blood vessels containing blood flowing to the heart
veins
blood vessels containing blood flowing from the heart
arteries
from the right ventricle, deoxygenated blood is pumped through WHAT and then WHAT
pulmonary valve then pul artery
primary function of the respiratory system
gas exchange
right side
into the lungs
left side
system
main pump of the heart
left ventricle
lowest volume system; responsible for the gas exchange
capillaries
govern the flow of blood in the vascular system.
principles of blood flow- look over this in book
Pressure Difference/Resistance
flow
between two ends of a vessel
pressure difference
causes of resistance of blood flow
sickle cell anemia, peripheral artery disease, mi
Distance measurement speed at which blood flows through the vessel
velocity
heart rate should be
60-100
the smaller the lumen
the higher the flow
velocity, cross-sec, and flow
velocity=flow rate over cross sectional
The relationship between the wall tension of a vessel, its intraluminal pressure, and its radius
law of laplace
Ability of a blood vessel to be stretched and accommodate an increased volume of blood
distensibility
depolarization of atria
P
depolarization of ventricles
QRS
repolarization of ventricles
ST
QT interval
de and repolarization of ventricles
baseline is also the
isoelectric line
PR segment
Impulse travel through AVN
PR interval
Atrial depolarization and travel time
Slow repolarization of the Purkrnje fibers
U wave
QT interval
Total ventricular activity
occurs when the heart contracts to pump blood out
systole
occurs when the heart relaxes after contraction
diastole
Endothelial relaxing factors
nitric oxide
What is the of nitric oxide role and what pharmacological agent produces the effect of nitric oxide.
it is a vasodilator. helping blood vessels to relax and expand when necessary ; nitro glycerin
ACE I end in
pril
ARBS end in
sartan
humoral controls of blood flow
Norepinephrine Epinephrine Angiotensin II Histamine Serotonin Bradykinin Prostaglandins
causes vasoconstriction of blood vessels
norepi
causes more increase in heart rate and cardiac output through contractibility
epi
hormones made by the adrenal glands
Catecholamines
angiotension ii is a what
vasoconstriction
histamine is a what
vasodilator
plays major role in control of bleeding
serotonin
serotonin is a what
vasoconstrictor
bradykinin is a what
vasodilator
bradykinin causes
constriction of venules
dilation of arterioles
increased capillary permeability
Prostaglandin E group
vasodilators
Prostaglandin F group
vasoconstrictors
refers to increased levels of cholesterol in the blood.
Hypercholesterolemia
a genetic disorder that affects the body’s connective tissue.
marfan syndrome
marfan syndrome clinical manifestations
Long arms, legs and fingers Tall and thin body type Curved spine Chest sinks in or sticks out Flexible joints Flat feet Crowded teeth Stretch marks on the skin that are not related to weight gain or loss
is a recurring progressive, nonatherosclerotic inflammation and thrombosis of small and medium-sized arteries and veins, usually the plantar and digital vessels in the foot and lower leg.
Thromboangitis Obliterans (Buerger)
fingers become white due to lack of blood flow; turn blue to keep blood vessels dilate; turn red as blood returns
raynauds
what is the predominant symptom of Thromboangitis Obliterans
pain
dyspnea, stridor, or a brassy cough caused by pressure on the trachea.
Hoarseness may result from pressure on the recurrent laryngeal nerve, and there may be difficulty swallowing because of pressure on the esophagus
aneurysms of thoracic
abdominal aneuryms
Saccular aneurysm-sac on the vessel
Fusiform aneurysm- takes up whole blood vessel
slide 106
go over
“strangling of the chest”
temporary imbalance
Ischemia limited in duration
Angina pectoris
Moderate to prolonged exertion
Frequency, duration, and intensity
Activity tolerance
Treatment: Goal
stable angina
Umbrella term for conditions that cause chest pain due to insufficient blood supply to the heart muscle (acute myocardial ischemia).
acute coronary syndrome
risk factors for ACS non modifiable
Age
Gender
Family history
Ethnic background
risk factors for ACS modifiable
Cholesterol levels
Smoking
Physical inactivity
Hypertension
Serum homocysteine
Pain assessment for ACS?
