Download RT 101 A and P CV

RT 210
A&P
Cardiovascular
Blood is Composed of Plasma &
Cells
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Plasma
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About 90% water
About 10% solutes
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Proteins
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Albumin
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Thickens blood
Globulin
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Includes antibodies
Fibrinogen & Prothrombin
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Necessary for clotting
Blood is Composed of Plasma &
Cells
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Plasma (cont)
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Energy Molecules
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Glucose
Lipids
Amino acids
Blood is Composed of Plasma &
Cells
Plasmas (cont)
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Electrolytes use values from Egan text
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Sodium (Na+)
Chloride (CL-)
Bicarbonate (HCO3-)
Potassium (K+)
Calcium (Ca+)
Magnesium (Mg+)
Phosphate
Sulfates
Organic Acids
Normal Electrolyte Values
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Sodium (Na+)
135-145 mEq/L
Chloride (CL-)
96-105 mEq/L
Bicarbonate (HCO3-)
22-26 mEq/L
Potassium (K+)
3.5 - 5 mEq/L
Calcium (Ca++)
4.25-5.25 mEq/L
Magnesium (Mg++)
1.4-2.2 mEq/L
Blood is Composed of Plasma &
Cells
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Cells
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Erythrocytes- Red blood cells
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Produced in bone marrow
Contain hemoglobin
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Normally 12-18gms Hb/100ml blood
Normally higher in males
Hematocrit approx. 3 * Hb (normally 40-50%)
Hb carries O2
4.2-6.2 million RBCs per cubic mm
Blood is Composed of Plasma &
Cells
Cells (cont)
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Leukocytes: White blood cells
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Eosinophils
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Basophils
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Function in the immune mechanism
Polymorphonuclear neutrophils
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Phagocytes
Lymphocytes
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Secrete heparin
Mononuclear Monocytes
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Protects body from parasites & allergens
Phagocytes
Normally white count 5,000-10,000 white blood cells per cubic
mm
Blood is Composed of Plasma &
Cells
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Cells (cont)
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Platelets
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Plays a role in clotting
150,000-400,000 per cubic mm
Blood Makes Up the Intravascular
Fluid
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There is fluid in the body in 2 other
areas also
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Interstitial: between cells
Intracellular: within cells
Purpose of the Blood
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Transport respiratory gases
Circulate defenses (Leukocytes)
Nutrients to cells
Remove wastes from cells
Clotting
Electrolytes
Lab Norms
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RBC- Measures the total volume of RBCs
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Male 4.6 – 6.2 Million
Female: 4.2 – 5.4 Million
WBC: Measures the total volume of
WBCs
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Male / Female: 5,000 - 10,000
Lab Norms
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DIFF: Percentage of which should add
up to 100%
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Neutrophils – 40-75%
Lymphocytes – 20-45%
Monocytes – 2-10%
Basophils – 0-1%
Eosinophils – 0-6%
Lab Norms
HCT- Percentage of packed cell volume
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Male : 40-54%
Female: 38-47%
HGB: Measurement of amount of hemoglobin
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Male 14 - 18 gm
Female: 12 - 14 gm
SED Rate: Determines rate of fall in 1 hour of
RBCs.
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Male : 0 - 10 mm
Female: 0 - 20 mm
Lab Norms
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Finger--Puncture: (Bleeding Time)
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Measures amount of time takes for blood to
clot
Male / Female: 2 - 9 Minutes
Finger pinch check
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Pinch fingernail until it blanches
Checks for cardiovascular integrity
Lab Norms
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Finger--Puncture: (Bleeding Time)
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Measures amount of time takes for blood to
clot
Male / Female: 2 - 9 Minutes
Finger pinch check
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Pinch fingernail until it blanches
Checks for cardiovascular integrity
Clinical Laboratory Studies
Hematology
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Complete Blood Cell Count
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White Blood Cells
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Primary role is fighting infection.
Five types: neutrophil, basophil, eosinophil,
lymphocyte, and monocyte.
Clinical Laboratory Studies
WBC Differential
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Counts the number of each type of white cell
present in a known volume of blood.
Neutrophils normally make up 40% to 75% of the
total white cell count.
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They are produced in the bone marrow and have a life
span of about 10 days.
Neutrophils are released into the circulating blood by the
bone marrow when acute infection is present.
Neutrophils contain enzymes that destroy bacteria.
