Final Exam (wk 5-8) Flashcards
What 4 conditions can an xray be used for?
-cardiomegaly
-CHF
-valve dysfxn
-differential dx of pulm conditions
What is echocardiography?
non-invasive procedure using high frequency US waves
What is doppler imaging used for?
to see BF direction and velocity
What do CTs show?
series of thin xrays to generate cross sectional images of heart and pulm vasculature
Does CT require that xray doesn’t in order to see specific structures?
IV contrast agent; distinguishes blood and tissue
What can a CT pulmonary angiography detect?
thrombus
What are 3 benefits of CT pulm angiography?
-rapid reporting
-high sensitivity/specificity
-widely available
What are 2 limitations of CT?
-artifact from pt moving/breathing
-radiation
Describe what an MRI does
-uses magnetic field to obtain images of internal structures
-requires no radiation
What is positron emission tomography?
nuclear technique that provides visualization and direct measurement of metabolic functioning
What is positron emission tomography the gold standard for?
BF measurement
Advantage and disadvantage of positron emission tomography
-advantage: can detect viable myocardium w/o ex
-disadvantage: costly
How does nuclear imaging work?
uses injected radioactive tracers to evaluate heart fxn
What does a duplex US do?
-records sound waves reflecting off objects to measure the qualities of flow
-determines if plaque is blocking artery flow
What does a carotid duplex do?
-evals neck arteries
-most accurate test to determine carotid artery disease
What is MRA? Purpose?
-magnetic resonance angiography
-detect PAD
2 advantages of MRA
-lack of radiation
-removal of background structures
What are the 4 ABI ranges?
> 1.1 - no symps
0.5-1.0 - claudication
0.2-0.5 - critical limb ischemia
< 0.2 - severe ischemia
What is arteriography? 3 SE?
-invasive dx test; contrast angiography; pic of blood vessels
SE: sensitive rxn, hemorrhage/hematoma
-thrombosis
What is contrast echocardiography? Purpose?
-uses IV contrast with echocardiogram
-assesses myocardial perfusion and ventricular chambers
What happens during trans-esophageal echogardiography?
-sedation, catheter into esophagus
Purpose of trans-esophageal echocardiography
-rule in/out bacterial endocarditis, aortic dissection, valve regurgitation, L atrial thrombus, septal defect
What is intravascular US?
tiny US on catheter inserted into artery to see interior artery walls
What is the purpose of R side cardiac catheterization?
evaluates R heart pressures
What is the purpose of L side catheterization? Where does catheter travel through?
-evaluates aorta
-common femoral artery or radial artery
6 indications for cardiac catheterization
-aortic dissection
-atypical angina
-cardiomyopathy
-congenital disease
-CAD
-s/p MI
-valve disease
Name 4 different angioplasty and briefly describe
-stent: supports arterial wall
-balloon angiography: tiny balloon pushes thrombus/thingy against arterial wall; percutaneous coronary intervention
-rotoblader: grinds up calcified blockage
-atherectomy: small vacuum that removes part/all blockage
What is percutaneous transluminal coronary angioplasty (PTCA)
-balloon and stent inserted into diseased artery
-balloon inflated, stent expands
-balloon taken out and stent left in to widen artery
What is an endarterectomy? Goal?
-surgical procedure to open/clear carotid artery
-goal: reducing stroke risk
What is ICU acquired weakness?
acute onset of NM and fxnal impairment in critically ill
3 dx criteria for ICU acquired weakness (ICUAW)
-generalized weakness developing after onset of critical illness
-diffuse weakness; spares CN nerves
-dependence on ventilation
2 S/S of critical illness polymyopathy
-loss of DTRs and diminished sensory and pinprick sensation
-loss of motor and sensory action potentials on
What are 3 factors of critical illness myopathy?
-proximal limb and respiratory mus weakness
-difficulty weaning off vent
-loss of motor action potentials but sensory ok
What are 4 main factors of post intensive care syndrome (PICS)?
-impaired cognition; similar to mild dementia
-psychiatric: depression, anxiety, PTSD
-physical fxn: ICUAW, vent > 7 days
3 big PT implications of ICUAW and PICS
-wean from vent
-reduce sedation
-EARLY rehab/mob
Target SaO2 range for norm adult
92-98%
Target SaO2 for COPD
88-92%
Oxygen delivery systems
-nasal cannula
-open face tents
-closed face mask
-trach collar
-non rebreather masks
-venturi masks/air entrainment masks
-CPAP/biPAP
What are 2 disadvantages of closed face mask for O2?
-interferes w/ coughing, eating, drinking
-not comfy so pt takes off often
One big disadvantage of non-rebreather masks
risk of suffocation - bag must always be partially inflated, pt can’t be left alone
What is the main purpose of CPAP/biPAP? 2 advantages
-“back pressure” keeps airways and alveoli open
-reduce work of breathing and demand on cardiac system
What are things to be aware of with brachial, radial, and femoral artery a-lines?
-brachial and radial: arm board, length of line limits mobility, avoid wrist and elbow flex
-femoral: avoid hip flex >60-80 degrees
What are 3 purposes of a-lines?
records mean arterial pressure (MAP), delivers meds, repeated blood samples
Where should a transducer be kept?
phlebostatic axis: intersection of midaxillary line and 4th intercostal space
What happens if transducer is too high or low?
-too low, BP reads high
-too high, BP reads low
Where is a central venous catheter placed? Another name?
-internal jugular, femoral, subclavian veins into R atrium via vena cava
-Hickman catheter
What are 3 important things to keep in mind with central venous catheter?
-no BP on arm with catheter in
-keep transducer at phlebostatic line
-ensure tape over insertion intact
What does a pulmonary artery catheter do? Who are they for?
