UNIT 2

• Cardiopulmonary assessment of mother and pregnant clients

  1. Review

  2. Nursing diagnoses

  3. Nursing interventions

  4. Integrating evidence-based practices
• External respiration


  Interchange of oxygen and carbon dioxide between the alveoli of the lungs and the pulmonary blood

  
• Internal respiration


  Interchange of O2 and CO2 between the circulating blood and the cells of the body tissues

  
• Respiration process


  1. Pulmonary ventilation or breathing

  2. Diffusion
• Pulmonary ventilation or breathing

  • Movement of air between the atmosphere and the alveoli of the lungs
  • Accomplished through inspiration and expiration
• Factors affecting adequate ventilation

  • Clear airways
  • Intact central nervous system and respiratory center
  • Intact thoracic cavity capable of expanding and contracting
  • Adequate pulmonary compliance and recoil
• Diffusion


  Movement of gases or other particles from an area of greater pressure or concentration to an area of lower pressure or concentration
• Factors affecting rate of oxygen transport from the lungs to the tissues

  • Cardiac output
  • Number of erythrocytes (RBCs) and blood hematocrit
  • Exercise

  
• Normal value of RBCs: Men: 5 million per cubic milliliter of blood, Non-Pregnant Women: 4–5.5 million per cubic milliliter, Pregnant Women: 3.75–5.0 million per cubic milliliter
• Normal value of Hematocrit: Men: 40% to 54%, Non-Pregnant Women: 37% to 47%, Pregnant Women: 32% to 42%
• Types of breathing


  • Costal (thoracic) breathing
  • Diaphragmatic (abdominal) breathing

  
• Mechanics and regulation of breathing

  1. During inhalation

  2. During exhalation
• Factors that increase respiratory rate


  • Exercise
  • Stress
  • Increased environmental temperature
  • Lowered oxygen concentration at increased altitudes
• Factors that may decrease the respiratory rate


  • Decreased environmental temperature
  • Medications i.e. Narcotics
  • Increased intracranial pressure
• Breathing patterns


  • Eupnea
  • Tachypnea
  • Bradypnea
  • Apnea

  
• Breathing volume


  • Hyperventilation
  • Hypoventilation
• Breathing rhythm


  • Cheyne-Stokes breathing
  • Biot's (Cluster) respirations

  
• Depth of respiration


  • Deep respirations
  • Shallow respirations
  • Normal respirations
• Breath sounds audible without amplification

  • Stridor
  • Stertor
  • Wheeze
  • Bubbling
• Breath sounds audible by stethoscope

  • Crackles (rales)
  • Gurgles (Rhonchi)
  • Pleural friction rub

  
• Ease or effort of breathing

  • Dyspnea
  • Orthopnea
• Secretions and coughing


  • Hemoptysis
  • Productive cough
  • Nonproductive cough
• Chest movements


  • Intercostal retraction
  • Substernal retraction
  • Suprasternal retraction
  • Tracheal tug
  • Flail chest
• Variations in respirations by age
• Cardiac assessment


  1. Inspection of the heart

  2. Palpation of the heart

  3. Percussion of the heart

  4. Auscultation of the heart
• Normal findings in cardiac assessment
• Electrocardiogram (ECG/EKG)


  Non-invasive painless test that measures the heart's electrical activity
• Echocardiography


  Uses high-frequency sound waves to visualize the shape, size, and movement of the structures of the heart
• Nursing responsibilities for echocardiography

  1. Explain the procedure to the patient

  2. Ensure no special preparation is needed

  3. Ensure the patient empties the bladder

  4. Encourage the patient to cooperate

  5. Inform the patient about the conductive gel
• Chest X-ray/Radiography


  Employs ionizing radiation in the form of x-rays to generate images of the chest
• Main regions where a chest X-ray may identify problems

  • Airways
  • Breast shadows
  • Bones
  • Cardiac silhouette
  • Costophrenic angles
  • Diaphragm
• Preparing patient for chest X-ray

  1. Empty the bladder

  2. Instruct patient to void prior and to change into a gown

  3. Encourage the patient to cooperate

  4. Advise the patient to remain still during the test because movement may distort results

  5. Inform that a conductive gel is applied to the chest area
• A conductive gel will be applied to the patient's chest and a quarter-sized transducer will be placed over it
• The patient may feel minor discomfort because pressure is exerted to keep the transducer in contact with the skin
• Main regions where a chest X-ray may identify problems

  • Airways, including hilar adenopathy or enlargement
  • Breast shadows
  • Bones, e.g. rib fractures and lytic bone lesions
  • Cardiac silhoutte, detecting cardiac enlargement
  • Costophrenic angles, including pleural effusions
  • Diaphragm, e.g. evidence of free air
  • Edges, e.g. apices for fibrosis, pneumothorax, pleural thickening or plaques
  • Extrathoracic tissues
  • Fields (lung parenchyma), being evidence of alveolar filling
  • Failure, e.g. alveolar air space disease with prominent vascularity with or without pleural effusions
• Normal pulmonary tissue is radiolucent and appears black on film
• Chest X-ray can detect densities produced by tumors, foreign bodies, infiltrates as lighter or white images
• Chest X-ray shows the position of normal structures, displacement, and presence of abnormal shadows
• Chest X-ray may reveal pathology in the lungs in the absence of symptoms
• Nursing and patient care considerations for chest X-ray

  1. Should be taken upright if patient's condition permits

  2. Assist technician at bedside in preparing patient for portable chest X-ray

  3. Encourage patient to take deep breath, hold breath, and remain still as X-ray is taken

  4. Make sure that all jewelry, electrocardiogram (ECG) leads or metal objects in X-ray field are removed so as not to interfere with film

  5. Consider the contraindication of X-rays for pregnant patients