Cardiopulmonary: Study Set 1 Flashcards
What are the general types of airway clearance techniques
Breathing strategies, manual and mechanical techniques, and postural drainage.
What are the indications for airway clearance
- Retained secretions in central airways
- Prophylaxis against post op complications
- Obtaining sputum for dx
- Difficulty clearing secretions
- Atelectasis caused by mucous plugging
What is atelectasis
collapse or partial collapse of the lung
What are the three phases of the ACB (active cycle of breathing)
Breathing control, thoracic expansion exercises, and forced expiratory technique.
What is an ABI and what is it used for?
An ABI compares systolic BP at the ankle and arm to check for peripheral artery disease
How is ABI taken and calculated?
An ABI measurement is done by taking the systolic BP of the brachial arteries bilaterally with a sphygmomanometer and tibialis posterior arteries bilaterally with a doppler ultrasound device
It is then calculated by dividing the highest ankle BP by the highest brachial BP
What ABI measurement is normal with no blockage
1.0-1.40
What is the ABI measurement of rigid arteries that require an additional ultrasound test to check for PAD
Greater than 1.40
What is the ABI measurement of mild blockage which could be the beginning of PAD
0.8 - 0.99
What is the ABI measurement of moderate blockage which could be associated with intermittent claudication during exercise
0.4 -0.79
What is the ABI measurement of severe blockage suggesting severe PAD and could cause claudication pain at rest
Less than 0.4
What is intermittent claudication
Pain felt in the calf with exercise and is relieved with rest
What is a contraindication of measuring ABI
deep vein thrombosis
When measuring arterial blood gas (ABG), what does pH stand for and what does its measurement indicate?
pH stands for potential hydrogen and it evaluates acid-base status. The balance of pH is dependent on PaCO2.
When measuring arterial blood gas (ABG), what does PaCO2 stand for and what does its measurement indicate?
PaCO2 stands for the partial pressure of Carbon Dioxide in arterial blood and it provides information regarding how well the lungs are able to remove carbon dioxide. Changes of PaCO2 directly affect the pH.
When measuring arterial blood gas (ABG), what does PaO2 stand for and what does its measurement indicate?
PaO2 is the partial pressure of oxygen in arterial blood and it provides information in combination with SaO2 (hemoglobin) about how well the lungs are functioning to oxygenate the blood.
When measuring arterial blood gas (ABG), what does HCO3- stand for and what does its measurement indicate?
HCO3- is bicarbonate and it plays a role in the chemical buffering system that keeps the blood from acidic or basic and is often part of an ABG test
When measuring arterial blood gas (ABG), what does SaO2 stand for and what does its measurement indicate?
SaO2 is the partial pressure of hemoglobin and it provides information in combination with PaO2 about how well the lungs are functioning to oxygenate the blood
In regards of ABG, what is the normal range of pH
7.35-7.45
In regards of ABG, what is the normal range of PaCO2
35-45 mm Hg
In regards of ABG, what is the normal range of PaO2
80-100 mm Hg
In regards of ABG, what is the normal range of HCO3-
22-25 mEq/L
In regards of ABG, what is the normal range of SaO2
95-98%
What is the correct order that ABG is written or spoken
pH/PaCO2/PaO2/HCO3-
What is acidemia
elevated acidity; pH less than 7.35
What is alkalemia
decreased acidity; pH greater than 7.45
What is Eucapnia
Normal levels of CO2 in arterial blood (PaCO2 of 35-45)
What is hypercapnia
elevated levels of CO2 in arterial blood (PaCO2 greater than 45)
What is hypocapnia
low levels of CO2 in arterial blood; PaCo2 less than 35
What is hypoxemia
low levels of O2 in the blood; PaO2 less than 80
What is mild hypoxemia
PaO2 of 60-79
What is moderate hypoxemia
40-59 PaO2
What is severe hypoxemia
PaO2 less than 40
What is hypoxia
low less of O2 despite adequate perfusion of the tissue
The ____ filter the amount of carbon dioxide in the blood, and the ____ filter the amount of bicarbonate
lungs; kidneys
Where is the apex of the heart located
At the lowest part of the heart which is formed by the inferolateral part of the left ventricle
Where is the base of the heart located?
The right and left atriums and up
What are the layers of the heart from deep to superficial
Endocardium surrounds interior of chambers and valves
Myocardium is the middle thick layer that is the bulk
Epicardium that contains coronary arteries and veins, autonomic nerves, and lymphatics
Pericardium is made up of the three layers above the
True or False:
The aorta is the body’s largest artery
True
What is the role of the inferior vena cava
Returns venous blood from the lower body to the right atrium
What is the role of the pulmonary arteries
These arteries carry deoxygenated blood from the right ventricle to the left and right lungs
What is the role of the pulmonary veins
These veins carry oxygenated blood from the right and left lungs to the left atrium
What is the role of the superior vena cava
Returns venous blood from the head, neck, and arms to the right atrium
What is the order of blood flow
- Vena cavas
- Right atrium
- Tricuspid valve
- Right ventricle
- Pulmonary valve
- Pulmonary arteries
- Lungs
- Pulmonary veins
- Left atrium
- Mitral/bicuspid valve
- left ventricle
- aortic semilunar valve
- Aorta out to body
What supplies the myocardium with blood
The right and left coronary arteries that come from the ascending aorta
What is the considered to be the normal pacemaker of the heart
SA node
What is the order of conduction in the heart
The SA node sends a signal and the atrial wall contract, then the signal is sent to the AV node and onto the bundle of HIS where the signal splits into two paths to right the purkinje fibers on the left and right ventricles, causing the ventricular walls to contract
What is the chronotropic effect and what is the inotropic effect
Both are influenced by the sympathetic system in which a release of epinephrine and norepinephrine will cause the chambers of the heart to beat faster (chronotropic effect) and the chambers of the heart to also beat harder (Inotropic effect)
What is the sympathetic influence on the heart and its innervation
The release of its neurotransmitters will make the heart beat faster and harder which is the chronotropic and inotropic effects respectively
What is the parasympathetic influence on the heart and its innervation
The vagus nerve releases acetylcholine which will slow the heart rate (chronotropic effect) primarily done through the SA node
Discuss how the parasympathetic nervous system and sympathetic nervous system play a role in the innervation of the heart.
The sympathetic nervous system will release epinephrine and norepinephrine which will cause the heart to beat faster and contract stronger. The parasympathetic nervous system will release acetylcholine from the vagus nerve, which will tell the SA node to slow the heart rate down.
What is the baroreceptor reflex
There are mechanoreceptors in the heart called baroreceptors that detect changes in the pressure as a direct response of the sympathetic and parasympathetic innervation system. The high BP detector baroreceptors are the arterial baroreceptors, and the low bp detector baroreceptors are the cardiopulmonary receptors
What is the bainbridge reflex
Increased heart rate due to increased venous return in the right atrium with inhibition of the parasympathetic nervous system.
What is the chemoreceptor reflex
There are chemosensitive cells that detect changes of pH and O2 stats. During acidosis, the chemoreceptors stimulate respiratory centers and increase rate and depth of ventilation
If a patient is experiencing persistent hypoxia, is there sympathetic or parasympathetic nervous system going to increase in activity
The sympathetic system will increase due to CNS overstimulation
What is the valsalva maneuver
Forced expiration against a closed glottis which increases intrathoracic pressure and decreases venous return. This will causes BP to be decreases which will then be sensed by baroceptors which will further kick on the sympathetic system to increase heart rate.
What happens when the glottis finally opens up after a valsalva maneuver is performed
Because of the decrease in BP while the glottis is closed, when it opens venous return and BP will be increased. Which will be detected by the baroreceptors and the parasympathetic nervous system will be kicked on to lower heart rate
True or False:
Preload refers to the tension in the atrial walls at the end of diastole and reflects the venous filling pressure that filles the left atrium during diastole
False:
Ventricular walls, and left ventricle
What is the definition and normal values of stroke volume
Stroke volume refers to the volume of blood ejected by each contraction of the left ventricle.
Normal SV range from 60 to 80 ml
What is the definition of cardiac output and what are the normal values of CO
Cardiac output is the amount of blood pumped from either the left or right ventricles in one minute. CO = HR x SV (stroke volume)
Normal CO for males is 4.5 - 5.0 L/min, females are slightly less
Normal CO levels during exercise can increase to 25 L/min
What is the definition of venous return and what are the normal values of venous return
Venous return is the amount of blood returned to the right atrium every minute.
Normal values of venous return must equal CO when averaged over time
What is the normal blood volume of an adult
between 4.5 and 5.0 L, with women’s being slightly less then men
What is hypovolemia and what can it be caused by
Decreased blood volume. This can be caused by bleeding, dehydration from vomiting, diarrhea, sweating, severe burns, and HTN medications
What are signs and symptoms of hypovolemia
orthostatic hypotension, tachycardia, and elevated body temperature
What can cause hypervolemia
Excess take of fluids through IV or blood transfusion, sodium/fluid retention
What are signs and symptoms of hypervolemia
Swollen legs, ascites (fluid in the abdomen, and fluid in the lungs
Plasma makes up more than half of the total blood volume. What is plasma made up of
water, electrolytes, and proteins
What happens if the amount of red blood cells in the plasma is too high or too low
Too low of RBC will result in fatigue and weakness from anemia
Too high of RBC will thicken the blood and increase the risk of stroke or heart attack
What is thrombocytopenia
too low of blood platelets that increase the risk of bleeding too much and bruising
What is thrombocythemia
Too high of platelets increases the risk of thrombosis which can result in stroke or heart attack
What is the role of white blood cells
to protect against infection
What are the five main types of white blood cells and their function/roles
neutrophils - clean up debris and bacteria
lymphocytes - protect against viral infections and produce antibodies
monocytes - ingest dead and damaged cells
eosinophils - kill parasites and are involved in allergic responses
basophils - participate in allergic responses
What is the trendelenburg position in regards to airway clearance
patient in supine with the head of the bed tilted down
What are the contraindications for trendelenburg airway clearance
Increased intracranial pressure >20
Esophageal sx
Tube feeding/uncontrolled airway
What is the postural drainage position and where is percussion performed for the right and left upper apical segments of the lungs
Patient is sitting leaning back 30-40 degrees
Percussion is performed above the clavicles
What is the postural drainage position and where is percussion performed for the right upper posterior segment
Patient 1/4 from prone on left side with head and shoulders raised
Percussion is performed around the medial border of the right scapula
What is the postural drainage position and where is percussion performed for the left upper posterior segment
Patient 1/4 from prone of right side
What is the postural drainage position and where is percussion performed for the lingula left upper lobe
Patient is 1/4 from supine on right side, feet elevated 12 inches
percussion is performed between left nipple and left axilla
What is the postural drainage position and where is percussion performed for the anterior segments right and left upper lobes
Patient is supine with level bed
percussion is performed below the clavicle
What is the postural drainage position and where is percussion performed for the right middle lobe
Patient is 1/4 from supine on left side with foot of bed elevated 12 inches
percussion is performed between the right nipple and axilla
What is the postural drainage position and where is percussion performed for the superior segments left and right lower lobs
Patient is prone with bed level
Percussion is performed below the inferior border of the left and right scapulas
What is the postural drainage position and where is percussion performed for the anterior basal segments left and right lower lobes
Patient supine with foot of bed elevated 18 inches
Percussion performed over the lower ribs on the left and right side
What is the postural drainage position and where is percussion performed for the posterior basal segments of the left and right lower lobes
patient prone with foot of bed elevated 18 inch
percussion performed over the lover ribs bilaterally
What is the postural drainage position and where is percussion performed for the lateral basal segments of the lower lobes
Patient is SL with foot of bed elevated 18 inches.
Percussion performed over lower ribs (percussion performed on left side to drain right side and visa versa.)
Which artery is used to take blood pressure
brachial artery
If a blood pressure cuff is too tight, will the blood pressure reading be too high or too low
Too high
What are the readings for the following blood pressure classifications
- Normal
- Elevated
- Stage 1 HTN
- Stage 2 HTN
- Hypertensive crisis
Normal: Less than 120 and less than 80
Elevated: 120-129 and less than 80
Stage 1: 130-139 and/or 80-89
Stage 2: 140+ and/or 90+
Hypertensive crisis: 180+ and/or 120+
What is the S4 heart sound associated with
hypertension or stenosis
Which ribs are considered to be true ribs, false ribs, and floating ribs
true ribs are 1-7
false ribs are 8-10
floating ribs are 11 and 12
What are the primary muscles of inspiration
diaphragm and external intercostals
How are the intercostal muscles directionally oriented
obliquely upward and backward from the upper border of one rib to the lower border of the rib above
If a patient is said to be using their accessory muscles to breath, what muscles are activating
SCM, scalenes, pecs, serratus anterior
What muscles are activating during forceful expiration
internal and external obliques, transverse abdominis, and rectus abdominis
What structures make up the upper respiratory tract
nasal cavity, pharynx, and larynx
What structures make up the lower respiratory tract
from the larynx down to the alveoli
How many lobes do the right and left lungs have
right has three, left has two
what nerve innervates the lungs
vagus
