Funds Module 3 Blueprint

Cardiac cycle

the sequence of mechanical events that occurs during a single heart beat; contraction of two atria, followed by simultaneous contraction of both ventricles

Systole

contraction

Diastole

Relaxation

Cardiac Output

amount of blood pumped by the heart in one minute

• usually 4-6L per minute

• CO = HR x SV

• SV components: preload, afterload, contractility

Preload

volume of blood within ventricles at end of diastole, direct correlation

Afterload

resistance foces opposing ventricular ejection

• measured by systemic blood pressure for left ventricle

Contractility

Squeeze; strength of muscle contractions

Cardiac conduction

electrical activity initiates contraction of the myocardium

• SA → AV → Bundle of His → Perkinje fibers

SA node

acts pacemaker; located in right atrium; initiates an impulse that triggers each heartbeat, the impulse then travels down the atrial conduction system so that both atria contract as a unit

• initiates rate of 60 to 100 bpm

AV node

second sequence of the conduction system located in the right atrium near the tricuspid valve

• slight delay

• 40-60 electrical impulses

Bundle of his

third sequence of conduction system located between the atria

• impulses 20-40 times

Purkinje fibers

last step in the conduction process to the ventricles

Depolarization

atrial or ventricle contraction

Repolarization

atrial or ventricle relaxation/resting

P-wave

represents electrical impulse starting in the SA node and spreading through atria

• represents atrial depolarization

• Normally: 2.5 mm or less in height; 0.12 sec or less in duration

QRS complex

represents ventricular depolarization

• Normally less than 0.12 sec induration

T wave

represents ventricular repolarization (resting state)

U wave

RARE, repolarization of purkinje fibers

• Appears in pt with hypokalemia

Atria

two thin-walled chambers receive blood into the heart

Valves

between the heart chambers; 1) open widely to allow blood flow easily without turbulence from one chamber to another 2) close tightly to prevent backflow of blood

Diagnostic (exploratory) surgery

surgery done to confirm or rule out a diagnosis

Palliative surgery

performed to relieve discomfort or other disease symptoms without producing a cure

Reconstructive surgery

surgery performed to restore function

Cosmetic surgery

surgery done to improve appearance 

Transplant surgery

surgery that replaces malfunctioning body part, tissue, or organ

Procurement surgery

transplant surgery relation but an organ or tissue is harvested from a patient that is pronounced dead

Emergency surgery

requires transport to the operating suite as soon as possible to preserve the patient’s life or function

• the surgical team is summoned, and preparations are made rapidly

Urgent surgery

is scheduled within 24 to 48 hours to alleviate symptoms, repair a body part, or restore function

Elective surgery

when surgery is the recommended course of action, but the condition is not time sensitive

Major surgery

high risk degree of surgery

Minor surgery

often performed on an outpatient basis, involves little risk and usually has few complications

General Anesthesia

produces rapid unconsciousness and loss of sensation; the anesthesiologist or NA

• Advantages: patient unconscious so not anxiety that might affect cardiac and lung function, muscles are relaxed to patient remains motionless during surgical procedure, if complications occur anesthesia can be continued for longer than planned

• Disadvantages: respiratory and cardio muscles are depressed so mechanical is needed while patient is under; high risk for death, heart attack, stroke and malignant hyperthermia; minor complaints – sore throat, n/v, headache, uncontrolled shivering, confusion

Conscious sedation

provides IV sedation and analgesia without producing unconscious; patient sleepy but aware of surroundings; patient may or may not recall events after

• Advantage: pain and anxiety are controlled without the risk of GA, recovery is rapid

• Disadvantage: not practical for highly anxious patients

Local Anesthesia

produces loss of pain sensation at the desired spot, for minor procedures; used for post op pain relief, can be applied topically, or injected

• usually rapid acting

Regional anesthesia

prevents pain by interrupting nerve impulses to and from the area of the procedure; patient remains alert but numb in the involved area

• Advantages: low in cost, simple to administer, requires minimal recovery; suitable for minor ambulatory procedures

• Types: nerve block, spinal anesthesia, epidural anesthesia

Ablative surgery

involves removal of a diseased body part

Incentive spirometry

prescribed for patients who are at high risk for atelectasis and pneumonia

• it facilitates deep breathing, increases lung volume, and promotes coughing to clear mucus from the respiratory tree

Sequential Compression Devices

may be prescribe for patients at high risk for thrombophlebitis as well as antiembolism stockings

• the pressure from the device compresses the veins and promotes venous return to the heart

