ACN MS Oxygenation PDF

ACN MS OXYGENATION OXYGENATION BASICS 2 phases Internal respiration External respiration Importance Cellular respiration ○ Aerobic respiration produces 32-36 ATP ○ 10-12 ATP to breath Brain function ○ Cerebral hypoxia Heart Health ○ main supplier of oxy...

ACN MS OXYGENATION OXYGENATION BASICS 2 phases Internal respiration External respiration Importance Cellular respiration ○ Aerobic respiration produces 32-36 ATP ○ 10-12 ATP to breath Brain function ○ Cerebral hypoxia Heart Health ○ main supplier of oxygenated blood Immune System Efficiency Tissue Repair and Healing ○ Inflammatory response ○ Cardinal Signs of Inflammation: ○ Redness (Rubor): Due to increased blood flow. ○ Heat (Calor): From increased blood flow and metabolic activity. ○ Swelling (Tumor): Due to fluid accumulation in the tissue. ○ Pain (Dolor): Caused by the release of inflammatory mediators that stimulate nerve endings. ○ Loss of Function (Functio Laesa): Occurs when swelling and pain interfere with movement or function in the affected area. Metabolic Processes ○ slows done and relies on anaerobic and produces toxic bypoducts ○ blood carries septic chemicals ○ by product, not yet end product ○ pH decrease ○ from 110 days lifespan to 60 days Oxygenation Process phrenic nerve innervates intercostal muscles ○ C1-C4 - whiplash, cutting off phrenic nerve when MVA negative and positive respiration¿ Internal respiration ○ occurs in tissue, exchange of gas between blood and cells External respiration ○ occurs in lungs, exchange of gas between alveoli and blood Factors affecting oxygenation Physiological ○ Decreased oxygen carrying capacity. ◆ anemia, sickle cell  ○ Decreased inspired oxygen concentration ◆ obstruction in airway tract hypovolemia, increased metabolic rate ○ Hyperventilation ◆ panic attack ○ Hypoventilation ○ Hypoxia ◆ MI, heart diseases ○ Condition affecting chest wall movement ◆ neuromuscular diseases, trauma Developmental factors Lifestyle ○ Nutrition ○ Exercise ○ Smoking ○ Substance abuse ○ Stress Environmental factors ○ Residence ○ Work-place ○ Usual location Stats - 2021 Coronary Heart Disease caused 375,476 deaths in 2021. Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups. One person dies every 33 seconds from cardiovascular disease In 2022, 702,880 people died from heart disease. That's the equivalent of 1 in every 5 deaths. ALTERATION IN CARDIAC FUNCTIONING Illness and conditions affecting cardiac strength of contraction, blood flow through the heart or to the heart muscles, and decreased peripheral circulation cause alteration in cardiac functioning. Older adults experience alterations in cardiac functions as a result of calcification of the conduction pathways, thicker and shifter heart valves caused by lipid accumulation and fibrosis and decreases in the number of pacemaker cells in the SA node. Cardiac Rhythms (review ECG) Sinus rhythms Atrial rhythms  Ventricular rhythms AV blocks Electrocardiogram ECG provides information that assists in diagnosing acute Ml. The classic ECG changes are- ○ ST segment elevation ○ ST depression ○ T wave inversion ○ Abnormal Q wave Sinus Bradycardia ○ normal in athletes and during sleep ○ vagal stimulation leads to this ○ Meds: ◆ digitalis ◆ beta blockers ◆ calcium channel blockers ○ Disease: ◆ MI ◆ myxedema ◆ increased ICP ○ Treatment: ◆ not required unless symptomatic ◆ anticholinergic ◆ pacemaker as needed Sinus Tachycardia ○ Fever ○ Shock ○ Pain Anxiety ○ Heart failure ○ Hyper metabolic states ○ Anemia ◆ treatment is to remove cause Premature Atrial Contractions  ○ Caffeine ○ Nicotine ○ Heart failure ○ MI ○ hyper metabolic states ○ treatment ◆ not usually necessary Atrial Flutter ○ saw tooth pattern ○ Disease: ◆ Rheumatic Heart disease ◆ Thyrotoxicosis ◆ Heart failure ◆ Myocardial