Cardiopulm Flashcards
1
Q
Active cycle of breathing
A
- Diaphragmatic breathing 5-10 sec
- Thoracic expansion exercises (3-4 deeeep breaths in to max inspiratory capacity followed by passive exhalation)
- Forced expiratory techniques (huffing)
2
Q
Indications for inspiratory hold technique
A
hypoventilation
atelectasis
ineffective cough
3
Q
Indications for lateral costal breathing
A
asymmetric chest wall expansion or posture
4
Q
Paced breathing indications
A
dyspnea with exertion
decreased endurance
fatigue/anxiety
5
Q
Describe paced breathing
A
controlling breathing with exercise
ex. inhaling on rest followed by exhalation during movement or exercise (weight lifting, stair climbing)
6
Q
Inspiratory muscle training
A
nose clips to help you breathe only through mouth + inspiratory device to create resistance
7
Q
Cheyne Strokes breathing
A
gradual increase in depths of respirations with periods of apnea
caused by cardiac insult
8
Q
Biots breathing
A
randoms depths of respirations with periods of apnea
biot = brain
9
Q
S4 heart sound
A
Ventricular hypertrophy or MI
not ever normal
happens during late diastole
10
Q
S3 heart sound
A
Ventricular gallop
CHF
Although, can be normal finding or with seasoned athlete, pregnancy, or children
happens during early diastole
11
Q
Symptoms of Right sided heart failure
A
jugular vein distension
swelling in legs and abdomen, ascites, pedal edema
enlarged liver
12
Q
Symptoms of Left sided heart failure
A
pulmonary congestion
pulmonary edema
crackles/diminished breath sounds
orthopnea
cool dry skin
13
Q
Imaging and pneumothorax
A
mediastinal structures are pushed laterally away from the affected side
ex. pneumothorax or pleural effusion takes up space in left thorax - the trachea and mediastinal structures would be pushed laterally to the right away from the affected
14
Q
Examples of obstructive diseases
A
cystic fibrosis
emphysema
asthma
chronic bronchitis
bronchiectasis
15
Q
Examples of restrictive diseases
A
sarcoidosis
pulmonary fibrosis
16
Q
Restrictive lung conditions present with what pulmonary function test values
A
Normal FEV1 (they dont have trouble with expelling air)
decreased FVC 0 as a function of decreased TLC
17
Q
Normal FEV1/FVC ratio
A
70% or greater
18
Q
What is a low FEV1/FVC ratio and what would that mean?
A
low would be less than 70%
indicative of obstructive condition
19
Q
Decreased FEV1 volume, normal FVC volume
A
lower ratio between the volumes (less than 70%)
indicative of an obstructive condition.
20
Q
Fremitus
A
Tactile fremitus is an assessment of the low-frequency vibration of a patient’s chest
used as an indirect measure of the amount of air and density of tissue present within the lungs
21
Q
Obstructive disorders pulmonary function test results
A
Increased FRC (ERV+RV)
Increased TLC
decreased VC d/t decreased ERV
TV normal or increased
22
Q
Functional residual capacity
A
the air inside the lungs after a normal exhalation
sum of ERV and RV
23
Q
Restrictive disorders pulmonary function test results
A
decreased RV
decreased VC
decreased TLC
decreased FVC
FEV1/FVC ratio not affected
24
Q
Appropriate measures of intensity for patient witch cardiovascular disease
A
HR
RPE
percieved dsypnea
not VO2max - these patients would not be able to achieve maximum oxygen consumption
25
Contraindications to manual percussion
platelets lower than 20,000 mm3
hemoptysis
pneumothorax
26
Can you percuss with a chest tube inserted?
