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147 Cards in this Set
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OBJECTIVES: 1. Describe the structure and function of the cardiopulmonary system. |
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OBJECTIVES: 2. Describe the physiological processes of ventilation, perfusion, and exchange of respiratory gases. |
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OBJECTIVES: 3. State the process of the neural and chemical regulation of respiration. |
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OBJECTIVES: 4. Differentiate among the physiological processes of cardiac output, myocardial blood flow, and coronary artery circulation. |
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OBJECTIVES: 5. Describe the relationship of cardiac output, preload, afterload, contractility, and heart rate to the process of oxygenation. |
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OBJECTIVES: 6. Identify the clinical outcomes occurring as a result of hyperventilation, hypoventilation, and hypoxemia. |
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OBJECTIVES: 7. Identify the clinical outcomes occurring as a result of disturbances in conduction, altered cardiac output, impaired valvular function, myocardial ischemia, and impaired tissue perfusion. |
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OBJECTIVES: 8. Discuss the effect of a patient's level of health, age, lifestyle, and environment on oxygenation. |
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OBJECTIVES: 9. Assess for the risk factors affecting a patient's oxygenation. |
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OBJECTIVES: 10. Assess for the physical manifestations that occur with alterations in oxygenation. |
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OBJECTIVES: 11. Develop a plan of care for a patient with altered need for oxygenation. |
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Respiratory Physiology List the basics |
1. Structure and function: a. Work of Breathing b. Lung Volumes c. Pulmonary Circulation 2. Respiratory Gas Exchange a. Oxygen transport b. Carbon Dioxide Transport 3. Regulation of Respiration |
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OBJECTIVES: 12. Describe nursing care interventions used to promote oxygenation in the primary care, acute care, and restorative and continuing care settings. |
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Scientific Knowledge Base: Pg. 821 4 KP |
1. Oxygen necessary for life. 2. Cardiac/Resp. system supply the oxygen demands of the body. 3. Oxygenated through ventilation, perfusion, and transport of respiratory gases. 4. Neural and chemical regulators control the rate and depth of respiration in response to changing tissue oxygen demands. |
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Respiratory Physiology Pg. 822 4 KP |
1. Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism. 2. The airways of the lung transfer oxygen from the atmosphere to the alveoli, where oxygen is exchanged for carbon dioxide. 3. Through the alveolar capillary membrane, oxygen goes to the blood, and carbon dioxide to the alveoli. 4. 3 steps: ventilation, perfusion, and diffusion. |
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STRUCTURE AND FUNCTION: 15 KP pg. 822 8/15 KP |
1. Conditions or changes that affect the structure and function of the pulmonary system alter respiration. 2. The respiratory muscles, pleural space, lungs, and alveoli are essential for ventilation, perfusion, and exchange of respiratory gases. 3. Gases move in/out of the lungs through pressure changes. 4. Intrapleural pressure is negative, or less than atmospheric pressure (760 mm Hg). 5. This negative pressure sets up a pressure gradient. 6. Diaphragm and external intercostal muscles contract to create a negative pleural pressure and increase the size of the thorax for inspiration. 7. Relaxation of the diaphragm and contraction of the internal intercostal muscles allow air to escape from the lungs. |
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STRUCTURE AND FUNCTION Last 7/15 KP |
1. Ventilation is the process of moving gases into and out of the lungs. 2. Requires coordination of the muscular and elastic properties of the lungs and thorax. 3. Major inspiratory muscle of respiration is the diaphragm. 4. Innervated by the phrenic nerve: exits via 4th cervical vertebra. 5. Perfusion: ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs. 6. Diffusion: moving the respiratory gases from one area to another by concentration gradients. 7. For exchange of rest. gases to occur, organs, nerves, and muscles of respiration need to be intact and CNS needs to be able to regulate the resp. cycle. |
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Work of Breathing
1. What is it? 2. How is breathing like for healthy people? 3. Amt. of energy expended on breathing? |
1. WOB is the effort required to expand and contract the lungs. 2. For healthy people, breathing is quiet and easy. 3. Amt. of energy expended on breathing depends on: a. rate and depth of breathing b. ease in which the lungs can be expanded (compliance) c. airway resistance |
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Inspiration and expiration Surfactant/atelectasis Pg. 822 6 KP |
1. Inspiration is an active process, stimulated by chemical receptors in the aorta. 2. Expiration is a passive process that depends on elastic recoil properties of the lungs, requiring little or no muscle work. 3. Surfactant is a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing. 4. Pts with (COPD) lose the elastic recoil of the lungs and thorax. 5. Decreased surfactant can develop into atelectasis. 6. Atelectasis is a collapse of the alveoli that prevents normal exchange of CO2/O2. |
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Accessory muscles 4 KP |
1. Can increase lung volume during inspiration. 2. Pts w/ COPD, (emphysema), use these to increase long volumes. 3. Prolonged use causes fatigue; isn't effective. 4. During asst., observe for elevation of pt's clavicles during inspiration: sign of ventilatory fatigue, air hunger, or decreased lung expansion. |
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Compliance pg. 822 |
1. Ability of the lungs to distend or expand in response to increased intraalveolar pressure. 2. Decreases in diseases such as pulmonary edema, interstitial and pleural fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs. |
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Airway resistance 4 KP |
1. The increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli. 2. Airway Resistance increases due to bronchoconstriction. 3. Diseases such as asthma and tracheal edema increase airway resistance. 4. Oxygen delivered to alveoli then decreases |
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WOB: 3 things that increases it. pg. 822 IMP |
1. Decreased lung compliance, increased airway resistance, and the increased use of accessory muscles increase WOB, resulting in energy expenditure. 2. Causes metabolic rate to increase and more O2 needed/more CO2 expended. 3. Vicious cycle for someone who is already ill. |
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Lung Volumes 1. Normal lung values determined by? 2. Tidal volumes 3. Residual volume 4. Forced vital capacity 5. Variations in lung volumes Pg. 822 |
1. Normal lung values determined by age, gender, and height. 2. Tidal volume: amt. of air exhaled after normal inspiration. 3. Residual volume: amt. of air left in the alveoli after a full expiration. 4. Forced vital capacity: max amt. of air that can be removed from the lungs during forced expiration. 5. Variations in long volumes occur w/ pt's health, exercise, obesity, and disease. |
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PULMONARY CIRCULATION Pg. 822-823 |