-gold standard
-extensive cardiac monitoring; pulm arterial pressure, R atrial pressure
-very sick pts
Important thing to keep in mind if pt has pulm artery catheter
cautious with mob; don’t dislodge or kink catheter
What is a peripherally inserted central catheter (PICC line)?
long catheter inserted into peripheral vein and to vena cava
Two things to look out for with PICC line
-no BP monitoring on arm with PICC line
-ensure tape is secure over PICC line
What does an interaortic balloon pump do?
-inflates during diastole
-deflates during systole
Where are chest tubes most commonly placed?
4-6 intercostal space
What is one important thing to keep in mind with chest tube?
keep drainage reservoir below the lvl of insertion site and below the suction system
Wound VAC purpose
-promotes healing by preparing wound bed closure
Jackson Pruitt drain (JP drain) purpose
removes excess fluid from beneath post-surg incision
3 important factors for PTs to know with JP drains
-secure tubing to pt’s clothing/gown or abdominal binder
-ensure tubing doesn’t dislodge
-bulb stays compressed to create gentle suction
3 important things to be aware of with intercranial pressure monitoring/external ventricular drain
-do not adjust stopcock
-head of bed no lower than 30 degrees
-must have drain “clamped” before changing the pt position
What are two important things to keep in mind for PEG or NG tubes
-when tube feedings are running, maintain head of bed at >30 degrees if in supine
-do not dislodge tube
5 wire EKG leads
-white (under R clavicle)
-brown (R chest)
-green (lower R abdomen)
-black (L under clavicle)
-red (L lower abdomen)
How many phases are in the cycle for action potential in an EKG?
5; phase 0-4
Describe the phases of the action potential in cardiac cells (EKG)
Phase 0 - depolarization and rapid entry of Na
Phase 1 - early depolarization, K+ slowly enters
Phase 2 - plateau continues and slower entry of Ca2+
Phase 3 - K+ moves out of the cell
Phase 4 - resting phase
How many small squares makes 6 seconds for EKG strip
30
How many seconds does a sm and lg square represent
Small square: 0.04 sec
Lg square: 0.2 sec
5 sm squares = 1 lg
Where are leads VI-II placed for EKG?
Near sternal border
Where is lead V3 placed for EKG?
Midway between V2 and V4
Where is lead V4 placed for EKG?
5th intercostal space, L midclavicular line
Where is lead V5 placed for EKG?
L anterior axillary line at V4 level
Where is lead V6 for EKG placed?
L mid axillary line at V4/5 level
How to quantify 6 sec tracing (1 min HR) for EKG
Count QRS complexes in 6 sec interval and multiply by 10
What is the normal PR-interval for EKG?
3-5 sm squares or 0.12-0.2 seconds
What is the normal QRS complex interval for EKG?
0.06-0.1 seconds (1.5-3 sm boxes)
What is an abnormal QRS complex interval in EKG?
> 0.12 seconds
Causes of premature atrial contractions (PACs)
-HTN, caffeine
-pregnancy
-COPD, asthma
-metabolic
-stress, extreme fatigue
-
Next step if pt has a premature atrial contraction (PAC)
Reduce intensity, monitor vitals, report to team
Symptoms of premature atrial contraction (PAC)
-skipped beat
-fatigue or SOB
-ex intolerance
-chest pain
Causes of atrial tachycardia
-HTN and cardiomyopathy
-previous MI
-excessive alc/drug use
-“irritable focus”
-sometimes idiopathic
Symps of atrial tachycardia
-palpitations
-fainting
-chest pain
-SOB
-fatigue
-ex intolerance
Next steps if pt has atrial tachycardia
Reduce intensity, monitor vitals, alert team
Symps of a fib and a flutter
-tachycardia
-SOB
-dizziness
-syncope
-fatigue
-ex intolerance
-chest pain/anxiety
-night sweats or waking w/ palpitations
Next step if pt has a-fib or a-flutter
new onset or worsening, stop activity, call team, monitor pt
What is the difference between a-flutter and a-fib
A-flutter — regular tachycardia
A-fib — quivers, irregular tachycardia and reduced atrial kick
Causes of premature ventricular complex (PVC)
-excessive caffeine
-hyperthyroidism
-excessive alc/tobacco
-STIMULANTS (rx and non-rx)
-anemia
-most have no etiology
Symps of PVCs
-asymptomatic
-lightheaded, chest pain/discomfort
-syncope rare
-dyspnea
Next steps if pt has PVC
-1 or 2, monitor and keep going
-increasing in frequency, reduce intensity
-RUNS IN 3, LET THEM BE
V-tach causes
-low CO, systemic hypoperfusion, syncope and potential death
V-tach symps
-syncope
-SOB d/t pulm edema
-cardiac arrest
Next steps if pt has v-tach
RAPID RESPONSE or possible CODE
Causes of v-fib
-MI
-electrolyte imbalance
-syncope, significant SOB
Next steps if pt has v-fib
Call a code and start CPR
What would show ischemia on an EKG
Inverted T wave
What is the normal range for pH (ABG)?
7.35-7.45
What are the abnormal pH values for ABGs?
< 7.35 indicates ACIDOSIS
> 7.45 indicates ALKALOSIS
What is the normal range for PaCO2 (respiratory system) ABGs
35-45
What are the abnormal PaCO2 values for ABGs
< 35 indicates ALKALOSIS
> 45 indicates ACIDOSIS
Normal range for HCO3 (metabolic system) ABGs
22-26
Abnormal HCO3 values for ABGs
< 22 indicates ACIDOSIS
> 26 indicates ALKALOSIS