Clinical Laboratory Studies
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Eosinophils make up a very small part of
the total white cell count normally.
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They account for zero to 6% of WBCs.
Appear to help with allergic reactions
Are present in the sputum of asthmatics in
many cases
Clinical Laboratory Studies
Basophils also make up a small percent of the
total WBC (zero-1%)
Lymphocytes make up a significant portion of
the WBC.
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They fight against viral, fungal, and tuberculosis
infections.
They make up 20% to 45% of the circulating WBC
normally.
Lymphocytes come in two types: T cells and B cells.
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T cells are important for antibody production and
immunity.
Clinical Laboratory Studies
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Monocytes make up 2% to 10% of the
circulation WBC count.
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In the tissue the monocyte becomes a
macrophage.
Its primary role is phagocytosis of foreign
material.
White Blood Cell Abnormalities
Leukocytosis is present when the total white
cell count is elevated.
Leukocytosis caused by neutrophils is known
as neutrophilia.
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Neutrophilia is common with bacterial pneumonia
and other infections.
Acute neutrophilia caused by infection typically
results in an increase in the immature neutrophils
known as bands. This is called a left shift.
Pseudoneutrophilia occurs when marginated cells
are released into the circulation. This is common
with acute trauma and stress.
White Blood Cell Abnormalities
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Leukopenia is present when the total
white cell count is reduced.
Leukopenia caused by the lack of
neutrophils is known as neutropenia.
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Neutropenia is common when the bone
marrow fails or when a severe infection is
present and neutrophils are destroyed faster
than they are produced.
Neutropenia is an ominous sign.
White Blood Cell Abnormalities
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Lymphocytosis is present when the
circulating lymphocytes are elevated in
count.
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Caused by viral infections and infectious
mononucleosis.
Lymphocytopenia is seen with trauma
and acute infection.
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Is common with HIV patients
White Blood Cell Abnormalities
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Monocytosis is characteristic of chronic
infections including tuberculosis (TB),
syphilis, typhoid fever, and subacute
bacterial endocarditis.
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It is a sign of active disease in TB patients.
Red Blood Cells
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Produced in the bone marrow
Have a life span of about 120 days
Assume the shape of a biconcave disk to
facilitate carrying oxygen
Made up largely of hemoglobin
The portion of the total blood volume made up
by the formed elements such as red blood cells
is known as the hematocrit.
Red Blood Cells
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The amount of hemoglobin on the red cells is
measured and reported as the hemoglobin
count.
Special red cell indices are determined to
measure the size of the average red cell, and
the amount of hemoglobin present in the
average red blood cell of each patient. These
indices are important to interpret when
abnormalities are present.
Red Blood Cells
Red cell abnormalities
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Anemia is an abnormal decrease in the RBC count.
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Microcytic anemia indicates that the cells are too small.
Hypochromic anemia is present when the cells have
too little hemoglobin.
Anemia with normal red cells is termed
normochromic, normocytic anemia. It is common
with acute blood loss.
The most common cause of anemia is iron
deficiency.
Red Blood Cells
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Polycythemia is an abnormal increase in the
red cell count.
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Primary polycythemia is uncommon but is due to
bone marrow disease.
Secondary polycythemia is common and often a
result of chronic hypoxemia. Heavy smoking and
COPD are common causes.
Platelet Count
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Platelets are the smallest formed
element in the blood.
Serve an important role in blood
coagulation
The platelet count should be checked
before arterial puncture by the RT.
Coagulation Studies
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In addition to the platelet count, the
bleed time, APTT, and PT/INR are used
to measure the patient’s ability to clot
the blood.
These tests are particularly useful in
monitoring heparin therapy in the patient
being treated for pulmonary embolism.
Obtaining Vital Signs and Clinical
Impression
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The four classic vital signs are pulse,
respiratory rate, body temperature, and
blood pressure.
Pulse oximetry results, sensorium, and
ECG monitoring results are also often
reported as well, as part of the vital
signs.
Frequency of Vital Sign
Measurement
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Routine vital signs on stable patients are
typically measured every 4 to 6 hours.
They are usually recorded before and
after each respiratory care treatment.
Vital signs are measured more often
when the patient’s condition may change
abruptly such as immediately after
surgery or any invasive procedure
Trends in the Vital Signs
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A series of vital sign measurements over
time establishes a trend and is far more
important than a single measurement.
