RESPIRATORY SYSTEM and its MANAGEMENT

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

characterized by airflow limitations that is not fully reversible COPD can co-exist with asthma. Both of these diseases have the same symptoms; however, symptoms are generally more variable in astma than in COPD.

Pathophysiology
Inflammatory response (occurs throughout the airways and pulmonary vasculature)

Narrowing in the small peripheral airways

Causes scar tissue formation and narrowing of the airway lumen

1. CHRONIC BRONCHITIS
a.

It is a disease of the airways; defines as the presence of cough and phlegm and sputum production for at least 3 months in each of 2 consecutive years Smoke or other environmetal pollutants irritate the airways hypersecretion of mucus and inflammation irritation mucus-secreting glands and goblet cells increase in no., reduced, ciliary function and production of more mucus thickening of the bronchial wall, narrowed bronchial lumens and mucus may plug the airways alveoli (adjacent to the bronchioles) may become damaged and fibrosed altered function of the alveolar macrophages

b.

CHRONIC BRONCHITIS

2. EMPHYSEMA
a)

b)

c)

d)

Impaired gas exchange (O2, CO2) resulting from the destruction of the walls of overextended alveoli. Pathological term that describes an abnormal distention of the air spaces beyond the terminal bronchioles, with destruction with walls of the alveoli. Destroyed walls of the alveoli inc. in dead space(lung area where no gas exchange can occur ) and impaired O2 diffusion Hypoxemia In the later stages of the disease: impaired CO2 elimination inc. CO2 tension in arterial blood (hypercapnea) respiratory acidosis breaking down of the alveolar walls reduction of the pulmonary capillary bed inc. pulmonary blood flow the ventricle is forced to maintain a higher blood pressure in the pulmonary artery hypoxemia (may further inc. pulmonary artery pressure)

EMPHYSEMA

Cont….

e.

Complications of Emphysema:
    

Right-sided heart failure Congestions Dependent edema Distended neck veins Pain in regions of the liver (development of cardiac failure)

Ty p e s o f
1.

Emphysema

PANLOBUBAR Destruction of the respiratory lobule, alveolar duct and alveoli All spaces at the lobular tube are essentially enlarged, but there is still inflammatory disease Hyperinflated chest, marked dyspnea on exertion, and weight loss. To move air in the lungs, negative pressure is required on inspiration and and adequate level of positive pressure must be attained and maintained during inspiration Instead of being an involuntary passive act, expiration becomes active and requires muscular effort. The patient becomes increasingly short of breath , the chest becomes rigid and the ribs

 

cont…. T y p e s o f E m p h y s e m a
CENTRILOBULAR Pathologic changes take place mainly at the center of the secondary lobule, preserving the peripheral portions of the acinus. There is derangement of ventilation-perfusion ratios, producing chronic hypoxemia, hypercannea, ploycythemia, and episode of right dsided heart failure leading to central cyanosis, peripheral edema and respiratory failure.

2.

Risks Factors
1. 2. 3.

Cigarette smoking: the most important risk factor Prolonged and intensed exposure to occupational dust and chemicals Indoor and outdoor condition add to the total burden of inhaled particles in the lung Deficiency of alpha 1-anitripsin  It is an enzyme inhibitor that protects the lung parenchyma from injury  It is one of the most common genetically –linked diseases Caucassian and affects the number of cases  The person with this is sensitive to environmental factors and in time, develops chronic obstructive symptoms  The carrier of these genetic defect must be identifies so that they can modify environmental risk factors to the delay or prevent overt symptoms of disease

4.

Clinical Manifestations
a) b) c)

d.

Cough Sputum production Dyspnea on exertion  May be severe and often interferes with eating, and the woork of breathing is energy depleting  Causes the patient`s inability to participate in mild exercise  Occurs even at rest Barreled chest thorax configuration: chronic hyperinflation  Results from fixation of the ribs in the inspiratory position (due to hyperinflation and from loss of lung elasticity)  Destruction of the supraclavicular fossae occurs on inspiration, causing the shoulders to heave upward.  In advanced emphysema, the abdominal muscles also contract on inspiration

ASSESMENT and DIAGNOSTIC FINDINGS

Pulmonary function studies

a.

b.

Spirometry To evaluate air flow obstruction, which is determined by the ratio of Forced Expiratory Volume (FEV1)(Volume of air that the patient that can forcibly inhaled in 1sec.) to force vital capacity Results are expressed as an absolute volume and as % predicted using appropriate normal values for gender, age and height

Bronchodilator reversibility testing
a. b. c.

To rule out diagnosis of asthma To guide initial treatment The spirometry is is first obtained, then the patient is given an inhaled bronchodilator protocol, and finally spirometry is repeated. The pt demonstrates a degree of reversibility if pulmonary function values improves after administration of bronchodilator.

Cont…ASSESMENT and DIAGNOSTIC FINDINGS

Arterial Blood Gas measurements  It may be obtained to assess baseline oxygenation and gas exchange


X-ray Alpha – 1 Antitripsin Deficiency Screening

SPIROMETRY

Bronchodilator Reversibility Test

Arterial Blood Gas Measurements

Factors that determines the clinical course and survival of patients with

COPD
   


     

History of cigarette smoking Passive smoking exposure Age Rate of decline of FEV Hypoxemia Pulmonary artery pressure Resting heart rate Weight loss Reversibility of air flow obstruction Stressors that leads to exaccerbation Psychosocial factors

Complications
   

Respiratory insuffiency and failure Respiratory infections Pulmonary edema Cor pulmonale Spontaneous pneumothorax from rupture exomathous bleb Sleep-onset dyspnea and frequent or early-morning awekenings

MEDICAL MANAGEMENT
Pharmacologic Therapy A. Bronchodilators
 

Relieve bronchospasm Reduce airways obstruction by allowing increase O2 distribition throughout the lungs including ventilation and improving alveolar ventilation delivered through a metered-dose inhaler by nebulization via oral route in pill or liquid form Maybe be used prophylactically to prevent breathlessness by having the patient use them before an activity -Metered-dose inhaler (MDI)- a pressurized device containing aerosolized power of medication

cont…

Spacer • May be used to enhance deposition of the medication in the lungs and to help the pt coordinate activation of the MDI with inspiration • Comes in several designs but are all attached to the MDI and have a mouth piece at the opposite end • Hold the aerosol in the chamber until the pt inhales  Classes of Brochodilator  Beta-adrenergic agonists  Anti-cholinergic agents  Methylxanthines

B.

Corticosteroids

May be inhaled or systemic (oral or intravenous)

cont….

