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The resistance to left ventricular ejection is called:
This reflects the electrical activity of the conduction system
______implies that the impulse originates at the SA node and follows the normal sequence through the conduction system. (ECG)
Normal sinus rhythm
This is a measure of cardiac output per square meter of BSA.
(Is determined by dividing cardiac output by the BSA)
The ventricles stretch when filling with blood. The more stretch on the ventricular muscle, the greater the contraction and the greater the stroke volume; this concept is referred to as __________
the amount of blood in the left ventricle at the end of diastole (end-diastolic volume)
The four cardiac chambers, two atria and two ventricles, fill with blood during _____ and empty during ______
- diastole (fill with blood)
- systole (empty)
Describe the Frank-Starling's (starling's) law of the heart.
As the myocardium stretches, the strength of the subsequent contraction increases
During ventricular diastole the atrioventricular valves _____ & _____ open, and blood flows from the higher-pressure atria into the relaxed ventricles. This represents S1 (lub) sound
mitral & tricuspid valve
During the systolic phase semilunar (____ & _____) valves open, and blood flows from the ventricles into the aorta & pulmonary artery. Closure of these valves represents S2, (dub).
aortic & pulmonic
This is heard when a pt. w/valvular disease have backflow or regurgitation of blood through an incompetent valve
This is the branch of the systemic cirulation that supplies the myocardium with oxygen and nutrients and removes waste
Coronary artery circulation
The _________, the most abundant blood supply, feeds the left ventricular myocardium, which is more muscular and does MOST of the heart's work
Left coronary artery
This part of the heart is more muscular and does most of the heart's work
This is where the exhange of respiratory gases, nutrients, and wastes occurs, and the tissues are oxygenated
The amount of blood ejected from the left ventricle each minute is the _____
_______is the amount of blood ejected from the left ventricle with each contraction
The ______ is a good clinical measure of afterload
diastolic aortic pressure
Related to the heartbeat:
The _________increases the rate of impulse generation and the speed of impulse transmission
sympathetic nerve fibers
Related to the heartbeat:
The ______decrease the rate of impulse generation
This is termed the "pacemaker" of the heart
List the intrisinsic rates for the following:
SA node: _______beats/min
AV node: _______beats/min
bundle of his & Purkinje network: ____beats/min
- SA node: 60-100 beats/min
- AV node: 40-60 beats/min
- bundle: 20-40 beats/min
____is the process of moving gases into and out of the lungs
The major inspiratory muscle of respiration is the ________
diaphragm (it is innervated by the phrenic nerve, which exits the spinal cord at the fourth cervial vertebra)
______relates to the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
_______is the process for the exchange of respiratory gases in the alveoli and the capillaries of the body tissues
______is the effort required to expand and contract the lungs
Work of breathing
Concerning breathing: This is an active process, stimulated by chemical receptors in the aorta __________
_______is a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work.
This is a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing
Pt. w/advanced COPD lose the elastic recoil of the lungs & thorax. (which means they are not exhaling to fullest) Which means their Work of breathing increases (effort required to expand & contract the lungs)
In addition, some pt w/ certain pulmonary diseases have decreased surfactant production & sometimes develop atelectasis (alveoli collapse)
During an assessment, this sign can indicate ventilatory fatigue, air hunger, or decreased lung expansion
observe for elevation of the client's clavicles during inspiration
This is the ability of the lungs to distend or to expand in response to increased intraalveolar pressure
- pulmonary edema, interstitial & pleural fibrosis and congenital or traumatic structural abnormalities such as kyphosis (hunchback) or fractured ribs decreases compliance
_____measures the volume of air entering or leaving the lungs
- the tidal volume is the amount of air exhaled in a normal breath and is assumed to equate with the amount of air inhaled w/each breath
______, which is a carrier for oxygen and carbon dioxide, transports most oxygen (approx. 97%)
This is a lower than normal hemoglobin level, and is a result of decreased heloglobin production, increased red blood cell destruction, and/or blood loss. Pt. have fatigue, decreased activity tolerance, and increased breathlessness, as well as pallor and increase in heart rate
This is the most common toxic inhalant decreasing the oxygen-carrying capacity of blood. It strongly binds with hemoglobin and is not easily dissociated, making hemoglobin unavailable for oxygen transport
INFO: When fever persists, the metabolic rate remains high and the body begins to break down protein stores, resulting in muscle wasting and decreased muscle mass, INCLUDING respiratory muscles such as the diaphragm and intercostal muscles!!!
Cervical trauma at ____ to ____ usually results in paralysis of the phrenic nerve. When this nerve is damaged, the diaphragm does not descend properly, reducing inspiratory lung volumes and causing hypoxemia.
C3 to C5
Spinal cord trauma below the 5th cervial vertebra usually leaves the phrenic nerve intact but damages nerves that:
innervate the intercostal muscles, preventing anteroposterior chest expansion
The physiological response to chronic hypoxemia is the development of increased red blood cells called _____.
