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Reminders! > CP > Flashcards

CP Flashcards

1
Q

atelectasis shifts heart

A

toward same side

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2
Q

pneumothorax shifts heart

A

away

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3
Q

Left coronary artery divides into

A

Anterior descending

Left circumflex artery

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4
Q

What carries deoxygenated blood to lungs

A

Pulmonary arteries

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5
Q

Left coronary artery - anterior descending - supplies what

A

anterior portion of interventricular septum

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6
Q

Left coronary artery - circumflex - supplies

A

Left atrium
Post and lat walls of LV
An and inf wall of LV

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7
Q

Right coronary artery divides into

A

Sinus node artery
Right marginal artery
Posterior descending artery

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8
Q

Right coronary artery - sinus node supplies

A

Right atrium

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9
Q

Right coronary artery - right marginal artery - supplies

A

Right ventricle

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10
Q

Right coronary artery - posterior descending artery supplies

A

Inf walls of both ventricles

Inf portion of the interventricular septum

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11
Q

Extrinsic heart regulation

A 
Vagus (dec HR - decrease conduction at AV)
Upper thoracic (inc HR - accelerates d/c from SA to AV)
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12
Q

SA node

A

pacemaker
Inate (without vagal influence) - is 100-110 bpm
But vagal influence - 60bpm

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13
Q

AV node fires at

A

40-60 bpm

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14
Q

Ventricles fire at

bundle of his - bundle branches - purkinje fibers

A

20-40 bpm

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15
Q

P wave

A

Atrial depolarization

0.08 - 0.10

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16
Q

PR

A

time to pass through AV junction

Norm is 0.12 - 0.20

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17
Q

QRS

A

Depolarization of ventricles

0.04 - 0.10

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18
Q

T wave

A

repolarization of ventricles

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19
Q

QT

A

total time for deplarization and repolarization of ventricles
Less than or equal to 0.44

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20
Q

Lead 2 (most common) shows what

A

Depolarization from R to L heart in diagonal

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21
Q

Procedure for ECG eval

A 
Evaluate P (atria, SA node)
Evaluate PR (AV node)
Evaluate QRS complex (ventricles)
Evaluate QRS interval (ventricles)
Evaluate T wave 
R-R interval (rate)
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22
Q

Heart blocks

A

1st = really long PR int
2nd type 1 = prog lengthened PR, drops every 4th
2nd type 2 = fixed long PR, drops every 2nd, 3rd, 4th
3rd = separate firing of atria and ventricle

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23
Q

Bundle branch blocks

A

Right - Rs go below isoelectric line

Left - Rs do not go below isoelectric line (mountain looking one)

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24
Q

Ischemia will show

A

ST segment depression

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25
Q

Myocardial injury will show

A

ST segment elevation

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26
Q

Box drawing for heart sounds

A

T between RA and RV, M between LA and LV
P after RV, A after LV

S1 at T and M
S2 at P and A

Dias above S1, Sys between, Dias below S2

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27
Q

S1 split

A

Heard at the bottom of the heart
Commonly due to RBBB
Tricuspid closing later than mitral

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28
Q

S2 split

A

Heard at the top of the heart
Can be normal in children
Pulmonary closing later than aortic

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29
Q

S3 occurs when

A

AFTER S2
Early ventricular filling after AV valves open
Due to diastolic distention and vibration of the ventricular walls
CHF
Heard best with bell

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30
Q

S4 occurs when

A

Right BEFORE S1
Rapid ventricular filling after the atrial kick
Ischemic heart disease, HTN

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31
Q

Pulm restriction

A

Trouble getting air in

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32
Q

Pulm obstruction

A

Trouble getting air out

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33
Q

Crackles

A

Low pitched on INSPIRATION

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34
Q

Ronchi

A

Low pitched on INSPIRATION and EXPIRATION

obstructive process

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35
Q

Wheezes

A

High pitched

bronchospasms

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36
Q

Pleural friction rub

A

Typically louder with inhale

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37
Q

Preload

A

The amount of stretch in the LV at the end of diastole

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38
Q

Afterload

A

Systemic vascular resistance

Amount of resistance the heart has to overcome to open the aortic valve and push blood volume into systemic circulation

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39
Q

Nitro will

A

Decrease preload and afterload by VD
Will also redistribute coronary blood flow to dec O2 demand of the heart

Sublingual in supine (used for angina)

Side effects - HA, dizzy, Ortho hypo

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40
Q

Ca channel blocker

A

Dec contractility, Dec HR, Dec BP

VD

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41
Q

Ace inhibitor

A

Prevents conversion of angiotensin 1 to angiotensin 2
Prevents Na and H20 retention - so dec afterload
Dec BP by dec arteriole constriction

“ril”
Dec release of aldosterone and ADH

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42
Q

Beta blockers

A

“lol”