1. Primary function of pulmonary circulation is to move blood to and from the alveolar capillary membrane for gas exchange. 2. Begins at the pulmonary artery, which receives poorly oxygenated mixed venous blood from the right ventricle. 3. Blood flow depends on right ventricle. 4. Flow continues from pulmonary artery through the pulmonary arterioles to the pulmonary capillaries. 5. Blood then comes into contact with the alveolar capillary membrane and the exchange of resp. gases occurs. 6. Oxygen-rich blood circulates through the pulmonary venues/veins, returning to the left atrium. |
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Respiratory Gas Exchange 5 KP Pg. 823 |
1. Diffusion: process for Exchange of respiratory gases in alveoli and capillaries of body tissue via concentration gradients. 2. Diffusion occurs at alveolar capillary membrane. 3. Thickness of membrane affects rate of diffusion. 4. Pts with pulmonary edema, pulmonary infiltrates, or pulmonary effusion = thickened membrane, resulting in slowER diffusion, exchange of respiratory gases, and delivery of oxygen to tissues. 5. Chronic disease (emphysema), acute disease (pneumothorax), and surgical processes (lobectomy) often alter the amt. of alveolar capillary membrane surface area. |
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Respiratory Gas Exchange Oxygen transport Consists of? Delivery depends on? Pg. 823 |
1. Oxygen-transport system consists of the lungs and cardiovascular system. 2. Delivery depends on the amt. of oxygen entering the lungs (ventilation), blood flow to the lungs and tissues (perfusion), rate of diffusion, and oxygen-carrying capacity. |
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3 things influence the capacity of the blood to carry oxygen |
1. The amount of dissolved oxygen in the plasma 2. The amount of hemoglobin 3. The tendency of hemoglobin to bind with oxygen |
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Hemoglobin 4 KP |
1. A carrier for oxygen and carbon dioxide 2. Transports 97% of oxygen 3. When combined with oxygen, forms oxyhemoglobin. 4. Formation back to hemoglobin easily obtained |
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Carbon Dioxide Transport Pg. 823 |
1. CO2 = product of cellular metabolism 2. Diffuses into red blood cells and hydrated into carbonic acid (H2CO3). 3. Carbonic acid dissociates into hydrogen and bicarbonate (HCO3-) ions. 4. Hemoglobin buffers hydrogen ion. 5. HCO3- diffuses into plasma 6. Reduced hemoglobin (deoxyhemoglobin) combines with CO2, and the venous blood transports majority of CO2 back to the lungs to be exhaled |
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Regulation of Respiration Pg. 823 |
1. Regulation of Respiration necessary to ensure sufficient oxygen intake and CO2 elimination to meed the demands of the body (during exercise, infection, or pregnancy). 2. Neural/chemical regulators control the process of respiration. 3. Neural regulation includes: CNS control of resp. rate, depth, and rhythm. 4. Cerebral cortex regulates the voluntary control of respiration by delivering impulses to the respiratory motor neurons by way of the spinal cord. 5. Chem. regulation maintains the appropriate rate and depth of respirations based on changes in the CO2, O2, and H+ concentration (pH) in the blood. 6. Changes in these stimulate chemoreceptors located in the medulla, aortic body, and carotid body. This in turn stimulates neural regulators to adjust the rate/depth of ventilation to maintain normal arterial blood gas levels. |
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Cardiac system delivers: Cardiac system removes: Pg. 823 |
1. Oxygen, nutrients, and other substances to the tissues. 2. Facilitates removal of cellular metabolism waste products by way of blood flow through other systems such as respiratory, digestive, and renal. |
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Structure and Function of the Cardiac system Myocardial Pump 8 KP |
1. The ventricles fill with blood during diastole, and empty during systole. 2. The volume of blood ejected from the ventricles during systole is stroke volume. 3. Hemorrhage and dehydration cause a decrease in circulating blood volume and stroke volume. 4. Myocardial fibers have contractile properties that allow them to stretch during filling. 5. This stretch proportionally related to contraction strength: Frank-Starling's Law of Heart (Starling) 6. In the diseased heart (cardiomyopathy/myocardial infarction (MI)), Starling's Law doesn't apply; the stretch has gone beyond the limits of the heart 7. Subsequent contractile responses aren't strong enough, resulting in decreased stroke volume. "Back up" develops. 8. Back up equals heart failure: in the right side of the heart = systemic, left side= pulmonary |
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Myocardial Blood Flow: pg. 823-824 2 KP |
1. During ventricular diastole the atrioventricular (mitral and tricuspid) valves open, and blood flows from the higher-pressure atria into the relaxed ventricles. As systole begins, ventricular pressure rises and closes the mitral and tricuspid valves. Valve closure causes the first heart sound (S1). 2. During the systolic phase the semilunar (aortic and pulmonic) valves open, and blood flows from the ventricles into the aorta and pulmonary artery. The mitral and tricuspid valves stay closed during systole so all of the blood is moved forward into the pulmonary artery and aorta. As the ventricles empty, the ventricular pressures decrease, allowing closure of the aortic and pulmonic valves, which causes the second heart sound (S2). Some patients with valvular disease have backflow or regurgitation of blood through the incompetent valve, causing a murmur that you can hear on auscultation (see Chapter 30). |
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Coronary Artery Circulation: Pg. 824 3kp |
1. The coronary circulation is the branch of the systemic circulation that supplies the myocardium with oxygen and nutrients and removes waste. 2. The coronary arteries fill during ventricular diastole 3. The left coronary artery has the most abundant blood supply and feeds the more muscular left ventricular myocardium, which does most of the work of the heart. |
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Systemic Circulation: Anatomy Pg. 824 6 KP |
1. The arteries of the systemic circulation deliver nutrients and oxygen to tissues, and the veins remove waste from tissues. 2. Oxygenated blood flows from the left ventricle through the aorta and into large systemic arteries. 3. These arteries branch into smaller arteries; then arterioles; and finally the smallest vessels, the capillaries. 4. The exchange of respiratory gases occurs at the capillary level, where the tissues are oxygenated. 5. The waste products exit the capillary network through venules that join to form veins. 6. These veins become larger and form the vena cava, which carry deoxygenated blood to the right side of the heart, where it then returns to the pulmonary circulation. |
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Blood Flow Regulation Cardiac output 5 KP pg. 824 |
1. Amount of blood ejected from the left ventricle each minute is the cardiac output. 2. The normal cardiac output is 4 to 6 L/min in the healthy adult at rest. 3. The circulating volume of blood changes according to the oxygen and metabolic needs of the body. 4. Ex: cardiac output increases with exercise, fever, and pregnancy but decreases with sleep. 5. CO = SV X HR |
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What affects stroke volume pg. 824 |
1. The amount of blood in the left ventricle at the end of diastole (preload) 2. the resistance to left ventricular ejection (after load) 3. myocardial contractility all affect stroke volume. |
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Preload pg. 824 |
1. Is the end-diastolic volume. Ventricles stretch when filled with blood. The more stretch, the greater the contraction and the greater the stroke volume (Starling's Law). 2. In clinical situations, med. treatment can alter stroke volume and preload by changing amt. of circulating blood volume. Example: hemorrhaging pt needs increased fluid therapy/blood volume thus increasing preload, stroke volume, and cardiac output. |
