Cardiopulmonary Flashcards
1
Q
Stenosis or fusion of valve leaflets = valves fail to open complete, impedes ____ ____
A
forward flow
2
Q
Regurgitations = valves fail to close in systole = ______ blood flow
A
reverse
3
Q
Dilated cardiomyopathy = increased mass of the heart, difficulty pumping (can fill but can’t _____) = blood backs up in _______ circulation
A
contract; pulmonary
4
Q
Dilated cardiomyopathy = stagnant blood increases risk of _______
A
clotting
5
Q
3 risk factors for dilated cardiomyopathy?
A
- pregnancy (third trimester)
- chronic alcohol use
- chemo drugs
6
Q
______ _______ = increased mass of the heart with thickening of the ventricular wall
A
hypertrophic cardiomyopathy
7
Q
Hypertrophic cardiomyopathy = abnormalities in _______ due to stiff tissues
A
filling
8
Q
Hypertrophic cardiomyopathy = generically determined (T/F)
A
TRUE
9
Q
Pt’s with hypertrophic cardiomyopathy are usually symptomatic (T/F)
A
FALSE - many asymptomatic
10
Q
3 S/S of hypertrophic cardiomyopathy ?
A
- angina
- dyspnea
- sudden death (think young athletes)
11
Q
________ ______ = compression of heart due to blood or fluid accumulation in pericardial sac
A
cardiac tamponade
12
Q
4 S/S of cardiac tamponade ?
A
- small decrease in systolic BP on inspiration
- low Q (hypotension, shock, death)
- jugular vein distention
- muffled heart sounds
13
Q
Decrease in systolic BP on inspiration = _____ ______
A
pulse paradoxus
14
Q
_________ = stiffening of the arteries, thickening, decreased elasticity
A
arteriosclerosis
15
Q
_________ = artery wall thickens due to accumulation of atheromas (WBC + cholesterol + triglycerides_ in LUMEN
A
atherosclerosis
16
Q
Pt’s with atherosclerosis are at risk for what 3 things?
A
- heart attack
- stroke
- aortic aneurism
17
Q
______ ______ = calcification due to age or lipid accumulation
A
aortic stenosis
18
Q
4 side effects of aortic stenosis ?
A
- heart murmur
- hypertrophy
- angina
- syncope
19
Q
_________ = localized abnormal dilation of the wall of a blood vessel which may rupture
A
aneurism
20
Q
Most common site for an aneurism?
A
abdominal aortic aneurism
21
Q
Results of AAA = aortic ______, tear in inner wall of aorta
A
dissection
22
Q
S/S of AAA?
A
chest or abdominal pain
23
Q
_______ _____ = multiple rib # result in free floating rib section which moves independently
A
flail chest
24
Q
Flail chest is often accompanied by ______ _____, (bruising of lung sections)
A
pulmonary contusion
25
Pulmonary contusion is usually main cause of respiratory failure (T/F)
TRUE
26
Explain inspiration and expiration process in flail chest
1) inspiration = flail segment sucks IN, lung, heart and mediastinum shift AWAY, reducing air entry into unaffected side
2) expiration = flail segment pushes OUT; lung , heart and mediastinum are pushed TOWARD flail segment
27
Pneumothorax = collapse of lung due to air in ____ _____
pleural space
28
2 causes of pneumothorax?
1. puncture of chest wall
| 2. lung spontaneously bursts
29
Rx for pneumothorax?
chest tube to release pressure
30
4 types of pneumothorax ?
1. open
2. tension
3. spontaneous
4. hemothorax
31
______ pneumothorax = stab wound + air in pleural space e
open
32
______ pneumothorax = critical emergency, flap opens on inspiration but seals on expiration = air trapped in pleural space + increased pressure on heart
Tension
33
_______ = sudden rupture of air containing space of lungs with no known cause
spontaneous
34
_____ = collapse of lung due to blood in pleural space
hemothorax
35
Terrible triad?
1. ischemia
2. injury
3. infarction
36
________ = inverted T ways, poor blood supply and hypoxia
ischemia
37
Ischemia occurs within ______ of onset
seconds
38
Ischemia is reversible (T/F)
TRUE
39
_____ = elevated ST segment OR depressed ST segment
injury
40
______ ST segment = myocardial tissue injured during MI, occurs in 20-40 mins
elevated
41
______ ST segment = injury to myocardial tissue, can occur during angina
depressed
42
Is elevated ST Segment reversible
| ?
YES
43
_______ = abnormal Q waves and QRS complexes
infarction
44
Infarction = can also have increased __ waves
R
45
______ = NOT reversible, occurs 2 hours after onset
infarction
46
Bradycardia = < __ bpm
60
47
Tachycardia = > ____ bpm
100
48
Ventricular fibrillation = not compatible w/ life - requires ________
defibrillation
49
___ degree AV block = caused by prolonged conduction in AV node
1st
50
1st degree AV block = PR interval > ___ s
.2
51
1st degree AV block =
| __ wave normal in shape
P
52
2nd degree AV block 2 types ?
1. MOBITZ type 1 (Wenckebach)
| 2. MOBITZ type 2
53
Mobitz type 1 = block occurs at ___ ____ and is transient; ___ lengthens until totally blocked
AV node; PR
54
Mobitz type 1 = NO _____ following a P causing a missed beat
QRS
55
Mobitz type 2 = block occurs at _____ ______; abrupt drop of QRS but ___ interval normal
bundle branches (bundle of His); PR
56
___ degree AV block = block at AV node, bundle of His OR bundle branches
3rd
57
3rd degree AV block = complete dissociated between _____ and ______
atria; ventricles
58
___ degree AV block = independent ventricular rate
3rd
59
With 3rd degree AV block, is ventricular or atrial rate faster?
atrial
60
If 3rd degree AV block is in bundle branches, _____ is longer
QRS
61
______ = heart unable to pump blood at rate required by tissues of the body OR able to but at elevated filling pressures
CHF
62
2 types of CHF?
1. systolic
| 2. diastolic
63
______ CHF = deterioration of contractile tissue
systolic
64
______ CHF = can't accommodate ventricular blood volume
diastolic
65
2 S/S of CHF?
1. breathlessness
| 2. abnormal retention of sodium / water
66
Result of ____ = edema w/ congestion of lungs OR peripheral circulation (or both)
CHF
67
_______ sided heart failure (CHF) = damming of blood in pulmonary circulation
left
68
4 major causes of left sided heart failure ?
