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CPT II > CPT II - Final > Flashcards

CPT II - Final Flashcards

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1
Q

Precautions for permanent pacemaker (so wires have time to scar into place)

A

Shoulder sling 24-48 hours

No shoulder elevation > 90 deg (x2 wks)

No lifting or WB (x2 wks)

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2
Q

Where is a pacemaker inserted?

A

In the infraclavicular fossa, through the subclavian veins

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3
Q

Temporary pacemaker precautions

A

Consider underlying indication

Don’t pull it out

Be sure of proper function

Watch rhythm

Bed rest after wire removal

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4
Q

What is an ECMO?

A

Extracorporeal Membranous Oxygen - cardiopulmonary bypass

Blood is oxygenated outside of the body

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5
Q

What are the 3 types of venous access?

A

Peripheral IV
PICC
Hickmann

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6
Q

What is a PICC line?

A

Peripherally Inserted Central Catheter

Distal part of the line is inserted in the R atrium

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7
Q

Should we avoid manual techniques to the shoulder in order to protect the IV lines?

A

No, patient is at risk for frozen shoulder and other pathologies. Just be very careful!!

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8
Q

What is a Portacath?

A

Version of the Hickman line but completely internal - port in the skin for access on a non-daily basis.

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9
Q

PICC and Hickman lines are used for what?

A

Prolonged daily access for antibiotics or chemotherapy

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10
Q

General IV precautions

A

Know what’s going on with your patient

Avoid BP on the involved side

Protect the line

Avoid kinking the line

May interfere with mobility and use of ADs (axillary crutches damage PICC lines)

Insertion into foot or femoral vein may keep patient from ambulating

Make IV pumps mobile

Observe integrity of insertion side (look for infection, phlebitis)

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11
Q

What is infiltration?

A

Medication enters the interstitial spaces instead of the veins, which damages the surrounding tissues.

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12
Q

What is phlebitis? How does it present?

A

Inflammation of a vein - red streak following the path of the vein.

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13
Q

What are the 2 types of chest tubes?

A

Pleural tube

Mediastinal tube

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14
Q

When are chest tubes used?

A

Hemothorax, pneumothorax, empyema, etc.

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15
Q

What should you do if a chest tube comes out?

A

Yell for help. Tell patient to breathe in and hold pressure over the wound.

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16
Q

Mobilizing concerns of the chest tube?

A

“Leash effect” of tubes

Keep device below level of insertion

Kinking, tripping, stepping on tubes

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17
Q

What are 3 types of feeding tubes?

A

NG tube - nasogastric (temporary)

G tube - stomach (permanent)

J tube - jejunum (permanent)

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18
Q

What are patients at risk for if they have a feeding tube? How can this be avoided?

A

Aspiration

Wait 30-60 minutes after bolus feeding and keep HOB 45 deg during feeding

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19
Q

What can feeding tubes also be used for?

A

Suctioning substances from the stomach

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20
Q

What is the difference between a foley catheter and a texas catheter?

A

Foley - goes into bladder through urethra

Texas - slips on like a condom

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21
Q

Mobilization consideration for urinary tubes?

A

Leash effect

Keep below bladder

Consider I’s and O’s (how much going in, how much coming out)

Empty if full and tell the nurse

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22
Q

What is longterm urinary tube?

A

Suprapubic indwelling catheter (surgical implant)

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23
Q

Considerations when treating a patient who had an epidural?

A

Remember that they can’t feel pain and that motor control might be affected

May experience spinal headaches with increasing severity when sitting upright

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24
Q

Considerations when treating a patient who has a PCA (patient-controlled analgesia pump)

A

Have patient pre-medicate before treatment

They can’t overdose, but don’t tell them that (placebo)

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25
Q

What are types of post-op drains?

A

JP or bulb drains (work like turkey basters)

Hemovac drains (suction)

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26
Q

If a patient had abdominal surgery, what should you do before treatment?

A

See if they are clear for OOB activity

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27
Q

What is used to promote circulation after surgery? Mobilization considerations?

A

Antithrombolytic boots - compressive boots that inflate/deflate

Boots must come off before mobilizing

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28
Q

What day does the heart of an embryo begin to beat?

A

Day 17

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29
Q

What day does the lung buds appear in an embryo?

A

Day 26

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30
Q

When have the 4 chambers of the heart fully developed in an embryo? Implication?

A

8 weeks

Defects usually occur at this point

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31
Q

When does surfactant begin to be produced in an embryo?

A

24 weeks

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32
Q

When does surfactant reach full maturity?

A

36 weeks

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33
Q

How does a fetus get oxygen?

A

From the placenta (umbilical vein)

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34
Q

What fetal circulation supplies the upper body?

A

IVC –> R atrium –> Foramen ovale –> L atrium –> L ventricle –> Ascending aorta

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35
Q

What fetal circulation supplies the lower body?

A

SVC –> R atrium –> R ventricle –> Pulmonary artery –> Ductus arteriosus –> Descending aorta

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36
Q

What are the 2 main points of shunting in embryonic heart?

A

Foramen ovale

Ductus arteriosus

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37
Q

What is the foramen ovale?

A

Opening between the atria which allows for right to left-blood flow bypassing the lungs

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38
Q

What closes the foramen ovale?

A

Before 1st breath, lungs are high pressure

At first breath, lungs expand with air; this decreases pulmonary vascular resistance and increases systemic resistance

Blood returns to the left atrium making pressure higher on the left than the right which causes the foramen ovale to gradually seal shut (within 3 months)

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39
Q

What is the ductus arteriosus?

A

Connection between the pulmonary artery and descending aorta

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40
Q

What closes the ductus arteriosus

A

After the 1st breath, lungs become filled with O2 which causes blood O2 to rise

The wall of the ductus arteriosus contracts and closes between 10-15 hours after birth. Anatomical closure by 2-3 weeks

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41
Q

Where do you look for cyanosis?

A

Nail beds and lips

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42
Q

What is an atrial septal defect?

A

Hole in septum between the atria (persistent foramen ovale).

Oxygenated blood flows from L to R atria. Can put stress on heart and lead to CHF.

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43
Q

What is a ventricular septal defect?

A

Opening in septum between L and R ventricle.

Blood flows from L –> R. Heart works harder to pump blood to body

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44
Q

What is a patent ductus arteriosus?

A

DA doesn’t close.

Oxygen-rich blood from aorta mixes with deoxygenated blood from pulmonary artery. Blood shunts from aorta to right ventricle.

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45
Q

What is coarctation of the aorta?

A

Narrowing of the aorta just after it branches off to the upper body. Blood flow is obstructed to the lower body.

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46
Q

What is pulmonary stenosis?

A

Fused, thickened, or missing leaflets of pulmonary valve

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47
Q

What is aortic stenosis?

A

Fused, thickened, or missing leaflets of aortic valve

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48
Q

What is tetrology of fallot?

A

Combination of heart defects

  • Ventricular septal defect
  • Aortic override
  • Right ventricular outflow obstruction
  • Right ventricular hypertrophy

Accounts for 50% of cyanotic defects

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49
Q

What is transposition of the great arteries

A

Aorta comes out of right ventricle, pulmonary artery out of left ventricle

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50
Q

What is a balloon atrial septostomy used for?

A

When transposition of the great arteries requires urgent intervention. Creates an ASD to solve the problem temporarily

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51
Q

What is a complete A-V canal defect?

A

Hole in center of heart where atria and ventricles meet - develop with one large valve

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52
Q

What is pulmonary atresia?

A

Abnormally formed pulmonary valve, often associated with VSD

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53
Q

What is tricuspid atresia?

A

Also Hypoplastic R Heart Syndrome

Tricuspid valve fails to develop. Smaller than normal R ventricle.

ALWAYS have ASD, sometimes VSD

54
Q

What is hypoplastic L heart syndrome?

A

Underdeveloped or absent L ventricle

Mitral valve stenosis/atresia or aortic stenosis/atresia.

Aorta is underdeveloped and narrowed

55
Q

Indications for pediatric heart transplant?

A
  1. Congenital defect
  2. Cardiomyopathy –> heart failure
  3. Intractable arrythmia
56
Q

Pediatric diagnoses associated with heart defects

A 
Duchenne's muscular dystrophy
Fetal alcohol syndrome
Juvenile RA
Marfan syndrome
Noonan's syndrome
Prematurity
Trisomy 13, 18, 21
Turner's syndrome
Williams syndrome
HIV-1 infection
57
Q

What is the pulmonary system like in infants

A

Narrow airway, soft trachea

High position of larynx

Low compliance of lungs

Immature alveolar structure/function

Less type I fibers in diaphragm

58
Q

What is the chest wall like in infants?

A

1/3 of trunk

Triangular in anterior plane, circular in lateral, Horizontal ribs

Narrow intercostal space (ms not at good length-tension relationship; belly breathing)

Minimal sternal stability

Limited ability to expand in all 3 planes

Diaphragmatic nose breather

59
Q

Why is there “reaching” in infant (3-6 mos)

A

UE muscle groups develop

Getting out of physiologic flexion

60
Q

Why does baby hold head upright and push up in prone (3-6 mos)?

A

Increased anterior chest and extensor musculature

Getting out of physiologic flexion

61
Q

When are infants able to fully expand their lungs/chest wall?

A

When they start to sit (around 6 mos). Before then, often laying against a surface

62
Q

Independent sitting at 6-12 months causes what developments?

A

Trunk tone balances between flexion/ext

Head moves independent of trunk

Developing abdominal muscles pull and rotate ribs downward

Elongation of chest wall

63
Q

What happens when the chest wall elongates at 6-12 months?

A

Diapragm becomes more dome shaped

Abs increase in strength - secretion clearance, diaphragm/visceral support

Intercostal muscles widen as ribs rotate down - stabilize chest wall, increase 3D dimension during inhalation

64
Q

What kind of abnormal developments show due to weakness and/or tone imbalance (infants)

A

Incomplete elongation of rib cage

Rib cage flaring - anterior or lateral

Diaphragm with lower resting position

Kyphotic posture

Pectus excavatum

65
Q

What is primary ciliary dyskinesia?

A

Genetic autosomal disorder where ciliary motion is abnormal or absent

66
Q

What is asthma?

A

Widespread narrowing of the airways in response to stimuli leading to bronchial smooth muscle spasm, inflammation of mucosa, and overproduction of viscous mucus.

67
Q

What is the most common chronic lung disease in infants? Cause?

A

Bronchopulmonary Dysplasia

Mechanical ventilator and oxygen therapy use in premature infants

68
Q

What is the most common respiratory disorder in premature infants?

A

Hyaline membrane disease

69
Q

How do you prevent meconium aspiration syndrome?

A

Suction airways immediately after delivery

70
Q

What is a differential diagnosis for transient ischemia of the newborn?

A

Hyaline membrane disease

71
Q

What is tracheoesophageal fistula?

A

Abnormal connection between the esophagus and trachea, often associated with other birth defects.

72
Q

Typical result of TEF?

A

tracheomalacia - can cause difficulties in airway clearance

73
Q

What is most common congenital deformity of the chest wall?

A

Pectus excavatum

74
Q

How does pectus excavatum present?

A

Indentation of lower sternum

Asymmetric chest

Shoulders protracted and IR

Protuberant abdomen

Rib cage moves vertically up, not out and up

Exercise intolerance

75
Q

2nd most common chest wall abnormality?

A

Pectus carinatum

76
Q

Pulmonary hypertension leads to…

A

R ventricular heart failure

77
Q

What is bronchiolitis obliterans?

A

Epithelial injury of lower respiratory tract, characterized by obstruction and destruction of distal airways

78
Q

What causes CF?

A

Mutation of gene on chromosome 7 that produces protein called cystic fibrosis transmembrane conductance regulator (CFTR) - autosomal recessive gene

79
Q

What is CFTR for? If absent?

A

Regulates how much salt gets across cell membranes.

Absent: less fluid in airways making for dry, sticky mucus that is hard to clear

80
Q

What is cystic fibrosis

A

Life-shortening disorder that affects the exocrine glands of the lungs, liver, pancreas, and intestines.

Affects ability of salt and water to move in and out of cells.

81
Q

Current life expectancy for CF?

A

37

82
Q

Lung transplants are assigned to kids based on

A

Body size
Blood type
Score
Amount of time on list

83
Q

What is huff cough used for?

A

Used in combination with all airway clearance techniques to increase effectiveness

84
Q

What do you do for children under 4 instead of huff cough?

A

10-12 months: mimic coughing

Activities involve blowing - bubbles, pinwheels, etc.

85
Q

At what age can you start using the trendelenberg position for postural drainage?

A

2 years old

86
Q

When can you start performing postural drainage, percussion, and vibration on kids?

A

Can initiate in newborns

87
Q

At what age do patients start using The Vest (High frequency chest wall oscillation - HFCWO)

A

Greater than 3 years

88
Q

How does positive expiratory pressure (PEP) work?

A

Prevents airway collapse to improve efficiency of airway clearance

Collateral ventilation - allows air to get behind mucus and push it out

89
Q

What are the types of Oscillating Positive Expiratory Pressure devices?

A 
Flutter
Acapella Choice (better)
90
Q

Key components to OPEP devices?

A

Breath hold after inspiration

Tight cheek musculature during expiration

91
Q

3 components of Active Cycle Breathing Technique (ACBT)?

A

Breathing control

Thoracic expansion

Forced expiration technique

92
Q

What is autogenic drainage?

A

Breath control technique designed to mobilize mucus at a variety of lung volumes.

Learn breathing at low, mid, and high lung volumes. Expirations are gentle with increasing velocity but avoiding airway compression.

93
Q

When do you start teaching autogenic drainage?

A

Around 10 years old

94
Q

Exercise capacity was an independent predictor of…

A

life expectancy in CF patients

95
Q

What is the relationship between exercise and secretion mobilization?

A

Exercise forces us to do the huffing maneuver

96
Q

Sternal precautions (pediatrics)

A

2 weeks: no prone

For 6 weeks: no bilateral UE over head, no pull to sit, no lift from under arms, no forward bend, no lifting > 10 lbs, no driving

97
Q

Relationship between exercise and CF patients?

A

Sodium conductance in respiratory epithelium is partially blocked during moderate intensity which increases water content of mucus and enhances airway clearance.

98
Q

Why is postural re-education important in cardiopulmonary PT?

A

All trunk muscles are both respiratory and postural muscles

99
Q

Why should you do scar massage on pediatric patients who had surgery in the trunk?

A

Scars can limit mobility as the child grows (decrease trunk expansion)

100
Q

Indications for mechanical ventilation

A

Airway protection

Respiratory muscle fatigue

Respiratory failure

Allow for sedation

Improve/maintain ventilation and respiration

101
Q

Ventilator considerations

A 
Route
Mode
Pressure support
Rate
Tidal volumes
Positive end-expiratory pressure
FiO2
102
Q

Things to remember about patients on a mechanical ventilator

A

Don’t pull it out

Don’t move it

Patient will be uncomfortable and will cough if they move; let them adjust to new positions

Not a contraindication for mobilization though might change how you go about it (ex: don’t do a sit-pivot transfer)

103
Q

Types of ventilator routes

A

Endotracheal tube (ETT)
Tracheostomy / Trach collar
Ventilator circuit

104
Q

How far down does a ventilator tube go?

A

Down to the carina

105
Q

Damage that can be caused by an ETT?

A

Damage to throat structures

If pushed in too far, can go into the R lung

106
Q

What is a water trap for on a ventilator circuit?

A

For condensation buildup - needs to be lower than patient so they do not aspirate

107
Q

What is the balloon/cuff for on an ETT/trach?

A

Holds the tube in place and creates a seal to make sure air gets into the lungs

108
Q

If a patient can speak while on a trach, you should suspect…

A

a cuff leak

109
Q

If a patient is on a trach and can speak, but there is no cuff leak, what could that mean?

A

Trach without a cuff is being used to wean the patient off the ventilator (look for lack of inflation tube)

Fenestrated trach (hole in proximal tube) allows for talking even with a cuff inflated

Cuff just isn’t able to create a seal

110
Q

PT considerations with Route

A

Don’t pull it out

Comfort

Inspect airway and note position

Cuff (is patient able to talk?)

111
Q

Why do you wean a patient off of a ventilator? PT consideration?

A

To prevent respiratory muscle atrophy.

Weaning requires more energy toward respiration. Activity after this can fatigue them too much.

112
Q

If a patient has a trach and wants to talk, what can you do?

A

Deflate the cuff and cover trach hole

113
Q

ETT vs. trach

A

ETT - short-term, no surgery

Trach - long-term, aid in weaning, decreased resistance, improves mobility, comfort, speech/eating, pulmonary hygiene, reduced laryngeal injury

114
Q

Types of breath provided by ventilators?

A

Mandatory breath
Assisted breath
Spontaneous breath

115
Q

Modes on the ventilator?

A

Assist control (AC)

Intermittent Mandatory Ventilation (IMV/SIMV)

Pressure Support Ventilation (PSV)

Continuous Positive Airway Pressure (CPAP)

116
Q

If patient moves from more to less support during the day, that means…

A

they are improving (though their exercise might be just the work of breathing)

117
Q

What is SIMV?

A

Same thing as AC but lets patient take over if he initiates the breath. Must overcome resistance of trach, though.

118
Q

What is CPAP?

A

Keeps a little extra pressure in the airways to keep them from collapsing which allows for more time for oxygenation

119
Q

Low pressure alarms

A

Patient disconnection
Circuit leaks
Airway leaks

120
Q

High pressure alarms

A 
Patient coughing
Secretions or mucus
Patient biting tube
Reduced lung compliance
Increased airway resistance
Patient fighting ventilator
121
Q

Mechanics of Normal Respiration

A

A: Airways
B: Body
C: Control of respiration

122
Q

Upper airways do what

A

Warm
Humidify
Prevent infection
Phonation

123
Q

Lower airways do what

A

Gas exchange

124
Q

What controls respiration?

A

Brainstem - pons, medula
Cortex
Chemoreceptors

125
Q

Internal factors impacting normal respiration

A

Neuromuscular
Musculoskeletal
Cardiopulmonary

126
Q

External factors impacting normal respiration

A

Gravity

Environment (temp, irritants, humidity)

Oxygen demand

Stress

127
Q

Strategies to maximize respiratory function in the patient with a neurologic diagnosis

A

A: Assessment
B: Body positioning
C: Control and clearance

128
Q

Effective coughing requires

A

Closing the glottis

Increased intrathoracic pressure

Opening of the glottis

Forced quick exhalation

129
Q

Manual assistive cough techniques

A

Costophrenic assist

Heimlich-type assist

Anterior chest compression assist

Massery counterrotation assist

130
Q

Self-assisted cough techniques

A

Prone on elbows

Long-sitting

Short sitting

Quadruped self-rocking

Standing self-assisted

131
Q

Impaired respiration following a neurologic insult

A

Decreased chest expansion

Decreased recruitment of muscles

Abnormal breathing patterns

Changes in pulmonary function

Decreased airway clearance

Decreased phonation

Decreased mobility and ADL

CPT II (2 decks)

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