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Basic Human Needs Oxygenation Ventilation/Perfusion

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Oxygenation Ventilation/Perfusion * * It can be acquired or congenital It is characterized by stenosis (narrowing or hardening), obstruction, or valve degeneration. – PowerPoint PPT presentation

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Title: Basic Human Needs Oxygenation Ventilation/Perfusion


1
Basic Human NeedsOxygenationVentilation/Perfusio
n
2
Basic Needs Oxygenation
3
Oxygenation
  • Oxygen is required to sustain life, primary basic
    human need
  • The cardiac respiratory systems function to
    supply the bodys oxygen demands
  • Cardiopulmonary physiology involves delivery of
    deoxygenated blood to the right side of the heart
    to the pulmonary system

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What are the 2 mechanisms that drive the function
of the heart?
  • Electrical/conduction
  • Mechanical/pump

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Coronary Artery Circulation
  • Right Coronary Artery
  • Left Coronary Artery
  • Circumflex

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Systemic Circulation
  • LV to aorta to arteries to arterioles to
    capillaries
  • Oxygen exchange occurs at the capillary level
  • Waste product exchange occurs here also and exits
    via venous system back to lungs

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Blood Flow Regulation
  • Cardiac Output
  • Cardiac Index
  • Stroke Volume
  • Ejection Fraction

15
Stroke Volume
  • Preload
  • Myocardial Contractility
  • Afterload

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Conduction System
  • Rhythmic relaxation contraction of atria
    ventricles
  • Dependent on continuous transmission of
    electrical impulses
  • Influenced by ANS (Sympathetic parasympathetic)

18
Conduction System
  • Originates in the sinoatrial node (SA node)
  • Intrinsic rate of 60-100 beats per minute
  • Electrical impulses transmitted through atria
    along intra-nodal pathways to AV node

19
Conduction System
  • AV node mediates impulses between atria
    ventricles
  • Intrinsic rate 40-60 beats per minute
  • AV node assists atrial emptying by delaying the
    impulses before transmitting it through to the
    Bundle of His Perkinje fibers

20
Conduction System
  • Intrinsic rate of Purkinje fibers 20-40 beats per
    minute
  • EKG reflects the electrical activity of
    conduction system
  • Normal Sinus Rhythm
  • Physiology of NSR

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Electrical Cycle
23
NSR
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Respiratory Physiology
  • Structure Function
  • Respiratory Gas
  • Exchange

26
Structure Function
  • Ventilation-Process of moving gases into and out
    of the lung
  • Requires coordination of the muscular elastic
    properties of lungs thorax as well as intact
    innervation
  • Diaphragm-Major muscle of inspiration, innervated
    by phrenic nerve (3rd cervical vertebrae)

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Structure FunctionWork of Breathing
  • Degree of compliance of lungs
  • Airway resistance
  • Presence of active expiration
  • Use of accessory muscles of respiration

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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.

33
Airway Resistance
  • Pressure difference between the mouth the
    alveoli in relation to the rate of flow of
    inspired gas
  • Airway resistance increased in airway
    obstruction, asthma, tracheal edema

34
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

35
Pulmonary Circulation
  • Move blood to and from the alveolocapillary
    membrane for gas exchange
  • Begins at pulmonary artery which receives
    deoxygenated blood from RV
  • Flow continues to PA to pulmonary arterioles to
    pulmonary capillaries where blood comes in
    contact with alveolocapillary membrane

36
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

37
Oxygen Transport
  • Consists of lung cardiovascular system
  • Delivery depends on O2 entering lungs
    (ventilation)
  • And blood flow to lungs tissues (perfusion)
  • Rate of diffusion V/Q ratio
  • O2- carrying capacity

38
Oxygen Transport
  • O2 transport capacity affected by hemoglobin
  • Oxyhemoglobin
  • CO2 Transport-diffuses into RBCs is rapidly
    hydrated into carbonic acid

39
Regulation Of Respiration
  • CNS control rate, depth, rhythm
  • 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.

