Cardiopulmonary Flashcards
1
Q
WBC standard number
A
5-10.0
2
Q
leukocytosis =
A
> 11.0 `
3
Q
neutropenia
A
<1.5
4
Q
leukopenia
A
<4.0
5
Q
moderate neutropenia=
A
0.5 -1.0
6
Q
severe neutropenia
A
<0.5
7
Q
symptoms of leukocytosis
A
fever, malaise, lethargy, dizziness, bleeding, bruising, weight loss if cancer, lymphadenopathy, painful inflamed joint
8
Q
symptoms of leukopenia
A
anemia, weakness, fatigue, fever, headache, shortness of breathe
9
Q
what is aplastic anemia
A
not making white blood cells
10
Q
symptoms of neutropenia
A
low-grade fever, skin abscesses, sore mouth, symptoms of pneumonia, infection risk
11
Q
male hemoglobin normal
A
14-17.4 g/dL
12
Q
what do we use hemoglobin for
A
assess anemia, blood loss, and bone marrow supression
13
Q
female hemoglobin normal
A
12-16 g/dL
14
Q
Polycythemia (upward trend in hemoglobin) could mean
A
congenital heart disease, severe dehydration, COPD< CHF, severe burns (leakage), high altitude
15
Q
symptoms of polycythemia
A
orthostasis, presyncope, dizziness, arrhythmias, CHF onset/exacerbation, seizure, symptoms of TIA or MI or angina
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 !!!
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
18
Q
signs of anemia (downward trending hemoglobin)
A
decreased endurance, decreased activity tolerance, palor, tachycardia
19
Q
which vital sign is useful for perfusion
A
SpO2
20
Q
if pt in hospital is hemodynamically stable and asymptomatic may transfuse at
A
7g/dL
21
Q
underlying cardiac or orthopedic pts with cardiovascular disease may transfuse at
A
8 g/dL
22
Q
sickle cell anemia and lupus, hemorrhage, and nutritional deficiency can cause
A
anemia (downward trending hemoglobin)
23
Q
hematocrit is used for
A
blood loss and fluid balance
24
Q
hematocrit for males
A
42-52%
25
hematocrit for females
37-47%
26
low critical value for hematocrit
<15-20% can lead to cardiac failure and death
27
high critical value for hematocrit
>60% spontaneous blood clotting
28
trending upward hematocrit (Polycythemia) symptoms
fever, HA, dizziness, weakness, fatigue, easy bruising or bleeding
29
trending downward hematocrit (anemia) symptoms
pale skin, HA, dizziness, cold hands/feet, chest pain, arrhythmia, SOB
30
what to do if hematocrit is <25%
symptoms based approach, collaborate with the interprofessional team -> about transfusion or mobility
31
examples of when hematocrit is low
leukemia, bone marrow failure, pregnancy, HYPERTHYROIDISM, cirrhosis, RA, hemorrhage, high altitude
32
platelet reference value
140-400 k/uL
33
thrombocytosis =
>450 k/uL
34
thrombocytopenia
<150 k/uL
35
symptoms of thrombocytosis
weakness, HA< dizziness, chest pain, tingling in hands in feet
36
causes of thrombocytosis
splenectomy, inflammation, cancer, stress, iron deficiency, infection, hemorrhage, hemolysis, high altitude, strenuous exercise, trauma
37
thrombocytopenia symptoms
petechiae, ecchymosis, fatigue, jaundice, splenomegaly, risk for bleeding
38
Causes of thrombocytopenia
viral infection, nutrition deficiency, leukemia, radiation/chemotherapy, malignant cancer, liver disease, aplastic anemia, premenstrual and postpartum
39
severe thrombocytopenia=
< 20 k/uL talk to interprofessional team
39
therapeutic range of INR for lupus
3.0-3.5
39
therapeutic range INR for prosthestic heart valve
2.5-3.5
40
what does INR measure
bleeding ratio/viscosity
40
therapeutic range INR for stroke prophylaxis
2.0-2.5
40
normal INR
0.8-1.2 (normal is 1.0)
40
therapeutic range INR for VTE, PE, DVT, a- fib
2-3.0
41
prothrombin time is used for ______
coumadin
42
normal prothrombin time
11-3
43
patient on coumadin have to keep at _____
>25
44
when can you mobilize a patient that isn't anticoagulated?
