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Acute W2 Flashcards

ABG, IPPA

1
Q

What is direct contact transmission?

A

Physical contact between an infected person and a susceptible person, transferring microorganisms.

Includes touching, kissing, sexual contact, and contact with body lesions.

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2
Q

What are some examples of frequent touch surfaces that can lead to indirect contact transmission?

A
  • Door knobs, door handles, handrails
  • Tables, beds, chairs
  • Washroom surfaces
  • Cups, dishes, cutlery, trays
  • Medical instruments
  • Computer keyboards, mice
  • Pens, pencils, phones, office supplies
  • Children’s toys

These surfaces are known as fomites.

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3
Q

What does droplet contact transmission involve?

A

Transfer of diseases through droplets contacting surfaces of the eye, nose, or mouth.

Generated by coughing, sneezing, or talking.

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4
Q

True or False: Airborne transmission allows microorganisms to remain suspended in air for long periods.

A

True

This type of transmission requires organisms to survive long outside the body.

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5
Q

What is fecal-oral transmission?

A

Ingestion of contaminated food and water leading to infection in the digestive system.

Microorganisms multiply in intestines and are shed in feces.

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6
Q

What are common vectors for disease transmission?

A
  • Mosquitos
  • Flies
  • Mites
  • Fleas
  • Ticks
  • Rats
  • Dogs

Mosquitos are the most common vector.

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7
Q

Fill in the blank: Hand hygiene refers to _______.

A

[removing or killing microorganisms on the hands]

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8
Q

What are the key moments for hand hygiene according to WHO?

A
  • Before touching a patient
  • Before clean/aseptic procedures
  • After body fluid exposure/risk
  • After touching a patient
  • After touching patient surroundings

This approach is known as ‘My 5 Moments for Hand Hygiene’.

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9
Q

How long should hand hygiene be performed for optimal effectiveness?

A

45-60 seconds

This can be done with soap and water.

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10
Q

What are the components of isolation precautions?

A
  • Private room
  • Mask
  • Gown
  • Gloves

Specific precautions depend on the type of transmission.

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11
Q

What diseases require droplet precautions?

A
  • Adenovirus pneumonia
  • Seasonal Human Influenza
  • Mumps
  • Meningococcal disease
  • Pertussis
  • Rubella

These may be combined with contact transmission.

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12
Q

What are the diseases associated with airborne transmission?

A
  • Varicella (chicken pox)
  • Measles
  • Tuberculosis
  • Avian influenza
  • SARS

Precautions must be in place until lesions dry/crust.

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13
Q

What is the correct order for doffing personal protective equipment (PPE)?

A
  • Hand hygiene
  • Gloves
  • Gown
  • Mask
  • Eye wear

Hand hygiene should be performed after removing each item.

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14
Q

What should be done to ensure a snug fit when putting on a mask?

A

Form the soft metal strip around the bridge of the nose and secure it with ties or loops.

Ensure the bottom of the mask covers the chin.

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15
Q

Fill in the blank: Gloves should be worn _______.

A

[over the gown]

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16
Q

What is the proper technique for removing goggles?

A

Take off from the back, avoiding contact with the front.

Normal eyeglasses are not sufficient for eye protection.

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17
Q

What is hypoxemic respiratory failure?

A

Gas exchange failure characterized by arterial hypoxemia without an increase in CO2

Common causes include pneumonia, ARDS, obstructive lung disease, and pulmonary embolism.

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18
Q

What is hypercapnic respiratory failure?

A

Ventilation issue resulting in too much CO2 in the blood and decreased O2

Causes include depression of the respiratory center by drugs, airway obstruction, and weak respiratory muscles.

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19
Q

Define Ventilation/Perfusion (V/Q) ratio.

A

The ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli

Optimal V/Q matching is equal to 1.

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20
Q

What does a low V/Q ratio indicate?

A

A shunt where alveoli are perfused with blood but fail to ventilate

Example: COPD.

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21
Q

What does a high V/Q ratio indicate?

A

Deadspace where air is inhaled but cannot participate in gas exchange

Example: Pulmonary embolism, emphysema.

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22
Q

What is the normal pH range for arterial blood?

A

7.35-7.45

Deviations can indicate acidosis or alkalosis.

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23
Q

What does a low PaCO2 indicate?