May improve symptomes A short trial of oral corticosteroids may be prescribes for pts with stage II or III COPD

Examples of Corticosteroids  Beclomethasone  Budesonide  Flunisolide  Fluticasone  Triamcinolone

OXYGEN THERAPY
a)

b)

c)

d)

It can be administered as long – term continous therapy, during exercise or to prevent acute dyspnea For pts with arterial O2 pressure of 55mm Hg or less room air, maintaining constant and adequate O2 saturation is associated with significantly reduced mortality and improve quality of life Nightime O2 therapy is recommended for pt who are hypoxemic while awake Intermittent O2 therapy is indicated for those who desaturate only during exercise or sleep

SURGICAL MANAGEMENT
a)

b)

BULLECTOMY • It is a surgical option for selected pts with bullous emphysema • May help reduce dyspnea and may improve lung function • It can be done thorascopically or via limited thoracotomy incision *BULLAE – enlarged air spaces that do not contribute to ventilation but occupy space in the thorax Lung volume reduction surgery • It is a treatment options for pt with homogeous disease or disease that is focused in one area and not widespread throughout the lungs • Removal of a portion of the diseased lung parynchema then functional tissue expands then improve elastic recoil of the lung and improve chest wall and diagphragmatic mechanics • It does not cure the disease but it may reduce dyspnea, improve lung function and improves the pt`soverall quality of life

cont
c)

• •

Lung transplantation It is a viable alternative f or definitive surgical treatment of end-stage emphysema It improves quality of life and functional capacity Specific criteria exist for several lung transporation: however, organs are short in supply and many pts die while waiting for a transplant

PULMONARY REHABILITATION
*Patient education  Breathing Exercise a) Inefficient breathing pattern may be changed to diaphragmatic breathing which reduces respiratory rates, increases alveolar ventilation and sometime help expel as much air as possible during expiration b) Through pursed lips breathing the pt is helped in controlling the rate and depth of respiration in prevention of the collapsed small airways and in slowing expiration c) It also promotes relaxation which helps the pt gain control of dyspnea and reduces feelings of panic

cont…PULMONARY REHABILITATION
 a)

b)

Breathing Muscle Exercise It is prescribed to help strenghten the muscles used in breathing The pt is required to be breath against resistance for 1015mins everyday. The resistance gradually increases so the muscle will become better condition. Activity Pacing Self-Care Activities a) The pt is encouraged to increase self-participation in selfcare activities b) The pt is taught to coordinate diaphragmatic breathing with activities such as walking, bathing bending or climbing stairs c) Fluids must be readily available, and the pt should begin the drink fluids without having to be reminded

cont…PULMONARY REHABILITATION

Physical Condition a) Includes breathing exercises and general exercises intended to conserve energy and increase pulmonary ventilation b) Graded exercise and physical conditioning programs using threadmills, stationary bike and measured level walk can improve symptoms and increase work capacity and exercise tolerance Oxygen Therapy a) It is supplied to the home in forms of compressed gas, liquid or concentrator systems b) Portable O2 systems allow the pt to exercise, work and travel c) Proper flow rate and required numbers of O2 must be well explained d) Smoking with or near the O2 is dangerous

BRONCHIECTASIS

 

It is a chronic, irreversible dilation of the bronchi and bronchiole It is considered a separate disease process from COPD It is usually localized, affecting the segment or lobe of a lung, most frequently the lower lobes

Pathophysiology
Inflammatory process w/ pulmonary infections damaged to the bronchial wall loss of supporting structure reduction of thick sputum obstruction of the bronchi permanently distended and distorted walls impaired mucociliary clearance inflammation and infection extended to the peribronchial tissues

BRONCHIECTASIS

Clinical Manifestations

a) b) c)

d)

Labored breathing Prolonged exhalation Engorged neck vains Wheezing

Assessment and Diagnostic Findings

PFT: most accurate means of assessment acute airway obstruction ABG: obtained if the pt can not perform pulmonary function maneuvers because of severe obstruction of fatigue; positive respiratory alkalosis

Medical Management

 

The pt is treated initially with the short-acting betaadrenergic agonist and corticosteroids O2 therapy If there is no response to treatments, hospitalization is required For tiring pts, mechanical ventilation is required

Nursing Management
 

 

Initial monitoring for the first 12-24 hrs Assessment of the pt`s skin turgor to identify signs of dehydration Monitoring of fluid intake Administration of IV Fluids Monitoring of the pt`s energy level, for it needs to be conserve Room should be quite and free of respiratory irritants Use of a non-allergenic pillows

RESPIRATORY THERAPY

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY

Oxygen Therapy

Is the administration of O2 at a concentration greater than that found in the enviromental athmosphere
a)
  

Indications
Change in the pt`s respiratory rate or pattern Hypoxemia – a decrease in the air arterial O2 tension in the blood Hypoxia – a decrease in O2 supply to the tissues

b)
 

Cautions in O2 therapy
O2 is a medication; except in emergency situations is only administered when prescribed by a physician Pt`s with respiratory conditions are given O2 therapy only to raise the arterial O2 pressure (PaO2) back to pt`s normal baseline, w/c may vary from 60-95mmHg It is important to observe for subtle indicators of inadequate oxygenation when O2 is administered by any method

RESPIRATORY cont…..NON-INVASIVE RESPIRATORYTHERAPY THERAPY
c) 1. 2. 3.

4.

Types of Hypoxia Hypoxemic Hypoxia – a decreased O2 level in blood resulting in decreased O2 diffusion into the tissues Circulating Hypoxia – hypoxia resulting from inadequate capillary circulation Anemic Hypoxia – a result of decreased effective hemoglobin concentration w/c causes a decrease in the O2 – carrying capacity of blood Histotoxic Hypoxia – occurs when the toxic substance such as cyanide, interferes with ability of tissue to use available O2

d)
  

O2 Toxicity
May occur when 2 high concentration of O2 (greater than 50%) is administered for an extended period (longer than 48hrs) Caused by over production of O2 free radicals, w/c are by-product of cell matabolism Antioxidants such as Vit. E, Vit.C, beta-carotene may help defend against O2 free radicals

RESPIRATORY cont…..NON-INVASIVE RESPIRATORYTHERAPY THERAPY

Signs and Symptoms of O2 Toxicity  Substernal discomfort  Paresthesia  Dyspnea  Restlessness  Fatigue  Malaise  Progressive respiratory difficulty  Alveolar infiltrates

e)

Suppression of Ventilation  Pts with COPD, thus stimulus for respiration is a decrease in blood O2 rather than elevation in CO2 level  O2 – induced hypoventilation is prevented by administering O2 at low flow rates (1-2 L/min).

