Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CardioPulmonary > Lecture 17: Special Patient Populations > Flashcards

Lecture 17: Special Patient Populations Flashcards

1
Q

What does ECMO stand for?

A

ExtraCorporeal Membrane Oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the purpose of ECMO?

A

To oxygenate the blood outside the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are (3) general patient types that use ECMO?

A

(1) Patients with severe ventilatory or heart failure (as long as it is reversible)
(2) Critically ill patients with reversible disorders to give the lungs/heart time to heal
(3) Patients who are waiting for a lung/heart transplant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

T/F: Neonates can be placed on ECMO.

A

True. Neonates to adults can all use ECMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

T/F. ECMO is used for End-Stage patients.

A

False. ECMO is only used for patients who WILL get better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the two types of ECMO?

A

(1) Veno-venous ECMO (VV ECMO)

2) Veno-aterterial ECMO (VA ECMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where does VV ECMO take & return blood?

A

Takes blood from the internal jugular vein

Returns it through the common femoral vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where does VA ECMO take & return blood? (2 ways)

A

Femoral–> Femoral

Femoral–> Aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T/F. VV ECMO is used to support the lungs only!

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F. VA ECMO is used to support the heart only!

A

False. It supports the heart and the lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What else must a patient be given if they are being supported with ECMO?

A

Patients are ventilated and given total parenteral nutrition (TPN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 3 PT implications when working with ECMO?

A

(1) These patients are on anticoagulation medications - they bruise easily
(2) Follow the protocol set by the institution - there are only a few hospitals that will use ECMO - some of the educational hospitals will get up and walk these patients
(3) Don’t dislodge any of the tubes - Holy shit that would be bad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are (3) pulmonary considerations in the pediatric population compared to the adult population?

A

(1) Smaller lungs (smaller thorax) > Smaller airways > *Prone to airway obstruction due to bronchospasm
(2) At risk for respiratory failure > more horizontal ribs
(3) Respiratory frequency (RR) is much faster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the resting HR of a child under 5 y.o.?

A

~120 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a resting heart rate of a child 15 y.o.?

A

~65 bpm (should be similar to an adult by now)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are (2) considerations for patients with congenital heart defects?

A

(1) All individuals with congenital heart defects are at higher risk for cardiac infections (such as endocarditis)
(2) Problems will worsen as the child ages because these defects are getting larger as the heart is growing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does ASD stand for?

A

Atrial septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is ASD?

A

a hole in the septum dividing the atria (usually the foramen ovale failing to close)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does PFO stand for?

A

Patent foramen ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a PFO?

A

When the foramen ovale fails to close within months after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What kind of shunt does a PFO lead to?

A

Left to right shunting occurs -> because pressure in the left heart is much higher than the right. So blood moves from high pressure to low pressure.

22
Q

When does a person with PFO usually start to notice symptoms?

A

They remain asymptomatic until ~30 years old

23
Q

What possible symptoms does an individual develop in PFO?

A

SOB, murmurs, atrial arrhythmia, recurring respiratory infections

24
Q

What are two treatment options for an individual with PFO?

A

(1) Cardiac catheterization

(2) Cardiac surgery

25
Q

What does VSD stand for?

A

Ventricular septal defect. Fun Fact: it is the most common congenital defect of the heart. And 50% will close spontaneously.

26
Q

What affect does VSD have on the right ventricle?

A

The right ventricle becomes incapable of accepting more blood (the pressure is too great for the little right atria to keep up with)

27
Q

What are some S&S for VSD?

A

(1) Murmur
(2) Recurrent Respiratory infections
(3) Pulmonary hypertension (more blood in the pulmonary trunk, causes respiratory overload)
(4) Increased risk for bacterial endocarditis

28
Q

What does PDA stand for?

A

Patent Ductus Arteriosus

29
Q

When should the Ductus arteriosus close?

A

When the baby takes its first breaths after birth

30
Q

What is the major problem with PDA?

A

Decreased SaO2 because deoxygenated blood goes straight to the aorta via the ductus arteriosus.

31
Q

What is Coarctation of the aorta?

A

Abnormal narrowing of the aorta

32
Q

What is the physiological result of a coarctation of the aorta that is concerning?

