Chapter 40 Fundamentals (Oxygenation)

Front 1

CAB

Back 1

Circulation, airway, and breathing

Front 2

Non-breathing time and what will happen

Back 2

0 minutes = breathing stops and heart will soon stop beating
4 to 6 minutes= brain damage is possible
6-10 minutes brain damage is likely
anything 10 minutes or over is def irreversible brain damage

Front 3

heart functions to

Back 3

deliver deoxygenated blood to the lungs for oxygenation. and to give oxygen and nutrients to tissues.

Front 4

preload

Back 4

volume of blood in ventricles at the end of diastole(end-diastolic volume)

Front 5

afterload

Back 5

resistance left ventricle must overcome to circulate blood (increased in hypertension and vasoconstriction)

Front 6

if you have increased afterload

Back 6

you will have increased cardiac workload

Front 7

preload is increased in

Back 7

hypervolemia, regurgitation of cardiac valves

Front 8

frank-strarling law

Back 8

(rubber band) as the myocardium stretches, the strength of the contraction increases.

Front 9

cardiac output

Back 9

is the amount of blood ejected from the left ventricle each minute.

Front 10

cardiac index

Back 10

is determined by dividing the cardiac output / body surface area( BSA)

Front 11

stroke volume

Back 11

amount of blood ejected from the ventricle with each contraction

Front 12

ECG (electrocardiogram)

Back 12

reflects the electrical activity of the conduction system

Front 13

NSR (normal sinus rhythm)

Back 13

normal sequence of the electrocardiogram (ECG)

Front 14

p- wave

Back 14

is conduction through both atria

Front 15

PR interval

Back 15

impulse travel time through the A V node (0.12 to .20 seconds)

Front 16

QRS complex

Back 16

the impulse traveled through the ventricles (0.06 to 0.12 seconds)

Front 17

QT interval

Back 17

time needed for ventricular depolarization and re polarization.
(0.12 to 0.42 seconds)

Front 18

alterations in cardiac functioning, factors affecting oxygenation

Back 18

dysrthmias, decreased cardiac output ( heart failure), impaired valvular functions, and myocardial hypoxia (MI or angina)

Front 19

Left-sided heart failure

Back 19

Cough, crackles, wheezes, blood-tinged sputum, tachypnea, restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis.

Front 20

right - sided heart failure

Back 20

fatigue, peripheral edema, increased venous pressure, ascites, enlarged spleen and liver, distended jugular vein, swelling in hands and fingers, dependent edema

Front 21

ventillation

Back 21

process of moving gases in and out of the lungs

Front 22

work of breathing

Back 22

effort required to expand and contract the lungs.

Front 23

Inspiration

Back 23

Active process stimulated by chemical receptors in the aorta.

Front 24

Expiration

Back 24

passive process dependent on the elastic recoil properties of the lungs.

Front 25

Compliance

Back 25

ability of the lungs to distend or to expand in response to increased intraalveolar pressure.

Front 26

Airway resistance

Back 26

pressure difference between the mouth and the alveoli in relation to the rate of flow of inspired gas.

Front 27

Diffusion

Back 27

process for the exchange of respiratory gases in the alveoli and the capillaries of the body tissues.

Front 28

deoxyhemoglobin

Back 28

reduced hemoglobin

Front 29

neural regualtion

Back 29

central nervous system (CNS) control of respiratory rate, depth, and rhythm.

Front 30

chemical regualtion

Back 30

influence of carbon dioxide and hydrogen ions on the rate and depth of respirations.

Front 31

atrial fibrillation

Back 31

electrical impulse in the atria is chaotic and originates from multiple sites.

Front 32

ventricular tachycardia

Back 32

life threatening impulse originates in ventricles QRS is usually widened and bizarre.

Front 33

Ventricular fibrillation

Back 33

uncoordinated electrical activity, no identifiable p, QRS, or t wave

Front 34

stenosis

Back 34

flow of blood through valve that is obstructed

Front 35

regurgitation

Back 35

back flow of blood into an adjacent chamber.

Front 36

myocardial ischemia

Back 36

the supply of blood to the mypocardium from the coronary arteries is insufficient to meet the myocardial oxygen perfusion.

Front 37

angina pectoris

Back 37

transient imbalance between myocardial oxygen supply and demand.

Front 38

myocardial infraction

Back 38

a sudden decrease in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion.

Front 39

hyperventilation

Back 39

excess ventilation required to eliminate the carbon dioxide produced (anxiety, infections, drugs, or an acid-base imbalance)

Front 40

hypoventilation

Back 40

alveolar ventilation is inadequate to meet the body’s oxygen demand

Front 41

Atelectasis

Back 41

collapse of the alveoli which prevents normal exchange of oxygen and carbon dioxide

Front 42

hypoxia

Back 42

inadequate tissue oxygenation at the cellular level (decreased hemoglobin levels, high altitudes, poisoning, pneumonia, shock, chest trauma)

Front 43

cyanosis

Back 43

blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries

Front 44

infants and toddlers

Back 44

upper respiratory tract infections due to frequent exposures and secondhand smoke

Front 45

school age children and adolescents

Back 45

exposure to respiratory infections, secondhand smoke, and smoking

Front 46

young and middle-age adults

Back 46

unhealthy diet, lack of exercise, stress, OTCs, illegal substances, smoking

Front 47

older adults

Back 47

aging changes, osteoporosis

Front 48

occupational pollutants

Back 48

a. asbestos
b. talcum powder
c. dust
d. airborne fibers

Front 49

cardiac function

Back 49

dyspnea, fatigue, peripheral circulation, cardiac risk factors

Front 50

respiratory function

Back 50

cough, SOB, wheezing, pain, environmental exposure, frequency of infections, risk factors, medication use, smoking use

Front 51

dyspnea

Back 51

clinical sign of hypoxia, usually associated with exercise or excitement associated with many medical and environmental factors

Front 52

orthopnea

Back 52

abnormal condition in which the client uses multiple pillows when lying down

Front 53

cough

Back 53

sudden, audible expulsion of air from the lungs; a protective reflex to clear the trachea, bronchi, and lungs of irritants and secretions

Front 54

wheezing

Back 54

high-pitched musical sound caused by high-velocity movement of air through a narrowed airway

Front 55

Holter monitor

Back 55

Portable ECG worn by the client. The test produces a continuous ECG tracing over a period of time. Clients keep a diary of activity, noting when they experience rapid heartbeats or dizziness. Evaluation of the ECG recording along with the diary provides information about the heart’s electrical activity during activities of daily living.

