Cardiovascular/Pulmonary System Flashcards
0
Q
Individuals with a total serum cholesterol >____mg/dl increases the relative risk of developing CAD
A
200
1
Q
What is the established risk age threshold for males and females for developing CAD?
A
55 years females, 45 years males, males more likely to have CAD
2
Q
Individuals with HD levels <____mg/dl increases the relative risk of developing CAD
A
40
3
Q
Is pleural effusion restrictive or obstructive?
A
Restrictive: total lung volume decreased, so FEV1/FVC most likely won’t be affected.
5
Q
If pt’s exercise program is for weight loss what is the weekly minimum calorie expenditure?
A
2000 kcal/week
6
Q
Which artery supplies the R atrium?
A
Sinus node
7
Q
Which artery supplies the R ventricle
A
R marginal
8
Q
Which artery supplies the inferior walls of both ventricles and IV septum?
A
Post. descending artry
9
Q
What does the circumflex artery supply?
A
L atrium, L ventricle
10
Q
Which artery supplies the anterior portion of the IV septum?
A
L anterior descending artery
11
Q
How does the sympathetic N.S. influence the heart?
A
stimulate chambers to beat faster (chonotropic), and increase the force of the contraction (inotropic effect)
12
Q
How does the parasympathetic influence the heart?
A
Slow the HR on by acting on SA node
13
Q
Bainbridge reflex
A
increase in venous return sends vagal signals to medulla which inhibits PS activity, resulting in increased HR
14
Q
What happens when arterial PPO2 of less than 50mmHg or conditions of acidosis?
A
Stimulates respiratory centers to increase depth and rate of ventilation. Then the para slows down HR and myocardial contractility. If persistent hypoxia, CNS will be directly stimulated and will increase sympathetic activity.
15
Q
Which white blood cells participate in allergic responses?
A
Eosinophils (also kill parasites and destroy cancer cells) and basophils
16
Q
Which white blood cells ingest damaged cells?
A
Monocytes
17
Q
Which white blood cells ingest bacteria?
A
neutrophils
18
Q
Which ribs articulate with only 1 vertebra?
A
1, 10, 11, 12
19
Q
The R superior lobar bronchus divides into which 3 segmental bronchi
A
apical, anterior, and posterior
20
Q
The R middle lobar bronchus divides into which 2 segmental?
A
medial and lateral
21
Q
The R inferior lobar bronchus divides into which 5 segmental bronchi
A
superior, medial basal, anterior basal, lateral bases, and posterior basal
22
Q
The anterobasil L segmental corresponds to which 2 R segmental?
A
medial basal, lateral basal
23
Q
the apical posterior l L segmental corresponds to which 2 R segmental?
A
posterior and apical
24
Q
Medications to treat dilated cardiomyopathy
A
ACE inhibitors, beta blockers, digoxin, diuretics.
25
Medications to treat hypertrophic cardiomyopathy
Medications to slow the HR and stabilize rhythm, e.g. Lopressor and calcium channel blockers
26
Medications to treat restrictive cardiomyopathy?
diuretics, antihypertensives, and antiarrhythmics.
27
What is the tetralogy of Fallot?
1) ventricular septal defect
2) pulmonary stenosis
3) R ventricular hypertrophy
4) Aorta overriding the ventricular septal defect
28
What is Cor Pulmonale
Hypertrophy of the R ventricle, from chronic R pulmonary circa. resistance.
29
Arterial hypertension in adults DP and SP, what is it for children?
Adults: DP >/=140, SP >/=90
Children: > than the 95th percentile
30
Which S sound is an early heart sound of hypertension complications?
S4
31
Sever HTN DP value
>120 bpm, can cause confusion, cortical blindness, hemiparesis, seizures
32
Stage 1 vs Stage 2 hypertension
1: 140-159/90-99
2: >/=160/>/=100
33
Endocarditis vs Myocarditis vs Pericarditis: location, etiology, signs/symptoms
Endo: bacteria, can damage heart valves, fever/chills, murmur, SOB, skin petechiae.
