Unit 3 Flashcards
3 functions important to daily life that GFHP activity and exercise covers
cardiac
respiratory
muscles
Energy expenditure requires 4 main support systems
neuro
respiratory
cardio
muscles
Why is GFHP activity and exercise important?
1/5 of the population has some disability involving mobility or self-care
assessment can reveal lack of exercise which leads to poor muscle tone, balance problems, mental and physical fatigue
minimal exercise, sedentary lifestyle, imbalanced nutrition lead to obesity
Obesity places clients at risk for
CAD CVA DM decreased activity tolerance impaired mobility
monitoring activity tolerance and ability to perform them is necessary
because it helps us identify client strength and physical ability.
and identify risk factors associated with activity intolerance
physiologic responses to activities/exercise
assess body’s attempt to meet O2 demands
assess for effective CO
O2 delivery to tissue.
decreased Hgb= not getting enough O2 to tissue
signs of decreased Hgb
lethargy fatigue anemia depression organ failure
Cardiovascular system and activity
HR is good indicator of activity tolerance
should return to normal after 5 minutes of exercise
continued increase is abnormal
Cardiac Output
is the amount of blood ejected from the left ventricle with each contraction
HR x Stroke volume
How many liters does the heart pump a minute
usually 5
Heart: size Base Apex Great vessels attatched
size of your fist
base= top of heart
apex= bottom of heart (where you hear the apical pulse
great vessels attached are the aorta, pulmonary artery, superior and inferior venacava and pulmonary vein
List the blood flow through the heart
S&I venacava, right atria, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary vein, left atria, mitral valve, left ventricle, aortic valve, aorta to the body
Conduction pathway
SA node AV node bundle of HIS bundle Branches purkinje fibers contractile fibers (muscle)
SA node pace
60-100
AV node pace
40-60
Bundle of HIS pace
20-40
P wave
atrial depolarization
PR interval
allowing ventricles to fill, pause of in AV node
QRS complex
ventricular depolarization
T wave
ventricular repolarization
Apical pulse techniques
rate 60-100 normal
stethoscope diaphragm= hear high pitched sounds
bell- low pitched sounds
what heart rhythm can cause a pulse deficit?
A-fib
First Heart Sound
S1, systole, ventricles contract, AV valves close, semilunar valves open (aortic, pulmonic), shorter than diastole, lub sound, with tachycardia less ventricular filling and diastole shortens
Second Heart Sound
S2, diastole, ventricles relax, SL valves closed, AV valves open, ventricular filling
Third heart sound
ABNORMAL S3 heard in diastole can be heard in kids and young adults called VENTRICULAR GALLOP use bell to hear associated with CHF, AV valve insufficiency with rapid ventricular filling with vibrations
Fourth Heart Sound
S4 heard in late diastole/ early systole called ATRIAL GALLOP use bell to hear associated with CAD, HTN, aortic and pulmonary stenosis, acute MIs
Heart Valves
Aortic: located right of sternum at 2nd intercostal space
Pulmonic: left of sternum at 2nd intercostal space
Tricuspid: left of sternum 5th ICS
Mitral: 5th ICS medial to midclavicular line
Arteries
flow away from the heart high pressure vessels strong compliant- they don't give a lot oxygenated blood most common used is radial
List the Artery Pulse sites
Temporal carotid brachial radial femoral popliteal posterior tibialis dorsalis pedis
Veins
Less sturdy/ expansible- enables them to store blood to decrease the workload of the heart
low pressure
valves in each vein keep blood flowing in forward direction to heart
deoxygenated blood
peripheral pulse assessment
ease of palpation rate time interval between beats rhythm elasticity of vessels ausculatory findings
Grading pulses
0= non palpable 1+= weak 2+= normal 3+= full easy to feel, less pressure Bounding= may indicate heart condition
Pulse deficit
difference between apical and radial
vasodilation
widening of blood vessels
vasoconstriction
narrowing of blood vessels
JVD
gives us info about R atrial pressure disappears in upright position distends when lying HOB up 30-60 degrees turn head to the left need good lighting distended in Right sided CHF venous insufficiency
parasympathetic nervous system
innervates thru vegus nerve, which supplies the SA node, atrial muscle fibers, and AV node
Causes a decrease in HR
rest and digest
sympathetic nervous system
supplies all areas of the atria and ventricles
HR increases when stimulated.
Fight or flight.
Baroreceptors
located in walls of carotid sinus and aortic arch
detect BP changes and respond
built to detect and notify the brain
factors that stimulate the CNS to send messages
stress, trauma, infection, fever, pain, fear, anxiety.
