Exam 2 Flashcards
This slide can go into integrated lab for SC3, CCPE, and for the Cardio-Pulm final
- Know the 5-6 major VO2 max tests, when/why/who would you use it for?
- What are contraindications, or when would you NOT use that VO2 test
- Know the “WHY” of why we do VO2 max tests (answer from integrated lab handout).
1) Rockport Walking Test
- pt will walk one mile as quickly as possible
2) Cooper 1.5 mile Run/Walk Test
- pt will walk/run 1.5 miles as quickly as possible
3) 2 min walk test
- pt will walk 2 mins
4) 6 min walk test
- pt walks as fast as they can for 6 mins
5) Single Stage Treadmill Walk Test
- pt walks on treadmill at 2.0-4.5 mph for 4 mins, then up the grade to 5% for another 4 mins
6) Single Stage Treadmill Run Test
- For pt’s age 18-28 or healthy adults
- Jog for 3 mins at around 4.3-7.5 mph
7) Arm Ergometer … cycling with arms?
- Use it on patient who possibly can’t use legs (NWB)
ok
1) What is RPP (Rate Pressure Product)
2) What is the RPP equation
3) What is it used for to predict / know
1) Measures the workload—or oxygen demand—of the heart. Measures the stress put on heart based on how many times it needs to beat.
2) RPP = HR x SBP
3) For pt’s with chronic stable ANGINA, it helps you know how far you can push them from an exercise standpoint
What heart conditions are a red flag and you’d stop exercise
A-Flutter A-Fib (unless it's a chronic issue) 3rd Degree AV Block SEVERAL PAC's, PJC's, PVC's in a row SVT V-Fib (very dangerous) V-Tach Agonale Asystole
What heart sound do you hear with CHF?
S3 ***** (missed on skills check)
1) T or F: Mobilizing a patient in ICU is recommended to improve physical function, reduce hospital length stay, and reduce costs
2) Why is getting a pt moving so important? What can result if you do not:
1) True. No matter the hospital setting (even the ICU) … patients need to get up and get moving. Obviously there is a “it depends” - but in general, get them up and moving.
2)
- Blood flow/circulation to help with healing
- Lymph flow (muscles will pump lymph to reduce edema/swelling)
- Contractures or atrophy
- Avoid a DVT (Deep Vein Thrombosis) which could lead to some embolism somewhere else
- Avoid Pressure Ulcers (sacrum, heel, elbows, even back of head)
- Pneumonia (fluid build up in lungs … aspiration)
1) List the special equipment you will see, need to know about, and how to use in an ICU setting:
1)
- Beds
- Catheters
- IV’s, PICC lines, Central Catheters (for drugs, fluids, nutrients, electrolytes/ions, dialysis, transfusions, etc.)
- Monitors
- Chest tubes
- Artificial airway / mechanical ventilation / tracheotomy’s
- O2 therapy devices and tubes
- Artificial nutrition
- Ostomy devices
Causes a change in the way urine or stool exits the
body as a result of a surgical procedure. Bodily waste
is rerouted from its usual path because of
malfunctioning parts of the urinary or digestive
system. An ostomy can be temporary or permanent.
- LE compression / offloading devices
- Etc.
BEDS:
1) T or F: there are many different types of hospital beds you’ll see and need to know how to use:
2) How do beds make a PT’s job easier AND harder:
3) What does a PT need to remember to ensure bed safety (for pt and PT):
4) What is the ‘Cardiac Feature’ on hospital beds:
1) True
2)
- Easier: You can higher/lower it, you can sit it up to a chair, you can tilt it to help move patients, you can deflate some, guard rails for protection, call buttons for nsg, comfort, etc.
- Harder: If the bed doesn’t move up/down or tilt, you as PT have to do more work (bad body mechanics). If it deflates, it makes it harder for pt since they have to sit on hard surface. AND - learning how to run/operate all the diff. beds is hard (learning curve).
3)
- Higher and lower bed for good body mechanics (allow pt to put feet on the ground)
- Bring patient to EOB (lower lever arm)
- Lock wheels **
- Move rails up or down for pt safety or mobility.
