Basic Human Needs Oxygenation Ventilation

1. Basic Human NeedsOxygenationVentilation/Perfusion

2. Basic Needs: Oxygenation Two body systems that work together to meet this basic need.Two body systems that work together to meet this basic need.

3. Oxygenation Oxygen is required to sustain life, primary basic human need The cardiac & respiratory systems function to supply the body’s oxygen demands Cardiopulmonary physiology involves delivery of deoxygenated blood to the right side of the heart & to the pulmonary system When we think about basic needs this is at the top of the list. If you cant find a bathroom you will find a place to go but you will continue to live. If your heart does not work or you are not breathing you are not able to sustain life.When we think about basic needs this is at the top of the list. If you cant find a bathroom you will find a place to go but you will continue to live. If your heart does not work or you are not breathing you are not able to sustain life.

4. What is the function of the cardiovascular system? to deliver oxygen and nutrients and to remove waste products of cellular metabolism through the cardiac pump, vascular system and the integration of other system. Tell me the flow of blood through the heart? superior vena cava, right atrium, tricuspid valve, right ventricle, semilunar valve, pulmonary artery (is the blood oxygenated here, it is an artery?), Lungs, pulmonary vein, left atrium, Mitral value, left ventricle, through the aortic valve into the aorta and the rest of the body. What part of the body does the heart feed with rich oxygenated blood first? coronary arteriesWhat is the function of the cardiovascular system? to deliver oxygen and nutrients and to remove waste products of cellular metabolism through the cardiac pump, vascular system and the integration of other system. Tell me the flow of blood through the heart? superior vena cava, right atrium, tricuspid valve, right ventricle, semilunar valve, pulmonary artery (is the blood oxygenated here, it is an artery?), Lungs, pulmonary vein, left atrium, Mitral value, left ventricle, through the aortic valve into the aorta and the rest of the body. What part of the body does the heart feed with rich oxygenated blood first? coronary arteries

5. What are the 2 mechanisms that drive the function of the heart? Electrical/conduction Mechanical/pump

7. Start of the cardiac cycle is with what? Spontaneous generation of action potential within the SA nodal tissue… So the SA node send out is impulse, this impulse then spreads throughout the artial muscle and leads to contraction of the two artia. As the atria contracts, the atrioventricular or AV valves remain open and the additional blood is forced in to the ventricles from the veins. The semilunar or aortic and pulmonary valves remain closed at this time. After the ventricles have filled and the atria has contracted the AV valves close as the ventricles begin their contraction. As this is happening he electrical stimulus is leaving in the AV node and going to the Purkinje Fibers to stimulate the ventricles. Ventricular contraction forces the blood through the semilunar valves, Where are the semilunar valves? Aortic and pulmonic……. Into the aorta and pulmonary trunk, as the ventricles relax the semilunar valves close, the AV valves open and the blood flows into the ventricles to begin another cycle. Start of the cardiac cycle is with what? Spontaneous generation of action potential within the SA nodal tissue… So the SA node send out is impulse, this impulse then spreads throughout the artial muscle and leads to contraction of the two artia. As the atria contracts, the atrioventricular or AV valves remain open and the additional blood is forced in to the ventricles from the veins. The semilunar or aortic and pulmonary valves remain closed at this time. After the ventricles have filled and the atria has contracted the AV valves close as the ventricles begin their contraction. As this is happening he electrical stimulus is leaving in the AV node and going to the Purkinje Fibers to stimulate the ventricles. Ventricular contraction forces the blood through the semilunar valves, Where are the semilunar valves? Aortic and pulmonic……. Into the aorta and pulmonary trunk, as the ventricles relax the semilunar valves close, the AV valves open and the blood flows into the ventricles to begin another cycle.

8. Coronary Artery Circulation Right Coronary Artery Left Coronary Artery Circumflex Coronary Artery Circulation is its own system. The coronary arteries are fill during ventricular diastole. The 2 main coronary arteries that branch off the aorta are the right and left coronary arteries, the left coronary artery divides into 2 branches the circumflex and the left anterior descending artery. The heart works very heard and has a large metabolic requirement, more so then the rest of the body that is why it needs it food first. Do you know that the heart consumes 80% of the oxygen that it is given compared to the rest of the body that only consumes about 25% of the oxygen that it is supplied. Coronary Artery Circulation is its own system. The coronary arteries are fill during ventricular diastole. The 2 main coronary arteries that branch off the aorta are the right and left coronary arteries, the left coronary artery divides into 2 branches the circumflex and the left anterior descending artery. The heart works very heard and has a large metabolic requirement, more so then the rest of the body that is why it needs it food first. Do you know that the heart consumes 80% of the oxygen that it is given compared to the rest of the body that only consumes about 25% of the oxygen that it is supplied.

9. Here we can see the front and back of the heart and where the coronary arteries run. With that it is important to know which coronary artery feeds which part of the heart. RCA- supplies blood to the right atrium…. What part if the electrical system is in the right atrium that will need this rich blood??? SA and AV node…., right ventricle, bottom portion of the left ventricle and the back of the septum LCA- circumflex artery- supplies the left atrium and the side and back of the left ventricle left anterior descending artery (LAD) supplies blood to the front and the bottom of the left ventricle and the front of the septum What part of the electrical system is there that needs this rich blood???? Purkinje Fibers.Here we can see the front and back of the heart and where the coronary arteries run. With that it is important to know which coronary artery feeds which part of the heart. RCA- supplies blood to the right atrium…. What part if the electrical system is in the right atrium that will need this rich blood??? SA and AV node…., right ventricle, bottom portion of the left ventricle and the back of the septum LCA- circumflex artery- supplies the left atrium and the side and back of the left ventricle left anterior descending artery (LAD) supplies blood to the front and the bottom of the left ventricle and the front of the septum What part of the electrical system is there that needs this rich blood???? Purkinje Fibers.

10. Another view of the coronary arteries.Another view of the coronary arteries.

11. So when we look at a blockage in a coronary artery we can tell by the ECG what are of the heart is being damage. This is a blockage of the middle portion of the LAD, What part of the heart does the LAD supple blood too????? ……..supplies blood to the front and the bottom of the left ventricle and the front of the septum and Purkinje Fibers. This creates and alternation in basic needs…… What basic need??? Oxygenation!!!!So when we look at a blockage in a coronary artery we can tell by the ECG what are of the heart is being damage. This is a blockage of the middle portion of the LAD, What part of the heart does the LAD supple blood too????? ……..supplies blood to the front and the bottom of the left ventricle and the front of the septum and Purkinje Fibers. This creates and alternation in basic needs…… What basic need??? Oxygenation!!!!

