Cardiac and Respiratory Systems

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Cardiac and Respiratory Systems
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Objectives

• Review the respiratory system and assessment
  techniques
• Review the cardiovascular system and assessment
  techniques
• Review arterial blood gas interpretation.
• Identify medical causes and treatments for both
  metabolic and respiratory acidosis and alkalosis

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Respiratory System Assessment

• Primary function is the exchange of oxygen and
  carbon dioxide through respirations.
• Plays an important role in maintaining acid-base
  balance.

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Respiratory System Assessment

• PQRST
• Any symptoms
• Cough
• Dyspnea
• Chest pain
• Related symptoms
• Focused respiratory history
• Medications

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Respiratory System Assessment

• Approach Inspection
• Palpation
• Percussion
• Auscultation
• A P
• Side to side
• Apex to base
• Position Sitting
• Toolbox Stethoscope, small ruler and marking
  pen

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Respiratory System Assessment
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Inspection
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Palpation
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Palpation
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Percussion
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Auscultation
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Cardiovascular Assessment

• Primary function is the delivery of oxygenated
  blood throughout the body
• Removal of metabolic wastes

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Cardiovascular Assessment

• PQRST
• Palpitations
• Syncope
• Edema
• Fatigue
• Extremity changes
• Related symptoms

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Cardiovascular Assessment

• Approach Inspection
• Palpation
• Auscultation
• Position Sitting, left lateral recumbent,
  supine
• Toolbox Stethoscope, BP cuff, ruler, marker,
  scale, penlight

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Cardiovascular Assessment
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Cardiovascular Assessment

• Heart sounds
• S1
• S2
• S3
• S4

• Apex / mitral
• Left lateral sternal boarder
• tricuspid area
• Erbs point
• Base left pulmonic area
• Base right aortic area

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Cardiovascular Assessment
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Cardiovascular Assessment
Heart Fail-ure
Hyper-ten-sion
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Cardiovascular Assessment
Identification of pulse locations.
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Arterial Blood Gases

• Normal Ranges

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ABG Interpretation and Treatment

• Mr. Jones is admitted to your unit with the
  diagnosis exacerbation of COPD and bronchitis.
  Mr. Jones has had multiple admissions for COPD
  has a 150 pack year history for smoking and uses
  oxygen at home. His home O2 is set at 1.5 L/min
  by n/c. Upon admission assessment you find BP
  141/82, HR 121, sinus tach, resp 38 with
  prolonged expiratory phase and purse lipped
  breathing. His breath sounds are extremely
  decreased throughout and he is unable to exhibit
  an effective cough.

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ABG Interpretation and TreatmentMr. Jones

• The following ABG is reported

Interpret the ABGs What is the first
intervention? What factors must be considered
before high flow O2 is provided to this patient?
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ABG Interpretation and Treatment

• Mrs. Wilson is a 48 year old female who is
  recovering from abdominal hysterectomy surgery.
  She was resting at home and suddenly developed
  shortness of breath. Her daughter called 911 for
  transfer to the hospital. During transport Mrs.
  Wilson became very anxious and fearful that she
  was going to die. Her VS are as follows HR
  158, atrial tach, resp 42 and shallow, BP 136/72.

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ABG Interpretation and TreatmentMrs. Wilson

• The following ABG is reported

Interpret the ABGs What is the first
intervention?
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ABG Interpretation and Treatment

• A 29 y/o female with Type I diabetes presents to
  your unit with a recent hx of vomiting and
  diarrhea. Her skin is dry, with poor tugor. She
  is lethargic but able to follow simple commands.
  HR 118, BP 88/50, Temp 101.8 . Respiratory rate
  is 40/min, deep and rapid. Labs returned
• Glucose 510
• Hgb 14 gm/dl
• Hct 48
• K 5.6 meq/l
• Na 139 meq/l
• Osmo 325mOsmo/l
• What type of breathing pattern does this patient
  exhibit?

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ABG Interpretation and Treatment29 y/o female

• The following ABG is reported

Interpret the ABGs
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ABG Interpretation and TreatmentWelcome to
Nursing

• Mr. Welch a 57 y/o man was admitted to the ICU
  with a dx of acute anterior MI. He complained of
  severe sub-sternal chest pain (8/10), radiating
  to the L arm, lasting over 6 hours that was
  accompanied by SOB and diaphoresis. Thrombolytic
  therapy was given with no improvement or EKG
  changes or in level of chest pain. Within 30
  minutes of admission Mr. Welch went from 4L/min
  O2 to a 50 venti mask. He continued to complain
  of severe chest pain and SOB and he became
  increasingly agitated and restless. His skin was
  cool, ashen and wet. His SpO2 remained 80.

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ABG Interpretation and TreatmentWelcome to
Nursing

• The following ABG is reported

Interpret the ABGs
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ABG Interpretation and Treatment

• The O2 device was changed to a 100 non
  rebreather mask and another ABG was done

What further intervention is needed?
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Metabolic Acidosis

• Diabetic ketoacidosis
• Diarrhea
• Renal failure
• Shock
• Salicylate overdose
• Sepsis

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Metabolic Alkalosis

• Loss of gastric secretions
• Overuse of antacids
• Potassium wasting diuretics

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Respiratory Acidosis

• Hypoventilation related to
• Drug overdose
• Chest trauma
• Pulmonary edema
• Airway obstruction
• COPD
• Neuromuscular disease.

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Respiratory Alkalosis

• Hyperventilation related to
• Anxiety
• High altitude
• Pregnancy
• Fever
• Hypoxia
• Excessive Tv in ventilated patients
• Initial stage of pulmonary embolus