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151 Cards in this Set

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The amount of blood ejected from the left ventricle each minute is the_______.
cardiac output
CO= stroke volume x heart rate normal range= 4-6 L/min
______ is a more precise measure and takes into consideration tissue perfusion and the clients body surface area.
cardiac index
normal range 2.5-4.0 L/min/m2 CI= cardiac output / BSA
_____ is the amount of blood ejected from the left ventricle with each contraction.
stroke volume
_____ is the end-diastolic volume
preload
________ law states; The more stretch on the ventricular muscle, the greater the contraction and the greater the stroke volume.
Starlings
____ is the resistance to left ventricular ejection.
Afterload
An ____ reflects the electrical activity of the conduction system.
electrocardiogram
*does not reflect muscular work of the heart
The normal sequence of the ECG is called _____.
normal sinus rhythm
_____ is the process of moving gases into and out of the lungs.
Ventilation
____ is an active process, stimulated by chemical receptors in the aorta.
Inspiration
____ is a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work.
Expiration
____ is the process for exchange of the respiratory gases in the alveoli and the capillaries of the body tissues.
Diffusion
Conditions such as shock and severe dehydration cause extracellular fluid loss and reduced circulating blood volume, or _______.
hypovolemia
Electrical impulses that do not originate from the SA node cause condition disturbances called _____.
dysrhythmias
Name 2 heart rhythms that are life threatening and require immediate intervention.
ventricular tachycardia; ventricular fibrillation
_____ results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands.
Myocardial ischemia
____ is a transient imbalance between myocardial oxygen supply and demand.
Angina pectoris
_____ occurs when alveolar ventilation is inadequate to meet the body's oxygen demand or to eliminate sufficient carbon dioxide.
Hypoventilation
_____ is inadequate tissue oxygenation at the cellular level.
Hypoxia
____ is a clinical sign of hypoxia. It is a sensation of difficult or uncomfortable breathing.
Dyspnea
____ is an abnormal condition in which the client uses multiple pillows when lying down or must sit with arms elevated and leaning forward to breath.
Orthopnea
Bloody sputum
hemoptysis
High pitched musical sound caused by high-velocity movement of air through a narrowed airway.
weezing
_____ with a 50% increase between two samples 3-6 hours apart, peaking 12 hours after chest pain, or a single elevation two fold is diagnostic for an acute myocardial infarction
creatine kinase
Normal Myoglobin Level
<90 mcg/L
Normal Serum Electrolyte level (checking for potassium K+)
3.5-5 mmol/L
Normal Cholesterol level
Fasting: 200 mg/dl Low-density lipoproteins (LDL's) bad cholesterol- 60-180 mg/dL High-density lipoproteins (good cholesterol) Male: >45 mg/dL Female: >55mg/dL
Normal Triglycerides
Male: 40-160 mg/dL Female: 35-135 mg/dL
A component of pulmonary hygiene, consists of drainage, positioning, and turning; accompanied by chest percussion and vibration
postural drainage
_____ encourages voluntary deep breathing.
Incentive spirometry
A _____ is a catheter inserted through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from reentering the pleural space, or to reestablish normal intrapleural and intrapulmonic pressures.
chest tube
A _____ is an accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae, usually as a result of trama.
hemothorax
A _____ is a collection of air in the pleural space.
pneumothorax
_____ involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse.
Pursed lip breathing
_____ is more difficult and requires the client to relax intercostal and accessory respiratory muscles while taking deep inspirations.
Diaphragmatic breathing
Deoxygenated blood is delivered to the ____ side of the heart, and oxygenated blood is delivered from the lungs to the ____ side of the heart and tissues.
right;left
The ____ ventricle of the heart pumps blood through the pulmonary circulation.
right
The ____ ventricle of the heart pumps blood through the systemic circulation.
left
There are ___ cardiac chambers; ___ atria, and ____ ventricles.
4;2;2
The blood chambers fill with blood during ____ and empty during ____.
diastole; systole
An enlarged heart is called _____.
cardiomyopathy
results in decreased pumping action and a decrease in stroke volume (blood ejected)
Hemorrhage and dehydration cause a ____ in circulating blood volume and stroke volume.
decrease
___ represents the first heart sound when the blood fills a relaxed ventricle after leaving the atria.
S1
Closure of the aortic and pulmonic valves represents, ___ or the second heart sound.
