Class 2 - Thermoregulation, Perfusion, Oxygenation, & Comfort

Factors that affect the blood pressure:

- Age (increases with age) - Exercise (increases BP) - Stress (increases BP) - Race (African American males over 35 have higher BPs than European American males) - Gender (females lower due to hormones until menopause) - Medications - Obesity (predisposes person to hypertension) - Diurnal variations (lower in AM) - Disease process (EX: HTN, CA, Diabetes)

Factors that affect the pulse:

- Age (pulse decreases with age) - Gender - Exercise (increases) - Fever (HR increases with increased metabolic rate) - Medications - Hypovolemia (decreased blood volume)(HR increases to compensate for low blood volume) - Stress (HR increases due to sympathetic nervous system) - Position changes - Blood pooling with sitting causes low blood volume and increased heart rate - Pathology (diseases)

Factors that affect blood pressure readings: HIGH READING

- Bladder cuff too narrow - Arm unsupported - Insufficient rest before assessment - Cuff wrapped too loosely

Factors that affect blood pressure readings: LOW READING

- Bladder cuff too wide = too low - Deflating cuff too quickly can cause low systolic/high diastolic - Deflating cuff too slowly can cause high diastolic - Repeating BP too quickly can cause high systolic/low diastolic

Factors affecting body temperatures:

- Circadian rhythms (physical, mental, and behavioral changes that follow a daily cycle - peak temp is 4-8pm) - Age and gender (old and young are sensitive to changes in temp) - Physical activity (increase with activity - increase metabolism) - State of health (disease and health problems) - Environmental temperature (hot or cold) - Afebrile (without fever) - Pyrexia or febrile (with fever)

Equipment for Assessing Temperature:

- Electronic and digital thermometers - Tympanic membrane thermometers - Disposable single-use thermometers - Temporal artery thermometers - Automated monitoring devices

Types of transfer of body heat to external environment:

- Radiation - Convection - Evaporation - Conduction

Sources of Heat Loss

- Skin (primary) - Evaporation of sweat - Warming and humidifying inspired air - Eliminating urine and feces

A nasal cannula is used to deliver from 1 L/minute to 6 L/minute of oxygen.

1 L/minute = 24% 2 L/minute = 28% 3 L/minute = 32% 4 L/minute = 36% 5 L/minute = 40% 6 L/minute = 44%

Fahrenheit to Celsius subtract ________ and multiply by _______.

32; 5/9

Celsius to Fahrenheit multiply by _________ and add _________.

9/5; 32

0-10 Numeric Rating Scale is used for ______________.

Adults and children (>9 years old) in all patient care settings who are able to use numbers to rate the intensity of their pain

Abnormal breath sound heard over the lungs

Adventitious

Small air sacs at the end of the terminal bronchioles that are the site of gas exchange

Alveoli

A temporary imbalance between the amount of oxygen needed by the heart and the amount delivered to the heart muscles

Angina

Which assessment findings are consistent with hypoxia?

Anxiety, restlessness, confusion, or drowsiness. - Other common symptoms of hypoxia are dyspnea, elevated blood pressure with small pulse pressure, increased respiratory and pulse rates, pallor, and cyanosis.

Semilunar valves

Aortic and pulmonic (S2)

Central pulse; point of maximum impulse (PMI [apical impulse])

Apical pulse

Temporary cessation of breathing

Apnea

A diagnostic test examining arterial blood; used to determine the pressure exerted by oxygen and carbon dioxide in the blood.

Arterial blood gas

Incomplete expansion or collapse of a part of the lungs

Atelectasis

Prolonged bed rest can result in the incomplete lung expansion and collapse of alveoli that characterize ______________.

Atelectasis

Upper chambers of the heart

Atria

________________ is used to detect airflow within the respiratory tract.

Auscultation

What is the term for the heat that is lost when a person goes out in the cold without a hat? A. Convection B. Radiation C. Evaporation D. Conduction

B. Radiation Rationale: Radiation is the diffusion and dissemination of heat by electromagnetic waves, such as occurs with an uncovered head. Convection is the dissemination of heat by motion between areas of unequal density. Evaporation is the conversion of a liquid to a vapor. Conduction is the transfer of heat to another object during direct contact.

An increased anteroposterior diameter, as seen in chronic lung diseases, is described as _____________.

