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Cardio > Cardio > Flashcards

Cardio Flashcards

1
Q

Physiological Instability

A

PT must see response at rest and with movement.

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2
Q

Physiological instability requries

A

Constant re-eval of symptomatic and hemodynamic tolerance

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3
Q

Specific goals of lines:

A
  1. Rapidly deliver important medications
  2. Obtain real-time measurements of physiological
    function
  3. Collect bodily fluids
  4. Facilitate tissue healing
  5. Minimize secondary infections from lines/tubes
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4
Q

Arterial Catheter/Line

A 
Indwelling catheter that
provides measurements of
systolic, diastolic, and mean
arterial pressures
continuously
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5
Q

Arterial line Precautions with PT

A
  • High pressure system, if
    dislodged –> hemorrhage
    – Transducer-height sensitive
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6
Q

Central Venous Catheter or central line

A

Useful for more immediate
delivery of medications or
fluids and more immediate
venous blood sampling

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7
Q

Central Line before mobilization

A

must secure the patient

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8
Q

Central Venous Pressure

A

Measures the blood
pressure in the vena cava
just proximal to right
atrium and reflect amount of venous return to the heart

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9
Q

Normal CVP

A

2-6 mmHg

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10
Q

CVC and PT complications

A

occur with insertion/removal

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11
Q

CVC and PT considerations

A

– Limit repeated shoulder flexion/abduction > 90 with
subclavian vein insertion to prevent vascular
injury/compromise of CVC
– Good oral hygiene/secretion hygiene with jugular vein
insertion to reduce infection risk
– Consider length of tubing/line traction with
mobilization

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12
Q

Peripherally Inserted Central Catheter

A

Intravenous access that can be used for a longer period of time

Catheter is inserted peripherally and the tip is advanced to the superior vena cava

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13
Q

PIIC Inserted

A

Basilic, cephalic, brachial veins

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14
Q

PA Catheter (Swan Ganz)

A 
Purpose is to detect heart
failure, pulmonary HTN, or
sepsis, monitor changes in
preload, and evaluate the
effects of drugs
Allows direct, simultaneous
measurement of pressures in
the right atrium, right
ventricle, pulmonary artery,
and the filling pressure
("wedge" pressure) of the left
atrium
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15
Q

Normal PA pressures

A

Systolic (PASP) 15 - 30 mmHg

Diastolic (PADP) 8 - 15 mmHg

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16
Q

PA catheter Precautions

A
  • Hemodynamic instability
    – Dysrhythmias
    – Shoulder/cervical ROM
    – Generally: patients are stable for PT, but you should ensure
    this with the medical team
    – Needs to be physically secured based on your institution’s
    policies prior to mobilization
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17
Q

Cardiac output

A

Normal CO = 4.0 - 8.0 L/min

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18
Q

Cardiac index

A

cardiac output per square meter

of body surface area

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19
Q

Normal Cardiac index

A

2.5-4.0 L/min/min

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20
Q

Cardiac ouput

A

SV x HR

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21
Q

Mixed venous oxygen saturation

A

Amount of oxygen returning to the heart
– Direct measure of venous oxygen reserve, indirect
measure of peripheral tissue O2 uptake

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22
Q

Normal SvO2

A

60-80%

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23
Q

Cerebral perfusion pressure

A

pressure at which brain is perfused

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24
Q

Intracranial pressure

A

pressure around the brain

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25
Q

Normal CPP

A

60-80 mmHg

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26
Q

Normal ICP

A

5-15 mmHg

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27
Q

EVD: monitor ICP indications

A 
Hydrocephalus, SAH, TBI,
stroke with hemorrhagic
conversion, tumor, postop,
vascular/ventricular
malformations
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28
Q

Hemodialysis

A

Artificially performs the normal function of the kidneys

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29
Q

Dialyzer

A

Blood crosses a semi-permeable membrane

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30
Q

Dialysate

A

metabolic waste products to diffuse into

correction fluid

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31
Q

HD can:

A
  • Correct fluid or electrolyte abnormalities
    – Remove toxic materials
    – Maintain acid-base balance
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32
Q

HD arterio-venous fistula

A

An artificially created
communication between
an artery in the arm and
an adjoining vein

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33
Q

HD Arterio-venous grafts

A

Uses an interposed
synthetic graft
– Less durable than an A-V
fistula

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34
Q

Continuous Renal Replacement Therapy

A

Consists of nonstop veno-venous or arterio-venous
HD

Extracorporeal blood circulation through a smallvolume,
low resistance filter to provide continuous
removal of solutes and fluid

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35
Q

Dialysis and PT

A

Mobilization typically contraindicated during
hemodialysis and during the inflow/outflow of the
dialysate during peritoneal dialysis

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36
Q

Patients with Dialysis you expect

A

potential dehydration, hypovolemia, orthostatic

hypotension, and patient fatigue post dialysis

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37
Q

3 Chambers of Chest Tube

A

– Collection
– Underwater seal
– Suction

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38
Q

Chest Tubes and PT

A 
• 1. Determine if you need to
keep to suction or if
“waterseal”/ “gravity seal”
is OK (should be an MD
order)
• 2. Note the quality and
quantity of the fluid
• 3. Plan your walking setup
to keep the chest tubes on
slack, but not dragging
• 4. Maintain collection
reservoir below the level of
insertion
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39
Q

Foley Catheter

A

Thin, sterile tube inserted into

the bladder to drain urine

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40
Q

Considerations for PT with patients with Catheters

A 
Need to maintain Foley
Catheters below the level
of the bladder
• Drain any urine in the
tubing before
mobilization for
prevention of backflow

– 1. Catheter bag needs to
be emptied
– 2. A patient is mobile
enough to use a commode

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41
Q

Feeding Tubes

A

• Deliver nutrition when GI obstruction, aspiration,

or calorie supplementation is needed

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42
Q

Feeding Tubes and PT

A

Determine if tube is to suction or gravity
drainage, and whether tube can be disconnected
for out of bed mobility
• Determine if the tube can be disconnected prior
to and/or during therapy session
• Feeds should be temporarily suspended for all
supine/head flat positioning due to risk of
aspiration

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43
Q

If suspending PT for therapy

A

consider feeding schedule and insulin doing

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44
Q

Pacemakers

A

To initiate myocardial contractions when intrinsic

electrical impulses are insufficient

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45
Q

Automatic Implantible Cardiac

Defibrillators (AICD)

A

ICD provides an electrical shock to temporarily
depolarize an irregularly beating heart
allowing normal electrical and coordinated
contractile activity to resume

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46
Q

Left Ventricular Assistive Device (LVAD)

A

Treatment for end stage heart failure

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47
Q

Pulse Oximetry

A

Non-invasive means of measuring pulse rate and

blood oxygenation/hemoglobin saturation (SpO2)

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48
Q

Normal SpO2

A

> 92%

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49
Q

Therapy needed for pulse ox

A

< 88-90%

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50
Q

Pulse Oximetry and PT

A

Inaccurate readings can occur related to nail polish,
motion artifact, poor circulation, dark complexion,
dysrhythmias/irregular pulses, etc.

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51
Q

Indications for Mechanical Ventilation

A 
Acute Lung Injury/Acute Respiratory Failure
– Hypoxic/hypoxemic
– Hypercarbic
• Impending Respiratory Failure
• Respiratory muscle weakness/paralysis
• Reduced myocardial oxygen consumption
– i.e. myocardial infarction, heart failure
• Prevent or reverse atelectasis
• Stabilize the chest wall after trauma
• Airway Protection
– i.e. angioedema, CNS injury or LOC
• Provide sedation/paralysis for a procedure
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52
Q

Pressure Control:

A

preset PIP amounts, – Limits potential for barotrauma, but may result in variable
tidal volumes and minute ventilation

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53
Q

Volume Control:

A

preset tidal volume and minute
ventilation
– May increase the risk of ventilator-induced lung injury due
to barotrauma

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54
Q

Pressure Support

A

The difference between PEEP and
PIP
– Vent augments spontaneous breaths to reach a preset PIP
– Patient-initiated
– Facilitates larger tidal volumes, minimizes barotrauma

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55
Q

CPAP:

A

applies constant pressure throughout the
breathing cycle to increase functional residual
capacity (FRC)

56
Q

BiPAP:

A

cycled bilevel ventilation between Inspiratory
Positive Airway Pressure (IPAP) and Expiratory
Positive Airway Pressure (EPAP)

57
Q

Intubation

A

The insertion of a flexible plastic tube into the trachea to

maintain an open airway

58
Q

Assist Control (AC)

A

Delivers a set TV, rate, and inspiratory flow
• Between the set rate of machine-delivered breaths,
the patient may initiate their own breath

59
Q

Synchronized Intermittent Mandatory

Ventilation (SIMV)

A

• Combination of spontaneous mode and AC
• Delivers a set number of mandatory breaths at a
preset TV
• Between the set rate of machine-delivered breaths,
the patient may breathe on their own, at their own
TV

60
Q

Pressure Support (PS)

A

• Delivers every breath at a preset pressure and
inspiratory time
• Allows the patient to control the rate and the
minute ventilation
• Benefits: pressure is

61
Q

The Risks of Ventilation

A

Mechanical ventilation is a highly effective, life-saving

therapy, but carries a high-risk for complications

62
Q

Methods of Weaning

A

Intermittent Mandatory Ventilation (IMV)
– Set machine rate reduced in steps of 1-3 breaths/min
– Gradual reduction in vent support, resulting in a
progressive workload for patient
• Timed spontaneous breathing periods using a T-piece
– T-shaped tubing connected to an ET tube
– Duration of trials gradually increases
• Pressure Support Ventilation (PSV)
– Vent augments spontaneous breaths with a fixed amount
of positive pressure
– Positive pressure is reduced for a trial duration

63
Q

PT considerations when weaning

A

– Facilitate upright positioning for improved
ventilation/perfusion ratio
– May require slightly higher pressure support
settings for mobility (compared to at rest)
– Balance patient’s energy expenditure
– Airway clearance techniques
– Cough/huff strategies
– Breathing strategies

64
Q

Lab value WBC

A

3.9-10.7

65
Q

Lab value Hemoglobin

A

Male: 14-17Gm/dL
Female: 12-16Gm/dL

66
Q

Lab value Lactate

A

0.5-1 mmol/L

67
Q

Lab value BUN

A

5-25 mg/dL

68
Q

Lab value Potassium

A

3.5-5.0 mEq/L

69
Q

Lab value BNP

A

< 100 pg/mL

70
Q

Lab value Troponins

A

<0.01 ng/mL

71
Q

Lab value PT/PTT

A

Normal: 23.8-36.6 sec
Therapeutic: ~60-80 sec

72
Q

Lab value INR

A

Normal: 0.9-1.1
Therapeutic: 2.0-3.0

73
Q

Exclusion Criteria

A

• Immediate plans to transfer to another floor / outside hospital
• Requires significant doses of vasopressors for hemodynamic stability (to maintain
mean arterial pressure >60 mm Hg)
• MAP <60 mm Hg
• Precaution: PAP > 50 cm H20
• Mechanically ventilated patient with FiO2 >0.8 and/or PEEP >12 mm Hg, or acutely
worsening respiratory failure
• Active bleeding
• Maintained on neuromuscular paralytics
• Currently in an acute neurological event (cerebrovascular accident, subarachnoid
hemorrhage, intracranial hemorrhage) with reassessment for mobility every 24
hours
• Unresponsive to verbal stimuli, unable to follow commands
• Unstable spine or extremity fractures
• Grave prognosis, transferring to comfort care
• Open chest/open abdomen (risk for dehiscence)

