Cardiopulmonary Flashcards
1
Q
Dyspnea
A
Shortness of breath
2
Q
Eupnea
A
Normal unlabored breathing
3
Q
Hypernpeana
A
Faster breathing
4
Q
Orthopnea
A
Needs pillows when supine (drowning in blood with L sided CHF)
Aka Proximal nocturnal dyspnea
5
Q
Apnea
A
Stopping of breathing
6
Q
Dependent Rubor
A
A condition of redness that appears when the extremity is placed in a dependent position and resolves with elevation
- most often observed with PAD (peripheral arterial disease)
7
Q
Pulse Pressure
A
The difference between systolic and diastolic blood pressure
Normal resting is 30-50 mmHg
8
Q
RPP
A
Rate Product pressure
The metabolic demand of the heart
RPP = HR x SBP
9
Q
Cardiac Ouput
A
HR X SV
10
Q
6 Minute Walk Test
A
outcome measure used to test aerobic endurance
- rest breaks are allowed but the timer CANNOT be paused
- practice test can be done an hour before
11
Q
Blood Pressure Guidelines
A
Normal: Less than 120/80
Elevated: Systolic 120-129, Diastolic less than 80
Stage 1: Systolic 130-139, Diastolic 80-89
Stage 2: Systolic at least 140 Diastolic at least 90
Hypertensive Crisis: Systolic over 180 and/or diastolic over 120
12
Q
Medical Management of a patient in Hypertensive Crisis
A
Prompt changes in medication if no other indications of problems exist
immediate hospitalization if there are signs of organ damage
13
Q
How does the Autonomic Nervous System affect Heart Rate?
A
SNS: tells heart to speed up
PNS: tells heart to slow down
14
Q
What does steady state VO2 in exercise mean?
A
That ATP demand of exercise is being aerobically met
15
Q
What happens to HR, BP, CO, and SV when you initially enter high altitude?
A
HR: increase
BP: increase
CO: Increase
SV: no change
16
Q
What happens to HR, BP, CO, and SV once you’re acclimated to a higher altitude?
A
HR: Increase
BP: normal
CO: normal
SV: decreases
17
Q
Cardiovascular Effects of being in water
A
HR: decrease
BP: decrease
VO2: decrease
CO: increase
SV: increase
18
Q
Respiratory Effects of Being in Water
A
Vital Capacity will DECREASE due to the pressure from the water and work required to breathe will INCREASE
19
Q
MSK Effects of Being in Water
A
Decreased weight bearing
Decreased edema due to improved circulation
20
Q
Beta Blockers
A
“olol”
anti-hypertensive drug
Blocks SNS hormones from landing on the heart
work to reduce heart rate and contractility which reduces energy/O2 demand
prescribed for hypertension and coronary artery disease
LOWER HEART RATE DURING SUBMAX AND MAX EXERCISE
21
Q
Borg RPE Scale
A
6-20
Rate of Perceived Exertion
SHVEHM
13- somewhat hard
15- hard
17- very hard
19- extremely hard
20- maximal exertion
22
Q
Auscultation Landmarks
A
Aortic Valve: 2nd intercostal space to the right of the sternal border
Pulmonic Valve: 2nd intercostal space to the left of the external border
Tricuspid: 4th intercostal space
Mitral: 5th intercostal space (midclavicular line)
23
Q
Normal Heart Sounds
A
S1 and S2 (lub and dub)
S1 = closure of the aortic and pulmonic valves –> onset of systole
S2 = closure of the tri/bi valves –> onset of diastole
24
Q
Abnormal Heart Sounds
A
S3 and S4
S3: ventricular gallop (overfilling of the left ventricle): will hear in CHF
S4: Aortic gallop (abnormal ventricular filling and atrial contraction): associated with hypertension, left ventricular hypertrophy, pulmonary hypertension and pulmonary stenosis
25
Sympathetic Stimulation of the Heart
Cardiacceleratory center in the medulla oblongata the nerves travel through the sympathetic trunk ganglion (T-T4) to the SA node, AV node, conduction pathways, and myocytes to the sympathetic receptors. Neurotransmitters released are epinephrine and norepinephrine
SNS increases the rate and force of myocardial contraction which INCREASES myocardial metabolism
- causes vasodilation of coronary arteries and vasoconstriction of the peripheral blood vessels
