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FONDATION OF NURSING

CHAPTER 39 exam 3

QuestionAnswer
CARDIOVASCULAR AND RESPIRATORY SYSTEM FUNCTION ARE ? CARDIO: oxygenation, oxygen to the body’s cells = pulse, pulse physiology, blood pressure, and the physiology of blood pressure RESPIRATORY:REMOVING CO2 AND REPLACING IT WITH O2 IN THE ALVEOLI
SYMPTOMES OF HYPOXIA? EARLY RESTLENESS-confused ANXIETY TACHYCARDIA/PNEA LATE BRADYCARDIA EXTREME RESTLENESS DYSPENEA
OXYGENATION AND PERFUSION?AIR in peds; feeding difficulty, inspiratory stridor, snare flares, expiratory grunting, strenal refractions =the process by which oxygenated capillary blood passes through body tissues.
AIRPATHWAY upper airway nose, pharynx, larynx, and epiglottiS ( warm, filter, and humidify inspired air.) lower airway, = trachea, right and left main stem bronchi, segmental bronchi, and terminal bronchIOLES=conduct air, mucociliary clearance,PRODUCE PUL SURFACANT
BLOOD PATHWAY from right atrium-tricuspid-ventricle-pulmonary valve-pulmonary artery. return with pulmonary veins from lung-left atrium-mitral-ventricle-AORTIC VALVE-AORTA
DIFFUSION OF GAS? more surface area, more perfusion Thickening of alveolar-capillary membrane Partial pressure Solubility and molecular weight of the gas O2 (97%) CARRIED BY OXYHEMOGLOBIN, VA PLASMA CO2 AS CARBOXYHEMOGLOBIN BLOOD FLOW B/W TISSUE & CELLS MUST OCCUR
PULMONARY VENTILATION? •Inspiration: active phase •Expiration: passive phase MOVEMENT OF AIR IN AND OUT OF THE LUNGS
ALTERATIONS IN RESPIRATORY FUNCTION Hypoxia: LOW 02 available to the cells Dyspnea: difficulty breathing •Hypoventilation: decreased rate or depth of air movement into the lungs
CARDIOPULMONARY CONCERN RELATED TO: •Level of health •Developmental considerations-CHILD LESS MOVEMENT •Medication considerations-OPIOD-RESPIRATORY DEPR. •Lifestyle considerations-NUTRITION •Environmental considerations-PULLUTED AIR •Psychological health considerations-STRESS, ANXIETY
ALTERATIONS IN THE CARDIOVASCULAR SYSTEM •Dysrhythmia or arrhythmia-ABNORMAL RYT •Myocardial ischemia-DEATH OF MUSCLE •Angina-PAIN •Myocardial infarction-HEART ATTACK •Heart failure
DEVELOPMENTAL CONSIDERATION PEDS: Transition lung function post-delivery •Chest smaller, airway shorter •Rates are more rapid-HIGHER HR+RR, LOWER BP •Higher risk factors for decompensation
OLDER ADULTS? Tissues become more rigid •Changes in posture /lifestyle/medication • Immune changes = increased risk for exposure •Aging heart, valves, PVS •Age related changes: CAHD, smoking, cancer
HISTORY OF NURSING •Determine why and type of care needed •Health history and Physical Exam (inspection, palpation(TOUCH, percussion,(TAP AND LISTEN) auscultation(LISTEN W/ SETHSCOPE)) •Identify current or potential health deviations. •Devices to improve intake of air
COMMON DIAGNOSTICS ARE: •O2 Saturation (pulse ox) goal = 100% RBC SAT E WITH O2 (ECG or EKG)-ELECT ACTIVITY •CXR (chest x-ray)/Scans/EndoscopicCHECK LUNG •Pulmonary function tests) -MEASURE AIR •CardiaC CTHRZN -BLOCKAGE •Stress testing and Holter monitoring-CARDIAC OUTPUT,
WHATS A PULSE OXIMETRY Measures % O2 in arterial bloOD •NOTE that O2 Desaturation is a LATE sign of compromise in some •Helpful assssessment, monitoring need for or use of O2 •Know Hgb—low values can still reflect high O2 Sat—WHY?•Ideal range of 95%-100% BLEEDING=DROP RBC02
Steps in using a PULSE OXIMETRY CLEAN FINGER ATTACH PROBE CONNECT SENSOR AND BEGIN TEST RECORD FINDINGS AND ASSESS PATIENT NEEDS
NURSING INTERVATION Teaching about a pollution-free environment •Promoting optimal function •Promoting comfort •Promoting proper breathing •Managing chest tubes •Promoting and controlling coughing •Suctioning the airway •Meeting oxygenation needs with medications
PROMOTING PROPER BREATHING & COMFORT Healthy lifestyle, nutrition, and NO SMOKING/Vaping •Vaccination (flu/pneumococcal) =NO PNEUMONIA •Breathing positioning: Deep breathing, purse-lip, and Diaphragmatic •Moving and use of incentive O2 devices as prescribed
OXYGEN DELIVERY SYSTEMS Nasal cannula Simple mask Partial rebreather mask Nonrebreather mask Venturi mask Tent IN ASTHMA, PEDS-LESS INVASIVE Nasopharyngeal catheter Transtracheal catheter
PROCESS OF VENTILATION:
O2 USING NASAL CANNULA 1. COnnect cannula to O2. Adjust Flow Rate ordered. Place cannula into nares 4. Place over ears 5. Adjust slide for comfort/stability 6. Clean cannula, nose, re-ass
O2 USING FACE MASK 1. Connect cannula to O2/flow rate 3. Allow O2 to fill bag 4. Secure mask over nose & mouth 5. Adjust straps for comfort/stability 6. Clean mask, nose, re-assess
PRECAUTIONS FOR OXYGEN ADMINISTRATION ARE= Avoid open flames in the patient’s room.•Place “no smoking” signs in conspicuous places.• Check to see that electrical equipment in the room is in good working order.•Avoid wearing and using synthetic fabrics (builds up static electricity).•Avoid using oils in the area (oils ignite spontaneously in oxygen).
ADMINISTERING CARDIOPULMONARY RESUSCITATION •Chest Compressions: Check the pulse. If the victim has no pulse, initiate chest compressions 30 COMPRESSION, 2 BREATHS, Airway: Tilt the head and lift the chin; check for breathing. •Breathing: If the victim does not start to breathe spontaneously after the airway is opened, give two breaths lasting 1 second each.•Defibrillation: Apply the AED as soon as it is available
BREATHING-CAVITY LUNG INCREASE, DIAPHRAM CONTRACT 6-PS OF DYSPENIA PULMONARY BRONCHIOL CONSTRICTION-POSSIBLE FOREIGN BODY-PULMONARY EMBOLUS-PNEUMIA-PUMP FAILURE-PNEUMIA THORAX
Created by: Seka_nurse
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