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Study Guide Chp 1-5

Test Thursday 1/11/18

Patient Related Factors 1) Preexisting, age, risk factors 2)Rapidity of onset 3) Type, stage, severity 4) Presence/absence of coexisting complications or drugs
Technical Factors 1) Improper setup/maintenance 2) Poor/inconsistent technique 3) Defects in monitor/cables 4) malposition or occlusion of catheter tip 5) artifacts 6) pt-related factors
Appropriateness of Monitor and Labs If pt looks "bad" despite "good" numbers, pt physiologic status is bad. Pt can also look "good" and have "bad" numbers due to acute problem.
Reliability of Monitor Alarm systems Depends on limits set by caregivers & whether alarms are activated and functioning
Pressures are equal / no airflow end expiration
Pressure in alveoli fall below atmospheric pressure / airflow In Inspiration
Pressure in alveoli rise above atmospheric pressure/ airflow out Expiration
Negative intrathoracic pressure brings in / positive pressure sends out spontaneous breathing
Positive Pressure sends air in Mechanical breathing
Increased PaCO2 will increase Rate & depth of breathing Decreased PaCO2 will decrease rate & depth of breathing CNS Control of Breathing
Hypoxemia causes an increased rate & depth of breathing PNS Control of Breathing
Other Factors that affect Mechanics of Ventilation 1) Stretch receptors and sensory nerves in lungs effect ventilation 2) Muscle and joint movement, pain, strong emotions, fever & sepsis
Abnormalities in Ventilatory Control Hypoxic ventilatory drive may become primary stimulus, esp in pts with COPD
CNS Disorders -- vascular A stroke may cause damage to brainstem & cause chronic resp depression ie: cerebral vascular disease
CNS Disorders -- Brain Acute increases in intracranial pressures cause alterations in rate & pattern of breathing ie: brain injury
Distribution Delivery of fresh air from upper airway to alveoli
Upper airways Nose, pharynx, and larynx
Lower airways trachea, bronchi, bronchioles, and terminal bronchioles
Alveoli Tiny air sacs
Anatomic Dead Space Air that doesn't reach the alveoli
Alveolar Dead Space Ventilation without perfusion
Physiologic Dead Space total of anatomic and Alveolar dead space
Factors that interfere with Adequate gas distribution and WOB 1) Decreased lung compliance (stiff) 2) Increased lung compliance (flabby) 3) Decreased chest wall compliance (rigid) 4) Increased RAW 5) Artificial airways
Diffusion Transfer of O2 and CO2 between alveoli, plasma, and tissue
Factors that determine rate of gaseous diffusion 1) Diffusion coefficient 2)Membrane surface area 3) Membrane thickness 4) Diffusion of resp gases in lungs & tissue level
Perfusion and Transport Means by which venous blood is brought to the AC membrane for oxygenation, CO2 removal, sustenance of lung tissue, & dlvy to left side of heart for transport to body cells
Increased PVR (pulmonary vascular resistance) Pulmonary arterial pressures & ventricular systolic work increases
Decreased PVR (pulmonary vascular resistance) Right ventricular systolic work & O2 demand decreases
Pulmonary Vasoactive Agents A. Vasoconstrictors = 1) Epinephrine & 2) Norepinephrine B. Vasodilators = 1) Isoproterenol 2) Diltiazem
PVR means Pulmonary Vascular Resistance
Causes of V/Q Mismatch 1) Shunting (absolute & relative) 2) Hypoventilation 3) Alveolar Dead Space 4) Silent Units
Silent Units No ventilation or perfusion
How the body compensates for V/Q mismatches 1) Poorly ventilated alveoli tend to be under perfused 2) Poorly perfused alveoli tend to be under ventilated
