The Pathophysiology of the Respiratory System

The respiratory system is one of the most vital systems in the body because it supplies the primary element that keeps everything going which is oxygen.

First, we’ll be going through the anatomy and physiology, the pathophysiology, and the common diseases associated with the lungs. Then, we’ll tackle the two types of respiratory drugs which are categorized as the bronchodilator team and the anti-inflammatory team.

Let’s get into it.

The Inverted Tree

For our anatomy and physiology discussion, think of the lungs as an inverted apple tree.  So, a tree has a stump with branches extending to smaller branches with leaves and apples. Much like the alveoli which are mainly responsible for oxygen exchange, the apples are the end product of the tree.

Parts of the Tree

The bronchi are the tree stumps that break off into bronchioles. The bronchioles, much like the branches, are the distal portions that extend to the leaves and apples which is also known as the alveoli.

Pathophysiology

There are a couple of things that can go wrong, primarily concerning with an exchange from oxygen to carbon dioxide. Remember, we breathe out carbon dioxide, and oxygen is what we breathe in and is what gets distributed to the various parts of the body.

What are some of the issues that affect the respiratory system?

  1. The blockage caused by allergens and smoking.

These factors are enough to create bronchial obstruction which will prevent oxygen to get into the distal portions of the lungs. If there is a lack of oxygen, the heart will be directly affected because it will compensate for the insufficiency.

  1. Cholinergic effects

This is simply increased mucus production inside the lungs. The presence of thick mucus secretions that builds to the branches of the lungs or inside the alveoli will compromise oxygen exchange. The lungs will become sluggish, and the client will experience coughing and hacking, and will eventually develop an infection.

In severe cases, the alveoli are drowned with too much mucus that oxygen exchange has become nearly impossible. This is what happens to pneumonia.

  1. Chronic obstructive pulmonary disease (COPD)

Emphysema and bronchitis are two types of chronic obstructive pulmonary disease that are primarily caused by chronic smoking. Emphysema is a condition wherein the alveoli are destroyed, causing the trapped air inside the lungs and making it difficult for the client to breathe. Bronchitis, on the other hand, is manifested by the frequent occurrence of a productive cough that also causes difficulty in breathing.

When the alveoli get hard, oxygen exchange will not take place; therefore, there will be a build-up of carbon dioxide that causes a lot of pressure inside the lungs. Infection, for bronchitis, is what causes the increased production of mucus, and without proper expectoration, the secretions worsen.

  1. Asthma

With asthma, the bronchioles are constricted due to a variety of reasons like viral infections, pollution, and allergens. Asthma is a condition wherein there is an inflammation of the bronchi which causes wheezing and shortness of breath.

There are a couple of drugs that can help relieve the production of mucus and relieve constriction – these are the primary goals for respiratory medicines which we will discuss in our next article.

And for more useful nursing-related lectures and videos, check out our Simple Nursing website and YouTube channel.

Neurology: CVA versus TIA Part 2

Our discussion will focus on the fundamental difference of cerebrovascular accident (CVA) from transient ischemic attack (TIA). In a nutshell, CVA is the absence of oxygen, while TIA is low oxygen. And probably, the most significant difference between the two is the presence of blood clot inside the brain, which is presented by CVA clients.

To explain further, let us look into the pathophysiology of both conditions.

Cerebrovascular Accident

Cerebrovascular accident, also known by many as stroke, is caused lack of oxygen due to the interruption of blood that flows within. A stroke can lead to an aneurysm which is simply a blood vessel that burst inside the brain. Aneurysms can cause a huge leak that will lead to the following signs and symptoms:

  • Increased bleeding
  • Increased intracranial pressure
  • Brain shifting to one side (seen in clients who underwent CAT scans)

Transient Ischemic Attack

On the other side of the spectrum is TIA. Here, there is just narrowing the blood vessels which then cause decreased oxygen going into the brain and various parts of the body. Take note: a transient ischemic attack is very self-limiting.

Plaque buildup is the most common cause of TIA.  Plaque buildup around the walls of the blood vessels is caused by the following:

  • Fried food
  • Sedentary lifestyle
  • Chronic smoking
  • Family history of high cholesterol

Consequences of Plaque Buildup

If clients who have extensive plaque buildup suddenly exerted physical effort or gets stressed due to external factors, blood vessels will react by activating the fight and flight response, which will cause vasoconstriction. This shrinking of the blood vessels will force the plaques to come together, causing decreased blood flow and oxygen.

