Exam 1 - Week 2 (Cardiopulmonary)

systems that supply the oxygen demands of body

cardiac and respiratory

3 factors that impact stroke volume

preload, afterload, contractility

respiration

exchange of respiratory gasses (oxygen and co2) that occurs between environment and blood during cellular metabolism

neural and chemical regulators control the…

rate and depth of respiration in response to changing tissue oxygen demands

steps in oxygenation

ventilation, perfusion, diffusion

ventilation

the process of moving gases into and out of the lungs

perfusion

ability of cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs

diffusion

exchange of respiratory gases in the alveoli and capillaries

inspiration/expiration

active process stimulated by chemical receptors in the aorta; a passive process for expiration

pulmonary circulation

moves blood to and from the alveolar capillary membranes for gas exchange

oxygen transport

lungs and cardiovascular system

co2 transport

diffuses into red blood cells and is hydrated into carbonic acid

lung volumes (4)

tidal, residual, forced vital capacity (FVC); spirometry

where does diffusion occur

alveolar-capillary membrane

What are some causes of slow diffusion

Pulmonary edema, pulmonary infiltrates, thickened alveolar capillary membrane

thicker alveolar capillary membrane means…

decreased rate of diffusion

what carries O2 and CO2

hemoglobin

central nervous system controls

respiratory rate, rhythm, depth

cerebral cortex regulates

voluntary control of respiration

chemical regulation maintains the

rate and depth of respirations based on changes in the blood concentrations of CO2 and O2, and in hydrogen ion concentration (pH)

chemoreceptors

sense changes in the chemical content and stimulate neural regulators to adjust

physiological factors influencing oxygenation (7)

• Decreased oxygen-carrying capacity

• Hypovolemia

• Decreased inspired oxygen concentration

• Increased metabolic rate

• Conditions affecting chest wall movement

• Musculoskeletal abnormalities

• Influences of chronic lung disease

What is anemia

low RBC count, low hemoglobin

Low hemoglobin means

Decreased oxygen to tissues

anemia effects

• low production (bone marrow, B12 def), RBC destruction (lupus), blood loss (cancer, ulcers, post surgery)

• S/S= fatigue, activity intolerance, SOB, increased breathlessness, increased HR, pallor

CO toxicity

Hgb binds with CO, making Hgb unavailable for O2

transport

BUS idea

RBC = bus, hemoglobin = seats, iron = what seats are made of, oxygen = passengers

What happens to your respiratory rate and depth of your CO2 is too high

Increase rate and depth

Deoxygenated blood is delivered where

To the right side of the heart and then to the lungs to be oxygnated

From the lungs where does oxygenated blood go

Travels from lungs to the left side of the heart and then the tissues

Stroke volume

The amount of blood ejected from the heart in one contraction. (Every time the heart pumps, it pumps a certain volume of blood)

Cardiac output

The volume of blood pumped per minute by each ventricle of the heart.

CO =

HR x SV

Preload

Volume of blood in ventricle before contraction, end diastolic volume

Volume ready to pump

Afterload

Resistance left ventricle must overcome to circulate blood; end of systole

Ejection fraction

amount of blood pumped out of left ventricle with each contraction

indication of effectiveness of heart as a pump

When is preload increased

hypervolemia, regurgitation of cardiac valves, heart failure

When is afterload increased

hypertension, vasoconstriction

Increased afterload means more or less cardiac worklod

More

What is a normal ejection fraction

>55%

What is the ejection fraction of someone with heart failure

<40

Hypovolemia

decreased blood volume

COPD

chronic obstructive pulmonary disease

Their stimulus to breathe is low oxygen (not high CO2)

What are normal O2 sats for COPD

88-92%

What should you be careful with for COPD prients

You cannot set their O2 too high or it could knock out their stimulus to breathe and could them to stop breathing

What do RBCs do?

carry oxygen

What is hemoglobin made of

Iron

Why do we see an increased heart rate with anemia

Decreased oxygen carrying capacity so your blood is trying to return to the heart to oxygenate through an increased heart rate.

Where will you see pallor

pale skin

conjuctivia of eyes

Lips

Tongue

Nailbeds

Hypovolemia

decreased blood volume

What causes hypovolemia

shock and severe dehydration

Severe blood loss from injury or surgery

result of hypovolemia

hypoxia to the body tissues

What is the body's response to hyppvolemia

Peripheral vasoconstriction, increased HR, decreased BP to dangerous low

FiO2

fraction of inspired oxygen (defined by percentage of oxygen inhaled)

decreases in FiO2

Obstruction, high altitudes, hypoventilation

increased metabolic rate effect and seen in who

increased O2 demand

seen in pregnacny, wound healing, and exercise - normal and body adapts

What happens if you don't treat fever stmptoms

Increase rate and depth of respiration

Increased WOB may become hypoxic

how does obesity affect chest wall movement

the fat has a lot of weight on the chest restricting the lung from fully expanding and having good lung compliance. This affects your ability to oxygenate appropriately (because you can't adequately fill your lungs)

how does an abnormal rib cage or vertebral column affect respiratory

doesn't allow lungs to properly expand

how does trauma like a rip fracture or chest surgery affect respirations

pain with normal deep breathing so patients may have shallow and rapid breathing

how does neuromuscular diseases affect respirations

shuts down motor center of respiratory ability

How does CNS alterations affect chest wall movement?