A

Respiratory alkalosis

Caused by hyperventilation due to various factors including anxiety and lung disorders.

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24
Q

What does a high PaCO2 indicate?

A

Respiratory acidosis

Caused by hypoventilation due to conditions like obesity or CNS problems.

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25
Q

What is the normal range for HCO3-?

A

22-28 mmol/L

Low levels indicate metabolic acidosis, high levels indicate metabolic alkalosis.

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26
Q

What does it mean if pH and PaCO2 move in opposite directions?

A

Respiratory disturbance

Indicates a primary respiratory issue affecting acid-base balance.

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27
Q

What does it mean if pH and HCO3- move in the same direction?

A

Metabolic disturbance

Indicates a primary metabolic issue affecting acid-base balance.

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28
Q

What is the normal range for PaO2?

A

80-100 mmHg

Low levels indicate varying degrees of hypoxemia.

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29
Q

What is the significance of SaO2?

A

Percentage of saturation of Hemoglobin (Hb) with oxygen

Normal range is 95-100%.

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30
Q

What are common causes of impaired oxygenation?

A

Decreased inspired oxygen, alveolar hyperventilation, diffusion impairment, shunt, V/Q mismatch

Addressing hypoventilation often involves sputum clearance and eliminating bronchospasm.

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31
Q

What compensatory mechanisms does the body use in acidosis?

A

Increase HCO3- or decrease H+

Hyperventilation can blow off CO2, and kidneys may reabsorb excess HCO3-.

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32
Q

What compensatory mechanisms does the body use in alkalosis?

A

Get rid of HCO3- or retain H+

Hypoventilation helps retain CO2.

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33
Q

What is the purpose of IPPA in assessment?

A

Inspection, Palpation, Percussion, Auscultation are used for a comprehensive physical examination

Each component provides different insights into the patient’s respiratory status.

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34
Q

What is the significance of Jugular Vein Distention?

A

Indicates central venous pressure and potential right atrial issues

Assessed by having the patient at a 45-degree angle.

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35
Q

What does diminished or absent breath sounds indicate?

A

Less or no air circulating through the airways

Causes include pleural effusion, pneumothorax, and atelectasis.

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36
Q

What is the BORG Rating of Perceived Exertion Scale?

A

A scale from 1 to 10 used to assess exercise intensity

A score above 5 indicates high exertion.

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37
Q

What is the effect of prolonged antacid use?

A

Potential metabolic alkalosis due to excess HCO3-

Example: Loss of gastric acid from vomiting.

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38
Q

What are the signs of respiratory distress during inspection?

A

Tachycardia, tachypnea, changes in facial expression, and use of accessory muscles

Observations can indicate the severity of the respiratory condition.

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39
Q

What does crackles indicate in lung auscultation?

A

Discontinuous sound associated with conditions like atelectasis and retained secretions

Fine crackles may indicate interstitial pulmonary fibrosis.

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40
Q

What is the significance of vocal resonance tests?

A

Assessing for lung consolidation

Techniques include whispered pectoriloquy and egophony.

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41
Q

What is a common indication for pulmonary rehabilitation?

A

Dyspnea that interferes with lifestyle

Conditions include COPD, asthma, and post-surgery recovery.

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42
Q

What is an indication of lung consolidation?

A

Presence of pulmonary abnormalities

Lung consolidation may suggest conditions like pneumonia or other pulmonary infections.

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43
Q

What are some diseases included in pulmonary rehab?

A
  • COPD
  • Interstitial lung disease
  • Asthma
  • Cystic fibrosis (CF)
  • Pre and post Lung Volume Reduction Surgery (LVRS)
  • Lung transplant
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44
Q

What are indicators for pulmonary rehab?

A
  • Dyspnea that interferes with lifestyle
  • Reduced ability to perform exercise/ADLs/self-care
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45
Q

What should SpO2 levels not fall below during exercise?

A

88%

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46
Q

What is the maximum BORG scale rating during exercise?

A

5

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47
Q

What are the criteria for exercise in pulmonary rehab?

A
  • No abnormal cardiac signs
  • No pain, nausea, dizziness, headache
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48
Q

What does the BORG Rating of Perceived Exertion Scale measure?

A

Perceived exertion during exercise

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49
Q

What is the scale range for the BORG Rating of Perceived Exertion?

A

1 to 10 scale

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50
Q

What does a BORG scale rating of 5 indicate?