Yes avoid any tender areas
27
VC =
IRV + TV + ERV
28
% of total lung volume: TV
10%
29
% of total lung volume: IRV
50%
30
% of total lung volume: ERV
15%
31
% of total lung volume: RV
25%
32
Total lung volume capacity
5 L or 5000mL
33
Lung changes with aging
chest wall stiffness
loss of elastic recoil
alveoli enlarging and thinning = decreased gas exchange
decline in TLC
-RV increases
VC decreases
34
PaO2 gas exhange decreases at . mmHg per decade
4
35
Common cardiac changes with aging
stiffening of valves
decreased blood flow and volume
decreased max HR
loss of pacemaker cells
decreased stroke volume
36
Normal PR interval
.12 -.20 seconds
3-5 small boxes
37
Normal QRS complex
.06-.10 sec
1-3 small boxes
38
How to estimate rhythm with EKG - regular rhythm
Triplets - 300, 150, 100, 75, 60, 50, 43, 38, 33
1500/ # of small squares
300/ # of large squares
39
How to estimate rhythm with EKG - irregular rhythm
take # of QRS complexes in full 30 box strip and multiply x10 = rough estimate of HR
6 second method - length of normal strip - x10
40
REEP
resting end expiratory pressure - point in which forces are balanced in equilibrium - occurs at end of tidal expiration
41
Normal PAO2 at room air
80-100 mmhg
42
90% FiO2 still seems high - what is the importance of this number
90% FiO2 corresponds to 60 mmHg - which is point where oxygen dissociates from hemoglobin
43
GOLD 1 classification COPD
mild severity
70%+ FEV1
44
GOLD 2 classification COPD
moderate
50-70% FEV1
45
GOLD 3 classification COPD
severe
30-50% FEV1
46
GOLD 4 classification COPD
very severe
less than 30% FEV1
47
Normal FEV1
80%
48
Chronic bronchitis signs and symptoms
Obstructive condition - Chronic inflammation of airways caused by airway irritants (smoke, dust)
increased mucus production/cough
SOB
increased pulm artery pressure
49
Asthma treatment
brochodilators - relax smooth muscle
knowing triggers
breathing exercises, airway clearance, muscle endurance and strength training
50
Asthma signs and symptoms
wheezing, chest tightness, SOB, cyanosis, cough
51
Chronic bronchitis treatment
antibiotics, anti-inflammatories, and lifestyle changes including decreasing smoke and pollutant irritation, using WARM air humidifier
52
Chronic bronchitis cough is worse when
morning and in cold damp environments
53
Emphysema signs and symptoms
Obstructive disease - destruction/enlargement of alveoli = decreased gas exchange and increased dead space within lungs
barrel chest
increased use of accessory muscles
wheezing constant cough
increased respiratory rate
54
Brochiectasis
chronic dilation of bronchial airways = weaken over time = frequent infections, aspiration
55
Cystic fibrosis is what kind of genetic disorder
autosomal recessive
56
Autosomal recessive disorders
Tay sachs
Sickle cell
Cystic fibrosis
TSC
57
Cystic fibrosis
genetic disease of exocrine glands affecting lungs pancreas liver intestines
sticky mucus production impacts lung infections, obstructs pancreas, inhibits normal digestion/absorption of food
median survival age 32 -pulm failure
58
Salty tasting skin
CF
59
Cystic fibrosis signs and symptoms
salty skin
frequent thick greasy stools
freq lung infections
wheezing/SOB/cough
failure to thrive
60
Pneumonia
can be aspiration, viral, or bacterial based
inflammation of lung alveoli
fever, SOB, sweating, shaking, muscle pains, fatigue
61
More than ... PVCs in a minute is bad
6
62
Triplets PVC
3 PVCs in a row - stop exercise
this preludes Vtach
63
Calcium channel blockers use
used for HTN, CHF, decreasing cardiac arrythmias
64
Action of calcium channel blockers
blocks entry of calcium into smooth muscle - decreases HR contractility, BP by creating vasodilation
65
Side effects calcium channel blockers
