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NPTE > Cardiopulmonary > Flashcards

Cardiopulmonary Flashcards

1
Q

WBC standard number

A

5-10.0

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2
Q

leukocytosis =

A

> 11.0 `

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3
Q

neutropenia

A

<1.5

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4
Q

leukopenia

A

<4.0

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5
Q

moderate neutropenia=

A

0.5 -1.0

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6
Q

severe neutropenia

A

<0.5

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7
Q

symptoms of leukocytosis

A

fever, malaise, lethargy, dizziness, bleeding, bruising, weight loss if cancer, lymphadenopathy, painful inflamed joint

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8
Q

symptoms of leukopenia

A

anemia, weakness, fatigue, fever, headache, shortness of breathe

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9
Q

what is aplastic anemia

A

not making white blood cells

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10
Q

symptoms of neutropenia

A

low-grade fever, skin abscesses, sore mouth, symptoms of pneumonia, infection risk

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11
Q

male hemoglobin normal

A

14-17.4 g/dL

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12
Q

what do we use hemoglobin for

A

assess anemia, blood loss, and bone marrow supression

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13
Q

female hemoglobin normal

A

12-16 g/dL

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14
Q

Polycythemia (upward trend in hemoglobin) could mean

A

congenital heart disease, severe dehydration, COPD< CHF, severe burns (leakage), high altitude

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15
Q

symptoms of polycythemia

A

orthostasis, presyncope, dizziness, arrhythmias, CHF onset/exacerbation, seizure, symptoms of TIA or MI or angina

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16
Q

Low critical value of hemoglobin both M and F

A

<5-7 g/dL
can lead to heart failure or death
don’t get them up !!!

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17
Q

high critical value of hemoglobin both M and F

A

> 20 g/dL
leading to clogging of capillaries
DON’T GET THEM UP

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18
Q

signs of anemia (downward trending hemoglobin)

A

decreased endurance, decreased activity tolerance, palor, tachycardia

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19
Q

which vital sign is useful for perfusion

A

SpO2

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20
Q

if pt in hospital is hemodynamically stable and asymptomatic may transfuse at

A

7g/dL

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21
Q

underlying cardiac or orthopedic pts with cardiovascular disease may transfuse at

A

8 g/dL

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22
Q

sickle cell anemia and lupus, hemorrhage, and nutritional deficiency can cause

A

anemia (downward trending hemoglobin)

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23
Q

hematocrit is used for

A

blood loss and fluid balance

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24
Q

hematocrit for males

A

42-52%

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25
Q

hematocrit for females

A

37-47%

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26
Q

low critical value for hematocrit

A

<15-20% can lead to cardiac failure and death

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27
Q

high critical value for hematocrit

A

> 60% spontaneous blood clotting

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28
Q

trending upward hematocrit (Polycythemia) symptoms

A

fever, HA, dizziness, weakness, fatigue, easy bruising or bleeding

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29
Q

trending downward hematocrit (anemia) symptoms

A

pale skin, HA, dizziness, cold hands/feet, chest pain, arrhythmia, SOB

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30
Q

what to do if hematocrit is <25%

A

symptoms based approach, collaborate with the interprofessional team -> about transfusion or mobility

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31
Q

examples of when hematocrit is low

A

leukemia, bone marrow failure, pregnancy, HYPERTHYROIDISM, cirrhosis, RA, hemorrhage, high altitude

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32
Q

platelet reference value

A

140-400 k/uL

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33
Q

thrombocytosis =

A

> 450 k/uL

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34
Q

thrombocytopenia

A

<150 k/uL

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35
Q

symptoms of thrombocytosis

A

weakness, HA< dizziness, chest pain, tingling in hands in feet

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36
Q

causes of thrombocytosis

A

splenectomy, inflammation, cancer, stress, iron deficiency, infection, hemorrhage, hemolysis, high altitude, strenuous exercise, trauma

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37
Q

thrombocytopenia symptoms

A

petechiae, ecchymosis, fatigue, jaundice, splenomegaly, risk for bleeding

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38
Q

Causes of thrombocytopenia

A

viral infection, nutrition deficiency, leukemia, radiation/chemotherapy, malignant cancer, liver disease, aplastic anemia, premenstrual and postpartum

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39
Q

severe thrombocytopenia=

A

< 20 k/uL talk to interprofessional team

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39
Q

therapeutic range of INR for lupus

A

3.0-3.5

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39
Q

therapeutic range INR for prosthestic heart valve

A

2.5-3.5

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40
Q

what does INR measure

A

bleeding ratio/viscosity

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40
Q

therapeutic range INR for stroke prophylaxis

A

2.0-2.5

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40
Q

normal INR

A

0.8-1.2 (normal is 1.0)

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40
Q

therapeutic range INR for VTE, PE, DVT, a- fib

A

2-3.0

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41
Q

prothrombin time is used for ______

A

coumadin

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42
Q

normal prothrombin time

A

11-3

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43
Q

patient on coumadin have to keep at _____

A

> 25

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44
Q

when can you mobilize a patient that isn’t anticoagulated?