issues with natural regulation of their breathing, cervical trauma - phrenic nerve

what causes clubbed nails and barrel chest

chronic lung disease (and chronic hypoxemia)

what are lifestyle risk factors for respiratory diseases

smoking, substance abuse, stress

what are environmental risk factors for respiratory diseases

higher in smoggy, urban areas than in rural areas

coccidioidmycosis = farmworkers in the dry southwest region are at risk for coccidioidmycosis

asbestosis = occupational lung disease that develops after exposure to abestos

what does an in depth assessment of the cardiopulmonary function include

-Past impairments in circulatory or respiratory functioning

-Methods that patient uses to optimize oxygenation

-Review of drug, food, and other allergies

-Physical examination

-Laboratory and diagnostic tests

respiratory assesment

chest pain, dyspnea, wheezing, respiratory infection, health risks, fatigue, cough, smoking, allergies, medication, environmental/geographical exposures

what do you do if someone is having chest pain

requires immediate thorough evaluation including assessment of location, duration, radiation, and frequency of chest pain

what is a sign of dyspnea

dyspnea has a subjective sensation of difficult or uncomfortable breathing

They tend to lean forward or sleep in a chair because they cannot breathe laying down

what is wheezing

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

what diseases is wheezing usually associated with

asthma, acute bronchitis, or pneumonia

what is often an early sign of a worsening of a chronic underlying disease process

fatigue

what to do if a patient is coughing bloody sputum

determine if blood is from coughing or a bleeding upper respiratory tract, sinage drainage, or bleeding from GI tract

what should you inspect for a cardiopulmonary assessment

skin and mucous membranes, level of consciousness, breathing patterns, chest wall movement

what should you palpate for a cardiopulmonary assessment

chest, feet, legs, and pulses

what should you percuss for a cardiopulmonary assessment

presence of abnormal fluid or air; diaphragmatic excursion

what does resonance percussion over lungs mean

normal

what does hyperresonance percussion over lungs mean

hyperinflated lung

ex. COPD

what does dull percussion over lungs mean

abnormal in thoracic cavity

what should you look, listen and count for respiratory assessment

-rate

-volume (shallow or deep)

-rhythm

-effort

-AP: LAT diameter = 1:2

-Cough (non productive vs. productive)

crackles/rales

• short, discrete, interrupted, crackling sound classified as fine to coarse

• caused by air passing through secretions, moisture

what do crackles indicate

pneumonia (with fever and other symptoms)

rhonchi/gurgles

• Continuous, low-pitched rattling resembling snoring

• caused by air moving through fluid-filled airways

What does rhonchi indicate?

Secretions in the large airway

what does wheezing sound like

• continuous, high pitched whistling sound

• caused by air moving through narrow passages

what disease does wheezing indicate

asthma, bronchitis, COPD

what does stridor sound like

• High-pitched, piercing sound most often during inspiration

• caused by obstruction in respiratory tree.

• Inspiration can be 3-4 X longer than expiration

what does stridor indicate

obstructed airway often from choking

what does a pleural friction rub sound like

• creaking, grating sound outside of respiratory tree

• caused by rubbing together of inflamed pleural surffaces

what does absent or diminished lung sounds indicate

seen in pneumothorax, emphysema, surgically removed lung lobes, obstruction, atelctasis

hypoxia

inadequate tissue oxygenation at the cellular level

hypoxemia

low O2 in the arterial blood

how can you evaluate for hypoxia or hypoxemia

pulse ox, arterial blood gases, clinical presentation

pulse ox

noninvasive way to measure o2 sat, % of HgB saturated with o2

arterial blood gases (ABGs)

invasive measure of partial pressure of oxygen (po2) in blood and other values, normal range is 80-100 mmHg

auses of acute hypoxia

obstructed airway (choking, clot in lung), pulmonary embolism, impaired ventilation (asthma, pnuemonia)

symptoms of acute hypoxia

anxious, sitting up, increased RR and pulse, confusion, behavior changes, nasal flaring

late sign of hypoxia

cyanosis

causes of chronic hypoxia

COPD, anemia, impaired ventilation (COPD), cardiac abnormalities

symptoms of chronic hypoxia

fatigue, lethargy, clubbed fingers, barrel chest, SOA, paraoxysmal nocturnal dyspnea (PND), orthopnea (has to sit up to breathe), activity intolerance