This scenario can be compared to a freeway accident that led to several cars blocking a couple of lanes; these blockages are the plaques situated in various areas of the blood vessels. Accumulation of plaques cause the shutdown of various lanes; therefore, there won’t be enough room for traffic (blood and oxygen) to pass through to get to vital areas in the body like the brain, heart, and lungs. Narrowing of blood vessels is the main cause of the transient ischemic attack.

Client Stabilization

TIA, which is self-limiting, goes away after management; clients start regaining function of their motor senses like smiling. TIA clients don’t have hemiparesis or weakness experienced on a particular side of the body or aphasia which is language impairment; they can talk and think again. On the other hand, CVA is permanent and detrimental, compromising movement and thinking.

Plan of Care

The plan of care for both CVA and TIA are similar, which are:

  1. Constant neurological checks.

There are a couple of things that you want to check when doing a neurological assessment, which are:

  • Check the grips
  • Check the pushes
  • Check the pulses
  • Check the sensation

Aside from that, the medical team also has to ask their clients pertinent questions about their life, and at the same, asking them to identify what part of the body is being touched. Lastly, circulation is checked by looking at the capillary refill within two seconds.

  1. Re-orientation.

After having a huge brain bleed or having doubts of constricting blood vessels in the brain that leads to low oxygen distribution, re-orientation of the client is essential to check the level of consciousness. Usually, four questions should be answered by the client, namely:

  • What is your name?
  • What is your date of birth?
  • What date and month is it?
  • General, easy questions about the client

Depending on how these questions are answered, the nurse can evaluate the neurological status of the client – whether the condition is getting better or worse.

  1. Check the intracranial pressure.

Aneurysms, as established, cause hemorrhage inside the brain; therefore, it is essential that healthcare providers look for signs and symptoms of increased intracranial pressure.

Treatment Options

For a CVA, since there is a clot, heparin is given to stabilize the clot. Heparin is not a clot buster but an anti-coagulant, which prevents further formation. Tissue plasminogen activator (TPA) is the only way to break or bust blood clots; however, this procedure is quite risky due to bleeding consequences.

Going back to intracranial pressure with clients who suffered from an aneurysm, how do nurses monitor ICP and what are the devices used? To answer this question and more, go to the Simple Nursing website and YouTube channel.

Cardio-Physiology Pt 1: Intro to our body’s Pumping Station

Cardiovascular physiology is primarily focused on getting to know the basic structures of the heart, how these structures work, and what areas are involved in electrical conductivity.

Functions of the Cardiovascular System

Realizing the main functions of the cardiovascular system is necessary for understanding the physiology of the body. With the heart’s intricate pathways of capillaries, arteries, and veins, pumping of oxygen-rich blood, which is one of the primary responsibilities of the cardiovascular system, throughout the body’s entire system is made possible.

Aside from keeping a steady flow of oxygen in the body, the heart and its vessels also perform the following:

  • Transport essential nutrients
  • Remove metabolic toxins and wastes
  • Regulate normal temperature

For more information about how blood flows and distribute oxygen throughout the body, we have prepared a separate video dedicated entirely to that topic. Check it out on our channel.

Hotel Cardiac

Keep in mind that the anatomy portion is different from the electrical part of the heart. So, inside the heart, there are four main chambers, namely:

  • Right atrium
  • Left atrium
  • Right ventricle
  • Left ventricle

We explain every single chamber in a song we’ve created titled, Hotel Cardiac. This is basically a spinoff of the popular song, Hotel California. You can also check the lyrics of that song in our channel so it would be easier for you to memorize and recall how the electrical portion of the cardiovascular system works.

The Rooms

Going back to the Hotel Cardiac song, think of the heart as a four-bedroom suite. Let’s identify each room and what their functions are.

  1. Atriums

As mentioned, the heart has four rooms or chambers, and at the upper portion, there are the attics or what we call as atriums. Atriums are considered as attics because they are comparably smaller than ventricles. These atriums are the receivers of blood either from the rest of the body or the lungs.

  1. Ventricles

Located just below the atriums, the ventricles are the suites of the hearts because they are relatively larger due to their principal objective which is to pump blood to the lungs and out of the heart to the rest of the body. The biggest between the left and right ventricle is the left ventricle which is tasked to pump all the oxygenated blood throughout the various systems. Therefore, if the left ventricle is compromised, the body is doomed.

