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Cardio Jean > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

obstructive lung disease is a problem with getting air ___

A

out

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2
Q

T or F, typically, pts with obstructive lung disease have just one type of obstructive issue

A

F, typically its multiple

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3
Q

4 generic sx of pts with chronic obstructive lung disease

A
  1. Chronic cough
  2. Productive cough
  3. Adventitious/abnormal breath sounds
  4. Dyspnea on exertion
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4
Q

4 types of pediatric obstructive lung disease

A

A. Bronchopulmonary dysplasia
B. Cystic fibrosis
C. Asthma
D. Bronchiectasis

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5
Q

4 types of adult obstructive lung disease

A

emphysema
asthma
chronic bronchitis
bronchiectasis

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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)

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7
Q

typically, premies born under ____ wks require a vent

A

under 32 weeks

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8
Q

tell tell sign on an image of bronchopulmonary dysplasia

A

ground glass appearance

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9
Q

primary sx of bronchopulmonary dysplasia

A
  1. Tachypnea
  2. Cyanosis with feeding or crying
  3. Chest retractions, nasal flaring, expiratory grunting
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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

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11
Q

cystic fibrosis is a(n) ____ disorder

A

autosomal recessive genetic disorder

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12
Q

CF is more prominent with what ethnicity

A

whites

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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

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14
Q

as a result of the CFTR/chloride issue with CF, what occurs

A

thick, sticky mucus that obstructs airways

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15
Q

pts with CF suffer from chronic

A

hypoxia

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16
Q

pts with CF often have what postural appearance

A

kyphosis from all of the coughing

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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

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18
Q

very well known indicator of CF babies/pts

A

salty sweat

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19
Q

the thick mucus production for CF pts often leads to ___

A

infections

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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)

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21
Q

why do pts with CF have steatorrhea

A

(excessive fat in feces) they don’t absorb all nutrients

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22
Q

what might you see in regards to fingernails of CF pts

A

clubbing dt chronic hypoxia

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23
Q

describe asthma

A

airways become sensitive to stimuli and a broncho spasm occurs = wheezing

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24
Q

4 main stimulants to asthma

A

allergens, exercise, infections, stress

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25
Q

main tx for acute asthma attack

A

bronchodialator (typically this solves the problem)

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26
Q

what environment would most likely cause asthma issues when exercising

A

in a cool, dry environment is most likely to aggravate exercise-induced asthma; swimming is excellent activity

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27
Q

what is suggested ex regime to handle asthma

A

Suggest short periods of exercise (less than 6 continuous minutes) for conditioning without bronchial irritation

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28
Q

what is bronchiectasis

A

permanent dialation of the bronchi = area for infections

these airways become fibrotic and produce lots of mucus

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29
Q

what is hemoptysis

A

coughing up bld

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30
Q

sx associated with bronchiectasis

A

hemoptysis, dyspnea, pleuritic chest px, bacteria in sputum

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31
Q

prognosis for brocnhiectasis

A

with antibiotic intervention, pts live into their 70s and 80s

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32
Q

who are the “pink Puffers”

A

emphysema pts

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33
Q

explain emphysema

A

permanent enlargement of airspaces distal to the terminal bronchiole, accompanied by destruction of their walls

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34
Q

emphysema is a ____ disease

A

permanent

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35
Q

what causes the enlargment of airspace with emphysema

A

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

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36
Q

people with the inherited version of emphysema have what issue (what is causing their emphysema)

A

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

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37
Q

smoking does what to the proteolytic enzyme (emphysema)

A

increases the number = more destruction of tissue

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38
Q

prognosis for which type of emphysema is worse

A

the inheireted one

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39
Q

sx for inheireted emphysema usually present themselves at what age

A

Symptoms (shortness of breath) occurs around age 40 if person also smokes; around age 55 if non-smoker

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40
Q

main effects she highlighted for emphysema (findings we would see from test/evaluations)

A

Decreased FEV
Increased TLC, FRC, and RV
Hyperresonance to mediate percussion

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41
Q

main signs/sx emphysema

A

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

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42
Q

T or F, if a person stops smoking, emphysema will clear up

A

F, If stop smoking, further destruction stops, but lungs don’t repair

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43
Q

Tx for emphysema

A

there is none (just tx their sx)

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44
Q

pt with chronic bronchitis are referred as

A

blue bloaters

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45
Q

in order to be dx with chronic bronchitis, you must have what characteristics

A

productive cough (> 100 ml/day) for 3 months of the year for 2 consecutive years.