History
Pain assessment
Cardiovascular assessment
Psychosocial assessment
Laboratory assessment
Radiographic assessment
Diagnostic assessments
Psychological assessment for ACS
(major defense mechanism) DENIAL
MONABATH
Morphine
Oxygen
Nitroglycerin
ASA
Beta-blockers
ACE-I
Thrombolytics
Heparin
Contraindications to thrombolytics….absolute
Active internal bleeding Known allergey to streptokinase products Recent head trauma Known bleeding discorders Suspected aortic dissection Increased BP 200/120 mm Hg Pregnancy or recent delivery CVA within past 2 months Recent spinal or cerebral surgery, cranial neoplasm Prolonged Cardiopulmonary resuscitation
Contraindications to thrombolytics….relative
Endocarditis or pericarditis
Hemostatic defects
Severe uncontrolled hypertension
Trauma within 10 days
Current use of oral anticoagulants
Active peptic ulcer disease
signs of infective endocarditis
osler node
janeway lesion
infection of the heart valves in the endocardium
infective endocarditis
involving pink rings on the torso and inner surfaces of the limbs which come and go for as long as several months. It is found primarily on extensor surfaces
Erythema Marginatum
sac surrounding the heart
pericardium
Acute Pericarditis: Clinical Manifestations
chest pain, friction rub, ecg changes
first-line therapy for acute perdicard
aspirin or NSAIDS
the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory or infectious process that includes pericarditis.
Pericardial Effusion
Cardiac Tamponade: Becks Triad
JUGULAR VENOUS DISTENSION, muffled heart sounds, low bp
right side heart failure clinical manifestations
congestion of peripheral tissue, liver congestion, gi tract congestion
left side heart failure clinical manifestations
decreased cardiac output, pulmonary congestion, impaired gas exchange, pulmonary edema
treating congestive heart failure
Upright position Nitrates Lasix- urinate less pressure in body Oxygen Ace i Digoxin Fluids - decrease Afterload- decrease Sodium restriction Test - Digoxin levels, ABGs, potassium levels
whats the main test for congestive hf
ABGs- blood test
compensatory mech for hf
slide 191
Loss of whole blood
Loss of plasma
Loss of extracellular fluid
hypovolemic shock
inability of the heart to maintain cardiac output necessary to meet body needs. extra strain on the heart causes decrease tissue perfusion
cardiogenic shock
respiratory airways
gas exchange takes place in alveoli
is used each day to humidify the air we breathe.
1 pint
why is it important to drink water when you have a fever
water vapors increase so you lose water in the resp tract; resp secretions thicken and this prevents the cilia from movement;impairing the protective function of the mucociliary defense system
what type of alveolar cells provide surface area for gas exchange
i
what type of alveolar cells provide surface tension; helps with destruction of pathogens; surfactant secreting
ii
slow down
parasym
flight or fight
sym
innervation of lungs airway constriction; increases respiratory secretions
parasym
How easily lungs can be inflated
compliance
Impedance to flow that the air encounters as it moves through the airways
airway resistance
what does gas exchange require
matching of ventilation and perfusion ; equal amounts of air and blood enter the respiratory portion of lung
the volume of air which is inhaled that does not take part in the gas exchange,
dead space
blood that moves from the left to the right side of the circulation without being oxygenated
shunt
ABG (partial blood gases)
ph 7.35-7.45
PCO2-35-45
HCO3- 22-26
PaO2- >80
pco2 is what
carbon dioxide
hco3
bicarbonate
Hemoglobin’s ability to bind oxygen
affinity
Hemoglobin binds oxygen more readily when its affinity is WHAT and releases it more readily when its affinity is WHAT
increased
decreased
Affinity is also influenced by
pH
Carbon dioxide concentration
Body temperature
a right shift in graph means
decreased oxygen affinityof hemoglobin allowing more oxygen to be available to the tissues.
a left shift in graph means
increased oxygenaffinity of hemoglobin allowing less oxygen to be available to the tissues
what nerve stimulates the diaphragm
phrenic nerve
3 upper respiratory viruses in adults
common cold
influenza
rhinosinusitis
Occur in early fall and late spring in persons between ages 5 and 40
rhinovirus
Occur in children younger than 3
parainfluenza
occur in winter and spring in children younger than 3
Respiratory syncytial virus
Occur in winter and spring
Coronaviruses and adenoviruses
facial pain, headache, purulent nasal discharge, decreased sense of smell, fever
acute rhino sinusitis
nasal obstruction, fullness in the ears, postnasal drip, hoarseness, chronic cough, loss of taste and smell, unpleasant breath, headache
chronic rhinosinusitis
influenza has 3 divisions what are they
URI- rhinotracheitis
viral pneumonia
respiratory viral infection followed by bacterial
how to differentiate between influenza and common cold
influenza is profound malaise
Transmission is by aerosol (three or more particles) or direct contact.
