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Written Prep > Cardiopulmonary > Flashcards

Cardiopulmonary Flashcards

1
Q

Stenosis or fusion of valve leaflets = valves fail to open complete, impedes ____ ____

A

forward flow

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2
Q

Regurgitations = valves fail to close in systole = ______ blood flow

A

reverse

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3
Q

Dilated cardiomyopathy = increased mass of the heart, difficulty pumping (can fill but can’t _____) = blood backs up in _______ circulation

A

contract; pulmonary

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4
Q

Dilated cardiomyopathy = stagnant blood increases risk of _______

A

clotting

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5
Q

3 risk factors for dilated cardiomyopathy?

A
  1. pregnancy (third trimester)
  2. chronic alcohol use
  3. chemo drugs
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6
Q

______ _______ = increased mass of the heart with thickening of the ventricular wall

A

hypertrophic cardiomyopathy

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7
Q

Hypertrophic cardiomyopathy = abnormalities in _______ due to stiff tissues

A

filling

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8
Q

Hypertrophic cardiomyopathy = generically determined (T/F)

A

TRUE

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9
Q

Pt’s with hypertrophic cardiomyopathy are usually symptomatic (T/F)

A

FALSE - many asymptomatic

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10
Q

3 S/S of hypertrophic cardiomyopathy ?

A
  1. angina
  2. dyspnea
  3. sudden death (think young athletes)
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11
Q

________ ______ = compression of heart due to blood or fluid accumulation in pericardial sac

A

cardiac tamponade

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12
Q

4 S/S of cardiac tamponade ?

A
  1. small decrease in systolic BP on inspiration
  2. low Q (hypotension, shock, death)
  3. jugular vein distention
  4. muffled heart sounds
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13
Q

Decrease in systolic BP on inspiration = _____ ______

A

pulse paradoxus

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14
Q

_________ = stiffening of the arteries, thickening, decreased elasticity

A

arteriosclerosis

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15
Q

_________ = artery wall thickens due to accumulation of atheromas (WBC + cholesterol + triglycerides_ in LUMEN

A

atherosclerosis

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16
Q

Pt’s with atherosclerosis are at risk for what 3 things?

A
  1. heart attack
  2. stroke
  3. aortic aneurism
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17
Q

______ ______ = calcification due to age or lipid accumulation

A

aortic stenosis

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18
Q

4 side effects of aortic stenosis ?

A
  1. heart murmur
  2. hypertrophy
  3. angina
  4. syncope
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19
Q

_________ = localized abnormal dilation of the wall of a blood vessel which may rupture

A

aneurism

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20
Q

Most common site for an aneurism?

A

abdominal aortic aneurism

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21
Q

Results of AAA = aortic ______, tear in inner wall of aorta

A

dissection

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22
Q

S/S of AAA?

A

chest or abdominal pain

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23
Q

_______ _____ = multiple rib # result in free floating rib section which moves independently

A

flail chest

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24
Q

Flail chest is often accompanied by ______ _____, (bruising of lung sections)

A

pulmonary contusion

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25
Q

Pulmonary contusion is usually main cause of respiratory failure (T/F)

A

TRUE

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26
Q

Explain inspiration and expiration process in flail chest

A

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

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27
Q

Pneumothorax = collapse of lung due to air in ____ _____

A

pleural space

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28
Q

2 causes of pneumothorax?

A
  1. puncture of chest wall

2. lung spontaneously bursts

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29
Q

Rx for pneumothorax?

A

chest tube to release pressure

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30
Q

4 types of pneumothorax ?

A
  1. open
  2. tension
  3. spontaneous
  4. hemothorax
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31
Q

______ pneumothorax = stab wound + air in pleural space e

A

open

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32
Q

______ pneumothorax = critical emergency, flap opens on inspiration but seals on expiration = air trapped in pleural space + increased pressure on heart

A

Tension

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33
Q

_______ = sudden rupture of air containing space of lungs with no known cause

A

spontaneous

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34
Q

_____ = collapse of lung due to blood in pleural space

A

hemothorax

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35
Q

Terrible triad?

A
  1. ischemia
  2. injury
  3. infarction
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36
Q

________ = inverted T ways, poor blood supply and hypoxia

A

ischemia

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37
Q

Ischemia occurs within ______ of onset

A

seconds

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38
Q

Ischemia is reversible (T/F)

A

TRUE

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39
Q

_____ = elevated ST segment OR depressed ST segment

A

injury

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40
Q

______ ST segment = myocardial tissue injured during MI, occurs in 20-40 mins

A

elevated

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41
Q

______ ST segment = injury to myocardial tissue, can occur during angina

A

depressed

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42
Q

Is elevated ST Segment reversible

?

A

YES

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43
Q

_______ = abnormal Q waves and QRS complexes

A

infarction

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44
Q

Infarction = can also have increased __ waves

A

R

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45
Q

______ = NOT reversible, occurs 2 hours after onset

A

infarction

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46
Q

Bradycardia = < __ bpm

A

60

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47
Q

Tachycardia = > ____ bpm

A

100

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48
Q

Ventricular fibrillation = not compatible w/ life - requires ________

A

defibrillation

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49
Q

___ degree AV block = caused by prolonged conduction in AV node

A

1st

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50
Q

1st degree AV block = PR interval > ___ s

A

.2

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51
Q

1st degree AV block =

__ wave normal in shape

A

P

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52
Q

2nd degree AV block 2 types ?

A
  1. MOBITZ type 1 (Wenckebach)

2. MOBITZ type 2

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53
Q

Mobitz type 1 = block occurs at ___ ____ and is transient; ___ lengthens until totally blocked

A

AV node; PR

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54
Q

Mobitz type 1 = NO _____ following a P causing a missed beat

A

QRS

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55
Q

Mobitz type 2 = block occurs at _____ ______; abrupt drop of QRS but ___ interval normal

A

bundle branches (bundle of His); PR

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56
Q

___ degree AV block = block at AV node, bundle of His OR bundle branches

A

3rd

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57
Q

3rd degree AV block = complete dissociated between _____ and ______

A

atria; ventricles

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58
Q

___ degree AV block = independent ventricular rate

A

3rd

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59
Q

With 3rd degree AV block, is ventricular or atrial rate faster?

