RT 210 A&PCardiovascular. Blood is Composed of Plasma & Cells Plasma Plasma About 90% water About 90% water About 10% solutes About 10% solutes Proteins.

RT 210RT 210

A&PA&P

CardiovascularCardiovascular

Blood is Composed of Plasma Blood is Composed of Plasma & Cells& Cells

PlasmaPlasma About 90% waterAbout 90% water About 10% solutesAbout 10% solutes

ProteinsProteins AlbuminAlbumin

Thickens blood Thickens blood GlobulinGlobulin

Includes antibodies Includes antibodies Fibrinogen & ProthrombinFibrinogen & Prothrombin

Necessary for clottingNecessary for clotting


Plasma (cont)Plasma (cont) Energy MoleculesEnergy Molecules

GlucoseGlucose LipidsLipids Amino acidsAmino acids


Plasmas (cont)Plasmas (cont) Electrolytes Electrolytes use values from Egan textuse values from Egan text

Sodium (Na+) Sodium (Na+) Chloride (CL-) Chloride (CL-) Bicarbonate (HCO3-) Bicarbonate (HCO3-) Potassium (K+)Potassium (K+) Calcium (Ca+) Calcium (Ca+) Magnesium (Mg+)Magnesium (Mg+) PhosphatePhosphate SulfatesSulfates Organic AcidsOrganic Acids

Normal Electrolyte Values

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


CellsCells Erythrocytes- Red blood cellsErythrocytes- Red blood cells

Produced in bone marrowProduced in bone marrow Contain hemoglobinContain hemoglobin

Normally 12-18gms Hb/100ml bloodNormally 12-18gms Hb/100ml blood Normally higher in malesNormally higher in males Hematocrit approx. 3 * Hb (normally 40-50%)Hematocrit approx. 3 * Hb (normally 40-50%) Hb carries O2 Hb carries O2

4.2-6.2 million RBCs per cubic mm4.2-6.2 million RBCs per cubic mm


Cells (cont)Cells (cont) Leukocytes: White blood cellsLeukocytes: White blood cells

EosinophilsEosinophils Protects body from parasites & allergensProtects body from parasites & allergens

BasophilsBasophils Secrete heparinSecrete heparin

Mononuclear MonocytesMononuclear Monocytes PhagocytesPhagocytes

LymphocytesLymphocytes Function in the immune mechanismFunction in the immune mechanism

Polymorphonuclear neutrophilsPolymorphonuclear neutrophils PhagocytesPhagocytes

Normally white count 5,000-10,000 white blood cells per Normally white count 5,000-10,000 white blood cells per cubic mmcubic mm


Cells (cont)Cells (cont) PlateletsPlatelets

Plays a role in clottingPlays a role in clotting 150,000-400,000 per cubic mm150,000-400,000 per cubic mm

Blood Makes Up the Blood Makes Up the Intravascular Fluid Intravascular Fluid

There is fluid in the body in 2 other There is fluid in the body in 2 other areas alsoareas also

Interstitial: between cellsInterstitial: between cells Intracellular: within cellsIntracellular: within cells

Purpose of the BloodPurpose of the Blood

Transport respiratory gasesTransport respiratory gases Circulate defenses (Leukocytes)Circulate defenses (Leukocytes) Nutrients to cellsNutrients to cells Remove wastes from cellsRemove wastes from cells ClottingClotting ElectrolytesElectrolytes

Lab NormsLab Norms

RBC- Measures the total volume of RBC- Measures the total volume of RBCsRBCs

Male 4.6 – 6.2 MillionMale 4.6 – 6.2 Million Female: 4.2 – 5.4 MillionFemale: 4.2 – 5.4 Million

WBC: Measures the total volume of WBC: Measures the total volume of WBCsWBCs

Male / Female: 5,000 - 10,000Male / Female: 5,000 - 10,000

Lab NormsLab Norms

DIFF: Percentage of which should DIFF: Percentage of which should add up to 100%add up to 100%

Neutrophils – 40-75%Neutrophils – 40-75% Lymphocytes – 20-45%Lymphocytes – 20-45% Monocytes – 2-10%Monocytes – 2-10% Basophils – 0-1%Basophils – 0-1% Eosinophils – 0-6%Eosinophils – 0-6%

Lab NormsLab Norms

HCT- Percentage of packed cell volumeHCT- Percentage of packed cell volume Male : 40-54%Male : 40-54% Female: 38-47%Female: 38-47%

HGB: Measurement of amount of HGB: Measurement of amount of hemoglobinhemoglobin

Male 14 - 18 gmMale 14 - 18 gm Female: 12 - 14 gmFemale: 12 - 14 gm

SED Rate: Determines rate of fall in 1 SED Rate: Determines rate of fall in 1 hour of RBCs.hour of RBCs.