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Afterload pg. 824 |
1. The resistance to left ventricular ejection.
2. Heart works harder to overcome the resistance so blood can be fully ejected from the left ventricle. 3. Diastolic aortic pressure good indicator for afterload. Example: hypertension increases afterload, thus increasing cardiac workload. |
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Myocardium 4 KP PG. 824 |
1. Myocardial contractility also affects stroke volume and cardiac output. 2. Poor ventricular contraction decreases the amount of blood ejected. 3. Injury to the myocardial muscle such as an acute MI causes a decrease in myocardial contractility. The myocardium of the older adult is stiffer with a slower ventricular filling rate and prolonged contraction time. |
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How does heart rate affect blood flow?
pg. 825 |
1. Heart rate affects blood flow because of the relationship between rate and diastolic filling time. 2. With a sustained heart rate greater than 160 beats/min, diastolic filling time decreases, decreasing stroke volume and cardiac output. 3. Heart rate of the older adult is slow to increase during stress: may be due to conditioning. |
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Conduction system
pg. 825 10 kp |
1. The rhythmic relaxation and contraction of the atria and ventricles depend on continuous, organized transmission of electrical impulses. 2. The cardiac conduction system generates and transmits these impulses. 3. The conduction system of the heart generates the impulses needed to initiate the electrical chain of events for a normal heartbeat. 4. The autonomic nervous system influences the rate of impulse generation and the speed of transmission through the conductive pathway and the strength of atrial and ventricular contractions. 5. Sympathetic and parasympathetic nerve fibers innervate all parts of the atria and ventricles and the sinoatrial (SA) and atrioventricular (AV) nodes. 6. Sympathetic fibers increase the rate of impulse generation and speed of transmission. 7. The parasympathetic fibers originating from the vagus nerve decrease the rate. 8. Conduction system originates with the SA node, the "pacemaker". 9. The SA node is in the right atrium next to the superior vena cava. 10. Impulses are initiated at the SA node at an intrinsic rate of 75 cardiac action potentials per minute while at rest. |
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AV node 3 kp |
1. The electrical impulses are transmitted through the atria along intraatrial pathways to the AV node. 2. The AV node mediates impulses b/w the ventricles and atria. 3. Assists atrial emptying by delaying the impulse before transmitting it through the bundle of His and the ventricular Purkinje network. |
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ECG basics pg. 825 |
1. An electrocardiogram reflects the electrical activity of the conduction system. 2. ECG monitors the regularity and path of the electrical impulse through the conduction system. 3. It doesn't reflect the muscular work of the heart. 4. Normal sequence/wave pattern called normal sinus rhythm (NSR) |
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Normal Sinus Rhythm 1. What does it mean? 2. First wave? 3. First interval? 4. complex 5. last interval Pg. 825 |
1. NSR means impulse originates from SA node and follows normal sequence through conduction system. 2. P wave: electrical conduction of both atria. Atrial contraction follows P wave. 3. PR interval: represents impulse travel time from SA node through AV node, through bundle of His, and to the Purkinje fibers. a. 0.12-0.2 seconds. b. <0.2 = block, c. >0.12 = diff. initiation other than SA node. 4. QRS complex: electrical impulse traveled through the ventricles. a. 0.06-0.1 seconds. b. Increase in duration - delay in impulse through ventricles. c. ventricular contraction follows QRS complex. 5. QT interval: time needed for ventricular depolarization and depolarization. a. 0.12-0.42 seconds. b. varies with changes in heart rate. c. hypocalcemia/drugs can increase this. d. hypercalcemia/kalemia/digitalis therapy shorten. |
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Four factors affecting oxygenation List Pg. 826 |
Four factors influence circulation, ventilation, perfusion, and transport of resp. gases to the tissues: 1. Physiological 2. Developmental 3. Lifestyle 4. Environmental |
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Physiological Factors: how does it affect oxygenation Pg. 826 5 KP |
1. Any condition affecting the cardiopulmonary system affects ability to meet oxygen demands. 2. Can affect the oxygen-carrying capacity of blood 3. Decreased inspired oxygen concentration 4. increases in the metabolic demand of the body 5. Alterations affecting chest wall movement due to musculoskeletal abnormalities and neuromuscular alterations. |
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List some cardiac disorders Pg. 825 |
1. Disturbances in conduction 2. Impaired valvular function 3. Myocardial hypoxia 4. Cardiomyopathic conditions 5. Peripheral tissue hypoxia |
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List a few Respiratory disorders Pg. 825 |
1. Hyperventilation 2. Hypoventilation 3. Hypoxia |
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Anemia Pg. 826 |
1. Anemia and inhalation of toxic substances decreases amt. of hemoglobin. 2. Anemia (lower-than-normal hemoglobin level) is a result of decreased hemoglobin production, increased red blood cell destruction, and/or blood loss. 3. Fatigue 4. Decreased activity tolerance 5. increased heart rate 6. breathlessness 7. pallor (conjunctiva in eye) 8. oxygenation decreases as secondary effect. |
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Hypoxemia
pg. 826 |
1. Arterial blood oxygen level lower than 60 mm Hg. Low oxygen level in the blood. 2. 1st symptom = restlessness 3. development of increased red blood cells (polycythemia) 4. Adaptive response of body to increase amt. of hemoglobin and available oxy-binding sites. |
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Hypovolemia Pg. 826 |
1. Abnormally low circulating blood volume 2. Conditions such as shock/severe dehydration cause extracellular fluid loss and reduced circulating blood volume 3. Decreased circulating blood volume = hypoxia to body tissues 4. With significant fluid loss, body adapts via peripheral vasoconstriction and increasing heart rate. 5. This increases volume of blood returned to the heart. 6. This increases cardiac output. |
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Decreased Inspired Oxygen Concentration Pg. 826 2 kp |
1. With a decline of the concentration of inspired oxygen, the oxygen-carrying capacity of the blood decreases. 2. Decreases in the fraction of inspired oxygen concentration (FiO2) are caused by upper or lower airway obstruction, which limits delivery of inspired oxygen to alveoli; decreased environmental oxygen (at high altitudes); or hypoventilation (occurs in drug overdoses). |
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Increased metabolic rate pg. 826 7 KP |
1. Increased metabolic activity increases oxygen demand. 2. Level of oxygenation declines when body systems unable to meet demand. 3. Pregnancy, wound healing, and exercise increase met. rate. 4. Fever increases as well. If persists, met. rate remains high and protein stores broken down, causing muscle waste including the diaphragm and intercostal muscles. 5. Body adapts to increased CO2 levels by increasing rate/depth of respirations 6. Increases WOB 7. Signs of hypoxemia, esp. if pt has pulmonary disease. |
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Conditions Affecting Chest Wall Movement