1. ischemic heart disease
2. HTN
3. aortic and mitral valve disease
4. myocardial disease
69
5 S/S of left sided heart failure?
1. SOB when lying
2. nocturnal gasp of breath when sleeping
3. decreased kidney and brain perfusion
4. exertional dyspnea
5. pulmonary congestion
70
Right sided heart failure = also called _____ _____
cor pulmonale
71
2 major causes of right sided heart failure?
1. left sided heart failure
| 2. chronic severe pulmonary hypertension
72
Result of right sided heart failure = damming of blood in ______ and partial _____ systems
systemic; venous
73
5 S/S of right sided heart failure?
1. decreased flow in periphery
2. pitting edema
3. congestion of the portal system (liver damage and enlarged spleen)
4. kidney and brain issues
5. fatigue
74
Right sided heart failure: long term increase in BP in lung arteries and R ventricle could be due to what 2 things (not including left sided heart failure)?
1. chronic severe pulmonary HTN (emphysema, COPD)
| 2. cystic fibrosis
75
3 S/S of ischemic heart disease?
1. angina
2. MI
3. sudden cardiac death (90% due to atherosclerosis)
76
Angina pectoris = _______, recurrent episodes of chest discomfort
paroxysmal
77
Cause of angina pectoris ?
transient ischemia of heart muscle due to obstruction and/or spasm of coronary arteries
78
3 types of angina ?
1. stable
2. unstable
3. prinzmetal
79
_____ ______ = blood not flowing properly to part of heart muscle, injury due to lack of O2
myocardial infarct
80
4 risk factors for myocardial infarct?
1. previous CV disease
2. old age
3. smoking
4. high levels of certain lipids
81
Cause of MI = ________ artery to heart develops blockage due to unstable ________ (WBC's, cholesterol, triglycerides)
coronary; ahteromas
82
3 S/S of MI?
1. sudden chest pain
2. L UE/neck pain
3. may have SOB, sweating, nausea, vomiting, abnormal heartbeats, anxiety
83
Do males or females have more symptoms of MI?
Males
84
Blood test for MI tests for what 2 things ?
1. troponin
| 2. creatine kinase
85
What type of MI requires more aggressive treatment?
STEMI (ST elevation MI)
86
Types of lung cancer?
1. small cell
| 2. non small cell
87
Small cell lung cancer makes up __ - __ % of lung cancers; develops in _______ cell mucosa; spreads rapidly and metastasizes early
20-25; bronchial
88
3 types of non small cell lung cancer?
1. squamous cell
2. adenocarcinoma
3. large cell
89
________ cell (non small cell lung cancer) = spread slow, arise in central portion near hilum, metastasizes late
squamous
90
_________ (non small cell lung cancer) = slow to moderate spread, early mets throughout lungs, brain and organs
adenocarcinoma
91
_____ ____ (non small cell lung cancer) = rapid spread, wide spread mets, kidney, liver, adrenals, poor prognosis :(
large cell
92
#2 cause of death for brain conditions ?
Tumours
93
Brain tumours = ___% chance of survival
50
94
____-_____ brain tumours area significant cause of death in kids
infra-tentorial
95
3 types of brain tumours?
1. intracerebral primary
2. intracerebral metastatic
3. other (medulloblastomas and nkuronomas)
96
_____ _____ brain tumour = tumour neurons don't proliferate (other glial cells around proliferate)
intracerebral primary
97
______ ______ come from lung, breast and prostate; compensate by decreasing brain tissue, volume, CSF volume + blood flow volume
intracerebral metastatic
98
_______ (brain tumours) frequently metastasize to other areas in brain and spine
medulloblastomas
99
_______ = such as schwannoma on CNVIII
neuroma
100
2 S/S of brain tumours ?
1. nerve root pain (worse at night, pain with cough, radicular pain)
2. headache and seizure, nausea, vomiting, cognition and behaviour change
101
_______ = inflammation of parenchyma of lungs with development of intra-alveolar exudate
pneumonia
102
3 causes of pneumonia?
1. bacterial, viral, fungal
2. inhalation of toxic chemicals
3. aspiration
103
2 types of pneumonia?
1. typical
| 2. atypical (walking pneumonia)
104
4 S/S of pneumonia?
1. most preceded by upper respiratory tract infection (followed by sudden and sharp chest pain)
2. productive cough w/ green sputum
3. tachypnea
4. SOB
105
PT Rx for pneumonia includes airway clearance techniques and positioning (T/F)
TRUE
106
2 types of atelectasis?
1. primary
| 2. post op
107
______ = collapse of normal expanded and aerated lung tissue, may involve all or part of lung
atelectasis
108
3 mechanisms of atelectasis?
1. blockage of bronchus / bronchiole
2. compression
3. post - anesthetic
109
4 S/S of atelectasis?
1. quiet breath sounds
2. dyspnea
3. tachypnea
4. cyanosis
110
Chest X ray findings of atelectasis = shifting of lung structures ______ collapse; if entire lobe, may show ______
toward; shadow
111
3 Rx for atelectasis?
1. identifying underlying cause
2. suctioning if due to secretions
3. chest tube if due to pneumo/hemo thorax or extensive pleural effusion
112
_______ = acute resp failure w/ severe hypoxemia, result of pulmonary or systemic problem
ARDS
113
ARDS = lung injury characterized by increased permeability of ______ ____ membrane, leading to leakage of fluid and blood into lung ______ and _______
alveolar capillary; interstitial; alveoli
114
4 causes of ARDS?
1. severe trauma
2. aspiration
3. embolism
4. indirect --> secondary to viral infection or pneumonia
115
ARDS = ________ reaction w/ alveolar edema + collapse
inflammatory
116
Key feature of CXR in ARDS?
white out
117
3 Rx for ARDS?
1. PEEP
2. Rx underlying cause
3. proning
118
______ = viral respiratory illness, caused by SARS coronavirus
SARS
119
S/S of SARS?
flu like --> fever, myalgia, cough, sore throat, lethargy
120
Lung ______ = infection leading to necrosis of lung tissue and cavity formation with necrotic debris
abcess
121
______ = occurs in infants whose lungs have not fully developed due to lack of SURFACTANT
IRDS
122
5 S/S of IRDS?
1. pre maturity
2. c section
3. multiple pregnancies
4. blue baby
5. stops breathing, grunts
123
______ resp failure = gas exchange failure, arterial _______, decrease in blood oxygen but NO increase in CO2
hypoxemic
124
4 causes of hypoxemic resp failure?