S2
_____ supplies the myocardium with oxygen and nutrients and removes wastes.
Coronary artery circulation
The arteries and veins of the _____ delivers nutrients and oxygen to and remove waste from the tissues.
systemic circulation
A _____ is a catheter inserted through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from reentering the pleural space, or to reestablish normal intrapleural and intrapulmonic pressures.
chest tube
A _____ is an accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae, usually as a result of trama.
hemothorax
A _____ is a collection of air in the pleural space.
pneumothorax
_____ involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse.
Pursed lip breathing
_____ is more difficult and requires the client to relax intercostal and accessory respiratory muscles while taking deep inspirations.
Diaphragmatic breathing
The upper respiratory system includes -
Nasal cavity, mouth, pharynx, larynx
The lower respiratory system includes -
Trachea, Bronchus, Bronchioles, Alveoli
Organ of voice production, houses the vocal cords
Larynx
Protective structures of the trachea
Lined with mucus secreting cells and cilia - carried foreign particles away from lungs
Trachea divides into _____ at site of carina. This airway conduction component is anatomical dead space, no gas exchange occurs here
Bronchi
The ______ main bronchi stem is shorter and wider posing an increased risk of foreign body obstruction
right
The last airways of the conducting system
Terminal bronchioles
Thin walled with extensive capillary system where oxygen and carbon dioxide are exchanged
alveoli
Protective functions of the thorax
provides some protection to heart, lungs, and great vessels from physical trauma
Primary muscle of breathing
diaphragm
Diaphagm moves _____ with inspiration
down (it contracts)
Layer of serous membrane closest to lungs
visceral pleura
Layer of serous membrane closest to chest wall
parietal pleural membrane
3 levels for respiratory control
Central nervous system (rhythm and depth)
Reflex control (cough, sneeze)
Peripheral control (depth/ventilation)
Areas of the CNS that controls respiration
Medulla (involuntary control)
Cerebral Cortex (voluntary control)
This type of control dictates depth and ventilation - Receptors located in the brain, carotid arteries, and aorta sense changes in partial pressures of O2 (PaO2) and carbon dioxide (PaCO2) and concentration of H ions
Peripheral control
The drive to breathe is derived from ______ in the blood
PCO2
Movement of gases in and out of the lungs
ventilation
Ventilation requires -
Coordination of muscular activity
Elastic properties of thorax and lungs
Innervation / Intact nervous system
Is the result of actions of the intercostal muscles and diapragm to create negative pressure in the lungs
inspiration
Ventilation is affected by these 5 factors
Compliance (the relationship between volume and pressure of the lungs)
Surface tension - at the level of the alveoli
Muscular effort
Airway resistance
Work of breathing - effort required to expand and contract the lungs
Air flow in and out of the lungs is ___________. Blood flow to tissues, particularly alveoli is __________. The ability to move O2 and CO2 in and out of the blood, particularly at the alveoli (uptake of O2 and release of CO2) is ___________.
Ventilation, Perfusion, Diffusion
Oxygen carrying capacity relies on 3 factors -
Amount of dissolved O2 in plasma
Amount of hemoglobin
tendency of hemoglobin to bind with O2
Anemia, decreased inspired oxygen, hypovolemia, increased oxygen demand
physiological factors that can negatively affect oxygenation
Obesity, pregnancy, scoliosis, CNS impairment
physiological factors that can negatively affect ventilation and therefore oxygenation
Rhythm disturbances, congestive heart failure, myocardial infarction
cardiac conditions that can affect oxygenation
State of ventilation in excess of that required to eliminate CO2 (common with fever, anxiety)
hyperventilation
Alveolar ventilation is inadequate to meet the body's oxygen demand
Hypoventilation
Inadequate concentration of oxygen in the blood (PaO2)
Hypoxemia
Inadequate tissue oxygenation to meet the needs of the cells (common with anemia, shock, high altitudes) (PO2)
Hypoxia
Anxious, irritable, altered LOC
symptoms of poor oxygenation
Respiration rate of 12-20 breaths per minute (adult)
eupnea
Respiration rate greater than 24 breaths per minute (adult)
tachypnea
Respiration rate less than 10 breaths per minute (adult)
bradypnea
___________ breathing is characterized as rapid, deep breathing. A deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also renal failure.
kussmaul
____ is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. Common when patients are close to death. It may also be caused by damage to respiratory centers or by physiological abnormalities in chronic heart failure, also seen in newborns with immature respiratory systems and in visitors new to high altitudes.