74
Q

Signs/Symptoms of Intolerance for exercise for lower intensity for ICU

A 
HR increases >20-30 bpm above
resting HR
– SBP increases > 20-30 mmHg
– RR > 30
– Increased accessory muscle use
– Dizziness, nausea/vomiting
– Mild/moderate pain
– Mild agitation, nonverbal signs of
pain
75
Q

Signs/Symptoms of Intolerance for exercise for terminate exercise for ICU

A 
>20% decrease in resting HR
– HR <40 bpm, >130 bpm
– MAP < 65, > 110 mmHg
– Orthostatic hypotension
– Severe agitation RASS >2
– Sedation or coma RASS ≤-3
– EKG changes, chest pain,
diaphoresis
– SpO2 decreases 4%, or <88-90%,
– RR < 5 breaths/min, >40
breaths/min, intolerable dyspnea
– Patient discomfort/refusal
76
Q

Signs/Symptoms of Intolerance for exercise for ventilator specific for ICU

A 
Ventilator alarms for disconnect
– FiO2 ≥ 0.60, PEEP >10
– Patient-ventilator asynchrony
– Mode changed to Assist-Control
– Tenuous airway
77
Q

know the alarms steps

A
  1. determine if alarm is accurate
  2. accurate and persistent
  3. perform cardio screen. HELP Asap
78
Q

Acute Respiratory Distress Syndrome

ARDS

A

severity of hypoxemia, pulmonary inflitrates

79
Q

Indications for heart transpalent

A

Patients who maxed out medical interventions

ejection fx <20-25%

<70 yr old

Pulmonary Vascular Resistance <4 wood units

Peak Oxygen Intake < 12-14 ml/kg/min

Ability to comply with medical follow-up care

80
Q

Absolute Contraindications For Heart Transplant

A

Irreversible advanced renal or liver failure

Advanced irreversible pulmonary disease with FEV1 < 1L/min

Advanced pulmonary artery HTN

History of solid organ or hematolgic malignancy within last
5 years

81
Q

Relative contraindications for heart transplant

A 
Severe PAD
• Cerebrovascular disease
• Severe osteoporosis
• BMI > 35 kg/m2
• Poor wound healing, increased risk of infection, higher risk for
DVT/PE
• Acute PE
• Active infection
• >70 years old
• Psychological instability
• Recent (w/I 6 months) substance use; tobacco, alcohol, opioids, etc.
• Diabetes with end organ damage
• Lack of support
82
Q

Ventricular Assist Devices (VAD) indications

A

Bridge to transplant
• VAD to stabilize patient and to prevent organ damage from HF
• Bridge to candidacy
• Same as above, but gives MDs time to examine if patient meets criteria
for txp
• Destination
• Bridge to recovery
• Has a reversible condition. VAD used temporarily and then
disconnected.

83
Q

Types of VADs: pulsatile

A

Have systolic and diastolic phase

84
Q

Types of VADs: Non pulsatile

A

Internal VAD
• Driveline exits through abdomen
• Blood is moved via centrigugal force
• Will not feel pulse (no diastolic phase)
• Blood pressure with doppler estimates MAP
• Pulse ox may not read appropriately
• Pump sometimes hemolyzes blood – Anemia and ex
tolerance

85
Q

PT and LVAD hold PT if

A

new onset orthostasis, SOB, SBP < 80mmHg, neurological changes

86
Q

Heart Transplant post op medications

A
  • (+) Inotrope medications
  • Dobutamine, Milranone, Dopamine
  • Anti-hypertensive medications
  • Medications to control fluid load
  • Diuretics
87
Q

Hall mark for Heart failure

A

Exercise intolerance

88
Q

Heart failure central changes

A

. Decreased cardiac output with activity

Diminished ejection during systole
Architectural changes in LV

Heightened sympathetic activation

Elevated resting HR
Decreased HRR

Angiotensin – Aldosterone system activation

  • Increased vasoconstriction
  • Increased plasma volume
  • Increased or decreased blood pressure
89
Q

Heart failure Peripheral changes

A

Abnormal distribution of blood to working muscles
• Diminished mitochondrial density
• Loss of Type I fibers
• Increased anaerobic enzymes
• Decreased ability to vasodilate in response to metabolic needs

90
Q

Non pharmacological management of strategies for Heart failure

A

Check weight daily and report gains of more than 2 lbs in a 2 to 3 day period.

