Chaper 38
Cardiac output is calculated by multiplying the heart rate in beats per minute
Preload- the amount of blood and pressure in the ventricle at the end of diastole
Afterload- the resistance has to be exceeded for the ventricle to eject the blood during systole.
Myocardial infarction- or heart attack
Copd-chronic obstructive pulmonary disease- group of disorders characterized by impaired airflow in the
lungs
Emphysema- one of the disorders and is characterized by enlargement of gas exchange airways and
damage to the alveolar walls in lungs
Chronic bronchitis- another disorder associated with COPD. Inflammation of the larger airways,
increased productions of mucus and chronic cough.
Asthma- produces symptoms of dyspnea, intermittent cough, chest tightness exertional wheeling heard
on auscultation and prolonged expiration.
Pneumonia- infection in the lungs. Fever cough increased secretions, difficulty breathing.
Atelectasis- blockage or collapse of air passages in at least one lobe of the lungs
Hemoptysis- presence of blood in the sputum. Characteristics of blood—weather it occurs as flecks,
streaks, frank bleeding
Pulmonary function test- look in patients chart and see what the results are from the radiologist.
Complete blood count- differential provide information regarding oxygen and carbon dioxide transport
capabilities and status of the immune response
Basic metabolic panel- renal function, glucose level, electrolyte status
Arterial blood gases- determines if someone gets put on a ventilator
Statin- cholesterol medicine.. you want to watch the liver enzyme.
Cardiac enzymes- troponin and CK levels Ck-mb levels.
CK- breakdown of muscle
Pneumothorax- air in the pleural cavity
Pleural effusion- excess fluid accumulation in the pleural cavity
Pericardial effusion- fluid around the heart
Chest x-ray should be priority—the lungs on the Xray need to be black- because that means they are
filled with air.. white cloudy means there is an infection.. white patches all over the lungs—CHF—fluid
Diagnostic tests are intermediate
Electrocardiogram (ecg also EKG)- graphic representation of the electrical activity that occurs in the
heart
ST segment is where the heart attack happens. Very vulnerable to electric impulses
Atrial fib- need to be on the anticoagulant. To prevent a PE.. this is when you take the radial pulse and it
is irregular, so you take the apical pulse for a full min. because the heartbeat is irregular
Pulmonary embolismArrhythmias- abnormal rhythms of the heart
Echocardiogram- ultrasound of the heart. Shows the movement of the blood through the heart and it is
used to measure cardiac output. (Congenital heart defects, pericardial effusion, disorders of the heart
valves, heart size, and effectiveness of cardiac output)
Cardiac Catheterization- uses contrast and long flexible catheter to visualize the heart chambers,
coronary arteries, and great vessels. Evaluate chest pain, locate the region of coronary artery occlusion
and determine the effects of valvular heart disease. Inserted into the femoral or brachial artery to view
the left side of the hear and inserted into the antecubital or femoral vein to see the right side of the
heart.
Education on oxygen at home, need to know
Petroleum products are flammable, teach oxygen patients this.
Hypoxemia- low level of oxygen in the blood
Cyanosis- a bluish discoloration of the skin related to deoxygenation of hemoglobin, a decreasing oxygen
saturation level, and a feeling of distress
Hypercapnia- may have respiratory depression when supplemental oxygen levels are too high.. high
level of carbon dioxide in the blood
Don’t over oxygenate a COPD patient
Fraction of inspired oxygenYou need an order for oxygen. However, if you patient needs oxygen you can usually use 2 liters on a
cannula, until you can get an order
On nclex, all answers are presumed that you have order
Nebulizers and humidifiers may have bacterial contamination leading to infection
Mask delivery system- gather and store oxygen between patients breath.
Reservoir masks- valve system
Patient needs a more precise airflow usually a % venti mask
Compare and contrast before and after you initiate oxygen
Wait 15-30 then check to see if anything has changed by doing a focused assessment
When you switch a flow rate you have to change the oxygen device. Nasal cannula can only put out so
much oxygen until you have to switch to a mask—chart oxygen cannula 2L/min don’t chart a percent
Venturi mask- %
Room air is 21% every liter you give raises it 3%
Masks should be anywhere from 6-8L.. Nasal cannula should be anything below 6 L
Any patient that is on oxygen is a high risk patient
Bag-valve mask device- or ambu bag- used to ambulate a patient
Pharyngeal airways
Nasopharyngeal airway- placed nasally
Pharyngeal airway- placed into the mouth
Endotracheal tubes- are semirigid curved tubes with a cuff at the distal end that seals to prevent
aspiration of gastric contents into the lung, allow positive pressure for ventilation (youtube placement
video)
If patient is gagging, they don’t need an airway. Take it out.
Assess the mucous membrane, make sure it is not cut or bleeding
Document if you gave oral care to the patient
Tracheostomy tube- placed directly in the trachea to control the airway.
Medication for pulmonary diseaseBronchodilators- increase the diameter of the bronchi and bronchioles which decreases wheezing and
improves oxygenation
Olol drugs-atenolol
ACE inhibitor for hypertension drug cards
Diuretics- study these drugs
Postural drainage- therapeutic way to position a patient to use gravity to help mobilize respiratory tract
secretions.
Know the complications of postural drainage therapy.. slide 43
Chest tube- when we put a tube in we disrupt the
If your caring for someone with a chest tube and it pops out you need to put an occlusion bandage over
it because you want to seal the chest from room air.. because it will create a vacuum
Predict and manage
Chest tubes help drain fluid or blood and excessive air from the pleural space
Coumadin **
INR thereaputic levels
Antiembolism hose
And sequential compression device questions will be in this chapter.
Collaboration and delegation—study this portion
Care of a chest tube must not be delegated
UAP can report any changes in vital signs.. or difficulties presented with the patient
You should tape it three sides so that way the air can escape and room air can not go in when the
breathe in.
If its taped in all four corners you have to eventually let the air out manually. Stay with the patient. Have
everything ready for the doctor so that way they can walk in and put the chest tube in