26
Parasympathetic Stimulation of the heart
Cardioinhibitory center in the medulla oblongota
Vagus nerve travels down to the heart
decreases rate and force of myocardial contraction and therefore decreases myocardial metabolism
decreases speed of conduction through AV node
causes vasoconstriction of coronary arteries and dilation of peripheral blood vessels
27
Baroreceptors
pressure sensors that provide the main mechanism for controlling HR
can be found in internal carotid artery, aortic arch, and carotid sinus
- Increased BP results in parasympathetic stimulation, sympathetic inhibition, decreased HR and force of contraction, and decreased peripheral resistance
- Decreased BP results in sympathetic stimulation, increased heart rate, and vasoconstriction of peripheral blood vessels
* baroreceptors send info to the brain and the pNS/SNS peeps send signals based on that
28
Chemoreceptors
located in the carotid body and aortic body
Chemoreceptors respond to changes in blood chemicals, such as O2 and CO2, lactic acid, and H+
- increased CO2, Decreased O2, of decrease pH (aka elevated lactic acid) will all lead to INCREASED HR
- increased O2 will lead to DECREASED HR
29
Cardiac Response to body temp
Increased temperature will lead to increased heart rate
decreased temp will lead to decreased heart rate
30
Ways to assess Body Temperature
- Rectal and tympanic membrane (typically a bit higher than oral temp_
- Axillary temp (lower than oral temp)
31
Normal Adult Temp
Oral: 98.6
Rectal and Tympanic Membrane: 99.5
Axillary Temp 97.6
32
Peripheral Resistance
- increased resistance will result in i- increased blood volume and pressure
- decreased resistance will result in decreased arterial blood volume and pressure
33
What are important lab values for a cardio exam?
Troponin and Creatine Kinase-myocardial band
34
Modifiable Risk Factors for Cardiovascular Disease
- smoking
- Hypertension (>140/90)
- Hyperlipidemia
- Sedentary Lifestyle
- Obesity
- Diabetes
35
What might Bilateral Peripheral edema indicate?
CHR, RV failure
36
Unilateral Peripheral Edema can indicate?
thrombophlebitis, lymphedema, DVT
37
Sites to take Pulse
- Radial (most common)
- Carotid
- Temporal
- Brachial
- Femoral
- Popliteral (hardest)
- dorsalis pedis
- post. tib
- apical pulse (5th intercostal space)
38
Grading Scale for Peripheral Pulse
0- Absent, not palpable
1+: diminished, barely palpable
2+ normal, easily palpable
3+ full pulse, increased strength
4+ bounding pulse
39
Compensatory Tachycardia
> 100 bpm
due to volume loss
40
Normal Respiratory Rates
Adults: 12-20
Child: 20-30
Newborn 30-40
41
Postural Tachycardia Syndrome
An increase in HR >/= 30 BPM within 10 mins of standing
42
What are the 3 parameters that can be used to prescribe exercise intensity in general conditioning?
1. Oxygen consumption AKA VO2 Max
2. HRR: Heart Rate Reserve
3. RPE (Rate of Perceived Exertion shout out to Borg)
43
VO2 Max
Oxygen consumption
- most accurate method to prescribe exercise intensity
- mod intensity is 40-60% of VO2 max
- Mod to vigorous intensity is 60% of VO2 ma
44
Heart Rate Reserve (HRR)
HRR is the diff between your max heart rate and your resting heart rate
- allows you to monitor intensity during actual performance
* pts with severe pulmonary impairment will not be able to reach max HR before ventilators maximum
45
Karvonen Formula
Used to calculate target HR
MaxHR = 208-(0.7x age)
Target HR = MAXhr-RESThr X (DESIRED INTENSITY %) + RESTING HEART RATE
46
Diaphragmatic Breathing
Increases ventilation, improves gas exchange, decreases workload, facilitates relaxation, improves chest/abdominal wall mobility during inhalation
Can be used for Obstructive and Restrictive pulmonary diseases including secretions, high breathing rates, post/op/trauma.