A

atrial

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60
Q

If 3rd degree AV block is in bundle branches, _____ is longer

A

QRS

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61
Q

______ = heart unable to pump blood at rate required by tissues of the body OR able to but at elevated filling pressures

A

CHF

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62
Q

2 types of CHF?

A
  1. systolic

2. diastolic

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63
Q

______ CHF = deterioration of contractile tissue

A

systolic

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64
Q

______ CHF = can’t accommodate ventricular blood volume

A

diastolic

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65
Q

2 S/S of CHF?

A
  1. breathlessness

2. abnormal retention of sodium / water

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66
Q

Result of ____ = edema w/ congestion of lungs OR peripheral circulation (or both)

A

CHF

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67
Q

_______ sided heart failure (CHF) = damming of blood in pulmonary circulation

A

left

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68
Q

4 major causes of left sided heart failure ?

A
  1. ischemic heart disease
  2. HTN
  3. aortic and mitral valve disease
  4. myocardial disease
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69
Q

5 S/S of left sided heart failure?

A
  1. SOB when lying
  2. nocturnal gasp of breath when sleeping
  3. decreased kidney and brain perfusion
  4. exertional dyspnea
  5. pulmonary congestion
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70
Q

Right sided heart failure = also called _____ _____

A

cor pulmonale

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71
Q

2 major causes of right sided heart failure?

A
  1. left sided heart failure

2. chronic severe pulmonary hypertension

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72
Q

Result of right sided heart failure = damming of blood in ______ and partial _____ systems

A

systemic; venous

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73
Q

5 S/S of right sided heart failure?

A
  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
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74
Q

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)?

A
  1. chronic severe pulmonary HTN (emphysema, COPD)

2. cystic fibrosis

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75
Q

3 S/S of ischemic heart disease?

A
  1. angina
  2. MI
  3. sudden cardiac death (90% due to atherosclerosis)
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76
Q

Angina pectoris = _______, recurrent episodes of chest discomfort

A

paroxysmal

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77
Q

Cause of angina pectoris ?

A

transient ischemia of heart muscle due to obstruction and/or spasm of coronary arteries

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78
Q

3 types of angina ?

A
  1. stable
  2. unstable
  3. prinzmetal
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79
Q

_____ ______ = blood not flowing properly to part of heart muscle, injury due to lack of O2

A

myocardial infarct

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80
Q

4 risk factors for myocardial infarct?

A
  1. previous CV disease
  2. old age
  3. smoking
  4. high levels of certain lipids
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81
Q

Cause of MI = ________ artery to heart develops blockage due to unstable ________ (WBC’s, cholesterol, triglycerides)

A

coronary; ahteromas

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82
Q

3 S/S of MI?

A
  1. sudden chest pain
  2. L UE/neck pain
  3. may have SOB, sweating, nausea, vomiting, abnormal heartbeats, anxiety
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83
Q

Do males or females have more symptoms of MI?

A

Males

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84
Q

Blood test for MI tests for what 2 things ?

A
  1. troponin

2. creatine kinase

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85
Q

What type of MI requires more aggressive treatment?

A

STEMI (ST elevation MI)

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86
Q

Types of lung cancer?

A
  1. small cell

2. non small cell

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87
Q

Small cell lung cancer makes up __ - __ % of lung cancers; develops in _______ cell mucosa; spreads rapidly and metastasizes early

A

20-25; bronchial

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88
Q

3 types of non small cell lung cancer?

A
  1. squamous cell
  2. adenocarcinoma
  3. large cell
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89
Q

________ cell (non small cell lung cancer) = spread slow, arise in central portion near hilum, metastasizes late

A

squamous

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90
Q

_________ (non small cell lung cancer) = slow to moderate spread, early mets throughout lungs, brain and organs

A

adenocarcinoma

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91
Q

_____ ____ (non small cell lung cancer) = rapid spread, wide spread mets, kidney, liver, adrenals, poor prognosis :(

A

large cell

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92
Q

2 cause of death for brain conditions ?

A

Tumours

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93
Q

Brain tumours = ___% chance of survival

A

50

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94
Q

____-_____ brain tumours area significant cause of death in kids

A

infra-tentorial

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95
Q

3 types of brain tumours?

A
  1. intracerebral primary
  2. intracerebral metastatic
  3. other (medulloblastomas and nkuronomas)
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96
Q

_____ _____ brain tumour = tumour neurons don’t proliferate (other glial cells around proliferate)

A

intracerebral primary

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97
Q

______ ______ come from lung, breast and prostate; compensate by decreasing brain tissue, volume, CSF volume + blood flow volume

A

intracerebral metastatic

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98
Q

_______ (brain tumours) frequently metastasize to other areas in brain and spine

A

medulloblastomas

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99
Q

_______ = such as schwannoma on CNVIII

A

neuroma

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100
Q

2 S/S of brain tumours ?

A
  1. nerve root pain (worse at night, pain with cough, radicular pain)
  2. headache and seizure, nausea, vomiting, cognition and behaviour change
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101
Q

_______ = inflammation of parenchyma of lungs with development of intra-alveolar exudate

A

pneumonia

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102
Q

3 causes of pneumonia?

A
  1. bacterial, viral, fungal
  2. inhalation of toxic chemicals
  3. aspiration
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103
Q

2 types of pneumonia?

A
  1. typical

2. atypical (walking pneumonia)

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104
Q

4 S/S of pneumonia?

A
  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
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105
Q

PT Rx for pneumonia includes airway clearance techniques and positioning (T/F)

A

TRUE

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106
Q

2 types of atelectasis?

A
  1. primary

2. post op

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107
Q

______ = collapse of normal expanded and aerated lung tissue, may involve all or part of lung

A

atelectasis

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108
Q

3 mechanisms of atelectasis?

A
  1. blockage of bronchus / bronchiole
  2. compression
  3. post - anesthetic
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109
Q

4 S/S of atelectasis?

A
  1. quiet breath sounds
  2. dyspnea
  3. tachypnea
  4. cyanosis
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110
Q

Chest X ray findings of atelectasis = shifting of lung structures ______ collapse; if entire lobe, may show ______

A

toward; shadow

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111
Q

3 Rx for atelectasis?

A
  1. identifying underlying cause
  2. suctioning if due to secretions
  3. chest tube if due to pneumo/hemo thorax or extensive pleural effusion
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112
Q

_______ = acute resp failure w/ severe hypoxemia, result of pulmonary or systemic problem

A

ARDS

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113
Q

ARDS = lung injury characterized by increased permeability of ______ ____ membrane, leading to leakage of fluid and blood into lung ______ and _______

A

alveolar capillary; interstitial; alveoli

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114
Q

4 causes of ARDS?

