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Nursing - Oxygenation
Module K - Oxygenation - Test 3
179
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Professional
02/24/2009

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Cards

Term

afterload

Definition

 

the resistance against which the left ventricle must eject the flow of blood during contraction

Term

 angina pectoris

Definition

 a thoracic pain caused by myocardial anoxia (lack of 02 in tissues) from artherosclerosis or coronary artery spasms

Term

 atelectasis

Definition

an abnormal condition which results in the collapse in the aveoli preventing the exchange of carbon dioxide and O2

Term

 bronchoscopy

Definition

an exam to visualize the tracheobronchial tree through a narrow, flexible fiberoptic scope

Term

 cardiac index

 

Definition

 a measure of cardiac output per square meter of body surface area of a patient

Term

 cardiac output

Definition

 the amt of blood expelled from the ventricles of the heart with each beat multiplied by the heart rate

Term

 cardiopulmonary rehabilitation

Definition

helping a patient acheive and maintain a maximum level of health for them

Term

 cardiopulmonary resuscitation

Definition

 a basic emergency procedure of artificial respiration and manual external cardiac massage

Term

 chest physiotherapy

Definition

an intervention used to mobilize secretions from peripheral airways to the more centralized airway for suctioning or expectroation

Term

 chest tube

Definition

 a catheter inserted into the pleural space

Term

 cyanosis

Definition

 a blue to gray discoloration of the skin and mucous membranes caused by an excess of deoxygenated hemoglobin in the blood

Term

 diaphragmatic breathing

Definition

 a pattern of exhalation an dinhalation in which most of the ventilatory work is done by the diaphragm

 

 

 

 

 

 

 

Term
diffusion
Definition
the process in which particles of a higher concentration move to an area of lower concentration, resulting in an even distribution of the particles in the fluid
Term
dyspnea
Definition
breathlessness. shortness of breath associated with exercise, excitement or anxiety and certain heart condition
Term
dysrhythmia
Definition
a disturbance in the normal rhythmic pattern of the heart
Term
electrocardiogram (ECG)
Definition
a graphic recording of the electrical conduction through the heart
Term
Expiration
Definition
the process of breathing out
Term
hematemesis
Definition
vomiting of bright red blood which is associated with upper GI bleed
Term
hemoptysis
Definition
bloody sputum
Term
hemothorax
Definition
the accumulation of blood in the pleural cavity between the parietal and visceral pleura
Term
humidification
Definition
the process of adding water to gas. making moist.
Term
hypoventilation
Definition
an abnormal condition of the respiratory system when the air enters the alveoli and takes part in the gas exchange but is not adequate to meet the needs of the body
Term
hypoxia
Definition
inadequate oxygen at the cellular level
Term
incentive spirometry
Definition
a method of encouraging deep breathing while providing visual feedback
Term
inspiration
Definition
the act of drawing air into the lungs, stimulated by the chemical receptors in the aorta
Term
myocardial infarction (MI)
Definition
also know as a "heart attack"; results from sudden decrease in blood supply to the heart
Term
nasal cannula
Definition
a simple, comfortable device used for oxygen delivery; inserted into the nares; flow rate up to 6L/minute. Flow rates greater than 4L/minute are not often used because of the drying effect on the mucosa and the little increase in delivered oxygen concentration. The percentage of oxygen concentration (FIO2) is from 24% to 44%.
Term
Nebulization
Definition
a process of adding moisture or medication to inspired air by mixing particles of varying sizes; this method allows delivery of medication into the respiratory tract
Term
normal sinus rhythm
Definition
the normal sequencing of the electrical activity of the heart; initiated by the SA node
Term
orthopnea
Definition
an abnormal condition in which a person must stand or sit to breathe deeply or comfortably
Term
peak expiratory flow rate
Definition
the maximum rate of airlflow that can be achieved during forced expiration beginning with inflated lungs
Term
pneumothorax
Definition
callapsed lung due to air/gas in the pleural space
Term
postural drainage
Definition
a positioning technique used to drain secretions from specific segments of the lungs and bronchi into the trachea for expectorant
Term
preload
Definition
the stretch of the ventricular muscle at end diastole; end diastolic volume
Term
pursed-lip breathing
Definition
deep inspiration followed by a prolonged expiration through pursed lips
Term
stroke volume
Definition
the amount of blood ejected from the left ventricle of the heart with each contraction
Term
thoracentesis
Definition
a method of surgically inserting a needle through the chest wall and pleural space to aspirate fluid, or other specimens for biopsy
Term
ventilation
Definition
a process that moves air in and out of the lungs
Term
ventricular fibrilation
Definition
a cardiac arrhythmia marked by rapid depolarization of the ventricular mycardium. Lacks organization of the electrical conduction which results in blood pressure falling to zero and an unconsciousness patient
Term
wheezing
Definition
a high pitch sound caused by the flow of air through a narrowing of the airway
Term
_____ is required to sustain life
Definition
oxygen
Term
What is the function of the cardiac and respiratory systems?
Definition
To supply the body's oxygen demands.
Term
Depth and rate of respiration is controlled by
Definition
neural and chemical regulators in response to changing tissue oxygen demands
Term
cardiopulmonary physiology involves...
Definition
delivery of deoxygenated blood (blood high in carbon dioxide and low in oxygen), to right side of heart and to pulmonary circulation and oxygenated blood from lungs to left side of heart and tissues.
Term
What does the cardiac system do?
Definition

