Oxygen

Cardiac and respiratory systems

The systems in the body that work together to supply oxygen to the body and remove carbon dioxide.

Ventilation

The process of moving gases into and out of the lungs through inhalation and exhalation.

Perfusion

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

Diffusion

The process of respiratory gases moving from one area to another by concentration gradients.

Work of breathing

The effort required to expand and contract the lungs.

Compliance

The ability of the lungs to expand in response to increased intraalveolar pressure.

Airway resistance

The increase in pressure that occurs as the diameter of the airways decreases.

Lung volumes

Measurements of the amount of air in the lungs, including tidal volume, residual volume, and forced vital capacity.

Pulmonary circulation

The movement of blood to and from the alveolar capillary membrane for gas exchange.

Respiratory gas exchange

The process of exchanging respiratory gases in the alveoli and capillaries.

Oxygen transport

The delivery of oxygen to the tissues through the lungs and cardiovascular system.

Carbon dioxide transport

The process of removing carbon dioxide from the body through red blood cells and exhalation.

Regulation of ventilation

The neural and chemical control of respiratory rate, depth, and rhythm to maintain normal arterial blood gas levels.

Cardiopulmonary physiology

The process of delivering deoxygenated blood to the right side of the heart and lungs, and oxygenated blood to the left side of the heart and tissues.

Right ventricle

Chamber of the heart that pumps deoxygenated blood through the pulmonary circulation.

Left ventricle

Chamber of the heart that pumps oxygenated blood through the systemic circulation.

Stroke volume

The volume of blood ejected from the ventricles during systole.

Frank-Starling law of the heart

The relationship between myocardial stretch and the strength of contraction in a healthy heart.

Myocardial blood flow

The supply of oxygen and nutrients to the myocardium itself.

Coronary circulation

The branch of the systemic circulation that supplies the myocardium with oxygen and nutrients.

Systemic circulation

The circulation of blood from the left ventricle to the tissues and back to the right side of the heart.

Cardiac output

The amount of blood ejected from the left ventricle each minute.

Preload

The amount of blood in the left ventricle at the end of diastole before the next contraction.

Afterload

The resistance to the ejection of blood from the left ventricle.

Myocardial contractility

The ability of the heart to squeeze blood from the ventricles.

Heart rate

The number of heartbeats per minute.

Conduction system

The system of electrical impulses that regulate the relaxation and contraction of the atria and ventricles.

SA node

The "pacemaker" of the heart, located in the right atrium, which initiates electrical impulses.

AV node

The node that mediates impulses between the atria and the ventricles.

Electrocardiogram (ECG)

A measurement of the electrical activity of the conduction system of the heart.

NSR

Impulse originates at the SA node and follows normal conduction sequence.

P wave

Represents atrial depolarization and electrical conduction through both atria.

PR interval

Represents impulse travel time from SA node through AV node, bundle of His, and Purkinje fibers.

QRS complex

Indicates ventricular depolarization and electrical impulse travel through ventricles.

QT interval

Represents time needed for ventricular depolarization and repolarization.

Factors affecting oxygenation

Physiological, developmental, lifestyle, and environmental factors.

Decreased oxygen-carrying capacity

Anemia and inhalation of toxic substances decrease the amount of available hemoglobin to transport oxygen.

Carbon monoxide (CO) toxicity

Hemoglobin binds with CO, creating functional anemia and reducing oxygen transport.

Hypovolemia

Shock and severe dehydration cause extracellular fluid loss and reduced circulating blood volume, leading to hypoxia.

Decreased inspired oxygen concentration

Upper or lower airway obstruction, decreased environmental oxygen, or hypoventilation decrease the concentration of inspired oxygen.

Increased metabolic rate

Increased metabolic activity increases oxygen demand, normal in pregnancy, wound healing, and exercise.

Conditions affecting chest wall movement

Any condition reducing chest wall movement results in decreased ventilation.

Pregnancy

Enlarging uterus pushes abdominal contents against the diaphragm, resulting in decreased inspiratory capacity and dyspnea.

Obesity

Morbid obesity reduces lung volumes, increases WOB, and may cause obesity-hypoventilation syndrome.

Musculoskeletal abnormalities

Abnormal structural configurations impair chest wall movement and oxygenation.

Trauma

Rib fractures or bruising cause pain and reduced ventilation, flail chest causes chest wall instability.

Neuromuscular diseases

Decrease patient's ability to expand and contract the chest wall, impairing ventilation.

Central nervous system alterations

Diseases or trauma impair neural regulation of ventilation and breathing patterns.

Influences of chronic lung disease

Alveolar and/or airway alterations in chronic lung disease decrease oxygenation.

