Transcript Basic Human Needs Oxygenation Ventilation/Perfusion

Basic Human Needs
Oxygenation
Ventilation/Perfusion
Basic Needs: Oxygenation
Oxygenation
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Oxygen is required to sustain life, primary basic
human need
The cardiac & respiratory systems function to
supply the body’s oxygen demands
Cardiopulmonary physiology involves delivery of
deoxygenated blood to the right side of the heart &
to the pulmonary system
What are the 2 mechanisms that
drive the function of the heart?
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Electrical/conduction
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Mechanical/pump
Myocardial Pump
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Pumping action of heart is essential to
maintenance of oxygen delivery
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Decreased effectiveness of pumping action
is a result of disease ( MI, CHF,
Cardiomyopathy)
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Results in diminished pumping action
(stroke volume)
Myocardial Pump
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Chambers of the heart fill during diastole & empty
during systole
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Myocardial fibers have contractile properties that
enable them to stretch during filling
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In healthy heart the stretch is proportionally related
to the strength of contraction
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Frank-Starling Law of the Heart
Myocardial Blood Flow
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Unidirectional
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4 Heart valves ensure forward flow
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Atrioventricular (mitral & tricuspid)
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Open during ventricular filling (diastole),
blood flows from atria into ventricles
Myocardial Blood Flow Review
Semilunar valves (aortic & pulmonic)
 Open during systolic phase
 Closure of atrioventricular valves & closure
of semilunar valves constitute normal heart
sounds
 “Lub” or S1=Closing of atrioventricular
valves just before the contraction of the
ventricles (systole)
 “Dub” or S2=Closing of Semilunar valves
after the ventricles have emptied and heart
enters the filling phase (diastole)
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Coronary Artery Circulation
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Right Coronary Artery
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Left Coronary Artery
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Circumflex
Systemic Circulation
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LV to aorta to arteries to arterioles to
capillaries
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Oxygen exchange occurs at the capillary
level
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Waste product exchange occurs here also
and exits via venous system back to lungs
Blood Flow Regulation
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Cardiac Output
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Cardiac Index
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Stroke Volume
Stroke Volume
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Preload
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Myocardial Contractility
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Afterload
Conduction System
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Rhythmic relaxation & contraction of atria &
ventricles
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Dependent on continuous transmission of
electrical impulses
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Influenced by ANS (Sympathetic &
parasympathetic)
Conduction System
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Originates in the sinoatrial node (SA node)
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Intrinsic rate of 60-100 beats per minute
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Electrical impulses transmitted through atria
along intra-nodal pathways to AV node
Conduction System
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AV node mediates impulses between atria &
ventricles
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Intrinsic rate 40-60 beats per minute
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AV node assists atrial emptying by delaying
the impulses before transmitting it through to
the Bundle of His & Perkinje fibers
Conduction System
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Intrinsic rate of Purkinje fibers 20-40 beats
per minute
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EKG reflects the electrical activity of
conduction system
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Normal Sinus Rhythm
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Physiology of NSR
Electrical Cycle
NSR
Respiratory Physiology
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Structure & Function
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Respiratory Gas
Exchange
Structure & Function
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Ventilation-Process of moving gases into and out
of the lung
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Requires coordination of the muscular & elastic
properties of lungs & thorax as well as intact
innervation
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Diaphragm-Major muscle of inspiration, innervated
by phrenic nerve (3rd cervical vertebrae)
Structure & Function
Work of Breathing
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Degree of compliance of lungs
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Airway resistance
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Presence of active expiration
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Use of accessory muscles of respiration
Lung Compliance
Ability of lungs to distend or expand in
response to increased intra-alveolar
pressure, the ease in which lungs are
inflated
 Compliance is decreased in pulmonary
fibrosis, emphysema
 Lung compliance is affected by surface
tension of alveoli, surfactant lowers surface
tension.
