121- Exam 3 Flashcards
What are 6 Treatments for Sleep Apnea?
Whats the #1 Treatment
1= CPAP
- Weight Reduction
- Sleep Position
- O2 Therapy
- Drug Therapy
- Protriptyline Hydrochloride to reduce REM sleep
- CPAP or BiPAP
What are the 3 Types of Sleep Apnea and their characteristics?
- Obstructive= Most Common. Obstruction of the airway. Pt appears to hold breath
- Central= No Airflow or Chest movement. Brain stops sending signal to Resp. Muscles. Brain Spinal injuries, Neuromuscular disorders
- Mixed= Combination of both. Presents as Central followed by Obstructive
8 Respiratory Events watched in a sleep study (polysomnography)
- Apneas
- Apnea Index
- Hypopneas
- Hypopnea Index
- Hypopnea + Apnea
- AHI (Apnea+Hypopnea Index)
- MEAN SPO2
- Irregular Breathing pattern
8 Indications for a Sleep Study (polysomnography)
- COPD with awake PAO2 <55
- Pulmonary Hypertension
- Right Heart Failure
- Polycythemia
- Excessive Daytime sleepiness
- Disturbances in Resp Control PACO2 <45
- Disturbed Sleep
- Morning Headaches
10 Things monitored during a sleep study (polysomnography)
- EEG= Brain Activity
- EOG= Eye Movement
- EMG= Muscle Movement
- ECG= Heart Rhythm/Rate
- Airflow in/out of lungs
- Ventilatory rate/effort
- Oximetry
- Breathing Effort
- Chest/Abdomen movement
- Audio/Video recording
What are the 5 stages of Sleep and how are they split?
Non-REM Sleep 1-4
1. Falling Asleep (easily awakened)
2. Deeper than 1 (N1 2-5% sleep)
3. Deeper than 2 Most sleep (N2 45-55%)
4. Deepest (N3 15-20%)
REM Sleep Stage 5
5. REM= Muscles can’t move, dreaming (REM 20-25%)
What is a doppler Echo detecting?
Speed and direction of blood flow in the heart
Echocardiogram TTE vs TEE
TTE= Transthoracic (Most common) (Through the Thorax, non invasive)
TEE= Transesophageal (through esophagus, invasive)
What is an echocardiogram?
Ultrasound of the heart
What does an echocardiogram examine?
Structures and functions of the heart
7 reasons we do echocardiograms?
- Look for blood clots
- Fluid around the heart
- Aorta Issues
- Cardiomyopathy
- Pulmonary Hypertension
- Septal Defects (ASD vs VSD
- Valve issues
5 Types of echocardiograms?
- TTE
- TEE
- Stress
- Doppler
- Bubble
Pulseless Electrical Activity (PEA)
What does it look like on EKG Strip?
Is it Shockable?
Has Normal Rhythm but there is no Pulse. It is electrical activity in the heart with no functioning muscle
NOT Shockable as there is no electricity to shock. DO CPR
Asystole
What does it look like on an EKG Strip?
Is it Schockable?
Flatline
NOT Shockable as there is no electricity in the heart. DO CPR
Atrial Flutter (A-Flutter)
Rate?
Rhythm?
CLUE to detect?
Atrial Rate 250-300 bpm
P-wave is irregular
CLUE= Saw Tooth P Waves
Atrial Fibrillation (A-FIB)
Rate?
Rhythm?
CLUE to detect?
> 400 atrial bpm (uncountable)
Wavy, erratic baseline (squiggles)
CLUE= QRS complex is irregular timing
Ventricular Fibrillation (V-FIB)
What does it look like on EKG?
Rhythm?
Shockable?
No solid looking QRS Complex. Fluttering or quivering of the ventricles. Bunch of short unorganized squiggly lines
YES Shockable= Emergent
Ventricular Tachycardia (V-TACH)
What does it look like on EKG?
Rhythm?
Shockable?
tall, regular rhythm, no QRS complexes, looks like even hills
YES Shockable=Emergent
Premature Ventricule Complex (PVC)
Multifocal Vs. Unifocal
What do they look like?
Impulses sent from somewhere other than SA Node (Atria). NO P Wave. Starts in the ventricles.
Multifocal= QRS do no match, they can be up or down, are irregular meaning the signal is coming from multi locations in ventricles
Unifocal= QRS do match, so signal is coming from the same spot
Sinus Tachycardia
Rate?
Rhythm?
Fast HR
>100 BPM
Regular Rhythm
Sinus Bradycardia
Rate?
Rhythm?
Slow HR
<60 BPM
Regular Rhythm
What is an EKG artifact?
irregular squiggles close together on EKG strip due to movement, shivering, loose electrodes or warn out leads
What does QT Interval Include and what is it?
Begins at the START of Q ends at the end of T
Measure depolarization & Repolarization of ventricles
What does the ST segment include and what is it?
Begins at END of S to Beginning of T
Ventricles preparing to repolarize
What does PR Segment include and what is it?
Begins at end of P ends at beginning of Q (P-Q without the P wave)
Impulses travel through HIS & Purkinje fibers
What does PR interval include and what is it?
Begins at beginning of P ends at beginning of Q (P-Q including P)
Depolarization of Heart from SA–>AV–>HIS–>Purkinje
What is the T Wave?
What is the max height?
What does it look like?
Ventricular repolarization AKA ventricles refilling with blood preparing to pump again
5mm height
Long hill after the QRS
What is QRS complex?
What is it’s duration?
What does it look like?
Electrical impulses through ventricles causing their contractions
.06-.12 seconds
Sharp point on EKG
What is the P Wave?
