Concepts from Potter and Perry Ch. 28
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| Why does the heart rate effect the blood flow? | show 🗑
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| What is preload? | show 🗑
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| What happens to diastolic filling time when a person has a sustained heart rate above 160 bpm? | show 🗑
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| show | Preload decreases
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| What is stroke volume? | show 🗑
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| show | They decrease as well
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| What is Cardiac Output? | show 🗑
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| show | 4-6L
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| show | Patients with long-term cardiovascular disease or patients with decreased myocardial reserve.
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| show | The stroke volume increases in order to increase the CO and BP.
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| What is the job of the conduction system? | show 🗑
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| show | The autonomic nervous system through the sympathetic and parasympathetic branches.
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| show | The vagus nerve.
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| Where is the SA node located? | show 🗑
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| What is the "pacemaker" of the heart? | show 🗑
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| show | 60-80 bpm
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| What is the range for older adults? | show 🗑
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| show | SA node, AV node, Bundle of His, bundle branches, purkinje fibers
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| show | The delay at the AV node assist in atrial emptying.
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| show | An electrocardiogram (ECG)
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| show | Electrocardiogram ECG
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| What measures the muscular work of the heart? | show 🗑
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| What is normal sequence of electrical impulses on an ECG called? | show 🗑
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| show | Atrial depolarization
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| show | Ventricular depolarization
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| What part of an ECG represents ventricular repolarization? | show 🗑
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| show | The organs, nerves, muscles of respiration and the portion of the CNS that regulates it.
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| show | They would alter respiration.
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| How many lobes in the right lung? | show 🗑
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| In a nut shell what is the function of respiratory regulation? | show 🗑
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| show | The lungs
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| show | The kidneys
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| show | 7.35 to 7.45
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| What is a substance that absorbs or releases hydrogen in order to correct an Acid-base imbalance called? | show 🗑
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| show | The Intake and Output of water and electrolytes, their distribution in the body and the regulation of pulmonary and renal function.
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| show | respiration, metabolism, cardiovascular, renal, and CNS function
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| show | Males 60%, Females 50%
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| What two kinds of compartments do we have for fluid? | show 🗑
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| show | 40%
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| show | 20%
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| Where is ECF found? | show 🗑
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| What is the technical name for salts and minerals in the body? | show 🗑
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| show | A compound or element that separates into ions in solution and is able to carry an electric current.
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| In the body how do the amount of anions and cations in usually compare? | show 🗑
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| How are electrolytes measured? | show 🗑
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| show | Diffusion
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| What is the movement of water from an area of lower concentration of solute to an area of higher concentration of solute through a semipermeable membrane called? | show 🗑
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| What is a concentration gradient? | show 🗑
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| show | When a higher concentration of solute on one side of a semipermeable membrane pulls water to that side.
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| show | The ability of a solution to create osmotic pressure.
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| What does isotonic mean in relation to body fluids? | show 🗑
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| What does hypertonic mean in relation to body fluids? | show 🗑
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| What does hypotonic mean in ralation to body fluids? | show 🗑
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| What is the force of fluid pressing outward against a surface called? | show 🗑
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| show | When hydrostatic pressure causes solutes and solution to move through a semipermeable membrane.
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| What is colloid osmotic pressure? | show 🗑
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| What is another name for colloid osmotic pressure? | show 🗑
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| show | Hydrostatic pressure on arterial end and colloid osmotic pressure on the venous end
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| What mechanism primarily regulates fluid intake? | show 🗑
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| show | In the hypothalamus
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| show | They constantly monitor the serum osmotic pressure.
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| What change in osmotic pressure would cause the hypothalamus to stimulate thirst? | show 🗑
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| Define hypovolemia. | show 🗑
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| show | Hypovolemia
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| Who might be at risk for dehydration and why? | show 🗑
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| What is the medical term for peeing-a-plenty? | show 🗑
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| show | Antidiuretic Hormone (ADH), Alodosterone, Renin, Agiotensin II
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| show | Comes from the posterior pituitary gland. Released when blood osmolarity increases
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| show | When there is an increase in osmolarity, stimulation of the osmoreceptors in the hypothalamus causes a release of ADH.