Recording the vital signs on a graph
allows better visualization of changes
over time.
Abrupt and gradual changes over time
are important to note.
Comparing Vital Sign Information
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Comparing the vital signs to other clinical
findings such as chief complaints and
other physical examination findings helps
determine a more exact cause of the
abnormalities.
Height and Weight
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Height and weight are routinely
measured as part of the initial physical
examination and as part of every
outpatient visit.
They are often recorded in the patient
chart in the same general location as the
vital signs.
General Clinical Presentation
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Part of the vital sign assessment is to
document the patient’s general clinical
presentation.
This is determined by observation of the
patient’s breathing pattern, facial expression,
level of consciousness, nutritional status, etc.
A single summary statement about the
patient’s general presentation is included with
the vital sign measurement for the initial
evaluation of the patient.
Level of Consciousness (Sensorium)
Patients who are alert and oriented to time,
place, and person are said to be “oriented ×
3.”
An abnormal sensorium is indicative of
inadequate cerebral oxygenation.
Glasgow Coma Scale (GCS)
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The GCS is one of the most popular tools used to
document the patient’s level of consciousness.
The GCS is the gold standard for assessing the
neurologic function of patients.
Temperature
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Normal body temperature is 37º C, or
97° to 99.5º F.
Body temperature is maintained by the
hypothalamus in the brain.
The respiratory system plays a role in
temperature balance by providing
another method for heat release.
Temperature
Fever
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Fever is the abnormal elevation of body temperature due to
disease.
One of the most common causes of fever is infection.
Patients with a poor immune system may not generate a fever
when infection is present.
Elevation of body temperature increases oxygen consumption
and increases the demand for CO2 removal. This may be a
problem in patients with lung disease.
Hypothermia is present when the body temperature drops
below normal. It is not common but is seen in patients with
head injuries and those exposed to a cold environment.
Temperature
Measurement of Body Temperature
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Body temperature is measured at several sites.
Rectal temperatures are not often used but may be measured
in comatose patients.
Axillary temperatures are popular for pediatric patients.
Axillary temperatures run about one degree F below oral
measurements.
Oral temperature measurements are very popular. They are
affected by recent oral ingestion of cold or hot liquids and
food.
Tympanic (ear) sites are common practice today especially in
the outpatient settings. In most cases tympanic measurement
of temperature run a few tenths of a degree below core
temperature.
Pulse
Measurement of Pulse Rate
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Pulse is often measured by palpating the radial or
brachial impulse.
It should be measured for 30 seconds and the total
multiplied by two. If the pulse is irregular,
measuring it for 1 full minute is recommended.
Rapid heart rate is tachycardia (>100 beats/min);
slow heart rate is bradycardia (<60 beats/min).
Pulse
Pulse Rhythm and Pattern
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The pulse normally is very regular with only slight
variations seen with breathing.
Irregular pulse could be a sign of serious heart
disease and should be investigated.
The volume of the pulse is also important to note.
Weak peripheral pulses are a sign of heart failure.
Extreme drops in the strength of the pulse with
inspiration are known as pulsus paradoxus.
Respiratory Rate
Measurement of Respiratory Rate
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The respiratory rate should be counted without the
patient being aware of the measurement.
Watching the patient’s chest move up and down
while continuing to palpate the radial pulse is a
good approach.
Rapid respiratory rate is known as tachypnea. Slow
respiratory rate is bradypnea
Blood Pressure
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Arterial blood pressure has two components: the peak
pressure that results during ventricular systole and the
baseline pressure that occurs during ventricular
diastole.
The peak pressure is known as the systolic pressure
and the resting pressure is the diastolic pressure.
The difference between the systolic and diastolic
pressures is the pulse pressure.
Hypotension is present when the BP is below 90/60
mm Hg.
Hypertension is present when the BP is 140/90 mm
Hg.
Blood Pressure
Measurement of Blood Pressure
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Most commonly measured with a blood pressure
cuff. The cuff is wrapped around the patient’s arm
and inflated to a pressure believed to be higher
than the patient’s systolic pressure.
The cuff pressure is released slowly while
monitoring a pressure monometer.
The initial Korotkoff sound is the systolic pressure,
and when the Korotkoff sounds disappear, the
diastolic pressure is noted.
Effects of the Respiratory Cycle on
Blood Pressure
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Normally the changes in blood pressure
with breathing are very slight.
