Other Cardiovascular conditions Flashcards
what lung sounds go with CHF? why?
rales/crackles fluid in alveoli
what heart sounds goes with CHF?
S3- hallmark! non-compliant LV
what is pulsus alternans?
alteration of strong/weak pulse in femoral and radial arteries= depressed myocardial fxn
What condition is marked by end-inspiratory dry rales?
IPF!
what will a chest X ray show if there is pneumonia?
> bacterial pneumonia= lobar consolidation in one or more lobes
viral pneumonia= fluffy shadows
necrotizing pneumonia= cavities
what will breath sounds sound like over pneumonia?
bronchial sound over lobar pneumonia, or absent/dull percussion
differentially diagnose between bacterial and viral pneumonia based on S&S
bacterial= high fever, productuve cough, pleuritic pain
viral= moderate fever, nonproductive cough, myalgias
*both come with dyspnea and tachypenea
pulmonary effusion, types:
accumulation of fluid in the pleural space
>transudate= low protein
>exudate= high protein
what pulmonary pathology is verified by presence of kerly B. lines?
pulmonary edema
what lung sounds go with chronic bronchitis
ronchi and wheezing
which types of pulmonary patients assume the tripod position for ease of breathing?
COPD
what diagnosis goes with a radiograph with netlike shadows and rales/crackles and rhonchi, blood streaked sputum, large amounts of purulent phlegm and sinusitis?
bronchiectasis
what causes bronchiectasis?
irreversible dilation of one or more bronchi with chronic inflammation and infection
what is literflow vs. FIO2?
literflow= liters of gas per minute (speed at which gas is moving) FIO2= fraction of inspired oxygen (part of a whole)
when do u need to use a bubbler/humidifier?
for flowrates greater than or equal to 4 liters per minute
if using upwards of 24 Lpm, what type of mask do u use?
a Venti-mask
what does a non rebreathing mask do?
100% O2 non-invasively
downside to non-rebreathers?
can’t humidify them- also can’t eat with it on, need NC for meals
FIO2 range for all purpose nebulizers?
21%-100%
IPAP and EPAP
> inspiratory positive airway pressure
>expiratory positive airway pressure
IPAP+EPAP=??
CPAP
what is used as a priming mechanism to enhance coughs?
huff breaths!
PS/ CPAP?
Pt. initiates breath with a preset inspiratory pressure to aid in WOB. – pressure support, continuous pressure – constant flow of positive pressure to help
A/C:
Tidal Volume and RR rate are preset. Can take added breath at preset Vt. – minimum minute ventilation – can be generated by patient whenever they want – pressure applied when he breathes. Also set up a predesired parameters but can be over ridden. Can become hyperventilation. (respiratory alkalosis)
SIMV:
Partial ventilatory support with some mandatory breaths. – synchro intermittent mandatory ventilation – patient spontaneously breaths – positive pressure with breath – pt controlled RR, given to decrease breathing work – preset TV with each breath plus mandatory breaths in between
APRV:
(Airway Pressure Release Ventilation). Release in pressure to allow expiratory phase. Helpful in ARDS when compliance is reduced.
how is alveolar recruitment treated?
> incentive spirometry (visual aid devices/games),
positive epiratory pressure therapy (PEP)
Intermittent positive pressure breathing (IPPB)= most aggressive
what is Lupus?
systemic lupus erythematosus (SLE): multi-system autoimmune disease, increased production of autoantibodies, immune complexes cause diffuse, widespread inflammation in the joints, skin,brain, kidney, heart. Ppl usually die from heart or pulmonary complications.
what type of lung impairment is common after cardiac surgery?
left lower lobe atelectasis
what is significant to know for PTs who are working with a patient who has had an anterior lateral thoracotomy?
pec major has been cut and serratus anterior seperated
what mm are cut in a lateral thoracotomy?
serratus ant. and latissimus dorsi is moved around and messed with
who is a candidate for a carotid endarterectomy?
> symptomatic pt with carotid stenosis of greater than or equal to 50-70%
or asymptomatic with stenosis of 60%
what do pacemakers correct?
arrhythmias, 2nd or 3rd degree heart blocks, tachycardias and bradycardias
which pacemakers are used with LBBB and severe heart failure
tripolar pacing system- leads in R atrium, R vent. and L vent.
what is an implantable cardioverter defibrillator? (ICD/ shock box)
designed to correct-life threatening arrythmias- decects and corrects all tachycardias, bradycardias and V. fibs
who benefits most from an ICD?
ppl with LVEF less than or equal to 30%
absolute contraindications for organ transplant?
>active malignancy within 2 years >HIV >untreatable psychiatric condition > non operable CV condition >DM with microvascular disease >chest wall or spinal deformity
relative contraindications for organ transplant
> irreversible renal dysfunction
severely limited functional status with poor rehab potential
morbid obesity
how do they decide who gets an organ when one is available?
heart= person who needs it most lung= first come first serve basis
PT after transplant?
transfers ambulation ADLs strength and ROM pulm. hygiene and chest wall mechanics
how soon after an organ transplant can u do a PT eval?
12-36 hours
how high can u push a patient after an organ transplant?
MET level 1-3
what is normal MAP?
70-110 mmHg
what is too low for MAP to provide adequate purfusion pressure?
less than 60 mmHg
intermittent mandatory ventilation (IMV)
preset breath rate
pt can take optional breaths
syndchronized intermittent mandatory ventilation (SIMV)
mandatory breaths plus optional ones with assistance
* avoid stacking because only mandatory if not breathing on their own
pressure support ventilation (PSV)
when patient inhales the ventilator supports it
inspiratory hold
provides a hold during inhalation, for hyperventilation and restrictive lung disease
positive end expiratory pressure
applied at end of expiration to prevent alveolar collapse
when is positive end expiratory pressure
emphysema
ppl in shock
pulmonary edema
expiratory retard
prolongs expiration phase
who needs expiratory retard?
COPD
constant positive airway pressure- CPAP
constant pressure throughout inspiration and expiration to keep airway open (sleep apnea)
when should bronchodilators and aerosolized antibiotics be taken in conjunction with postural drainage and percussion?
bronchodilators= BEFORE
aerosolized antibiotics= AFTER
4 stages of an effective cough
1) inspiration greater tidal volume
2) closure of the glottis
3) abdominal and intercostal mm contract
4) sudden opening of glottis and air forced out
what population of pts has trouble with coughing?
obstructive lung diseases
technique for helping cough? Pump cough: breath holding: pursed lip breathing: diaphragmatic breathing:
3 huffs then 3 short coughs, repeat x3 until spontaneous coughing begins
holding inhale may help too.
pursed lip breathing helps ppl with obstructive disease by controling exhale
small breath=?
medium breath?
large breath?
small breath= small cough
medium breath= med. cough
large breath= large cough
