TOPIC 8 Flashcards
right side of the heart has
deoxygenated blood
left side of the heart has
oxygenated blood
What are early signs of hypoxia?
Restlessness, headache, fatigue, SOB.
the ventricles ____ with blood during diastole
fill
the ventricles ______ with blood during systole
empty
stroke volume
The volume of blood ejected from the ventricles during systole
sterlings law
As the myocardium stretches, the strength of the subsequent contraction increases
S1 heart sound “Lub”
mitral and tricuspid valves close
s2 heart sound “dub”
aortic and pulmonic close
cardiac output
The volume of blood ejected from the left ventricle each minute.
what is normal cardiac output
4 to 6 L/min
stroke volume
Amount of blood ejected from the left ventricle with each contraction
Cardiac output equation
CO = HR(heart rate) x S(stroke volume)
the circulating blood volume changes according to the….
oxygen and metabolic needs of the body
preload
The amount of blood in the left ventricle at the end of diastole, often referred to as end-diastolic volume.
afterload
Resistance to left ventricular ejection
myocardial contractility
The ability of the heart muscle to contract.
what can affect myocardial contractility
o Injury to the myocardial muscle such as an acute MI causes a decrease in myocardial contractility.
o The myocardium of the older adult is stiffer with a slower ventricular filling rate and prolonged contraction time.
where should electrical impulses originate from
SA node (if they don’t start in the SA node it can cause conduction disturbances)
dysrhythmias
Rhythm disturbances, meaning a deviation from the normal sinus heart rhythm
tachycardia
greater than 100 bpm (fast HR)
bradycardia
less than 60 bpm (slow HR)
Tachydysrhythmias and bradydysrhythmias lower…
cardiac output and blood pressure.
atrial fibrillation
rapid, random, ineffective contractions of the atrium “quivering”
Paroxysmal supraventricular tachycardia
A sudden, rapid onset of tachycardia originating above the AV node.
-It often begins and ends spontaneously. Sometimes excitement, fatigue, caffeine, smoking, or alcohol use precipitates paroxysmal supraventricular tachycardia
Ventricular tachycardia and ventricular fibrillation are…
life-threatening rhythms that require immediate intervention.
Ventricular tachycardia is a life-threatening dysrhythmia because
the decreased cardiac output and the potential to deteriorate into ventricular fibrillation or sudden cardiac death.
Left-sided heart failure s/s
fatigue, breathlessness, dizziness, and confusion as a result of tissue hypoxia from the diminished cardiac output.
Left-sided heart failure clinical findings
crackles in the bases of the lungs on auscultation, hypoxia, shortness of breath on exertion, cough, and paroxysmal nocturnal dyspnea.
Right-sided heart failure clinical findings
weight gain, distended neck veins, hepatomegaly and splenomegaly, and dependent peripheral edema.
Myocardial ischemia
results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands.
Valvular heart disease
an acquired or congenital disorder of a cardiac valve that causes either hardening (stenosis) or impaired closure (regurgitation) of the valves. When stenosis occurs, the flow of blood through the valves is obstructed. When the ventricles contract, blood escapes back into the atria, causing a murmur, or “whooshing” sound.
Angina pectoris
a transient imbalance between myocardial oxygen supply and demand, resulting in chest pain that is aching, sharp, tingling, or burning or that feels like pressure.
Chest pain associated with MI in men
described as crushing, squeezing, or stabbing. The pain is often in the left chest and sternal area; may be felt in the back; and radiates down the left arm to the neck, jaws, teeth, epigastric area, and back
The most common initial symptom in women (MI)
angina, but they also present with atypical symptoms such as fatigue, indigestion, shortness of breath, and back or jaw pain.
what labs would you order to check cardiopulmonary function?
O2 saturation and hemoglobin (RBCs count)
Pulse oximetry provides…
instant feedback about the patient’s level of oxygenation.
Capnography
also known as end title CO2 monitoring
Kussmaul respirations
Deep, rapid breathing; to compensate by decreasing CO2 levels
apnea
the absence of respirations for lasting for 15 seconds or longer.