1. Delivers oxygen, nutrients and other substances to tissues

2. Removes waste products of cellular metabolism through cardiac pump, circulatory vascular system ,and integration of other systems

Term
The right ventricle pumps blood through...
Definition
the pulmonary circulation
Term
the left ventricle pumps blood...
Definition
to the systemic circulation
Term
the circulatory system exchanges...
Definition
respiratory gases, nutrients, and waste products between the blood and the tissues
Term
Myocardial Pump
Definition
Pumping action of heart essential to maintaining oxygen delivery
Term
Coronary artery disease (CAD) and cardiomyopathic (enlarged heart) conditions result in...
Definition
diminished stroke volume
Term
Cardiac output
Definition
is equal to stroke volume (SV) multiplied by the heart rate (HR)
Term

Cardiac output ____ in the older adult due to...

 

 

Definition

1. decreases

2. arterial wall tension and mild to moderate mycardial hypertrophy (from BP)

Term
Blood flow through heart is
Definition
undirectional
Term
What ensures foward blood flow in the heart?
Definition
he four heart valves
Term
What does the myocardium require to maintain adequate blood flow to the pulmonary and systemic circulation?
Definition
sufficient oxygen and nutrients
Term
ventricular diastole
Definition
when atrioventricular (mitral and tricuspid) valves open and blood flows from higher pressure atria into relaxed ventricles which equals S1, or the first heart sound.
Term
After ventricular filling, which phase begins?
Definition
Systolic phase
Term
Systolic phase
Definition
When the smilunar (aortic and pulmonic) valves open and blood flows form ventricles into aorta and pulmonary artery.
Term
Closure of aortic and pulmonic valves represents...
Definition
S2, or second heart sound
Term
The conduction system depends on...
Definition
organized transmission of electrical impulses needed for a heartbeat
Term
The conduction system originates in the
Definition
sinoatrial node (or SA node) or the pacemaker located in the right atrium.
Term
In the conduction system, the AV node is...
Definition
the atrioventricular node is the mediator of impulses between the atria and the ventricles
Term
Most cells in the body obtain energy from...
Definition
chemical reactions involving oxygen and elimination of carbon dioxide
Term
exchange of respiratory gases occurs between...
Definition
enviromental air and blood
Term
Steps in the process of oxygenation:
Definition
Ventilation and diffusion
Term
Work of Breathing:
Definition

Inspiration - active process; stimulated by chemical receptors in aorta

Expiration - passive process; requires little to no muscle work

Term
The major inspiratory muscle of respiration is the...
Definition
diaphragm
Term

The diaphragm is innervated by the ______ which exits the spinal cord at the ______.