chene-stokes
When assesing oxygenation, palpate -
PMI, skin temp, capillary refill, peripheral edema, pulses, tenderness
a high pitched wheezing sound resulting from turbulent air flow in the upper airway. Stridor is a physical sign which is produced by narrow or obstructed airway path. It can be inspiratory, expiratory or biphasic . Inspiratory stridor is common
stridor
refers to sounds heard apart from the normal sounds of inspiration and expiration.
adventitious breath sounds
the coarse low-pitched rattling sound somewhat like snoring, usually caused by secretion in bronchial airways.
rhonchi
a medical device used to help patients improve the functioning of their lungs. The patient breathes in from the device as slowly and as deeply as possible. An indicator provides a gauge of how well the patient's lung or lungs are functioning, by indicating sustained inhalation vacuum.
Incentive spirometer
A comfortable method of O2 delivery that doesn't interfere with talking or eating and comes in sizes appropriate for all age groups. Can deliver flow rates of 2-6 L/min to adults at 32% to 60% concentration. Expect about 4% increase for each L/min
nasal cannula
Somewhat more cumbersome method of O2 delivery acceptable for short-term use. 30% to 60% concentration, 6-8L/min
simple face mask
can provide oxygen supplementation between 65% and 75% at 6-10 L/min. Flow rate must be high enough to prevent bag collapse.
partial re-breathing mask
Oxygen delivery method that can be used over the full range of FiO2. 85%-95% concentration, rate of 8-12 L/min, unidirectional valve, bag must inflate properly.
nonbreathing mask
Oxygen delivery method in which flow varies but concentration must be precise. Ordered by concentration rather than flow rate. Delivers O2 at 24% - 50% concentration.
Venturi mask
Oxygen delivery method recommended for use in unstable patients who need stable, low-levels of oxygen
air entrainment mask
Examples include oxyhoods, isolettes and tents. Restricted to use in neonates, infants and small children
enclosure devices
Which patients receiving oxygen require extra attention to temperature, humidity, and infection control?
Patients who are intubated or have a tracheostomy because you will bypass the upper airway that typically warms, filters and humidifies air.
not a single disease but an umbrella term used to describe chronic lung diseases that can limit your airflow. Most common conditions are chronic bronchitis and emphysema.
COPD
Easily fatigued, frequent respiratory infections, use of accessory muscles to breathe, orthopneic, Cor pulmonale (rt sided heart failure) late in desease, thin appearance, dyspnea, pursed-lip breathing, chronic non-productive cough, barrel chest, wheezing, prolonged expiratory time, digital clubbing, history of smoking
common symptoms of COPD
CO2 retention produces pink skin tones (no cyanosis), pursed-lip breathing, increased mucus, ineffective cough, bronchi collapse on expiration, orthopnea, barrel chest, short of breath, exertional dyspnea, easily fatigued, wheezing, speaks in short jerky sentences, anxious, frequent URIs, prolonged expiratory time, use of accessory muscles, digital clubbing, thin, leads to rt sided heart failure.
common symptoms of Pulmonary Emphysema (aka "Pink Puffer")
Dusky or cyanotic skin tone, edematous, recurrent cough and sputum production, hypoxia, hypercapnia (CO2 retention), acidosis, increased respiration rate, exertional dyspnea, history of heavy smoking, cardiac enlargement, use of accessory muscles to breath, cor pulmonale
common symptoms of Chronic Bronchitis (aka "Blue Bloater")
Conditions in which the lungs themselves cannot expand. Examples include loss of compliance, spinal conditions such as kyphosis or scoliosis.
Restrictive breathing disorders
diseases of the lung where the airways (i.e. bronchi, bronchioles, alveoli) become reduced in volume or have free flow of gas impeded, making it more difficult to move air in and out of the lung. (i.e. asthma)
Obstructive breathing disorders
"itis" suffix indicates
inflammation
Immune responses that may create problems of the upper airway -
Edema, smooth muscle constriction, increased mucus production
Common medical diagnoses associated with problems of the upper airways
Sinusitis, pharynitis, nasal polyps, epistaxis, laryngitis, allergic rhinitis, common cold
Common nursing goals associated with problems of the upper airways
maintain patent airway, increase effectiveness of airway clearance, relieve pain, prevent infection, prevent spread of infection
Common nursing interventions associated with problems of the upper airways.