Male : 0 - 10 mmMale : 0 - 10 mm Female: 0 - 20 mmFemale: 0 - 20 mm

Lab NormsLab Norms

Finger--Puncture: (Bleeding Time)Finger--Puncture: (Bleeding Time) Measures amount of time takes for Measures amount of time takes for

blood to clotblood to clot Male / Female: 2 - 9 MinutesMale / Female: 2 - 9 Minutes

Finger pinch checkFinger pinch check Pinch fingernail until it blanchesPinch fingernail until it blanches Checks for cardiovascular integrityChecks for cardiovascular integrity

Lab NormsLab Norms

Finger--Puncture: (Bleeding Time)Finger--Puncture: (Bleeding Time) Measures amount of time takes for Measures amount of time takes for

blood to clotblood to clot Male / Female: 2 - 9 MinutesMale / Female: 2 - 9 Minutes

Finger pinch checkFinger pinch check Pinch fingernail until it blanchesPinch fingernail until it blanches Checks for cardiovascular integrityChecks for cardiovascular integrity

Clinical Laboratory Studies Clinical Laboratory Studies

HematologyHematology Complete Blood Cell CountComplete Blood Cell Count

White Blood CellsWhite Blood Cells Primary role is fighting infection.Primary role is fighting infection. Five types: neutrophil, basophil, eosinophil, Five types: neutrophil, basophil, eosinophil,

lymphocyte, and monocyte.lymphocyte, and monocyte.


WBC Differential WBC Differential Counts the number of each type of white cell Counts the number of each type of white cell

present in a known volume of blood.present in a known volume of blood. Neutrophils normally make up 40% to 75% of Neutrophils normally make up 40% to 75% of

the total white cell count.the total white cell count. They are produced in the bone marrow and have a They are produced in the bone marrow and have a

life span of about 10 days.life span of about 10 days. Neutrophils are released into the circulating blood by Neutrophils are released into the circulating blood by

the bone marrow when acute infection is present.the bone marrow when acute infection is present. Neutrophils contain enzymes that destroy bacteria.Neutrophils contain enzymes that destroy bacteria.


Eosinophils make up a very small Eosinophils make up a very small part of the total white cell count part of the total white cell count normally.normally.

They account for zero to 6% of WBCs.They account for zero to 6% of WBCs. Appear to help with allergic reactionsAppear to help with allergic reactions Are present in the sputum of Are present in the sputum of

asthmatics in many casesasthmatics in many cases


Basophils also make up a small percent Basophils also make up a small percent of the total WBC (zero-1%)of the total WBC (zero-1%)

Lymphocytes make up a significant Lymphocytes make up a significant portion of the WBC.portion of the WBC.

They fight against viral, fungal, and They fight against viral, fungal, and tuberculosis infections.tuberculosis infections.

They make up 20% to 45% of the circulating They make up 20% to 45% of the circulating WBC normally.WBC normally.

Lymphocytes come in two types: T cells and Lymphocytes come in two types: T cells and B cells.B cells.

T cells are important for antibody production and T cells are important for antibody production and immunity.immunity.


Monocytes make up 2% to 10% of Monocytes make up 2% to 10% of the circulation WBC count.the circulation WBC count.

In the tissue the monocyte becomes a In the tissue the monocyte becomes a macrophage.macrophage.

Its primary role is phagocytosis of Its primary role is phagocytosis of foreign material.foreign material.

White Blood Cell White Blood Cell AbnormalitiesAbnormalities

Leukocytosis is present when the total Leukocytosis is present when the total white cell count is elevated.white cell count is elevated.

Leukocytosis caused by neutrophils is Leukocytosis caused by neutrophils is known as neutrophilia.known as neutrophilia.

Neutrophilia is common with bacterial Neutrophilia is common with bacterial pneumonia and other infections.pneumonia and other infections.

Acute neutrophilia caused by infection typically Acute neutrophilia caused by infection typically results in an increase in the immature results in an increase in the immature neutrophils known as bands. This is called a left neutrophils known as bands. This is called a left shift.shift.

Pseudoneutrophilia occurs when marginated Pseudoneutrophilia occurs when marginated cells are released into the circulation. This is cells are released into the circulation. This is common with acute trauma and stress.common with acute trauma and stress.


Leukopenia is present when the total Leukopenia is present when the total white cell count is reduced.white cell count is reduced.

Leukopenia caused by the lack of Leukopenia caused by the lack of neutrophils is known as neutropenia.neutrophils is known as neutropenia.

Neutropenia is common when the bone Neutropenia is common when the bone marrow fails or when a severe infection marrow fails or when a severe infection is present and neutrophils are destroyed is present and neutrophils are destroyed faster than they are produced.faster than they are produced.