 

 

Definition

1. phrenic nerve

2. 4th cervical vertebra

Term
Perfusion
Definition
relates ability of cardiovascular system to pump oxygenated blood to tissues and return de-oxygenated blood to lungs
Term
Spirometry
Definition
used to measure volume of air entering or leaving the lungs
Term
Lung capacities are made up of...
Definition
two ore more lung volumes
Term
totoal lung capacity
Definition
Term
inspiratory reserve volume
Definition
Term
expiratory reserve volume
Definition
Term
Sumptum characteristics to assess
Definition
color, color changes, odor, quantity, consistency, presence of blood
Term
elastic recoil
Definition
ability of lungs to contract and extract gas
Term
compliance
Definition
ability of lungs to expand in response to inspiratoin
Term
airway resistance seen in
Definition
asthma
Term
blood is oxygenated by...
Definition
ventilation, perfusion, and transport of respiratory gases
Term
deoxygenated blood is transported to the...
Definition
right side of the heart and to pulmonary circulation
Term
oxygenated blood is transported from the ___ to the ___
Definition

1. lungs

2. left side of the heart and the tissues

Term
the right ventricle pumps blodd through
Definition
pulmonary circulation
Term
the left ventricle pumps blood through...
Definition
the systemic circulation
Term
the four cardiac chambers are...
Definition
the 2 atria and 2 ventricles
Term
the four cardiac chambers fill with blood during ____ and empties druing ____
Definition

1. diastole

2. systole

Term
Starlings law
Definition
as the myocardium stretches, the strength of the subsequent contraction increases; the law doesn't apply in a diseased heart
Term
blood flow through the heart is _-directional
Definition
uni
Term
With valvular disease, there is _____ or _____ of blood through the incompetent valve, causing a murmur that you can hear on auscultation.
Definition
backflow or regurgitation
Term
coronary artery circulation
Definition
branch of systemic circulation that supplies myocardium with oxygen and nutrients and removes waste
Term
coronary arteries fill during
Definition
ventricular diastole
Term
the left coronary artery is the most...
Definition
abundant blood supply
Term
the left coronary artery feeds the
Definition
left ventricular myocardium
Term
the left ventricular myocardium is more ____ and does most of the heart's work
Definition
muscular
Term
systemic circulation
Definition
delivers nutrients and oxygen to tissues and removes wastes from tissues
Term
flow of oxygenated blood:
Definition
from left ventricle through the aorta, into large systemic arteries, then to arterioles, then to capillaries
Term
What happens at the capillary level?
Definition
Exchange of respiratory gases, nutrients, and wastes. Tissues are oxygenated.
Term
Process of removal of wastes into systemic circulation:
Definition
Wastes exit the capillary network through venules that join to form veins, then larger veins carry deoxygenated blood to the right side of the heart, wehre it returns to pulmonary circulation.
Term
Cardiac output (CO)
Definition
amount of blood ejected from left ventricle each minute; normal CO is 4 to 60 L/min in a normal 150 lb adult at rest.
Term
Examples of time CO would increase
Definition
pregnancy, exercise, and fever
Term
CO decreases during
Definition
sleep
Term
Cardiac index (CI)
Definition

more precise than CO; takes into account tissue prefusion and BSA;

 

Calculate by:  CO / BSA = CI

 

Normal CI : 2.5 to 4 L/min/m2

Term
Stroke volume
Definition
amount of blood ejected from left ventricle with each contraction
Term
Preload
Definition
amount of blood in left ventricle at the end of diastole
Term
afterload
Definition
resistance to left ventricle ejection
Term
myocardial contractility, preload, and afterload all affect...
Definition
stroke volume
Term
To overcome afterload...
Definition
the heart must work to fully eject blood from left ventricle
Term
Good measurement of afterload is...
Definition
diastolic aortic pressure
Term
In hypertension, afterload _____, which makes CO workload increase.
Definition
increases
Term
Afterload can be manipulated by...
Definition
reducing systemic blood pressure
Term
The myocardium of an older adult is more ____ and ____.
Definition
rigid and slower
Term
Heart rate affects blood flow because...
Definition
the relationship between rate and diastolic filling time
Term
With heart rate great than 160, filling time ____, which  ____ stroke volume and CO.
Definition
decreases, decreases
Term
Conduction System
Definition
generates and transmits electrical impulses that relax and contract the atria and ventricles; it originates w/ the SA node
Term
SA node
Definition

in the right atrium next to the entrance of the superior vena cava; impulses are initiated by the SA node at a rate between 60 to 100 beats/min; it is also called the "pacemaker" of the heart