List them: 7 Pg. 826 |
1. Pregnancy 2. Obesity 3. Musculoskeletal Abnormalities 4. Trauma 5. Neuromuscular disorders 6. Central Nervous System Alterations 7. Influences of Chronic disease |
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Conditions Affecting Chest Wall Movement Pregnancy 3 KP |
1. Fetus grows during pregnancy, enlarging uterus and putting pressure against diaphragm. 2. Last trimester = inspiratory capacity declines. 3. dyspnea and fatigue |
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Conditions Affecting Chest Wall Movement Obesity 6 KP |
1. Reduced long volumes due to heavy thorax/abdomen, esp. when lying down. 2. Obstructive sleep apnea common 3. Lung and chest wall compliance reduction 4. Increased WOB 5. Decreased long volumes 6. More susceptible to atelectasis and pneumonia |
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Conditions Affecting Chest Wall Movement Musculoskeletal Abnormalities 5 KP |
1. Impairments of musculoskeletal in abdomen reduce oxygenation. 2. abnormalities 3. trauma 4. diseases of CNS 5. kyphosis, lordosis, scoliosis |
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Conditions Affecting Chest Wall Movement Trauma 3 KP |
1. Flail chest: multiple rib fractures cause instability in chest wall. Lungs contract during inspiration and bulge on expiration instead. Hypoxia 2. Pts w/ thoracic/abdominal incisions use shallow respirations to avoid pain, which decreases chest wall movement. 3. Opioids used to treat pain depress resp. center, further decr. resp. rate and chest wall exp. |
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Conditions Affecting Chest Wall Movement Neuromuscular Diseases 6 KP |
1. Affects tissue oxygenation 2. Decreases pt's ability to contract/expand chest wall. 3. Ventilation impaired 4. Results in hypoxemia, atelectasis, and hypercapnia(elevated CO2 levels). 5. Hypoventilation 6. Some examples: myasthenia gravis, polimyelitis, Guillain-Barre syndrome |
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Conditions Affecting Chest Wall Movement Central Nervous System Alterations 6 KP |
1. Disease/trauma of spinal cord and medulla oblongata results in impaired respiration. 2. Neural regulation impaired when medulla oblongata damaged. Abnormal breathing patterns develop. 3. Cervical trauma to C3-C5 of spinal cord results in damage to phrenic nerve . . . usually. 4. w/o phrenic nerve, diaphragm cannot descend properly, reducing respiratory lung volumes 5. Causes hypoxemia 6. Spinal cord injury below C5 causes intercostal muscle to not contract, preventing anteroposterior chest expansion. |
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Influences of Chronic Disease 6 KP Pg. 826 |
1. Oxygenation decreases due to chronic lung disease.
2. Changes anteroposterior chest wall: barrel chest. 3. Due to overuse of accessory muscles and air trapping in emphysema 4. Diaphragm flattened 5. Lung fields over distended 6. Hypoxemia and/or hypercapnia |
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3 Primary Respiration Alterations Pg. 826 |
1. Hypoventilation 2. Hyperventilation 3. Hypoxia |
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Goal of ventilation Describe how hypoventilation/hyperventilation is determined. pg. 826 5 KP |
1. To produce normal arterial carbon dioxide tension (PaCO2between 35-45 mm Hg and normal arterial oxygen tension(PaO2) of 80-100 mm Hg. 2. Imp. b/c hypoventilation/hyperventilation determined by arterial blood gas analysis. 3. Hypoxemia refers to decrease in amt. of arterial oxygen. 4. Nurses monitor arterial oxygen saturation (SpO2) using pulse oximeter. 5. Should be higher than 95% |
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Hypoventilation Pg. 827 |
1. Occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide. 2. As alveolar ventilation decreases, carbon dioxide increases. 3. Atelectasis, for ex., stops normal exchange b/w oxygen/carbon dioxide. 4. As more alveoli collapse, hypoventilation occurs. 5. |
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COPD and hypoventilation 6 KP 827 |
1. Hypoventilation caused by excessive oxygen 2. pts w/ COPD have adapted to high CO2 levels, so CO2 chemoreceptors are not the same. 3. Peripheral chemoreceptors on aortic arch and carotid bodies detect lower oxygen levels, causing increased ventilation. 4. Stimulus to breathe destroyed if nasal cannula increases PaO2 level to higher than 1-3 L/min (24-28%). 5. Causes hypoventilation, leading to excess retention of CO2. 6. Can lead to respiratory acidosis and respiratory arrest. |
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COPD symptoms If untreated? 827 |
1. Mental status changes 2. dysrhythmias 3. cardiac arrest 1. Convulsions 2. Unconsciousness 3. Death |
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Hyperventilation
pg. 827 |
1. State of ventilation in which lungs remove carbon dioxide faster than produced by cellular metabolism. 2. Caused by severe anxiety, drugs, or acid-based imbalance. 3. Fever can also cause it by increased metabolic rate, producing more CO2. This increased CO2 level increases resp. rate/depth, also leading to hyperventilation. 4. Signs and symptoms: a. rapid resp. b. sighing breaths c. numbness/tingling of hands/feet d. light headedness e. loss of consciousness 5. Can lead to respiratory alkalosis Ex: pt w/ diabetes in ketoacidosis produces large amts. of metabolic acids = over breathing to lower CO2 formed by this Anxiety = overbreathing |
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Hypoxia (1 of 3) 4 general KP Pg. 827 |
1. Inadequate tissue oxygenation at the cellular level. 2. It results from a deficiency in oxygen delivery or oxygen use at the cellular level. 3. A life-threatening condition. 4. Produces fatal cardiac dysrhythmias. |
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Hypoxia (2 of 3) 6 Causes Pg. 827 |
1. Decreased hemoglobin level and oxygen-carrying capacity of the blood. 2. Diminished conc. of inspired oxygen, which occurs at high altitudes. 3. Inability of the tissues to extract oxygen from blood, as with cyanide poisoning. 4. Decreased diffusion of oxygen from alveoli to blood, as in pneumonia. 5. Poor tissue perfusion w/ oxygenated blood, as with shock. 6. Impaired ventilation, as w/ multiple rib fractures or chest trauma. |
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Hypoxia (3 of 3)
14 Signs/symptoms Pg. 827 |
1. Apprehension 2. Restlessness 3. Inability to concentrate 4. Decreased level of consciousness 5. Dizziness 6. Behavioral changes 7. Agitated/fatigued 8. Increased pulse rate 9. Increased rate/depth of respiration 10. During early stages, blood pressure elevated. 11. Resp. rate declines as a result of resp. muscle fatigue 12. Cyanosis in later stages due to desaturated hemoglobin in capillaries. 13. Central cyanosis: observed in tongue, palate, conjunctiva of eye. 14. Peripheral Cyanosis: extremities, nail beds, earlobes, due to vasoconstriction and stagnant blood flow. |
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Alterations in Cardiac Functioning due to what? 4 KP pg. 827 |
Illnesses/conditions that affect 1. cardiac rhythm 2. strength of contraction 3. Blood flow through the heart or to heart muscle 4. Decreased peripheral circulation |
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Older adults exp. alterations in cardiac function due to: 3 KP pg. 827 |
Older adults exp. alterations in cardiac function as a result of 1. calcification of the conduction pathway, 2. thicker/stiffer heart valves caused by lipid accumulation and fibrosis, 3. decrease in the # of pacemaker cells in the SA node. |
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Disturbances in conduction: dysrhythmia pg. 827 |
