CP 2 Flashcards
What branch of the left coronary artery supplies the L arterium, L ventricle (anterior, lateral, posterior, and some inferior)
Circumflex artery
Cardiac conduction system
Sa node to av node to bundle of his to purkinje fibers
Forced expiration against a closed glottis produces increased intrathoracic pressure, increased central venous pressure, and decreased venous return know as ?
Valsalva maneuver - the resultant decrease in CO and blood pressure is sensed by baroreceptors, which reflexively increase HR and myocardial contractility through sympathetic stim.
Once the glottis opens following a valsalva maneuver what happens
Venous return increases and so does the blood pressure, causing the baroreceptors to reflexively decrease the HR through the parasympathetic efferent pathway
Contraction of the external and internal interconstals muscles does what
Elevates the ribs during INSPIRATION
Four muscles of expiration
Rectus abdominis, external oblique, internal oblique, and transverse abdominis
Carina is at the level of
T4 and sternal angle
What sympathetically innervates the smooth muscles or the bronchi and pulmonary blood vessels
Post ganglionic sympathetic fibers. Parasympathetic is via vagus nerve
What structure increases ventilation by responding to increases in partial pressure of CO2 and hydrogen ion
Central chemoreceptors in the medulla
What structures respond to hypoxia by increasing ventilation
Peripheral chemoreceptors in carotid bodies
Pain at the navel, abdominal and/or LBP
Abdominal Aneurysm
Sudden severe headache, vomiting, stiff neck, seizure
Cerebral aneurysm
A congenital heart disease where the foramen ovale fails to shut leaving a hole between the R and L atria allowing blood to bypass the lungs
Atrial septal defect
A congenital heart disease in which the ductus arteriosus, which normally shunts blood from the pulmonary artery directly to the aorta in utero does not close after birth
Patent ductus arteriosus causes back flow of from aorta to the PA then to lungs. If left untreated will cause lung damage, heart failure and pulmonary hypertension
A congenital heart defect where there’s a hole in the septum separating the right and left ventricles.
Ventricular septal defect VSD- can cause r sided heart failure, cyanosis, rapid HR
Tetralogy of fallot four defects
Ventricular septal defect, pulmonary stenosis, right ventricular hyper trophy, aorta overriding the ventricular septal defect
Antihistamine action and side effect
Blocks the effects of histamine resulting in a decrease in nasal congestion, mucosal irritation and symptoms of common cold or allergy … May side effect is postural hypotension !!!
Anti inflammatory agents corticosteroid inhaler implication for PT
Instruct pt to rinse mouth with water after use to avoid irritation of local mucosa and advise them that these should not substitute Bronchodilators during acute asthma attack
What is heart sound is heard at the onset of diastole
S2
What is heard when vibrations of longer duration than the heart sound occur due to disruption of blood flow past a stenotic or regurgitating valve
Murmur
Lung sound auscultation with bell or diaphragm
Diaphragm- start at the apices and work downward, pt breathe in through mouth a little deeper than usual
Sudden opening and closing of airways
Dry crackles
Sound heard due to movement of fluid or secretions during inspiration
Wet crackles
Child and adolescent BMI in the 95th percentile or great is considered
Overweight or obese
For circumferential measurements how many sites per extremity are recommended
7
Procedure for claudication test
Pt walks on a flat track at max speed or on a treadmill at 2.0 mph at a constant grade between 0-12 %
Initial claudication distance
Pain free walking
Absolute claudication distance
Max distance walked when test had to be terminated due to pain
One small box amount of time?
.04 secs
One large box is
.2 secs- 1 second -5 large boxes
How many boxes in a 6 sec strip
30
Memorization method procedure
Find a qrs complex where the R hits directly on a dark line. The following dark line is 300, next dark line is 150-100-75-60-50
Rapid arterial depolarization from one foci
A flutter. Many p waves
Quivering of atrial with absent p wave
A fib
Controlled a fib
hr
Uncontrolled a fib
Hr >100
Monitor vital closely
Prolonged pr interval (longer than 3-5 cubes)
1st degree heart block - asymptomatic (no impact on co)
Progressive prolongation of PR interval until one impulse doesn’t get through
Second degree heart block - asymptomatic and rarely progresses to other blocks BENIGN
Blocked conduction of one impulse to ventricles, making qrs miss a beat
Second degree heart block type II- drop in CO and Can progress to Complete Heart Block
No impulses from above the ventricle are conducted through AV node. No communication between atria and ventricles, so no relationship between p wave and qrs
Third degree heart block- medical emergency
PVC are more dangerous when
Couplets, multifocal, > 6/minute, triplets – May progress to V tach or V fib
3 or more PVC in a row
Vtach - Cardiac output greatly affected ***Emergency
Quivering ventricles causing no CO
V fib
Non q wave mi
Sub endocardial more likely to reinfarct
Earliest sign of acute transmural infraction
ST elevation
A sign of subendocardial ischemia
ST segment depression
A characteristic marker of infraction signifying a loss of positive electrical voltages due to necrosis
Q wave
6 absolute indications for terminating an exercise test
10 mmhg drop or greater in SBP with other evidence if ischemia, moderately severe angina (3/4), increasing nervous system symptoms( ataxia, dizziness), signs of poor perfusion ( cyanosis, pallor), sustained vtach, 1.0 mm ST elevation
Relative indications for terminating an exercise test
Drop Sbp >10 mm hg from baseline without other evidence of ischemia, >2 mm ST segment depression, arrhythmias (multi focal PVCs, supra ventricular tachycardia, heart block or Brady arrhythmias), fatigue claudication, inc chest pain, hypertensive response ( Sbp >250 mm hg, dbp > 115 mm hg)
Radial pulse location
Lateral to the flexor Capri radialis tendon
Femoral pulse point
One third of the distance from the pubis to the asis
Dorsalis pedis pulse point
Near the center of the long axis of the foot, between the first and second metatarsals
Inferred from spirometry when FVC is reduced and fev1/FVC is normal or >80%
Restrictive impairment
Percent of arterial oxygen saturation (spo2) of hemoglobin is measure via
Pulse oximetry
RPP (25.5 x 10^3) is useful for guiding exercise prescription because
Keeping the intensity below the RPP will reduce the risk of developing ischemia/angina
Irregular breathing c periods of apnea due to damage to the medulla or inc intrathoracic cranial pressure
Biots pattern
Deep and fast breathing often associated c metabolic acidosis
Kussmaul’s breathing pattern
Chronic adaptations to aerobic exercise for BP and blood lactate
Slight increase at max exercise and slight decrease at submax exercise
Active cycle breathing procedure
Breath control ie diaphragmatic breathing - thoracic expansion ie 3-4 slow, deep inhalations to inspiratory reserve with passive exhalation combined with chest percussion, vibration, or shaking- forced expriratory technique ie 2-3 huff cough combined c brisk adduction of the upper arms
Autogenic drainage procedure
Unsticking phase- slow, low breathing c breath hold for collateral ventilation, the exhale into expiratory ERV—- collection phase- breathe at tidal volume, interspersed breath holds —– evacuation phase- deeper inspiration from low-to- mod inspiration reserve volume, c breath holding followed by a huff
Acapella and flutter are handheld devices that combine positive expiratory pressure and high frequency vibration to mob mucus in the airway. What is the procedure?