Neutropenia is an ominous sign.Neutropenia is an ominous sign.


Lymphocytosis is present when the Lymphocytosis is present when the circulating lymphocytes are circulating lymphocytes are elevated in count.elevated in count.

Caused by viral infections and Caused by viral infections and infectious mononucleosis.infectious mononucleosis.

Lymphocytopenia is seen with Lymphocytopenia is seen with trauma and acute infection. trauma and acute infection.

Is common with HIV patientsIs common with HIV patients


Monocytosis is characteristic of Monocytosis is characteristic of chronic infections including chronic infections including tuberculosis (TB), syphilis, typhoid tuberculosis (TB), syphilis, typhoid fever, and subacute bacterial fever, and subacute bacterial endocarditis.endocarditis.

It is a sign of active disease in TB It is a sign of active disease in TB patients.patients.

Red Blood CellsRed Blood Cells

Produced in the bone marrowProduced in the bone marrow Have a life span of about 120 daysHave a life span of about 120 days Assume the shape of a biconcave disk to Assume the shape of a biconcave disk to

facilitate carrying oxygenfacilitate carrying oxygen Made up largely of hemoglobinMade up largely of hemoglobin The portion of the total blood volume The portion of the total blood volume

made up by the formed elements such as made up by the formed elements such as red blood cells is known as the red blood cells is known as the hematocrit.hematocrit.


The amount of hemoglobin on the red The amount of hemoglobin on the red cells is measured and reported as the cells is measured and reported as the hemoglobin count.hemoglobin count.

Special red cell indices are determined to Special red cell indices are determined to measure the size of the average red cell, measure the size of the average red cell, and the amount of hemoglobin present in and the amount of hemoglobin present in the average red blood cell of each the average red blood cell of each patient. These indices are important to patient. These indices are important to interpret when abnormalities are present.interpret when abnormalities are present.


Red cell abnormalitiesRed cell abnormalities Anemia is an abnormal decrease in the RBC Anemia is an abnormal decrease in the RBC

count.count. Microcytic anemia indicates that the cells are too Microcytic anemia indicates that the cells are too

small.small. Hypochromic anemia is present when the cells Hypochromic anemia is present when the cells

have too little hemoglobin.have too little hemoglobin. Anemia with normal red cells is termed Anemia with normal red cells is termed

normochromic, normocytic anemia. It is normochromic, normocytic anemia. It is common with acute blood loss.common with acute blood loss.

The most common cause of anemia is iron The most common cause of anemia is iron deficiency.deficiency.


Polycythemia is an abnormal increase Polycythemia is an abnormal increase in the red cell count.in the red cell count.

Primary polycythemia is uncommon but is Primary polycythemia is uncommon but is due to bone marrow disease.due to bone marrow disease.

Secondary polycythemia is common and Secondary polycythemia is common and often a result of chronic hypoxemia. Heavy often a result of chronic hypoxemia. Heavy smoking and COPD are common causes.smoking and COPD are common causes.

Platelet CountPlatelet Count

Platelets are the smallest formed Platelets are the smallest formed element in the blood.element in the blood.

Serve an important role in blood Serve an important role in blood coagulationcoagulation

The platelet count should be The platelet count should be checked before arterial puncture by checked before arterial puncture by the RT.the RT.

Coagulation StudiesCoagulation Studies

In addition to the platelet count, the In addition to the platelet count, the bleed time, APTT, and PT/INR are bleed time, APTT, and PT/INR are used to measure the patient’s used to measure the patient’s ability to clot the blood.ability to clot the blood.

These tests are particularly useful These tests are particularly useful in monitoring heparin therapy in the in monitoring heparin therapy in the patient being treated for pulmonary patient being treated for pulmonary embolism.embolism.

Obtaining Vital Signs and Obtaining Vital Signs and Clinical ImpressionClinical Impression

The four classic vital signs are The four classic vital signs are pulse, respiratory rate, body pulse, respiratory rate, body temperature, and blood pressure.temperature, and blood pressure.

Pulse oximetry results, sensorium, Pulse oximetry results, sensorium, and ECG monitoring results are also and ECG monitoring results are also often reported as well, as part of often reported as well, as part of the vital signs.the vital signs.

Frequency of Vital Sign Frequency of Vital Sign Measurement Measurement

Routine vital signs on stable patients are Routine vital signs on stable patients are typically measured every 4 to 6 hours.typically measured every 4 to 6 hours.

They are usually recorded before and They are usually recorded before and after each respiratory care treatment.after each respiratory care treatment.

Vital signs are measured more often Vital signs are measured more often when the patient’s condition may when the patient’s condition may change abruptly such as immediately change abruptly such as immediately after surgery or any invasive procedureafter surgery or any invasive procedure

Trends in the Vital SignsTrends in the Vital Signs

A series of vital sign measurements A series of vital sign measurements over time establishes a trend and is over time establishes a trend and is far more important than a single far more important than a single measurement.measurement.

