18.5: Summary

18.1 Respiratory System

The various structures of the respiratory system, from the upper to lower airway, into the lungs, and to the capillary-alveolar bed, have been identified and explored. At the capillary-alveolar bed, the primary function of the respiratory system is gas exchange. The functions of these structures have been categorized, relating specific components to the purpose relative to ventilation and perfusion. This section has delved into the physiology of the respiratory system, and how it fits in the cardiopulmonary system. Specifics as to the role this system plays in ventilation, how respiration and gas exchange transpire, and the role the lungs play in the renin-angiotensin-aldosterone system are presented. Respiration is a basic function, generated by the neurological system, with control centers within the medulla oblongata and pons. Regulation by these systems, including actions stimulating the length and depth of each breath, is controlled by opposing actions of the apneustic and pneumotaxic centers, in efforts to maintain homeostasis throughout the body.

18.2 Cardiovascular System

The cardiovascular system is structurally unique insofar as it contains the muscular four-chambered heart (the pump), fluid/blood volume (the tank), and the blood vessels (the pipes). It is an electrical system. Electrical impulses precede the muscular movement or contraction of the heart. When the signals and responses are normal, it functions impeccably. These structures and processes have been explored and analyzed in an effort to understand cardiovascular system physiology.

In the process of investigating the normal anatomy and physiology of the cardiovascular system, regulation of this complex and intertwined system has been reviewed as well. Because normal cardiovascular function is critical to the maintenance of homeostasis, and in anticipation of the next module exploring various aspects of impaired function, this section introduced several cardiovascular dysfunctions and disorders, some of which intertwine and affect one another. Hypertension and arteriosclerosis impact one another and are implicated in CAD. Sometimes, the electrical system does not function normally, causing dysrhythmias and even cardiac arrest, which have been elaborated on through the disorders and interventions.

18.3 Factors Affecting Cardiopulmonary Function

When cardiopulmonary function is not performing properly, the physiological impacts can range from asymptomatic to severe and even life threatening. Some examples of disorders and dysfunctions affecting the cardiopulmonary system have been presented and discussed. Additionally, contributors to the development of such physiological concerns, including those risk factors considered nonmodifiable, such as genetics and age, as well as lifestyle decisions and behaviors that promote or prevent the development of cardiopulmonary diagnoses are discussed. Genetic input is not something that can be erased, although some negative impacts may be slowed or prevented by positive lifestyle and behavioral actions and decisions. Similarly, negative choices and decisions can have negative physical results.

Health status is also a factor in cardiopulmonary dysfunction. Comorbidities have a negative influence on a patient’s ability to physically (and perhaps mentally) come through the problems that accompany malfunctions of the cardiac or pulmonary systems. As critical as this combined system is, the impacts may not only be obvious from the primary diagnosis but may be more insidious and be based on a secondary or tertiary effect.

Finally, a variety of diagnostic tests were investigated—from laboratory blood studies like cultures to arterial or venous blood gases to analyze acid-base balance and respiratory status, to monitoring devices such as pulse oximeter and capnography. Some of the components of PFTs were presented, although this practice area is quite specialized, with many details specific to pulmonology care. Since the electrical system is so vital to cardiovascular function, electrocardiograms were explored, with a focus on the entry-level, generalist nurse.

18.4 Management of Impaired Cardiopulmonary Functioning

The nursing roles in care of the cardiopulmonary patient can be varied and may take place in varied settings. Care of chronic disorders may happen most often in outpatient settings: physician’s offices, clinics, or home care. Acute care and emergent care involve inpatient settings, and recovery, either between exacerbations or complete, is likely to entail rehabilitation. Nursing care may include total, intensive care, or focus more on maximizing an individual’s recovery and return to best function.

Nurses caring for patients with cardiopulmonary dysfunction should be vigilant and compassionate in their care delivery. Patient status can change rapidly, so frequent assessment is necessary. Prevention of complications is important; therefore, helpful practices like assertive pulmonary toilet should be employed to prevent atelectasis and possibly pneumonia. The importance of pain and anxiety control and other comfort measures cannot be diminished throughout the provision of care.

The nurse is not alone in the provision of cardiopulmonary care but is a member of an interdisciplinary team. Team members work in concert to coordinate the various aspects of patient status and goals, as well as the different care available through specialists in medicine, nursing, and other care providers. Cardiopulmonary emergencies benefit from the fast identification of the circumstance and immediate collaboration and action of the interdisciplinary team. The nurse works very closely with advanced practitioners—physicians, nurse practitioners, and physician’s assistants—collaborating during routine and emergent care. The professional interaction during emergencies offers respect and recognition for all team members, from frequent nursing assessment to chest tube placement, or necessary advanced airways and mechanical ventilation. Respiratory therapists assist with intubations and set up and manage ventilators; radiology personnel take and read x-rays; and entire collaborative teams manage arrest situations in an organized manner to maximize the patient’s outcome. Throughout a patient’s journey, all sorts of multidisciplinary players contribute their expertise through varied therapies and support.