Cardiopulm Flashcards
what are the S1 and S2 heart sounds?
S1: closing of mitral and bicuspid valves (start of systole)
S2: closing of aortic and pulmonary valves (end of systole)
what are the S3 and S4 heart sounds? what are they associated with?
S3: ventricular gallop; associated with congestive heart failure
S4: atrial gallop; associated with MI or chronic HTN
what is rate pressure product (RPP)?
RPP = HR * SBP
what are the two main red flags that occur with blood pressure during exercise that would indicate to stop?
(1) a DROP in systolic BP by 20+
(2) an increase or decrease of diastolic BP by more than 10
what are the blood pressure guidelines for normal, elevated, Stage 1, Stage 2, and hypertensive crisis?
(1) normal: LESS than 120/80
(2) elevated: systolic between 120-129 AND diastolic less than 80
(3) Stage 1: systolic 130-139 OR diastolic 80-89
(4) Stage 2: systolic 140+ OR diastolic 90+
(5) hypertensive crisis: systolic >180 AND / OR diastolic >120
how does being immersed in water affect the cardiovascular system?
- HR: decreases (due to increased SV)
- SV: increases
- BP: decreases (due to increased peripheral pressure)
- CO: increases
- Vital capacity: decreases (due to increased pressure on lungs)
how do beta blockers affect the heart? what conditions are beta blockers used for?
(1) decrease HR and contractility
2) HTN, CAD (reduce myocardial O2 demand
what are the BORG scale numbers and intensities?
L-SHVEM
11: Light
13: Somewhat hard
15: Hard
17: Very hard
19: Extremely hard
20: Max exertion
what percent of max HR correlates with each BORG scale rating?
starting with 6 and ending at 20 First 4 - 50-60% Next 3 - 60-70% Next 2 - 70-80% Next 2 - 80-90% Last 4 - 90-100%
where are the auscultation locations for the aortic and pulmonary valves?
(1) aortic valve: RIGHT 2nd intercostal space
(2) pulmonary valve: LEFT 2nd intercostal space
* Both along sternal line
where are the auscultation locations for the tricuspid and mitral valves?
(1) tricuspid: LEFT 4th intercostal space (along sternal line)
(2) mitral: LEFT 5th intercostal space (along midclavicular line)
what is the route that conduction occurs in the heart?
(1) SA node
(2) AV node
(3) bundle branches (left and right)
(4) purkinje fibers
how many seconds is each large box? how is HR calculated using the 6-second method?
(1) large box: 0.2 seconds
(2) count 30 large boxes (which equals 6 seconds) and determine how R waves are in that six seconds, then multiply by 10 to get HR
what is a 1st degree heart block and how is it determined?
(1) delay in conduction; also known as AV nodal disease
2) classified by a PR interval >0.2 seconds (one large box
what is a 2nd degree (TYPE 1) heart block and how is it determined? what is usually the cause?
(1) p-wave is blocked from initiating QRS complex; 2nd degree type 1 is also called Wenckebach
(2) the PR interval gets progressively longer each beat until a QRS is dropped (there is a clear pattern)
(3) disease of the AV node
what is a 2nd degree (TYPE 2) heart block and how is it determined? what is usually the cause?
(1) p-wave is blocked from initiating QRS complex; 2nd degree type 2 is also called Mobitz II
(2) PR intervals are constant and QRS are randomly / intermittently dropped (no clear pattern)
(3) disease of bundles of his and purkinje fibers
what is a 3rd degree heart block and how is it determined?
(1) complete conduction block
(2) no relationship between PR intervals; PR interval is constantly changing and QRS is usually wide and bizzare
what do ST segment elevation and ST segment depression indicate on an ECG?
(1) ST segment elevation: MI
(2) ST segment depression: ischemia
how large of an ST segment elevation must occur for it to be considered an MI?
> 1mm depression (1 small box is 1mm)
>2mm depression if a previous positive episode of same condition
what are the heart rates for atrial tachycardia, atrial flutter, and atrial fibrillation?
(1) atrial tachycardia: 100-250
(2) atrial flutter: 250-350
(3) atrial fibrillation: 400-600
what does atrial flutter look like on an ECG?
sawtooth
how are premature ventricular contractions determined on an ECG?
occur when ventricles contract before atria; no p-wave and wide bizarre QRS
what is it called when 3 or more PVCs contract in a row?
ventricular tachycardia (ectopic focus)
what are bigeminy and trigeminy on an ECG?
(1) bigeminy: every other beat is a PVC
(2) trigeminy: every third beat is a PVC
what are couplets and triplets on an ECG?
(1) couplet: 2 consecutive PVCs
(2) triplet: 3 consecutive PVCs
what is tidal volume? what is the average tidal volume for a healthy person?
(1) air inspired during normal, relaxed breathing
(2) 500 mL
what is inspiratory reserve volume?
additional air that can be forcibly inhaled above normal tidal volume
what is expiratory reserve volume?
additional air that can be forcibly exhaled below normal tidal volume
what is residual volume?
air still present in the lungs after expiratory reserve volume is exhaled (always present in the lungs)
what are total lung capacity and vital capacity?
(1) total lung capacity: maximum amount of air the can fill the lungs
(2) vital capacity: total amount of air that can be forcefully inhaled and then exhaled TV+IRV+ERV
what are inspiratory capacity and functional residual capacity?
(1) inspiratory capacity: max amount of air that can be inhaled (RV+IRV)
(2) functional residual capacity: amount of air remaining in the lungs after a normal expiration (ERV+RV)
what airflow volume measurements change with restrictive lung diseases?
ALL MEASURES DECREASE (or stay the same) nothing increases
what airflow volume measurements change with obstructive lung diseases?
