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Intro to PT > Intro to PT chapter 11 > Flashcards

Intro to PT chapter 11 Flashcards

1
Q

CVD

A

Number one cause of death\
647,000 deaths in US 2017

351 billion in costs

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2
Q

of more than 2.7 million people
who died in 2017

A

24% died of CVD

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3
Q

Estimated direct and indirect costs for 2014 & 2015 CVD

A

$350 billion for American adults

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4
Q

AHA statement

A

40.5% of population is projected to have CVD by 2030.

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5
Q

Direct medical costs of CVD

A

tripple by 2030

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6
Q

Indirect costs of CVD

A

60% increase by 2030.

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7
Q

US Adults with hypertension

A

46%

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8
Q

Percent of highschool smokers

A

15%

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9
Q

Coronary Heart Disease CHD

A

48% of all CVD deaths -

most common cause of death for CVD

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10
Q

Myocardial Infaction, MI

A

790,000 a year US.

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11
Q

Percutaneous Coronary Interventions per year

A

480,000

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12
Q

coronary artery bypass per year

A

371,000

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13
Q

Pacemakers per year

A

411,000

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14
Q

COPD

A

16 million people in US
4th leading cause of death.

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15
Q

COPD gender

A

Women twice as likely as men

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16
Q

COPD race

A

greatest prevelence in non-hispanic black or african american individuals

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17
Q

Anual cost of COPD

A

49 billion by 2020 – 32 billion in 2010

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18
Q

Pericardial sac

A

Fibbrous tissue that surrounds the heart.

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19
Q

Myocardium

A

Muscle tissue of the heart, cross striated with layers of muscle fibers arranged in multiple directions.

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20
Q

Superior and inferior vena cava

A

Right atrium recieves blood from here

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21
Q

Right ventricle

A

recieves blood from right atrium through tricuspid valve

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22
Q

Right Ventrical sends blood too

A

left and right pulminary arteries for oxigination. Must go through the pulminary valve ( right semilunar valve).

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23
Q

oxiginated bloods returns through pulminary veins.

A

And into left atrium.

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24
Q

From left atrium

A

blood flows through the mitral valve into the left ventrical

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25
Q

From the left ventrical

A

blood flows out the aortic vlave into the aorta and distributed throughout the body.

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26
Q

Nodal or Purkinje fibers

A

special types of tissue responsible for conducting the electrical impulses and sychronizing the heartbeat.

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27
Q

Sinoatrial (SA node)

A

Initiates the impulse (sinus rythm) - pacemaker

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28
Q

Atriventricular (AV) node

A

Transports this signal to bundle of His.

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29
Q

Bundle of His

A

where Purkinje fibers start to spread out into muscle fibers.

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30
Q

Two major arteries supplying blood to myocardium

A

left and right coronary arteries.

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31
Q

A blockage in a coronary artery

A

myocardial infarction

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32
Q

Arterioles another name

A

Resistence vessels

elasticity and smooth muscles can change diameter and resistence.

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33
Q

Arteriosclerosis

A

“hardening of the arteries” thick and stiff walls. Higher resistence to blood flow.

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34
Q

Capillaries

A

one cell thick “exchange vessels” Nutrients and wastes exchange here.

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35
Q

Viens hold a significant percentage of our blood supply
larger viens are called

A

capacitance vessels.

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36
Q

Respiration

A

exchange of oxygen and carbon dioxide between the air we breath and blood cells passing through lungs.

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37
Q

Ventilation

A

process of exchanging air between the atmosphere and the lungs through inspiration and expiration.

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38
Q

inspiration

A

diaphram contracts. - lungs expand

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39
Q

expiration

A

diaphram relaxes.
- lung volume decreases expelling air.

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40
Q

Nose, pharynx and larynx

A

Upper conducting airways. Cleans and humidifies air.
Terminates at begining of trachea.

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41
Q

Trachea and bronchiole system

A

System of tubes starting with trachea and branching out left and right with the bronchiole system into a many fine tubes.

