Mod 7: Cardiopulmonary Flashcards by Alyssa Donley

decreased PaO2 in blood

hypoxemia

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increased PaCO2 in blood

hypercapnia

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inc. PaCO2 causes s/s: disoriented, dizzy, cyanosis, stupor & dec. ventilation

respiratory acidosis

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dec PaCO2 causes s/s: dizzy, lightheaded, tachycardia, hyperventilation

respiratory alkalosis

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dec. HCO3 causes s/s: hyperventilation, HA, weak, cardiac arrythmia

metabolic acidosis

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inc. HCO3 causes s/s: nausea, diarrhea, confusion, mm cramps, hypoventilation

metabolic alkalosis

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when you fall asleep & wake up a couple hrs later SOB (ex: CHF, PE)

paroxysmal nocturnal dyspnea

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type of breathing thats difficult prone/supine but relieved when sitting

orthopnea

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type of breathing with prolonged inhalation d/t TBI

apneustic breathing

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irregular depths of breathing d/t cerebellar dysfunction

ataxic

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FEV1: what it stands for? tests what?

forced expiratory volume in 1 sec
tests pulmonary function
(FEV1/FVC)

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FEV1/FVC for restrictive LD vs. obstructive LD

RLD: normal or >80%
OLD: <70%

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decreased lung volumes w/ normal expiratory flow rates

RLDs

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decreased expiratory flows & narrowed airways but increase lung volumes/capacities
hyperinflated lungs
dec. surface area & gas exchange at alveoli

OLDs

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s/s: chronic cough, inc mucus, wheezing, dyspnea w/ exertion, accessory mm hypertrophy

OLDs

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s/s: dec. compliance of breathing structures, dec. volume moving in/out lungs, tachypnea, inefficient, inc. accessory mm use, dec. breath sounds, hypoxemia, dyspnea, mm wasting

RLDs

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loss of lung compliance causes hypoxemia
inflammatory process that causes irreversible fibrotic scarring of lung walls
dec. TLC, VC etc, dyspnea w/ exertion, cough, sleep disturbances

idiopathic pulmonary fibrosis
/ interstitial lung disease

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ideal FITT Rx for respiratory pts

20-30 min/day, 5x/wk
if discontinuous, shorter sessions 1-2x/day

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RPE range

6-20
easy- veryvery hard(90% MHR)

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what is the increase in Syst BP per MET level?

8-12 mm Hg

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secretion mobilization techniques:

postural drainage
percussion
vibration (upon exhalation)
PEP devices
hydration
gen. mobility
assisted & self-assisted cough techniques

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respiratory mm training techniques:

paired body motions w/ inhalation/exhalation (thoracic ext/flex)
mm recruitment- diaphragmatic (or accessory mm if only option, COPD)
inspiratory mm training w/ incentive spirometer

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what does an incentive spirometer do?
how to perform?

strengthen diaphragm & intercostals for inspiration
full exhale, slow/full inhale & hold 3 sec, exhale; 5-10x/hr

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4 stages of effective cough

inspiration > TV
glottis closure
abs & intercostals contract to inc. thoracic pressure
sudden glottis opening & forceful expulsion of inspired air

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how to perform self-assisted cough

pt supports abdomen or anchors UEs to inc. intraabdominal pressure

techniques for cough assistance

max inspiratory phase w/ vc, positioning & arm movement -facilitate w/ tapping, manual cues, arm flexion & head ext mm contraction & trunk movement to max out intraabd/intrathoracic pressure "bear down" or dig deep

drugs for bronchospasm & asthma -prevent inflammatory mediated bronchoconstriction & reverse capillary permeability

anti-inflammatory agents

drug for allergies, rhinitis, sneezing, motion sickness has SE of arrhythmia, postural hypotension, dizzy, drowsy. etc

antihistamine agents

drug for bronchospasm, wheezing, SOB (asthma), COPD - stimulates receptors causing bronchodilation & blocks receptors causing brochoconstriction

Bronchodilator agents

drug for cough, congestions, thick mucus - increases respiratory secretions, loosens mucus to improve efficacy of cough -perform airway clearance 1 hr after intake**

expectorant agents

drug for pneumonia, emphysema, chronic bronchitis, Cystic fibrosis -decreases viscosity of mucus by altering its composition/consistency -delivered via nebulizer

mucolytic agents

technique to dec. RR, PaCO2, & dyspnea, maintain pos. pressure in bronchioles, improve TV, SAO2 & activity tolerance -perform slowly

pursed lip breathing

technique to dec. RR & use of inspiratory mm groups, improve TV, dyspnea & activity tolerance

diaphragmatic breathing

how to perform diaphragmatic breathing

place hand on upper chest & below rib cage -use semi-fowler's position "sniff" to facilitate

technique used to dec. work of breathing & prevent dyspnea & breath holding for pts w/ dyspnea at rest or minimal activity

paced breathing & exhale w/ effort

how to perform paced breathing

with an activity at comfortable temp -use comfortable ratio to synch w/ exertion -inhale during before/easy part & exhale w/ exertion/hard part

