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NPTE Exam > Cardiopulmonary: Study Set 1 > Flashcards

Cardiopulmonary: Study Set 1 Flashcards

1
Q

What are the general types of airway clearance techniques

A

Breathing strategies, manual and mechanical techniques, and postural drainage.

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2
Q

What are the indications for airway clearance

A
  1. Retained secretions in central airways
  2. Prophylaxis against post op complications
  3. Obtaining sputum for dx
  4. Difficulty clearing secretions
  5. Atelectasis caused by mucous plugging
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3
Q

What is atelectasis

A

collapse or partial collapse of the lung

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4
Q

What are the three phases of the ACB (active cycle of breathing)

A

Breathing control, thoracic expansion exercises, and forced expiratory technique.

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5
Q

What is an ABI and what is it used for?

A

An ABI compares systolic BP at the ankle and arm to check for peripheral artery disease

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6
Q

How is ABI taken and calculated?

A

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

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7
Q

What ABI measurement is normal with no blockage

A

1.0-1.40

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8
Q

What is the ABI measurement of rigid arteries that require an additional ultrasound test to check for PAD

A

Greater than 1.40

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9
Q

What is the ABI measurement of mild blockage which could be the beginning of PAD

A

0.8 - 0.99

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10
Q

What is the ABI measurement of moderate blockage which could be associated with intermittent claudication during exercise

A

0.4 -0.79

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11
Q

What is the ABI measurement of severe blockage suggesting severe PAD and could cause claudication pain at rest

A

Less than 0.4

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12
Q

What is intermittent claudication

A

Pain felt in the calf with exercise and is relieved with rest

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13
Q

What is a contraindication of measuring ABI

A

deep vein thrombosis

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14
Q

When measuring arterial blood gas (ABG), what does pH stand for and what does its measurement indicate?

A

pH stands for potential hydrogen and it evaluates acid-base status. The balance of pH is dependent on PaCO2.

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15
Q

When measuring arterial blood gas (ABG), what does PaCO2 stand for and what does its measurement indicate?

A

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.

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16
Q

When measuring arterial blood gas (ABG), what does PaO2 stand for and what does its measurement indicate?

A

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.

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17
Q

When measuring arterial blood gas (ABG), what does HCO3- stand for and what does its measurement indicate?

A

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

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18
Q

When measuring arterial blood gas (ABG), what does SaO2 stand for and what does its measurement indicate?

A

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

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19
Q

In regards of ABG, what is the normal range of pH

A

7.35-7.45

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20
Q

In regards of ABG, what is the normal range of PaCO2

A

35-45 mm Hg

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21
Q

In regards of ABG, what is the normal range of PaO2

A

80-100 mm Hg

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22
Q

In regards of ABG, what is the normal range of HCO3-

A

22-25 mEq/L

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23
Q

In regards of ABG, what is the normal range of SaO2

A

95-98%

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24
Q

What is the correct order that ABG is written or spoken

A

pH/PaCO2/PaO2/HCO3-

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25
Q

What is acidemia

A

elevated acidity; pH less than 7.35

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26
Q

What is alkalemia

A

decreased acidity; pH greater than 7.45

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27
Q

What is Eucapnia

A

Normal levels of CO2 in arterial blood (PaCO2 of 35-45)

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28
Q

What is hypercapnia

A

elevated levels of CO2 in arterial blood (PaCO2 greater than 45)

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29
Q

What is hypocapnia

A

low levels of CO2 in arterial blood; PaCo2 less than 35

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30
Q

What is hypoxemia

A

low levels of O2 in the blood; PaO2 less than 80

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31
Q

What is mild hypoxemia

A

PaO2 of 60-79

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32
Q

What is moderate hypoxemia

A

40-59 PaO2

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33
Q

What is severe hypoxemia

A

PaO2 less than 40

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34
Q

What is hypoxia

A

low less of O2 despite adequate perfusion of the tissue

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35
Q

The ____ filter the amount of carbon dioxide in the blood, and the ____ filter the amount of bicarbonate

A

lungs; kidneys

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36
Q

Where is the apex of the heart located

A

At the lowest part of the heart which is formed by the inferolateral part of the left ventricle

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37
Q

Where is the base of the heart located?

A

The right and left atriums and up

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38
Q

What are the layers of the heart from deep to superficial

A

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

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39
Q

True or False:

The aorta is the body’s largest artery

A

True

40
Q

What is the role of the inferior vena cava

A

Returns venous blood from the lower body to the right atrium

41
Q

What is the role of the pulmonary arteries

A

These arteries carry deoxygenated blood from the right ventricle to the left and right lungs

42
Q

What is the role of the pulmonary veins

A

These veins carry oxygenated blood from the right and left lungs to the left atrium

43
Q

What is the role of the superior vena cava

A

Returns venous blood from the head, neck, and arms to the right atrium

44
Q

What is the order of blood flow

A
  1. Vena cavas
  2. Right atrium
  3. Tricuspid valve
  4. Right ventricle
  5. Pulmonary valve
  6. Pulmonary arteries
  7. Lungs
  8. Pulmonary veins
  9. Left atrium
  10. Mitral/bicuspid valve
  11. left ventricle
  12. aortic semilunar valve
  13. Aorta out to body
45
Q

What supplies the myocardium with blood

A

The right and left coronary arteries that come from the ascending aorta

46
Q

What is the considered to be the normal pacemaker of the heart

A

SA node

47
Q

What is the order of conduction in the heart

A

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

48
Q

What is the chronotropic effect and what is the inotropic effect

A

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)

49
Q

What is the sympathetic influence on the heart and its innervation

A

The release of its neurotransmitters will make the heart beat faster and harder which is the chronotropic and inotropic effects respectively

50
Q

What is the parasympathetic influence on the heart and its innervation

A

The vagus nerve releases acetylcholine which will slow the heart rate (chronotropic effect) primarily done through the SA node

51
Q

Discuss how the parasympathetic nervous system and sympathetic nervous system play a role in the innervation of the heart.

A

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.

52
Q

What is the baroreceptor reflex

A

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

53
Q

What is the bainbridge reflex

A

Increased heart rate due to increased venous return in the right atrium with inhibition of the parasympathetic nervous system.

54
Q

What is the chemoreceptor reflex

A

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

55
Q

If a patient is experiencing persistent hypoxia, is there sympathetic or parasympathetic nervous system going to increase in activity

A

The sympathetic system will increase due to CNS overstimulation

56
Q

What is the valsalva maneuver

A

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.

57
Q

What happens when the glottis finally opens up after a valsalva maneuver is performed

A

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

58
Q

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

A

False:

Ventricular walls, and left ventricle

59
Q

What is the definition and normal values of stroke volume

A

Stroke volume refers to the volume of blood ejected by each contraction of the left ventricle.

Normal SV range from 60 to 80 ml

60
Q

What is the definition of cardiac output and what are the normal values of CO

A

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

61
Q

What is the definition of venous return and what are the normal values of venous return

A

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

62
Q

What is the normal blood volume of an adult

A

between 4.5 and 5.0 L, with women’s being slightly less then men

63
Q

What is hypovolemia and what can it be caused by

A

Decreased blood volume. This can be caused by bleeding, dehydration from vomiting, diarrhea, sweating, severe burns, and HTN medications

64
Q

What are signs and symptoms of hypovolemia

A

orthostatic hypotension, tachycardia, and elevated body temperature

65
Q

What can cause hypervolemia

A

Excess take of fluids through IV or blood transfusion, sodium/fluid retention

66
Q

What are signs and symptoms of hypervolemia

A

Swollen legs, ascites (fluid in the abdomen, and fluid in the lungs

67
Q

Plasma makes up more than half of the total blood volume. What is plasma made up of

A

water, electrolytes, and proteins

68
Q

What happens if the amount of red blood cells in the plasma is too high or too low

A

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

69
Q

What is thrombocytopenia

A

too low of blood platelets that increase the risk of bleeding too much and bruising

70
Q

What is thrombocythemia

A

Too high of platelets increases the risk of thrombosis which can result in stroke or heart attack

71
Q

What is the role of white blood cells

A

to protect against infection

72
Q

What are the five main types of white blood cells and their function/roles

A

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

73
Q

What is the trendelenburg position in regards to airway clearance

A

patient in supine with the head of the bed tilted down

74
Q

What are the contraindications for trendelenburg airway clearance

A

Increased intracranial pressure >20
Esophageal sx
Tube feeding/uncontrolled airway

75
Q

What is the postural drainage position and where is percussion performed for the right and left upper apical segments of the lungs

A

Patient is sitting leaning back 30-40 degrees

Percussion is performed above the clavicles

76
Q

What is the postural drainage position and where is percussion performed for the right upper posterior segment

A

Patient 1/4 from prone on left side with head and shoulders raised

Percussion is performed around the medial border of the right scapula

77
Q

What is the postural drainage position and where is percussion performed for the left upper posterior segment

A

Patient 1/4 from prone of right side

78
Q

What is the postural drainage position and where is percussion performed for the lingula left upper lobe

A

Patient is 1/4 from supine on right side, feet elevated 12 inches

percussion is performed between left nipple and left axilla

79
Q

What is the postural drainage position and where is percussion performed for the anterior segments right and left upper lobes

A

Patient is supine with level bed

percussion is performed below the clavicle

80
Q

What is the postural drainage position and where is percussion performed for the right middle lobe

A

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

81
Q

What is the postural drainage position and where is percussion performed for the superior segments left and right lower lobs

A

Patient is prone with bed level

Percussion is performed below the inferior border of the left and right scapulas

82
Q

What is the postural drainage position and where is percussion performed for the anterior basal segments left and right lower lobes

A

Patient supine with foot of bed elevated 18 inches

Percussion performed over the lower ribs on the left and right side

83
Q

What is the postural drainage position and where is percussion performed for the posterior basal segments of the left and right lower lobes

A

patient prone with foot of bed elevated 18 inch

percussion performed over the lover ribs bilaterally

84
Q

What is the postural drainage position and where is percussion performed for the lateral basal segments of the lower lobes

A

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.)

85
Q

Which artery is used to take blood pressure

A

brachial artery

86
Q

If a blood pressure cuff is too tight, will the blood pressure reading be too high or too low

A

Too high

87
Q

What are the readings for the following blood pressure classifications

  1. Normal
  2. Elevated
  3. Stage 1 HTN
  4. Stage 2 HTN
  5. Hypertensive crisis
A

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+

88
Q

What is the S4 heart sound associated with

A

hypertension or stenosis

89
Q

Which ribs are considered to be true ribs, false ribs, and floating ribs

A

true ribs are 1-7
false ribs are 8-10
floating ribs are 11 and 12

90
Q

What are the primary muscles of inspiration

A

diaphragm and external intercostals

91
Q

How are the intercostal muscles directionally oriented

A

obliquely upward and backward from the upper border of one rib to the lower border of the rib above

92
Q

If a patient is said to be using their accessory muscles to breath, what muscles are activating

A

SCM, scalenes, pecs, serratus anterior

93
Q

What muscles are activating during forceful expiration

A

internal and external obliques, transverse abdominis, and rectus abdominis

94
Q

What structures make up the upper respiratory tract

A

nasal cavity, pharynx, and larynx

95
Q

What structures make up the lower respiratory tract

A

from the larynx down to the alveoli

96
Q

How many lobes do the right and left lungs have

A

right has three, left has two

97
Q

what nerve innervates the lungs

A

vagus

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