Cardio Flashcards
Hypotension
Hypertension
Normal
Orthostatic. hypotension
<90/60
>140/90
120/80
-Drop of SBP >20 mmHg going from supine to standing
SpO2
Peripheral capillary oxygen saturation
Normal: >94%
<88% requires supplemental O2
Inspiration:expiration rate
Normal: 1:2
Restrictive lung disease: 1:1
Obstructive lung disease: 1:3
Foul smelling odour for sputum is present with which conditions
Bronchiectasis and lung abcess
Sputum of Pulmonary edema
Sputum of active TB
Pink frothy sputum
Frank blood
What conditions cause edema
Pulmonary edema
Lymphedema
Pregnant women
Right-sided heart failure
Tracheal positioning with:
Pneumothorax
Pleural effusion
tumor/mass
Atelecctasis
pleural fibrosis
peumenectomy
Ipsilateral deviation:
Atelecctasis
pleural fibrosis
peumenectomy
Contralateral deviation:
Pneumothorax
Pleural effusion
tumor/mass
Crackles
coarse vs. fine
Coarse:
sputum and secretions
Fine:
fluid (pulmonary edema) , atelectasis, and fibrosis
What condition do you hear pleural friction rub
Pleural effusion only
Voice sounds for cardioresp
Egophony
-If hear A when asked to say E then it indicates consolidation
whispered pectoriloquy
-Whispered words become clearer over consolidation
bronchophony
-Increase intensity and clarity of vocal resonance represents consolidation
What FEV1/FVC indicates an obstructive lung disease
<70%
Normal values
ABGs
PH
PaCO2
HCO3-
SpO2
PaO2
PH: 7.35-7.45
PaC02: 35-45 mmHg
HCO3-:22-26 mEq/L
SpO2: >95%
PaO2: 80-100 mmHg
ABGs
Respiratory acidosis and alkalosis
Metabolic acidosis and alkalosis
Respuratory acidosis: PaC02 >45
Respiratory alkalosis: PaCo2 <35
Metabolic acidosis: HCO3- <22
Metabolic alkalosis: HCO3- >26
ABG compensations
Uncompoensated
-PH is abnormal, 1 component is normal, while the other is abnormal
Partially Compensated
-PH is abnormal, both components are abnormal
Compensated
-PH is normal, both components are abnormal
Pneumona
An acute inflamation of the lungs associated with filling of the alveoli with exudates (consolidation)
-Common complication of morbidity and mortality
Pathophysiology
-Infectious agent (bacteria or virus) or irritant reaches the lungs triggering an inflammatory reaction
Etiology:
- Aspiration
- Contact (trauma or chest tube)
- inhalation (droplet)
- hematogenous (circulation)
Inspection
- Dyspnea
- Increase RR (tachypneic breathing)
- Cyanosis
- Cough (productive=bacterial, non-productive=viral)
- Fever (high=bacterial, moderate - viral)
0Tactile fremitus increased
- Percussion dull
- Auscultation - wet inspiratory crackles
- ABG - Decrease PaO2, may have decreased PaCO2
CXR: Air bronchograms, and opecity in surrounding alveoli
Tuberculosis
-An infectious, systemic, inflamatory disease that primarily affects the lungs and other organs
Airborne precautions (N95 respirator)
Respiratory
- Cough >2 weeks
- Dry cough (early)
- Productive cough (mucus/blood)
Systemic
- Fatigue
- Fever
- Night sweats
- Weight loss
- May have swollen lymph nodes
Diagnosis
infection
-TB skin test
-TB blood test
TB disease
- CXR
- Infiltrates and cavitation typically in the upper lobes
- may have pleural involvement and or parenchymal fibrosis
- Sputum sample
Interventions
- Negative pressure room
- N95 respirator
- Secretion clearance techniques
- Deep breathing
- Coughing
Myocardial infarction
Death of cardiac muscle cells due to lack of blood flow
- Injury refers to acutely injured myocardial tissue during a sudden heart attack
- Infarction refers to myocardial tissue that was injured and progressed to irreversible
Symptoms
- Angina
- Dyspnea
- disphoresis (unusual sweating)
- anxiety
- dizziness
- fatigue
- nausea
ECG changes
Ischemia
-ST segment depression
-T wave inversion
Small Acute MI
- No ST segment change
- NSTEMI, non-Q-wave MI (NQMI)
Large Acute MI
- ST Segment elevation (STEMI)
- Pathological Q wave
Cardiac biomarkers
- Tropnonin I
- Troponin T
- Creatine kinase-Myocardial band
- Myoglobin
CABG
-Donor vessels are Saphenous vein, internal thoracic or internal mammary artery, radial artery of the non-dominant arm
Phases of cardiac rehab
Phase I: Acute/inpatient phase
- Prepare for discharge, monitor activity tolerance, support risk factor modification technique, provide emotional support, build self-efficacy, and educate on recognizing adverse S & S with activity
- Interventions focus ob hemodynamic response to exercise, independence in functional activities (transfers, mobilization, etc.