A
  1. severe trauma
  2. aspiration
  3. embolism
  4. indirect –> secondary to viral infection or pneumonia
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115
Q

ARDS = ________ reaction w/ alveolar edema + collapse

A

inflammatory

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116
Q

Key feature of CXR in ARDS?

A

white out

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117
Q

3 Rx for ARDS?

A
  1. PEEP
  2. Rx underlying cause
  3. proning
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118
Q

______ = viral respiratory illness, caused by SARS coronavirus

A

SARS

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119
Q

S/S of SARS?

A

flu like –> fever, myalgia, cough, sore throat, lethargy

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120
Q

Lung ______ = infection leading to necrosis of lung tissue and cavity formation with necrotic debris

A

abcess

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121
Q

______ = occurs in infants whose lungs have not fully developed due to lack of SURFACTANT

A

IRDS

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122
Q

5 S/S of IRDS?

A
  1. pre maturity
  2. c section
  3. multiple pregnancies
  4. blue baby
  5. stops breathing, grunts
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123
Q

______ resp failure = gas exchange failure, arterial _______, decrease in blood oxygen but NO increase in CO2

A

hypoxemic

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124
Q

4 causes of hypoxemic resp failure?

A
  1. pneumonia
  2. ARDS
  3. obstructive lung disease
  4. pulmonary embolism
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125
Q

_________ resp failure = ++ CO2 in blood, decrease in blood O2

A

hypercapnic

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126
Q

4 causes of hypercapnic resp failure ?

A
  1. decrease in ventilation
  2. acute upper / lower airway obstruction
  3. weak / impaired resp muscles
  4. SCI
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127
Q

_______ = chronic inflammation of lungs, variable expiratory air flow limitation + hyper responsiveness

A

asthma

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128
Q

Wheezing, chest tightness, coughing, breathlessness (all reversible) are all S/S of what?

A

asthma

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129
Q

2 categories of asthma ?

A
  1. extrinsic

2. intrinsic

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130
Q

________ asthma = allergic or atopic (most common), kids > adults

A

extrinsic

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131
Q

Extrinsic asthma = _____ cells release mediators which cause bronchospasm and hyper secretion

A

mast

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132
Q

_______ asthma = non allergic, hypersensitivity to environmental triggers, late onset (adults > kids)

A

intrinsic

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133
Q

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)

A

1) T
2) F *HYPERinflated
3) F (NORMAL)
4) T
5) T

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134
Q

3 Rx for asthma ?

A
  1. self management and education (avoid triggers, inhaler technique)
  2. pharmacological (corticosteroids)
  3. if exercise induced –> upright, lean forward and PLB
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135
Q

Exercised induced asthma = ____ mm constriction

A

smooth

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136
Q

5 characteristics of COPD?

A
  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
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137
Q

2 Rx for COPD?

A
  1. pharma management (smooth mm relaxation and reduce airway inflammation)
  2. O2 therapy
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138
Q

O2 therapy for COPD patients: NOT for pts with what two conditions ?

A
  1. pulmonary HTN

2. CHF

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139
Q

________ = excessive mucus production

A

bronchitis

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140
Q

_______ = results in destruction of air spaces distal to there terminal bronchiole and destruction of alveolar septa

A

emphysema

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141
Q

Emphysema causes merging of ______ into larger air spaces, leading to _____ SA for gas exchange

A

alveoli; decreased

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142
Q

Emphysema results in old air becoming ______ , leading to ______ space available for O2 rich air

A

trapped; decreased

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143
Q

Pts with emphysema will be hyperinflated, leading to a ________ diaphragm and therefore a mechanical disadvantage

A

flattened

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144
Q

Can slow progression emphysema but cannot reverse damage (T/F)

A

TRUE

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145
Q

________ - irreversible destruction + dilation of airways w/ chronic bacterial infection

A

bronchiectasis

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146
Q

3 things that can cause bronchiectasis ?

A
  1. CF
  2. TB
  3. endobronchial tumours
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147
Q

2 characteristics of bronchiectasis?

A
  1. excess mucus leading to SOB

2. eventually alveoli replaced w/ scar tissue due to chronic inflammation

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148
Q

PT rx for bronchiectasis?

A

secretion clearance!

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149
Q

_______ lung disease = progressive scaring leading to stiffness and decreased lung compliance (not airway obstruction)

A

interstitial

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150
Q

4S/S of interstitial lung disease?

A
  1. dyspnea
  2. severe O2 desaturation
  3. clubbing of fingers and toes
  4. decreased exercise tolerance
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151
Q

4 Rx for ILD?

A
  1. O2 therapy
  2. lung transplant
  3. pulmonary rehab
  4. cessation of exposure
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152
Q

Pulmonary fibrosis: ___ no known cause, __ TB

A

2/3; 1/3

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153
Q

Cause of pulmonary fibrosis and 2 Rx?

A

Cause = inhaling harmful particles
Rx:
1) radiation therapy
2) meds

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154
Q

______ = coal workers lung

A

pneumoconiosis

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155
Q

___ = infection, inflammatory systemic disease that affects lungs (caused by airborne particles)

A

TB

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156
Q

TB may desseminate to involve kidneys, growth plates, meninges, avascular necrosis of hip joints lymph nodes and other organs (T/F)

A

TRUE

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157
Q

5 S/S of TB?

A
  1. productive cough 3+ weeks
  2. weight loss
  3. fever
  4. night sweats
  5. fatigue
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158
Q

TB will have ______ breath sounds

A

bronchial

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159
Q

TB results in _______ in lung tissue

A

granulomas

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160
Q

_____ ______ = abnormal accumulation of fluid in the pleural space

A

pleural effusion

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161
Q

Pleural effusion leads to decrease lung ______

A

expansion

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162
Q

2 causes of pleural effusion?

