*exam 3 Chapter 40 Potter Perry Fundamentals Of Nursing

Front 1

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

Back 1

cardiac output

Hint 1

CO= stroke volume x heart rate normal range= 4-6 L/min

Front 2

______ is a more precise measure and takes into consideration tissue perfusion and the clients body surface area.

Back 2

cardiac index

Hint 2

normal range 2.5-4.0 L/min/m2 CI= cardiac output / BSA

Front 3

_____ is the amount of blood ejected from the left ventricle with each contraction.

Back 3

stroke volume

Front 4

_____ is the end-diastolic volume

Back 4

preload

Front 5

________ law states; The more stretch on the ventricular muscle, the greater the contraction and the greater the stroke volume.

Back 5

Starlings

Front 6

____ is the resistance to left ventricular ejection.

Back 6

Afterload

Front 7

An ____ reflects the electrical activity of the conduction system.

Back 7

electrocardiogram

Hint 7

*does not reflect muscular work of the heart

Front 8

The normal sequence of the ECG is called _____.

Back 8

normal sinus rhythm

Front 9

_____ is the process of moving gases into and out of the lungs.

Back 9

Ventilation

Front 10

____ is an active process, stimulated by chemical receptors in the aorta.

Back 10

Inspiration

Front 11

____ is a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work.

Back 11

Expiration

Front 12

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

Back 12

Diffusion

Front 13

Conditions such as shock and severe dehydration cause extracellular fluid loss and reduced circulating blood volume, or _______.

Back 13

hypovolemia

Front 14

Electrical impulses that do not originate from the SA node cause condition disturbances called _____.

Back 14

dysrhythmias

Front 15

Name 2 heart rhythms that are life threatening and require immediate intervention.

Back 15

ventricular tachycardia; ventricular fibrillation

Front 16

_____ results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands.

Back 16

Myocardial ischemia

Front 17

____ is a transient imbalance between myocardial oxygen supply and demand.

Back 17

Angina pectoris

Front 18

_____ occurs when alveolar ventilation is inadequate to meet the body's oxygen demand or to eliminate sufficient carbon dioxide.

Back 18

Hypoventilation

Front 19

_____ is inadequate tissue oxygenation at the cellular level.

Back 19

Hypoxia

Front 20

____ is a clinical sign of hypoxia. It is a sensation of difficult or uncomfortable breathing.

Back 20

Dyspnea

Front 21

____ 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.

Back 21

Orthopnea

Front 22

Bloody sputum

Back 22

hemoptysis

Front 23

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

Back 23

weezing

Front 24

_____ 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

Back 24

creatine kinase

Front 25

Normal Myoglobin Level

Back 25

<90 mcg/L

Front 26

Normal Serum Electrolyte level (checking for potassium K+)

Back 26

3.5-5 mmol/L

Front 27

Normal Cholesterol level

Back 27

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

Front 28

Normal Triglycerides

Back 28

Male: 40-160 mg/dL Female: 35-135 mg/dL

Front 29

A component of pulmonary hygiene, consists of drainage, positioning, and turning; accompanied by chest percussion and vibration

Back 29

postural drainage

Front 30

_____ encourages voluntary deep breathing.

Back 30

Incentive spirometry

Front 31

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.

Back 31

chest tube

Front 32

A _____ is an accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae, usually as a result of trama.

Back 32

hemothorax

Front 33

A _____ is a collection of air in the pleural space.

Back 33

pneumothorax

Front 34

_____ involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse.

Back 34

Pursed lip breathing

Front 35

_____ is more difficult and requires the client to relax intercostal and accessory respiratory muscles while taking deep inspirations.

Back 35

Diaphragmatic breathing

Front 36

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.

Back 36

right;left

Front 37

The ____ ventricle of the heart pumps blood through the pulmonary circulation.

Back 37

right

Front 38

The ____ ventricle of the heart pumps blood through the systemic circulation.

Back 38

left

Front 39

There are ___ cardiac chambers; ___ atria, and ____ ventricles.

Back 39

4;2;2

Front 40

The blood chambers fill with blood during ____ and empty during ____.

Back 40

diastole; systole

Front 41

An enlarged heart is called _____.

