Ch. 29 Nsng 105
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| Hemoglobin transports what | most O2(97%) and carries both O2 and CO2
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| what three ways does the blood carry CO2 What is most dangerous toxic inhalant? | dissolved in plasma, as carbamino compounds, bicarbonate
CO2
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| 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
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| 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
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| what are clinical signs of hypoventilation | dizziness, occipital headache upon wakening, lethargy, disoriented, dysrhythmias, convulsions, coma, cardiac arrest
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| treatment for hypoventilation | improve tissue oxygenation, restore ventilation, achieve acid-base balance
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| hyperventilation | incr in resp rate, excess CO2 elimination
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| causes of hyperventilation | anxiety, infection, head injury, meds, acid-base imbalance
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| what can hyperventilation be first sign of | embolism
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| what are clinical signs of hyperventilation | numbness, tinnitus, blurred vision
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| treatment for hyperventilation | improve tissue oxygenation, restore ventilation, reduce resp rate, achieve acid-base balance
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| what is normal Cardiace output for adult | 4-6 mL/min
CO = SV x HR
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| what is SV | stroke volume is amt of blood ejected from ventricle with ea contraction. Normal adult = 50-75mL per contraction
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| what is myocardial contractility | ability of heart to squeeze blood from vent and prepar for next contraciton
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| what is cardiac index | measure of adequacy of CO. it = CO divided by pt's BSA
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| what is the pacemaker of the heart | SA node
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| what is the P wave represent | atrial depolarization(atrial contraction)
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| what is the QRS complex represent | ventricular depolarization
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| What is the T wave What is QT | vent. repolarization
whole vent cycle(if SA slows, longer QT)
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| what contributes to failure of the myocardial pump | primary CAD, valvular disorders, cardiomyopathic conditions, pulmonary disease
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| How does myocardial ischemia happen? | when coronary artery does not supply sufficient blood to heart muscle; angina
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| what is orthopnea | difficulty breathing while lying down
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| 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
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| what are the four valves in the heart | tricuspid, pulmonic,mitral, aortic
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| how many beats a year typically | 80 million or 5 to 6 billion in lifetime
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| tripsuspid and mitral valves control blood flow how | from atria to vent
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| aortic and pulmonary valves control blood flow how | out of vent
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| 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
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| what is preload | amt of blood before ejection of vent, at end diastole
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| what is afterload | resistance to ejection of blood from vent
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| what is hypercapnia | incr CO2 levels
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| what is starling's law | A contractile property where the myocardial fiber stretches during filling, which incr strength of following contraction
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| name parts of cardiac conduction system | ANS,SNS,PSNS, SA node, AV node, Bundle of His, Purkinje fibers
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| 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.
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| what are the two regulators for respiration | The CNS(cerbral cortex, medulla) and Chemicals in blood (CO2, O2, H ions)
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| which is longer inspiratory or expiratory | inspiratory
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| how is O2/CO2 transported | ventilation, oxygenation, perfustion, rate of diffusion
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| what is diff b/n perfusion and diffusion | diffusion, always gases; perfusion - tissues, blood flow in exchange of gas
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| 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
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| what are some nervous system diseases that lead to hypoventilation What are some muscle diseases | myasthenia gravis, Guillain-Barre syndrome, poliomyelitis
MS
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| 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
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| 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
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| 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
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| Splinter hemmorrhages are sign of Clubbing sign of distended neck veins flaring nares | bacterial endocarditis
chronic hypoxemia
rt. sided heart failure
dyspnea
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| Dyspnea when person is sleeping is called | paroxysmal nocturnal dyspnea (PND)
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| what is hemoptysis | blood sputum
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| what is a positive TB test | palpable, elevated, hardened area around injection site, NOT reddened flat area
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| 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
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| what is goal of O2 therapy | prevent or relieve hypoxia
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| 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
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| what are three types of O2 systems | compressed O2, liquid O2, )2 concentrators
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| When is humidification necessary | for pts receiving O2 therapy more than 4 L/min
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| 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
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| When caring for tracheostomy, how often do you clean and what should you never do | clean q8h, never cut gauze to fit around tube
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| What are three tracheal airways | endotracheal, size 6-10
nasotracheal
tracheal-size....all need humidity
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| What are the postural positions for drainage | high fowlers- l/r upper lobes
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| 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
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| Lung Segment 3/4 supine w/ dependent lung in trendelenburg's |
l/r middle lobes, ant seg
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| prone with thorax and abd elevated | r middle lobe, post seg
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| supine in trendelenberg's pos | both lower lobes, ant seg
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| right side lying in trendelenberg's pos | left lower lobe, lat seg
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| what is vibration | fine, shaking pressure applied to chest wall only during exhalation, use with CF, not for infants and children
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| what is postural drainage | use of positioning tech that drain secretions from lungs into trach
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| what is a chest tube | catheter inserted thru rib cage into pleural space to remove air adn fluids from space
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| 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
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| what is hemothorax | blood and fluid in pleural cavity, prevents lung expansion
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| What do you normaly set suction at for adults | 120-150 mmHG, portable unit-7-15
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| Clamping a chest tube can lead to what | tension pneumothorax
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| 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
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| What is BiPAP | provide assistance during inspiration and prevent airway closure during expiration.
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| BiPap provides two levels of pressure | inspiratory + airway pressure(IPAP) and lower expiratory ) airway pressure(EPAP)
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| Left side lying Trendelenburg's | right lower lobe, lat seg
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| prone with right side of chest elevated in Trendelenburg's | right lower lobe, post seg
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| pront in Trendelenburg's | both lower lobes, post seg
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| 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
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| Why are disposable units the way to go | cost effective, easy to use
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| If chest tube disconnects then what | cleanse tip of tubing, have client exhale and cough adn reconnect
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| When are chest tubes clamped | to assess air leak, quickly empty or change disposable drainage system
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| 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.
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| What are three types of resp muscle training | 1. breathing exercises
2. pursed lip breathing
3. diaphragmatic breathing
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| When inserting catheter for resp, what should pt do | say "ahh" or cough, not swallowing
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| When should you stop suctioning at what pulse and O2 sat | pulse <20 or >40 and PaO2 <90% or 5% from baseline
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| What does chest physiotherapy include | postural changes, percussion, vibration
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| what is primary fx of lungs | transfer O2 from atmosphere into alveoli and CO2 out of body as waste product
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| Inspiration (active process) and exhalation (passive) is achieved when | lung changes in pressures and volumes
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