Oxy/Circ FA23 Lecture

Oral temperature range

96.4 - 99.5°F

Rectal temperature range

97.4 - 100.5°F

axillary temperature range

95.6 - 98.5°F

Tympanic temperature range

98.2 - 100.9°F

Temporal temperature range

98.7 - 100.5°F

Normal HR

60-100 bpm at rest

Normal respiratory rate

12-20 breaths per minute

Normal blood pressure

>90/60 and

normal oxygen saturation

95-100%

Afebrile

without fever

Pyrexia

fever

intermittent fever

temperature returns to normal at least once every 24 hours

Remittent fever

temperature does not return to normal and fluctuates a few degrees up and down

sustained/continuous fever

temperature remains above normal with minimal variations

relapsing/recurrent fever

The body temperature returns to normal for one or more days with one or more episodes of fever, each as long as several days.

Equipment for assessing temperature

-Electronic and digital thermometers

-Tympanic membrane thermometers

-Disposable single-use thermometers

-Temporal artery thermometers

-Automated monitoring devices

pulse points in the body

Temporal, Carotid, Brachial, Radial, Femoral, Popliteal, Posterior Tibial, Dorsalis Pedis

Pulse is regulated by

autonomic nervous system through cardiac sinoatrial node

parasympathetic simulation

decreases heart rate

sympathetic simulation

increases heart rate

Layers of the heart wall

epicardium, myocardium, endocardium

Vital exchange of gases

Alveoli -> vascular system (capillaries)

Think about grapes touching a hammock. If they are not touching, gas exchange is not happening

Oxygen is carried in the blood by

hemoglobin

Electrical impulses of the heart

SA node (pacemaker) --> AV node --> atrioventricular bundle (Bundle of His) --> Purkinje fibers

dysrhythmia

not in normal sinus rhythm

myocardial ischemia

blockage of blood to the heart muscle

Angina

chest pain caused by decreased blood flow to heart muscle

myocardial infarction (MI)

Death of cardiac muscle due to ischemia

(heart attack)

heart failure

heart can't pump enough blood to meet the body's needs

Modifiable risk factors

changeable or controllable

Ex. Diet, smoking, activity level, obesity, alcohol/drug use, etc.

unmodifiable risk factors

cannot be altered

Ex. age, genetics, gender

Chest pain/discomfort locations

-under the jaw

-in the arms

-behind the back

-other areas of upper body

diabetic neuropathy can result in

silent heart attacks

Physical assessment of CV system

-General appearance

-Skin and extremities

-Pulse pressure

-Blood pressure; orthostatic changes

-Arterial pulses

-Jugular venous pulsations

-Heart inspection, palpation, auscultation

-Assessment of other systems

Cardiac biomarkers

troponin and creatine kinase

-elevated levels can indicate heart damage or even heart attack

kidney function tests

BUN, creatinine, GFR

Normal sodium levels

136-144 mmol/L

normal potassium levels

3.7 - 5.1 mmol/L

High potassium = peak t wave

Low potassium = flat t wave or inversion

normal calcium levels

8.5 - 10.2 mg/dL

normal chloride levels

97 - 105 mmol/L

Normal magnesium levels

1.7-2.2 mg/dL

normal phosphate levels

2.5-4.8 mg/dL

normal bicarbonate levels

22-30 mmol/L

normal fasting blood glucose level

70-100 mg/dL (3.9-5.6 mmol/L)

Normal RBC count

3.93 to 5.69 million/mm3

Normal Hgb (hemoglobin) lab value:

males: 12.6-17.5 g/dL

females: 12-16 g/dL

normal HCT (hematocrit)

38% to 47.7%

Normal platelet count

150,000-450,000/mm3

clotting test for warfarin

PT/INR (prothrombin time test and international normalized ratio)

clotting test for heparin

PTT (partial thromboplastin time test)

Mean Arterial Pressure (MAP)

1/3 systolic + 2/3 diastolic

Regulation of blood pressure

-body fluids

-cardiac output (strength of heart contractions)