1. pneumonia
2. ARDS
3. obstructive lung disease
4. pulmonary embolism
125
_________ resp failure = ++ CO2 in blood, decrease in blood O2
hypercapnic
126
4 causes of hypercapnic resp failure ?
1. decrease in ventilation
2. acute upper / lower airway obstruction
3. weak / impaired resp muscles
4. SCI
127
_______ = chronic inflammation of lungs, variable expiratory air flow limitation + hyper responsiveness
asthma
128
Wheezing, chest tightness, coughing, breathlessness (all reversible) are all S/S of what?
asthma
129
2 categories of asthma ?
1. extrinsic
| 2. intrinsic
130
________ asthma = allergic or atopic (most common), kids > adults
extrinsic
131
Extrinsic asthma = _____ cells release mediators which cause bronchospasm and hyper secretion
mast
132
_______ asthma = non allergic, hypersensitivity to environmental triggers, late onset (adults > kids)
intrinsic
133
During asthma attack:
1) gas exchange normal (T/F)
2) hypo inflated (T/F)
3) elastic recoil reduced (T/F)
4) exercise capacity reduced (T/F)
5) possible due to allergic exposure (T/F)
1) T
2) F *HYPERinflated
3) F (NORMAL)
4) T
5) T
134
3 Rx for asthma ?
1. self management and education (avoid triggers, inhaler technique)
2. pharmacological (corticosteroids)
3. if exercise induced --> upright, lean forward and PLB
135
Exercised induced asthma = ____ mm constriction
smooth
136
5 characteristics of COPD?
1. progressive airway obstruction that is NOT fully reversible
2. gas exchange is normal
3. always hyperinflated
4. decreased elastic recoil
5. middle aged to older adults
137
2 Rx for COPD?
1. pharma management (smooth mm relaxation and reduce airway inflammation)
2. O2 therapy
138
O2 therapy for COPD patients: NOT for pts with what two conditions ?
1. pulmonary HTN
| 2. CHF
139
________ = excessive mucus production
bronchitis
140
_______ = results in destruction of air spaces distal to there terminal bronchiole and destruction of alveolar septa
emphysema
141
Emphysema causes merging of ______ into larger air spaces, leading to _____ SA for gas exchange
alveoli; decreased
142
Emphysema results in old air becoming ______ , leading to ______ space available for O2 rich air
trapped; decreased
143
Pts with emphysema will be hyperinflated, leading to a ________ diaphragm and therefore a mechanical disadvantage
flattened
144
Can slow progression emphysema but cannot reverse damage (T/F)
TRUE
145
________ - irreversible destruction + dilation of airways w/ chronic bacterial infection
bronchiectasis
146
3 things that can cause bronchiectasis ?
1. CF
2. TB
3. endobronchial tumours
147
2 characteristics of bronchiectasis?
1. excess mucus leading to SOB
| 2. eventually alveoli replaced w/ scar tissue due to chronic inflammation
148
PT rx for bronchiectasis?
secretion clearance!
149
_______ lung disease = progressive scaring leading to stiffness and decreased lung compliance (not airway obstruction)
interstitial
150
4S/S of interstitial lung disease?
1. dyspnea
2. severe O2 desaturation
3. clubbing of fingers and toes
4. decreased exercise tolerance
151
4 Rx for ILD?
1. O2 therapy
2. lung transplant
3. pulmonary rehab
4. cessation of exposure
152
Pulmonary fibrosis: ___ no known cause, __ TB
2/3; 1/3
153
Cause of pulmonary fibrosis and 2 Rx?
Cause = inhaling harmful particles
Rx:
1) radiation therapy
2) meds
154
______ = coal workers lung
pneumoconiosis
155
___ = infection, inflammatory systemic disease that affects lungs (caused by airborne particles)
TB
156
TB may desseminate to involve kidneys, growth plates, meninges, avascular necrosis of hip joints lymph nodes and other organs (T/F)
TRUE
157
5 S/S of TB?
1. productive cough 3+ weeks
2. weight loss
3. fever
4. night sweats
5. fatigue
158
TB will have ______ breath sounds
bronchial
159
TB results in _______ in lung tissue
granulomas
160
_____ ______ = abnormal accumulation of fluid in the pleural space
pleural effusion
161
Pleural effusion leads to decrease lung ______
expansion
162
2 causes of pleural effusion?
1. transudate
| 2. exudate
163
_______ = commonly due to heart or renal failure, low protein and clear
transudate
164
______ = formation of fluid by inflammation or disease (infection or cancer of pleura); opaque
exudate
165
Pleural effusion = ____ percussion notes, decreased or absent breath sounds and you may hear pleural ___
dull; rub
166
Pleural effusion: CXR may show ________ shift
mediastinal
167
Pulmonary edema = increased fluid in ________ spaces of lungs
extravascular
168
2 possible causes of pulmonary edema?
1. increased hydrostatic pressure due to heart or kidney failure
2. increased alveolar permeability
169
3 presentations in pulmonary edema?
1. stiff lungs
2. dyspnea
3. classic symptom = cough that produces a frothy pink tinged sputum
170
Pulmonary edema ausculation findings?
fine crackles
171
5 s/s of pulmonary embolism?
1. bloody sputum
2. dyspnea
3. inc RR
4. SOB
5. cyanotic
172
_______ ______ = inherited autosomal disorder affecting ALL EXOCRINE glands
CF
173
5 effects of CF?
1. defective Cl- = excretion and Na+ absorption, = thick mucus
2. recurrent chest infections
3. consolidation
4. atelectasis
5. thickened bronchial walls
174
Sweat test for CF = looking at amount of _______ in sweat
chloride
175
3 Rx for CF?
1. airway clearance techniques
2. bronchodilators
3. aggressive antibiotics
176
______ _______ _____ = account for 95 % of arterial occlusive disease
peripheral arterial disease
177
Underlying cause of PAD?
atherosclerosis
178
S/S of PAD occur _____ to the site of narrowing or occlusion
distal
179
4 S/S of PAD?
1. intermittent claudication
2. acute ischemia
3. ulceration and gangrene
4. skin = shiny, thin and hairless
180
PAD = leading cause of limb loss in adults (T/F)
TRUE
181
PAD and peripheral vascular disease = same thing (T/F)
TRUE
182
3 common arteries effected by PVD?