PACU includes

• recovery from anesthesia

• airway management

• vital signs

• level of consciousness

• dressing assessment/drainage

• fluid therapy

• pain control

Post op Assessment frequency

• Every 15 min first hour

• Every 30 min for the next 2 hours

• Every hour for the next 4 hours

• Then every 4 hours

Surgical Consent

confirm the presence of surgical consent and its signed and witnessed;

• if not consent call prescriber to get consent filled out

• The surgeon is responsible for giving patient necessary info and determine patients competence to make the informed decision for surgery

Urge incontinence

involuntary loss of urine with a strong urge to void (aka overactive bladder)

Stress incontinence

involuntary loss of urine with increase intraabdominal pressure in the absence of an overactive bladder

• Causes: pregnancy, childbirth, obesity, chronic constipation and straining at stool, exercise, laughing, sneezing, lifting

Mixed incontinence

combination of urge and stress incontinence

Reflex (unconscious) incontinence

loss of urine when the person does not realize the bladder is full and has no urge to void

• Causes: central nervous system disease, tissue damage from radiation, cystitis, bladder inflammation, radical pelvic surgery

Functional incontinence

untimely loss of urine with no urinary or neurological cause

• Causes: immobility, pain, external obstacles, problems in thinking or communicating

Transient incontinence

short term incontinence expected to resolve spontaneously

• Causes: UTI, medications

Overflow incontinence

leakage of urine with a distended bladder

• Causes: fecal impaction, neurological disorders enlarged prostate

s/s of incontinence

• back pain-sides or at ribs

• bladder spasms

• chills

• dysuria

• edema

• fever

• foul smelling urine

• hematuria

• n/v, pyuria

• urgency

• urinary frequency

Interventions for incontinence

• Prevention of skin breakdown

• Encourage/teach lifestyle modification

• Implement bladder training

• Encourage patient to perform Kegel exercises

• Use and anti-continence devices as needed

Strategies to promote independent urination

• Pharmacological interventions

• Surgical interventions

• Parenteral teaching for enuresis

Normal urine output

50 to 60 mL per hour; 1,500 mL per day

Urinary tract infection

infection in any part of the urinary system

Urethritis

inflammation limited to the urethra

Cystitis

bladder infection cause by microbes within the urethra

Pyelonephritis

infection that progress upward to the ureters or kidneys

CAUTIs

asymptomatic; resolves spontaneously with removal of the catheter

Urinary retention

inability to completely empty the bladder

• Causes: obstruction in the urinary tract, neurological problems, medication

• s/s: urgent need to urinate, weak urine stream; pain, discomfort in lower abdomen, distention

Routine Urinalysis (UA)

uses an overall screening test and aid for diagnosing and monitoring health conditions

• Color: ranges from pale yellow to amber

• Clarity: clear when first excreted

• Odor: faintly aromic

• Specific gravity: 1.002-1.030

• Ph: 5.0-9.0

• Protein: < 20 mg/dL

• None: glucose, ketones

Freshly voided specimen

having patient collect urine same and pouring the urine into a specimen container with their name, ID, DOB, and d/t of specimen collection

Clean-catch specimen

collection of the sample in the midstream of flow; this allows for the urine to be free of over contaminants in the urinary tract

Sterile urine specimen

collect specimen by inserting a catheter into the balder or by withdrawing a sample from and indwelling

• aids in determining presence of UTI

24-hour urine specimen

nurse collects urine over a 24-hour period in large container that will preserve the urine

Blood studies

• Blood urea nitrogen: 8-21 mg/dL

• Creatinine: 0.5-1.2 mg/dL most specific

Cystoscopy

direct visualization of the urethra, bladder, and ureteral orifices by insertion of a scope

Cystometry

 catheter is inserted into bladder and warm fluid is injected which measure how much the bladder can hold

• done to determine whether a muscle or nerve problem is causing problems with how well the bladder holds or releases urine

Intravenous pyelogram

IVP uses IV radiopaque contrast medium to visualize the kidneys, ureters, bladder, and renal pelvis

• it evaluates renal function by analyzing flow of contrast over time

Ultrasound

uses high frequency sound waves to produce an image of the organs (kidneys, ureters, bladder)

CT scan

using contrast media, a CT scan examines body sections from different angles using a narrow x-ray beam to produce a three-dimensional picture of the area of the body being scanned

Renal biopsy

removal of a piece of kidney tissue for microscopic evaluation, usually done with ultrasound guidance

