Exam 3 Flashcards
1
Q
obstructive lung disease is a problem with getting air ___
A
out
2
Q
T or F, typically, pts with obstructive lung disease have just one type of obstructive issue
A
F, typically its multiple
3
Q
4 generic sx of pts with chronic obstructive lung disease
A
- Chronic cough
- Productive cough
- Adventitious/abnormal breath sounds
- Dyspnea on exertion
4
Q
4 types of pediatric obstructive lung disease
A
A. Bronchopulmonary dysplasia
B. Cystic fibrosis
C. Asthma
D. Bronchiectasis
5
Q
4 types of adult obstructive lung disease
A
emphysema
asthma
chronic bronchitis
bronchiectasis
6
Q
explain t he cause of bronchopulmonary dysplasia
A
babies get this as a result of being mechanically ventilated. the issue is that there has been damage to the alveoli and it is harder to expand lungs bc lack of surfactant, and they have low strength in muscles)
7
Q
typically, premies born under ____ wks require a vent
A
under 32 weeks
8
Q
tell tell sign on an image of bronchopulmonary dysplasia
A
ground glass appearance
9
Q
primary sx of bronchopulmonary dysplasia
A
- Tachypnea
- Cyanosis with feeding or crying
- Chest retractions, nasal flaring, expiratory grunting
10
Q
The issue with adults who had bronchopulmonary dysplasia as a baby
A
they battle chronic pulmonary issues, Often have decreased growth and increased incidence of neurodevelopmental sequelae (e.g., cerebral palsy, impairments in gross and fine motor skills, cognition and language development
11
Q
cystic fibrosis is a(n) ____ disorder
A
autosomal recessive genetic disorder
12
Q
CF is more prominent with what ethnicity
A
whites
13
Q
explain the pathophysiology of CF
A
Problem affects the formation of the protein CFTR (cystic fibrosis transmembrane regulator), a protein channel that controls chloride movement
14
Q
as a result of the CFTR/chloride issue with CF, what occurs
A
thick, sticky mucus that obstructs airways
15
Q
pts with CF suffer from chronic
A
hypoxia
16
Q
pts with CF often have what postural appearance
A
kyphosis from all of the coughing
17
Q
explain the concept of pancreatic insufficiency with CF
A
bc of the thick mucus, the ducts in the pancreas get clogged and enzymes get trapped. this results in decreased absorption of nutrients
18
Q
very well known indicator of CF babies/pts
A
salty sweat
19
Q
the thick mucus production for CF pts often leads to ___
A
infections
20
Q
explain the result of ventilation perfusion mismatching with CF pts
A
hypoxemia resulting in dyspnea
Pulmonary hypertension –>cor pulmonale –>right ventricular failure
Increased CO2 (later in disease)
Respiratory acidosis (as respiratory failure occurs)
21
Q
why do pts with CF have steatorrhea
A
(excessive fat in feces) they don’t absorb all nutrients
22
Q
what might you see in regards to fingernails of CF pts
A
clubbing dt chronic hypoxia
23
Q
describe asthma
A
airways become sensitive to stimuli and a broncho spasm occurs = wheezing
24
Q
4 main stimulants to asthma
A
allergens, exercise, infections, stress
25
main tx for acute asthma attack
bronchodialator (typically this solves the problem)
26
what environment would most likely cause asthma issues when exercising
in a cool, dry environment is most likely to aggravate exercise-induced asthma; swimming is excellent activity
27
what is suggested ex regime to handle asthma
Suggest short periods of exercise (less than 6 continuous minutes) for conditioning without bronchial irritation
28
what is bronchiectasis
permanent dialation of the bronchi = area for infections
| these airways become fibrotic and produce lots of mucus
29
what is hemoptysis
coughing up bld
30
sx associated with bronchiectasis
hemoptysis, dyspnea, pleuritic chest px, bacteria in sputum
31
prognosis for brocnhiectasis
with antibiotic intervention, pts live into their 70s and 80s
32
who are the "pink Puffers"
emphysema pts
33
explain emphysema
permanent enlargement of airspaces distal to the terminal bronchiole, accompanied by destruction of their walls
34
emphysema is a ____ disease
permanent
35
what causes the enlargment of airspace with emphysema
Destruction of alveolar walls and elastic tissue , Leads to permanent enlargement of the gas exchanging airways.