A

Hard exertion

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51
Q

What heart rate percentage corresponds to the BORG scale range of 12-16?

A

60-80% HRmax

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52
Q

What are the goals of inspiratory muscle training?

A
  • Improve inspiratory muscle strength
  • Improve endurance
  • Decrease dyspnea
  • Improve quality of life and exercise tolerance
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53
Q

Who are the ideal candidates for inspiratory muscle training?

A
  • Patients with moderate to severe COPD who are medically stable
  • People with weak muscles of inspiration
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54
Q

When should inspiratory muscle training not be used?

A

During acute exacerbation or right after an exacerbation

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55
Q

What are the training parameters for inspiratory muscle training?

A
  • 30 minutes per day (may be spread out in 2-3 sessions)
  • 4-6 days a week
  • Slow progression of resistance levels
  • Indefinitely for continued benefit
56
Q

What are the effects of anaesthetic on respiratory function?

A

Decreased deep breathing, decreased tidal volume (TV), suppressed reflexes, decreased respiratory drive, decreased functional residual capacity (FRC), increased closing volume, increased respiratory rate, increased risk if elderly or with co-morbidities.

57
Q

What are the main results of anaesthetic effects?

A

Increased risk of infection, decreased level of consciousness (LOC), increased work of breathing (WOB), decreased vital capacity.

58
Q

What are the main goals of physical therapy treatment after anaesthesia?

A

Improved breathing and mobility.

59
Q

What are the indications for oxygen therapy?

A

SaO2 less than 95%, PaO2 less than 80mmHg, to decrease work of breathing, to decrease myocardial work.

60
Q

What is the fractional concentration of inspired oxygen (FiO2) for room air?

61
Q

What are the types of oxygen delivery systems?

A
  • Nasal prongs: 1-6 L/min, FiO2 24-44%
  • Simple mask: 6-10 L/min
  • Partial re-breathing mask: 10-15 L/min
  • Non re-breathing mask: Minimum flow of 10L/min
  • Aerosol or Venturi face mask
  • Tracheostomy mask.
62
Q

What is the blood flow path through the heart?

A

Superior & Inferior Vena Cava –> R atrium –> Tricuspid Valve –> R ventricle –> Pulmonary valve –> lungs –> L atrium –> Mitral Valve –> L ventricle –> Aortic Valve –> Ascending aorta.

63
Q

What is the normal pulse rate range?

A

60-100 bpm.

64
Q

Define arteriosclerosis.

A

The thickening, hardening, and stiffening of arterial walls.

65
Q

What is atherosclerosis?

A

A form of arteriosclerosis characterized by narrowing of arteries due to plaque buildup.

66
Q

What can atheroma consist of?

A
  • Cholesterol
  • Lipids
  • Calcium.
67
Q

What are the consequences of atherosclerosis?

A
  • Heart attack
  • Stroke
  • Aortic aneurism
  • Peripheral vascular disease (PVD).
68
Q

What is congestive heart failure (CHF)?

A

Inability of the heart to pump sufficient amounts of oxygenated blood to meet body demands.

69
Q

What are the signs and symptoms of right-sided heart failure?

A
  • Peripheral edema
  • Shortness of breath
  • Weakness/fatigue.
70
Q

What are the causes of left-sided heart failure?

A
  • Diastolic dysfunction
  • Systolic dysfunction.
71
Q

What are common signs and symptoms of left-sided heart failure?

A
  • Pulmonary edema
  • Dyspnea
  • Orthopnea
  • Paroxysmal nocturnal dyspnea (PND).
72
Q

What is the treatment for end-stage CHF?

A

Cardiac transplantation.

73
Q

What are the guidelines for lifting after a sternotomy?

A

No lifting 10lbs below waist and 5lbs above waist for 6-8 weeks.

74
Q

What is valvular heart disease?

A

Conditions involving the failure of heart valves to open or close properly.

75
Q

What is aortic stenosis?

A

Calcification of the aortic valve leading to left systolic dysfunction.

76
Q

What are the signs and symptoms of aortic insufficiency?

A

Rapid increase in left ventricle pressure leading to pulmonary edema.

77
Q

What characterizes stable angina?

A

Predictable chest pain that occurs during exertion and is relieved by rest.

78
Q

What is myocardial ischemia?

A

Decreased blood flow to heart tissue leading to angina.

