1 - Cardiopulmonary Management Flashcards
1
Q
What are the 3 key components of Cardiovascular Pulmonary Management (CVP)?
A
- Know
- Apply
- Manage
2
Q
Of the 3 key components of CVP, what makes up Know?
A
Know
- Normal Physiology
- -Cardiac
- -Pulmonary
- -Vascular
(how is it supposed to work?)
3
Q
Of the 3 key components of CVP, what makes up Apply?
A
Apply
- Pathology
- Disease Progression
- Pharmacology
(what makes the patient not typical? Is it going to get worse? Meds to deal with CVP?)
4
Q
Of the 3 key components of CVP, what makes up Manage?
A
Manage
- Primary and Secondary Prevention
- -Primary = have impairment and directly addressing
- -Secondary = preventing any further complications
-Inpatient and Outpatient
5
Q
How do you calculate Oxygen Delivery (DO2)?
A
DO2 = arterial O2 x cardiac output
6
Q
How do you calculate Oxygen Consumption (VO2)?
A
VO2 = (arterial O2 - venous O2) x cardiac output
7
Q
What might happen to VO2 is a severe cardiopulmonary dysfunction exists?
A
VO2 (oxygen consumption) may fall shor of demand
8
Q
How do you calculate Oxygen Extraction Ratio (OER)?
A
OER = consumption / delivery = VO2 / DO2
9
Q
If you have cardiopulmonary dysfunction, what does this mean in terms of the OER?
A
You are consuming more than you are delivering
10
Q
What is DO2 dependent on?
A
the demands of the tissue
11
Q
How does DO2 at rest compare with the consumption?
A
At rest, DO2 is 3-4 x greater than the actual consumption (can allow for wiggle room if not receiving oxygen you need)
12
Q
How is 98% of oxygen in the body transported?
A
In combination with hemoglobin
13
Q
What can cause the affinity between hemoglobin and O2 to change?
A
pH and temperature
14
Q
What 4 main fluid problems can exist with blood?
A
Too much water
Not enough water
Too much Sodium
Not enough sodium (Hyponeutrmia)
15
Q
What are the 9 steps in Oxygen Transport?
A
- Inspired Oxygen and Quality of Air
- Airways
- Lungs and Chest Wall
- Diffusion
- Perfusion
- Myocardial Function
- Peripheral Circulation
- Tissue Extraction and Utilization of Oxygen
- Return of Partially Saturated Blood and CO2 to Lungs
16
Q
What is our air made of of in the atmosphere?
A
79% Nitrogen
21% O2
0.03% CO2
17
Q
What role does the Nitrogen in the air in the atmosphere play in inspiring oxygen?
A
Nitrogen is not absorbed in the lungs but is important for keeping the alveoli in the lungs open.
18
Q
What is the result of poor air quality on inspiring oxygen? (2)
A
- Interferes with respiratory tract filtering
2. Leads to inflammation of alvolar membrane (thickening of airways makes it harder for O2 to get in)
19
Q
What three factors play into the Inspiration of oxygen?
A
- Atmospheric Air
- Air Quality
- Air Humidity
20
Q
In the alveoli, inspired air is saturated with what?
A
water vapor
21
Q
In dry environments, what can happen in the lungs?
A
Loss of mucus covering which can lead to erosion and infection. Want a fine balance of phlegm.
22
Q
What is the purpose of cilia in the airway?
A
To catch debri and get it out. Can get burnt off if smoker.
23
Q
When you breath in what is the diaphragm doing? What is happening to the negative pressure? Breathing out?
A
Contracting and moving down, this increases the negative pressure in the cavity drawing air in. When the diaphragm goes back this is a passive process.
24
Q
Do we want symmetrical use of our lungs? Why or why not?
A
Mucous can pool in lungs and lead to infection. So when lying on back or even sitting up a bit your lungs are not fully symmetrically expanding.
25
Which 2 muscles are used during inspiration and how?
1. External Intercostals
- elevate ribs and therefore increases the volume of pleural cavities
2. Diaphragm
- depress the inferior wall of thoracic cavity and, therefore increase the volume of the pleural cavities.
26
Which 2 muscles are using during expiration (normally a passive process; if mm used) and how?
1. Internal Intercostals
- compress and lower the ribs and therefore decrease the volume of the pleural cavities
2. Abdominals
- compress the abdominal cavity which elevates the abdominal organs and passively elevates the diaphragm and, therefore, decreases the volume of the plural cavity.
27
Where does oxygen diffuse from to get into the blood stream?
