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Ch 28 Oxygenation

Concepts from Potter and Perry Ch. 28

Why does the heart rate effect the blood flow? Because of the relationship between the rate and the diastolic filling time.
What is preload? The amount of blood in the ventricle at the end of diastole.
What happens to diastolic filling time when a person has a sustained heart rate above 160 bpm? Diastolic filling time decreases
If diastolic filling time decreases what happens to preload? Preload decreases
What is stroke volume? In cardiovascular physiology, stroke volume (SV) is the volume of blood pumped from one ventricle of the heart with each beat (Wikipedia).
If preload decreases what happens to Stroke Volume and Cardiac Output? They decrease as well
What is Cardiac Output? Amount of blood ejected from the left ventricle per minute.
What is a normal adult range for cardiac output? 4-6L
What kind of patients might have a decrease in SV and CO at heart rates less than 160bpm? Patients with long-term cardiovascular disease or patients with decreased myocardial reserve.
How does the heart of an older person compensate for being slower to increase heart rate when under stress. The stroke volume increases in order to increase the CO and BP.
What is the job of the conduction system? The conduction system generates, controls and organizes the impulses that cause the rhythmic contraction and relaxation of the atria and ventricles.
What system regulates the rate of impulse conduction, transmission speed and strength of contraction? The autonomic nervous system through the sympathetic and parasympathetic branches.
What is the name of the nerve utilized to slow the heart rate via the parasympathetic nervous system? The vagus nerve.
Where is the SA node located? In the right atrium next to the entrance of the superior vena cava.
What is the "pacemaker" of the heart? The sinoatrial node.
What is the range of the adult resting heart rate? 60-80 bpm
What is the range for older adults? 40-100bpm
What route would an impulse through the conduction system take from beginning to end? SA node, AV node, Bundle of His, bundle branches, purkinje fibers
What does the delay at the AV node help the heart do? The delay at the AV node assist in atrial emptying.
What records the electrical activity of the conduction systen as waves and complexes? An electrocardiogram (ECG)
What monitors the regularity and path of the electrical impules through the conduction system? Electrocardiogram ECG
What measures the muscular work of the heart? I don't know, but its not the ECG!
What is normal sequence of electrical impulses on an ECG called? Normal Sinus Rhythm.
What does the P wave of an ECG represent? Atrial depolarization
What does the QRS part of an ECG represent Ventricular depolarization
What part of an ECG represents ventricular repolarization? The T wave
In order for the exchange of respiratory gases to occur what has to be in working order? The organs, nerves, muscles of respiration and the portion of the CNS that regulates it.
What would diseases that alter the structure or function of the lungs do to respiration? They would alter respiration.
How many lobes in the right lung? 3
In a nut shell what is the function of respiratory regulation? To make sure that there is adequate oxygen to provide for metabolic needs.
Which organ regulates CO2 levels? The lungs
Which organ regulates HCO3 (Bicarbonate) levels? The kidneys
What pH is required in arterial blood in order to maintain cellular integrity and the speed of cellular enzymatic reactions? 7.35 to 7.45
What is a substance that absorbs or releases hydrogen in order to correct an Acid-base imbalance called? buffer
What 3 factors contribute to the fluid, electrolyte, acid-base balance in the body? The Intake and Output of water and electrolytes, their distribution in the body and the regulation of pulmonary and renal function.
What body functions would be affected by an acid-base imbalance? respiration, metabolism, cardiovascular, renal, and CNS function
How much of our body weight is water? Males 60%, Females 50%
What two kinds of compartments do we have for fluid? Intracellular Fluid (ICF) and Extracellular Fluid (ECF)
What percent of weight is ICF in an average adult? 40%
What percent of weight is ECF in an average adult? 20%
Where is ECF found? interstitial spaces and intravascular (also in lymph vessels and organs)
What is the technical name for salts and minerals in the body? Electrolytes
Define electrolyte. A compound or element that separates into ions in solution and is able to carry an electric current.
In the body how do the amount of anions and cations in usually compare? Usually they are balanced.
How are electrolytes measured? mEq/L = Milliequivalents per liter
What is the movement of a solute from an area of higher concentration to an area of lower concentration called? Diffusion
What is the movement of water from an area of lower concentration of solute to an area of higher concentration of solute through a semipermeable membrane called? osmosis
What is a concentration gradient? the difference between two concentrations
What is osmotic pressure? When a higher concentration of solute on one side of a semipermeable membrane pulls water to that side.