Alterations in respiratory functioning

Hypoventilation, hyperventilation, and hypoxia are primary alterations in respiratory functioning.

Hypoventilation

In patients with COPD, excessive administration of oxygen can lead to hypoventilation, resulting in excessive retention of carbon dioxide and potential respiratory acidosis and respiratory arrest.

Hyperventilation

Hyperventilation is a state of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism. It can be induced by severe anxiety, infection, drugs, or an acid-base imbalance, and can result in symptoms such as rapid respirations, numbness and tingling of hands/feet, light-headedness, and loss of consciousness.

Hypoxia

Hypoxia is inadequate tissue oxygenation at the cellular level, resulting from a deficiency in oxygen delivery or oxygen use. It is a life-threatening condition and can be caused by various factors such as decreased hemoglobin level, diminished concentration of inspired oxygen, impaired tissue perfusion, and impaired ventilation.

Cyanosis

Cyanosis is a late sign of hypoxia and refers to the blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries. Central cyanosis indicates hypoxemia, while peripheral cyanosis is often a result of vasoconstriction and stagnant blood flow.

Conduction disturbances

Conduction disturbances refer to electrical impulses that do not originate from the SA node, leading to dysrhythmias or deviations from the normal sinus heart rhythm. They can be caused by various factors such as ischemia, valvular abnormalities, drug toxicity, or acid-base or electrolyte imbalances.

Left-sided heart failure

Left-sided heart failure is characterized by decreased functioning of the left ventricle, resulting in decreased cardiac output. It can lead to symptoms such as fatigue, breathlessness, and pulmonary congestion, with clinical findings including crackles in the lungs and shortness of breath on exertion.

Right-sided heart failure

Right-sided heart failure results from impaired functioning of the right ventricle, often due to pulmonary disease or as a result of long-term left-sided failure. It is characterized by elevated pulmonary vascular resistance and systemic symptoms such as weight gain, distended neck veins, hepatomegaly, and peripheral edema.

Valvular heart disease

Valvular heart disease refers to acquired or congenital disorders of a cardiac valve that cause either stenosis (hardening) or regurgitation (impaired closure) of the valves. Stenosis obstructs blood flow, while regurgitation causes backflow of blood into an adjacent chamber.

Myocardial ischemia

Myocardial ischemia occurs when the supply of blood to the myocardium is insufficient to meet oxygen demands. It can lead to angina pectoris (chest pain) or myocardial infarction (heart attack).

Angina pectoris

Transient imbalance between myocardial oxygen supply and demand, resulting in chest pain.

Myocardial infarction

Sudden decrease in coronary blood flow or increase in myocardial oxygen demand without adequate coronary perfusion, leading to cellular death.

Chest pain associated with MI

Crushing, squeezing, or stabbing pain in the left chest and sternal area that radiates to the left arm, neck, jaws, teeth, epigastric area, and back, lasting more than 20 minutes and not relieved by rest or nitroglycerin.

Women and coronary artery disease

Women have a higher risk of heart disease as they get older, with greater blood cholesterol and triglyceride levels. They may experience atypical symptoms such as fatigue, indigestion, shortness of breath, and back or jaw pain.

Developmental factors affecting oxygenation

Infants and toddlers are at risk for upper respiratory tract infections and airway obstruction. School-age children and adolescents are exposed to respiratory infections, smoking, and other risk factors. Young and middle-age adults are exposed to multiple risk factors such as an unhealthy diet, lack of exercise, stress, and smoking. Older adults experience age-related changes in the cardiac and respiratory systems.

Lifestyle factors affecting oxygenation

Risk-factor modification is important and includes smoking cessation, weight reduction, a low-cholesterol and low-sodium diet, management of hypertension, and moderate exercise. Good nutrition supports normal metabolic functions, while poor nutrition can lead to respiratory muscle weakness and increased risk of cardiovascular diseases. Hydration is essential for cellular health, and fluid volume overload or deficit can affect oxygen delivery. Exercise increases oxygen demand and has numerous benefits. Smoking is associated with various diseases, including heart disease, COPD, and lung cancer.

Smoking and women

Smoking increases the risk of thrombophlebitis and pulmonary emboli in women who take birth control pills. Smoking during pregnancy can have adverse effects on the baby's health.

Smoking

The act of inhaling and exhaling the smoke of tobacco or other substances, which is linked to various cancers and respiratory diseases.

Nicotine patches, gum, and lozenges

Over-the-counter products that contain nicotine and are used as aids for smoking cessation.

Secondhand smoke

The smoke that is exhaled by a smoker or emitted from the burning end of a cigarette, which increases the risk of lung cancer and cardiovascular disease in nonsmokers.