Two ways Oxygenated blood is transported to body tissue 1) Dissolved in plasma or 2) bound to Hb
Factors that affect the affinity of Hb to O2 PO2, Body Temperature, Quantity of 2,3 DPG, ph & PCO2
If PaO2 is elevated, Hb has a(n) ____________ affinity for O2 Increased
If PaO2 is low, Hb has a (n) ____________ affinity for O2 Decreased
Hypercarbia High CO2
Hypocarbia Low CO2
Acidemia and hypercarbia do what to Hb affinity for O2? Decrease
Alkalemia and hypocarbia do what to Hb affinity for O2? Increase
Monitors are only _____________ to patient evaluation adjuncts
_____________ conditions for accurate physical assessment Optimize
Assessment ________________ and specific assessment ____________ are to be determined by the pts known or suspected problems Frequency -- with which assessment needs to be done Techniques -- those that are key and those that aren't
______________ of certain assessment findings are patient dependent Characteristics
General considerations under physical assessment Transcultural considerations
Evaluation of symptoms of pulmonary disease Cough, Dyspnea, and chest pain
Signs of pulmonary disease 1) pt mentation 2) abnormalities in RR 3) abnormal breathing patterns 4) characteristics of breathing 5)Entirely thoracic breathing 6) Entirely abdominal breathing 7) Abnormal resp cycles 8) Stridor
Abnormalities in Respiratory Rate 1) Tachypnea & 2) Bradypnea
Abnormalities in Characteristics of Breathing 1) asymmetry of movement between both sides of chest 2) asymmetry of movement between chest & abdomen
Entirely thoracic breathing Indicates that diaphragmatic movement is restricted
Entirely abdominal breathing Indicates paralysis of intercostal muscles
Abnormalities relative to phases of respiratory cycle 1) Labored inspiration (retractions & nasal flaring) 2) Labored expiration (using accessory muscles, prolonged, purse lip breathing, or grunting)
Other signs of Pulmonary Disease 1) Cyanosis 2) pitting & edema 3) Subcutaneous emphysema 4) Pt posture 5) Pleural friction rub
Types of Cyanosis 1) Central 2) Peripheral 3) Mixed 4) Differential
Central Cyanosis Around the core, lips & tongue
Peripheral Cyanosis Extremities and fingers; hypothermia
Mixed Cyanosis Combination of central and peripheral cyanosis.
Differential Cyanosis Coloration of lower but not upper part of head.
Specific Techniques of physical assessment A. Tracheal position; 1)Tension pneumothorax, 2)atelectasis, 3)percussion B. 1)Resonance, 2)Hyperresonance, 3)Tympany, 4)Dullness C. Auscultation
Structures of Heart Wall Pericardium, Myocardium, Endocardium
Cardiac Chambers 1) Atria; upper right and left 2) Ventricles; lower right and left
Cardiac Valves 1) Semilunar -- aortic & pulmonary 2) Atrioventricular -- Mitral & Tricuspid
Preload -- determines CO Amount of stretch on myocardial muscle fibers at end diastole; determined by volume of blood in ventricles at that time
Afterload -- determines CO Sum of forces against which the ventricular muscle fibers must shorten to eject blood into arterial circulation.
Left Ventricular Afterload Imposed by aortic diastolic pressure and SVR
Right Ventricular Afterload Imposed by pulmonary artery diastolic pressure and SVR
SVR Systemic Vascular Resistance
Contractility -- determines CO Force and velocity of myocardial fiber shortening independent of preload & afterload. Inotropic stimuli will increase or decrease strength of contraction.
Muscular Synergy - determines CO Pattern of ventricular contractile dynamics.