RESPIRATORY THERAPY cont…..NON-INVASIVE RESPIRATORY THERAPY
f)

  

Methods of O2 Administration O2 is dispensed from a cylinder or pipe-insystem The use of O2 concentrates is another means of providing varying amounts of O2, especially in the home setting The appropriate form of O2 therapy is the best determine by the arterial blood gas level, w/c indicates the pt`s oxygenation status

g)

Types of O2 delivery system  Low-flow system- contribute partially inspired gas to the pt breathes 1. Nasal cannula – used when the pt requires low-medium concentration of O2 from w/c precise accuracy is most essential 2. Oropharyngeal Catheter – rarely but may be prescribed for short term therapy to administer low to medium concentrations of oxygen 3. Simple Mask- used for low to moderate concentration of O2 4. Partial Rebreathable Mask- have a reservoir that have a bag that must remain inflated during both inspiration and expiration 5. Non-rebreathable Mask- similar to rebreathable only it has 2 valves

NON-INVASIVE RESPIRATORY THERAPY RESPIRATORY THERAPY

NASAL CANULA

SIMPLE MASK

RESPIRATORY THERAPY

NON REBREATHABLE OROPHARYNGEAL

RESPIRATORY THERAPY


   

High flow systems provides the total amount of inspired air.
Venturi Mask- the most reliable and accurate method for delivering concentration of O2 through noninvasive means Transtracheal O2 Catheter – inserted directly into the thrachea for pts w/ chronic O2 therapy needs T-Piece – connect to the endotracheal tube and is useful in weaning pts from mechanical ventilation Aerosol Mask, Face Tents – used with aerosol devices (nebulizer) that can be adjusted for O2 concentration from 27% - 100% (0.27 – 1.00)

RESPIRATORY THERAPY

TRACHEA

VENTURI MASK

TRANSTRACHEAL O2 CATHETER

RESPIRATORY THERAPY

T-PIECE

FACE TENT

Nursing Management

The nurse should instruct the patient or family in the methods of administering O2 and informs the pt or family that O2 is available in gas. Liquid and concentrated forms. Humidity must be provided while O2 is used (except w/ potable devices) to counteract the dry, irritating effects of compressed O2 on the airway.

NON-INVASIVERESPIRATORY RESPIRATORY THERAPY THERAPY

Intermittent Positive Pressure Breathing (IPPB)

a)

  
b)

       

A form of assisted or controlled respiratory produced by a ventilatory apparatus in w/c compressed gas is delivered under positive pressure into a person`s airways until a preset pressure is reached. Indications Difficulty in raising respiratory secretions Reduced vital capacity w/ ineffective sleep breathing and coughing Unsuccessful trials of simpler and less costly methods for loosening secretions Complications Pneumothorax Mucosal dryness Inc intracranial pressure Hemoptosis Gastric distension Vomiting Hyperventilation Excessive O2 administration Cardiocascular problems

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY

Mini Nebulizer Therapy

a)

A hand held apparatus that dispenses a moisture agent or medications, such as bronchodilator or mucolytic, into microscopic particles and delivers it to the lungs as the patient inhales Indications  Similar to IPPB  Pt must be able to degenerate a deep breath without the aid of the positive pressure machine.  Diaphragmatic breathing is a helpful technique to prepare for proper use of mini nebulizer. b) Nursing Management  Instruct the patient to breath through the mouth taking slow, deep breaths, and then to hold the breath for a few seconds at the end of inspiration to increase intrapleural pressure and reopen collapsed alveoli, thereby increasing functional and residual capacity.  Encourage the patient to cough and to monitor the effectiveness of the therapy.

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY
 

Incentive Spirometry (Sustained Maximal Inspiration)
A method of deep breathing that provides visual feedback to help the patient inhale slowly and deeply to maximize lung inflation and prevent or reduce atelectasis.

a)

Two Types of Incentive Spirometry
Volume – The tidal volume of spirometer is set according to the manufacturer’s instructions. Flow – Same as the volume but it is not preset; contains a number of movable balls that are pushed up by the force of the breath and held suspended in the air while the patient inhales.

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY
b) Indications
Used after surgery especially thoracic and abdominal surgery  To promote the expansion of the alveoli and to prevent or treat atelectasis  More effective than IPPB because it maximizes the amount of air inhaled while maintaining relatively low airway pressures. c) Nursing Management  Placing the patient in the proper position.  Teaching the technique for using the incentive spirometer.  Setting realistic goals for the patient.  Recording the results of the therapy.

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY

Chest Physiotherapy

Includes the postural drainage, chest percussion and vibration and breathing exercises/ breathing retaining. Postural Drainage (Segmented Bronchial Drainage)
Uses specific positions that allow the force of gravity to assist in the removal of bronchial secretions Removes the secretions by coughing or suctioning. Because the patient usually sits in an upright position, secretion are likely to accumulate in the lower parts of the lungs. The nurse should instruct the patient to inhale bronchodilators and mucolytic agents, if prescribed, before postural drainage because these medications improve bronchial tree drainage.

a)
   

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY

Nursing Management

 



Nurse should be aware of patient’s diagnosis as well as the lung lobes or segments involved, the cardiac status and any structural deformities of the chest wall and spine. Postural drainage is done two to four times daily before meals to prevent nausea, vomiting and aspiration. Recommended sequence of positioning: position to drain the lower lobes first then position to drain the upper lobes. Make the patient comfortable as possible in each position and provide an emesis basin, sputum cup , and paper tissues. Instruct the patient to remain in each position for 10-15 minutes and breath in slowly through pursed lips to help keep the airway open so that secretions can drain in each position. If the patient cannot cough, the nurse may need to suction the secretions mechanically. If the sputum is foul smelling, it is important to perform postural drainage in a room away from other patients and/or family members and to use deodorizers unless contraindicated.

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY
b)

Chest Percussion and Vibration

• 

Percussion is carried out by cupping the hands and lightly striking the chest wall in rhythmic fashion over the lung segment to be drained.
Positions over chest drainage tubes, the sternum, spine, liver, kidneys, spleen or breasts ( in women) is avoided. Vibration is the technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration.



   1. 2. 3. 4. 5.