Cardiovascular deficits lead to
chest pain, fatigue, weakness
Respiratory deficits lead to
dyspnea, cough, SOB, orthopnea, BP to decrease
Musculoskeletal deficits lead to
leg cramps, pain
Angina definition and signs and symptoms
decreased O2 to heart, precipitated with activities
CP, C tightness, squeezing, pressure,
Aortic Aneurysm definition and S&S
dilation of vessel wall
constant intense CP that radiates to back, anterior chest and abdomen
Pericarditis definition and S & S
heart sac inflammation
sharp pain aggravated by deep breathing
activity tolerance classifications with Heart disease (1-4)
Class 1: has heart disease but asymptomatic. activity isn’t a real problem
Class 2: slight limitation of physical activity no distress at rest, activity causes fatigue, dyspnea or angina
Class 3: significant limitation of activity, no distress at rest. low intensity activity causes fatigue, palpitations, dyspnea or angina
Class 4: symptoms at rest angina or dyspnea at rest, any activity aggravates symptoms
Pulmonary chest pain description
pleuritic pain (sharp/ knife like) SOB and poor tolerance to activities
Claudication
not getting good flow intermittent sharp, cramping, squeezing pain in legs after activity pain in calf muscle after walking caused by ischemia, atherosclerosis pain decreases with rest
Musculoskeletal pain
caused by direct palpation (rule out ischemia)
localized bone pain
check tendons, joints and muscles
fatigue
decreased energy levels
assess for cause (physiologic/psychologic)
physical work, infection, disease
Weakness
decreased muscular strength
rarely from psychologic problems
sxplore cause
may require additional testing.
SOB/dyspnea
can be cardiac, pulmonary or pschogenic
difficulty lying flat
assess for orthopnea, CHF or COPD
assess if during exertion or at rest.
coughing
assess if pulmonary or cardiac
note if it’s productive
self care ability rating 0-4
0- independent 1- requires use of equipment device 2- assist of 1 person 3- assist of 1 person and equipment 4- dependent on others, does not participate
CBC
hgb, hct, plt, RBC, WBC.
anemia if values are decreased
Lipid profile
for cholesterol
lipoprotein
atherosclerosis or CAD if increased
serum enzymes
troponin
MI
Structures within the thorax
Mediastinum: Heart aortic arch superior vena cava lower esophagus lower trachea
Right pleural cavity
lung with 3 lobes
Left pleural cavity
lung with 2 lobes
Primary muscles of inspiration
diaphragm
intercostal muscles
accessory muscles of respiration
sternocleidomastoid scalenus pectoralis minor serratus anterior rectus abdominus muscle
upper airway structures and functions
nose pharynx larynx trachea
conduct air to lower airway
protect from foreign matter
warm filter humidify inspired air
lower airway structures
trachea R/L main stem bronchi segmental/subsegmental bronchi terminal bronchioles alveoli: where gas exchange occurs
increased compliance respirations
easy lung expansion
decreased compliance respirations
difficult to expand increased stiffness of lung more effort to breath
surfactant
protein phospholipid that decreases surface tension of alveoli to prevent collapse and decrease breathing efforts
external respiration
pressure gradient
internal respiration
cellular level with exchange of O2 and CO2
O2 to cells via diffusion
Pons
regulates respiratory rhythm
Medulla
controls respiratory rate and depth
depends on CO2, O2 and HCO3 ion concentration in blood and body tissues
Abnormal breath sounds
Crackles
wheezes
Normal lung sounds
Bronchial- normal in child and young adults >40 is abnormal, heard over the trachea. Loudest sound.
Broncho-vesicular- heard over the anterior and posterior area of the bronchi
Vesicular- heard through lung fields.
Crackles
heard on inspiration, expiration or both
may or may not clear with coughing
causes atelectasis (alveolar collapse)
heard with smphysema bronchitis, pneumonia, CHF, pulmonary edema, pulmonary fibrosis and COPD
sounds like crackling, bubbling related to fluid in small airways and alveoli
Fine Crackles
lower airways, high pitched sound wet.
coarse crackles
upper airways louder pitch
Wheezes
heard on inspiration, expiration, or both and with or without stethoscope.
heard with asthma, pneumonia, bronchospasms, airway obstruction, foreign body or tumor.
sounds like continuous musical, high pitched rt air rushing in over narrow obstructed airways
plural friction rub
heard on inspiration or expiration
does not clear with coughing
painful on inspiration
post pleural effusion removal, MI, pericarditis, pneumonia and pleurisy
sounds like grating.