Dec HR and contractility which dec O2 demand of heart
Dec CO

Will block beta 2 in rest of body too so BronchoCONstirction and dec BP with VC

Side effects = Bradycardia, chest pain, hypotension

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43
Q

Troponin elevates ___ and stays for ___

A

Troponin elevates in 1 to 2 hours after MI and stays up for 10 days

Myoglobin elevates quickly and then drops quickly after MI so not as good to look at as troponin

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44
Q

Congestive heart failure - tx

A

Fluid and Na restrictions
Diuretics (to dec preload)

Ace inhibitors, beta blockers, Na/fluid restrictions, VDs, Positive ionotropes (inc contractility)

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45
Q

Four classes of antiarrhythmic agents

A

Na channel blockers
Beta blockers
K channel blockers
Ca channel blockers

46
Q

For pts on antiarrhythmic drugs - exercise might

A

exacerbate their arrhythmia
Might have hypotension
Might have poor response to exercise

47
Q

Positive ionotropic drugs do wht

A

increase contractility

48
Q

Frank starling relationship

A

Inc fiber length = stronger contraction

Fiber stretch length detmines strength of contraction

49
Q

Digoxin

A

Pos ionotropic agent
(cardiac glycoside)

Inc contractility through inc in Ca conc, dec HR by blocking Na/K ATPase

Allows for more time for blood to flow from atria to ventricles

50
Q

Digoxin toxicity

A

Low margin of safety - Lethal dose is only 5-10x minimal effective dose!
Do not take with diruetics! - enhanced morbidity when combined

N/V, arrhthmias, visual/neuro disturbances

51
Q

BP lowering meds

A 
Diuretics (dec preload)
Beta blockers (dec HR and cx and afterload and BP)
ACE inhib (VD, dec conc of fluid, dec BP)
52
Q

Swan Ganz

A

Catheter is passed through R side of heart into pulmonary vessels
Immediate profile of CO and pulm artery pressure

DO NOT TREAT!

53
Q

Pulmonary artery pressure norm

A

Measured with swan ganz
5-15 is normal
Pt should NOT be horizontal if over 12

54
Q

Precautions with art line

A

If wrist - keep straight
If femoral - don’t flex more than 45
Turn only to 90 in sidelying

55
Q

Central venous catheter

A

Through internal jug, subclavian, or femoral veins
Tip enters SVC
Gives status of volume and R ventricular function = Measures R arterial pressure

56
Q

Normal Central venous pressure

A

0 to 6

57
Q

PICC line

A

Through basilic, medial cubital, or cephalic vein at antecubital space
Tip advances 1/3 of SVC
DONT FLEX ARM OVER 90

58
Q

ICP precautions

A

0-15 norm, DONT TREAT over 20
If sit pt up, make sure to CLAMP (NEED ORDER TO DO SO)
CODMAN DRAIN

59
Q

ICP bolt

A

Camino bolt - Draining the subarachnoid space

NOT WORKING WITH THEM

60
Q

CPP

A 
Cerebral perfusion pressure 
MAP minus ICP
BP that is available to perfuse the brain 
Should be 60-150 mmHg
If above 150 = NOT WORKING WITH THEM
61
Q

Intra aortic balloon pump (IABP)

A

Assist with circulation
No hip flexion at site
Strict bed Frest!
ONLY ACTIVITY IS LOG ROLL

62
Q

Feeding tubes

A 
NG = nutrition more than 3-4 wks
PEG = long term enteral feeding
Gastrostomy = bolus feeding 
Jejunostomy = good if no gag reflex (also bolus)

Keep head of bed elevated 30 deg when eating!!!

WATI 15-20 MIN after eating to lay flat!!!

Clamp and disconnect for tx

63
Q

Jackson pratt

A

Commonly used to eliminate air or blood from the abdominal cavity or drain blood from skull

NEED TO TAPE TO PERSON TO GET THEM UP

64
Q

Most common dialysis = hemodialysis

A

Filters blood by moving it through a semipermeable membrane outside of the body and then returning it
3-4 hours long, 3x/wk

65
Q

Dialysis precautions

A

Do not exercise before or immediately after

66
Q

1L O2/min =

A

24%

67
Q

Nasal canula can deliver

A

1-6 L

68
Q

Significant desat - how much

A

3%

Should come back to baseline within 1-2 min - if not, need to adjust tx

69
Q

Suction device PTs can use

A

Oropharyngeal suction AKA Yaunker

Suction for 5-10 sec as you are withdrawing the tube!

