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Cardio > Cardio Pulmonary Exam > Flashcards

Cardio Pulmonary Exam Flashcards

1
Q

Sleep apnea

A

Daytime sleepiness and objective findings of airways narrowing/obstructing at night

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2
Q

Sleep apnea hallmark

A

Airway narrow at night and collapse

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3
Q

Three types o f sleep apnea

A

central, obstructive, mixed

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4
Q

Central sleep apnea

A

altered chemosensitivity, decreased signals to respiratory muscle

Brain injury, encephalopathy

Premature infants < 40 weeks conceptual age

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5
Q

Obstructive Sleep apnea syndrome

A

repeated episodes of apnea > 10 seconds

Partial or complete pharyngeal collapse during sleep, leading to either reduction (hypopnea) or cessation (apnea) of breathing.

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6
Q

What happens do the pressure of muscles for someone who has OSAS?

A

Negative pressure during inspiration triggers a reflex which results in relaxation of pharyngeal muscles

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7
Q

What happens to the chemoreceptors for sleep apnea?

A

Dampening of the chemoreceptors during sleep, worsening the loss of airway tone

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8
Q

Classifications of Sleep Apnea:

A

● SEVERE: >30 episodes per night

● MODERATE: 15-30 episodes per night

● MILD: 5-14 episodes per night

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9
Q

sleep apnea risk factors (Adults)

A

Age, family, gender, Elevated BMI

Neck circumference:

Men greater than 17 inches
women greater than 16 inches

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10
Q

Sleep apnea risk factors (kids)

A

boys more than girls, increase CMI, african american, large adenoids or tonsils, low tone children, craniofacial abnormalities, chronic nasal obstruction

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11
Q

Signs and symptoms for adults with OSAS

A 
⦿ Bed partner complaints
⦿ Sleep disturbances
⦿ Feel tired, groggy despite “sleeping” a full 8 hours
⦿ Morning headaches
⦿ Irritability
⦿ Diminished memory
⦿ Dry mouth
⦿ Car accidents
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12
Q

Signs and symptoms: children

A

Hyperactivity (primary symptom; opposite from adults)

Difficulty concentrating

Poor school performance

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13
Q

Long term consequences OSAS

A

HTN, coronary artery disease, heart failure, dysrhythmias, cerebrovascular disease (stroke, dementia, TIA, depression, erectile dysfunction)

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14
Q

Untreated OSAS have a higher death rate by how much?

A

3x higher

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15
Q

What is Obesity hypoventilation syndrome?

A

daytime hypercapnia PaCO2 > 45 mmHg and sleep disorder breathing

Altered breathing results in daytime low PaO2 and Daytime Elevated PCO2

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16
Q

Signs and symptoms hypoventilation syndrome?

A 
Sleepiness
Depression
SOB with activity
Irritability
Signs of Cor Pulmonale
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17
Q

OHS risks:

A 
HTN
Cor Pulmonale
Sexual dysfunction
Dysrhytmia
Polycythemia
CVA
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18
Q

Treatment of Sleep Apnea with non invasive ventilation .

A

Goal : airway stenting

Goal: increase functional residual capacity

Increases VT by 25% and decreases by 30%

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19
Q

What is functional residual capacity?

A

the volume in the lungs after a normal expiration

  • limits or decreases “de-recruitment” of alveoli
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20
Q

Continuous Positive Airway Pressure does what and how?

A

constant pressure during expiration to prevent patient from exhaling all the volume of lungs

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21
Q

Bilevel positive airway pressure

A

has two different pressures during inhale and exhale

Higher pressure during inhale for stenting

Lower pressure during exhale to facilitate blowing off of CO2

22
Q

Indications for lung transplant

A
  • Adv lung disease functional class 3/4
  • progressive lung disease
  • refractory to maximum medical intervention
  • estimate survival chance of <50% in 2 years
23
Q