What is osmolality? The ability of a solution to create osmotic pressure.
What does isotonic mean in relation to body fluids? A solution with the same osmotic pressure as cells.
What does hypertonic mean in relation to body fluids? A solution with higher osmotic pressure than the cells. (Memory trick - the R in hypeRtonic stands for Raisin because cells shrivel up like a raisin in hypeRtonic solutions).
What does hypotonic mean in ralation to body fluids? Solutions that have a lower osmotic pressure than the cells so that the cells draw water in and expand. (Memory- HypOtonic. The O stands for a bubble that pops, because cells expand and pop in hypotonic solutions)
What is the force of fluid pressing outward against a surface called? Hydrostatic pressure
What is filtration? When hydrostatic pressure causes solutes and solution to move through a semipermeable membrane.
What is colloid osmotic pressure? When the proteins in the veins act like a sponge and pull water in.
What is another name for colloid osmotic pressure? Oncotic pressure
In the capillary system which side should have hydrostatic pressure and which side should have colloid osmotic pressure? Hydrostatic pressure on arterial end and colloid osmotic pressure on the venous end
What mechanism primarily regulates fluid intake? The thirst mechanism
Where is the thirst control mechanism located? In the hypothalamus
What is the function of osmoreceptors? They constantly monitor the serum osmotic pressure.
What change in osmotic pressure would cause the hypothalamus to stimulate thirst? When osmolality increases the hypothalamus stimulates thirst.
Define hypovolemia. a state of decreased blood volume ; more specifically, decrease in volume of blood plasma.
What condition might occur as a result of excessive diarrhea and vomiting, or a hemorrhage? Hypovolemia
Who might be at risk for dehydration and why? Infants, patients with neurological or psychological problems, some older aldults are unable to percieve or respond to the thirst mechanism.
What is the medical term for peeing-a-plenty? diuresis
Name four hormones that play a role in fluid balance. Antidiuretic Hormone (ADH), Alodosterone, Renin, Agiotensin II
Where does antidiuretic hormone come from and what activates its release? Comes from the posterior pituitary gland. Released when blood osmolarity increases
What role do osmoreceptors and the hypothalamus play in the release of ADH? When there is an increase in osmolarity, stimulation of the osmoreceptors in the hypothalamus causes a release of ADH.
What happens to the kidney tubules and collecting ducts when they are influenced by ADH? They become more permeable to water, allowing more water to leak back into the peritubular capillaries, back into circulation.
What does the reabsorbed water from peritubular capillaries do the the osmolarity of blood? Decreases osmolarity, Dilutes the blood.
Explain the effect of ADH on urine and blood. ADH causes more concentrated urine and less concentrated blood.
What happens when osmoreceptors recognize that blood osmolarity has been sufficiently diluted? The negative feedback of normal blood osmolarity turns off the release of ADH.
Where does Aldosterone come from and where does it act? Comes from the adrenal cortex, and acts on distal kidney tubules.
What happens to the distal kidney tubules in the presence of aldosterone? They let allow more sodium to be reabsorbed back into the body and more potassium and chloride to be released (out with urine).
What follows sodium? Water
If sodium retention increases, what happens to water retention? Increases too
What does aldosterone do to blood volume? Increases blood volume
What are two triggers that release aldosterone? Increased potassium levels and Angiotensin II
What enzyme reacts to decreased renal perfusion secondary to a decrease in ECF? Renin
What is the effect of angiotensin II? It causes vasoconstriction and the release of aldosterone (so more water due to aldosterone and narrower pipes due to vasoconstriction)
What cation in our body is most responsible for water balance and also the most abundant cation in ECF? Sodium Na+
Name four important body functions that require sodium ions. 1. Sodium ions affect serum osmolality. 2. Nerve impulse transmission require sodium ions. 3. Regulation of acid-base balance 4. Cellular chemical reactions
What are two things that regulate sodium amounts in the body? Aldosterone and dietary intake
What is the normal amount of sodium in ECF? 135 to 145 mEq/L
Where potassium mainly found? Intracellular fluid - only 2% in EFC
What are several important body functions that we need potassium for? regulates many metabolic activities, needed for glycogen deposit in the liver and skeletal muscles, transmission and conduction of nerve impulses, normal cardiac rhythms, contraction of smooth and skeletal muscle.