decreased HR and BP - postural hypotension with change in position
use RPE
66
Types of calcium channel blockers
-pines
amlodipine
felodipine
isradipine
Procardia
exception in cardizem
67
Cardizem, Procardia
calcium channel blocker
68
How to remember calcium channel blockers
-pine cones are great source of calcium
69
ACE inhibitors how to remember
-prils
If you have pocket ACEs in poker, you relax, decrease BP
Lisinopril
Benazepril
Perindopril
70
Ace inhibitors use
HTN, CHF
71
Ace inhibitors side effects
orthostatic hypotension, dry cough, hyperkalemia
72
Ace inhibitors action
suppresses enzyme that converts AGTN 1 to 2 - which is a potent vasoconstrictor
decreases BP and afterload
73
Positive ionotropic agents use
slows HR but increases force of contraction, increases BP
- used for CHF, afib
74
Examples of positive ionotropic agents
digitalis, digoxin
75
How to remember positive ionotropic agents
I (ion)
DIG (digogin)
Star Wars (force) - increases force of contraction
76
Beta blockers use
cardiac arrythmias
77
Beta blockers action
blocks action of beta receptors of sympathetic NS = decreases HR and increases force of contraction = decreased oxygen demand
78
Beta blockers side effects
OH
use RPE
79
Types of diuretics
furosemide
hydroclorothaizide
lasix
80
Nitrates
dilate peripheral arteries to decrease preload and relieve chest pressure/angina
81
Pulmonary fibrosis
irreversible scarring of alveoli and interstitial tissue - thickens the alveoli and makes them less flexible
82
Pulmonary fibrosis symptoms
SOB
dry cough - not until advanced state
83
Pulmonary fibrosis treatment
not much as PTs - meds to manage inflammation and education/counseling, improving QOL
84
Sarcoidosis
multisystem inflammatory disease - affects lungs, skin, lymph, eyes, liver
affects more colored than white people
85
What outcome measure would you think about using with sarcoidosis
6MWT - baseline to track progression of disease
86
Plueral effusion vs pulmonary edema
Plueral effusion is buildip of fluid in space between lung and chest cavity (pleural space)
pulmonary edema is fluid in alveoli within the lungs
87
When does pulmonary edema most often occur
left sided heart failure casues fluid and pressure build up into lungs
88
Safety considerations with pulmonary edema
a 911 emergency if acute
signs of gasping or wheezing
extreme SOB or sweating
cyanosis
drop in BP
tinged sputum
89
Rule out time for TB
2 weeks on meds ans isolated
90
Potts disease
spinal TB - affects thoracic and lumbar vertebra, arthritic changes - flexibility and postural re-education
91
Is atelectasis an indication or contraindication for postural drainage
indication
92
Indications for percussion and vibration
atelectasis
pulmonary secretions
aspiration
93
Procedure for vibration
therapist hands parallel to ribs duration 5-10 breaths
94
Normal LDL
less than 100
95
Normal HDL
40-60
96
Upper apical lobe postural drainage
sitting HOB elevated 30-40 degrees
percussion above clavicle
97
Anterior segments upper lobe postural drainage
Supine with percussion below clavicles
98
Posterior segments R upper lobe
1/4 prone laying on L
percussion to medial border of R scapula
99
Posterior segments upper lobe
Leaning over pillow in sitting
100
L lingula lobe postural drainage
supine with 1/4 turn to elevate L side
feet raised 12 inches
persussion between axilla and nipple on L
101
R middle lobe postural drainage
supine with 1/4 turn to elevate L side
feet raised 12 inches
persussion between axilla and nipple on R
102
Lower anterior basal lobe
supine
feet raises 18 in
percussion to lower ribs on respective side
103
Lower lateral basal lobe
Prone w 1/4
feet elevated 18 in
percussion to lower ribs on respective side
104
Lower posterior basal lobe
prone
feet elevated 18 in
