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NPTE > Cardiopulm > Flashcards

Cardiopulm Flashcards

1
Q

heart conduction pathway

A

SA node, AV node, Bundle of His, Purkinje fibers

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2
Q

Stroke volume

A

blood ejected per contraction: 55-100mL/beat

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3
Q

Preload

A

LV end diastolic volume, increases quantity of blood pumped, frank-starling law

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4
Q

afterload

A

force LV must generate to overcome aortic pressure to open aortic valve

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5
Q

Cardiac Output

A

amount of blood from L or R ventricle per min (4-5 L/min)

HR x Stroke Volume

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6
Q

Ejection fraction

A

SV/EDV

>55% is normal

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7
Q

atrial filling pressure changes during strong ventricular contraction

A

decreases - enhances atrial filling

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8
Q

Atrial filling pressure - def

A

diff bet venous and atrial pressures

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9
Q

R atrial filling pressure affected by changes in intrathoracic pressure - how

A

decreases during insp (increased atrial filling)

increases during cough (decreased atrial filling)

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10
Q

venous return increases when blood volume expands or decreases?

A

expands

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11
Q

venous return decreases or increases with hypovolemic shock?

A

decreases

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12
Q

lymph gets dumped back into venous system where?

A

L subclavian vein

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13
Q

lymph in R arm gets dumped through

A

R lymphatic duct

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14
Q

lymph in L arm gets dumped through

A

thoracic duct

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15
Q

Lymph in legs gets dumped through

A

thoracic duct

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16
Q

Cholinergic is symp or parasymp

A

parasymp

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17
Q

adrenergic is symp or parasymp

A

symp

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18
Q

parasymp control (brain, nerve)

A

medulla, vagus nerve

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19
Q

symp control (brain, nerve)

A

medulla, T1-T4, releases epi & norepi

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20
Q

baroreceptors located where and for what

A

aortic arch walls, carotid sinus

main mechanisms for ctrlling HR

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21
Q

Circulatory response to changes in BP: inc BP results in what stimulation? causing what response?

A

parasymp, dec HR & F of cardiac contraction

symp inhibition, dec peripheral resistance

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22
Q

Circulatory response to changes in BP: dec BP results in what stimulation? causing what?

A

symp, inc HR & BP, vasoconstriction of peripheral blood vessels

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23
Q

Inc R Atrial pressure causes what?

A

reflex acceleration of HR

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24
Q

Chemoreceptors found where? for what?

A

carotid body, sense O2, CO2, lactic acid

increased CO2, decreased O2, or decreased pH (lactic acid) leads to increased HR

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25
Q

temp effect on HR

A

inc temp, inc HR

dec temp, dec HR

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26
Q

Hyperkalemia what and causes?

A

Inc potassium K, dec rate and F of contraction, ECG widened PR interval & QRS, tall T waves

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27
Q

Hypokalemia what and causes?

A

dec K, flattened T, prolonged PR & QT intervals, arrythmia, v fib

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28
Q

Hypercalcemia what and causes what?

A

inc Ca+, increases heart actions

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29
Q

Hypocalcemia what and causes what?

A

dec Ca+, depress heart actions

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30
Q

Hypermagnesemia what and causes what?

A

inc Mg is a calcium blocker, arrythmias or cardiac arrest

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31
Q

Hypomagnesemia what and causes what?

A

dec Mg, causes ventricular arrythmias, coronary artery vasospasm, sudden death

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32
Q

apical pulse is palpable where?

A

5th intercostal midclavic line

33
Q

normal HR adult? children, newborn?

A

60-100
60-140
90-164 (ave 127)

34
Q

tachycardia, bradycardia

A

> 100, <60

35
Q

aortic valve auscultation

A

2nd R intercostal space sternal border

36
Q

Pulmonic valve auscultation

A

2nd L intercostal space sternal border

37
Q

Tricuspid valve auscultation

A

4th L interconstal space sternal border

38
Q

Mitral valve auscultation

A

5th L intercostal space midclavicular line

39
Q

S1 is?

A

lub, closing of mitral and tricuspid valves

start of systole, decreased in 1st degree heart block

40
Q

S2 is?

A

dub, closing of aortic and pulmonary valves

end of systole, decreased in aortic stenosis

41
Q

murmur: systolic where? what?

A

between S1 & S2, may be normal, may be valve

42
Q

murmur: diastolic where? what?

A

between S1 & S2, usu valvular disease

grade 1-6

43
Q

Bruit is?

A

blowing sound of arterial or venous origin, atherosclerosis

44
Q

S3 is?

A

soon after S2, ventricular filling

LV/congestive heart failure

45
Q

S4 is?

A

just before S1, ventricular filling and atrial contraction;

CAD, MI, aortic stenosis, chronic HTN

46
Q

P wave is?

A

atrial depolarization

47
Q

P-R interval time is?

A

time required for impulse to travel from atria through purkinje fibers

48
Q

QRS wave is?

A

ventricular depolarization

49
Q

ST segment is?

A

beginning of ventricular repolarization

50
Q

T wave is?