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Airway Resistance
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Pressure difference between the mouth &
the alveoli in relation to the rate of flow of
inspired gas
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Airway resistance increased in airway
obstruction, asthma, tracheal edema
Structure & Function
Accessory Muscles
Assist in increasing lung volume during
inspiration
 Scalene & sternocleidomastoid (inspiration)
 COPD patients use these frequently
 Abdominal muscles
 Trapezius muscle and pectoralis play minor
role
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Pulmonary Circulation
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Move blood to and from the alveolocapillary
membrane for gas exchange
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Begins at pulmonary artery which receives
deoxygenated blood from RV
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Flow continues to PA to pulmonary arterioles to
pulmonary capillaries where blood comes in
contact with alveolocapillary membrane
Respiratory Gas Exchange
Diffusion-movement of molecules from an
area of higher concentration to areas of
lower concentration (oxygen & CO2)
 Occurs at the alveolocapillary level
 Rate of diffusion affected by thickness of
membrane
 Increased thickness: COPD, pulmonary
edema, pulmonary infiltrates, effusions
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Oxygen Transport
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Consists of lung & cardiovascular system
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Delivery depends on O2 entering lungs
(ventilation)
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And blood flow to lungs & tissues (perfusion)
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Rate of diffusion V/Q ratio
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O2- carrying capacity
Oxygen Transport
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O2 transport capacity affected by
hemoglobin
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Oxyhemoglobin
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CO2 Transport-diffuses into RBC’s & is
rapidly hydrated into carbonic acid
Regulation Of Respiration
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CNS control rate, depth, & rhythm
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Change in chemical content of O2, CO2 can
stimulate chemorecptors which regulate
neural regulators to adjust rate & depth of
ventilation to maintain normal Arterial Blood
Gases.
Factors Affecting Cardiopulmonary
Functioning
Physiological
 Age
 Medications
 Stress
 Developmental
 Lifestyle
 Environmental
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Factors Affecting Oxygenation:
Physiologic
Any factor that affects cardiopulmonary functioning
directly affects the body’s ability to meet O2
demands
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Physiologic factors include: decreased O2 carrying
capacity, hypovolemia, increased metabolic rate,
& decreased inspired O2 concentration
Conditions Affecting Chest Wall
Movement
Pregnancy
 Obesity
 Trauma
 Musculoskeletal Abnormalities
 Neuromuscular Disease
 CNS Alterations
 Influences of Chronic Disease
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Alterations in Cardiac
Functioning
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Disturbances in Conduction
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Altered Cardiac Output
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Impaired Valvular Function
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Impaired Tissue Perfusion (Myocardial)
Disturbances of Conduction
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Dysrhythmias-deviation
from NSR
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 Junctional
Classified by cardiac
response origin of impulse dysrhythmias
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Tachycardia
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Bradycardia
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Supraventricular
dysrhythmias
Ventricular
dysrhythmias
Altered Cardiac Output
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Left-sided heart failure
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Right-sided heart Failure
Impaired Valvular Function
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Stenosis
-Stenosis of valves can cause ventricles to
hypertrophy (enlarge)
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Obstruction of Flow
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Valve Degeneration
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Lead to Regurgitation of Blood
Valves
Impaired Tissue Perfusion:
Myocardial
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Insufficient blood flow from coronary arteries to
meet heart O2 demand
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Manifested as angina, MI
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Angina-transient imbalance between O2 supply &
demand’ resulting in chest pain
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Atherosclerosis: most common cause of impaired
blood flow to organs
Myocardial Ischemia
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Myocardial Infarction-sudden decrease in
coronary blood flow or an increase in
myocardial oxygen demand without
adequate perfusion
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Infarction occurs because of ischemia
