Human Physiology Quiz: Respiration and Circulation

Bachelor Degree in Nursing

• Course title: Nursing Practice
• University: La Sapienza of Rome
• Instructor: Prof. Matteo Bonifazi
• Qualification: RN, MSN
• Academic year: 2024/2025

Nursing Practice Course Objectives

• Incorporate essential cultural and professional knowledge
• Develop skills to contribute meaningfully to healthcare
• Cover general and pediatric nursing science
• Demonstrate thorough comprehension of the nursing process
• Apply nursing process in clinical contexts

Suggested Textbook

• Kozier & Erb's (2022). Fundamentals of nursing. Global Edition. Concepts, Process and Practice. 11th Edition

Contact Information

• Email: [email protected]

Vital Signs

• Measurements of the body's most basic functions
• Traditional vital signs: body temperature, pulse, respiration, blood pressure
• Additional vital signs: pain, oxygen saturation

Monitoring Vital Signs

• Methodical, scientific approach
• Evaluate regarding the client's present/prior health status, usual readings, and accepted standards
• Increased frequency if client's health status warrants it

Times to Assess Vital Signs

• Admission to a healthcare setting to establish baseline data
• When a client experiences a change in health condition or reports symptoms (e.g., chest pain, feeling faint).
• Before/After surgery or an invasive procedure
• Before/After medication with potential effects on respiratory/cardiovascular systems (e.g., digitalis administration)
• Before/After any nursing intervention affecting vital signs (e.g., transferring a confined client.)

Body Temperature

• Balance between heat production & loss
• Measured in degrees
• Core temperature: deep body tissues (abdominal/pelvic cavity)
• Surface temperature: skin, subcutaneous tissue, fat (influenced by the environment).
• Body is in heat balance when heat produced equals heat lost

Factors Affecting Heat Production

• Basal metabolic rate (BMR): decreases with age, higher in younger people.
• Muscle activity: shivering increases BMR
• Thyroxine output: a hormone that increases cellular metabolism
• Epinephrine & norepinephrine: released during stress, increases cellular metabolism, and thus increases body temperature.
• Fever: elevates cellular metabolic rate, raising body temperature.

Mechanisms of Heat Loss

• Radiation: transfer of heat from one object to another without contact (infrared rays)
• Conduction: transfer of heat from one molecule to another of lower temperature; direct contact required.
• Convection: heat loss via air currents.
• Evaporation: water loss from respiratory tract and skin; called insensible heat loss.

Body Temperature Regulation

• System with three main parts:
  • Sensors in the periphery and core
  • Integrator in the hypothalamus
  • Effector system adjusting heat production and loss.

Physiological Processes Raising Body Temperature in Response to Cold exposure:

• Shivering (increased heat production)
• Reduced sweating (decreased heat loss)
• Vasoconstriction (reduced heat loss).

Hypothalamic Integrator

• Controls core temperature.
• Sends signals to reduce temperature by decreasing heat production and increasing heat loss when heat is detected
• Sends signals to increase heat production and decrease heat loss when cold is detected.

Effector System

• Initiates responses like vasoconstriction, shivering, and epinephrine release (increased cellular metabolism, heat production) when cold stimuli detected.
• Initiates sweating and vasodilation when warmth stimuli detected.
• The client can also make voluntary adjustments such as wearing more clothes or using a fan.

Factors Affecting Body Temperature

• Age (infants are most susceptible to environmental temperature changes.)
• Circadian rhythms (lowest body temperature during the night.)
• Exercise (increases body temperature.)
• Hormones (progesterone in women around ovulation.)
• Stress (sympathetic nervous system stimulation boosts metabolic activity & heat production.)
• Environmental factors (extremes of heat/cold.)

Alterations (Temp.)

• Pyrexia (fever): body temperature above normal range
• Hyperpyrexia (iperpyrexia): body temperature around 41°C
• Febrile/afebrile: describing a person with/without fever
• Different types of pyrexia (e.g. intermittent, remittent, relapsing, constant, spike).
• Heat exhaustion: excessive heat/dehydration; moderately elevated temp. - Heat stroke: A dangerously high temp.; warm flushed skin and can lead to delirium/loss of consciousness.

