...RESPIRATION * Act of breathing * Supply the body with oxygen and remove carbon dioxide Types: a. External respiration – interchange of oxygen & carbon dioxide between alveoli & pulmonary blood b. Internal respiration – interchange of same gases between circulating blood & cells of body tissues VENTILATION * Movement of air in and out of the lungs Inhalation/Inspiration – intake of air into the lungs Exhalation/Expiration – breathing out or the movement of gases from the lungs to the atmosphere | Inhalation | Exhalation | Diaphragm | Contracts (flattens) | Relaxes | Sternum | Outward | Inward | Ribs | Upward & downward | Downward & inward | Lungs | Expand | Compressed | Two types of Breathing: 1. Costal/Thoracic breathing * Involves the external intercostal muscle and other accessory muscle * Observed by the movement of the chest upward and outward 2. Diaphragmatic/Abdominal breathing * Involves the contraction and relaxation of the diaphragm * Observed by the movement of the abdomen PARAMETERS OF RESPIRATION 1. Rate – normally described in breaths per minute. Normal adult: 12-20 bpm/cpm * Eupnea – normal respiration that is quiet, rhythmic, and effortless. * Tachypnea/Polypnea – rapid respiration, quick and shallow breaths (greater 20cpm) * Bradypnea – slow breathing (less than 12 bpm/cpm) 2. Depth – person’s respirations can be established by watching the movement of...
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... I. Factors Involved in Blood Circulation A. Blood Flow - the actual VOLUME of blood moving through a particular site (vessel or organ) over a certain TIME period (liter/hour, ml/min) B. Blood Pressure - the FORCE exerted on the wall of a blood vessel by the blood contained within (millimeters of Mercury; mm Hg) blood pressure = the systemic arterial pressure of large vessels of the body (mm Hg) C. Resistance to Flow (Peripheral Resistance) - the FORCE resisting the flow of blood through a vessel (usually from friction) 1. viscosity - a measure of the "thickness" or "stickiness" of a fluid flowing through a pipe a. V water < V blood < V toothpaste b. water flows easier than blood 2. tube length - the longer the vessel, the greater the drop in pressure due to friction 3. tube diameter - smaller diameter = greater friction D. Relation Between Blood Flow, Pressure, Resistance difference in blood pressure ( P) Blood Flow (F) = peripheral resistance (R) a. increased P -> increased flow b. decreased P -> decreased flow c. increased R (vasoconstriction) -> DECREASED flow d. decreased R (vasodilation) -> INCREASED flow II. Systemic Blood Pressure A. Blood Pressure Near the Heart ...
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...overview of care for the adult patient with sepsis, focusing on sepsis identification and the first 6 hours of goal-directed treatment according to current guidelines. Defining sepsis Sepsis is the presence of infection along with systemic manifestations of infection. If sepsis isn’t recognized and treated early, it progresses rapidly to severe sepsis, defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion. Sepsis-induced tissue hypoperfusion is defined as infection-induced hypotension, elevated lactate level, or oliguria.1 24 l Nursing2014 l April Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. www.Nursing2014.com D VOUGAO/iSTOCK sepsis www.Nursing2014.com April l Nursing2014 l 25 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Patients with severe sepsis may have low systolic or mean arterial pressure (MAP), a lactate level above 2 mmol/L, or a urine output of less than 0.5 mL/kg/hr for at least 2 hours despite adequate fluid...
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...Based on these desired outcomes, the nurse’s tasks centered around the following: • Ensuring that systolic blood pressure was at a level of at least 90, which was important not only as a measure of septic shock but also of adverse reactions to erythromycin or dopamine • Using interactions to ensure that the patient’s mental status and acuity were unchanged • Measuring capillary refill times to ensure that such times were below 3 seconds or trending in that direction • Checking urine output in order to determine whether there was an upward or downward trend, with a goal of at least 30 ml/hour output • Checking the color and warmth of the extremities • Ensuring the existence of a palpable peripheral...