Cheyne-Stokes respiration
repeated breathing pattern characterized by fluctuation in the depth of respiration: first deeply, then shallow, then not at all
When does the cheyne stokes respiration pattern occur?
when there is decreased blood flow or injury to the brainstem.
edema scale
- 1+ Mild pitting, slight indentation, no perceptible swelling of the leg
- 2+ Moderate pitting, indentation, subsides rapidly
- 3+ Deep pitting, indentation remains for a short time, leg looks swollen
- 4+ Very deep pitting, indentation lasts a long time, leg is very swollen
pulse scale
0-absent,
1-barely palpable, intermittent,
2-weak, possibly thready, but constantly palpable and with consistent quality,
3- normal strength and quality,
4-bounding, easily palpable, may be visible
Cardiopulmonary resuscitation (CPR)
the attempt to restore cardiac and pulmonary function
1. circulation
2. airway
3. breathing
Permanent heart, brain, and other tissue damage occur within how many minutes
4-6 minutes
Defibrillation (automatic external defibrillator [AED])
Is needed to stop an abnormal heart rhythm
when can you NEVER use and AED on a patient
-if the patient has a pulse
-if they are flat line
what are situations you can use a defibrillator
-v-fib: ventricular fibrillation (quiver)
-v-tach: ventricular tachycardia (beating fast)
cardiopulmonary rehabilitation includes…
maintaining an optimal level of health through controlled physical exercise, nutrition counseling, relaxation and stress-management techniques, and prescribed medications and oxygen.
what are the three basic techniques for breathing exercises?
-deep-breathing and coughing exercises
-pursed-lip breathing
-diaphragmatic breathing
Pursed-lip breathing
deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse. While sitting up, instruct the patient to take a deep breath and exhale slowly through pursed lips as if blowing through a straw.
Diaphragmatic breathing
useful for patients with pulmonary disease, postoperative patients, and women in labor to promote relaxation and provide pain control. The exercise improves efficiency of breathing by decreasing air trapping and reducing the WOB.
circadiam rhythm
Biological time clock by which the body functions, most familiar rhythm is the 24-hour, day-night cycle
what is circadian rhythm affected by?
light, temperature, social activities, and work routines.
what biological and behavioral factors does the circadian rhythm influence?
changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood
electroencephalogram (EEG) measures…
electrical activity in the cerebral cortex
electromyogram (EMG) measures…
muscle tone
the electrooculogram (EOG) measures…
eye movements provide information about some structural physiological aspects of sleep.
where is the major sleep center int he body
hypothalamus
Hypocreatins (ovexins)
secreted from the hypothalamus and Promote wakefulness and rapid eye movement (REM) sleep
Reticular activating system (RAS)
Located in the upper brainstem contains special cells that maintain alertness and wakefulness.
Homeostatic process (Process S)
primarily regulates the length and depth of sleep; and the circadian rhythms (Process C: “biological time clocks”)
NREM
non rapid eye movement
REM
rapid eye movement
what are the two sleep phases
REM & NREM
how many stages of NREM sleep are there
4
N1 (stage 1)
lightest stage of sleep lasting a few minutes
N2 (stage 2)
-Stage of sound sleep during which relaxation progresses.
-Arousal is still relatively easy.
N3 (stage 3 and 4)
-Called slow-wave sleep.
-Deepest stage of sleep.
-Sleeper is difficult to arouse and rarely moves.
how long does the presleep period last
10-30mins
if a person has difficulty falling asleep, how long does this period last?
an hour or more
how many complete sleep cycles does a person pass through in a night
4-5
how many minutes does it take a person to reach REM sleep
90 minutes
How long do sleep cycles last?
90-100minutes
purpose of sleep: physiological and psychological restoration
-NREM sleep contributes to body tissue restoration.
-During sleep the heart rate falls to 60 beats/min or less, which benefits cardiac function. Other biological functions decreased during sleep are respirations, blood pressure, and muscle tone.
the dreams of _______ sleep are more vivid and elaborate
REM
physical illnesses that disturb sleep
-hypertension
-respiratory disorders
-nocturia
-restless leg syndrome
restless leg syndrome symptoms
recurrent, rhythmical movements of the feet and legs. Patients feel an itching sensation deep in the muscles
relief from restless leg syndrome comes from..