A

if they have an IVC filter

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45
Q

if on coumadin, what INR can we mobilize at

A

2-5

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46
Q

in hyperkalemia what on the EKG will be big

A

T-waves will be giant

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47
Q

normal potassium level

A

3.7-5.1

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48
Q

normal Sodium level

A

134-142 mEq/L

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49
Q

hypernatremia value

A

> 145

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50
Q

hyponatremia value

A

<130

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51
Q

symptoms of hypernatremia

A

irritability, agitation, seizure, coma, hypotension, tachycardia, decreased urinary output

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52
Q

symptoms of hyponatremia

A

lethargy, orthostatic hypotension, pitting edema, coma, headache, N&V&D

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53
Q

reference value of potassium

A

3.7-5.1

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54
Q

hyperkalemia causes

A

renal failure, metabolic acidosis, DKA, addison’s disease, excess potassium supplements, blood transfusion

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55
Q

hypokalemia causes

A

Diarrhea, vomitting, GI impairment, diuretics, cushing’s, malnutrition, restrictive diet, ETOH abuse

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56
Q

symptoms of hyperkalemis

A

muscle weakness/paralysis, paresthesia, bradycardia, heart block, ventricular fibrillation, cardiac arrest

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57
Q

symptoms of hypokalemia

A

extremity weakness, decreased reflexes, leg cramps, EKG changes, cardiac arrest, hypotension, constipation

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58
Q

if a patient is on a diuretic what are we worried about

A

hypokalemia

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59
Q

severe hypokalemia=

A

<2.5 mEq/L

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60
Q

hyperkalemia trending upward=

A

> 5 mEq/L

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61
Q

reference value for blood urea nitrogen

A

6-25 mg/dL

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62
Q

hypokalemia on the EKG

A

might see two 2 waves, second called a U wave

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63
Q

what does BUN measure

A

kidney function

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64
Q

presentation of increased BUN

A

HTN, fluid retention, itchy/dry skin, dyspnea, bone pain

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65
Q

male reference value for serum creatinine

A

male: 0.7-1.3 mg/dL

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66
Q

female reference value for serum creatinine

A

0.4-1.1 mg/dL

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67
Q

someone with trending upward serum creatinine has

A

decreased exercise tolerance

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68
Q

glucose reference value

A

70-100 mg/dL

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69
Q

fasting plasma glucose (FPG)

A

90-130 mg/dL

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70
Q

diagnosis of diabetes

A

FPG > 126 mg/dL or 2-hour plasma glucose > 200 mg

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71
Q

hyperglycemia=

A

> 200 mg/dL

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72
Q

hypoglycemia

A

<70 mg/dL

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73
Q

symptoms of hyperglycemia

A

DKA, severe fatigue, decreased exercise tolerance

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74
Q

hypoglycemia symptoms

A

lethargy, irritability, shaking, extremity weakness, LOC , probably won’t tolerate therapy until glucose is increased

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75
Q

Don’t get the patient up if glucose levels are

A

> 300 mg/dL, 275 with ketones present don’t get them up!!!

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76
Q

normal A1C

A

< 5.7%

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77
Q

pre-diabetic A1C

A

5/7-6.4%

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78
Q

DM A1C

A

> 6.5%

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79
Q

A1C is a good indicator of

A

long term blood glucose control: reflects 2-3 months

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80
Q

As a PT what should we do if a patient’s A1C is out of control

A

educate them on the importance of blood glucose control

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81
Q

if patient has BG of <100 mg/dL how much carbohydrates should they receive

A

30 g

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82
Q

respiratory alkalosis pH and PaCO2

A

> 7.45
≤ 35 mm Hg

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83
Q

respiratory acidosis pH and PaCO2

A

<7.35
≥ 40 mmHg

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84
Q

symptoms of respiratory alkalosis

A

confusion, dizziness, paresthesia, chest pain, seizure

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85
Q

normal value of PaCO2

A

37-43 mmHg

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86
Q

normal pH

A

7.35-7.45

87
Q

what can cause respiratory alkalosis

A

restrictive lung disease (breathing quick and heavy)
anxiety, CHF, CVA, PE meningitis, psychosis

