W13 - Gas exchange/O2

HR x SV = CO (4-6L) - turn & cought 2-3 times Every 2hrs , 10 deep breaths every

pulmonary edema and crackles in lungs are associated with left or right heart?

Left side heart failure / Congestive heart failure

Where is S1 heard the loudedest? how about S2?

Which is the closure of the AV valves? how about Semilunar Valves?

S1 → apex and AV closure

S2 → Base and semilunar closure

What are the main coronary arteries and what areas of the heart does it supply blood to?

Right cornary Artery → right side of the heart

Left cornary Artery

• (widow maker) Left anterior descending artery → Left side of heart

• Circumflex artery → around the heart

For a patient who recently had a MI, which lab values would be elevated? Which labs is more reliable and why?

Creatine phosphopkinase (CPK)

• CK-MB (enzyme in heart tissue)

Troponin would be the better one to look at since it stays in the blood for a longer period of time

What are the 3 treatments for artial Occlusion, please give a short description for each

Thrombolytic (TPA) → breaks down blood clots

Angioplasty → inflates a baloon in the blood vessel

Stent placement → wire mesh to keep the vessel open

What is the major difference between Thrombolytic and anticoags?Why would you not give a thrombolytic to a pt that had recent trauma/ surgery?

Thrombolytic → breaks down present blood clots

Anticoag→ prevents blood clots

You can’t give to pts w/ recent trauma b/c it will cause internal bleeding via dissolving all the blood clots

What is the cardiac conduction pathway? How does it start?

Pacemaker (SA node) → AV node → bundle of His → left and right bundle of his → purkinje fibers

automaticity

When does a wandering pacemaker occur in the heart, and how does it affect electrical impulses?

A wandering pacemaker happens when impulses come from different areas of the heart (heart damage) instead of only the SA node, this causes irregular electrical activity

Electrical Impulses

• SA Node: ? BPM

• AV Node: ? BPM

• Bundle of His & Purkinje Fibers: ? BPM

Electrical Impulses

• SA Node: 60-100 BPM

• AV Node: 40-60 BPM

• Bundle of His & Purkinje Fibers: 20-40 BPM

Describe the cardiac cycle 3 phases

Polarization

• K+ leak out of cell

• Makes inside of cell (-)

Depolarization

• Inflow of Na+ and Ca+

• makes inside of cell (+)

• Triggers contraction of heart muscle

Repolarization

• Return of cell to resting state

• Makes inside of cell (-)

What 3 things affects contractility, please provide a description for each

Venous return (Starling Law)

Inotropic Effect

Ejection Fraction

Venous return (Starling Law)

• Inc volume of blood in the chamber, Inc stretch, Inc recoil = Inc contracility

Inotropic Effect

• Positive inotropes (SNS) = inc contractions

Ejection Fraction (55%-75% normal)

• % of blood out of ventricle w/each beat

Define

Ventilation

Diffusion

Perfusion

Ventilation → Moving air into lungs

Diffusion → The exchange of respiratory gases from alveoli and capillaries via alveolocapillary membran (high to low concentration)

Perfusion → pumping oxygenated blood into the tissues and returning de-oxygenate

What is the resipatory drive for COPD and NON - COPD?

COPD → O2

NON - COPD → CO2

Goal of ventilation is maintaining:

– CO2 between ? mmHg

– Arterial O2 between ? mm Hg

Goal of ventilation is maintaining:

– CO2 between 35-45 mmHg

– Arterial O2 between 95-100 mm Hg

How does the does the brain regulates respiration? For the automoatic control what is the receptor and what does it detect?

Medulla oblongata (chemorecptor check pH(H+), O2, Co2)

• Automatic control

• Senstive to narcotics

Cerebral Cortex

• Voluntary Control

What is normal blood pH?

7.35 - 7.45

Define…

What are the causes…

What are the effects…

Hyperventilation

Define → Exhaling excessive CO2

What are the causes:

• Anxiety

• Infections

• Hypoxia

• Compesation for metabolic Acidosis

What are the effects

• Agitaiton

• inc rate/depth of Respirtation

• Alkalosis state, which cause vasoconstriction

• paresthesia

Define…

What are the causes…

What are the effects…

Hypoventilation

Define → Dec amount of air entering alveoli

What are the causes:

• Obstuction

• Atelectasis (collaps aveoli)

• Inappropriate administeration of O2 in COPD pts

What are the effects

• Mental status change

• Dysrythmias

Define…

What are the causes…

What are the effects…

Hypoxia

Define → Inadequate tissue oxygenation at cell lvl

What are the causes:

• Obstuction

• Atelectasis (collaps aveoli)

• Inappropriate administeration of O2 in COPD pts

What are the effects

• Mental status changes (early signs)

• Cyanosis (late sign)

What do these Cardiopulmonary diagonstic test do?

EKG/ECG

Holter Monitor/Event Monitor

Stress Test (exercise/chemical)

Echocardiography

Cardiac Catheterization

ABG

Pulse Oximetry

Spirometry/Peak Flow Meter

Blood Studies (Cardiac Enzymes, Serum Electrolytes)

EKG/ECG

Holter Monitor/Event Monitor

Stress Test (exercise/chemical)

Echocardiography

Cardiac Catheterization

ABG

Pulse Oximetry

Spirometry/Peak Flow Meter

Blood Studies (Cardiac Enzymes, Serum Electrolytes)

What diet improve heart functions?

Low fat high fiber diets

What is a low-Flow system and what are some examples?

The amount of O2 delivered is variable since it depends on the paient breathing pattern

• Nasal Cannula

• Simple mask

• Nonrebreather

What is a high-Flow system and what are some examples?

The amount of O2 delivered is set and the pt is getting that O2 %

• Venturi Mask

2L is what % of O2

28%

What us the O2 % for NC and what’s the min-max Liters of O2 that can be adminstered?

22-44%

1/2- 6L/min

What us the O2 % for Simple mask and what’s the max Liters of O2 that can be adminstered?

40%-60%

5-8L/min

What us the O2 % for Nonrebreather and what’s the max Liters of O2 that can be adminstered?

80% - 95%

10-15L

What us the O2 % for Venturi mask and what’s the max Liters of O2 that can be adminstered?

24-50%

4-12 L/min

When suctioning the trachea, how long should the pt breath between each suction session? Why can’t a nurse continuously suction the trachea?

3 seconds

The pt can sufficated cuz ur suctioing out air

What does COCA stand for and when is it used?

C → Color

O → Oder

C → Consistencty

A → Amount

For assessing sputum

What is Splininting ?

Cushioning the blow of coughing , such as a hugging a pillow and coughing

What is a Incentive Spirometer? and does it treat?

It a device that the pts sucks in and it treats Atelectasis