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42
Q

end of conduction system

A

Alveoli - small sacks where oxygen and carbon dioxide are exchanged.

Alveolar ducts- the part right before the sac, can also have exchange

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43
Q

Pleura

A

membrane surround lungs.

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44
Q

Ischemia

A

inadequate oxygenation of tissues that occurs due to insufficient blood flow as a result of a blocked blood vessel.

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45
Q

Coronary Heart Desease

A

another word for arteriosclerosis

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46
Q

Angina

A

chest pain occurs from ischemia of the heart muscle.

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47
Q

Risk factors for CHD

A
  • age
  • family history
  • cigarette smoking
  • sedentary lifestyle
  • obesity
  • hypertension
  • elevated cholesterol (LDL, total - HDL is fine)
  • prediabetes.

HDL is a negative risk factor.

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48
Q

Heart failure

A

disease process or congenital defect causes a decrease in the pumping capability of the heart. Accute or gradual.

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49
Q

MI

A

accute change to pumping capability of heart

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50
Q

MI cause

A

embolus blocking a coronary artery

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51
Q

major complication of MI

A

abnormal heart rythm.
(abnormal conduction)-
inneficient heart contraction.

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52
Q

Congestive Heart Failure (CHF)

A

**Right ventricle isn’t contracting efficiently. **
* Blood volume backs up into venous system.
* fluid collects in abdomen liver and legs.
* abnormal amount of blood in lungs.
* Fluid collects in lungs.
* Even harder to push blood through lungs. so RV has to work harder.
* Blood doesn’t oxygenate as well.

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53
Q

Obstructive lung disease

A

pathologic changes lung cause abnormality in airflow through the bronchial tubes

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54
Q

restrictive lung disease

A

pathologic changes cause the volume of air in lungs to be reduced.

55
Q

Common lung diseases cause both

A

obstructive and restrictive lung disease

56
Q

dyspnea

A

shortness of breath.

57
Q

COPD

A

chronic productive cough, excessive mucuus, changes in sound produced when air passes through bronchial tubes - dyspnea

58
Q

In COPD

chronic bronchitis

A

inflamation of the bronchial tubes.

59
Q

in COPD

emphysema

A

trapping of air in the alveoli

60
Q

In COPD

peripheral airway disease

A

collapse of terminal bronchioles

61
Q

In COPD

bronchial asthma

A

smasm like contraction of bronchi, resulting in trapped air.

62
Q

In COPD

Cystic Fibrosis

A

disfunction of mucus glands causing blockage of bronchi

63
Q

In COPD

decrease lumen size and alveolar destruction

A

causes air trapped in lungs. - overinflation - decreased air exchange.

64
Q

IN COPD

Trapped air also causes

A

increase in size of thorax and difficulty for breathing muscles to work

65
Q

In COPD

hypoxemia

A

changes in heart, blood pressure and thickness of blood leading to respiratory failure.

66
Q

Causes of restrictive lung disease

A
  • coal dust
  • , silicon
  • , asbestos,
  • pneumonia,
  • cancer of lung,
  • and changes in heart function**
67
Q

diseases of nerve supply or trauma to nerve supply to the muscles of ventilation

A

can cause restrictive lung disease

68
Q

S/S restrictive lung disease

A
  • shortness of breath
  • cronic cough - non productive
  • tachypnea - increased rate of breath
  • weight loss
  • hypoxemia
69
Q

cardiac catheterization

A

passing a catheter into artery of leg until it reaches the heart… coronary arteries or pulmonary veins.
Pressure measure tip.
Dye can be released for an imaging technique to demonstrate where blockages are.
small camera

70
Q

Echocardiography

A

use of high frequency sound to assess the size of the heart chambers, the thickness of the chamber walls, and the bumping ability and motion of the chamber walls and heart valves.

71
Q

transesophageal echocardiography

A

transducer is placed in esophagus.