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46
Q

number one cause of chronic bronchitis

A

smoking

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47
Q

with emphysema, is there any issue with over production of mucus

A

no

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48
Q

explain chronic bronchitis

A

the chronic irritation causes hyperproduction of mucus = damage to the cillia = infections

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49
Q

pts with chronic bronchitis have a ____ PaO2

A

Low PaO2 – bc less O2 that can get across

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50
Q

pts with chronic bronchitis have a ___ PaCO2

A

high

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51
Q

pts with chronic bronchitis will have polycythemia, what is this

A

Increased red blood cell production (polycythemia) secondary to hypoxemia

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52
Q

pts with chronic bronchitis will have ___FEV1

A

decreased

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53
Q

what lung sounds presents with chronic bronchitis

A

Rhonchi “rattle”

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54
Q

main sx of chronic bronchitis

A

cough, especially in the morn

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55
Q

often times pts with chronic bronchitis will have edema to LE dt ___

A

right sided heart failure

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56
Q

tx for chronic bronchitis

A

quit smoking (can improve some if get to patient before they become blue and bloated)

chest PT

tx infections prn

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57
Q

diff btwn restrictive and obstructive lung disease

A

restrictive- prob getting air in

obstructive- prob getting air out

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58
Q

restrictive lung disease is usually dt decreased__

A

compliance

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59
Q

FEV with restrictive lung disease is usually

A

normal or increased, cant get lungs to open well, but when the finally do they will collapse and close quickly

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60
Q

Cor pulmonale means what

A

Pulmonary hypertension leads to Right-sided ventricular disease

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61
Q

overall, restrictive lung disease usually causes a _____ , ____cough

A

dry, nonproductive

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62
Q

RDS is aka

A

hyaline membrane disease - lack of surfactant

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63
Q

RDS in a premie can lead to the need to have a ventilator, this can result in

A

bronchopulmonary dysplasia

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64
Q

gestation less than ___ weeks is at risk for RDS

A

36

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65
Q

biggest issue with RDS

A

surfactant levels are too low = decresed compliance

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66
Q

RDS babies are usually born with what pathology in the heart

A

patent ductus arteriosis

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67
Q

PaO2, PaCO2, and Ph do what with RDS babies

A

Decreased PaO2
Increased PaCO2 (acidosis)
Decreased pH

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68
Q

prognosis for RDS babies

A

if they can survive first 2-4 days it improves

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69
Q

What is Boop stand for

A

bronchiolitis obliterans with organizing pneumonia-

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70
Q

Explain BOOP

A

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

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71
Q

5th leading cause of death in the US

A

pneumonia

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72
Q

pnuemonia is either ___ aquired or ____ aquired

A

community or hospital (nosocomial)

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73
Q

if pneumonia is community aquired, it is usually dt

A

bacteria - streptococcus pneumoniae (pneumococcus)

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74
Q

Inflammation of lung parenchyma in response to exposure to various microbes

A

pneumonia

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75
Q

infection of the lower respiratory tract that begins 72 or more hours after hospitalization

A

a nosocomial pneumonia

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76
Q

risk factors for hospital aquired pneumonia

A

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

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77
Q

First response to infection is edema, followed by polymorphonuclear leukocytes (phagocytosis) and deposits of fibrin
Does this describe viral or bacterial pneumonia

A

bacterial

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78
Q

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

A

viral

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79
Q

which type of pneumonia (bacterial or viral) isolates to specific areas of the lung (so whe pt coughs the ick can come out)

A

bacterial

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80
Q

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
A

bacterial

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81
Q 
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
A

viral

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82
Q

this is a key component of any pneumonia tx

A

hydration

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83
Q

Cause of ARDS

A

truly is unknown, but trauma, shock, transfusions or situations like this can bring it on

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84
Q

explain pathophysiology of ARDS

A

damage to alveolar and capillary cells, this increases permeability and fluid leaves the cells and goes into interstitial space damaging the alveoli

