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NUR 101 Unit3
NUR 101 Lecture Unit 3 GRCC 1of 3 stacks
| Question | Answer |
|---|---|
| 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 |
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