The Doors

In each of the four bedrooms inside the heart, there are doors which we call valves. These valves are automatic doors that allow blood through the various rooms or suites inside Hotel Cardiac. The sounds, “lub dub,” that are heard when a heart is auscultated are the valves closing.

The Cardiac Gang Sign

The cardiac gang sign, which is just the right hand forming an L like a gun or a loser sign, is a technique that is used to determine the location of the tricuspid and bicuspid valves. By forming an L-shaped figure with your thumb and index finger and closing the rest of the fingers, place the cardiac gang across the chest. Here, you’ll identify that there are two valves at the left side of the heart that is known as the bicuspid valves. On the right side of the heart is where the tricuspid valves are located, which is represented by the three closed fingers.

The Pulmonic and Aortic Valves

The pulmonic and aortic valves create the fundamental sounds that are heard inside the heart. These doors operate through electrical conduction. Currently, the heart is utilizing electricity being transported by the valves.

With that in mind, why is the body not electrocuted? Because the heart is equipped with a zip-lock bag referred to as the pericardium that makes sure electricity flowing inside the heart does not leak to adjacent organs or all over the body.

In part two of our cardiovascular physiology, we will further delve into the process of electrical conduction from one valve and chamber to another. We will tackle the importance of the nodes and branches of the cardiovascular system.

For more nursing-related information that can help you pass major exams, especially the NCLEX®, visit our Simple Nursing website and check out our informative YouTube videos.

A Simplified Overview of Meningitis

Swelling of the meninges, that’s the basic meaning of meningitis; there is the presence of inflammation due to several external and internal factors. The types of meningitis entirely depend on what caused the condition in the first place.

 

To start this lecture, let’s talk about how the meninges have gotten infected and became impaired. Let’s focus on the pathophysiology.

Meningitis Pathophysiology

Meninges serve as the protective coating that aids in the reduction of friction for the entire central nervous system, consisting mainly of the brain and spinal cord. In the event of an infection, meningitis occurs.

Brain Pizza

To help you further figure out the entire structure of the brain and how the meninges fit in, we’ll consider the brain as a whole pizza.

First, we have the crust of the pizza which is the cranium. The cranium covers the meninges. Underneath this crust, is the dura, arachnoid, and pia mater – they make up the meninges.

When considering the meninges, you have to think of it as the pizza toppings. The dura is the pizza sauce or the tomato sauce. The arachnoid is the cheese because the arachnoid looks like small cheese sprinkled around, that helps in cushioning the brain. Lastly, the pia mater is the pepperoni.

We compared the brain to a pizza to help you imagine how all these components come to place and how they are affected when there is the presence of a virus, bacteria, or fungus.

Two Main Types of Meningitis

The meninges can get infected either by a virus or bacteria. What’s the difference between the two?

  1. Viral Meningitis

With viral meningitis, there is the presence of infection inside the brain caused by pre-existing conditions like mumps, measles, or herpes. Viral meningitis is not contagious and is a more preferred diagnosis than bacterial meningitis.

  1. Bacterial Meningitis

Bacterial meningitis is the more lethal version of meningitis due to its effects on the brain and because it can spread very quickly. Bacterial meningitis occurs due to the following reasons:

  • A bacterial infection is happening inside the body like an upper respiratory tract infection.
  • Immunosuppressed clients who are suffering from an infection.
  • Nursing students who are exposed to clients with bacterial meningitis.
  • College students who have roommates or friends who have bacterial meningitis.
  • Injuries to the cranium, usually penetrating wounds that go deep into the crust.

Bacterial meningitis starts when bacteria from the throat, ears, or sinuses invade the bloodstream. Once the bacteria have infiltrated the bloodstream, it can easily travel to different parts of the body, especially the brain. Bacterial meningitis can be passed on to other people with a mere cough or sneeze.

Unlike viral meningitis, bacterial meningitis is life-threatening, and if not treated right away, the client might have brain damage.

So, how can you identify that your client is experiencing meningitis? In our next lecture, we’ll go into the different signs and symptoms of viral and bacterial meningitis, the nursing interventions, diagnostic studies, and client teaching.

For other nursing-related discussions, drop by Simple Nursing’s website and YouTube channel and check out tons of comprehensive topics that will help you in major nursing exams and the NCLEX®.

 

Wound Care: Effectively Staging Pressure Ulcers

In this portion of our wound care article, we’ll be discussing skin integrity issues, particularly, staging pressure ulcers.

Let’s get into it.

