N200

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LaurenFleming
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47740
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N200
Updated:
2010-11-06 18:15:50
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Oxygenation
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Oxygenation
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  1. Frank-Starling Law
    As the myocardium stretches, the strength of the contraction increases
  2. Cardiac output
    Amount of blood ejected from the left ventricle each minute
  3. Cardiac index
    is determined by dividing the cardiac output by the body surface
  4. Stroke Volume
    Amount of blood ejected from the ventricle with each contraction
  5. Preload
    end-diastolic volume
  6. Afterload
    the resistance to let ventricular ejection
  7. ECG
    reflects the electrical activity of the conduction system
  8. Normal sinus rhythm (NSR)
    Normal sequence on the electrocardiogram (ECG)
  9. P wave in the conduction system
    conduction thru both atria
  10. PR interval in the conduction system
    impulse travel time through the AV node (.012 -.20 seconds)
  11. QRS complex in the conduction system
    the impulse traveled through the ventricles (0.06 – 0.12 seconds)
  12. QT interval in the conduction system
    time needed for ventricular depolarization and repolarization (0.12-0.42 seconds)
  13. Ventilation
    Process of moving gases into and out of the lungs
  14. Work of breathing
    Effort required to expand and contract the lungs
  15. Inspiration
    Active process stimulated by chemical receptors in the aorta
  16. Expiration
    Passive process dependent on the elastic recoil properties of the lungs
  17. Compliance
    Ability of the lungs to distend or to expand in response to increased inraalveolar pressure
  18. Airway resistance
    Pressure difference between the mouth and the alveoli in relation to the rate of flow of inspired gas
  19. Diffusion
    Process for the exchange of respiratory gases in the alveoli and the capillaries of the body tissues
  20. Deoxyhemoglobin
    Reduced hemoglobin
  21. Neural regulation
    Central nervous system (CNS) control of respiratory rate, depth, and rhythm
  22. Chemical regulation
    Influence of carbon dioxide and hydrogen ions on the rate and depth or respirations
  23. How do Cardiac disorders affect oxygenation ????
    disturbances in conduction, impaired valvular function, myocardial hypoxia, cardiomyopathic conditions, and peripheral tissue hypoxia Respiratory disorders (hyperventilation, hypoventilation, hypoxia)
  24. How does Anemia affect oxygenation ???
    alterations that affect the oxygen-carrying capacity
  25. How does high altitudes and drug overdoses affect oxygenation ??
    decreased inspired oxygen concentration
  26. How does Hypovolemia (shock and severe dehydration) affect oxygenation ???
    ex. increased metabolic rate (pregnancy, fever, infection)
  27. What conditions affect the movement of the chest wall ???
    a. pregnancy (inspiratory capacity declines)

    b. obesity (reduced lung volumes)

    c. musculoskeletal abnormalities (structural configurations, trauma, muscular disease, CNS)

    d. trauma (flail chest, incisions)

    e. neuromuscular diseases (decrease the ability to expand and contract the chest wall)

    f. CNS (reduced inspiratory lung volumes)

    g. chronic diseases (chronic hypoxemia)
  28. Sinus tachycardia
    Regular rhythm, rate greater than 100
  29. Sinus Bradycardia
    Regular rhythm, rate less than 60
  30. Atrial fibrillation
    Electrical impulse in the atria is chaotic and originates from multiple sites
  31. Ventricular tachycardia
    Life threatening, impulse originates in ventricles, QRS complex is usually widened and bizarre
  32. Ventricular fibrillation
    Uncoordinated electrical activity, no identifiable P, QRS, or T wave
  33. Left sided heart failure
    decreased functioning of the left ventricle (fatigue, breathlessness, dizziness, and confusion)
  34. Right sided heart failure
    impaired functioning on the right ventricle (weight gain, distended neck veins, hepatomegaly and splenomegaly, and dependent peripheral edema)
  35. Stenosis
    flow of blood through the valve is obstructed
  36. Regurgitation
    back flow of blood into an adjacent chamber
  37. Myocardial ischemia
    results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet the myocardial oxygen demand
  38. Angina pectoris
    transient imbalance between myocardial oxygen supply and demand
  39. Myocardial infarction
    results from a sudden decrease in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion
  40. Acute coronary syndrome
    includes unstable angina, non-ST segment elevation MI, and ST-segment elevation, MI (nonocclusive thrombus, coronary vasospasm, atherosclerosis, inflammation, or infection)
  41. Hyperventilation
    excess ventilation required to eliminate the carbon dioxide produced (anxiety, infections, drugs, or an acid-base imbalance)
  42. Hypoventilation
    alveolar ventilation is inadequate to meet the body’s oxygen demand
  43. Atelectasis
    collapse of the alveoli which prevents normal exchange of oxygen and carbon dioxide
  44. Hypoxia
    inadequate tissue oxygenation at the cellular level (decreased hemoglobin levels, high altitudes, poisoning, pneumonia, shock, chest trauma)
  45. Cyanosis
    blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries
  46. What are the cardiopulmonary risk factors for infants and toddlers???
    upper respiratory tract infections due to frequent exposures and secondhand smoke
  47. What are the cardiopulmonary risk factors for school-age children and adolescents???
    exposure to respiratory infections, secondhand smoke, and smoking
  48. What are the cardiopulmonary risk factors for young and middle age adults???
    unhealthy diet, lack of exercise, stress, OTCs, illegal substances, smoking
  49. What are the cardiopulmonary risk factors for Older adults????
    aging changes, osteoporosis
  50. What are the lifestyle modifications to decrease cardiopulmonary risks??
    a. smoking cessation