1. Electrical impulses that don't originate from SA node cause conduction disturbances. 2. These rhythm disturbances called dysrhythmias: deviation from normal sinus rhythm/pattern of the heart. 3. Occur as primary conduction disturbance 4. Response to ischemia; valvular abnormality, anxiety; drugs; caffeine/alcohol; tobacco; or acid-base/electrolyte balance. |
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Classify Dysrhythmias Pg. 827 4 KP |
1. Classified by cardiac response and site of impulse origin. 2. Tachycardia (100 beats/min) = tachydysrhythmia: decreases diastolic filling time 3. Bradycardia (60 beats/min or less) = bradydysrhythmia: decreased heart rate 4. Both lower cardiac output/blood pressure. |
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Atrial Fibrillation pg. 827 |
1. Common dysrhythmia, frequently seen in older adults. 2. Electrical impulse in the atria chaotic and originates from multiple sites. 3. Rhythm is irregular b/c of multiple pacemaker sites and unpredictable conduction to the ventricles. 4. irregularly irregular rhythm. |
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Supraventricular dysrhythmias |
Abnormal impulses originating from above the ventricles. 2. Abnormality of the waveform is the configuration and placement of the P wave. |
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Paroxysmal supraventricular tachycardia: |
sudden rapid tachycardia originating above the AV node. Begins/ends spontaneously Caused by fatigue, caffeine, smoking, alcohol. |
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Ventricular tachycardia/Ventricular fibrillation 827-828 |
1. Life-threatening rhythms that require immediate intervention. 2. Ventricular tachycardia: decreased cardiac output and potential to deteriorate into ventricular fibrillation or sudden cardiac death. |
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Altered Cardiac Output |
1. Failure of the myocardium to eject sufficient volume to the systemic and pulmonary circulations occurs in heart failure. 2. Primary coronary artery disease, cardiomyopathy, valvular disorders, and pulmonary disease lead to myocardial pump failure. |
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Left-Sided heart failure Right-sided heart failure |
1. Left ventricular failure leads to pooling/pulmonary congestion. 2. hypoxia, crackles, shortness of breath, etc. 1. Right ventricle failure. 2. Pulmonary disease or due to left-sided failure. 3. Primary pathological factor in right-sided failure: (PVR)pulmonary vascular resistance. 4. Blood begins to back up in the systemic circulation. 5. Weight gain, distended neck veins, hepatomegaly, dependent peripheral edema. |
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Impaired Valvular Function Valvular heart disease |
1. Acquired or congenital disorder of a cardiac valve either hardening (stenosis) or impaired closure (regurgitation) of the valves.
2. When stenosis occurs, the flow of blood through the valves is obstructed. 3. If stenosis occurs in semilunar valves (aortic and pulmonic), adjacent ventricles work harder to move ventricular blood volume beyond stenotic valve. 4. Stenosis, over time, leads the ventricle to hypertrophy(enlarge) and can cause heart failure on either side. 5. Regurgitation causes back flow into adjacent chamber. 6. For example, in mitral regurgitation the mitral leaflets do not close completely. 7. When the ventricles contract, blood escapes back into the atria, causing a murmur, or "whooshing" sound. |
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Myocardial Ischemia |
Results when supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands. Two outcomes of this: a. angina pectoris b. MI |
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Angina |
1. Angina pectoris is a transient imbalance b/w myocardial oxygen supply and demand. 2. Sharp, burning, pressure like chest pain. 3. Lasts from 3-5 minutes. 4. Precipitated by exercise, heavy meal, stress. 5. Relieved with rest, coronary vasodilators (nitroglycerin preparation). |
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Myocardial Infarction |
1. Also called Acute coronary syndrome (ACS) 2. Results from sudden decreases in coronary blood flow or an increase in myocardial oxygen demand w/o adequate coronary perfusion. 3. Occurs b/c ischemia not reversed. 4. Cellular death occurs 20 minutes after myocardial ischemia. 5. Crushing, squeezing, stabbing. 6. Occurs at rest/exertion, lasts more than 20 minutes. 7. Women = greater blood cholesterol/triglyceride than men. 8. For women, most common symptom = angina 9. Women twice more likely to die within first year after heart attack. |
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DEVELOPMENTAL FACTORS Infants and Toddlers pg. 828 3 KP |
1. At risk for upper resp. tract infections (not dangerous) 2. Due to other children, immature immune system, and secondhand smoke. 3. nasal congestion during teething process increases potential for respiratory tract infection. |
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DEVELOPMENTAL FACTORS School-Age Children and Adolescents |
1. Exposed to resp. infections via smoking/secondhand smoke. |
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DEVELOPMENTAL FACTORS Young and Middle-Age Adults Pg. 828 |
1. Exposed to multiple cardiopulmonary risk factors a. unhealthy diet b. lack of exercise c. stress d. drugs/illegal substances e. smoking 2. Time when individuals establish lifelong habits and lifestyles. |
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Oxygenation Changes in Older Adults 4 easy KP. Tuberculin atypical incidence of atrial fibrillation |
1. Tuberculin skin test unreliable. 2. More atypical signs and symptoms of coronary artery disease. 3. Incidence of atrial fibrillation increases w/ age and is the leading contributing factor for stroke in the older adult. |
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Oxygenation Changes In Older Adults 5 KP IMPORTANT |
1. Mental status changes are often the first signs of resp. problems and include forgetfulness and irritability. 2. Older adults do not always complain of dyspnea until it affects their ADL's that are imp. to them. 3. Changes in older adult's cough mech. lead to retention of pulmonary secretions, airway plugging, and atelectasis if pts do not use cough suppressants w/ caution. 4. Age-related changes in the immune system lead to decline of both cell-mediated and humoral immunity, resulting in an increased risk of respiratory infections. 5. Changes in the thorax that occur from ossification of costal cartilage, decreased space between vertebrae, and diminished respiratory muscle strength lead to problems w/ chest expansion and oxygenation. |
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Lifestyle Factors pg. 829 |
1. Risk-factor modification important and includes:
1. Smoking cessation 2. weight reduction 3. low-cholesterol/low sodium 4. management of hypertension 5. moderate exercise 2. Helping pts acquire healthy habits reduces risk/slows progression of cardiopulmonary diseases. |
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Nutrition
9 kp |
1. Affects cardiopulmonary function in several ways. 2. Severe obesity decreases lung expansion 3. Increased body weight increases tissue oxygen demands. 4. Malnourished pt exp. resp. muscle wasting, resulting in decreased muscle strength/resp. excursion. 5. Cough efficiency reduced secondary to muscle weakening. 6. Puts pt at risk for retention of pulmonary secretions. 7. Morbidly obese/malnourished at risk for anemia. 8. Diets high in carbs plays role in increasing CO2 load for pts w/ CO2 retention. 9. Too many carbs metabolized, increasing load of CO2 created/excreted via lungs. |
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NUTRITION Dietary practices pg. 829 |