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85
Q

sx of ARDS

A
  1. Dyspnea at rest
  2. Breathing is fast and labored
  3. Cyanotic
  4. Headache
  5. Impaired mental status
  6. Restlessness
  7. Increased anxiety
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86
Q

List the 5 main restrictive lung diseases

A

RDS, BOOP, pneumonia, ARDS, ideopathic pulmonary fibrosis

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87
Q

cause of ideopathic pulmonary fibrosis

A

Unknown, it s an IMMUNE response to acute injury or infection

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88
Q

what is the result of ideopathic pulmonary fibrosis

A

inflammation leads to scars and fibrous tissue

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89
Q

what are 2 big tx or interventions for ideopathic pulmonary fibrosis

A

start with steroids, and will prob end up getting a lung transplant

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90
Q

2 cardio causes of restrictive lung dysfunctions

A

A. Pulmonary edema

B. Pulmonary emboli

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91
Q

NM casues of restrictive lung dysfunctions

A 
A.	Spinal cord injury
B.	Amyotrophic Lateral Sclerosis
C.	Poliomyelitis
D.	Guillain-Barre Syndrome
E.	Myasthenia Gravis
F.	Tetanus
G.	Duchenne’s Muscular Dystrophy
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92
Q

MSK causes of restrictive lung dysfunctions

A

A. Paralysis or paresis of diaphragm
B. Vertebral abnormalities (kyphosis and or scoliosis)
C. Ankylosing Spondylitis
D. Pectus Excavatum

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93
Q

nutritional or metabolic reasons for restrictive lung diseases

A

diabetes, obesity

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94
Q

atrial septal defect is aka

A

patent foramen ovale

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95
Q

explain atrial septal defect, what has ocurred physiologically

A

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

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96
Q

This is the most common congenital issue of the heart

A

VSD

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97
Q

ASD is usually dx how

A

bc heart murmur is detected

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98
Q

VSD pathophysiology

A

This is a defect that results in an opening between the left and right ventricle

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99
Q

blood flows which way with VSD

A

Blood will flow from the left to the right side of the heart

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100
Q

With VSD, pressure is greater on which side of the heart

A

(greater pressure on the left side than the right).

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101
Q

With VSD, what is compromised

A

CO

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102
Q

VSD is also detected by

A

heart murmur

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103
Q

which defect can result in just, right sided heart failure

A

ASD

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104
Q

which defect can result in right or left sided heart failure

A

VSD

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105
Q

When the opening between the pulmonary trunk and the aorta remains open after birth.

A

Patent Ductus Arteriosus

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106
Q

the opening between the pulmonary trunk and aorta is known as

A

the ductus arteriosus

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107
Q

explain pathophysiology of patent ductus arteriosis

A

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)

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108
Q

patent ductus arteriosus can lead to

A

CHF

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109
Q

what is Coarctation of the Aorta

A

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

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110
Q

coarctation of the aorta will present this very clear sx

A

decreased bp in lower ext and decreased femoral pulse

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111
Q

if not treated, coarctation of the aorta will lead to

A

left vent hypertrophy, heart failure

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112
Q

list the 4 abnormalities that occur with tetralogy of fallot

A

both ventricles empty into the aorta
stenosis of the pulmonary artery opening
ventricular septal defect
right ventricular hypertrophy

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113
Q

Why does squatting or bringing knees to the chest acutely decrease cyanosis in tetralogy of fallot

A

Increases systemic vascular resistance causing increase in pulmonary blood flow

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114
Q

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

A

endocardial cushion defect

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115
Q

endocardial cushion defect occurs with what disease

A

downs syndrome

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116
Q

what pathology is this:

Narrowing or constriction that keeps valve from opening

A

valvular stenosis

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117
Q

what causes hypertrophy with stenosis

A

the chamber above or prior to the stenoic area has to work harder = hypertrophy

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118
Q

this pathology often occurs with rheumatic fever, infective endocarditis, arthritis, lupus, and is characterized by incomplete closure of a valve causing leakage

A

Regurgitation or Insufficiency (prolapse)

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119
Q

explain dilated cardiomyopathy

A

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.