12. Systemic Circulation LV to aorta to arteries to arterioles to capillaries Oxygen exchange occurs at the capillary level Waste product exchange occurs here also and exits via venous system back to lungs Oxygenated blood leaves the heart via the left ventricle to the aorta and to the major arteries in the body. Smaller arteries branch, then those arteries branch off to arterioles and then finally into the capillaries, it is at the capillary sites that gases exchange occurs. The waste products exits the capillary network via the venules that join the form veins, veins carry deoxygenated blood to what side of the heart??? Right!!!!Oxygenated blood leaves the heart via the left ventricle to the aorta and to the major arteries in the body. Smaller arteries branch, then those arteries branch off to arterioles and then finally into the capillaries, it is at the capillary sites that gases exchange occurs. The waste products exits the capillary network via the venules that join the form veins, veins carry deoxygenated blood to what side of the heart??? Right!!!!

13. This picture attempts to capture the systemic circulatory system.This picture attempts to capture the systemic circulatory system.

14. Blood Flow Regulation Cardiac Output Cardiac Index Stroke Volume Ejection Fraction Cardiac Output The hearts overall performance. What is cardiac output????? The amount of blood ejected from the left ventricle each minute. CO=stroke volume x heart rate normal range is 4-6 l/min So if you have a decrease in circulating volume ie. Bleeding you will have a decrease in CO. CO changes according to oxygen and metabolic demand. Cardiac Index It is a cardiac measurement based on cardiac output, The difference is that cardiac index takes into account a persons body surface area, this is a more accurate measure of the hearts function per each individual and there metabolic needs. CI=CO/BSA normal is 2.5-4 l/minCardiac Output The hearts overall performance. What is cardiac output????? The amount of blood ejected from the left ventricle each minute. CO=stroke volume x heart rate normal range is 4-6 l/min So if you have a decrease in circulating volume ie. Bleeding you will have a decrease in CO. CO changes according to oxygen and metabolic demand. Cardiac Index It is a cardiac measurement based on cardiac output, The difference is that cardiac index takes into account a persons body surface area, this is a more accurate measure of the hearts function per each individual and there metabolic needs. CI=CO/BSA normal is 2.5-4 l/min

15. Stroke Volume Preload Myocardial Contractility Afterload Stroke Volume is effected by 3 things Preload Myocardial contractility Afterload Preload Degree of stretch of the ventricles during end diastolic volume, so we have a balloon here it is the stretch of the balloon as you blow air into it. Who law discusses this concept????? Frank-Starlings Law Myocardial Contractility Inherent ability of the myocardium to contract, poor contraction decreases the amount of the blood that is ejected from the ventricles to the lungs and the systemic circulation. Myocardial contraction can be increased by medication that increases the force of contraction such as digoxin. Afterload The resistance the left ventricle pushing against to eject the blood. So, what force is the left ventricle pushing against????? Systemic Vascular resistance…… So back to the balloon theory if we blow up the balloon and stick our fingers in it the air will come out slowly, the bigger the finger is the more resistance and more pressure that would be required to get the air out. If the ventricles are subjected to increased SVR for prolonged periods of time that will over work the muscle and cause it to become hypertorphied, over worked. So if we over stretch our balloon over and over again it looses its elasticity and is big and boggy.Stroke Volume is effected by 3 things Preload Myocardial contractility Afterload Preload Degree of stretch of the ventricles during end diastolic volume, so we have a balloon here it is the stretch of the balloon as you blow air into it. Who law discusses this concept????? Frank-Starlings Law Myocardial Contractility Inherent ability of the myocardium to contract, poor contraction decreases the amount of the blood that is ejected from the ventricles to the lungs and the systemic circulation. Myocardial contraction can be increased by medication that increases the force of contraction such as digoxin. Afterload The resistance the left ventricle pushing against to eject the blood. So, what force is the left ventricle pushing against????? Systemic Vascular resistance…… So back to the balloon theory if we blow up the balloon and stick our fingers in it the air will come out slowly, the bigger the finger is the more resistance and more pressure that would be required to get the air out. If the ventricles are subjected to increased SVR for prolonged periods of time that will over work the muscle and cause it to become hypertorphied, over worked. So if we over stretch our balloon over and over again it looses its elasticity and is big and boggy.

17. Conduction System Rhythmic relaxation & contraction of atria & ventricles Dependent on continuous transmission of electrical impulses Influenced by ANS (Sympathetic & parasympathetic) These impulses are generated and transmitted by way of the cardiac conduction system. The hearts conduction system generates the necessary action potentials that conduct impulses required to initiate the electrical chain of events that result in a heart beat. What makes up the electrical system in the heart????? SA node Internodal Fibers AV Node Purkinje Fibers The sympathetic nerve fibers can increase the rate of impulse generated and the speed of impulses generated in all parts of the atira and ventricles. The parasympathetic fibers from the Vegas nerve which decreases the heart rateThese impulses are generated and transmitted by way of the cardiac conduction system. The hearts conduction system generates the necessary action potentials that conduct impulses required to initiate the electrical chain of events that result in a heart beat. What makes up the electrical system in the heart????? SA node Internodal Fibers AV Node Purkinje Fibers The sympathetic nerve fibers can increase the rate of impulse generated and the speed of impulses generated in all parts of the atira and ventricles. The parasympathetic fibers from the Vegas nerve which decreases the heart rate

18. Conduction System Originates in the sinoatrial node (SA node) Intrinsic rate of 60-100 beats per minute Electrical impulses transmitted through atria along intra-nodal pathways to AV node It is the initiation of the cardiac cycle, it is the pacemaker of the heart, it is in the upper right atrium.It is the initiation of the cardiac cycle, it is the pacemaker of the heart, it is in the upper right atrium.

