Oxygenation_and_Cardio_Lecture.pdf

Care of Clients with Problem in Oxygenation and Cardiovascular System Evan Ruel C. Reglos, RN, MMIHS Anatomy & Physiology Oxygenation Respiratory System Upper Respiratory Known as the upper airway (Nose, Paranasal Sinuses, Pharynx, Larynx Trachea) Warms inspired air Filters inspired air....

Care of Clients with Problem in Oxygenation and Cardiovascular System Evan Ruel C. Reglos, RN, MMIHS Anatomy & Physiology Oxygenation Respiratory System Upper Respiratory Known as the upper airway (Nose, Paranasal Sinuses, Pharynx, Larynx Trachea) Warms inspired air Filters inspired air. Respiratory System Lower Respiratory Consist of the LUNGS, which contain bronchial and alveolar structures Accomplishes gas Exchange or Di usion We have 2 Lungs divided into lobes, The Right Lung has 3 and the Left lung has 2 R has 3 lobar bronchi & L has 2 R has 10 segmental bronchi & L has 8 ff Respiratory System Lower Respiratory The Bronchi and Bronchioles is lined and covered with CILIA Cilia creates a constant whipping motion that propels mucus and foriegn substances away from the lungs Alveoli is where O2 nd Co2 exchange takes place (about 300 million in the lungs) Function of the Rrespiratory System Oxygen Transport - O2 to the cell (mitochondria) Respiration -cell to blood and vice versa Ventilation- inspiration and expiration of air that requires in ation and de ation of the lungs fl fl Assessment Health History Always initially focus on the patient's presenting problem and associated symptoms. Check for the. Onset, Location, Duration, Charater, aggravating factors, radiation, frequency, and associated Symptoms. ff Common Sx Dyspnea- Subjective feeling of DOB, maybe pulmonary or cardiac in origin. Can also be associated with allergic reactions, anemia, neurologic, trauma and many more(like post exercise) Pneumothorax - air in the pleural cavity Tachypnea Hypoxemia Orthopnea- found usually to px with Heart disease and occassionally to COPD (Dyspnea with expiratory wheezes) Stridor - high pitched sound during inspiration (blocked airway) Common Sx Cough - re ex that protects the lungs but maybe impaired due to weakness or pralysis of respiratory muscles. Is the result of irritation or in ammation of the mucous membranes anywhere in the respiratory tract. Sputum production Chest pain - should be sharp, stabbing, an intermittent Wheezing - high pitched on expiration and inspiration Rhonchi - low pitched and continous Hemoptysis fl fl Physical Assessment Respiratory System Clubbing of ngers - Diamond shape angle is absent Cyanosis - refer with lips, tongue, nail beds, earlobes fi Diagnostic Evaluation Pulmonary Function Test (Spirometer with recorder) ABG Arterial Blood Gas (Tic Tac Toe). pH 7.35-7.45, PaCo2 35-45 (reversed) HCo3 22-26. Pulse oximetry (95%-100%) Culture- results within 48-72hrs Sputum Studies CXR, CT- Scan, MRI etc. CBC, Neutro (nabaktirya), Eosino (ewwii paraites), lympho( viral) Oxygen Administration Oxygen Therapy - is usually initiated at the onset of chest pain in an attempt to increase the amount of oxygen delivered to the myocardium and to decrease chest pain. (MS Nursing 13th edition chapt. 27, p739, Vol. 1) Oxygen Administration Nasal Cannula- 2 to 3LPM (independent nursing management) may increase up to 5 or 6 LPM NOTE: May give 1-2LPM for COPD patients, stimulus for respiration is a decreased in blood o2 rather an elevation in Co2 Oxygen Administration O2 Face Mask - 6-8LPM Oxygen Administration Non- rebreathing O2 Face Mask - 12 to 15 LPM Oxygen Administration High Flow System (Nasal Cannula) Oxygen Administration Endotracheal Intubation - is a medical procedure wherein a tube is placed into the trachea through a person's mouth. Also known as an advance airway. The Heart Blood Flow The Heart Electrical Impulses/ Conduction System of the heart/Inherent Rate SA Node (SinoAtrial) Pacemaker 60-100BPM AV Node (ArterioVentrical) Gatekeeper 40-60BPM Bundle of HIS 40-60BPM Right and Left Bundle brunch 20-40BPM Perkenje Fibers 20-40BPM The Heart Basic ECG/EKG Reading ECG - Electrocardiogram Also known as EKG Graphycal Presentation of the Electrical Activity of the Heart Obtained with the use of ECG Machine The Heart Basic ECG/EKG Reading ECG Machine The Heart Basic ECG/EKG Reading ECG Reminders Obtain Consent Provide privacy Instruct patient to remove all Metals in his/her body Do skin preparation Instruct patient to stay still for few seconds The Heart Basic ECG/EKG Reading ECG Placement First Place the Extremity Metal clips to obtain long Lead II (most stable lead on an ECG Strip) V1 - 4th intercostal space, right sternal border V2 - 4th intercostal space, left sternal border V3 - place between v2 and v4 V4 - 5th intercostal space, left midclavicular line V5 - 5th intercostal