percussion to lower ribs on respective side
105
Superior segment of lower lobe
prone
table level
percussion to inferior border of scapula on respective side
106
Absolute exercise termination and 911 emergency with cardiac rehab
more than 6 PVC in one minute
3-4 PVCs in a row - this is Vtach
Vtach or Vfib on EKG
ST depression greater than 2 mm
ST elevation greater than 1 mm
107
Terminate exercise with ST depression
greater than 1.5-2 mm
108
Terminate exercise with ST elevation
greater than 1 mm
109
Stop and refer, but not 911 parameters
Second degree Type 2 AV block
A fib
Mulifocal PVC
angina
110
Continue exercise but at lower intensity
1st degree AV block
111
ST depression is indicative of
ischemia
112
ST elevation is indicative of
acute MI
113
Normal EF %
55% +
114
Normal stroke volume
70 mL
EDV-ESV
120-50
115
Normal CO
4.5-5 L
HR x SV
can increase to 25 L during exercises
116
Normal venous return
same as CO since heart is a closed system
4.5-5 L
117
PS stimulation causes coronary artery vasoconstriction or vasodilation
constriction
slows rate and force of myocardial contraction
vasodilation to skeletal muscles
118
Hyperkalemia
what does it mean
what are effects
increased potassium
decreases rate and force of contraction - this will show through EKG changes such as widened PR interval and QRS, tall T wave
119
widened PR interval and QRS, tall T wave
effects of hyperkalemia
120
Hypokalemia can progress to
vfib
121
prolonged PR and QT intervals
flattened T wave or inverted
hypokalemia
122
Components of WBC
neutrophils - bacteria
eosinophils - kill parasites
basophils - allergies
monocyte - garbage men
lymphocytes - infections and produce antibodies
123
Purpose of neutrophils
kill bacteria
124
Purpose of eosinophils
kill parasites
125
Purpose of basophils
allergies
126
Purpose of monocytes
clean up garbage
127
Purpose of lymphocytes
fight off infections and produce antibodies
128
Signs of respiratory acidosis
hypoventilation (Co2 is increased as they are holding in too much air)
disorientation - stupor
129
Signs of respiratory alkalosis
hyperventilation
hyperreflexia
dizziness/lightheaded
130
Conditions associated with respiratory alkalosis
pregnancy
anxiety
PE
liver disease
sepsis
fever
131
Conditions associated with respiratory acidosis
hypoventilation
COPD
respiratory depressants
132
Normal WBC count
4000-10000
133
Normal HCT count
45-52 males
37-47 females
134
Normal Hgb
13-18 males
12-16 females
135
Normal platelet count
150,000-450,000
136
Platelet count less than 20,000
ADLs only
137
Platelets 20-30,000
light exercise
138
Platelets 30-50,000
moderate exercise
139
Normal INR
1
140
High INR = risk of
bleeding
141
Low INR = risk of
clotting
142
Inverted t wave =
hypokalemia
Means ventricular hyoertrohy or ischemia
143
After what age do children follow adult BP guidelines
13
144
Aortic valve auscultation
R sternal border 2nd
145
Pulmonary valve auscultation
Left sternal border 2nd
146
Tricuspid valve auscultation
left sternal border 4th space
147
Bicuspid valve auscultation
left midclavicular line 5th space
148
Class 1 CHF
no limitation of activity up to 6.5 METS
149
Class 2 CHF
slight limitation 4.5 METS
150
Class 3 CHF
3.0 METS
151
Class 4 CHF
ADLs onlly 1.5 METS
152
3-6 METs
moderate intensity
brisk wallking, dancing, gardening, housework, building
153
Anterior MI affects
LADA
154
Inferior MI affects
right ventricle and right coronary artery
155
Lateral MI affects
circumflex artery
156
Posterior MI affects
Left ventricle posterior wall
157
Phase 1 cardiac rehab
inpatient portion - prescribed after stable EKG and CK/troponin levels, no chest pain 8 hours
158
When can active exercise begin for cardiac rehab
24 hours after CABG or 2 days after infarction
159
Karvonen formula