How Pressure Ulcers Happen

Also known as decubitus ulcers, pressure ulcers are injuries to the skin and its underlying tissues. The main cause of skin breakdown, especially with skin ulcers, is increased pressure on the site, which leads to ischemia or low oxygen supply.

To give you a better idea, other examples of low oxygen issues happening inside the body are:

  • Myocardial infarction (the heart is not getting enough oxygen)
  • Deep vein thrombosis (a blockage causes insufficient blood flow)
  • Peripheral vascular disease (narrowing of blood vessels, disrupting oxygen perfusion)

Stages of Pressure Ulcers

What are the different stages of pressure ulcer and how does one identify each stage?

Stage 1: Non-blanchable ulcer

What is non-blanching? When you push the skin, the normal reaction would be, that the area turns white, then, it comes back to its original skin color. This is similar to a capillary refill wherein you check clients for peripheral oxygenation. Blanchable is when there is a red ulcer that you’ve pushed and the redness goes away then comes back.

On the other hand, non-blanchable is when you push the skin of your client, and the area stays red that means that there is little or no blood flow going to that area.

Pressure ulcers are mostly seen on bony prominences like the hip, tailbone, and the heels.

Stage 2: Partial thickness

Partial thickness skin loss means that there is a skin break. Now that the skin is open, there is a risk for infection.

Stage 3: The subcutaneous layer

In basic anatomy, the integumentary system is primarily composed of the epidermis, dermis, subcutaneous tissue, and all the way to the muscles and bones. At this stage, the subcutaneous tissues are now visible. This is most prominent around the sacral area or the tailbone.

In the Medical-Surgical ward, nurses take pictures of newly admitted clients especially those who are already experiencing skin breakdown even before they get admitted to prove that they weren’t the ones responsible for the client having the pressure ulcer.

Stage 4: Full-thickness tissue loss

In this stage, the ulcer has gone deeper, reaching the muscles and bones. The muscles and bones are now visible; thus, this condition is termed as tissue necrosis. As this happens, muscles and bones are affected together with the neighboring structures. Stage four pressure ulcers appear as deep pockets, and the client is at increased risk of acquiring a wound-related infection.

Stage 5: Eschar

Considered unstageable, this type of pressure ulcer is charcoal-like and is highly necrotic; thus, the name, eschar. Eschars are sloughed off, necrotic skin that are primarily darkened and dried-up.

In our next topic about pressure ulcers, we’ll be elaborating the risk factors like obesity, smoking, and the reasons for the breaking down of skin. We will also focus on the different nursing considerations to manage and treat the wound, and prevent further damage.

For more useful nursing-related lectures and videos, check out our Simple Nursing website and YouTube channel.

Esophageal Varices: Patho, Manifestations, & Diagnostics

Esophageal varices are complications due to liver diseases or dysfunctions. You can think of esophageal varices as the result of having a backup of plumbing.

How?

The Septic Tank Analogy

Associating esophageal varices with having a backup of septic tank content is helpful in a way that one can compare the liver as the body’s septic tank. If the septic tank becomes clogged or has hardened, there will be an immediate backup from the system. Toilets and sinks will have a backflow of waste products; water will not drain properly from the shower.

Liver: The Body’s Septic Tank

Now that we’ve established that the liver is the body’s septic tank, we’ll now proceed to the process of how the body consumes and absorbs food, and at the same time, how the backing up of contents, happen.

As food is chewed inside the mouth, it goes down the esophagus, then into the stomach to be broken down by gastric juices. Digested food now goes inside the duodenum, which is the first part of the small intestine. After the duodenum, the contents are sucked into the portal vein that goes through the pancreas. This process is referred to as the first pass phenomenon with regards to medications.

Hardening of the Liver

When the liver hardens due to some type of scarring, for instance:

  • Cirrhosis that is basically the production of scar tissue in the liver
  • Hepatitis

Whatever the condition is, the backing up of blood into the portal vein is the main cause of esophageal varices.

Signs and Symptoms

Since there is the backing up of blood or fluid inside the esophagus, the following manifestations will occur:

  • Esophageal bleeding 
  • Vomiting with blood
  • Bloody stools

Physical Assessment

Let’s go over the necessary physical assessment findings to confirm the diagnosis of esophageal varices.

  1. Bleeding.
  2. Decreased blood pressure due to decreased volume caused by bleeding
  3. A skyrocketing heart rate. Due to the decreased hemoglobin, the heart will compensate by pumping faster to distribute oxygen to the different systems of the body.
  4. Tachycardia.