Recording the vital signs on a graph Recording the vital signs on a graph allows better visualization of allows better visualization of changes over time.changes over time.

Abrupt and gradual changes over Abrupt and gradual changes over time are important to note.time are important to note.

Comparing Vital Sign Comparing Vital Sign InformationInformation

Comparing the vital signs to other Comparing the vital signs to other clinical findings such as chief clinical findings such as chief complaints and other physical complaints and other physical examination findings helps examination findings helps determine a more exact cause of determine a more exact cause of the abnormalities.the abnormalities.

Height and Weight Height and Weight

Height and weight are routinely Height and weight are routinely measured as part of the initial measured as part of the initial physical examination and as part of physical examination and as part of every outpatient visit.every outpatient visit.

They are often recorded in the They are often recorded in the patient chart in the same general patient chart in the same general location as the vital signs.location as the vital signs.

General Clinical General Clinical PresentationPresentation

Part of the vital sign assessment is to Part of the vital sign assessment is to document the patient’s general clinical document the patient’s general clinical presentation.presentation.

This is determined by observation of the This is determined by observation of the patient’s breathing pattern, facial patient’s breathing pattern, facial expression, level of consciousness, expression, level of consciousness, nutritional status, etc.nutritional status, etc.

A single summary statement about the A single summary statement about the patient’s general presentation is included patient’s general presentation is included with the vital sign measurement for the with the vital sign measurement for the initial evaluation of the patient.initial evaluation of the patient.

Level of Consciousness Level of Consciousness (Sensorium)(Sensorium)

Patients who are alert and oriented to Patients who are alert and oriented to time, place, and person are said to be time, place, and person are said to be “oriented × 3.”“oriented × 3.”

An abnormal sensorium is indicative of An abnormal sensorium is indicative of inadequate cerebral oxygenation.inadequate cerebral oxygenation.

Glasgow Coma Scale (GCS)Glasgow Coma Scale (GCS) The GCS is one of the most popular tools used The GCS is one of the most popular tools used

to document the patient’s level of to document the patient’s level of consciousness.consciousness.

The GCS is the gold standard for assessing the The GCS is the gold standard for assessing the neurologic function of patients.neurologic function of patients.

TemperatureTemperature

Normal body temperature is 37º C, Normal body temperature is 37º C, or 97° to 99.5º F.or 97° to 99.5º F.

Body temperature is maintained by Body temperature is maintained by the hypothalamus in the brain.the hypothalamus in the brain.

The respiratory system plays a role The respiratory system plays a role in temperature balance by in temperature balance by providing another method for heat providing another method for heat release.release.


FeverFever Fever is the abnormal elevation of body temperature Fever is the abnormal elevation of body temperature

due to disease.due to disease. One of the most common causes of fever is infection.One of the most common causes of fever is infection. Patients with a poor immune system may not generate Patients with a poor immune system may not generate

a fever when infection is present.a fever when infection is present. Elevation of body temperature increases oxygen Elevation of body temperature increases oxygen

consumption and increases the demand for CO2 consumption and increases the demand for CO2 removal. This may be a problem in patients with lung removal. This may be a problem in patients with lung disease.disease.

Hypothermia is present when the body temperature Hypothermia is present when the body temperature drops below normal. It is not common but is seen in drops below normal. It is not common but is seen in patients with head injuries and those exposed to a cold patients with head injuries and those exposed to a cold environment.environment.


Measurement of Body TemperatureMeasurement of Body Temperature Body temperature is measured at several sites.Body temperature is measured at several sites. Rectal temperatures are not often used but may be Rectal temperatures are not often used but may be

measured in comatose patients.measured in comatose patients. Axillary temperatures are popular for pediatric Axillary temperatures are popular for pediatric

patients. Axillary temperatures run about one degree F patients. Axillary temperatures run about one degree F below oral measurements.below oral measurements.

Oral temperature measurements are very popular. Oral temperature measurements are very popular. They are affected by recent oral ingestion of cold or They are affected by recent oral ingestion of cold or hot liquids and food.hot liquids and food.

Tympanic (ear) sites are common practice today Tympanic (ear) sites are common practice today especially in the outpatient settings. In most cases especially in the outpatient settings. In most cases tympanic measurement of temperature run a few tympanic measurement of temperature run a few tenths of a degree below core temperature.tenths of a degree below core temperature.

PulsePulse

Measurement of Pulse RateMeasurement of Pulse Rate Pulse is often measured by palpating the Pulse is often measured by palpating the

radial or brachial impulse.radial or brachial impulse. It should be measured for 30 seconds and the It should be measured for 30 seconds and the

total multiplied by two. If the pulse is total multiplied by two. If the pulse is irregular, measuring it for 1 full minute is irregular, measuring it for 1 full minute is recommended.recommended.