Term
Electrical impulses are transmitted through the atria along intaatrial pathways to the...
Definition
AV node
Term
AV node
Definition
mediates impulses between the atria and ventricles; normal rate of AV node is between 40 to 60 beats/min; it assists atrial emptying by delaying the impulse before transmitting through the bundle of HIS and the ventricular Perkinje network
Term
The rate of the bundle of HIS and the Perkinje network is between...
Definition
20 and 40 beats/min
Term
Electrocardiogram (ECG) (EKG)
Definition
reflects the electrical activity of the conduction system; monitors regularity and path of impulses; DOES NOT reflect muscular work of the heart
Term
The normal sequence on an ECG is called
Definition
normal sinus rhythm
Term

NSR

Definition
implies that an impulse originates at SA node and follows a normal sequence
Term
P wave
Definition
represents electrical conduction through both atria
Term
What follows the P wave?
Definition
atrial contraction
Term
PR interval
Definition
represents the impulse travel time through AV node, through bundle of HIS, and to the Perkinje fibers; Normal PR length is .12 to 0.2 second.
Term
PR interval greater than 0.2 indicates...
Definition
a block in the impulse transmission through the AV node
Term
PR interval less than 0.12 second indicates...
Definition
the initiation of an impulse from a source other than the SA node.
Term
QRS complex
Definition
indicates that the impulse traveled through the ventricles
Term
QRS complex normal duration
Definition
.06 to 0.12 second
Term
Ventricular contraction usually follows what part of EKG?
Definition
QRS complex
Term
QT interval
Definition
represents the time needed for ventricular depolarization and repolarization; normal QT interval is .12 to .42 second
Term
Lungs transfer oxygen from ______ to ______, where it is then exchanged for carbon dioxide.
Definition

atmosphere

 

alveoli

Term
Alveoli transfer oxygen and carbon dioxide from _____ through the _____ _____ _____.
Definition

blood

 

alveolar capillary membrane

Term
3 steps in the process of oxygenization:
Definition
ventilation, perfusion, and diffusion
Term
Structures essential for ventilation, perfusion, and exchange of respiratory gases:
Definition
respiratory muscles, pleural space, lungs, alveoli
Term
Gases move in/out of lungs through
Definition
pressure changes
Term
Intrapleural pressure is
Definition
negative (less than atmospheric pressure), which is 760 mmHg at sea level
Term
the diaphragm and intercostal muscles contract to...
Definition
create a negative pleural pressure and increase size of thorax for inspiration
Term
How does air escape the lungs?
Definition
relaxation of the diaphragm and contraction of the internal intercostal muscles
Term
Ventilation
Definition
moves gas in/out of lungs; requires coordination of the muscular and elastic properties of lungs and thorax, as well as intact innervation
Term
the major inspiratory muscle of respiration is...
Definition
diaphragm
Term
the ability of the cardiovascular system to pump oxygenated blood to tissues and return deoxygenated blood to lungs
Definition
perfusion
Term
moves the respiratory gases from one area to another
Definition
diffusion
Term
What regulates the respiratory cycle so that exchange of respiratory gases can occur?
Definition
CNS
Term
Work of breathing (WOB)
Definition
the effort required to expand and contract the lungs; when healthy, breathing is quiet and done with minimal effort
Term
Work of breathing depends on what factors?
Definition
rate and depth of breathing, compliance (ease that lungs expand), and airway resistance
Term
Inspiration is a(n) _____ process.
Definition
active
Term
Expiration is a(n) _____ process.
Definition
passive; and it depends on the elastic recoil of the lungs
Term
surfactant
Definition
chemical produced in the lungs to maintain surface tension of the alveoli and keep them from collapsing
Term
COPD patients lose elastic recoil, resulting in...
Definition
WOB increase
Term
During assessment, observe for elevation of clavicles because...
Definition
it can indicate venilatory fatigue, air hunger, or decreased lung expansion
Term
Compliance decreases in patients with...
Definition
pulmonary edema, intersitial and pleural fibrosis, and congenital or traumatic structural abnormalities...such as, kyphosis or fractured ribs
Term
airway resistance
Definition
pressure difference between mouth and alveoli in relation to rate of flow or inspired gas; increased by asthma, airway obstruction, and tracheal adema
Term
spirometry
Definition
measures volume of air entering/leaving the lungs
Term
tidal volume
Definition
amount of air exhaled in a normal breath
Term
Pulmonary Circulation
Definition
primary function is to move blood to and from alveolar capillary membrane for gas exchange; it is also a resevoir for blood so lungs can increase blood volume without large increases in pulmonary artery or venous pressures
Term
pulmonary circulation also acts as a filter by
Definition
removing thrombi before they reach vital organs
Term

