EXAM 2 Flashcards
PR interval needs to be no more than
5 small boxes, 0.2 msec
QRS complex should be no more than
2.5 small boxes or 0.1 msec
What can causes Sinus Bradycardia and can you work with this patient?
Beta Blocker, and you can work with them as long as they are not symptomatic
A patient that has a sinus arrhythmia, can you work with them?
This would be considered a benign arrhythmia, because conduction is normal. This arrhythmia typically happens at rest, with exercise patient should become normal due to the changes with breathing and intra-throacic pressure. COMMON in AEROBIC athletes.
What type of Arrhythmia is a sinus pause or drop beat?
If a patient had a lot of drop beats, more than 6 in a minute the would become light-headed and symptomatic. This arrhythmia can only bet detected through a HOLTER MONITOR, can be due to a congenital abnormality. Treat with Pacemakers.
What type of arrhythmia is a premature atrial contraction, can you work with this patient?
p-wave more rounded, R-R is regular, one isolated beat, which came early. P wave and q wave look like all the others. considered benign because there is a p wave, normal conduction.
Describe paroxymal atrial tachycardia and can you work with this patient?
normal conduction–>to supraventricular tach, usually seen with mitral valve dysfunction, if HR over 100 probably can’t work with this patient.
Describe atrial flutter and can you work with this patient?
avaiant p waves, look at the rate, if its less than a 100 you can work with the patient, just takes conduction a little longer to get to the AV node because atria are ‘fluterring”
Define Pre-mature nodal contraction and can you work with this patient?
This is a benign arrythmia, no p-wave but has nomral qrs, you can work with them because AV node is still working
Would you work with a patient that displayed “Bradycardia”?
this person is probably symtomatic, so you wouldn’t work with them, you would treat with pace maker.
Describe Junctional/Supraventricular tachycardia.
normal, QRS, no p-wave and very fast rate.
R on T PVC are considered, couplets?
life threatening, couplets are very dangerous.
V-Fib is considered…
a medical emergency,get AED, call code.
Describe first degree AV block and can we work with this patient?
longer than normal time to get to the av node so PR interval is longer but usually a begin block.
Type 1 second degree block is common in what type of a patient?
RCA blockage, infract or ischemia, treated with temp pacemaker, probably wouldn’t be seeing this patient, because they would most likely be in the ER
Type II Second degree block, where a beat drops twice, work with is patient?
nope, pacemaker
What is the signature of a bundle branch block?
notched QRS
What should you monitor changes (HISBED), what are the symtpoms that a patient maybe be having an arrhythmia?
palpitations, dizziness, SOB, racing heart... HYPOXIA ISCHEMIA Bradycardia Electrolyte disturbance (postassium) Drugs (digoxin)
just have one PVC in a 6 sec strip you probably could exercise as long as the rate is alright.
What is the normal range for cardiac index and how is it calculated?
2.6-4.2, a low cardiac index = poor contractility of the left ventricle, cardiac output/body surface area.
If a patient has an LVAD, what vitals will you not be able to measure appropiately?
BP, pulse ox, HR. need to use RPE, and MAP.
What are the factors for heart transplant candidacy?
- less than 1 year to live
- VO2max<14mg/o2…
- no other organ damage
- appropriate BMI
- no smoking/drinking
- Family support.
- no cancer.
A patient who has a heart transplant, their vitals may change how?
elevated resting HR and may take up to 5 minutes to see a rise in HR with exercise.
T/F you can rehab someone with an LVAD as early as 2 weeks post op?
t (watch for decreased o2 sta, OH, ataxia, big changes SBP)
PREDISONE(cortiocosteriod) side effects?
osteoporosis, proximal muscle weakness…
Immunosupressants can cause
kidney issues, increase infection rate, high potassium, muscle weakness, GI problems
The main complication to LVAD is
infection and clotting
AV node disorders and bradycardia usually require the patient to have a
pacemaker. (infection be aware of)
What are the qualification to cardiac resynchronization therapy?