A

ventricular repolarization

51
Q

QT interval is?

A

time for electrical systole

52
Q

PVCs are? serious PVCs are?

A

premature beat from ventricle, no P wave, wide QRS;

>6/min, paired or in sequential runs, multifocal, very early

53
Q

ventricular tachycardia is?

A

run of 3+ PVCs rapidly, usu the result of an ischemic ventricle

54
Q

non sustained ventricular tachycardia

A

3+ PVCs consecutive, terminating spontaneously in 30s

55
Q

sustained ventricular tachycardia

A

> 30s in duration

56
Q

Edema grading scale

A

1+ mild, barely palpable
2+ moderate, easily identified depression, returns to normal in 15 seconds
3+ severe, takes 15-30 seconds to rebound, 1/2-1inch pitting
4+ very severe, depression lasts for >30 seconds or more

57
Q

How many breaths per minute should a therapist administer when performing rescue breathing on an infant?

A

12-20

58
Q

Which condition would maintain a normal heart rate of 60-100 beats per minute?

A

PAC

59
Q

Which breath sound is a continuous adventitious sound comprised of a very high-pitched wheeze that can be heard with inspiration and expiration?

A

Stridor

60
Q

Which value would be most representative of an adult’s normal resting cardiac output?

A

5 L

61
Q

Hematocrit values

A

Hematocrit refers to the percentage of packed red blood cells in total blood volume. The normal hematocrit value for males is 40-54 mL/dL and for females is 37-47 mL/dL.

62
Q

ABI values

A

An ankle-brachial index value of .5 or lower is indicative of severe arterial disease and as a result, exercise would be unrealistic. A value of .7 is indicative of moderate arterial disease and would likely permit limited exercise activity. Values greater than .9 and less than 1.1 are within the acceptable range of the ideal value of 1.0.

63
Q

Vital capacity volume

A

Vital capacity is the maximal volume forcefully expired after a maximal inspiration. Normal vital capacity for an adult is 4,000-5,000 mL.

Vital capacity is the maximal volume forcefully expired after a maximal inspiration. Normal vital capacity for an adult is 4,000-5,000 mL. Normal values for forced expiratory volumes are as follows: forced expiratory volume in one second = 83% of vital capacity; forced expiratory volume in two seconds = 94% of vital capacity; forced expiratory volume in three seconds = 97% of vital capacity.

64
Q

ACE inhibitor

A

Action: ACE inhibitor agents decrease blood pressure and afterload by suppressing the enzyme that converts angiotensin I to angiotensin II.

Indications: hypertension, congestive heart failure

Side effects: hypotension, dizziness, dry cough, hyperkalemia, hyponatremia

Implications for PT: Avoid sudden changes in posture due to the risk of dizziness and fainting from hypotension. Patients with heart failure should avoid rapid increases in physical activity.

Examples: Capoten (captorpril), Vasotec (enalapril), Prinivil (lisinopril), Altace (ramipril)

65
Q

Nitrates

A

Action: Nitrate agents decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels. My also dilate coronary arteries and improve blood flow

Indications: angina pectoris

Side effects: headache, dizziness, orthostatic hypotension, reflex tachycardia, nausea, vomiting

Implications for PT: Patients must be educated to come to a standing position slowly to minimize the risk of orthostatic hypotension. Sublingual administration of nitroglycerin is the preferred method to treat an acute angina attack.

Examples: Nitrostat (nitroglycerin), Isordil (isosorbide dinitrate), Amyl nitrite solution for inhalation

66
Q

Beta blockers

A

Action: Beta blocker agents decrease the myocardial oxygen demand by decreasing heart rate and contractility by blocking ß-adrenergic receptors.

Indications: hypertension, angina, arrhythmias, heart failure, migraines, essential tremor

Side effects: bradycardia, cardiac arrhythmias, fatigue, depression, dizziness, weakness, blurred vision

Implications for PT: Heart rate and blood pressure response to exercise will be diminished. Rate of perceived exertion may be used to monitor exercise intensity. Closely monitor patients during positional changes due to an increased risk for orthostatic hypotension.

Examples: Tenormin (atenolol), Lopressor (metoprolol), Inderal (propanolol)

67
Q

Calcium channel blockers

A

Action: Calcium channel blocker agents decrease the entry of calcium into vascular smooth muscle cells resulting in diminshed myocardial contraction, vasodilation, and decreased oxygen demand of the heart.

Indications: hypertension, angina pectoris, arrhythmias, congestive heart failure

Side effects: dizziness, headache, hypotension, peripheral edema

Implications for PT: Heart rate and blood pressure response to exercise will be diminished. Monitor patient closely when moving to an upright position secondary to dizziness and/or orthostatic hypotension. Observe the patient for signs and symptoms of congestive heart failure such as worsening peripheral edema, dyspnea or weight gain.

Examples: Norvasc (amlodipine), Procardia (nifedipine), Calan (verapamil), Cardizem (diltiazem)

68
Q

Digitalis

A

Action: Positive inotropic agents increase the force and velocity of myocardial contraction, slow the heart rate, decrease conduction velocity through the AV node, and decrease the degree of activation of the sympathetic nervous system.