1. iliac
2. femoral
3. popliteal
183
PVD = feel pain during physical activity, most often in the _____
calf
184
________ = partial or complete occlusion of a vein by a thrombus w/ secondary inflammation
thrombophlebitis
185
Thrombophlebitis can be superficial or deep (T/F)
TRUE
186
2 S/S of DVT?
1. tender calf
| 2. fever
187
Biggest risk of DVT?
may become a PE
188
Test for DVT?
Homan's sign (+ test = pain_
189
3 causes of chronic venous insufficiency?
1. DVT
2. trauma
3. obstruction (such as tumour)
190
3 effects of chronic venous insufficiency?
1. damaged or destroyed valves lead to venous stasis
2. progressive edema
3. thickened brown skin (due to pooling blood) and ulcers
191
Rx for chronic venous insufficiency ?
1. compression
| 2. elevation
192
________ veins = faulty valves cause abnormal dilation of veins
varicose
193
Varicose veins = at risk for _______
thrombosis
194
VC = made up of what 4 volume?
1. IRV
2. TV
3. ERV
4. RV
195
IC = made up of what 2 volumes?
1. IRV
| 2. TV
196
FRC = made up of what 2 volumes?
1. ERV
| 2. RV
197
TLC made up of what 2 capacities ?
1. VC
| 2. FRC
198
TV = ____ mL
500
199
IRV = __ - __ L; max volume that can be inspired on top of TV, used during exercise / exertion
2-3
200
ERV= __ L; max volume that can be expired after the expiration of tV
1
201
RV = __ L; volume that remains in lungs after max expiration
1
202
RV can be measured by spirometry (T/F)
TRUE
203
IC = volume of max inspiration (___ - ___ L)
2.5 - 4
204
FRC = __ L, volume of gas remaining after normal expiration
2
205
____ / ___ cannot be measured by spirometry bc they includes residual volume
FRC/ TLC
206
VC = ___ - __ L, volume of max inspiration and expiration
3-4.5
207
TLC = __ - __ L
4-6
208
Dead space = ___ mL in norma lungs
300
209
_____ _____ = volume of resp apparatus that does not participate in gas exchange
dead space
210
______ dead space (150mL) = volume of the conducting airways (ie nose, trachea, etc)
anatomic
211
______ dead space (150mL) = volume of the lung that dos not participate in gas exchange
physiologic
212
_______ dead space = volume of the lung that does not participate in gas exchange
physiologic
213
_____ = volume of air that can be expired in 1 sec after max inspiration
FEV1
214
Normal FEV1 = ___% of the forced vital capacity (expressed as FEV1/FVC)
80
215
___________ lung disease = decreased FEV1 and FVC
restrictive
216
Restrictive lung disease = FEV1/FVC ratio ?
> or equal to .8
217
______ lung disease = ++ decreased FEV1
obstructive
218
Obstructive lung disease = FEV1/FVC ratio ?
< .8
219
Stage___ resp condition = ___ _____; risk factors and chronic symptoms but normal spirometry
0; at risk
220
Stage __ resp condition: ____; FEV1/FVC ratio < 70%; FEV1 at least 80% of predicted value; may have symptoms
1; mild
221
Stage __ resp condition: _____; FEV1/FVC ratio < 70%; FEV1 50% - <80% of predicted value; may have chronic symptoms
2; moderate
222
Stage __ resp condition: ___;; FEV1/FVC ratio < 70%; FEV1 30% - < 50% of predicted value; may have chronic symptoms
3; severe
223
Stage ___ resp condition: ___ ____; FEV1/FVC ratio < 70%; FEV1 < 30% of predicted value OR FEV1< 50% of predicted value + reverse chronic symptoms
4; very severe
224
Give minimum 5 S/S of cardiopulmonary disease.
Any of:
1. pain in chest, neck, jaw, arms
2. SOB at rest or mild exertion
3. dizzy or syncope
4. orthopnea or nocturnal dyspnea
5. ankle edema
6. palpitations or tachycardia
7. intermittent claudication
8. known heart murmur
9. unusual fatigue
225
_______ ______ = size of heart in relation to thorax
cardiothoracic index
226
3 goals of cardiac rehab?
1. restore optimal function
2. prevent progression of underlying processes
3. reduce risk of sudden death and re infarction
227
3 exercises to AVOID during cardiac rehab?***
1. NO VALSALVA
2. extensive upper body activity
3. isometric / static exercise
228
FIIT prescription for cardiac rehab?
F: 3-5 days per week
I: 60-80% of HRR, talk test, RPE around 4-6
T: work up to 45 - 60 minute intervals in 5-10 minute intervals
T: whole body dynamic movement
229
Cardiac rehab: do not use ____ for those on beta blockers of pacemakers
HRR
230
Cardiac rehab: for pacemakers stay __ BPM below level that it starts OR at __ - __ BPM below onset of abnormal symptoms / angina
30 ; 10-15
231
How to calculate HRR?
(HRmax - resting HR) x intensity % + resting HR
232
Cardiac rehab should include a ____ _____ and _____ _____ (5- 10 mins)
warm up ; cool down
233
Meds: _____ ______ decrease pulse, myocardial contraction force, myocardial O2, conduction velocity between SA and AV node
beta blockers
234
4 uses for beta blockers?
1. CAD
2. angina pectoris
3. HTN
4. irregular heath rhythms
235
Meds: considerations for pt using _____ ______ = blunted response to HR and BP, decrease resting and exercise BP, postural hypotension, dosed time related, decreased ischemia w/ exercise, increase exercise capacity in people w/ angina
beta blockers
236
Pt's w/ beta blockers: use _____ rather than age predicted HR range
RPE
237
Pt's w/ beta blockers: ensure gradual ____ ____ and ____ ____
warm up; cool down
238
Meds: _____ and _______ relaxes smooth muscle in blood vessels, increases blood flow and decreases workload and O2 supply of heart muscles
nitrate ; nitroglycerin
239
3 uses of nitrate / nitroglycerin?
1. angina
2. CHF
3. acute MI
240
Considerations for pts on ______ / _______ = increased resting HR and possible exercise HR; decreased resting BP and possible exercising BP; may cause postural hypotension w/ postural changes, increased exercise capacity w/ angina pts
nitrate; nitroglycerin
241
For pt's on nitrate and nitroglycerin ensure adequate ______ ____ and ______ _____
warm up; cool down
242
Pt's on nitroglycerin: nitro doses __ - __ mins apart
3-5
243
Key to touch on for those using nitro?