Tactile cueing from PT onto subcostal angle can be used (inhale against the pressure)
47
Pursed Lip Breathing
Used to increase tidal volume, reduce respiratory rate, reduce dyspnea, and facilitates relaxation, improves gas exchange
Works bc of the positive pressure from pursed lips which prevents early airway collapse
USED FOR OBSTRUCTIVE DISEASES that experience dyspnea at rest
Pt inhales and blows out for 4-6s
48
Segmental Breathing
Improves ventilation to a hypoventilated segment, maintains/restores functional residual capacity, used for pleuritic incision or postttrauma that causes decreased movement in a portion of the thorax
- can help reduce risk of atelectasis
49
Stacked Breathing
The purpose of stacked breathing is to improve hypoventilation, decrease atelectasis, improve breathing coordination, and ineffective coughs
Stacked breathing is a series of deep breaths that build on top of each other until max volume is reached
50
Lateral Costal Breathing Purpose and Positioning
Lateral Costal Breathing can help with asymmetrical chest wall expansion AND relieve localized lung consolidation OR secretions
Patient is placed in sidelying with uninvolved side against the bed and arm of the involved side abducted over the head
51
(SMI)/Inspiratory Hold
Sustained Maximal Inspiration is used to increase inhaled volume and restore functional residual capacity
Typically used in acute situations + ineffective cough. Can prevent alveolar collapse
Pt inhales slowly through the nose or pursed lips to max inhalation and holds for 3 s before exhaling —> incentive spirometer can be used for this
52
Positioning for Dyspnea Relief
Have the pt lean forward with arms supported to allow accessory muscles to act on ribcage/thorax and increase expansion/inspiration
53
What are the 4 Lung Volumes?
1. Tidal Volume (normal breath cycle) 500 mL
2. Inspiratory Reserve Volume (air that can be forcibly inhaled after normal inhale TV) 3100 mL
3. Expiratory Reserve Volume (air that can be forcibly exhaled after after normal expiration of TV) 1200 mL
4. Residual Volume (1200 mL volume of air remaining in lungs after expiratory reserve volume is exhaled) : ALWAYS PRESENT
54
What are the 4 lung capacities?
1. Total Lung Capacity (6,000mL): maximum amount of air that can fill the lungs (TLC= TV + IRV + ERV + RV)
2. Vital Capacity (4800 mL): max amount of air that can be expired after full inhaling (80% of TLC)
3. Inspiratory Capacity (3600 mL) max amount of air that can be inspired
Functional Residual Capacity (2400) amount of air remaining in the lungs after NORMAL expiration TV
55
Obstructive Pulmonary Diseases
CBABE
- cystic fibrosis
- Bronchitis (chronic)
- Asthma
- Bronchiectasis
Emphysema
- Chronic Obstructive Pulmonary Disease (COPD)
56
What Measurements increase with Obstructive pulmonary diseases?
Tidal volume
Functional Residual Capacity
Residual Volume
Total Lunge Capacity
* everything else decreases
* remember things can’t GET OUT they are OBSTRUCTED
57
What lung measurements decrease with restrictive pulmonary diseases?
ALL OF THEM
58
Restrictive Pulmonary Diseases
Pneumothorax
Lungs Sarcoidosis
Fibrosis
Ankylosing Spondylitis
Pulmonary Effusion
Hemothorax
Pulmonary Fibrosis
59
COPD Gold Classification
HINT: 30 is ur number
For ALL staging FEV1/FVC is < 70%
Stage 1 (mild): FEV1 >80%; with or without chronic sx of cough and sputum production
Stage 2 (moderate): FEV1 (50-80%: with or without chronic sx of cough, sputum, and dyspnea
Stage 3 (Severe): FEV1 (30-50%) with or without chronic sx of cough, sputum, and increased dyspnea
Stage 4 (Very Severe): FEV1 (<30%) Chronic respiratory failure, severe dyspnea
60
FEV1
FEV1 is the expiratory volume in the 1st second of expiration
61
What is the most consistent change in a COPD exacerbation?
