Acute/Surgical Cardiopulm Patients Flashcards
Chest Tubes
-placed to suction air or fluid
-avoid pulling out, dont tip over, treat as drainage tube
-encourage upright positions, ambulation and deep breathing
Anesthesia
-restrictive
-depresses breathing and diaphram contractions (intubation)
-decreases TLC, FRC, RV, lung compliance
-can cause collapse, shunting, atelectasis
-consider time under and O2 given during procedure
-airway obstructions from tubes/fluids
FRC
-causes alveolar collapse in supine
PT Intervention Goal
-prevent bedrest issues
-weightbearing activites
-ADLs
-pulmonary toilet/normal breathing
-o2
-family support
Incentive Spirometry
-ball rises as patient inspires
-helps inflate the lungs
Positive Expiratory Decives: Acapella
-vibratory PEP therapy
-exhale through device and vibrations looses secretions
-10x followed by huffs and a cough
Inspiratory Muscle Training
-use if pt can diaphragmatically breath w/o accessory muscles
-90-90-90 positioon, nose clippped, back supported
-lower pressures= weakness
Maximal Inspiratory Pressure:
-expire fully then maximal inspire
-can be used with sniff pressure
Maximal Expiratory: inspire fully then perfoorm maximal expiratory
IMP Endurance
-15-20% MIP
-30min/day
IMP Strength
-50-60% MIP
-train to failure 25-35 breaths
High Frequency Chest Wall Oscillation
-vibration of chest wall to remove secretions
Bed Rest Effects
Cardio:
-increased resting HR, risk of DVT
-decreased max HR, Vo2max
Respiratory:
-decreased vital capacity, inpaire toilet, increase V/Q mismatch
Abnormal Response to Exercise
-HR increase 20-30 or drop below resting
-SBP increase 20-30 or drop by 10
-Spo2 drop
-High RR, accessory muscles
Coronary Artery Bypass Graft
-CABG
-open heart surgery
-place another vessel from one spot to bypass blockage (radial arteries, saphenous veins, mammary arteries)
On pump: extensive, machine pumps for heart
Off pumo: minimally invase
Check:
-hemoglobin, hemocrit, xrays, nurses and drs, temporary pacemakers
Sternal Precautions
-limit movement for 6-8 weeks
-gentle coughing
-move “in the tube”: keep arms to the side
-infection control/incision
Intra Aortic Balloon Pump
-severe heart failure; shock
-restore CO and perfusion
-inserted in femoral (bedrest) and axillary (might be allowed to exercise) to ascending aorta
-balloon inflates and deflates to increase CO by 40%
Complications: dissectiono, perforation, ischemia, emboli
Mechanical Circulatory Support
Bridge to recovery: allow organ to regain function
Bridge to Decision: determine if transplant candidate
Bridge to transplant: keep paitents alive before transplant
Destination Therapy: prolong survival and quality of life
Fried Frailty Phenotype
-weight loos, low PA, slow gait, exhaustion, weakness
Impella Device
-cathater based ventricular assist device
-increased blood flow from LV to aorta 2.2-6.2 L/min
ECMO
-Veno-Arterial Ecmo: supports heart and lungs
-Veno-venous Ecmo: supports lungs
-cannot be turned off by PT
LVAD
-Left ventricular assist device
-pump blood from LV to aorta
-has outer controller
-3-10L/m (drop in flow could be pump failure)
-Speed usually fixed (abnormal condition)
-10 Watts
-Pump Index (higher is better LV function
Complications:
-bleeding, infection, MAP
Heart Transplant
Indications:
-CHF, Cardiomyopathy, low prognosis
Post op:
-infections, low response to activity, sternal precautions
Denervated heart:
-no ischemic pain
-higher RHR >90
-slower HR changes
-orthostatic HTN
Lung Transplant
Single:
-Thoracotomy
Double:
-clamshell
Complications:
-pneumothorax, plural effusion, hypoventilation, phrenic n injury
Denervated Lungs:
-decreased cough reflex, ciliary mmt
-Increased infection risk, edema, mucous