This is the body's adaptive response to increase the amount of hemoglobin and increase the available oxygen binding sites.
INFO: Older adults experience alterations in cardiac function as a result of:
1. calcification of the conduction pathways
2. thicker & stiffer heart valves due to lipid accumulation & fibrosis
3. decrease in the number of pacemaker cells in the SA node
Electrical impulses that do not originate from teh SA node cause conduction disturbances. These rhythm disturbances are called ________, meaning a deviation from the normal sinus heart rhythm
Dysrhythmias occur as a primary conduction disturbance such as:
- 1. in response to ischemia
- 2. vavular abnormality
- 3. anxiety
- 4. drug toxicity; as a result of caffeine alcohol or tobacco use
- 5. complication of acid-base or electrolyte imbalance
Cardiac response is ____ (>100 bts/min)
a ______(early beat) or a _______(delayed or absent) beat
- tachycardia >100 beats/min
- bradycardia <60 beats/min
- premature (early beat)
- blocked (delayed or absent beat)
Tachydysrhythmias & bradydysrhythmias ________cardiac output & BP.
_______reduce cardiac output by decreasing diastolic filling times & _____lower cardiac output because of the decreased heart rate
- They LOWER cardiac output & BP
________is often described as an irregularly irregular rhythm
___________ & _______ are life threatening fhythms that require immediate intervention.
- Ventricular tachycardia & vetricular fibirllation
- *ventricular tachycardia is a life-threatening dysrhythmia because of the decreased cardiac output & the potential to deteriorate into ventricular fibrillation
______ has a regular rhythm, rate 100-180 beats/min....usually a normal response to exercise, emotion or stressor such as pain, fever, caffine & certain drugs
Sinus tachycardia: in pt w/heart disease that is unable to increase their heart rate to meet increased oxygen demands; discontinue drugs producing the side effect
________ has regular rhythm, rate <60 beats/min. Rate decrease is a normal response to sleep or in well conditioned athlete; diminished blood flow to SA node, vagal stimulation, hypothyroidism, increased intercranial pressure or pharmacological agents
_______chaotic, irregular atrial activity RESULTING in an irregular ventricular response. Caused by aging, calcification of the SA node, or changes in mycardial blood supply
- Atrial Fibrillation (A-fib)
- *There is a loss of the atrial kick, pooling of blood in the atria & development of microemboli. Fatigue, fluttering chest, shortness of breath. Commonly occuring dysrhythmia in the aging & older adult
______Rhythm slightly irregular, rate 100-200 beats/min.Caused by changes in teh normal pacemaker of the heart such as decreased blood flow, ischemia or embolus.
- Ventricular Tachycardia
- *results in decreased cardiac output due to decreased ventricular filling time; leads to severe hypotension & loss of pulse consciousness
________uncoordinated electrical activity, Causes include sudden cardiac death, electrical shock, acute myocardial infarction, drowning or trauma
- Ventricular Fibrillation
- *acute loss of pulse & respiration
Every minute of a sudden cardiac arrest w/out defibrillation decreases the survival rate by _____% to ____%
7% to 10%
________heart failure more commonly results from pulmonary disease
right sided heart failure
Signs of Right or Left sided heart failure?
fatigue, breathlessness, dizziness & confusion..pulmonary congestion...crackles on ausculation, hypoxia
Left sided heart failure
Signs of Right or Left sided heart failure?
Elevated pulmonary vascular resistance (PVR)...weight gain, distended neck veins, hepatomegaly & splenomegaly & dependent peripheral edema....(due to the back up in the systemic circulation)
Right sided heart failure
When _____occurs, the flow of blood through the valves is obstructed. (an abnormal condition characterized by the constriction or narrowing of an opening or passageway in a body structure.
- *when stenosis occurs in the semilunar valves the adjacent ventricles have to work harder to move the ventricle blood volume beyone the stenotic valve....over time the stenosis causes the ventricle to hypertrophy (enlarge) and if untreated, "L" or "R" heart failure occurs
When ______occurs, there is a backflow of blood into an adjacent heart chamber
- * ex: mitral regurgitation the mitral leaflets do not close completely. when the ventricles contract, blood escapes back into the atria, causing a murmer, or "whooshing" sound
two manifestations of myocardial ischemia are:
- angina pectoris
- myocardial infarction
________is a transient imbalance between myocardial oxygen supply & demand. Results in chest pain that is aching, sharp, tingling or burning or feels like pressure. Usually left sided or substernal & radiates to the left or both arms, jaw, neck & back. Usually lasts from 1 to 15 minutes. Often precipitated by activities that increase myocardial oxygen demand (excercising, stress, heavy meals)
Angina pectoris - usually relieved w/rest & coronary vasodilators, (nitroglycerin)
______results from sudden decreases in coronary blood flow or an increase in myocardial oxygen demand w/out adequate coronary perfusion
- Myocardial infarction
- *crushing, squeezing, stabbing, often in the "L" chest & sternal area, may be felt in the back & it radiates down the left arm to the neck, jaws, teeth, epigastric area. occurs at rest or exertions and lasts more than 30 minutes. nitroglycerin & rest don't relieve
INFO: There is a significant difference between men and women in relation to coronary artery disease. As women get older their risk begins to rise
- The MOST common initial symptom in women is angina, but atypical symptoms of fatigue, indigestion, vasospasm, shortness of breat, back or jaw pain are present.