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... Pathophysiology Initiation | * Decreased tissue oxygenation * Decreased intravascular volume * Decreased Myocardial contractility (cardiogenic ) * Obstruction of blood flow (obstructive) * Decreased vascular tone (distributive) * Septic (mediator release) * Neurogenic (suppression of SNS) | No observable clinical indications Decreased CO may be noted with hemodynamic monitoring | Compensatory | * Neural compensation by SNS * Increased HR and Contractiliy * Vasoconstriction * Redistribution of blood flow from nonessential to essential organs * Bronchodilation * Endocrine Compensation (RAAS, ADH, glucocorticoid release) * Renal reabsorption of sodium, chloride, and water * Vasoconstriction * Glycogenolysis | * Increased HR (EXCEPT NEUROGENIC) * Narrowed pulse pressure * Rapid, deep respirations causing respiratory alkalosis * Thirst * Cool,moist skin * Oliguria * Diminished bowel sounds * Restlessness progressing to confsion * Hyperglycemia * Increased specific gravity and decreased creatinine clearance. | Progressive | * Progressive tissue hypoperfusion * Anaerobic metabolism wih lactic acidosis * Failure of sodium potassium pump * Cellular edema | * Dysrhythmias * Decreased BP with narrowed pulse pressure * Tachypnea * Cold, clammy skin * Anuria * Absent bowel sounds * Lethargy progressing to coma * Hyperglycemia * Increase BUN, CREATININE, AND POTASSIUM * Respiratory...
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...steps, the patient will be provided the care he or she is entitled to. Obvious ascites with 3+ edema Ascites is the collection of fluid within the peritoneal cavity due to increased hydrostatic pressure from portal hypertension. Cirrhosis is the most common cause of ascites whereas ascites is the most common complication...
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...sepsis, and septic shock is key to early recognition. Early recognition allows for appropriate treatment to begin sooner, decreasing the likelihood of septic shock and life-threatening organ failure. Once sepsis is diagnosed, early and aggressive treatment can begin, which greatly reduces mortality rates associated with sepsis. sep•sis (ˈsep-səs) n. Sometimes called blood poisoning, sepsis is the body's often deadly response to infection or injury (Merriam-Webster, 2011) Sepsis is a potentially life-threatening condition caused by the immune system's reaction to an infection; it is the leading cause of death in intensive care units (Mayo Clinic Staff, Mayo Clinic 2010). It is defined by the presence of 2 or more SIRS (systemic inflammatory response syndrome) criteria in the setting of a documented or presumed infection (Rivers, McIntyre, Morro, Rivers, 2005 pg 1054). Chemicals that are released into the blood to fight infection trigger widespread inflammation which explains why injury can occur to body tissues far from the original infection. The body may develop the inflammatory response to microbes in the blood, urine, lungs, skin and other tissues. Manifestations of the systemic inflammatory response syndrome (SIRS) include abnormalities in temperature, heart, respiratory rates and leukocyte counts. This is a severe sepsis that arises...
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...inflammatory response syndrome Two or more of the following clinical signs of systemic response to endothelial inflammation: • Temperature > 38°C or < 36°C x Heart rate > 90 beats/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 ⋅ 109/l or < 4 ⋅ 109/l or the presence of more than 10% immature neutrophils In the setting (or strong suspicion) of a known cause of endothelial inflammation such as: • Infection (bacteria, viruses, fungi, parasites, yeasts, or other organisms) • Pancreatitis x Ischaemia x Multiple trauma and tissue injury x Haemorrhagic shock x Immune mediated organ injury x Absence of any other known cause for such clinical abnormalities Sepsis Systemic response to infection manifested by two or more of the following: • Temperature > 38°C or < 36°C x Raised heart rate > 90/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 × 109/l or < 4 × 109/l or the presence of more than 10% immature neutrophils Septic shock Sepsis induced hypotension (systolic blood pressure < 90 mm Hg or a reduction of >40 mm Hg from baseline) despite adequate fluid resuscitation Multiple organ dysfunction syndrome Presence of altered organ function in an acutely ill patient such that homoeostasis cannot be maintained without intervention Pathogenesis Systemic sepsis may complicate...