- renin-angiotensin-aldosterone system raises pressure

Factors affecting blood pressure

Age, gender, race

Circadian rhythm

Food intake

Exercise

Weight

Emotional state

Body position

Drugs/medications

hypotension

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

Normal blood pressure

Systolic

elevated blood pressure

systolic: 120-129

diastolic: less than 80

Stage 1 hypertension

Systolic: 130-139

Diastolic: 80-89

Stage 2 hypertension

Systolic > 140

Diastolic > 90

Manifestations of hypertension

Usually no symptoms other than elevated blood pressure

Symptoms seen related to organ damage are seen late and are serious

Retinal and other eye changes

Renal damage

Myocardial infarction

Cardiac hypertrophy

Stroke

Measuring blood pressure

-Correct arm cuff size

-Sit quietly with arm at the level of the heart

-Confirmation of diagnosis by average of two blood pressure readings

-Can also evaluate lifestyle modifications and success of prescription medications

Major risk factors

Hypertension

Smoking

Obesity

Physical inactivity

Dyslipidemia

Diabetes mellitus

Microalbuminuria or GFR

Loop Diuretics

Furosemide (Lasix)

-reduces fluid volume

Thiazide diuretics

Hydrochlorothiazide (HCTZ)

-reduces fluid volume

ACE inhibitors

lisinopril, enalapril

-Reduces BP and afterload

ARBs (angiotensin II receptor blockers)

valsartan, losartan

-reduces BP and afterload

Beta Blockers

Metoprolol, Bisoprolol

-dilates vessels and reduces afterload

Calcium Channel Blockers

Amlodipine, Diltiazem, Nifedipine, Verapamil

-Decrease heart rate by limiting use of calcium

Digitalis

Digoxin

-improves contractility and slows heart rate

Cardiac Output (CO)

Amount of blood pumped in 1 minute (~5 L)

CO = HR x SV (Heart Rate x Stroke Volume

Preload

degree of stretch of the cardiac muscle fibers at the end of diastole

Afterload

the amount of resistance to ejection of blood from the ventricle

Cardiac Cycle: Diastole

relaxation

Cardiac Cycle: Systole

contraction

Stroke volume

The amount of blood pumped out of the heart with each contraction.

Indicators of the Heart's Effectiveness

Pulse rate, strength, and rhythm

Blood pressure

Skin color and temperature

Level of consciousness

iron deficiency anemia

anemia caused by inadequate iron intake (most common)

iron deficiency anemia treatment

iron supplements and dietary changes(green leafy vegetables and meat)

macrocytic anemia

bone marrow produces abnormally large RBCs

megaloblastic anemia

red blood cells are larger than normal because of deficiency of folic acid or vitamin B12

manifestations of anemias

fatigue, pallor, faster HR, tongue changes, nail changes, angular cheilitis, pica

diagnostic testing for anemia

-Hemoglobin and hematocrit

-Reticulocyte count

-Iron studies

-Vitamin B12

-Folate

treatment of anemia

-dietary therapy

-iron or vitamin supplementation: iron, folate, B12

-Transfusion of packed RBCs

-Immunosuppressive therapy

P wave

atrial depolarization

QRS complex

ventricular depolarization (contraction)

T wave

ventricular repolarization

Depolarization

influx of sodium into cell while potassium exits cell

Repolarization

reentry of potassium into cell while sodium exits

Normal Electrical Conduction

SA Node→

AV node→

Conduction→

bundle of his→

R and L bundle branches→

Purkinje fibers

P wave characteristics

Amplitude: 2-3 mm

Duration: 0.08-0.10 seconds (2 - 2.5 small squares)

PR interval duration

0.12-0.20 seconds (3-5 small boxes)

QRS complex characteristics

Duration: 0.08 - 0.12 seconds (2 - 3 small squares)

Amplitude: 5-30 mm high

QT interval

should be 0.35 - 0.43 seconds (1.5 to 2.5 big boxes)

T wave characteristics

Amplitude: 0.5 mm (half a small square)

Duration: 0.1 - 0.25 seconds

Sinus Bradycardia manifestations

-Hypotension

-Pale, cool skin

-Weakness

-Angina

-Dizziness or syncope

-Confusion or disorientation

-Shortness of breath

Sinus Bradycardia Treatment

-Atropine

-Avoid Valsalva

-Hold Rate Slowing Drugs (Digoxin, Beta Blockers)

-dopamine or epinephrine infusion

Sinus tachycardia manifestations

-dizziness

-dyspnea

-hypotension

-angina in pt with CAD

Sinus Tachycardia Treatment

-vagal maneuver

-beta blockers, adenosine, or CCBs

-synchronized cardioversion

physical assessment of arrhythmia

-skin (pale and cool)

-signs of fluid retention (jugular vein distention and lung auscultation)

-rate + rhythm of apical pulse

-heart sounds

-blood pressure

Upper airway function

warm, filter, humidify inspired air