19. Conduction System AV node mediates impulses between atria & ventricles Intrinsic rate 40-60 beats per minute AV node assists atrial emptying by delaying the impulses before transmitting it through to the Bundle of His & Perkinje fibers The AV node works as the gait keeper to decide what impulses will come through. The works great when the patients is in Atrial Fibrulation and the SA node/atrium is firing and beating at 300-400 beats per minute. Also when the SA is not working the AV node will take over so the heart will still have an electrical stimulusThe AV node works as the gait keeper to decide what impulses will come through. The works great when the patients is in Atrial Fibrulation and the SA node/atrium is firing and beating at 300-400 beats per minute. Also when the SA is not working the AV node will take over so the heart will still have an electrical stimulus

20. Conduction System Intrinsic rate of Purkinje fibers 20-40 beats per minute EKG reflects the electrical activity of conduction system Normal Sinus Rhythm Physiology of NSR When the SA and AV node are not working the Purkinje fibers will take over and produce and stimulus and maintain a heart rate. The rate will be slow and the patient most likely will not feel well. Do you think your heart beating 20-30 beats per minute is enough to maintain the metabolic demand of the heart and body???? NoWhen the SA and AV node are not working the Purkinje fibers will take over and produce and stimulus and maintain a heart rate. The rate will be slow and the patient most likely will not feel well. Do you think your heart beating 20-30 beats per minute is enough to maintain the metabolic demand of the heart and body???? No

21. This is a picture of the electrical system and were they are in the heart.This is a picture of the electrical system and were they are in the heart.

22. Electrical Cycle Electrocardiogram reflects the electrical activity of the conduction system. This does not reflect the mechanical activity of the heart. Can you have electrical activity with not heart beat????? Yes PEA This is the picture of the electrical current through the heart for one beat. P wave- the electrical current through the atrium, atrial contraction through the atrium follows that impulse PR interval- represents the impulse travel time thru AV node bundle of his to the Purkinje Fibers, Normal interval is .12-.20 seconds, increased PR interval indicates a block in the transmission thru the AV node whereas a decrease or less then .12 indicates the source of electrical impulse is other than the SA node QRS Complex- electrical impulse thru ventricles, normal QRS .06-.12 ventricular contraction follows QRS complex ST segment - time between depolarization of the ventricles and repolarization of the ventricles T wave- is the resting period of the heart the heart cannot receive an electrical stimulus during this time. If so the heart can go into a lethal arrhythmia. This is ventricular repolarization. Changes in body’s electrolytes or curtain drugs can effect the QT interval. Drugs Amiodarone, Quindene, digitalis toxicity Electrolytes Hyperkalemia, hypercalcemia, Prolong the QT interval Electrocardiogram reflects the electrical activity of the conduction system. This does not reflect the mechanical activity of the heart. Can you have electrical activity with not heart beat????? Yes PEA This is the picture of the electrical current through the heart for one beat. P wave- the electrical current through the atrium, atrial contraction through the atrium follows that impulse PR interval- represents the impulse travel time thru AV node bundle of his to the Purkinje Fibers, Normal interval is .12-.20 seconds, increased PR interval indicates a block in the transmission thru the AV node whereas a decrease or less then .12 indicates the source of electrical impulse is other than the SA node QRS Complex- electrical impulse thru ventricles, normal QRS .06-.12 ventricular contraction follows QRS complex ST segment - time between depolarization of the ventricles and repolarization of the ventricles T wave- is the resting period of the heart the heart cannot receive an electrical stimulus during this time. If so the heart can go into a lethal arrhythmia. This is ventricular repolarization. Changes in body’s electrolytes or curtain drugs can effect the QT interval. Drugs Amiodarone, Quindene, digitalis toxicity Electrolytes Hyperkalemia, hypercalcemia, Prolong the QT interval

23. NSR Several regular complexes make NSRSeveral regular complexes make NSR

25. Respiratory Physiology Structure & Function Respiratory Gas Exchange Cells in the body obtain their energy from chemical reactions involving O2 and elimination of CO2. The lung provide this exchange in 3 steps: Ventilation Perfusion Diffusion Respirations can be altered by conditions or disease that change the structure and function of the lung. Cells in the body obtain their energy from chemical reactions involving O2 and elimination of CO2. The lung provide this exchange in 3 steps: Ventilation Perfusion Diffusion Respirations can be altered by conditions or disease that change the structure and function of the lung.

26. Structure & Function Ventilation-Process of moving gases into and out of the lung Requires coordination of the muscular & elastic properties of lungs & thorax as well as intact innervation Diaphragm-Major muscle of inspiration, innervated by phrenic nerve (3rd cervical vertebrae) Ventilation- Process of moving gases into and out of the lungs, This requires the coordination of the muscular and elastic properties of the lung and thorax Major muscles of inspiration- Diaphragm stimulated by phrenic nerve, So what do you think would happen if you severed your phrenic nerve???? In quiet breathing inspiration is activated chiefly by the diaphragm, which is attached to the bottom of the rib cage. The diaphragm is dome-shaped at rest but flattens out when contracted, sucking air in. It is helped by a set of muscles which attach between the ribs. Identify these muscles. In quiet breathing expiration does not require muscular contraction (it is brought about by gravity and elasticity). As the breathing rate increases muscles are used to supplement gravity & elasticity. Perfusion For perfusion, the distribution throughout the lung is largely due to the effects of gravity. Therefore in the upright position this means that the perfusion pressure at the base of the lung is equal to the mean pulmonary artery pressure Exchange of Respiratory gases Cellular respiration involves the breakdown of organic molecules to produce ATP. A sufficient supply of oxygen is required for the aerobic respiratory machinery of Kreb's Cycle and the Electron Transport System to efficiently convert stored organic energy into energy trapped in ATP. Carbon dioxide is also generated by cellular metabolism and must be removed from the cell. There must be an exchange of gases: carbon dioxide leaving the cell, oxygen entering. Animals have organ systems involved in facilitating this exchange as well as the transport of gases to and from exchange areas. Ventilation- Process of moving gases into and out of the lungs, This requires the coordination of the muscular and elastic properties of the lung and thorax Major muscles of inspiration- Diaphragm stimulated by phrenic nerve, So what do you think would happen if you severed your phrenic nerve???? In quiet breathing inspiration is activated chiefly by the diaphragm, which is attached to the bottom of the rib cage. The diaphragm is dome-shaped at rest but flattens out when contracted, sucking air in. It is helped by a set of muscles which attach between the ribs. Identify these muscles. In quiet breathing expiration does not require muscular contraction (it is brought about by gravity and elasticity). As the breathing rate increases muscles are used to supplement gravity & elasticity. Perfusion For perfusion, the distribution throughout the lung is largely due to the effects of gravity. Therefore in the upright position this means that the perfusion pressure at the base of the lung is equal to the mean pulmonary artery pressure Exchange of Respiratory gases Cellular respiration involves the breakdown of organic molecules to produce ATP. A sufficient supply of oxygen is required for the aerobic respiratory machinery of Kreb's Cycle and the Electron Transport System to efficiently convert stored organic energy into energy trapped in ATP. Carbon dioxide is also generated by cellular metabolism and must be removed from the cell. There must be an exchange of gases: carbon dioxide leaving the cell, oxygen entering. Animals have organ systems involved in facilitating this exchange as well as the transport of gases to and from exchange areas.