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| show | They become more permeable to water, allowing more water to leak back into the peritubular capillaries, back into circulation.
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| What does the reabsorbed water from peritubular capillaries do the the osmolarity of blood? | show 🗑
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| show | ADH causes more concentrated urine and less concentrated blood.
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| What happens when osmoreceptors recognize that blood osmolarity has been sufficiently diluted? | show 🗑
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| Where does Aldosterone come from and where does it act? | show 🗑
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| What happens to the distal kidney tubules in the presence of aldosterone? | show 🗑
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| What follows sodium? | show 🗑
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| show | Increases too
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| What does aldosterone do to blood volume? | show 🗑
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| show | Increased potassium levels and Angiotensin II
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| show | Renin
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| What is the effect of angiotensin II? | show 🗑
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| show | Sodium Na+
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| show | 1. Sodium ions affect serum osmolality. 2. Nerve impulse transmission require sodium ions. 3. Regulation of acid-base balance 4. Cellular chemical reactions
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| What are two things that regulate sodium amounts in the body? | show 🗑
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| show | 135 to 145 mEq/L
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| Where potassium mainly found? | show 🗑
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| show | regulates many metabolic activities, needed for glycogen deposit in the liver and skeletal muscles, transmission and conduction of nerve impulses, normal cardiac rhythms, contraction of smooth and skeletal muscle.
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| What is the normal serum potassium level? | show 🗑
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| What two things regulate potassium levels? | show 🗑
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| What will happen to potassium levels is a person is having diuresis? Why? | show 🗑
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| show | Sodium, Potassium, Calcium, Magnesium
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| What cation is found 99% in bones and only 1% in EFC? | show 🗑
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| show | Calcium is necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses and muscle contraction.
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| What percent of calcium is bound to proteins in the blood and what percent is free ions in the serum? | show 🗑
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| What is the normal free ionized calcium range in serum? | show 🗑
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| show | 8.5 to 10.5 mg/dl
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| show | Chloride, bicarbonate and phosphate
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| What is the major anion in ECF? | show 🗑
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| What cation does chloride follow? | show 🗑
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| What is the normal range for chloride? | show 🗑
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| show | Dietary intake and the kidneys
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| What will happen if a person with normal kidney function takes in more chloride than the body needs? | show 🗑
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| show | Bicarbonate
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| show | Both
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| What organ regulates bicarbonate? | show 🗑
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| What are normal bicarbonate levels in the arteries? | show 🗑
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| What are bicarbonates measured as in veins and what is the normal range? | show 🗑
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| show | High hydrogen ion concentration=Acid=low pH
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| show | Low hydrogen ion concentrartion=Alkaline=High pH
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| show | The lungs
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| Which organ regulates bicarbonate? | show 🗑
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| show | pH
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| show | 7.34-7.45
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|
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| What are the three types of acid-base regulators in the body? | show 🗑
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| show | Buffer absorb or release hydrogen ions to correct an acid-base imabalance.
🗑
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| show | Serum sodium levels are too low due to sodium loss or water excess.
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| What is hypernatremia? | show 🗑
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| Name 4 things that affect the delivery of oxygen. | show 🗑
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| show | Hemoglobin
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| What is oxyhemoglobin? | show 🗑
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| How does oxyhemoglobin get oxygen to cells? | show 🗑
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| show | Carbonic acid H2CO3
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| show | It is rapidly hydrated and becomes carbonic acid.
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| How do we get bicarbonate ions from carbonic acid? | show 🗑
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| show 🗑
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| What is oxyhemoglobin? | show 🗑
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| show | The formation of oxyhemoglobin is easily reversible. When they dissociate the oxygen is free to enter tissues.
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| show | Carbonic acid H2CO3
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| show | It is rapidly hydrated and becomes carbonic acid.
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| How do we get bicarbonate ions from carbonic acid? | show 🗑
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| show | The hydrogen ion is buffered by hemoglobin and bicarbonate diffuses into plasma.
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| show | Deoxyhemoglobin is reduced hemoglobin. It carries CO2 more easily than oxyhemoglobin. So venous blood can return CO2 to the lungs to be expired.
