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NPTE > Cardiopulm > Flashcards

Cardiopulm Flashcards

1
Q

what are the S1 and S2 heart sounds?

A

S1: closing of mitral and bicuspid valves (start of systole)
S2: closing of aortic and pulmonary valves (end of systole)

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2
Q

what are the S3 and S4 heart sounds? what are they associated with?

A

S3: ventricular gallop; associated with congestive heart failure
S4: atrial gallop; associated with MI or chronic HTN

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3
Q

what is rate pressure product (RPP)?

A

RPP = HR * SBP

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4
Q

what are the two main red flags that occur with blood pressure during exercise that would indicate to stop?

A

(1) a DROP in systolic BP by 20+

(2) an increase or decrease of diastolic BP by more than 10

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5
Q

what are the blood pressure guidelines for normal, elevated, Stage 1, Stage 2, and hypertensive crisis?

A

(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

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6
Q

how does being immersed in water affect the cardiovascular system?

A
  • 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)
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7
Q

how do beta blockers affect the heart? what conditions are beta blockers used for?

A

(1) decrease HR and contractility

2) HTN, CAD (reduce myocardial O2 demand

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8
Q

what are the BORG scale numbers and intensities?

A

L-SHVEM

11: Light
13: Somewhat hard
15: Hard
17: Very hard
19: Extremely hard
20: Max exertion

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9
Q

what percent of max HR correlates with each BORG scale rating?

A 
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%
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10
Q

where are the auscultation locations for the aortic and pulmonary valves?

A

(1) aortic valve: RIGHT 2nd intercostal space
(2) pulmonary valve: LEFT 2nd intercostal space
* Both along sternal line

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11
Q

where are the auscultation locations for the tricuspid and mitral valves?

A

(1) tricuspid: LEFT 4th intercostal space (along sternal line)
(2) mitral: LEFT 5th intercostal space (along midclavicular line)

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12
Q

what is the route that conduction occurs in the heart?

A

(1) SA node
(2) AV node
(3) bundle branches (left and right)
(4) purkinje fibers

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13
Q

how many seconds is each large box? how is HR calculated using the 6-second method?

A

(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

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14
Q

what is a 1st degree heart block and how is it determined?

A

(1) delay in conduction; also known as AV nodal disease

2) classified by a PR interval >0.2 seconds (one large box

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15
Q

what is a 2nd degree (TYPE 1) heart block and how is it determined? what is usually the cause?

A

(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

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16
Q

what is a 2nd degree (TYPE 2) heart block and how is it determined? what is usually the cause?

A

(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

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17
Q

what is a 3rd degree heart block and how is it determined?

A

(1) complete conduction block

(2) no relationship between PR intervals; PR interval is constantly changing and QRS is usually wide and bizzare

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18
Q

what do ST segment elevation and ST segment depression indicate on an ECG?

A

(1) ST segment elevation: MI

(2) ST segment depression: ischemia

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19
Q

how large of an ST segment elevation must occur for it to be considered an MI?

A

> 1mm depression (1 small box is 1mm)

>2mm depression if a previous positive episode of same condition

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20
Q

what are the heart rates for atrial tachycardia, atrial flutter, and atrial fibrillation?

A

(1) atrial tachycardia: 100-250
(2) atrial flutter: 250-350
(3) atrial fibrillation: 400-600

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21
Q

what does atrial flutter look like on an ECG?

A

sawtooth

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22
Q

how are premature ventricular contractions determined on an ECG?

A

occur when ventricles contract before atria; no p-wave and wide bizarre QRS

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23
Q

what is it called when 3 or more PVCs contract in a row?

A

ventricular tachycardia (ectopic focus)

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24
Q

what are bigeminy and trigeminy on an ECG?

A

(1) bigeminy: every other beat is a PVC

(2) trigeminy: every third beat is a PVC

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25
Q

what are couplets and triplets on an ECG?

A

(1) couplet: 2 consecutive PVCs

(2) triplet: 3 consecutive PVCs

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26
Q

what is tidal volume? what is the average tidal volume for a healthy person?

A

(1) air inspired during normal, relaxed breathing

(2) 500 mL

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27
Q

what is inspiratory reserve volume?

A

additional air that can be forcibly inhaled above normal tidal volume

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28
Q

what is expiratory reserve volume?

A

additional air that can be forcibly exhaled below normal tidal volume

29
Q

what is residual volume?

A

air still present in the lungs after expiratory reserve volume is exhaled (always present in the lungs)

30
Q

what are total lung capacity and vital capacity?

A

(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

31
Q

what are inspiratory capacity and functional residual capacity?

A

(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)

32
Q

what airflow volume measurements change with restrictive lung diseases?

A

ALL MEASURES DECREASE (or stay the same) nothing increases

33
Q

what airflow volume measurements change with obstructive lung diseases?

A 
Increases
(1) Total lung capacity
(2) Residual volume
(3) Functional residual capacity
Decreases
(1) Everything else (vital capacity, ERV, FVC, IC)
34
Q

what are the COPD Gold Classification stages? what are the FEV1 and FEV1/FVC values for each stage?

A

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

35
Q

when is an assisted couch indicated for pulmonary conditions?

A

for weak muscles when the pt. can’t produce a cough themselves

36
Q

what are the 4 normal breath sounds in order of increasing pitch and intensity?