- Vital signs b4 and after exercise
- low level intensity
Phase 2: Subacute conditioning phase
- Typically begins after hospital discharge in the outpatient sertting
- conditioning exercises with close cardiac monitoring
Phase 3: Intensive rehab phase
- Exercise in large groups
- Resistance training typically initiated here
- *Phase 4: Maintence phase**
- Pt encourage to continue exercise training in a group setting or self monitored
Patient self monitor with palpating pulse, HR monitor or RPE (most appropriate for older individuals)
- Patients with heart disease educated on reducing fat intake
- Patients with CHF educated on reducing fluid intake
Pulmonary edema
-Abnormal accumulation of fluid in the lungs, fluid from pulmonary capilaries into interstitial space and then onto the alveoli
- Types
- Cardiogenic: High pressure (increase pulmonary capillary hydrostatic pressure, LHF
Non-cardiogenic pulmonary edema: Low pressure, increase permeability of the pulmonary capillaries, and alveolar endothelium d/t trauma or toxins (ARDS)
Inspections:
- Increase WOB, dyspnea, cyanosis, pink frothey sputum (cardiogenic), orthopnea, swelling g in lower extremities if severe
- Increase tactile fremitus and dull percussion, decrease BS or fine inspiratory crackles on ausciultation
- CXR: Cardiomegaly, white haziness, kerly B lines, enlarged pulmonary vessels
Congestive heart failure
- Syndrome characterized by impairemnts in the hearts ability to pump
- M>F
- Compensated by increasing SNS activity to increase HR and further CO but overtime fatigue myocardium, leads to CHF and can cause pulmonary edema
Risk factors
- cardiac muscle dysfunction
- dyarrthmias
- cardiomyopathies, long term CAD
- hypertension
- valve abnormalities
- pericardial pathology
S&S
LHF: dyspnea, fatigue, weakness, pulmonary edema, paroxysmal nocturnal dyspnea, othopnea
RHF: Fatigue, dyspnea, weakness, jugular vein distension, peripheral edema, pitting edema, fluid weight gain, ascites
Interventions
- with orthopnea positioning in semi-fowler position
- diaphramatic breathing
- supplemental O2
- 0graded increased ambulation and exercise
- cardiac rehab program
Chronic Bronchitis
Emphysema
Asthma
Bronchiectasis
Interstitial pulmonary fibrosis
Atelectasis
Acute respiratory distress syndrome
Pneumothorax
Pleural effusion
Cystic fibrosis
Pulmonary embolism
Peripheral Vascular Disease
Intermitent claudication
Infectious prevention and control precautions
Contact (gloves): MRSA, VRE, C diff
Droplet (Gloves and Gown): Munps, rubella, whooping cough
Droplet and Contact: Pneumonia, influenza, meningitis, acute respiratory illness
Airborne (N 95 respirator, negative pressure room):TB, Disseminated shingles, measles, Aevere acute respiratory syndrome (SARS), and varicella (chickenpox)
Pneumenectomy contraindication and surgical complications
-Cant lie patient with surgical side up
Complicsations: aspiration, increased pain, DVT, phrenic nerve impairment, atelectasis, and ulcers
Sternal precautions
- No pushing and pulling
- No lifting one arm above 90 degrees
- No hand behind back
- No driving for 4 weeks
- No lifting >10 pounds for 6 weeks
Complications of mechanical ventilation
- Barotrauma (alveolar rupture, can lead to pneumothorax)
- Volutrauma(alveolar overdistension)
- ventilator acquired pneumonia
- diapraghm atrophy
- hemodynamic compromise
Cardiovasular risk factors and criteria
- Age: Males >45 and females >55
- Family Hx: Sudden death, MI or coronary revascularization before 55 years old in farther or brother, 65 years old for mother or sister
- PA level: Not engaging in at least 30 mins of moderate physical activity at least 3x/week in last 3 months
Obesity: >30 BMI, waist circumference Male>102 cm, Female >88 cm\\
Pre-diabetes: Any hx of diabetes, any blood test looking at glucose, if not sure then >45 years old and BMI>25 count as a risk factor
Dyslipidemia: LDL > 130 mg/dl, HDL <40 mg/dl (if >60 counts as a negative risk factor), total serum cholesterol >200 mg/dl
