N200

As the myocardium stretches, the strength of the contraction increases

Amount of blood ejected from the left ventricle each minute

is determined by dividing the cardiac output by the body surface

Amount of blood ejected from the ventricle with each contraction

end-diastolic volume

the resistance to let ventricular ejection

reflects the electrical activity of the conduction system

Normal sequence on the electrocardiogram (ECG)

conduction thru both atria

impulse travel time through the AV node (.012 -.20 seconds)

the impulse traveled through the ventricles (0.06 – 0.12 seconds)

time needed for ventricular depolarization and repolarization (0.12-0.42 seconds)

Process of moving gases into and out of the lungs

Effort required to expand and contract the lungs

Active process stimulated by chemical receptors in the aorta

Passive process dependent on the elastic recoil properties of the lungs

Ability of the lungs to distend or to expand in response to increased inraalveolar pressure

Pressure difference between the mouth and the alveoli in relation to the rate of flow of inspired gas

Process for the exchange of respiratory gases in the alveoli and the capillaries of the body tissues

Reduced hemoglobin

Central nervous system (CNS) control of respiratory rate, depth, and rhythm

Influence of carbon dioxide and hydrogen ions on the rate and depth or respirations

disturbances in conduction, impaired valvular function, myocardial hypoxia, cardiomyopathic conditions, and peripheral tissue hypoxia Respiratory disorders (hyperventilation, hypoventilation, hypoxia)

alterations that affect the oxygen-carrying capacity

decreased inspired oxygen concentration

ex. increased metabolic rate (pregnancy, fever, infection)

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

decreased functioning of the left ventricle (fatigue, breathlessness, dizziness, and confusion)

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

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

upper respiratory tract infections due to frequent exposures and secondhand smoke

exposure to respiratory infections, secondhand smoke, and smoking

unhealthy diet, lack of exercise, stress, OTCs, illegal substances, smoking

aging changes, osteoporosis

a. smoking cessation

b. weight reduction

c. low-cholesterol and low-sodium diet

d. management of hypertension

e. moderate exercise

a. asbestos

b. talcum powder

c. dust

d. airborne fibers

does not occur with respiratory variations

is peripheral and radiates to the scapular regions

often present following exercise, trauma, prolonged coughing episodes

is a subjective sensation (loss of endurance)

clinical sign of hypoxia, usually associated with exercise or excitement associated with many medical and environmental factors

abnormal condition in which the client uses multiple pillows when lying down

sudden, audible expulsion of air from the lungs; a protective reflex to clear the trachea, bronchi, and lungs of irritants and secretions

high-pitched musical sound caused by high-velocity movement of air through a narrowed airway

observe the client for skin and mucous membrane color, general appearance, level of consciousness, systemic circulation, breathing patterns, and chest wall movement

type of thoracic excursion; areas of tenderness; identifies tactile fremitus, thrills, heaves, and PMI

detects the presence of abnormal fluid or air in the lungs

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.

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

An ECG stress test with the addition of thallium-201 injected IV. Determines coronary blood flow changes with increased activity

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

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.

Determine the ability of the lungs to efficiently exchange oxygen and carbon dioxide. Used to differentiate pulmonary obstructive disease from restrictive disease.

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

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

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

a. exercise

b. breathing techniques

c. cough control

d. relaxation techniques

e. biofeedback

f. meditation

a. humidification

b. nebulization

c. chest physiotherapy

d. postural drainage

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

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

is to prevent or relieve hypoxia

• 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.

• 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.

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.

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

A-airway B-breathing C-circulation

a. physical exercise

b. nutrition counseling

c. relaxation and stress management techniques

d. prescribed medications and oxygen

e. compliance

• *cascade cough
• *Huff cough

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

improves muscle strength and endurance

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

• Respiration
• **These are the 3 steps in the process of oxygenation.

• The resistance to left ventricular ejection
• *The heart must work to overcome this resistance to fully eject blood from the left ventricle.

• The pressure gradient between the atmosphere and the alveoli
• **Gases move into and out of the lungs through pressure changes (intrapleural and atmospheric).

Use of accessory muscles of respiration

• Percussion
• **CPT includes postural drainage, percussion, and vibration.