There is a loss of elastic tissue that normally serves to hold airways open leads to bronchiole collapse, this is due to imbalance between proteolytic enzyme inhibitors and proteolytic enzymes
36
people with the inherited version of emphysema have what issue (what is causing their emphysema)
people with the inherited version have a decreased number of the proteolytic enzyme inhibitors (α1-antitrypsin) that would control the action of the enzyme (proteolytic enzyme destroys or eats lung tissue) so the enzymes go crazy and destroy the tissue
37
smoking does what to the proteolytic enzyme (emphysema)
increases the number = more destruction of tissue
38
prognosis for which type of emphysema is worse
the inheireted one
39
sx for inheireted emphysema usually present themselves at what age
Symptoms (shortness of breath) occurs around age 40 if person also smokes; around age 55 if non-smoker
40
main effects she highlighted for emphysema (findings we would see from test/evaluations)
Decreased FEV
Increased TLC, FRC, and RV
Hyperresonance to mediate percussion
41
main signs/sx emphysema
Primary symptom is dyspnea on exertion and SOB
No wheezing or coughing.
Trouble getting air out.
Physically inactive and deconditioned
Tend to be thin, may have rosy skin tones
Barrel chested
42
T or F, if a person stops smoking, emphysema will clear up
F, If stop smoking, further destruction stops, but lungs don’t repair
43
Tx for emphysema
there is none (just tx their sx)
44
pt with chronic bronchitis are referred as
blue bloaters
45
in order to be dx with chronic bronchitis, you must have what characteristics
productive cough (> 100 ml/day) for 3 months of the year for 2 consecutive years.
46
number one cause of chronic bronchitis
smoking
47
with emphysema, is there any issue with over production of mucus
no
48
explain chronic bronchitis
the chronic irritation causes hyperproduction of mucus = damage to the cillia = infections
49
pts with chronic bronchitis have a ____ PaO2
Low PaO2 – bc less O2 that can get across
50
pts with chronic bronchitis have a ___ PaCO2
high
51
pts with chronic bronchitis will have polycythemia, what is this
Increased red blood cell production (polycythemia) secondary to hypoxemia
52
pts with chronic bronchitis will have ___FEV1
decreased
53
what lung sounds presents with chronic bronchitis
Rhonchi "rattle"
54
main sx of chronic bronchitis
cough, especially in the morn
55
often times pts with chronic bronchitis will have edema to LE dt ___
right sided heart failure
56
tx for chronic bronchitis
quit smoking (can improve some if get to patient before they become blue and bloated)
chest PT
tx infections prn
57
diff btwn restrictive and obstructive lung disease
restrictive- prob getting air in
| obstructive- prob getting air out
58
restrictive lung disease is usually dt decreased__
compliance
59
FEV with restrictive lung disease is usually
normal or increased, cant get lungs to open well, but when the finally do they will collapse and close quickly
60
Cor pulmonale means what
Pulmonary hypertension leads to Right-sided ventricular disease
61
overall, restrictive lung disease usually causes a _____ , ____cough
dry, nonproductive
62
RDS is aka
hyaline membrane disease - lack of surfactant
63
RDS in a premie can lead to the need to have a ventilator, this can result in
bronchopulmonary dysplasia
64
gestation less than ___ weeks is at risk for RDS
36
65
biggest issue with RDS
surfactant levels are too low = decresed compliance
66
RDS babies are usually born with what pathology in the heart
patent ductus arteriosis
67
PaO2, PaCO2, and Ph do what with RDS babies
Decreased PaO2
Increased PaCO2 (acidosis)
Decreased pH
68
prognosis for RDS babies
if they can survive first 2-4 days it improves
69
What is Boop stand for
bronchiolitis obliterans with organizing pneumonia-
70
Explain BOOP
result of having something else (boop is secondary)
Fibrotic lung disease that affects smaller airways
Can cause both restrictive and obstructive lung disease
usually caused by viral infection
71
5th leading cause of death in the US
pneumonia
72
pnuemonia is either ___ aquired or ____ aquired
community or hospital (nosocomial)
73
if pneumonia is community aquired, it is usually dt
bacteria - streptococcus pneumoniae (pneumococcus)
74
Inflammation of lung parenchyma in response to exposure to various microbes
pneumonia
75
infection of the lower respiratory tract that begins 72 or more hours after hospitalization
a nosocomial pneumonia
76
risk factors for hospital aquired pneumonia
any tubes going down throat (NG tube,
intubation, mechanical ventilation); dysphagia, lung injury, diabetes, chronic cardiopulmonary disease, intra-abdominal infection; uremia; shock; smoker; elderly; poor nutritional; long term use of certain drugs
77
First response to infection is edema, followed by polymorphonuclear leukocytes (phagocytosis) and deposits of fibrin
Does this describe viral or bacterial pneumonia
bacterial
78
First localizes in the epithelial cells and destroys cilia
May proceed to the alveoli leading to edema, hemorrhage, hyaline membrane formation, and possibly ARDS
Does this describe viral or bacterial pneumonia
viral
79
which type of pneumonia (bacterial or viral) isolates to specific areas of the lung (so whe pt coughs the ick can come out)
bacterial
80
does this describe viral or bacterial pneumonia
