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36 Cards in this Set
- Front
- Back
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*HEMOGLOBLIN VALUE*
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PROVIDES INFORMATION ABOUT OXYGEN CARRYING CAPACITY OF BLOOD
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*PROCESS OF BREATHING IS CONTROLLED BY CNS*
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*PROCESS OF BREATHING IS CONTROLLED BY CNS*
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BEFORE YOU INTERVENE YOU NEED TO DO AN ASSESSMENT
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BEFORE YOU INTERVENE YOU NEED TO DO AN ASSESSMENT
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HYPOXIA: EARLY SIGN
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RESTLESSNESS
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HYPOXIA: LATE SIGN
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CYANOSIS
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SYSTOLIC BLOOD PRESSURE
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MAX AMT. OF PRESSURE BEING EXERTED AGAINST ARTERIAL WALLS DURING VENTRICULAR CONTRACTION
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DIASTOLIC BLOOD PRESSURE
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MIN. AMT. OF PRESSURE WITHIN ARTERIES, WHEN VENTRICLES RELAX
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PULSE OXIMETRY
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USED TO DETERMINE ARTERIAL BLOOD SATURATION
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Briefly describe the structure and function of the respiratory system.
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chemoreceptors in the medulla, carotid arteries and the aorta detect changes in the blood pH, oxygen levels and CO2 levels
ventilation (breathing- rate and depth, compliance, elastic recoil, airway resistance, accessory muscles) |
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Describe the processes involved in ventilation
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rate and depth of breathing, compliance, elastic recoil, airway resistance, accessory muscles
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Describe the processes involved in perfusion
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circulation of blood to and from the surface of the alveoli for gas exchange. Dependent on right ventricle for pulmonary circulation and systemic blood pressure for venous return
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Describe the processes involved in exchange of respiratory gases.
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Exchange occurs at alveoli and capillaries of body tissue. Method of transport is simple diffusion
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Describe the processes involved in ventilation, perfusion, and exchange of respiratory gases.
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Clients health (obesity, allergies), age (premature infants, elderly), environment (altitude, temperature), lifestyle (stress, smoking), physiological (COPD), decreased inspried O2 concentration (Ariway obstructions, hypovolemia-shock, severe dehydration, increases O2 demand), increased metabolic rate
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hyperventilation
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ventilation, greater than that which is required to eliminate normal CO2 level
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causes of hyperventilation
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anxiety, panic, high altitude, infection, asthma, drugs, heat
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effects of hyperventilation
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excessive intake of O2 and elimination of CO2 -> dizziness, faintness, numbness of fingers and toes, syncope, psycho motor impairment
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hypoventilation
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ventilation inadequate to meet O2 demands or eliminate sufficient CO2
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causes of hypoventilation
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bronchitis, obesity, neuromuscular or skeletal disease affecting the thorax, decreased response of the respiratory center to CO2, decreased functional lung tissue as in atelectasis or COPD
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effects of hypoventilation
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hypoxia, hypercapnia (low level of dissolved CO2 in blood due to hyperventilation), respiratory acidosis
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treatment for hyperventilation
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reassurance from family or friend to help relax breathing, breathing thru pursed lips, exercise regulalry
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treatment for hypoventilation
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weight reduction, artificial respiration, and possible tracheostomy
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hypoxemia
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abnormal defficiency of oxygen in arterial blood; most reliable method of measuring blood in gas analysis. Determines the partial pressure of O2 in arterial blood
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EARLY SIGN OF BODY ADAPTING
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INCREASED HEART RATE
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Develop nursing diagnoses related to oxygenation, breathing, circulation and gas exchange
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airway clearance, ineffective
activity intolerance tissue perfusion, inadequate |
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nursing interventions to maintain or promote lung expansion
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positioning, semi-fowlers is best, incentive spirometry, chest physiotherapy (percussion, postural drainage), chest tubes (pneumothorax, hemothorax)
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nursing interventions to promote mobilization of respiratory secretions
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hydration, humidification, nebulization
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nursing interventions to maintain a patent airway
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deep breathing and coughing, suctioning, artificial airways
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nursing interventions to promote oxygenation
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nasal canula, nasal catheter, oxygen mask, transtrachael
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nursing interventions to restore cardiopulmonary function
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Digoxin, Lidocaine, Nitroglycerin, Albuterol, Terbutaline
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Accessory muscles
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not efficient way of breathing; muscles in back neck and abdomen (can lead to barrel chest look)
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COPD
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chronic obstructive pulmonary disease
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Tachycardia
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HR > 100 BPM;
normal: fever, exercise, excitement abnormal: CHF, shock, anemia |
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Bradycardia
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HR<60 BPM;
normal: well developed athlete abnormal: brain tumor, drug toxicity, medications |
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Premature beats
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Heart beat comes too soon early in cardiac cycle; incomplete emptying of heart
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Blocked beats
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delayed beats
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Dysrhythmias
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deviation from normal sinus heart rhythm. electrical impulses that do not result from the SA node
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