1. strorage
2. expiration date
3. cool dry space
4. prime before taking first dose: sit down, wait 5 mins x3 then sit down or return at a lower rate
244
ACE inhibitors = also known as ______ _______ ______
angiotensin converting enzyme
245
______ _______ = block conversion of angiotensin I to II, prevents vasoconstriction, decreases peripheral resistance, increases urine output
ACE inhibitors
246
5 populations that ACE inhibitors may be used by
| ?
1. CHF
2. HTN
3. CVD
4. MI
5. kidney function in diabetics
247
Considerations for pts using ____ _______ = increased exercise tolerance in clients with CHF, decreased resting and exercising BP, gradual warm ups and cool downs
ACE inhibitors
248
_______ ________ = decreased mortality in heart disease patients even if cholesterol is normal, decrease cholesterol levels (esp ___) and triglycerides
anticholesterol agents; LDLs
249
Anticholesterol agents can include which 2 types?
1. niacin
| 2. statins
250
2 considerations for pts on niacin?
1. postural hypotension
| 2. need gradual warm up and cool down
251
2 considerations for pts on statins?
1. muscle aches
| 2. joint stiffness
252
_______ ______ = decreased platelet aggregation at site of tissue damage
anti-platelet agents
253
3 uses of antiplatelet agents?
1. reduces risk of MI
2. TIA
3. brain attacks / ischemic strokes
254
Pts on anitplatelet agents = no CI's to exercise or effect on pulse / BP (T/F)
TRUE
255
3 parts of Hx to touch on w/ pt who has cardiopulmonary disease?
1. risk factors
2. acuity and progression
3. PMHx
256
6 symptoms typical of cardiopulmonary disease ?
1. dyspnea
2. cough
3. wheeze
4. cyanosis
5. finger and toe clubbing
6. decreased O2 saturation
257
Dyspnea can be measured using what scale ?
Borg scale of perceived breathlessness
258
______ can be inspiratory, expiratory, low pitched or high pitched
wheeze
259
_______ = blue or purple colour in skin that has mucous membranes (nail beds, lips, etc)
cyanosis
260
_____ ______ = seen in conditions like COPD and CF due to chronic hypoxia
finger (and toe) clubbing
261
Below ___ % O2 sat you may need some supplementary O2
90
262
Physical exam of cardiopulmonary pts?
IPPA!
263
Name 5 possible Dx tests for pt w/ cardiopulmonary disease
any of ...
1) flow volume loop
2) simple spirometry
3) plethysmography
4) diffusing capacity
5) resp muscle strength
6) methocholine and other challenge tests
7) chest X ray
8) VQ scan
9) bronchoscopy
10) blood tests and ABGs
11) exercise testings
264
Flow volume loop: CI are any conditions prohibiting a ____ maneuver
MAX
265
What typically is the first test to be ordered for cardiopulmonary Dx?
simple spirometry
266
5 CI for simple spirometry?
1. MI in last month
2. recent stroke
3. recent abdominal / thoracic Sx
4. uncontrolled HTN
5. recent pneumothorax
267
What are 5 indications to use simple spirometry?
1. Dx lung disease
2. quantify extent of known disease
3. measure effect of occupational / environmental exposure
4. Ax for risk of resp complications during Sx
5. evaluate disability or impairment
268
Simple spirometry: ______ lung disease = increased lung volumes, decreased FVC, ++ decreased FEV1, decreased ratio
obstructive
269
Simple spirometry: _______ lung disease = decreased lung volumes, decreased FVC, decreased FEV1, ratio is normal or even increased
restrictive
270
Diffusing capacity provides Dx of ______
emphysema
271
VQ scan is used for ______ disorders (pulmonary embolism)
diffusion
272
Trachea starts at ________ cartilage to ___ SP posteriorly
cricoid; T4
273
___ bronchus is more steeply angled (vertical) and gets more things caught in it bc of path or least resistance
R
274
Carina of trachea is at which level?
sternal angle (rib 2)
275
Diaphragm is at the level of the ___ thoracic vertebrae, moves __ - __ cm in quiet breathing
8; 1-2
276
What muscles are active during quiet inspiration ?
1. diaphragm
| 2. external intercostals
277
What muscles are active during forced inspiration?
1. SCM
2. scalene
3. pec minor
278
What muscles are active during quiet expiration?
passive recoil of lung tissues - no muscles!
279
What muscles are active during forced expiration ?
internal intercostals and abs
280
Inspection: looking at ____ / monitors and ______ of the patients
lines; position
281
Name things youre looking for during inspection part of IPPA
1. facial expression
2. Ox3
3. speech
4. skin (colour, temp, sweat)
5. lip colour
6. nose flaring
7. neck (accessory mm use, JVD)
8. chest (muscles and shape)
9. breathing pattern
10. limbs (colour, edema, CLUBBING)
11. cough
12. sputum
282
4 things to palpate for in IPPA?
1. chest wall expansion (upper, middle and lower lobe x2 front and back)
2. tactile fremitus (using ulnar border of hands, same locations as above)
3. tracheal position
4. rates (HR, BP, RR)
283
HR: count pulse for __ s; RR: count breaths for ___ s
15; 30-60
284
________ = middle finger over intercostal space w/ non-dominant hand, ax right vs left anterior to posterior upper, middle, and lower lobes
percussion
285
3 sounds percussion notes can be?
1. resonant (normal)
2. dull (consolidation, pleural fluid)
3. hyper - resonant = air
286
Diaphragm of stethoscope picks up ____ pitch better, the bell picks up __ pitch better
high; low
287
Auscultation: gold standard lobe points = __ in front, ___ in back
11; 14
288
Normal breath sounds?
1. vesicular
| 2. bronchial
289
_____ breath sound = hollow, short pause between inspiration and expiration, normal over trachea
bronchial
290
Abnormal breath sounds ?
1. bronchial
| 2. decreased or absent
291
What conditions might have bronchial breath sounds (2)?
1. consolidated pneumonia
| 2. lobar collapse
292
Decreased or absent breath sounds might be heard due to what conditions (7)?
1. pleural effusion
2. hemothorax
3. pneumothorax
4. emphysema
5. contused lung
6. obese
7. elderly
293
4 adventitious breath sounds?