1. Influence prevalence of cardiovascular diseases.
2. Cardioprotective nutrition includes: 1. fiber 2. whole grains 3. fresh fruits/veggies 4. nuts 5. antioxidants 6. lean meats, fish and chicken 7. omega-3 fatty acids Low sodium = reduces antihypertensive med. requirements/lowers left ventricular hypertrophy Diets high in potassium : prevent hypertension |
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Exercise
pg. 829 |
1. Increases metabolic activity and oxygen demand of body.
2. Rate/depth of resp. increases 3. Enables person to inhale more O2 and exhale excess CO2. 4. 30-60 min. of exercise daily = a. lower pulse rate b. lower blood pressure c. decreased cholesterol level d. increased blood flow e. greater oxygen extraction by working muscles. f. fully conditioned people increase O2 consumption by 10-20% |
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Smoking
pg. 829 9 KP |
1. Associated w/ heart disease, COPD, and lung cancer.
2. Worsens peripheral vascular/coronary artery diseases. 3. Inhaled nicotine causes vasoconstriction of peripheral/coronary blood vessels. 4. This increases blood pressure and decreases blood flow to peripheral vessels. 5. 10x risk for lung cancer 6. Tobacco = 30% of all cancer deaths 7. Includes 87% of deaths from lung cancer and cancer of larynx, mouth, pharynx, esophagus and bladder. 8. Smoking linked to cancers of kidney, cervix, and leukemia. 9. Secondhand smoke increases: asthma, sudden death syndrome, pneumonia, ear infections for babies. |
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Smoking and Women pg. 829
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1. Women who smoke and take birth control pills have increased risk for thrombophlebitis and pulmonary emboli.
2. While pregnant, smoking can result in low-birth-weight babies, preterm delivery, and babies w/ reduced lung function. 3. |
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Substance Abuse
pg. 830 6 KP |
Impairs tissue oxygenation in two ways
1. Poor nutritional intake = decrease in iron-rich foods = decrease in hemoglobin production. 2. use of alcohol and certain drugs depresses respiratory center, reducing rate/depth of respiration and in turn, inhaled oxygen. 3. Inhalation of drugs can lead to permanent/direct injury to lung tissue. 4. Paint thinner, nail polish remover, spray paint, nitrous oxide, etc. 5. Sudden death possible: cardiac arrhythmia 6. Chronic abuse can cause damage to heart, lungs, and kidneys. |
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Stress pg. 830
4 KP |
1. Continuous state of stress/severe anxiety increases metabolic rate and O2 demand of the body.
2. Body responds to anxiety/stress with an increased rate/depth of resp. 3. Most people adapt to the higher oxygen demands caused by anxiety/stress. 4. Some cannot, particularly those w/ chronic illnesses/acute life-threatening illnesses such as MI. Th |
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Environmental Factors
pg. 830 3 KP |
1. Environment also influences oxygenation
2. Pulmonary disease higher in smoggy, urban areas compared to rural. 3. workplaces can cause it too: asbestos, talcum powder, dust, and airborne fibers. |
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CRITICAL THINKING 3 KP |
1. Requires synthesis of knowledge, experience, info/data from pts, crit. thinking attitudes, and professional standards.
2. Anticipate info, analyze the data, and make decisions regarding your pt's care. 3. Approach patient care in a methodical and logical way. |
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NURSING PROCESS assessment |
1. Thoroughly assess each pt and critically analyze.
2. Ensure you make patient-centered clinical decisions required for safe nursing care. 3. Nursing assessment of cardiopulmonary functioning includes: 1. in-depth history of pts normal/present cardiopulmonary function 2. Past impairments in circulatory or resp. functioning 3. methods that a pt uses to optimize oxygenation. 4. Nursing history: drugs, food, allergies. 5. Physical examination reveals signs/symptoms 6. Review of lab/diagnostic tests. |
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Pg. 830: Fig. 40-6: Assessment based upon |
1. Knowledge 2. Experience 3. Standards 4. Attitudes |
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Through the Patient's Eyes: assessment
pg. 831 8 KP |
1. Ask about pts priorities
2. Ask what they expect from health care visit 3. Identifying pts expectations involves pts in decision-making process and helps them participate in care. 4. Ex: planning smoking cessation for pt not interested only causes frustration 5. Establish short-term outcomes that are realistic 6. Will lead to a larger goal. 7. A combination of counseling and medication better than one alone 8. Knowing pts mindsets and respecting their wishes helps them make beneficial lifestyle changes. |
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NURSING PROCESS
Assessment Nursing History includes: |
Include presence of:
1. cough 2. SOB 3. dyspnea 4. wheezing 5. pain 6. Env. exposure 7. frequency of resp. tract infections 8. pulmonary risk factors 9. past resp. problems 10. current meds 11. smoking history For cardiac: 1. pain 2. peripheral circulation 3. fatigue 4. cardiac risk factors 5. present/past cardiac conditions. |
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NURSING PROCESS:
Assessment Pain: pg. 831 |
1. Requires immediate thorough evaluationa. locationb. durationc. radiationd. frequency
2. For men: left side/left arm.3. Women: sensation of breathlessness, jaw/back pain, nausea, and fatigue.4. Pleuritic chest pain: knifelike/radiates. |
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Box 40-2 Nursing Assessment Questions:
6 KP |
Pg. 831: very good to look at.