ischemia ○ Treatment: ◆ Stable ◇ Digoxin - digitalis therapy ◇ Ca channel blockers ◇ Beta-blockers ◇ K-blockers ◆ Unstable ◇ CARDIOVERSION ◆ Anticoagulation ◇ monitor prothrombin time ◇ Heparin - monitor partial prothrombin time ◇ Monitor signs of bleeding Atrial Fibrillation  ○ dysthythmia CARDIAC CONDITIONS Myocardial Infarction disease condition which is caused by reduced blood flow in a coronary artery due to atherosclerosis and occlusion of an artery by an embolus or thrombus Insufficient blood flow to the heart muscle from narrowing of coronary artery may cause chest pain Bad cholesterol - LDL, forming plaque antilipidemics not more than 3 months - liver profiling again - then wash out period 1 month - then antilipidemics again Epidemiology ○ MI’s are the leading cause of death in the United States, affecting one in five men and one in six women. ○ 450,000 people in the US die from coronary disease each year. Client presents with chest pain but undetermined ECG and absent clinical s/sx = put in 24hr halter STEMI, NSTEMI, Unstable angina = stay in ER MI does not improve with nitroglycerin, unlike Angina Lung/pleuritic pain - hold breath then px grimaces and tears due to pain Cardiac/anginal pain - if px relaxes after breath and pain does not worsen MI pain - if after 3 nitrogly and pain persists more than 20 mins, like an elephant is sitting on chest Etiology ○ Non modifiable ◆ age - more than 40 ◆ sex - 3x more in men ◆ family history ○ Modifiable ◆ high blood lipid levels ◆ hypertension  ◆ smoking ◆ physical inactivity ◆ obesity ◆ diabetes mellitus ◆ stress Pathophysiology ○ High blood pressure ◆ Our arteries are designed to pump blood at a certain pressure. If that pressure is exceeded, the walls of the arteries will be damaged ◆ Injury to endothelial lining (arteriosclerosis) ◆ Narrowed & thickened arterial walls (atherosclerosis) ◆ Risk of MI ○ Physical inactivity ◆ Improper lipid metabolism ◆ LDL level increases ◆ Starts accumulating in blood vessels ◆ Risk of MI ○ Obesity ○ Smoking ○ Diabetes Mellitus ◆ Diabetes increases the risk of MI because it increases the rate of atherosclerotic progression and adversely affects the lipid profile ◆ Risk of having MI ○ Stress ◆ Release stress hormones like adrenaline, noradrenaline, and cortisol ◆ Increase in heart rate, and elevated blood pressure ◆ It’s causing damage over time to all your blood vessel ◆ That damage increases the risk or plaque buildup in coronary arteries or can even cause a rupture of plaque ◆ MI Clinical Manifestations ○ Pain ◆ Chest pain due to a lack of blood and oxygen supply of the heart muscle ◆ Characteristics: Severe, immobilizing chest pain. ◆ Usually prescribed as heaviness, pressure, tightness, burning. ◆ Location: Substernal, Retrosternal or Epigastric. ◆ Radiation: It may radiate to neck, jaw, arm or back. ◆ Duration: Lasts for 20 minutes or more. ○ Cardio ◆ Initially the BP and pulse may be elevated Later, BP will drop due to decreased cardiac output = palpitation. ◆ Jugular veins may become distended and nave ODVIOus pulsations. ○ Respiratory  ◆ Respiratory symptoms occur when the damaged heart muscle limits the pumping action of the left ventricle, causing acute left heart failure and consequent lung congetion. ◆ Shortness of breath ◆ Dyspnea/Tachypnea ◆ Crackles ◆ Pulmonary edema ○ Integumentary ◆ Integumentary system (Skin) ◆ cool, clammy skin ◆ Diaphoresis ◆ Pallor, Cyanosis ◆ Coolness of extremities ○ Genitourinary ◆ Myocardial damage ◆ Failure of the pump action of the heart, resulting in reduced cardiac output ◆ Hypoperfusion to the kidneys leads to decrease renal perfusion pressure which is required to maintain glomerular filteration rate in the kidney ◆ Decrease GFR leads to decrease urinary output ◆ Urine output (Oliguria): 30ml/HR or