a. Rapid onset
b. High fever
c. Chills
d. Tachypnea
e. Dyspnea
f. Productive cough
g. Lobar consolidation
h. Leukocytosis – increased WBC
i. Pleuritic pain – hurts
bacterial
81
```
which type of pneumonia it’s spread throughout the lung, (not in specific spots) and causes these sx
a. Insidious onset (slow)
b. Moderate Fever
c. Myalgia
d. Tachypnea
e. Dyspnea
f. Nonproductive cough
g. Patchy diffuse follows the path of the
central conducting airways
h. Normal white blood cell count
```
viral
82
this is a key component of any pneumonia tx
hydration
83
Cause of ARDS
truly is unknown, but trauma, shock, transfusions or situations like this can bring it on
84
explain pathophysiology of ARDS
damage to alveolar and capillary cells, this increases permeability and fluid leaves the cells and goes into interstitial space damaging the alveoli
85
sx of ARDS
1. Dyspnea at rest
2. Breathing is fast and labored
3. Cyanotic
4. Headache
5. Impaired mental status
6. Restlessness
7. Increased anxiety
86
List the 5 main restrictive lung diseases
RDS, BOOP, pneumonia, ARDS, ideopathic pulmonary fibrosis
87
cause of ideopathic pulmonary fibrosis
Unknown, it s an IMMUNE response to acute injury or infection
88
what is the result of ideopathic pulmonary fibrosis
inflammation leads to scars and fibrous tissue
89
what are 2 big tx or interventions for ideopathic pulmonary fibrosis
start with steroids, and will prob end up getting a lung transplant
90
2 cardio causes of restrictive lung dysfunctions
A. Pulmonary edema
| B. Pulmonary emboli
91
NM casues of restrictive lung dysfunctions
```
A. Spinal cord injury
B. Amyotrophic Lateral Sclerosis
C. Poliomyelitis
D. Guillain-Barre Syndrome
E. Myasthenia Gravis
F. Tetanus
G. Duchenne’s Muscular Dystrophy
```
92
MSK causes of restrictive lung dysfunctions
A. Paralysis or paresis of diaphragm
B. Vertebral abnormalities (kyphosis and or scoliosis)
C. Ankylosing Spondylitis
D. Pectus Excavatum
93
nutritional or metabolic reasons for restrictive lung diseases
diabetes, obesity
94
atrial septal defect is aka
patent foramen ovale
95
explain atrial septal defect, what has ocurred physiologically
The opening between the right and left atrium remains open after birth .
This creates a right to left shunt- if the valve stays open, bld will be shunted from right to left side. Unoxygenated blood then goes to aorta and out to body
96
This is the most common congenital issue of the heart
VSD
97
ASD is usually dx how
bc heart murmur is detected
98
VSD pathophysiology
This is a defect that results in an opening between the left and right ventricle
99
blood flows which way with VSD
Blood will flow from the left to the right side of the heart
100
With VSD, pressure is greater on which side of the heart
(greater pressure on the left side than the right).
101
With VSD, what is compromised
CO
102
VSD is also detected by
heart murmur
103
which defect can result in just, right sided heart failure
ASD
104
which defect can result in right or left sided heart failure
VSD
105
When the opening between the pulmonary trunk and the aorta remains open after birth.
Patent Ductus Arteriosus
106
the opening between the pulmonary trunk and aorta is known as
the ductus arteriosus
107
explain pathophysiology of patent ductus arteriosis
Creates a left to right shunt- blood from aorta goes to pulmonary trunk (in this case, there is a decreased CO bc some blood will go back into pulm trunk)
108
patent ductus arteriosus can lead to
CHF
109
what is Coarctation of the Aorta
This occurs due to a fibrous constriction in the descending aorta, bc aorta is constricted, blood will go elsewhere (UE) = decreased CO to lower ext. and dec BP in LE
110
coarctation of the aorta will present this very clear sx
decreased bp in lower ext and decreased femoral pulse
111
if not treated, coarctation of the aorta will lead to
left vent hypertrophy, heart failure
112
list the 4 abnormalities that occur with tetralogy of fallot
both ventricles empty into the aorta
stenosis of the pulmonary artery opening
ventricular septal defect
right ventricular hypertrophy
113
Why does squatting or bringing knees to the chest acutely decrease cyanosis in tetralogy of fallot
Increases systemic vascular resistance causing increase in pulmonary blood flow
114
what pathology is this:
there is a large hole in the center of the heart where the septum between the atria is to join the septum between the ventricles, tricuspid and mitral valve may not be separate
endocardial cushion defect
115
endocardial cushion defect occurs with what disease
downs syndrome
116
what pathology is this:
Narrowing or constriction that keeps valve from opening
valvular stenosis
117
what causes hypertrophy with stenosis
the chamber above or prior to the stenoic area has to work harder = hypertrophy
118
this pathology often occurs with rheumatic fever, infective endocarditis, arthritis, lupus, and is characterized by incomplete closure of a valve causing leakage
Regurgitation or Insufficiency (prolapse)
119
explain dilated cardiomyopathy
Characterized by ventricular dilation and severely impaired systolic function- think about the length tension curve, we have to have cross bridge overlap to create tension, here the chamber is so large it gets stretched out, so the ability of the heart to have good/normal contraction isn’t great.