    b. weight reduction

    c. low-cholesterol and low-sodium diet

    d. management of hypertension

    e. moderate exercise
  51. What are four occupational pollutants??
    a. asbestos

    b. talcum powder

    c. dust

    d. airborne fibers
  52. Cardiac Pain
    does not occur with respiratory variations
  53. Pleuritic chest pain
    is peripheral and radiates to the scapular regions
  54. Musculoskeletal pain
    often present following exercise, trauma, prolonged coughing episodes
  55. How does fatigue affect oxygenation??
    is a subjective sensation (loss of endurance)
  56. How does dyspnea affect oxygenation??
    clinical sign of hypoxia, usually associated with exercise or excitement associated with many medical and environmental factors
  57. How does orthopnea affect oxygenation???
    abnormal condition in which the client uses multiple pillows when lying down
  58. How does a cough affect oxygenation ??
    sudden, audible expulsion of air from the lungs; a protective reflex to clear the trachea, bronchi, and lungs of irritants and secretions
  59. How does wheezing affect oxygenation??
    high-pitched musical sound caused by high-velocity movement of air through a narrowed airway
  60. Inspection of tissue oxygenation
    observe the client for skin and mucous membrane color, general appearance, level of consciousness, systemic circulation, breathing patterns, and chest wall movement
  61. Palpation of tissue oxygenation
    type of thoracic excursion; areas of tenderness; identifies tactile fremitus, thrills, heaves, and PMI
  62. Percussion of tissue oxygenation
    detects the presence of abnormal fluid or air in the lungs
  63. Auscultation of tissue oxygenation
    identify normal and abnormal heart and lung sounds
  64. Holter monitor
    Portable ECG worn by the client. The test produces a continuous ECG tracing over a period of time. Clients keep a diary of activity, noting when they experience rapid heartbeats or dizziness. Evaluation of the ECG recording along with the diary provides information about the heart’s electrical activity during activities of daily living.
  65. Exercise stress test
    ECG is monitored while the client walks on a treadmill at a specified speed and duration of time. Used to evaluate the cardiac response to physical stress. The test is not a valuable tool for evaluation of cardiac response in women due to an increased false-positive finding
  66. Thallium stress test
    An ECG stress test with the addition of thallium-201 injected IV. Determines coronary blood flow changes with increased activity
  67. Electrophysiological study (EPS)
    Invasive measure of intracardiac electrical pathways. Provides more specific information about difficult-to-treat dysrhythmias. Assesses adequacy of antidysrhythmic medication.
  68. Echocardiography
    Noninvasive measure of heart structure and heart wall motion. Graphically demonstrates overall cardiac performance
  69. Scintigraphy
    Radionuclide angiography. Used to evaluate cardiac structure, myocardial perfusion, and contractility
  70. Cardiac catheterization and angiography
    Used to visualize cardiac chambers, valves, the great vessels, and coronary arteries. Pressures and volumes within the four chambers of the heart are also measured.
  71. Pulmonary function tests
    Determine the ability of the lungs to efficiently exchange oxygen and carbon dioxide. Used to differentiate pulmonary obstructive disease from restrictive disease.
  72. Peak expiratory flow rate (PEFR)
    The PEFR reflects changes in large airway sizes and is an excellent predictor of overall airway resistance in the client with asthma. Daily measurement is for early detection of asthma exacerbations
  73. Bronchoscopy
    Visual examination of the tracheobronchial tree through a narrow, flexible fiberoptic bronchoscope. Performed to obtain fluid, sputum, or biopsy samples; remove mucous plugs or foreign bodies
  74. Lung scan
    Used to identify abnormal masses by size and location. Identification of masses is used in planning therapy and treatments
  75. Thoracentesis
    Specimen of pleural fluid is obtained for cytological examination. The results may indicate an infection or neoplastic disease. Identification of infection or a type of cancer is important in determining a plan of care
  76. Nursing diagnoses for a client with alterations in oxygenation
    1. activity intolerance