What is the length?
What does it look like?
What is the duration?
initiation of impulse from SA node to AV node. Results in Atria contractions
<1.5-2.5 boxes on EKG strip
Upright and rounded before QRS. (1 for every QRS)
.06-.10 seconds
What parts are included in a complete waveform on EKG?
P, QRS complex and T wave
3 uses for an EKG?
- Identify irregularities in heart Rhythm
- Reveal presence of injury, death or physical changes in heart muscle
- Assessment and Diagnostic
What are 3 intrinsic rates in order?
- SA Node= 60-100 BPM
- AV node= 40-60 BPM (SA Back up)
- Purkinje Fibers= 20-40 BPM (SA/AV Back up)
What is the conductive pathway of the heart
- SA Node initiates heart beat to AV node
- Bundles of HIS divides R/L
- Purkinje fibers carries electrical impulses to ventricles
4 electrical systems of the heart
- Automaticity= Produces electrical impulses
- Excitability= Responds to Impulses
- Conductivity= Transmits impulses
- Contractility= Contracts when stimulated
What is the MRI Hazards
Magnetic Field is 21k times greater than earths natural field. Anything containing metal can be airborne
When would we get a PET Scan? How is it done?
Checking for disease in the body like cancer. Body is scanned with special dye that is radioactive
Determines between benign & Malignant
- lung cancer stages
- fibrosis from tumor
- metastatic diseases
When would we get a CT Scan? How is it done?
determine/diagnose Pleural Effusion
Images taken in slices and placed together
5 Xray lines/tubes and how they look
- ETT= radiopaque lines 3-6cm above carina
- Trach= beyond 1/2 distance between stoma and carina
- Swan Ganz= in pulmonary artery in neck
- NG= Flows down to stomach toward the left
- Chest= in Pleural Cavity. There are breaks in the Chest tube radiopaque lines to indicate chest tubes
List the AA, B, Cs of Xray evals (A-I)
A= Assessment
A= Airway
B= Bones
C= Cardiac
D= Diaphragm
E= Equal & Effusions
F= Fissures
G= Gastric Bubble
H= Hilum
I= Impression
What is the A= Assessment looking for on Xray?
Pt Positioning
Good Inspiration
Good exposure (over, under, proper)
Rotation of clavicles (Equal distance from sternum)
What is the A=Airway looking for on Xray?
Is there an ETT tube and is it in good placement?
What is the B=Bones looking for on Xray?
Are there any fractures?
If so, is there subcutaneous air outside the rib cage?
What is the C=Cardiac looking for on Xray?
Is the heart more than 50% of the chest cavity?
Can you see the Aortic Knob?
What is the D=Diaphragm looking for on Xray?
What is it’s position?
Is it Flat or curved?
Are the Costophrenic angles sharp or rounded?
If rounded= Pleural Effusion
What is the E=Equal & Effusion looking for on Xray?
Any Infiltrates or effusions?
What is F=Fissures looking for on Xray?
Fluid in the fissures= Pleural Effusion or CHF
What is G=Gastric Bubble looking for on Xray?
Can you see the air in the stomach?
What is H=Hilum Looking for on Xray?
Should be slightly white in the hilum region as this is normal
What is I=Impression looking for on Xray?
What is our overall impression of the Xray?
What does over-penetrated, under-penetrated, Xray Film look like?
Over= Dark
Under= Light
What is Xray Positions PA, AP, Lateral Decubitus and expiratory & When would we use it?
PA= Posteroanterior Most common (Back to Front)
AP= Anteroposterior Common in ICU (Front to back)
Lateral Decubitus= L or R. side laying position looking for pleural fluid or air fluid levels
Expiratory= Determine small Pneumothorax or unilateral airway obstructions
Radiopaque vs Radiolucent
Radiopaque= Light cannot be penetrated by Xray
Radiolucent= Xrays can pass through (air, soft tissue, fat)
What is calorimetry and when would we use it?
The amount of body heat in units of calroies generated by the body during metabolism
Increased calories measured–>increase metabolic rate–>increased nutrient consumption
Use it= Difficult to wean pts
What is parenteral feeding? How is it done?
Long or short term?
Nutrition through an IV live (peripheral or central) used only for nutrient support
Short term
What are the 3 complications from parenteral feeding?
- Mechanical
- Infections
- Metabolic
What is enteral feeding?
Is it better or worse than Parenteral?
Nutrients delivered strait to gut. Safer and cheaper.
stimulates gut hormones, less hyperglycemia and fewer ulcers
3 types of enteral feeding?
- NG Tube= Through Nose)
- OG Tube= Through Mouth
- PEG= Through Stomach
6 Pts at high risk for malnutrition
- Underweight
- Pook intake
- Protracted nutrient loss (Dialysis, malabsorption, draining wounds/abscesses)
- Hyper metabolic state (fear, trauma, burns)
- Chronic Drug/Alcohol use
- Poverty, isolation, late age
5 underlying causes of malnutrition in COPD pts
- Increased energy expenditure (Increased WOB)
- inadequate calorie intake (dyspnea while eating)
- Poor utilization of calories (Mal-absorption)
- Psychological factors (depression, smoking, poverty)
- Eating & living arrangements
7 Respiratory Consequences of malnutrition
- Affects all ages
- Increase morbidity and mortality for resp, cardia, renal failure
- Resp muscle dysfunction, affects ventilations, higher resp infections and changes to lung parenchymal
- underlying disease increases energy and promotes muscle catabolism
- Prone to hypercapnia (high CO2 in blood)
- Difficult to wean from vent
- Higher mortality rate
