Cardiopulmonary Flashcards
why can you not do manual lymph drainage on a heart failure patient
the manual lymph drainage in the LE will push fluid back towards the trunk and to the heart and away from the LE. The heart already has a difficult time with the load of fluid on the heart, and this will further aggravate it and overload the heart even more.
name 3 conditions that manual lymph drainage is acceptable
edema
chronic venous insufficiency
CRPS (for the pain modulation)
normal range of WBC
4500-11,000
why must you withhold treatment for PT if the WBC count is over 11,000
signs of infection
what range of oxygen saturation will make you alter the exercises you do
90% or below
hemoglobin normal values in men and women
men: 13.3 - 16.2
women: 12 - 15.8
range of PaCO2 and Pa O2
PaCO2: 35-45 mmHg
PaO2: 80-100 mmHg
what kind of orthotic is useful when a person has a weak diaphragm
a corset, to hold contents in and support the diaphragm
why is sitting and bending forward while sitting not advantageous for the diaphragm
this will cause the diaphragm to move anteriorly and inferiorly making it even more in a disadvantageous position for proper use
what is egophony
(A sounds when the patient says E)
egophony voice sounds will increase in volume with a person with ___
consolidation
egophony voice sounds will decrease in a person with
atelectasis (b/c lung volume and tissues are deflated)
do you have voice sounds where a person has pleural effusion? why or why not
no, because the lung tissue is deflated in that area
will the voice sounds be increased or decreased in a person with pneumothorax
decreased because the lung is deflated
what is an objective measure to use when looking at diaphragm function in a patient
a tape measurement from the xiphoid to the umbilicus during inhalation
how should you measure chest excursion
take a tape measure and measure around the axilla and around the xiphoid
what is normal diastolic pulmonary arterial pressure
5-15 mmHg
what is normal ICP in adults and kids
adults: 0-10
kids: 0-5 mmHg
normal platelet count
165-415
why is percussion a precaution/contraindication (and at what levels) for coagulapathy
if platelets are below 20,000 units, may have impaired ability to heal, and percussion can cause micro-traumas
normal breathing rate
12-20 breaths per minute
what is Biot respirations
irregular breathing with highly variable respiratory depths and intermittent periods of apnea. Brain insults (strokes,…). Brain cannot regulate breathing, and is only kicked in when CO2 levels get too high. Cannot control normal breathing.
what is Cheyne -Stokes respiratory pattern
irregular respiratory pattern with periods of apnea followed by gradually increasing depths of respiration. Heart problems.
what is metropolol (Lopressor) and what does it do
a beta-blocker, which lowers the HR max so you need to use RPE to determine exercise intensity
what is very common in patients (95% of patients) who just underwent abdominal surgery (in terms of pulmonary conditions). How can we address this?
atelectasis.
deep breathing.
is excursion increased or decreased in a patient with COPD
decreased because there is hyperinflation of the lungs.
what is normal excursion of the diaphragm
1.2-2 inches (3-5cm)
how should systolic and diastolic pressures change when exercising
systolic should increase and diastolic should RTS.
what is stridor
Stridor is a continuous monophonic high-pitched crowing sound heard during inspiration. It is usually caused by upper airway obstruction.
what are wheezes
High-pitched wheezes are continuous musical sounds of variable pitch and duration that are heard on inspiration, expiration (most common), or both and are usually caused by narrow airways or stenosis (asthma/COPD)
pleural rub?
A pleural rub is inspiratory and expiratory grating, creaking sound like sandpaper or leather being rubbed together, usually due to pleural inflammation
what are crackles/rales?
Crackles (rales) are discontinuous, nonmusical, crackling sounds similar in sound to several hairs being rubbed together. It is most often heard on inspiration and usually caused by sudden opening of closed airways or movement of secretions. bronchitis
Kussmaul breathing
in acidotic states, rapid and full in and rapid and full out.
what condition (respiratory/metabolic and acid/alkalosis) would benefit from rebreathing
resp alk.
list some aquatic therapy contraindications
seizures within the last year
water/airborne transmission infections
open wounds NOT covered by occlusive dressing.
vital capacity of 1 L or less.
describe angina symptoms
transient pain that radiates down the left arm into the 4th and 5th digit. increases with exertion and decreases with rest.
how does the diaphragm make the abdomen move when breathing in
it makes it move outward, because the diaphragm pushes abdominal contents outward.