Indications: heart failure, atrial fibrillation

Side effects: cardiac arrhythmias, gastrointestinal distress, dizziness, blurred vision

ECG changes characteristic: gradual downsloaping ST segment, flat T wave, shortened QT interval

Leads to decreased HR and increased exercise capacity. BP will be unchanged.

Implications for PT: Therapists should monitor heart rate during activity, teach the patient and family to take the patientʼs pulse, and seek health care providerʼs advice for rates less than 60 beats/minute or more than 100 beats/minute.

Examples: Lanoxin (digoxin)

69
Q

classifications of heart failure NY vs AHA

A

NY:

1: Mild HF. no limitations in physical activity (up to 6.5 mets)
2: Slight HF. up to 4.5 mets. comfortable at rest but ordinary physical activity results in fatigue, palp, dysp, or angina
3: marked HF. marked limitation. up to 3 mets. comfortable at rest. less than ordinary physical activity results in symptoms
4: severe HF. unable to carry out physical activity (1.5 mets)

AHA stages

A: at high risk for HF but without structural heart disease or symptoms of HF
B: Structural heart disease but without symptoms of HF
C: Structural heart disease with prior or current symptoms of HF
D: Refractory HF requiring specialized interventions

70
Q

normal adult pH

A

7.35-7.45

71
Q

normal paO2 and paCo2

A

O2: 80-100 mmhg
CO2: 35-45 mmhg

72
Q

Crackles

A

Crackle (formerly rales)
An abnormal, discontinuous, high-pitched popping sound heard more often during inspiration. May be associated with restrictive or obstructive respiratory disorders.
Typically represents the movement of fluid or secretions during inspiration (wet crackles) or occurs from the sudden opening of closed airways (dry crackles). Crackles that occur during the latter half of inspiration typically represent atelectasis, fibrosis, pulmonary edema or pleural effusion. Crackles due to the movement of secretions are usually low-pitched and can be heard during inspiration and/or expiration like the sound of hairs being rubbed together between the thumb and forefinger.
Pulmonary edema may produce fine crackles as air bubbles through fluid in the distal small airways.
Often heard in the bases of lungs with interstitial lung disease, atelectasis, pneumonia, bronchiectasis, and pulmonary edema.

73
Q

Plural friction rub

A

Pleural friction rub
Dry, crackling sound heard during both inspiration and expiration.
Occurs when inflamed visceral and parietal pleurae rub together.
Heard over the spot where the patient feels pleuritic pain.

74
Q

Rhonchi

A

Rhonchi
Continuous low-pitched sounds described as having a “snoring” or “gurgling” quality that may be heard during both inspiration and expiration.
Caused by air passing through an airway which is obstructed by inflammatory secretions or liquid, bronchial spasm or neoplasms in the smaller (sibilant rhonchi) or larger (sonorous rhonchi) airways.

75
Q

Stridor

A

Continuous high-pitched wheeze heard with inspiration or expiration.
Indicates upper airway obstruction.

76
Q

Wheeze

A

Continuous “musical” or whistling sound composed of a variety of pitches.
Heard during both inspiration and/or expiration, but variable from minute to minute and area to area.
Arise from turbulent airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm or foreign body.

77
Q

MET activities

A

Light (< 3 METs)
Moderate (3-6 METs)
Vigorous (>6 METs)

Walking, Jogging, Running
Walking slowly at home or office = 2.0 
Walking 3 mph = 3.0 – 4.0 
Walking 4 mph = 4.5 – 7.0 
Walking 4.5 mph = 6.3 
Jogging 5 mph = 8.0 
Running 7 mph = 11.5
Self-care, Household, and Occupation
Toileting = 1.0 – 2.0
Driving a car = 1.0 – 2.0
Working at a computer or desk = 1.5
Making bed, washing dishes = 2.0 
Bathing = 2.0 – 3.0
Cooking = 2.0 – 3.0
Washing windows or car = 3.0
Sweeping, vacuuming = 3.0 – 3.5
Light gardening = 3.0 – 4.0
Carrying, stacking wood = 5.5
Power lawn mowing = 5.5
Shoveling = 7.0
Carrying heavy loads = 7.5
Heavy farm work = 8.0
Digging ditches = 9.5
Leisure Time and Sports
Playing cards, arts, and crafts = 1.5
Playing musical instrument = 2.0 – 2.5
Fishing (sitting) = 2.5
Slow dancing = 3.0
Table tennis = 4.0
Fast dancing = 4.5
Basketball shooting around = 4.5
Sexual intercourse = 4.0 – 5.0
Golf (walking) = 4.0 – 7.0
Swimming = 4.0 – 8.0
Tennis doubles = 5.0
Backpacking = 5.0 – 11.0
Basketball game = 8.0
Bicycling (flat) 10-12 mph = 6.0
Bicycling (flat) 12-14 mph = 8.0 
Bicycling (flat) 14-16 mph = 10.0
78
Q

homans sign

A

associated with DVT. pain in calf on forceful abrupt DF

NPTE (4 decks)

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