27. Work of Breathing is determined by degree of compliance of the lungs airway resistance presence of active expiration use of accessory muscles of resirationWork of Breathing is determined by degree of compliance of the lungs airway resistance presence of active expiration use of accessory muscles of resiration

30. Structure & FunctionWork of Breathing Degree of compliance of lungs Airway resistance Presence of active expiration Use of accessory muscles of respiration COMPLIANCE is the ability of the lung to stretch; its distensibility.   It represents the change in volume that occurs for a given change in pressure.  It is inversely related to ELASTASTICITY, the ability of the lung to recoil to its resting volume after the stretching force is released.  Elastance depends on the elastic tissue of the lung and chest wall. RESISTANCE of the airway opposes the flow of gases.  Air flow is characterized as Laminar when it is stream-lined, low velocity and follows Poiseuille's Law (see below); it is usually confined to the small peripheral airways. Air flow is characterized as TURBULENT when the movement of molecules of gas is disorganized; it occurs when velocity of flow exceeds a limiting value or when irregularities in the configuration of the airway preclude laminar flow. The diaphragm, a dome shaped structure that separates the thoracic and abdominal cavities, is the major muscle of respiration. The phrenic nerve innervates the diaphragm. The external and internal intercostal muscles elevate the ribs, increasing the anterior-posterior diameter of the thoracic cavity. Breathing may need to be assisted by other muscles, known as secondary or accessory muscles of respiration. These muscles may include the parasternal, scalene, sternocleidomastoid, trapezius, and pectoralis muscles. Accessory respiratory muscles do not function during normal ventilation, but may be needed in some respiratory disorders. COMPLIANCE is the ability of the lung to stretch; its distensibility.   It represents the change in volume that occurs for a given change in pressure.  It is inversely related to ELASTASTICITY, the ability of the lung to recoil to its resting volume after the stretching force is released.  Elastance depends on the elastic tissue of the lung and chest wall. RESISTANCE of the airway opposes the flow of gases.  Air flow is characterized as Laminar when it is stream-lined, low velocity and follows Poiseuille's Law (see below); it is usually confined to the small peripheral airways. Air flow is characterized as TURBULENT when the movement of molecules of gas is disorganized; it occurs when velocity of flow exceeds a limiting value or when irregularities in the configuration of the airway preclude laminar flow. The diaphragm, a dome shaped structure that separates the thoracic and abdominal cavities, is the major muscle of respiration. The phrenic nerve innervates the diaphragm. The external and internal intercostal muscles elevate the ribs, increasing the anterior-posterior diameter of the thoracic cavity. Breathing may need to be assisted by other muscles, known as secondary or accessory muscles of respiration. These muscles may include the parasternal, scalene, sternocleidomastoid, trapezius, and pectoralis muscles. Accessory respiratory muscles do not function during normal ventilation, but may be needed in some respiratory disorders.

32. Lung Compliance Ability of lungs to distend or expand in response to increased intra-alveolar pressure, the ease in which lungs are inflated Compliance is decreased in pulmonary fibrosis, emphysema Lung compliance is affected by surface tension of alveoli, surfactant lowers surface tension. Compliance Ability of lungs to distend or expand is in response to increase intra-alveolar pressure Disease process that cause a decrease in compliance Pulmonary edema Pulmonary fibrosis Fractured ribs Emphysema Compliance Ability of lungs to distend or expand is in response to increase intra-alveolar pressure Disease process that cause a decrease in compliance Pulmonary edema Pulmonary fibrosis Fractured ribs Emphysema

33. Airway Resistance Pressure difference between the mouth & the alveoli in relation to the rate of flow of inspired gas Airway resistance increased in airway obstruction, asthma, tracheal edema Airway Resistance Pressure difference in relation to the rate of flow of inspired gas Increased airway resistance Obstruction Asthma Tracheal edema If you have decreased lung compliance, leads to increased airway resistance, increase work of breathing, increased energy expenditure, body increase metabolic rate to meet the demand, increase need for oxygen, this turns onto a vicious cycle resulting in further deterioration of the lungs. Airway Resistance Pressure difference in relation to the rate of flow of inspired gas Increased airway resistance Obstruction Asthma Tracheal edema If you have decreased lung compliance, leads to increased airway resistance, increase work of breathing, increased energy expenditure, body increase metabolic rate to meet the demand, increase need for oxygen, this turns onto a vicious cycle resulting in further deterioration of the lungs.

34. Structure & Function Accessory Muscles Assist in increasing lung volume during inspiration Scalene & sternocleidomastoid (inspiration) COPD patients use these frequently Abdominal muscles Trapezius muscle and pectoralis play minor role Accessory Muscles Can increase lung volume during inspiration Abdominal Intercostals Neck Shoulders Patients with COPD frequently use these muscle to increase lung volume-prolonged use results in fatigue Accessory Muscles Can increase lung volume during inspiration Abdominal Intercostals Neck Shoulders Patients with COPD frequently use these muscle to increase lung volume-prolonged use results in fatigue