A decrease of FEV1 due to airway narrowing and increased residual volume/functional capacity
62
What is assisted coughing in a supine position used for?
USED FOR SOMEONE WITH NO COUGHING MECHANISM: ex. SCI high t spine or c spine
63
What is Huffing used for?
Huffing can be used to strengthen a weak cough and help the patient clear secretions
64
What are the 4 normal breath sounds?
1. Vesicular: all over the place, soft and low pitch ( Inspiratory > Expiratory)
2. Broncho-Vesicular: intermediate and intermediate, between 1st and 2nd intercostal space between scap. (Inspiratory = expiratory)
3. Bronchial: loud and high pitched, over manubrium (expiratory > inspiratory)
4. Tracheal: very loud and high over trachea (inspiratory = expiratory)
65
4 Abnormal Breath Sounds
1. Rhonchi
2. Wheeze
3. Crackles aka Rales
4. Pleural rub
66
Rhonchi
Continuous low pitched, rattling lung sounds (snoring)
- associated with COPD, bronchiectasis, pneumonia, chronic bronchitis, cystic fibrosis
67
Wheeze
High pitched sound heard in expiration, caused by airway obstruction
- asthma, COPD, choking (aspiration)
68
Crackles
Brief continuous, popping lung sounds that are high pitched, Heard in both phases of expiration
CHF
69
Pleural Rub
Sandpaper sound heard in lateral lower chests with inspiration and expiration —> indication of pleural inflammation
70
When are voice sounds abnormal?
When the sound is CLEAR
71
Broncophony
Increased vocal resonance with greater clarity and loudness of spoken words
Ex. 99
72
Egophony
Long “E” sounds changes to an “A” sound
Typically indicative of lung consolidations
Seen with pneumonia and pleural effusion
73
Whispered Pectoriloquy
Increased loudness of whispering —> can recognize what the patient is saying
74
Normal pH
Normal PaCO2
Normal HCO3
7.35-7.45
35-45
22-26
75
Uncompensated Respiratory Acidosis and Alkalosis
Due to increased OR decreased PaCO2
Acidosis = low pH
Alkalosis = high pH
76
Uncompensated Metabolic Acidosis and Alkalosis
Metabolic is due Bicarbonate HCO3
Alkalsosis is increased bicarbonate
Acidosis is decreased bicarbonate
77
Perfusion of the Lungs in an Upright Position
*perfusion is gravity dependent
- more blood found at the base of the lungs in an upright position
78
Ventilation in an Upright Position
Apical alveoli contain more O2 than alveoli at the base during resting and expiratory pressure
79
Ventilation/Perfusion Ratio (Ve/Q)
Alveolar ventilation: capillary perfusion
In an upright position,
- the apices are gravity INDEPENDENT (air > blood), there is dead space
- Middle Zone: Air = blood, ratio is equal
- Base is gravity DEPENDENT and the amount of blood > air (shunt)
80
What controls ventilation?
Receptors
- baroreceptors
- chemoreceptors
Irritant receptors
- stretch receptors
Central Cord Centers
- cortex
- pons
- medulla
ANS
81
What do you expect to OBSERVE in R sided CHF?
- peripheral edema
- jugular vein distension
(Hepatojugular reflex)
82
What do you expect to observe in L sided CHF?
- dyspnea
- crackles
- cyanosis
- clubbing (3 levels)
-
83
When might you see CONTRALATERAL tracheal shift and why might it occur?
CONTRALATERAl tracheal shift is due to increased pressure on the affected side
Due to
- hemothorax, pneumothorax
- pleural effusion
- large mass
* essentially something whether it’s air, inflammation, or a tumor is pushing the trachea to the other side
84
When might you see IPSILATERAL tracheal shift and when might it occur?
