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Ch. 29 Nsng 105

Hemoglobin transports what most O2(97%) and carries both O2 and CO2
what three ways does the blood carry CO2 What is most dangerous toxic inhalant? dissolved in plasma, as carbamino compounds, bicarbonate CO2
what is hypoxia what is hypoxemia inadequate tissue oxygenation with deficiency in O2 delivery or O2 utilization at cellular level Decr arterial O2 level in blood, incr P, R, BP, anxiety, restlessness
When does hypoventilation occur ventilation is inadequate to meet body's O2 demand or eliminate CO2, cause CO2 retention, life threatening causes: atelectasis, alveolar collapse, COPD whose drive is low PaO2
what are clinical signs of hypoventilation dizziness, occipital headache upon wakening, lethargy, disoriented, dysrhythmias, convulsions, coma, cardiac arrest
treatment for hypoventilation improve tissue oxygenation, restore ventilation, achieve acid-base balance
hyperventilation incr in resp rate, excess CO2 elimination
causes of hyperventilation anxiety, infection, head injury, meds, acid-base imbalance
what can hyperventilation be first sign of embolism
what are clinical signs of hyperventilation numbness, tinnitus, blurred vision
treatment for hyperventilation improve tissue oxygenation, restore ventilation, reduce resp rate, achieve acid-base balance
what is normal Cardiace output for adult 4-6 mL/min CO = SV x HR
what is SV stroke volume is amt of blood ejected from ventricle with ea contraction. Normal adult = 50-75mL per contraction
what is myocardial contractility ability of heart to squeeze blood from vent and prepar for next contraciton
what is cardiac index measure of adequacy of CO. it = CO divided by pt's BSA
what is the pacemaker of the heart SA node
what is the P wave represent atrial depolarization(atrial contraction)
what is the QRS complex represent ventricular depolarization
What is the T wave What is QT vent. repolarization whole vent cycle(if SA slows, longer QT)
what contributes to failure of the myocardial pump primary CAD, valvular disorders, cardiomyopathic conditions, pulmonary disease
How does myocardial ischemia happen? when coronary artery does not supply sufficient blood to heart muscle; angina
what is orthopnea difficulty breathing while lying down
what is hypovolemia reduced circulating blood vol resulting from extracellular fluid losses that occurs in conditions such as shock and severe dehydration....incr HR, constrict peripheral vessels
what are the four valves in the heart tricuspid, pulmonic,mitral, aortic
how many beats a year typically 80 million or 5 to 6 billion in lifetime
tripsuspid and mitral valves control blood flow how from atria to vent
aortic and pulmonary valves control blood flow how out of vent
how does blood go through heart vena cavas to rt atria to rt vent to pulmonary veins(w/ O2) Pulmonary aa (no O2)to lft atria to lft vent to aortas
what is preload amt of blood before ejection of vent, at end diastole
what is afterload resistance to ejection of blood from vent
what is hypercapnia incr CO2 levels
what is starling's law A contractile property where the myocardial fiber stretches during filling, which incr strength of following contraction
name parts of cardiac conduction system ANS,SNS,PSNS, SA node, AV node, Bundle of His, Purkinje fibers
how does a conduction work in the heart begins with SA node, then AV node, slows down signal before enters vent to give atria time to contract before vent. The purkenje fibers are the fast acting fibers that contract the vent.