Hypothermia

• Low core body temperature
• Three mechanisms: excessive heat loss, inadequate heat production, impaired hypothalamic thermoregulation
• Clinical signs: decreased body temperature, pulse, and respirations; shivering (initially); pale, cool skin; frostbite; hypotension; decreased urinary output; lack of muscle coordination; drowsiness/ coma.
• Two types: induced and accidental

Assessing Body Temperature

• Oral (wait 30 minutes)
• Rectal (accurate, but not appropriate in certain circumstances)
• Axillary (lower readings than rectal)
• Tympanic (core temperature)
• Forehead (suitable for infants/children)

Types of Thermometers

• Mercury-in-glass (outdated)
• Electronic
• Chemical disposable
• Temperature-sensitive tape
• Infrared
• Temporal artery

Temperature Scales

• Celsius/Centigrade (using degrees Celsius)
• Fahrenheit (using degrees Fahrenheit). Conversion formulas provided.

Pulse

• Wave of blood created by left ventricle contraction
• Reflects stroke volume/amount of blood entering arteries with each contraction.
• Affected by arterial compliance (ability to contract/expand). With age, this decreases, requiring higher pressure to pump.
• Cardiac output = Stroke volume X Heart rate (example calculation)

Factors Affecting Pulse

• Age (decreases with age)
• Sex (males generally have slower resting pulse rates.)
• Exercise
• Fever (increased heart rate)
• Medications (some affect heart rate)
• Hypovolemia/dehydration
• Stress
• Body Position
• Pathology

Pulse Sites

• Temporal
• Carotid
• Apical (heart)
• Brachial
• Radial
• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis

Assessing Pulses

• Palpating/listening
• Consider medications, recent activity, baseline data, and positional changes affecting rate.

Respirations

• Act of breathing (inhalation, inspiration, exhalation, expiration, ventilation)
• Two types: costal/thoracic breathing and diaphragmatic/abdominal breathing.

Mechanics and Regulation of Breathing

• Inhalation: diaphragm contracts (flattens), ribs move upward/outward, sternum moves outward, enlarging thorax and lungs
• Exhalation: diaphragm relaxes, ribs move downward/inward, sternum moves inward, decreasing thorax size and compressing lungs
• Automatic and effortless process

Factors Controlling Respirations

• Respiratory centers in the medulla oblongata and the pons
• Chemoreceptors (centrally in medulla/peripherally in carotid/aortic bodies) respond to changes in oxygen (O2), carbon dioxide (CO2), and hydrogen (H+) levels in the arterial blood.

Assessing Respirations

• Rate (normal, abnormally slow, abnormally fast, absence of breathing)
• Depth (shallow, deep, normal)
• Rhythm (regular, irregular)
• Quality (effort required, abnormal sounds)
• Relationship to cardiovascular system

Factors Affecting Respirations

• Exercise/Stress/Temperature/environmental oxygen concentration
• Medications (e.g., morphine)
• Increased intracranial pressure.

Breathing Patterns

• Tachypnea, Bradypnea, Apnea
• Hyperventilation/Hypoventilation
• Biot breathing, Cheyne-Stokes breathing

Breath Sounds

• Descriptions and causes of different sounds (crackles, gurgles, friction rub, wheeze).
• Location of audible sounds.

Blood Pressure

• Measure of pressure exerted by blood as it flows through the arteries.
• Systolic pressure: peak pressure during ventricular contraction
• Diastolic pressure: lowest pressure when ventricles relax
• Pulse pressure: difference between systolic and diastolic pressure

Determinants of Blood Pressure

• Pumping action of heart
• Peripheral vascular resistance (arterial stiffness)
• Blood volume
• Blood viscosity

Factors Affecting Blood Pressure

• Age, Exercise, Stress, Race/Ethnicity Sex. Medications, Obesity, Diurnal variation. Medical conditions. Temperature

Blood Pressure Scales

• Normal blood pressure readings/MAP
• Elevated Blood Pressure Readings
• Hypertension / Hypotension

Assessing Blood Pressure

• Manual blood pressure measurement methods using a cuff, sphygmomanometer, and stethoscope
• Indirect measurement methods: auscultatory, palpatory, direct (invasive)

Assessing Blood Pressure

• Assessment sites (upper arm, thigh) in various conditions
• Conditions contraindicated for measuring on some limbs (e.g., injuries, casts.).