Rapid heart rate is tachycardia (>100 Rapid heart rate is tachycardia (>100 beats/min); slow heart rate is bradycardia beats/min); slow heart rate is bradycardia (<60 beats/min).(<60 beats/min).

PulsePulse

Pulse Rhythm and PatternPulse Rhythm and Pattern The pulse normally is very regular with only The pulse normally is very regular with only

slight variations seen with breathing.slight variations seen with breathing. Irregular pulse could be a sign of serious heart Irregular pulse could be a sign of serious heart

disease and should be investigated.disease and should be investigated. The volume of the pulse is also important to The volume of the pulse is also important to

note. Weak peripheral pulses are a sign of note. Weak peripheral pulses are a sign of heart failure.heart failure.

Extreme drops in the strength of the pulse with Extreme drops in the strength of the pulse with inspiration are known as pulsus paradoxus.inspiration are known as pulsus paradoxus.

Respiratory RateRespiratory Rate

Measurement of Respiratory RateMeasurement of Respiratory Rate The respiratory rate should be counted The respiratory rate should be counted

without the patient being aware of the without the patient being aware of the measurement.measurement.

Watching the patient’s chest move up and Watching the patient’s chest move up and down while continuing to palpate the radial down while continuing to palpate the radial pulse is a good approach.pulse is a good approach.

Rapid respiratory rate is known as tachypnea. Rapid respiratory rate is known as tachypnea. Slow respiratory rate is bradypneaSlow respiratory rate is bradypnea

Blood Pressure Blood Pressure

Arterial blood pressure has two components: Arterial blood pressure has two components: the peak pressure that results during the peak pressure that results during ventricular systole and the baseline pressure ventricular systole and the baseline pressure that occurs during ventricular diastole. that occurs during ventricular diastole.

The peak pressure is known as the systolic The peak pressure is known as the systolic pressure and the resting pressure is the pressure and the resting pressure is the diastolic pressure.diastolic pressure.

The difference between the systolic and The difference between the systolic and diastolic pressures is the pulse pressure.diastolic pressures is the pulse pressure.

Hypotension is present when the BP is below Hypotension is present when the BP is below 90/60 mm Hg.90/60 mm Hg.

Hypertension is present when the BP is 140/90 Hypertension is present when the BP is 140/90 mm Hg.mm Hg.


Measurement of Blood PressureMeasurement of Blood Pressure Most commonly measured with a blood Most commonly measured with a blood

pressure cuff. The cuff is wrapped around the pressure cuff. The cuff is wrapped around the patient’s arm and inflated to a pressure patient’s arm and inflated to a pressure believed to be higher than the patient’s systolic believed to be higher than the patient’s systolic pressure.pressure.

The cuff pressure is released slowly while The cuff pressure is released slowly while monitoring a pressure monometer. monitoring a pressure monometer.

The initial Korotkoff sound is the systolic The initial Korotkoff sound is the systolic pressure, and when the Korotkoff sounds pressure, and when the Korotkoff sounds disappear, the diastolic pressure is noted.disappear, the diastolic pressure is noted.

Effects of the Respiratory Cycle Effects of the Respiratory Cycle on Blood Pressureon Blood Pressure

Normally the changes in blood pressure Normally the changes in blood pressure with breathing are very slight.with breathing are very slight.

The systolic pressure drops slightly with The systolic pressure drops slightly with normal inspiration. When it drops normal inspiration. When it drops significantly with inspiration, pulsus significantly with inspiration, pulsus paradoxus is present. This may be a paradoxus is present. This may be a sign of cardiac (e.g., cardiac sign of cardiac (e.g., cardiac tamponade) or respiratory problems tamponade) or respiratory problems (e.g., asthma(e.g., asthma

The HeartThe Heart

LocationLocation Posterior to the sternumPosterior to the sternum Superior to diaphragmSuperior to diaphragm To the left sideTo the left side

The HeartThe Heart

Layers of the heartLayers of the heart Pericardium - sac surrounding the Pericardium - sac surrounding the

heartheart Epicardium - exterior heart wallEpicardium - exterior heart wall Endocardium - inner heart wallEndocardium - inner heart wall Myocardium – heart muscleMyocardium – heart muscle

The HeartThe Heart

Chambers of the heart (4)Chambers of the heart (4) RA - right atriaRA - right atria RV - right ventricleRV - right ventricle

RA and RV – pulmonary circulationRA and RV – pulmonary circulation LA – left atriaLA – left atria LV – left ventricleLV – left ventricle LA and LV – systemic circulationLA and LV – systemic circulation