rest, 2-3 liters of fluid daily (unless contraindicated), humidified air, saline nasal spray, elevate head of bed, soothe throat
antihistamines, nasal and systemic decongestants, nasal glucocorticoids
decrease inflammation in upper airways
Dyspnea, fatigue, cough, sputum, hemoptysis, wheezing, chest pain/pressure/tightening, orthopnea
Common complaints associated with problems of the lower respiratory tract
Placing thumbs on back at 10th intercostal space just to left and right of spine and observing their lateral movement during patient's inspiration measures _______
thoracic excursion
Trachea offset to one side may indicate
collapsed lung - atelectasis
a vibration felt on the patient's chest during low frequency vocalization. Vibration is pathologically decreased or absent over areas of pleural effusion or pneumothorax (where there is liquid or air instead of usual lung).
tactile fremitus
Normal percussion tone heard over lungs
Resonance
Percussion tone heard over lungs that indicates increased air
Hyperesonance
Percussion tone heard over lungs that indicates tissue or fluid
Dull sound
Increased fluid in the pleural space
Pleural effusion
Lab test that provides information about oxygenation, acid-base balance, and ventilation.
ABGs (arterial blood gas)
What nursing actions would accompany an ABG test?
Prepare patient - no activity 20 min before, no food, explain procedure
Allen's test (determines collateral blood flow)
Apply direct pressure to puncture site at least 5 min
Lab test that would provide information about oxygen-carrying capacity
RBC
Testing for collateral circulation to the hand by evaluating the patency of the radial and ulnar arteries.
Allen's test
Lab test that determines culture and sensitivity of organisms
microbiology
Lab test that determines cell type
cytology
Provides a cross-sectional scan of a body area - not as detailed as an MRI but much less costly
CT scan (computed tomography)
Internal scope of lower airways
endoscopy
Nursing care prior to endoscopy
NPO, sedation, local anesthetic, supplemental O2
Insertion of a needle into pleural space to remove fluid, instill medications, or biopsy
Thoracentesis
of unknown origin
idiopathic
Intrapulmonary disease, interstitial lung disease, pneumonia, atelactasis, neuromuscular/neurological conditions, scoliosis, kyphosis, pleural effusion
restrictive lung disorders
Increased respiratory rate, shallow respiratory depth, dyspnea, cough with sputum production, respiratory alkalosis
common symptoms of restrictive lung disorders
Prolonged expiratory time, increased work of breathing, increased anterioposterior thorax diameter (barrel chest), hyperresonance on percussion
Clinical manifestations of obstructive breathing disorders
A result of increased alveolar membrane thickness, decreased alveolar surface area, or decrease in pressure gradient between lungs and atmousphere
Obstructive breathing disorders
Altered LOC, dyspnea, increased respiratory rate, possible chest pain, fatigue
common clinical manifestations of cardiovascular problems
Establishes and maintains patent airway, prevents aspiration by sealing off digestive tract, permits removal of tracheobronchial secretions in patients who cannot cough, vehicle to apply positive pressure ventilation, short-term (up to 14 days).
endotracheal tube
Establishes and maintains patent airway for patients requiring airway maintenance for longer than 10-14 days. May also be used if endotracheal tube cannot be inserted.
Tracheostomy
type of medication that dilates bronchioles
Bronchodilator
Leukotrine modifiers
Help to maintain patent airway by reducing symptoms of inflammation
glucocorticoids act as an
antiinflammatory
Methods to improve airway clearance
Humidification both to air and through fluid intake
Strengthen respiratory muscles
Chest physiotherapy (postural drainage, percussion)
coughing
minimize bronchospasm
"huff" to expectorate thick secretions
inhale maximally to reinflate alveoli
To help relieve some breathing issues associated with right upper lobe, position patient
high fowler
To help relieve some breathing issues associated with left upper lobe, position patient
sitting hunched slightly forward with pillows or folded blanket for support
To help relieve some breathing issues associated with right middle lobe, position patient
left side with food of bed elevated about 12 inches, chest rotated toward supine position
To help relieve some breathing issues associated with right lower lobe, position patient
left lateral recombent position with food of bed elevated 20 inches
medications to liquefy and loosen secretions
mucolytics
medications to loosen bronchial secretions so they can be eliminated with cough
expectorants
medications to suppress cough reflex
antitussives
Tilt head ____ to ____ degrees to maintain airway patency and lean forward about ____ degrees
tilt head 16 to 18 degrees, lean 30 degrees
To improve efficiency of breathing pattern, encourage longer ________ ; about double the length of __________
expiration, about 2X inspiration (example 5 sec in, 10 out)