Oxygen Saturation

• The proportion of hemoglobin binding sites occupied by oxygen.
• Measured via pulse oximetry on finger, toe, nose, earlobe, forehead
• Detects low oxygen saturation (hypoxemia) before clinically apparent signs or symptoms appear.

Factors Affecting Oxygen Saturation Readings

• Hemoglobin levels, Circulation, Activity, Carbon monoxide poisoning

Health Assessment: Integument

• Includes skin, hair, and nails
• Inspection and palpation used to assess various aspects (color, moisture, texture, shape, lesions, etc.)

Skin Assessment

• Possible findings: pallor, cyanosis, jaundice, erythema, edema, lesions, assessment of rashes and other conditions, hair growth/loss.
• Includes structural/color aspects, evaluation for skin lesions based on location, distribution, configuration, and their characteristics

Hair Assessment

• Normal hair qualities: resiliency, even distribution
• Appearance changes in severe protein deficiency (e.g., kwashiorkor) or certain therapies (alopecia)
• Inspection

Nails Assessment

• Nail plate shape, the angle between the nail and the nail bed, nail texture, the color of the nail bed and the surrounding skin, presence of any lesions,
• Abnormal conditions such as spoon shape and clubbing, capillary refill test

Health Assessment: Head

• Inspection and palpation are essential assessment tools (simultaneously) for the head. The structures addressed are the skull, the face, eyes, ears, sinuses, mouth, and pharynx.

Skull and Face

• Landmarks, normal anatomy, and abnormalities in head/face shape.

Eye and Vision

• External structures, visual acuity, ocular movement, visual fields
• Common refractive errors, examination procedures (inspection)
• Inflammatory problems (conjunctivitis, dacryocystitis, iritis)

Ears and Hearing

• External ear (auricle/pinna, external auditory canal, tympanic membrane). Middle ear (ossicles, eustachian tube). Inner ear (cochlea). Sound transmission (air and bone conduction) processes.

Nose and Sinuses

• Inspection and palpation method, assessing patency using a penlight

Mouth and Oropharynx

• Structures, examination using inspection & palpation, specific problems (e.g., dental caries, periodontal disease, gingivitis).

Neck

• Muscles, lymph nodes, trachea, thyroid gland, carotid arteries, and jugular veins.

Thorax and Lungs

• Assessment of the thorax and lungs; using inspection, palpation, percussion, and auscultation
• Landmarks (rib position, spinous processes)
• Abnormal conditions (e.g., lung sounds, symmetry, spinal alignment, chest expansion/fremitus)

Chest Shape and Size

• Oval shaped thorax; anteroposterior diameter half of the transverse diameter; abnormalities in adults (kyphosis, osteoporosis) cause chest cavity size/shape changes

Breath Sounds

• Identifying various breath sounds (crackles, gurgles, friction rub, wheezes).

Abdomen

• Assessment techniques (inspection, auscultation, percussion, palpation), quadrant/regions division.
• Listening to bowel sounds and for variations
• Percussion to determine presence of air/fluid/masses

Musculoskeletal System

• Bones, Muscle strength, tone, size and symmetry, presence of tremors.
• Assessment of tenderness, pain, swelling, range of motion, or abnormal movement patterns.

Neurological Assessment

• Mental status, cranial nerves, reflexes, sensory function.
• Three significant considerations (chief complaints, client's physical condition/level of alertness) of neurological examination.

Mental Status

• Cognitive/intellectual and emotional functions (e.g. language, orientation, memory, and attention span/calculation).

Language

• Assessment for language defect/loss (e.g., aphasia, sensory, motor)

Orientation

• Assessment of awareness of person, place, and time.

Level of Consciousness (LOC)

• Glasgow Coma Scale for assessing level of consciousness (eye, motor, verbal responses).

Sensory Assessments

• Test for touch, pain, temperature, position, and tactile discrimination.
• Identify abnormal responses (anesthesia, hyperesthesia, hypoesthesia, and paresthesia).

Female Genitals and Inguinal Area

• Assessments and inspection
• Papanicolaou tests (Pap smears)
• Identifying lesions and performing palpation of axillary/inguinal lymph nodes

Male Genitals and Inguinal Area

• Include inspection of the genitalia, prostate gland assessing for hernias, and awareness of common reproductive/urinary issues (e.g., hernias, prostate cancer)

Anus

• Inspection of the anus and surrounding tissue for unusual parameters
• Observe for skin lesions, color, and pain.