Nursing Management The patient should be comfortable, not wearing restrictive clothing and has not just eaten. Uppermost part of the lungs are treated first. Give medication for pain as prescribed. Stop treatment if any of the following occur: Increased pain Increased shorness of breath Weakness Light-headedness hemoptysis

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY

Breathing Retraining  Consists of exercise and breathing practices designed to achieve more efficient and controlled ventilation and to decrease the work of breathing  Usually don in patients with COPD and dyspnea.  Promotes muscle relaxation; relieves anxiety; eliminates ineffective, uncoordinated patterns of respiratory muscle activity; slows the respiratory rate and decreases the work of breathing. Types of Breathing a) Diaphragmatic breathing  Strengthens the diaphragm during breathing  Can become automatic with sufficient practice and concentration. b) Pursed-lip breathing  Improves oxygen transport  Induces a slow, deep breathing pattern  Assists the patient to control breathing even during periods of stress  Trains the muscle of expiration to prolong exhalation and increase airway pressure during aspiration, thus lessening the amount of airway trapping and resistance.

RESPIRATORY THERAPY NON-INVASIVE RESPIRATORY THERAPY

Nursing Management  Instruct the patient to breathe slowly and rhythmically in a relaxed manner and to exhale completely to empty the lungs.  Instruct the patient to concentrate on prolonging the length of exhalation rather than merely slowing the rate of breathing.  Minimize the amount of dust or particles in the air and provide adequate humidification.  Instruct the patient to have an adequate dietary intake to promote gas exchange and to increase energy levels.

INVASIVE RESPIRATORY THERAPY

I. ENDOTRACHEAL I N T U B AT I O N AND TRACHEOSTOMY

Endotracheal Intubations  Involve passing an endotracheal tube through the mouth or nose into the trachea.  Nurses should be aware that complications could occur from pressure in the cuff in the tracheal wall.  May be used for no more than three weeks.
   

  

Disadvantages of Endotracheal Tubes Causes discomfort Depression of cough reflex Secretions tend to become thicker because the warming and humidifying effect of the upper respiratory tract that has been bypassed. Depressed swallowing reflex Development of laryngeal laceration and stricture. Inability to talk and communicate needs.

Cont…ENDOTRACHEAL INTUBATION AND TRACHEOSTOMY

Prevention or Removal of Tube by the patient  Explain to the patient and family the purpose of the tube  Distract the patient through one-to-one interaction with the nurse and family or with television  Maintain comfort measures.  As a last resort, soft wrist restraints may be used.

Tracheostomy A surgical procedure in which an opening is made into the trachea. Procedure Performed in the operating room or intensive care unit where the patient’s ventilation can be well controlled and optimal aseptic technique can be maintained. The cuff is an inflatable attachment to the tracheostomy tube that is designed to occlude the space between the trachea walls and the tube to permit effective mechanical ventilation and to minimize the risk of aspiration.

 a)

b)

Cont…ENDOTRACHEAL INTUBATION AND TRACHEOSTOMY

Complications a) Early Complication  Bleeding  Pneumothorax  Air embolism  Aspiration  Subutaneous or mediastinal emphysema  Recurrent laryngeal nerve damage  Posterior tracheal wall penetration b) Long term complications  Airway obstruction  Infection  Rupture of the innominate artery  Dysphagia  Tracheoesophageal fistula  Tracheal dilation  Tracheal ischemia  Necrosis

Cont…ENDOTRACHEAL INTUBATION AND TRACHEOSTOMY

POST OPERATIVE NURSING MANAGEMNET a) After the vital signs are stable, the patient is placed ina semifowlers position to facilitate ventilation, promote drainage, minimize edema, prevent strain on the suture lines b) Analgesic and sedative agents must be administered with caution because of the risk of suppressing the cough. b) Suctioning the Tracheal Tube a) it is usually necessary to suction the pt`s secretion because of the decreased effectiveness of the cough mechanism. b) it is performed when adventitious breath sounds are detected or whenever secretions are obviously present. c) an in-line suction device allows the pt to be suctioned w/o

Cont…ENDOTRACHEAL INTUBATION AND TRACHEOSTOMY

MANAGING THE CUFF a) The cuff on the endotracheal or tracheostomy tube should be inflated. b) The pressure within the cuff should be the lowest possible that allows the delivery of adequate tidal volumes and prevents pulmonary aspiration. c) With long-term intubations, higher pressures may be needed to maintain an adequate seal.

Endotracheal

Intubation
Trachea

Endotracheal tube

Endotracheal tube and Laryngoscope inserted into the trachea

Laryngoscope

Tr a c h e o s t o m y

Intubation

Silicone air cuff tube

Tube inserted into the trachea

II. MECHANICAL VENTILATION
> > > > A positive or negative-pressure breathing device that can maintain ventilation and O2 delivery for a prolonged period. Need to control the pt`s respiration during surgery or during treatment of severe head injury Used to oxygenate the blood when the pt`s ventilatory efforts are inadequate Used to rest the respiratory muscle

Indications for mechanical ventilation  Thoracic or abdominal surgery  Drug overdose  Neuromuscular disorder  Inhalation injury  COPD  Multiple trauma  Shock  Multisystem failure  Coma

MECHANICAL VENTILATION

MECHANICAL VENTILATOR

cont… MECHANICAL VENTILATION
Classifications of Ventilators
a) Negative-Pressure Ventilators > exert a negative pressure on the external chest > decrease the intrathoracic pressure during inspiration during inspiration thereby allowing air to flow into the lungs and fill its volume > Indications: - Poliomyelitis - Muscular Dystrophy - Amyotrophic Lateral Sclerosis - Myasthenia Gravis > Types - Iron Lung (Drinker Respirator Tank) - used for ventilation - used intensively during polio epidemics in the past and polio survivors - Body Wrap (Pneumowrap) and Chest Cuirass (Tortoise Shell) - requires a rigid cage or shell to create a negative-pressure chamber around the thorax and abdomen. - has potential problem with proper fitting and system leaks

cont… MECHANICAL VENTILATION
 b) 

  a.

b.

c.

Classifications of Ventilators Early Complication Positive-Pressure Ventilators Airway obstruction inflate the lungs by exerting positive pressure on the airway, forcing alveoli to expand during inspiration used at home for pts with primary lung disease Dysphagia Types: Time-Cycled Ventilators - terminate to control inspiration after a preset time - have a rate control that determines the respiratory rate, but pure time cycling is rarely used for adult Volume-Cycled Ventilators - most commonly used today - the volume to be delivered with each inspiration is present - the volume of air delivered by the ventilator is relatively constant, ensuring consistent, adequate breaths. Noninvasive Positive-Pressure ventilators - eliminate the need for endotracheal intubations or tracheostomy

the

cont… MECHANICAL VENTILATION
d.