if they have an IVC filter
45
if on coumadin, what INR can we mobilize at
2-5
46
in hyperkalemia what on the EKG will be big
T-waves will be giant
47
normal potassium level
3.7-5.1
48
normal Sodium level
134-142 mEq/L
49
hypernatremia value
>145
50
hyponatremia value
<130
51
symptoms of hypernatremia
irritability, agitation, seizure, coma, hypotension, tachycardia, decreased urinary output
52
symptoms of hyponatremia
lethargy, orthostatic hypotension, pitting edema, coma, headache, N&V&D
53
reference value of potassium
3.7-5.1
54
hyperkalemia causes
renal failure, metabolic acidosis, DKA, addison's disease, excess potassium supplements, blood transfusion
55
hypokalemia causes
Diarrhea, vomitting, GI impairment, diuretics, cushing's, malnutrition, restrictive diet, ETOH abuse
56
symptoms of hyperkalemis
muscle weakness/paralysis, paresthesia, bradycardia, heart block, ventricular fibrillation, cardiac arrest
57
symptoms of hypokalemia
extremity weakness, decreased reflexes, leg cramps, EKG changes, cardiac arrest, hypotension, constipation
58
if a patient is on a diuretic what are we worried about
hypokalemia
59
severe hypokalemia=
<2.5 mEq/L
60
hyperkalemia trending upward=
> 5 mEq/L
61
reference value for blood urea nitrogen
6-25 mg/dL
62
hypokalemia on the EKG
might see two 2 waves, second called a U wave
63
what does BUN measure
kidney function
64
presentation of increased BUN
HTN, fluid retention, itchy/dry skin, dyspnea, bone pain
65
male reference value for serum creatinine
male: 0.7-1.3 mg/dL
66
female reference value for serum creatinine
0.4-1.1 mg/dL
67
someone with trending upward serum creatinine has
decreased exercise tolerance
68
glucose reference value
70-100 mg/dL
69
fasting plasma glucose (FPG)
90-130 mg/dL
70
diagnosis of diabetes
FPG > 126 mg/dL or 2-hour plasma glucose > 200 mg
71
hyperglycemia=
>200 mg/dL
72
hypoglycemia
<70 mg/dL
73
symptoms of hyperglycemia
DKA, severe fatigue, decreased exercise tolerance
74
hypoglycemia symptoms
lethargy, irritability, shaking, extremity weakness, LOC , probably won't tolerate therapy until glucose is increased
75
Don't get the patient up if glucose levels are
>300 mg/dL, 275 with ketones present don't get them up!!!
76
normal A1C
< 5.7%
77
pre-diabetic A1C
5/7-6.4%
78
DM A1C
>6.5%
79
A1C is a good indicator of
long term blood glucose control: reflects 2-3 months
80
As a PT what should we do if a patient's A1C is out of control
educate them on the importance of blood glucose control
81
if patient has BG of <100 mg/dL how much carbohydrates should they receive
30 g
82
respiratory alkalosis pH and PaCO2
>7.45
≤ 35 mm Hg
83
respiratory acidosis pH and PaCO2
<7.35
≥ 40 mmHg
84
symptoms of respiratory alkalosis
confusion, dizziness, paresthesia, chest pain, seizure
85
normal value of PaCO2
37-43 mmHg
86
normal pH
7.35-7.45
87
what can cause respiratory alkalosis
restrictive lung disease (breathing quick and heavy)
anxiety, CHF, CVA, PE meningitis, psychosis
88
causes of respiratory acidosis
COPD, decreased ventilation, depression of central respiratory center (drugs vs cerebral disease), ALS,GBS,MS, asthma
89
symptoms of respiratory acidosis
confusion, fatigue/lethargy, SOB, somnolence
90
Metabolic Alkalosis
pH > 7.45
HCO3 30 mmHg
91
metabolic acidosis
pH < 7.35
HCO3 <24 mmHg
92
as a PT what are we worried about with Metabolic acidosis
arrhythmias with mobility
93
clinical considerations with elevated anion gap
ETOH ketoacidosis, uncontrolled diabetes, methanol intoxication, ketogenic diet, tissue hypoxia-lactic acid increased, fasting, poisoning
94
normal serum albumin
3.5-5.2
95
Serum Prealbumin normal value
19-39 mg/dL
96
lab value test for heart failure
BNP- Brain Neuropeptide Protein
97
NYHA stage I
no limitation of PA, normal PA does not cause undue fatigue, palpitation, dyspnea
BNP= 100-300 pg/mL
98
NYHA stage II
mild symptoms, slight limitation of PA, comfortable at rest but ordinary PA results in fatigue, palpitation, dyspnea
BNP >300 pg/mL
99
NYHA stage III
BNP >600, marked limitation of physical activity, comfortable at rest, less than ordinary activity causes fatigue, palpitation or dyspnea
100
NYHA stage IV
BNP> 900 pg/mL, severe limitations. Experience symptoms even at rest, symptom based approach when determining appropriateness
101
what is the gold standard for diagnosing MI
Troponin I (cTnI) and T (cTnT)
102
what is measured alongside troponin
creatine kinase in cardiac muscle (CK2-MB)
103
when does CK2-MB typically rise
3-6 hours after cardiac injury, returns within 2-3 days
104
when does Troponin I (cTnI) and T (cTnT) peak
6 hours to 3 days after an event
105
other causes of elevated troponin
rhabdomyolysis, renal failure, hypertrophic cardiomyopathy, CHF, cardiac surgery, large PE, large burns and acute CVA/TBI
106
positive Troponin I (cTnI) and T (cTnT)=
>0.10
107
desired total CHO
<200 mg/dL
108
borderline high CHO
200-239 mg/dL
109
high CHO
≥240 mg/dL
110
normal triglycerides
<150mg/dL
111
borderline high triglycerides
150-199 mg/dL
112