60-80%(HR max - resting HR) +resting HR
160
Parameters for phase 1 cardiac rehab
short low intensity (2-3 METs) exercise 2-3x day
max 50-70% HR
10-20 increase bpm initially
160
Goals for phase 1 cardiac rehab
educate on symptoms and monitor EKG changes
D/C home with assist ADLs
Tolerate 2-3 METS up to 4-5
Active and AAROM exercises - starting LE (UE increases HR and BP greater than LE)
160
At end of phase 1 cardiac rehab patient should be at what MET level
4 METs - walking up 1 set of stairs
161
Post MI cap on HR phase 1 cardiac rehab
120 bpm or 20 above resting
seems low but ok
162
Phase 2 cardiac rehab
outpatient portion
163
Phase 2 cardiac rehab begins when
1-2 weeks after infarct
164
Phase 2 cardiac rehab goals
progress towards ADLs
tolerating 30-60 mins 3-4x week
165
Lifting restrictions with cardiac rehab
6 weeks
166
Strength training for cardiac rehab should be held
5 weeks post MI
8 weeks post CABG
167
MET level for entry into level 3 cardiac rehab
5 METs
168
RPE rating 12-13
60% max HR
169
RPE 14-15
70% max HR
170
16 RPE
80% - 85% max HR
171
Failure of SBP to rise during exercise =
Do not exercise or STOP
172
10-15 mmHg fall in SBP with increase in exercise =
Do not exercise or STOP
173
Glucose greater than = do not exercise
Glucose less than ... = do not exercise
280
70
174
SBP greater than 200-250
DBP greater than 110-115
Do not exercise or STOP
175
Patient fatigue or discomfort or wants to stop
Do not exercise or STOP
176
Type 1 or Type 2 heartblock warrants stop exercise
Type 2
177
PTT greater than 60 seconds =
do not or STOP exercise
178
Seek EMS with
vfib
asystole
SOB at rest
unstable angina not relieved by 3 nitro
3rd degree heart block
vtach - 3+ PVC in row
179
Indication for cardiac rehab
post MI
post CABG
post PTCA
CHF
PAD
stable angina
other cardiac surgeries
180
PTCA
less invasive than CABG
catheter introduced through femoral artery and sent up through aorta to blockage - stent placed
181
Contraindications for cardiac rehab
unstable angina
BP greater than 200-250 systolic; 110-115 diastolic
orthostatic
resting ST segment depression greater than 2 mm
resting ST segment elevation greater than 1 mm
182
When can cardiac rehab begin?
no chest pain 8 hours
no EKG changes 8 hours
no new signs CHF
stable CK and trops
183
First degree heart block
increase in PR interval with no dropped beat
184
increase in PR interval with no dropped beat
First degree heart block
185
Ectopic beats
synonymous to PVCs - 3 in a row
Make sure patient is comfortable then call 911 and start CPR
186
Causes of hypocalcemia
hypoparathyroidism
malabsorption of calcium
vitamin D deficiency
acute pancreatitis
187
Symptoms of hypocalcemia
tetany, twitching, muscle cramps,
188
Causes of hypercalcemia
hyperparathyroidism
189
Symptoms of hypercalcemia
fatigue, depression, mental confusion, NV, increased urination
190
Change in altitude initially results in
decreased BP
increased CO
tachycardia
no changes in SV
191
Beta blockers affect on stroke volume
decreases HR therefore decreases SV
192
Crackles are also known as
rales
193
Crackles/rales most commonly heard with
CHF
also atalectasis
pulmonary fibrosis
194
Lung sounds with atelectasis
diminished or crackles
195
Wheezes are typically associated with
asthma
chronic bronchitis
196
WHat is a wheeze
high pitch whistling produced by air passing through narrow airways
197
Wheezing is most commonly heard on
expiration
198
Rhonchi
low pitched dull sound d/t blockage
think RHino snoring
199
Rhonchi most commonly heard with
pnuemonia
CF
chronic brochitis
200
Stridor usually heard on
inspiration
201
Stridor
ST-ridor
TS - Tracheal Stenosis
heard on inspiration
202
Erb's point
3rd intercostal space L sternum
point at which S1 and S2 are heard simultaneously
