NUR 101 Lecture Unit 3 GRCC 1of 3 stacks
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| GFHP #4 ACTIVITY-EXERCISE Describe the 3 functions important to daily life: | 1. Mobility
2. Independent self-care
3. Exercise and leisure
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| The underlying concept of ENERGY EXPENDITURE requires 4 main support systems: | 1. neurological
2. musculoskeletal
3. cardiovascular
4. respiratory
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| 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
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| 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)
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| Heart rate (HR) is good indicator of: | activity tolerance
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| ***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).
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| ***What is the calculation for the cardiac output (c/o)? | c/o = heart rate x stroke volume
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| ***Stroke volume | amount of blood that enter arteries with each contraction
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| Top of heart = | base
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| bottom of heart = | apex
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| Great vessels attached to the heart: | - aorta
- pulmonary artery
- superior/ inferior vena cava
- pulmonary veins
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| ***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
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| ***SA node | Sino Atrial
60-100 bpm
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| ***AV node | Atrial/Ventricular
40-60 bpm
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| ***Bundle of His | 20-40 bpm
bundle branches
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| ***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
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| ***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
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| Apical pulse | 1.rate 60-100 bpm
2.stethoscope (diaphragm=high pitched sounds; bell=low pitched sounds)
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| 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
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| Cardiac cycle 2nd heart sound: | S2, diastole, ventricles relax, SL valves closed, AV valves open, and ventricular filling
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| Name the four heart valves | aortic, pulmonic, tricuspid, mitral
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| aortic valve | located right of sternum at 2nd intercostal space (ICS)
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| pulmonic valve | left of sternum at 2nd ICS
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| tricuspid valve | left of sternum at 5th ICS
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| mitral valve | 5th ICS medial to midclavicular line (MCL)
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| 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
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| 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
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| 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
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| 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
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| ***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
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| ***Pulse deficit: definition | difference between apical and radial pulses
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| ***vasodilation: definition | enlarge or open blood vessels (lowers b/p)
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| ***vasoconstriction: definition | narrows or closes blood vessel (increases b/p)
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| ***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
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| Central Nervous Systems (CNS) | 1. parasympathetic
2. sympathetic
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| Parasympathetic (definition) | innervates heart thru vegus nerve which supplies the SA node, atrial muscle fibers, and AV node=====>causes heart rate to decrease.
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| Sympathetic (definition) | supplies all areas of the atria and ventricles=====>heart rate increases when stimulated.
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| Name some factors that stimulate the CNS. | Stress, trauma, infection, fever, pain, fear, anxiety
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| angina | decreased O2 to heart, precipitated with activities: chest pain with pressure, tightness, squeezing, pressing
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| aortic aneurysm | dilation of vessel wall: constant intense chest pain that radiates to ===>back, anterior chest or abdomen
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| pericarditis | heart sac inflammation===>sharp pain aggravated by deep breaths
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| 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
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| Assess for the following associated activity/exercise symptoms: | 1. pulmonary chest pain (pleuritic pain, SOB, and poor tolerance to activities) 2. claudication
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| 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
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| ***fatigue | low energy levels; assess for cause; physical work, infection, disease, etc.
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| ***weakness | decrease muscular strength; rarely from psychological problems(explore cause); may need more testing
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| 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)
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| coughing | assess if pulmonary or cardiac problem; note if productive (color, amount, consistency)
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| ***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
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| Diagnostic test: CBC | anemia if values decreased
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| Diagnostic test: Lipid profile | for cholesterol
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| Diagnostic test: lipoprotein | atherosclerosis or CAD if increased
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| Diagnostic test: Serum enzymes | troponin
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| Diagnostic test(non-invasive): EKG | electrical activity, conduction, rhythm, cellular death or injury, electrolyte problems
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| Diagnostic test(non-invasive): holter monitor with diary | 24hr EKG for arrhythmias
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| Diagnostic test(non-invasive): stress test | evaluates cardiac function thru exercise
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| Diagnostic test(non-invasive): Echocardiogram | evaluate chambers, valves via ultrasound transmission for CAD AAA,left ventricular dysfunction
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| Diagnostic test(non-invasive): x-ray | anterior/posterior to evaluate heart size
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| 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)
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| Diagnostic test (invasive): Cardiac catheterization | evaluates left ventricular function, cardiac output, confirms (pathological conditions and pressures in chambers)
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| Angio/Arteriograms | 1.radiographic study with dye
2. to study for occlusions in===>chambers, arteries, coronary arteries, veins
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| Swan Ganz | To study cardiac output and chamber pressures
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