Definitions

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Definitions Tachycardia Heart
Rate 90 beats/ minute Tachypnea Respirations/
minute 20 Dyspnea Shortness of Breath
(SOB) Orthopnea SOB when in a supine
position Paroxysmal Noctural Dyspnea SOB upon
awakening Nocturia Frequent nightime urination
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CONGESTIVE HEART FAILURE
Congestive heart failure (or heart failure) is
a condition in which the heart can't pump enough
blood to meet the needs of the body's other
organs. This can result from narrowed
arteries that supply blood to the heart muscle
past heart attack, or myocardial infarction ,
with scar tissue that interferes with the
heart muscle's normal work. high blood
pressure. cardiomyopathy . congenital
heart disease. infection of the heart valves
and/or heart muscle itself - endocarditis
and/or myocarditis.
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What does CHF feel like? Because the "failing"
heart is an inefficient pump CHF
causes sufferers to become SOB and tired.
Blood flow from heart Blood returning to
heart Backs Up causing tissue to become
congested Congestion causes swelling
in legs/ankles and, possibly, the
lungs Heart failure also affects the
ability of the kidneys to dispose of sodium and
water. The retained water increases the edema.
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Congestive heart failure usually requires a
treatment program of rest proper
diet modified daily activities surgery or
drugs such as A.C.E. or
angiotensin converting enzyme inhibitors and
vasodilators expand blood vessels and decrease
resistance blood then flows more easily
and makes the heart's work easier or more
efficient.
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Some beta blockers can improve the function of
the left ventricle . Digitalis increases the
pumping action of the heart. Diuretics help
the body eliminate excess salt and water.
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Nutritional Interventions in CHF include grams Na if large dose diuretics taken, reduce
to 1 drink/day. Adequate protein/kcal intake
so serum albumin 3.5 g/dl BMI
thiamin supplementation if large dose
diuretics given. Avoid excessive fluid
intakes Quit Smoking!
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Chronic Obstructive Pulmonary Disease
Chronic Bronchitis (an infectious
condition) Emphysema (a non-infectious
condition) Bronchitis (Asthmatic, Chronic
Obstructive et al.) Most Common COPD
condition Emphysema
Bronchitis
Smoking Causes COPD
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Symptomatology in
COPD Patients often present with
Fatigue, SOB, productive cough,
wheezing Caused by Obstructed of airflow out of
the lungs May be accompanied by Precipitous
weight loss Persistent viral illness (e.g.,
colds)
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Treatments for COPD are palliative and focused
on QOL.
Drink lots of fluids (8-12 cups/ day low
caffeine) Vitamin A intake of 25,000-50,000
units/day (Vegetables and fruit) Limit simple CHO
/ replace with fat
Maintain a healthy weight Engage in moderate
physical activity
Stop smoking
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Acute Respiratory Failure
Causes Treatment Goals Physiologic
Stress Prevent progression (e.g., surgical,
infectious, etc.) of resp.
failure Aspiration Pneumonia Preserve
immune Pulmonary Emboli system with
high Allergic Rxns protein/kcal
without causing The Problem? respirato
ry distress Insufficient oxygenation of
tissues with excess CO2 retention supports lung
fxn prevents infections
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Building Pulmonary Infections
Weak Muscles Less Forceful
Breathing Poor Respiration Poor
Circulation Poor Nutrition
Pulmonary Infections Edema Acute
Respiratory Failure Mechanical Ventilator
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Fuel Utilization and Lung
Function Respiratory Quotient (RQ) ratio of
CO2 produced to O2 consumed.
RQ CO2 produced
Workload for respiratory
system
Glucose Oxidation 1.00

Triglyceride Oxidation 0.71 0.82
Amino Acid Oxidation 0.80
RQ
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High Kcals or Adequate Kcals with excessive
glucose Increased Lung Workload Difficulty
in Weaning from Mechanical
Ventilator Decrease Kcals or Replace glucose
with fat to lower RQ
Nutrient Requirements Kcals 25 to 35
nonprotein kcal/kg/day (maintenance) 45
nonprotein kcal/kg/day (anabolism/severe
stress) Protein 1.5 g/kg 2-2.5 g/kg in
severe stress 30-60 of kcal lipids
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Fluid and Sodium Restrictions Ease Pulmonary
Edema Lung Muscle Tissue Maintained by
optimal Ca, Mg, PO4
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Acid-Base Balance Acid Base
pH
7 Normal Physiological pH 7.35-7.45 Extreme
acidosis 7.8
Death!
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Regulation of Acid-Base Balance Body
has components that act in Seconds, Minutes, and
Hours/Days to combat pH changes. Seconds
Chemical Buffers Inside cells phosphate
buffers (NaH2PO4 acid or hydrogen donor
Na2HPO4 base or hydrogen acceptor) In
Bloodstream serum proteins (Hgb) Minutes Respi
ration Rate Controls plasma CO2 plasma CO2
Respiration Rate plasma pH plasma CO2
Respiration Rate plasma pH
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Hours/ Days Renal Function Controls
Plasma Plasma Bicarbonate (HCO3)
Levels. How to Measure Acid-Base
Status? ABGs Arterial Blood Gases All are
expressed partial pressures because there are
many dissolved gases in blood. Normal
Values pO2 80-100 mm Hg (NL 90)
pCO2 35-45 mm Hg (NL 40) pH 7.35-7.45
(NL 7.4) HCO3- 22-26 mEq/L (NL
24)