A
  1. transudate

2. exudate

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163
Q

_______ = commonly due to heart or renal failure, low protein and clear

A

transudate

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164
Q

______ = formation of fluid by inflammation or disease (infection or cancer of pleura); opaque

A

exudate

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165
Q

Pleural effusion = ____ percussion notes, decreased or absent breath sounds and you may hear pleural ___

A

dull; rub

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166
Q

Pleural effusion: CXR may show ________ shift

A

mediastinal

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167
Q

Pulmonary edema = increased fluid in ________ spaces of lungs

A

extravascular

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168
Q

2 possible causes of pulmonary edema?

A
  1. increased hydrostatic pressure due to heart or kidney failure
  2. increased alveolar permeability
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169
Q

3 presentations in pulmonary edema?

A
  1. stiff lungs
  2. dyspnea
  3. classic symptom = cough that produces a frothy pink tinged sputum
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170
Q

Pulmonary edema ausculation findings?

A

fine crackles

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171
Q

5 s/s of pulmonary embolism?

A
  1. bloody sputum
  2. dyspnea
  3. inc RR
  4. SOB
  5. cyanotic
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172
Q

_______ ______ = inherited autosomal disorder affecting ALL EXOCRINE glands

A

CF

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173
Q

5 effects of CF?

A
  1. defective Cl- = excretion and Na+ absorption, = thick mucus
  2. recurrent chest infections
  3. consolidation
  4. atelectasis
  5. thickened bronchial walls
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174
Q

Sweat test for CF = looking at amount of _______ in sweat

A

chloride

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175
Q

3 Rx for CF?

A
  1. airway clearance techniques
  2. bronchodilators
  3. aggressive antibiotics
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176
Q

______ _______ _____ = account for 95 % of arterial occlusive disease

A

peripheral arterial disease

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177
Q

Underlying cause of PAD?

A

atherosclerosis

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178
Q

S/S of PAD occur _____ to the site of narrowing or occlusion

A

distal

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179
Q

4 S/S of PAD?

A
  1. intermittent claudication
  2. acute ischemia
  3. ulceration and gangrene
  4. skin = shiny, thin and hairless
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180
Q

PAD = leading cause of limb loss in adults (T/F)

A

TRUE

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181
Q

PAD and peripheral vascular disease = same thing (T/F)

A

TRUE

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182
Q

3 common arteries effected by PVD?

A
  1. iliac
  2. femoral
  3. popliteal
183
Q

PVD = feel pain during physical activity, most often in the _____

A

calf

184
Q

________ = partial or complete occlusion of a vein by a thrombus w/ secondary inflammation

A

thrombophlebitis

185
Q

Thrombophlebitis can be superficial or deep (T/F)

A

TRUE

186
Q

2 S/S of DVT?

A
  1. tender calf

2. fever

187
Q

Biggest risk of DVT?

A

may become a PE

188
Q

Test for DVT?

A

Homan’s sign (+ test = pain_

189
Q

3 causes of chronic venous insufficiency?

A
  1. DVT
  2. trauma
  3. obstruction (such as tumour)
190
Q

3 effects of chronic venous insufficiency?

A
  1. damaged or destroyed valves lead to venous stasis
  2. progressive edema
  3. thickened brown skin (due to pooling blood) and ulcers
191
Q

Rx for chronic venous insufficiency ?

A
  1. compression

2. elevation

192
Q

________ veins = faulty valves cause abnormal dilation of veins

A

varicose

193
Q

Varicose veins = at risk for _______

A

thrombosis

194
Q

VC = made up of what 4 volume?

A
  1. IRV
  2. TV
  3. ERV
  4. RV
195
Q

IC = made up of what 2 volumes?

A
  1. IRV

2. TV

196
Q

FRC = made up of what 2 volumes?

A
  1. ERV

2. RV

197
Q

TLC made up of what 2 capacities ?

A
  1. VC

2. FRC

198
Q

TV = ____ mL

A

500

199
Q

IRV = __ - __ L; max volume that can be inspired on top of TV, used during exercise / exertion

A

2-3

200
Q

ERV= __ L; max volume that can be expired after the expiration of tV

A

1

201
Q

RV = __ L; volume that remains in lungs after max expiration

A

1

202
Q

RV can be measured by spirometry (T/F)

A

TRUE

203
Q

IC = volume of max inspiration (___ - ___ L)

A

2.5 - 4

204
Q

FRC = __ L, volume of gas remaining after normal expiration

A

2

205
Q

____ / ___ cannot be measured by spirometry bc they includes residual volume

A

FRC/ TLC

206
Q

VC = ___ - __ L, volume of max inspiration and expiration

A

3-4.5

207
Q

TLC = __ - __ L

A

4-6

208
Q

Dead space = ___ mL in norma lungs

A

300

209
Q

_____ _____ = volume of resp apparatus that does not participate in gas exchange

A

dead space

210
Q

______ dead space (150mL) = volume of the conducting airways (ie nose, trachea, etc)

A

anatomic

211
Q

______ dead space (150mL) = volume of the lung that dos not participate in gas exchange

A

physiologic

212
Q

_______ dead space = volume of the lung that does not participate in gas exchange

A

physiologic

213
Q

_____ = volume of air that can be expired in 1 sec after max inspiration

A

FEV1

214
Q

Normal FEV1 = ___% of the forced vital capacity (expressed as FEV1/FVC)

A

80

215
Q

___________ lung disease = decreased FEV1 and FVC

A

restrictive

216
Q

Restrictive lung disease = FEV1/FVC ratio ?

A

> or equal to .8

217
Q

______ lung disease = ++ decreased FEV1

A

obstructive

218
Q

Obstructive lung disease = FEV1/FVC ratio ?

A

< .8

219
Q

Stage___ resp condition = ___ _____; risk factors and chronic symptoms but normal spirometry

A

0; at risk

220
Q

Stage __ resp condition: ____; FEV1/FVC ratio < 70%; FEV1 at least 80% of predicted value; may have symptoms

A

1; mild

221
Q

Stage __ resp condition: _____; FEV1/FVC ratio < 70%; FEV1 50% - <80% of predicted value; may have chronic symptoms

A

2; moderate

222
Q

Stage __ resp condition: ___;; FEV1/FVC ratio < 70%; FEV1 30% - < 50% of predicted value; may have chronic symptoms

A

3; severe

223
Q

Stage ___ resp condition: ___ ____; FEV1/FVC ratio < 70%; FEV1 < 30% of predicted value OR FEV1< 50% of predicted value + reverse chronic symptoms

A

4; very severe

224
Q

Give minimum 5 S/S of cardiopulmonary disease.