influenza
URI is a division of influenza (rhinotracheitis) a clinical manifestation
PROFOUND MALAISE
clinical manifestation of this division of influenza;
fever, tachypnea, tachycardia, cyanosis, hypotension
viral pneumonia
survivors of viral pneumonia might have what
stiffening of the lungs..not good
causative organisms of a Respiratory viral infection followed by a bacterial infection.
S. pneumoniae
S. aureus
H. influenza
M. catarrhalis
children with reyes syndrome should not be given what? and why
aspirin
kids being treated from a viral infection and fever and are given aspirin could result in reyes syndrome
Pneumococcal Pneumonia is caused by
s. pneumoniae
legionnaires disease is caused by
gram-negative rod, Legionella pneumophila.
characterized by patchy involvement of the lung alveolar septum and pulmonary interstitium
primary atypical pnemoniae
most causative organism of primary atypical pneumoniae
m. pneumoniae
community acquired pneumonia
infection that begins outside the hospital or is diagnosed within 48 hours after admission to the hospital in a person who has not resided in a long-term care facility for 14 days or more before admission.
most common cause of community acquired pneumonia
bacterial or viral
s. pneumonia
key components of VAP (ventilator associated pneumonia)
Elevation of the head of the bed
Daily “sedation vacations” and assessment of readiness to extubate
Peptic ulcer disease prophylaxis
Deep venous thrombosis prophylaxis
causative organism of tuberculosis
Mycobacterium tuberculosis hominis
type of necrosis tuberculosis will cause
caseous necrosis
clinical manifestations of pulmonary tb
night sweats, coughing up blood (hemoptysis)
what test is done for pulmonary tb
a culture OR The Mantoux tuberculin skin test (TST) or the TB blood test
how to know if tb is positive
read 48-72 hours after; looking for induration-how big is it, feel raised area, hard
histoplasmosis comes from
poop from birds; fungi H. capsulatum
what is the lung cancer called
Bronchogenic carcinoma; arises from epithelial cells of the lining
manifestations of lung cancer
coughing up blood, chest pain worse with deep breathing, hoarseness,
blueness
cyanosis
decrease in blood oxygen levels so not oxygenating tissues
hypoxemia
manifestations of hypoxemia
hypotension, bradycardia, retinal hemorrhage
PO2 less than than 60 mm Hg
hypoxemia
increase in carbon dioxide levels of the atrial blood; respiratory acidosis
hypercapnia
manifestations of hypercapnia
respiratory acidosis; sleepy; decrease muscle contraction (vasodilation)
PCO2 greater than 50 mm Hg
hypercapnia
lines the thoracic wall and superior aspect of the diaphragm.
parietal pleura
covers the lungs
visceral pleura
space between the two layers contains a thin layer of serous fluid.
pleural cavity
fluid in the pleural cavity
pleural effusion
serous fluid in the pleural cavity
hydrothorax
pus in the pleural cavity
empyema ; yogurt
what can happen in the body when pneumothorax occurs
medial stenum shift
Air enters the pleural cavity.
Air takes up space, restricting lung expansion.
pneumothorax
Incomplete expansion of the lung
Atelectasis
tachypnea, tachycardia, dyspnea, cyanosis, signs of hypoxemia, diminished chest expansion, absence of breath sounds, and intercostal retractions.
manifestations of atelectasis
treatment of atelectasis
chest tube to expand the lung
inflamed airways in lungs; makes them swollen and sensitive
asthma
when does cough occur for asthma
at night, sometimes in the early am
external environment causes it; mast cells release histamine as an inflammatory mediator
extrinsic atopic asthma
internal environment; Respiratory infections
Epithelial damage, IgE production
intrinsic nonatopic asthma
what can cause intrinsic asthma
smoking, medications, sulfites, viral cold
COPD types
emphysema
Chronic obstructive bronchitis
Bronchiectasis
affects the air spaces and destruction of lung tissue; destruction to alveoli
emphysema
increase muscus product; obstruction of airways
Chronic obstructive bronchitis
path of emphysema
α1-antitrypsin inactivates the trypsin before it can damage the alveoli.