35. Pulmonary Circulation Move blood to and from the alveolocapillary membrane for gas exchange Begins at pulmonary artery which receives deoxygenated blood from RV Flow continues to PA to pulmonary arterioles to pulmonary capillaries where blood comes in contact with alveolocapillary membrane The blood that comes from the RV is poorly oxygenated venous blood this blood return is dependent of the pumping action of the right ventricle, which is 4-6 liters, What is that call, the pumping action of the right ventricle that produces 4-6L of blood. Cardiac output The flow is continuous from the PA thru pulmonary arterioles to the pulmonary capillaries where blood comes into contact with alveolocapillary membrane and gas exchange occurs, oxygenated rich blood then circulates thru the pulmonary venules to pulmonary vein to the left ventriclesThe blood that comes from the RV is poorly oxygenated venous blood this blood return is dependent of the pumping action of the right ventricle, which is 4-6 liters, What is that call, the pumping action of the right ventricle that produces 4-6L of blood. Cardiac output The flow is continuous from the PA thru pulmonary arterioles to the pulmonary capillaries where blood comes into contact with alveolocapillary membrane and gas exchange occurs, oxygenated rich blood then circulates thru the pulmonary venules to pulmonary vein to the left ventricles

36. Respiratory Gas Exchange Diffusion-movement of molecules from an area of higher concentration to areas of lower concentration (oxygen & CO2) Occurs at the alveolocapillary level Rate of diffusion affected by thickness of membrane Increased thickness: COPD, pulmonary edema, pulmonary infiltrates, effusions Patients with these disease process have increase thickness to alveolocapillary membrane slowing diffusion and thus slow gas exchange and impairs O2 delivery to tissues The surface of the membrane can be altered by chronic disease (emphysema) and acute injury (pneumo thorax) or surgery (lobectomy) Patients with these disease process have increase thickness to alveolocapillary membrane slowing diffusion and thus slow gas exchange and impairs O2 delivery to tissues The surface of the membrane can be altered by chronic disease (emphysema) and acute injury (pneumo thorax) or surgery (lobectomy)

37. Oxygen Transport Consists of lung & cardiovascular system Delivery depends on O2 entering lungs (ventilation) And blood flow to lungs & tissues (perfusion) Rate of diffusion V/Q ratio O2- carrying capacity Oxygen transport depends on many different factersOxygen transport depends on many different facters

38. Oxygen Transport O2 transport capacity affected by hemoglobin Oxyhemoglobin CO2 Transport-diffuses into RBC’s & is rapidly hydrated into carbonic acid The capacity of blood to carry O2 is influenced by the amount of dissolved O2 in plasma, amount of hemoglobin, and tendency of hemoglobin to bind to O2 The capacity of blood to carry O2 is influenced by the amount of dissolved O2 in plasma, amount of hemoglobin, and tendency of hemoglobin to bind to O2

39. Regulation Of Respiration CNS control rate, depth, & rhythm Change in chemical content of O2, CO2 can stimulate chemorecptors which regulate neural regulators to adjust rate & depth of ventilation to maintain normal Arterial Blood Gases. Chemoreceptors in the medulla, aorta and carotids sence changes in O2, CO2, and hydrgen can stimulate chemoreceptors which stimulate neural regulators to adjust rate and depth of ventilation to maintain normal blood levelsChemoreceptors in the medulla, aorta and carotids sence changes in O2, CO2, and hydrgen can stimulate chemoreceptors which stimulate neural regulators to adjust rate and depth of ventilation to maintain normal blood levels

40. Factors Affecting Cardiopulmonary Functioning Physiological Age Medications Stress Developmental Lifestyle Environmental Is the most extensive Age related problems with oxygenation like asthma and congenital conditions and like COPD in the elderly Medications that increase rate or decrease rate Body is under stress what happens flight or fight Premature babies Ones lifestyle smoking Environmental exposure to chemical or any other hazards, aspestosis.. Is the most extensive Age related problems with oxygenation like asthma and congenital conditions and like COPD in the elderly Medications that increase rate or decrease rate Body is under stress what happens flight or fight Premature babies Ones lifestyle smoking Environmental exposure to chemical or any other hazards, aspestosis..

41. Factors Affecting Oxygenation: Physiologic Any factor that affects cardiopulmonary functioning directly affects the body’s ability to meet O2 demands Physiologic factors include: decreased O2 carrying capacity, hypovolemia, increased metabolic rate, & decreased inspired O2 concentration Tell me some reasons you would have decreased O2 carrying capacity Anemia CO2 poisoning Decreased Inspired O2 Concentration Airway obstruction Decreased environmental O2 high altitudes Hypovolemia- Shock dehydration Extracellular fluid loss Reduced circulating volume Increased Metabolic Rate Result in increase O2 demand when body system cant meet this increased demand, this happens during Pregnancy Wound healing Fever Exercise Tell me some reasons you would have decreased O2 carrying capacity Anemia CO2 poisoning Decreased Inspired O2 Concentration Airway obstruction Decreased environmental O2 high altitudes Hypovolemia- Shock dehydration Extracellular fluid loss Reduced circulating volume Increased Metabolic Rate Result in increase O2 demand when body system cant meet this increased demand, this happens during Pregnancy Wound healing Fever Exercise

42. Conditions Affecting Chest Wall Movement Pregnancy Obesity Trauma Musculoskeletal Abnormalities Neuromuscular Disease CNS Alterations Influences of Chronic Disease Decreased room due to the abdomen putting pressure o the diaphragm Decreased lung volumes from being heavier and lower thorax pressure Trauma broken ribs kyphosis structural changes Myasthenea gravis, gullion-barre, polio Trauma involving the medula or spinal cordDecreased room due to the abdomen putting pressure o the diaphragm Decreased lung volumes from being heavier and lower thorax pressure Trauma broken ribs kyphosis structural changes Myasthenea gravis, gullion-barre, polio Trauma involving the medula or spinal cord

43. Alterations in Cardiac Functioning Disturbances in Conduction Altered Cardiac Output Impaired Valvular Function Impaired Tissue Perfusion (Myocardial) What is CO????? Force the ventricles push against to eject the blood. What condition can cause these alterations???? MI, congenital defects What is CO????? Force the ventricles push against to eject the blood. What condition can cause these alterations???? MI, congenital defects