A

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
Q

_______ ______ = size of heart in relation to thorax

A

cardiothoracic index

226
Q

3 goals of cardiac rehab?

A
  1. restore optimal function
  2. prevent progression of underlying processes
  3. reduce risk of sudden death and re infarction
227
Q

3 exercises to AVOID during cardiac rehab?***

A
  1. NO VALSALVA
  2. extensive upper body activity
  3. isometric / static exercise
228
Q

FIIT prescription for cardiac rehab?

A

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
Q

Cardiac rehab: do not use ____ for those on beta blockers of pacemakers

A

HRR

230
Q

Cardiac rehab: for pacemakers stay __ BPM below level that it starts OR at __ - __ BPM below onset of abnormal symptoms / angina

A

30 ; 10-15

231
Q

How to calculate HRR?

A

(HRmax - resting HR) x intensity % + resting HR

232
Q

Cardiac rehab should include a ____ _____ and _____ _____ (5- 10 mins)

A

warm up ; cool down

233
Q

Meds: _____ ______ decrease pulse, myocardial contraction force, myocardial O2, conduction velocity between SA and AV node

A

beta blockers

234
Q

4 uses for beta blockers?

A
  1. CAD
  2. angina pectoris
  3. HTN
  4. irregular heath rhythms
235
Q

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

A

beta blockers

236
Q

Pt’s w/ beta blockers: use _____ rather than age predicted HR range

A

RPE

237
Q

Pt’s w/ beta blockers: ensure gradual ____ ____ and ____ ____

A

warm up; cool down

238
Q

Meds: _____ and _______ relaxes smooth muscle in blood vessels, increases blood flow and decreases workload and O2 supply of heart muscles

A

nitrate ; nitroglycerin

239
Q

3 uses of nitrate / nitroglycerin?

A
  1. angina
  2. CHF
  3. acute MI
240
Q

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

A

nitrate; nitroglycerin

241
Q

For pt’s on nitrate and nitroglycerin ensure adequate ______ ____ and ______ _____

A

warm up; cool down

242
Q

Pt’s on nitroglycerin: nitro doses __ - __ mins apart

A

3-5

243
Q

Key to touch on for those using nitro?

A
  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
Q

ACE inhibitors = also known as ______ _______ ______

A

angiotensin converting enzyme

245
Q

______ _______ = block conversion of angiotensin I to II, prevents vasoconstriction, decreases peripheral resistance, increases urine output

A

ACE inhibitors

246
Q

5 populations that ACE inhibitors may be used by

?

A
  1. CHF
  2. HTN
  3. CVD
  4. MI
  5. kidney function in diabetics
247
Q

Considerations for pts using ____ _______ = increased exercise tolerance in clients with CHF, decreased resting and exercising BP, gradual warm ups and cool downs

A

ACE inhibitors

248
Q

_______ ________ = decreased mortality in heart disease patients even if cholesterol is normal, decrease cholesterol levels (esp ___) and triglycerides

A

anticholesterol agents; LDLs

249
Q

Anticholesterol agents can include which 2 types?

A
  1. niacin

2. statins

250
Q

2 considerations for pts on niacin?

A
  1. postural hypotension

2. need gradual warm up and cool down

251
Q

2 considerations for pts on statins?

A
  1. muscle aches

2. joint stiffness

252
Q

_______ ______ = decreased platelet aggregation at site of tissue damage

A

anti-platelet agents

253
Q

3 uses of antiplatelet agents?

A
  1. reduces risk of MI
  2. TIA
  3. brain attacks / ischemic strokes
254
Q

Pts on anitplatelet agents = no CI’s to exercise or effect on pulse / BP (T/F)

A

TRUE

255
Q

3 parts of Hx to touch on w/ pt who has cardiopulmonary disease?

A
  1. risk factors
  2. acuity and progression
  3. PMHx
256
Q

6 symptoms typical of cardiopulmonary disease ?

A
  1. dyspnea
  2. cough
  3. wheeze
  4. cyanosis
  5. finger and toe clubbing
  6. decreased O2 saturation
257
Q

Dyspnea can be measured using what scale ?

A

Borg scale of perceived breathlessness

258
Q

______ can be inspiratory, expiratory, low pitched or high pitched

A

wheeze

259
Q

_______ = blue or purple colour in skin that has mucous membranes (nail beds, lips, etc)

A

cyanosis

260
Q

_____ ______ = seen in conditions like COPD and CF due to chronic hypoxia

A

finger (and toe) clubbing

261
Q

Below ___ % O2 sat you may need some supplementary O2

A

90

262
Q

Physical exam of cardiopulmonary pts?

A

IPPA!

263
Q

Name 5 possible Dx tests for pt w/ cardiopulmonary disease

A

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
Q

Flow volume loop: CI are any conditions prohibiting a ____ maneuver

A

MAX

265
Q

What typically is the first test to be ordered for cardiopulmonary Dx?

A

simple spirometry

266
Q

5 CI for simple spirometry?

A
  1. MI in last month
  2. recent stroke
  3. recent abdominal / thoracic Sx
  4. uncontrolled HTN
  5. recent pneumothorax
267
Q

What are 5 indications to use simple spirometry?

A
  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
Q

Simple spirometry: ______ lung disease = increased lung volumes, decreased FVC, ++ decreased FEV1, decreased ratio

A

obstructive

269
Q

Simple spirometry: _______ lung disease = decreased lung volumes, decreased FVC, decreased FEV1, ratio is normal or even increased

A

restrictive

270
Q

Diffusing capacity provides Dx of ______

A

emphysema

271
Q

VQ scan is used for ______ disorders (pulmonary embolism)

A

diffusion

272
Q

Trachea starts at ________ cartilage to ___ SP posteriorly

A

cricoid; T4

273
Q

___ bronchus is more steeply angled (vertical) and gets more things caught in it bc of path or least resistance

A

R

274
Q

Carina of trachea is at which level?

A

sternal angle (rib 2)

275
Q

Diaphragm is at the level of the ___ thoracic vertebrae, moves __ - __ cm in quiet breathing

A

8; 1-2

276
Q

What muscles are active during quiet inspiration ?

A
  1. diaphragm

2. external intercostals

277
Q

What muscles are active during forced inspiration?