What is the normal serum potassium level? 3.5 - 5 mEq/L
What two things regulate potassium levels? Renal excretion and dietary intake.
What will happen to potassium levels is a person is having diuresis? Why? The body does not conserve potassium well so any condition that increases urine output will decrease serum potassium.
What are the major cations in the body? Sodium, Potassium, Calcium, Magnesium
What cation is found 99% in bones and only 1% in EFC? Calcium
What are some important roles calcium plays in the body? Calcium is necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses and muscle contraction.
What percent of calcium is bound to proteins in the blood and what percent is free ions in the serum? 50% bound to protein, mostly albumin, and 40% free ionized calcium.
What is the normal free ionized calcium range in serum? 4-5 mEq/L
What is the normal total calcium range in blood? 8.5 to 10.5 mg/dl
What are the major Anions in the body? Chloride, bicarbonate and phosphate
What is the major anion in ECF? Chloride
What cation does chloride follow? Sodium
What is the normal range for chloride? 95 - 108 mEq/L
What two things regulate the levels of chloride? Dietary intake and the kidneys
What will happen if a person with normal kidney function takes in more chloride than the body needs? It will be excreted in the urine.
What ion is the major chemical base buffer in the body and very important for acid-base balance? Bicarbonate
Is bicarbonate found in ICF or ECF? Both
What organ regulates bicarbonate? The kidneys
What are normal bicarbonate levels in the arteries? 22-26 mEq/L
What are bicarbonates measured as in veins and what is the normal range? Bicarbonates are measured as carbon dioxide in veins and the normal range is 24 -30 mEq/L.
If Hydrogen ion concentration is high what kind of solution is it and what kind of pH does it have? High hydrogen ion concentration=Acid=low pH
If Hydrogen ion concentration is low what kind of solution is it and what kind of pH does it have? Low hydrogen ion concentrartion=Alkaline=High pH
Which organ regulates Carbon dioxide? The lungs
Which organ regulates bicarbonate? The kidneys
The balance between carbon dioxide and bicarbonate is reflected in what measurement? pH
What is the normal pH in arterial blood? 7.34-7.45
What are the three types of acid-base regulators in the body? 1. chemical - carbonic acid-bicarbonate buffering system2. biological - the absorption and release of hydrogen ions by cells3. physiological buffering systems - the lungs and kidneys
What do buffers do? Buffer absorb or release hydrogen ions to correct an acid-base imabalance.
What is hyponatremia and two possible causes? Serum sodium levels are too low due to sodium loss or water excess.
What is hypernatremia? excess sodium
Name 4 things that affect the delivery of oxygen. Amount of oxygen entering the lungs (oxygenation), Blood flow to the lungs and tissues (perfusion), Oxygen-carrying capacity of the blood (rate of diffusion), Amount of CO2 excreted by the lungs (Ventilation)
What is the carrier for oxygen and CO2? Hemoglobin
What is oxyhemoglobin? Its oxygen combined with hemoglobin.
How does oxyhemoglobin get oxygen to cells? The formation of oxyhemoglobin is easily reversible. When they dissociate the oxygen is free to enter tissues.
What do you get when you add h20 and CO2? Carbonic acid H2CO3
What happens to CO2 when it diffuses into blood cells? It is rapidly hydrated and becomes carbonic acid.
How do we get bicarbonate ions from carbonic acid? One of the hydrogens dissociates leaving hyrdrogen and bicarbonate. H2CO3=H+ and HCO3
What is oxyhemoglobin? Its oxygen combined with hemoglobin.
How does oxyhemoglobin get oxygen to cells? The formation of oxyhemoglobin is easily reversible. When they dissociate the oxygen is free to enter tissues.
What do you get when you add h20 and CO2? Carbonic acid H2CO3
What happens to CO2 when it diffuses into blood cells? It is rapidly hydrated and becomes carbonic acid.
How do we get bicarbonate ions from carbonic acid? One of the hydrogens dissociates leaving hyrdrogen and bicarbonate. H2CO3=H+ and HCO3
what happens to the hydrogen ion and bicarbonate ion when they separate? The hydrogen ion is buffered by hemoglobin and bicarbonate diffuses into plasma.
What is deoxyhemoglobin and why is it important? Deoxyhemoglobin is reduced hemoglobin. It carries CO2 more easily than oxyhemoglobin. So venous blood can return CO2 to the lungs to be expired.