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120
Q

bc the ability of the heart to have a normal contraction is compromied with dilated cardiomyopathy, what is the main concern

A

very poor CO = low O2 to the body

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121
Q

3 main causes of dilated cardiomyopathy

A

1) Familial tendency
2) Alcoholic
3) Peripartum

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122
Q

where does the “back up” or the congestion occur with dilated cardiomyopathy

A

pulmonary bc if left vent cant contract there is back up to left atria = back up in pulmonary capillaries

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123
Q

tx for dilated cardiomyopathy includes digitalis glycosides, what does this do

A

Digitalis glycosides – acts like a SNS effect, for same length of muscle you get more tension, you get pos ionotropic effect

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124
Q

prognosis for dilated cardiomyopathy

A

not good- death within 5 years

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125
Q

does the chamber size itself change with hypertropic cardiomyopathy

A

no, just the wall size thickens (or the septum)

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126
Q

hypertrophic cardiomyopathy is caused by what 2 things typically

A

hypertension or valvular heart disease

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127
Q

tx for hypertrophic cardiomyopathy

A

Beta-blockers

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128
Q

this describes what pathology:

Characterized by rigid, noncompliant myocardium (doesn’t really “receive” blood bc it doesn’t stretch)

A

restrictive cardiomyopathy

129
Q

Overall, big picture, if the frank starling mech isn’t working, this leads to

A

CHF

130
Q

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

A

CHF

131
Q

CHF effects which side of the heart

A

can be either

132
Q

left sided heart failure causes a back up where

A

can’t get blood out of left vent, so there will be a back up in lungs

133
Q

diastolic heart failure is because there is an inability to get blood from the ____ causing a back up in the lungs

A

left atria

134
Q

preload and afterload

A

pre load is the area before

afterload is the area after

135
Q

the left vent’s afterload is the ____, so the left vent has to squeeze harder than the ___ to send blood there

A

aorta

136
Q

4 main sx left sided heart failure

A

dyspnea on exertion that ends up dyspnea at rest
fluid accumulation in lungs
frothy pink sputum
S3 heart sound

137
Q

always do what before working with pts with left sided heart failure

A

listen to lungs to know where rales are, and also listen after to compare/document

138
Q

what to keep in mind when working with pts with left sided heart failure

A

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
Q

right sided heart failure presents with the “back up” where

A

the body, periphery

140
Q

explain the basic pathophysiology of right sided heart failure

A

decreased CO leads to baroreceptors recognizing the lack of volume/pressure, kidneys then retain fluid

141
Q

sx of right sided heart failure

A

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
Q

2 types of CHF

A

compensated, decompensated

143
Q

explain compensated CHF

A 
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
Q

explain decompensated CHF

A

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
Q

3 common ways to dx CHF

A

main way is echo, S3 heart sound, elevated BNP

146
Q

for CHF, would you want your pts to take pos or neg ionotripic drugs

A

pos

147
Q

limiting factors for left sided heart failure

A

primarily SOB

148
Q

limiting factors for right sided heart failure

A

SOB and leg pain (periphery)

149
Q

our ex goal for CHF pts is

A

Goal is once daily, 4-6 times per week working to 30 min

150
Q

how to determine what intensity for CHF pts

A

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
Q

what is the recommendation for ex in post infarc CHF pts

A

Evidence for exercise in postinfarction CHF now support use of high intensity interval training

152
Q

its been found that the increased in aerobic capacity for CHF pts are due to _____

A

Increased aerobic capacity due to adaptations affecting the peripheral circulation and skeletal muscle NOT adaptations affecting the cardiac muscle

153
Q

3 main stages of atherosclerosis

A

fatty streak, raised plaque formation, complex plaque

154
Q

fatty streaks begin where (what layer)

A

intima

155
Q

in the raised plaque stage of atherosclerotic formation, where is this seen, and what appearance

A

subendothelial tissue, Appears as a yellowish-gray elevated lump which begins to impede on the arteries

156
Q

explain the complicated plaque stage

A

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
Q

the major component of a plaque forming

A

LDL

158
Q

3 main lifestyle choices leading to atherosclerosis

A

fatty diet, smoking, HTN

159
Q

most common sites for atherosclerosis

A

Tend to occur at bifurcations especially in high velocity areas carotid, iliac arteries, and coronary arteries.

160
Q

in regards to prognosis, what is the most important factor for atherosclerosis

A

how many vessels are 75% or more blocked

161
Q

most common area for blockage (atheroscl)

A

LAD

162
Q

angina is the result of

A

when myocardial O2 demand is greater than the supply

163
Q

RPP =

A

HR x SBP

164
Q

bc RPP is correlated with myocardial O2 demand, ____ is roughly equal to RPP

A

angina

165
Q

6 main ways (descriptor words) pts describe angina

A

Squeezing, burning, aching, pressing, bursting, choking

166
Q

women may experience these non classical sx of angina

A

sensation similar to inhaling cold air; may not have chest pain, but signs/sx of diaphoresis, light-headedness, shortness of breath, n/v

167
Q

for men, the location of angina px is usually

A

behind the sternum

168
Q

for women, the location of angina px is usually

A

pain in left chest area or midthoracic back; aching in right biceps

169
Q

angina px usually follows (radial or ulnar) distrubution

A

ulnar

170
Q

4 things that are classified as angina triggers

A

a. Physical exertion
b. Emotional stress
c. Cold, heat, and humidity
d. Heavy meals

171
Q

angina is usually relieved by

A

rest

172
Q

for women, angina can be relieved with

A

antacids

173
Q

3 types of angina

A

chronic stable, unstable, prinzmetal

174
Q

char of chronic stable angina

A

1) Occurs at predictable physical/ emotional stress level
2) Location, duration, and intensity are consistent
3) Relieved by rest or NTG

175
Q

char of unstable angina

A

Change in anginal threshold or intensity (any change)

Necessitates immediate medical attention

176
Q

char of prinzmetal angina

A

ischemia is due to coronary artery spasm

Occurs at rest, in the early morning hours (often at the same time)

177
Q

MI px lasts how long usually

A

Pain lasts more than 30 minutes and not relieved except with potent analgesics

178
Q

MI sx will vary depending on

A

whether SNS or PSN is more controlling

179
Q

in order to be dx with an MI you have to have what sx/signs

A

2 or more of the following

1) classic signs and symptoms
2) EKG changes
3) Enzyme changes

180
Q

at first, the tissue effected by an MI will appear

A

purple or reddish

181
Q

long term appearance of heart tissue after an MI

A

scar formation

182
Q

what does zone 1 mean in regards to an MI

A

necrosis. Tissue is dead and will ultimately become scar tissue.

183
Q

what does zone 2 mean in regards to an MI

A

injury. Tissue is injured, but still living. Recovery depends upon collateral circulation.

184
Q

what does zone 3 mean in regards to an MI

A

ischemia. This usually heals within 6-8 weeks.

185
Q

First initial problem in nearly 20-25% of patients with CHD is ___

A

sudden cardiac death

186
Q

explain sudden cardiac death

A

Death occurs within one hour of the attack.

Death is due to ventricular fibrillation.

187
Q

how to survive sudden cardiac death

A

defibrilator, get to ER within 10 min

188
Q

what population is sudden cardiac death a real concern

A

athletes - if they have any hx of any form of cardiac issue

189
Q

the PPE that is listed in her notes states any family member who died under what age is a risk (from CV issue)

A

50

190
Q

list some red flags for a sports PPE

A 
Exertional chest pain/discomfort
Exertional syncope/near syncope
Excessive, unexpected, and unexplained SOB
Fatigue associated with exercise
Heart murmur
Increased systemic blood pressure
191
Q

In order to qualify for cardiac rehab, a pt had to have an MI within

A

in past 12 months

192
Q

what kind of angina qualifies for cardiac rehab

A

stable only!