Back 41

cardiomyopathy

Hint 41

results in decreased pumping action and a decrease in stroke volume (blood ejected)

Front 42

Hemorrhage and dehydration cause a ____ in circulating blood volume and stroke volume.

Back 42

decrease

Front 43

___ represents the first heart sound when the blood fills a relaxed ventricle after leaving the atria.

Back 43

S1

Front 44

Closure of the aortic and pulmonic valves represents, ___ or the second heart sound.

Back 44

S2

Front 45

_____ supplies the myocardium with oxygen and nutrients and removes wastes.

Back 45

Coronary artery circulation

Front 46

The arteries and veins of the _____ delivers nutrients and oxygen to and remove waste from the tissues.

Back 46

systemic circulation

Front 47

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.

Back 47

chest tube

Front 48

A _____ is an accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae, usually as a result of trama.

Back 48

hemothorax

Front 49

A _____ is a collection of air in the pleural space.

Back 49

pneumothorax

Front 50

_____ involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse.

Back 50

Pursed lip breathing

Front 51

_____ is more difficult and requires the client to relax intercostal and accessory respiratory muscles while taking deep inspirations.

Back 51

Diaphragmatic breathing

Front 52

The upper respiratory system includes -

Back 52

Nasal cavity, mouth, pharynx, larynx

Front 53

The lower respiratory system includes -

Back 53

Trachea, Bronchus, Bronchioles, Alveoli

Front 54

Organ of voice production, houses the vocal cords

Back 54

Larynx

Front 55

Protective structures of the trachea

Back 55

Lined with mucus secreting cells and cilia - carried foreign particles away from lungs

Front 56

Trachea divides into _____ at site of carina. This airway conduction component is anatomical dead space, no gas exchange occurs here

Back 56

Bronchi

Front 57

The ______ main bronchi stem is shorter and wider posing an increased risk of foreign body obstruction

Back 57

right

Front 58

The last airways of the conducting system

Back 58

Terminal bronchioles

Front 59

Thin walled with extensive capillary system where oxygen and carbon dioxide are exchanged

Back 59

alveoli

Front 60

Protective functions of the thorax

Back 60

provides some protection to heart, lungs, and great vessels from physical trauma

Front 61

Primary muscle of breathing

Back 61

diaphragm

Front 62

Diaphagm moves _____ with inspiration

Back 62

down (it contracts)

Front 63

Layer of serous membrane closest to lungs

Back 63

visceral pleura

Front 64

Layer of serous membrane closest to chest wall

Back 64

parietal pleural membrane

Front 65

3 levels for respiratory control

Back 65

Central nervous system (rhythm and depth)
Reflex control (cough, sneeze)
Peripheral control (depth/ventilation)

Front 66

Areas of the CNS that controls respiration

Back 66

Medulla (involuntary control)
Cerebral Cortex (voluntary control)

Front 67

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

Back 67

Peripheral control

Front 68

The drive to breathe is derived from ______ in the blood

Back 68

PCO2

Front 69

Movement of gases in and out of the lungs

Back 69

ventilation

Front 70

Ventilation requires -

Back 70

Coordination of muscular activity
Elastic properties of thorax and lungs
Innervation / Intact nervous system

Front 71

Is the result of actions of the intercostal muscles and diapragm to create negative pressure in the lungs

Back 71

inspiration

Front 72

Ventilation is affected by these 5 factors

Back 72

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

Front 73

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 ___________.

Back 73

Ventilation, Perfusion, Diffusion

Front 74

Oxygen carrying capacity relies on 3 factors -

Back 74

Amount of dissolved O2 in plasma
Amount of hemoglobin
tendency of hemoglobin to bind with O2

Front 75

Anemia, decreased inspired oxygen, hypovolemia, increased oxygen demand

Back 75

physiological factors that can negatively affect oxygenation

Front 76

Obesity, pregnancy, scoliosis, CNS impairment

Back 76

physiological factors that can negatively affect ventilation and therefore oxygenation

Front 77

Rhythm disturbances, congestive heart failure, myocardial infarction

Back 77

cardiac conditions that can affect oxygenation

Front 78

State of ventilation in excess of that required to eliminate CO2 (common with fever, anxiety)