70
Q

Most mechanical ventilators are

A

positive pressure ventilators

71
Q

Tidal volume - is what and norm

A

Volume of air in a normal breath
Normal is 5-10 ml/kg BW
10-15 for vent patients

72
Q

Constant minute ventilation

A

vent does everything

73
Q

Assist control vent

A

min # of assisted breaths, if not met gives fixed TV

74
Q

SIMV

A

Set min # of assisted breaths and TV

Pt can breathe above it, but depends on pt effort

75
Q

Mandatory minute vent

A

Sets min # of breaths

Only breathes for pt when needed

76
Q

CPAP

A

Maintains positive airway pressure

77
Q

NIPPV

A

Non invasive - just a mask with O2

78
Q

COPD =

A

20% Emphysema (pink puffer) and 80% Chronic bronchitis (blue bloater)

79
Q

Acute resp failure - PaO2 and PaCo2

A 
PaO2 = less than 60 mmHg
PaCO2 = more than 50 mmHg
80
Q

Signs of resp distress

A

Hypoxia - inc RR, BP, HR, resless, cyanosis

Hypercapnia - HA and LOC changes

81
Q

Functional residual capacity

A

volume of air in lungs after normal exhale
= ERV + RV
40% of total lung volume

82
Q

Tidal volume

A

air in and out in a normal breath

10% of total lung volume

83
Q

IRV

A

amount you can inhale above normal inhale

50% of total lung volume

84
Q

ERV

A

amount you can exhale after normal exhale

15% of total lung volume

85
Q

RV

A

amount left after end of max expiration

25% of total lung volume

86
Q

TLC

A

FRC + IC (ERV + RV) + (TV + IRV)
or
RV + VC (RV) + (TV + IRV + ERV)

87
Q

IC

A

The max volume that can be inspired after normal tidal exhalation
= TV + IRV
60% of total lung volume

88
Q

Vital capacity

A

Volume change that occurs btw max inspiration and max expiration
TV + IRV + ERV
75% of total lung volume

89
Q

Lung CA - worst to have

A

Small cell carcinoma

Early met and worst prognosis

90
Q

Non small cell carinoma

A

Squamous cell - central - late met
Adenocarcinoma - periph - early met
Large cell - early met and grow fast

91
Q

Metastatic lung CA more common than primary - Most common prim CA that met to lungs

A 
Breast!!!
GI
F genital
Kidneys
Melanoma
M genital
92
Q

Restrictive lung diseases

A

Lungs can’t fully expand
Lung volumes are decreased
Work of breathing increased

93
Q

Classic signs of restrictive lung disease

A

Dyspnea!!!
Dry non productive cough!!!
Weight loss/wasting!!!

Cor pulmonale (R VENTRICLE ENLARGEMENT)
Tachypnea
Hypoxemia
Dec breath sounds
Dec lung volumes
Dec diffusion capacity
94
Q

Bacterial vs. Viral pneumonia - cough

A

Bacterial - productive

Viral - non productive

95
Q

Chronic aspiration - more common in which lobe

A

Right!

Because it is more vertical and has a larger diameter

96
Q

BOOP

A

Bronchiolitis obliterans with organ pneumonia

Bronchioles and alveloi become inflames and plugged with CT

97
Q

Pulmonary edema - ___ heart failure

A

LEFT

L is not pumping out to system so things get backed up and you end up with inc pressure in pulm system

98
Q

Asthma - quick tx vs. long term (meds)

A

Quick = albuterol = beta adrenergic agent - SNS activation - BD

Long term = corticosteroid with beta 2 agonists

99
Q

COPD tx (meds)

A

Bronchodilators (beta adrenergic agents, anticholinergics)

O2 therapy

100
Q

BP contraindication to exercise

A

SBP over 180
DBP over 110

Drop in SBP of more than 20

101
Q

Inspiration:Expiration ratio

A

1:2

COPD will be 1:4

102
Q

Listening for diaphragm movememnt

A

Lung will be resonant
Diaphragm will be dull

Mediate percussion

103
Q

Resonant, Dull, FLat, Tympanic

A 
Resonant = lungs
Dull = liver, diaphragm
Flat = mm mass
Tympanic = hollow organ like stomach
104
Q

Norm diaphragmatic excursion

A

3 to 5 cm

DEC IN COPD

105
Q

Chest wall excursion

A

Upper 2/8 norm, 1.5 to 2 with deep
Middle 3/8 norm, 2-3 with deep
Lower 4/8 norm, 3-4 with deep

106
Q

Dyspnea

A 
Count to 15 and see how many breaths takes them
0 = no dyspnea
1 = 1 breath
2 = 2 breaths
3 = 4+ breaths 
4 = can't finish

DO NOT LET GET TO 3 (stop when 3 or greater)

107
Q

Stages of cough

A

Air in - epiglottis closes - diaphragm cx - epiglottis open

108
Q

Angina scale

A 
0 = none
1 = light, barely noticeable
2 = mod, bothersome
3 = severe
4 = worst pain ever

DO NOT LET GET TO 2! (stop when 2 or greater)

109
Q

EF norm and no tx

A

Norm 55-70%

NO TX if less than 20%

110
Q

Pulmonary hypertension

Norms and no tx

A

Norm 12-18 mmHg
Htn will be above 20
NO TX if above 25

Reminders! (22 decks)

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