193
Q

these conditions qualify for medicare to cover cardiac rehab

A 
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
Q

contraindication for cardiac rehab is MI or extension of the infarct within the past ___ days

A

2

195
Q

what BP is contraindication for cardiac rehab

A

S over 200

D over 110

196
Q

explain the phases of cardiac rehab

A

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
Q

“In Hospital” Phase: the acute stage

A

phase 1

198
Q

what phase is done in the home

A

phase 1 B (b as in bridge)

199
Q

when does phase 1 begin

A

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
Q

goal during (METS) phase 1

A

1-2 METS

201
Q

who usually progress faster, surgical pts or MI pts

A

surgical

202
Q

list some goals in phase I

A

decrease effects of deconditioning, education, METS at 1-2, prevent pneumonia, monitor pt status for changes

203
Q

what tx is ESSENTIAL for post surgical pts in phase I

A

coughing and breathing interventions/techniques to prevent pneumonia

204
Q

for pts in cardiac rehab, you MUST do what before doing any form of intervention on them in phase I

A

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
Q

all ex (in cardiac rehab) should include these 3 stages

A

pre ex
mid ex
post ex (recovery)

206
Q

Intensity level for phase I if you are using RPE

A

RPE ≤ 13 (6-20 scale)

207
Q

Intensity level for phase I if you are using HR alone

A

HR ≤ 120 bpm OR

208
Q

Intensity level for phase I if you are using RHR + ___

A

RHR + 20 bpm (arbitrary upper limit) for post MI

RHR + 30 bpm (arbitrary upper limit) for post surgical

209
Q

In phase I it is recommended to do intervals of 3-5 min for ____ min

A

20 min total

210
Q

how many METS are needed for most ADLS

A

5

211
Q

Do not go over RPE of ___ in phase 1, if that happens what do you do

A

13, document and call dr

212
Q

What grade of dyspnea and cladication would terminate exercise in phase I

A

3 for both (stay under 3)

213
Q

HR increase of ____ with phase 1 would indicate you to stop ex and call dr

A

an increase over 50 bpm

214
Q

goal is to reach _____ mets at dc of phase I

A

3-5

215
Q

phase II begins when (cardiac rehab)

A

at dc from hospital (should be within 6 months of dc)

216
Q

in phase II of cardiac rehab, ex is ____

A

supervised, but pt status still monitored

217
Q

frequency for phase II of cardiac rehab

A

three times/week (12 weeks or 36 visits)

218
Q

intensity for phase II of cardiac rehab

A

10 beats below angina threshold

219
Q

we want RPE for phase II to be

A

11-13

220
Q

by 3-6 months, our goal for phase II of cardiac rehab is for the pt to achieve _____ kcal / week (burning)

A

By 3-6 months, goal of 1000 kcal/week of caloric output

221
Q

Goal of phase II cardiac rehab (duration)

A

20-30 min of continuous

222
Q

METS goal by end of phase II

A

up to 9 so they can return to work

223
Q

explain phase III of cardiac rehab

A

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
Q

phase II takes place where

A

hospital or satelliete setting

225
Q

which of the phases of the cardiac rehab really focuses on increasing strength and endurance (these are the key components to)

A

phase II, phase I is more getting used to their situation and preventing pneumonia and serious issues

226
Q

what is SLGXT

A

sx limited graded ex test

227
Q

guidelines for resistance ex for post MI and post surgical

A

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
Q

in order to participate in resistance training, pts in cardiac rehab must be able to tolerate ____ METS and be without ___

A

5

angina

229
Q

pts are typically dc from phase II card rehab after

A

6-12 mos

230
Q

what is AOD

A

arterial occlusive disease

231
Q

List the big risk factors for PAD or AOD

A

diabetes, smoking, HTN, high cholesterol, claudication, vascular disease, african american

232
Q

intermittent claudication is a sx of PAD or AOD, explain what is going on with this

A

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”.

233
Q

an occlusion in popliteal artery would cause px where

A

calf

234
Q

an occlusion in femoral artery would cause px where

A

thigh or calf pain

235
Q

an occlusion in Occlusion in aorta or iliac arteries = px where

A

buttocks, thigh, or leg pain, abdominal pain, kidney problems

236
Q

arterial insufficiency yields what color of pts skin

A

pale/blue

237
Q

so overall, px in legs that goes away with rest, or px at night (especially to MT heads) would be a red flag for