Diagnostic Procedures

One of the main diagnostic procedures that are done with clients who have esophageal varices is esophagogastroduodenoscopy (EGD). With EGD, a tube with a camera is inserted to visualize the inside of the esophagus.

Liver function tests are also done to check the status of the liver through abnormalities with alanine transaminase (ALT) and aspartate aminotransferase (AST).

The hemoglobin and hematocrit levels are also tested because if there is bleeding anywhere in the body, the lab results for H&H will be low.

NCLEX® Tip Question

When a client comes in with perfused bleeding from his mouth, should you do an EGD?

Answer: No. The airway is the priority in any kind of situation. In this case, if the client is vomiting blood, stopping the bleeding is paramount.

The first thing to do is to relieve the client of the blood by suctioning its mouth, and once the bleeding ceases, that’s when an EGD is done.

Aside from suctioning, there are other procedures done to stop the bleeding, namely:

  • Medications
  • Inserting a balloon catheter into the esophagus

GI Disorders: Crohn’s Disease and Colitis

Inflammatory bowel disease (IBD) is entirely different from irritable bowel syndrome (IBS). Having an irritable bowel syndrome means that there is the presence of pain and irritation. Mainly, there is irritability; however, there is no presence of inflammation. Therefore, inflammation and irritation are two separate things.

Inflammatory bowel disease is broken down into two different categories, namely:

  • Crohn’s disease
  • Colitis/Ulcerative Colitis

Crohn’s Disease

As a test tip reminder, you can easily remember Crohn’s disease as “Crown’s disease” because of the granulomas that are present inside the gastrointestinal tract which looks like jewels to a crown. To further explain, let’s get into a quick roundup of the pathophysiology.

Crohn’s disease is a condition that can happen anywhere in the gastrointestinal tract – from the mouth to the rectum. The primary concern with Crohn’s disease is the presence of granulomas.

Granulomas

Granulomas happen when macrophages seclude bacteria like a small block and result in a protective covering, usually around a bacteria, foreign body, or virus; in most cases, tuberculosis viruses.

Upon detection of harmful, foreign bodies, macrophages will surround the infection and block it, which causes the appearance of little lumps. With a tuberculosis client, these little lumps are present during an X-ray scan. The presence of little lumps inside the lungs indicates that the client has tuberculosis or has a history of the disease.  

As for Crohn’s disease (Crown’s disease), the small granulomas attached to the bacteria are the ones causing the pain, distention, and inflammation of the gastrointestinal tract.

Colitis/Ulcerative Colitis

In colitis and ulcerative colitis, the large intestine or the colon is the main concern.

Ulcers are openings inside the gut that causes bloody stool (at least 15 episodes a day); this is the usual diagnosis of ulcerative colitis. The suffix, “-itis” means that there is the presence of inflammation. Therefore, with ulcerative colitis, there is an open source of bleeding inside the colon that also causes inflammation.

Colitis, on the other hand, is not about granulomas but scar formations with an inflamed colon. Due to the edema in the colon, there is a loss of colon absorption and elasticity.

Causes of Inflammatory Bowel Disease

The causes for inflammatory bowel diseases like Crohn’s disease and colitis or ulcerative colitis are the three S’s, namely:

  • Stress
  • Sickness
  • Smoking

When the body has inflamed bowel disease, it attacks itself which is also known as an autoimmune disorder like myasthenia gravis. In this situation, the body thinks that it is its foreign enemy.

Nursing Considerations

When dealing with a client with a heightened immune system, the main goal is to decrease the elements that cause the condition to worsen. Therefore, the nurse has to make sure that the client:

  • Is not be exposed to stressful events or situations
  • Refrains from getting sick
  • Stops smoking 

These three causes are the main culprits for the outburst of this type of autoimmune disorder.

If you’re having a hard time studying for major nursing exams and the NCLEX®, head on to Simple Nursing’s website and YouTube channel to get a more simplified, concise approach to memorizing and remembering every single nursing-related topics.

The Pathophysiology of Cardiogenic Shock

Shock has different types, and the manifestations are different for every type. We’ve made a series of lectures talking about these types. Here, we’ll be talking about cardiogenic shock, what it really is, and how it differs from the other types of shock.

The important detail that you have to remember with cardiogenic shock is this: low pressure equals low perfusion.

For those who are unfamiliar with what perfusion is, it is the amount of oxygen being distributed around the body. Therefore, cardiogenic shock is decreased oxygen perfusion in the body.