Diffusion = transfer of oxygen from alveolar sacs to pulmonary circular (high to low concentration)
28
What 5 things does diffusion of oxygen from the alveoli to the pulmonary circular depend on?
1. Surface area of alveolar capillary (larger surface area = more diffusion)
2. Diffusing capacity of alveolar-capillary membrane (thicker membrane = diffuse more slowly)
3. Pulmonary capillary blood volume (more blood = more oxygen)
4. Ventilation / perfusion ratio (balance between how much is breathed in and how much blood flow)
5. Transit time of blood in alveolar capillary membrane
29
Amount of oxygen that diffuses across alveolar-capillary membrane varies directly with ____ and inversely with ___.
Amount of oxygen that diffuses across alveolar-capillary membrane varies directly with SIZE (SURFACE AREA) and inversely with THICKNESS.
30
What result will a decrease in the surface area and increase in thickness of alveolar membrane have on amount of O2 in blood?
Decrease in the amount of O2 and blood.
31
As a PT, why is position and activity critical in care of patients in acute care?
Want to maximize the amount of ventilation and perfusion. Why we want upright to maximize this in lungs.
32
How do the Apical and Lung Bases differ in terms of perfusion and alveoli expansion?
Apical: Low perfusion and alveoli expand fully.
Bases: Perfusion increased due to gravity, enlarged vessels compress alveoli.
33
Where is the most optimal place for ventilation/perfusion in the lungs? Why?
Right in the middle, balance between perfusion from gravity vessel size and expansion of alveloi.[
34
Optimal function depends on synchronized coupling of ___ and ____ [of the heart.]
Optimal function depends on synchronized coupling of ELECTRICAL CONDUCTION and MECHANICAL CONTRACTION [of the heart.]
35
What result would messed up electrical excitation of the heart have on oxygen transport in the body?
Un-synchronized contraction of atria followed by ventricals won't allow blood the flow properly through the body which is carrying oxygen.
36
Define Preload
left ventricular end diastolic pressure - determines how hard the ventricle will contract and push blood out to body. Amount ventricle stretches with blood. Synonymous the pressure water balloon feels when filled.
37
Define Afterload
Amount of resistance from periphery that blood or ventrical has to overcome in order to get to the body. Synonymous to the pressure from water on knot in balloon.
38
If a medication has a ionotropic effect, what will it be effecting?
Force
39
If a medication has a chronotropic effect, what will it be effecting?
Rate of Contraction
40
What 4 things can effect Cadiac Output?
1. Preload
2. Force
3. Rate of Contraction
4. Afterload
41
What 2 things are measures of impairment?
1. Heart Rate
| 2. Ejection Fraction
42
Large vessels have more ___ and ____ compared to medium to small vessels having more ___.
Large vessels have more ELASTIC and CONNECTIVE TISSUE compared to medium to small vessels having more SMOOTH MUSCLE.
43
Why to Large vessles have more elastic and connective tissue?
To withstand high pressures and prevent blowout.
44
Blood pressure is regulated by ____ and ____ pressures.
Blood pressure is regulated by HYDROSTATIC and ONCOTIC pressures.
45
What is oncotic pressure compared to hydrostatic?
Oncotic pressure is the pull of fluid INTO blood due to proteins while Hydrostatic is the push of fluid OUT into the periphery.
46
What regulates blood flow through regional vascular beds?
Arterioles
47
Does O2 diffusion (high content to low content) occur slowly or quickly?
Quickly
48
Do we have just the right amount or excess of oxygen in our blood? How can we tell in terms of PO2?
Excess, Intracellular PO2 averages 23mmHg while only 3mmHg pressure is needed for cell metabolism. Good because if we require more oxygen than it is there.
49
What is OER at rest?
Amount of O2 extracted at rest = 23%
50
T/F: The rate of O2 extraction is regulated by oxygen availability.
FALSE: The rate of O2 extraction is regulated by oxygen demand (not oxygen availability).
51
Will PO2 be higher in venous or arterial blood?
Arterial as it has been oxygenated.
