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Board exam review > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

what anatomical landmark is the apex of the heart found at ?

A

Intercostal space of the 5th rib and Left mid clavicular line
Apex is the lowest part of the heart formed by the inferolateral part of the left ventricle. It projects anteriorly

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2
Q

What is the base considered to be in the heart ? what anatomical landmark is it at?

A

the upper border of the heart, involves the left atrium part of the righr atrium and proximal portion of the great vessels
2nd rib space

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3
Q

what is the endocardium, epicardium, pericardium and myocardium

A

endocardium - Lines the interior of the heart chambers and valves
epicardium- serous layer of the pericardium. Contains the epicardial coronary arteries and veins, autonomic nerves, and lymphatics
pericardium - Double walled connective tissue sack that surrounds the outside of the heart and great vessels
myocardium- Makes up the majority of the heart wall. Made up of thick contract tail Lair made up of muscle cells

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4
Q

What is the aorta and its anatomical pathway?

A

The aorta is the largest artery in the body.
Starts at the upper left ventricle, ascends and goes backward and left arch of aorta)
Then descends to the thorax to become the thoracic aorta, then passes to the abdominal cavity to become the abdominal aorta

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5
Q

What are The inferior and superior vena cava

A

suppioer vena cava- Returns blood from the head neck arms to the right atrium
Inferior vena cava- Returns blood from the lower body viscera to the right atrium

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6
Q

What are the pulmonary veins and artery?

A

Pulmonary viens Carry oxygenated blood from the lungsto the left atrium
Pulmonary artery -Carry deoxygenated blood from the right ventricle to the lungs

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7
Q

Separates the right and left ventricles? What separates the right and left atrium?

A

The wall between the atria = atrial septum

Wall between the ventricles is the ventricle septum

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8
Q

What valve separates the right atrium and the right ventricle?

A

Tricupsid or Right AV valve (3 leaflets)

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9
Q

Valve separates the left atrium and the left ventricle

A

Mitral valve or Left AV valve (2 leaflets)

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10
Q

whats the role of the right and left heart chambers

A

The right side collects blood from the body.

Left side pumps blood to the body

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11
Q

What does the aortic valve connect?

A

LV and aora to pump blood to body

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12
Q

What does the pulmonary valve connect

A

RV and pulmonary artery

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13
Q

What is the pathway for blood in the heart?

A

Superior/inferior vena cava> RA> tricupsid> RV>pulmonary valve> pulmonary trunk> L/R pulmonary arteries> R/L lung> pick up O2 drop off CO2> pulmonary veins> LA> bicupsid (mital) > LV> Aortic valve> aorta > coronary/systemic circulation

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14
Q

where do the right and left coronary arteries come from ?

A

ascending aorta, just below where the aorta leaves the LV

- coronary arteries supply the myocardium

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15
Q

what 3 arteries come off the aortic arch ?

A

Brachiocephalic artery
left, carotid artery
left subclavian artery

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16
Q

what are the main branches of the right coronary artery ?

A

Sinus node artery
right marginal artery
posterior descending artery

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17
Q

what are the main branches of the left coronary artery ?

A

Circumflex artery

left anterior descending A.

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18
Q

What artery supplies the left atrium

A

Circumflex artery

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19
Q

What artery supplies the right atrium

A

Sinus node artery

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20
Q

What artery supplies the right ventricle

A

right marginal artery

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21
Q

Artery supplies the bottom of the ventricles

A

posterior descending artery

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22
Q

which vessels are the Great vessels of the heart

A

Inferior vena cava
Superior vena cava
pulmonary arteries /veins
aorta

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23
Q

what makes up the coronary venous circulation?

A

cornonary sinus
cardiac veins
thesbian veins

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24
Q

what drains into the coronary sinus ? where does this drain into?

A
  • Great cardiac vein
  • small and middle cardiac veins
  • veins drain into the RA
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25
Q

what is the normal pace maker of the heart? What does it do? How does conduction go from L and R atria?

A

SA node

  • causes the atria to contract
  • backman bundle conduct cardiac impulse from R to L
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26
Q

What does the AV node do?

A
  • causes the ventricles to contract
  • accomplished by the bundle of His, at the lower end of the AV node, which pass to the interventricular septum to form left and right branches which become purjunkie fibers.
  • purjunkie fibers extend into ventricle wall
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27
Q

what influences the rate, rhythm, and contractility of the heart?

A

autonomic nervous system

- vagus and sympathetic nerves make up the cardiac plexus

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28
Q

what is the sympathetic influence on the heart?

A

release of epinephrine and no epinephrine

  • sympa nerves stimulate heart to beat faster (chronotropic effect) and with greater force (inotropic)
  • increased: contractility, venoconstriction, arterial vasoconstriction, which leads to increased BP, total peripheral resistance, and CO
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29
Q

what is the parasympathetic influence on the heart?

A

ACH released from the vagus nerve to slow the heart rate (chronotropic effect) mainly though SA node
- Decrease in HR small decrease in contractility and results in decreased BP

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30
Q

what is the baroreceptor reflex?

A
  • detect change in pressure
  • maintain BP
  • high pressure (arterial barorecpetors) receptors located in the carotid sinus, aortic arch, R subclavian
  • low pressure (cardiopulmonary) recpetors
  • Pressure is maintained by sympa or parasympa input
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31
Q

what is the bainbridge reflex? will it cause increase of decrease in HR?

A
  • increases HR
  • increase in venous return will cause stretch to recpetors on RA wall
  • sends afferent vagus signal to cardio vascualr center in medulla
  • parasympa activity inhibited therfore increasing HR
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32
Q

Chemoreceptors reflex

A
  • located in aortic body and cartid body
  • respond to changes in O2 tension and pH
  • < 50mmhg O2 or acidosis will cause:
  • increased ventilation depth and rate by parasympa system to decrease HR and contractility
  • persistent hypoxia will result in the sympa system
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33
Q

What will occur with persistent hypoxia

A

activation of sympa activity (after para is activated to try to deepen breaths and decrease contractility)

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34
Q

What will occur secondary to a Valsalva maneuver

A

increased: central venous pressure,
Decreased: venous return, CO, BP

  • decrease is sensed by baroreceptors which increases HR via the sympa system.
  • When the glottis open again, venous return increases and therefore increase BP and Heart contractiltiy which will stimulate the parasympa system to decrease the HR
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35
Q

what is pre load and after laod ?