Barrel chest

Slow rate of breathing

Bradypnea

High-pitched and longer, heard primarily over the trachea

Bronchial

Those heard over the larynx and trachea are high-pitched, harsh "blowing" sounds, with sound on expiration being longer than inspiration

Bronchial

Medication that relaxes contractions of smooth muscles of the bronchioles

Bronchodilator

Medium pitch and sound during expiration, heard over the upper anterior chest and intercostal area

Bronchovesicular

Bronchioles deliver air to alveoli. Normal breath sounds heard over the mainstem bronchus; they are moderate blowing sounds, with inspiration equal to expiration.

Bronchovesicular sounds

Which respiratory organ is the site of gas exchange? A. Mediastinum B. Parietal pleura C. Alveoli D. Diaphragm

C. Alveoli Rationale: At the end of the terminal bronchioles, there are clusters of alveoli that are the site of gas exchange. The wall of each alveolus is made of a single-cell layer of squamous epithelium. This thin wall allows for exchange of gases within the capillaries covering the alveoli.

A method to monitor ventilation and, indirectly, blood flow through the lungs

Capnography

The oxygen in inhaled air passes across the thin lining of the air sacs and into the blood vessels. This is known as diffusion. The oxygen in the blood is then carried around the body in the bloodstream, reaching every cell. When oxygen passes into the bloodstream, __________________ leaves it.

Carbon dioxide

Refers to the events that occur in the heart from the beginning of one heartbeat to the next. - Number of cycles depends on heart rate - Each cycle has three major sequential events: Diastole Atrial systole Ventricular systole

Cardia cycle

What creates heart sounds?

Closure of valves - S1 and S2 are normal - AV valve produces S1 "Lub" - Semilunar valve produces S2 "Dub"

Heat transfer from one surface to another

Conduction

Heat transfer through fluid or air

Convection

Temperature of the internal organs. - Deep tissues, constantly fluctuates, controlled by the hypothalamus

Core Temperature

_________________ are soft, high-pitched, discontinuous sounds. Fine, crackling sounds made as air moves through wet secretions in the lungs

Crackles

Which of the following is the primary pacemaker for the myocardium? A. Atrioventricular junction B. Bundle of His C. Purkinje Fibers D. Sinoatrial Node

D. Sinoatrial Node Rationale: The sinoatrial node is the primary pacemaker for the myocardium.

Energy production _______________ and heat production increases.

Decreases

Ventricular relaxation

Diastole

Tendency of solutes to move freely throughout a solvent from an area of higher concentration to an area of lower concentration until equilibrium is established

Diffusion

A channel between the pulmonary artery & the aorta. Blood becomes mixed.

Ductus Arteriosus (DA)

Blood flows from the placenta to fetus through the umbilical vein to the __________________ (channel to inferior vena cava) to the right atrium

Ductus venosus

Difficult or labored breathing

Dyspnea

What are the three layers of the heart?

Endocardium, myocardium, epicardium

____________ and ____________ are released when additional heat is required, and alter metabolism.

Epinephrine; norepinephrine

Breathing within the expected respiratory rates (breaths per minute)

Eupnea

Converting water to a vapor (sweating)

Evaporation

Fetus to Newborn Neurological adaptation Thermoregulation Methods of heat loss

Evaporation - Wet surface exposed to air. (Dry infant immediately) Conduction - Direct contact with cool objects (Place on mothers body skin to skin) Convection - Surrounding cool air (drafts) (Cover with a blanket, wear a cap) Radiation - Transfer of heat to cooler objects not in direct contact with infant (Keep away from cold windows and cold objects)

The passive phase of ventilation, movement of air out of the lungs

Expiration

A _____________ is used without a mask; it is open and loose around the face and is often used for patients with facial trauma or burns.

Face tent

Opening between atria allows blood to flow from right atria to left then into ventricle

Foramen Ovale

Rubbing or grating Loudest over lower lateral anterior surface Inflamed pleura rubbing against chest wall

Friction Rib

Harsh, blowing sounds caused by disruption of blood flow into the heart

Heart murmurs

Thyroid hormone and shivering increase _________________.

Heat production

Condition in which there is more than the normal amount of air entering and leaving the lungs

Hyperventilation

Decreased rate or depth of air movement into the lungs

Hypoventilation

Deficient oxygenation of blood

Hypoxemia

In _______________, crackles heard at the end of deep respiration are normal. Respiratory rate is rapid and respiratory activity is primarily abdominal.