Myo: viral or bacterial, arrhythmias, angina, SOB, fever, fatigue
Peri: viral, bacterial, fungal, angina,SOB, dry cough, anxiety, fatigue, fever. The amount of fluid between the 2 layers increases (pericardial effusion) If severe cardiac tamponade (pressure prevents heart from properly filling with blood, sharp drop in BP)
34
Supervised exercise training for PAD recommendations
30-45 minutes, at least 3x/wk, at least 12 weeks.
35
Rheumatic Fever
From untreated strep throat (Strep A)
36
Etiology of valvular heart disease
congenital, calcific degeneration, infective endocarditis, CAD, MI, and rheumatic fever
37
Acute Respiratory Distress Syndrome: etiology, causes, fatality rate
Fluid leaks from the smaller vessels in the lungs, into the alveoli. Fatal in 25-40%. Caused by sepsis, HF, severe pneumonia, serious head/chest injury, drug overdose (e.g. heroin), shock, near drowning, adverse reaction to cancer drugs, prolonged use of large volumes of supplemental O2
38
Bronchiectasis vs Bronchitis
Ectasis: obstructive, abnormal dilation of the bronchus, due to injury of the airways or lung infection
Itis: Inflammation of the bronchi, productive cough for 3 months over the course of 2 consecutive years. Cough worse in morning and in damp weather
39
What are the 2 main obstructive lung disorders? What happens to lung capacity?
Bronquitis and emphysema. Increase in total lung capacity, increase in residual volume.
40
Signs and symptoms of acute pulmonary edema, call 911?
It is life threatening! Extreme SOB, bubbly wheezing, gasping, frothy sputum, cyanosis, rapid irregular pulse, hypotension
41
Pulmonary fibrosis: restrictive or obstructive, type of cough
Restrictive, non-productive cough
42
RLDs: etiology
Abnormal lung parenchyma, eg atelectasis, pneumonia, pulmonary fibrosis, pulmonary edema, ARDS, pleural effusion-fibrosis, pneumothorax, hemothorax
43
Arterial Blood Gas, mean range of adult normal values, conventional order
```
In this order
pH: 7.4
PaCO2: 40 (35-45) at sea level
PaO2: 97 at sea level
HCO3-: 24 (22-26) mEq/L
eg. 7.4/40/97/24
```
44
Eucapnia, hypercapnia, hypo
normal level of PaCo2, to much, too little
45
Mild hypoxemia value
PaO2 of 60-79 mmHG, SPO2 90-95%, if no shift in the oxyhemoglobin curve
46
Moderate hypoxemia
40-59, SPO2 60-80%, if no shift in the oxyhemoglobin curve
47
Severe Hypoxemia
<60%, if no shift in the oxyhemoglobin curve
48
Hypoxia
low level of O2 in the tissue despite adequate tissue perfusion
49
Which tests specific for MI
CK-MB, peaks at 12-24 hours following MI, declines over 2-3 days
Cardiac Troponin-I, remains elevated for 5-7 days
50
PaCO2 > 45 and pH < 7.4 indicates what?
respiratory acidosis
51
PaCO2 > 45 and pH > 7.4 indicates what?
retention of CO2 to compensate for metabolic alkalosis
52
PaCO2 < 35 and pH > 7.4 indicates what?
respiratory alkalosis
53
PaCO2 < 35 and pH < 7.4 indicates what?
retention of CO2 to compensate for metabolic acidosis
54
HCO3- < 22 and pH < 7.4 indicates what?
metabolic acidosis
55
HCO3- < 22 and pH > 7.4 indicates what?