79
Q

What are non-modifiable risk factors for cardiovascular disease?

A
  • Age
  • Gender
  • Family history.
80
Q

What are modifiable risk factors for cardiovascular disease?

A
  • Smoking
  • Diabetes
  • High cholesterol
  • Hypertension
  • Obesity.
81
Q

What is the most frequent location for myocardial infarction?

A

Left ventricle due to occlusion of left coronary artery.

82
Q

What does the P wave in an ECG represent?

A

Atrial depolarization.

83
Q

What is cardiomyopathy?

A

Heart muscle disease resulting in decreased cardiac output.

84
Q

What are the signs and symptoms of dilated cardiomyopathy?

A

Heart failure due to left ventricle dilation.

85
Q

What is cardiac tamponade?

A

Compression of the heart due to blood or fluid buildup in the pericardial sac.

86
Q

What is infective endocarditis?

A

Inflammatory destruction of heart tissue usually caused by bacterial infection.

87
Q

What is an aneurysm?

A

Localized abnormal dilation of a blood vessel wall.

88
Q

What are the signs and symptoms of deep vein thrombosis (DVT)?

A
  • Dull ache
  • Tightness/pain in calf
  • Swelling.
89
Q

What is intermittent claudication?

A

Pain during activity that is alleviated by rest.

90
Q

What is the distinguishing feature of arterial insufficiency compared to venous insufficiency?

A

Diminished or absent pulse.

91
Q

What is Deep Vein Thrombosis (DVT)?

A

Thrombosis: blood clot that can become a pulmonary embolism (thrombo-embolism)

92
Q

What are the risk factors for DVT?

A
  • Venous stasis (e.g., prolonged sitting/immobilization)
  • Venous damage
  • Hypercoagulability
  • Trauma/surgery
  • Pregnancy
  • Obesity
  • Cancer
  • Smoking
  • Genetic susceptibility
93
Q

What are common signs and symptoms of DVT?

A
  • Dull ache
  • Tightness/pain in calf and tenderness on palpation
  • Swelling
  • May have a fever
  • Pain with Dorsiflexion
94
Q

What is HOMAN’S SIGN?

A

Calf pain on passive Dorsiflexion of the foot

95
Q

What is the most appropriate test for DVT?

A

Rapid screening with Doppler Ultrasonography

96
Q

What are the medical treatments for DVT?

A
  • Heparin: immediate response, injection/IV use
  • Warfarin (Coumadin): long-term treatment, oral medication, slower onset
97
Q

What is the timeframe to mobilize someone with DVT after starting anticoagulation?

A

Depends on the type of medications being administered; check with physician for mobilization orders.

98
Q

True or False: It is unsafe to mobilize patients with DVT.

99
Q

What should patients being treated for venous thrombosis watch for?

A

New leg pain, swelling, and/or redness

100
Q

What is a pulmonary embolism (PE)?

A

Passage of ANY material capable of getting lodged in a blood vessel (thrombus, air bubble, plaque)

101
Q

What are the signs and symptoms of a pulmonary embolism?

A
  • Bloody sputum
  • Dyspnea
  • Increased respiratory rate and work of breathing
  • Cyanotic
  • Tachycardia
  • New chest pain
  • Decrease oxygen saturation
102
Q

What is a Ventilation/Perfusion Scan used for?

A

Diagnosis of pulmonary embolism (shows area of poor perfusion in lungs)

103
Q

What are key treatments once a PE is suspected?

A
  • Education
  • Deep and segmental breathing
  • Oxygenation
104
Q

What should be monitored when mobilizing a patient with PE?

A
  • Oxygen saturation
  • Heart rate
  • Blood pressure
  • Chest pain
105
Q

What considerations are there for rehab of a patient with DVT/PE?

A
  • No contraindications to basic stretching or strengthening
  • Avoid potentially harmful activities while on anticoagulation
  • Discuss travel decisions with doctors
106
Q

What are the differences in skin characteristics between peripheral arterial disease and venous insufficiency?

A
  • Peripheral arterial disease: Cool to touch, pallor, paler, shiny, thin, hairless
  • Venous insufficiency: Warm to touch, swelling, bluish-brownish, darker, thicker
107
Q

What findings are associated with DVT leading to chronic venous insufficiency?