203
Closure of which valves creates S1 heart sound
mitral and tricuspid
204
Closure of which valves creates S2 heart sound
aortic and pulmonary
205
S1 heart sound occurs at
beginning of systole
end of diastole
206
S2 heart sound occurs at
end of systole
beginning of diastole
207
Which heart sound happen during late diastole
S4
208
Which heart sound happen during early diastole
S3
209
BP should be inflated ... mmHg above anticipated value
20-30 above
decrease by 2-3 mmHg
210
Phase 1 Korotkoff sound
clear tapping - indicative of systolic BP
211
Phase 5 Korotkoff sound
sound disappears completely
212
Phases of Korotkoff sounds
1 - clear loud tapping
2 - softer and longer
3 - crisper and louder
4 - muffled and softer
5 - sounds disappear
213
Normal breath sounds
vesicular - normal in out breathing - rustling sound - throughout inspiration and beginning of expiration
tracheal - loud, tubular sound
bronchial - hollow echoing sound
214
Insipratory phase > Expiratory
w/o pause
vesicular breath sounds
215
Expiratory phase > inspiratory
w/ pause
bronchial
216
Normally heard over distal airways
vesicular
217
Normally heard superior anterior thorax
bronchial sound
hollow echoing
218
Pathologies with wheezing
COPD, asthma, anaphalxsis
219
Pleural friction rub
dry crackling sound
heard directly over area of inflammation and pain
happens during inspiration and expiration
220
Crackles vs pleural friction rub
Crackles - often heard and auscultated in bottom of lungs, mainly inspiration
PFR - heard over spot of pleuritic pain - equally during inspiration and expiration
221
Foreign object produces what lung sound
stridor
222
Most optimal perfusion position lungs
prone
Perfusion ratio is high in upright position
223
In upright position, top of lung is
bottom of lung is
ventilated
perfused
224
Bronchophany
normally lung sounds should be muffled, but 99 sounds clear
225
Whispered pectrilouqy
whisper 123abc, should sound muffled, but if clear - indicated secretions/consolidations
226
Kussmals breathing
deep and fast breathing associated with metabolic alkalosis
227
Graded exercise test termination criteria
Fall of 10 mmHg PaCO2; 65 mmHg or greater PaC02
fall of PAO2 more than 20 mmHg; less than 55
increase in DBP greater than 20 mmHg
max SOB , fatigue
228
Metabolic syndrome diagnosis
fasting glucose greater than 100
40 in Male; 35 in Female
low HDL less than 40 male; 50 female
135/85 + BP
Must have 3/4
229
Diabetes disgnosis criteria
126+ fasting glucose
200+ random glucose
6.5% A1C
230
Statin drugs
lower LDL
end in -or
lipitor, zocor, tricor
231
Location of 4 main limb leads EKG
Right Arm
Left Arm
Left Leg
Right Leg
`
232
5 lead EKG
Cloud over grass
Smoke over fire
I heart chocolate
White on right
233
White EKG lead location
2nd R IC space mid clavicular
234
Green EKG lead location
7/8 IC space R mid clavicular
235
Brown EKG lead location
4 IC space R of sternum
236
FEF 25-75
flow in med to small airways
237
Primary use of incentive spirometer
Atelectasis
or post surgery
238
Treatments for sputum in lungs
coughing, huffing
239
Head thrust /impulse test positive
compensatory saccade denoted by a slow phase in which the eyes drift off their fixation target and a fast phase where they return to the fixation point (nose)
240
Imaging and atelectasis
trachea deviates toward side of atelectasis
241
Pneumothorax vs atelectasis
Pneumothorax - physical leak where air escapes from lung and fills into pleural space - places pressure on lung and cannot inflate as it normally would
atelectasis - partial collapse of 1 or more lobes d/t blockage - primarily caused by surgery
242
EKG changes with beta blockers
causes increased PR interval - decreased HR
243
Pericaridal friction rub =
pericarditis