Explain what happens with carbon monoxide poisoning. Carbon monoxide binds to hemoglobin 210 times better than oxygen. Carbon monoxide does not disassociate easily so the hemoglobin is not available to carry oxygen resulting in hypoxia.
What disorder (common among menstrating women who don't eat much meat) decreases the ability of blood cells to carry oxygen? Anemia
Give some examples of situations where inspired oxygen would be decreased. Upper or lower respiratory obstruction, High altitudes, incorrect oxygen setting on respiratory therapy equipment.
What is hypovolemia? Decreased circulating blood volume resulting from ECF loss.
How does the body try to adapt to significant fluid loss? The heart beats faster and the peripheral vessels constrict in order to get more blood to the heart and increase cardiac output.
What are some situations that would increase oxygen demand? Exercise, pregnancy, wound healing, because the body is building new tissues. Fever increases the tissues' need for oxygen.
What also increases as fever increases the tissues' need for oxygen? Production of carbon dioxide.
Under what conditions could fever lead to muscle wasting? If the fever lasts a long time, metabolic rate stays high and the body begins to break down protein stores.
How does the body attempt to adapt to increased carbon dioxide levels (hypercapnia)? By increasing the rate and depth of respirations in order to eliminate the excess CO2.
What is decreased arterial oxygen level in the blood called? hypoxemia
What could the following signs and symptoms indicate?Anxiety, Restlessness, Inability to concentrate, Increased heart rate, Increased respiratory rate and BP, Cardiac dysrhythmias and eventual uncosciousness Hypoxemia
What happens to ventilation if any condition reduces chest wall movement? Ventilation will decrease.
What happens if the diaphragm is not able to fully descend? The volume of inspired air decreases, delivering less air to the alveoli and subsequently to the tissues.
Give some examples of musculoskeletal abnormalities that would decrease pectus excavatum, Kyphosis, and muscular dystrophy
What are some examples of nervous system diseases that would reduce ventilation? Myashtenia Gravis, Guillain-Barre' syndrome, poliomyelitis
What happens to respiration if the medulla oblongata is injured? Neural regulation of respiration is damaged and abnormal breathing patterns develop.
What happens if there is damage to the spinal cord, c3 - c5 or below the 5th cervical vertebra? If the phrenic nerve is damaged the diaphragm will not descend. If the damage is below the fifth cervical vertebra the nerves that go to the intercostal muscles would be damaged.
What is the condition called where trauma to the chest causes breathing in which the chest sinks in on inspiration and moves out on in expiration? Flail Chest
What is polycythemia? The body attempts to make up for decreased oxygenation by creating more red blood cells, (there are other causes too).
Name several things that would alter cardiac functioning. Illnesses or conditions that affect heart rate, rhythm, strength of contraction, blood flow through the heart, or peripheral circulation
What are deviations from normal sinus rhythm or impulses that do not originate from the SA node called? Dysrhythmias
Name several things that can cause dysrhythmias. ischemia, valvular abnormality, anxiety, drug toxicity, caffeine, alcohol, tabacco, acid-base imbalance
What is the normal heart rate range for an adult and what do we call rates above and below that? 60-100 bpm, tachycardia and bradycardia
What is failure of the heart to pump sufficient blood volume to systemic and pulmonary circulation called? Heart Failure
A patient has severe chest pain, breathlessness, diaphoresis, and hypotension. What could be the problem? Myocardial Infarction
Describe the cause of angina. Angina is the result of decreased blood flow to the heart (Myocardial Ischemia).
What is the name of the artery that supplies the heart? coronary artery
What cardiac condition is caused by chronically elevated arterial pressure and pulmonary congestion? Left sided heart failure. This condition results in reduced cardiac output.
What condition is characterized by venous congestion, (distended jugular vein) and often a result of pulmonary diseases or secondary to left sided heart failure? Right sided heart failure.
What are some examples of impaired valvular function? Faulty valves can cause back flow or obstruction.Stenosis in pulmonary or Aortic valve makes the ventricles have to work harder to expel blood.