Increases (1) Total lung capacity (2) Residual volume (3) Functional residual capacity Decreases (1) Everything else (vital capacity, ERV, FVC, IC)
what are the COPD Gold Classification stages? what are the FEV1 and FEV1/FVC values for each stage?
Stage I: mild; FEV1 >80
Stage II: moderate; FEV1 50-80
Stage III: severe; FEV1 30-50
Stage IV: very severe; FEV1 <30
FEV1/FVC is less than 0.7 for all stages
when is an assisted couch indicated for pulmonary conditions?
for weak muscles when the pt. can’t produce a cough themselves
what are the 4 normal breath sounds in order of increasing pitch and intensity?
(1) vesicular
(2) broncho-vesicular
(3) bronchial
(4) tracheal
where can each of the 4 normal breath sounds be heard?
(1) vesicular: over most of the lungs
(2) broncho-vesicular: between 1st and 2nd interspace anteriorly; between the scapulae
(3) bronchial: over manubrium
(4) tracheal: over trachea in the neck
what do rhonchi sounds resemble? are they continuous? how’s the pitch? what conditions are they commonly seen in?
(1) snoring
(2) continuous
(3) low pitched
(4) COPD, pneumonia, bronchiectasis, CF
when are wheeze sounds observed? are they continuous? how’s the pitch? what conditions are they commonly seen in?
(1) during expiration
(2) continuous
(3) high pitched
(4) asthma, COPD
when do crackles sound like? are they continuous? how’s the pitch? what conditions are they commonly seen in?
(1) popping lung sounds
(2) discontinuous
(3) high pitched
(4) CHF, pneumonia, atelectasis, bronchiectasis
what does a pleural rub sound like? where is it heard? when are they heard? what conditions are they commonly seen in?
(1) sandpaper
(2) lower, lateral chest areas
(3) inspiration and expiration
(4) pneumonia, pulmonary embolism
what is bronchophony?
increased vocal resonance with auscultation; you shouldn’t hear words clearly and loudly when using a stethoscope in healthy lungs (it should be muffled)
what is egophony?
form of bronchophony where E sounds like an A
what is whispered pectoriloquy?
increased loudness of whispers; recognizing 1,2,3 when they should be muffled
what is fremitus? what do increased and decreased fremitus indicate?
(1) vibrations produced by the presence of secretions in the airways
(2) increased fremitus: increased SECRETIONS
(3) decreased: increased AIR
would a patient with bronchitis or COPD present with increased or decreased fremitus?
DECREASED; these conditions cause increased air to get trapped (obstructive disease)
what are normal values for pH, PaCO2, and HCO3?
pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26
what are the main s/s of metabolic acidosis? what are some causes?
(1) bicarbonate deficit, hyperventilation
(2) diabetic ketoacidosis, diarrhea, renal failure
what are the main s/s of respiratory acidosis? what are some causes?
(1) hypercapnia (too much CO2), hypoventilation
(2) COPD, pulmonary edema, airway obstruction, drug OD
what are the main s/s of respiratory alkalosis? what are some causes?
(1) hypocapnea, lightheadedness
(2) hyperventilation (2nd to anxiety), high altitude, pregnancy
what are the main s/s of metabolic alkalosis? what are some causes?
(1) excessive bicarbonate, depressed respirations, dizziness
(2) loss of gastric secretions, antacid, low K+ levels
what conditions how long should each position be maintained for postural draining techniques?
5-10 minutes
for postural drainage, what lobes is the prone position ideal? (2)
(1) Lower Lobe - Superior segments
(2) Lower Lobe - Posterior Basal segments
for postural drainage, what lobes is the sitting position ideal? (2)
(1) Upper Lobe - Posterior segments
(Leaning over a pillow)
(2) Upper Lobe - Apical segments
(Leaning backwards slightly)
for postural drainage, what lobes is the supine position ideal? (1)
(1) Upper Lobe - Anterior segments
for postural drainage, what lobes is the sidelying position ideal? (2)
(1) Right Middle Lobe
(2) Left Upper Lobe - Singular segments
(3) Lower Lobe - Anterior Basal segments
(4) Lower Lobe - Lateral Basal segments
what percentage of max HR is a good starting point for elderly individuals?
60-70% of HR max - this is because elderly people have lower HR maxes and 50% of their max HR would be about their resting HR
how do METs correlate to intensity?
Very light - <2 METs Light - 2-3 METs Moderate - 3-6 METs Vigorous - 6-8 METs Max: >8 METs
what can coronary artery bypass surgery cause in the UE?
ulnar nerve palsy due to prolonged time in crucifix position
when prescribiing exercise to patients in Phase 1 cardiac rehab (inpatient), what should the target METs be?
1-5 METs (No higher than 5 METs)
when can resistance training be started in cardiac rehab? how many weeks post MI and CABG can resistance training be started?
PHASE II
- 3 weeks after starting phase II
- 5 weeks post MI
- 8 weeks post CABG
what are the two main signs of exertional intolerance?
(1) dyspnea
(2) angina
what are 3 secondary risk factors for atherosclerosis?
(1) sedentary lifestyle
(2) stress
(3) obesity
what intensity of exercise should be prescribed to patients for obesity?
Initially - 40-60% HR max
Progress to 50-75%
what ECG change is seen with hypocalcemia?
prolonged QT interval (lengthened ST segment)
what ECG change is seen with hypercalcemia?
QT interval shortening (larger T wave)
what ECG change is seen with hypokalemia?
U wave or inverted T wave
what ECG change is seen with hyperkalemia?
tall, peaked T waves (also small p-waves and wider QRS)
what are normal respiratory rates in adults, school aged children, toddlers, and infants?
Adults: 12-18
School age: 18-30
Toddler: 24-40
Infant: 30-60