Hypertension: Systoli >140, diastolic > 90, taking hypertensive meds
Stress/psychosocial: Depression, anxiety, stress levels, SF 36 QOL, Beck depression inventory
Smoker: Quit in last 6 months, exposed to second hand smoking, current smoker
Alcohol: Male >14 drinks/week, Female >9drinks per week
Exercise testing Relative and absolute contraindications
Absolute contraindicstions: Recent significant change in ECG suggesting significant ischemia, rrecnt MI (within 2 days), Unstable angina, uncontrolled cardiac dysarrhytmias, symptomatic severe aortic stenosis, uncontrolled symptomatic heart failure, acute pulmonary embolus or infarction, acute myocarditis or pericarditis, suspected or knowing dissecting aneurysm, and acute systemic infection
Relative contraindications: Left main coronary stenosis, moderate stenotic valvular heart disease, electrolyte abnormalities, SBP >200, DBP >110, tachydysrhytmias hypertrophic cardiomyopathy, neuromotor MSK or RA pathologies affected by exercise, high degree AV block, ventricular aneurysm, uncontrolled metabolic disease (DM), Chronic infectious disease (HIV), mental or physical impairment leading to inability to exercise
Max exercise test
Administered by physician
- Stress test
- Graded exercise tests (used to predict VO2) - treadmill test (bruce protocol)
Submax exercise tests
-May be administered by PT
- used as a measure of endurance and exercise capacity
- 6MWT
- Predictive submax exercise tests (used to predict VO2 max
- Treadmill test (modified bruce protocol)
- Cycle ergometer test (astrand rhyming cycle ergometer test)
KARVONEN equation
target HR= ((HR max-HR rest) x %intensity desired) + HR rest
Things to monitor during exercise
-HR,BP,SpO2, Dyspnea, and other signs of respiratory distress
Indications to terminate exercise
Signs and symptoms
- Moderate or severe angina
- Marked dyspnea
- Dizziness, lightheadedness, or ataxia
- Cyanosis or pallor
- Excessive fatigue
- leg cramps or claudication
Other abnormal responses
- Failure of SBP to rise as exercise continues
- Progressive fall in SBP of 10-15 mmHg
- Hypertensive BP response (SBP >200mmHg) &,or DBP>110
- Significant changes in cardiac rhythm detected by palpation or ECH (Arrythmias, ST-T wave changes)
Positioning for cardioresp conditions
- Unilateral lung disease: Good lung down, lieing on unaffected lung
- Bilateral lung disease; Lie prone
- Pneumenectomy: Lie affected lung down
- ARDS: Lie in prone positioning
Breathing exercises
Deep diaphragmatic breathing
- Pursed lip breathing for COPD (exhalation 3x the length of inspiration)
- Segmental breathing
- Sustained maximal inspiration (used post op to prevent atelectasis and airway closure
- Inspiratory muscle training
Airway clearence
- Postural drainage (maintain position for 5 - 10 minutes or longer)
- Percussion
- Vibration
- PEP device (>15 mins 2-3 x/day) (low pressure more commonly used, 10-20 cm H2O, lower risk of pneumothorax then high pressure)
- independent breathing techniques
- Suctioning
3 cycles of active cycle of breathing technique
1) Breathing control
2) Thoracic expansion exercise (TEE)
3) Forced expiration technique
Advantage that the airways are always open bc the patient is always breathing
3 stages of autogenic drainage
1) Unstick (Exhaling to low volumes (ERV) will mobilize mucus (5-6 reps, with a 3 second hold)
2) Collect : Mucus will collect when breathing in mid lung volumes (5-6 reps1 with 3 second hold)
3) Evacuatee: Evacuation of mucus occurs when breathing into larger lung volumes (5-6 reps, 3 second holds). May perform cuff or huff at the end.
At the end of one cycle perform 203 hufss/coughs followed by deep breathing to prevent airway closuree
-Treatment time 30-45 minutes/session once a day
4 stages of a cough
1) Inspiration
2) Glottic closure
3) Compression
4) Expulsion
Huff is prefered to a cough in patients with obstructive lung disease due to the risk of small airway closure