Functions of the Heart

To fully understand what is happening with cardiogenic shock, we must first discuss, very quickly, the heart’s main function and how blood is pumped effectively in and out of the organ.

The heart’s primary function is to pump blood throughout the body. Blood is composed of a lot of components, and one of them is hemoglobin. Hemoglobin is a protein that holds oxygen and is responsible for transporting oxygen to different parts of the body.

Hematocrit is another blood component that is basically the liquid portion of the blood which helps hemoglobin to move around every system.

Decreased H&H

If there is decreased hemoglobin and hematocrit (H&H), there will be decreased perfusion since these two components are primarily tasked with transporting oxygen to all parts of the body. Insufficient hemoglobin and hematocrit are directly correlated with cardiac output.

H&H Ratio

If there is a decrease in hemoglobin, the hematocrit will also decrease because the two are intertwined with each other. If they go down, they go down together. The ratio is 1:3. One hemoglobin is equivalent to three hematocrit. For example, in your client’s laboratory values, if the hemoglobin is eight, the hematocrit will be 24.

Borderline H&H

If the hemoglobin value is eight or less, the client will immediately need a blood transfusion; therefore, the borderline value for hemoglobin around 10 g/dl.

Blood Flow

So, this is what happens with proper blood flow inside the heart and lungs:

The right side of the heart will push unoxygenated blood to the lungs to get oxygenated. Then, oxygenated blood will get pushed into the left atrium down to the bicuspid valve and into the left ventricle. The left ventricle is the area of the heart that pumps out all the blood to the rest of the body through the aorta. This is also called as the preload and afterload.

Stroke Volume

Now that we have a clearer picture of hemoglobin and hematocrit, the next thing that you have to know is the stroke volume. The stroke volume is referred to the amount of blood that comes out from the left ventricle in one pump. Stroke volume is composed of the preload and the afterload.

Question: How much blood is normally pushed out of the left ventricle?

Answer: About an ounce or two of fluid per stroke.

Preload and Afterload

Preload and afterload are phases of stroke volume. Preload refers to the time it takes for the left ventricle to be filled with blood, while afterload is the pumping of the blood out of the left ventricle. You can think of the preload and afterload as a slingshot. Preload is the pull while the release is the afterload. So, preload and afterload is equivalent to the stroke volume.

Cardiac Output

Cardiac output is simply the amount of blood being pumped out in 60 seconds or one minute. The normal cardiac output is between four to eight liters per minute. Cardiac output is also influenced by a client’s body build.

Blood Pressure

Blood pressure is a mixture of cardiac output (amount of blood coming out of the heart in a minute) and heart rate (how hard the heart pumps blood to get out of the heart).

Cardiogenic Shock

Knowing about cardiac output, stroke volume, and blood pressure will provide a better understanding of what happens in cardiogenic shock. Basically, cardiogenic shock is decreased pressure which equates to reduced perfusion.

Therefore, there’s decreased cardiac output which will result in decreased blood pressure. Instead of the normal cardiac output of four to eight liter per minute, there would be two liters per minute. And anything that’s less than two liters per minute can be categorized as cardiogenic shock.

Remember that shock, in any form, is decreased pressure which influences perfusion. If there is decreased perfusion, there will be decreased oxygen. A body that has decreased oxygen will become anxious and hypoxic, and the client will have really faint pulses.

Aside from those basic signs and symptoms, there are other manifestations that a client with cardiogenic shock will present. This will be tackled in our next lecture. Drop by SimpleNursing’s website and YouTube channel.

Hypovolemic Shock: Assessment and Manifestations

Hypovolemic shock is quite similar to cardiogenic shock, almost. Both have the same signs and symptoms and are about issues regarding blood volume.

Hypovolemic shock, much like cardiogenic shock, is due to decreased perfusion which results in decreased oxygen transport to the rest of the body. Therefore, the clinical manifestations of hypovolemic shock would be the same with cardiogenic shock.

Hypovolemic Shock Pathophysiology

Though almost similar, there are still a couple of differences between cardiogenic shock and hypovolemic shock; for one, the causes and pathophysiology.

Cardiogenic shock is about decreased cardiac output that results in low pressure and low oxygen pumped around the body. Hypovolemic shock, on the other hand, is having low volume being pushed around the body.

Hemorrhage

Hemorrhage or bleeding, be it external or internal, is the primary reason for hypovolemic shock. Any form of intense bleeding can result in decreased hemoglobin in the body. Hemoglobin is a protein and blood component that is mainly responsible for transporting oxygen throughout the body.