- Don’t let cords/tubes get caught or pulled
- Have patient do as much of the work as possible
- Use sheets to help lift or roll pt’s
4) “Cardiac Feature” is a big red button that you push and it instantly deflates the bed so patient is on a HARD surface so you can do CPR (you can’t do CPR unless you are on a hard surface).
VITAL SIGNS MONITOR:
1) All hospital rooms have a vital signs monitor. What will you see on the display of this screen:
2) What is MAP acronym stand for::
3) Explain what MAP is:
4) What is formula for the MAP:
5) What is the amount (MAP) that it needs to be (at least) to indicate adequate perfusion:
6) What is Pulse Oximetry:
7) Difference between SpO2 and SaO2 … and how you measure each:
8) Is SpO2 or SaO2 more accurate and why?
9) Which one is used more, and why?
10) What do you ideally want SpO2 to be, and what is too low:
11) If you fall below that number (from question #10) it is called ___________, and that means:
11A) Not enough RBC’s = __________, not enough O2 = ___________, not enough blood =
12) How do you make sure you get a good SpO2 reading:
1) BP, HR, RR, SpO2, Temp, EKG, Intercranial pressure, MAP
2) : MAP = mean arterial pressure
3) The average pressure in a patient’s arteries during one cardiac cycle. It is an indicator of blood flow and perfusion to tissues and believed to be BETTER indicator of tissue perfusion than SBP (since it accounts for the fact that 2/3 of blood is in diastole).
4) MAP = 1/3 (SBP – DBP) + DBP
5) 60mmHg or higher to maintain adequate tissue perfusion. ***
6) Devise placed on finger tip to measure how saturated the blood is with Oxygen (and takes your pulse too). It measures O2 saturation (SO2) in the blood.
7)
- SpO2 = saturation of PERIPHERAL oxygen in blood.
- SaO2 = saturation of ARTERIAL oxygen in blood.
- SaO2 is from a blood draw, and SpO2 is with a pulse ox device on finger tip or ear or other places.
8) SaO2. It measures oxygen concentration in the actual blood, taken from an artery.
9) SpO2 because it is easy, quick, non-invasive, and pretty accurate.
10) You want 95% or higher. Anything below 85% is scary
11) Hypoxic (means you are oxygen deprived).
11A) Anemia, Hypoxic, Ischemic
12)
- Check waveform to make sure you are getting good signal
- Compare pulse reading on monitor with that taken manually
- No fingernail polish or sunlight
- Poor circulation prevents accurate reading
- Prevent movement of sensor cord
- Make sure probe is clean
ICP Monitoring:
1) What does ICP Monitor stand for:
2) What is ICP monitoring:
3) What reading / amount do you ideally want to see on an ICP monitor reading:
4) What could impact the pressure in the brain for an ICU patient:
5) Instructions to pt on a ICP monitor:
6) What to remember as a PT when working with a pt with an ICP monitor (or brain injury).
1) Intercranial Pressure Monitor
2) When the brain suffers severe trauma it begins to swell inside the skull. If the brain swelling goes undetected and is not treated the brain becomes deprived of oxygen-rich blood and “starves”. This secondary injury causes permanent brain damage. As ICP monitoring allows doctors to determine how much swelling the brain has sustained, cerebrospinal fluid can be drained accordingly in order to prevent oxygen deprivation.
So, you hook up a ICP monitor to measure the pressure in the brain.
3) 5-15 mmHg
4) Moving head lower than body; neck flexion; hip flexion; valsalva manuever.
5) Keep head and neck neutral
6) These pt’s are very fragile … so be very very cautious. You can move them, but still be extremely cautious.
ARTIFICIAL AIRWAYS and MECHANICAL VENTILATION:
1) There are 2 main types of artificial airways, what are they and why / when would you use each:
2) What is intubation and extubation
3) There are 3 different types of trach’s … explain each:
4)
- T or F: Outer balloon of a cuffed trach is always inflated if the inner cuff is inflated?
- Why is this important?
5) What is an ‘inner cannula’
6) Why do you want to keep the trach shield covering the trach hole?
7) Decannulate means … and what do you do:
8) You obviously want to wean patient off trach. Why and How?