high triglycerides
200-499 mg/dL
113
very high triglycerides
≥500 mg/dL
114
desired LDL level
<100 mg/dL
115
borderline high LDL
130-159 mg/dL
116
high LDL
160-189 mg/dL
117
very high LDL
≥190 mg/dL
118
reference value for male HDL
≥40 mg/dL
119
reference value for female HDL
≥50 mg/dL
120
severe protein depletion = serum prealbumin of
0-5
121
moderate protein depletion = serum prealbumin of
5-10 mg/dL
122
mild protein depletion = serum prealbumin of
10-15 mg/dL
123
low serum prealbumin or albumin symptoms
peripheral edema, hypotension, non-healing wounds
124
if serum prealbumin = <10 g/dL there is
significant nutritional risk, poor would healing and generalized edema
125
if concerned of too high or too low serum albumin what should you do daily
check integumentary and wounds and always check with the interdisciplinary team about nutrition
126
causes of high serum albumin
severe infection, congenital disorders, hepatitis, TB, chronic inflammation, overdose of cortisone, CHF< renal disease, CA
127
causes of low serum albumin
infection, nutritional compromise, liver disease, inflammation, crohn's disease, burns, malnutrition, thyroid disease
128
critical value serum bilirubin
>12 mg/dL
129
normal serum bilirubin
0.3-1.0
130
causes of elevated serum bilirubin
cirrhosis, hepatitis, jaundice, transfusion reaction, chemo, bile duct occlusion
131
symptoms of elevated serum bilirubin
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
ammonia reference value
15-60 ug/dL
133
what does ammonia evaluate
liver function and metabolism
134
has encephalopathy with increase ammonia they are at risk for
falls
135
elevated ammonia symptoms
hepatic encephalopathy, confusion, lethargy, dementia, daytime sleepiness, tremors, breakdown of fine motor skills, numbness and tingling, speech impairment
136
137
ABI critical level where they need to go to the ER
0.5
138
ABI level should be
1.0
139
sinus arrhythmia common population
younger patients, maybe due to breathing pattern or drugs
140
premature atrial contraction look on ECG
QRS complex narrow, RR interval shorter than sinus QRS, P wave morphology
141
how can you tell an ectopic atrial rhythm
inverted P wave in Lead II
142
Wandering atrial pacemaker on ECG
3 different P wave morphologies possible with ventricular rate < 100 bpm
143
difference between multifocal atrial tachycardia and wandering atrial pacemaker.
multifocal is ventricular rate > 100 bpm , and wandering is less
144
atrial flutter on ECG
lots of P waves before a QRS
145
ventricular flutter on ECG
most likely won't see QRS complex
146
a fib on ECG
irregular irregular rhythm with NO P WAVES , ventricular rate usually > 100 bpm
147
a fib is closely associated with ______
stroke
148
1st degree AV block
QRS get's through but slowly, P-R interval is > .2 sec
149
2nd degree AV heart block (WENKEBACH or Mobitz)
some get through but not all, P wave, p wave P wave QRS
150
3rd degree AV heart block
nothing get's through, P waves and QRS are not related, hard to note
151
Wenkebach (II type 1) heart block
PR intervals longer longer longer and then no QRS
152
Mobitz (II type 2) heart block
PR interval is constant and then eventually one doesn't get through
153
characteristics of ventricular arrhythmias
wide QRS complex, variable rate, no P waves
154
premature ventricular contraction
large dip and then big peak or vice versa and then large pause before next complex
155
Torsades de pointes
occurs secondary to prolonged QT interval
156
what happens before a potential flatline
ventricular fibrillation
157
causes of L bundle branch block
normal variant, idiopathic degeneration of conduction system, cardiomyopathy, ischemic heart disease, aortic stenosis, hyperkalemia, left ventricular hypertrophy
158
Right bundle branch block on the QRS
bunny ear QRS complex so two R's
159
an acute heart ischemia will show ______ on the ECG
ST segment elevation
160
post MI exercise prescription
resting HR + 10-20 bpm or < 120 , PRE < 13 for first 3 days
161
post cardiac surgery exercise prescription
HR + 10 bpm or <110, PRE 11-13 x first 3 days
162
exercise prescription for pt with serious dysrhythmia
HR + 10 bpm or <110 , PRE 11-13
163
crackles on lung sounds may indicate
collapsed alveoli likely secondary to pulmonary edema
164
wheezes on lung sounds may indicate
narrowing of small bronchi secondary to broncho-constriction of inflammation
165
S3 heart sound may indicate
cardiac hypertrophy in adolescent or athlete, but in older individual usually indicates pathological hypertrophy or heart failure
166
S4 heart sound may indicate
cardiac hypertrophy and/or heart failure
167
if left ventricular end diastolic volume increases what happens to stroke volume
increases
168
if there is greater afterload, what happens to stroke volume
decreases
169
what is a clinically useful measure of left ventricular function
ejection fraction= SV/LVEDV
170
increased CO2, decreased O2 and decreased pH do what to HR
increase `
171
which heart block requires atropine and artificial pacemaker?
