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2011-03-02 23:06:45
Chapter Forty

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  1. Explain the blood flow of the heart, starting from the vena cava.
    Deoxygenated blood flows from the vena cava into the right atreum through the tricuspid valve unto the right ventricle through the semilunar value into the pulmonary artery and to the lungs, the from the lungs, oxygenated blood flows into the left atrium through the mitral valuve into the left ventricle and up through the aorta to the rest of the body then back through the superior and inferior vena cava
  2. Explain Frank-Starling law (Starling's) of the heart.
    As the myocardium stretches, the strength of the subsequent contraction increases
  3. What side of the heart is pulmonary heart failure?
  4. What side of the heart fails in systemic circulation?
  5. What happens to the heart and its valves during diastole?
    The atrioventricular (mitral and tricuspid) valvues open, and blood flows from the higher-pressure artia into the relaxed ventrilces.
  6. What happens to the heart and its valves during systole?
    The semilunar (aortic and pulmonic valves open, and blood flows from the ventricles into the aorta and pulmonary artery.
  7. Define Cardiac Output
    The amount of blood ejected from the left ventrilce each minute.
  8. What is normal cardiac output for a healthy 150lb person?
  9. What is Cardiac Index (CI), and what is the normal range?
    • A more percise measure and takes inot consideration tisue perfusion and the client's body surface area (BSA).
    • Normal range is 2.5-4.0L/min/m2
  10. Define stroke volume.
    The amount of blood ejected from the left ventrilce with each contraction.
  11. Define airway resistance
    The pressure difference between the mouth and the alveoli in relation to the rate of flow of inspired air
  12. What is tital volume?
    The amount of air exhaled in a normal breath and is assumed to equate with the amount of air inhaled with each breath.
  13. What is the primary function of the pulmonary circulation?
    To move blood to and from the alveolar capillary membrane for gas exchange.
  14. What are the four factors that influence the adequacy of circulation, ventilation, perfusion, and transport of respiratory gases to the tissue?
    • Physiological
    • Developmental
    • Lifestyle
    • Environmental
  15. Clients with pulmonary disease are at greater risk for what?
  16. What are some conditions that afftec chest wall movement and therefore decrease ventilation?
    • Pregnancy
    • Obesity
    • Musculoskepetal Abnormalities
    • Trauma
    • Neuromuscular Disease
    • Central Nervous System Alterations
    • Influences of chronic disease
  17. Explain Atrial Fibrillation
    • Common in older adults
    • The electrical impulse in the atria is chaotic and originated from multiple sites
    • Irregular rhythm as a result of multiple pacemaker sites and unpredictable conduction to the ventricles
  18. Explain Myocardia ischemia.
    Results when the supply of blood to ehe myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands
  19. What is Angina pectoris?
    A transient imbalabce between oxygen supply and demand. The condition results in chest pain that is aching, sharp, tingling, or burning, or that feels like pressure. Lasts 1-15 minutes. Clients report that pain is often precipitated by activites that increased myocardial oxygen demand.
  20. What does Myocardial Infarction (MI) result from? What are the symptoms?
    • Results from sudden decreases in coronary blood flow or an increase in myocardial oxygen demand without adequate perfusion. Usually occurs becayse of ichemia and necrosis of myocarial tissue.
    • Symptoms in men is chest pain usually described as crushing, squeezing, or stabbing. Pain is often in the left chest and sternal area, nay be felt in the back and it radiated down the left arm to the neck, jaws, teeth, and and epigastirc area.
    • Symptoms in women ia typically angina, but atypical symptoms of fatigue, indigestion, casospasm, shortness or breath, or back or jaw pain.
  21. Define Hyperventilation.
    A state of ventilation in excess of that required to eliminate the carbon dioxiode produced by cellular metabolism. Anxiety, infections, drugs, or acid-base imbalance induce hyperventilation.
  22. Define Hypoventilation.
    • Occurs when alveolar ventilation is inadequate to meet the body's oxygen demand or to eliminate sufficient carbon dioxide.
    • S&S: mental status changes, dysrhythmias, and potential cardiac arrest.
  23. What is atelectasis?
    A collapse of the alveoli
  24. Six causes of hypoxia:
    • 1. a decreased hemoglobin level and lowered oxygen-carrying capacity of the blood
    • 2. a diminished concentration of inspired oxygen, which occurs at high altitudes
    • 3. the inability of the tissues to extract oxygen from the blood, as with cyanide poisoning
    • 4. decreased diffusion of oxygen from the alveolu in the blood, as in pmeumonia
    • 5. poor tissue perfusion with oxygented blood, as with shock
    • 6. impaired ventilation, as with multiple rib fractures or chest trauma.
  25. Define Hypoxia. What are some signs and symptoms?
    • Inadequate tissue oxygenation of the cellular level.
    • S&S: apprehension, restlesness, inabiliyt to concentrate, declining level of consciousness, dizziness, ad behavioral changes.
  26. Define Dsypnea.
    The clinical sign of hypoxia.
  27. Define Orthopnea.
    An abnormal condition in which the client uses multiple pillows when lying down or must sti with arms elevated and leaning forward to breath.
  28. What are the three most common environmental exposures in the home?
    • Cigarette somke
    • Carbon monoxide
    • Radon
  29. Define Humidification.
    The process of adding water to gas. It is necessary for cleitnes receiving oxygen therapy at greater than 4 L/min
  30. What is Nebulization?
    Adds moisture of medications to inspired aire by mixing particles of varying sizes with the air.