9) What are the weaning devices you can use, and explain each:
9A) Biggest difference between a trach plug and trach button:
9B) What is the order you’d take to wean pt off a trach (from the options just listed):
9C) What is the purpose of all these weaning devices:
10) Most common one way valve:
10A) Can a pt talk with a PMV on?
11) In order to do a one way valve, it must be what type of valve … and why?
12) If you put in a PMV into a pt and then inflate the cuff, what will happen?
13) So if a pt has a PMV in, how do you know if the cuff is inflated?
(There will be a test ? on the PMV concept above)
14) Last step of weaning before pulling a trach out is:
14A) Why would you use a trach plug:
15) T or F: You can use a nasal cannula for a person on a trach plug or trach button?
16) After they take trach and trach plug out, how long does it take to heal and close off?
17) Whether person is on a trach, or has a plug or button, how does that impact you as a PT:
1)
- Oral Endotracheal Tube: Tube entering MOUTH and down trachea. Person can’t talk or eat, and typically person is UNCONCIOUS (since otherwise they’d have a GAG reflex). This is for patients SHORT-TERM 1-7 days (for intensive care pt’s).
- Tracheostomy: Tube inserted into pt’s neck into trachea to help them breathe. Person can be CONSCIOUS, but it is irritating. Trach will help bring air in, (and if they have a ventilator with trach) it will humidify and warm it to help person breath.
2) Intubation is putting a tube IN throat. Extubation is the process of REMOVING the tube (oral endotracheal tube … ETT … or trach from a pt).
3)
- Cuffed: In the throat / trachea is a cuff that you can inflate. If the balloon on the outside is inflated, the cuff on the inside is also inflated (and visa versa). This separates upper respiratory system from lower so no upper breathing can happen (it’s all done through the trach).
- Cuffless (non-cuffed): Trach with NO internal cuff inflated to block upper airway (thus no outer balloon either). Patient can thus breathe through trach or themselves through upper airway. So trach does most of the work, but this helps patient to allow them to breath through nose to start learning how to breath on their own (weaning).
- Fenestrated: Fenestrated means holes, so the trach has little holes in the tube. This allows for more air passage over vocal cords. It encourages air to go up to mouth to help patient be able to SPEAK. You use fenestrated trachs for patients who may need it for a LONGER period of time.
4)
- True
- If you see pilot balloon NOT inflated, then cuff would not be inflated and that is problem. The inside cuff seals off trachea so no air can escape up into mouth. It allows air to only stay in trachea and lungs … so air comes from machine outside. The CUFF is essentially an inflated balloon in the trachea to seal off the trachea so no air can escape up to mouth/nose.
5) An “inner cannula” is a piece that goes into trachea to help collect MUCOUS. That way you can remove it, CLEAN it, etc. without taking trach out.
6) To prevent CONTAMINENTS from entering trach, and to prevent SPUTUM from coming out.
7) Either you or the pt (or an accidental movement) pulled the trach out. This is a medical emergency and you need to get trach back in ASAP.
8)
Why: to get lungs working and functioning independently again.
How:
- Decrease size or type of trach used
- Decrease amount of oxygen delivered
- Put on weaning devices over trach (explained below)
9)
- One Way Valves: Allows air in through trach, and then pt breaths out of nose/mouth.
- Trach Plugs: Plug up trach, and used with a CUFFLESS trach (or deflated cuff). A plug is an option to cuff off trach or open it when needed.
- Trach Button: The trach is removed and the hole is plugged essentially, but you don’t want the hole to heal over yet, so you keep the hole open just in case they need to get a trach back in quickly in the next week or so (for some reason). All breathing is still going through mouth/nose by the pt, but their trach hole is plugged up in case you need to access it quickly.
9A) With the plug, you still have the trach in, but it is plugged up. With the button, the trach is OUT, but the hole is kept in tact (so it doesn’t heal over) in case you need to quickly access the hole in the next few days to put a trach in again.
9B) Trach -> one way valve -> trach plug -> trach button
9C) Wean patient off trach to get them to learn how to breathe on their own again.
10) Passy Muir Valve
10A) Yes, that is the whole point
11) A cuffless valve (or deflated cuff) so air can get back up and out by the patient (so they don’t sufficate).