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| Explain what happens with carbon monoxide poisoning. | show 🗑
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| What disorder (common among menstrating women who don't eat much meat) decreases the ability of blood cells to carry oxygen? | show 🗑
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| Give some examples of situations where inspired oxygen would be decreased. | show 🗑
|
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| show | Decreased circulating blood volume resulting from ECF loss.
🗑
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| How does the body try to adapt to significant fluid loss? | show 🗑
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| What are some situations that would increase oxygen demand? | show 🗑
|
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| show | Production of carbon dioxide.
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| Under what conditions could fever lead to muscle wasting? | show 🗑
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| show | By increasing the rate and depth of respirations in order to eliminate the excess CO2.
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|
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| What is decreased arterial oxygen level in the blood called? | show 🗑
|
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| show | Hypoxemia
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| What happens to ventilation if any condition reduces chest wall movement? | show 🗑
|
||||
| show | The volume of inspired air decreases, delivering less air to the alveoli and subsequently to the tissues.
🗑
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||||
| show | pectus excavatum, Kyphosis, and muscular dystrophy
🗑
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| show | Myashtenia Gravis, Guillain-Barre' syndrome, poliomyelitis
🗑
|
||||
| show | Neural regulation of respiration is damaged and abnormal breathing patterns develop.
🗑
|
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| show | If the phrenic nerve is damaged the diaphragm will not descend. If the damage is below the fifth cervical vertebra the nerves that go to the intercostal muscles would be damaged.
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| show | Flail Chest
🗑
|
||||
| show | The body attempts to make up for decreased oxygenation by creating more red blood cells, (there are other causes too).
🗑
|
||||
| show | Illnesses or conditions that affect heart rate, rhythm, strength of contraction, blood flow through the heart, or peripheral circulation
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|
||||
| What are deviations from normal sinus rhythm or impulses that do not originate from the SA node called? | show 🗑
|
||||
| show | ischemia, valvular abnormality, anxiety, drug toxicity, caffeine, alcohol, tabacco, acid-base imbalance
🗑
|
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| show | 60-100 bpm, tachycardia and bradycardia
🗑
|
||||
| What is failure of the heart to pump sufficient blood volume to systemic and pulmonary circulation called? | show 🗑
|
||||
| show | Myocardial Infarction
🗑
|
||||
| Describe the cause of angina. | show 🗑
|
||||
| show | coronary artery
🗑
|
||||
| What cardiac condition is caused by chronically elevated arterial pressure and pulmonary congestion? | show 🗑
|
||||
| show | Right sided heart failure.
🗑
|
||||
| show | Faulty valves can cause back flow or obstruction.Stenosis in pulmonary or Aortic valve makes the ventricles have to work harder to expel blood.
🗑
|
||||
| show | Hyperventilation
🗑
|
||||
| show | Hypoventilation
🗑
|
||||
| Your patient is experiencing tachycardia, SOB, chest pain, dizziness, light-headedness, decreased concentration, pareshtesia, circumoral and/or extremity numbness, tinnitus, blurred vision, disorientation, and tetany. Why? | show 🗑
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||||
| What are the signs and symptoms of hypoventilation? | show 🗑
|
||||
| show | The body adapts to higher levels of paCO2 by shutting down chemoreceptors for CO2. The only stimulus for breathing left is chemorecptors that monitor for decreased paO2. If oxygen prevents paO2 from falling there is no stimulus to breathe. CO2 builds up.
🗑
|
||||
| What is the difference between hypoxia and hypoxemia? | show 🗑
|
||||
| What does the treatment for hyperventilation and hypoventilation involve? | show 🗑
|
||||
| What happens if hypoxia is left untreated? | show 🗑
|
||||
| show | Administration of oxygen and treatment of underlying cause.
🗑
|
||||
| Your patient with a chest tube is not having relief from respiratory distress, has a sharp stabbing chest pain, decreased BP and increased heart rate. What do you do? | show 🗑
|
||||
| Your patient with a chest tube is not having relief from respiratory distress, has a sharp stabbing chest pain, decreased BP and increased heart rate. What do you do? | show 🗑
|
||||
| show | Developmental status, behaviors, and lifestyle choices that predispose to respiratory risks.