what are the two regulators for respiration The CNS(cerbral cortex, medulla) and Chemicals in blood (CO2, O2, H ions)
which is longer inspiratory or expiratory inspiratory
how is O2/CO2 transported ventilation, oxygenation, perfustion, rate of diffusion
what is diff b/n perfusion and diffusion diffusion, always gases; perfusion - tissues, blood flow in exchange of gas
left sided heart failure leads to right sided heart failure leads to blood back up in pulmonary system blood back up from vena cava, edema, classic sign is distended jugular veins
what are some nervous system diseases that lead to hypoventilation What are some muscle diseases myasthenia gravis, Guillain-Barre syndrome, poliomyelitis MS
What are dev. factors that affect tissue oxygenation premature infants risk for hyaline membrane disease, due to surfactant deficiency. Surfactant is chemical in lung maintain integrity of alveoli, keep dry. Dev in 7th month
Dev factors for infants/toddlers child/adol young/middle age older adults choking, resp infections second hand smoke and smoking workplace issues, smoking, preg changes in cardiac/resp system
what are lifestyle factors influencing resp fx nutrition- no more than 50% carbs for CAD Exercise - 60 min/day smoking- risk 10x for lung cancer substance abuse- decr iron rich stress- incr BMR
Splinter hemmorrhages are sign of Clubbing sign of distended neck veins flaring nares bacterial endocarditis chronic hypoxemia rt. sided heart failure dyspnea
Dyspnea when person is sleeping is called paroxysmal nocturnal dyspnea (PND)
what is hemoptysis blood sputum
what is a positive TB test palpable, elevated, hardened area around injection site, NOT reddened flat area
What are three cough techniques cascade- slow,deep breath, hold 2 sec while contracting exp muslces, then series of coughs Huff- stimulates cough Quad- push inward, upward on abds and cough
what is goal of O2 therapy prevent or relieve hypoxia
what are indications of home O2 therapy to be covered by insurance PaO2 of 55mmHg or less or arterial O2 saturation of 88% or less on room air at rest
what are three types of O2 systems compressed O2, liquid O2, )2 concentrators
When is humidification necessary for pts receiving O2 therapy more than 4 L/min
When is orotracheal and nasotracheal suctioning necessary and are they sterile When pt can't cough, and does not have artificial airway, nose is preferred route, b/c gag reflex is minimal nasotrachea and trachea r sterile
When caring for tracheostomy, how often do you clean and what should you never do clean q8h, never cut gauze to fit around tube
What are three tracheal airways endotracheal, size 6-10 nasotracheal tracheal-size....all need humidity
What are the postural positions for drainage high fowlers- l/r upper lobes
apical segments Supine with head elevated sitting on sie of bed side lying with left side of chest elevated on pillows RUlobe, ant segment LUlobe, ant segment LUlobe, post segment
Lung Segment 3/4 supine w/ dependent lung in trendelenburg's l/r middle lobes, ant seg
prone with thorax and abd elevated r middle lobe, post seg
supine in trendelenberg's pos both lower lobes, ant seg
right side lying in trendelenberg's pos left lower lobe, lat seg
what is vibration fine, shaking pressure applied to chest wall only during exhalation, use with CF, not for infants and children
what is postural drainage use of positioning tech that drain secretions from lungs into trach
what is a chest tube catheter inserted thru rib cage into pleural space to remove air adn fluids from space
what is a pneumothorax what is tension pneumothorax collection of air or other gas in pleural space, gas destroys neg intrapleural pressure, can't expand, sharp pain 1st sign collapse of lung, need chest tube
what is hemothorax blood and fluid in pleural cavity, prevents lung expansion
What do you normaly set suction at for adults 120-150 mmHG, portable unit-7-15
Clamping a chest tube can lead to what tension pneumothorax
What is CPAP positive airway pressure keeps terminal airways (alveoli) partially inflated, reduce atelectasis, good for sleep apnea. Usually set to 5 - 20 cm of water
What is BiPAP provide assistance during inspiration and prevent airway closure during expiration.
BiPap provides two levels of pressure inspiratory + airway pressure(IPAP) and lower expiratory ) airway pressure(EPAP)
Left side lying Trendelenburg's right lower lobe, lat seg
prone with right side of chest elevated in Trendelenburg's right lower lobe, post seg
pront in Trendelenburg's both lower lobes, post seg
In the 3 chamber system for chest drainage, what are the three chambers Thora-Seal III/Pleur-Evac 1st- provides H2O seal, prevent air from drawn into pleural space 2nd- collects fluid/blood 3rd- suction, see bubbling
Why are disposable units the way to go cost effective, easy to use
If chest tube disconnects then what cleanse tip of tubing, have client exhale and cough adn reconnect
When are chest tubes clamped to assess air leak, quickly empty or change disposable drainage system
Emergency procedures CPR defibrillation within 2 breaths for every 30 compressions, infant/child 2 rescuer 15 compressions to 2br defib w/in 5min out of hosp, 3 min in hosp.
What are three types of resp muscle training 1. breathing exercises 2. pursed lip breathing 3. diaphragmatic breathing
When inserting catheter for resp, what should pt do say "ahh" or cough, not swallowing
When should you stop suctioning at what pulse and O2 sat pulse <20 or >40 and PaO2 <90% or 5% from baseline
What does chest physiotherapy include postural changes, percussion, vibration
what is primary fx of lungs transfer O2 from atmosphere into alveoli and CO2 out of body as waste product
Inspiration (active process) and exhalation (passive) is achieved when lung changes in pressures and volumes
Created by: palmerag