Kebutuhan dasar

manusia
oksigenasi
Basic Needs: Oxygenation
 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
What are the 2 mechanisms that
drive the function of the heart?
 Electrical/conduction  Mechanical/pump
Coronary Artery Circulation

 Right Coronary Artery

 Left Coronary Artery

 Circumflex
 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
 Blood Flow Regulation

 Cardiac Output

 Cardiac Index

 Stroke Volume

 Ejection Fraction
Stroke Volume

 Preload

 Myocardial Contractility

 Afterload
 Conduction System

 Rhythmic relaxation & contraction of atria & ventricles

 Dependent on continuous transmission of electrical impulses

 Influenced by ANS (Sympathetic & parasympathetic)

 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
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
 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
Electrical Cycle
NSR
 Respiratory Physiology

 Structure & Function

 Respiratory Gas
Exchange
 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)
Structure & Function
Work of Breathing
 Degree of compliance of lungs

 Airway resistance

 Presence of active expiration

 Use of accessory muscles of respiration

 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.
 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

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
 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
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
 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

 O2 transport capacity affected by hemoglobin

 Oxyhemoglobin

 CO2 Transport-diffuses into RBC’s & is rapidly hydrated into carbonic acid
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.
Factors Affecting Cardiopulmonary
Functioning
 Physiological
 Age
 Medications
 Stress
 Developmental
 Lifestyle
 Environmental
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
Conditions Affecting Chest Wall
Movement
 Pregnancy
 Obesity
 Trauma
 Musculoskeletal Abnormalities
 Neuromuscular Disease
 CNS Alterations
 Influences of Chronic Disease
Alterations in Cardiac Functioning

 Disturbances in Conduction

 Altered Cardiac Output

 Impaired Valvular Function

 Impaired Tissue Perfusion (Myocardial)

Disturbances of Conduction

 Supraventricular dysrhythmias  Dysrhythmias-deviation

from NSR
 Junctional dysrhythmias
 Classified by cardiac
 Ventricular dysrhythmias response origin of impulse

 Tachycardia

 Bradycardia
Altered Cardiac Output
 Right-sided heart Failure
 Left-sided heart failure
Impaired Valvular Function

 Stenosis
-Stenosis of valves can cause ventricles to hypertrophy (enlarge)

 Obstruction of Flow

 Valve Degeneration

 Lead to Regurgitation of Blood

Valves
 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

 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
Impaired Tissue Perfusion

Cardiac perfusion
Cerebral perfusion (TIA, CVA)
Peripheral vascular perfusion
Incompetent valves
Thrombus formation
Blood alterations (anemia)
Electrical Picture of an MI
 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

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

 Lightheadedness
 Disorientation
 Dizziness
 Tachycardia
 Chest pain
 SOB
 Blurred vision
 Extremity numbness
 Hypoventilation

 Alveolar ventilation is inadequate to meet body’s O2 demand

 PaCO2 elevates, PaO2 drops

 Severe atelectasis can cause

hypoventilation

 Hypoventilation and COPD

 Hypoventilation

 Disorientation
 Lethargy
 Dizziness
 Headache
 Decreased ability to follow instructions
 Convulsions
 Coma
 Dysrhythmias, cardiac death
 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

 Restlessness
 Inability to concentrate
 Decreased LOC
 Dizziness
 Behavioral changes
 Agitation
 Change in vital signs
 Cyanosis: Peripheral vs Central
Other Factors Affecting Oxygenation

 Age
 Environmental
 Lifestyle
 Medications
 Stress
 Infection
Pediatric Differences

 Cardiac Functioning

 Oxygenation
Normal Changes of Aging

 Cardiovascular
 Vascular
 Pulmonary
 Renal
 Nursing Process

Assessment
History
Physical Exam
Diagnostic Tests
Blood Studies
Assessment: Nursing History
 Client’s ability to meet  Environmental Exposure
oxygen needs  Respiratory Infections
 Pain  Allergies
 Fatigue  Health Risks
 Smoking  Medications
 Dyspnea  Cough
 Orthopnea  Wheezing
 Altered breathing patterns
Physical Exam

 Inspection

 Palpation

 Percussion

 Auscultation
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
    
           
 
                                        

Marked clubbing of the nails.

  

  

   
 25Clubbing

 
                                                                                                                               

Clubbing nails
Palpation

 Palpate for thoracic excursion

 PMI
 Palpation of peripheral pulses
 Palpation for skin temperature, capillary refill
 Palpation of lower extremities for peripheral edema
Auscultation

 Identification of normal and abnormal breath sounds

 Blood Pressure
 Heart sounds S1, S2
 Abnormal heart sounds
 Murmurs
 Bruits
Diagnostic Tests
 EKG  Pulmonary function tests
 Holter Monitor  Chest x-ray
 Stress tests  Arterial blood gases
 Echocardiogram  Pulse ox
 Cardiac cath  Bronchoscopy
 TEE  Thoracentesis
 CT Scan/MRI
 Ventilation/Perfusion Scan
Bronchoscopy/Thoracentesis
Lab Studies
 Electrolytes  Sputum culture
 Cardiac enzymes  Throat culture
 BNP  AFB
 Lipid Profile  Cytology
 Coagulation Studies
 CBC
 Troponin
 D Dimer
 C reactive protein
Nursing Diagnosis

 Activity Intolerance
 Ineffective Tissue Perfusion
 Decreased Cardiac Output
 Impaired Gas Exchange
 Ineffective Airway Clearance
 Ineffective Breathing Pattern
 Fatigue
 Anxiety
Planning for Care

 Develop goals and outcomes

 Set Priorities
 Select appropriate interventions
 Collaborate
 Involve patient and family in care
Implementation:
Health Promotion/Prevention
 Vaccinations

 Healthy Lifestyle

 Environmental pollutants
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
Dyspnea Management

 Treat underlying disease process and add additional therapies as

needed:
 Pharmacological agents
 Oxygen therapy
 Physical techniques
 Psychosocial techniques
 Airway Maintenance
Mobilization of Secretions

 Hydration
 Humidification
 Nebulization
 Coughing techniques
 Chest PT
 Postural drainage
 Suctioning
 Artificial airways
Suctioning

 Oropharyngeal

 Nasopharyngeal

 Orotracheal

 Nasotracheal

 Tracheal
 Promotion or Maintenance of Lung Expansion

 Positioning of patient

 Incentive Spirometer

 Chest tubes
 Oxygen Therapy

 Goal is to prevent or relieve hypoxia

 Not a substitute for other treatment

 Treated as a drug

 Safety precautions
 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


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
Acute MI Core Measures
www.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
Promoting Cardiovascular Circulation

 Positioning

 Medications

 Preventing venous stasis

 Cardiopulmonary Resusitation
Alterations in Ventilation

 COPD
 Asthma
 SIDS
 Acute Respiratory Distress Syndrome
 Pneumonia
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
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
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
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
Clicker Question

 Which of the following is an early sign of hypoxia?

 A. Pallor
 B. Restlessness
 C. Difficulty breathing
 D. Decreased heart rate
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.

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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

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