88
Q

causes of respiratory acidosis

A

COPD, decreased ventilation, depression of central respiratory center (drugs vs cerebral disease), ALS,GBS,MS, asthma

89
Q

symptoms of respiratory acidosis

A

confusion, fatigue/lethargy, SOB, somnolence

90
Q

Metabolic Alkalosis

A

pH > 7.45
HCO3 30 mmHg

91
Q

metabolic acidosis

A

pH < 7.35
HCO3 <24 mmHg

92
Q

as a PT what are we worried about with Metabolic acidosis

A

arrhythmias with mobility

93
Q

clinical considerations with elevated anion gap

A

ETOH ketoacidosis, uncontrolled diabetes, methanol intoxication, ketogenic diet, tissue hypoxia-lactic acid increased, fasting, poisoning

94
Q

normal serum albumin

A

3.5-5.2

95
Q

Serum Prealbumin normal value

A

19-39 mg/dL

96
Q

lab value test for heart failure

A

BNP- Brain Neuropeptide Protein

97
Q

NYHA stage I

A

no limitation of PA, normal PA does not cause undue fatigue, palpitation, dyspnea
BNP= 100-300 pg/mL

98
Q

NYHA stage II

A

mild symptoms, slight limitation of PA, comfortable at rest but ordinary PA results in fatigue, palpitation, dyspnea
BNP >300 pg/mL

99
Q

NYHA stage III

A

BNP >600, marked limitation of physical activity, comfortable at rest, less than ordinary activity causes fatigue, palpitation or dyspnea

100
Q

NYHA stage IV

A

BNP> 900 pg/mL, severe limitations. Experience symptoms even at rest, symptom based approach when determining appropriateness

101
Q

what is the gold standard for diagnosing MI

A

Troponin I (cTnI) and T (cTnT)

102
Q

what is measured alongside troponin

A

creatine kinase in cardiac muscle (CK2-MB)

103
Q

when does CK2-MB typically rise

A

3-6 hours after cardiac injury, returns within 2-3 days

104
Q

when does Troponin I (cTnI) and T (cTnT) peak

A

6 hours to 3 days after an event

105
Q

other causes of elevated troponin

A

rhabdomyolysis, renal failure, hypertrophic cardiomyopathy, CHF, cardiac surgery, large PE, large burns and acute CVA/TBI

106
Q

positive Troponin I (cTnI) and T (cTnT)=

A

> 0.10

107
Q

desired total CHO

A

<200 mg/dL

108
Q

borderline high CHO

A

200-239 mg/dL

109
Q

high CHO

A

≥240 mg/dL

110
Q

normal triglycerides

A

<150mg/dL

111
Q

borderline high triglycerides

A

150-199 mg/dL

112
Q

high triglycerides

A

200-499 mg/dL

113
Q

very high triglycerides

A

≥500 mg/dL

114
Q

desired LDL level

A

<100 mg/dL

115
Q

borderline high LDL

A

130-159 mg/dL

116
Q

high LDL

A

160-189 mg/dL

117
Q

very high LDL

A

≥190 mg/dL

118
Q

reference value for male HDL

A

≥40 mg/dL

119
Q

reference value for female HDL

A

≥50 mg/dL

120
Q

severe protein depletion = serum prealbumin of

A

0-5

121
Q

moderate protein depletion = serum prealbumin of

A

5-10 mg/dL

122
Q

mild protein depletion = serum prealbumin of

A

10-15 mg/dL

123
Q

low serum prealbumin or albumin symptoms

A

peripheral edema, hypotension, non-healing wounds

124
Q

if serum prealbumin = <10 g/dL there is

A

significant nutritional risk, poor would healing and generalized edema

125
Q

if concerned of too high or too low serum albumin what should you do daily

A

check integumentary and wounds and always check with the interdisciplinary team about nutrition

126
Q

causes of high serum albumin

A

severe infection, congenital disorders, hepatitis, TB, chronic inflammation, overdose of cortisone, CHF< renal disease, CA

127
Q

causes of low serum albumin

A

infection, nutritional compromise, liver disease, inflammation, crohn’s disease, burns, malnutrition, thyroid disease

128
Q

critical value serum bilirubin

A

> 12 mg/dL

129
Q

normal serum bilirubin

A

0.3-1.0

130
Q

causes of elevated serum bilirubin

A

cirrhosis, hepatitis, jaundice, transfusion reaction, chemo, bile duct occlusion

131
Q

symptoms of elevated serum bilirubin

A

if severe= fatigue, anorexia, nausea, fever, occasionally vomiting, loose fatty stool , with advanced disease pts are at risk for OP and bleeding due to deficiencies of fat soluble vitamins