52
Which step of oxygen transport would be affected in a: MYOCARDIAL INFARCTION
1. Inspired Oxygen and Quality of Air
2. Airways
3. Lungs and Chest Wall
4. Diffusion
5. Perfusion
6. Myocardial Function
7. Peripheral Circulation
8. Tissue Extraction and Utilization of Oxygen
9. Return of Partially Saturated Blood and CO2 to Lungs
6. Myocardial Function
53
Which step of oxygen transport would be affected in a: CHEST STAB WOUND
1. Inspired Oxygen and Quality of Air
2. Airways
3. Lungs and Chest Wall
4. Diffusion
5. Perfusion
6. Myocardial Function
7. Peripheral Circulation
8. Tissue Extraction and Utilization of Oxygen
9. Return of Partially Saturated Blood and CO2 to Lungs
3. Lungs and Chest Walls
54
Which step of oxygen transport would be affected with: ASTHMA
1. Inspired Oxygen and Quality of Air
2. Airways
3. Lungs and Chest Wall
4. Diffusion
5. Perfusion
6. Myocardial Function
7. Peripheral Circulation
8. Tissue Extraction and Utilization of Oxygen
9. Return of Partially Saturated Blood and CO2 to Lungs
2. Airways
| and 3. Diffusion b/c irritation, thickened membrane
55
Which step of oxygen transport would be affected with: PULMONARY EMBOLUS (clot in lung)
1. Inspired Oxygen and Quality of Air
2. Airways
3. Lungs and Chest Wall
4. Diffusion
5. Perfusion
6. Myocardial Function
7. Peripheral Circulation
8. Tissue Extraction and Utilization of Oxygen
9. Return of Partially Saturated Blood and CO2 to Lungs
5. Perfusion (clot is in lung circulation)
56
Which step of oxygen transport would be affected with: HYPERTENSION
1. Inspired Oxygen and Quality of Air
2. Airways
3. Lungs and Chest Wall
4. Diffusion
5. Perfusion
6. Myocardial Function
7. Peripheral Circulation
8. Tissue Extraction and Utilization of Oxygen
9. Return of Partially Saturated Blood and CO2 to Lungs
7. Peripheral Circulation
57
Which step of oxygen transport would be affected with: ANEMIA (low iron, hemoglobin)
1. Inspired Oxygen and Quality of Air
2. Airways
3. Lungs and Chest Wall
4. Diffusion
5. Perfusion
6. Myocardial Function
7. Peripheral Circulation
8. Tissue Extraction and Utilization of Oxygen
9. Return of Partially Saturated Blood and CO2 to Lungs
8. Tissue Extraction and use of O2 (not enough hemoglobin to pull oxygen off)
58
Name a Normal factor that "shakes up" O2 transport. (3)
1. Activity (Increased heart rate)
2. Position (I.E. Gravity)
3. Emotional Stress (increased heart rate)
59
Name a Disease factor that "shakes up" O2 transport. (6)
1. Bedrest (position of lungs)
2. Fever (increase heart rate to fight infection)
3. Disease Itself
4. Inflammation Process
5. Medication
6. Fluid Imbalance (laying down causes pressure on lungs and fluid buildup or balance of fluid in lungs)
60
What has the greatest influence on O2 transport?
Gravity
Humans are designed to function upright, 60% body weight is fluid: small shifts in gravity --> big fluid shifts.
61
What affect does bedrest and restricted activity have on Cardiac Output? VO2? Oxygen Extraction Ratio?
All decrease along with other systems affected.
62
What physiological impacts does a reduction in gravitation forces and bed rest have ?
1. Change in fluid distribution
2. Reduced muscle activity
3. Change in body weight distribution and pressure
4. Aerobic reconditioning and all that impacts with Oxygen transport exchange.
63
What are "Puffy Face and Bird Legs"?
Loss of Gravitational Stress. Gravity normally keeps fluid in body/legs, loss of gravity allows fluid to shift to thorax/head.
64
What are the 7 elements of patient/client management?
1. Screening
2. Examination
3. Evaluation
4. Diagnosis
5. Prognosis
6. Intervention
7. Outcomes
65
What 8 things/systems are considered when screening for CVP disease?
1. General Health
2. Skin
3. Respiratory System
4. Cardiovascular System
5. Peripheral Vascular System
6. Neurologic System
7. Hematologic System
8. Endocrine System
66
What is included in Examination? (2)
1. Patient History
| 2. Systems Review
67
What is included in Patient History? (3)
1. Subjective Information
2. PIPs
3. Information from Medical Chart
68
After the Examination, what is determined?