72
Q

electrocardiogram

A

non invasive evaluation of heart function

73
Q

electrocardiogram

P-wave:

A

Represents atrial depolarization, which is the electrical activity that initiates atrial contraction (systole). During this phase, blood is pushed from the atria into the ventricles.

74
Q

electrocardiogram

P-R Interval:

A

Encompasses the time from the start of atrial depolarization to the start of ventricular depolarization. It reflects the time taken for the electrical impulse to travel from the atria through the AV node, where there is a slight delay, allowing the ventricles to fill with blood before they contract.

75
Q

electrocardiogram

QRS Complex:

A

Represents ventricular depolarization, which triggers the contraction of the ventricles (ventricular systole). This contraction pumps blood out of the heart—into the pulmonary artery from the right ventricle and into the aorta from the left ventricle.

76
Q

electrocardiogram

ST Segment:

A

Represents the period between ventricular depolarization and repolarization. It’s a short phase where the ventricles are still contracting but no further electrical activity is occurring. It is part of the plateau phase in the action potential, keeping the ventricles contracted.

77
Q

electrocardiogram

T-wave:

A

Represents ventricular repolarization, or the recovery phase, where the ventricles relax (diastole). This allows the ventricles to start filling with blood again in preparation for the next cycle.

78
Q

electrocardiogram

Q-T Interval:

A

Encompasses the entire period of ventricular depolarization and repolarization, essentially covering the start of ventricular contraction to the completion of ventricular relaxation.

79
Q

Exercise stress testing

A
  • noninvasive method of determining how the cariovascular and pulmonary systems respond to controlled increases in activity.
  • common to diagnose suspected or established CVD.
  • Performance after MI, coronary bipass, or heart valve replacement
80
Q

Other uses for Exercise stress testing

A
  • assess someone’s functional status,
  • evaluate the effectiveness of treatment,
  • to help prescribe limitations for occupational activities.
  • can be used to guide an exercise program
81
Q

Methods of exercise stress test

A

walking on a treadmill
riding a bicycle ergometer.
includes:
* continous EEG
* Heart rate monitorinig
* blood pressure monitoring
* feedback from pt reporting symptoms

may include analysis of expired gasses from lungs.

82
Q

Bruce Treadmill Protocol for exercise Stress test.

A

Stage Time (min) Speed (mph) Grade (%)
1 0 - 3 1.7 10
2 3 - 6 2.5 12
3 6 - 9 3.4 14
4 9 - 12 4.2 16
5 12 - 15 5.0 18
6 15 - 18 5.5 20
7 18 - 21 6.0 22

83
Q

Radiographs

A

x-ray of chest

84
Q

computed tomography

A

CT - x-rays are used to take pictures of small slices of the chest and lungs

85
Q

magnetic resonance imaging (MRI)

A

pictures of small slices of chest and lungs by displacing hyrdrogen atoms with magnetic rays.

86
Q

Ventilation-perfusion scan (V/Q ratio)

A

inhale radioactive isotopes.

87
Q

CT pulmonary angiography (CTPA)

A

radiocontrast agent injection - ct image of pulmonary arteries.

88
Q

Bronchoscopy

A

flexible fiber-optic tube placed in bronchial trree to perrit visualization of the structure and suctioning of any accumulated secretions.

89
Q

Pulmonary Function test

A

Use a spirometer to measure volume and airflow rates
tidal volume and other measures.

90
Q

Spirometer

A

measures the various volumes and airflow rates

  • Tidal Volume (TV): The amount of air inhaled or exhaled in a normal breath at rest.
  • Inspiratory Reserve Volume (IRV): The additional amount of air that can be inhaled after a normal inhalation.
  • Expiratory Reserve Volume (ERV): The additional amount of air that can be exhaled after a normal exhalation.
  • Residual Volume (RV): The amount of air remaining in the lungs after a maximal exhalation (cannot be measured directly by spirometry but is often estimated).
  • Vital Capacity (VC): The total amount of air that can be exhaled after a maximal inhalation, calculated as TV + IRV + ERV.
  • Inspiratory Capacity (IC): The maximum amount of air that can be inhaled after a normal exhalation, calculated as TV + IRV.
  • Functional Residual Capacity (FRC): The amount of air remaining in the lungs after a normal exhalation, calculated as ERV + RV.
  • Total Lung Capacity (TLC): The maximum amount of air the lungs can hold, calculated as TV + IRV + ERV + RV.