🗑
|
||||
| What are the specific respiratory risk for premature infants? | show 🗑
|
||||
| show | Upper respiratory risk from contact with other children and teething. Airway obstruction from putting stuff in their mouths.
🗑
|
||||
| What are the specific respiratory risk for school age children and adolescents? | show 🗑
|
||||
| show | lack of exercise, fast food, stress, and cigarettes -pregnancy.
🗑
|
||||
| show | age related changes to the cardiac and respiratory systems like calcification of hart valves, SAnode, and costal cartiledge, athersclerosis in arteries, ect leading to increased risk for Flu, pneumonia, and RSV.
🗑
|
||||
| show | Severe obesity decreases lung expansion and increased body weight increase oxygen demand
🗑
|
||||
| How does malnourishment affect oxygenation? | show 🗑
|
||||
| show | Heat causes vasodilation and increases circulation to the area.
🗑
|
||||
| show | To help maintian open airways
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|
||||
| Name 3 ways that substance abuse can impair oxygenation. | show 🗑
|
||||
| What is another term for bloody sputum? | show 🗑
|
||||
| What affect does anxiety have oxygen demand? | show 🗑
|
||||
| What do we record when we see hemoptysis? | show 🗑
|
||||
| show | Nope
🗑
|
||||
| What is xanthelasma and what causes it? | show 🗑
|
||||
| If a man has has substernal pain that radiates to the left arm and jaw what would we suspect is the source of the pain? | show 🗑
|
||||
| What are some symptoms a woman might experience from cardiac pain? | show 🗑
|
||||
| show | a whitish opaque ring around the junction of cornea and sclera caused by hyperlipidemia in young and middle aged adults.
🗑
|
||||
| show | Pericardial pain from inflammation of the pericardial sac.
🗑
|
||||
| Distention of neck veins is a sign of ________. | show 🗑
|
||||
| show | peripheral, radiating to the scapular regions, knifelike, increasing with inspirations
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|
||||
| A patient with eupnea takes about how many breathes per minute? | show 🗑
|
||||
| show | Dyspnea
🗑
|
||||
| A patient with tachypnea takes about how many breathes per minute? | show 🗑
|
||||
| show | Dyspnea that occurs while a patient is sleeping
🗑
|
||||
| show | <10
🗑
|
||||
| show | reabsorption of fluid from dependent body parts while the patient is recumbent
🗑
|
||||
| What are periods of no respiration lasting more than 15 seconds called? | show 🗑
|
||||
| show | The number of pillows used to sleep
🗑
|
||||
| show | Mycobacterium tuberculosis
🗑
|
||||
| What is orthopnea? | show 🗑
|
||||
| If a patient gets a positive result on a TB test what is the next step to confirm infection? | show 🗑
|
||||
| According to the CDC who should have annual influenza vaccines? | show 🗑
|
||||
| show | People with allergies to eggs, chickens, or feathers.
🗑
|
||||
| show | When patient has a fever.
🗑
|
||||
| How often hous patients recieve the pneumococcal vaccine? | show 🗑
|
||||
| show | After the first trimester, but conult obstetrician first
🗑
|
||||
| Name 3 interventions used to maintain a patent airway. | show 🗑
|
||||
| Name 3 ways we can measure effectiveness of coughing. | show 🗑
|
||||
| show | Deep breath and cough
🗑
|
||||
| How often would we like a patient with lots of sputum to cough while awake? While sleeping? | show 🗑
|
||||
| In what kind of cough does the patient perform a series of coughs through exhalation? | show 🗑
|
||||
| What cough is a predecessor to the cascade cough and only effective for clearing the central airway? | show 🗑
|
||||
| show | Quad cough
🗑
|
||||
| _______ technique is used for nasotracheal and orotracheal suctioning. | show 🗑
|
||||
| show | Clean
🗑
|
||||
| show | Nasotrachea and trachea before oral and nasopharyngeal
🗑
|
||||
| show | It has not been proven effective and may cause harm.