A
  1. SCM
  2. scalene
  3. pec minor
278
Q

What muscles are active during quiet expiration?

A

passive recoil of lung tissues - no muscles!

279
Q

What muscles are active during forced expiration ?

A

internal intercostals and abs

280
Q

Inspection: looking at ____ / monitors and ______ of the patients

A

lines; position

281
Q

Name things youre looking for during inspection part of IPPA

A
  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
Q

4 things to palpate for in IPPA?

A
  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
Q

HR: count pulse for __ s; RR: count breaths for ___ s

A

15; 30-60

284
Q

________ = middle finger over intercostal space w/ non-dominant hand, ax right vs left anterior to posterior upper, middle, and lower lobes

A

percussion

285
Q

3 sounds percussion notes can be?

A
  1. resonant (normal)
  2. dull (consolidation, pleural fluid)
  3. hyper - resonant = air
286
Q

Diaphragm of stethoscope picks up ____ pitch better, the bell picks up __ pitch better

A

high; low

287
Q

Auscultation: gold standard lobe points = __ in front, ___ in back

A

11; 14

288
Q

Normal breath sounds?

A
  1. vesicular

2. bronchial

289
Q

_____ breath sound = hollow, short pause between inspiration and expiration, normal over trachea

A

bronchial

290
Q

Abnormal breath sounds ?

A
  1. bronchial

2. decreased or absent

291
Q

What conditions might have bronchial breath sounds (2)?

A
  1. consolidated pneumonia

2. lobar collapse

292
Q

Decreased or absent breath sounds might be heard due to what conditions (7)?

A
  1. pleural effusion
  2. hemothorax
  3. pneumothorax
  4. emphysema
  5. contused lung
  6. obese
  7. elderly
293
Q

4 adventitious breath sounds?

A
  1. crackles (rales)
  2. wheezes (rhonchi)
  3. stridor
  4. pleural rub
294
Q

______ = inspiratory vs expiratory, early could mean airway obstruction, late could mean edema, fibrosis, partial consolidation

A

crackles (rales)

295
Q

______ = inspiratory vs expiratory, high = uniformly narrowed, low pitch = intermittently narrowed

A

wheezes (rhonchi)

296
Q

_____ = loud musical constant pitch w/ laryngeal or tracheal obstruction

A

stridor

297
Q

______ _____ = creaky, leathery sound due to pleural irritation

A

pleural rub

298
Q

11 step process for CXR?

A
  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
Q

Overexposed chest X ray will be completely _____

A

black

300
Q

Satisfactory inspiration on CXR = __ ribs post or __ ribs anterior above dome of the left diaphragm

A

9;6

301
Q

A/B ratio ( A = width of heart, B = width of inside lung cavity) should not be over ___ %

A

50

302
Q

What 3 landmarks should you see if there are no silhouette signs?

A
  1. costophrenic angles
  2. costocardiac angles
  3. right dome
303
Q

Mediastinum will shift away from _____ volume and towards _____ volume

A

increased; decreased

304
Q

Position of mediastinum = __:__ from R - L

A

2:1

305
Q

What to look for in terms of landmarks of mediastinum?

A
  1. pulmonary artery

2. cobweb appearance of blood vessels

306
Q

Want hila to be the same heigh or within __ - __ levels of each other close to _____ bifurcation; fissures only seen in about __% of CXR

A

1-2; bronchi

307
Q

_________ = 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

A

atelectasis

308
Q

______ 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

A

consolidation ; pleural effusion

309
Q

_______ = dark area because of air, absence of lung markings, fine line showing outline of the collapsed lung

A

pneumothorax

310
Q

_______ _______ = enlarged peripheral vessels, opacities and fluffy shadows

A

pulmonary edema

311
Q

______ = flattened diaphragm, pear shaped heart, enlarged chest cavity

A

COPD

312
Q

Lateral CXR ALWAYS to be interpreted w/ a frontal CXR (T/F)

A

TRUE

313
Q

4 questions to ask when looking at lateral CXR?

A
  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
Q

____ = only measures free unbound O2 molecules, is the driving force for Hb saturation w/ O2

A

PO2

315
Q

PO2 is determined by what 3 things ?

A
  1. alveolar ventilation
  2. V/Q
  3. FiO2
316
Q

____ = measure of partial pressure and pH of O2 and CO2 in blood

A

ABGs

317
Q

PCO2 is controlled by _______

A

ventilation

318
Q

pH normal range?

A

7.35 - 7.45

319
Q

PaCO2 normal range?

A

35-45

320
Q

HCO3 normal range?

A

22-28

321
Q

PaO2 normal range?

A

80-100mmHg

322
Q

SaO2 normal range?

A

95-100%

323
Q

Metabolic and resp acidosis =the pH is _____ than normal

A

lower

324
Q

Metabolis and resp alkalosis = pH is _____ than normal

A

higher

325
Q

Resp acidosis = pH _____, PaCO2 _____, HCO3 _____

A

dec; inc; normal

326
Q

Resp alkalosis = pH ____, PaCO2 ___, HCO3 ____

A

inc; dec; normal

327
Q

Metabolic acidosis = pH ___, PaCO2 ____, HCO3 ____

A

dec; normal; dec

328
Q

Metabolic alkalosis = pH ____, PaCO2 ____, HCO3 ____

A

inc; normal; inc

329
Q

6 rules when looking at ABGs?

A
  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
Q

_____ line constantly monitors arterial BP

A

ART

331
Q

4 arteries ART line may be inserted into?

A
  1. radial
  2. axillary
  3. femoral
  4. pedal
332
Q

3 precautions w/ ART line?

A
  1. infusion bag MUST be kept above insertion line
  2. notify RN if transducer disconnected
  3. ROM restrictions
333
Q

No hip flexion past __ degrees w/ femoral ART line!

A

90

334
Q

____ line = to deliver chemo or antibiotics

A

PICC

335
Q

______ line inserted into large vein of the arm near bend of elbow and pushed until tip sits above heart

A

PICC

336
Q

Precautions w/ PICC line?

A

do not mobilize until proper insertion confirmed w/ Xray

337
Q

Sternotomy precautions for lifting?

