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NUR 101 Unit3

NUR 101 Lecture Unit 3 GRCC 1of 3 stacks

GFHP #4 ACTIVITY-EXERCISE Describe the 3 functions important to daily life: 1. Mobility 2. Independent self-care 3. Exercise and leisure
The underlying concept of ENERGY EXPENDITURE requires 4 main support systems: 1. neurological 2. musculoskeletal 3. cardiovascular 4. respiratory
Why is the Gordon Functional Health Pattern, Activity-Exercise, so important? 1/5 of population has disability involving mobility/self care; Assessment can reveal lack of exercise which lead to poor muscle tone, balance problem, mental/physical fatigue; minimal exercise lead to obesity; monitoring activity tolerance & ability
Physiologic responses to activities/exercise 1. assess body's attempt to meet O2 demand 2. assess for effective cardiac output 3. O2 delivery to tissue (note Hgb)
Heart rate (HR) is good indicator of: activity tolerance
***What is Cardiac output (c/o)? The amount of blood ejected from the LEFT VENTRICLE with each contraction. c/o = 5 liters/minute range = 4 to 8 liters/adult (ideally 5 liters for adults).
***What is the calculation for the cardiac output (c/o)? c/o = heart rate x stroke volume
***Stroke volume amount of blood that enter arteries with each contraction
Top of heart = base
bottom of heart = apex
Great vessels attached to the heart: - aorta - pulmonary artery - superior/ inferior vena cava - pulmonary veins
***Blood flow through the heart: - superior and inferior vena cava - right atria - tricuspid valve - right ventricle - pulmonic valve - pulmonary artery (carrying deoxygenated blood)-lungs -pulmonary vein (carry oxygen rich blood) -left atria - mitral valve -left ventricle-aortic valve
***SA node Sino Atrial 60-100 bpm
***AV node Atrial/Ventricular 40-60 bpm
***Bundle of His 20-40 bpm bundle branches
***Conduction Pathway Electrical impulse causes heart muscle depolarization in the sino atrial (SA) node; Atrial/ventricular (AV) node; bundle of his; purkinje fibers, contractile fibers...muscle
***Electrocardiogram (ECG, EKG) p wave/atrial depolorization; PR interval/allowing ventricles to fill; QRS complex/ventricle depolarization (contraction); T wave/ventricular repolarization (relaxation); no reflective/atrial repolarization
Apical pulse 1.rate 60-100 bpm 2.stethoscope (diaphragm=high pitched sounds; bell=low pitched sounds)
Cardiac Cycle 1st heart sound: S1, systole, ventricles contract, AV valves closed, semilunar valves open, shorter than diastole, lub sound, with tachycardia less ventricular filling & diastole shortens
Cardiac cycle 2nd heart sound: S2, diastole, ventricles relax, SL valves closed, AV valves open, and ventricular filling
Name the four heart valves aortic, pulmonic, tricuspid, mitral
aortic valve located right of sternum at 2nd intercostal space (ICS)
pulmonic valve left of sternum at 2nd ICS
tricuspid valve left of sternum at 5th ICS
mitral valve 5th ICS medial to midclavicular line (MCL)
Arteries (6 main points) 1. flow away from the heart 2. high pressure vessels 3. strong 4. compliant 5. oxygenated blood (except pulmonary) 6. most common used is radial & apical
Name the 9 types of pulses. 1. temporal 2. carotid 3.apical 4.brachial 5.radial 6.femoral 7.popliteal 8.posterior tibialis 9. dorsalis pedis
veins (3 main points) 1. less sturdy, expansible (enables them to act as a reservoir for extra blood to decrease workload on heart) 2. low pressure 3. valves in each vein keep blood flowing in forward direction to heart
Peripheral pulse assessment (6 main points) 1. ease of palpation 2.rate 3.time interval between beats 4. rhythm 5.elasticity of vessels 6. ausculatory findings
***Grading pulses 0=non-palpable; 1+=weak (too much pressure may obliterate); 2+=normal; 3+=full, easy to feel, less pressure; bounding=may indicate heart condition
***Pulse deficit: definition difference between apical and radial pulses
***vasodilation: definition enlarge or open blood vessels (lowers b/p)
***vasoconstriction: definition narrows or closes blood vessel (increases b/p)
***Jugular Vein Distention/JVD (6 main points) 1. disappears in upright position 2. distends when lying 3.HOB up 30 to 60 degrees 4.turn head to the left, need good lighting 5. distended in right side=CHF 6.venous insufficiency
Central Nervous Systems (CNS) 1. parasympathetic 2. sympathetic
Parasympathetic (definition) innervates heart thru vegus nerve which supplies the SA node, atrial muscle fibers, and AV node=====>causes heart rate to decrease.
Sympathetic (definition) supplies all areas of the atria and ventricles=====>heart rate increases when stimulated.
Name some factors that stimulate the CNS. Stress, trauma, infection, fever, pain, fear, anxiety
angina decreased O2 to heart, precipitated with activities: chest pain with pressure, tightness, squeezing, pressing
aortic aneurysm dilation of vessel wall: constant intense chest pain that radiates to ===>back, anterior chest or abdomen
pericarditis heart sac inflammation===>sharp pain aggravated by deep breaths
Activity tolerance classification with heart disease Class I:has heart disease,asymptomatic ClassII: slight limitation of physical activity, no distress at rest, activity; Class III:significant limitation of activity, no distress at rest ClassIV: symptoms at rest, angina or dyspnea at rest
Assess for the following associated activity/exercise symptoms: 1. pulmonary chest pain (pleuritic pain, SOB, and poor tolerance to activities) 2. claudication
claudication definition intermittent sharp, cramping, squeezing pain in legs after activity; pain in calf muscle after walking(how far/long) caused by ischemia, atherosclerosis; pain decreases with rest
***fatigue low energy levels; assess for cause; physical work, infection, disease, etc.
***weakness decrease muscular strength; rarely from psychological problems(explore cause); may need more testing
SOB/Dyspnea can be cardiac or pulmonary or psychogenic; difficulty lying flat; assess for orthopnea, CHF, COPD; assess if during exertion or rest (may have severe cardiac problems if at rest)
coughing assess if pulmonary or cardiac problem; note if productive (color, amount, consistency)
***Self Care Abilities O=self care; I=equipment needed; II=assist of 1 person; III=assist of 1 person and equipment; IV=depends on others
Diagnostic test: CBC anemia if values decreased
Diagnostic test: Lipid profile for cholesterol
Diagnostic test: lipoprotein atherosclerosis or CAD if increased
Diagnostic test: Serum enzymes troponin
Diagnostic test(non-invasive): EKG electrical activity, conduction, rhythm, cellular death or injury, electrolyte problems
Diagnostic test(non-invasive): holter monitor with diary 24hr EKG for arrhythmias
Diagnostic test(non-invasive): stress test evaluates cardiac function thru exercise
Diagnostic test(non-invasive): Echocardiogram evaluate chambers, valves via ultrasound transmission for CAD AAA,left ventricular dysfunction
Diagnostic test(non-invasive): x-ray anterior/posterior to evaluate heart size
Diagnostic test: Nuclear studies 1. thallium scan(radioisotopes injected to evaluate for CAD) 2. MUGA Scan(radioisotopes for calculating left ventriclar wall and ejection function)
Diagnostic test (invasive): Cardiac catheterization evaluates left ventricular function, cardiac output, confirms (pathological conditions and pressures in chambers)
Angio/Arteriograms 1.radiographic study with dye 2. to study for occlusions in===>chambers, arteries, coronary arteries, veins
Swan Ganz To study cardiac output and chamber pressures
Created by: 1265258671