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)
Regular rhythm, rate greater than 100
Regular rhythm, rate less than 60
Electrical impulse in the atria is chaotic and originates from multiple sites
Life threatening, impulse originates in ventricles, QRS complex is usually widened and bizarre
Uncoordinated electrical activity, no identifiable P, QRS, or T wave
Left sided heart failure
decreased functioning of the left ventricle (fatigue, breathlessness, dizziness, and confusion)
Right sided heart failure
impaired functioning on the right ventricle (weight gain, distended neck veins, hepatomegaly and splenomegaly, and dependent peripheral edema)
flow of blood through the valve is obstructed
back flow of blood into an adjacent chamber
results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet the myocardial oxygen demand
transient imbalance between myocardial oxygen supply and demand
results from a sudden decrease in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion
Acute coronary syndrome
includes unstable angina, non-ST segment elevation MI, and ST-segment elevation, MI (nonocclusive thrombus, coronary vasospasm, atherosclerosis, inflammation, or infection)
excess ventilation required to eliminate the carbon dioxide produced (anxiety, infections, drugs, or an acid-base imbalance)
alveolar ventilation is inadequate to meet the body’s oxygen demand
collapse of the alveoli which prevents normal exchange of oxygen and carbon dioxide
inadequate tissue oxygenation at the cellular level (decreased hemoglobin levels, high altitudes, poisoning, pneumonia, shock, chest trauma)
blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries
What are the cardiopulmonary risk factors for infants and toddlers???
upper respiratory tract infections due to frequent exposures and secondhand smoke
What are the cardiopulmonary risk factors for school-age children and adolescents???
exposure to respiratory infections, secondhand smoke, and smoking
What are the cardiopulmonary risk factors for young and middle age adults???
unhealthy diet, lack of exercise, stress, OTCs, illegal substances, smoking
What are the cardiopulmonary risk factors for Older adults????
aging changes, osteoporosis
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
What are four occupational pollutants??
b. talcum powder
d. airborne fibers
does not occur with respiratory variations
Pleuritic chest pain
is peripheral and radiates to the scapular regions
often present following exercise, trauma, prolonged coughing episodes
How does fatigue affect oxygenation??
is a subjective sensation (loss of endurance)
How does dyspnea affect oxygenation??
clinical sign of hypoxia, usually associated with exercise or excitement associated with many medical and environmental factors
How does orthopnea affect oxygenation???
abnormal condition in which the client uses multiple pillows when lying down
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
How does wheezing affect oxygenation??
high-pitched musical sound caused by high-velocity movement of air through a narrowed airway
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
Palpation of tissue oxygenation
type of thoracic excursion; areas of tenderness; identifies tactile fremitus, thrills, heaves, and PMI
Percussion of tissue oxygenation
detects the presence of abnormal fluid or air in the lungs
Auscultation of tissue oxygenation
identify normal and abnormal heart and lung sounds
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.
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
Thallium stress test
An ECG stress test with the addition of thallium-201 injected IV. Determines coronary blood flow changes with increased activity
Electrophysiological study (EPS)
Invasive measure of intracardiac electrical pathways. Provides more specific information about difficult-to-treat dysrhythmias. Assesses adequacy of antidysrhythmic medication.
Noninvasive measure of heart structure and heart wall motion. Graphically demonstrates overall cardiac performance
Radionuclide angiography. Used to evaluate cardiac structure, myocardial perfusion, and contractility
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.
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.
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
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
Used to identify abnormal masses by size and location. Identification of masses is used in planning therapy and treatments
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
Nursing diagnoses for a client with alterations in oxygenation
1. activity intolerance
3. decreased cardiac output
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
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
list the modalities appropriate for a client with dyspnea (implementation)
b. breathing techniques
c. cough control
d. relaxation techniques
List interventions that promote mobilization of pulmonary secretions (implementation)
c. chest physiotherapy
d. postural drainage
What are the common suctioning techniques??
a. oropharyngeal and nasopharyngeal
b. orotracheal and nasotracheal
c. artificial airway
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)
noninvasive technique to promote/ maintain lung expansion
**encourages voluntary deep breathing and prevents atelectasis by using visual feedback
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
accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae usually due to trauma
collection of air in the pleural space, caused by loss of negative intrapleural pressure
The goal of oxygenation therapy is: ..
is to prevent or relieve hypoxia
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.
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.
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.
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
the ABCs or cardiopulmonary resuscitation are:
A-airway B-breathing C-circulation
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
promotes airway clearance and patent airway in clients with large volumes of sputum.
stimulates a natural cough reflex and is effective only for clearing central airways
Respiratory muscle training
improves muscle strength and endurance
Pursed lip breathing
involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse
improves efficiency of breathing by decreasing air trapping and reducing the work of breathing
Ventilation, perfusion and exchange of gases are the major purposes of :
**These are the 3 steps in the process of oxygenation.
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.
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).
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
The use of chest physiotherapy to mobilize pulmonary secretions involves the use of:
**CPT includes postural drainage, percussion, and vibration.