third degree heart block
172
serious PVCs
> 6/minute, sequential runs, multifocal or very early PVC (R on T)
173
what is the carotid sinus baroreceptor reflex
drop in pulse rate of blood pressure, can be stimulated through compression of carotid artery on both sides
174
what might cause an apical pulse to shift laterally
congestive heart failure, cardiomyopathy, ischemic heart disease
175
what might cause an apical pulse to shift superiorly
elevated diaphragm or pregnancy
176
systolic murmurs heard between
S1-S2
177
diastolic murmurs heard between
S2-S1
178
where to listen to aortic valve
second right intercostal space
179
where to listen to pulmonic valve
second left intercostal space
180
where to listen to tricuspid valve
4th, left intercostal space
181
where to listen to mitral valve
5th intercostal space mid clavicular line
182
s2 sound is closing of the
aortic and pulmonary valves
183
when is S2 sound decreased
aortic stenosis
184
S1 sound is closing of the
mitral and tricuspid valves
185
S1 is decreased with
first-degree heart block
186
which murmur always indicates valvular disease
diastolic murmur between S2-S1
187
what is a bruit
an adventitious sound or murmur of arterial or venous origin common in the carotid or femoral arteries
188
what does a bruit sound indicate
atherosclerosis
189
what does S4 sound indicate
coronary heart disease, myocardial infarction, aortic stenosis or chronic hypertension
190
S3 may indicate
normal in athletes, or congestive heart failure
191
ventricular tachycardia is a run of ____ PVCs in a row
4, with 150-200 bpm
192
atrial fib bpm
>300
193
atrial flutter bpm
250-350
194
atrial tachycardia bpm
140-250
195
ECG changes when taking digitalis
depresses ST segment, flattens T wave, QT shortens
196
ECG changes when taking Quinidine
QT and QRS lengthen, t wave flattens of inverts
197
normal mean arterial pressure
70-110
198
respiratory rate for newborn child
30-40
199
respiratory rate for normal child
20-30
200
female symptoms of MI
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
diagnosis requirements for chronic bronchitis
cough present for at least 3 months for 2 consecutive years
202
types of COPD
chronic bronchitis and emphysema
203
number one cause of emphysema
smoking
204
most common type of pneumonia
pneumococcal pneumonia
205
most common form of pneumonia in children
viral RSV
206
diagnostic tests for cystic fibrosis
positive sweat electrolyte test, tripsinogen in blood
207
signs and symptoms of cystic fibrosis
frequent respiratory infections, inability to gain weight regardless of caloric intake, thickening secretions, meconium ileus
208
what causes respiratory distress syndrome
inadequate amount of surfactant leading to alveolar collapse, found in premature infants
209
bronchiectasis=
abnormal dilatation of the bronchi leading to excessive sputum production
210
what is sarcoidosis and what tissues does it impact
multisystem inflammatory disease, typically effecting lung, liver, eyes, skin and lymph nodes, a restrictive lung disease
211
sx and sx of sarcoidosis
pulmonary fibrosis, increased secretions, skin lesions, visual changes, diaphoresis, palpitations, joint pain and swelling, muscle weakness
212
what characterizes a flail chest
two or more fractures in two or more adjacent ribs
213
how long is the primary disease of TB
10 days to 2 weeks
214
isolation for TB:
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
huffing is more successful with ____ patients
chronic obstructive disease
216
steps of autogenic drainage of the lungs
unstick phase, collect phase and then evacuation phase
217
when is segmental breathing contraindicated
with intractable hypoventilation until medical solution is resolved
218
indications for segmental breathing
risk for developing atelectasis, pleuritic, incisional or post-trauma pain that decreases movement
219
exercise prescription for pulmonary conditioning
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