The systolic pressure drops slightly with
normal inspiration. When it drops
significantly with inspiration, pulsus
paradoxus is present. This may be a sign
of cardiac (e.g., cardiac tamponade) or
respiratory problems (e.g., asthma
The Heart
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Location
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Posterior to the sternum
Superior to diaphragm
To the left side
The Heart
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Layers of the heart
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Pericardium - sac surrounding the heart
Epicardium - exterior heart wall
Endocardium - inner heart wall
Myocardium – heart muscle
The Heart
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Chambers of the heart (4)
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RA - right atria
RV - right ventricle
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RA and RV – pulmonary circulation
LA – left atria
LV – left ventricle
LA and LV – systemic circulation
The Heart
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Valves of the heart
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Tricuspid - between RA and RV
Pulmonary valve – between RV and
pulmonary artery
Bicuspid or mitral valve - between LA and LV
Aortic valve – between LV and aorta
The Heart
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Types of vessels
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Arteries – carries blood away from heart
Veins –carries blood to heart
Capillaries - between arteries and vein
exceptions - pulmonary arteries and veins
Circulation
Pathway beginning with
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Superior and inferior vena cava
Right atria
Tricuspid valve
Right ventricle
Pulmonic valve
Pulmonary artery
Pulmonary capillaries
oxygenation
Pulmonary vein
Left atria
Mitral or bicuspid valve
Left ventricle
Aortic valve
Aorta
Pulse
Reflects contraction of the left ventricle –
systole
Take pulse with fingers, not thumb
Pulse sites
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Radial
Carotid Femoral
Temporal
Ulnar
Brachial
Dorsalis pedis
Blood Pressure
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Monitoring equipment
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Sphygmomanometer
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Column of mercury in a glass tube used to
measure blood pressure sounds, as reflected
through a stethoscope. The anometer is attached
by hollow rubber tubing to the cuff.
Stethoscope
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Ear pieces attached to an amplification
diaphragm by hollow rubber tubing.
Blood Pressure
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Procedure
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Stethoscope over brachial pulse point
Inflate cuff until blood flow stops (no pulse)
Slowly deflate cuff
1st sound is systolic blood pressure
Change of muffling sound is diastole
Blood pressure is always recorded in patient
chart
Spread of Infection
Source
Host
Pathogens
Transmission route
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Contact
Airborne
Droplet
Vehicle
Vector
Spread of infection to the lungs
Infection Control Strategies
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Decreasing host susceptibility
Eliminating the source of pathogens
Interrupting routes of transmission
Equipment Processing
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Cleaning
Disinfection
Sterilization
Cross contamination
Equipment handling procedures
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Maintenance of in-use equipment
Processing reusable equipment
Disposable equipment
Fluids and medications precautions
Barrier Measures and Isolation
Precautions
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CDC
General Barrier measure (Standard
Precautions)
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Handwashing
Gloves
Mask, eye protection or face shield
Cover gown
Isolation precautions
Cardiac Cycling
Pathway to Stimulation
SA - sinoatrial node initiates at rate of 60-100 bpm
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AV - atrioventricular node or junction delays and
delivers impulse from atria to ventricles
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Referred to as the pace maker of the heart
Can act as a back up pace maker
Rate of 40-60 bpm
Bundle of His – divides into left & right bundle
branches
Left & right bundle branches
Purkinje Fibers - dispense impulse to muscles
Pathway to Stimulation
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Vagal nerve stimulation of the
parasympathetic nervous system can slow
heart rate
Terminology
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Systole –contraction
Diastole –relaxation
Tachycardia - heart rate greater than
100
Bradycardia - heart rate less than 60
Electrophysiology
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Intracellularly elevated levels of
potassium (K+)
Extracellularly elevated levels of sodium
(NA-)
Negative electrical imbalance across cell
membrane with a positive charge on
outside and negative on inside
Electrophysiology
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Depolarization - change in intracellular
charge from negative to positive due to
influx of sodium ions into the interior of
the cell which results in muscle
contraction
Repolarization – electrical imbalance is
restored by “pumping” sodium ions out
of the cell-results in muscle relaxation
Basic EKG
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Parts of the EKG wave
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P – atrial depolarization
Atrial repolarization is buried under QRS
QRS - ventricle depolarization
T – ventricular repolarization
Basic EKG
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Basic interpretations of EKG waves
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Sinus rhythms
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Start at the SA node
Normal sinus rhythm
Sinus bradycardia - less than 60
Sinus tachycardia - greater than 100
Sinus arrhythmia – irregular
Basic EKG
Atrial rhythms
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Abnormal P wave