The HeartThe Heart

Valves of the heartValves of the heart Tricuspid - between RA and RVTricuspid - between RA and RV Pulmonary valve – between RV and Pulmonary valve – between RV and

pulmonary arterypulmonary artery Bicuspid or mitral valve - between LA Bicuspid or mitral valve - between LA

and LVand LV Aortic valve – between LV and aortaAortic valve – between LV and aorta

The HeartThe Heart

Types of vesselsTypes of vessels Arteries – carries blood away from Arteries – carries blood away from

heartheart Veins –carries blood to heartVeins –carries blood to heart Capillaries - between arteries and vein Capillaries - between arteries and vein

exceptions - pulmonary arteries and exceptions - pulmonary arteries and veinsveins

CirculationCirculation

Pathway beginning withPathway beginning with Superior and inferior vena cavaSuperior and inferior vena cava Right atriaRight atria Tricuspid valveTricuspid valve Right ventricleRight ventricle Pulmonic valvePulmonic valve Pulmonary arteryPulmonary artery Pulmonary capillariesPulmonary capillaries oxygenationoxygenation Pulmonary veinPulmonary vein Left atriaLeft atria Mitral or bicuspid valveMitral or bicuspid valve Left ventricleLeft ventricle Aortic valveAortic valve AortaAorta

PulsePulse

Reflects contraction of the left ventricle – Reflects contraction of the left ventricle – systolesystole

Take pulse with fingers, not thumbTake pulse with fingers, not thumb Pulse sitesPulse sites

RadialRadial Carotid FemoralCarotid Femoral TemporalTemporal UlnarUlnar BrachialBrachial Dorsalis pedisDorsalis pedis


Monitoring equipmentMonitoring equipment SphygmomanometerSphygmomanometer

Column of mercury in a glass tube used to Column of mercury in a glass tube used to measure blood pressure sounds, as measure blood pressure sounds, as reflected through a stethoscope. The reflected through a stethoscope. The anometer is attached by hollow rubber anometer is attached by hollow rubber tubing to the cuff.tubing to the cuff.

StethoscopeStethoscope Ear pieces attached to an amplification Ear pieces attached to an amplification

diaphragm by hollow rubber tubing.diaphragm by hollow rubber tubing.


ProcedureProcedure Stethoscope over brachial pulse pointStethoscope over brachial pulse point Inflate cuff until blood flow stops (no Inflate cuff until blood flow stops (no

pulse)pulse) Slowly deflate cuffSlowly deflate cuff 1st sound is systolic blood pressure1st sound is systolic blood pressure Change of muffling sound is diastoleChange of muffling sound is diastole Blood pressure is always recorded in Blood pressure is always recorded in

patient chartpatient chart

Spread of InfectionSpread of Infection

SourceSource HostHost PathogensPathogens Transmission routeTransmission route

ContactContact AirborneAirborne DropletDroplet VehicleVehicle Vector Vector

Spread of infection to the lungsSpread of infection to the lungs

Infection Control StrategiesInfection Control Strategies

Decreasing host susceptibilityDecreasing host susceptibility Eliminating the source of pathogensEliminating the source of pathogens Interrupting routes of transmissionInterrupting routes of transmission

Equipment ProcessingEquipment Processing

CleaningCleaning DisinfectionDisinfection SterilizationSterilization Cross contaminationCross contamination

Equipment handling Equipment handling proceduresprocedures

Maintenance of in-use equipmentMaintenance of in-use equipment Processing reusable equipmentProcessing reusable equipment Disposable equipmentDisposable equipment Fluids and medications precautionsFluids and medications precautions

Barrier Measures and Isolation Barrier Measures and Isolation Precautions Precautions

CDCCDC General Barrier measure (Standard General Barrier measure (Standard

Precautions)Precautions) HandwashingHandwashing GlovesGloves Mask, eye protection or face shieldMask, eye protection or face shield Cover gownCover gown

Isolation precautionsIsolation precautions

Cardiac CyclingCardiac Cycling

Pathway to Stimulation Pathway to Stimulation

SA - sinoatrial node initiates at rate of 60-100 SA - sinoatrial node initiates at rate of 60-100 bpmbpm

Referred to as the pace maker of the heartReferred to as the pace maker of the heart AV - atrioventricular node or junction delays and AV - atrioventricular node or junction delays and

delivers impulse from atria to ventriclesdelivers impulse from atria to ventricles Can act as a back up pace makerCan act as a back up pace maker Rate of 40-60 bpmRate of 40-60 bpm

Bundle of His – divides into left & right bundle Bundle of His – divides into left & right bundle branchesbranches

Left & right bundle branchesLeft & right bundle branches Purkinje Fibers - dispense impulse to musclesPurkinje Fibers - dispense impulse to muscles