12) YOU WILL SUFFICATE THE PATIENT. They’ll just turn blue.
13) First, the balloon outside should NOT be inflated. If it is, deflate cuff immediately.
14) Trach plug
14A) You do this just to test and trial it with patient to see how they do. If patient does well, then Dr’s can pull trach out (extubation). If not, at least the trach is still in.
15) True
16) Just a few days amazingly.
17)
- Obviously means they’ll have respiratory dysfunction, become SOB easy, fatigue, can’t do as much activity, etc.
- You’ll need to monitor vitals
- Monitor cyanosis
- You’ll need to monitor secretions and help them remove excess secretions. They’ll have excess mucuous - teach them how to cough it out (4 phases).
- Don’t bump or pull trach out (decannulate)
- If trach plug or button falls out, seek medical help immediately.
MECHANICAL VENTILATION:
1) What is mechanical ventilation
2) When or why would you need to do mechanical ventilation?
2A) 3 types of mechanical ventilation, and breifly explain:
3) Would respiratory therapist place the setting on the mechanical ventilator based on volume or pressure?
1) Mechanical ventilation is artificial ventilation to assist or replace spontaneous breathing by a pt. This may involve a machine called a ventilator or the breathing may be assisted by some medical professional. Mechanical ventilation is termed “invasive” since they put a tube into mouth and down throat/trachea.
2) In respiratory failure or severe hypoxemia … they need help breathing, but more than a trach.
2A)
- Full support (does all breathing for pt)
- Synchronous Intermittent Mandatory Ventilation (SIMV) … dialed down amount/breaths to help wean pt.
- Continuous Positive Airway Pressure (CPAP) … pt breaths on their own, but a small continual stream of air comes in.
3) PRESSURE
SUPPLEMENTAL O2 DELIVERY DEVICES:
1) List the various types of O2 delivery devices, briefly explain each, and when/why you’d use them (for how much O2)
2) Some of these devices deliver O2 based on FiO2 or by L/min. What is FiO2
3) Breathing room air contains how much O2
4) For every L you breath in with a nasal cannula, you increase your FiO2 by how much:
5) From #4 above, if you had a pt breathe in room air and they were on 2L of O2 through a nasal cannula, what is their FiO2
6) Do PT’s have responsibility to adjust, take off, put on any of these respiratory devices?
1)
- Nasal Cannula: Low flow rates (1-6L … for every 1L increase it is 3-4% increase in FiO2).
- Simple Mask: Provides 35-55% O2 flow (5-10L). Typically used for pt’s that are mouth breathers. Need flow rate at least set to 5L so you don’t have CO2 build up in mask.
- Venti Mask/Venturi Trach: Delivers 24-100% O2, adjustable port to adjust FiO2. These bypass upper respiratory tract, so they need to humidify and warm air.
- Non-breather mask: 100% O2 delivery (and obviously limited PT activity since pt is not breathing on their own at all).
- Oximizer: Like a nasal cannula, up through nose, up to 15L, provides a resivoir of O2
- Ambu bag: Take pt off vent and can manually pump O2 into system.
2) Fraction of Inspired Oxygen
3) 21%
4) 3-4%
5) 2L X 4% = 8. So 21 (from room air) + 8 = 29. So FiO2 is 29% FiO2.
6) NO. That is what a respiratory therapist does.
OXYGEN SOURCES:
1) Is it in scope of practice for a PT to change oxygen source, adjust it, turn up/down O2, etc.
2)
- In a hospital setting, GREEN device =
- In a hospital setting, YELLOW device =
3) Explain a few things about why transportable O2 devices are good AND bad:
4) O2 starvation is:
1) Technically no. Now, we realistically will adjust O2 for a pt, but it is not in our scope of practice since O2 is considered a ‘drug.’
2)
- Green = O2 (100% O2)
- Yellow = Room air (21% O2)
3)
- Good: to get pt O2 they need, allows them to have O2 anywhere they go
- Bad: They are bulky, hard to transport, tripping hazard, are a matter of life and death
4) Hypoxia (hypoxemia)
VENOUS CATHETERS:
1) What is an IV:
2) What is a PICC line:
2A) What is a Central Line
3) Where would you insert an IV, where would you insert a PICC line, where would you insert Central Line:
4) IV lasts how long, PICC lasts how long
5) What are implications for PT:
6) Who inserts an IV, who inserts a Central line:
7) What is the Swan-Ganz Catheter:
(how to remember)
8) What is a good example of a long-term central line used for a pt. And explain what it is.