6MWT normative value for a 72 y/o with CHF should be able to walk roughly…
300 m
for individuals with a diagnosis of heart failure, a 6MWT distance of less than ___ m has been shown to be predictive of readmission to the hospital.
390m
the average distance for a 6MWT of a 70-79 y/o man should be
527 m
p wave represents the
atrial depolarization
QRS complex represents the
ventricular depolarization
on an ECG, when does arterial repolarization happen
during the QRS complex, so you cannot see it on an exam.
T wave represents
ventricular repoloarization.
what does the test “tapping the great saphenous vein” test for
the competence of the vein valves of the LE.
how do you preform the great saphenous vein percussion test
the patient is standing, and the therapist will have one hand on the proximal femoral-saphenous junction. The distal hand is on the distal great saphenous vein and starts to tap. If the tapping and percussion is felt proximally, there is dysfunction within the venous system valves.
what is the single most effective intervention for COPD prevention and prevention of progression
smoking cessation. also breathing techniques to increase O2 in and increase CO2 out.
difference between phase 1 and phase 5 korotkoff sounds?
phase 1 is the first distinct sounds heard, which is the systolic BP when deflating the cuff. Then phase 5 is the last sound heard, which is the diastolic BP.
where do you find the dorsal pedialis pulse.
on the dorsum of the foot between the first metatarsal space.
what is RDS
respiratory distress syndrome in infants due to a decrease in surfactant production. high respiratory rate, edema and nasal flaring with RR over 60. with less surfactant, the alveoli surface tension increases which will then lead to collapsing alveoli.
what does surfactant do
decreases surface tension and allows alveoli to stay open.
what is meconium aspiration
when the fetus breaths in amniotic fluid and meconium.
what things should a post CABG patient not do when participating in PT
should not do MMT of UE, and should not use the arms to sit to stand.
lingual lobe drainage
in a sidling position with legs evaluated 12inches
posterior basal lobes
prone, trendeleberg with legs elevated 18-20 inches.
posterior apical segments
sitting with knees and hips flexed to 90 degrees.
superior portions of lower lobes
prone with pillow under abdomen.
autogenic drainage
for CF. requires a lot of practice. controlled breathing at different lung volumes to mobilize secretions.
BiPAP is used for
apnea
abnormal BP changes in response to exercise
increase over 20-30mmHg for systolic and decrease over 10mmHg for diastolic
if someone has an elevated hemi -diaphragm, what should you do
train inspiratory muscles.
Brudzinski-Kernig test
for meningitis, brudzinski is when you do passive flexion of the neck and the knee bends
Kernig is a 90/90 position, and you raise the leg up to extend the knee and you have pain with the test.
Lasegue’s SLR tests
L5-S1 nerve root
bicycle test of van Gelderen
bike with backward lean to increase lordosis and bring symptoms on. Then you lean forward to see if they go away, then lean back to see if they come back. for intermittent neurological claudication.
metabolic syndrome S+S and can lead to
insulin resistance, visceral adiposity, dyslipidemia, hypertension, and elevated blood pressure. leads to increased risk CVD or T2DM.
if you have a pneumothorax there will be a shift _____ from eh injured side of the mediastinum and the trachea
away, not towards. you will also have dyspnea, chest pain and decreased absent breath sounds.
rubor of dependency test, or Buerger’s test
for lower limb ischemia. you have the patient supine with legs straight and hips flexed to 45 degrees for 2 minutes. Then you lower legs down off the table. (+) if there is loss of color in the feet with elevation and then rubor or redness with the dependent position.
bruce protocol stages are ___ minutes long
3
when can an MI patient begin OP cardiac rehab
1 week post MI
Swan-Ganz catheter
hemodynamic monitoring of the heart.
what does cold air do to asthma
makes it worse.
PLB PURSED LIP BREATHING which is twice as long as the other? inspiration or expiration
expiration is twice as long as inspiration
difference between stable and unstable angina
the stable is predictable and alleviated with rest. Unstable, could happen at rest and is unpredictable.