***on test

 

The normal intrinsic rate of the AV node is b/w 40 and 60 beats per minute

Definition
Term

*** on test ***

 

When assessing clients with COPD, observe for

Definition
elevation of the clavicles during inspiration
Term

*** on test ***

 

How does obesity affect chest wall movement?

Definition
they have reduced lung volumes from the heavy lower thorax and abdomen, increased WOB, decreased lung volumes; obesity-hypoventilation develops in which O2 is decreased and CO2 is retained; susceptible to pueumonia after surgery or upper resp tract infection because lungs do NOT fully expand and lower lobes retain pulmonary secretions!!!
Term

*** on test ***

 

Cervical trauma at C3 usually results in

Definition
paralysis of the phrenic nerve
Term

*** on test ***

 

 

V-fib requires what kind of intervention?

Definition
immediate - CPR!
Term

* on test *

 

Left sided heart failure can result in

Definition
pulmonary congestion!
Term

* on test *

 

regular rhythm, normal p wave, normal QRS complex and HR of 100-180 beats/min

Definition

 

sinus tachycardia

Term

* on test *

 

Atrial Fibrilation symptoms include

Definition

 

 fluttering of the heart

Term

* on test *

 

Angina pectoris symptoms

Definition
aching, sharp, tingling, or burning pain; lasts from 1 to 15 minutes; induced by heavy meanls, exercise, or stress; pain often relieved with vasodialators, most common being nitroglycerin
Term

* on test *

 

Female symptoms of Myocardial Infarction

Definition
angina is most common symptom, atypical symptoms are fatigue, indigestion, vasospasm, shortness of breath, back or jaw pain
Term

* on test *

 

clinical signs of hypoxia

Definition
apprehension, RESTLESSNESS, inability to concentrate, declining level of conciousness, unable to lie down, appears fatigued
Term

* on test *

 

When caring for a pt. with a narcotic overdose (ex. heroin), what symptom may be seen?

Definition
hypoventiliation
Term

* on test *

 

Central cyanosis is observed in the

Definition
TONGUE, soft palate, and conjuctiva of the eye
Term

* on test *

 

Cardiac catheterization???

 

 

Definition
Term

* on test *

 

Annual fluenza vaccines are recommened for 

Definition
children 6 months to 5 years, adults over 50, and ANY CLIENTS WITH CHRONIC ILLNESSES
Term

* on test *

 

A humidity tent can often do what as a negative outcome

Definition
cause a child to become chilled
Term

* on test *

 

what type of suctioning is used when a client CAN cough?

Definition
oroPHARYNGEAL or nasoPHARYNGEAL
Term

* on test *

 

Know process for nasopharyngeal, oropharyngeal, nasotracheal, and orotracheal suctioning and when each is used. Also note what to do when unexpected outcomes occur (ex. resistance)

Definition
Term

* on test *

 

Upper airway is always "clean" and lower airway is "sterile". Therefore you can use the same catheter when suctioning from sterile to clean areas.

Definition
Term

* on test *

 

 

Definition
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