Premature atrial contraction (PAC)
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Atrial flutter
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Rapid atrial rate of 240-400 bpm
Characterized as having a saw tooth pattern
Atrial fibrillation
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Early atrial beat caused by an ectopic stimulus in the atria
Chaotic twitching of atrial tissue
Rate of 360-700 bpm
May cause decrease in cardiac output because of impaired
ventricular filling
Not life threatening
Basic EKG
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Junctional or nodal rhythms
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Often inverted P wave
Stimulus originates near AV node
Basic EKG
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Ventricular arrhythmias
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Premature Ventricular Contractions
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Large, wide, bizarre QRS
Early in the cycle
May not follow P wave
Can be dangerous when:
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Multiple configuration
More than 1 in 10 beats
Landing near a T wave
Basic EKG
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Ventricular Tachycardia
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Rapid rate-140-300 bpm
Appear like a continuous series of PVC's
Dangerous
Untreated may cause ventricular fibrillation
Ventricular Flutter may appear between
ventricular tachycardia and ventricular
fibrillation
Basic EKG
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Ventricular Fibrillation
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Life ending
Physiologically the same as cardiac standstill
CPR must be initiated
Defibrillation
Electric shock to totally depolarize heart to
allow synchronization of repolarization
Stand clear of the bed to avoid shock
Stop ventilation
Basic EKG
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Asystole – straight line, no electrical
activity, cardiac standstill
EMD – electrical mechanical dissonance,
electrical activity with no pulse.
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Also known as Pulseless Electrical Activity
Cardiovascular Diseases
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Hypertension (high pressure in the CV
system); Caused by
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Driving pressure of heart
Resistance of vascular system
Normal blood pressure is 120/80
systolic/diastolic
Cardiovascular Diseases
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Myocardial Infarction (M.I., "heart
attack")
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Coronary arteries become blocked
Tissue become ischemic
Tissue becomes necrotic
Muscle is weakened
Cardiovascular Diseases
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Cor Pulmonale
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Right-sided heart failure
Usually due to pulmonary disease
Right-sided hypertrophy
Can cause left-sided failure
Venous distension may be noted in neck
veins with patient sitting up at 30' angle
Cardiovascular Diseases
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Congenital Abnormalities
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May cause right to left shunt
Blood may be unable to oxygenate
Discuss common occurrences
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VSD
ASD
Transposition
Coarctation
Cardiovascular Diseases
Vascular Disease
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Aneurysm
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Arteriosclerosis
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Ballooning out of vessels
Weakening of vessel
Can rupture and cause death
Hardening of the arteries by calcium
Atherosclerosis
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Fat deposits
Narrowed arteries
Cardiovascular Diseases
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Vascular Disease (cont)
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Ischemia
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Decrease blood flow to area
For variety of reasons
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Blood clots
Low BP
Hemorrhage (loss of the blood)
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Uncontrolled bleeding
Usually a ruptured or torn vessel
Cardiovascular Diseases
Vascular Disease (cont)
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Shock
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Acute peripheral circulatory failure due to:
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Derangement of circulatory control
Loss of circulating fluid
Brought about by injury
Marked by
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Pallor
Clamminess of the skin
Decreased blood pressure
Feeble, rapid pulse
Decreased respiration
Restlessness
Anxiety
Sometimes unconscious
Cardiovascular Diseases
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Vascular Disease (cont)
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Phlebitis
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Inflammation of veins
Thrombus stationary clot
Cardiovascular Diseases
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Cardiac Inflammation
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Endocarditis – inflamed endocardium
Myocarditis - inflamed heart muscle
Pericarditis - inflamed pericardium
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May lead to cardiac tamponade (blood in
pericardial sac causing compression of the heart
muscle.)
Cardiovascular Diseases
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Rheumatic Fever
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May damage heart valves or muscle
Decrease blood flow
Angina Pectoris
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Pain
Located over heart, left shoulder or in jaw
Due to decreased blood supply (ischemia) to
heart by the coronary arteries
Cardiovascular Diseases
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Congestive Heart Failure
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Impaired cardiac pumping; Caused by:
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Myocardial infarction
Ischemic heart disease
Cardiomyopathy