44. Disturbances of Conduction Dysrhythmias-deviation from NSR Classified by cardiac response origin of impulse Tachycardia Bradycardia Supraventricular dysrhythmias Junctional dysrhythmias Ventricular dysrhythmias What can cause these dysrhythmias????? ETOH withdrawal, Caffeine, Tobacco, Valve abnormalities, Anxiety, Drug toxicity, Acid base disturbances Dysrhythmia occurs when the average adult heart rate falls below or rises above the normal range of 60 to 100 beats per minute. Cardiac dysrhythmia can be life threatening. Dysrhythmias can decrease CO Supraventricular Dysrhythmias Abnormal impulses that originate above the ventricles rate is greater then 160 Junctinoal dysrhythmias They are an ectopic beat, the site of impulse is above or below the AV node Ventricular Impulse is from the ventricle, QRS is wide and bizarre Do you think you would have a P-wave???? No were does the P wave generate They require immediate medical attention and are life threathening V tach, V fibWhat can cause these dysrhythmias????? ETOH withdrawal, Caffeine, Tobacco, Valve abnormalities, Anxiety, Drug toxicity, Acid base disturbances Dysrhythmia occurs when the average adult heart rate falls below or rises above the normal range of 60 to 100 beats per minute. Cardiac dysrhythmia can be life threatening. Dysrhythmias can decrease CO Supraventricular Dysrhythmias Abnormal impulses that originate above the ventricles rate is greater then 160 Junctinoal dysrhythmias They are an ectopic beat, the site of impulse is above or below the AV node Ventricular Impulse is from the ventricle, QRS is wide and bizarre Do you think you would have a P-wave???? No were does the P wave generate They require immediate medical attention and are life threathening V tach, V fib

45. How does this look what do you think know that you have seen NSR????How does this look what do you think know that you have seen NSR????

47. Altered Cardiac Output Left-sided heart failure Right-sided heart Failure Left sided heart failure-The impairment of the left ventricle due to elevated pressure and pulmonary congestion, blood ejected from the left ventricle drops greatly, then resulting in decrease CO Assessment Decrease activity tolerance, SOB, Dizziness, Confusion from hypoxia As the LV continues to fail the blood pools in the pulmonary circulation causing pulmonary congestion Assessment findings are Rales/crackles, Wheezes, Hypoxia, SOB on exertion and at rest , Cough (pink frothy sputum), Paroxysmal nocturnal dyspnea Right Sided Heart Failure-So what part of the heart is not working in right sided heart failure????? RV This is characterized by venous congestion in the systemic circulation. This is a result of pulmonary disease or ling term left sided failure. Assessment-Distended neck veins, Organomegaly, Dependent peripheral edema, Weight gain, Ascites, Elevated central venous pressure and right atrial pressure Treatment -Decrease Na and fluid intake, Decrease the need to increase oxygen demand, bed rest, diuretics ACE inhibitors, Nitrates, Beta blockers, Inotropics digoxinLeft sided heart failure-The impairment of the left ventricle due to elevated pressure and pulmonary congestion, blood ejected from the left ventricle drops greatly, then resulting in decrease CO Assessment Decrease activity tolerance, SOB, Dizziness, Confusion from hypoxia As the LV continues to fail the blood pools in the pulmonary circulation causing pulmonary congestion Assessment findings are Rales/crackles, Wheezes, Hypoxia, SOB on exertion and at rest , Cough (pink frothy sputum), Paroxysmal nocturnal dyspnea Right Sided Heart Failure-So what part of the heart is not working in right sided heart failure????? RV This is characterized by venous congestion in the systemic circulation. This is a result of pulmonary disease or ling term left sided failure. Assessment-Distended neck veins, Organomegaly, Dependent peripheral edema, Weight gain, Ascites, Elevated central venous pressure and right atrial pressure Treatment -Decrease Na and fluid intake, Decrease the need to increase oxygen demand, bed rest, diuretics ACE inhibitors, Nitrates, Beta blockers, Inotropics digoxin

48. Is right or left hearted failure???????Is right or left hearted failure???????

49. Impaired Valvular Function Stenosis -Stenosis of valves can cause ventricles to hypertrophy (enlarge) Obstruction of Flow Valve Degeneration Lead to Regurgitation of Blood It can be acquired or congenital It is characterized by stenosis (narrowing or hardening), obstruction, or valve degeneration. An one of these conditions can cause the blood to regurgitate or leak. The leaking of the valves can cause a murmur to be heard when auscultating heart tones. It can be acquired or congenital It is characterized by stenosis (narrowing or hardening), obstruction, or valve degeneration. An one of these conditions can cause the blood to regurgitate or leak. The leaking of the valves can cause a murmur to be heard when auscultating heart tones.

50. Valves

52. Impaired Tissue Perfusion: Myocardial Insufficient blood flow from coronary arteries to meet heart O2 demand Manifested as angina, MI Angina-transient imbalance between O2 supply & demand’ resulting in chest pain Atherosclerosis: most common cause of impaired blood flow to organs Angina can be stable or unstable, stable pain goes away with rest and medication NTG MI Q wave vs non Q waveAngina can be stable or unstable, stable pain goes away with rest and medication NTG MI Q wave vs non Q wave

53. Myocardial Ischemia Myocardial Infarction-sudden decrease in coronary blood flow or an increase in myocardial oxygen demand without adequate perfusion Infarction occurs because of ischemia (reversible) or necrosis (irreversible) of heart tissue The coronary artery becomes occluded or blood flow is seeverly decreased or stopped to the heart muscle Assessment-Chest pain, Does everyone one feel like they have an elephant on their chest??? No review women, SOB, Diaphoretic, EKG changes, Lab work Treatment Gold standard is to get pt to the cath lab to have the vessel opened up you want re-profussion to the heart muscle Depending on onset of pain you can use thromolytic therapy, clot busters angiomax or TPA Pt are also placed on medication to stop platelet aggregation integrilin plavix ASA Nitrates dilates the coronary artery promoting blood flow to the heart, decrease pre load and afterload Anticoagulation therapy heparin, Analgesics for pain MSO4, , beta blockers, Ace inhibitors, Antiarryhthias, Oxygen bedrestThe coronary artery becomes occluded or blood flow is seeverly decreased or stopped to the heart muscle Assessment-Chest pain, Does everyone one feel like they have an elephant on their chest??? No review women, SOB, Diaphoretic, EKG changes, Lab work Treatment Gold standard is to get pt to the cath lab to have the vessel opened up you want re-profussion to the heart muscle Depending on onset of pain you can use thromolytic therapy, clot busters angiomax or TPA Pt are also placed on medication to stop platelet aggregation integrilin plavix ASA Nitrates dilates the coronary artery promoting blood flow to the heart, decrease pre load and afterload Anticoagulation therapy heparin, Analgesics for pain MSO4, , beta blockers, Ace inhibitors, Antiarryhthias, Oxygen bedrest