A

claudication = arterial insufficiency

238
Q

formula for ABI

A

SBP leg/SBP arm

239
Q

where to measure BP in LE for ABI

A

both posterior tibialis and dorsalis pedis pulses in both right and left legs

240
Q

how to figure ABI

A

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

241
Q

what number (ABI) indicates arterial insufficiency

A

below .90

242
Q

if a person has PAD, BP in LE is ____ than BP in UE

A

less

243
Q

for PAD, ex freq should be

A

1-2 times/day; 7 days/week

244
Q

PVD grading scale goal for PAD pts

A

3 to 4, they will be in px, but we need them at a high intensity

245
Q

grade O for PVD scale is

A

no px

246
Q

grade 1 for PVD scale is what

A

Definite discomfort or pain, but only of initial or modest levels (established, but minimal)

247
Q

grade 2 for PVD scale is what

A

moderate discomfort, you can divert pt

248
Q

grade 3 on PVD scale is what

A

intense px, pt cannot be diverted

249
Q

grade 4 on PVD scale is what

A

excrutiating/unbearable

250
Q

parameters of ex for PAD pts

A

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)

251
Q

a pt reporting a “throbbing” px in the calf and skin is pallor should be thought as

A

an acute arterial thrombus

252
Q

those at risk for chronic venous sx

A

Obese; pregnant; job requiring prolonged standing or sitting; prolonged bedrest; CHF; thrombophlebitis; varicose veins; insult to veins

253
Q

Sharp”, intense, localized px. deep muscle feels tender to palpate, skin is red and swollen, you should suspect

A

acute venous thrombus

254
Q

Third most common cardiovascular disease after CAD and stroke

A

DVT

255
Q

diff dx for dvt

A 
A.	Muscle hematoma
B.	Muscle tear
C.	Muscle cramp
D.	Sciatica
E.	Phlebitis
F.	Cellulitis
256
Q

at risk for DVT

A

cancer, 55-60 yrs of age, pmh of thrombus, oral contraception, pregnancy, immobility

257
Q

These are all ways to help prevent _______

Leg exercises such as ankle pumps
Ambulations as soon as possible
Hydration
Correct use of compression stockings

A

DVT

258
Q

according the Wells DVT score, what is considered a risk or no risk

A

DVT unlikely ≤ 1 point

DVT likely ≥ 2 points

259
Q

Pauda DVT score is high risk at what number

A

at or above 4

260
Q

what ages and extra criteria puts one at risk for PAD

A

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

261
Q

smoking increases ones chance of getting PAD by

A

4 times

262
Q

adults usually get heart transplants for what diseases

A

severe coronary artery disease and end-stage cardiomyopathy/heart failure

263
Q

children get heart transplants for what disease/pathology

A

cardiomyopathy

264
Q

babies typically get heart transplants for what pathologies

A

congenital

265
Q

Typically, what are the 4 main reasons why pts get lung transplants

A

COPD, idiopathic pulmonary fibrosis, cystic fibrosis, pulmonary arterial hypertension

266
Q

typically for transplants, pts are under age of

A

65

267
Q

other criteria for transplant

A

Expected life span of less than 1 year
Nonsmoker
Adequate social support
Other systems disease free

268
Q

goals for pre transplant pts

A

prevent loss of ROM, for lung transplants emphasize chest wall ROM (diaphragmatic breathing)

269
Q

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

A

heterotopic

270
Q

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

A

orthotopic

271
Q

what is a huge consideration with heart transplant

A

Heart is denervated – so the autonaumic NS no longer connects with the heart

They also need longer warm up and cool down

272
Q

in an orthotopic transplant, what articulates

A

old vena cava and old SA node with new SA node

273
Q

physiological effects of heart transplant

A

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

274
Q

eventhough the auto. NS no longer connects with heart, the heart rate will still increase with ex, why and how

A

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.

275
Q

why is there an increased CO with heart transplant pts

A

Increase in cardiac output

Initial increase is achieved by increase in stroke volume for submaximal exercise

276
Q

factors effecting whether there is “re innervation” with a heart transplant

A

if the donor was young, or amt of time (more time with the donor heart = more chance for new innervation)

277
Q

As PT’s one issue we will battle with transplants pts during our rehab is

A

they are really deconditioned, we need to work on ADLs at first

278
Q

how to rate intensity with transplant pts

A

RPE (due to slowed HR response to ex)

279
Q

Other than RPE , whats another way to rate effects of ex on transplant pts

A

use systolic BP (not HR)