1. Nature of Cardiopulmonary problem 2. Signs and symptoms 3. Onset and Duration 4. Severity 5. Predisposing Factors 6. Effect of Symptoms on Patient |
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NURSING PROCESS Assessment Fatigue: pg. 831 |
1. Subjective sensation 2. Objective measure = 0-10 scale needed. |
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NURSING PROCESS Assessment Dyspnea Pg. 831 8 KP |
1. Clinical sign of hypoxia. 2. Subjective sensation of difficulty/uncomfortable breathing. 3. SOB associated w/ exercise/excitement. In some cases, w/o it. 4. Associated w/ pulmonary diseases, cardio diseases, neuromuscular, and anemia. 5. Occurs in final months of pregnancy. 6. Env. factors worsen it 7. Associated w/ exaggerated resp. effort, use of accessory muscles of resp., nasal flaring, and marked increases in rate/depth of resp. 8. VAS: 0-10 scale. 9. When conducting nursing history on pt with dyspnea, ask when it occurs (with exertion, stress, or resp. tract infection). 10. Does it affect ability to lie flat (orthopnea) |
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Orthopnea |
1. An abnormal condition in which a pt uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated. 2. # of pillows quantifies orthopnea (one-two-three pillow orthopnea). 3. Ask pt if they prefer sleeping in a recliner chair to breathe easier. |
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NURSING PROCESS Assessment Cough Pg. 832 |
1. Sudden, audible expulsion of air from lungs. 2. Pt breathes in, glottis partially closed, and accessory muscles of expiration contract to expel their air forcibly 3. A protective reflex to clear trachea, bronchi, and lungs of irritants/secretions. 4. Difficult to evaluate cough 5. Chronic cough = they deny/underestimate it since they've had it for so long. |
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NURSING PROCESS Assessment Cough If pt has cough, determine: 7 kp |
1. Frequency 2. Productive/nonproductive 3. Productive = sputum 4. Sputum contains mucus, cellular debris, microorganisms, and pus/blood 5. Collect data/type/quantity of sputum 6. Instruct pt to cough up, not just clear throat 7. Inspect for color, blood, consistency, odor, and amt. |
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Hemoptysis/hematemesis pg. 832 6 kp |
1. Bloody sputum 2. If present, determine if it is from upper respiratory tract, sinus drainage, or gastrointestinal tract (hematemesis). 3. Hemoptysis has an alkaline pH 4. Hematemesis has acidic pH. 5. Use pH testing to determine source 6. If bloody sputum, use x-rays, bronchoscopy, and more. |
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NURSING PROCESS Assessment Wheezing pg. 832 4 kp |
1. High-pitched musical sound caused by high-velocity movement of air through a narrowed pathway. 2. Asthma, acute bronchitis, or pneumonia. 3. Occurs during inspiration/expiration, or both 4. Determine precipitating factors: resp. infection, allergens, exercise, or stress. |
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Environmental or Geographical Exposures pg. 832 7 kp |
1. Most common exposures are cig. smoke, CO, and radon. 2. CO poisoning results from blocked furnace or fireplace. 3. General malaise, flulike symptoms, and excessive sleepiness. 4. Risk fall 5. Radon gas: radioactive, in soil, rock, and water that enters homes through ground/well water. 6. Radon = high risk for lung cancer. 7. Get radon/Co detector |
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Smoking pg. 832 2 KP |
1. Determine direct/secondary exposure 2. Ask pack-year history: # of years, packs per day. |
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NURSING PROCESS Assessment Respiratory Infections: pg. 832 6 kp |
1. Obtain info about pts frequency and duration of resp. tract inf. 2. A simple cold/flu can result in bronchitis/pneumonia for some. 3. 4 colds per year on average 4. Determine when pt has had vaccine. 5. Imp. in older adults due to their increased risk. 6. Ensure they have TB skin test done. |
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HIV indicator |
1. Pneumocystis carinii pneumonia (PCP) an early indication. |
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Allergies pg. 832 4 kP |
1. inquire about pts exposure to allergens (pet dander/mold) 2. Allergic response is often watery eyes, sneezing, runny nose, or resp. systems such as cough or wheezing. 3. Safe nursing practice: obtain info about food, drug, insect allergies. 4. Double-check |
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Health Risks: pg. 832 |
1. Familial family history 2. Documentation includes blood relatives who had same disease and their present level/time of death. 3. TB risk factors as well |
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Medications pg. 832-833 |
1. Nursing history shows prescribed, over-the-counter, folk, herbal, and alternative/illegal drug use. 2. Can have adverse effects when combined. 3. Ex: prescribed bronchodilator doesn't combine well w/ over-the-counter inhalers, which contains ma huang, which acts like epinephrine. 4. Pts taking warfarin for blood thinning prolong the prothrombin time (PT/INR) results if taking gingko biloba, garlic, or ginseng w/ anticoagulant. 5. Can lead to life-threatening bleed. 6. Assess pts ability/knowledge to self-administer correctly. 7. Ensure they know side-effects and adverse rxns, esp. when combining drugs. |
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Physical Examination: Give brief summary: 3 kp List the 4 aspects of it |
1. Includes assessment of cardiopulmonary system 2. Give special consideration to older adult pts.due to changes that occur with aging process 3. These changes affect activity tolerance, fatigue, and even change vital signs. INSPECTION PALPATION AUSCULTATION PERCUSSION |
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1. Inspection |
1. Perform head-to-toe observation 2. Check skin/mucous membrane color 3. General appearance 4. Level of consciousness 5. Systemic circulation 6. Breathing patterns 7. Chest wall movement. 8. Nails for clubbing 9. Chest wall for retraction (sinking of soft tissues b/w intercostals) 10. Observe pts breathing pattern: paradoxical breathing (chest wall contracts w/ inspiration, expands with exhalation). 11. 12-20 normal breaths 12. Bradypnea: less than 12 breaths/min 13. Tachypnea is greater than 20 breaths/min. |
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Kussmaul respiration |
1. Occurs w/ metabolic acidosis. 2. The acidic pH stimulates an increase in body rate and depth of respirations to compensate by decreasing carbon dioxide levels. |
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APnea |
1. The absence of respirations for a period of time. |
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Cheyne-Stokes respiration 3 kp pg. 834 |
1. When there is decreased blood flow/injury to the brainstem. 2. Apnea periods followed by shallow breathing. 3. Barrel shape chest |
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Table 40-2 VERY GOOD FOR INSPECTION OF CARDIOPULMONARY STATUS |
