Cardiopulm

Question 1

ECG small box time

Answer 1

0.04 sec

Question 2

ECG big box time

Answer 2

0.2 sec

Question 3

normal PR wave time

Answer 3

0.12-0.2 sec (up to one big box)

Question 4

normal QRS time

Answer 4

0.04 to 0.12 sec

Question 5

ECG rate estimation

Answer 5

if regular, number of big boxes between R spikes:

300, 150, 100, 75, 60, 50

Question 6

First degree AV block

Answer 6

prolonged PR interval (> 0.2 sec, one big box)

each P wave gives rise to QRS

Question 7

Second degree AV block, Mobitz type 1 (Wenckebach)

Answer 7

PR lengthens progressively until P wave fails to create QRS

incomplete block

Question 8

Second degree AV block, Mobitz type 2

Answer 8

fixed PR interval with dropped QRS every 2nd, 3rd or 4th P wave

incomplete block

Question 9

Third degree AV block

Answer 9

complete heart block

P waves present, but no relationship to QRS

Question 10

needle-like spikes in ECG

Answer 10

usually indicate artificial pacing by a pacemaker, check for regular rhythm

Question 11

supraventricular tachycardia

Answer 11

HR > 150, P wave often not visible, QRS normal/narrow

Question 12

normal cholesterol

Answer 12

total < 200

LDL <160 if low risk
<130 if intermediate risk
<100 if high risk, existing heart disease, diabetes

HDL <40 men, <60 women

triglicerides < 150

Question 13

grading scale for pulses

Answer 13

0 - absent
1+ diminished
2+ normal
3+ full pulse, increased strength
4+ bounding

Question 14

heart sound landmarks

Answer 14

aortic valve: 2nd R intercostal space at sternal border
pulmonic valve: 2nd L intercostal space at sternal border
tricuspid valve (R AV): 4th L intercostal space, sternal border
Mitral valve (L AV): 5th L intercostal space, midclavicular line

Question 15

normal INR (international normalized ratio)

Answer 15

PT/reference PT (PT: prothrombin time)

0.9-1.1

for pt’s on anticoagulation, INR will be 2-3

Question 16

normal CRP (C-reactive protein)

Answer 16

< 10 mg/L

> 100 mg/L associated with inflammation and infection

Question 17

S4 heart sound

Answer 17

low frequency in late diastole, just before S1

due to exaggerated atrial contraction and turbulence

occurs in CAD, MI, aortic stenosis, chronic hypertension

Question 18

heart murmur

Answer 18

swishing sound, can be heard whenever

Question 19

pericardial rub

Answer 19

leathery sound during systole

Question 20

S3 heart sound

Answer 20

low frequency during early diastole, after S2

due to poor ventricular compliance and turbulence

may be indicative of left ventricular failure

Question 21

S2 heart sound

Answer 21

marks end of systole

closure of aortic and pulmonary valves

decreased in aortic stenosis

Question 22

S1 heart sound

Answer 22

marks beginning of systole

closure of mitral and tricuspid valves

decreased in 1st degree heart block

Question 23

normal SpO2

Answer 23

98-100%

SaO2 < 88-90% requires supplemental O2

Question 24

normal PaO2

Answer 24

90-100 mmHg

Question 25

normal PaCO2

Answer 25

35-45mmHg increased in COPD, hypoventilation decreased in hyperventilation, pregnancy, pulmonary embolism, anxiety

Question 26

normal ESR (erythrocyte sedimentation rate)

Answer 26

male <15 mm/hr female <20 mm/hr increased in infection and inflammation, rheumatic or pelvic inflammatory disease, osteomylitis used to monitor effects of treatment

Question 27

normal Hct (hematocrit)

Answer 27

male: 45-52% | female 37-48%

Question 28

normal Hgb (hemoglobin)

Answer 28

male 13-18 | female 12-16

Question 29

normal platelet count

Answer 29

150,000-450,000 cells/mm3 30-50,000 - moderate exercise only 20-30,000 - light exercise only <20,000 - ADL's only

Question 30

pH of blood

Answer 30

normal: 7.35-7.45 if abnormal, look at CO2 next, if abnormal (should be 35-45), it is respiratory acid/alk. then look at HCO3 (should be 21-26)

Question 31

normal prothrombin time

Answer 31

11-15 sec

Question 32

normal partial thromboplastin time

Answer 32

25-40 sec

Question 33

normal WBC count

Answer 33

4,300-10,800 cells/mm3 use mask if <1,000-2,000

Question 34

normal RBC

Answer 34

male 4.6-6.2 female 4.2-5.9

Question 35

When are PVC's dangerous?

Answer 35

>6 in one minute In paired or sequential runs Multifocal Very early

Question 36

ST elevation

Answer 36

acute MI

Question 37

ST depression

Answer 37

impaired coronary perfusion

Question 38

atelectasis

Answer 38

collapsed or airless alveolar unit caused by pain during ventilatory cycle, internal bronchial obstruction, external bronchial compression, low tidal volumes, or neurological insult

Question 39

phase 1 cardiac rehab - post-MI

Answer 39

while still in hospital (3-5 days) Initially 2-3 MET's, up to 5 MET's, short sessions 2-3 x/day for 6 weeks after MI - do not exceed 70% HR max or 5 MET's

Question 40

phase 2 cardiac rehab

Answer 40

after 3 weeks cardiac rehab, 5 weeks post MI, 8 weeks post CABG progress up to 9 MET 2-3 sessions/week, 30-60 min with 5-10 min of warmup/cooldown may begin resistance training, 1-3 lbs, progress to moderate loads for 12-15 reps

Question 41

MET levels

Answer 41

``` 1.5-2: standing/slow walking 3-4: level walking at 3 mph, bike 6 mph 5-6: walking at 4 mph, bike 10 mph 7-8: jogging at 5 mph, bike 12 mph 8-9: running 5.5 mph, bicycling 13 mph ```

Question 42

phase 3 cardiac rehab

Answer 42

community, must be able to work at 5 MET progress to 50-85% of functional capacity, 3-4 times/week, >45min/session

Question 43

right heart failure symptoms

Answer 43

jugular distension and peripheral edema higher pulmonary vascular pressures, mitral valve disease, chronic lung disease

Question 44

left heart failure (CHF)

Answer 44

pulmonary congestion, edema, low cardiac output due to backup of blood from the left ventricle to the left atrium. caused by excessive workload of the heart (HBP, valve disease, congenital defects), arrhythmia or heart damage.

Question 45

precautions to Trendelenburg position

Answer 45

pulmonary edema, CHF, hypertension, SOB obesity, ascites, pregnancy, hiatal hernia, n/v, recently eaten recent neurosurgery, increased ICP, aneurysm

Question 46

precautions for side-lying

Answer 46

axillo-femoral bypass graft

Question 47

considerations to percussion/shaking

Answer 47

treatment makes pain worse, aneurysm precautions, hemoptysis, increased PT/PTT time, decreased platelet count (<50,000) fractures/weak bones

Question 48

changes in HR/BP with manual pressure to carotid sinus

Answer 48

decrease