4 positions for dyspnea relief

Reverse Trendelenburg forward lean on arm support (seated/standing) Semi-fowler's w/ sidelying standing lean w/ back against wall

how to perform active cycle of breathing

1-breathing control for 5-10 sec 2-thoracic expansion exercise in postural drainage position (deep inhale w/ relaxed exhale 3-4x) 3-repeat cycle 4-breathing control for 5-10 sec 6-forced expiratory technique (1-2 huffs) 7-breathing control for 5-10 sec

Autogenic Drainage is: ____ w/ 3 phases: Tx time:

controlled breathing at 3 lung volumes unsticking phase (slow breath w/ hold) , collecting phase (TV breath w/ hold) , evacuating phase (deep breath w/ hold & 2 huffs) 25-30 min

technique to improve ventilation for pts w/ dec. lung volume & dec. chest wall lung compliance -a thoracic expansion exercise

segmental breathing

how to perform segmental breathing

therapist puts pressure at end of exhalation to pt chest wall area needing expansion - pt deep inhale and expands ribs under therapist hands therapist provide resistance or dec. hand pressure during

chronotropic vs inotropic effect

chrono: inc/dec HR ino: inc/dec force of contraction

neural reflex that maintains BP

baroreceptor reflex

neural reflex that inc. HR d/t increased venous return

Bainbridge reflex

neural reflex that responds to changes in pH

chemoreceptor reflex

what is the scale of pulse amplitude?

0- absent 1-small 2- normal 3- large/bounding (ex pregnant)

drug for HTN & benign prostate hypertrophy - reduces peripheral vascular tone by blocking alpha 1 adrenergic receptors (cause vasodilation)

alpha andrenergic antagonist agents

drug for HTN & CHF -decreases BP & afterload by suppressing enzyme that converts angiotensin 1 to II

ACE inhibitors

drug for CABG, post PTCA, DVT prevention, embolism -inhibits platelet aggregation & thrombus formation

Anticoagulant agents

drug for hyperlipidemia, atherosclerosis, & coronary disease prevention -inhibits enzyme action in cholesterol synthesis, increases HDLs & breaks down LDLs

Antihyperlipidemia Agents

drug for post MI, A-fib and thrombus prevention -inhibits platelet aggregation & clot formation

Antithrombotic/Antiplatelet Agents

drug for HTN, angina, arrhthmias, CHF, migraines, essential tremor -decreases myocardial O2 demand by decreasing HR & contractility by blocking beta-adrenergic receptors

Beta Blocker Agents

drug for HTN, angina pectoris, arrythmia, CHF -decreases entry of Ca into vascular smooth mm cells causing dec. myocardial contraction, vasodilation & O2 demands on heart

Calcium channel blocker Agents

drug for HTN, Edema from CHF, pulmonary edema & glaucoma -increases excretion of Na & water to decrease BP

Diuretic Agents

special considerations for tx w/ pts on diuretics

-prevent fluid overload -OH -mm may be weak/cramping -monitor edema/weight

drug for angina pectoris -decreases ischemia through smooth mm relaxation & dilation of peripheral vessels

Nitrate Agents

drug for heart failure & A-fib -increases force & velocity of myocardial contraction, dec. HR, AV node conduction & SNS activity

Positive Inotropic Agents

drug for acute MI, PE, ischemic stroke, arterial/venous thrombosis -facilitates clot dissolution

Thrombolytic Agents

norms for O2 saturation, HR, BP, & RR

>90% 60-100 120/80 12-18 bpm

what is P, QRS complex, T wave & ST segment?

P: atrial depolarization (atria contract) QRS: ventricular depolar (ventricle contract) [& atrial repolarization] T wave: ventricular repolarization (ventricle relax) ST: time between ventricular depolar/repolar

what do wide/prolonged Q waves mean?

MI or other pathologies

ST elevation on EKG indicates?

STEMI Myocardial Infarction - emergency

ST depression on EKG indicates?

ischemia from NSTEMI or angina *yellow flag- check lab values

T wave inversion indicates?

angina/ischemia, healing STEMI or NSTEMI *yellow flag- check lab values

what are PVCs? 3+ PVCs indicate what? & then can progress to what?

premature ventricular contractions ventricular tachycardia ventricular fibrillation- no CO

at what levels of BP (S/D) should you terminate exercise?

systolic: 210 mm Hg diastolic: 110 Hg