A

(1) vesicular
(2) broncho-vesicular
(3) bronchial
(4) tracheal

37
Q

where can each of the 4 normal breath sounds be heard?

A

(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

38
Q

what do rhonchi sounds resemble? are they continuous? how’s the pitch? what conditions are they commonly seen in?

A

(1) snoring
(2) continuous
(3) low pitched
(4) COPD, pneumonia, bronchiectasis, CF

39
Q

when are wheeze sounds observed? are they continuous? how’s the pitch? what conditions are they commonly seen in?

A

(1) during expiration
(2) continuous
(3) high pitched
(4) asthma, COPD

40
Q

when do crackles sound like? are they continuous? how’s the pitch? what conditions are they commonly seen in?

A

(1) popping lung sounds
(2) discontinuous
(3) high pitched
(4) CHF, pneumonia, atelectasis, bronchiectasis

41
Q

what does a pleural rub sound like? where is it heard? when are they heard? what conditions are they commonly seen in?

A

(1) sandpaper
(2) lower, lateral chest areas
(3) inspiration and expiration
(4) pneumonia, pulmonary embolism

42
Q

what is bronchophony?

A

increased vocal resonance with auscultation; you shouldn’t hear words clearly and loudly when using a stethoscope in healthy lungs (it should be muffled)

43
Q

what is egophony?

A

form of bronchophony where E sounds like an A

44
Q

what is whispered pectoriloquy?

A

increased loudness of whispers; recognizing 1,2,3 when they should be muffled

45
Q

what is fremitus? what do increased and decreased fremitus indicate?

A

(1) vibrations produced by the presence of secretions in the airways
(2) increased fremitus: increased SECRETIONS
(3) decreased: increased AIR

46
Q

would a patient with bronchitis or COPD present with increased or decreased fremitus?

A

DECREASED; these conditions cause increased air to get trapped (obstructive disease)

47
Q

what are normal values for pH, PaCO2, and HCO3?

A

pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26

48
Q

what are the main s/s of metabolic acidosis? what are some causes?

A

(1) bicarbonate deficit, hyperventilation

(2) diabetic ketoacidosis, diarrhea, renal failure

49
Q

what are the main s/s of respiratory acidosis? what are some causes?

A

(1) hypercapnia (too much CO2), hypoventilation

(2) COPD, pulmonary edema, airway obstruction, drug OD

50
Q

what are the main s/s of respiratory alkalosis? what are some causes?

A

(1) hypocapnea, lightheadedness

(2) hyperventilation (2nd to anxiety), high altitude, pregnancy

51
Q

what are the main s/s of metabolic alkalosis? what are some causes?

A

(1) excessive bicarbonate, depressed respirations, dizziness

(2) loss of gastric secretions, antacid, low K+ levels

52
Q

what conditions how long should each position be maintained for postural draining techniques?

A

5-10 minutes

53
Q

for postural drainage, what lobes is the prone position ideal? (2)

A

(1) Lower Lobe - Superior segments

(2) Lower Lobe - Posterior Basal segments

54
Q

for postural drainage, what lobes is the sitting position ideal? (2)

A

(1) Upper Lobe - Posterior segments
(Leaning over a pillow)
(2) Upper Lobe - Apical segments
(Leaning backwards slightly)

55
Q

for postural drainage, what lobes is the supine position ideal? (1)

A

(1) Upper Lobe - Anterior segments

56
Q

for postural drainage, what lobes is the sidelying position ideal? (2)

A

(1) Right Middle Lobe
(2) Left Upper Lobe - Singular segments
(3) Lower Lobe - Anterior Basal segments
(4) Lower Lobe - Lateral Basal segments

57
Q

what percentage of max HR is a good starting point for elderly individuals?

A

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

58
Q

how do METs correlate to intensity?

A 
Very light - <2 METs
Light - 2-3 METs
Moderate - 3-6 METs
Vigorous - 6-8 METs
Max: >8 METs
59
Q

what can coronary artery bypass surgery cause in the UE?

A

ulnar nerve palsy due to prolonged time in crucifix position

60
Q

when prescribiing exercise to patients in Phase 1 cardiac rehab (inpatient), what should the target METs be?

A

1-5 METs (No higher than 5 METs)

61
Q

when can resistance training be started in cardiac rehab? how many weeks post MI and CABG can resistance training be started?

A

PHASE II

  • 3 weeks after starting phase II
  • 5 weeks post MI
  • 8 weeks post CABG
62
Q

what are the two main signs of exertional intolerance?

A

(1) dyspnea

(2) angina

63
Q

what are 3 secondary risk factors for atherosclerosis?

A

(1) sedentary lifestyle
(2) stress
(3) obesity

64
Q

what intensity of exercise should be prescribed to patients for obesity?

A

Initially - 40-60% HR max

Progress to 50-75%

65
Q

what ECG change is seen with hypocalcemia?

A

prolonged QT interval (lengthened ST segment)

66
Q

what ECG change is seen with hypercalcemia?

A

QT interval shortening (larger T wave)

67
Q

what ECG change is seen with hypokalemia?

A

U wave or inverted T wave

68
Q

what ECG change is seen with hyperkalemia?

A

tall, peaked T waves (also small p-waves and wider QRS)

69
Q

what are normal respiratory rates in adults, school aged children, toddlers, and infants?

A

Adults: 12-18
School age: 18-30
Toddler: 24-40
Infant: 30-60

NPTE (10 decks)

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