40
Factors Affecting Cardiopulmonary Functioning
  • Physiological
  • Age
  • Medications
  • Stress
  • Developmental
  • Lifestyle
  • Environmental

41
Factors Affecting Oxygenation Physiologic
  • Any factor that affects cardiopulmonary
    functioning
  • directly affects the bodys ability to meet O2
    demands
  • Physiologic factors include decreased O2
    carrying capacity, hypovolemia, increased
    metabolic rate, decreased inspired O2
    concentration

42
Conditions Affecting Chest Wall Movement
  • Pregnancy
  • Obesity
  • Trauma
  • Musculoskeletal Abnormalities
  • Neuromuscular Disease
  • CNS Alterations
  • Influences of Chronic Disease

43
Alterations in Cardiac Functioning
  • Disturbances in Conduction
  • Altered Cardiac Output
  • Impaired Valvular Function
  • Impaired Tissue Perfusion (Myocardial)

44
Disturbances of Conduction
  • Dysrhythmias-deviation
  • from NSR
  • Classified by cardiac
  • response origin of impulse
  • Tachycardia
  • Bradycardia
  • Supraventricular dysrhythmias
  • Junctional dysrhythmias
  • Ventricular dysrhythmias

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Altered Cardiac Output
  • Left-sided heart failure
  • Right-sided heart Failure

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Impaired Valvular Function
  • Stenosis
  • -Stenosis of valves can cause ventricles to
    hypertrophy (enlarge)
  • Obstruction of Flow
  • Valve Degeneration
  • Lead to Regurgitation of Blood

50
Valves
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Impaired Tissue Perfusion Myocardial
  • Insufficient blood flow from coronary arteries to
    meet heart O2 demand
  • Manifested as angina, MI
  • Angina-transient imbalance between O2 supply
    demand resulting in chest pain
  • Atherosclerosis most common cause of impaired
    blood flow to organs

53
Myocardial Ischemia
  • Myocardial Infarction-sudden decrease in coronary
    blood flow or an increase in myocardial oxygen
    demand without adequate perfusion
  • Infarction occurs because of ischemia
    (reversible) or necrosis (irreversible) of heart
    tissue

54
Impaired Tissue Perfusion
  • Cardiac perfusion
  • Cerebral perfusion (TIA, CVA)
  • Peripheral vascular perfusion
  • Incompetent valves
  • Thrombus formation
  • Blood alterations (anemia)

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Electrical Picture of an MI
57
Alterations in Respiratory Function
  • 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
  • Alterations affect ventilation or O2 transport
  • Hyperventilation, Hypoventilation, Hypoxia

58
Alterations in Respiratory Function
  • Hyperventilation- state of ventilation in excess
    of that required to eliminate the normal venous
    CO2 produced by cell metabolism
  • Anxiety, infection, drugs or acid-base imbalance
    can produce hyperventilation

59
Hyperventilation
  • Lightheadedness
  • Disorientation
  • Dizziness
  • Tachycardia
  • Chest pain
  • SOB
  • Blurred vision
  • Extremity numbness

60
Hypoventilation
  • Alveolar ventilation is inadequate to meet bodys
    O2 demand
  • PaCO2 elevates, PaO2 drops
  • Severe atelectasis can cause
  • hypoventilation
  • Hypoventilation and COPD

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Hypoventilation
  • Disorientation
  • Lethargy
  • Dizziness
  • Headache
  • Decreased ability to follow instructions
  • Convulsions
  • Coma
  • Dysrhythmias, cardiac death

63
Hypoxia
  • Inadequate tissue oxygenation at the cellular
    level
  • Deficiency of O2 delivery or O2 utilization at
    cell level
  • Causes Decreased Hgb, diminished concentration
    of inspired O2, decreased diffusion poor tissue
    perfusion, impaired ventilation

64
Hypoxia
  • Restlessness
  • Inability to concentrate
  • Decreased LOC
  • Dizziness
  • Behavioral changes
  • Agitation
  • Change in vital signs
  • Cyanosis Peripheral vs Central

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Other Factors Affecting Oxygenation
  • Age
  • Environmental
  • Lifestyle
  • Medications
  • Stress
  • Infection

68
Pediatric Differences
  • Cardiac Functioning
  • Oxygenation

69
Normal Changes of Aging
  • Cardiovascular
  • Vascular
  • Pulmonary
  • Renal

70
Nursing Process
  • Assessment
  • History
  • Physical Exam
  • Diagnostic Tests
  • Blood Studies

71
Assessment Nursing History
  • Clients ability to meet oxygen needs
  • Pain
  • Fatigue
  • Smoking
  • Dyspnea
  • Orthopnea
  • Environmental Exposure
  • Respiratory Infections
  • Allergies
  • Health Risks
  • Medications
  • Cough
  • Wheezing
  • Altered breathing patterns

72
Physical Exam
  • Inspection
  • Palpation
  • Percussion
  • Auscultation

73
Inspection of Cardiopulmonary Status
  • 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

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             Nails           Nails   
   Clubbing                                           Marked clubbing of the nails.                Clubbing                                           Marked clubbing of the nails.                  
   