EF/= 120 msec, NYHA Class 3 or ambulatory class 4, after “drug therapy” is exhausted. Step before LVAD.
AICDS are used when?
only for life threatening arrhtymias, Runs of V-Tach
Low EF
Coupled PVCs
Fast and abnormal heart rates
Relations of diabetes and adhesive capsulitis
collagen can build up
affects circulation, which can affect healing
glucose in the blood MAJOR PROBLEM (binds to collagen)
What happens to EF after an aneurysmectomy?
INCREASE, attaching contractile tissue to contractile tissue.
What is the major side effect to amiodarone-anti-arrhytmic?
trial fib. toxicity is possible in pulmonary Toxicity ARDS, so be careful if patient complains of changes in breathing.
Phases of Cardiac Rehab
Phase 1: Acute Care, inpatient
Phase 2: Outpatient, Early post incident Rehab ( a lot more monitoring and conditioning)
Phase 3: Outpatient ( maintenance) -medicare doesn’t pay for this
Phase 4: Pre-preventative lifestyle modification -not typically covered
What is covered under medicare?
MI
CABG
heart transplant
other cardiac procedures
Scolosis will affect the lung on which side?
the convex side
What is special about the conducting zone?
has muscle around it, resistance in the airway, bronchoconstriction
Where does gas exchange take place in the lung?
alveolar ducts and sacs
why does running in cold weather hurt?
cold weather causes bronchocontriction.
where is surfactant made?
pores of kohn
if a patient has trouble getting air out, what type of disorder do they have?
obstructive.
Restricted disease, what does the person have trouble with?
taking air in
PARAMETERS indicating lack of readiness in the ICU to be mobilized.
SpO2 < 88% or 10% desat below rest RR > 35 breaths/min PEEP >10 cm H2O FiO2 > 0.59 Cardiovascular Measures MAP 120 mmHg or > 10 lower than NL--LVAD RHR 140 bpm Systolic BP 200 mm Hg New arrhythmia developed New onset angina like chest pain Laboratory Values HCT < 8 g/dL NO exercise , may want to limit exercise, Dr. Hillegass doesnt agree with NO EXERCISE Platelets < 20,000/mm3 NO exercise Anticoagulation INR .>2.5-3.0 discuss with physician Metabolic Measures Glucose levels < 70 or > 200 mg/dL
Contraindications for Early Mobility?
Significant change in resting ECG Unstable angina Uncontrolled cardiac arrhythmias, severe Uncontrolled symptomatic heart failure Suspected or known dissecting aneurysm Uncontrolled active bleeding Acute respiratory failure Acute pulmonary embolus: NOT on anticoagulants Acute neurological changes Severe combativeness Acute, unstable fracture Acute untreated compartment syndrome too much sedation, neuro changes
Minute Ventilation Formula, increases with exercise
VE= tidal volume x RR
What is the anatomic dead space?
not invovled in gas exhange. 150ml (air breathed in)
what does the valsva manuver do?
There is an intial increase in bp, but over decreases bp and increase intrathoroacic pressure, decreases hr.
How to calculate if it’s obstructive vs. restrictive disorder?
FEV1/FVC if this ratio is less than 70 then it’s obstructive disorder can’t get air out, if greater than 70 restrictive (can’t take air in).
What imaging is the gold standard to detect lung cancer?
MRI
What is the Gold standard for PE?
Spiral CT
What can ventilation perfusion scans detect?
PE
PET scan can detect
metastasis
Normal PH Range?
7.35-7.45
Normal pCo2
35-45
normal po2
greater than 80
Normal range for HCO3
22-26
Case 1: PH 7.32 pCO2 68 PO2 60 HCO3 28
Respiratory Acidosis
Case 2: PH 7.33 pCO2 35 PO2 80 HCO3 18
Metabolic Acidosis
Case 3: PH 7.48 pCO2 42 PO2 70 HCO3 30
Metabolic Alkalosis
Case 4: PH 7.49 pCO2 31 PO2 90 HCO3 24
Respiratory Alkalsis
