
Smoking during pregnancy can have what effect on the baby.
can result in low-birth-weight babies, preterm delivery, and babies with reduced lung function.
smoking cigs has been linked to the development of what other cancers?
kidney, cervix, and leukemia.
Excessive use of alcohol and other drugs impairs tissue oxygenation in what two ways?
poor nutritional intake. with resultant decrease in intake of iron-rich foods, hemoglobin production declines. Second, excessive use of alcohol and certain other drugs depresses the respiratory center, reducing the rate and depth of respiration and the amount of inhaled oxygen.
nursing history for respiratory function includes the presence of what?
cough, SOB, dyspnea, wheezing, pain, environmental exposures, frequency of respiratory tract infections, pulmonary risk factors, past respiratory problems, current medication use, and smoking history or secondhand smoke exposure.
nursing history for cardiac function includes what?
pain and characteristics of pain (PQRST), fatigue, peripheral circulation, cardiac risk factors, and the presence of past or concurrent cardiac conditions.
cardiac pain does not occur with what
respiratory variations
pericardial pain results from inflammation of the pericardial sac which occurs when during respiration.
inspiration.
what is pleuritic chest pain
it is chest pain that is peripheral and radiates to the scapular regions. Patients usually describe it as knife like, lasting from a minute to hours and always in association with inspiration.
what makes pleurtic chest pain worse
inspiratory maneuvers such a coughing , yawning, and sighing.
What often causes pleuritic chest pain
an inflammation or infection in the pleural space often causes this.
in a patients with cardiopulmonary alterations, this is often an early sign of a worsening
fatigue
dyspnea is a clinical sign of what
hypoxia
dyspnea is assoicated with what symptoms
exaggerated respiratory effort, use of the accessory muscles of respiration, nasal flaring, and marked increases in the rate and depth of respirations.
what is orthopnea
it is shortness of breath (dyspnea) which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.
what helps quantify the degree of orthopnea
the number of pillows used (ex. two or three pillow orthopnea)
patients with chronic sinusitis usually cough only when
early in the morning or immediately after rising from sleep.
what kind of pH does hemoptysis have
Alkaline
What kind of pH does hematemesis have
Acidic
what conditions is wheezing associated with
asthma, acute bronchitis, or pneumonia.
when does wheezing occurs
inspiration, expiration, or both.
what is CO posisoning mostly the result of?
blocked furnances or fireplaces.
what is radon gas
is a radioactive substance from the breakdown of uranium in soil, rock, and water that enters homes through the ground or well water.
patients do not always display symptoms of HIV infection until they present with what 2 infections
Pneumocystis carinii pneumonia or Mycoplasma pneumonia.
what does the presence of pneymocystis carinii pneumonia or Mycoplasma pneumonia indicate
it indicates a significant depression of a patient’s immune system and progression to AIDS.
clubbed nails often occur in what type of patients
Prolonged oxygen deficiency (chronic hypoxia), endocarditis, and congenital heart defects.
what condition would stimulate an increase in both rate and depth of respirations (kussmaul respirations) to compensate by decreasing carbon dioxide levels.
metabolic acidosis. (DKA for example)
Cheyne-stokes respirations occurs when
there is decreased blood flow or injury to the brainstem.
this respiratory pattern has periods of apnea followed by by peirods deep breathing and then shallow breathing followed by more apnea. and the apnea can last 15 to 60 seconds
cheyne-stokes respiration
what conditions will cause a barrel chest
emphysema, advancing age, and COPD
what is the cause of xanthelasma (yellow lipid lesions on eyelids)
hyperlipidemia
What is the cause of corneal arcus (whitish opaque ring around junction of cornea and sclera)
abnormal finding in young to middle age adults with hyperlipidemia (normal finding in older adults with arcus senilis)
what causes Petechiae on conjunctivae
fat embolus or bacterial endocarditis
what is associated with periorbital edema
kidney disease
what does splinter hemorrhages
bacterial endocarditis
what is dependent edema associated with
left or right sided heart failure.
For TB test how many mL of what is given in the forearm
0.1 mL of Purified protein derivative .
when should TB skin be read
between 48-72 hours after the test.
what is a positive TB test result
A palpable ,elevated, hardened area around the injection site, caused by edema and inflammation from the antigen-antibody reaction, measured in millimeters.
what is a negative result
redden flat area.
decreased iron results in
decreased hemoglobin=decreased oxygen to tissues
pernicious anemia
absence of intrinsic factor which prevents B12 absorption
folic acid anemia
associated w/ alcoholism, malabsorption and meds
what are the symptoms of acute hypoxia
anxiety, restlessness, dyspnea, high BP, small pulse pressure, pallor, cyanosis
what are the symptoms of chronic hypoxia
altered thought process, headaches, chest pain, enlarged heart, clubbing
what are retraction of the lungs
sucking in of chest wall between ribs and above clavicle
what are the lab values for Cardiac enzymes (cardiac kinase)
a serial CK with 50 % increase between two samples 3-6 hours apart, peaking 12-24 hours after chest pain or a single CK elevation twofold is diagnostic for an acute myocardial infarction. Providers use cardiac enzymes to diagnose acute myocardial infarcts.
cardiac troponins (plasma cardiac troponin I <0.03 ng/mL)
value elevates as early as 3 hours after myocardial injury
Plasma cardiac troponin T <0.1 ng/mL
Value often remains elevated for 10-14 days.
lab values for myoglobin and its interpretation
<90 mcg/L early index of damage to myocardium in myocardial infarction or reinfarction. Increases within 3 hours.
LDL and VLDls lab values and interpretation?
LDLs<130 mg/dL VLDls 7-32 mg/dL Hypercholesterolemia is caused by excessive intake of saturated fatty acids, dietary cholesterol intake, and obesity. Familial hypercholesterolemia and hyperlipidemia, hypothyroid, nephrotic syndrome, and DM are also contributing factors. VLDLs are predominant carriers of triglycerides and can be converted to LDL by lipoprotein lipase. Levels in excess of 25-50% indicate increased risk of cardiac disease.
What are the lab values for HDL and what can cause low HDL
male >45 mg/dL; female: >55 mg/dL. Factors such as cigarette smoking, obesity, lack of regular exercise, beta adrenergic blocking agents, genetic disorders of HDL metabolism, hypertriglyceridemia, and type 2 DM cause Low HDL cholesterol.
what are the lab values of triglycerides
male 40-160 mg/dL; female: 35-135 mg/dL
what racial group have the highest incidences of COPD and cystic fibrosis
Caucasians
ECG stress test with addition of a chemical injected intravenously. It determines coronary blood flow changes with incrased activity .
Thallilum stress test
what is an invasive measure of intracardiac electrical pathways. It provides more specific information about difficult to threat dysrhythmias and assesses adequacy of antidysrhythmic medication
Electrophysiological study
what is a radionuclide angiography; used to evaluate cardiac structure, myocardial perfusion, and contractility.
Scintigraphy
the annual flu vaccines are recommended for all people from what age on up?
6 months and older.
what kinds of patients shouldn’t receive the flu vaccine
People with known hypersensitivity to eggs or other components of the vaccine.
Pneumococcal vaccine is routinely given to who and in a series of how many doses and for what kinds of patients that are at an increased risk for developing pneumonia.
Adults over 65 years of age, those with chronic illnessess or who are immunocompromised (HIV/AIDS), any adult who smokes or has asthma, and those living in special environments such as nursing homes or long term-care facilities.
what types of interventions assist in managing alterations in airway clearance.
Suctioning, CPT, nebulizer therapy, adequate hydration to prevent thick, tenacious secretions, and proper coughing techniques.