9) What are Arterial lines, and how are they different:
10) Where would you do an arterial line, where would NOT do it:
1) Intravenous therapy (IV) are lines inserted into a peripheral blood vessel in the forearm for: delivers liquid substances, drugs, electrolytes, nutrients, blood transfusion, blood draw, etc. Line is directly inserted into a vein to distribute this substance to heart to circulate through blood. The intravenous route of administration can be used for injections or infusions. Intravenous infusions are commonly referred to as drips. Typically done for SHORT-TERM reasons.
2) Peripherally Inserted/Indwelling Central Catheter. It is a form of intravenous access that can be used for a PROLONGED period of time (e.g., for long chemotherapy regimens, extended antibiotic therapy, or nutrition intake) or for administration of substances that should not be done peripherally. It is inserted into a peripheral vessel, but then a tube/catheter is pushed up to the superior vena cava and it stays in place (dwells within the veins) for days or weeks.
2A) Basically same thing as a PICC and IV, but now this is done more centrally into a larger vein because perhaps there is MORE substances to be delivered that won’t fit in a smaller peripheral vein. Central venous line, or central line, is a catheter placed into a large vein (internal jugular, subclavian, femoral) to also administer medication or fluids, draw blood, etc. that are unable to be taken by mouth or would harm a smaller peripheral vein.
3) IV is in forearm or hand, PICC line is upper arm (still peripheral), and Central Line would be in Jugular vein or Subclavian or even Femoral (larger central vein).
4) IV is short term (few days), PICC is long time (many days, weeks, months).
5) Avoid BP cuff over a PICC line, avoid moving or trauma to the area, do not dislodge lines, avoid crutches over line or blocking/squeezing any vessel. They will be very weak … so monitor vitals … but ok to exercise (if you can actually transport the lines).
6) Nurse can do IV, physician (surgeon in surgery) does a central line.
7) Pulmonary Artery catheter: Used to monitor cardiac and pulmonary status and pressures in the heart, detect heart failure, monitor use of drugs. Measure RA pressure, pulmonary artery pressure, cardiac output. Just know this patient is sicker and much more unstable, so Dr’s want constant monitoring of heart and lungs
(remember: swans have big wings … like the lungs,
swan is heart in middle, lungs are wings)
8) Hemodyalysis. If your kidney’s don’t work to filter blood properly, you need to be on dialysis to take blood out of body, filter it, and retransfuse it back in.
9) Line directly into an ARTERY (rather than a vein) for constant BP monitoring or blood draw access … in artery for the highly O2 saturated blood.
10)
- Would: radial, brachial, femoral
- Wouldn’t: Axillary, dorsalis pedis
T or F: there is lots of EBP and research showing benefits of mobility of ICU patients
True: Tons of evidence out there that early mobility in an ICU is very beneficial. The right patients can be mobilized safely.
1) What are normative values for TV, VC, ERV, IRV, etc.?
1A) What do you want VC to be at (at the least) for boys and girls to ensure good lung capacity?
2) Is Forced Vital Capacity different than VC? How
1) It depends on age, sex, race, condition. So it depends. But there are charts with normative values based on those demographics
1A) But VC you need or want at least 2,000 (for girls) and 2500 (for guys). Healthy person will be higher than that.
2) FVC is a set value obtained from a formal PFT (more on it below)
ENTERAL NUTRITION
1) What is it:
2) What are different types or places it can be done:
3) Why might someone get a G tube vs. orally?
4) How do people get their water or hydration?
5) As a PT what would you make sure you do / know / avoid with people who have feeding tubes?
1) Feeding a pt via a feeding tube so pt’s can get their nutrition
2) Can be done orally through normal route, or a tube entered straight into stomach or intestines or blood.
- G Tube: goes into gut
- J Tube: Goes into Jejunom of upper intestine
- TPN: The bright yellow bag, and done through IV
3) They are trached or need it long term, can’t move tongue or jaw or chew.