- Almost 2X's as many women die w/in the 1st year after the first heart attack
_____refers to a decrease in the amount of arterial oxygen
_____is a state of ventilation in excess of that required to eliminate the carbon dioxide produced by cellular metabolism
- *anxiety, infections, drugs, fever or acid-base imbalance induce hyperventilation. Acute anxiety leads to hyperventilation & causes loss of consciousness from excess carbon dioxide exhalation
_____occurs when alveolar ventilation is inadequate to meet the body's oxygen demand or to eliminate sufficient carbon dioxide.
- *signs & symptoms include mental status changes, dysrhythmias & potential cardiac arrest
_____ a collapse of the alveoli; prevents normal exchange of oxygen and carbon dioxide
INFO: hyperventilation and hypoventilation refer to alveolar ventilation and not to the client's respiratory rate.
_____is inadequate tissue oxygenation at the cellular level
- *clinical signs include apprehension, restlessness, inability to concentrate, declinings level of conscoiusness, dizziness & behavioral changes. Unable to lie down & appears fatigued & agitated. +pulse rate & +rate & depth of respiration
Causes of _________
1. decreased hemoglobin level & lowered oxygen-carrying capacity of the blood2. diminshed concentration of inspired oxygen (high altitudes)3. inability of tissues to extract oxygen from the blood (cyanide poisoning4. decreased diffusion of oxygen from alveoli to blood (pneumonia)5. poor tissue perfusion w/ oxygenated blood (shock)6. impaired ventilation (multiple rib fractures or chest trauma)
________is shortness of breath usually associated w/exercise or excitement, but in some pts, is present w/out any relation to activity of exercise
- *associated w/pulonary diseases, cardiovascular diseases, neuromuscular conditions, anemia, pregnant women, environmental factors (pollution, cold air, smoking)
______is a clinical sign of hypoxia
______is associated w/exaggerated respiratory effort, use of the accessory muscles of respiration, nasal flaring, and marked increases in the rate & depth of respirations
- *rated using visual analog scale (VAS)...pt makes visual analog scale 100-mm vertical line & pt rates dyspnea on scale 0 to 100
_____is an abnormal condition iin which the pt uses multiple pillows when lying down or must sit with arms elevated & leaning forward to breath
Pt w/_______usually cough only in the early morning or immediatly after rising from sleep
chronic sinusitis - this is clearing airway of mucus resulting from sinus drainage
Pt w/______generally cough and produce sputum all day, although greater amounts are produced after rising from a semirecumbent or flat position
_______bleeding from the gastrointestinal tract
_____high-pitched musical sound caused by high-velocity movement of air through a narrowed airway
- *associated w/astham, bronchitis, pneumonia....occurs during insp/resp or both
On average, client's will have _____colds a year
______is the absence of respirations
Use a scale of 0 to 3 to rate pulse
0 = ________
- 0 absent
- +1 weak, thready
- +2 normal pulse
- +3 full, bounding
These lung sounds occur w/collapse of a lung segment, fluid in a lung segment, or narrowing or obstruction of an airway
What are some nursing diagnosis that are appropriate for the client with alterations in oxygenation?
- activity intolerance
- decreased cardiac output
- impaired gas exchange
- impaired spontaneous ventilation
- impaired verbal communication
- ineffective airway clearance
- ineffective breathing pattern
- ineffective health maintenance
- risk for imbalanced fluid volume
- risk for infection
INFO: relative humidity is the percentage of water in the gas. Air or oxygen with a high relative humidity keeps the airways moist and helps loosen and mobilize pulmonary secretions
Humidification is the process of adding water to gas AND is necessary for clients receiving oxygen therapy at greater than 4L/min.
_______adds moisture or medications to inspired air by mixing particles of varying sizes with the air
A ______is a collection of air in th pleural space
A _________is an accumulation of blood and fluid in the pleural cavity between the parietal & visceral pleurae, usually as a result from trauma
A rupture of small blood vessels from inflammatory processes, such as pneumonia or tuberculosis, can cause a _________
A ______ can occur spontaneously of as a result of chest trauma such as a stabbing or the chest striking the steering wheel in an auto accident
Handle a check drainage unit carefully and maintain the drainage device _____ the client's chest. If the tubing disconnects from the drainage unit, instruct the client to __________ & ____.
- exhale as much as possible and cough
- *you should temporarily reestablish a water seal by immersing the open end of the chest tube in a container of sterile water
What is the best way to maintain thin secretion?
provide a fluid intake of 1500 to 2000mL/day
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