Bilevel Positive Airway Pressure Ventilators - offers independent control of inspiratory and expiratory pressure while providing pressure support ventilation -can be initiated by the pt or by the machine if it is programmed with a backup rate - most often used for pts who require ventilatory assistance at night, such as those with severe COPD or sleep apnea

Indications - Acute or Chronic respiratory Failure - Acute Pulmonary Edema - COPD - Congestive Heart Failure with sleep-related breathing disorder Contraindications - Have experienced respiratory arrest - Serious dysrhythmia - Cognitive impairmant - Head or facial trauma

cont… MECHANICAL VENTILATION

Adjusting the ventilators  Ventilator is adjusted so that the patient is comfortable and breathes “in sync” with the machine  Done if the patient`s arterial blood gas values will be satisfactory and there will be satisfactory and there will be little or no cardiovascular compromise Assessing the Equipments  The nurse is responsible for the patient and therefore needs to evaluate how the ventilator affects the pt`s overall status. Reminders in assessing the equipment a. Type of ventilator b. Controlling modes c. Tidal volume and rate settings d. FiO2 (Fraction of Inspired O2) e. Inspiratory pressured reached and pressure limit f. Sensitivity

cont… MECHANICAL VENTILATION
g. h. i. j.

k.
l. m.

Inspiratory-to-expiratory ratio Minute volume High settings (if applicable) Water in the tubing, disconnection or kinking of the tubing Humidifucation and temperature Alarms PEEP and/or pressure support level (if applicable)

 

Problems with the Mechanical Ventilation Complications a. Cardiovascular compromise b. Pneumothorax c. Pulmonary infection d. Bucking the ventilator causes: • Anxiety • Hypoxia • Increased secretions • Hypercapnea • Inadequate minute volume pulmonary edema

Bottle

System

C

C A = one-way bottle B =two-way

3 – way bottle system

cont… MECHANICAL VENTILATION

NURSING MANAGEMENT

Enhancing Gas Exchange a. Maintain alveolar ventilation and O2 therapy b. The nurse should include judicious administration of analgesics agents to relieve pain w/o supporting respiratory drive and frequent repositioning to diminish the pulmonary effects of immobility Promoting Effective Airway Clearance a. Asses for presence of secretions by lung auscultation at least 2-4hrs b. Humidification of the airway via the ventilator is maintained to help liquify the secretions c. Adrenergic or anticholinergic bronchodiators are dminstered to dilate the brionchioles Preventing Trauma and Infection a. Maintain the endotracheal or tracheostomy tube b. Position the ventilator tubing so that there is minimal pulling or distortion of the tube in the trachea c. Evaluate if there is presence of cuff leak d. Tracheostomy care is performed at least q8 and more frequently if needed e. Administer oral hygiene frequently because the oral cavity is a primary source of contamination of the lungs in the intubated and compromised pt.

cont… MECHANICAL VENTILATION

NURSING MANAGEMENT
 a. b. c.

Promoting Optimal Level of Mobility Assist a pt whose condition has become stable to get out of bed and to a chair as soon as possible If the pt cannot get out of bed, the nurse encourages the pt to perform active range of motion exercises every 6-8 hrs If the pt cannot perform the exercise, the nurse performs passive range of motion exercise every 8 hrs to prevent contracture and venous stasis Promoting Optimal Communication  Know the alternative way of communication like lip reading, pad or pencil or magic slate


a.

Managing and Monitoring Potential Complication
Alternative in Cardiac Function  Evaluate cardiac function by looking for signs and symptoms of hypoxia  If there pulmonary artery index and other hemodynamic values can be used to assess the pts status Barotrauma and Pneumothorax  Nurse should consider any sudden onset of changes in O2 saturation or respiratory distress to be a life-threatening emergency requiring immediate action

b.

cont… MECHANICAL VENTILATION

NURSING MANAGEMENT
c.

Pulmonary Infection  The nurse should report fever or a change in the co;or of sputum to the physician for follow-up.


a. b.

Weaning the Patient from the Ventilator
Respiratory muscles become weak or atrophied just after few days of mechanical ventilation, especially if utrition is inadequate Provide a high-fat diet because it produces less CO2 that CHO.


Weaning the Patient from Ventilator
Respiratory Weaning  The process of withdrawing the pt from dependence on the ventilator;  Three stages: - gradually remove from the ventilator; - from the tube; - from the O2 It is performed at the earliest possible time consistent with pt1s safety. Starts when pt is recovering from the acute stage of medical and surgical problems and when the cause of respiratory failure is sufficiently reversed.

 

cont… MECHANICAL VENTILATION

NURSING MANAGEMENT

 

Weaning the Patient from the Tube If the pt breaths spontaneously , maintain an adequate airway by instructing the patient to effectively cough up secretions, swallow and move the jaw. Contraindicated if there is a need to clear secretions STEPS: 1. Changing the tube to smaller size and replaced by cuffless tracheostomy tube 2. Changing to a fenestrated tube (a tube with an opening or window) 3. Switching to a smaller tracheostomy buttons

III. CHEST DRAINAGE SYSTEM
Used to remove accumulations of air and fluids from the pleural space  Used in treatment of spontaneous pneumothorax and trauma resulting in pneumothorax Types: a. Traditional Water Seal (Wet Suction) – has 3 chamber: a collection chamber, water seal chamber (middle chamber) and wet suction control chamber b. Dry Seal Water Seal (Dry Suction)- has 3 chambers: a collection chamber, water seal chamber (middle chamber) and wet suction chamber c. Dry Suction (One-way Valve System)- has one-way mechanical valve that allows air to leave the chest and prevents air from moving back into the chest

cont…CHEST DRAINAGE SYSTEM

Parts: a. Collection Chamber - located where the chest tbe inserted coming from the client connects to the system b. Water Seal Chamber  Tip of the tube is submerged in water to allow fluid and air to drain from the pleural space and prevents air from moving back into the chest as the patient inhales.  Water oscilates as the patient inhales and exhales (tidaling)  Intermittent bubbling in the water seal chamber is normal. However, continuous bubbling indicates an air leak. c. Suction Control Chamber  Regulates the amount of of negative pressure applied to the chest  Usually set at 20cm H2O  Gentle bubbling indicates that the suction system is working properly

cont…CHEST DRAINAGE SYSTEM

INTERVENTIONS 1. Monitor drainage from the collection chamber and notify the healthcare provider if drainage is ore than 100ml, bright red or has increase greatly. 2. Keep system below the patients chest level. 3. Assess for fluctuations in the water seal chamber. Absent fluctuations could indicate tube obstruction, presence of loops, malfunctioning or suction or lung re-expansion. 4. Report to the physician the presence of continuous bubbling in the water seal chamber. 5. Notify the physician if there is vigorous bubbling in the suction control chamber (possible air leak). 6. If the drainage system breaks, place tube in a bottle of sterile water, then replace the broken system. 7. If the chest tube is pulled out of the patient’s chest, pinch the opening and apply an occlusive dressing then notify the physician. 8. Maintain a clamp and sterile occlusive dressing at bedside. 9. Ask the patient to perform Valsalva maneuver when the chest tube s being removed.