Substance abuse

Excessive use of alcohol and illicit drugs, which impairs tissue oxygenation and can lead to lung damage and other health issues.

Stress

A perceived threat that results in sympathetic stimulation, leading to increased metabolic rate, oxygen demand, and release of cortisol, which can affect oxygenation and increase the risk of cardiovascular diseases.

Environmental factors

Factors in a patient's environment that can impact pulmonary health, such as exposure to occupational pollutants and rural populations with higher rates of smoking and limited access to smoking cessation programs.

Critical thinking

The synthesis of knowledge, experience, and data gathered from patients to ensure safe and appropriate care, including the ability to anticipate information, analyze data, recognize cues, and make decisions about patient care.

Nursing process

A clinical decision-making approach that involves assessment, analysis or diagnosis, planning, implementation, and evaluation to develop and implement an individualized plan of care for patients.

Assessment

The process of thoroughly assessing a patient, critically analyzing findings, and identifying cues to make patient-centered clinical decisions about their health problems.

Pulse oximetry

A noninvasive method of measuring a patient's oxygen saturation level, providing instant feedback about their level of oxygenation.

Capnography

A method of monitoring a patient's ventilation, perfusion, and cellular metabolism by measuring the level of carbon dioxide in their exhaled breath.

Patient-centered care

A care approach that involves considering the patient's priorities, expectations, and perspectives in decision-making and planning their care.

Nursing history

The collection of information about a patient's normal and present cardiopulmonary function, past impairments, and methods used to optimize oxygenation, including questions about symptoms, environmental exposures, risk factors, and medication use.

Cardiopulmonary Problem

Describe the problem you're experiencing with your heart.

Abnormal Beats

Do you notice abnormal beats? When do they occur and what makes them better or worse?

Breathing Problems

Describe the breathing problems you are having and how your breathing pattern has changed.

Cough

Do you have a cough? Is it increasing? Is it dry or moist? Do you have sputum with coughing? Describe the color, volume, and thickness of the sputum.

Chest Pain

If you are having chest pain, what causes it and how long does it last? Does it occur with coughing? Rate the severity of the pain. Do you have any other symptoms when you have chest pain?

Predisposing Factors

Have you been exposed to respiratory illnesses? What medications and over-the-counter medications/supplements are you taking? Do you smoke? Have you been exposed to secondhand smoke? Have you been doing any unusual exercises?

Effect of Symptoms

Describe your typical daily diet. How do your symptoms affect your daily activities, appetite, sleeping, and exercise routine?

Familial Risk Factors

Determine if there is a family history of lung cancer or cardiovascular disease.

Pain Assessment

Assess the location, duration, radiation, and frequency of chest pain. Note associated symptoms such as nausea, diaphoresis, fatigue, or weakness.

Fatigue

Rate your level of fatigue on a scale of 0 to 10. When did you notice the fatigue? What makes it better or worse? How does it affect your daily activities?

Dyspnea

When does the dyspnea occur? What improves the dyspnea? Does it affect your ability to lie flat? Do you experience orthopnea or paroxysmal nocturnal dyspnea?

Cough Assessment

Determine the onset, frequency, and productivity of the cough. Describe the type, quantity, color, consistency, odor, and amount of sputum.

Hemoptysis

Describe the amount and color of bloody sputum. Note if it is associated with coughing and if the patient is on anticoagulant therapy.

Environmental and Occupational Factors

Investigate exposure to inhaled substances, such as smog, dust, mold, and asbestos. Determine if the patient is exposed to secondhand smoke or carbon monoxide. Ask about radon gas exposure.

Smoking History

Determine the patient's smoking history, including the number of years smoked and the number of packs per day. Inquire about exposure to secondhand smoke.

Respiratory Infections

Obtain information about the frequency and duration of respiratory tract infections. Ask about pneumococcal and influenza vaccines, exposure to tuberculosis, and risk for HIV infection.

COVID-19

A respiratory infection caused by the SARS-CoV-2 virus that poses increased health risks, especially for older adults and individuals with underlying medical conditions.

Respiratory droplets

The primary mode of transmission for COVID-19, where the virus is spread through close contact with an infected person's respiratory secretions.

Allergies

Immune system responses to airborne allergens, such as pet dander, pollen, or mold, that can cause symptoms such as watery eyes, sneezing, runny nose, cough, or wheezing.

Medications

Various substances, including prescribed medications, over-the-counter drugs, herbal medicines, and illicit drugs, that can interact with each other and cause adverse effects or decrease the effectiveness of certain medications.

Illicit drugs

Illegal substances, such as inhaled opioids or cocaine, that can have detrimental effects on the respiratory system and cardiovascular health.