A

limitations in lifting ; no lifting 10lbs above waist no pushing STS, and no pull/push over 5 lbs)

338
Q

______ ______ _____ = self administered meds, will preset how much they can get

A

patient controlled analgesic

339
Q

Patient controlled analgesic: looks for ____ drop, RR less than ___ and altered mental status

A

BP; 10

340
Q

_______ line = be careful w/ movements of trunk, hips, LE: can be very uncomfortable

A

epidural

341
Q

2 precautions for epidurals?

A
  1. ALWAYS check orders

2. if dislodged get help immediately

342
Q

_____ ______ = feed is kept above site of insertion, need feeds turned off prior to start of therapy

A

NG tube

343
Q

Big precaution w/ NG tube?

A

HOB NOT FLAT; feed will flow back; keep at LEAST 30 deg incline

344
Q

Chest tube: keep ____ site of insertion to prevent backflow

A

below

345
Q

Urinary catheter (foley) = keep _______ site of insertion to prevent backfow

A

below

346
Q

5 indications for O2 therapy?

A
  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
Q

Require RT for O2 greater than __ % , acute resp distress, transport w/ O2 and ______ airway

A

40; artificial

348
Q

___ _____ system = supplemental O2 to tidal volume, via NP, simple mask, partial rebreathing and non-rebreathing mask

A

low flow

349
Q

NP = __ L O2 max

A

6

350
Q

___ _____ = enough O2 to supply the entire TV

A

High flow

351
Q

3 ways high flow O2 can be provided?

A
  1. venturi face mask
  2. face tent
  3. tracheostomy mask
352
Q

1L/min O2 = __% O2, goes up by __% every L increase

A

24; 4

353
Q

Incentive spirometry purpose=for patients w/ ______; provides visual input / incentive goal

A

atelectasis

354
Q

There is NO evidence for use of IS to prevent post op complications (T/F)

A

TRUE

355
Q

Method for using incentive spirometry?

A
  1. sustained inspiration effort ~ 3 sec
  2. relaxed expiration
  3. attesting to achieve max inspiration to TLC
356
Q

CI’s to incentive spirometry?

A
  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
Q

Purpose of inspiratory muscle training: retrains muscles of ________ in populations needing it - name these populations (4)

A

inspiration;

  1. COPD
  2. CHF
  3. endurance athletes
  4. SCI
358
Q

What do you need in order to perform inspiratory muscle training?

A

reliable measure of max inspiratory pressure + max expiratory pressure (pulmonary tests)

359
Q

What would an initial Rx for inspiratory muscle training look like and following sessions (aka FITT)?

A
  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
Q

2 CI’s for inspiratory muscle training?

A
  1. acute resp failure

2. cognitive impairment

361
Q

Always monitor for sings of _____ _____ distress during inspiratory muscle training

A

cardio-resp

362
Q

VQ matching: ______ = normal perfusion but no ventilation (ie alveoli is collapse and the capillary is expanded)

A

SHUNTING

363
Q

VQ matching: _____ _____ _____ = normal ventilation w/ poor perfusion (capillary is completely collapsed and alveoli is enlarged)

A

dead space unit

364
Q

VQ matching: ____ ______ = no ventilation of perfusion (both collapsed)

A

silent unit

365
Q

For atelectasis, to encourage re-expansion put the diseased long in the _________ position and do _______ breathing exercises in this position

A

non-dependent; unilateral

366
Q

Normal lungs: ventilation is greatest in _______ regions

A

dependent

367
Q

Normal lung: perfusion is best in _______ regions

A

dependent

368
Q

Normal lungs Rx principle: _______ regions of lungs have greatest SA and therefore best VQ matching in ______ lung

A

lower; upright

369
Q

Abnormal lungs: ventilation is best in ___ -_______ regions

A

non diseased

370
Q

Abnormal lungs: perfusion is best in ______ _____ regions

A

gravity dependent

371
Q

Abnormal lung Rx principle: generally place affected area in the ___ ________ position to increase VQ matching

A

non dependent (bad lung up!)

372
Q

Mechanical ventilation: increased pressure can restrict blood flow to ___ -_____ regions

A

non dependent

373
Q

Mechanical ventilation: air follows path of least resistance, usually best in ___- ________ region

A

non dependent

374
Q

Give 5 reasons for breathing exercises.

A

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
Q

3 indications for diaphragmatic breathing?

A
  1. post op patients
  2. resp failure
  3. chronic resp distress
376
Q

3 reasons diaphragmatic breathing is effective?

A
  1. increase lung expansion and compliance
  2. reduce VQ mismatch
  3. increase resp muscle strength
377
Q

Prescription for diaphragmatic breathing?

A

10 breaths every hour

378
Q

4 possible additions to diaphragmatic breathing ?

A
  1. end inspiratory hold
  2. single percussion
  3. sniff
  4. lateral costal breathing
379
Q

PLB indications ?

A

for COPD pts!

380
Q

How to perform PLB: inhale w/ lips in pucker position for __ counts, exhale for __ counts

A

2;4 (expiration 2x as long as inspiration)

381
Q

Indications for segmental breathing ?

A

healthy individuals can direct O2 in the upper or lower lung fields upon instruction

382
Q

_______ breathing = tactile stimulation or pressure to increase expansion of specific areas, pressure on inspiration and relax on expiration

A

segmental

383
Q

Incentive spirometry / sustained max inspiration ?

A

same uses as diaphragmatic breathing, just as good

384
Q

How to perform incentive spirometry / sustained max inspiration ?

A

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
Q

2 indications for breath stacking ?

A
  1. when breathing is painful

2. ventilatory dependent pts

386
Q

Who to NOT give breath stacking to?

A

COPD PATIENTS ! BAD !

387
Q

SOS for SOB?

A
  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
Q

Who to give SOS for SOB to?

A

COPD pt in resp distress

389
Q

Indications to perform assisted cough technique ? (4)

A

ineffective cough seen in pts w/ …

  1. SCI
  2. NMD
  3. chemically paralyzed
  4. weak resp muscles
390
Q

CI’s for assisted cough?

A

ruptured diaphragm!

391
Q

Precautions for assisted cough? (5)

A
  1. inferior vena cava filter
  2. rib #
  3. abdominal or thoracic Sx
  4. pneumothorax
  5. perforated bowel
392
Q

Assisted cough: after coughing, ensure proper _______ clearance removal

A

secretion

393
Q

Indications for huffing ?