1. crackles (rales)
2. wheezes (rhonchi)
3. stridor
4. pleural rub
294
______ = inspiratory vs expiratory, early could mean airway obstruction, late could mean edema, fibrosis, partial consolidation
crackles (rales)
295
______ = inspiratory vs expiratory, high = uniformly narrowed, low pitch = intermittently narrowed
wheezes (rhonchi)
296
_____ = loud musical constant pitch w/ laryngeal or tracheal obstruction
stridor
297
______ _____ = creaky, leathery sound due to pleural irritation
pleural rub
298
11 step process for CXR?
1. PA or AP?
2. over or underexposed?
3. satisfactory inspiration?
4. patient rotated?
5. heart enlarged?
6. silhouette signs (both domes of diaphragm clearly seen?)
7. position of the mediastinum?
8. landmarks of the mediastinum?
9. hila and fissures normal?
10. bones normal?
11. clinical reasoning
299
Overexposed chest X ray will be completely _____
black
300
Satisfactory inspiration on CXR = __ ribs post or __ ribs anterior above dome of the left diaphragm
9;6
301
A/B ratio ( A = width of heart, B = width of inside lung cavity) should not be over ___ %
50
302
What 3 landmarks should you see if there are no silhouette signs?
1. costophrenic angles
2. costocardiac angles
3. right dome
303
Mediastinum will shift away from _____ volume and towards _____ volume
increased; decreased
304
Position of mediastinum = __:__ from R - L
2:1
305
What to look for in terms of landmarks of mediastinum?
1. pulmonary artery
| 2. cobweb appearance of blood vessels
306
Want hila to be the same heigh or within __ - __ levels of each other close to _____ bifurcation; fissures only seen in about __% of CXR
1-2; bronchi
307
_________ = will usually result in shifting of the landmarks, silhouette signs, lobar collapse can be white b/c there is no air in it, full of secretions
atelectasis
308
______ or ____ ______ = lung fields will be opaque, usually will have signs of atelectasis w/ consolidation as well, pleural effusion may have blunting of the costophrenic angle and sometimes mediastinal shift to opposite side
consolidation ; pleural effusion
309
_______ = dark area because of air, absence of lung markings, fine line showing outline of the collapsed lung
pneumothorax
310
_______ _______ = enlarged peripheral vessels, opacities and fluffy shadows
pulmonary edema
311
______ = flattened diaphragm, pear shaped heart, enlarged chest cavity
COPD
312
Lateral CXR ALWAYS to be interpreted w/ a frontal CXR (T/F)
TRUE
313
4 questions to ask when looking at lateral CXR?
1. are the vertebral bodies getting backer from superior to inferior ?
2. are the dorms of the diaphragm well defined ?
3. are the hila normal?
4. change in density across the cardiac shadow?
confirm w/ frontal CXR
314
____ = only measures free unbound O2 molecules, is the driving force for Hb saturation w/ O2
PO2
315
PO2 is determined by what 3 things ?
1. alveolar ventilation
2. V/Q
3. FiO2
316
____ = measure of partial pressure and pH of O2 and CO2 in blood
ABGs
317
PCO2 is controlled by _______
ventilation
318
pH normal range?
7.35 - 7.45
319
PaCO2 normal range?
35-45
320
HCO3 normal range?
22-28
321
PaO2 normal range?
80-100mmHg
322
SaO2 normal range?
95-100%
323
Metabolic and resp acidosis =the pH is _____ than normal
lower
324
Metabolis and resp alkalosis = pH is _____ than normal
higher
325
Resp acidosis = pH _____, PaCO2 _____, HCO3 _____
dec; inc; normal
326
Resp alkalosis = pH ____, PaCO2 ___, HCO3 ____
inc; dec; normal
327
Metabolic acidosis = pH ___, PaCO2 ____, HCO3 ____
dec; normal; dec
328
Metabolic alkalosis = pH ____, PaCO2 ____, HCO3 ____
inc; normal; inc
329
6 rules when looking at ABGs?
1. look at pH first to determine whether it is alkalosis or acidosis
2. remember clinical context (resp or metabolic?)
3. resp compensation can take minutes to hours
4. renal compensation can take 1-5 days to occur
5. compensation can be partial or total
6. for alveolar hypoventilation the PO2 should only decrease 1mmHg for every 1mmHg increase in PaCO2
330
_____ line constantly monitors arterial BP
ART
331
4 arteries ART line may be inserted into?
1. radial
2. axillary
3. femoral
4. pedal
332
3 precautions w/ ART line?
1. infusion bag MUST be kept above insertion line
2. notify RN if transducer disconnected
3. ROM restrictions
333
No hip flexion past __ degrees w/ femoral ART line!
90
334
____ line = to deliver chemo or antibiotics
PICC
335
______ line inserted into large vein of the arm near bend of elbow and pushed until tip sits above heart
PICC
336
Precautions w/ PICC line?
do not mobilize until proper insertion confirmed w/ Xray
337
Sternotomy precautions for lifting?
limitations in lifting ; no lifting 10lbs above waist no pushing STS, and no pull/push over 5 lbs)
338
______ ______ _____ = self administered meds, will preset how much they can get
patient controlled analgesic
339
Patient controlled analgesic: looks for ____ drop, RR less than ___ and altered mental status
BP; 10
340
_______ line = be careful w/ movements of trunk, hips, LE: can be very uncomfortable
epidural
341
2 precautions for epidurals?
1. ALWAYS check orders
| 2. if dislodged get help immediately
342
_____ ______ = feed is kept above site of insertion, need feeds turned off prior to start of therapy
NG tube
343
Big precaution w/ NG tube?
HOB NOT FLAT; feed will flow back; keep at LEAST 30 deg incline
344
Chest tube: keep ____ site of insertion to prevent backflow
below
345
Urinary catheter (foley) = keep _______ site of insertion to prevent backfow
below
346
5 indications for O2 therapy?
1. SaO2 < 90%
2. PaO2v < 80 mmHg
3. to dec work of breathing
4. acute MI or decrease myocardial work
5. short term post Sx
347
Require RT for O2 greater than __ % , acute resp distress, transport w/ O2 and ______ airway
40; artificial
348
___ _____ system = supplemental O2 to tidal volume, via NP, simple mask, partial rebreathing and non-rebreathing mask
low flow
349
NP = __ L O2 max
6
350
___ _____ = enough O2 to supply the entire TV
High flow
351
3 ways high flow O2 can be provided?
1. venturi face mask
2. face tent
3. tracheostomy mask
352
1L/min O2 = __% O2, goes up by __% every L increase
24; 4
353
Incentive spirometry purpose=for patients w/ ______; provides visual input / incentive goal
atelectasis
354
There is NO evidence for use of IS to prevent post op complications (T/F)
TRUE
355
Method for using incentive spirometry?