🗑
|
||||
| What do we do for a patient who can cough up sputum but is unable to clear them out by spitting or swallowing? | show 🗑
|
||||
| What device is used for oropharyngeal suctioning? | show 🗑
|
||||
| Describe the patient that needs orotracheal or nasotracheal suctioning. | show 🗑
|
||||
| Why is the nose preferred to the mouth as a passageway for tracheal suctioning? | show 🗑
|
||||
| show | Because it continuously delivers oxygen during suctioning.
🗑
|
||||
| show | For a patient with decreased level of consciousness, airway obstruction, mechanical ventilation, and for removal of tracheobronchial secretions
🗑
|
||||
| show | Oral airway
🗑
|
||||
| What does the oral airway prevent? | show 🗑
|
||||
| Where is the oral airway located and what does it do? | show 🗑
|
||||
| How do we determine the proper oral airway size? | show 🗑
|
||||
| show | Because of the artificial airway the patient no longer has normal humidification of the tracheal mucosa. Humidification reduces risks of airway plugging.
🗑
|
||||
| show | Because the ability of a patient to mobilize pulmonary secretions makes the difference between getting better and long term illness with complications
🗑
|
||||
| show | hydration of 1500 to 2000 mL a day (unless contraindicated by cardiac condition)
🗑
|
||||
| How is oxygen by way of nasal catheter, nasal cannula, or face mask humidified? | show 🗑
|
||||
| What kind of liquid is used for hydrating oxygen and why? | show 🗑
|
||||
| When is hydration of oxygen required? | show 🗑
|
||||
| show | Nebulization
🗑
|
||||
| show | positioning, incentive spirometry, chest physiotherapy, chest tube management
🗑
|
||||
| What is the best position for patients with cardiopulmonary diseases for lung expansion? | show 🗑
|
||||
| Why position patients with unilateral lung disease like atelectasis or pneumothorax with the healthy lung down? | show 🗑
|
||||
| show | to prevent drainage toward the healthy lung
🗑
|
||||
| What nursing intervention is used to provide patients visual feedback about air volume? | show 🗑
|
||||
| show | atelectasis
🗑
|
||||
| What is an acceptable postoperative inspiratory capacity? | show 🗑
|
||||
| show | pain medication and splinting
🗑
|
||||
| show | Ambulate
🗑
|
||||
| show | postural drainage, chest percussion, vibration, followed by productive cough or suctioning
🗑
|
||||
| show | Long-term steroid use increases the patients risk for rib fractures
🗑
|
||||
| What kind of medications would decrease a patient’s tolerance of positional change and postural drainage due to fluid and hemodynamic effects? | show 🗑
|
||||
| show | Diuretics= Lasix, HCTZ, Aldactone, Mannitol Antihypertensive = Captopril, Lisinopril, Losartan, Valsartan, Verapamil, Caridzem, Procardia,
🗑
|
||||
| show | Positional changes of postural drainage
🗑
|
||||
| Do we percuss the scapular area when performing CPT? | show 🗑
|
||||
| Percussion is contraindicated for patients with __________, ________, or __________. | show 🗑
|
||||
| show | Vibration shakes loose trapped air and mucus and induces coughing.