IPSILATERAL tracheal shift is due to decreased pressure on the affected side
Due to
- atelectasis
- pneumonectomy
- lobectomy
- pleural fibrosis
- agenesis (failure to develop)
Ex. Right sided atelectasis ( L pressure > R pressure) so the trachea will move IPSILATERAL
85
3 Landmarks to Measure Chest Wall Excursion
- Sternal angle of Louis
- Xiphoid Process
- between xiphoid process and umbilicus
86
What are normal breath sounds?
Vesicular (all over lungs)
Bronchovesicular
Bronchial
Tracheal (on trachea)
87
Rhonchi
Abnormal breath sound (low ratting sound), heard during inspiration and exhalation
May see Rhonchi with COPD, bronchiectasis, cystic fibrosis, chronic bronchitis (secretions are hall thick so they trap air)
88
Wheeze
Abnormal breath sound you’ll hear with exhalation
- high pitched sound that occurs due to difficulty getting the air out
- due to COPD, asthma, foreign body aspiration
89
Crackles
Abnormal breath sound
- signifies there is consolidation/secretion
- will see with CHF, pulmonary edema, atelectasis, and fibrosis
90
Stridor
Abnormal breath sound
BAD
High pitched crowing sound
Stridor is due to airway obstruction/narrowing trachea or glottis (stenosis)
91
Pleural Rub
Abnormal breath sound
Heard during inspiratory and expiratory phases
Due to pleural inflammation
Heard in lower lateral chest areas
92
Mediate Percussion
Dull or thud like sound= consolidation or tumors or some blockage
Tympanic sound = hyperinflated lung
93
What is fremitus AKA tactile fremitus?
Vibrations produced by the voice or by the presence of secretions in the airways
Normal: vibrations felt through the entire chest wall
Increased: consolidation due to excessive secretions and infection such as Pneumonia
Decreased: more air in the area (obstructive) COPD, pneumothorax, pleural thickening
94
Signs of Pneumonia
- increased fremitus
- SOB (dyspnea)
- productive cough
- crackles
95
What do increased voice sounds mean?
Consolidation
96
What do decreased voice sounds mean?
Atelectasis
97
Egophony
Tell the pt to say “E”
Abnormal if you hear an “A” sound
98
Bronchophony
Tell the patient to say 99
Normal: muffled
Abnormal: clearly hear 99 indicating fluid in lungs, consolidation
BRONCHOS WON THE SUPERBOWL IN 99
99
Pectoriloquy
Whisper
Normal: can’t hear
Abnormal: can clearly hear whisper
Whisper bc the birds are PECking
100
Sputum Colors and their meanings
Clear = normal
Yellow = cold
Green = bacterial infection
Pink Frothy = pulmonary edema due to CHF
Red = bleeding
Brown = blood or dirt
Black = fungal infection, smoking
* can be described as fetid (bad smell), frothy (pulmonary edema) or mucous (thick white and clear)
101
Where can one auscultate the Apical pulse?
5th intercostal space in midclavicular line
- where the contraction of the left ventricle is most pronounced
102
What is the best position for a patient in high-risk pregnancy in their second trimester and WHY?
Left sidelying
Because it is OPTIMAL for reducing pressure on the inferior vena cava and maximizing cardiac output which enhances maternal and fetal circulation
103
What will you see in a Type 1 Mobitz/Wenckebach heart block?
A gradual increase in the PR interval length in the preceding beats and then an eventual dropped beat
104
What will you see in a 1st degree heart block?
an increase in PR interval with no dropped beats
occurs when the conduction time through the AV node is prolonged
105
What will you see in a 3rd degree heart block?
No relationship between P waves and QRS complexes
106
What will you see in a Second Degree Heart block Mobitz II?
normal PR intervals in all the beats preceding a dropped beat
107
The Ankle Brachial Index (Arm SBP/ ARM SBP)
>1.2 = falsely elevated, or arterial disease or diabetes
1.19-0.95 - normal
0.95-0.75 = mild arterial disease and intermittent claudication
0.74-0.50 = moderate arterial disease and pain at rest
<0.50 = SEVERE ARTERIAL DISEASE
108
What is a good intervention for patients with supraventricular tachycardia?
carotid massage and valsava maneuver
(sends signals to baroreceptors to start a parasympathetic response
109
Normal Prothrombin Time
11-15s
110
Normal INR
0.9-1.1
Higher INR --> blood clot
Lower INR --> bleeding risk
111
Normal Platelet
150,000 to 400,000
112
Platelets <50,000
No resistance
light aerobic only
113
Platelet 20,000 to 35,000
ADLs only
114
Platelet <20,000
no exercise
115
Hypercapnea
Increased CO2
116
What is normal venous filing time?