Infants

FLACC Behavioral Scale is used for ___________________.

Infants and children (2 months-7 years) who are unable to validate the presence of or quantify the severity of pain.

The active phase of ventilation, involves movement of muscles and the thorax to bring air into the lungs

Inspiration

Deficiency of blood in a particular area

Ischemia

Hormones, muscle movements, and exercise increase ____________.

Metabolism

Primary source of heat production is _________________.

Metabolism

Normal temperatures for Healthy adults

Oral: 37.0°C, 98.6°F Rectal: 37.5°C, 99.5°F Axillary: 36.5°C, 97.7°F Tympanic: 37.5ºC, 99.5°F Forehead (temporal artery): 34.4°C, 94.0°F

Shortness of breath when lying flat; relieved by sitting or standing

Orthopnea

Mechanism that facilitates the body's ability to supply oxygen to all cells of the body

Oxygenation

________________ is used to detect areas of sensitivity, chest expansion during respirations, and vibrations (fremitus). Use the palmar surface of the hands to palpate the anterior and posterior thoracic landmarks in a sequential pattern for temperature, moisture, muscular development, and any tenderness or masses.

Palpation

To assess the position and motion of the diaphragm, the nurse instructs the patient to take a deep breath and hold it while the maximal descent of the diaphragm is ______________.

Percussed

____________ is the function of cardiovascular & respiratory systems to provide a continuous supply of oxygenated blood to every cell in the body.

Perfusion

Air in the pleural cavity

Pneumothorax

Observe the neck and ________________ (the portion of the body over the heart and lower thorax, encompassing the aortic, pulmonic, tricuspid, and apical areas, and Erb's point) for visible pulsations.

Precordium

Heat transfer with no physical contact - Sunshine

Radiation

___________ are small clicking, bubbling, or rattling sounds in the lungs.

Rales

Actual exchange of oxygen & carbon dioxide

Respiration

What structural changes to the respiratory system should a nurse observe when caring for older adults?

Respiratory muscles become weaker

Sonorous or coarse; snoring quality Low-pitched, continuous sounds

Rhonchi (Sonorous Wheeze)

What are the four chambers of the heart?

Right atrium and ventricle, left atrium and ventricle

Instrument used to measure lung capacities and volumes; one type is used to encourage deep breathing (incentive spirometry)

Spirometer

Harsh, loud, high-pitched. Narrowing of upper airway (larynx or trachea); presence of foreign body in airway

Stridor

Temperature of skin, changes with environment, controlled by sensors.

Surface Temperature

Detergent-like phospholipid that reduces surface tension of the fluid lining the alveoli. A surface tension-reducing lipoprotein found in the newborn's lungs that prevents alveolar collapse at the end of expiration and loss of lung volume.

Surfactant

_____________ can be given to the infant to reopen alveoli.

Synthetic surfactant

Ventricular contraction

Systole

Rapid rate of breathing

Tachypnea

_____________ is the body process that balances heat production and heat loss to maintain the body's temperature.

Thermoregulation

The ______________ comprises the lungs, rib cage, cartilage, and intercostal muscles.

Thorax

Atrioventricular valves

Tricuspid and mitral (S1)

T/F: Body temperature is controlled through negative feedback loops.

True. Rationale: When the body senses a change out of the norm, it activates mechanisms that oppose that change (vasodilation and sweating with increased temperatures; vasoconstriction and shivering with decreased temperatures). This is known as negative feedback. Positive feedback, on the other hand, senses a change but activates a mechanism that exaggerates the change.

Act of inhaling & exhaling air to transport oxygen to alveoli

Ventilation

Lower chambers of the heart

Ventricles

Low-pitched, soft sound during expiration heard over most of the lungs

Vesicular

__________ breath sounds are heard across the lung surface. Normal sound of respirations heard on auscultation over peripheral lung areas

Vesicular

Air moving in and out of lobes at alveolar level. Soft & breezy

Vesicular sounds

______________ are a whistling or rattling sound in the chest as a result of obstruction in the air passages. Continuous, high-pitched squeak or musical sound made as air moves through narrowed or partially obstructed airway passages

Wheezes

___________ are at a greater risk of developing heart disease after menopause due to the loss of estrogen.

Women