CARDIOVASCULAR PROBLEM MANAGEMENT
Antonietta Rosemelinda C. Edra, RN, MAN (Lecturer)
Level III Coordinator

CARDIOVASCULA R DISORDERS

CARDIOVASCULAR DISORDERS
A. 

     

Angina (Angina Pectoris - Latin For Squeezing Of The Chest) is chest discomfort that occurs when there is a decreased blood oxygen supply to an area of the heart muscle. In most cases, the lack of blood supply is due to a narrowing of the coronary arteries as a result of arteriosclerosis. Clinical Manifestations of Angina: Giddiness, nausea and vomiting Profuse sweating Difficulty in breathing normally Rapid increase or irregular heart beats Loss in the skin’s pallor Relieved by rest and nitroglycerine:
     

S- substernal A - anterior chest V- vague (radiates) E- exertion-related R- relieved by rest and nitroglycerine S- short duration (less than 30mins)

ANGINA PECTORIS

cont….CARDIOVASCULAR DISORDERS
-

Angina:
 

Method of assessment: P – Provocative  “What activities bring on the pain?” Q- Quality  “What does the pain feel like R- region/radiation  “Does it radiate elsewhere?” S- severity  “How does the pain rate on the scale of 1-10?” T- timing/treatment  “When did the pain begin?”  “Hpw long does it last?”  “What do you do to relieve the pain?”  “Are these measures affective?”

cont….CARDIOVASCULAR DISORDERS
A.

B.

C.

TYPES OF ANGINA: Stable Angina Stable angina is the most prevalent type of angina, and is usually predictable as it exhibits a definite pattern. It is commonly induced by exercise or any other physical exertion like running or walking. The pain in the chest is generally relieved after resting for sometime. The pain usually lasts for 3 to 5 minutes, and medications help relieve the pain. The pain experienced in the chest may sometimes spread to other parts of the body such as arms, back and shoulders, etc. It can be responsible for increasing the risk of heart attack. Unstable Angina Unlike stable angina, unstable angina is not triggered by physical activities. It is more severe than stable angina and can occur even while resting. The chest pain can last for 10 or 15 minutes and can't be cured by rest or medications. It does not follow a regular predictable pattern like stable angina, and can be an indication of an imminent heart attack. Variant Angina Variant angina is also known as Prinzmetal's angina. Variant angina can occur while you are resting or sleeping. This type of angina can be relieved by taking appropriate medicines. It occurs usually between midnight and morning.

cont….CARDIOVASCULAR DISORDERS
D.

Nocturnal Angina Occurs only at night and is possibly associated with rapid eye movements (REM) sleep

E.

Angina Decubitus is a form of angina that occurs when a person is lying down (not necessarily during sleep). It occurs because the fluids in the body are redistributed in this position due to gravity, and the heart has to work harder.

F.

Intractable Angina

chronic, incapacitating angina unresponsive to intervention
G.

Post infarction Angina occurs after MI, when residual ischemia may cause episodes of angina

Precipitating factors of Angina Pectoris: 1. Exertion: vigorous exercise 2. Emotions: excitement, sexual activity 3. Eating heavy meals 4. Environment: exposure to cold

cont….CARDIOVASCULAR DISORDERS
D.

Medications  Vasodilators are medicines that act directly on muscles in blood vessel walls to make blood vessels widen (dilate).  Controlling high blood pressure Examples:  Propanolol  Metropolol  Nadolol  Atenolol  Pindolol  Esmolol  Calcium channel blockers often used to reduce systemic vascular resistance and arterial pressure Examples:  Amlodpine  Nifedipine  Nicardipine

cont….CARDIOVASCULAR DISORDERS

Platelet Aggregation Inhibitors
  

Aspirin ASA Dipyridamole Clopidogrel Ticlodipine Heparin sodium – inactivates thrombin and other clotting factors Warfarin sodium Dicumarol – inhibit hepatic synthesis of vit.K

Anticoagulants
 

cont….CARDIOVASCULAR DISORDERS

NURSING INTERVENTIONS IN DRUG THERAPY
Nitoglycerine Therapy Advise patient to:
        

Assume sitting or supine position when taking the drug

Take maximum 3 doses at 5-min interval
Gradual change of position to prevent orthostatic hypotension Sublingual route causes tingling or burning sensation w/c indicates drog is potent Avoid drinking alcohol Always carry 3 tablets in their pocket Change stock of medication every 3months Observe closely for side effects Transderm route: applied OD in the morning or at night to prevent tolerance

Beta adrenergic Blockers Advise patient to:
  

Assess pulse before taking the medication Take it with food Take with extreme caution

cont….CARDIOVASCULAR DISORDERS
 

NURSING INTERVENTIONS IN DRUG THERAPY Calcium-channel Blocker  Assess heart rate and BP  Monitor hepatic and renal function  Administer 1hr before meals or 2hrs after meals. Food delays absorption.  Antidote: GLUCAGON NURSING INTERVENTIONS IN PATIENTS WITH ANGINA PECTORIS Promoting Comfort

 

Relieve pain
Nitroglycerine for pain Instruct pt not to over fatigue

Promoting Tissue Perfusion
 

Stop activity immediately once pain and dyspnea is felt
Encourage mild and slower activities Plan for activity program

Promoting activit yand rest
  

Take nitroglycerine before exercise

cont….CARDIOVASCULAR DISORDERS
 

NURSING INTERVENTIONS IN PATIENTS WITH ANGINA PECTORIS Facilitate Learning  Promote positive attitude and active participation of the family to encourage compliance Promoting Relief Of Anxiety And Feeling Of Well-being  Reduce level of anxiety  Advise to minimize emotional outburst  Maintain optimistic outlook Diet  Low Na, low fat, low cholesterol, high fiber diet  Avoid saturated fats  Encourage to white meats  Read labels Activity  Encouraged within patient`s limitations

MYOCARDIAL INFARCTION

CARDIOVASCULAR DISORDERS
B.

 


       

Myocardial infarction commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary to prolonged ischemia. This usually results from an imbalance in oxygen supply and demand, which is most often caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium.  Clinical manifestations: Pain, fullness, and/or squeezing sensation of the chest Jaw pain, toothache, headache Shortness of breath Nausea, vomiting, and/or general epigastric (upper middle abdomen) discomfort Sweating Heartburn and/or indigestion Arm pain (more commonly the left arm, but may be either arm) Upper back pain General malaise (vague feeling of illness) Acute pulmonary edema Elevated CK-MB,LDL, AST

CARDIOVASCULAR DISORDERS

3 areas w/c develop MI:  Zone of infarction w/c record pathologic Q wave in the ECG  Zone of injury w/c gives rise to the ST segment  Zone of ischemia w/c produces inversion of T wave

Medications  Anagesics  Thrombolytic therapy  Anticoagulants Treatment  Supplemental O2  Cardiac monitoring  Diet  Activity  Angioplasty may be done to re-open occluded artery

CARDIOVASCULAR DISORDERS

Nursing Interventions  Promoting Oxygenation And Tissue Perfusion  Promote comfort  Promoting activity  Promoting relief of anxiety and feeling of well-being  Facilitate learning

BLOOD TESTS FOR HEART DISEASES

Blood tests for heart disease  Introduction

Your blood offers many clues about your heart health. For example, high levels of "bad" cholesterol in your blood can be a sign that you're at increased risk of having a heart attack. And other substances in your blood can help your doctor determine if you have heart failure or are at risk of developing plaques in your arteries (atherosclerosis). It's important to remember that one blood test alone doesn't determine your risk of heart disease and that the most important risk factors for heart disease are smoking, high blood pressure, high cholesterol and diabetes.

cont….Blood tests for heart disease

Introduction
Your blood offers many clues about your heart health. For example, high levels of "bad" cholesterol in your blood can be a sign that you're at increased risk of having a heart attack. And other substances in your blood can help your doctor determine if you have heart failure or are at risk of developing plaques in your arteries (atherosclerosis). It's important to remember that one blood test alone doesn't determine your risk of heart disease and that the most important risk factors for heart disease are smoking, high blood pressure, high cholesterol and diabetes.

cont….Blood tests for heart disease
1. Complete blood count - a measurement of size, number, and maturity of different blood cells in a specific volume of blood. Red blood cells are important because they carry oxygen through the bloodstream to the organs and cells of the body. Having too few red blood cells can make a child feel tired, and having too many red blood cells may also indicate a problem. For example, children with cyanotic congenital heart disease may have high numbers of red blood cells in the bloodstream, in an effort by the body to provide enough oxygen to the organs. White blood cells multiply when inflammation or infection is present.

2. Electrolytes - minerals in the bloodstream such as sodium, potassium, calcium, and magnesium (that are important for the proper function of organs) may be measured. Electrolytes may be out of balance when a child is taking diuretics.

3. Total Protein And Albumin - these tests can help evaluate a child's nutritional status.

cont….Blood tests for heart disease
4. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), And International Normalized Ratio (INR) - tests done to evaluate the effectiveness of anticoagulant drugs (also known as blood thinners) taken for various heart problems, including artificial valve replacement and irregular heart rhythms.

5. Blood Gas - a blood sample taken from an artery that measures the amounts of oxygen and carbon dioxide in the bloodstream, as well as the acidity or pH of the blood.

6. Pulse Oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (similar to an adhesive bandage) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

cont….Blood tests for heart disease
7. Complete Blood Count  The CBC is one of the most common blood tests. It's often done as part of a routine checkup.  The CBC can help detect blood diseases and disorders, such as anemia, infections, clotting problems, blood cancers, and immune system disorders. 8. Coagulations Tests:
 

Prothrombin Time Blood Test-PT This test is done to evaluate the blood for its ability to clot. It is often done before surgery to evaluate how likely the patient is to have a bleeding or clotting problem during or after surgery. Normal PT Values: 10-12 seconds (this can vary slightly from lab to lab) Common causes of a prolonged PT include vitamin K deficiency, hormones drugs including hormone replacements and oral contraceptives, disseminated intravascular coagulation (a serious clotting problem that requires immediate intervention), liver disease, and the use of the anti-coagulant drug warfarin. Additionally, the PT result can be altered by a diet high in vitamin K, liver, green tea, dark green vegetables and soybeans.

 

cont….Blood tests for heart disease
 

 

Partial Thromboplastin Time Blood Test-PTT This test is performed primarily to determine if heparin (blood thinning) therapy is effective. It can also be used to detect the presence of a clotting disorder. It does not show the effects of drugs called “low molecular weight heparin” or most commonly by the brand name Lovenox. Normal PTT Values: 30 to 45 seconds (this can value slightly from lab to lab) Extended PTT times can be a result of anticoagulation therapy, liver problems, lupus and other diseases that result in poor clotting. Blood Urea Nitrogen test is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a by- product from metabolism of proteins by the liver, and therefore removed from the blood by the kidneys.

cont….Blood tests for heart disease
       


       

Blood Lipid Test Serum cholesterol Client should be NPO for 10-12 hrs Normal range: 150 – 200 mg/dl Serum tirglycerids Client should observe fasting 10-12hrs Normal range: 140 – 200 mg/dl Blood Cultures Assist on diagnosing infectious disease of the heart -eg: pericarditis Serum enzyme studies Aspartate Aminotransferase (AST) formerly, SGOT Elevated levels indicates tissue necrosis Normal range: 7-40 mu/ml Lactic Dehydrogenase (LDH) Normal range: 100-225mU/ml Range with MI:

Onset:12hrs

cont….Blood tests for heart disease
  

Hydroxybutyrate Dehydrogenase (HBD) Normal range: 140-359u Range with MI:  Onset:12hrs  Peaks: 48-72hrs  Returns to normal: 10-13days Troponin Most specific lab test Individual subunits serve different functions: Troponin C binds to calcium ions to produce a conformational change in TnI

    

Troponin T binds to tropomyosin, interlocking them to form a troponin-tropomyosin complex
Troponin I binds to actin in thin myofilaments to hold the troponin-tropomyosin complex in place

cont….Blood tests for heart disease
 

Urinalysis (UA) simply means analysis of urine. This is a very commonly ordered test that is performed in many clinical settings such as hospitals, clinics, emergency departments, and outpatient laboratories. Urinalysis is a simple test, which can provide important clinical information, it has a quick turn-around time, and it is also cost effective.


Blood uric acid test
measures the amount of uric acid in a blood sample. Uric acid is produced from the natural breakdown of your body's cells and from the foods you eat Normal range: 2.5-8mg/dl


Serologic test
any laboratory test involving serologic reactions, such as PRECIPITIN REACTION, AGGLUTINATION, or complement FIXATION, especially any such test measuring serum antibody titer Serum Electrolytes Tests Na, K, Ca – electrolytes affect cardiac contractility Normal range: Na-= 135 – 145 mEq/dl

  

K = 3.5 – 45.5 mEq/dl Ca = 4.5 – 5.5 mEq/dl

Cardiovascular Laboratory Tests

Cardiovascular Lab Tests
1. Electrocardiogram (EKG or ECG)

An electrocardiogram is a recording of the heart's electrical activity on a strip of moving paper. It is one of the first tests used to diagnose heart disease, although a normal EKG doesn't guarantee that the heart and coronary arteries are normal. Many patients receive EKGs prior to having surgery to make sure the heart is functioning normally.

2. Echocardiogram

An echocardiogram uses sound waves to produce pictures of the heart in motion. It is used to diagnose abnormalities of the heart valves, the heart muscle and the fluidfilled sac surrounding the heart.

3. Transesophageal Echocardiogram

A transesophageal echocardiogram is performed by positioning an ultrasound probe in the esophagus, behind and below the heart. It is used to diagnose the extent of heart valve disease and assess the effectiveness of valve repair or replacement surgery.

Electrocardiogram (EKG or ECG)

ECG strip

ECG machine

Electrodes

Echocardiogram

Ultrasound Probe Sample image

Ultrasound machine

Transesophageal Echocardiogram

Image taken Tip of probe

cont..Cardiovascular Lab Tests
4. Stress Testing

Stress testing helps your doctor evaluate your heart at rest, while your heart rate is increasing as you exercise on a treadmill or as a result of medication, and after your heart rate reaches its peak. The test can show how well the heart muscle is contracting and if portions of the heart muscle are deprived of blood. Your doctor may also order a stress test to determine the safety of an exercise program.

5. Nuclear Medicine

Nuclear scans of the heart involve injection of a radioactive isotope followed by one or two 30-minute scans under a gamma camera. Cardiac scans are helpful in finding coronary artery disease and can be used to:  detect heart attacks, by showing if part of the heart muscle has been damaged  measure the heart's pumping action  study the heart's ability to expand and contract  Nuclear scans are often done in conjunction with stress testing.

Stress Testing

Nuclear Medicine

cont..Cardiovascular Lab Tests
6. Holter Monitor Holter monitor is a continuous tape recording of a patient's EKG for 24 hours. Since it can be worn during the patient's regular daily activities, it helps the physician correlate symptoms of dizziness, palpitations (a sensation of fast or irregular heart rhythm) or black outs. Since the recording covers 24 hours, on a continuous basis, Holter monitoring is much more likely to detect an abnormal heart rhythm when compared to the EKG which lasts less than a minute. It can also help evaluate the patient's EKG during episodes of chest pain, during which time there may be telltale changes to suggest ischemia (pronounced is-keem-ya) or reduced blood supply to the muscle of the left ventricle. 7. Central venous pressure (CVP)

(also known as: right atrial pressure; RAP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. It is a good approximation of right atrial pressure,[1] which is a major determinant of right ventricular end diastolic volume. (However, there can be exceptions in some
[

Holter Monitoring

Central Venous Pressure

Central Venous Catheter Inserted into the vein

cont..Cardiovascular Lab Tests
7. Pulmonary Artery Pressure And Pulmonary Artery Wedge Pressure

Swan-Ganz catheterization is the passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs to monitor the heart's function and blood flow, usually in persons who are very ill Normal range: PAP = 4-12 mmHg 4-12 mmHg PCWP =

Nursing interventions: a. Inflate balloon only for PCWP readings deflate between readings b. Observe catheter insertion site: culture site every 48hrs as prescribed c. Assess extremity for color, Temperature, capillary filling and sensation. To observe signs and symptoms of circulatory impairment in the extremity involved.

Pulmonary Artery Pressure And Pulmonary Artery Wedge Pressure

cont..Cardiovascular Lab Tests
8. Radiologic Tests

8.
• 9. •

The chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest. An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging. Cardiac Flouroscopy Facilitates observation of the heart from varying views, while the heart is in motion Cardiac Catheterization (Heart Cath) Is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes. Subsets of this technique are mainly coronary catheterization, involving the catheterization of the coronary arteries, and catheterization of cardiac chambers and valves.

Cardiac Flouroscopy

Cardiac Catheterization ( Heart Cath )

Cardiac Catheter

cont..Cardiovascular Lab Tests
10. 

Angiography is a test that uses an injection of a liquid dye to make the arteries easily visible on X-rays. Angiogram

is commonly used to check the condition of blood vessels. There are alternatives nowadays to angiography, such as CT scan, MRI scans, nuclear scans, and ultrasound scans, which often produce information as accurate and useful as angiograms. An MRI (Or Magnetic Resonance Imaging) Scan
is a radiology technique that uses magnetism, radio waves, and a computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet. The patient is placed on a moveable bed that is inserted into the magnet. The magnet creates a strong magnetic field that aligns the protons of hydrogen atoms, which are then exposed to a beam of radio waves. This spins the various protons of the body, and they produce a faint signal that is detected by the receiver portion of the MRI scanner. The receiver information is processed by a computer, and an image is produced.

11. 

Angiography/Angiogram

Angiogram Catheter With Balloon

Surgeon inserting a guide catheter into an artery in the arm/groin

Magnetic Resonance Imaging

cont..Cardiovascular Lab Tests
12. 

Myocardial Scintigraphy is a simple, safe, and valuable noninvasive technique in evaluating the condition of patients with cardiac disorders. Images obtained at rest appear to have limited usefulness at the present time. However, rest imaging may prove to have advantages in the future for early diagnosis of myocardial infarction, thus aiding in the selection of patients to be admitted to the coronary care unit. Exercise imaging, on the other hand, has a high degree of sensitivity and specificity in detecting ischemic heart disease; when combined with treadmill exercise testing, imaging improves the diagnostic accuracy even further

Myocardial

Scintigraphy

cont..Cardiovascular Lab Tests

Intra-arterial blood pressure (IABP) measurement
is often considered to be the gold standard of blood pressure measurement. Whilst not without risk, it has a number of advantages over non-invasive blood pressure measurement (NIBP):

• it allows continuous beat-to-beat pressure measurement, useful for the close monitoring of patients whose condition may change rapidly, or those who require careful blood pressure control; for example those on vasoactive drugs • the waveforms produced may be analysed, allowing further information about the patient’s cardiovascular status to be gained (pulse contour analysis) • it may also be useful where NIBP measurement is difficult e.g. burns or obesity • it reduces the risk of tissue injury and neuropraxias in patients who will require prolonged blood pressure measurement • it allows frequent arterial blood sampling • it is more accurate than NIBP, especially in the extremely hypotensive or the patient with arrhythmias.

 

  

  

Intra-arterial Cardiac Pressure (IABP) Measurement

IABP monitor screen shot

Intra-arterial Catheter

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