  31. Explain postural drainage.
    A component of pulmonary hygiene; it consists of drainage, posiioning, and turning and is sometimes accompanied by chest percussion and vibration.
  32. If a client had fluid in his left lobe with a chest tube, what position would you put the client in?
    On the client's left side
  33. If a client had fluid in his left lobe without a chest tube, what position would you place the client in?
    On the client's right side
  34. What is a pneumothorax?
    A collection of air in the pleural space.
  35. What is a hemothorax?
    An accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae, usually as a result from truama. It produces a couterpressure and prevents the lung from full expansion.
  36. How much oxygen should a client be on when using a nasal cannula?
    Up to 6 L/min.
  37. What should the nurse be alert to with a client using a nasal cannula?
    Skin breakdown over the ears and in the nares from too tight an appliction.
  38. How much oxygen should be used for a nonrebreather?
    6-10 L/min
  39. How much oxygen should a client be on when using a Venturi mask?
    4-12 L/min
  40. Right ventricle pumps blood through:
    pulmonary circulation
  41. Left ventricle pumps blood through:
    systemic circulation
  42. Normal Cardiac Output is:
    4 to 6L/min
  43. What is pre-load?
    The end diastolic volume
  44. What is afterload?
    The resistance to left ventrcular ejection.
  45. What is the pacemaker?
    SA Node
  46. What does the AV node do?
    Mediates impulses between atria and ventricles
  47. The nurse reviewed information about the cardiovascular system before caring for a client with heart disease. The nurse knows that which of the following statements is true concerning the physiology of the cardiovascular system?
    A. The SA node has the function or rate control for the heart
    B. As preload increases cardiac output increaeses
    C. An increase in stroke volume would lead to a decrease in cardiac output
  48. What is ventricular fibulation
    no organized rhythm (shockable rhythm)
  49. What is ventricle tachycardia?
    • A lifethreatening dysrhythmia because of the decreased cardia output and the potential to deteriorate into ventricle fibrillation.
    • pt still alert but not (shockable rhythm)
  50. When is it approprate for a shock?
    With abnormal dystrhythmias in the ventricles.
  51. Explain Left sided heart failure
    • decreased CO
    • fatigure
    • breathlessness
    • backs up to pulmonary
    • crackles
  52. Explain right sided heart failure.
    • impaired right ventricle
    • left turns to right
    • blood ejected from right decreases
    • "Backs up" systemically
    • peripheral edema
    • results from left sided heart failure
  53. Explain COPD.
    inspiration/experiation will be declined/decreased because they don't have the elasticity they needhave an increased CO2 levels because they can't get it out of lungs. SpO2 will be in lower 90s. keep on lower %of O2 because body is use to not enough O2, pt will have periods of apnea.
  54. What is tital volume?
    the amount of air exhaled in a normal breath
  55. Where does the exchange of gases occur?
    between the environment and blood. The lungs transfer oxygen from the atmosphere to the alveoli, where the oxygen is exchanged for carbon dioxide
  56. Define Ventilation
    The process of moving gases into and out of the lungs
  57. Define Inspiration/Expration
    An active process stimulated by chemical receptors in the aorta and a passive process for expiration
  58. What is pulmonary circulation?
    Moves blood to and from the alveolar capillary membranes for gas exchange
  59. What is diffusion?
    Exchange of respiratory gases in the alveoli and capillaries
  60. What is involved in Oxygen Transport
    Lungs and cardiovascular system
  61. What is invloved in Carbon dioxide transport
    Diffuses into red blood cells and is hydrated into carbonic acid
  62. Physiological factors affecting oxygenastion
    • Decreased oxygen-carrying capacity
    • Decreased inspired oxygen
    • Hypovolemia
    • Increased metabolic rate
  63. What are some ways to manage dypsnea?
    • Airway management
    • Mobilization of pulmonary secretions
    • Humidification
    • Nebulization
    • Chest physiotherapy
  64. Explain Oropharyngeal and nasopharyngeal suctioning
    Used when the client can cough effectively but is not able to clear secretions
  65. Explain Orotracheal and nasotracheal suctioning
    Used when the client is unable to manage secretions
  66. Explain Tracheal suctioing
    Used with an artificial airway
  67. What are artifical airways used?
    for clients with airway obstruction or decreased level of consciousness. They also aid in the removal for tracheobronchial secretions
  68. Explain Oral airway
    Prevents obstruction of the trachea by displacement of the tongue into the oropharynx
  69. Explain Endotracheal airway
    Short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, clear secretions
  70. Explain Tracheostomy
    Long-term assistance, surgical incision made into trachea
  71. Define Cascade cough:
    the client takes a slow, deep breath and hold it for 2 seconds while contracting expiratory muscles. The client opens the mouth and performs a series of coughs throughout exhalation, progressively lowering lung volumes
  72. Define Huff cough:
    the client simulates a natural cough reflex that is effective for clearing the airway.Quad cough: clients without abdominal muscle control use this while breathing out with a maximal effort
  73. Define Purse Lipped-Breathing:
    deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse.
  74. Define Diaphragmatic Breathing:
    requires the client to relax intercostal and accessory muscles while taking deep inspirations.
  75. Cardiopulmonary Resucutation
    • Airway
    • Breathing
    • Circulation
    • Defibrilation