Renal compensation for respiratory alkalosis
56
HCO3- > 26 and pH > 7.4 indicates what?
metabolic alkalosis
57
HCO3- > 26 and pH < 7.4 indicates what?
renal compensation for respiratory alkalosis
58
Conventional and SI hematology value for erythrocytes:
Males: 4.3-5.6 x 10^6/ml (conventional) or 10^12/L
Females: 4.0-5.2
59
Conventional and SI hematology value for total leukocytes:
3.54-9.0 x 10^3/mm^3 or 10^9/L
60
Conventional and SI hematology value for neutraphils
.4-.7 or 40-70%
61
Conventional and SI hematology value for lymphocytes
.2-.5 or %
62
Conventional and SI hematology value for monocytes
.04-.08 or %
63
Conventional and SI hematology value for eosinophils
.0-.06 or %
64
Basophils
.0-.2 or %
65
Conventional and SI hematology value for platelet count
165-415 x 10^3/mm^3 or 10^9/L
66
Conventional and SI hematology value for PTT
26.3-39.4 sec
67
Conventional and SI hematology value for hematocrit
Males: .3388-.464 or %
Females: .354-.444 or %
68
Conventional and SI hematology value for hemoglobin
Males: 13.3-16.3 gm/dL
Females: 12.0-15.8 gm/dL
69
Conventional and SI hematology value for borderline total serum cholesterol
200-239 mg/dL or 5.17-6.20mmol/L
70
Conventional and SI hematology value for borderline LDL and very high LDL
Borderline: 130-159 mg/dL or 3.36-4.12 mmol/L
| Very high: >/= 190mg/dl or 4.91 mmol/L
71
Conventional and SI hematology value for low and high HDL
Low: /= 60mg/dL or 1.55 mmol/L
72
Conventional and SI hematology value for borderline and very high triglycerides
Borderline: 150-159mg/dL or 1.7-2.25 mmol/L
| >/= 500 mg/dL or 5.64 mmol/L
73
Which clotting time is more sensitive for detecting minor deficiencies? (PTT or PT)
PTT
74
What is a Holter Monitor?
Ambulatory ECG-worn for 24-48 hours to monitor someone
75
What is electrophysiologic testing?
using 3-5 catheters inserted into a blood vessel and threaded to the heart, evaluates the rhythm or electrical conduction abnormalities of the heart, to locate abnormal tissue that causes arrhythmias
76
Swan-Ganz catheter where? measures what?
Pulmonary artery, measures pulmonary artery wedge pressure and L atrial pressure
77
Thermodilution catheter measures what?
cardiac output
78
CVP line where? measures what?
vena cava or R atrium, pressure in either
79
What is myocardial perfusion imaging?
Also known as a radionuclide stress test, injected into blood at rest and at max execs to show how well heart muscle is perfused under these conditions.
80
What is phonocardiography?
makes a graph of heart sounds, supplements auscultation, improves detection of S3 and S4
81
```
Alpha Adrenergic Antagonist Agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " "):
```
Action: reduces peripheral vascular tone by blocking alpha-1-adrenergic receptors
Indications: hypertension, BPH
Side Effects: dizziness, ortho. hypotension, drowsiness
Implications for PT: careful supine to sit/stand
Examples: "osin"Cardura (doxazosin), Minipress (prazosin), Hytrin (terazosin)
82
```
ACE Inhibitor Agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " ")
```
Action: Suppress the enzyme that converts antiotensin I to II, therefore decreases BP and after-load
Indications: HTN, CHF
Side Effects: hypotension, dizziness, DRY COUGH, HYPERKALEMIA
Implications for PT: Avoid sudden changes in posture and with CHF, avoid rapid increases in physical activity.
Examples (all end in " "): phil Capoten (captorpril), Vasotec (enalapril), Prinivil (lisinopril), Altace (ramipril)
83
```
Angiotensin II Receptor Antagonist Agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " "):
```
Action: Block II receptors which limits vasoconstriction and limits stimulation of vascular tissue
Indications: HTN, CHF
Side Effects: dizziness, BACK AND LEG PAIN, ANGINA
Implications for PT: Minimal
Examples (all end in " "): arran Cozaar (losartan), Atacand (candesartan), Diovan (valsartan)
84
```
Antiarrhythimic Agents
The 4 Classes, and each's action, which class considered most effective?
```
Indications
Side Effects
Implications for PT
Examples (all end in " ")
I: Sodium channel blockers, control cardiac excitation and conduction
II: beta blockers, inhibit sympathetic activity
III: prolong repolarization by inhibiting both potassium and sodium channels, most effective.
IV: Calcium channel blockers, depress depolarization and slow conduction through the AV node
Indications: arrhythmias
Side Effects: exacerbation of arrhythmias, hypotension, dizziness
Implications for PT: its should adhere to dosing schedule
Examples (all end in " "):
I: Quinidine (generic), xylocain (lidocaine)
II: Tenormin (atenolol)
III: Cordarone (amiodarone)
IV: Cardizem (diltiazem"
85
```
Anticoagulant Agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " "):
```
Action: Inhibit platelet aggregation and thrombus formation.
Indications: prevention of embolism
Side Effects: bleeding
Implications for PT: avoid injury
Examples (all end in " "): Heparin, Coumadin (warfarin), Lovenox (enoxaparin)
86
```
Antihyperlipidemia Agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " "):
```
Action: 5 categories, statins most common, inhibit enzyme action in cholesterol synthesis, and break down LDLs, decrease trig. increase HDL
Indications: hyperlipidemia, atherosclerosis, prevent coronary events in ppl with CAD, diabetes, PVD
Side Effects: headache, GI, MYALGIA, rash
Implications for PT: Exercise good for HDLs
Examples (all end in " "): Lipitor (atorvastatin) Zocor (simvastatin), Tricor (fenobibrate)
87
```
Antithrombotic Agents
Action
Indications
Side Effects
Implications for PT
Examples (all end in " "):
```
Action: Inhibit platelet aggregation and clot formation
Indications: post-MI, a-fib, prevent thrombus
Side Effects: bleeding, thrombocytopenia, liver toxicity with use of aspirin, GI
Implications for PT: avoid injury
Examples (all end in " "): Bayer (aspirin), Plavix (clopidogrel), Persantine (dipyridamole)
88
```
Calcium channel blocker agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " ")
```
Action: Decrease entry of calcium into vascular smooth muscle, causing vasodilation, decreased myocardial contractions, decreased oxygen demands of the heart.
Indications: HTN, angina, arrhythmias, CHF
Side Effects: dizziness, headache, hypotension, PERIPHERAL EDEMA
Implications for PT: HR and BP response to exercise will be blunted
Examples (all end in " ") Norvasc (amlodapine) Procardia (nifedipine) Calan (verapamil) Cadizem (diltiazem)
89
3 types of diuretics, and examples of each
Thiazide: Diuril (chlorothiazide)
Loop: Lasix (furosemide)
Potassium-sparing: Dyrenium (triamterene)
90
```
Nitrate Agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " ")
```
Action: decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels
Indications: angina
Side Effects: headache, dizziness, hypotension, REFLEX TACHYCARDIA
Implications for PT: Sublingual administration of nitroglycerin is the preferred method to treat an acute angina attack.
Examples (all end in " ") Nitrostat (nitroglycerin), Isordil (isosobide dinitrate), Amyl nitrate solution for inhalation.
91
```
Positive Ionotropic Agents
Action
Indications
Side Effects
Implications for PT
Examples (all end in " ")
```
Action: Increase force and velocity of myocardial contraction, slow HR, and decrease conduction velocity through AV node, and decrease sympathetic NS activation.
Indications: HF, Afib
Side Effects: arrhythmias, GI, dizziness, blurred vision
Implications for PT: Monitor HR during activity, SEEK MD ADVICE FOR HR100
Examples (all end in " "): Lanoxin (digoxin)
92
```
Thrombolytic Agents:
Action
Indications
Side Effects
Implications for PT
Examples (all end in " ")
```
Action: Facilitate clot dissolution through conversion of plasminogen to plasmin.
Indications: Acute MI, pulmonary embolism, ischemic stroke, A or V throbosis
Side Effects: intracranial hemorrhage, allergy, arrhythmia
Implications for PT: avoid injury
Examples (all end in " "): Linlytic (urokinase), Activase (alteplase)
93
What is amiodarone?
Class III Antiarrhythmic Agent (Cordarone)
94
What is Lovenox?
Anticoagulant agent (enoxaparin)
95
What is digoxin?
Positive ionotropic agent (Lanoxin)
96
What is triamteren?
Potassium sparing diuretic (Dyrenium)
97
What is dipyridamole?
Antithrombotic agent (Persantine)
98
What is diltiazem?
Calcium channel blocker agent (Cardizem)
99
What is alteplase?
Thrombolytic agent (Activase)
100
What is nifedipine?
Calcium channel blocker agent (Procardia)
101
What is Isordil?
Nitrate agent (isosorbide dinitrate)
102
What is amlodipine?
Calcium channel blocker agent (Norvasc)
103
What is quinidine?
Sodium channel blocker (Quinidine-generic is same thing)
104
What is lidocaine?
A sodium channel blocker also (Xylocain)
105
What is clopidogrel?
Antithrombotic Agent (Plavix)
106
Angiotensin II Receptor Antagonist Agents are gents that end in " "
"sartan"
107
Thrombolytic agents are agents that end in " "
"ase"
108
alpha-1 adrenergic antagonist agents are agents that end in " "
"zosin"
109
Anticoagulant agents are agents that end in " "
"in"
110
ACE inhibitor agents are agents that end in " "
"pril"
111
Calcium channel blocker agents are agents that end in " "
"dipine"
112
What is an artherectomy?
similar to an angioplasty except the catheter has a rotating shaver to cut away plaque.
113
What is an AICD?
Automatic Implantable Cardioverter-Defibrillator. Similar to a pacemaker but also a defibrillator
114
What is cardiac ablation for?
to remove parts of the myocardium that are causing cardiac arrhythmia
115
What is enhanced extracorporeal counterpulsation
Inflation of pressure cuff at the LEs to increase venous return
116
NBG Pacemaker Code: I
```
Chamber paced
V
A
D
O
```
117
NBG Pacemaker Code: II
```
Chamber sensed
V
A
D
O
```
118
NBG Pacemaker Code: III
```
Response Sensed
T (triggered)
I (inhibited
D
O
```
119
NBG Pacemaker Code: IV (rate)
Rate modulation
R
O
120
NBG Pacemaker Code: IV (multisite)
```
Multisite Pacing
V
A
D
O
```
121
Antihistamines:
Ends in:
Examples
"ine"
| diphenhydramine, fexofenadine, cetirizine, loratadine
122
Implications for PT for Anti-inflammatory agents that are inhaled: corticosteroids, leukotriene modifiers, mast cell stabilizers.
Advise pt to rinse mouth out after use to avoid irritation of local mucosa, advise them that they should not be used to treat acute episodes of asthma as they are not bronchodilators.
123
What is flunisolide?
Corticosteroid
124
What is cromolyn sodium?
Mast-cell stabilizer
125
What is belomethasone diopropionate?
Corticosteroid
126
What is zileuton?
Leukotriene modifier
127
What is budesonide?
Corticosteroid
128
The 3 primary classifications of bronchodilators
Anticholinergic, sympathomimetics, xanthine derivatives
129
What is albuterol?
Sympathomimetic
130
What is ipatropium?
Anticholinergic
131
What is theophylline?
Xanthine derivative
132
What is tiotropium?
Anticholinergic
133
What is Aminophylline?
Xanthine derivative
134
What is salmeterol?
Sympathomimetic
135
What do guaifenesin and terpin hydrate do?
Expectorants (gua is Mucinex)
136
What do dornase alpha and acetylcysteine do?
Mucolytic Agents
137
What is a bullectomy?
Surgical procedure where bullae are removed (formed from destroyed alveoli)
138
Oxygen therapy recommended for pts with PaO2
55, 88, 56-59, 89
139
The Angina Pain Scale:
1 to 4, mild to moderate/bothersome to moderately severe to most severe
140
```
ABI interpretation:
>/= 1.3
1-1.3
.8-.99
.4-.79
<.4
```
```
>/= 1.3 indicates rigid arteries and need for U/S to check for PAD
1-1.3 is normal, no blockage
.8-.99 is mild blockage
.4-.79 is moderate
<.4 is severe
```
141
How slowly should the pressure cuff be deflated when taking BP?
2-3 mmHg/sec
142
The 5 phases of BP
```
I: First appearance of clear tapping sounds, SBP
II: Sounds become softer and longer
III: Sounds become crisper and louder
IV: Sounds become muffled and softer
V: Sound disappear completely, DBP
```
143
Prehypertension, Stage 1, and Stage 2 hypertension for kids
>/= 90th percentile to 99th plus 5 mmHg
144
```
Auscultation of heart sounds:
Aortic area
Pulmonic area
Mitral
Tricuspid
```
Aortic: 2nd intercostal space at R sternal border
Pulmonic: 2nd ICS at L sternal border
Mitral: 5th IC space, medial to L midclavicular line
Tricuspid: 4th intercostal space at L sternal border
145
What is an S3 sound? Associated with?
Vibrations of the distended ventricle during diastole normal in healthy young children (physiologic 3rd HS), in adults may indicate HF (ventricular gallop)
146
What is an S4 heart sound? Associated with?
"atrial gallop" pathological, vibration of the ventricular wall with ventricular filling and atrial contraction, may be assoc. with atrial contraction. HTN, stenosis, hypertensive HD, MI,
147
Normal bronchial sounds: is inspiration or expiration longer?
Expiration w/ pause between
148
Normal vesicular sounds: is inspiration or expiration longer?
Inspiration w/out pause
149
Crackles (formerly called _____) may be associated with which types of respiratory disorders
Formerly Rales. Obstructive and restrictive, more often heard during inspiration
Dry or wet, if heard at during the later half of inspiration, represent atelectasis, fibrosis, pulmonary edema, or pleural effusion.
150
Pleural friction rub
both insp and exp, when inflamed visceral and parietal pleura rub together.
151
Rhonchi
"snoring" or "gurgling", both insp and exp, caused by air passing through an airway that is obstructed by inflamm. or liquic.
152
Stridor
Cont. high-pitched wheeze, insp or exp
153
Wheeze:
insp and/or exp, variable from minute-minute/area-area.
154
Bronchial breath sounds
Heard in area where vesicular sounds normally present
155
Bronchophony, egophony, whispered pectoriloquy
increased clarity of spoken words eg 99, spken E sounds like nasal A, recognition of whispered words 1, 2, 3
156
Underweight adult BMI
<18.5
157
Obesity class I BMI
30-34.9
158
Normal BMI
18.5-24.9
159
Normal capillary refill time
<2 secondsq
160
Lymphedema: circumference measurements differences for unaffected/affected limbs
Mild: 5
161
Procedure and grading scale for the claudication test
Pt walks on flat track at max speed or treadmill at 2mph between 0-12 percent
ICD is initial pain free distance
ACD is maximum distance before terminated due to pain
Grade 1: initial/modest discomfort
2: Mod
3: Intense, pt can't be diverted from pain
4. Excruciating/unbearable
162
Borg Dyspnea Scale
0
3 Moderate
7 Very Severe
10 Maximal
163
Which is the ground electrode for an ECG?
R Leg (R side of abdomen)
164
P Wave
Atrial depol
165
PR Interval
Atrial depol and SA to AV node conduction time .12 to .2s
166
QRS complex
ventrical depol .06-.1
167
QT interval
ventricular depol and repol .2-.4s
168
ST segment
isoelectric period when ventricles depolarized
169
T wave
ventricular repolarization
170
What represents contraction of the L ventricle?
R
171
What represents contraction of the R ventricle
S
172
What represents ventricle relaxation?
T wave
173
With a premature ventricular contraction, which wave is usually absent?
P wave
174
Bigeminy vs trigeminy?
Bi: Sinus pulse followed by PVC
Tri: 2 sinus followed by PVC
175
What defines V-tac?
3 or more consecutive PVCs at a ventricular rate of >150 bpm if >30s life-threatening, can turn into v -fib too which causes cardiac arrest.
176
A depressed ST segment can be a result of which 3 things?
Subendocardial ischemia, digitalis toxicity, hypokalemia.
177
An elevated ST segment indicates what 2 things?
Earliest sign of acute transmural infarction, benign early repolarization pattern in a normal heart,
178
What does a Q wave signify?
A characteristic marker of infarction-.4 ms sand larger and 1/3 the amplitude of the R wave.
179
What 4 things can a T wave inversion signify?
Hours/days after an MI, or R and L bundle branch blocks, after a CVA, and as a normal juvenile T wave pattern in children and some adults.
180
Absolute indications for terminating an exercise test: 6
1) Drop in SBP > 10mmHg with other evidence of ischemia
2) Moderately severe angina (3/4)
3) Increasing NS symptoms such as ataxia and dizziness
4) Signs of poor perfusion (cyanosis, pallor)
5) Sustained v-Tac
6) 1.0 mm ST elevation in leads without diagnostic Q waves
181
Relative indications for terminating an exercise test:
1) Drop in SBP >10mmHg from baseline despite increase in workload but without other evidence of ischemia
2) >2 mm ST segment depression
3) Fatigue, SOB, wheezing, leg cramps
4) Development of bundle branch block or IV conduction delay
5) SBP >250 and/or DBP > 115
182
Normal infant and child HR
infant: 100-130
Child: 80-100
183
FEV1/FVC <___ % is the primary indicator of an obstructive lung disease
70%
184
If SPO2 <____% in patients with chronic lung disease, activity should be stopped
90, 85
185
RPP=
HR x SBP
| An easy to measure physiologic correlate to the onset of angina-ischemia usually occurs at this reproducible value
186
Original and Revise RPE values: very hard/strong
17, 7
187
Original and Revise RPE values: very light/weak
9, 1
188
Original and Revise RPE values: Somewhat hard/strong
13, 4
189
Original and Revise RPE values: Very very hard/strong
19, 10
190
Original and Revise RPE values: Hard/strong
15, 5
191
Original and Revise RPE values: very very light/weak
7, 0.5
192
Original and Revise RPE values: fairly light/moderate
11, 3
193
RPE of 13-14 represent about ____% of max HR
70%
194
Newborn, 1 y/o, and 10 y/o RR
33-45, 25-35, 15-20
195
Biot's breathing pattern
vary in depth and rate with periods of apnea, often associated with increase IC pressure of damage to the medulla
196
Cheyne-Stokes (periodic) breathing pattern
decreasing rates and depth with periods of apnea, can occur with CNS damage
197
Kussmaul's breathing pattern
deep and fast, assoc. with metabolic acidosis
198
Increased risk for DM2 etc in women w/ waste circumference of ___cm/___in in men and ___cm/___in
102, 40
88, 35
If BMI >35 won't do much good to do this, know they are already at risk
199
Normal inhalation to exhalation ratio vs obstructive ratio
1:2, 1:3/4
200
Active cycle breathing technique-used to be called
forced expiratory technique
201
The 3 phases of autogenic drainage
Unsticking: exhale at low volume, 2-3 second hold, then exhale down to expiratory reserve
Collecting: Breathe at tidal volume, with interspersed 2-3 second holds
Evacuation: deeper inspirations from low to mid insp. RV, with breath holding followed by a huff.
202
Why would you choose to do a huff instead of a cough for a patient?
less potential for airway collapse.
203
All positions contraindicated for postural drainage: 9 reasons
1) IC pressure >20
2) Head/neck injury not stabilized
3) recent spinal surgery
4) Hemoptysis
4) Empyema (pus between chest wall and pleura)
5) Bronchopleural fistula (abnormal space between lung and pleura)
6) Pulmonary edema assoc. with CHF
7) Pulmonary embolism
8) Rib Fx
9) Surgical wound
204
Contraindications for Trendelenburg position: 5
Feet higher than head
1) HTN (uncontrolled)
2) Distended abdomen
3) Esophageal surgery
4) Recent gross hemoptysis related to lung carinoma treated surgically or with radiation therapy
5) Uncontrolled airway at risk for aspiration
205
Semi-Fowler's position
supine, head/chest elevated to 30 degrees
206
The 2 types of inspiratory muscle training
1) Flow resistive breathing: gradual narrow diameter of mouthpiece they have to breathe in.
