cp dd 1/20 (ptfe) Flashcards
hypertensive BP
hypotensive BP
> 140
<100
what is hemoglobin?
norms?
carry O2
12-18gm/dL
Causes of Low Hgb or Hematocrit
• Loss of blood • Nutritional deficiency • Bone marrow problems • Chemotherapy • Kidney failure • Abnormal hemoglobin anemia
Hbg cutoffs for ambulation
8
greater than 8 ambulate
less than 8 probably wait
what is hematocrit?
norms?
35-45%
%blood erythrocytes
increased hematocrit
- Dehydration
- Burns
- Vomiting
- Polycythemia
- Extreme physical exercise.
hct cutoffs
- Essential activities of daily living
< 25%
hct cutoff
- Ambulation and self-care as tolerated.
> 35%
hct cutoffs
- Light aerobics and light weights of 1 to 2 lbs
25% - 35%
Hematocrit is roughly # times the amount of hemoglobin
3
what is PaO2?
norms?
cutoff?
• The oxygen tension or partial pressure in arterial blood.
• Increased in oxygen therapy.
normal >80mmHg
<60mmHg no PT
Decreased PaO2
• Ventilation/perfusion mismatching, • Air obstruction by foreign body or • Shock. • Alveolar hypoventilation (kyphoscoliosis, neuromuscular disease, head injury or stroke) • Barbiturates and opioids
what is glucose?
norms?
sugar, metabolized in the cells to produce energy
norm 80 to 120 mg/dL
according to Oxyhemoglobin dissociation curve,
SaO2 stop and start pursed lip breathing
SaO2 92% ~ PaO2 80mmHg
unless COPD
increased or decreased glucose? • Diabetes mellitus • Cushing syndrome (hypercortisolism) • Chronic pancreatitis • Sepsis • Brain tumors • Medications • Eating • IV glucose.
increased, hyperglycemia
increaese or decreased glucose? • Too much insulin • Brain damage or pituitary deficiency • Addison’s disease (hypocortisolism) • Cancers such as adrenocortical cancer, stomach cancer or fibro sarcomas • Ethanol
hypoglycemia
glucose cutoff for PT
< 70 mg/dL or > 300 mg/dL.
what are platelets?
norm?
norm 150,000 to 450,000 mcL
Platelets initiate clotting sequence and the plugging of damaged blood vessels. important for homeostasis
if COPD want what SaO2
88-92%
causes of increase or decrease platelets?
• Myeloproliferative disorders
• Reactive thrombocytosis secondary to inflammatory disorders
• Infections
• Tissue injury,
• Iron deficiency
increase
causes of increase or decrease platelets? • Leukemia or • Lymphoma, in some other cancers • Bone marrow suppression or replacement/infiltration • Post bone marrow transplant • Myelodysplasia • Chemotherapy • Drugs and alcohol • HIV
decreased
next step?
platelet <10,000
with temp >100.5
hold PT
next step?
platelet 10,000 – 20,000
Therapeutic exercise and bike without resistance
next step?
platelet > 20,000
No restrictions
function of potassium?
norm?
notes on treatment?
Nerve impulse transmission, contractility of myocardial, skeletal and smooth muscle
Normal 3.5 – 5.0 mEq/L
- look at telemetry. Be aware that arrhythmias may occur with increased activity
increased or decreased potassium? • Hemolysis • Severe tissue damage • Rhabdomyolysis • Acidosis • Dehydration • Acute or chronic renal failure • Addison disease
Hyperkalemia
increased or decreased potassium? • Prolonged vomiting or diarrhea, • Cushing syndrome, • Osmotic diuresis, • Alkalosis • Trauma • SAH • Diuretics.
hypokalemia
function sodium? norm?
135 to 145 mEq/L
• Regulates body’s water balance
• Maintains acid-base balance and electrical nerve potential
sodium increased or decreased? • Excessive fluid loss • Dehydration • Diarrhea • Diuretics
Hyponatremia
sodium increased or decreased? • Kidney disease • Excessive water intake • Adrenal insufficiency • CHF • Salt intake
Hypernatremia
hyperglycemic triad
Polyphagia – frequent hunger, especially pronounced hunger.
Polydipsia – frequent thirst, especially excessive thirst.
Polyuria - frequent urination
when to take insulin vs exercise?
do not exercise during peak time (2-3 hours after dose)
high or low sodium?
can cause confusion and balance problems
low
what is function of troponin?
norm?
found in striated muscle cells only. Cell necrosis leads to the release of troponins into circulation.
<0.03 mcg/L
lab orders - troponin test 3x with a series of 8 hours between them.
troponin level
Negative for MI
< 0.03 ng/mL
troponin level
Intermediate for myocardial damage
0.03 – 0.09 ng/mL
troponin level
Positive for myocardial damage
> 0.10 ng/mL
Important Troponin Times
- 4-6 hours
- 12-16 hours
- 3 – 10 days
- 4-6 hours - Time of Initial Elevation
- 12-16 hours - Time of Peak Elevation
- 3 – 10 days - Time to Return to Normal
function of Partial Thromboplastin Time (PTT)? norm? therapeutic range?
22 to 36 seconds
- intrinsic clotting factor that is used to monitor the effectiveness of heparin level.
- therapeutic range would be 2 - 3 times the normal range. 60 to 109 seconds
function of Prothrombin Time (PT)? norm? therapeutic range?
9.5 to 13 seconds
effectiveness of Coumadin or Warfarin therapy. This is what the patients are bridged to after heparin if they need long-term anticoagulation.
- 2- 3 times the normal, around 18 to 30 seconds
> 25 guarded therapy high risk of bleeding
who is on Coumadin or warfarin at home?
afib
INR higher or lower = blood thinner
higher
function of INR? norm? therapeutic range?