Back 78

hyperventilation

Front 79

Alveolar ventilation is inadequate to meet the body's oxygen demand

Back 79

Hypoventilation

Front 80

Inadequate concentration of oxygen in the blood (PaO2)

Back 80

Hypoxemia

Front 81

Inadequate tissue oxygenation to meet the needs of the cells (common with anemia, shock, high altitudes) (PO2)

Back 81

Hypoxia

Front 82

Anxious, irritable, altered LOC

Back 82

symptoms of poor oxygenation

Front 83

Respiration rate of 12-20 breaths per minute (adult)

Back 83

eupnea

Front 84

Respiration rate greater than 24 breaths per minute (adult)

Back 84

tachypnea

Front 85

Respiration rate less than 10 breaths per minute (adult)

Back 85

bradypnea

Front 86

___________ 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.

Back 86

kussmaul

Front 87

____ 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.

Back 87

chene-stokes

Front 88

When assesing oxygenation, palpate -

Back 88

PMI, skin temp, capillary refill, peripheral edema, pulses, tenderness

Front 89

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

Back 89

stridor

Front 90

refers to sounds heard apart from the normal sounds of inspiration and expiration.

Back 90

adventitious breath sounds

Front 91

the coarse low-pitched rattling sound somewhat like snoring, usually caused by secretion in bronchial airways.

Back 91

rhonchi

Front 92

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.

Back 92

Incentive spirometer

Front 93

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

Back 93

nasal cannula

Front 94

Somewhat more cumbersome method of O2 delivery acceptable for short-term use. 30% to 60% concentration, 6-8L/min

Back 94

simple face mask

Front 95

can provide oxygen supplementation between 65% and 75% at 6-10 L/min. Flow rate must be high enough to prevent bag collapse.

Back 95

partial re-breathing mask

Front 96

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.

Back 96

nonbreathing mask

Front 97

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.

Back 97

Venturi mask

Front 98

Oxygen delivery method recommended for use in unstable patients who need stable, low-levels of oxygen

Back 98

air entrainment mask

Front 99

Examples include oxyhoods, isolettes and tents. Restricted to use in neonates, infants and small children

Back 99

enclosure devices

Front 100

Which patients receiving oxygen require extra attention to temperature, humidity, and infection control?

Back 100

Patients who are intubated or have a tracheostomy because you will bypass the upper airway that typically warms, filters and humidifies air.

Front 101

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.

Back 101

COPD

Front 102

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

Back 102

common symptoms of COPD

Front 103

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.

Back 103

common symptoms of Pulmonary Emphysema (aka "Pink Puffer")

Front 104

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

Back 104

common symptoms of Chronic Bronchitis (aka "Blue Bloater")

Front 105

Conditions in which the lungs themselves cannot expand. Examples include loss of compliance, spinal conditions such as kyphosis or scoliosis.

Back 105

Restrictive breathing disorders

Front 106

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)

Back 106

Obstructive breathing disorders

Front 107

"itis" suffix indicates

Back 107

inflammation

Front 108

Immune responses that may create problems of the upper airway -

Back 108

Edema, smooth muscle constriction, increased mucus production

Front 109

Common medical diagnoses associated with problems of the upper airways

Back 109

Sinusitis, pharynitis, nasal polyps, epistaxis, laryngitis, allergic rhinitis, common cold

Front 110

Common nursing goals associated with problems of the upper airways

Back 110

maintain patent airway, increase effectiveness of airway clearance, relieve pain, prevent infection, prevent spread of infection

Front 111

Common nursing interventions associated with problems of the upper airways.

Back 111

rest, 2-3 liters of fluid daily (unless contraindicated), humidified air, saline nasal spray, elevate head of bed, soothe throat

Front 112

antihistamines, nasal and systemic decongestants, nasal glucocorticoids

Back 112

decrease inflammation in upper airways

Front 113

Dyspnea, fatigue, cough, sputum, hemoptysis, wheezing, chest pain/pressure/tightening, orthopnea

Back 113

Common complaints associated with problems of the lower respiratory tract

Front 114

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 _______

Back 114

thoracic excursion

Front 115

Trachea offset to one side may indicate

Back 115

collapsed lung - atelectasis

Front 116

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).