A

Pre load is the tension built up in the ventricles after being filled post diastole

after load is the resistance of the peripheral vasculature. Resistance agiainst the heart pumping out
- includes aorta complaince, blood viscosity and mass

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36
Q

what is stroke volume and cadiac output

A

SV: norm is 60-80ml
blood ejected from L ventricle

CO: blood pumped out of L/R ventricle per min

  • CO= SVxHR
  • men= 5L/min, women is little bit lower
  • can go up to 25L/min with exercise
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37
Q

T/F when averages over time CO will = Venous return

A

true

cardiovascular system is closed loop

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38
Q

what type of veins will have more valves?

A

Deep> superficial

LE > UE

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39
Q

what are S/S of hypovolemia

A
  • tachycardia, elevated temp, orthostatic hypo tension

- caused by decreased blood volume; severeburns, dehydration, diuretics for HTN, sweating,

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40
Q

what are s/s of hypervolemia?

A
  • leg swelling, ascites, fluid in lungs

- caused by: fluid overload such as in heart failure, kidney dx, excess fluid like blood transfusion, elevated NA+,

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41
Q

what is the norm blood volume in a man

A

5L

- slighlty less in a female

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42
Q

what is plasma ?

A

makes up 50% of blood volume

  • water electrolyes and protiens
  • important in regulating BP and temp
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43
Q

what are RBCs

A
  • make up 40% of total blood volume

- polycythemia increases risk for stroke and heart attack

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44
Q

what will a high or low number of platletes cause?

A

high: can result in stroke or heart attck
low: thombosytopenia increases risk for thrombosis that can result in abnormal bruise & bleedings

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45
Q

What are the 5 types of WBCs and what do they do?

A

Basophils - allergic repsonse
Neutrophils - protect body from infection bu eating
lymphocytes- t- lymphocytes, natural killers that protect agianst viruses, destroy some cancer, B-cells make antibodies
monocytes-eat dead/damaged cells and defend against organisms
eosinophils- kill parasites, destroy cancer, involved in allergic response.

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46
Q

which ribs are considered true ribs?

A

ribs 1-7 = true
attach to sternum by costal cartilage
- false ribs do not attach to costal cartilage, they attach to the cartilage of the rib above

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47
Q

which ribs only connect to 1 thoracic vertebrae ?

what about the ones that dont?

A

1,10, 11, 12

  • Ribs that don’t connect to one vertebrae have a superior and inferior facet to articulate to 2 adjacent thoracic vertebrae
  • the rib # of superior costal facet will articulate with the inferior facet
  • superior facet articulates with the inferior costal facet of lower vertebrae
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48
Q

what makes up the costotransverse joint

A
  • Transverse process of each vertebrae will have costal facet.
  • Costal facet articulates with facet on rib tubercle
  • will form the costotransverse joints
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49
Q

What are the muscles of principal inspiration

A

Diaphragm.

External intercostals; Oriented upward and backward from lower rib to upper rib

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50
Q

How are internal intercostal muscles oriented? What will contraction of the internal and external intercostal muscles do

A

Obliquely upward and forward from the upper rib to the lower rib
- Contraction of internal and external intercostal muscles will cause the ribs to elevate for inspiration

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51
Q

What will movement of the upper ribs increase? Elevation of the lower ribs will increase?

A

Movement of upper ribs increases A-P chest diameter

Elevation of lower ribs increases transverse diameter

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52
Q

What muscles are used during exhalation? Active exhalation?

A
  • Quiet breathing requires passive recoil of lungs in rib cage.
  • Forceful exhale; rectus abdominis, external oblique, internal oblique, transversus abdominis.
  • Will depress lower ribs and compress rib contents therefore pushing and diaphragm up and helping with active exhalation
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53
Q

Is considered to be a part of the upper respiratory tract?

What is its function?

A

Nasal cavity, larynx , and pharynx

  • fxn: Warm or cool air and filter air before it reaches alveoli.
  • Nostril hair filters out particles
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54
Q

Is considered to be a part of the lower respiratory tract?

What is its function?

A

larynx to the alveoli (includes the trachea, which is the beginning of the larynx )

  • Includes conducting airways, terminal respiratory units
  • The airways divide roughly 23 times between trachea and alveoli.
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55
Q

Where does the trachea begin where does it end?

A
  • Begins at the larynx, approximately at base of neck.
  • Ends at carina, at T4
  • Carina divides the tracheae get into right and left main bronchi
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56
Q

How many lobes does the right and left lung have

A
  • Right lung: 3 lobes; upper middle and lower
  • Left lung: upper and lower, lingula
  • Lingula is the same as the right middle lobe
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57
Q

Describe the normal conditions for the pleurae

A

the visceral pleurae will cover the lungs and the parietal pleurae will cover the ribs, mediastineum, vertebrae, diaphragm,
- the two will touch eahc other and are only separated by serous fluid

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58
Q

what carries blood from the heart to the lungs?

A

the pulmonary trunk, pulmonary arteries

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59
Q

what do the bronchial arteries do

A

deliver O2 blood to the lungs and connective tissue and bronchi.
- this blood drains into the bronchial veins

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60
Q

how does symps and parasympa innervation innervate the lungs?

A

para: vagus nerve
sympa: post ganglionic sympathetic fibers will innervate smooth muscle of the bronchi, and pulomonary vessels

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61
Q

what controls breathing? what is the response to hypoxemia ?

A

motor neurons that innervate respiratory muscles will be stimulated by central and peripheral chemo receptors and mechano receptors

hypoexemia response

  • central chemo receptors in medulla sense pressure of CO2and H+ and react by increasing ventialtion
  • peripheral chemoreceptrs wil react via cartic bodies that increase ventilation
  • mechanoreceptors inhibit mus activity when force is potentially dangerous
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62
Q

What is anatomic dead space volume

A

Air that occupies non-respiratory airways

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63
Q

What is expiratory reserve volume

A

Maximal amount of air that can be exhaled after a tidal exhalation.
15% of lung volume

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64
Q

Forced expiratory volume

A

Volume of air expired maximally In the 1st 2nd 3rd second of forced vital capacity maneuver

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65
Q

Forced vital capacity

A

Volume of air expired forcefully after forced Max inspiration

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66
Q

Functional residual capacity

A

Lung volume after normal exhale
FRC=ERV+RV
40% of total lung volume

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67
Q

Inspiratory capacity

A

Max amount of air that can be inspired after tidal exhalation
IC=TV+IRV

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68
Q

inspiratory reserve volume

A

Max amount of air that can be inhaled after normal total volume inhalation.
50% of total lung volume

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69
Q

Minute volume ventilation

A

Air volume expired in one minute.

VE = TE x respiratory rate

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70
Q

Peak expiratory flow

A

Max flow of air at beginning of forced expiratory maneuver

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71
Q

Residual volume

A

Volume of gas in lungs at end of max expiration.

-25% of total long volume

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72
Q

tidal volume

A

Total volume inhaled and exhaled with each breath and quiet breathing.
10% of total lung volume

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73
Q

Total lung capacity

A

volume of air after max inspiration sum of all lung volumes
TLC = RV + VC.
or
TLC = FRC + IC

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74
Q

Vital capacity

A

Volume change that occurs between max inspiration and expiration.
VC = TV + RV + ERV.
75% of lung volume

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75
Q

Determines how much oxygen chemically combined with hemoglobin

A

Physically dissolved oxygen contributes to the PaO2, this determines how much oxygen combines with hemoglobin.
Oxygen is more available in hemoglobin that in the plasma.

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76
Q

why are airway clearance techniques used?

A

To help impaired cilliary transport or inability to protect airway (impaired cough)

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77
Q

cann atelectasis be due to mucus plugging?

A

yes, is suspected to be caused by muscus build up air way clearance can be used

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78
Q

what is active cycle breathing?

A

used to be called forced expiratory technique
-Emphasize breathing with the huff cough
-Three phases;
*Breathing control at tidal volume
*Thoracic exhalation : deep breathes, Percussion and vibration can be paired with expiration
Forced expiratory technique, A few huffs with open Gladys

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79
Q

What is the procedure and precautions for active cycle of breathing

A

breathing control– Begin with breathing, controled gentle relax breathing (diaphragmatic breathing), For 5 to 10 seconds or as long as patient needs to prep for next phase. Performed at tidal volume at resting respiratory rate

Thoracic expansion– 3 - 4 slow deep relaxed inhalations to inspiratory reserve with passive exhalation.Chest percussion, vibration or shaking may be combined with exhalation.

forced expiratory technique:1-2 Huffs at mid-low lung volume with Glottis open into expiratory reserve volume. Brisk adduction of upper arms can be added for thorax compression

precautions
Splint postoperative incisions with pillow. Contraindication if bronchospasm or hyperreactive airways

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80
Q

autogenic drainage

A

Controlled breathing is used to mobilize secretions with exhales and no postural drainage or coughing to imprive airflow in small airways by clearing mucus.
- 30-45mins

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81
Q

What is the procedure and precautions for autogenic drainage

A

-Patient sitting upright with back support.
-Controlled breathing at three lung volumes for: Unsticking phase:
Breathe in through the nose at low volume hold 2-3 secs and hold to allow contralateral ventilation, exhale to expiratory reserve volume

Collecting phase:
Breath at tidal volumes interspersed by 2 to 3 second breath holds

Evacuating phase:
Breathe deeper from low-mid inspiratory reserve volume, With breath holding followed by a huff

-precautions: Requires motivation and concentration to learn. Not suitable for easily distracted or children

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82
Q

Directed huffing and cough

A

attempts to elicit maximum force exhalation by directed cough to compensate for physical limitations.
Cough+ huff
Patient is directed to cough by closing Glottis and hold breath for 1- 2 seconds, then contracting expiratory muscles to produce increase thoracic pressure then coughing sharply 2 -3 times with a slightly open mouth

huff: inhale deeply with rapid exhalation by pretending to fog mirror or saying ha ha Ha

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83
Q

What are precautions and contraindications to huff cough

A

Don’t do if :
possible transmission of infection.
Elevated intracranial pressure or known intracranial aneurysm.
Reduce coronary artery perfusion/myocardial infarction.
Unstable head neck or spine.
Potential for aspiration/regurgitation.
Abdominal pathology: AAA. Hiatal hernia, pregnancy
Untreated pneumothorax.
Osteoporosis.
Flail chest

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84
Q

High frequency airway oscillation

A

A cappella or pickle are used to produce high frequency airway vibration to mobilize secretions
procedure:
Inhale slowly to 75% with device and mouth. Hold breath for 2- 3 secs. Exhale for 3- 4 secs. Repeat 10- 20x. Follow with 2 to 3 coughs or Huffs

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85
Q

What are precaution/intra- contraindications for high frequency airway oscillation

A 
Acute asthma, COPD.
 Above 20 mmHG intracranial pressure. 
Hemodynamic instability
Recent face surgery or trauma. 
Acute sinusitis. 
Nosebleed. 
Esophageal surgery. 
Active hemoptysis 
 Nausea. 
Suspected tympanic membrane rupture or middle ear pathology. 
Untreated pneumothorax
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86
Q

What are precautions and contraindications for postural drainage in all positions

A 
Intracranial pressure above 20 mmHG. 
Head and neck injury until stabilized.
Active hemorrhage/hemodynamic instability.
Recent spine surgery. 
Emphysema. 
Active hemoptysis
Bronchopleural fistula.
 Pulmonary edema associated with congestive heart failure. 
Large Plural effusion. 
Pulmonary embolism. 
Confuse/ anxious patient who cannot tolerate position. Read fracture. 
Surgical wound
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87
Q

What are precautions and contraindications for postural drainage in trendelenburg

A 
Uncontrolled hypertension. 
Distended abdomen. 
Esophageal surgery.
 Recent growth
Hemoptysis related to lung carcinoma. 
Uncontrolled airway at risk for aspiration (tube feeding or recent meal)
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88
Q

What is the position for postural drainage for the apical segments.

A

Right and left upper lobes.
Seated.
Percussion and vibration performed above clavicles

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89
Q

What is the position for postural drainage for the posterior segments

A

-Respectively belong to right and left upper lobe of the lung.
Right:
Patient is turned 1/4 from prone on left side so the medial border of the right scapula can be percussed and vibrated.
Bed in horizontal patient in prone shoulder raised with pillow

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90
Q

What is the position for postural drainage for the lingula

A

-upper left lobe
-prone
1/4 from supine on right side with foot of bed elevated 12 inches.
Percussion and vibration over left chest between auxilla and left nipple

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91
Q

What is the position for postural drainage for the anterior segments

A
  • L and R lobes
  • supine
  • Percussion and vibration performed below clavicle’s with the bed and horizontal
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92
Q

What is the position for postural drainage for the right middle lobe

A

Patient is turned 1/4 from supine on the left.
Bed and is elevated 12 inches.
Percussion and vibration over right chest between auxilla and right nipple

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93
Q

What is the position for postural drainage for the supperior segments

A

left and right lobes

  • prone
  • bed horizontal
  • Percussion and vibration below the inferior border of left and right scapula
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94
Q

What is the position for postural drainage for the anterior basal segment

A

left and right lobe

  • supine
  • bed end is elevated 18 inches
  • Percussion and vibration over lower R/L ribs
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95
Q

What is the position for postural drainage for the posterior basal segments

A

left and right lobe

  • prone
  • bed end is elevated 18 inches
  • Percussion and vibration over lower R/L ribs over the posterior side
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96
Q

What is the position for postural drainage for the lateral basal segments

A
  • sidelying
  • bed is 18 inches elevated
  • Percussion and vibration over lower R/L ribs
  • If for left lower lobe have patient lye on right side to expose left side
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97
Q

What are accessory muscles of inspiration?

A 
Sternocleidomastoid.
 Scalene's. 
Pectoralis major sternocostal portion,
 pectoralis minor, 
Serratus anterior
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98
Q

what are the 4 parameters of of respiration?

A

-Rate- # breaths/ min
-Rhythm-regularity of inspirations/ expirations inspire:expire= 1:2 (COPD 1:3-4)
-Depth volume of air exchanged with each breath. deeper or shallower than tidal volume
Character -effort and sound. Laboured breathing; use of accesory mus, wheezing/crackles.

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99
Q

how long should you asses respiratory rate?

A

observe or palpate 60 secs and document 4 parameters

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100
Q

what are the norms for respiration for a new born?
1 year?
10 years?
adult?

A

new born? 33-45
1 year? 25-35
10 years?15-20
adult?12-20

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101
Q

what is apnea ?

A

absence of spontaneous breathing

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102
Q

Biot’s

A

Irregular breathing. Breaths vary in-depth, rate with periods of apnea associated with increased intracranial pressure or medulla damage

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103
Q

Bradypnea

A

Under 12 breaths per minute. Associated with nuerologic or electrolyte imbalance, infection, or high cardio resp fitness

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104
Q

Cheyne- stokes

A

Decreasing rate and depth of breathing with periods of apnea can occur due to CNS damage

105
Q

Eupnea

A

breathing norm for rate and depth

106
Q

Hyper/ hypopnea

A

Increased/ decreased rate and depth of breathing

107
Q

kussmaul’s breathing pattern

A

Deep and fast breathing, associated with metabolic acidosis

108
Q

Paradoxical breathing

A

Best wall moves in with inhalation and out with exclamation due to chest trauma or paralysis or diaphragm

109
Q

Tachypnea

A

fast RR >20 breaths/min in adults

110
Q

What is rate pressure product

A

Index of myocardial oxygen consumption and coronary blood flow
correlates to onset of angina or ECG abnormalities for pts with heart disease
- S/S of myocardial ischemia occur at reproducible RPP value

111
Q

How do you measure and interpret RPP rate pressure product

A

HRxSBP reported at 10^3

RPP obtained during an exercise test can dicatate exercise Rx and by keeping exercise below level will redice angina

112
Q

What is ABI?

A

compares systolic blood pressure at ankle and arm to check for peripherla artery disease
- BP taken at brachial and tibialis posterior artery with sphygmomanometer and doppler
divide the highest of the 2 measurements of ankle and arm (ankle/arm)
->1.3 ridgid arteries- need for a US check to look for PAD
1-1.3 normal, no blockage
.80-.99 - mild PAD, the beginning
. 4-.79- moderate claudication and blockage
>.4 severe PAD

113
Q

Which vitals are taken to measure the lung function to oxygenate the blood

A

SaO2 - Oxygen saturation of hemoglobin (Refers to how much hemoglobin is saturated on the RBC for molecules/cell)
Pao2 - arterial partial pressure actual oxygen content in arterial blood

114
Q

Vital measures the lungs ability to remove carbon dioxide? changes in this molecule indicate what

A

PaCO2

-Changes in co2 reflect changes of pH in the body

115
Q

Molecule acts as a buffer from blood becoming too acidic or basic

A

HCO3- Bicarb

116
Q

What is the normal pH for an adult

A

7.35- 7.45

117
Q

PaC02 norm

A

40mmhg @ sea level
35-45
Partial pressure of carbon dioxide in arterial blood (PaCO2) provides info on how well the lungs are able to remove CO2

118
Q

Pa02 Norm

A

97 mmHg @ sea level

80-100 norm

119
Q

HCO3- norm

A

24meq/L

120
Q

SaO2 norm

A

95-98%

121
Q

Acidemia

A

Elevated blood acidity less than 7.35 (low Ph)

122
Q

Alkalemia

A

Decreased blood acidity pH is greater than 7.45

123
Q

Eucapinea

hyper/hypocapenia

A

Normal CO2 levels in arterial blood 35 to 45mmHG
Hyper - Elevated levels of CO2
Hypo Low levels of CO2

124
Q

Hypoxemia
Mild hypoxemia
Moderate hypoxemia
Severe hypoxemia

A

Hypoxemia - Low 02 in arterial blood <80mmHg
Mild hypoxemia 60-79 mmHg
Moderate hypoxemia 40-59 mmHg
Severe hypoxemia <40

125
Q

What is the difference between hypoxemia and hypoxia

A

Hypoxemia is low arterial blood.

Hypoxia is low level of O2 in the tissue despite adequate perfusion

126
Q

What are cardiac biomarkers?

A

Enzymes leak out of heart cells into blood after MI
Indicator of CK, creatine phosphokinase and tropnin in blood
CK-MB- MI indicator up to 2 days after an incident. Most elevated 4 hours after
Tropinin-I- MI indicator up to 5 - 7 days

127
Q

What’s considered good cholesterol and what does it do

A
  • HDL is referred to good because it helps carry away LDL and protects against arthro-genesis.
  • LDL is bad. Associated with fatty plaque buildup in arteries that can reduce BF
128
Q

What PaCO2 and pH will indicate respiratory acidosis

A

PaCO2 >45
pH <7.4
(not compensated, therefore values of greater and less than will be opposite)

129
Q

PaCO2 and pH values would you indicate for compensated metabolic alkalosis

A

PaCO2 >45
pH >7.4

(compensated, therefore values will be in the ‘same direction’)

130
Q

PaCO2 and pH values would you indicate for compensated metabolic acidosis

A

PaCO2 <35
pH <7.4
(compensated, therefore values will be in the ‘same direction’)

131
Q

What PaCO2 and PH will indicate respiratory alkalosis

A

PaCO2 <35
pH >7.4
(not compensated, therefore values of greater and less than will be opposite)

132
Q

What HCO3- and pH will indicate metabolic acidosis

A

ph <7.4

HCO3- <22

133
Q

What HCO3- and pH will indicate respiratory alkalosis

A

ph >7.4

HCO3- <22

134
Q

What HCO3- and pH will indicate metabolic alkalosis

A

ph >7.4

HCO3- >26

135
Q

What HCO3- and pH will indicate respiratory acidosis

A

ph <7.4

HCO3- >26

136
Q

what reading error will happen if the BP cuff is too small

A

reading will be too high and false

if in doubt use larger cuff

137
Q

how slow if the BP cuff deflated?

A

2-3 mmhg / second

138
Q

A you are listening to BP, what is the 1st sounds that is heard?

A

systolic- appearance of clear tapping sounds

139
Q

When the sounds disappear completely in a BP reading, what does the is indicate

A

diastolic

140
Q

what are phases I-V in BP reading

A 
I - systolic, first sound
II- sounds become softer and longer 
III- sound is crisp and louder 
IV- sounds are muffled and softer 
V- Sound disappears all together
141
Q

what us the norm BP for an adult

A

<120/<80

142
Q

what is elevated HTN

A

120-129 systolic
or
< 80 Diastolic

143
Q

stage 1 HTN

A

130-139 systolic
or
80-89 Diastolic

144
Q

stage 2 HTN

A

140-159 systolic

or at least 90 Diastolic

145
Q

Hypertensive crisis

A

> 180
and or
120

146
Q

What does systolic pressure and diastolic pressure measure

A

SBP: pressure on arteries when heart is contracting/ ejection phase
DBP: Force agianst arteries at rest

147
Q

IS BP directly related to CO and Total peripheral resistnace?

A

yes

therefore effective measure at for the pumping mechanism of the heart

148
Q

how fast does SBP increase with MET equivalent

A

8-12 mmhg

  • with sustained activity, no further increases ahppen
  • if SBP doesnt rise with work load, can indicate functional reserve capacity of heart has been exceeded
149
Q

how much can diastolic BP increase or decrease ?

A

10 mmhg

150
Q

At what BP should exercises be terminated in phase 1 cardiac rehab

A

> 130mmhg SBP or over 30 beats above Resting HR
decrease in SBP of >10 mmhg
110 DBP

151
Q

What is pulse pressure? What is normal and during exercise?

A

difference btwn SBP and DBP
should increase with activity to 40-50 mm (Systolic increase por. to exercises when DBP stays the sameish)
If PP gets too high, may indicate stiffening of aorta secondary to arthrosclerosis

152
Q

What type of exercises increase BP

A

concentric and valsalva
Concentric> eccentric
Concentric/ eccentric > isokinetic

153
Q

How does our body compensate for age to maintain blood pressure

A

Same volume of blood filled ventricles, but pumping is less affective. Body compensates by increasing blood pressure to maintain homeostasis

154
Q

If a patient is performing an exercise test and SBP fails to increase or decrease with increasing workload, what does that indicate?

A

Plateau or decrease in cardiac output

155
Q

By how much should SBP decrease after 3 mins of exercise ?

A

general guidline:

  • SBP normally decreases soon after exercise stops.
  • Post SBP should be less than 90% of peak SBP
156
Q

When is diaphragmatic breathing indicated?

A
  • post sx when pt has pain in chest or abdomen
  • learning/instructing active cycle of breathing or airway clearance
  • dyspnea at rest it min activity
  • inability to perform ADLs or 2/2 dyspnea or inefficient breathing pattern
157
Q

what are precautions/ contraindication for diaphragmatic breathing (DB)

A
  • mod-severe COPD, marked hyperinflation of chest
  • paradoxical breathing patterns
  • increased inspiratory effort
  • increased dyspnea during DB
158
Q

how do you teach diaphragmatic breathing

A

1 hand on chest 1 hand on belly
breathe into belly and keep chest still
in thorugh nose, out through pursed lips

159
Q

what are the expected outcomes from diaphragmatic breathing

A

Decrease:
RR
Use of accessory muscles during exhalation
Respiratory flow rate

Increase:
tidal volume
activity tolerance
subjective improvement of dyspnea

160
Q

what is inspiratory muscle training (IMT)

A
  • strengthens diaphragm and interscostal muscles
161
Q

inspiratory muscle training (IMT) contraindications and percautions

A 
signs of inspiratory muscle fatigue: 
- tachypnea,
 reduced tidal volume
 increased PaCO2
bradypnea, decreased minute ventilation
162
Q

inspiratory muscle training (IMT) procude

A

calculate the training load by measuring MIP max inspiratory pressure with manometer
2 types of IMT: Threshold and flow resistive
- T`hreshold: valve opens at critical pressure and provides consistent and specific pressure for IMT regardless of how slow/quick breathing rate is

-Flow resistive: decreasing diameter increases resistance

  • place tool over mouth and INHALE forcefully to open valve
  • adjust pressure spring to adequate load
  • the higher the setting the higher the load
  • Pt begin at 30-40% of MIP
  • breathe against resistance at resting respiratory rate and tidal volume 5-15 mins 3x day
163
Q

what are thr benefits of IMT

A

increase inspiratory mus strength and endurance, fxn exercise capacity
decrease dyspnea at rest and with exercise

164
Q

paced breathing and exhale with effort technique

A
  • PB strategy to decrease work of breathing and dyspnea during activity
  • EET prevent breath holding; inhale at rest, exhale with work
165
Q

when would you use paced breathing and exhale with effort technique

A
  • dyspnea at rest or min activity
  • inefficient breathing pattern in activity
  • inability to perform activity due to pulmonary limitation
  • outcome is patient will have less fear of becoming short of breath during activity and be able to complete w.o dyspnea
166
Q

how do you teach paced breathing and exhale with effort technique

A

time exhales with work and inhales with rest/easy periods

walking: breathe in thro nose 2 steps, breathe out with pursed lips for 4 steps

Stairs: in thro nose while standing, exhale with pursed lips during 2 stairs

lifting: inhale thro nose before lift in sit/stand, exhale with pursed lips during bend and reach. Pause. inhale thro nose when grabing object, exhale while standing

167
Q

when would you use PLB pursed lip breathing

A
  • Reduce respiratory rate, reduce dyspnea, maintain small positive pressure in bronchioles that can help emphysema/ airway collapse
  • forcing exhalation is a contraindication
168
Q

what is segmetnal breathing ?

A

localized breathing or thoracic expansion to help regional ventilation post sx for pulmonary complications.

  • asymmetrical chest wall expansion may imply pathology
  • hand placement verbal cues or coordination can be done to facilitate or inhibit pattern
169
Q

Segmental breathing procedure:

A

basal atelectasis: sitting
Sidelying with affected lung up
postural drainage postions with affected side up to help with secretion removal
- firm handplacment over area that needs to expand as the pt breathes in.
- as pt breathes out, pt decreases hand placment pressure

170
Q

When would you choose to use incentive spirometry ?

A

Decreased: intrathoracic volume, chest wall compliance,
increased flwo resistance from decreased lung volume
ventilation: perfusion V:Q mismatch

171
Q

When would you not choose to use incentive spirometry ?

A
  • uncooporative patient
  • cant breathe deep
    vital capacity is less than 10%
    mod-severe COPD
172
Q

incentive spirometry benefits ?

A 
absence or imprive atelectasis 
decreased RR
improved PaO2, forced vital capacity,peak expiratory flows 
- resolved fever 
- normal pulse rate
173
Q

what postions can help with dyspnea

A

leaning forward with arms supported will allow pect to raise ribcage

  • reverse trendeleburg: head above trunk and LE
  • Semi fowler, head of bed height at 45* and pillow under knees
174
Q

What does RPE assess?

A

patient exertion

-shouldnt consider mus soreness, pain or shortness of breath

175
Q

what is considerd 70% of max HR according to RPE

A

13-14

176
Q

what does a RPE of 11-13 correspond to?

A

upper limit of HR while in early cardiac rehab training

177
Q

when can RPE sub for HR when Rxing exercise intensity

A
  • ability to monitor HR is compromised
  • pts with exercise based rehab prgram without preliminary exercises test
  • HR response to exercise is altered (cardiac transplant)
  • physical activities other than endurance are assessed
178
Q

What is considered very very light (or weak in revised RPE)

A

original: 7 (6-20)
6= nothing

revised: 0.5
0= nothing (0-10)

179
Q

What is considered somewhat hard (moderate in revised RPE)

A

Original: 13

Revised:3

180
Q

What is considered hard (strong in revised RPE)

A

Original: 15

Revised:5

181
Q

What is considered very hard (very strong in revised RPE)

A

Original: 17

Revised:7

182
Q

What is considered very very hard (very very strong in revised RPE)

A

Original: 19 (max will go up to 20)

Revised:10

183
Q

what if PFT testing (pulmonary function testing)

A

measures volume/ floe of air during inhalation and exhalation
- will measure forced vital capacity FVC, forced expiratpry volume in first second (FEV1), mid expirtory flow and peak expirtory flow.

184
Q

How is PFT testing (pulmonary function testing) performed

A

patient is seated and exhales as maximally and as forcefully for as long as they can into mouth piece for 6 seconds

185
Q

what would the PFT testing (pulmonary function testing) results be for a obstructive ventilatory impairment

A
  • FEV1/FVC < 70 is indicator
  • results are decreased flow
  • airway narrowing during exhale caises disporportioante reduction in max airflow comparred to the volume displacement that can occur
186
Q

how is obstruction classified via FVC

A 
>100- normal 
70-100 mild 
60-70 moderate 
50-60 mod-severe
<50% severe obstruction
187
Q

WHAT ARE OBSTRUCTIVE PATHOLOGIES (cap lock srry)

A

asthma, emphysema, chronic bronchitis

188
Q

what would the PFT testing (pulmonary function testing) results be for a restrictive ventilatory impairment

A
  • FVC is reduced and or FEV1/FVC are normal or >80%

- characterized by reduced lung volume are near normal expiratory flow rates

189
Q

what are restrictive lung diseases?

A

interstitial lung disease
pleural diseases
chest wall deformities
obesity, pregnancy, neuromsk disease or tumor

190
Q

What types of pathologies/ clinical indications for in/outpatient cardiac rehab?

A 
Medically stable post MI 
stable angina 
coronary bypass sx 
PTCA Percutaneous transluminal coronary angioplasty
compensated HF 
cardiomyopathy 
heart transplant 
cardia sx
PAD 
high risk for CAD with dx of DM, HTN or obesity 
end stage renal dx
191
Q

Who wouldn’t be recommended for cardiac rehab ?

A

unstable angina
resting SBP >200 or resting diastolic greater than 110 mmhg
orthostatic BP drop by 20 with symps
critical atherosclerosis
acute systemic illness.fever
uncontrolled atrial or ventricular arrhythmias
3rd degree ventricular block w.o pace maker
active pericarditis/myocarditis
recent embolism
thrombophlebitis
resting ST segment elevation/depression >2mm
uncompensated FH
orthopedic or metabolic condition prohibiting exercise

192
Q

What is phase 1 of cardiac rehab

A
  • inpatient cardiac rehab
  • begins with physician referral and medically stable patient
  • patient and family education
    Exercises emphasis on AROM, self care, low level exercise, ambulation, vital monitoring
    -Exercises prescribed according to heart rate and RPE
  • lasts 3-5 days
193
Q

when is a patient considered medically stable To begin cardiac rehab

A
  • no new or recirrent chest pain in 8 hours
  • no new signs of congestive HF; dyspnea at rest or bilateral basilar crackles
  • no new sig abnormal hearth rhythm or ECG changes in 8 hours
  • stable CK and troponon levels
194
Q

when should exercise be discontinued during

phase 1 of Cardiac rehab?

A

HR >130 or >30 above resting HR
DBP>110
decrease in SBP 10mmhg
significant arterial and ventricular dysrhythmias
2/3rd degree heart block
s/s of angina, marked dyspnea, and ECG changes suggestive of ischemia

195
Q

what are considerations for active exercise in phase 1 of cardiac rehab?

A

1-4 mets; progress from sitting to standing

UE exercises should not stress post surgical incisions

196
Q

when can LE and UE exercise start after a bypass graft or a infarct ?

A

bypass graft : 24 hours

infarct 2 days

197
Q

how should aerobic exercises be Rxd in cardiac rehab phase 1?

Mode, intensity, duration, frequency, progression

A

Mode: supervised walking on level surface (2-3 mets) to walking on steps or treadmill (3-4 mets)

Intensity: <13 RPE. Post infarct: <120bpm or <20 bpm from resting. Post Surgery: <30 bpm from resting

Duration:3-5 min bouts increasing to 10-15 of continous activity

Frequency: first 3 day: 3-4x/day. After 3days 2x/day with increased duration

Progression: based on tolerance and risk stratification

198
Q

when can activity be progressed within phase 1 of cardiac rehab ?

A

adequate increase of HR
adequete rise in SBP
no dysarthmias or ST changes on ECG
no cardiac symptoms: palpitations, dyspnea, angina,excess fatigue.

199
Q

what outcomes are expected after phase 1 of inpatient cardiac rehab?

A
  • prevent harmful effects of bed rest
  • walk 5-10 min continuously or 1000ft 4x day
  • can perform stairs IND
  • know safe HR and RPE
  • recognize abnormal signs/ symps that suggest activity intolerance
200
Q

When a patient enters phase 2 of cardiac rehab, what is performed during their medical entrance exam ?

A

-when entering OP cardiac rehab, exercise test with ECG is done to monitor conditions such as:
HR, rhythm, signs/ symptoms, ST segment change, exercise capacity, target HR, baseline, risk stratification

  • Physical exam: med hx, lung auscultation, BMI, pulses skin integrity, orthopedic status, resting ecg, exam of chest and leg wounds after CABG ect
201
Q

how many sessions would a patient with a stable coronary artery disease have to perform to determine exercise level

A

6-12

202
Q

What is rec’d for pts who have mod-high risk and/or are unable to understand/ adhere to activity levels

A

continuous ECG and BP monitors, med supervision until safety is established usually over 12 session

203
Q

when would you discontinue exercise in phase 2 of cardiac rehab ? (Indications to stop exercise due to red flags)

A
  • plateau or decrease in HR with increased work
  • SBP plateau or fall with work increase or >250
  • DBP >115
  • ST segment depression > 1mm
  • 2/3rd heart block
  • ventricular arrhythmias
  • angina or other symptoms of cardiac insuff
  • Rating of 1 on Angina scale is recommended end point of activity for inpatient and outpatient cardiac rehab
204
Q

How should aerobic exercises be Rxd for phase 2 cardiac rehab?

Mode, intensity, duration, frequency, progression

A

Mode: activities with large mus groups for rhythmic activity; walking hiking, running, jumprope, skiing, bike,swimming,rowing ect

Intensity based off HR,RPE and MET.

  • If pt has not has exercise testing done, +20 bpm from resting HR at standing is used as target for exercise HR.
  • Target HR is est by upper and lower limits, karvonen or MET formula

Duration:

  • initial training: 15- 20 mins of continuous training in 1st month
  • improvement stage: 25- 30 mins 3-4 months
  • maintenance stage: >40 mins after 6 months

Frequency 3-5x/week
Progression as pt confidence and fitness improve

205
Q

an RPE rating of 12-16 is equal to what capacity

A

MAX capacity 65-85% in cardiac rehab

206
Q

an RPE rating of 11-13 is equal to what capacity

A

UPPER LIMIT OF initial cardiac rehab phase in outpatient.

207
Q

IS RPE specific to the mode of exercise

A

yes

208
Q

What is the norm heart rate of an infant, child, adult

A

Infant: 100-130
Child: 80-100
Adult:60-100

209
Q

What is bradycardia, tachycardia

A

bradycardia, <60 bpm

tachycardia<100

210
Q

How do you characterize the volume of a pulse

A

0- abscence
1+ - small or reduced
2+ normal
3+ large,bounding

211
Q

What is considered light activity according to MET

A 
light 1-3 METs 
walking slow
toileting 
drivign 
desk.comuter work 
making bed 
doing dishes
bathing/cooking (2-3 mets)
playing cards/craft
playing intrument 
fishing (sitting)
212
Q

What is considered moderate activity according to MET

A 
3-7
walking 3mph 
walking 4mph (7 mets)
washing car
sweep/vacuum
light gardening 
carry/stack wood 
power lawn mowing 
 dancing 
ping pong 
sex
golf,walking (4-7 mets)
swim (4-8 mets)
doubles tennis 
bike on flat
213
Q

What is considered vigorous activity according to MET

A 
walking 4.5 mph 
jog
run (11.5 highest)
shovel 
carry heavy load 
heavy farm work 
dig ditch 
backpacking 
basketball 
bke flat 14-16mph
214
Q

How do you time the pulses for regular and irregular rhythms

A

regular 15 secs x 4

irregular count for 60

215
Q

How do you palpate the radial and ulnar pulse

A

radial Lateral to flexor carpi radialis

ulnar Between flexor digitorum superficialis and flexor carpi ulnaris

216
Q

cardiac catheterization

A

Thin catheter is advanced through an artery in leg/arm to coronary arteries. Contrast dye is injected. Evaluate narrowing or occlusion of coronary artery, measures blood pressure and O2 in blood

217
Q

angiography

A

Shows location of plaque and coronary arteries and extent of occlusion via cardiac catheterization

218
Q

Carotid ultrasound

A

Sound waves examine/visualize carotid artery. Screen for blockages that may indicate increase risk of stroke and evaluate use of stent or function of artery after carotid after endarterectomy

219
Q

chest radiograph

A

Visualize location size and shape of heart, lungs, blood vessels, ribs and bones. Can show fluid in lungs or plural space, pneumonia, emphysema, cancer

220
Q

CT scan

A

New CT scanners can take photos of coronary arteries without need some times for catheterization

221
Q

echocardiogram

A

Heart function is viewed in real time via high frequency sound waves. Provides information on size and function of ventricles, thickness of septum, wall/ valves, and chambers.

222
Q

Electrophysiologic testing

A

Evaluate rhythm or electrical conduction abnormalities using 3 to 5 catheters inserted into blood vessel and threaded to heart. Recordings help locate abnormal tissue that cause cardiac arrhythmias

223
Q

Fluoroscopy

A

Continuous x-ray shows heart and lungs. Involves high dose of radiation, component of cardiac catheterization and electrophysiological testing. Unless for those tests, It has been replaced by echocardiograms

224
Q

Invasive hemodynamic monitoring

A

Monitoring of cardiovascular status via intra-arterial catheter and intravenous lines to measure pressure, volume, temp.
-Balloon catheter Swan-Ganz catheter: placed in pulmonary artery to get pulmonary artery wedge pressure and left arterial pressure

  • Thermodilution catheter measures cardiac output.
  • Central venous pressure (CVP) line- measures vena cava or right atrium pressure
225
Q

MRI

A

Assess damage after MI or heart disease, structural problems and aorta, presence of plaque and blockages and blood vessels. Images masses located in mediastinum but cant image the lungs
- 3-D images of the heart blood vessels to assess size and function of chambers

226
Q

Myocardial perfusion imaging MPI

A

Known as radionucleotide stress test and nuclear stress test.

  • Shows how heart is perfused at rest and under exercise stress.
  • Radionucleotide agent injected into blood at rest and maximal level of exercise.
  • Heart images show areas of reduced blood flow due to narrowing of one or more coronary arteries
227
Q

Pharmacological stress test

A

Cardiovascular stressed is induced by pharmacological agents as a diagnostic procedure. Includes adenosine dipyridamole and dobtamine

228
Q

Phonocardiography

A

Helps detect S3 and S4 heart sound for heart failure diagnosis. Diagnostic test creates graphic record for heart sounds and great vessels

229
Q

Positron emission tomography PET

A

Small amount of radioactive material is injected inhaled or swallowed.
Increased radioactive material accumulates in areas of high chemical activity or areas of disease.
Different or brighter spots on the skin appear.
PET is helpful with cancer and heart disease diagnosis

230
Q

Venography

A

Radio opaque dye is injected into vein while x-ray create image of vein to detect clot or blockage

231
Q

Ventilation perfusion scan

A

Small amounts of radioactive material studies airflow and blood flow and lungs. Commonly used to diagnose PE

232
Q

What does pulse oximetry measure

A

SP O2 indicates partial pressure of oxygen in arterial blood.

233
Q

At which SPO2 should activity be stopped for acutely ill patients or chronic lung disease?

A

acutely ill patients >90

chronic lung disease >85

234
Q

Arthrectomy

A

Similar to angioplasty except catheter has a rotating shaver to cut the plaque away and increase blood flow

235
Q

Automatic implantable cardioverter defibrillator AICD

A

Surgically implanted device similar to pacemaker. Continuously monitors heart rhythm and delivers electrical shocks to restore normal heart rhythm when necessary

236
Q

Balloon angioplasty

A
  • Small balloon tipped catheter is inserted into stenotic artery.
  • Balloon is expanded at blockage of narrowed artery to widden it.
  • Often a small metal coil is left in the narrowed artery to help prop it open and decrease chance of re-stenosis.
  • This is the stent
237
Q

Balloon valvuloplasty

A

Cardiac catheterization treats stenotic heart valves.

  • Balloon tipped catheter is threaded through the veins to faulty heart valve valve.
  • Then inflated to open narrowed valve and increase blood flow
238
Q

Cardiac ablation

A

Chemical or radio frequencies are used to destroy myocardial areas that have been identified via electrophysiologic testing that can cause cardiac arrhythmias
-Option for patients who have Tachyarrhythmias that can’t be controlled by medication or arrhythmias it’s respond well to abolition such as wolf Parkinson White syndrome

239
Q

Cardiac pacemaker

A

Surgically implanted in the left anterior chest wall under the skin.

  • Standard treatment for conditions affecting slow heart rate and arrhythmias.
  • Prevent slow heart rate in order to prevent fatigue lightheadedness and fainting.
240
Q

Cardioversion

A

Done to restore normal heart rate for tacky arrhythmias that do not respond to medication. Electric shocks delivered by defibrillator through chest electrodes

241
Q

Coronary artery bypass graft surgery (CABG)

A
  • Surgery performed to treat coronary arteries narrowed/included.
  • Attempt to revascularized myocardium.
  • Blood is rerouted around affected artery and joins patient’s saphenous vein, internal thoracic/mamamary artery or radial artery to connect affected artery above and below occlusion
242
Q

Enhannced extracorporeal counterpulsation EECP

A

nonInvasive procedure cuff on lower extremities inflate to compress veins to assist with venous return to the heart

243
Q

Heart Transplant

A

Failing, diseased heart is replaced with healthy donor heart.
Received in patients with end-stage heart failure when other treatments are not successful.

244
Q

Intra-aortic Balloon counterpulsation IABP

A

Inflation and deflation of balloon in aorta provide circulatory assistance for patient with infarct or with cardiogenic shock

245
Q

Valve replacement

A

Thetic valve is implanted to replace leaky or narrowed heart valve.
Types:
Mechanical (ball in cage, tilting desk, bileaflet)
tissue graft from same patient.
Cadaver.
Pig

246
Q

Ventricular assist device VAD

A

Mini pump implanted to help provide mechanical support to ventricle.
-Right ventricular device RVAD attaches to right atrium and pulmonary artery bypass the right ventricle.
-Left ventricular device attaches to the left atrium bypasses L ventricle
biventricular device BiVAD- Ventricles are bypassed.
-VADs commonly used as temporary treatment for people waiting for heart transplant
- increasingly as permanent treatment for heart failure

247
Q

Antihistamine agents

A

Action
Indication
SIde effect arrhythmias, postural hypotension, GI distress, dizzyness,, drowsiness, blurred vision, headache, fatigue. nausea, thickening of secretions
Implication for PT : Guard patient is case for positional hypotension
Examples benadryl, alegra

248
Q

Anti-inflammatory

A

Action
Indication
SIde effect: like glucocorticoids, destruction of bone and airways tissue. Systemic effects minimized with airway passage.

Implication for PT : not for acute episodes. EDU on correct inhaler use

Examples Q var, pulmicort, leukotriene

249
Q

Bronchodilator agents

A

Action
Indication relieves bronchospasm/ wheezing/ SOB in asthma, COPD,
SIde effect : paradoxical bronchospasm, dry mouth, GI distress, chest pain, palpitations, tremor, nervousness, asthma related death with salmterol a long lasting sympathomimetic

Implication for PT take long lasting before PT and bring short acting (rescure inhaler) to PT

Examples anticholinergic atrovent, spiriva, vetolin, serevent,

250
Q

Expectorant agents

A 
Action 
Indication 
SIde effect 
Implication for PT 
Examples
251
Q

Mucolytic agents

A 
Action 
Indication 
SIde effect 
Implication for PT 
Examples
252
Q

airway adjuncts

A

Devices used to maintain or protect airway to provide mechanical ventilation or to promote airway clearance.

  • Oral pharyngeal airway: plastic tube to fit curvature of soft palate and tongue holds tongue away from back the throat to maintain clearance.
  • Nasal pharyngeal airway: latex/rubber tube inserted through nose to allow nasotracheal suctioning
  • Endotracheal tube: plastic tube inserted in trachea from mouth or nose to provide airway to allow mechanical ventilation
  • Tracheostomy tube: artificial airway inserted in trachea from incision in neck below vocal cords used in patients needing prolong mechanical ventilation
253
Q

Bullectomy

A
  • Bullae form when alveoli are destroyed by emphysema.
  • Bullectomy is surgical procedure where more of the large air spaces are removed.
  • Improves breathing
254
Q

Lung transplant

A

Reserved for patients with end-stage COPD, interstitial pulmonary fibrosis, cystic fibrosis, and other serious lung diseases but do not have serious comorbidities

255
Q

Mechanical ventilation

A

Severe pulmonary dysfunction may require assistance from positive pressure mechanical ventilator.

  • Positive pressure from ventilator provides force to deliver air into lungs by increasing intrathoracic pressure.
  • Connected to tracheostomy tube or mask to assist patient breathing
256
Q

What is oxygen therapy indicated

A

Treatment of acute and chronic hypoxemia.

  • PaO2 less than 55
  • oxygen saturation less than 88%
257
Q

normal HR for a infant

A

100-130

258
Q

normal HR for an adult

A

60-100

259
Q

normal HR for a child

A

80-100

Board exam review (23 decks)

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