A genetic defect in α1-antitrypsin synthesis leads to alveolar damage.
emphysema is aka
pink puffer
characteristics of pink puffer
increase co2, can get in, purse lip breathing, barrel chest,
chronic irritation of the airways; mucus hyper secretion; productive cough
chronic bronchitis
chronic bronchitis is aka
blue bloaters
Increase respiration to maintain oxygen levels
Dyspnea; increased ventilatory effort
Use accessory muscles; pursed-lip breathing
pink puffers; emphysema- prob w alveoli
Cannot increase respiration enough to maintain oxygen levels
Cyanosis and polycythemia
Cor pulmonale
blue bloaters ; bronchitis- mucus
right sided heart failure, is an enlargement of the right ventricle due to high blood pressure in the arteries of the lungs usually caused by chronic lung disease
cor pulmonae
MAIN lab test that indicates severity of heart failure and normal value
BNP test. brain natriuretic peptide
affects the cells that produce mucus, sweat, and digestive juices. It causes these fluids to become thick and sticky.
cystic fibrosis
high concentrations of sodium in sweat ; less sodium in resp mucus so it becomes thick
cystic fibrosis
what is a hallmark of cystic fibrosis
salty skin. Normally, salt is carried to the skin by perspiration. Once the skin is cool, the salts are reabsorbed into the body.
blood clot in the lung
pul emb
shortness of breath, anxiety, chest pain
pul em
most common form of WHAT DVT (deep venous thrombus)
pulmonary embolism
prevention of deep vein thrombosis
early ambulation
anticoagulant
TED hose
Pneumatic compression stockings or boots
what is considers pulmonary hypertension
elevated mean arterial is greater than 25 at rest
if it precedes lung or breathing problems it is considered what
cor pulmonale
Risk Factors Atherosclerosis non modifiable
male
Genetic disorders of lipid metabolism
Family history of premature coronary artery disease
increasing age
Risk Factors Atherosclerosis modifiable
Cigarette smoking Obesity Hypertension Hyperlipidemia with elevated low-density lipoprotein and low high-density lipoprotein cholesterol Diabetes mellitus
blackened of arteries, thickening of blood vessels
atherosclerosis
when does atherosclerosis happen
can begin in the late teens; rapid progressive around 30s
a peaked t wave is what
hyperkalemia (high potassium)
inverted t wave is what
ischemia
stretch on ventricle after diastole
preload
pressure that ventricles eject blood
after load
what is a side effect of pril
dry cough
for hyperlipidemia, what is optimal for LDL
<100
for hyperlipidemia, what total cholesterol is desirable
<200
for hyperlipidemia, what is the low and high of HDL
<40 -LOW
>60- HIGH
an irregular yellow patch or nodule on the skin, caused by deposition of lipids.
xanthoma
a condition marked by a line of opacity close to the border of the cornea, from which it is separated by a narrow band of clear cornea
arcus lipoides
t wave inversion
zone of ischemia
st elevation
zone of injury
abnormal q
zone of necrosis
Atherosclerotic blockages found in the lower extremities.
peripheral artery disease
manifestation of PAD
claudication
why is claudication important
atherosclerosis leads to restriction of blood flow, coronary disease and strokes. leads to pain in calf, heart attacks that reduces life expectancy
strongest risk factors of PAD
smoking and diabetes mellitus
intrinsic rate for sa node
60-100
intrinsic rate for av node
40-60
why is av node aka gatekeeper
impulse comes from SA node it holds onto that impulse for 1/10 of a second allows the atrium to squeeze in systole
intrinsic rate of perkingje fibers
20-40
help to hold the heart structure
chordinae tendinae and papillary muscles
STEMI
ST elevated MI
full thickness MI; taken up all three of layers
STEMI
not all three layers
NONSTEMI
actin and myosin
tip of actin is troponin
sacromere
unit of muscle cell
inhibits sliding action of the muscle to contract
troponin
electrolyte that helps move off the troponin so the two can contract
calcium
troponin are very specific to what
myocardial injury
if troponin are elevated what does this mean
sarcomere has been injured
4 characteristics of cardiac cell
excitability
automaticity
contractility
conductivity
2 things to have a heartbeat
mechanical and electrical activity