120
bc the ability of the heart to have a normal contraction is compromied with dilated cardiomyopathy, what is the main concern
very poor CO = low O2 to the body
121
3 main causes of dilated cardiomyopathy
1) Familial tendency
2) Alcoholic
3) Peripartum
122
where does the "back up" or the congestion occur with dilated cardiomyopathy
pulmonary bc if left vent cant contract there is back up to left atria = back up in pulmonary capillaries
123
tx for dilated cardiomyopathy includes digitalis glycosides, what does this do
Digitalis glycosides – acts like a SNS effect, for same length of muscle you get more tension, you get pos ionotropic effect
124
prognosis for dilated cardiomyopathy
not good- death within 5 years
125
does the chamber size itself change with hypertropic cardiomyopathy
no, just the wall size thickens (or the septum)
126
hypertrophic cardiomyopathy is caused by what 2 things typically
hypertension or valvular heart disease
127
tx for hypertrophic cardiomyopathy
Beta-blockers
128
this describes what pathology:
| Characterized by rigid, noncompliant myocardium (doesn’t really “receive” blood bc it doesn’t stretch)
restrictive cardiomyopathy
129
Overall, big picture, if the frank starling mech isn't working, this leads to
CHF
130
what pathology is this:
Condition where the heart's cardiac output is unable to supple the body's needs due to an abnormality of heart muscle. Results in diminished blood flow to the tissues, retention of sodium and water, and congestion in the pulmonary and/or systemic circulation
CHF
131
CHF effects which side of the heart
can be either
132
left sided heart failure causes a back up where
can’t get blood out of left vent, so there will be a back up in lungs
133
diastolic heart failure is because there is an inability to get blood from the ____ causing a back up in the lungs
left atria
134
preload and afterload
pre load is the area before
| afterload is the area after
135
the left vent's afterload is the ____, so the left vent has to squeeze harder than the ___ to send blood there
aorta
136
4 main sx left sided heart failure
dyspnea on exertion that ends up dyspnea at rest
fluid accumulation in lungs
frothy pink sputum
S3 heart sound
137
always do what before working with pts with left sided heart failure
listen to lungs to know where rales are, and also listen after to compare/document
138
what to keep in mind when working with pts with left sided heart failure
Keep in mind, as you start to walk them, bc they already have a back up and are lacking CO, you do RDE and listen to their lungs and document where rales are.
139
right sided heart failure presents with the "back up" where
the body, periphery
140
explain the basic pathophysiology of right sided heart failure
decreased CO leads to baroreceptors recognizing the lack of volume/pressure, kidneys then retain fluid
141
sx of right sided heart failure
a. Weight gain (2-3 lbs overnight) (or sacral edema)
b. Symmetrical edema in lower extremities
c. JVD
d. Hepatomegaly
e. Right upper quadrant pain
f. Ascites-periteneal space
142
2 types of CHF
compensated, decompensated
143
explain compensated CHF
```
loss of CO causes decrease in pressure throughout
body will go through changes to help bring BP back up
NTS -->SNS will go into action
increase HR (pos ionotropic, vasoconstriction)
all of this going on to try and fix the low BP, but this all makes the heart work harder
```
decreased CO--> decreased blood flow to kidney
renin is enacted to retain fluid
144
explain decompensated CHF
much like compensated but worse, the cycle that has begun, continues to perpetuates itself and the already damaged heart can no longer accommodate for the increased volume of blood
145
3 common ways to dx CHF
main way is echo, S3 heart sound, elevated BNP
146
for CHF, would you want your pts to take pos or neg ionotripic drugs
pos
147
limiting factors for left sided heart failure
primarily SOB
148
limiting factors for right sided heart failure
SOB and leg pain (periphery)
149
our ex goal for CHF pts is
Goal is once daily, 4-6 times per week working to 30 min
150
how to determine what intensity for CHF pts
If GXT performed use maximal heart rate achieved
If SLGXT performed use 10 bpm below symptom level
If no GXT available use 11-14 on 6/20 RPE Scale
151
what is the recommendation for ex in post infarc CHF pts
Evidence for exercise in postinfarction CHF now support use of high intensity interval training
152
its been found that the increased in aerobic capacity for CHF pts are due to _____
Increased aerobic capacity due to adaptations affecting the peripheral circulation and skeletal muscle NOT adaptations affecting the cardiac muscle
153
3 main stages of atherosclerosis
fatty streak, raised plaque formation, complex plaque
154
fatty streaks begin where (what layer)
intima
155
in the raised plaque stage of atherosclerotic formation, where is this seen, and what appearance
subendothelial tissue, Appears as a yellowish-gray elevated lump which begins to impede on the arteries
156
explain the complicated plaque stage
at that point the formation has calcified or formed a thrombus, there is a decrease in blood flow and sx are experienced by pt
157
the major component of a plaque forming
LDL
158
3 main lifestyle choices leading to atherosclerosis
fatty diet, smoking, HTN
159
most common sites for atherosclerosis
Tend to occur at bifurcations especially in high velocity areas carotid, iliac arteries, and coronary arteries.