Hypoxemia
blood oxygen levels drop below normal
PaO2 tells how much O2 the lungs are delivering to blood and tissues
mild hypoxemia
PaO2 60-79 mmHg
moderate hypoxemia
PaO240-59 mmHg
Severe hypoxemia
PaO2 less than 40 mmHg
Hypoxia
blood unable to take adequate amount of O2 to tissues
occurs during internal respirations
signs and symptoms agitations anxiety change LOC headache irritability restlessness tachypnea
late symptoms: bradycardia cardiac dysrhythmias bradypnea retractions
pH
7.35-7.45 acid base level of H+ ion
PaO2
80-100 mmHg tells how much O2 lungs delivering to blood and tissues
PaCO2
35-45 mmHg tells how well lungs getting rid of CO2
if increased resp acidosis if decreased resp alkalosis
HCO3
22-26 mEq/L assesses H ion levels
bicarb
SaO2 saturation
95-100% O2 saturation of hemoglobin
respiratory acidosis
low pH high CO2
respiratory alkalosis
high pH low CO2
metabolic acidosis
low pH low HCO3
metabolic alkalosis
high pH high HCO3
PROM
passive range of motion
nurse does for patient
AROM
active range of motion
patient can perform
Lordosis
abnormal concave of lumbar spine
booty pop
kyphosis
abnormal increased rounding of the thoracic curve
hunchback of notre dame
scoliosis
lateral deviation of the spine
elimination is a _________behavior so it requires
biopschosocial
privacy
appropriateness of location, discussion, disposal of waste.
I&Os provide information on
fluid balance
Incontinence may cause
anxiety depression and social isolation
Urinary retention is common after
surgery
factors influencing bowel function
diet, age, activity, exercise, stress, drugs, pathology
alimentary tract
from mouth to anus esophagus stomach intestines rectum anal canal
functions of GI tract
ingest and digest food
absorb nutrients electrolytes and water
excrete waste
oral cavity
mouth and oropharynx
teeth- adults have 28, 32 if wisdom teeth are intact
saliva- 1200 ml/day
digestion
liver
largest organ functions: bile transfer bilirubin from blood to gallbladder protein, CHO fat metabolism glycogen storage synthesis of plasma proteins detoxification storage of iron, vitamin A&B
gall bladder
concentrates and stores bile
located in the RUQ
pancreas
endocrine: insulin glycagon gastrin exocrine: bicarb pancreatic enzyme
spleen
store RBC and platelets
activates B/T lymphocytes
RBC production
abdominal quadrants
RUQ
LUG
RLQ
LLQ
epigastric
periumbelical
suprapubic
bowel elimination amount r/t
amount and composition of ingested food
absorption
passive process of converting semi liquid chime into formed fecal mass
peristalsis
wave like movements that propel feces to sigmoid and rectum
borborygmi
audible sounds produced by hyperactive peristalsis
associated with intestinal obstruction
defecation
movement of feces from bowel
reflex initiated when stool enters rectum
internal and external sphincters relax allowing for defecation
if continuously suppressed results in constipation/fecal impaction
tarry stool
black
caused by upper GI bleed
bleeding, iron, licorice, peptobismol
green stool
spinach, in kids= increase passage of stool thru bowels
white/ grey stool
gallbladder problems or antacids
yellow stool
increased fat r/t malabsorption
Red stool
lower GI bleed
check for surface bleeding, hemorrhoids or fissures
occult
not seen with the naked eye
possible causes are cancer of the GI tract
factors affecting bowel elimination
medications: laxatives antibiotics psychological: boredom stress depression
tenesmus
rectal pain associated with urge to defecate and feeling or incomplete emptying after defecation
ulcerative colitis
inflammation of the colon and rectum
can have up to 30 episodes of diarrhea/day
crohns
inflammatory problem of the large or small intestines
lesion on the intestinal wall, cramping, fever
diverticulitis
colon pouching, with constipation abd pain
+ for occult (blood) stools
hemorrhoids
dialated veins in rectum
internal or external
can cause pain, bleeding, swelling with stools
anal fissures
cracks in the rectum.
neurological injuries
can alter GI functioning
obstructive problems
block the passage way of stools
can be serious if not corrected
IBS
spasm of the colon with cramping & pain
gastroenteritis
viral or bacterial inflammation with diarrhea
malabsorption
problems digesting fats, proteins, CHO
causes rapid emptying and diarrhea with weight loss or malnutrition
polyps
wart like growth on the intestinal wall
can grow in clusters and become cancerous
illeostomy
surgical diversion of the ileum stool is liquid or semi liquid limited control 700-800ml a day is average norm can do a continent ileostomy with a kock pouch: to help control, has nipple valve for removal of stool
colostomy
large intestine brought to the abdominal wall
opening on abdominal wall called stoma
location depends on the stool consistency
ascending more loose than descending
control depends on location
may be temp. to rest bowel
has external appliance for stool
correct fitting of appliance is importantn to decrease skin irritation.
diet/fluids
need adequate hydration to provide weight, bulk and softness to stools
dehydration-> hard feces, constipation
6-8 glass of water daily, high fiber diet
activity/exercise
helps with muscle tone in abdomen and pelvis
helps propel stool
decreased mobility causes weakness and decreased peristalisis
laxatives
can become dependent
can be harmful practice especially for the elderly
avoid chronic use
four classes of laxatives
lubricants: mineral oil
bulk formers: fiber all, citrual
saline cathartics: MOM, Epsom salts
stimulants: sennekot, correctol, castor oil
assessment of abdomen
IAPP inspect: skin, contour auscultate: listen in 4 quadrants with diaphragm of stethoscope. palpate in four quadrants percuss