From A&P flashcards.

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91
Q

Blood Gas Analysis

A

assessing arterial blood to deterrine the concentration of oxygen and carbon dioxide.

92
Q

major way to treat heart and lung disease

A

pharmacologic management.

93
Q

drugs

For cardiac conditions

A

drugs are used to alter rate,
rhythm, or strength of contraction or improve blood
flow.

94
Q

drugs

For pulmonary conditions

A

drugs are used to
promote bronchodilation and decrease inflammation.

95
Q

PT completes detailed evaluation

A

 Assesses signs, symptoms, or syndromes resulting from the pathologic condition

 Develops a prognosis estimating maximum level of improvement the patient will experience

 Develops plan of care

 Develops goals to enhance movement and function

 Estimates frequency and duration of treatment

 Develops criteria for discharge

96
Q

Surgical management: cardiac conditions

Percutaneous coronary interventions (PCI)

A
  • Insert tube into coronary artery and dilate the artery by inflating a balloon (inserted through artery in leg most often.)
  • May insert a stent to maintain the opening
97
Q

Surgical management: cardiac conditions

percutaneous transluminal coronary angioplasty

A

name for PCI with balloon.

98
Q

Surgical management: cardiac conditions

coronary laser angioplasty

A

name for PCI with laser to destroy plaque.

99
Q

Surgical management: cardiac conditions

Coronary artery bypass graft (CABG)

A

surgically opening chest wall and grafting a small artery or leg vein between the aorta nd a point beyond the blockage or plaque.

100
Q

Surgical management: cardiac conditions

Valve replacement

A

can invove repair or complete replacement.

101
Q

Surgical management: cardiac conditions

cardiac pacemaker

A

electronic device that produces a pulse to control heart depolarization. Replaces function of SA node.

-careful monitoring of pt in exercise at maximum intensity is manditory for PT-PTA

102
Q

Surgical management: cardiac conditions

Heart transplant

A

Only in end-stage disease

103
Q

Surgical management: pulmonary conditions

A

 Resection of entire of part of lung
used for tumors or treatment of fungal infections

 Lung transplantation
performed for end stage lung disease.

104
Q

atelectasis

A

collapse of alveoli

105
Q

Functional classifications of patients with heart disease & HF

Class I

functional classification

A

patients with cardiac disease but without resulting limitations of physical activity

Ordinary physical capacity does not cause undue fatigue, palpitation, dyspnea or anginal pain.

106
Q

Functional classifications of patients with heart disease & HF

Class II

functional classification

A

Patients with cardiac disease resulting in slight limitation of physical activity

patients are comfortable at rest

ordinary physical activity results in fatiqgue, palpitation, dyspnea or pain.

107
Q

Functional classifications of patients with heart disease & HF

Class III

functional classification

A

Pts with cardiac disease resulting in marked limitation of physical activity

Pts are comfortable at rest

Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain.

108
Q

Functional classifications of patients with heart disease & HF

Class IV

functional classification

A

Patients with cardiac disease resulting in an inability to cary out any physical activity without discomfort

Smptoms of cardiac insufficiency or anginal syndrome may be present even at rest

If any physical activity is undertaken, discomfort is increased.

109
Q

Functional classifications of patients with heart disease & HF

Stage A

stages of HF

A

Pts at high risk of developing HF because of conditions that are strongly associated with the development of HF

Such pts have no identified structural or functional abnormalities of the pericardium, myocardium, or cardiac valves, and have never shown signs or symptoms of HF

110
Q

Functional classifications of patients with heart disease & HF

Stage B

stages of HF

A

Patients who have developed structural heart disease that is strongly associated with the development of HF but who have never shown signs or symptoms of HF

111
Q

Functional classifications of patients with heart disease & HF

Stage C

stages of HF

A

Pts who have current or prior symptoms of HF associated with underlyinjg structural heart disease.