Relief comes only from moving the legs, which prevents relaxation and subsequent sleep.
what are the 8 categories of major sleep disorders
-sleep-related breathing disorders
-hypersomnias
-circadian rhythm sleep disorders
- parasomnias
-sleep and wake distrubances
-sleep-related movement disorders
-“other” sleep disorders
hypersomnia
excessive daytime sleepiness
circadian rhythm sleep disorder
caused by a misalignment between the timing of sleep and individual desires or the societal norm
parasomnia
are sleep problems that are more common in children (sleep walking, night terrors, bedwetting, etc)
polysomnogram
involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep.
Insomnia
the most common sleep disorder, is a symptom patients experience when they chronically have difficulty falling asleep.
Sleep apnea
characterized by lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep.
Obstructive sleep apnea (OSA)
occurs when muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing nasal airflow (hypopnea) or stopping it (apnea) for as long as 30 seconds.
what are major risk factors for OSA
obesity and hypertension.
Central Sleep Apnea (CSA)
involves dysfunction in the respiratory control center of the brain.
-The impulse to breathe fails temporarily, and nasal airflow and chest wall movement cease.
what are major risk factors for CSA
patients with brainstem injury, muscular dystrophy, and encephalitis.
narcolepsy
a dysfunction of mechanisms that regulate the sleep and waking states.
Cataplexy
sudden muscle weakness/loss of muscle control during intense emotions such as anger, sadness, or laughter, occurs at any time during the day.
sleep paralysis
the experience of waking up unable to move
sleep deprivation causes
fever, difficulty breathing, pain, emotional stress, medications, and disturbances in the health care setting.
somnambulism
sleepwalking
night terrors
a sleep disorder characterized by high arousal and an appearance of being terrified; unlike nightmares, night terrors occur during Stage 4 sleep, within two or three hours of falling asleep, and are seldom remembered
night mares
bad dreams occurring during REM sleep
nocturnal enuresis
bed wetting
body rocking
moving back and forth in a slow, rhythmic fashion
bruxism
grinding teeth
young adults should get ____ hours of sleep
6-8.5
factors influencing sleep: drugs and substances
Hypnotics, antidepressants and stimulants, alcohol, caffeine, diuretics, beta-adrenergic blockers, benzos, nicotine, narcotics, anticonvulsants
factors influencing sleep: exercise and fatigue
Moderate exercise and fatigue cause a restful sleep
factors influencing sleep: food and calorie intake
Time of day, caffeine, nicotine, alcohol
sleep is a ____ experience
subjective
who are the sources for a sleep assessment
patient and the family
tools for sleep assessment
Epworth Sleepiness Scale - evaluates severity of EDS
Pittsburg Sleep Quality Index - evaluates sleep quality & patterns
Visal Analog Scale
Numeric Scale
environmental controls and sleep
All patients require a sleeping environment with a comfortable room temperature and proper ventilation, minimal sources of noise, a comfortable bed, and proper lighting. Eliminate distracting noise so the bedroom is as quiet as possible
promoting bedtime routines
-It is always important for persons to go to sleep when they feel fatigued or sleepy.
-A bedtime routine (e.g., same hour for bedtime, snack, or quiet activity) used consistently helps young children avoid delaying sleep.
-Adults need to avoid excessive mental stimulation just before bedtime.
any patient prone to confusion or falls, safety is critical
· Night light
· Beds set lower to the floor
· Remove clutter
when someone is sleep walking…
they are are unaware of their surroundings and are slow to react, increasing the risk of falls.
-Do not startle sleepwalkers but instead gently awaken them and lead them back to bed.
infants’ bed
-reduce the chance of suffocation
-do not place pillows, stuffed toys, or the ends of loose blankets in cribs
-Loose-fitting plastic mattress covers are dangerous
-Parents need to place an infant on his or her back to prevent suffocation.
what foods promote sleep
A dairy product such as warm milk or cocoa that contains L-tryptophan is often helpful
what is the recommended dose of melatonin
0.3 to 1 mg taken 2 hours before bedtime.
Recommend lifestyle changes to patients with OSA:
include sleep hygiene, alcohol moderation, smoking cessation, and a weight-loss program.
continuous positive airway pressure (CPAP)
device used to treat sleep apnea; includes a mask that fits over the sleeper’s nose and mouth, which is connected to a pump that pumps air into the person’s airways, forcing them to remain open
-A mask delivers room air at a high pressure.
hypnotics
medications that induce sleep
Sedatives
medications that produce a calming or soothing effect