International Normalized Ratio (INR)
patients on oral anticoagulation therapy, if they have been on it for two weeks, how thin blood is (more likely bruise)
-norm 0.8 to 1.2
- therapeutic range’ on a standard dose of oral anticoagulation is 2 to 3x (2.5 to 3.5.)
If INR >4 what?
use caution, risk vs benefit may need approval from physician
If INR >5 what?
serious risk of bleeding
medication Calcium Channel Blockers
what does it do?
pathologies?
names?
Relax and widen blood vessels, decreased HR and BP
- indication: HTN and CHF
- names: - pines Amlodipine, Felodipine, Isradipine.
what kind of medication?
Amlodipine, Felodipine, Isradipine.
side effects?
Calcium Channel Blockers
RPE, OH, Peripheral edema, dyspnea
ACE (Angiotensin Converting Enzyme) Inhibitors
what does it do?
pathologies?
names?
- Results in decreased BP
- Relaxes blood vessels, decreases BP, decreases oxygen demand
- Decreased BP and afterload by suppressing the enzyme that converts
Angiotensin I to Angiotensin II (which vasoconstricts) - indication: HTN and CHF
- drug: Benazepril, Lisinopril, Perindopril.
what kind of medication?
Benazepril, Lisinopril, Perindopril.
side effects?
ACE (Angiotensin Converting Enzyme) Inhibitors
side effects- OH, dizziness, hyperkalemia (changes in electrical activity of heart)
Positive Inotropic Agents
what does it do?
pathologies?
names?
- Increases force of muscular contraction
- Increases force myocardial contraction,
slows HR, decreases conduction through AV node (increases BP) - slow heart to get better beat - Improves cardiac pumping, better CO
- indication: CHF, A-fib (quivering)
- Digitalis/Digoxin
what kind of medication?
Digitalis/Digoxin
side effects?
Positive Inotropic Agents
side effects: feeling confused, dizzy or generally unwell.
feeling or being sick (nausea or vomiting) and loss of appetite.
diarrhoea.
changes in your vision (including blurred vision and not being able to look at bright light)
skin rashes.
Beta Blockers
what does it do?
pathologies?
names?
- decreasing HR and contractility
- Block the action of beta receptors of the sympathetic nervous system
- Results in decreased HR and BP
indication: cardiac arrhythmias, sometimes angina
name: Atenolol, Bisoprolol, Metoprolol, Propranolol
what kind of medication?
Atenolol, Bisoprolol, Metoprolol, Propranolol
side effects?
beta blocker
RPE, orthostatic hypotension
postural drainage: what segment?
SEATED
R & L Apical (upper lobe)
postural drainage: what segment?
SIDE LYING
R & L Lateral Basal (lower lobe)
postural drainage: what segment?
SUPINE flat
R & L Anterior (upper lobe)
postural drainage: what segment?
SUPINE, FOB ⬆ 18”
R & L Anterior Basal (lower)
postural drainage: what segment?
SUPINE, 1⁄4 from supine, FOB ⬆ 12”
Right Middle
postural drainage: what segment?
SUPINE, , 1⁄4 from supine, FOB ⬆ 12”
Left Lingula (upper)
postural drainage: what segment?
PRONE
R & L Superior (lower lobe)
postural drainage: what segment?
PRONE, FOB ⬆ 18”
R & L Posterior Basal (lower)
postural drainage: what segment?
PRONE, 1⁄4 from prone
Right Posterior
postural drainage: what segment?
PRONE, 1⁄4 from prone, HOB ⬆ 45*
Left Posterior (upper)
obstructive or restrictive lung disease?
SOB, difficulty exhaling because of damage to lungs,increased/elongated exhalations
obstructive
obstructive or restrictive lung disease?
COPD, emphysema, chronic bronchitis, asthma, cystic fibrosis, bronchiectasis
obstructive
obstructive or restrictive lung disease?
Cannot fully fill lungs with air, restricted from full expansion, Interstitial lung disease, decreased/shortened exhalations
restrictive
obstructive or restrictive lung disease?
sarcoidosis, obesity, scoliosis, DMD, ALS
restrictive
obstructive or restrictive lung disease?
ABCDE
Asthma, Bronchitis, COPD/CF, Dry cough, Emphysema
obstructive
normal tidal volume
what %TLC?
0.5L
10%
normal IRV
2.5L inspiratory residual volume
normal ERV
1.5L expiratory residual volume
normal RV
1.5L residual volume
normal IC
3L inspiratory capacity
tidal (0.5) + IRV (2.5)
normal TLC?
5L total lung capacity
IRV(2.5) + TV (0.5) + ERV(1.5) + residual (1.5)
normal FRV
3L functional residual volume
ERV(1.5) + RV(1.5)
normal VC
4.5L vital capacity
tidal (0.5) + IRV (2.5) + ERC (1.5)
obstructive or restrictive?
decrease VC, IRV, ERV
obstructive
lung is larger but increased residual volume, cannot get out air so cannot get in more
obstructive or restrictive?
increase TLC, RV, FRC
obstructive
lung is larger, cannot get air out so larger RV
obstructive or restrictive?
decrease TLC, RV, VC, FRC
restrictive
lung cannot take in air
obstructive or restrictive?
FEV1/FVC ratio higher
restrictive
easier to breathe out fast bc high elastic recoil of the stiff lungs.
obstructive or restrictive?
FEV1/FVC ratio much lower
obstructive, FEV1 much lower bc cannot get air out
normal
FEV1/FVC ratio
75%
normal FEV1
80% and 120%
FEV1 for COPD
<=80%