A

The left ventricle must work really hard (increased workload) to push against this extra resistance in the aorta. Leads to hypertrophy of the LV.

33
Q

What are two signs of coarctation of the aorta?

A

(1) Hypertension (UE BP>LE BP)

(2) Pulmonary edema

34
Q

What is the treatment option of coarctation of the aorta for younger patients? For older patients?

A

Younger Patients: balloon with stent (for younger patients)

Older Patients: Synthetic graft (for older patients)

35
Q

What does Tetralogy of Fallot include (4)?

A

(1) VSD: Increasing the afterload of RV
(2) Pulmonary artery stenosis: Increasing the afterload of RV
(3) RVH: this is due to (1) and (2)
(4) Overriding of the aorta into RV

36
Q

What are (4) S&S of Tetralogy of Fallot?

A

(1) Child tries to increase venous return with squatting position
(2) Very cyanotic (low SaO2)
(3) Clubbing
(4) Polycythemia > increased production of RBCs because of low SaO2

37
Q

What are some reasons for lung transplantation?

A

Cystic fibrosis, COPD, pulmonary fibrosis

38
Q

Who are candidates for lung transplantation?

A

(1) Individuals with less than a year to live
(2) Does not have multiple comorbidities
(3) Needs to match an existing donor
(4) Undergoes rehabilitation

39
Q

What is the surgical procedure for a bilateral lung transplantation (in other words, what structure do they want to save on the recipient when doing a bilateral lung transplantation)?

A

> Maintains the patient’s own carina by transplanting at the main-stem bronchi

40
Q

What are the two major Post-Op complications of lung transplantation?

A

(1) Infection: Because of the immuno-supression drugs

(2) Rejection

41
Q

What are the signs of rejection in lung transplantation?

A

(1) Low SaO2 indicates rejection with the new cells

(2) Pulmonary vascular congestion on Chest X-ray

42
Q

What is the PT intervention of patients after lung transplantation?

A

(1) Start slow with longer warm ups and longer cool downs

(2) if there is sign of rejections > don’t work with them

43
Q

When can PTs start working with patients after lung transplantation?

A

PT intervention can begin 48 hours after surgery

44
Q

What is the candidacy of heart transplantation?

A

Less than 6 months to a year to live

45
Q

What is the pre-op treatment?

A

(1) Ventricular assist device (IABP)

2) Pre-hab (avoiding resistance exercise

46
Q

What are the two post-op complications of heart transplantation?

A

(1) Infection

(2) Rejection: the most common sign is the new development of an arrhythmia

47
Q

What are the PT considerations after a patient undergoes heart transplantation?

A

(1) Denervated heart (no long innervated by vagus nerve)
(2) Heart does not sense an increase in venous return during exercise
(3) Frank-Starling response > heart pumps what it gets
(4) Rest heart rate could be as high as 90 because of lack of vagal regulation and medications
(5) RPE scale is important to use in monitoriing these patients (because HR is not accurate)
(6) Longer warm up (15 minutes) and cool downs (15 minutes)

48
Q

What are the respiratory mechanics of a spinal cord injury at C7 or above?

A

(1) Restrictive issue since the person has problems getting air into the lungs
(2) Cervical transection will have flaccid abdominal muscles

49
Q

What are the PT considerations of a person with a SCI C7 or higher?

A

(1) Flaccid abdominal muscles with a working diaphragm: work with patient in supine for easier breathing
(2) An “abdominal binder” may be used for comfortable breathing in the upright position
(3) Air shift technique
(4) Quad Cough
(5) Glossopharyngeal breathing (aka frog breathing)
(6) Highly susceptible to respiratory infection

50
Q

What is the air shift technique when working with patients with SCI?

A

Ask the person to inhale and attempt to shift the air into the lower chest from the upper chest while the therapist presses on the abdomen

51
Q

What is Glossopharyngeal breathing (“frog breathing”)?

A

A technique used by SCI patients who are chronically dependent on a ventilator
- use of the tongue, cheeks, and pharynx to assist in air movement into the lungs (use of positive pressure to push air into the lungs)

CardioPulmonary (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions