Cardiovascular, Pulmonary, and Lymphatic Flashcards
What heart enzyme stays elevated the longest
Cardiac Troponin (elevated for 14 days)
What is the patient at risk for when INR is high
Excessive bleeding
What is the patient at risk for when INR is low
Clots
Normal value for PO2
Greater than 80
Normal value for PaCO2
35-45
Normal value for HCO3 (bicarbonate)
22-26
What happen when HCO3 is too low
Metabolic acidosis
What happens when HCO3 is too high
Metabolic alkalosis
What occurs when S1 heart sound is absent
Heart block
What occurs when S2 heart sound is absent
Aortic stenosis
What does S3 heart sound indicate
CHF
Normal HR for babies-age 1
100-160 bpm
Normal HR for children 1-10
60-140 bpm
Normal HR for children 10+ and adults
60-100 bpm
Normal HR for well conditioned athletes
40-60 bpm
Below what ABI would you not want to use compression
0.6
ABI less than what is considered abnormal
0.9
An ABI less than what is would indicate PAD
0.9
Normal WBC level
43,000-10,800
Borderline ABI =
0.91-0.99
Is restrictive lung disease a volume or flow problem?
volume (issue getting air in)
Is obstructive lung disease a volume or flow problem
flow (issue getting air out)
S3 Heart sound will be heard for what
CHF
What will be seen with left sided HF?
Lung issues
What will be seen with right sided HF?
Peripheral sx (asictes and jugular distension)
What is cor pulmonale
pulmonary HTN
What CV condition can present with back pain
abdominal aortic aneursym
Valsalva can be helpful in doing what
Slowing down tachycardia
Muscles of inspiration
Diphragm
External intercostals
SCM
Pec minor
Muscles of expiration
Internal intercostals
Abdominals
QL
Normal respiration rate for 0-1 yr old
30-60
Normal respiration rate for 1-3 year old
24-40
Normal respiration rate for 3-6 year old
22-34
Normal respiration rate for 6-12 yr old
18-30
Normal respiration rate for 12-18 yr old
12-16
Normal respiration rate for 18+
12-20
What is Kussmaul breathing due to
Too much acid in the body
-often due to Metabolic acidosis due to diabetes
What does Kussmaul breathing look like
rapid deep breathing
What does Biot’s respiration look like
periodic breathing with hyperopnea and then aponoea
What is Biot’s respiration due to
Neuron damage
What are some things that can cause an abnormality in pulse ox
- nail polish
- anemia
- low perfusion
Which way would the trachea shift with:
-tension penumothorax
CL
Which way would the trachea shift with:
Pleural effusion
CL
Which way would the trachea shift with:
Space-occupying lesion
CL
Which way would the trachea shift with:
Pneumonectomy
IL
Which way would the trachea shift with:
Pleural fibrosis
IL
Which way would the trachea shift with:
Atlectasis
IL
What type of breath sound is commonly heard in CHF and is due to bubbles/fluid in the alvoli
Crackles
What type of breath sound would be heard with asthma
wheezes
What type of breath sound would be heard with pneumonia or chronic bronchitis
Ronchi (low pitched wheezing)
**deep snoring sound
What type of breath sound would be heard if there was blocking of upper airway
Stridor
What type of breath sound is a low pitched wheezing and is heard in CF, COPD, and secretions in larger airways
Ronchi
Examples of restrictive lung dz
- Sarcoidosis
- Pneumoconiosis
- Chest wall NM diseases
- Intersitital lung dz
What are the two main things that are found to be decreased in obstructive lung diseases
FEV1 AND FEV1/FVC ratio will be decreased in obstructive lung dz
Will FEV1 be normal in obstructive lung dz
No
Will FEV1 be normal in restrictive lung dz
yes
What are the main two things that are decr in restrictive lung dz
TLC and FVC
Is FVC normal in restrictive lung dz
No
Is FVC normal in obstructive lung disease
Yes
Is FEV1/FVC ratio normal in restrictive lung dz
yes
Is FEV1/FVC ratio normal in obstructive lung dz
no
What types of diseases have a decr FEV1
obstructive
What types of diseases have a decr FVC
restrictive
What will nail clubbing be seen with
COPD
A flattened diaphragm will be seen with what type of dz
COPD
Name the three diseases in COPD
- Emphysema
- Chronic Bronchitis
- Asthma
Enlargement of air spaces in the alveoli, loss of elasticity
Emphysema
What types of medicines are given for asthma
B-agonists
What will beta agonists due to HR
incr it
True or false B-agonists cause vasoconstriction
true
What can a Pancoast tumor mimic
TOS
What can be seen in Pancoast’s tumor
- Horner’s syndrome (miosis, ptosis)
- sharp shoulder pain
- C8, T1, T2 dermatome paresthesia
- Pulmonary sx- dyspnea, cough, hemoptysis
Normal EKG response during exercise
- P wave increases height
- R wave decreases
- ST segment becomes sharply upsloping
- QT interval shortens
What does inverted T wave mean (2 things potentially)
- ) Left ventricular hypertrophy
2. ) Myocardial ischemia
What does ST segment elevation mean
MI
What do alpha adrengeric antagonist agents do
Reduce BP
Dilates peripheral arterioles and veins
-pril drugs
ACE Inhibitors
What do ACE Inhibitors do
Reduce BP
-artan drugs
Angio-tension 2 receptor antagonist agents
What do angio-tension 2 receptor antagonists do
Reduce BP
What type of drugs are heparin, coumadin, warfarin, and lovenox
Anticoagulants
Stains do what
Decr LDL and incr HDL
Aspirin, Bayer, Plavix are what type of drugs
Antithrombotic
What type of drugs inhibit platelet formation
Antithrombotic
-olol drugs
Beta blockers
What do beta blockers do
-Decr HR
What is a key thing to remember when a patient is on beta blocker and/or calcium channel blockers
use RPE instead of HR bc HR will be blunted
Procardia, Cardizem are what type of drugs
Calcium Channel Blockers
What do Calcium Channel blockers do
Reduce the demands of the heart
What is a major side effect of calcium channel blockers
Edema in the legs/feet and hypotension
Thiazide and Lasix are what type of drugs
Diuretics (can lead to hypokalmia)
What would be an indication for someone to be on a diuretic
HTN or edema due to CHF
Nitrostat or Nitrogylcerin are what type of drugs
Nitrates
What do nitrates do
cause smooth muscle dilation and peripheral vessel dilation
When to use nitrates
angina or acute angina
Digoxin and Lanoxin are wha type of drugs
Positive Inotropic
When to use positive inotropic drugs
HF
What do positive inotropic drugs do
Incr contractility of heart and slow HR
Urokinase, Activose, and Linlytic are what type of drugs
Thrombolytic
What positions would you NOT want someone exercising in if they have CHF
supine
prone
Milroy’s disease is what type of lymphedema
Primary (B LE lymphedema)
Filariasis is what type of lymphedema
Secondary (nematode infection)
Is lymphedema pitting or non pitting in later stages
Non pitting
What is the Stemmer’s sign
When the dorsal foot/hand skin cannot be lifted
Is left or right draining area larger for the lymphatic system
Left is larger
Where is lymph fluid pump back into
Subclavian v
How much difference in size from one limb to the other would be positive for lymphedema
2 cm
Radiological imaging of lymphatic nodes/vessels
Lymphoscintingraphy
What stage of lymphedema:
Heaviness, minimal edema, patient feels fullness in extremity, mild fluid and fibrotic changes
Preclinical (Stage 0)
What stage of lymphedema:
Reversible lymphedema.
Fluid accumulation, pitting edema, reduces with elevation
Stage 1
What stage of lymphedema:
Spontaneously irreversible lymphedema. Fibroblast formation, connective tissue proliferation, minimal to no pitting edema, moderate swelling, pos stemmer’s sign
Stage 2
Will stage 1 have pos stemmer’s sign
no, but stage 2 will
What stage of lymphedema:
Hardening of dermal tissues, papillomas present, skin induration, elephant-like skin
Stage 3
What stage of pitting edema scale:
Indentation barely detectable
1+
What stage on pitting edema scale:
Slight indentation, returns in 15 sec
2+
What stage on pitting edema scale:
Deeper indentation, returns in 30 sec
3+
What stage on pitting edema scale:
Deep indentation, lasting more than 30 sec
4+
What would be a normal pulse
3+
What would be a bounding pulse
4+
What type of bandages are best for lymphedema
Short stretch
Short stretch bandages have ______resting pressure and ______working pressure
Low resting pressure
High working pressure
Should you decongest lymphatic system proximal to distal
Yes
Should you decongest lymphatic system distal to proximal
no
What type of exercise is best for lymphedema
Low impact that is functional
Should strokes for lymphedema be in the direction of flow
Yes
Manual Lymphatic Drainage CIs
Acute infection Cellulitis Cardiac edema Renal failure Cancer
CI for Compression therapy for lymphedema
PAD…..ABI <0.8
An ABI less than what would be a CI to compression
ABI less than 0.8
Superficial or deep pressure for MLD
superficial