Pathway to Stimulation Pathway to Stimulation

Vagal nerve stimulation of the Vagal nerve stimulation of the parasympathetic nervous system can parasympathetic nervous system can slow heart rateslow heart rate

TerminologyTerminology

Systole –contractionSystole –contraction Diastole –relaxationDiastole –relaxation Tachycardia - heart rate greater Tachycardia - heart rate greater

than 100than 100 Bradycardia - heart rate less than Bradycardia - heart rate less than

6060

Electrophysiology Electrophysiology

Intracellularly elevated levels of Intracellularly elevated levels of potassium (K+)potassium (K+)

Extracellularly elevated levels of Extracellularly elevated levels of sodium (NA-)sodium (NA-)

Negative electrical imbalance Negative electrical imbalance across cell membrane with a across cell membrane with a positive charge on outside and positive charge on outside and negative on insidenegative on inside

Electrophysiology Electrophysiology

Depolarization - change in intracellular Depolarization - change in intracellular charge from negative to positive due charge from negative to positive due to influx of sodium ions into the to influx of sodium ions into the interior of the cell which results in interior of the cell which results in muscle contractionmuscle contraction

Repolarization – electrical imbalance is Repolarization – electrical imbalance is restored by “pumping” sodium ions restored by “pumping” sodium ions out of the cell-results in muscle out of the cell-results in muscle relaxationrelaxation

Basic EKGBasic EKG

Parts of the EKG waveParts of the EKG wave P – atrial depolarizationP – atrial depolarization Atrial repolarization is buried under Atrial repolarization is buried under

QRSQRS QRS - ventricle depolarizationQRS - ventricle depolarization T – ventricular repolarizationT – ventricular repolarization

Basic EKGBasic EKG

Basic interpretations of EKG wavesBasic interpretations of EKG waves Sinus rhythmsSinus rhythms

Start at the SA nodeStart at the SA node Normal sinus rhythmNormal sinus rhythm Sinus bradycardia - less than 60Sinus bradycardia - less than 60 Sinus tachycardia - greater than 100Sinus tachycardia - greater than 100 Sinus arrhythmia – irregularSinus arrhythmia – irregular

Basic EKGBasic EKG

Atrial rhythmsAtrial rhythms Abnormal P waveAbnormal P wave Premature atrial contraction (PAC)Premature atrial contraction (PAC)

Early atrial beat caused by an ectopic stimulus in the Early atrial beat caused by an ectopic stimulus in the atriaatria

Atrial flutterAtrial flutter Rapid atrial rate of 240-400 bpmRapid atrial rate of 240-400 bpm Characterized as having a saw tooth patternCharacterized as having a saw tooth pattern

Atrial fibrillationAtrial fibrillation Chaotic twitching of atrial tissueChaotic twitching of atrial tissue Rate of 360-700 bpmRate of 360-700 bpm May cause decrease in cardiac output because of May cause decrease in cardiac output because of

impaired ventricular fillingimpaired ventricular filling Not life threateningNot life threatening

Basic EKGBasic EKG

Junctional or nodal rhythms Junctional or nodal rhythms Often inverted P wave Often inverted P wave Stimulus originates near AV nodeStimulus originates near AV node

Basic EKGBasic EKG

Ventricular arrhythmiasVentricular arrhythmias Premature Ventricular ContractionsPremature Ventricular Contractions

Large, wide, bizarre QRSLarge, wide, bizarre QRS Early in the cycleEarly in the cycle May not follow P waveMay not follow P wave Can be dangerous when:Can be dangerous when:

Multiple configurationMultiple configuration More than 1 in 10 beatsMore than 1 in 10 beats Landing near a T waveLanding near a T wave

Basic EKGBasic EKG

Ventricular TachycardiaVentricular Tachycardia Rapid rate-140-300 bpmRapid rate-140-300 bpm Appear like a continuous series of PVC'sAppear like a continuous series of PVC's DangerousDangerous Untreated may cause ventricular Untreated may cause ventricular

fibrillation fibrillation Ventricular Flutter may appear between Ventricular Flutter may appear between

ventricular tachycardia and ventricular ventricular tachycardia and ventricular fibrillationfibrillation

Basic EKGBasic EKG

Ventricular FibrillationVentricular Fibrillation Life endingLife ending Physiologically the same as cardiac Physiologically the same as cardiac

standstillstandstill CPR must be initiatedCPR must be initiated DefibrillationDefibrillation Electric shock to totally depolarize heart Electric shock to totally depolarize heart

to allow synchronization of repolarizationto allow synchronization of repolarization Stand clear of the bed to avoid shockStand clear of the bed to avoid shock Stop ventilationStop ventilation

Basic EKGBasic EKG

Asystole – straight line, no electrical Asystole – straight line, no electrical activity, cardiac standstillactivity, cardiac standstill

EMD – electrical mechanical EMD – electrical mechanical dissonance, electrical activity with dissonance, electrical activity with no pulse.no pulse.

