Exam 1 Flashcards
(182 cards)
1
Q
At what rib level is the top of the heart?
A
Between 2nd and 3rd
2
Q
At what rib level is the base of the heart?
A
5th rib
3
Q
What are the two phases of the cardiac cycle?
A
Diastole and systole
4
Q
During which phase do the coronary arteries fill?
A
Diastole
5
Q
What happens when the sympathetic nervous system is stimulated
A
Norepinephrine increases activity of the heart by increasing HR and force of contraction Coronary arteries dilate/ Peripheral arteries constrict = increasing peripheral vascular resistance
6
Q
What happens when the parasympathetic system is stimulated?
A
By way of the vagus nerve slows HR, decreases force of artial contraction, decreases speed of conduction through the AV node In extremities: vasodilation on bowel bladder, & genitals
7
Q
Cardiac output
A
The amount of blood that leaves the ventricles per minute, L/min
8
Q
What is the normal cardiac output at rest?
A
4 to 6 L/min
9
Q
What influences cardiac output
A
Heart rate and Stroke Volume
10
Q
Stroke volume
A
the volume of blood ejected w/ each heart contraction
11
Q
What 3 factors influence stroke volume?
A
Preload Contractility Afterload
12
Q
Preload
A
amount of blood in the ventricle at the end of diastole
13
Q
Contractility
A
the ability of the ventricle to contract
14
Q
Afterload
A
the force the LV must generate during systole to overcome aortic pressure and open the aortic valve
15
Q
What is AKA Left ventricle-end diastolic volume
A
Preload
16
Q
During diastole….
A
The filling phase ventricles must be able to stretch to accommodate the blood entering the ventricles
17
Q
During systole…
A
The contraction phase Ventricles must contract adequately to eject the SV
18
Q
What happens to muscle length during diastole?
A
it lengthens
19
Q
What would cause an increase in SV?
A
An increase in preload or contractility
20
Q
What would cause a decrease in SV?
A
An increase in afterload
21
Q
Normal ejection fraction
A
67% + /- 8% Clinically used as an index of contractility
22
Q
What is mean arterial pressure (MAP)
A
(2x Diastolic) + Systolic / 3
23
Q
What MAP range is it ok to perform PT?
A
over 60 MAP
24
Q
Myocardial oxygen demand
A
MVO2 is the energy cost to the myocardium (HR * SBP) aka rate pressure product
25
What does cardiac output measure and what are the normal values?
HR & stroke volume 4-5L/min
26
What does stroke volume measure and what are the normal values?
Amount of blood pumped from the heart in 1 contraction .5-1 L/beat
27
What does ejection fraction measure and what is the normal value?
The heart's ability to contract 55%-75%
28
What does cardiac index measure and what is the normal value?
Cardiac output in relation to a person's body size 2.5-5 L/min/m2
29
What does central venous pressure measure and what are the normal values?
Pressure of blood inside of large vein- jugular, subclavian 0-8 mmHg
30
What is normal HR value
60-100 bpm
31
What does pulmonary capillary wedge pressure measure and what are the normal values?
Pressure in the L ventricle at the end of the diastole, it indicates the health of the L ventricle
32
What is the formula for rate pressure product?
HR x systolic pressure
33
What should happen to the rate pressure product as aerobic fitness improves?
It should go down
34
What are the first arteries that branch off the aorta? What do they do?
Coronary arteries supply the heart w/ oxygen rich blood
35
What are the functions of the myocardium?
To extract O2 and perform aerobic cardiac muscle functions
36
What part of the nervous system simulates fight or flight? What hormones are released
Sympathetic Norepinephrine increases HR and force of contraction Beta adrenergic receptors in SA node Catecholamine from adrenal cortex
37
What are hormonal responses of the parasympathetic nervous system?
Decreases HR, force of atrial contraction, speed of impulse through the AV node, peripheral vasodilation, vasodilation of bowel, bladder, and genitals
38
What medications can be used to mimic sympathetic hormonal conditions?
Adrenaline, dopamine, epinephrine- increases CO Atropine- increases HR
39
What medication can inhibit the sympathetic nervous system?
Beta blockers
40
What are beta blockers used for?
To manage hypertension, anti-ischemia
41
What are general signs and symptoms of cardiac conditions?
Atrial fib, ventricular fib, Tachycardia, palpitations Fatigue, Dyspnea Fever, Weakness Pallor or cyanosis Chest pain, Edema Unusual sweating, especially at night Nausea, vomiting, anorexia Anxiety, Headache Syncope Intermittent claudication Heart block, reduced ejection fraction PVCs
42
Beta blockers effect
Diminised HR response to ex! Sensitive to cold, orthostatic hypotension
43
Calcium channel blocker effect
May have dizziness, headache, peripheral edema
44
Diuretics effect
Dehydration, electrolyte imbalance, hypotension, hydrate during activity
45
Nitrate agents effect
Dizziness, headache, peripheral edema, and orthostatic hypotension
46
Anticoagulants effect
Risk of bruising and bleeding
47
Contraindications for exercise
Unstable angina Symptomatic heart failure Uncontrolled arrhythmias Moderate to severe aortic stenosis Uncontrolled diabetes Acute systemic illness or fever Uncontrolled tachycardia (Resting HR \> 100) Resting systolic \> = 200 Resting diastolic \> = 110 Thrombophlepitis
48
Cardiac rehab for myocardial infraction (MI)
Phase I : inpatient (levels 1-6 always monitored) Phase II: outpatient, professionally monitored program Phase III: community based, patient monitored
49
Strength Training following a (MI)
Pt must be at least 5 weeks post MI and in cardiac exercise program for at least 3 weeks At least 8 weeks post CABG Recommendations Large muscle groups before small No val salva!, no sustained tight grips Keep RPE at 11 -13 Slow, controlled movements Low weight, high reps Stop with onset of symptoms
50
How often should post CABG patients perform cardiac rehab?
A few sessions throughout the day
51
Things to consider w/ exercise for Heart transplant patients
Leg cramps (may be due to immunosupressive meds) Decreased LE strength Obesity and osteo-porosis due to long term corticosteroid use May develop athlerosclerosis in donor heart in 1st year post op The heart is denervated! HR will not be good measure of cardiac health RPE and BP are best measures Cardiac Rehab protocols, but with strict BP and RPE restrictions! Will have sternal precautions
52
Readiness to have sex?
If you can climb a flight of stairs you can have sex
53
During normal exercise when does stroke volume decrease?
When the HR spikes
54
What happens to total peripheral resistance (TPR) during exercises
Decreases as a result of vasodilation
55
What are normal systolic and diastolic BP changes as a result of exercise?
Systolic increases Diastolic stays the same or may increase slightly
56
When do you stop a graded exercise test?
When a patient becomes symptomatic
57
On the Borg RPE Scale (6-20) was level is considered aerobic?
12-13
58
What are the goals for patients w/ Coronary artery disease?
Increase aerobic capacity Ability to perform ADLs, home management, community and work activities Physiological response to increased O2 demand is improved Strength, power, and endurance are improved Ability to recognize and manage a recurrence Reduce risk factors Wellness, healthy habits, prevention Foster decision making re: use of health care resources
59
What is used to determine the exercise prescription?
Results from graded exercise tolerance tests, then determine appropriate MET level
60
What happens as a result of deconditioning?
Decrease in muscle mass, strength, cardiovascular function, total blood volume, plasma volume, heart volume, orthostatic tolerance, exercise tolerance, bone mineral density
61
What is a MET?
oxygen consumed (mL) per kg of body weight per minute 3.5mL/kg/min
62
Efficiency
Work output= force X distance Work input= net O2 consumption per unit of time
63
What responses to exercises provide additional O2 to the muscle?
Increased blood flow More oxygen can be extracted from the blood Important because oxygen is everything – with more mitrochondria, more oxygen is needed
64
What are normal responses to exercise after 10 minutes of brisk walking and stairclimbing?
Increases in HR, BP, respirations
65
What additional factors can affect ones response to exercise?
Temperature Humidity Altitude Menstruation
66
Benefits of aerobic conditioning?
Benefits: improved oxygen uptake with performance of regular activity More efficient performance of exercise Improved cardioresporatory fitness Improved fitness Psychological benefits Health and wellness benefits: prevention of disease
67
How do you establish a target heart rate (THR)?
Max HR (220-age) \* % Training % must remain be adjusted to the lower ranges for older, sedentary patients
68
Name forms of aerobic conditioning?
treadmill walking, stair climbing, running, bicycling, swimming, jumping rope
69
6 min walk test protocol
Take patient BP and HR measure pre-test Lay out a course and have patient walk at a brisk pace for 6 minute Re-check BP and HR
70
What is respirator rate (RR)?
Number of breaths (inspiration & expiration cycle) per minute
71
What occurs during restrictive cardiomyopathy?
Fibrosis of the ventricles leading to diastolic dysfunction Walls of the ventricle become stiff
72
What occurs during dilated cardiomyopathy?
Stretching and thinning of the heart muscle
73
What occurs during hypertrophic cardiomyopathy?
thickening of the walls of the Left ventricle
74
Systolic dysfunction can be further classified as?
ischemic or nonischemic \*Ischemic HF has a worse prognosis
75
When is diastolic HF detected?
After all other HF symptoms have been excluded
76
What are the classifications of the New York Hearth Association Classification of HF?
I- no symptoms w/ ordinary exertion II- symptoms w/ ordinary exertion III- symptoms w/ less than ordinary exertion IV- symptoms at rest
77
Exercise intolerance characteristics among patients w/ heart failure?
Fatigue w/ very low levels of exertion ie- brushing teeth or walking to the bathroom May only achieve half the normal increase in cardiac output during exercise Abnormal pressures within the heart, reduced left ventricular EF, reduced cardiac output, and increased pulmonary capillary wedge pressure contribute to exercise intolerance
78
Angina Scale
1- Onset of angina, mild discomfort pt. is familiar with 2- Moderate/sever pain, uncomfortable but tolerable 3- Severe angina pain, pt. will stop exercising 4- Unbearable chest pain, most severe pain pt. has felt
79
Dyspnea Index
0- Count to 15 w/o a breath 1- Takes 1 breath counting to 15 2- Takes 2 breaths counting to 15 3- Takes 3 breaths counting to 15
80
BMI formula
Body weight in kg/(height in meters)2
81
Name two medical tests for patient's w/ heart failure?
Echocardiography and Heart Catheterization
82
Echocardiography
provides info about the size of the heart chambers, the thickness of the heart walls, valve form and function, and other info
83
Heart catheterization
can be used to measure pressures at various sites in the heart and blood vessels
84
What are two disease specific measures that have been developed to assess quality of life in patients w/ HF?
Minnesota Living w/ HF questionnaire (LHFQ) and Kansas City Cardiomyopathy Questionnaire (KCCQ)
85
What are the 3 most important factors affecting the risk of exercise in patients w/ HF?
Age Intensity of exercise Presence of ischemic heart disease
86
Exercise program for patients with heart failure
Exercise mode: the exercise prescription will include some form of aerobic exercise Brisk walking can elicit an adequate training effect in many patients with heart failure Exercise frequency and duration: severely compromised patients may require a longer rest interval between exercise sessions, with gradual progression Exercise prescription in all patients always includes adequate warm-up and cool-down periods Exercise intensity: generally, patients with heart failure can tolerate an initial intensity ranging from 40% to 70% of peak Vo2 Exercise progression: patients with a low initial exercise capacity will generally make faster initial progress than those who start at a high functional capacity Isometric resistance exercise should be avoided in patients with heart failure because it increases afterload on the heart Moderate resistive training in combination with aerobic exercise may be safe in this population Interval training allows the muscles to work harder than they could with steady-state exercise without excessively stressing the cardiovascular system
87
Six minute walk test
is a simple clinical tool that can be used by clinicians to assess submaximal exercise capacity; easily performed in hospital corridors or therapy gyms and does not require any special equipment other than a stopwatch
88
TLC
Total lung capacity Vol. of air in the lungs at the end of maximum inspiration
89
FVC
Forced Vital capacity Vol. of air forcefully exhaled from max inspiration to max expiration
90
TV
Tidal volume Vol. of air inspired or expired per breath
91
IRV
Inspiratory reserve volume Vol. of air from the end of tidal inspiration to max inspiration
92
ERV
Expiratory reserve volume Vol. of air from end tidal expiration to max expiration
93
Restrictive pulmonary disease
All volumes are less w/ the exception of RV it stays the same \*lung tissue looses some of its elasticity ie- normal aging, and pleurisy
94
Obstructive pulmonary disease
Inspired air gets trapped causing RV to be higher than it should be Patients have "barrel chest" appearance ie- COPD, Emphysema
95
Goals of Pulmonary Rehab
Increase pt. understanding of disease process, exceptations, goals, and outcomes Increase cardiovascular endurance Increase strength, power, and endurance of peripheral and ventilatory muscles Improve ADLs and vocational task perf. Improve independent airway clearance Decrease work of breathing Improve decision making- meds, use of the health care system Enhanced self-management of symptoms and self-management of pulmonary disease
96
Anterior chest Auscultation listening points
8 points (4L/ 4R) 1- B/t clavicle and 1st rib 2- b/t 3rd and 4th rib 3- Just above zyphoid process 4- 2 ribs below zyphoid process level and wider`
97
Posterior chest Auscultation listening points
8 points (4L/ 4R) 1- Spine of the scap level 2- 2 ribs below the spine of the scap 3- 1 rib below tip of scapula 4-1 rib lower and wider
98
Components of Pulmonary Rehab
Breathing retraining Diaphragmatic and lateral costal expansion Pursed lip and spirometer, PEP Positional stretching Respiratory muscle exercises / training Generalized exercise Aerobic 3 min or 6 min walk tests Airway clearance – Chest PT, flutter valves, acapella Splinted and supported cough
99
RV
Residual Volume Vol. of air in the lungs after max expiration
100
IC
Inspiratory capacity Vol. of air from tidal expiration to max inhalation
101
FRC
Functional Residual Capacity Vol. of air in the lungs after a tidal expiration
102
FEV1
Force Expiratory Volume in 1 sec Vol. of air moved in the 1st second of an FVC maneuver
103
PEF
Peak Expiratory flow Peak flow reached during an FVC maneuver
104
Restrictive Lung Disease
a group of diseases w/ differing etiologies that result in difficulty expanding the lungs and a reduction in lung volumes
105
Lung restriction can arise from....
1. Diseases of the alveolar parenchyma or pleura 2. Changes in chest wall 3. An alteration in the neuromuscular apparatus of the thorax
106
What causes restrictive lung disease
Radiation therapy Inorganic dust inhalation of noxious gases Oxygen toxicity Asbestos exposure
107
What physical changes result from a restrictive lung disease
Lung parenchyma becomes inflammed and alveoli and interstitium become thickened. This causes the airspaces to become fibrosed and more resistant to expansion. Consequently reducing lung volume
108
Clinical presentation of Restrictive lung disease
Dyspena w/ activity and a nonproductive cough Rapid shallow breathing Limited chest expansion Inspiratory crackles especially in lower lung areas Presence of finger clubbing and cyanosis
109
Results of chest radiograph of restrictive lung disease
Honeycombing and Traction Bronchiectasis- misshapen airways due to pulling by fibrotic tissue on the wall
110
Pulmonary function test results
Reduction in VC, FRC, RV, and TLC
111
Pursed- lip breathing
Breathing through puckered lips Slows breathing rate and extends exhalation time to make room for next inhalation Exhalation is actively pushed through a narrowed mouth
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Exercise Programs for Respiratory Conditions
Breathing exercises- Pursed lip, supported sitting, incentive spirometer Segmental breathing Manual Resisted ex to diaphragm, intercostals Cough / huff , cough + positional Feedback – rate and ratio Exercises for ADLs Functional activity Ambulation/gait training Bed mobility – prone, reverse trendellenberg Orthopaedic issues - muscle tightness/weakness Aerobic conditioning
113
Documenting Pulmonary Rehab
Respiratory Rate Breathing Pattern (quality of movement!) Time to recover following exercise RPE Functional walk tests: 3 or 6 minute tests Report of dyspnea Dyspnea scale similar to Borg scale Chest PT Report specific segments drained Report on productive cough or huff Amount, color, odor
114
Respiration
is the process of gas exchange between the alveolar air spaces and the blood, and ventilation is the movement of air in and out of the lungs
115
Respiratory failure
caused by impairment of gas exchange between ambient air and circulating blood because of reduced intrapulmonary gas exchange or reduced movement of gases in and out of the lungs Can be caused by disorders of the airways, lungs, or the skeletal, muscular and neural components of the respiratory system
116
What are the skeletal components of the respiratory system?
thoracic vertebrae, the sternum, and the ribs, which together make up the thorax
117
Muscular components of the respiratory system
primary breathing muscle, the diaphragm, and the accessory muscles of ventilation
118
Respiratory physiology
Most breathing is under involuntary control and, under normal resting conditions, breathing is primarily under chemical control Airways and pulmonary vessels are under a degree of autonomic control Breathing can also be voluntarily controlled via the motor cortex
119
Ventilatory pump system
controls the volume of air moving in and out of the airways and the rate at which the air moves
120
What are compromised lung volumes and capacities associated with?
Restrictive lung disease
121
When flow rates are compromised this is often associated with...
Obstructive Pulmonary disease
122
Arterial–alveolar oxygen difference
difference in O2 concentration between the arterial blood and the air within the alveoli
123
Ventilation
refers to the movement of a volume of air from the atmosphere in and out of the airways
124
Perfusion
of the lungs refers to the amount of blood flowing through the lungs
125
Arterial blood gases (ABGs)
are measures of the partial pressure of O2 (Pao2), partial pressure of CO2 (Paco2), levels of bicarbonate (HCO3), and the pH of arterial blood
126
Work of breathing (WOB)
is the amount of energy or O2 consumption needed by the respiratory muscles to produce enough ventilation and respiration to meet the metabolic demands of the body
127
What must match to adequate gas and respiration to occur?
Ventilation and perfusion
128
Airway resistance
is the force opposing air flow in the airways
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Elasticity
refers to the ability of the lungs and chest wall to recoil or deflate passively during exhalation
130
Lung compliance
refers to the change in lung volume per unit of pressure change
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Surface tension
refers to the cohesive state that occurs at a liquid-gas interface or liquid-liquid interface and occurs in the lungs at the interface between the alveolar membrane and the airway
132
Hypoventilation
refers to a state of decreased or inadequate ventilation Primary causes are central nervous system depression, neurological disease, or disorders of the respiratory muscles
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Ventilation-perfusion mismatch
results in impaired gas exchange in the affected areas of lungs and a decreased ability to maintain a steady state of O2 and CO2 concentrations
134
Diffusion abnormalities
increases the overall WOB by interfering w/ gas exchange
135
Hypoxic respiratory failure (Type I)
is primarily characterized by abnormally low Pao2 (partial pressure of oxygen) and a normal or close to normal Paco2 (partial pressure of carbon dioxide)
136
Hypercapnic respiratory failure (Type II)
is primarily characterized by an abnormally elevated Paco2 that may or may not be associated with hypoxia
137
In what position is HR and BP checked in patient's w/ respiratory failure
Resting, lying down, and in various body positions
138
Patients on ventilators receiving more O2
are likely to have poorer O2 transport and a greater dependency on supplemental O2
139
What type of information does Aucultation provide?
provides information about which parts of the lungs are being ventilated during breathing and about the location and presence of secretions in the lungs When normal breath sounds are heard in a different region, these sounds are considered abnormal
140
How does one determine whether WOB is increased?
Palpation of increased accessory muscle activity during inspiration
141
What does percussion check for?
Changes in lung density
142
How is percussion performed?
Performed by tapping the finger of one hand against the middle finger of the other hand placed on the chest wall Sound produced is affected by the density of the underlying tissue; denser tissue sounds flat or dull and less dense tissue sounds hyperresonant or tympanic
143
What are two important indicators of potential problems w/ respiration?
RPE and level of dyspnea
144
What is the ultimate goal of PT for patients requiring prolonged mechanical ventilation
minimize loss of mobility, maximize independence, and facilitate weaning from ventilator support
145
What 3 groups are at risk for airway clearance problems
Patients with disorders caused by chronic inhalation of particulate matter (organic or inorganic) Patients with infectious disorders Patients who have had operative procedures
146
Goals of patient instruction
is to provide basic knowledge about their disease, its medical management, and daily techniques and activities to enhance their quality of life
147
Direct interventions for patients w/ airway clearance dysfunction
Airway clearance techniques Cough Therapeutic Exercise Equipment
148
Breathing strategies for airway clearance
Force expiratory techniques (FET) Active cycle of breathing technique (ACBT) Autogenic drainage (AD) Coughing and huffing
149
Forced expiratory technique (FET)
employs a forced expiration or huff after a medium-sized breath
150
Active cycle of breathing technique (ACBT)
uses several individual breathing strategies in sequential combination to accomplish the goals of mobilizing and evacuating bronchial secretions
151
Autogenic drainage (AD)
requires the patient to know when bronchial secretions are present in the smaller, medium, or larger airways; patient then learns to breathe at low, medium, and high lung volumes to mobilize secretions in those airways
152
Coughing and huffing
is an effective means of removing secretions and is critically important for the individual with airway clearance dysfunction
153
When is it recommended to use huffing ?
Huffing has been recommended in lieu of coughing because it is thought to reduce the physical work of the activity but research has not shown huffing to be any more energy efficient than coughing
154
Postural drainage manual techniques
Chest percussion, vibration, and shaking aka- chest physiotherapy, chest PT, postural drainage, or bronchial drainage
155
Purpose of percussion and vibration techniques
Performed to loosen accumulated secretions Intended to enhance movement of secretions to the more proximal airways during positioning for gravity-assisted postural drainage
156
How to perform percussion technique?
Percussion involves rhythmically clapping with a cupped hand for 2-5 minutes over the appropriate area of thorax being drained by gravity
157
How to perform vibration technique?
involves placing one’s hands on the area previously percussed and having the patient perform several deep breaths using sustained maximal inspiration as in the ACBT maneuver
158
Mechanical devices for airway clearance
The Flutter and the Acapella are vibratory positive expiratory pressure devices that add oscillation during the expiratory cycle of PEP breathing Percussors and vibrators have been shown to produce similar changes in patients with CF in both pulmonary function and secretion production as unassisted manual airway clearance techniques alone but with less effort
159
Positive expiratory pressure device
breathing employs a device that tries to maintain airway patency by applying positive pressure during expiration
160
Forward leaning posture
produces a significant increase in maximum inspiratory pressures, thereby relieving the sensation of dyspnea
161
How do flexibility exercises help respiration?
Maintaining or improving thoracic and shoulder girdle flexibility enhances respiratory effort by increasing thoracic compliance
162
Diaphragmatic breathing exercises
are intended to enhance diaphragmatic descent during inspiration and diaphragmatic ascent during expiration
163
Purse-lip breathing
is suggested for improving ventilation and oxygenation and relieving respiratory symptoms in individuals with airway clearance dysfunction
164
Segmental breathing
presumes that inspired air can be actively directed to a specific area of lung by emphasizing and increasing movement of the thorax overlying that lung area
165
Sustained maximal breathing exercises
during which a maximal inspiration is sustained for about 3 seconds have also been associated with improved oxygenation
166
Relaxation exercise techniques
are often administered to decrease unnecessary muscle contraction throughout the body
167
Benefits of the strength training
improved muscle strength, endurance, function, and exercise tolerance and reduced dyspnea
168
Functional training in self-care and home management, work, community, and leisure integration/reintegration
Bed mobility and transfers Self-care such as bathing, grooming, dressing Household activities and related chores Activity adaptation to conserve energy Injury prevention
169
Oxygen catheters
may be inserted into the nasal passage or via a small surgical incision directly into the trachea, with a transtracheal device
170
Things to document Pulmonary Rehab
Respiratory Rate Breathing Pattern (quality of movement!) Time to recover following exercise RPE Functional walk tests: 3 or 6 minute tests Report of dyspnea Dyspnea scale similar to Borg scale Chest PT Report specific segments drained Report on productive cough or huff Amount, color, odor
171
What are the most common pediatric pulmonary diseases?
Cystic fibrosis and asthma
172
What treatment methods are recommended for pediatric pulmonary patients?
Aerobic exercise, airway clearance, upper body strength and flexibility
173
Reason for pulmonary issues in geriatric patients
Normal aging: lungs less compliant, age-related postural changes, normal muscle wasting in inspiratory and expiratory muscle. Lack of forceful cough Decrease in ability to take full, deep breath
174
What are the four basic routes of intubation?
via a nasopharyngeal airway, an oropharyngeal airway, an endotracheal tube (ETT), or a tracheostomy
175
What are the modes of ventilation?
Controlled ventilation, assisted ventilation, and assist control Synchronized intermittent mandatory ventilation Continuous positive airway pressure (CPAP)
176
What are cadiovascular complications in respiratory patients
pulmonary hypertension, decreased cardiac output, hypotension, and cardiac dysrhythmias
177
Weaning from mechanical ventilation
Weaning may be needed to allow the strength and endurance of the respiratory muscles to improve When weaning from mechanical ventilation, more energy will be needed for breathing, leaving less of a reserve for other activities
178
Goals of positioning for clearance of secretions
Primary goals of proper positioning include the reduction of pulmonary complications and skin breakdown and promotion of optimal cardiovascular and pulmonary function Alternating right and left side lying is commonly used
179
Functional exercise benefits in respiratory patients?
exercise may accelerate weaning, decrease hospital length of stay, and improve the sense of well-being in patients with respiratory failure receiving mechanical ventilation
180
Inspiratory muscle training (IMT)
Type of exercise that involves using a device that provides resistance to inspiration These studies demonstrate that IMT can improve pulmonary function, increase MIP, and decrease wean time from mechanical ventilation
181
Behavioral interventions
Prolonged mechanical ventilation can result in moderate to extreme psychological and emotional issues, including pain, fear, anxiety, lack of sleep, feeling tense, inability to speak or communicate, lack of control, nightmares, and loneliness
182
Recap of Pulmonary rehab goals
Increase understanding of disease process, expectations, goals, and outcomes Increased cardiovascular endurance Increased strength, power and endurance (peripheral and ventilatory muscles) Improved performance of ADLs; avocational or vocational tasks Improved independence in airway clearance Decreased work of breathing Improved decision-making re: meds, used of health care system Enhanced self-management of symptoms and self-management of pulmonary disease