1. sustained inspiration effort ~ 3 sec
2. relaxed expiration
3. attesting to achieve max inspiration to TLC
356
CI's to incentive spirometry?
1. cognitive impairment
2. patients unable to deep breathe effectively due to pain
diaphragmatic dysfunction, or opiate analgesia
3. unable to generate adequate inspiration w/ a vital capacity < 10mL/kg or an inspiratory capacity < 33% predicted
357
Purpose of inspiratory muscle training: retrains muscles of ________ in populations needing it - name these populations (4)
inspiration;
1. COPD
2. CHF
3. endurance athletes
4. SCI
358
What do you need in order to perform inspiratory muscle training?
reliable measure of max inspiratory pressure + max expiratory pressure (pulmonary tests)
359
What would an initial Rx for inspiratory muscle training look like and following sessions (aka FITT)?
1. start w/ 5 mins
2. progress over 2-3 weeks to 2x15 minute or 1x 30 min sessions
3. 4-5 days a week
4. begin at 20-30% MIP and progress to 50% MIP as tolerated (fit individuals up to 70% as tolerated)
360
2 CI's for inspiratory muscle training?
1. acute resp failure
| 2. cognitive impairment
361
Always monitor for sings of _____ _____ distress during inspiratory muscle training
cardio-resp
362
VQ matching: ______ = normal perfusion but no ventilation (ie alveoli is collapse and the capillary is expanded)
SHUNTING
363
VQ matching: _____ _____ _____ = normal ventilation w/ poor perfusion (capillary is completely collapsed and alveoli is enlarged)
dead space unit
364
VQ matching: ____ ______ = no ventilation of perfusion (both collapsed)
silent unit
365
For atelectasis, to encourage re-expansion put the diseased long in the _________ position and do _______ breathing exercises in this position
non-dependent; unilateral
366
Normal lungs: ventilation is greatest in _______ regions
dependent
367
Normal lung: perfusion is best in _______ regions
dependent
368
Normal lungs Rx principle: _______ regions of lungs have greatest SA and therefore best VQ matching in ______ lung
lower; upright
369
Abnormal lungs: ventilation is best in ___ -_______ regions
non diseased
370
Abnormal lungs: perfusion is best in ______ _____ regions
gravity dependent
371
Abnormal lung Rx principle: generally place affected area in the ___ ________ position to increase VQ matching
non dependent (bad lung up!)
372
Mechanical ventilation: increased pressure can restrict blood flow to ___ -_____ regions
non dependent
373
Mechanical ventilation: air follows path of least resistance, usually best in ___- ________ region
non dependent
374
Give 5 reasons for breathing exercises.
any of...
1. increase ventilation
2. prevent atelectasis
3. decrease WOB and O2 consumption
4. remove secretions
5. increase chest wall mobility
6. improve relaxation
375
3 indications for diaphragmatic breathing?
1. post op patients
2. resp failure
3. chronic resp distress
376
3 reasons diaphragmatic breathing is effective?
1. increase lung expansion and compliance
2. reduce VQ mismatch
3. increase resp muscle strength
377
Prescription for diaphragmatic breathing?
10 breaths every hour
378
4 possible additions to diaphragmatic breathing ?
1. end inspiratory hold
2. single percussion
3. sniff
4. lateral costal breathing
379
PLB indications ?
for COPD pts!
380
How to perform PLB: inhale w/ lips in pucker position for __ counts, exhale for __ counts
2;4 (expiration 2x as long as inspiration)
381
Indications for segmental breathing ?
healthy individuals can direct O2 in the upper or lower lung fields upon instruction
382
_______ breathing = tactile stimulation or pressure to increase expansion of specific areas, pressure on inspiration and relax on expiration
segmental
383
Incentive spirometry / sustained max inspiration ?
same uses as diaphragmatic breathing, just as good
384
How to perform incentive spirometry / sustained max inspiration ?
sustain inspiratory effort for 3 s, then relax expiration, max inspiration to TOC, give a visual reminder and an incentive goal; can be flow or volume sensitive
385
2 indications for breath stacking ?
1. when breathing is painful
| 2. ventilatory dependent pts
386
Who to NOT give breath stacking to?
COPD PATIENTS ! BAD !
387
SOS for SOB?
1. stop and rest in comfy position
2. get head down
3. get shoulders down
4. breathe in through mouth
5. breathe out through mouth
6. breathe in and out as fast as you want
7. begin to blow out longer, but not forcibly, used PLB if you find it effective
8. begin to slow breathing
9. begin to use nose
10. begin diaphragmatic breathing
11. stay in position for 10 mins longer
388
Who to give SOS for SOB to?
COPD pt in resp distress
389
Indications to perform assisted cough technique ? (4)
ineffective cough seen in pts w/ ...
1. SCI
2. NMD
3. chemically paralyzed
4. weak resp muscles
390
CI's for assisted cough?
ruptured diaphragm!
391
Precautions for assisted cough? (5)
1. inferior vena cava filter
2. rib #
3. abdominal or thoracic Sx
4. pneumothorax
5. perforated bowel
392
Assisted cough: after coughing, ensure proper _______ clearance removal
secretion
393
Indications for huffing ?
1. for improving secretion clearance
| 2. adjunct for manual techniques
394
Huffing: __ reps of huffing, mouth is O shape so ____ remains open; follow up with ________ breathing
2; glottis; diaphragmatic
395
Best position for postural draining / positioning?
upright and mobile !
396
______ position is the optimal coughing position for pts with SCI
supine
397
Indications for postural drainage / positioning ?
to put patient in position that drains the airway in gravity directed movement
398
Time spent in postural drainage position ?
3-10 mins
399
CI's / precautions for postural drainage positions ?