LOOK OVER |
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Palpation: pg. 834 |
1. Shows areas of tenderness 2. Helps identify tactile fremitus, thrills, heaves, and PMI. 3. Palpating extremities provides data about peripheral circulation: skin temp, color, cap. refill. 4. Palpate feet/legs for edema. +1 to +4. 5. Palpate pulses in neck/extremities 6. 0 (absent pulse), +4 (full, bounding) 7. normal is +2, weak is +1 |
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Percussion: |
1. Detects abnormal fluid or air in the lungs. |
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Auscultation Pg. 834 7 kp |
1. Helps identify normal/abnormal heart and lung sounds. 2. Includes assessment for normal S1 and S2 sounds 3. Includes assessment/presence of abnormal S3 and S4 sounds (gallops), murmurs, or rubs. 4. Identify location, radiation, intensity, pitch, and quality of a murmur. 5. Identify bruit over carotid, abdominal aorta, and femoral arteries. 6. Involves listening for movement of air through all lung fields: anterior, posterior, and lateral. 7. Adventitious/abnormal, breath sounds occur w/ collapse of a lung segment, fluids, or narrowing. |
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Diagnostic Tests |
TB tests: myobacterium tuberculosis Intradermal 48-72 hours Thoracentesis: painful |
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Cultural Impact on pulmonary diseases |
1.Differences in race: caucasian, african, asian, to native. 2. Asians = highest rate of TB. |
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Nursing Diagnosis |
1. Based upon your assessment, you develop nursing diagnoses for patients with oxygenation alterations by clustering specific defining characteristics and identifying the related etiology (Box 40-5). 2. The defining characteristics for diagnoses related to oxygenation can be similar. For example, both impaired gas exchange and ineffective breathing pattern have the defining characteristics of dyspnea and nasal flaring. 3. A closer review of assessment findings as well as an analysis of the patient's history will help you clarify and select the correct diagnosis. 4. For example, a patient who is a victim of trauma and has rib pain and is showing an increased respiratory rate is more likely to be suffering ineffective breathing pattern. 5. The clustered defining characteristics and related factor must support the nursing diagnosis. (Potter, 2013, pp. 835-836)Potter, P., Perry, A., Stockert, P., Hall, A. (2013). Fundamentals of Nursing, 8th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/978-0-323-07933-4 |
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These nursing diagnosis examples are appropriate for the patient with alterations in oxygenation: pg. 837 13 |
1. Activity intolerance 2. Decreased cardiac output 3. Fatigue 4. Impaired gas exchange 5. Impaired spontaneous ventilation 6. Impaired verbal communication 7. Ineffective airway clearance 8. Ineffective breathing pattern 9. Ineffective health maintenance 10. Risk for aspiration 11. Risk for imbalanced fluid volume 12. Risk for infection 13. Risk for suffocation |
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Planning pg. 837 |
1. During planning, use critical thinking skills to synthesize information from multiple sources (Fig. 40-7). 2. Critical thinking ensures that your plan of care integrates individualized patient needs. 3. Professional standards are especially important to consider when developing a plan of care. 4. These standards often establish scientifically proven guidelines for selecting effective nursing interventions. |
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Goals and outcomes pg. 838 |
1. Develop individualized plan of care for each nursing diagnosis 2. Set realistic expectations, goals, and measurable outcomes of care. 3. Patient centered 4. Pts with cardiopulmonary disease will have multiple nursing diagnoses. 5. Identify when goals/outcomes apply to more than one diagnosis. |
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Setting Priorities Pg. 838 5 kp |
1. A Pts level of health, age, lifestyle, and environmental risks affect level of tissue oxygenation. 2. Consider which goal is imp. in hospital or primary care setting. 3. Ex: patent airway more important than activity tolerance. 4. In community-based setting, priorities focus on smoking cessation, exercise, and/or diet modifications. 5. Reasonable outcomes w/ timeframes. |
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Teamwork and Collaboration pg. 838 |
1. Collab. w/ P.T.s, nutritionists, and community-based nurses important for those with heart failure or chronic lung conditions. |
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Independent Nursing Interventions for Oxygenation: pg. 840 3 kp |
1. Coughing techniques 2. Positioning 3. Health education |
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Physician-initated interventions for Oxygenation pg. 840 3 kp |
1. Oxygen therapy 2. Lung inflation techniques 3. chest physiotherapy |
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Annual vaccines are recommended for all people: |
1.) older than 6 months. 2.) Pts w/ chronic illness 3.) People in contact with those who are sick |
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Patients with acute pulmonary illnesses require nursing interventions directed toward: |
1.) halting the pathological process (e.g., respiratory tract infection); 2.) shortening duration/severity off illness (e.g., hospitalization with pneumonia) 3. Preventing complications from the illness or treatments (e.g., hospital-acquired infection resulting from invasive procedures). |
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Dyspnea Management pg 841-842 4 kp |
1. Difficult to manage and treat 2. Health care providers individualize treatment, and implement more than one therapy 3. Treatment of the underlying cause is then followed 4. Therapies include: a. pharmacological: bronchodilators, steroids, antianxiety meds b. Oxygen therapy w/ dyspnea related to exercise and hypoxemia c. physical techniques: cough control/breathing tech. |
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Name some interventions that help with airway clearance. Pg. 842 3 KP |
1. Suctioning 2. Chest physiotherapy 3. Nebulizer therapy |
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Hydration pg. 842 4 KP |
1. Keeps mucociliary clearance normal. 2. Secretions thin, white, water, easily removable w/ minimal coughing. 3. 1500-2500 mL/day unless contraindicated 4. Color, consistency, and ease of mucus expectoration determines hydration adequacy. |
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Coughing and Deep-Breathing Techniques 1. Maintains? 2. cough mechanism 3. Deep inhalation 4. Diaphragmatic hearing |
1. Maintains a patent airway. 2. cough mechanism: deep inhalation, closure of glottis, active contraction of expiratory muscles, glottis opening. 3. Increases lung volume and airway diameter 4. Increases air to lower lungs |
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