Hypothesis
| -"Pre-PT Diagnoses" (may incude more than one based on History or Systems Review)
69
What are 2 Systems we assess and 4 things we look for in each? (just have an idea of things)
General Health
1. Weight gain or loss
2. Fatigue, weakness, malaise
3. Fever, chills
4. Sweats, night sweats
Skin
1. Excessive dryness or moisture
2. Itching (pruritis)
3. Excessive bruising
4. Lesion or rash
70
What are 8 things we look for when assessing a patients Respiratory System? (just have an idea of things)
1. History of lung disease
2. Chest pain with breathing
3. Wheezing or noisy breathing
4. Shortness of breath (how much activity)
5. Cough
6. Sputum (color, amount)
7. Hemoptysis
8. Medications
71
What are 8 things we look for when assessing a patients Cardiovascular System? (just have an idea of things)
1. Heart or retrosternal pain
2. Palpitations
3. Cyanosis (not getting enough oxygen so blue skin)
4. Dyspnea on exertion (amount of exertion)
5. Orthopnea (shortness of breath lying down)
6. Edema
7. History of heart murmur, HTN, CAD or anemia
8. Medications for cardiac disease
72
What are 8 things we look for when assessing a patients Peripheral Vascular System? (just have an idea of things)
1. Coldness, numbness, tingling of legs
2. Swelling of legs (time of day and activity)
3. Discoloration hands or feet
4. Varicose veins (poor venous return so pooling)
5. Intermittent claudication
6. Thrombophlebitis (inflammation of veins)
7. Ulcers
8. Medications
73
What are 5 things we look for when assessing a patients Hematologic System? (just have an idea of things)
1. Bleeding in skin or mucus membranes
2. Excessive bruising
3. Lymph node swelling
4. Blood transfusion and reactions
5. Medications
74
What are 7 things we look for when assessing a patients Endocrine System? (just have an idea of things)
1. History of diabetes (medications)
2. History of thyroid disease or symptoms
- 3. Chang in skin texture
- 4. Excessive sweating
- 5. Relationship between appetite and weight
- 6. Nervousness
- 7. Tremors
75
What are the 2 ways in which we can detect Oxygen Transport Dysfunction?
1. External Signs
| 2. Internal Signs
76
What are the 3 External Signs of Oxygen Transport Dysfunction?
1. Skin: pale, cyanotic, cold
2. Speech: short of breath
3. Diaphoresis (flush)
77
What are the 4 Internal Signs of Oxygen Transport Dysfunction?
1. Vital Signs
2. Respiratory patterns
3. Hypoxia/low pulse oximetry
4. Poor peripheral circulation
- Decreased capillary refill (> 3 sec)
78
"Patient with shoulder pain when lifting arm overhead."
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
a. Patient History
| - Includes subjective information, PIPs and information from medical chart
79
"Has COPD, cough with some sputum, Inhalers"
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
b. Systems Review
80
"Patient will have increased use of accessory breathing muscles which contributes to abnormal shoulder mechanics."
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
c. Hypothesis
| - "Pre-PT Diagnosis" (may include more than one based upon History and Systems Review)
81
What is included in Diagnostic Exams and Tests?
Includes medical and PT Tests and Measures
82
What is included in Evaluation?
Interpretation of Examination Findings
83
What is included in PT Diagnosis
Processional statement of PT Related PT Status
84
"Shoulder ROM, strength, breathing pattern."
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
d. Diagnostic Exams and Tests
| - Includes medical and PT Tests and Measures
85
"Abnormal breathing pattern, Abnormal shoulder mechanics"
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
e. Evaluation
| - Interpretation of Examination Findings
86
"Impaired ventilatory pump action, shoulder dysfunction"
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
f. PT Diagnosis
| - Professional statement of PT related PT Status
87
"Yes, PT will benefit this patient"
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
g. PT Prognosis
| - Professional statement of PT related PT Status, is there possibility PT will improve problems.
88
What is included in PT Prognosis?
Professional statement of PT related PT Status, is there possibility PT will improve problems.
89
What is included in Working Problem List?
Problems and Anticipated Problems
| Goals that address Problems
90
"Ventilatory pump abnormality"
Select the proper category:
a. Patient History
b. Systems Review
c. Hypothesis
d. Diagnostic Exams and Tests
e. Evaluation
f. PT Diagnosis
g. PT Prognosis
h. Working Problem List
i. Plan of Care
h. Working Problem List
91
What are 2 examples of Physical Therapy Interventions for Prevention?
1. Address physical activity
| 2. Address CV risk factors
92
What are 2 examples of Physical Therapy Interventions for Secondary Prevention?
1. Increase aerobic capacity/endurance
| 2. Improve breathing pattern/ventilation
93
What are 2 examples of Physical Therapy Interventions for Treatment?
1. Airway clearance
| 2. Exercise: Strength mobility, ADL