15 s
Less = venous insufficiency
more = arterial disease
117
Best Medication for Cystic Fibrosis Exacerbation characterized by increased cough, purulent sputum, and respiratory distress?
Antibiotics
- pts with cystic fibrosis are prone to bacterial growth in airways
Additional meds may include mucolytic medications or cystic fibrosis transmembrance conductance regulator modulaters
118
Best Medication for Cystic Fibrosis Exacerbation characterized by increased cough, purulent sputum, and respiratory distress?
Antibiotics
- pts with cystic fibrosis are prone to bacterial growth in airways
Additional meds may include mucolytic medications or cystic fibrosis transmembrance conductance regulator modulators
119
Why might minimal finger clubbing be present in CF?
Obstruction of the small airways and subsequent air trapping results in ventilation and perfusion mismatch, which leads to hypoxemia. Hypoexemia or chronic low blood oxygen can lead to clubbing of fingers
120
What is Peak Expiratory Flow (PEF)?
Measure of maximum speed at which a person can exhale air forcefully after taking a deep breath
Measured by a peak flow meter
Decrease can indicate worsening airway obstruction
Improvement can indicate positive response to treatment
For CF: can help gauge the severity of airway obstruction and guide interventions such as bronchodilator therapy and responses to treatment
121
What will a chest-ray of a patient with pneumonia reveal?
Typically an x-ray will show radiopaque infiltrate somewhere in the lobes
122
Absolute Contraindication for Aquatic Therapy
Respiratory disorders and vital capacity <1 L
123
Cardiovascular Criteria for Terminating Exercise
- 20 mmHg or greater decrease (hypotensive response)
- Respiratory Rate > 40
- 240/110 or higher BP
- ventricular tachycardia with 3 or more PVCs
- type 2 or 3rd degree heart block
- displacement of the ST segment in ECG >1 cube
- angina, dyspnea, ECG changes, pallor or cyanosis, nausea, confusion, light headedness
124
What does an ABI >1.1 indicate?
Arterial Calcification
125
What does an ABI <1.0 indicate?
ARTERIAL OCCLUSION
126
What does an ABI of 1.0 indicate?
y'all good
127
Cheyne-Stokes Breathing Pattern
Irregular respiration with period of apnea followed by increase depth of respiration
Due to depression of cerebral hemisphere, basal ganglia, sometimes CHF
128
Biot Respirations
Irregular respiration with highly variable respiratory depth and intermittent periods of apnea
129
Postural Drainage for Right middle lobe
Supine with lower extremities raised 12 inches
130
Postural Drainage for anterior segment secretions
Supine with lower extremity raised 18 inches
131
Postural Drainage for R lateral segment
Left sidelying with legs raised 18 inches
132
Best Hand Placement to Assess upper lobe excursion
Hands placed over the anterior portion of the first four ribs with fingertips extended over the traps
133
Best Hand Placement to Assess the Diaphragm
hands placed over the costal margin so the tips of fingers almost meet at the xiphoid process (lowest point of ribs) think of the attachment
134
Normal Diastolic Pulmonary Arterial Pressure
5-15
135
Normal Range of Intracranial Pressure
0-10 adults
0-5 children
*elevated ICP is a contraindication for percussion
136
How to Assess Chest Excursion
tape circumferentially around axillae and xiphoid process
137
Breath Movement Pattern of Patient with SPC
outward motion of abdomen and inward motion of the chest
--> accessory muscles affected, diaphragm intact
138
toe Nails of patients with arterial disease
brittle and thick
139
What would you expect in terms of auscultation of a patient with emphysema?
diminished or absent breath sounds