🗑
|
||||
| What nursing intervention uses positioning techniques to drain secretions from specific segments of the lungs and bronchi into the trachea? | show 🗑
|
||||
| show | An inherited condition in which the exocrine glands produce abnormally viscous mucus, causing chronic respiratory and digestive problems
🗑
|
||||
| show | a catheter inserted through the thorax to remove air and fluids from the pleural space and to reestablish normal intrapleural and intrapulmonic pressures, promote lung expansion
🗑
|
||||
| show | Pneumothorax
🗑
|
||||
| show | Spontaneously , Trauma
🗑
|
||||
| What keeps the lungs from expanding fully if a patient has hemothorax? | show 🗑
|
||||
| What do the Thora- Seal III and Pleur-Evac do? | show 🗑
|
||||
| What does the first chamber in a chest drainage system do? | show 🗑
|
||||
| What does the second chamber in a chest drainage system do? | show 🗑
|
||||
| What is the third chamber in a chest drainage system for? | show 🗑
|
||||
| show | 3rd section
🗑
|
||||
| show | -15 to -20 cm H2O
🗑
|
||||
| show | a collection of pus in a body cavity (especially in the lung cavity)
🗑
|
||||
| show | Empyema
🗑
|
||||
| show | contraindicated
🗑
|
||||
| Chest drainage devices need to be maintained ________ the patient’s chest. | show 🗑
|
||||
| What should we have the patient do if the tube disconnects from the unit and why? | show 🗑
|
||||
| show | pain medication and monitoring of vital signs and spO2
🗑
|
||||
| What will the patient likely feel when the chest tube is removed? | show 🗑
|
||||
| What are the purposes of non-invasive ventilation? | show 🗑
|
||||
| How does NIV prevent reduce atelectasis? | show 🗑
|
||||
| How does NIV improve oxygentation? | show 🗑
|
||||
| show | the extra alveolar pressure presses interstitial fluid out of the lungs and back into pulmonary circulation
🗑
|
||||
| How does NIV improve cardiac function in patients with sleep apnea? | show 🗑
|
||||
| show | Reduced risks for pneumonia, gastric aspiration, and ventilator dependency
🗑
|
||||
| show | CPAP uses continuous (during inhalation and exhalation) airway pressure to keep upper airway open. Collapsing of airway usually causes sleep apnea.
🗑
|
||||
| show | 5-20cm of H2O
🗑
|
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| What are some disadvantages of CPAP? | show 🗑
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| show | Although continuous pressure is present in inhalation and expiration, however it is greater during inhalation.
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| show | oxygen therapy
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| Since _______ is a drug, we follow the six rights of medication administration. | show 🗑
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| show | the tissues do not receive oxygen, carbon dioxide is not transported away from tissues, metabolism becomes anaerobic, metabolic and respiratory acidosis occurs. Permanent brain and heart damage can occur in 4-6 minutes.
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| According the American Heart Association when do we start CPR on an adult and what are the exceptions? | show 🗑
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| show | within 5 mins or 3mins if in the hospital
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|
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| I f a 12-lead ECG finds acute myocardial infarction what does the AHA recommend? | show 🗑
|
||||
| show | Streptokinase, Tenectoplase, Alteplase, Reteplase (Memory trick- STAR= Thrombolytic little STAR, race the blood clot to my heart, please, dissolve my emboli, because I am too young to die.)
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| What is actively assisting a patient to achieve and maintain optimal health through exercise, nutrition, relaxation/ stress management, medications, and oxygen administration part of? | show 🗑
|
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| Name some breathing exercises we might teach our COPD patients. | show 🗑
|
||||
| What is the purpose of pursed-lip breathing? | show 🗑
|
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| show | Patients need to gain control of the exhalation phase so that it is longer than inhalation
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|
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| show | diaphragmatic breathing
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|
||||
| What is subcutaneous emphysema? | show 🗑
|
||||
| show | when pressure decreases inside the lungs due to respiratory muscles increasing chest volume air leaks in and compressing the lung. If allowed to continue it becomes life threatening compressing the heart and trachea.
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|
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| Chest tubes are only clamped under what circumstances? | show 🗑
|
||||
| show | to prevent causing leaks
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|
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| show | a leak
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|
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| show | Tension Pneumothorax
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|
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| show | 50-200ml/hour, 500ml per 1st 24 hours
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|
||||
| show | 100-300mL 1st 2 hours then rate decreases, 500-1000ml/ 24 hours
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|
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| show | It starts out bloody and becomes serous
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|
||||
| Why is it especially important for patients with chest tubes to have pain control? | show 🗑
|
||||
| What do we record and report for our patients with chest tubes? | show 🗑
|
||||
| What do we need on hand if a chest tube needs to be replaced due to pneumothorax? | show 🗑
|
||||
| If the bubbling stops in the water seal chamber of the chest drainage system when the clamp is closest to the patient’s chest where is the leak and what do we do? | show 🗑
|
||||
| show | because leaving the chest tube clamped can cause a tension pneumothorax
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|
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