Coronary Circulation Supplies blood in the sinus node, AV node, and initial portion of Bundle of HIS
Left Main Coronary Artery (2) 1) LAD (Left Anterior Descending branch) 2) Circumflex branch
Physical factors that determine coronary blood flow 1) Coronary perfusion pressure 2) coronary vascular resistance
Factors that may globally or locally decrease coronary blood flow 1) physical obstruction/narrowing of lumen 2) decrease in aortic diastolic pressure or significant increase in right atrial pressure
Ventricular Wall _____________ will proportionately affect myocardial work Tension = determined by afterload and ventricular size
Myocardial ______________ will proportionately affect myocardial work Contractility = determined by inotropic stimuli
___________ rate will proportionately affect myocardial work Heart
Normal systemic circulation pressure gradient 90 mm Hg to drive systemic blood flow
Normal Pulmonary circulation pressure gradient 8 mm Hg to drive pulmonary blood flow
Vascular System rate and volume of blood flow is determined by 1) Inflow vs. outflow pressure difference (gradient) 2) The resistance to blood flow
Components of Vascular system 1) Systemic Vessels 2) pressure by blood on arterial walls 3) blood pressure 4) Arterial Pressure 5) anything influencing systolic and diastolic pressures
3 types of systemic vessels Systemic arteries, systemic capillaries, systemic veins
3 controllers of blood pressure Arterial baroreceptors, chemoreceptors, strong emotional stimuli
2 components of arterial pressure 1) systolic pressure 2) diastolic pressure
Systolic pressure The higher pressure that relates to contraction of ventricles and ejection of a bolus of blood into arterial system
Diastolic pressure The lower pressure that relates to relaxation and runoff of blood through the vascular system
Factors influencing systolic and diastolic pressures 1) Stroke volume 2) Vascular resistance 3)Heart rate 4) Intravascular volume
Symptoms of Cardiovascular disease Chest pain, Dyspnea, Weakness, and fatigue
Signs of Cardiovascular disease 1) Changes in mentation 2) Changes in skin color and temp 3) Cyanosis 4) Urine output
Specific Techniques of Physical Assessment 1) Evaluate HR and rhythm (repeatability & regularity) 2) Evaluate arterial pressure (time doman & frequency)
O2 Consumption `VO2 = `QT [C(a-v)O2 x 10]
Total O2 Delivery (amount of O2 transported to tissues) DO2 = `QT x (CaO2 x 10)
O2 Content Arterial CaO2 = (Hb x 1.34 x SaO2) + (PaO2 x .003)
O2 Content Mixed Venous CvO2 = (Hb x 1.34 x SvO2) + (PvO2 x .003)
O2 Content Pulmonary Capillary CcO2 = (Hb x 1.34) + (PAO2 x .003)
A-a gradient or Ideal Alveolar Air Equation PAO2 = [PB - PH2O] FiO2 - PaCO2 (1.25) If all is normal PAO2 = (713 x FiO2) - (PaCO2 x 1.25)
Cardiac Output CO = SV x HR
Blood pressure BP = CO x SVR (Systemic Vascular Resistance)
Vascular Resistance SVR = BP/CO
O2 Bound to Hb 1.34 x Hb x SaO2
Dissolved O2 PaO2 x 0.003
Arterial - Venous O2 Content Difference C (a-v)O2 = CaO2 - CvO2
O2 Extraction Ratio O2ER = CaO2 - CvO2 / CaO2
Shunt Equation Qs/Qt = CcO2 - CaO2 / CcO2 - CvO2
Semilunar Heart Valves Aortic & Pulmonary Systole = open ; Diastole = closed
Atrioventricular Heart Valves Mitral & Tricuspid Systole = closed ; Diastole = open
Vasoconstrictors (drugs) Epinephrine and Norepinephrine
Vasodilators (drugs) Isoproterenol and Diltiazem
Hypoxia (PVR) Stimulates vasoconstriction and increases PVR
Acidemia (PVR) Stimulates vasoconstriction and increases PVR
Atelectasis (PVR) May increase PVR
Increased pulmonary blood flow (PVR) decreases PVR (unless it's a great amt of blood flow)
Increased pulmonary venous & left atrial pressures PVR response varies; depends on complications & underlying condition(s)
Vascular Obstruction Massive blockage will increase PVR ie. PE/Tumor
Common Therapeutic Interventions for Hypothermia Remove wet clothing, provide dry clothing, place pt in warm area, cover pt with warm blankets, apply warming pads, keep pts limbs close to body, cover pts head with a cap or towel, supply warm oral or iv fluids
Cyanosis is a result of decreased V/Q ratio, pulmonary shunting, venous admixture, and hypoxemia
Created by: Beccaboop