Hemoglobin is like the blood’s oxygen tank for distributing oxygen to the different areas of the body. Without adequate perfusion due to bleeding, there wouldn’t be enough blood to go around; therefore, hemoglobin will be unable to sustain oxygen distribution.

Hemorrhage can be due to a couple of reasons, and some common ones are:

  • Trauma
  • Car accident
  • Gastrointestinal bleeding
  • Gunshot wound
  • Stabbing

It doesn’t really matter how the bleeding started for as long as the bleeding continues and is not subdued, it will eventually lead to hypovolemic shock.

Clinical Manifestations

Bleeding decreases perfusion which then decreases oxygen in the body leading to hypovolemic shock. If this happens, the body will compensate, and the clinical manifestations will be quite similar to cardiogenic shock.

The primary signs and symptoms of hypovolemic shock are:

  1. Increased respiratory rate – breathing hard to get in more oxygen in the lungs and in the bloodstream
  2. Increased heart rate – the heart tries its best to transport the limited blood around the body with an increased pace
  3. Vasoconstriction due to increased resistance – the blood vessels are trying to bring more blood back to the lungs, heart, and brain
  4. Urinary retention – the kidneys will hold on to all the fluid it can hold onto to not lose further blood volume
  5. Altered level of consciousness – this is due to decreased oxygen going inside the brain
  6. Pale or dusky skin
  7. Decreased capillary refill

So, just remember that all of these manifestations happen due to decreased perfusion that leads to low oxygenation. Without oxygen, the body will try its best to compensate, and when that happens, everything will go haywire.

Nursing Interventions

One of the leading nursing interventions that you have to do to prevent hypovolemic shock is to stop the bleeding. So, what are the different things that you should do?

  1. Put direct pressure on the affected area to promote the coagulation process and for the bleeding to stop.
  2. Give blood transfusion to increase the blood volume; thereby increasing the red blood cells and oxygen going around the body.
  3. Give epinephrine to increase peripheral vessel resistance.
  4. Provide a dopamine drip to shrink down the vessels in the peripherals.

For our next shock-related lecture, we’ll be delving into anaphylactic shock. Compared to cardiogenic and hypovolemic shock which are both due to blood volume issues, anaphylactic shock is due to decreased resistance. Simply visit our SimpleNursing website and YouTube channel for that discussion.

See you there!

Pediatric Nursing: Overview of Congenital Heart Defects

In this edition of our pediatric nursing lecture, we’ll be focusing on the different congenital heart defects that are experienced by pediatric infant clients.

It is advisable that you have a strong background regarding the different cardiac conditions for adults in your medical-surgical nursing. If not, you’ll find this subject a bit complicated because not only is this going to focus on the anatomy and physiology of proper cardiac blood flow but also the different structural issues that arise with pediatric clients.

We’ll make this overview quick and straightforward. Let’s begin.

Anatomy and Physiology

First off, we’ll get a brief rundown of the normal physiology of the lungs and heart. So, what are the important pointers that you have to take note of?

  1. The right side of the heart (right atrium and right ventricle) – pumps deoxygenated blood into the pulmonary arteries to become re-oxygenated. The hemoglobin in red blood cells are the carriers of oxygen.
  2. The left side of the heart (left atrium and left ventricle) – receives oxygenated blood from the lungs. The left atrium pumps oxygenated blood through the left ventricle (preload) then, the left ventricle forcefully contracts to squeeze oxygenated blood into the aorta to be distributed to the rest of the body.

So, this how the heart and lungs work together to provide a sufficient amount of oxygen to the different parts of the body.

Arteries vs. Veins

One of the major confusions that students usually encounter when it comes to the heart and lungs is differentiating between arteries and veins.

To easily remember which does what, here’s a trick:

  • Arteries – away from the heart
  • Veins – vacuums back blood to the heart

So, you would notice that “arteries” and “away” both start with “a,” while “veins” and “vacuums back” both start with “v.”

Remember, arteries carry oxygenated blood away from the heart to be distributed to the whole body, while the veins vacuum blood back to the heart to receive oxygen.

This concept is also applied to pulmonary arteries and veins. Pulmonary arteries push blood away, and it really doesn’t matter if the blood is oxygenated or de-oxygenated. And the pulmonary veins will pull blood back into the heart.