Contraindications for Lung Transplant

A
  • active malignancy w/I last 2-5 years

adv and untreatable disease of any organ

significant chest wall or spine deformity

documented non compliance

Untreatable psychiatric condition

no reliable social support

susbstance abuser

24
Q

Relative contraindications for lung transplant

A

Age > 75 years

poor functional status with low potential for rehab

colonization with high resistant micro-ogranisms

obesity (BMI >30)

severe symptomatic osteoporosis mechanical ventilation

25
Q

Lung allocation score

A

formulas that predict the probability of: survival in the next year without transplant, length of survival post-transplant

LAS 0-100 with higher numbers indicating the patient is more likely to benefit from a lung transplant

26
Q

LAS: factors

A

diagnosis, age, BMI, diabetes, functional capacity defined by NYHA, % predicted FVC, six minute walk test distance adults <400m correlated with higher mortality, mechanical vent, creatinine in blood, cardiac index, bilirubin levels, CO2 levels

27
Q

What determination of LAS in adults?

A

lung transplant depends on: LAS and distance from organ

28
Q

Lung Transplants listing: <12 years what are the main priorities ?

A

Medical status
Blood type
Size of donor/recipient
Proximity of donor/recipient

29
Q

Drugs Main Course: calcinurin inhibitors

A

Tacrolimus & cyclosporin

30
Q

Drugs Main Courses: side effect

A
  • kidney injury
  • HTN
  • Headache
  • Tremor
  • trouble shooting
  • high blood sugar
  • Electrolyte abnormalities
    Low magnesium, high potassium
  • cosmetic effects
  • seizures
31
Q

Drug Side dishes:

A

Mycophenelate

Imuran

32
Q

Drug side dishes: common effect

A

mycophenelate: N/V, diarrhea, leukopenia,
thrombocytopenia, anemia

Imuran: leukopenia, thrombocytopenia

33
Q

Drug salads:

A

They can replace main course if major side effects or more is needed

Sirolimus and Everolimus

34
Q

What is an issue with salads?

A

they delay wound healing

35
Q

Bread and butter: steriods

A

Methylprednisolone and prednisone

maintenance immunosuppression

used for rejection episodes

36
Q

What changes do you see in people with COPD?

A

Atrophy type 1 fibers

Increased muscle fatigue

lower lactic acid threshold

37
Q

Side effect of corticosteroids?

A

Atrophy type 1 fibers

atrophy of proximal hip and shoulder musculature

38
Q

Cyclosporine interferes with what?

A

mitochondria function affecting oxidative capacity

39
Q

As a PT to monitor effectiveness of lung transplant what are you looking into?

A

● oxygen saturation
● ability to clear secretions
● functional mobility
● signs of rejection

40
Q

Normal WBC

A

3.9-10.7 k

41
Q

Normal HgB

A

male: 14-17 g/dl
female: 12-16 g/dl

42
Q

Normal Postassium

A

3.5-5.0 mg/dl

43
Q

Normal pH

A

7.35 - 7.45

44
Q

Normal Pa CO2

A

35-45 mmHg

45
Q

Normal Pa O2

A

80-100 mmHg

46
Q

Normal HCO3

A

22-26 mEq/L

47
Q

signs and symptoms of intolerance: Lower intensity

A

HR increases > 20-30 bpm above resting

SBP increases > 20-23 mmHg

increased accessory muscle use

dizzy, nausea/vomit

mild agitation

48
Q

signs and symptoms of intolerance: terminate exercise

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

SpO2 decreases 4% or 88-90%

RR <5 breaths/min, >40 breaths/min, intolerable dsypnea

patient discomfort

49
Q

signs and symptoms of intolerance: ventilator - specific

A

ventilator alarms for disconnect

FiO2 > 0.60, PEEP >10

Patient ventilator asynchrony

mode of assist control

tenous airway

50
Q

In the Outpatient settings PT will monitor for rejection how?

A 
● Decrease in ex tolerance
● Decrease in microspirometry
● Signs of heart failure
● Auscultation
● Pain
● Shortness of breath, desaturation
● Medication side effects (tremors, joint aches)
 ● Fever
● Flu-like symptoms

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