2) Threshold: build up of negative pressure before flow occurs through a valve that opens at a critical pressure.
207
Phase I cardiac (inpatient) rehab: Discontinue if any of the following adverse responses: Heart rate post surgery, HR post infarction
>130 or >30 above resting HR, if post-infarctions should be <120/20 above resting. also if any ECG signs or symptoms suggestive of ischemia
208
Phase I cardiac rehab: Discontinue if any of the following adverse responses: DBP >/=
110 mm Hg
209
Phase I cardiac rehab: Discontinue if any of the following adverse responses: Decrease in SPB > ___
10
210
Active upper and LE exercises may begin how long after bypass graft surgery and how long after infarction?
1 day, 2 days
211
Phase I cardiac rehab: MET levels, RPE levels
1-4 METs, RPE<13
212
Phase I cardiac rehab: Duration of exercises, frequency
3-5 minutes, progressing to 10-15 minutes
| 3-4 times per day first few days, 2 times per day after
213
Phase II (immediate outpatient) cardiac rehab: for low risk pts or pts with known stable CAD, how many ECG/BP monitoring sessions? How many for pts with mod/high risk or unable to self-regulate/understand recommended activity levels?
6-12 sessions
| Usually >/= 12 sessions
214
A rating of ___ on the angina scale is the recommended end-point to cease activity during Phase I and II cardiac rehab
1
215
If angina is not relieved by stopping activity or by ___ sublingual nitroglycerin tablets, take to ED
3
216
The exercise target HR should be >/= ____ below the known ischemic or anginal threshold
10 bpm
217
Karvonen formula
HR reserve: ([HRmax-HRrest] x___%) + HR rest
218
ST elevation/depression of ____ is a contraindication for inpatient and outpatient cardiac rehab, while elevation/depression of ____ is a sign to stop stop activity with pt in cardiac rehab
2mm, 1mm
219
An RPE of 12-16 corresponds with ___ to ____ % of max capacity
40-85%
220
An RPE of ___ to ___ is appropriate for pts duing initial outpatient cardiac rehab, while ___ to ___ for pts later with no signs of ischemia or dysrhythmias
11-13
| 14-16
221
Phase II (immediate outpatient) cardiac rehab: Duration of exercise
15-20 minutes (first month)
25-30 (next 3-4 months)
40+ (after 6 months)
intervals may be appropriate for patients who can't exercise continuously.
222
Approximate METs: Toileting
1-2
223
Approximate METs: light gardening
3-4
224
Approximate METs:Washing windows or car
3
225
Approximate METs: Cooking
2-3
226
Approximate METs: Walking 3mph
3-4
227
Approximate METs: Walking 4 mph
4.5-7
228
Approximate METs: Jogging 5 mph
8
229
Approximate METs: Shoveling
7
230
Approximate METs: making bed/washing dishes
2
231
Approximate METs: sweeping/vacuuming
3-3.5
232
Bathing
2-3
233
If exercising in heat, weigh pt, then replace fluids, ____ (amount) for every pound loss
1 pint
234
Lung sound: dry crackling sound heard during insp and exp
pleural friction
235
Continuous low-pitches sounds resembling snoring or gurgling during insp/exp
Rhonchi
236
Continuous high-pitched wheeze heard during insp/ex
Stridor
237
Discontinuous high-pitched popping heard during insp
crackles
238
Continuous musical or whistling sound composed of a variety of pitches
wheeze
239
The radial artery pulse is (medial/lateral) to the flexor carpi radialis tendon,
lateral
240
The brachial pulse is (medial/lateral) to the biceps tendon
medial
241
The ulnar pulse is between which two tendons?
FDS andFCU
242
How is minute volume ventilation calculated?
tidal volume x RR
243
Eupnea
normal breathing