Back 116

tactile fremitus

Front 117

Normal percussion tone heard over lungs

Back 117

Resonance

Front 118

Percussion tone heard over lungs that indicates increased air

Back 118

Hyperesonance

Front 119

Percussion tone heard over lungs that indicates tissue or fluid

Back 119

Dull sound

Front 120

Increased fluid in the pleural space

Back 120

Pleural effusion

Front 121

Lab test that provides information about oxygenation, acid-base balance, and ventilation.

Back 121

ABGs (arterial blood gas)

Front 122

What nursing actions would accompany an ABG test?

Back 122

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

Front 123

Lab test that would provide information about oxygen-carrying capacity

Back 123

RBC

Front 124

Testing for collateral circulation to the hand by evaluating the patency of the radial and ulnar arteries.

Back 124

Allen's test

Front 125

Lab test that determines culture and sensitivity of organisms

Back 125

microbiology

Front 126

Lab test that determines cell type

Back 126

cytology

Front 127

Provides a cross-sectional scan of a body area - not as detailed as an MRI but much less costly

Back 127

CT scan (computed tomography)

Front 128

Internal scope of lower airways

Back 128

endoscopy

Front 129

Nursing care prior to endoscopy

Back 129

NPO, sedation, local anesthetic, supplemental O2

Front 130

Insertion of a needle into pleural space to remove fluid, instill medications, or biopsy

Back 130

Thoracentesis

Front 131

of unknown origin

Back 131

idiopathic

Front 132

Intrapulmonary disease, interstitial lung disease, pneumonia, atelactasis, neuromuscular/neurological conditions, scoliosis, kyphosis, pleural effusion

Back 132

restrictive lung disorders

Front 133

Increased respiratory rate, shallow respiratory depth, dyspnea, cough with sputum production, respiratory alkalosis

Back 133

common symptoms of restrictive lung disorders

Front 134

Prolonged expiratory time, increased work of breathing, increased anterioposterior thorax diameter (barrel chest), hyperresonance on percussion

Back 134

Clinical manifestations of obstructive breathing disorders

Front 135

A result of increased alveolar membrane thickness, decreased alveolar surface area, or decrease in pressure gradient between lungs and atmousphere

Back 135

Obstructive breathing disorders

Front 136

Altered LOC, dyspnea, increased respiratory rate, possible chest pain, fatigue

Back 136

common clinical manifestations of cardiovascular problems

Front 137

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).

Back 137

endotracheal tube

Front 138

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.

Back 138

Tracheostomy

Front 139

type of medication that dilates bronchioles

Back 139

Bronchodilator

Front 140

Leukotrine modifiers

Back 140

Help to maintain patent airway by reducing symptoms of inflammation

Front 141

glucocorticoids act as an

Back 141

antiinflammatory

Front 142

Methods to improve airway clearance

Back 142

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

Front 143

To help relieve some breathing issues associated with right upper lobe, position patient

Back 143

high fowler

Front 144

To help relieve some breathing issues associated with left upper lobe, position patient

Back 144

sitting hunched slightly forward with pillows or folded blanket for support

Front 145

To help relieve some breathing issues associated with right middle lobe, position patient

Back 145

left side with food of bed elevated about 12 inches, chest rotated toward supine position

Front 146

To help relieve some breathing issues associated with right lower lobe, position patient

Back 146

left lateral recombent position with food of bed elevated 20 inches

Front 147

medications to liquefy and loosen secretions

Back 147

mucolytics

Front 148

medications to loosen bronchial secretions so they can be eliminated with cough

Back 148

expectorants

Front 149

medications to suppress cough reflex

Back 149

antitussives

Front 150

Tilt head ____ to ____ degrees to maintain airway patency and lean forward about ____ degrees

Back 150

tilt head 16 to 18 degrees, lean 30 degrees

Front 151

To improve efficiency of breathing pattern, encourage longer ________ ; about double the length of __________

Back 151

expiration, about 2X inspiration (example 5 sec in, 10 out)