Quiz 3 Study Guide Flashcards
1) Which gasses are factors in the maintenance of normal pH?
“Your body’s pH balance, also referred to as its acid-base balance, is the level of acids and bases in your blood at which your body functions best. The human body is built to naturally maintain a healthy balance of acidity and alkalinity. The lungs and kidneys play a key role in this process.” (Google)
○ pH is inversely proportional to the number of hydrogen ions
■ The more H+ present, the (higher/lower) pH will be
■ The less H+ present, the (higher/lower) pH will be
○ Balance is managed between the respiratory and renal systems
○ Blood pH changes according to level of carbonic acid H2CO3 present
○ Acidotic states exist from-
■ Too (little/much) CO2 (carbonic acid H2CO3)
■ Too (little/much) HCO3 (bicarbonate)
○ Alkalotic state exists from-
■ Too (little/much) pCO2 (partial pressure of carbon dioxide)
■ Too (little/much) HCO3 (bicarbonate)
lower; higher; much; little; little; much;
2) Which organs are involved in the maintenance of normal pH
“By increasing the respiratory rate, we excrete more carbon dioxide, which is in equilibrium with carbonic acid. Breathing more deeply and quickly can move the blood pH toward the alkaline side (increasing the pH). This usually happens without our being aware of it. The kidneys are the other important organ for long-term regulation of pH.” (google)
○ The renal and respiratory systems
■ Kidneys - excrete or retain bicarbonate as a base (HCO3-) to maintain pH
● As pH decreases, kidneys (excrete/retain) bicarbonate
● As pH increases, kidneys (excrete/retain) bicarbonate
● This response is slower than the respiratory system response
■ lungs
● Increasing rate or depth of breathing to reestablish CO2 levels
○ Fast compensation within 1-3 minutes
retain; excrete;
● 3) What are the risk factors for thoracic aortic aneurysms
“A thoracic aortic aneurysm is a weakened area in the body’s main artery (aorta) in the chest. When the aortic wall is weak, the artery may widen. When the vessel is significantly widened, it’s called an aneurysm. A thoracic aortic aneurysm is also called a thoracic aneurysm” (google).
○ Age, SMOKING, (low/high) blood pressure, buildup of plaque in arteries, family health history, (low/high) cholesterol
high; high
● 4) What is the most precise medical test for coronary anatomy patency?
“Patency is defined as the state of being open or unobstructed, or showing an infection of parasites. When your arteries are free from obstruction, this is an example of patency. When you have an infection of parasites large enough to be detected, this is an example of patency.” (Google)
Cardiac catheterization
Cardiac catheterization-
■ A procedure where a thin flexible tube (catheter) is guided through a blood vessel to diagnose or treat certain heart conditions (clogged arteries or irregular heart beats)
● Gives MD information about the heart muscle, heart valves, and blood vessels in the heart
■ Can be used to do heart tests, deliver treatments, or remove a piece of heart tissue for examination
● Locate narrowing or blockages of blood vessels, measure O2 levels in the heart, see how the heart pumps blood, diagnose heart valve disease, examine blood vessels for clots
■ Quick recovery time
● 5) How does HR relate to exercise intensity
○ The higher the heart rate, the (less/more) intense the exercise
○ Need to be aware of patients on certain medications that alter heart rate and may give readings that can not be interpreted the same as for someone who is unmedicated
“Atenolol, metoprolol, and other beta-blockers bind to epinephrine receptors in the heart, thus lowering resting/exercise heart rate and blood pressure. These effects blunt increases in heart rate and blood pressure, which serve as a proxy for exercise intensity and workload” (google)
more
● 6) How does BP respond during exercise in normal and abnormal situations
○ Normal → normally systolic blood pressure (declines/rises) during exercise (b/c the cardiac output (increases/decreases) during exercise - need more O2 to muscles during exercise)
○ Abnormal situations
■ Some people may present with abnormally exaggerated rise in systolic BP during exercise → hypertensive response to exercise (often seen in individuals with known cardiovascular diseases)
● Ex: LV hypertrophy, myocardial infarction, cerebrovascular stroke, cardiovascular death, hypertension
■ If a patient is already hypotensive → during exercise session, contracting muscles will help pump blood back to the heart, but after exercise the blood will pool in extremities (less blood in the heart - causes decline in CO and causes BP to drop)
■ Abnormal systolic response → hypertensive, hypotensive, blunted, or flat
● Pt typically have CAD, moderate to severe aortic valvular stenosis, or other cardiac muscle dysfunction
■ Abnormal diastolic response → increase or decrease of more than _ mmHg; sustained DBP elevation during recovery
■ Medications for hypertension can affect BP response during exercise:
● ACE inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, diuretic (heart failure)
rises; increases; 10
● 7) Which is the most common approach for cardiac surgeries?