54. Impaired Tissue Perfusion Cardiac perfusion Cerebral perfusion (TIA, CVA) Peripheral vascular perfusion Incompetent valves Thrombus formation Blood alterations (anemia) Blockages in any part of your cardiovascular system will cause impaired tissue perfussionBlockages in any part of your cardiovascular system will cause impaired tissue perfussion

56. Electrical Picture of an MI

57. Alterations in Respiratory Function Goal of ventilation is to produce a normal arterial CO2 tension (PaCO2) between 35-45mmHg and maintain normal arterial O2 tension (PaO2) between 95-100 Alterations affect ventilation or O2 transport Hyperventilation, Hypoventilation, Hypoxia

58. Alterations in Respiratory Function Hyperventilation- state of ventilation in excess of that required to eliminate the normal venous CO2 produced by cell metabolism Anxiety, infection, drugs or acid-base imbalance can produce hyperventilation Hyperventilation- stated of ventilation in excess of that required to eliminate the normal venous CO2 produced by the cell membrane Acute events of anxiety can lead to loss of consciousness from excess CO2 lossHyperventilation- stated of ventilation in excess of that required to eliminate the normal venous CO2 produced by the cell membrane Acute events of anxiety can lead to loss of consciousness from excess CO2 loss

59. Hyperventilation Lightheadedness Disorientation Dizziness Tachycardia Chest pain SOB Blurred vision Extremity numbness At times your body will cause you to hyperventilate to compensate for medibolic acidosis.At times your body will cause you to hyperventilate to compensate for medibolic acidosis.

60. Hypoventilation Alveolar ventilation is inadequate to meet body’s O2 demand PaCO2 elevates, PaO2 drops Severe atelectasis can cause hypoventilation Hypoventilation and COPD Hypo- alveolar ventilation is inadequate to meet bodies O2 demand or to eliminate sufficient CO2. elevate CO2 and a decrease in PAO2 Hypo- alveolar ventilation is inadequate to meet bodies O2 demand or to eliminate sufficient CO2. elevate CO2 and a decrease in PAO2

62. Hypoventilation Disorientation Lethargy Dizziness Headache Decreased ability to follow instructions Convulsions Coma Dysrhythmias, cardiac death In COPD patients excessive oxygen administration can result in hypoventilation In this population they have adapted to higher levels and their CO2 chemoreceptor's are essentially not functioning. Their stimulus to breath is a decreased PAO2. If excessive O2 is given the O2 requirement is satisfied and the stimulus to breath is negated. You should never give a COPD patient more then 2LNC until you know if they are a CO2 retainer or not.In COPD patients excessive oxygen administration can result in hypoventilation In this population they have adapted to higher levels and their CO2 chemoreceptor's are essentially not functioning. Their stimulus to breath is a decreased PAO2. If excessive O2 is given the O2 requirement is satisfied and the stimulus to breath is negated. You should never give a COPD patient more then 2LNC until you know if they are a CO2 retainer or not.

63. Hypoxia Inadequate tissue oxygenation at the cellular level Deficiency of O2 delivery or O2 utilization at cell level Causes: Decreased Hgb, diminished concentration of inspired O2, decreased diffusion poor tissue perfusion, impaired ventilation Hypoxia- what is that????? Hypoxia / hypoxemia is a condition in which there is an inadequate supply of oxygen in the blood. Thierefore there is not enough oxygen at the cellular level Hypoxia is caused by: A reduction in partial pressure of oxygen Inadequate oxygen transport The inability of the tissues to use oxygen Decreased hemoglobin level Diminished concentration of inspired oxygen Inability decreased diffusion of O2 from alveoli to blood pneumonia Poor tissue perfusion shock Impaired ventilation chest trauma Hypoxia- what is that????? Hypoxia / hypoxemia is a condition in which there is an inadequate supply of oxygen in the blood. Thierefore there is not enough oxygen at the cellular level Hypoxia is caused by: A reduction in partial pressure of oxygen Inadequate oxygen transport The inability of the tissues to use oxygen Decreased hemoglobin level Diminished concentration of inspired oxygen Inability decreased diffusion of O2 from alveoli to blood pneumonia Poor tissue perfusion shock Impaired ventilation chest trauma

64. Hypoxia Restlessness Inability to concentrate Decreased LOC Dizziness Behavioral changes Agitation Change in vital signs Cyanosis: Peripheral vs Central Pt. may have dyspnia, tachycardia, and cyanosis. Cyanosis-blue discoloration of skin and mucous membranes caused by presence of desaturated hemoglobin in capillaries. Peripheral cyanosis blue fingers, toes, and ear lobes extremities will be cold. Central cyanosis is a later sign and the pt. has had decreased levels of oxygen for awhile, you will see modeling and blue color on the trunk of the body and the tongue. This is a very late sign and is very serious.Pt. may have dyspnia, tachycardia, and cyanosis. Cyanosis-blue discoloration of skin and mucous membranes caused by presence of desaturated hemoglobin in capillaries. Peripheral cyanosis blue fingers, toes, and ear lobes extremities will be cold. Central cyanosis is a later sign and the pt. has had decreased levels of oxygen for awhile, you will see modeling and blue color on the trunk of the body and the tongue. This is a very late sign and is very serious.