160
in regards to prognosis, what is the most important factor for atherosclerosis
how many vessels are 75% or more blocked
161
most common area for blockage (atheroscl)
LAD
162
angina is the result of
when myocardial O2 demand is greater than the supply
163
RPP =
HR x SBP
164
bc RPP is correlated with myocardial O2 demand, ____ is roughly equal to RPP
angina
165
6 main ways (descriptor words) pts describe angina
Squeezing, burning, aching, pressing, bursting, choking
166
women may experience these non classical sx of angina
sensation similar to inhaling cold air; may not have chest pain, but signs/sx of diaphoresis, light-headedness, shortness of breath, n/v
167
for men, the location of angina px is usually
behind the sternum
168
for women, the location of angina px is usually
pain in left chest area or midthoracic back; aching in right biceps
169
angina px usually follows (radial or ulnar) distrubution
ulnar
170
4 things that are classified as angina triggers
a. Physical exertion
b. Emotional stress
c. Cold, heat, and humidity
d. Heavy meals
171
angina is usually relieved by
rest
172
for women, angina can be relieved with
antacids
173
3 types of angina
chronic stable, unstable, prinzmetal
174
char of chronic stable angina
1) Occurs at predictable physical/ emotional stress level
2) Location, duration, and intensity are consistent
3) Relieved by rest or NTG
175
char of unstable angina
Change in anginal threshold or intensity (any change)
| Necessitates immediate medical attention
176
char of prinzmetal angina
ischemia is due to coronary artery spasm
Occurs at rest, in the early morning hours (often at the same time)
177
MI px lasts how long usually
Pain lasts more than 30 minutes and not relieved except with potent analgesics
178
MI sx will vary depending on
whether SNS or PSN is more controlling
179
in order to be dx with an MI you have to have what sx/signs
2 or more of the following
1) classic signs and symptoms
2) EKG changes
3) Enzyme changes
180
at first, the tissue effected by an MI will appear
purple or reddish
181
long term appearance of heart tissue after an MI
scar formation
182
what does zone 1 mean in regards to an MI
necrosis. Tissue is dead and will ultimately become scar tissue.
183
what does zone 2 mean in regards to an MI
injury. Tissue is injured, but still living. Recovery depends upon collateral circulation.
184
what does zone 3 mean in regards to an MI
ischemia. This usually heals within 6-8 weeks.
185
First initial problem in nearly 20-25% of patients with CHD is ___
sudden cardiac death
186
explain sudden cardiac death
Death occurs within one hour of the attack.
| Death is due to ventricular fibrillation.
187
how to survive sudden cardiac death
defibrilator, get to ER within 10 min
188
what population is sudden cardiac death a real concern
athletes - if they have any hx of any form of cardiac issue
189
the PPE that is listed in her notes states any family member who died under what age is a risk (from CV issue)
50
190
list some red flags for a sports PPE
```
Exertional chest pain/discomfort
Exertional syncope/near syncope
Excessive, unexpected, and unexplained SOB
Fatigue associated with exercise
Heart murmur
Increased systemic blood pressure
```
191
In order to qualify for cardiac rehab, a pt had to have an MI within
in past 12 months
192
what kind of angina qualifies for cardiac rehab
stable only!
193
these conditions qualify for medicare to cover cardiac rehab
```
A. Acute post-MI (MI within the last 12 months) *
B. Stable angina*
C. Post coronary bypass graft surgery*
D. Post heart vale repair/replacement*
E. Post PTCA or coronary stent*
F. Post heart or heart/lung transplant*
```
194
contraindication for cardiac rehab is MI or extension of the infarct within the past ___ days
2
195
what BP is contraindication for cardiac rehab
S over 200
| D over 110
196
explain the phases of cardiac rehab
A. Phase I "In Hospital" Phase: the acute stage
B. Phase IB (Bridge) - done in home with goal of getting ready for Phase II or end point is home (this phase primarily result of shorter hospital stays) (home health)
C. Phase II "Out of Hospital" Phase
D. Phase III out of hospital, less closely supervised
E. Phase IV - lifetime follow through
197
"In Hospital" Phase: the acute stage
phase 1
198
what phase is done in the home
phase 1 B (b as in bridge)
199
when does phase 1 begin
as soon as vitals and angina are stable (This may be as early as the 2nd or 3rd day following uncomplicated MI to 4th or 5th day following complicated MI)
200
goal during (METS) phase 1
1-2 METS
201
who usually progress faster, surgical pts or MI pts
surgical
202
list some goals in phase I
decrease effects of deconditioning, education, METS at 1-2, prevent pneumonia, monitor pt status for changes
203
what tx is ESSENTIAL for post surgical pts in phase I
coughing and breathing interventions/techniques to prevent pneumonia
204
for pts in cardiac rehab, you MUST do what before doing any form of intervention on them in phase I
check with nurse on their status
| AND check their status on your own (O2 Sat, lung sounds, BP, current EKG....ect) in supine, seated and standing
205
all ex (in cardiac rehab) should include these 3 stages
pre ex
mid ex
post ex (recovery)
206
Intensity level for phase I if you are using RPE
RPE ≤ 13 (6-20 scale)
207
Intensity level for phase I if you are using HR alone
HR ≤ 120 bpm OR
208
Intensity level for phase I if you are using RHR + ___
RHR + 20 bpm (arbitrary upper limit) for post MI
| RHR + 30 bpm (arbitrary upper limit) for post surgical
209
In phase I it is recommended to do intervals of 3-5 min for ____ min
20 min total
210
how many METS are needed for most ADLS
5
211
Do not go over RPE of ___ in phase 1, if that happens what do you do
13, document and call dr
212
What grade of dyspnea and cladication would terminate exercise in phase I
3 for both (stay under 3)
213
HR increase of ____ with phase 1 would indicate you to stop ex and call dr
an increase over 50 bpm
214
goal is to reach _____ mets at dc of phase I
3-5
215
phase II begins when (cardiac rehab)
at dc from hospital (should be within 6 months of dc)
216
in phase II of cardiac rehab, ex is ____
supervised, but pt status still monitored
217
frequency for phase II of cardiac rehab
three times/week (12 weeks or 36 visits)
218
intensity for phase II of cardiac rehab
10 beats below angina threshold
219
we want RPE for phase II to be
11-13
220
by 3-6 months, our goal for phase II of cardiac rehab is for the pt to achieve _____ kcal / week (burning)
By 3-6 months, goal of 1000 kcal/week of caloric output
221
Goal of phase II cardiac rehab (duration)
20-30 min of continuous
222
METS goal by end of phase II
up to 9 so they can return to work
223
explain phase III of cardiac rehab
not usually covered by insurance
truly is just "supervised"
pt would work towards 40-60 min
uses a phone to calibrate EKG to check
224
phase II takes place where
hospital or satelliete setting
225
which of the phases of the cardiac rehab really focuses on increasing strength and endurance (these are the key components to)
phase II, phase I is more getting used to their situation and preventing pneumonia and serious issues
226
what is SLGXT
sx limited graded ex test
227
guidelines for resistance ex for post MI and post surgical
minimum 5 weeks post MI that includes 3 weeks of continuous program participation
minimum 8 weeks post CABG including 3 weeks of continuous program participation
228
in order to participate in resistance training, pts in cardiac rehab must be able to tolerate ____ METS and be without ___
5
| angina
229
pts are typically dc from phase II card rehab after
6-12 mos
230
what is AOD
arterial occlusive disease
231
List the big risk factors for PAD or AOD
diabetes, smoking, HTN, high cholesterol, claudication, vascular disease, african american
232
intermittent claudication is a sx of PAD or AOD, explain what is going on with this
Anaerobic metabolism occurs as they walk bc there is an occlusion and muscles won’t get good blood, so if they stop, the pain stops. Classic sx, "I can walk for 5-10 min and then have to rest dt pain".