○ Median sternotomy → typical for cardiac procedures
○ Subxiphoid → common for pericardium or epicardium
○ Axillary (lateral) thoracotomy → most frequently minimal invasive cardiac procedures
■ Pt can have issues with stretching to nerves around brachial plexus in this type of procedure
○ Coronary artery bypass grafting → most common type of open-heart surgery performed on adults today
○ “A coronary artery bypass graft involves taking a blood vessel from another part of the body (usually the chest, leg or arm) and attaching it to the coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft” (google)
○ “Coronary artery bypass graft surgery (CABG), also called coronary artery bypass, coronary bypass or bypass surgery, is the most common type of heart surgery. More than 300,000 people have successful bypass surgery in the United States each year.” (google)
● 8) Which is the most common approach for lung surgeries?
○ Off of google → thoracotomy, and video-assisted thoracoscopic surgery (VATS)
■ video-assisted thoracoscopic surgery (VATS) → minimally invasive
■ OVERALL VATS IS THE BETTER OPTION BC LESS STRUCTURES ARE DISRUPTED + LESS PAIN + LESS SIDE EFFECTS
○ Anterolateral thoracotomy (if this is done bilaterally this is called a clamshell procedure)
■ Left incision → cardiac tamponade, descending aorta repair, pericardial effusion, left pneumonectomy (lung removal), smaller resection of left lung
■ Right incision → primary prigh pneumonectomy (or small resection), distal esophageal surgeries, access to hilum, mitral valve repair/replacement
○ Posterolateral thoracotomy → commonly used for unilateral pulmonary procedures
○ Clamshell incision→ typical for bilateral lung transplantation
“A thoracotomy is surgery to open your chest. During this procedure, a surgeon makes an incision in the chest wall between your ribs, usually to operate on your lungs. Through this incision, the surgeon can remove part or all of a lung.
Thoracotomy is often done to treat lung cancer. Sometimes it’s used to treat problems with your heart or other structures in your chest, such as your diaphragm. Thoracotomy can also be used to help diagnose disease. For example, it can enable a surgeon to remove a piece of tissue for further examination (biopsy)” (google)
● 9) What are the advantages of video assisted surgeries?
○ Video assisted surgeries help make the surgery minimally invasive
○ It decreases the length of stay because you do not have to cut through large muscles, ribs are not split, and you are entering through the intercostal spaces
○ A lot less blood is lost
○ Less negative reactions and responses occur with video assisted surgeries
● 10) Understanding of cardiac catheterization, angioplasty, coronary artery bypass graft surgery
○ Cardiac catheterization-
■ A procedure where a thin flexible tube (catheter) is guided through a blood vessel to diagnose or treat certain heart conditions (clogged arteries or irregular heart beats)
● Gives MD information about the heart muscle, heart valves, and blood vessels in the heart
■ Can be used to do heart tests, deliver treatments, or remove a piece of heart tissue for examination
● Locate narrowing or blockages of blood vessels, measure O2 levels in the heart, see how the heart pumps blood, diagnose heart valve disease, examine blood vessels for clots
■ Quick recovery time
○ Angioplasty-
■ A procedure used to open blocked coronary arteries caused by CAD
■ Helps restore blood flow to heart muscle w/o open heart surgery
■ A long, thin tube is put into a blood vessel and is guide to the blocked coronary artery (has small balloon at end of catheter)
● Once the catheter is in place the balloon is inflated at the narrowed area of the heart artery → this presses the plaque or blood clot against the sides of the artery making more room for blood flow
○ Coronary artery bypass graft surgery-
■ This is the optimal choice of management of coronary artery disease when three vessels are severely obstructed
■ They do this when the angioplasty does not work and atherosclerotic lesion in coronary arteries progresses resulting in complete occlusion
■ Blockage needs to be _% in order to be eligible for this surgery
■ Vascular grafts use saphenous veins, left internal mammary artery
■ Smaller incision
■ Preoperative PT:
● Incentive spirometry, deep breathing, coughing, early ambulation decreases incidence of atelectasis (Complete or partial collapse of a lung or a section (lobe) of a lung).
● We want to get them up quickly after surgery
50
● 11) What are the causes of referred pain?
