Cardiopulmonary Disorders Flashcards
1
Q
What is the main organ of the circulatory system?
A
the heart
2
Q
Where is the heart located?
A
middle chest, towards the left side
3
Q
The heart is roughly the size of what?
A
a fist
4
Q
What is the heart surrounded by?
A
pericardium
5
Q
What is the pericardium?
A
fluid-filled sac
protects from trauma and infection
6
Q
What are the 3 layers of the heart?
A
- Epicardium: outermost layer
- myocardium: muscle
- endocardium: innermost layer w/ valves, vessels, chordae tendineae
7
Q
What are the chordae tendineae?
A
attaches to valves and allows them to open and close
8
Q
What is the general route of blood in the cardiopulmonary system?
A
- oxygen-poor blood enters right side of heart from the body and goes out to lungs
- oxygen-rich blood enters the left side of heart from the lungs and goes out to the body
9
Q
What are the 3 sections of the pulmonary system?
A
- Lung parenchyma
- upper airway
- lower airway/bronchial tree
10
Q
What is housed in lung parenchyma
A
- right lung (3 lobes)
- left lung (2 lobes)
11
Q
What is housed in upper airway?
A
- nose
- pharynx
- larynx
12
Q
What is housed in the lower airway/bronchial tree?
A
- trachea
- bronchii
- lungs
13
Q
Where does O2 (gas) exchange occur?
A
alveoli
14
Q
What happens in the upper airway when we breathe in air?
A
air is humidified and filtered
15
Q
What happens in upper airway when we speak?
A
air passes through larynx, causing vocal chords to vibrate creating sound
16
Q
What is the purpose of the epiglottis?
A
- protective measure to flap over trachea when we are eating
- Flaps over pharynx to prevent aspiration into larynx and trachea
17
Q
What happens during gas exchange at the alveoli?
A
CO2 is removed and blood is re-oxygenated
O2 crosses from alveoli to capillaries surrounding it via diffusion and binds with hemoglobin
18
Q
What is the diaphragm doing as we breathe?
A
- creates pressure between outside and inside to allow air entering lungs
- moving down: creates negative pressure, so air moves into lungs
19
Q
Which nerve is responsible for respiration?
A
vagus nerve (X)
20
Q
Define ventilation
A
breathing (inspiration/expiration)
21
Q
Why does ventilation occur?
A
occurs through pressure changes between the inside and outside of the body
22
Q
What is the relationship between lung pressure and outside pressure?
A
- outside pressure > lung pressure = inspiration
- lung pressure > outside pressure = expiration
23
Q
What is respiratory rate and what is it a function of?
A
number of times chest rises and falls with each breath (inhaled and exhaled)
12-20 is normal range
function of ventilation
24
Q
What is perfusion?
A
blood flow through pulmonary capillaries where O2 exchange occurs
25
What is the pulmonary defense system?
- lungs exposed to many microorganisms
- 1st line of defense = upper airway filters
- other defense mechanisms: cough, mucous (acts like a trap), immune system (phagocytosis of unwanted intruders)
26
What is pulse rate, how is it taken, and what is the normal range?
- # of beats / min
- taken w/ radial artery
- normal: 60-100 bpm
- lower than 60: bradycardic
- above 100: tachycardic
27
What is respiratory rate and what is the normal range?
- # beats / min
| - normal: 12-20 beats per minutes
28
What is blood pressure and how is it taken?
- force of blood pushing against artery walls
| - taken by flexing muscle and find bicep tendon, just medial is brachial artery where there is pulse
29
Define the 2 components of taking blood pressure and their averages?
- Systolic: bp in arteries when heart is contracting (higher # - 1st heart beat is when pressure is released on bp cuff)
- diastolic: pressure in arteries when heart relaxes
- normal: 120/80 (systolic/diastolic)
- hypertension: over 90 diastolic
30
What is O2 saturation and what is the normal range?
- % measure of the amount of oxygen the blood is carrying
- normal: 95 and above
- below 90: dont treat unless orders from physician; suffer from pulmonary disease or cardiopulmonary disease
31
What are the systolic and diastolic ranges for prehypertension?
systolic: 120-130
diastolic: 80-89
32
What are the systolic and diastolic ranges for stage 1 high blood pressure?
systolic: 140-159
diastolic: 90-99
33
What are the systolic and diastolic ranges for stage 2 high blood pressure?
systolic: 160 or greater
diastolic: 100 or greater
34
What is the leading cause of death in men and women?
heart disease
35
What is the most common type of heart disease and why?
coronary artery (heart) disease b/c of obesity issue
36
What is seen in the arteries in coronary heart disease?
arteriosclerosis: hardening of arteries in the heart - plaque buildup
37
What are causes of coronary heart disease?
genetics and lifestyle
38
What are symptoms of coronary heart disease?
angina, shortness of breath, fatigue
39
What is an angioplasty?
helps with coronary artery disease
insert a balloon in artery through femoral artery
40
What are some treatment options for people with coronary artery disease?
- lifestyle changes
- lowering cholesterol- main mission
- weight reduction
- smoking cessation
- medication (pharmaceuticals)
- treatment in hospital: CABG or percutaneous coronary intervention (PCI) (aka angioplasty)
41
What is a CABG?
coronary artery bypass graft used to improve blood flow to heart
healthy vein/artery is connected to blocked artery
42
What can coronary artery disease lead to?
heart attack
43
What is the major determinate of impaired function and disability in coronary heart disease?
angina
44
How can functional impairment and disability be best determined?
based on medical history, physical exam, and exercise stress testing
45
How should the functional capacity of the individual with heart disease be described?
according to the classification of the New York Heart Association (NYHA)
46
What is the Class 1 functional capacity of an individual with heart disease?
- mild
- asymptomatic at ordinary effort level
- no limitation of physical activity
- symptoms with moderate effort
- ordinary activity does NOT result in fatigue, rapid/irregular heartbeat (palpitation) or shortness of breath (dyspnea)
47
What is the Class 2 functional capacity of an individual with heart disease?
- mild
- symptomatic w/ ordinary effort (e.g out of breath walking up stairs)
- slight limitation of physical activity; comfortable at rest
- ordinary activity results in fatigue, rapid/irregular heartbeat (palpitation) or shortness of breath (dyspnea)
48
What is the Class 3 functional capacity of an individual with heart disease?
- moderate
- symptomatic with minimal effort (eg. out of breath rolling out of bed)
- marked limitation of physical activity; comfortable at rest
- less than ordinary activity results in fatigue, rapid/irregular heartbeat (palpitation) or shortness of breath (dyspnea)
49
What is the Class 4 functional capacity of an individual with heart disease?
- severe
- symptomatic at rest (no effort)
- unable to carry out any physical activity w/o discomfort
- symptoms of fatigue, rapid/irregular heartbeat (palpitation) or shortness of breath (dyspnea) present at rest
- physical activity increases discomfort
50
In terms of coronary heart disease, what should be the main mission in all health care professionals?
primary prevention
51
What are some psychological and vocational implications of CHD/CAD
- psychosocial stress response
- depression
- type A personality
- denial
- economic loss
- reemployment: Rehab programs w/ multidisciplinary approach incorporating supervised exercise, education, nutritional and psychological counseling prove to be beneficial—improving psychological status and increasing rates of return to work.
52
What is progressive congestive heart failure (CHF)
- heart becomes weak and cant pump blood efficiently
- chambers of heart become enlarged and less efficient
- blood backs up (congests) in venous system
- tissues become overloaded (edematous)
- may see swelling in lower legs
53
What are the risk factors for congestive heart failure?
- hypertension
- previous damage to heart tissues (ie. from MI)
- valvular disease
- congenital defects
- stress
- obesity
- thyroid disease
- cardiomyopathies
54
Most patients with CHF have a past medical history of what?
hypertension
55
What is the most common cause of congestive heart failure?
coronary artery disease
56
Does congestive heart failure have a good prognosis?
no
57
American Heart Association heart failure Stage A
- at high risk for heart failure but w/o structural heart disease or symptoms of heart failure
- ex. hypertension, diabetes mellitus, CAD (port-MI or revascularization), peripheral vascular disease, CVA family history, exposure to cardiac toxins
58
American Heart Association heart failure Stage B
- has structural heart disease but w/o signs and symptoms of heart failure
- prior MI, left ventricular hypertrophy or reduced LVEF, asymptomatic valvular disease
59
American Heart Association heart failure Stage C
- has structural heart disease w/ prior or current symptoms of heart failure
- known structural heart disease and dyspnea, fatigue, reduced exercise tolerance
- NYHA class 1-4
60
American Heart Association heart failure Stage D
- has refractory heart failure requiring specialized interventions
- marked symptoms at rest despite maximal medical therapy, w/ recurrent hospitalizations
- NYHA class 3-4
61
What is a myocardial infarction?
-heart attack: occluded blood flow causing heart muscle tissue to be without oxygen
62
What is the leading cause of death in the US?
myocardial infarction
63
What is the focus for medical interventions in myocardial infarctions?
- limit damage to the heart
- relieve pain
- prevent clot formation
- improve blood flow to injured tissue
64
How long does it take for a heart muscle to heal after a MI?
- 4-8 weeks (severity dependent)
65
What are some risk factors for MI?
- high BP
- diabetes
- smoking
- sedentary lifestyle
- excessive alcohol intake
66
What are the symptoms of a MI?
chest pain, cold sweats, nausea/vomiting
67
What is a protective factor for MI?
estrogen
68
Do most people survive/recover to return to full active lives following MI?
yes
69
What are some ways to manage MI?
- aspirin
- nitroglycerin
- coronary angioplasty
- smoking cessation
- increase exercise
70
What are the 2 types of MI?
- STEMI MI
| - NSTEMI MI
71
What is a STEMI MI?
- ST segment elevated MI
- takes longer for heart to relax and repolarize
- significant damage
- affects all layers of the heart
72
What is NSEMI MI?
- non-ST elevated MI
- less damage than STEMI
- limited to 1-2 layers of the heart
73
What are the determinants of extent of damage from MI?
- location of occlusion
- length of time of occlusion
- presence of collateral circulation
74
What is the max MET levels of early activity following acute MI?
should not exceed 1-2 MET levels
75
What are the therapy contraindications for a MI?
- Active signs and symptoms of MI
- Active infection
- Acute myocarditis or pericarditis
- Digoxin toxicity
- Uncontrolled arrhythmias
- Severe CHF
- Recent pulmonary embolism
- Abnormal vital signs or blood counts*
76
What are the ADLs, IADLs, work, play, and leisure at 1-2 MET level
- ADLs: Eating seated, transfers bed->chair, washing face and hands, walking 1mph
- IADLs/work/play/leisure: Hand sewing, machine sewing, sweeping floors, driving automatic car, drawing knitting
77
What are the ADLs, IADLs, work, play, and leisure at 2-3 MET level
- ADLs: Seated sponge bath, standing sponge bath, dressing and undressing, seated warm shower, walking 2-3 MPH, wheelchair propulsion 1.2 MPH
- IADLs/work/play/leisure: Dusting, kneading dough, hand washing small items, using electric vacuum, preparing a meal, washing dishes, golfing
78
What are the ADLs, IADLs, work, play, and leisure at 3-4 MET level
- ADLs: Standing warm shower, BM on toilet, climbing stairs at 24 ft/min
- IADLs/work/play/leisure: Making a bed, sweeping, mopping, gardening
79
What are the ADLs, IADLs, work, play, and leisure at 4-5 MET level
- ADLs: Hot shower, BM on bedpan, sexual intercourse
| - IADLs/work/play/leisure: Changing bed linen, gardening, raking, weeding, roller skating, swimming 20 yards/min
80
What are the ADLs, IADLs, work, play, and leisure at 5-6 MET level
- ADLs: Sexual intercourse, walking up stairs 30 feet/min
| - IADLs/work/play/leisure: Biking 10 mph on level ground
81
What are the ADLs, IADLs, work, play, and leisure at 6-7 MET level
- ADLs: Walking with braces and crutches
- IADLs/work/play/leisure: Swimming breaststroke, skiing, playing basketball, walking 5 mph, shoveling snow, spading soil
82
What is hypertension?
- high bp
| - persistently above 140/90
83
What causes secondary hypertension?
coexisting condition
84
In which population is hypertension most prevalent?
African American women
85
What are the symptoms of hypertension?
asymptomatic
86
What may be damage from hypertension?
kidneys
heart
87
What may help control hypertension?
- medications
- lifestyle changes
- diuretics
88
What are arrhythmias?
Irregularity in rate/rhythm due to conduction disturbance
may be benign or serious
89
What are the causes of arrhythmias?
- Drug toxicity
- Electrolyte imbalance
- Heart disease, hypertension
- Acid-base imbalance
- Congenital defects
- Connective tissue disorders (i.e. Marfan Syndrome)
90
What initiates the heart's electrical conduction and is considered the natural pacemaker of the heart?
SA node
91
Where do impulses travel from the SA node?
to the AV node and ultimately the purkinje fibers of the ventricles
92
Where do conduction problems that cause arrhythmias occur?
anywhere along route
93
How are arrhythmias categorized?
by where problem originates, the rate, and the regularity
94
What is asystole?
absence of any cardiac activity
results in death
95
What is fibrillation?
uncoordinated, extremely rapid and irregular contraction of the atria or ventricles
96
What is atrial fibrillation?
-one of the most common arrhythmias
-HR can be as high as 350-600 bpm
-Can be a chronic condition- treat w/ meds or shock to return normal rhythm
-If cleared for therapy:
Determine activity parameters/precautions, Monitor patient’s tolerance to activity, Modify treatment sessions prn
97
What is atrial flutter?
- rapid, irregular HR
- Distinctive saw tooth pattern on EKG
- Treated with medication and/or atrial pacing or cardioversion
- Potential issue after cardiac surgery or MI
98
What are premature ventricular contractions (PVCs)?
- irregular rhythm but normal HR 60-100 bpm)
| - may be triggered by stress, caffiene, smoking, digitalis toxicity, heart disease, MI
99
What is ventricular tachycardia?
- HR > 100 bpm
- defer therapy (pt medically unstable)
- can be caused by heart disease or acute MI
100
What is ventricular fibrillation?
- ventricle doesn’t contract, may just be fluttering
| - serious condition that could lead to cardiac arrest or sudden cardiac death
101
What are the normal HR at the SA node, AV node, and ventricular HR?
- SA node: 60-100bpm
- AV node: 40-60bpm
- ventricular HR: 20-40bpm
102
What are the HR ranges for supraventricular tachycardia, atrial flutter, and atrial fibrilation?
- supraventricular tachycardia: 150-250bpm
- atrial flutter: 250-350bpm
- atrial fibrillation: >350 irregular bpm
103
What is valvular disease?
- Stenosis of the valves: Poor blood flow due to narrowing
- Regurgitation occurs: Leakage (backflow) due to poor valve closure
- Prolapse: Affects the mitral valve cusps (mitral valve prolapse); Leaflets bulge into the left atrium; Usually not problematic, but can lead to more serious issues such as regurgitation
104
What are the causes of valvular disease?
- Endocarditis: Bacterial infection of the endocardium and valves
- Rheumatic Fever: affects connective tissues of body- can affect heart, joints. May start as strep throat. Usually happens in young kids- teen years
- Congenital Heart Disease
- Cardiomyopathy: Group of diseases of the myocardium
- Aortic Root Dilation: Aneurysm
- Atherosclerotic Heart Disease
- Connective Tissue Disorders: Marfan Syndrome
105
What may cause a risk for valvular disease causes?
heart conditions or risk factors like heart disease, high bp, smoking, obesity, diabetes, etc
106
What kind of congenital heart defects are commonly seen?
- atrial septal defect
- coarctation of the aorta
- patent ductus arteriosus (PDA)
- transposition of the great arteries
- tetralogy of fallot
107
What is an atrial septal defect?
- Opening in the septum between then left and right atrium
- Associated with Down syndrome
- May cause right side heart enlargement
- Can also have ventricular septal defect
108
What is coarctation of the aorta?
- Narrowing of the aorta
- Associated w/ aortic valve abnormalities
- Associated w/ Turner Syndrome: aka gonadal disgenetis- includes several conditions in women in which theres an absence in an entire sex chromosome on the X chromosome
- May limit blood flow to the extremities
109
What can coarctation of the aorta lead to?
ventricular hypertrophy (enlargement-muscle thickens) and proximal aorta dilation
110
What is patent ductus arteriosus (PDA)?
- Ductus arteriosus normally closes after birth
- In PDA, duct remains open
- Allows continuous left to right flow of blood
111
What can PDA lead to?
Can cause hypertrophy of the left ventricle, chronic pulmonary artery hypertension, or heart failure
112
What is transposition of the great arteries?
- aka cyanotic heart defect b/c of decrease blood pumping to rest of body
- Symptoms: shortness of breath, blueish skin, clubbing of finger and toes
- Risk factors: moms over 40, alcoholism, diabetes, viral illnesses during pregnancy
113
What is tetralogy of fallot?
- multiple defects (People are born with 4 heart defect)
- 1. Pulmonary trunk too narrow and pulmonary valve (artery) stenosed results in:
- 2. Hypertrophied right ventricle
- 3. Ventricular septal defect
- 4. Aorta opens from both ventricles
- Right and left ventricles thicken
- Baby is cyanotic within minutes of birth
- Mix of oxygenated and unoxygenated blood
- Can be corrected with surgery
114
What is chronic obstructive pulmonary disease (COPD)?
- Lung diseases characterized by airflow obstruction that interferes with normal breathing
- Progressive; increased difficulty breathing
- Most common: emphysema / chronic bronchitis
115
What is the leading cause of COPD?
cigarette smoking
116
Who does COPD affect the most?
- chronic bronchitis affects aged 65 and older more often
- both emphysema and chronic bronchitis are more common in women
- more prevalent in smokers
117
What are the symptoms of COPD?
- chronic cough
- dyspnea
- wheezing
- chest tightness
- cyanosis
118
How can COPD be managed?
- spirometry test
- lifestyle changes
- CT scan
- smoking cessation
- inhalers
- antibiotics
- lung volume reduction surgery / transplant
119
What is the most common pulmonary disease and the 3rd leading cause of death in the US?
COPD
120
What is bronchiectasis?
a type of chronic obstructive lung disease
121
What is used in a medical evaluation and disability assessment for COPD?
- complete history
| - chest x-ray and diagnostic including pulmonary function tests (PFTs)
122
What is Global Initiative for Chronic Obstructive Lung Disease (GOLD)?
Classification of COPD severity
123
What is the lung function and symptoms for each stage of the GOLD classification?
- stage 1 (mild): FEV1 >80%; FEV1/FVC <0.7; symptoms: w/ or w/o cough, sputum
- stage 2 (moderate): FEV1 50-80%; FEV1/FVC <0.7; symptoms: w/ or w/o cough, sputum, dyspnea
- stage 3 (severe): FEV1 30-50%; FEV1/FVC <0.7; symptoms: w/ or w/o cough, sputum, dyspnea
- stage 4 (very severe): FEV1 <30%; FEV1/FVC <0.7; symptoms: respiratory or right heart failure
124
Describe dyspnea (shortness of breath) in terms of pulmonary disorder?
- symptom
| - Severely affects occupational performance, daily activities, quality of life
125
Dyspnea grade scale
- 0: degree-none; describes being breathless only w/ strenuous exercise
- 1: degree-slight; describes shortness of breath when hurrying on level ground or walking up slight hill
- 2: degree-moderate/mod severe; describes on level ground, walk slower then people of the same age b/c of SOB, or having to stop for breath when walking at own pace
- 3: degree-severe; describes stopping for breath after walking ~100yds or after a few minutes on level ground
- 4: degree- very severe; describes being too breathless to leave house or even dress.
126
What is bronchitis COPD characterized by?
- chronic cough
- sputum production
- hypoxia (the body or a region of the body is deprived of adequate oxygen supply at the tissue level.)
- hypercapnic (elevated CO2)
- patients look cyanotic
127
What is emphysema COPD characterized by?
- less cough and sputum production
- less hypoxic
- less hypercapnic
- greater loss of alveoli (decreased elastic recoil of the lungs, resulting in greater hyperinflation
128
What are some COPD intervention strategies?
- pharmacological regime
- may be on Oxygen therapy (do not make O₂ changes without medical consult!)
- encourage pt. to receive influenza and pneumococcal vaccinations
- chest PT
- pulmonary rehabilitation
- nutritional counseling
- exercise
129
What does pulmonary rehab assist with?
- Fatigue
- Anxiety
- Breathing
- Activity tolerance
- Confidence
- Independence
130
What is an OTs overall goal in pulmonary rehab?
- enable participation in all occupations
- Patient-family education
- Psychosocial support
- Quality of life
131
What types of goals may an OT develop for pulmonary rehab?
- Patient education re disease process
- Activity tolerance – graded activities
- Occupation prioritizing
- Instruction in dyspnea relief strategies
132
What is cystic fibrosis?
- Chromosome (gene) mutation, inherited
- Body produces thick sticky mucus in the lungs and blocks pancreas which stops the body from properly absorbing food- malnourished, weaker immune system. May impact liver and cause cirrhosis
- Avg. life expectancy 32 years
- Results in airway dehydration
133
What could airway dehydration cause in those with cystic fibrosis?
- Produces thick mucous
- Adheres to airway surfaces
- Leads to infection, inflammation, obstruction
- Multiple hospitalizations for exacerbation of symptoms very common
- Multi organ system involvement
134
What is cystic fibrosis characterized by?
recurrent respiratory tract infections and progressive respiratory insufficiency
135
What does cystic fibrosis affect in cells?
- the mechanism by which sodium and chloride pass out of cells, producing thick mucus secretions that obstructs passages
- leads to infection and destruction of tissue and mucus clogging bronchioles
136
What characterizes the functional disability aspect of cystic fibrosis?
- Recurrent respiratory tract infection
- chronic cough with wheezing
- dyspnea
- recurrent bronchitis, pneumonia, sinusitis, hemoptysis, and bronchiectasis
- multiple organ involvement can lead to other issues
137
What is the medical evaluation used for cystic fibrosis?
Sweat test: measures amount of salt in sweat and helps diagnose CF, people w/ CF have 2-5x more sodium in their sweat
138
What is the treatment used for cystic fibrosis?
Chest physiotherapy / medication / exercise
139
What is asthma characterized by?
- marked reversibility of airway obstruction and bronchial hyperactivity
- Allergic (extrinsic asthma)
- Nonallergic (intrinsic) asthma
- shortness of breath and wheezing, often accompanied by cough and mucus production
140
Mechanisms of an asthma attack
- Constriction of the bronchial smooth muscle lining the RT
- Excessive mucous production plugs small airways obstructing airflow
- severe attacks can lead to respiratory arrest
141
Types of asthma
Reactive airways dysfunction syndrome (RADS)
irritant-induced asthma (IIA)
142
What is recorded in a medical evaluation for asthma?
- Complete history
- Laboratory evaluation for cystic fibrosis (CF)
- Psychological evaluation
- PFTs
- The AMA Guides to the Evaluation of Permanent Impairment 2008
143
Treatments for asthma
Inhalers
Pills
OT: managing and working around it during ADLs
144
Vocational Implications for asthma
Avoid irritants
Vocational modification or rehabilitation
145
What are the 3 graft sites for a CABG
saphenous vein from leg
radial artery from the arm
internal mammary artery from the chest wall
146
What is a bypass pump?
- also called heart-lung machine
- Does the work of the heart and the lungs when the heart is stopped for a surgical procedure to maintain blood circulation and oxygen content of the body
- may be used in a CABG
147
What does a CABG off-pump do?
Slows heart rate and surgeons developed ways to stabilize a beating heart
148
Where are the CABG incisions located?
- minimally invasive: 2-3in incision in chest wall between ribs
- traditional CABG: 6-8in incision made down center of sternum
149
Purpose of precautions following CABG
- used to help protect sternum
- to prevent the sternum from coming apart from an injury
- prevent pain and bleeding
150
Sternal precautions include..
- Limit horizontal abduction/Limit bilateral arm extension
- No lifting greater than 10lbs
- Hold a pillow when moving, sneezing or coughing
151
What are parameters vital signs?
MD may specify certain parameters for BP or HR during activity (IE no activity is BP is >180/100)
152
How do you calculate how much 02 is left in an O2 tank?
- Minutes remaining = PSIG x F/ LPM
- PSIG = pounds per square inch gauge
- F = factor
- LPM = liters per min (Rx)
-So, if there's 400 PSIG left in an E tank (.28 factor) and the patient is on 4 LPM
(400 * 0.28)/4= 28 minutes of O2 remaining in the tank