4) Through an IV, or it could be delivered through a G tube with their food as well.
5) Don’t take blood pressure over a line, don’t pull it out, avoid a gait belt on any line, have them sit up so they don’t aspirate.
URINARY CATHETORS:
1) Where should urinary catheters be placed and why?
2) What should you be aware of as a PT with a urinary catheter?
1) BELOW the level of their insertion into the bladder … so they drain properly and don’t create a urinary tract infection.
2) Have a plan … think ahead. Don’t pull it out, and keep it out of the way and down below level of insertion of bladder. Ensure pt doesn’t trip over it or pull it out.
OSTOMY BAGS:
1) What is an ostomy bag
2) What is the stoma:
3) What does the PT want to know / avoid about these bags?
1) A surgically created opening in body for the discharge of bodily waste. A bag is place on exterior to collect feces and defecation
2) An OPENING (to the outside world) made into a hollow organ, especially one on the surface of the body leading to the gut or trachea (like an ostomy bag or trach).
3) You do NOT want to bump it with gait belt or any treatment … it coming out is a huge mess and stinks so bad. Also, empty it before treatment. Have a plan and think ahead.
CHEST TUBES:
1) What are they and what are chest tubes used for
2) What should we know as a PT about chest tubes:
1) Typically with a pleural effusion you want to drain the liquid or air from the pleural cavity. The chest tube does this. Like a thoracostomy. But you can drain liquid from mediastinum, abdomen, lungs, etc.
2) Obviously keep canister below level of chest (gravity), pt will have limited mobility, avoid pulling or tension in area.
HEMODYALYSIS:
1) What is hemodyalysis … and why does a pt need it
2) What does a pt experience during a hemodyalysis:
1) Blood transfusion. If the pt’s kidneys are not working, pt will need blood filtered. Hemodyalysis does this for pt. It is used until kidney/renal function is restored. So hemodyalysis filters blood and fluids and does what the kidneys do. So the machine takes blood out, filters it, removes waste (urine) and then redistributes good filtered O2 rich blood back into the body.
2) Obviously people are really cold and exhausted. They are extremely weak. They are also prone to osteoporosis long-term, and BP and HR is all over the place the day it happens.
CAPD:
1) What is CAPD (what does it stand for)
2) What does a CAPD do:
3) Difference between Hemodyalysis and CAPD:
4) What would the pt want to avoid if they had a CAPD (what would you instruct them to do / not to do):
5) What do you as PT need to know / do / avoid about pt’s with CAPD:
1) Continuous Ambulatory Peritoneal Dialysis
2) Peritoneal dialysis: the internal lining of the abdomen acts as the artificial kidney. The abdomen is lined by a thin membrane called the peritoneum, which has a rich supply of tiny blood vessels (capillaries). If the peritoneal membrane is bathed in fluid, waste products can pass from the capillary blood vessels into that fluid, which removes them from the blood. During peritoneal dialysis, fluid is drained into the peritoneal cavity, allowed to sit there for several hours whilst it absorbs waste products, and then drained out. This process, repeated several times a day, can effectively replace kidney function and - because it is a continuous process which allows you to carry on with normal activities - it is known as continuous ambulatory peritoneal dialysis (CAPD).
3) Hemodyalysis is where you have blood removed, filtered through a machine (AT THE HOSPITAL) to remove wastes, and blood then entered back into the body. But peritineal (CAPD) requires no machine, and is done manually by the pt themselves a few times daily AT HOME. Same concept though.
4) Avoid heavy lifting, pulling out line (it is usually taped on to avoid being pulled out), and do NOT do the valsalva manuever.
5) Moniter blood pressure regularily, they will be weak and prone to infections. And due to lower blood volume amounts, they get tired and are prone to osteoporosis and fracturing bones much easier.
PCA PUMP:
1) What is PCA (stand for):
2) What is a PCA pump … what does it do / why does a pt need it?
1) Patient-controlled anastegia
2) It is a pump allowing pt in pain to administer their own pain relief (increase amount of drugs administered … to a certain point). It helps pt manage pain. They will have a catheter and it administers the drug when patient feels pain.