Right and Left-Sided Pathophysiology

Normally, the right side of the heart pushes blood into the lungs. However, in cases of fibrosis or stiff lungs, there will be a backing-up of blood that can lead to right-sided heart failure. One prominent manifestation would be edema.

On the other hand, if the body is already experiencing fluid overload or edema, blood will go back up into the left side of the lung which will cause left-sided heart failure.

Congenital Cardiac Defects for Pediatric Clients

Here, we’ll go through the major types of congenital cardiac defects that pediatric clients experience especially during infancy. The main cardiac defects are:

  1. Increased pulmonary blood flow
  2. Decreased pulmonary blood flow
  3. Outflow problems
  4. A mixture of saturated and de-saturated oxygen in the blood – Transportation of Great Vessels

We’ll go through each one briefly as a basic overview. Then, we’ll be discussing each elaborately in separate lectures to provide a more in-depth focus on what really happens with every condition.

Increased Pulmonary Blood Flow

Increased pulmonary blood flow or what is also known as increased lung blood flow has a couple of conditions under its umbrella. The conditions are the following:

  1. Atrial septal defect – a hole between the atriums causes blood to flow from the left aorta to the right aorta, resulting to increased pressure on the right side of the heart, which can lead to right-sided heart failure.
  2. Ventricular septal defect – a hole in the ventricles causes blood to go to the right side of the heart, thus; increasing pressure and size.
  3. Patent ductus arteriosus – here, the atriums are normal, but the pulmonary aorta is problematic because a connection between the pulmonary artery and the aorta has been created. The consequence of this abnormal connection is that deoxygenated blood gets mixed with oxygenated blood and this mixture goes to the rest of the body.
  4. Atrial-ventricular canal – with the presence of an extra-large canal or hole, the AV canal can be categorized into atrial septal defect and ventricular septal defect. This condition is commonly seen in clients with Down Syndrome.

Decreased Pulmonary Blood Flow

With decreased pulmonary blood flow, there is decreased blood flow into the lungs. Therefore, the primary manifestation would be cyanosis or bluish discoloration of the skin. Cyanosis is not apparent with increased pulmonary blood flow conditions since there is increased blood going inside the lungs.

Signs and symptoms seen in infants with decreased pulmonary blood flow are:

  • Bluish lips and skin
  • Clubbing/rounding of the fingers

Tetralogy of Fallot

Tetralogy of Fallot (TOF) is the main condition for decreased pulmonary blood flow.

When pediatric clients have “Tet spells,” this means that the baby has been crying too much, resulting in decreased oxygen levels in the body. A common sign that pediatric clients are experiencing Tet spells is when they curl their knees to their chest or when they crouch down to add pressure and increase blood flow to the lungs and help them breathe better.  

With Tetralogy of Fallot, the client has a right to left shunting of blood with the defect of the obstruction going to the pulmonary outflow; meaning, there is not enough blood flowing into the lungs, but there is increased blood flowing into the aorta.

Normally, oxygenated blood from the left ventricle is pumped out to the rest of the body through the aorta. However, with Tetralogy of Fallot, deoxygenated blood is going through the aorta and is distributed all over the body. Without oxygen, the client will become cyanosis.

Outflow Problems

In this congenital heart defect, there is an obstruction of the cardiac chambers. The types of outflow problems are:

  1. Coarctation of the aorta – a narrowed aorta caused by twisting
  2. Pulmonic stenosis – narrowing of the pathway going to the lungs
  3. Aortic stenosis – narrowing and hardening of the aorta

Medical management for outflow problems is surgery.

Transposition of Great Arteries

Also called as “trans of great vessels,” the transposition of great arteries happens when saturated and de-saturated oxygen gets mixed up.

How does this happen?

The pathways or canals where blood flows are not situated correctly – the aorta is connected to the right ventricle while the left ventricle is connected to the lungs; which is not the normal structure.

Remember, that the right side is supposed to pump de-oxygenated blood to the lungs, and the left side is supposed to pump oxygenated blood to the aorta then gets distributed to the different parts of the body.

With the transposition of great arteries, the right side of the heart pumps de-oxygenated blood back to the body, and the left side pumps oxygenated blood right back to the lungs. Because of this mixed-up structure, there will be severe cyanosis because the body does not receive blood with oxygen.

Transposition of great arteries, like the Tetralogy of Fallot, also requires surgical intervention.

So, that’s a quick overview of the different pediatric congenital heart defects. We’ll have a more elaborate discussion of each condition with the nursing and medical interventions in our next videos.