Med/Surg Exam 3

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Stephunny
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Med/Surg Exam 3
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2011-11-24 02:13:24
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  1. Excitability
    Ability of cell to respond to stimulus
  2. Automaticity
    Ability of cell to reach threshold potential & generate impulse without outside stimulus
  3. Conductivity
    Ability of muscle to move impulse from cell to cell
  4. Contractility
    shortening of muscle when stimulated
  5. Epinephrine & Norepinephrine
    • Sympathetic (Adrenergic)
    • Increases HR and BP
    • Enhances force of myocardial contraction
  6. Acetylcholine
    • Parasympathetic (Cholenergic)
    • Decreases HR and BP
    • Reduces force of myocardial contraction
  7. Sinus node
    Rate 60-100
  8. Atrioventricular
    Rate 40-60
  9. Bundle of His
    Rate 40-60
  10. Bundle Branches
    Rate 20-40
  11. Purkinje Fibers
    Rate 15-40
  12. Resting State -- Cellular
    • K+ higher inside Cell
    • Na+ and Ca++ Higher outside cell
  13. Depolarization
    • Basic electrical activity of the heart.
    • K+ moves out; Na+ & Ca++ move inside cell causing heart to conduct impulse and contract
  14. Repolarization
    Returning to resting state
  15. Action Potential
    Depolarization
  16. Electrocardiogram
    • -Graphic display of conduction
    • -Magnitude and duration of the electrical activity of the heart
    • -Electrodes sense activity & transmit to ECG machine
    • -Machine transforms activity to waveforms that correspond with depolarization and repolarization
  17. Dysrhythmias
    • -Disorders of heart’s conduction
    • -Disturbance of rate, rhythm or both

    -Identified by analyzing ECG
  18. Origin of Impulse
    Sinus Node --> Atria --> Atrial-Ventricular node --> Ventricles
  19. Mechanism of Conduction
    • -Bradycardia
    • -Tachycardia
    • -Flutter
    • -Fibrillation
    • -Premature beats
    • -Escape Beats
    • -Heart blocks
  20. EKG Paper
    HORIZONTAL

    • Speed 25 mm/second
    • Small block = 0.04 seconds
    • One large block = 0.20 seconds = 5 small blocks


    • TIME:
    • 5 large blocks = 1 second

    15 large blocks = 3 seconds

    30 large blocks = 6 seconds
  21. P Wave
    • Atrial fibrillation
    • Normal = no longer than 0.11 sec
    • No notching or peaking
  22. QRS Complex
    • Ventricular depolarization
    • Normal = no longer than 0.10 sec
    • R= positive
    • Q & S = Negative
  23. T Wave
    • Ventricular repolarization
    • Rounded and asymmetrical
  24. ST segment
    • ventricular repolarization
    • Norm = not depressed more than 0.5 mm
  25. PR interval
    • AV conduction time
    • 0.12-0.20 sec
  26. QT interval
    • repolarization time
    • less than HALF the preceding RR interval
  27. Ectopic beat
    nEctopic beats (also called extrasystoles or premature contractions) may originate in the atria, the AV junction or the ventricles.
  28. Hypertension
    systolic >140 mmHg and a diastolic > 90 mmHg
  29. Pre-hypertention
    systolic 120-139 mmHg & diastolic 80-90 mmHg
  30. Stage 1 Hypertention
    • systolic 140-159 mmHg
    • diastolic 90-99 mmHg
  31. Stage Two Hypertension
    • systolic 160+
    • diastolic 100+
  32. Risk factors for hypertention
    • Dyslipidemia
    • Diabetes Mellitus
    • Smoking
    • Age >60 y/o
    • men > women (post menopause have greater risk)
    • Family Hx
  33. Hypertention: Clinical Manefestation
    • •Angina
    • •Cerebrovascular bleeding
    • •Coronary artery disease
    • •Heart failure
    • •Left ventricular hypertrophy
    • •Papilledema (swelling of the optic
    • disc)
    • •Renal damage
    • •Retinal changes
  34. Hypertention: Medical Management
    • •Pharmacologic therapy
    • –Diuretics and beta blockers
    • –Adrenergic blockers (Catapres)
    • –ACE inhibitors, calcium channel blockers, vasodilators

    • •Nutrition management
    • •Weight reduction
    • •Stress
    • •Exercise
  35. Ventilation
    The movement of air in and out of the airways
  36. Upper airways
    warm and humidify the air we breathe
  37. Lower airways
    gas exchange occurs and O2 is delivered to the tissues via the bloodstream
  38. Lungs
    • -Paired elastic structures
    • -Chest capacity enlarges and air enters the lungs via negative pressure
    • -Chest wall and diaphragm passively contract for expiration
    • -Lungs recoil and force air out of the bronchi and trachea
    • -Inspiration requires energy and is an active process
    • -Expiration is a passive process
    • -Inspiration is 1/3 of the respiratory cycle
    • -Expiration is 2/3 of the cycle,
    • -A ratio of 1:2 Inspiration:Expiration
    • -Pleura is the thin serous membrane that lines lung
    • ---Visceral
    • ---Parietal
  39. Respiratory anatomy
    Mediastinum

    • Lobes
    • Left lung -- upper, lower lobes – 2
    • Right lung -- upper, lower & middle lobes-3
    • Segments -- 2-5 per lobe
    • Bronchi-lobar -- 3 on the right 2 on the left
  40. Resistance
    determined by the radius of the airway
  41. Compliance
    how easily lungs can be expanded
  42. Diffusion
    O2 and CO2 are exchanged at air-blood interface (capillary membrane)
  43. Perfusion
    the blood flow through the pulmonary circulation
  44. Oxidation
    O2 and CO2 moving by diffusion
  45. Respiration
    the entire process of gas exchange between the atmospheric air and the blood
  46. Alveolar Oxygen and Carbon Dioxide Exchange
    • Oxygen transported by hemoglobin and dissolved in the plasma
    • Carried to the cell for use in energy production and growth
    • Needed for the conversion of ATP
    • Oxygen is always needed for combustion
  47. Narrows the airways
    • Brochial diameter affects airway resistance
    • Contraction of bronchial smooth muscle
    • Thickening of bronchial mucosa
    • Airway obstruction
    • Intubation
  48. Air pressure variance
    • affect ventilation
    • air goes from higher to lower pressure
  49. Expiration
    • affects ventilation
    • diaphragm relaxes and lungs recoil
  50. Examples of conditions which decrease pulmonary compliance
    • Pneumothorax
    • Hemothorax
    • Pleural effusion
    • Pulmonary edema
    • Atelactasis

    When the lungs lose elasticity the thorax becomes over distended (emphysema)

    When the lungs become stiff they have decreased compliance
  51. Tidal Volume (TV)
    volume inhaled AND exhaled w/ each breath
  52. Inspiratory reserve (IRV)
    maximum volume that can be inhaled AFTER a normal inhalation
  53. Expiratory reserve (ERV)
    • maximum voume that can be exhaled AFTER a normal exhalation
    • decreased w/ obesity, ascites and pregancy
  54. Residual volume (RV)
    • colume of air in the lungs AFTER maximum exhalation
    • increase with obstructive disease
  55. Vital Capacity (VC)
    max volume exhaled from

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