Also known as Pulseless Electrical Also known as Pulseless Electrical ActivityActivity

Cardiovascular DiseasesCardiovascular Diseases

Hypertension (high pressure in the Hypertension (high pressure in the CV system); Caused byCV system); Caused by

Driving pressure of heartDriving pressure of heart Resistance of vascular systemResistance of vascular system Normal blood pressure is 120/80 Normal blood pressure is 120/80

systolic/diastolicsystolic/diastolic


Myocardial Infarction (M.I., "heart Myocardial Infarction (M.I., "heart attack")attack")

Coronary arteries become blockedCoronary arteries become blocked Tissue become ischemicTissue become ischemic Tissue becomes necroticTissue becomes necrotic Muscle is weakenedMuscle is weakened


Cor PulmonaleCor Pulmonale Right-sided heart failureRight-sided heart failure Usually due to pulmonary diseaseUsually due to pulmonary disease Right-sided hypertrophyRight-sided hypertrophy Can cause left-sided failureCan cause left-sided failure Venous distension may be noted in Venous distension may be noted in

neck veins with patient sitting up at 30' neck veins with patient sitting up at 30' angleangle


Congenital AbnormalitiesCongenital Abnormalities May cause right to left shuntMay cause right to left shunt Blood may be unable to oxygenateBlood may be unable to oxygenate Discuss common occurrencesDiscuss common occurrences

VSDVSD ASDASD TranspositionTransposition CoarctationCoarctation


Vascular DiseaseVascular Disease AneurysmAneurysm

Ballooning out of vesselsBallooning out of vessels Weakening of vesselWeakening of vessel Can rupture and cause deathCan rupture and cause death

ArteriosclerosisArteriosclerosis Hardening of the arteries by calciumHardening of the arteries by calcium

AtherosclerosisAtherosclerosis Fat depositsFat deposits Narrowed arteriesNarrowed arteries


Vascular Disease (cont)Vascular Disease (cont) IschemiaIschemia

Decrease blood flow to areaDecrease blood flow to area For variety of reasonsFor variety of reasons

Blood clotsBlood clots Low BPLow BP

Hemorrhage (loss of the blood)Hemorrhage (loss of the blood) Uncontrolled bleedingUncontrolled bleeding Usually a ruptured or torn vesselUsually a ruptured or torn vessel


Vascular Disease (cont)Vascular Disease (cont) ShockShock

Acute peripheral circulatory failure due to:Acute peripheral circulatory failure due to: Derangement of circulatory controlDerangement of circulatory control Loss of circulating fluidLoss of circulating fluid

Brought about by injuryBrought about by injury Marked byMarked by

PallorPallor Clamminess of the skinClamminess of the skin Decreased blood pressureDecreased blood pressure Feeble, rapid pulseFeeble, rapid pulse Decreased respirationDecreased respiration RestlessnessRestlessness AnxietyAnxiety Sometimes unconsciousSometimes unconscious


Vascular Disease (cont)Vascular Disease (cont) PhlebitisPhlebitis

Inflammation of veinsInflammation of veins Thrombus stationary clotThrombus stationary clot


Cardiac InflammationCardiac Inflammation Endocarditis – inflamed endocardiumEndocarditis – inflamed endocardium Myocarditis - inflamed heart muscleMyocarditis - inflamed heart muscle Pericarditis - inflamed pericardiumPericarditis - inflamed pericardium

May lead to cardiac tamponade (blood in May lead to cardiac tamponade (blood in pericardial sac causing compression of the pericardial sac causing compression of the heart muscle.)heart muscle.)


Rheumatic FeverRheumatic Fever May damage heart valves or muscleMay damage heart valves or muscle Decrease blood flowDecrease blood flow

Angina PectorisAngina Pectoris PainPain Located over heart, left shoulder or in jawLocated over heart, left shoulder or in jaw Due to decreased blood supply (ischemia) Due to decreased blood supply (ischemia)

to heart by the coronary arteriesto heart by the coronary arteries


Congestive Heart FailureCongestive Heart Failure Impaired cardiac pumping; Caused by:Impaired cardiac pumping; Caused by:

Myocardial infarctionMyocardial infarction Ischemic heart diseaseIschemic heart disease CardiomyopathyCardiomyopathy

RT 210 A&PCardiovascular. Blood is Composed of Plasma & Cells Plasma Plasma About 90% water About 90% water About 10% solutes About 10% solutes Proteins.

Documents

plasma cells plasma

cells intracellular

cells interstitial

white blood cells leukocytes

meql slide

clotting slide

blood globulin globulin

gms hb100ml blood