280
Q

for transplant pts, rehab, RPE should be (acute phase)

A

10 or less

281
Q

HR should be less than _____ and not greater than ___ bpm over resting for transplant rehab (acute phase)

A

120 bpm

HR not greater than 20 bpm above resting

282
Q

transplant rejection usually occurs within the first ___ months

A

6

283
Q

what is often the first sign of transplant rejection

A

ex intolerance

284
Q

signs/sx of transplant rejection (heart)

A

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
285
Q

signs sx of lung transplant rejection

A

SOB, desaturation at rest

286
Q

explain basics of beginning progression of transplant tx (acute phase for heart and lung)

A

Begins with active/passive ROM in bed progressing to walking up flight of stairs and 500 feet

287
Q

parameters of acute phase of transplantation rehab

A 
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
288
Q

after the acute phase of transplantation rehab, there is outpatient rehab, what are the parameters (RPE, freq, duration)

A
  1. RPE 11-15
  2. Frequency: 4-6 days/week
  3. Time: progress from 15 to 60 min/session
289
Q

peribronchial cuffing occurs with a specific pathology, what pathology and what is it

A

CF, edema or fluid has left the capillaries

290
Q

type of emphysema that destroys alveoli

A

panlobular

291
Q

type of emphysema that destroys bronchioles

A

centrilobular

292
Q

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

A

bullae

293
Q

which is primarily the disease associated with increased WOB (restrictive lung dis. or obst. lung diseae)

A

restrictive- getting air in

294
Q

PTs are able to help pts with bacterial or viral pneumonia more

A

bacterial

295
Q

according to her chart, what do you do if you suspect angina

A

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

296
Q

for persons with DVT or venous insufficiency, what is more comfortable position

A

elevate legs

297
Q

for pts with arterial insufficiency, its more comfortable to

A

let legs dangle to get blood flow

298
Q

questions to ask if pt is having any px above the waist

A

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?

299
Q

with pts who have had a cut sternum dt cardiac surgery, they are most comfortable with what type of mvmt

A

bilateral

300
Q

what sx would be of great concern for a pt on sternal precautions

A

clicking or clunking or unstable feeling

301
Q

it is probably not angina if what 3 things can reproduce sx

A

deep breath, palpation, ROM change (if these cause sx then it’s probably not angina)

302
Q

hypokineses (as a result of an MI) would be located where and what type of MI

A

subendocardial - partial

303
Q

akinesis (as a result of an MI) would be located where and what type of MI

A

transmural - full

304
Q

COPD encompasses what diagnosis’s

A

emphysema, asthma, chronic bronchitis, bronchiectasis

305
Q

of the dx that come with COPD, which is the only one that is usally relieved by bronchodilators

A

asthma

306
Q

of the dx’s that come with COPD, which (in addition to decreased FEV) ONE will also increase lung volume (increasing RV and TLC)

A

emphysema (barrel chest)

307
Q

diffuse hypoxia pulmonary disease, can cause right sided heart failure

A

cor pulmonale

308
Q

with bronchiectasis, we know there is an issue with permanent dilation of the bronchioles. what happens to the tissue

A

it becomes fibrotic, and the body responds by creating lots of mucus in that area

309
Q

With emphysema, there is a(n) _____ in compliance and a(n) ______ in elastic recoil

A

increase

decrease

310
Q

2 pathologies that create perm enlargement of airways

A

emphysema, bronchiecatasis

311
Q

main tx for bronchiectasis

A

antibiotics

312
Q

unique sx of chronic bronchitis is an increase in ____

A

RBC -polycythemia

313
Q

emphysema pts would yield what kind of resonance during assessment

A

hyper resonance = dt increased compliance

314
Q

which type of pneumonia causes an increase in WBC

A

bacterial only

315
Q

When there are congenital defects that create a left to right shunt (patent ductus arteriosis and VSD) this decreases what

A

CO

316
Q

In regards to the 3 main COPD obstructive diseases, which have an increase in volume and which dont

A

They all have decreased FEV, but emphysema also has an increase in lung volume (TLC and RV), bronchitis and asthma do not

317
Q

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

A

BOOP

318
Q

ARDS damages what

A

alveoli and capillaries

Cardio Jean (4 decks)

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