Front 56

exercise stress test

Back 56

ECG is monitored while the client walks on a treadmill at a specified speed and duration of time. Used to evaluate the cardiac response to physical stress. The test is not a valuable tool for evaluation of cardiac response in women due to an increased false-positive finding.

Front 57

Thallium stress test

Back 57

An ECG stress test with the addition of thallium-201 injected IV. Determines coronary blood flow changes with increased activity.

Front 58

Electrophysiological study (EPS)

Back 58

Invasive measure of intracardiac electrical pathways. Provides more specific information about difficult-to-treat dysrhythmias. Assesses adequacy of antidysrhythmic medication.

Front 59

Echocardiography

Back 59

Noninvasive measure of heart structure and heart wall motion. Graphically demonstrates overall cardiac performance.

Front 60

Scintigraphy

Back 60

Radionuclide angiography. Used to evaluate cardiac structure, myocardial perfusion, and contractility.

Front 61

cardiac catheterization and angiography

Back 61

Used to visualize cardiac chambers, valves, the great vessels, and coronary arteries. Pressures and volumes within the four chambers of the heart are also measured.

Front 62

pulmonary function test

Back 62

Determine the ability of the lungs to efficiently exchange oxygen and carbon dioxide. Used to differentiate pulmonary obstructive disease from restrictive disease.

Front 63

peak expiratory flow rate (PEFR)

Back 63

The PEFR reflects changes in large airway sizes and is an excellent predictor of overall airway resistance in the client with asthma. Daily measurement is for early detection of asthma exacerbations.

Front 64

Bronchoscopy

Back 64

Visual examination of the tracheobronchial tree through a narrow, flexible fiberoptic bronchoscope. Performed to obtain fluid, sputum, or biopsy samples; remove mucous plugs or foreign bodies.

Front 65

Lung scan

Back 65

Used to identify abnormal masses by size and location. Identification of masses is used in planning therapy and treatments.

Front 66

thoracentesis

Back 66

Specimen of pleural fluid is obtained for cytological examination. The results may indicate an infection or neoplastic disease. Identification of infection or a type of cancer is important in determining a plan of care.

Front 67

specific outcomes for maintaining a patent airway

Back 67

a. lungs are clear to auscultation
b. achieves maintenance and promotion of bilateral lung expansion
c. coughs productively
d. pulse oximetry is maintained or improved

Front 68

interventions that help with mobilization of pulmonary secretions

Back 68

a. humidification
b. nebulization
c. chest physiotherapy
d. postural drainage

Front 69

common suctioning techniques

Back 69

a. oropharyngeal and nasopharyngeal
b. orotracheal and nasotracheal
c. artificial airway

Front 70

three reason for inserting a chest tube

Back 70

a. to remove air and fluids from the pleural space
b. to prevent air or fluid from reentering the pleural space
c. to reestablish normal intrapleural and intrapulmonic pressures

Front 71

hemothorax

Back 71

accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae usually due to trauma

Front 72

pnemothorax

Back 72

collection of air in the pleural space, caused by loss of negative intrapleural pressure

Front 73

the goal of oxygen therapy

Back 73

is to prevent or relieve hypoxia

Front 74

nasal cannula

Back 74

A nasal cannula is a simple, comfortable device used for oxygen delivery (Skill 40-4). The two cannulas, about 1.5 cm (½ inch) long, protrude from the center of a disposable tube and are inserted into the nares (Figure 40-13). Advantages include: safe and simple; easily tolerated; delivers low concentrations while allowing the client to eat, speak, and drink; does not impede eating or talking; is inexpensive and disposable. Disadvantages include: unable to use with nasal obstruction; drying to mucous membranes; can dislodge easily; causes skin irritation or breakdown; client’s breathing pattern will affect exact FIO2

Front 75

face mask

Back 75

An oxygen face mask is a device used to administer oxygen, humidity, or heated humidity. It fits snugly over the mouth and nose and is secured in place with a strap and it assists in providing humidified oxygen. Disadvantages include: exact FIO2 level is difficult to estimate; requires high FIO2 levels to prevent re-breathing of carbon dioxide; client inhales room air through the side holes in the mask.

Front 76

venturi mask

Back 76

The Venturi mask delivers oxygen concentrations of 24% to 60% with oxygen flow rates of 4 to 12 L/min, depending on the flow-control meter selected. Advantages include: controls the amount of specified oxygen concentration. Delivers percentage of FIO2 from 24-60%; does not dry mucous membranes; delivers humidity with oxygen concentration.

Front 77

coughing techniques

Back 77

promotes airway clearance and patent airway in clients with large volumes of sputum. Huff cough – stimulates a natural cough reflex and is effective only for clearing central airways

Front 78

respiratory muscle training

Back 78

improves muscle strength and endurance

Front 79

pursed lip breathing

Back 79

improves efficiency of breathing by decreasing air trapping and reducing the work of breathing