Limit sodium to < 1500 mg daily.

Limit alcohol consumption completely (preferred) or to
less than one drink per day.

For stable heart failure patients, exercise training may improve survival and quality of life.

91
Q

Strength training for heart transplant

A
  • Sternal Precautions
  • Borg 12-14/20
  • muscle endurance training
92
Q

Heart transplant Considerations

A

Long warm up and cool down

Use RPE

Incorporate strength training

endurance training

93
Q

Heart block 1st degree

A

PR interval prolonged

94
Q

Heart block 2nd degree type 1

A

progressive prolongation of PR interval until one QRS is dropped

95
Q

Heart block 2nd degree type 2

A

PR interval is normal however one dropped QRS

96
Q

Heart block 3rd degree

A

P waves have no relationship to QRS

97
Q

maximal graded exercise test limitations

A

➢A lot of motivation needed
➢Potential to perform at a high workload needed
➢Equipment needed
➢Qualified and trained medical staff needed with emergency procedures in
place
➢Expensive

98
Q

Ventilatory threshold

A

Measurements of oxygen consumption, carbon

dioxide production, respiratory rate and volume

99
Q

Lactate threshold

A

measured by blood samples to determine when lactate

clearance is falling behind lactate production

100
Q

To improve aerobic conditioning must apply

A

OVERLOAD

101
Q

Training zone: low intensity

A

40-60%

102
Q

Training zone: moderate intensity

A

50-70%

103
Q

Training zone: high intensity

A

70-85%

104
Q

Training zone: for cardiac patients

A

40-70%

105
Q

Hyperglycemia if BG is 300

A

do not exericse

106
Q

Primary prevention of exercise rehab

A

• Risk factor management to prevent cardiopulmonary
& vascular diseases
• “Client”

107
Q

secondary prevention of exercise rehab

A

People with known CV or P disease

Reducing symptoms

Slow progression of disease

108
Q

Chronotropic Incompetence

A

blunted adrenergic response

109
Q

Left ventricle for aging and cardiac rehab

A

wall thicken - increased collagen, calcification

prolonged time is systole

prolonged late diastole

110
Q

Structural and Physiological Changes

with Aging: Impact on Exercise

A
  • Lower Cardiac Reserve
  • Higher blood lactate levels during sub-max ex
  • HR, peripheral vasodilation have a blunted response
111
Q

AHA class A level 1

A

Children, adolescents, Men<45, women< 55 with no symptoms or presence
of heart disease or major risk factors

112
Q

AHA class A level 2

A

Men > 45 and women >55 with no symptoms/presence of HD with < 2 major
CV risk factors

113
Q

AHA class A Level 3

A

Men > 45 and women > 55 with no symptoms/presence of HD and with >2 risk
factors

114
Q

AHA Class A Guidelines

A
  • No activity restrictions
  • 45-85% HRR (Karvonen)
  • 12-16 BORG
  • No medical clearance required
  • ECG not required
  • No supervision necessary
115
Q

Class A Level 2 and 3 for high intensity

A

need medical supervision

116
Q

NYHA Class 1 PA

A

No limitation of physical activity. Ordinary
physical activity does not cause undue fatigue,
palpitation, or dyspnea

117
Q

NYHA Class 2 PA

A

Slight limitation of physical activity.
Comfortable at rest, but ordinary physical
activity results in fatigue, palpitation, or
dyspnea.