132
Q

ammonia reference value

A

15-60 ug/dL

133
Q

what does ammonia evaluate

A

liver function and metabolism

134
Q

has encephalopathy with increase ammonia they are at risk for

A

falls

135
Q

elevated ammonia symptoms

A

hepatic encephalopathy, confusion, lethargy, dementia, daytime sleepiness, tremors, breakdown of fine motor skills, numbness and tingling, speech impairment

136
Q
A
137
Q

ABI critical level where they need to go to the ER

A

0.5

138
Q

ABI level should be

A

1.0

139
Q

sinus arrhythmia common population

A

younger patients, maybe due to breathing pattern or drugs

140
Q

premature atrial contraction look on ECG

A

QRS complex narrow, RR interval shorter than sinus QRS, P wave morphology

141
Q

how can you tell an ectopic atrial rhythm

A

inverted P wave in Lead II

142
Q

Wandering atrial pacemaker on ECG

A

3 different P wave morphologies possible with ventricular rate < 100 bpm

143
Q

difference between multifocal atrial tachycardia and wandering atrial pacemaker.

A

multifocal is ventricular rate > 100 bpm , and wandering is less

144
Q

atrial flutter on ECG

A

lots of P waves before a QRS

145
Q

ventricular flutter on ECG

A

most likely won’t see QRS complex

146
Q

a fib on ECG

A

irregular irregular rhythm with NO P WAVES , ventricular rate usually > 100 bpm

147
Q

a fib is closely associated with ______

A

stroke

148
Q

1st degree AV block

A

QRS get’s through but slowly, P-R interval is > .2 sec

149
Q

2nd degree AV heart block (WENKEBACH or Mobitz)

A

some get through but not all, P wave, p wave P wave QRS

150
Q

3rd degree AV heart block

A

nothing get’s through, P waves and QRS are not related, hard to note

151
Q

Wenkebach (II type 1) heart block

A

PR intervals longer longer longer and then no QRS

152
Q

Mobitz (II type 2) heart block

A

PR interval is constant and then eventually one doesn’t get through

153
Q

characteristics of ventricular arrhythmias

A

wide QRS complex, variable rate, no P waves

154
Q

premature ventricular contraction

A

large dip and then big peak or vice versa and then large pause before next complex

155
Q

Torsades de pointes

A

occurs secondary to prolonged QT interval

156
Q

what happens before a potential flatline

A

ventricular fibrillation

157
Q

causes of L bundle branch block

A

normal variant, idiopathic degeneration of conduction system, cardiomyopathy, ischemic heart disease, aortic stenosis, hyperkalemia, left ventricular hypertrophy

158
Q

Right bundle branch block on the QRS

A

bunny ear QRS complex so two R’s

159
Q

an acute heart ischemia will show ______ on the ECG

A

ST segment elevation

160
Q

post MI exercise prescription

A

resting HR + 10-20 bpm or < 120 , PRE < 13 for first 3 days

161
Q

post cardiac surgery exercise prescription

A

HR + 10 bpm or <110, PRE 11-13 x first 3 days

162
Q

exercise prescription for pt with serious dysrhythmia

A

HR + 10 bpm or <110 , PRE 11-13

163
Q

crackles on lung sounds may indicate

A

collapsed alveoli likely secondary to pulmonary edema

164
Q

wheezes on lung sounds may indicate

A

narrowing of small bronchi secondary to broncho-constriction of inflammation

165
Q

S3 heart sound may indicate

A

cardiac hypertrophy in adolescent or athlete, but in older individual usually indicates pathological hypertrophy or heart failure

166
Q

S4 heart sound may indicate

A

cardiac hypertrophy and/or heart failure

167
Q

if left ventricular end diastolic volume increases what happens to stroke volume

A

increases

168
Q

if there is greater afterload, what happens to stroke volume

A

decreases

169
Q

what is a clinically useful measure of left ventricular function

A

ejection fraction= SV/LVEDV

170
Q

increased CO2, decreased O2 and decreased pH do what to HR

A

increase `

171
Q

which heart block requires atropine and artificial pacemaker?