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an occlusion in popliteal artery would cause px where
calf
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an occlusion in femoral artery would cause px where
thigh or calf pain
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an occlusion in Occlusion in aorta or iliac arteries = px where
buttocks, thigh, or leg pain, abdominal pain, kidney problems
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arterial insufficiency yields what color of pts skin
pale/blue
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so overall, px in legs that goes away with rest, or px at night (especially to MT heads) would be a red flag for
claudication = arterial insufficiency
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formula for ABI
SBP leg/SBP arm
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where to measure BP in LE for ABI
both posterior tibialis and dorsalis pedis pulses in both right and left legs
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how to figure ABI
ALL SYSTOLIC
Right ABI = higher right dorsalis pedis OR post tib over higher right OR left UE systolic pressure
Left ABI = Higher left dorsalis pedis OR post tib over
higher right OR left UE systolic pressure
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what number (ABI) indicates arterial insufficiency
below .90
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if a person has PAD, BP in LE is ____ than BP in UE
less
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for PAD, ex freq should be
1-2 times/day; 7 days/week
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PVD grading scale goal for PAD pts
3 to 4, they will be in px, but we need them at a high intensity
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grade O for PVD scale is
no px
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grade 1 for PVD scale is what
Definite discomfort or pain, but only of initial or modest levels (established, but minimal)
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grade 2 for PVD scale is what
moderate discomfort, you can divert pt
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grade 3 on PVD scale is what
intense px, pt cannot be diverted
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grade 4 on PVD scale is what
excrutiating/unbearable
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parameters of ex for PAD pts
Initially begins as intervals
Interval time determined by onset of 3+ pain
Progress to 30-60 minutes of continuous exercise (longer periods of time most beneficial)
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a pt reporting a "throbbing" px in the calf and skin is pallor should be thought as
an acute arterial thrombus
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those at risk for chronic venous sx
Obese; pregnant; job requiring prolonged standing or sitting; prolonged bedrest; CHF; thrombophlebitis; varicose veins; insult to veins
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Sharp", intense, localized px. deep muscle feels tender to palpate, skin is red and swollen, you should suspect
acute venous thrombus
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Third most common cardiovascular disease after CAD and stroke
DVT
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diff dx for dvt
```
A. Muscle hematoma
B. Muscle tear
C. Muscle cramp
D. Sciatica
E. Phlebitis
F. Cellulitis
```
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at risk for DVT
cancer, 55-60 yrs of age, pmh of thrombus, oral contraception, pregnancy, immobility
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These are all ways to help prevent _______
Leg exercises such as ankle pumps
Ambulations as soon as possible
Hydration
Correct use of compression stockings
DVT
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according the Wells DVT score, what is considered a risk or no risk
DVT unlikely ≤ 1 point
| DVT likely ≥ 2 points
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Pauda DVT score is high risk at what number
at or above 4
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what ages and extra criteria puts one at risk for PAD
Less than 50 years of age with diabetes and one other atherosclerosis risk factor
50-69 years of age and history of smoking or diabetes
or Over the age of 70 years
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smoking increases ones chance of getting PAD by
4 times
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adults usually get heart transplants for what diseases
severe coronary artery disease and end-stage cardiomyopathy/heart failure
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children get heart transplants for what disease/pathology
cardiomyopathy
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babies typically get heart transplants for what pathologies
congenital
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Typically, what are the 4 main reasons why pts get lung transplants
COPD, idiopathic pulmonary fibrosis, cystic fibrosis, pulmonary arterial hypertension
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typically for transplants, pts are under age of
65
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other criteria for transplant
Expected life span of less than 1 year
Nonsmoker
Adequate social support
Other systems disease free
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goals for pre transplant pts
prevent loss of ROM, for lung transplants emphasize chest wall ROM (diaphragmatic breathing)
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This is what type of transplant
Donor heart is anastomosed to the host heart without removing the host heart, LA attached to LA; RA attached to RA, both have a shared venous return
heterotopic
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This is what type of transplant
Donor heart replaces the host heart
Recipient's vena cavae and SA Node left behind; donor SA Node attached
Results in two P waves
orthotopic
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what is a huge consideration with heart transplant
Heart is denervated – so the autonaumic NS no longer connects with the heart
They also need longer warm up and cool down
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in an orthotopic transplant, what articulates
old vena cava and old SA node with new SA node
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physiological effects of heart transplant
They have higher RHR
Elevated systolic and diastolic pressures
Decreased HR response to ex
Peak heart rate of donor heart is 80% of peak of old
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eventhough the auto. NS no longer connects with heart, the heart rate will still increase with ex, why and how
After about 5 minutes, heart rate increases in response to circulating catecholamines (no SNS to heart, as they begin to ex their SNS doesn’t turn on bc the nerves were cut, however, there is a connection with SNS to adrenal medulla which causes epinephrine and norep, increasing the HR, but it is delayed, it is due to circulating cateholimines) this is why heart transplant pts need longer warm up and cool down, the cascade takes longer.