(reversible) or necrosis (irreversible) of heart
tissue
Impaired Tissue Perfusion
Cardiac perfusion
Cerebral perfusion (TIA, CVA)
Peripheral vascular perfusion
Incompetent valves
Thrombus formation
Blood alterations (anemia)
Electrical Picture of an MI
Alterations in Respiratory
Function
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Goal of ventilation is to produce a normal arterial
CO2 tension (PaCO2) between 35-45mmHg and
maintain normal arterial O2 tension (PaO2)
between 95-100
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Alterations affect ventilation or O2 transport
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Hyperventilation, Hypoventilation, Hypoxia
Alterations in Respiratory
Function
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Hyperventilation- state of ventilation in
excess of that required to eliminate the
normal venous CO2 produced by cell
metabolism
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Anxiety, infection, drugs or acid-base
imbalance can produce hyperventilation
Hyperventilation
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Lightheadedness
Disorientation
Dizziness
Tachycardia
Chest pain
SOB
Blurred vision
Extremity numbness
Hypoventilation
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Alveolar ventilation is inadequate to meet
body’s O2 demand
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PaCO2 elevates, PaO2 drops
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Severe atelectasis can cause
hypoventilation
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Hypoventilation and COPD
Hypoventilation
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Disorientation
Lethargy
Dizziness
Headache
Decreased ability to follow instructions
Convulsions
Coma
Dysrhythmias, cardiac death
Hypoxia
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Inadequate tissue oxygenation at the cellular level
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Deficiency of O2 delivery or O2 utilization at cell
level
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Causes: Decreased Hgb, diminished
concentration of inspired O2, decreased diffusion
poor tissue perfusion, impaired ventilation
Hypoxia
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Restlessness
Inability to concentrate
Decreased LOC
Dizziness
Behavioral changes
Agitation
Change in vital signs
Cyanosis: Peripheral vs Central
Other Factors Affecting Oxygenation
Age
 Environmental
 Lifestyle
 Medications
 Stress
 Infection
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Nursing Process
Assessment
History
Physical Exam
Diagnostic Tests
Blood Studies
Assessment: Nursing History
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Client’s ability to meet
oxygen needs
Pain
Fatigue
Smoking
Dyspnea
Orthopnea
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Environmental
Exposure
Respiratory Infections
Allergies
Health Risks
Medications
Cough
Wheezing
Altered breathing
patterns
Physical Exam
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Inspection
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Palpation
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Percussion
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Auscultation
Inspection of Cardiopulmonary
Status
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Cyanotic mucous membranes
Pursed lip breathing
Jugular neck vein distention
Nasal faring
Use of accessory muscles
Peripheral or central cyanosis
Edema
Clubbing of fingertips
Altered breathing patterns
Pale conjunctivae
Marked clubbing of the nails.
25Clubbing
Clubbing nails
Palpation
Palpate for thoracic excursion
 PMI
 Palpation of peripheral pulses
 Palpation for skin temperature, capillary refill
 Palpation of lower extremities for peripheral
edema
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Auscultation
Identification of normal and abnormal breath
sounds
 Heart sounds S1, S2
 Abnormal heart sounds
 Murmurs
 Bruits
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Diagnostic Tests
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EKG
Holter Monitor
Stress tests
Echocardiogram
Cardiac cath
TEE
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Pulmonary functions
Chest x-ray
Arterial blood gases
Pulse ox
Bronchoscopy
Thoracentesis
CT Scan/MRI
Ventilation/Perfusion
Scan
Lab Studies
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Electrolytes
Cardiac enzymes
BNP
Lipid Profile
Coagulation Studies
CBC
Troponin
D Dimer
C reactive protein
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Sputum culture
Throat culture
AFB
Cytology
Interventional Cardiology
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PTCA
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Balloon Angioplasty
Nursing Diagnosis
Activity Intolerance
 Ineffective Tissue Perfusion
 Decreased Cardiac Output
 Impaired Gas Exchange
 Ineffective Airway Clearance
 Ineffective Breathing Pattern
 Fatigue
 Anxiety
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Planning for Care
Develop goals and outcomes
 Set Priorities
 Select appropriate interventions
 Collaborate
 Involve patient and family in care
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Implementation:
Health Promotion/Prevention
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Vaccinations
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Healthy Lifestyle
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Environmental pollutants
Implementation:
Acute Care
Dyspnea Management
