CP Flashcards
1
Q
atelectasis shifts heart
A
toward same side
2
Q
pneumothorax shifts heart
A
away
3
Q
Left coronary artery divides into
A
Anterior descending
Left circumflex artery
4
Q
What carries deoxygenated blood to lungs
A
Pulmonary arteries
5
Q
Left coronary artery - anterior descending - supplies what
A
anterior portion of interventricular septum
6
Q
Left coronary artery - circumflex - supplies
A
Left atrium
Post and lat walls of LV
An and inf wall of LV
7
Q
Right coronary artery divides into
A
Sinus node artery
Right marginal artery
Posterior descending artery
8
Q
Right coronary artery - sinus node supplies
A
Right atrium
9
Q
Right coronary artery - right marginal artery - supplies
A
Right ventricle
10
Q
Right coronary artery - posterior descending artery supplies
A
Inf walls of both ventricles
Inf portion of the interventricular septum
11
Q
Extrinsic heart regulation
A
Vagus (dec HR - decrease conduction at AV) Upper thoracic (inc HR - accelerates d/c from SA to AV)
12
Q
SA node
A
pacemaker
Inate (without vagal influence) - is 100-110 bpm
But vagal influence - 60bpm
13
Q
AV node fires at
A
40-60 bpm
14
Q
Ventricles fire at
bundle of his - bundle branches - purkinje fibers
A
20-40 bpm
15
Q
P wave
A
Atrial depolarization
0.08 - 0.10
16
Q
PR
A
time to pass through AV junction
Norm is 0.12 - 0.20
17
Q
QRS
A
Depolarization of ventricles
0.04 - 0.10
18
Q
T wave
A
repolarization of ventricles
19
Q
QT
A
total time for deplarization and repolarization of ventricles
Less than or equal to 0.44
20
Q
Lead 2 (most common) shows what
A
Depolarization from R to L heart in diagonal
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)
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
23
Q
Bundle branch blocks
A
Right - Rs go below isoelectric line
Left - Rs do not go below isoelectric line (mountain looking one)
24
Q
Ischemia will show
A
ST segment depression
25
Myocardial injury will show
ST segment elevation
26
Box drawing for heart sounds
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
27
S1 split
Heard at the bottom of the heart
Commonly due to RBBB
Tricuspid closing later than mitral
28
S2 split
Heard at the top of the heart
Can be normal in children
Pulmonary closing later than aortic
29
S3 occurs when
AFTER S2
Early ventricular filling after AV valves open
Due to diastolic distention and vibration of the ventricular walls
CHF
Heard best with bell
30
S4 occurs when
Right BEFORE S1
Rapid ventricular filling after the atrial kick
Ischemic heart disease, HTN
31
Pulm restriction
Trouble getting air in
32
Pulm obstruction
Trouble getting air out
33
Crackles
Low pitched on INSPIRATION
34
Ronchi
Low pitched on INSPIRATION and EXPIRATION
| obstructive process
35
Wheezes
High pitched
| bronchospasms
36
Pleural friction rub
Typically louder with inhale
37
Preload
The amount of stretch in the LV at the end of diastole
38
Afterload
Systemic vascular resistance
| Amount of resistance the heart has to overcome to open the aortic valve and push blood volume into systemic circulation
39
Nitro will
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
40
Ca channel blocker
Dec contractility, Dec HR, Dec BP
| VD
41
Ace inhibitor
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
42
Beta blockers
"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
43
Troponin elevates ___ and stays for ___
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
44
Congestive heart failure - tx
Fluid and Na restrictions
Diuretics (to dec preload)
Ace inhibitors, beta blockers, Na/fluid restrictions, VDs, Positive ionotropes (inc contractility)
45
Four classes of antiarrhythmic agents
Na channel blockers
Beta blockers
K channel blockers
Ca channel blockers
46
For pts on antiarrhythmic drugs - exercise might
exacerbate their arrhythmia
Might have hypotension
Might have poor response to exercise
47
Positive ionotropic drugs do wht
increase contractility
48
Frank starling relationship
Inc fiber length = stronger contraction
Fiber stretch length detmines strength of contraction
49
Digoxin
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
Digoxin toxicity
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
BP lowering meds
```
Diuretics (dec preload)
Beta blockers (dec HR and cx and afterload and BP)
ACE inhib (VD, dec conc of fluid, dec BP)
```
52
Swan Ganz
Catheter is passed through R side of heart into pulmonary vessels
Immediate profile of CO and pulm artery pressure
DO NOT TREAT!
53
Pulmonary artery pressure norm
Measured with swan ganz
5-15 is normal
Pt should NOT be horizontal if over 12
54
Precautions with art line
If wrist - keep straight
If femoral - don't flex more than 45
Turn only to 90 in sidelying
55
Central venous catheter
Through internal jug, subclavian, or femoral veins
Tip enters SVC
Gives status of volume and R ventricular function = Measures R arterial pressure
56
Normal Central venous pressure
0 to 6
57
PICC line
Through basilic, medial cubital, or cephalic vein at antecubital space
Tip advances 1/3 of SVC
DONT FLEX ARM OVER 90
58
ICP precautions
0-15 norm, DONT TREAT over 20
If sit pt up, make sure to CLAMP (NEED ORDER TO DO SO)
CODMAN DRAIN
59
ICP bolt
Camino bolt - Draining the subarachnoid space
| NOT WORKING WITH THEM
60
CPP
```
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
Intra aortic balloon pump (IABP)
Assist with circulation
No hip flexion at site
Strict bed Frest!