Straight catheter

a single-lumen tube that is inserted for immediate drainage of the bladder

Indwelling catheter

known as a Foley or retention catheter, is used for continuous bladder drainage

Double-lumen indwelling catheter

usually a double-lumen tube: one lumen is used for urine drainage, and the second lumen is used to inflate a balloon near the tip of the catheter

Tripe lumen indwelling catheter

a triple-lumen indwelling catheter is used when the patient requires intermittent or continuous bladder irrigation

Inflated balloon

holds the catheter in place at the neck of the bladder

• the balloon is sized according to the volume of fluid used to inflate it

Suprapubic catheter

used for continuous urine drainage when the urethra must be bypassed

• inserted through an incision above the symphysis pubis; may be sutured in place initially

Indwelling catheter procedure

1.     Position the patient

2.     Drape the patient

3.     Cleanse the perineal with donned clean procedure gloves

4.     Organize the work area: arrange bedside table within reach with open sterile catheter kit

5.     Apply the sterile under pad and fenestrated drape

6.     Organize the kit supplies on the sterile field

7.     Spread the labia and cleanse the urinary meatus

8.     Insert the catheter

9.     Manage the catheter: insert catheter until urine flows (5 to 7.5 cm), and then inflate the balloon with water filled syringe

10.  Secure the catheter: hang the drainage back on the side of the bed below the bladder level

11.  Finish up: remove and dispense all supplies in the biohazard receptable

Oxygenation goals

• Expectorates secretions effectively

• No dyspnea or shortness of breath

• Lungs clear; no adventitious sounds present

Less invasive/ independent interventions for oxygenation

•  Smoking cessation

• Positioning

• Aspiration precautions

• Incentive spirometer

•   Mobilization secretions

  •   Maintain hydration

• Perform chest physiotherapy

• Teach deep breathing and coughing

• Promotion respiratory function

  • Prevent HA pneumonia

  • Immunizations/prevent URIs

Invasive/dependent interventions for oxygenation

•   Administering respiratory medications

• Use of chest tube drainage systems

• Oxygen therapy

• Using artificial airways

• Use of mechanical ventilator

Oxygen Therapy

administration of oxygen at at concentration greater than that found in the environmental atmosphere

• Sea level: oxygen concentration is 21%

•   A change in the clients RR or pattern indicates need for oxygen therapy

• Complications:

  • Oxygen is a medication and needs prescription from a health care provider with prescriptive authority (except in emergencies)

  • Oxygen toxicity: too high a concentration of oxygen (>50%) is extended for an extended period (> 48 hours)

• Suppression of ventilation: stimulus for respiration in some clients

• FLAMMABLE

• Potential for infection

Tidal volume (Vt)

the amount of air moved into and out of the lungs with each normal breath

Inspiratory Reserve Volume (IRV)

the maximum amount of air that can be inhaled above and beyond the normal tidal volume

Expiratory Reserve Volume (ERV)

the maximum extra amount of air that can be forcefully exhaled after the end of a normal tidal expiration

Residual volume (RV)

the amount of air remaining in the lungs after the most forceful exhalation

Inspiratory Capacity (IC)

the combination of the tidal volume and the inspiratory reserve volume

Functional residual capacity (FRC)

the combination of expiratory reserve volume and residual volume

Vital capacity (VC)

the combination of inspiratory reserve and expiratory reserve

Eupnea

normal breathing, 12-20 bpm

Bradypnea

slow, > 10 bpm

Apnea

period of cessation of breathing

Hyperventilation

increased rate and depth of respirations

Cheyne-stokes

regular cycle, rate and depth increase, then decrease until apnea occurs

Kussmal Respiration

increase in rate and abnormally deep respirations; DKA

Biots respirations

periods of normal breathing followed by carrying period of apnea; no cycle

premature infants developmental competence

high risk for IRDS, do not have fully developed alveolar surfactant system, have immature pulmonary circulation; all structures immature and small

Toddlers developmental compentence

risk for increase respiratory and immune system infections due to maturation; tonsils and adenoids large predisposing to tonsilitis

• children exposed to new infectious agents in preschool and daycare

Adolescents developmental considerations

begin to smoke for social reasons, use of e-cigarettes, adolescents make fewer routine healthcare visits, exercised induced asthma

Young, middle adults

unhealthy practices that continue into adulthood, changes in the respiratory system being in the middle and increase in older; endurance training and regular exercise can minimize the rates of the changes

Older adults

reduced lung expansion, difficulty expelling mucous or foreign material, diminished ability to increase ventilation when oxygenation demands increase, declining immune response, GERD is more common risking aspiration into the lungs, chemoreceptors response more slowly to increased O2 demands or rising CO2 levels