 
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25Clubbing                                   
                                                  
                                             Club
bing nails
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Palpation
  • Palpate for thoracic excursion
  • PMI
  • Palpation of peripheral pulses
  • Palpation for skin temperature, capillary refill
  • Palpation of lower extremities for peripheral
    edema

78
Auscultation
  • Identification of normal and abnormal breath
    sounds
  • Blood Pressure
  • Heart sounds S1, S2
  • Abnormal heart sounds
  • Murmurs
  • Bruits

79
Diagnostic Tests
  • EKG
  • Holter Monitor
  • Stress tests
  • Echocardiogram
  • Cardiac cath
  • TEE
  • Pulmonary function tests
  • Chest x-ray
  • Arterial blood gases
  • Pulse ox
  • Bronchoscopy
  • Thoracentesis
  • CT Scan/MRI
  • Ventilation/Perfusion Scan

80
Bronchoscopy/Thoracentesis
81
Lab Studies
  • Electrolytes
  • Cardiac enzymes
  • BNP
  • Lipid Profile
  • Coagulation Studies
  • CBC
  • Troponin
  • D Dimer
  • C reactive protein
  • Sputum culture
  • Throat culture
  • AFB
  • Cytology

82
Nursing Diagnosis
  • Activity Intolerance
  • Ineffective Tissue Perfusion
  • Decreased Cardiac Output
  • Impaired Gas Exchange
  • Ineffective Airway Clearance
  • Ineffective Breathing Pattern
  • Fatigue
  • Anxiety

83
Planning for Care
  • Develop goals and outcomes
  • Set Priorities
  • Select appropriate interventions
  • Collaborate
  • Involve patient and family in care

84
ImplementationHealth Promotion/Prevention
  • Vaccinations
  • Healthy Lifestyle
  • Environmental pollutants

85
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

86
Dyspnea Management
  • Treat underlying disease process and add
    additional therapies as needed
  • Pharmacological agents
  • Oxygen therapy
  • Physical techniques
  • Psychosocial techniques

87
Airway Maintenance Mobilization of Secretions
  • Hydration
  • Humidification
  • Nebulization
  • Coughing techniques
  • Chest PT
  • Postural drainage
  • Suctioning
  • Artificial airways

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Suctioning
  • Oropharyngeal
  • Nasopharyngeal
  • Orotracheal
  • Nasotracheal
  • Tracheal

93
Promotion or Maintenance of Lung Expansion
  • Positioning of patient
  • Incentive Spirometer
  • Chest tubes

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Oxygen Therapy
  • Goal is to prevent or relieve hypoxia
  • Not a substitute for other treatment
  • Treated as a drug
  • Safety precautions

100
Methods of O2 Delivery
  • Nasal cannula-1-4 liters/min
  • Oxygen Mask-Simple face mask, Venturi mask,
    Non-rebreather face mask, Rebreather mask
  • Home Oxygen Therapy

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Medications Affecting Cardiopulmonary Functioning
  • Cardiovascular agents Nitrates, Calcium Channel
    Blockers, Beta Blockers, ACE Inhibitors/Blockers
  • Positive Inotropic Agents (Digoxin)
  • Antiarrhythmic Agents
  • Antilipemic Agents (Statins)
  • Bronchodilators
  • Cough suppressants/expectorants
  • Benzodiazepines/Narcotics
  • Diuretics
  • Anticoagulants/Antiplatelet Agents

107
Acute MI Core Measureswww.the jointcommission.org
  • Aspirin at arrival
  • Aspirin prescribed at discharge
  • ACE Inhibitor/ARB prescribed at discharge for
    left ventricular systolic dysfunction
  • Adult smoking cessation counseling
  • Beta Blocker prescribed at discharge
  • Beta Blocker at arrival
  • Thrombolysis within 30 minutes
  • Statin prescribed at discharge
  • Percutaneous coronary intervention within 90
    minutes

108
Promoting Cardiovascular Circulation
  • Positioning
  • Medications
  • Preventing venous stasis
  • Cardiopulmonary Resusitation

109
Alterations in Ventilation
  • COPD
  • Asthma
  • SIDS
  • Acute Respiratory Distress Syndrome
  • Pneumonia

110
Alterations in Perfusion
  • Cardiomyopathy
  • Congenital Heart Defects
  • Coronary Artery Disease
  • Deep Vein Thrombosis
  • Heart Failure
  • Hypertension
  • Dysrhythmias
  • Peripheral Vascular Disease
  • Cerebral Vascular Accident
  • Pulmonary Embolism
  • Shock

111
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

112
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

113
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

114
Clicker Question
  • Which of the following is an early sign of
    hypoxia?
  • A. Pallor
  • B. Restlessness
  • C. Difficulty breathing
  • D. Decreased heart rate

115
Clicker Question
  • 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 clients 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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