112
Q

unctional classifications of patients with heart disease & HF

Stage D

stages of HF

A

Pts. with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions.

113
Q

FITT principle

A

Frequency, Intensity, time and Type of exercise

    • Inpatient rehabilitation recommendations follow this.
  • pt involved in education activities-risk factor modification - understading of the medications prescribed, and discharge planning.
114
Q

FITT recomendations for cardiac Rehab

Aerobic Frequency

A

Mobilization 2-4 times per day for the first 3 days.

115
Q

FITT recomendations for cardiac Rehab

Aerobic Intensity

A
  • Seated or standing resting HR +20 bpm for pts with an MI.
  • resting HR+30 for pts with heart surgury - upper limit <120 bpm exertion <13 on scale of 6 to 20.
116
Q

FITT recomendations for cardiac Rehab

Aerobic Time

A

3-5 min as tolerated.; progressivly increasing durration.
rest period may be slower walk or complete rest
attempt 2:1 exercise to rest ratio
progress to 10-15 min of continous walking.

117
Q

FITT recomendations for cardiac Rehab

Aerobic Type

A

Walking. Other modes are useful… treadmil, cycle

118
Q

FITT recomendations for cardiac Rehab

Flexibility - frequency

A

Minimally once per day but as often as tolerated

119
Q

FITT recomendations for cardiac Rehab

flexibility - Intensity

A

Very mild stretch discomfort

120
Q

FITT recomendations for cardiac Rehab

flexibility time

A

All major joints with at least 30s per joint.

121
Q

FITT recomendations for cardiac Rehab

Flexibility Type

A

Focus on ROM and dynamic movement

Pay particular attention to lower back and posterior thigh regions. Bedbound pts may benifit from passive stretching.

122
Q

Cardiac Rehab divided into four phases

A

phase I - IV

123
Q

Cardiac Rehab

phase 1

A

acute - inpatient phase.

124
Q

Cardiac Rehab

Phase II

A

subacute - begining of outpatient phase - close physician management is always available

supervised training sessions 3-4 times a week for 10 to 12 weeks.

125
Q

Cardiac Rehab

Phase III and Phase IV

A

Intensive rehabilitation - Ongoing rehabilitation

More independen and agressive activities.

Individual must be able to self monitor.

126
Q

quantifying exercise

A

HR reserve
ratings of percieved exertion (RPE)
Percentage of age-predicted heart rate
percentage of oxygen uptake
Metabolic equivalents (METs)

127
Q

Target heart rate

A

([HRmax-HR rest] * intensity desired) +HR rest

128
Q

PT and PTA must monitor

A

vital signs and
cardiovascular response to exercise

129
Q

training zone

A

minimum and maximum hrs that must be achieved to produce an aerobic training effect.

130
Q

Pulmonary Rehab

postural drainage for mucus removal

A
131
Q

Pulmonary Rehab

Percussion

A

promotes movement of mucus through the bronchial tubes - trendelenburg right after and cough.

132
Q

Pulmonary Rehab

cough - breathing exercies

A
  • strengthening both primary and secondary muscles of ventilation
  • changing the breathing patern
  • use diffeerent devices to support the chest wall so that the expiration force generated during coughing is enhanced.
133
Q

Pulmonary Rehab

Aerobic performance occurs

A

when muscles get all the oxigen they need

– appropriate intensity from examination
– must monitor patient’s cardiovascular response

134
Q

The Well Individual

PTs can provide information on modifiable risk
factors.

Strategies to prevent disease

A

 Nutrition

 Regular exercise

 Weight control

 Blood pressure control

 Cholesterol management

 Smoking avoidance

PT examination and intervention apply to well
individuals (clients).

Intro to PT (15 decks)

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