Inhale slowly 75% of full breath — hold for 2-3 secs—exhale through device for 3-4 secs— repeat 10-20 breaths— remove device and perform 2-3 coughs or huff coughs
Percussion for how long in postural drainage position?
2-3 min
Vibrations take place c tightened hand one on top of the other, during?
Exhalation
Cough or huff cough should take place after ____ vibrations
2-3
Procedure for Threshold IMTs
Measure the pt’s max inspiratory pressure MIP with a manometer – begin training at 30-40% of pt’s MIP, the pt breathes against the resistance at TV for 5-15 mins, 2-3 x per day— progress in small increments until the training load reaches 40-60% of MIP
PFLEX IMT procedure
Begin at 30-40% level of MIP for 10-15 min daily, gradually inc to 20-30 min, once pt can do 30 min at one setting inc the resistance
Which breathing exercise is indicated for a pt with dyspnea at rest or activity, or inefficient breathing pattern during activity
Pacing
Expected outcomes of pacing
Ability to time easy component of task with inhalation and the more strenuous component with exhalation
Technique to reduce RR and prevent airway collapse
Pursed lip breathing
Respiratory technique during which PT applies a firm pressure at the end of exhalation on the pt’s chest wall overlying the area to be expanded. Then the pt inhales deeply and slowly expanding the rib cage under PTs hand
Segmental breathing / thoracic expansion
Respiratory exercise used for atelectasis, restricted lung disease associated c SCI, or dec intrathoracic lung volume
Sustained max inhalation c incentive spirometry vs IMTrainers are just for poor inspiratory muscle strength
Sustained max inhalation c incentive spirometry procedure
Hold in a vertical position- have pt exhale completely, then breath in slowly and deeply through the mouth raising the ball of the spirometer– encourage pt to move diaphragm not upper chest while inspiring — hold breath for at least 3 sec— do 5-10 breathes per hour when awake
Phase I cardiac rehab active exercises progress from sitting to standing, ambulation, stairs. What is the appropriate MET range?
1-4 METS
Phase I cardiac rehab intensity prescription (RPE, and HR )
Phase I cardiac rehab active exercise direction
Intermittent bouts of 3-5 min, progressing to 10-15 mins of continuous activity .. Multiple time per day
How many sessions of medical and ECG monitoring are required for a pt with low risk and known stable CAD
6-12 sessions
12 or more sessions for pt with mod - high risk
Terminate exercise in phase II (OP) cardiac rehab if
SBP plateaus or falls c inc work or >250 mmhg, DBP 115 or greater, ST segment depression >1 mm, 2nd or 3rd degree heart block, ventricular dysrhythmias, angina or other symptoms of cardio insufficiency
Exercise target HR should be ____ or less BPM below the known ischemic or anginal threshold
10
A rating of 1 on the angina scale during inpatient and outpatient cardiac rehab
Recommended end point to cease activity - have the pt rest, if the angina doesn’t terminate with rest or by 3 sublingual nitroglycerin tablets transport individual to ER
RPE of 12-16 represent _____% of max capacity
40-85%
Appropriate RPE upper limit in the initial phases of OP cardiac rehab
11-13
Bathing or cooking MET
2-3
Walking at home MET
2
Playing a musical instrument MET
2-2.5
Carrying or stacking wood MET
5.5
Walking 3 MPH MET
3-4
Walking 4 MPH MET
4.5-7.0
Bicycling MET flat 10-12 Mph MET
6.0
3-6 mod
Jogging MEt
8
Running 7 MPH MET
11.5
More than 6 METS is vigorous
Compression depth for adults?
At least 2 inches- allow complete recoil of chest
Compression depth for children and infants ?
At least 1/3 AP depth
Compression to ventilation ratio CPR
30:2
Or compressions only when the provider is untrained
When to attach and use AED
As soon as possible c minimal interruption in the compressions
Respiratory acidosis the pH will be dec, the PaCO2 will be inc, how about the HCO3?
Inc… HCO3 and PaCO2 always same direction
Original RPE rating that represents 70% of max HR
14/20
What artery supplies the interventricular septum
Left anterior descending