 Airway Management
 Mobilization of Airway Secretions
 Maintenance and Promotion of Lung
Expansion
 Maintenance and Promotion of Oxygenation
 Breathing Exercises
 Hydration
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Dyspnea Management
Treat underlying disease process and add
additional therapies as needed:
 Pharmacological agents
 Oxygen therapy
 Physical techniques
 Psychosocial techniques
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Airway Maintenance
Mobilization of Secretions
Hydration
 Humidification
 Nebulization
 Coughing techniques
 Chest PT
 Postural drainage
 Suctioning
 Artificial airways
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Suctioning
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Oropharyngeal
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Nasopharyngeal
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Orotracheal
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Nasotracheal
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Tracheal
Promotion or Maintenance of Lung
Expansion
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Positioning of patient
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Incentive Spirometer
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Chest tubes
Oxygen Therapy
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Goal is to prevent or relieve hypoxia
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Not a substitute for other treatment
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Treated as a drug
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Safety precautions
Methods of O2 Delivery
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Nasal cannula-1-4 liters/min
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Oxygen Mask-Simple face mask, Venturi
mask, Non-rebreather face mask,
Rebreather mask
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Home Oxygen Therapy
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Medications Affecting
Cardiopulmonary Functioning
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Cardiovascular agents: Nitrates, Calcium Channel
Blockers, Beta Blockers, ACE Inhibitors/Blockers
Positive Inotropic Agents (Digoxin)
Antiarrhythmic Agents
Antilipemic Agents
Bronchodilators
Cough suppressants/expectorants
Benzodiazepines/Narcotics
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Diuretics
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Anticoagulants/Antiplatelet Agents
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Acute MI Core Measures
www.the jointcommission.org
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Aspirin at arrival
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Aspirin prescribed at discharge
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ACE Inhibitor/ARB prescribed at discharge for left
ventricular systolic dysfunction
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Adult smoking cessation counseling
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Beta Blocker prescribed at discharge
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Beta Blocker at arrival
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Thrombolysis within 30 minutes
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Percutaneous coronary intervention within 90 minutes
Promoting Cardiovascular
Circulation
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Positioning
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Medications
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Preventing venous stasis
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Cardiopulmonary Resusitation
Clicker Question
During the first heart sound, S1 or “Lub”,
what valves are closing?
 A. Aortic and pulmonic
 B. Tricuspid and mitral
 C. Aortic and mitral
 D. Mitral and pulmonic
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Clicker Question
Nursing care prior to cardiac catheterization
includes all of the following except:
 A. Assess for allergy to iodine
 B. Evaluation of peripheral pulses
 C. Informed consent
 D. Clear liquids prior to the test
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Clicker Question
Treatment of suspected myocardial
infarction (MI) includes:
 A. Oxygen, aspirin, morphine, nitroglycerin
 B. Acetaminophen, bedrest, EEG
 C. Oxygen, cardiac catheterization
 D. Mechanical ventilation, CEA levels,
acetaminophen
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Clicker Question
Which of the following is an early sign of
hypoxia?
 A. Pallor
 B. Restlessness
 C. Difficulty breathing
 D. Decreased heart rate
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Clicker Question
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3. When evaluating a postthoracotomy client with
a chest tube, the best method to properly maintain
the chest tube would be to:
A. Strip the chest tube every hour to maintain
drainage.
B. Place the device below the client’s chest.
C. Double clamp the tube except during
assessment.
D. Remove the tubing from the drainage device to
check for proper suctioning.
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Clicker Question
2. A client with a tracheostomy has thick
tenacious secretions. To maintain the
airway, the most appropriate action for the
nurse includes:
 A. Tracheal suctioning
 B. Oropharyngeal suctioning
 C. Nasotracheal suctioning
 D. Orotracheal suctioning
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To have a persons Heart in Your
Hands!!!!