66. Is this ????Is this ????

67. Other Factors Affecting Oxygenation Age Environmental Lifestyle Medications Stress Infection Developmental Infants premature with not enough surfactant or have congenital heart defects Toddlers- URI and air way obstruction from putting thing in their mouth School age and adolescents second hand smoke and smoking Young and Middle age adults- poor diet, lack of exercise Older adults- atherosclerotic changes, decreased chest wall compliance Lifestyle Nutrition Exercise Smoker Substance abuse Environmental Coal miners, asbestosis, 2nd hand smoke Stress and anxiety Infection Developmental Infants premature with not enough surfactant or have congenital heart defects Toddlers- URI and air way obstruction from putting thing in their mouth School age and adolescents second hand smoke and smoking Young and Middle age adults- poor diet, lack of exercise Older adults- atherosclerotic changes, decreased chest wall compliance Lifestyle Nutrition Exercise Smoker Substance abuse Environmental Coal miners, asbestosis, 2nd hand smoke Stress and anxiety Infection

68. Pediatric Differences Cardiac Functioning Oxygenation

69. Normal Changes of Aging Cardiovascular Vascular Pulmonary Renal

70. Nursing Process Assessment History Physical Exam Diagnostic Tests Blood Studies

71. Assessment: Nursing History Client’s ability to meet oxygen needs Pain Fatigue Smoking Dyspnea Orthopnea Environmental Exposure Respiratory Infections Allergies Health Risks Medications Cough Wheezing Altered breathing patterns

72. Physical Exam Inspection Palpation Percussion Auscultation

73. Inspection of Cardiopulmonary Status Cyanotic mucous membranes Pursed lip breathing Jugular neck vein distention Nasal faring Use of accessory muscles Peripheral or central cyanosis Edema Clubbing of fingertips Altered breathing patterns Pale conjunctivae

74. Is right or left hearted failure???????Is right or left hearted failure???????

77. Palpation Palpate for thoracic excursion PMI Palpation of peripheral pulses Palpation for skin temperature, capillary refill Palpation of lower extremities for peripheral edema

78. Auscultation Identification of normal and abnormal breath sounds Blood Pressure Heart sounds S1, S2 Abnormal heart sounds Murmurs Bruits

79. Diagnostic Tests EKG Holter Monitor Stress tests Echocardiogram Cardiac cath TEE Pulmonary function tests Chest x-ray Arterial blood gases Pulse ox Bronchoscopy Thoracentesis CT Scan/MRI Ventilation/Perfusion Scan

80. Bronchoscopy/Thoracentesis

81. Lab Studies Electrolytes Cardiac enzymes BNP Lipid Profile Coagulation Studies CBC Troponin D Dimer C reactive protein Sputum culture Throat culture AFB Cytology

82. Nursing Diagnosis Activity Intolerance Ineffective Tissue Perfusion Decreased Cardiac Output Impaired Gas Exchange Ineffective Airway Clearance Ineffective Breathing Pattern Fatigue Anxiety

83. Planning for Care Develop goals and outcomes Set Priorities Select appropriate interventions Collaborate Involve patient and family in care

84. Implementation:Health Promotion/Prevention Vaccinations Healthy Lifestyle Environmental pollutants

85. Implementation: Acute Care Dyspnea Management Airway Management Mobilization of Airway Secretions Maintenance and Promotion of Lung Expansion Maintenance and Promotion of Oxygenation Breathing Exercises Hydration

86. Dyspnea Management Treat underlying disease process and add additional therapies as needed: Pharmacological agents Oxygen therapy Physical techniques Psychosocial techniques

87. Airway Maintenance Mobilization of Secretions Hydration Humidification Nebulization Coughing techniques Chest PT Postural drainage Suctioning Artificial airways

92. Suctioning Oropharyngeal Nasopharyngeal Orotracheal Nasotracheal Tracheal

93. Promotion or Maintenance of Lung Expansion Positioning of patient Incentive Spirometer Chest tubes

99. Oxygen Therapy Goal is to prevent or relieve hypoxia Not a substitute for other treatment Treated as a drug Safety precautions

100. Methods of O2 Delivery Nasal cannula-1-4 liters/min Oxygen Mask-Simple face mask, Venturi mask, Non-rebreather face mask, Rebreather mask Home Oxygen Therapy

103.

106. Medications Affecting Cardiopulmonary Functioning Cardiovascular agents: Nitrates, Calcium Channel Blockers, Beta Blockers, ACE Inhibitors/Blockers Positive Inotropic Agents (Digoxin) Antiarrhythmic Agents Antilipemic Agents (Statins) Bronchodilators Cough suppressants/expectorants Benzodiazepines/Narcotics Diuretics Anticoagulants/Antiplatelet Agents

107. Acute MI Core Measureswww.the jointcommission.org Aspirin at arrival Aspirin prescribed at discharge ACE Inhibitor/ARB prescribed at discharge for left ventricular systolic dysfunction Adult smoking cessation counseling Beta Blocker prescribed at discharge Beta Blocker at arrival Thrombolysis within 30 minutes Statin prescribed at discharge Percutaneous coronary intervention within 90 minutes

108. Promoting Cardiovascular Circulation Positioning Medications Preventing venous stasis Cardiopulmonary Resusitation

109. Alterations in Ventilation COPD Asthma SIDS Acute Respiratory Distress Syndrome Pneumonia

110. Alterations in Perfusion Cardiomyopathy Congenital Heart Defects Coronary Artery Disease Deep Vein Thrombosis Heart Failure Hypertension Dysrhythmias Peripheral Vascular Disease Cerebral Vascular Accident Pulmonary Embolism Shock

111. Clicker Question During the first heart sound, S1 or “Lub”, what valves are closing? A. Aortic and pulmonic B. Tricuspid and mitral C. Aortic and mitral D. Mitral and pulmonic

112. Clicker Question Nursing care prior to cardiac catheterization includes all of the following except: A. Assess for allergy to iodine B. Evaluation of peripheral pulses C. Informed consent D. Clear liquids prior to the test

113. Clicker Question Treatment of suspected myocardial infarction (MI) includes: A. Oxygen, aspirin, morphine, nitroglycerin B. Acetaminophen, bedrest, EEG C. Oxygen, cardiac catheterization D. Mechanical ventilation, CEA levels, acetaminophen

114. Clicker Question Which of the following is an early sign of hypoxia? A. Pallor B. Restlessness C. Difficulty breathing D. Decreased heart rate

115. Clicker Question 3. When evaluating a postthoracotomy client with a chest tube, the best method to properly maintain the chest tube would be to: A. Strip the chest tube every hour to maintain drainage. B. Place the device below the client’s chest. C. Double clamp the tube except during assessment. D. Remove the tubing from the drainage device to check for proper suctioning. Answer: BAnswer: B

116. Clicker Question 2. A client with a tracheostomy has thick tenacious secretions. To maintain the airway, the most appropriate action for the nurse includes: A. Tracheal suctioning B. Oropharyngeal suctioning C. Nasotracheal suctioning D. Orotracheal suctioning Answer: AAnswer: A

117. To have a persons Heart in Your Hands!!!!