ONLY ACTIVITY IS LOG ROLL
62
Feeding tubes
```
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
Jackson pratt
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
Most common dialysis = hemodialysis
Filters blood by moving it through a semipermeable membrane outside of the body and then returning it
3-4 hours long, 3x/wk
65
Dialysis precautions
Do not exercise before or immediately after
66
1L O2/min =
24%
67
Nasal canula can deliver
1-6 L
68
Significant desat - how much
3%
| Should come back to baseline within 1-2 min - if not, need to adjust tx
69
Suction device PTs can use
Oropharyngeal suction AKA Yaunker
| Suction for 5-10 sec as you are withdrawing the tube!
70
Most mechanical ventilators are
positive pressure ventilators
71
Tidal volume - is what and norm
Volume of air in a normal breath
Normal is 5-10 ml/kg BW
10-15 for vent patients
72
Constant minute ventilation
vent does everything
73
Assist control vent
min # of assisted breaths, if not met gives fixed TV
74
SIMV
Set min # of assisted breaths and TV
| Pt can breathe above it, but depends on pt effort
75
Mandatory minute vent
Sets min # of breaths
| Only breathes for pt when needed
76
CPAP
Maintains positive airway pressure
77
NIPPV
Non invasive - just a mask with O2
78
COPD =
20% Emphysema (pink puffer) and 80% Chronic bronchitis (blue bloater)
79
Acute resp failure - PaO2 and PaCo2
```
PaO2 = less than 60 mmHg
PaCO2 = more than 50 mmHg
```
80
Signs of resp distress
Hypoxia - inc RR, BP, HR, resless, cyanosis
| Hypercapnia - HA and LOC changes
81
Functional residual capacity
volume of air in lungs after normal exhale
= ERV + RV
40% of total lung volume
82
Tidal volume
air in and out in a normal breath
| 10% of total lung volume
83
IRV
amount you can inhale above normal inhale
| 50% of total lung volume
84
ERV
amount you can exhale after normal exhale
| 15% of total lung volume
85
RV
amount left after end of max expiration
| 25% of total lung volume
86
TLC
FRC + IC (ERV + RV) + (TV + IRV)
or
RV + VC (RV) + (TV + IRV + ERV)
87
IC
The max volume that can be inspired after normal tidal exhalation
= TV + IRV
60% of total lung volume
88
Vital capacity
Volume change that occurs btw max inspiration and max expiration
TV + IRV + ERV
75% of total lung volume
89
Lung CA - worst to have
Small cell carcinoma
| Early met and worst prognosis
90
Non small cell carinoma
Squamous cell - central - late met
Adenocarcinoma - periph - early met
Large cell - early met and grow fast
91
Metastatic lung CA more common than primary - Most common prim CA that met to lungs
```
Breast!!!
GI
F genital
Kidneys
Melanoma
M genital
```
92
Restrictive lung diseases
Lungs can't fully expand
Lung volumes are decreased
Work of breathing increased
93
Classic signs of restrictive lung disease
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
Bacterial vs. Viral pneumonia - cough
Bacterial - productive
| Viral - non productive
95
Chronic aspiration - more common in which lobe
Right!
| Because it is more vertical and has a larger diameter
96
BOOP
Bronchiolitis obliterans with organ pneumonia
Bronchioles and alveloi become inflames and plugged with CT
97
Pulmonary edema - ___ heart failure
LEFT
| L is not pumping out to system so things get backed up and you end up with inc pressure in pulm system
98
Asthma - quick tx vs. long term (meds)
Quick = albuterol = beta adrenergic agent - SNS activation - BD
Long term = corticosteroid with beta 2 agonists
99
COPD tx (meds)
Bronchodilators (beta adrenergic agents, anticholinergics)
| O2 therapy
100
BP contraindication to exercise
SBP over 180
DBP over 110
Drop in SBP of more than 20
101
Inspiration:Expiration ratio
1:2
COPD will be 1:4
102
Listening for diaphragm movememnt
Lung will be resonant
Diaphragm will be dull
Mediate percussion
103
Resonant, Dull, FLat, Tympanic
```
Resonant = lungs
Dull = liver, diaphragm
Flat = mm mass
Tympanic = hollow organ like stomach
```
104
Norm diaphragmatic excursion
3 to 5 cm
| DEC IN COPD
105
Chest wall excursion
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
Dyspnea
```
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
Stages of cough
Air in - epiglottis closes - diaphragm cx - epiglottis open
108
Angina scale
```
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
EF norm and no tx
Norm 55-70%
| NO TX if less than 20%
110
Pulmonary hypertension
| Norms and no tx
Norm 12-18 mmHg
Htn will be above 20
NO TX if above 25