A

third degree heart block

172
Q

serious PVCs

A

> 6/minute, sequential runs, multifocal or very early PVC (R on T)

173
Q

what is the carotid sinus baroreceptor reflex

A

drop in pulse rate of blood pressure, can be stimulated through compression of carotid artery on both sides

174
Q

what might cause an apical pulse to shift laterally

A

congestive heart failure, cardiomyopathy, ischemic heart disease

175
Q

what might cause an apical pulse to shift superiorly

A

elevated diaphragm or pregnancy

176
Q

systolic murmurs heard between

A

S1-S2

177
Q

diastolic murmurs heard between

A

S2-S1

178
Q

where to listen to aortic valve

A

second right intercostal space

179
Q

where to listen to pulmonic valve

A

second left intercostal space

180
Q

where to listen to tricuspid valve

A

4th, left intercostal space

181
Q

where to listen to mitral valve

A

5th intercostal space mid clavicular line

182
Q

s2 sound is closing of the

A

aortic and pulmonary valves

183
Q

when is S2 sound decreased

A

aortic stenosis

184
Q

S1 sound is closing of the

A

mitral and tricuspid valves

185
Q

S1 is decreased with

A

first-degree heart block

186
Q

which murmur always indicates valvular disease

A

diastolic murmur between S2-S1

187
Q

what is a bruit

A

an adventitious sound or murmur of arterial or venous origin common in the carotid or femoral arteries

188
Q

what does a bruit sound indicate

A

atherosclerosis

189
Q

what does S4 sound indicate

A

coronary heart disease, myocardial infarction, aortic stenosis or chronic hypertension

190
Q

S3 may indicate

A

normal in athletes, or congestive heart failure

191
Q

ventricular tachycardia is a run of ____ PVCs in a row

A

4, with 150-200 bpm

192
Q

atrial fib bpm

A

> 300

193
Q

atrial flutter bpm

A

250-350

194
Q

atrial tachycardia bpm

A

140-250

195
Q

ECG changes when taking digitalis

A

depresses ST segment, flattens T wave, QT shortens

196
Q

ECG changes when taking Quinidine

A

QT and QRS lengthen, t wave flattens of inverts

197
Q

normal mean arterial pressure

A

70-110

198
Q

respiratory rate for newborn child

A

30-40

199
Q

respiratory rate for normal child

A

20-30

200
Q

female symptoms of MI

A

indigestion or gas like pain, dizziness or nauseau, unexplained weakness or fatigue, pain/discomfort between shoulder blades, recurring chest discomfort or sense of impending doom , confusion

201
Q

diagnosis requirements for chronic bronchitis

A

cough present for at least 3 months for 2 consecutive years

202
Q

types of COPD

A

chronic bronchitis and emphysema

203
Q

number one cause of emphysema

A

smoking

204
Q

most common type of pneumonia

A

pneumococcal pneumonia

205
Q

most common form of pneumonia in children

A

viral RSV

206
Q

diagnostic tests for cystic fibrosis

A

positive sweat electrolyte test, tripsinogen in blood

207
Q

signs and symptoms of cystic fibrosis

A

frequent respiratory infections, inability to gain weight regardless of caloric intake, thickening secretions, meconium ileus

208
Q

what causes respiratory distress syndrome

A

inadequate amount of surfactant leading to alveolar collapse, found in premature infants

209
Q

bronchiectasis=

A

abnormal dilatation of the bronchi leading to excessive sputum production

210
Q

what is sarcoidosis and what tissues does it impact

A

multisystem inflammatory disease, typically effecting lung, liver, eyes, skin and lymph nodes, a restrictive lung disease

211
Q

sx and sx of sarcoidosis

A

pulmonary fibrosis, increased secretions, skin lesions, visual changes, diaphoresis, palpitations, joint pain and swelling, muscle weakness

212
Q

what characterizes a flail chest

A

two or more fractures in two or more adjacent ribs

213
Q

how long is the primary disease of TB

A

10 days to 2 weeks

214
Q

isolation for TB:

A

2 weeks in negative pressure room, anyone entering must wear a protective TB mask and follow universal precautions, if patient leaves the room they must wear a specialized mask

215
Q

huffing is more successful with ____ patients

A

chronic obstructive disease

216
Q

steps of autogenic drainage of the lungs

A

unstick phase, collect phase and then evacuation phase

217
Q

when is segmental breathing contraindicated

A

with intractable hypoventilation until medical solution is resolved

218
Q

indications for segmental breathing

A

risk for developing atelectasis, pleuritic, incisional or post-trauma pain that decreases movement

219
Q

exercise prescription for pulmonary conditioning

A

20-30 minutes, 3-5x/week, if less than 20-30 min, then should increase frequency to 5-7x per week, circuit program, intensity should be at or near max heart rate

220
Q
A

NPTE (7 decks)

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