    2. anxiety

    3. decreased cardiac output

    4. fatigue

    5. impaired gas exchange

    6. impaired spontaneous ventilation

    7. impaired verbal communication

    8. ineffective airway clearance

    9. ineffective breathing pattern

    10. ineffective health maintenance

    11. risk for imbalanced fluid volume

    12. risk for infection
  77. Specific outcome for maintaining a patent airway (Planning)
    a. lungs are clear to auscultation

    b. achieves maintenance and promotion of bilateral lung expansion

    c. coughs productively

    d. pulse oximetry is maintained or improved
  78. list the modalities appropriate for a client with dyspnea (implementation)
    a. exercise

    b. breathing techniques

    c. cough control

    d. relaxation techniques

    e. biofeedback

    f. meditation
  79. List interventions that promote mobilization of pulmonary secretions (implementation)
    a. humidification

    b. nebulization

    c. chest physiotherapy

    d. postural drainage
  80. What are the common suctioning techniques??
    a. oropharyngeal and nasopharyngeal

    b. orotracheal and nasotracheal

    c. artificial airway
  81. Positioning
    • noninvasive technique to promote/ maintain lung expansion
    • **frequent changes of position are effective for reducing
    • stasis of pulmonary secretions and decreased chest wall expansion (Semi-Fowler’s is the most effective position)
  82. Incentive spirometry
    • noninvasive technique to promote/ maintain lung expansion
    • **encourages voluntary deep breathing and prevents atelectasis by using visual feedback
  83. 3 reasons for inserting chest tubes
    a. to remove air and fluids from the pleural space

    b. to prevent air or fluid from reentering the pleural space

    c. to reestablish normal intrapleural and intrapulmonic pressures
  84. Hemothorax
    accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae usually due to trauma
  85. Pneumothorax
    collection of air in the pleural space, caused by loss of negative intrapleural pressure
  86. The goal of oxygenation therapy is: ..
    is to prevent or relieve hypoxia
  87. Nasal cannula (methods of oxygen delivery, and advantages and disadvantages)
    • A nasal cannula is a simple, comfortable device used for oxygen delivery (Skill 40-4). The two cannulas, about 1.5 cm (½ inch) long, protrude from the center of a disposable tube and are inserted into the nares (Figure 40-13). Advantages include: safe and simple; easily tolerated; delivers low concentrations while allowing the client to eat, speak, and drink; does not impede eating or talking; is
    • inexpensive and disposable. Disadvantages include: unable to use with nasal
    • obstruction; drying to mucous membranes; can dislodge easily; causes skin
    • irritation or breakdown; client’s breathing pattern will affect exact FIO2.
  88. Face mask (methods of oxygen delivery and advantages and disadvantages)
    • An oxygen face mask is a device used to administer oxygen, humidity, or heated humidity. It fits snugly over the mouth and nose and is secured in place with a strap and it assists in providing humidified oxygen. Disadvantages include: exact FIO2 level is difficult to estimate; requires high FIO2 levels to prevent
    • re-breathing of carbon dioxide; client inhales room air through the side holes
    • in the mask.
  89. Venturi mask (methods of oxygen delivery and advantages and disadvantages)
    The Venturi mask delivers oxygen concentrations of 24% to 60% with oxygen flow rates of 4 to 12 L/min, depending on the flow-control meter selected. Advantages include: controls the amount of specified oxygen concentration. Delivers percentage of FIO2 from 24-60%; does not dry mucous membranes; delivers humidity with oxygen concentration.
  90. What are the indications for a client to receive home oxygen therapy
    a PaO2 of 55 mm Hg or less or an SaO2 of 88% or less on room air at rest, on exertion, or with exercise
  91. the ABCs or cardiopulmonary resuscitation are:
    A-airway B-breathing C-circulation
  92. The goal of cardiopulmonary rehabilitation for the client to maintain an optimal level of health focuses on:
    a. physical exercise

    b. nutrition counseling

    c. relaxation and stress management techniques

    d. prescribed medications and oxygen

    e. compliance
  93. Coughing techniques
    • *cascade cough
    • *Huff cough
  94. Cascade cough
    promotes airway clearance and patent airway in clients with large volumes of sputum.
  95. Huff cough
    stimulates a natural cough reflex and is effective only for clearing central airways
  96. Respiratory muscle training
    improves muscle strength and endurance
  97. Pursed lip breathing
    involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse
  98. Diaphragmatic breathing
    improves efficiency of breathing by decreasing air trapping and reducing the work of breathing
  99. Ventilation, perfusion and exchange of gases are the major purposes of :
    • Respiration
    • **These are the 3 steps in the process of oxygenation.
  100. Afterload refers to :
    • The resistance to left ventricular ejection
    • *The heart must work to overcome this resistance to fully eject blood from the left ventricle.
  101. The movement of gases into and out of the lungs depends on:
    • The pressure gradient between the atmosphere and the alveoli
    • **Gases move into and out of the lungs through pressure changes (intrapleural and atmospheric).
  102. Mr. Isaac comes to the emergency department complaining of difficulty breathing. An objective finding associated with his dyspnea might include:
    Use of accessory muscles of respiration
  103. The use of chest physiotherapy to mobilize pulmonary secretions involves the use of:
    • Percussion
    • **CPT includes postural drainage, percussion, and vibration.

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