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why is there an increased CO with heart transplant pts
Increase in cardiac output
| Initial increase is achieved by increase in stroke volume for submaximal exercise
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factors effecting whether there is "re innervation" with a heart transplant
if the donor was young, or amt of time (more time with the donor heart = more chance for new innervation)
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As PT's one issue we will battle with transplants pts during our rehab is
they are really deconditioned, we need to work on ADLs at first
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how to rate intensity with transplant pts
RPE (due to slowed HR response to ex)
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Other than RPE , whats another way to rate effects of ex on transplant pts
use systolic BP (not HR)
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for transplant pts, rehab, RPE should be (acute phase)
10 or less
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HR should be less than _____ and not greater than ___ bpm over resting for transplant rehab (acute phase)
120 bpm
| HR not greater than 20 bpm above resting
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transplant rejection usually occurs within the first ___ months
6
283
what is often the first sign of transplant rejection
ex intolerance
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signs/sx of transplant rejection (heart)
like the flu
1. Low-grade fever
2. Increase in resting blood pressure
3. Hypotension with activity
4. Myalgias
5. Fatigue
6. Decreased exercise tolerance
7. Ventricular dysrhythmias
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signs sx of lung transplant rejection
SOB, desaturation at rest
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explain basics of beginning progression of transplant tx (acute phase for heart and lung)
Begins with active/passive ROM in bed progressing to walking up flight of stairs and 500 feet
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parameters of acute phase of transplantation rehab
```
HR not greater than 120 bpm
HR not greater than 20 bpm above resting
No significant arrhythmias
SBP < 200, DBP < 120 during exercise
< 10 to 15 DBP drop during exercise
RPE of 10 or less
No angina
Able to complete entire step
```
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after the acute phase of transplantation rehab, there is outpatient rehab, what are the parameters (RPE, freq, duration)
1. RPE 11-15
2. Frequency: 4-6 days/week
3. Time: progress from 15 to 60 min/session
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peribronchial cuffing occurs with a specific pathology, what pathology and what is it
CF, edema or fluid has left the capillaries
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type of emphysema that destroys alveoli
panlobular
291
type of emphysema that destroys bronchioles
centrilobular
292
large dilated airspaces that bulge out from beneath the pleura as a result of loss of lung parenchyma by destruction of alveoli (occurs with emphysema) these are on the OUTSIDE of lungs
bullae
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which is primarily the disease associated with increased WOB (restrictive lung dis. or obst. lung diseae)
restrictive- getting air in
294
PTs are able to help pts with bacterial or viral pneumonia more
bacterial
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according to her chart, what do you do if you suspect angina
First thing to ALWAYS do, = decrease activity (rest)
If it goes away with rest you should think that it could be angina
If you can reproduce it with CV ex, it very well could be angina
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for persons with DVT or venous insufficiency, what is more comfortable position
elevate legs
297
for pts with arterial insufficiency, its more comfortable to
let legs dangle to get blood flow
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questions to ask if pt is having any px above the waist
A. What are the symptoms?
B. Where is it located?
C. What is the effect of palpation?
D. What is the effect of a deep breath/cough?
E. What is the effect of body position or ROM?
F. What is the effect of cardiovascular exercise?
G. What is the effect of rest?
H. What is the effect of NTG?
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with pts who have had a cut sternum dt cardiac surgery, they are most comfortable with what type of mvmt
bilateral
300
what sx would be of great concern for a pt on sternal precautions
clicking or clunking or unstable feeling
301
it is probably not angina if what 3 things can reproduce sx
deep breath, palpation, ROM change (if these cause sx then it's probably not angina)
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hypokineses (as a result of an MI) would be located where and what type of MI
subendocardial - partial
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akinesis (as a result of an MI) would be located where and what type of MI
transmural - full
304
COPD encompasses what diagnosis's
emphysema, asthma, chronic bronchitis, bronchiectasis
305
of the dx that come with COPD, which is the only one that is usally relieved by bronchodilators
asthma
306
of the dx's that come with COPD, which (in addition to decreased FEV) ONE will also increase lung volume (increasing RV and TLC)
emphysema (barrel chest)
307
diffuse hypoxia pulmonary disease, can cause right sided heart failure
cor pulmonale
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with bronchiectasis, we know there is an issue with permanent dilation of the bronchioles. what happens to the tissue
it becomes fibrotic, and the body responds by creating lots of mucus in that area
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With emphysema, there is a(n) _____ in compliance and a(n) ______ in elastic recoil
increase
| decrease
310
2 pathologies that create perm enlargement of airways
emphysema, bronchiecatasis
311
main tx for bronchiectasis
antibiotics
312
unique sx of chronic bronchitis is an increase in ____
RBC -polycythemia
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emphysema pts would yield what kind of resonance during assessment
hyper resonance = dt increased compliance
314
which type of pneumonia causes an increase in WBC
bacterial only
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When there are congenital defects that create a left to right shunt (patent ductus arteriosis and VSD) this decreases what
CO
316
In regards to the 3 main COPD obstructive diseases, which have an increase in volume and which dont
They all have decreased FEV, but emphysema also has an increase in lung volume (TLC and RV), bronchitis and asthma do not
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restrictive disease that is caused by something else, the characteristics include: Fibrotic lung disease that affects smaller airways. Can cause both restrictive and obstructive lung disease. Can effect children or adults.
usually caused by viral infection
BOOP
318
ARDS damages what
alveoli and capillaries