What alteration in respiratory function results in excess elimination of CO2? Hyperventilation
What alteration in respiratory function results in hypercapnia? Hypoventilation
Your patient is experiencing tachycardia, SOB, chest pain, dizziness, light-headedness, decreased concentration, pareshtesia, circumoral and/or extremity numbness, tinnitus, blurred vision, disorientation, and tetany. Why? Hyperventilation
What are the signs and symptoms of hypoventilation? dizziness, occipital headache upon awakening, lethargy, disorientation, decreased ability to follow instructions, cardiac dysrhythmias, electrolyte imbalances, convulsions, possible coma and cardiac arrest
How could giving a patient with COPD and hypercapnia too much oxygen result in respiratory arrest? The body adapts to higher levels of paCO2 by shutting down chemoreceptors for CO2. The only stimulus for breathing left is chemorecptors that monitor for decreased paO2. If oxygen prevents paO2 from falling there is no stimulus to breathe. CO2 builds up.
What is the difference between hypoxia and hypoxemia? Hypoxemia is shortage of arterial O2. Hypoxia is inadequate tissue oxygenation.
What does the treatment for hyperventilation and hypoventilation involve? Treating the underlying cause, improving tissue oxygenation, restoring ventilation to normal, acheiving acid-base balance
What happens if hypoxia is left untreated? Hypoxia is a life threatening condition that if left untreated will cause cardiac dysrhythmias and death.
How is hypoxia treated? Administration of oxygen and treatment of underlying cause.
Your patient with a chest tube is not having relief from respiratory distress, has a sharp stabbing chest pain, decreased BP and increased heart rate. What do you do? Notify the physician immediately.These signs could indicate pneumothorax.
Your patient with a chest tube is not having relief from respiratory distress, has a sharp stabbing chest pain, decreased BP and increased heart rate. What do you do? Notify the physician immediately.These signs could indicate pneumothorax.
Knowledge of what two factors help you anticipate your patient's oxygen needs? Developmental status, behaviors, and lifestyle choices that predispose to respiratory risks.
What are the specific respiratory risk for premature infants? Sufactant deficiency resulting in hyalin membrane disease and Respiratory Syncytial virus due to underdevelopment of the lungs.
What are the specific respiratory risk for infants and todlers? Upper respiratory risk from contact with other children and teething. Airway obstruction from putting stuff in their mouths.
What are the specific respiratory risk for school age children and adolescents? At risk for respiratory infections due to second hand smoke and smoking - increases risk of lung cancer and cardiopulmonary disease in middle age.
What are the respiratory risks for young and middle age adults? lack of exercise, fast food, stress, and cigarettes -pregnancy.
what are the specific respiratory risks factors for older adults? age related changes to the cardiac and respiratory systems like calcification of hart valves, SAnode, and costal cartiledge, athersclerosis in arteries, ect leading to increased risk for Flu, pneumonia, and RSV.
How does obesity affect oxygenation? Severe obesity decreases lung expansion and increased body weight increase oxygen demand
How does malnourishment affect oxygenation? Respiratory muscle wasting results in decreased respiratory excursion, and cough efficiency.
Would we use a warm or cold compress to increase circulation? Heat causes vasodilation and increases circulation to the area.
What is the purpose of pursed lip breathing? To help maintian open airways
Name 3 ways that substance abuse can impair oxygenation. 1. Reduced iron intake due to poor nutrition decreases hemoglobin. 2. Some drugs depress respiration. 3. Some drugs cause direct injury to lung tissue
What is another term for bloody sputum? Hemoptysis
What affect does anxiety have oxygen demand? Increases metabolic rate and oxygen demand
What do we record when we see hemoptysis? amount, color, duration of bleeding, presence of sputum
Does cardiac pain occur with respiratory variations? Nope
What is xanthelasma and what causes it? yellow lipid lesions on eyelid caused by hyperlipidemia
If a man has has substernal pain that radiates to the left arm and jaw what would we suspect is the source of the pain? the heart
What are some symptoms a woman might experience from cardiac pain? epigastric pain, indigestion, choking feeling, dyspnea
What is corneal arcus? a whitish opaque ring around the junction of cornea and sclera caused by hyperlipidemia in young and middle aged adults.
What kind of pain is usually nonradiating and often occurs with respiration? Pericardial pain from inflammation of the pericardial sac.