A
  1. for improving secretion clearance

2. adjunct for manual techniques

394
Q

Huffing: __ reps of huffing, mouth is O shape so ____ remains open; follow up with ________ breathing

A

2; glottis; diaphragmatic

395
Q

Best position for postural draining / positioning?

A

upright and mobile !

396
Q

______ position is the optimal coughing position for pts with SCI

A

supine

397
Q

Indications for postural drainage / positioning ?

A

to put patient in position that drains the airway in gravity directed movement

398
Q

Time spent in postural drainage position ?

A

3-10 mins

399
Q

CI’s / precautions for postural drainage positions ?

A
  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
Q

Positioning: RUL/LUL ______ sitting upright in bed, back supported

A

apical

401
Q

Positioning: LUL _____ = semi-fowler’s (supine, head at 45 deg)

A

anterior

402
Q

Positioning: RUL _______ = supine, hips in ER

A

anterior

403
Q

Positioning: LUL ______ = semi prone (lt side elevated by pillow, HOB at 30 deg)

A

posterior

404
Q

Positioning: RUL _____ = semi prone (rt side elevated by pillows), bet flat

A

posterior

405
Q

Positioning: LUL _____ = Rt side lying (semi - supine, Lt side elevated by pillows) bed inverted 30 deg

A

lingula (middle)

406
Q

Positioning: ____ = lt side lying (semi prone, rt side elevated by pillows) bed inverted 30 deg

A

RML

407
Q

Positioning: RLL/LLL ______ = prone

A

superior

408
Q

Positioning: RLL/LLL _____ = supine, bed inverted 30 deg

A

anterior

409
Q

Positioning: RLL/LLL ________ = prone, bed inverted 30 deg (head not supported by pillows? only one)

A

posterior

410
Q

Positioning: RLL _____ = lt sidelying, bed inverted 30 deg

A

lateral

411
Q

Positioning: LLL _____ and RLL _____ = rt sidelying, bed inverted 30 deg

A

lateral; medial (cardiac)

412
Q

Proning indicatons?

A

for pts in ARDS (last ditch effort to get VQ matching)

413
Q

CI’s for proning? (4)

A
  1. facial trauma
  2. open wound in chest or abdomen
  3. unstable SC injury
  4. cerebral HTN
414
Q

Precautions for proning? (2)

A
  1. hemodynamic instability

2. active intra-abdominal process

415
Q

Proning: slide pt away from ______ side

A

ventilator

416
Q

Can be prone for __ - __ hours; change position every __ hours

A

2-10; 2

417
Q

Indication for percussion: to remove _______

A

secretions

418
Q

Duration for percussions ?

A

2-5 mins

419
Q

CI’s / precautions for percussions ?

A
  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
Q

Indications for vibrations?

A

remove bronchial secretions and improve TV

421
Q

Vibrations are done on _______

A

expiration

422
Q

Duration of vibrations ?

A

5 mins

423
Q

_____ ______ = chest compression following by overpressure and quick release at end of expiration, can be combined w/ percs and vibs

A

rib springing

424
Q

Rib springing: thought to increase chest _______ and therefore trigger a bigger ______

A

expansion; inspiration

425
Q

Indications for manual hyperinflation?

A
  1. acute lobar collapse

2. sputum clearance

426
Q

3 things needed for manual hyperinflation?

A
  1. ambu bag
  2. O2 tubing
  3. pressure manometer
427
Q

Manual hyperinflation: Cannot go over __ - __ cm H2O pressure

A

30-40

428
Q

Ci’s for manual hyperinflation (5)

A
  1. acute pneumonectomy
  2. undrained pneumothorax
  3. proximal tumour or obstruction
  4. unstable head injury
  5. HFOV
429
Q

Precautions for manual hyperinflation (5)?

A
  1. hemoptysis
  2. bullae
  3. high RR or PEEP
  4. severe bronchospasm
  5. CVS instability
430
Q

Indications for active cycle of breathing ?

A

for secretion removal; allow increased pressure behind the huge, not forceful at all

431
Q

Have pts do active cycle of breathing ___ - __ mins a day

A

15-20

432
Q

Procedure for active cycle of breathing ?

A
  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
Q

Indications for autogenic drainage?

A

alter rate and depth of breathing to produce highest possible airflow in bronchi while maintaining stability

434
Q

3 phases of autogenic drainage?

A
  1. unsticking
  2. collecting
  3. evacuating
435
Q

Autogenic drainage: slow _______ breathing, take slightly deeper breaths than normal, then exhale normally for __ - __ breaths at a ____ lung volume

A

diaphragmatic; 10-20; higher

436
Q

PEP indications ?

A

to keep airways open an to get behind mucus via collateral airways

437
Q

PEP = __ way valve mask that helps create resistance on ______

A

one; expiration

438
Q

PEP procedure: inspiration __ - __ times w/ active exhalation at 1:_ or 1:_ usually followed by huffing or FET

A

5;10;3;4

439
Q

Oscillating PEP = handheld device that oscillates and vibrates during ____ that will help dislodge mucus in ___ and ___ airways

A

inspiration; large; small

440
Q

Oscillating PEP used most often in which pt population?

A

CF

441
Q

3 possible areas to suction?

A
  1. trach
  2. nasopharyngeal
  3. pharyngeal
442
Q

3 possible suction techniques ?

A
  1. sterile
  2. modified sterile
  3. clean technique
443
Q

Suction parameters: adults = __ - ___ mmHg

A

120-150

444
Q

Suction parameters: children = __ - ___ mmHg

A

80-120

445
Q

Suction parameters: infants = ___ - ___ mmHg

A

60-80

446
Q

4 indications for suctioning?

A
  1. pt can’t clear secretions
  2. loss of airway control
  3. lung pathologies
  4. obtain sputum
447
Q

CI’s for suctioning?

A 
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
Q

3 scales used in pulmonary rehab?

A
  1. dyspnea scale (0-4)
  2. BORG breathlessness scale (0-10)
  3. RPE (0-10)
449
Q

Aerobic exercise prescription for pulmonary rehab?

A

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
Q

Strength exercise prescription pulmonary rehab?

A

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
Q

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

A

88; 5

452
Q

Absolute CI’s to exercise? (13)

A
  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
Q

Relative CI’s to exercise?

A
  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

Written Prep (9 decks)

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