1. untreated pneumothorax
2. hemoptysis
3. unstable CV status
4. increased ICP
5. esophageal anastomosis
6. aneurism
7. PE (pleural effusion / and pulmonary embolism?)
8. CHF
9. patient upset or agitated
10. recent laminectomy
400
Positioning: RUL/LUL ______ sitting upright in bed, back supported
apical
401
Positioning: LUL _____ = semi-fowler's (supine, head at 45 deg)
anterior
402
Positioning: RUL _______ = supine, hips in ER
anterior
403
Positioning: LUL ______ = semi prone (lt side elevated by pillow, HOB at 30 deg)
posterior
404
Positioning: RUL _____ = semi prone (rt side elevated by pillows), bet flat
posterior
405
Positioning: LUL _____ = Rt side lying (semi - supine, Lt side elevated by pillows) bed inverted 30 deg
lingula (middle)
406
Positioning: ____ = lt side lying (semi prone, rt side elevated by pillows) bed inverted 30 deg
RML
407
Positioning: RLL/LLL ______ = prone
superior
408
Positioning: RLL/LLL _____ = supine, bed inverted 30 deg
anterior
409
Positioning: RLL/LLL ________ = prone, bed inverted 30 deg (head not supported by pillows? only one)
posterior
410
Positioning: RLL _____ = lt sidelying, bed inverted 30 deg
lateral
411
Positioning: LLL _____ and RLL _____ = rt sidelying, bed inverted 30 deg
lateral; medial (cardiac)
412
Proning indicatons?
for pts in ARDS (last ditch effort to get VQ matching)
413
CI's for proning? (4)
1. facial trauma
2. open wound in chest or abdomen
3. unstable SC injury
4. cerebral HTN
414
Precautions for proning? (2)
1. hemodynamic instability
| 2. active intra-abdominal process
415
Proning: slide pt away from ______ side
ventilator
416
Can be prone for __ - __ hours; change position every __ hours
2-10; 2
417
Indication for percussion: to remove _______
secretions
418
Duration for percussions ?
2-5 mins
419
CI's / precautions for percussions ?
1. # ribs
2. prone to hemorrhage
3. metastatic bone cancer
4. OP
5. burns
6. subcutaneous emphysema of neck and thorax
7. poor / unstable CV condition
8. recent skin graft or flap
9. resectable tumour
10. pneumothorax
420
Indications for vibrations?
remove bronchial secretions and improve TV
421
Vibrations are done on _______
expiration
422
Duration of vibrations ?
5 mins
423
_____ ______ = chest compression following by overpressure and quick release at end of expiration, can be combined w/ percs and vibs
rib springing
424
Rib springing: thought to increase chest _______ and therefore trigger a bigger ______
expansion; inspiration
425
Indications for manual hyperinflation?
1. acute lobar collapse
| 2. sputum clearance
426
3 things needed for manual hyperinflation?
1. ambu bag
2. O2 tubing
3. pressure manometer
427
Manual hyperinflation: Cannot go over __ - __ cm H2O pressure
30-40
428
Ci's for manual hyperinflation (5)
1. acute pneumonectomy
2. undrained pneumothorax
3. proximal tumour or obstruction
4. unstable head injury
5. HFOV
429
Precautions for manual hyperinflation (5)?
1. hemoptysis
2. bullae
3. high RR or PEEP
4. severe bronchospasm
5. CVS instability
430
Indications for active cycle of breathing ?
for secretion removal; allow increased pressure behind the huge, not forceful at all
431
Have pts do active cycle of breathing ___ - __ mins a day
15-20
432
Procedure for active cycle of breathing ?
1. normal breathing 1 min
2. deep breathing 3-4 breaths
3. normal breathing 2-3 breaths
4. huff, repeat 2-3 times
If sputum not produced, go back to normal breathing and repeat, if sputum then repeat huff 2-3 times
433
Indications for autogenic drainage?
alter rate and depth of breathing to produce highest possible airflow in bronchi while maintaining stability
434
3 phases of autogenic drainage?
1. unsticking
2. collecting
3. evacuating
435
Autogenic drainage: slow _______ breathing, take slightly deeper breaths than normal, then exhale normally for __ - __ breaths at a ____ lung volume
diaphragmatic; 10-20; higher
436
PEP indications ?
to keep airways open an to get behind mucus via collateral airways
437
PEP = __ way valve mask that helps create resistance on ______
one; expiration
438
PEP procedure: inspiration __ - __ times w/ active exhalation at 1:_ or 1:_ usually followed by huffing or FET
5;10;3;4
439
Oscillating PEP = handheld device that oscillates and vibrates during ____ that will help dislodge mucus in ___ and ___ airways
inspiration; large; small
440
Oscillating PEP used most often in which pt population?
CF
441
3 possible areas to suction?
1. trach
2. nasopharyngeal
3. pharyngeal
442
3 possible suction techniques ?
1. sterile
2. modified sterile
3. clean technique
443
Suction parameters: adults = __ - ___ mmHg
120-150
444
Suction parameters: children = __ - ___ mmHg
80-120
445
Suction parameters: infants = ___ - ___ mmHg
60-80
446
4 indications for suctioning?
1. pt can't clear secretions
2. loss of airway control
3. lung pathologies
4. obtain sputum
447
CI's for suctioning?
```
worsening clinical condition for all
Nasopharyngeal:
1. basal skull #
2. nasal bleeding or bleeding disorders
3. epiglottis or croup
4. CSF leakage
5. nasal stenosis
```
448
3 scales used in pulmonary rehab?
1. dyspnea scale (0-4)
2. BORG breathlessness scale (0-10)
3. RPE (0-10)
449
Aerobic exercise prescription for pulmonary rehab?
F: 1-2x per day, 3-5 x per week
I: interval training
T: 5-10 mins, 2-5 min rest, work up to 10-40 mins continuous exercises
T: dynamic activity using large muscle groups
450
Strength exercise prescription pulmonary rehab?
F: 1,3 or 10 reps resp mm training; 8-10 reps other
I: 50-80% max
T: light weight higher reps, resp mm training and functional training
451
Pulmonary rehab: for all exercises, SpO2 should not fall below __ %, BORG should not go above __, and no abnormal changes in rhythm, HR, pain, dizziness /headaches, and monitor blood sugar
88; 5
452
Absolute CI's to exercise? (13)
1. acute MI
2. unstable angina
3. serious arrhythmias
4. acute pericarditis, myocarditis endocarditis
5. uncompensated or uncontrolled heart failure
6. severe aortic stenosis
7. severe left ventricular dysfunction
8. acute PE
9. aortic aneurysm
10. uncontrolled systemic HTN
11. uncontrolled asthma
12. acute DVT / thrombophlebitis
13. ICP > 20 mmHg
453
Relative CI's to exercise?
1. significant arterial HTN (resting DBP >110; SBP >200)
2. pulmonary HTN
3. brady/tachycardia
4. moderate valvular disease
5. uncontrolled metabolic disease (eg. DM)
6. O2 sat < 85% on room air
7. unstable asthma
8. diabetic pt w/ autonomic denervation of heart