Distention of neck veins is a sign of ________. Right-sided heart failure
Describe pleuritic chest pain. peripheral, radiating to the scapular regions, knifelike, increasing with inspirations
A patient with eupnea takes about how many breathes per minute? Eupnea=normal breathing = 16-20 breathes per minute
What is a subjective sensation of breathlessness? Dyspnea
A patient with tachypnea takes about how many breathes per minute? >35
What is paroxysmal nocturnal dyspnea (PND)? Dyspnea that occurs while a patient is sleeping
A patient experiencing bradypnea takes about how many breathes per minute? <10
What is the probable cause of PND? reabsorption of fluid from dependent body parts while the patient is recumbent
What are periods of no respiration lasting more than 15 seconds called? Apnea
What qauntifies the presence or severity of orthopnea? The number of pillows used to sleep
What kind of bacteria causes TB? Mycobacterium tuberculosis
What is orthopnea? a condition in which a patient has difficulty breathing unless sitting up or supported by multiple pillows
If a patient gets a positive result on a TB test what is the next step to confirm infection? Chest X-ray
According to the CDC who should have annual influenza vaccines? Patients over age 65 and with chronic illness regardless of age (controversial for immunocompromised patients)
Who should not have influenza vaccines? People with allergies to eggs, chickens, or feathers.
When should flu vaccine be delayed? When patient has a fever.
How often hous patients recieve the pneumococcal vaccine? Every 10 years for low risk patients. Every 5 years for those with multiple underlying conditions
When is it safe to give flu and pneumococcal vaccine to a pregnant woman and what do we do first? After the first trimester, but conult obstetrician first
Name 3 interventions used to maintain a patent airway. coughing techniques, suctioning, and insertion of an artificial airway
Name 3 ways we can measure effectiveness of coughing. sputum expectoration, patient reports swallowing sputum, adventitious lung sounds clear
What do we encourage patients with chronic pulmonary diseases, upper and lower respiratory tract infection to do every 2 hours? Deep breath and cough
How often would we like a patient with lots of sputum to cough while awake? While sleeping? Every hour while awake and wake up every 2 or 3 hours to cough
In what kind of cough does the patient perform a series of coughs through exhalation? Cascade cough
What cough is a predecessor to the cascade cough and only effective for clearing the central airway? Huff cough
What kind of cough is for patients without abdominal muscle control? Quad cough
_______ technique is used for nasotracheal and orotracheal suctioning. Sterile
__________ technique is used for oral and nasopharyngeal suctioning. Clean
When combining suctioning techniques which go first? Nasotrachea and trachea before oral and nasopharyngeal
What do we think about installation of normal saline into artificial airways to improve airway clearence? It has not been proven effective and may cause harm.
What do we do for a patient who can cough up sputum but is unable to clear them out by spitting or swallowing? Oropharyngeal or Nasopharyngeal suctioning
What device is used for oropharyngeal suctioning? Yankauer or tonsillar tip suction device
Describe the patient that needs orotracheal or nasotracheal suctioning. Uanble to cough and does not have an artificial airway.
Why is the nose preferred to the mouth as a passageway for tracheal suctioning? Stimulation of the gag reflex is lessened
Why will we use closed suctioning most often for patients who require mechanical ventilation? Because it continuously delivers oxygen during suctioning.
When do we use an artificial airway? For a patient with decreased level of consciousness, airway obstruction, mechanical ventilation, and for removal of tracheobronchial secretions
What is the simplest type of artificial airway? Oral airway
What does the oral airway prevent? obstruction of the trachea by the tongue
Where is the oral airway located and what does it do? It extends from the teeth to the oropharynx and maintains the tongue in normal position.
How do we determine the proper oral airway size? We measure from the corner of the mouth to the angle of the jaw just below the ear.
Why is a nebulizer important for a patient with a tracheal tube? Because of the artificial airway the patient no longer has normal humidification of the tracheal mucosa. Humidification reduces risks of airway plugging.
Why is the mobilization of pulmonary secretions important? Because the ability of a patient to mobilize pulmonary secretions makes the difference between getting better and long term illness with complications
What does the patient need in order to have thin, white, watery, mobile secretions? hydration of 1500 to 2000 mL a day (unless contraindicated by cardiac condition)
How is oxygen by way of nasal catheter, nasal cannula, or face mask humidified? bubbled through water
What kind of liquid is used for hydrating oxygen and why? Sterile saline because microbes like moist environments
When is hydration of oxygen required? When the patient is receiving 4L/min or more
What uses the aerosol principle to suspend water droplets in inspired air and to deliver bronchodilators and mucolytic agents? Nebulization
Name 4 nursing interventions that maintain or promote lung expansion. positioning, incentive spirometry, chest physiotherapy, chest tube management
What is the best position for patients with cardiopulmonary diseases for lung expansion? 45 degree semi-fowler’s
Why position patients with unilateral lung disease like atelectasis or pneumothorax with the healthy lung down? To promote better perfusion of the healthy lung thus improving oxygenation
Why position patients with unilateral lung abscess or hemorrhage damaged lung down? to prevent drainage toward the healthy lung
What nursing intervention is used to provide patients visual feedback about air volume? incentive spirometry?
What does incentive spirometry help prevent or treat in postoperative patients? atelectasis
What is an acceptable postoperative inspiratory capacity? half to ¾ of preoperative inspiratory capacity
What measures will help the patient achieve deeper breathing by reducing postoperative pain? pain medication and splinting
Encourage postoperative patients to __________ as early as possible because this cannot be replaced by incentive spirometry. Ambulate
What 4 things are included in chest physiotherapy? postural drainage, chest percussion, vibration, followed by productive cough or suctioning
Why would chest physiotherapy be contraindicated for a patient who has used steroids for an extended period? Long-term steroid use increases the patients risk for rib fractures
What kind of medications would decrease a patient’s tolerance of positional change and postural drainage due to fluid and hemodynamic effects? Diuretics and Antihypertensives
Name some diuretics and antihypertensives from Pharm. Diuretics= Lasix, HCTZ, Aldactone, Mannitol Antihypertensive = Captopril, Lisinopril, Losartan, Valsartan, Verapamil, Caridzem, Procardia,
What part of CPT would cause a problem for patients with intracranial pressure, spinal cord injuries, and abdominal aneurysm resection? Positional changes of postural drainage
Do we percuss the scapular area when performing CPT? Nope
Percussion is contraindicated for patients with __________, ________, or __________. bleeding disorders, osteoporosis, fractured ribs
What is a fine shaking pressure applied to the chest wall called and what does it accomplish? Vibration shakes loose trapped air and mucus and induces coughing.
What nursing intervention uses positioning techniques to drain secretions from specific segments of the lungs and bronchi into the trachea? Postural drainage
What is cystic fibrosis? An inherited condition in which the exocrine glands produce abnormally viscous mucus, causing chronic respiratory and digestive problems
What is a chest tube and what purpose does it serve? a catheter inserted through the thorax to remove air and fluids from the pleural space and to reestablish normal intrapleural and intrapulmonic pressures, promote lung expansion
What happens if the negative intra-pleural pressure is altered? Pneumothorax
Pneumothorax occurs _________ or from chest _______. Spontaneously , Trauma
What keeps the lungs from expanding fully if a patient has hemothorax? counter pressure from blood between the parietal and visceral pleurae
What do the Thora- Seal III and Pleur-Evac do? Evacuate any volume of air or fluid with controlled suction
What does the first chamber in a chest drainage system do? Provide a water seal to prevent air from being drawn back into the pleural space
What does the second chamber in a chest drainage system do? Collect fluid or blood
What is the third chamber in a chest drainage system for? suction
What chamber continuously bubbles in a chest drainage system? 3rd section
What is the normal pressure setting for adults on a chest drainage system? -15 to -20 cm H2O
What is empyema? a collection of pus in a body cavity (especially in the lung cavity)
The one bottle chest drainage system is rarely used except to drain exudates from _________. Empyema
Clamping chest tubes is ____________ when a patient is ambulating or being transported. contraindicated
Chest drainage devices need to be maintained ________ the patient’s chest. below
What should we have the patient do if the tube disconnects from the unit and why? exhale as much as possible and cough in order to remove as much air from the pleural space as possible
What nursing interventions are part of a chest tube removal? pain medication and monitoring of vital signs and spO2
What will the patient likely feel when the chest tube is removed? burning, pain, pulling sensation
What are the purposes of non-invasive ventilation? Reduce/prevent atelectasis, improve oxygenation, reduce pulmonary edema, and improve cardiac function
How does NIV prevent reduce atelectasis? the positive airway pressure keeps the alveoli partially inflated
How does NIV improve oxygentation? Because the alveoli are always inflated there is a continuous exchange of gases going on resulting in improved oxygenation
How does NIV reduce pulmonary edema in cardiac patients? the extra alveolar pressure presses interstitial fluid out of the lungs and back into pulmonary circulation
How does NIV improve cardiac function in patients with sleep apnea? Improved myocardial oxygenation improves cardiac function
What are some reduced risks with NIV as compared to Invasive ventilation? Reduced risks for pneumonia, gastric aspiration, and ventilator dependency
How does CPAP help someone with sleep apnea? CPAP uses continuous (during inhalation and exhalation) airway pressure to keep upper airway open. Collapsing of airway usually causes sleep apnea.
What is the normal range of pressure for CPAP? 5-20cm of H2O
What are some disadvantages of CPAP? uncomfortable, risk to skin integrity, dry mucous membranes, gastric distention, noisy machine, hypercapnia
How does the BiPAP differ from the CPAP? Although continuous pressure is present in inhalation and expiration, however it is greater during inhalation.
The goal of _____ ______ is the prevention and relief of hypoxia. oxygen therapy
Since _______ is a drug, we follow the six rights of medication administration. drug
What are the effects on the body immediately following a cardiac arrest? the tissues do not receive oxygen, carbon dioxide is not transported away from tissues, metabolism becomes anaerobic, metabolic and respiratory acidosis occurs. Permanent brain and heart damage can occur in 4-6 minutes.
According the American Heart Association when do we start CPR on an adult and what are the exceptions? After calling 911 except in the case of drowning, drug overdose, or trauma
How soon is defibrillation recommended? within 5 mins or 3mins if in the hospital
I f a 12-lead ECG finds acute myocardial infarction what does the AHA recommend? administration of clot-busting medication (within 4-6 hours)
What some clot-busting medications from Pharm? Streptokinase, Tenectoplase, Alteplase, Reteplase (Memory trick- STAR= Thrombolytic little STAR, race the blood clot to my heart, please, dissolve my emboli, because I am too young to die.)
What is actively assisting a patient to achieve and maintain optimal health through exercise, nutrition, relaxation/ stress management, medications, and oxygen administration part of? Cardiopulmonary Rehabilitation
Name some breathing exercises we might teach our COPD patients. deep breathing and coughing exercises, pursed-lip breathing, and diaphragmatic breathing.
What is the purpose of pursed-lip breathing? The resistance created by exhaling against pursed lips keeps the alveoli from collapsing
How should exhalation compare to inhalation with pursed-lip breathing? Patients need to gain control of the exhalation phase so that it is longer than inhalation
What kind of breathing exercise is also used to teach trumpet players how to breathe and utilizes the abdomen? diaphragmatic breathing
What is subcutaneous emphysema? Air trapped in the subcutaneous tissue
What happens with tension pneumothorax? when pressure decreases inside the lungs due to respiratory muscles increasing chest volume air leaks in and compressing the lung. If allowed to continue it becomes life threatening compressing the heart and trachea.
Chest tubes are only clamped under what circumstances? to assess an air leak, by a trained nurse in order to change or empty drainage sytem, by physicians order to determine patient is ready to have chest tube removed or monitor of recurrent pneumothorax
Why do we shod hemostats to clamp chest tubes? to prevent causing leaks
What does bubbling in the water seal chamber indicate? a leak
Severe respiratory distress, Low O2 sat, chest pain, lack of breath sounds on affected side, tracheal shift, hypotension, signs of shock, venous distention, tachycardia are signs of what in a chest tube patient? Tension Pneumothorax
What is the normal amount of drainage per hour and for a 24 hour period for a mediastinal chest tube immediately after surgery? 50-200ml/hour, 500ml per 1st 24 hours
How much drainage is normal per hour an in a day for a pleural chest tube? 100-300mL 1st 2 hours then rate decreases, 500-1000ml/ 24 hours
What is the nature of chest tube drainage initially and after time? It starts out bloody and becomes serous
Why is it especially important for patients with chest tubes to have pain control? so that they breathe deeply/avoid pneumonia
What do we record and report for our patients with chest tubes? patency of chest tube; status of dressing; drainage presence, amount and type; presence of fluctuations; vital signs; amount of suction /or water seal; patient’s comfort level
What do we need on hand if a chest tube needs to be replaced due to pneumothorax? flutter (Heimlech ) valve or large-gage needle to get air out of intra-pleural space, oxygen, code cart
If the bubbling stops in the water seal chamber of the chest drainage system when the clamp is closest to the patient’s chest where is the leak and what do we do? Inside the patient’s thorax- Unclamp the tube and notify the physician. Reinforce the dressing
Why do we unclamp the chest tube when we discover that the leak is in the patient’s thorax? because leaving the chest tube clamped can cause a tension pneumothorax