118
Q

Class B risk:

A

known stable cardiovascular disease - low risk

• NYHA classes I & II
• Exercise capacity < 6 METS (walking at 4.5mph)
• No ischemia or angina at rest or with GXT when workload
<6METs
• BP appropriately rises with exercise
• No tachycardia at rest
• Can self-monitor activity

119
Q

Class B Guidelines

A

Medical Clearance PRIOR to exercise initiation
• Supervised exercise program during initial sessions
• Supervised sessions by non-medical personnel after first few sessions if
normal response to exercise and
• When person able to self-monitor then can be unsupervised

120
Q

Class C - moderate/high risk

A

CAD, valve disease, congenital heart disease,
cardiomyopathy with EF<30%, dysrhythmia not
well controlled
• NYHA class 3 or 4
• Exercise capacity < 6 METS
• Angina or ischemic ST depression at workload < 6
METS
• Fall in SBP with exercise
• Non sustained ventricular tachycardia with exercise
• Previous cardiac arrest

121
Q

Class C – Exercise Guidelines

A

Medical Clearance
• Exercise stress test
• Medical supervision during sessions
• ECG monitoring

122
Q

Class D- Unstable disease with activity restriction

A

• Unstable ischemia, severe valve stenosis or regurgitation,
uncompensated heart failure, uncontrolled dysrhythmia
• ACTIVITY GUIDELINES
• No activity until medically cleared

123
Q

Indications for Cardiac Rehab

A 
Medically stable post-MI
• Stable angina
• CABG
• PTCA
• Compensated, controlled CHF
• Cardiomyopathy
• Heart transplant
• Valve or pacemaker surgery
• PAD
• High-risk CV disease, ineligible for surgery
• End-stage renal disease
• Heart failure (new in 2014!!)
124
Q

Contraindications cardiac and aging

A 
• Unstable angina
 Resting SBP>180 or resting DBP > 110
 Orthostatic blood pressure drop > 20mm
with symptoms
 Critical AS
 Acute systemic illness or fever
 Uncontrolled dysrhythmias
 Uncontrolled sinus tachycardia (>120 bpm)
 Uncontrolled Diabetes
125
Q

Contraindications cardiac and aging

A 
Uncompensated CHF
• Third degree heart block without
pacemaker
• Active pericarditis or myocarditis
• Thrombophlebitis
• Resting ST displacement (>2mm) or >3mm if on Digitalis
• Orthopedic problems that would prohibit
exercise
126
Q

Blood pressure normal

A

<120/ 80

127
Q

Elevated BP

A

120-129/ <80

128
Q

Stage 1 HTN

A

130-139/ 80-89

129
Q

Stage 2 HTN

A

> 140 or > 90

130
Q

Decrease BP with medicine top things

A 
- Weight loss
• DASH diet
• Aerobic Exercise
• Strength (you can take the average of isometric and dynamic RT)
• Alcohol consumption
131
Q

Cardiac rehab - phase 1

A
  • In-hospital rehabilitation
  • Stable
  • No chest pain x 8 hours
  • Stable heart function
  • No significant dysrhythmia
  • Monitored
132
Q

Cardiac Phase 1 goals

A

Assessment of post event/intervention response to activity

Prevention of DVT, Pneumonia, orthostatic hypotension

Lifestyle modification education

Activity Guidelines

Education regarding cardiopulmonary signs of overexertion

Referral for cardiac rehabilitation

133
Q

Increase in CV risk within 2 hours of sex

A

1.10% in Patients vs 1% in healthy

134
Q

Cardiac phase 2

A
  • Medically Supervised
  • Cardiologist on-site
  • Cardiac Rehabilitation Specialist
  • Physical Therapist
  • Nurse, exercise physiologist
  • Monitored
  • Telemetry
  • Blood pressure, HR, RPE, O2 sats, dyspnea scale
  • Exercise prescription based upon GXT
  • Lifestyle modification classes
135
Q

Phase 2 Frequency and intensity

A

F- 2/3x a wk\ and HEP total 5-6 …intensity based on stress test, risk stratification

Cardio (5 decks)

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