space, left Anterior midaxillary line V6 - 5th intercostal space, left midaxillary line The Heart Basic ECG/EKG Reading Cardiac Monitor Right - is good so it's WHITE When you are good you go to GREENer pastures Left - is bad so it's BLACK When you are bad you go to hell so it's RED Center is V Brown The Heart Basic ECG/EKG Reading Cardiac Monitor "Read Your Green Book" R - RED (Upper Right) Y - YELLOW (Upper Left) G - GREEN (Lower Left) B - BLACK (Lower Right) V is at the middle ( color white) The Heart Basic ECG/EKG Reading P Wave - Atrial Depolarization QRS Complex -Ventricular Depo/ Atrial Repolarization T Wave - Ventricular Repolarization The Heart Basic ECG/EKG Reading Identify and examine the P wave Measure the PR Interval Measure the QRS Complex Identify the rhythm Determine the Heart Rate Interpret the strip The Heart Basic ECG/EKG Reading Identify and examine the P wave - Present and upright Measure the PR Interval - PRI 0.12 - 0.20 sec Measure the QRS Complex - QRS 0.06-0.12 sec Identify the - use of paper Determine the Heart Rate - 6 second strip/ 6 magical number Interpret the strip The Heart Basic ECG/EKG Reading SINUS RHYTHM Normal Heart rhythm with P wave, QRS Complex and T wave prominent to the strip Sinus Rhythm can be Bradycardic or Tachycardic The Heart Causes of Heart Blocks Scarring of Cardiac Cells Heart attacks Infection withing the valves of the Heart Medications The Heart Types of Heart Blocks FIRST DEGREE AV BLOCK Partial Heart block between SA and AV node In ECG - consistent prolonged PR Interval (0.12-0.20sec) The Heart Types of Heart Blocks SECOND DEGREE AV BLOCK TYPE 1/ Mobitz 1/ Wenckebach Progressive Heart block between SA and AV node In ECG - Progressively longer PR Interval then dropped QRS "Long, long,drop" The Heart Types of Heart Blocks SECOND DEGREE AV BLOCK TYPE 2/ Mobitz 2 Intermittent Heart block between SA and AV node In ECG - Drops in QRS complex "Normal,normal, drop" The Heart Types of Heart Blocks Third DEGREE AV BLOCK Complete Heart block between SA and AV node In ECG - P waves march and QRS complexes march but no correlation "Severe Bradychardia" The Heart Types of Heart Blocks MANAGEMENT If Patient is stable and has no Symptoms, No treatment maybe indicated Pacemaker Implantatoin Atrophine is the Choice of Drug (may not be applicable with Mobitz 2 and 3rd degree AV block) Transcutaneous Pacing If Pulseless, may start CPR The Heart Cardiac Dysrhythmia Atrial Fibrillation Several cardial cells in the Atria sends signals to the AV node Quivering Occurs "Regularly irregular rhythm" "No De nite P waves" fi The Heart Cardiac Dysrhythmia Atrial Fibrillation Management Cardioversion Heparin (prior to Cardioversion), Warfarin (3-4 weeks prior to cardioversion) Beta Blockers (lols) Cardiac Glycoside (Digoxin) Antithrombotic drugs The Heart Cardiac Dysrhythmia Atrial Flutter One excited cardial cells in the Atria sends signals to the AV node aside from the SA node Saw-tooth wave pattern "Usually regular rhythm" The Heart Cardiac Dysrhythmia Atrial Flutter Management Administration of ADENOSINE IV Cardioversion Antithrombotic therapy The Heart Cardiac Dysrhythmia Ventricular Fibrillation Heart rhythms originates from the ventricles causing quivering of the ventricles Cardiac output will fall causing DEATH Chaotic, rapid rhythm that has no real organization The Heart Cardiac Dysrhythmia Ventricular Fibrillation Absence of audible heart beat, a palpable pulse, and respirations Heart rhythms originates from the ventricles causing quivering of the ventricles Cardiac output will fall causing DEATH Chaotic, rapid rhythm that has no real organization  The Heart Cardiac Dysrhythmia Ventricular Fibrillation Management De brillation May start CPR until De brillation is available Epinephrine IV fi fi The Heart Cardiac Dysrhythmia Ventricular Tachycardia Heart rhythms originates from the ventricles causing rapid movement of the ventricles (101-250BPM) Blood can't pump e ciently, cardiac output can't be maintained QRS Complex is the hallmark with continous mountain appearance Rapid regular Rhythm QRS Complex is Wide, regular and Fast. NO P wave, T wave or PR Interval ffi The Heart Cardiac Dysrhythmia Ventricular Tachycardia (Monomorphic Vtach) The Heart Cardiac Dysrhythmia Ventricular Tachycardia (Polymorphic Vtach)/Torsades de pointes The Heart Cardiac Dysrhythmia Ventricular Tachycardia Managment Cardioversion (for monophasic VT in a symptomatic patient) Defbrillation (pulseless VT) Procainamide (Monomorphic and Stable VT without MI) Amiodarone ( For patients with acute MI) The Heart Cardiac Dysrhythmia Asystole "Flat Line" The Heart Cardiac Dysrhythmia Asystole Management Start CPR/ BLS/ACLS protocol The Heart Cardiac Dysrhythmia PEA Pulseless Electrical Activity Start CPR/ BLS/ACLS protocol