○ Referred pain of diaphragmatic irritation
○ Kehr’s sign (referred pain) → irritation of the ____ is signaled by the phrenic nerve and refers pain to the area (below/above) the collar bone
○ Referred pain from parietal pleura → parietal pleural and phrenic nerve cause (chest and leg/neck and shoulder) pain
○ Angina → worse with (rest/activity) less with (rest/activity) - can’t touch (msk/angina) and can touch (angina/musculoskeletal) pain
● Nitroglycerin meds – be careful of syncope (fainting or passing out)
● Chest pain not related to angina – nitroglycerin has (an/no) effect
● Chest pain at lower HR / less activity – (stable/unstable) angina – something is happening and need to make the doctor aware
● Angina – cold sweats, pallor, change of colour, SOB, feeling of doom (I don’t feel right),
● Anxiety and angina tend to be best friends.
● Won’t see changes in ecg for those who have musculoskeletal pain
● Can’t touch angina!!
● If unsure of angina – send them to their doctors – send them to their doctors.
diaphragm; above; neck and shoulder; activity; rest; angina; msk; no; unstable;
12) How do you differentiate angina pain from referred pain?
○ Angina pain - worse with (rest/activity) less than (rest/activity); you cannot “touch” (angina/MSK) pain the way you can “touch” (angina/MSK) pain.
○ Kehr’s sign: (angina/referred) pain - irritation of the diaphragm is signaled by the phrenic nerve and refers pain to the are above the collarbone
○ Referred pain from parietal pleura → parietal pleural and phrenic nerve cause (chest and leg/neck and shoulder) pain
activity; rest; angina; MSK; referred; neck and shoulder
● 13) What are the components to Cardiac Output?
○ CO = __ X ___
■ HR is the beats per minute
■ SV is the amount of blood pumped out of the (left/right) ventricle during each systolic cardiac contraction
○ It is the amount of blood the heart pumps in one minute
■ It is dependent upon heart rate, contractility, preload, and afterload
HR; SV; left;
● 14) What are the components to Cardiac index?
○ Cardiac index is the assessment of a patient cardiac ____ in comparison to their (lung volume/size)
○ To find the cardiac index, divide the (lung volume/cardiac output) by the person’s (body surface area/height) (BSA). The normal range for CI is - L/min/m2.
output; size; cardiac output; body surface area; 2.5-4
● 15) What is an a-line and where is it most commonly placed?
○ Aka arterial line, it is an indwelling catheter which provides measurements of systolic, diastolic and mean arterial pressures continuously
○ It allows for arterial blood gas sampling
○ May be indicated for patient in the ICU who are hemodynamically unstable or at risk for instability
○ Common locations for it are the (ulnar or spinal accessory/radial or femoral) artery
○ Precautions - DO NOT DISLODGE
■ High pressure system
■ Level of transducer = level of heart
■ Avoid hyperflexion/hyperextension
radial or femoral;
● 20) What can you do for an individual to improve their cough?
○ Controlled coughing
■ Effective cough consists for four stages:
● An inspiration (lower/greater) than tidal volume
● (Opening/Closure) of glottis
● Contraction of abdominal and intercostal muscles, producing (negative/positive) intrathoracic pressure
● Sudden opening of the glottis and forceful expulsion of the inspired air
○ First line interventions to promote effective cough → positioning, teaching proper coughing techniques (can use ventilator strategies with cough: arms up with (exhale/inhale), trunk (extension/flexion) with compression)
greater; closure; positive; inhale; flexion;
● 20) What can you do for an individual to improve their cough?
○ Splinted coughing → for surgical patients do splinting! (ex: holding pillow when coughing)
■ Splinting supports the incision and surrounding tissues and reduces pain when coughing (sternum can’t move as much with increased pressure b/c pillow is there to block)
20) What can you do for an individual to improve their cough?
Huff Coughing:
■ There are also cough assistance and cough assistance devices (where pt or device applies some pressure to abdomen to help patient get full cough)
● 21) What interventions would you provide to an individual who is post-surgery to prevent respiratory complications?
○ (Decrease/Increase) coughing, maintain patient’s ability to deep breathe, (decrease/increase) thoracic expansion
■ Active cycle of breathing → consists of a series of maneuver performed by patient to emphasize independence in secretion clearance and thoracic expansion
■ Lateral costal expansion
Increase; increase;
21) What interventions would you provide to an individual who is post-surgery to prevent respiratory complications?