A
  • Dull ache
  • Tightness
  • Pain
  • Superficial ulcers (usually lateral malleolus)
  • Paresthesias
  • Venous stasis ulceration over medial malleolus
108
Q

What causes orthostatic hypotension from bed rest?

A

Decreased venous tone leading to pooling of blood in the lower extremities upon standing

This results in reduced blood return to the heart, decreasing ventricular filling and cardiac output.

109
Q

What are the signs and symptoms of orthostatic hypotension?

A
  • Dizziness
  • Light headedness
  • Fatigue
  • Blurred vision
  • Muscle weakness
  • Syncope
110
Q

What is the diagnostic criterion for orthostatic hypotension?

A

Drop in BP: SBP >20 mmHg OR DBP >10 mmHg when standing

111
Q

What is the optimal position for a patient demonstrating signs of orthostatic hypotension?

112
Q

What treatment can assist with standing in severe cases of orthostatic hypotension?

A

Tilt table with progressive vertical positioning

113
Q

What is cardioversion?

A

Uses electrical charge to stop a rapid rhythm originating in the atriums

114
Q

What is defibrillation?

A

Electrical charge used to stop a rapid life-threatening rhythm originating in the ventricles

115
Q

What is a coronary angiogram?

A

X-ray of the heart and major blood vessels; dye is injected to look for blockages

116
Q

What does CABG stand for?

A

Coronary Artery Bypass Graft

117
Q

What does CABG do?

A

Re-routes blood around blockages in the coronary arteries

118
Q

What is the recommended initial load for upper extremities post-CABG?

A

30-40% 1RM

119
Q

What is stroke volume?

A

Amount of blood ejected with each stroke

120
Q

How is cardiac output calculated?

A

CO = HR x SV

121
Q

What are the normal values of cardiac output at rest for males and females?

A

M = 5L; F = 4L

122
Q

What is blood pressure?

A

Force exerted by the blood against the arterial walls during a cardiac cycle

123
Q

What is the formula for blood pressure?

A

BP = CO x TPR (Total Peripheral Resistance)

124
Q

What defines normal blood pressure?

A

SBP <120 and DBP <80

125
Q

What is considered hypertensive blood pressure?

A

SBP > 139 and DBP > 89

126
Q

What happens to blood pressure during exercise?

A
  • SBP increases with workload
  • DBP may decrease or stay the same
127
Q

What are absolute contraindications to exercise?

A
  • Acute MI
  • Unstable angina
  • Serious arrhythmias
  • Acute pericarditis, myocarditis, endocarditis
  • Uncompensated or uncontrolled heart failure
  • Severe aortic stenosis
  • Severe left ventricular dysfunction
  • Acute PE
  • Aortic aneurysm
  • Uncontrolled systemic HTN
  • Uncontrolled asthma
  • Acute DVT/thrombophlebitis
  • ICP > 20 mmHg
128
Q

What are relative contraindications to exercise?

A
  • Significant arterial HTN (resting DBP > 110; SBP > 200)
  • Pulmonary HTN
  • Brady/Tachycardia
  • Moderate valvular disease
  • Uncontrolled metabolic disease (e.g., Diabetes)
  • Unstable asthma
  • Diabetic patient with autonomic denervation of heart
129
Q

What does the Rate of Perceived Exertion (RPE) scale measure?

A

Exercise effort and the way you feel during exercise

130
Q

What is the maximum heart rate formula?

A

220 - age = Max HR

131
Q

What is the Karvonen Formula used for?

A

To calculate training zones based on both maximum and resting HR

132
Q

What are the precautions for a chest tube?

A
  • Do NOT lift above the site of insertion
  • Do NOT lay or roll onto chest tube
  • Disconnection can lead to pneumothorax, infection
133
Q

What is the purpose of a Foley/Urinary Catheter?

A

Self-retaining catheter held in place by inflated balloon in urethra

134
Q

What are the indications for a lumbar drain?

A
  • Reduce intracranial pressure (ICP)
  • Monitor CSF chemistry, cytology, and physiology
  • Provide temporary CSF drainage in patients with infected cerebrospinal fluid shunts
135
Q

What is the purpose of Patient-Controlled Analgesic (PCA)?

A

Self-administered IV opioid

136
Q

What are the precautions for using an epidural?

A
  • Do NOT pull out
  • Drop in BP, infection, headache

PCE (11 decks)

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