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...Courtesy of L E K A R SPECIAL EDITION Authors: Marino, Paul L. Title: ICU Book, The, 3rd Edition Copyright ©2007 Lippincott Williams & Wilkins ISBN: 0-7817-4802-X Authors Dedication Quote Preface to Third Edition Preface to First Edition Acknowledgments Table of Contents Section I - Basic Science Review Basic Science Review Chapter 1 - Circulatory Blood Flow Chapter 2 - Oxygen and Carbon Dioxide Transport Section II - Preventive Practices in the Critically Ill Preventive Practices in the Critically Ill Chapter 3 - Infection Control in the ICU Chapter 4 - Alimentary Prophylaxis Chapter 5 - Venous Thromboembolism Section III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia...
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...CNE V Continuing Nursing Education Objectives and instructions for completing the evaluation and statements of disclosure can be found on page 224. What Is Normal?' Evaluating Vital Signs Dehra Van Kuiken, Myra Martz Huth ital signs (VS) are indicators of physiological functioning and include temperature, respiratory rate, fieart rate (pulse), and blood pressure (BP). Health care professionals measure VS to assess, monitor, evaluate, and document an individual's physiological status or change in condition (Royal College of Nursing, 2011). Depending on the individual's condition, VS are monitored and recorded routinely by policy, tradition, or expert opinion, whether needed or not (Evans, Hodgkinson, & Berry, 2001; Zeitz & McCutcheon, 2006). Five years ago, pédiatrie nurse leaders and evidencebased practice (EBP) experts from children's hospitals across the country voiced concerns about the frequency of VS at a National Summit for Pédiatrie and Adolescent EvidenceBased Practice (Melnyk et al., 2007). This summit resulted in our team formulating a clinical question, searching for the evidence, critically appraising the evidence, and formulating conclusions on normal parameters. Before the question on the frequency of ys could be addressed, two fundamental questions needed exploration, and thus, became the focus of our work. The questions are: • Among pédiatrie patient ages 1 through 5 years, what are "normal" VS parameters? • Among pédiatrie patient ages 1 through 5 years...
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...REVIEW XIAN WEN JIN, MD, PhD Department of General Internal Medicine, The Cleveland Clinic JACQUELYN SLOMKA, PhD, RN Department of Bioethics, The Cleveland Clinic CAROL E. BLIXEN, PhD, RN Department of General Internal Medicine, The Cleveland Clinic Cultural and clinical issues in the care of Asian patients s A B S T R AC T Special problems of Asian patients have considerable impact on diagnosis and treatment, and the number of persons of Asian ancestry seen in primary care in the United States is increasing. Knowledge of how to provide optimal care despite language barriers, low socioeconomic status, different health beliefs and practices, and medical issues unique to this heterogeneous group is crucial to competent health care. with Asian patients include language barriers, low socioeconomic status, traditional health beliefs and practices, and epidemiologic issues. This article presents three case studies that illustrate how these problems can affect the health care of Asian patients, and describes ways to deal with them constructively. We also discuss what diseases are more common and what conditions have unique clinical aspects in this population. Asians: The fastest-growing minority Asians and Pacific Islanders are the fastest growing ethnic minorities in the United States, and are predicted to number more than 17 million by 2010.1 This heterogeneous population is from many cultures and speaks many languages—the 1990 US Census identified 25 distinct Asian...
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...systems allow for maintenance of heartbeat, blood pressure, breathing, digestion, excretion, thermoregulation, visual accommodation, and procreation. Automatic or involuntary processes occur due to the actions of organs, hormones from the endocrine system, and neuron communication from the nervous system. The portion of the nervous system that regulates these involuntary processes is aptly called the autonomic nervous system (ANS). The ANS is composed of afferent and efferent neurons that work to communicate messages to and from the brain and spinal cord, also known as the central nervous system (CNS). The...
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... venous stasis ulcers, PAD, acute arterial ischemia. (be sure to know the difference in venous and arterial disease!) PAD (thickening of the artery walls, which results in the progressive narrowing of the arteries of the upper and lower extremities) -risk factors: tobacco use (most important), hyperlipidemia, elevated high sensitivity C-reactive protein, diabetes (occurs much earlier), uncontrolled hypertension, increases with age, African Americans, 2 times higher in Mexican/Hispanic American women then white women -PAD is a marker for advanced systemic artherosclerosis** -atherosclerosis is the leading cause** -these patients are more likely to suffer from CAD and cerebral artery disease -artherosclerosis= migration and replication of smooth muscle cell, deposition of connective tissue, lymphocyte and macrophage infiltration, and accumulation of lipids -clinical symptoms occur when the vessel is 60 to 70 percent occluded Thoracic and Abdominal aortic aneurysms -aneuryisms happen more in men than women, increases with age - most occur as abdominal aortic aneurisms -thoracic= often asymptomatic, chest pain extending into interscapular area (most common symptom), hoarseness, dysphagia -abdominal= often asymptomatic, abdominal pain, back pain, pulsatile mass pre-umbilical and slightly to the left -abdominals a. are caused by artherosclerosis (male gender, over 65, high blood pressure, high cholesterol, and tobacco use are the risk factors) - growth rates of aneurysms...
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...Nursing Management of a Patient with Raised Intracranial Pressure after Traumatic Brain Injury and Dealing with Family Anxiety. Introduction The aim of this assignment is to explore, analyse and evaluate the nursing management of raised intracranial pressure (ICP) and family anxiety after head injury. In order to obtain a wider knowledge of the care of patients with raised ICP, a literature review was carried out. From this information I hope to improve the standard of care and ultimately patient outcome. The anxiety felt by family members are large and therefore I have decided to discuss this in my assignment. Consent has been sought from the next of kin. Confidentiality will be maintained in accordance with Nursing and Midwifery Council (NMC 2008). Patient’s Presentation Aldi is a 42 year old male who was found by police lying in the street, with loss of consciousness and believed to be assaulted. His eyes, lips and face was swollen. He was brought to the nearest hospital via ambulance as he had a seizure episode. In A&E it was noted that Aldi has sustained a head injury associated with a decrease level of consciousness and seizure activity. His pupils are both 2mm and reacting to light. His Glasgow Coma Scale (GCS) was 9-10. Opening eyes on pain, incomprehensible sound and moving all limbs. GCS is a worldwide recognized scale for documenting neurological assessment (Mavin,2008). After the initial presentation in A&E his neurological condition was rapidly...
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...Adult ACLS 2010 อ.นพ.อนทนนท อมสุวรรณโครงการจัดตัวรรณ โครงการจัดตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คดตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยงภาควชาเวชศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยรฉุกเฉิน คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์àeกเฉุกเฉิน คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์àeน คณะแพทยศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยร มหาวทยา"ยธรรมศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยร Key changes from the 2005 ACLS Guidelines Continuous quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal t ube placement Cardiac arrest algorithms are simplified and redesigned to emphasize the importance of hig h-quality CPR Key changes from the 2005 ACLS Guidelines Atropine is no longer recommended for routine use in the management of PEA/asystole There is an increased emphasis on physiologic monitoring to optimize CPR quality and detec t ROSC Key changes from the 2005 ACLS Guidelines Chronotropic drug infusions are recommended as an alternative to pacing in symptomatic and unstable bradycardia Adenosine is recommended as a safe and potentially effective therapy in the initial mana gement of stable undifferentiated regular mono morphic wide-complex tachycardia Topic in ACLS 2010 Management Management of Cardiac Arrest of Symptomatic Bradycardia and Tachycardia Management of Cardiac Arrest Management of Cardiac...
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