Random Cardiac Flashcards
Ankle-Brachial index procedure
ABI compares systlic BP at teh ankle and arm to check for peripheral artery disease
- SBP ar emeasured in both brachial arteries and both tibialis posterior arteries with a sphygmomanometer and a handheld doppler US device
- the ABI is calculated by dividing the higher of teh two BP measurements in the ankles by the higher of the two SBP measurements at the arms
ABI ranges
> 1.30: indicates rigid arteries
- 0-1.30: normal; no blockage
- 8-0.99: mild blockage; beginning of PAD
- 4-0.79: moderate blockage: may have intermittent claudication during exercise
<0.4: severe blockage suggesting severe PAD: claudication pain at rest
exercise stress testing
- used to assess the patient’s ability to tolerate increasing intensity of exercise while ECG, BP, HR and symptoms are monitored for evidence of myocardial ischemia, abnormal electrical conduction, or other abnormal S/S of exertion. they may be used to evaluate disease severity and prognosis and to determine functional capacity, especially for exercise prescription and counceling. a number of exercise protocols are available using a treadmill, cycle ergometer or upper extremity ergometer
absolute indications for terminating an exercise test:
- drop in SBP >10 mm Hg from baseline despite increase in workload with other evidence of ischemia
- moderately severe angina
- increasing nervous system symptoms(ataxia , dizziness etc)
- signs of poor perfusion (cyanosis, pallor)
- sustained ventricular tachycardia
- 1.0 mm ST elevation in leads without diagnostic Qwaves
Relative indications fro terminating an exercise test
- drop in SBP >10mm Hg from baseline despite increase in workload without other evidence of ischemia
- > 2mm ST segment depression
- Arrhythmias other than sustained ventricular tachycardia, including multifocal PVCs, supraventricular tachycardia, heart block or bradyarrhythmias
- fatigue SOB, wheezing leg cramps, and claudication
- development of bundle branch block or intraventricular conduction delay
- increasing chest pain
- Hypertensive response (SBP >250mm Hg and/or DBP> 115 mmHg)
metabolic alkalosis
pH
- increases
metabolic alkalosis
PaCO2
- within normal limits
metabolic alkalosis
HCO3
- increases
metabolic alkalosis
- causes
- bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease
metabolic alkalosis
Signs and symptoms
- weakness, lethargy, early tetany
Metabolic acidosis
-pH
- decreases
Metabolic acidosis
- PaCO2
- within normal limits
Metabolic acidosis
HCO3
- decreases
Metabolic acidosis
- causes
dibetic, lactic or uremic acidosis; prolonged diarrhea
Metabolic acidosis
- signs and symptoms
- secondary hyperventilation, nausea and vomiting, cardiac dysrhythmias, lethargy, coma
Respiratory alkalosis
- pH
increases
Respiratory alkalosis paCO2
- decreases
Respiratory alkalosis
HCO3
- within normal limits
Respiratory alkalosis
-causes
alveolar hyperventilation
Respiratory alkalosis
- signs and symptoms
- dizziness, syncope, tingling, numbness, early tetany, confusion, cramping
Respiratory Acidosis
- pH
- decreases
Respiratory Acidosis
- PaCO2
- increases
Respiratory Acidosis
- HCO3
- within normal limits
Respiratory Acidosis
- causes
- alveolar hypoventilation
Respiratory Acidosis
- signs and symptoms
- early:anxiety, restlesness, dyspnea, HA
- Late: confusion, somnolence, coma
forward leaning position to relieve dyspnea
- often provides relief of dyspnea to patients with lung disease
- with arms support optimizes teh length-tension relationship of the disphragm and allows the pectoralis minor and pectoralis major muscles to assist in elevating the rib cage during inspiration
- the positions may be combined with oteh rbreathing techniques
reverse trendelenburg position to relieve dyspnea
- places a person in supine with their head above their trunk and lower extremities, decreasing the weight of the abdominal contents on the diaphragm and reducing teh resistance to movement during breathing
demi-fowlers position to relieve dyspnea
- places a patient in supine with teh head of teh bed levated to 45 degrees and pillows under the knees for support and maintenance of a proper lumbar curve
- this position is used often for patients with congestive heart failure or other cardiac conditions
postural drainage
apical segments right and left upper lobes
the patient is in a sitting position, leaning back 30-40 degrees
-percussion and vibration are performed above the clavicles
postural drainage
posterior segment right upper lobe
- patient is turned 1/4 from prone on the left side with the bed horizontal and the head and shoulders raised on a pillow
- percussion and vibration are performed around the medial border of the right scapula
postural drainage
posterior segment left upper lobe
- patient is turned 1/4 from prone on the right side with the head of the bed elevated 45 degrees and the head and shoulders raised on a pillow
- percussion and vibration are performed around the medial border of the left scapula
postural drainage
lingula left upper lobe
- the patient is turned 1/4 from supine on the right side with the foot of the bed elevated 12 inches
- percussion and vibration are performed over the left chest between the axilla and the left nipple
postural drainage
anterior segments right and left upper lobes
- patient is in supine with the bed horizontal
- percussion and vibration are performed below the clavicles
postural drainage
right middle lobe
- the patient is turned 1/4 from supine on the left side with the foot of the bed elevated 12 inches
- Percussion and vibration are performed over the right chest between the axilla and the right nipple
postural drainage
- superior segments left and right lower lobes
the patient is prone with the bed horizontal
-percussion and vibration are performed below the inferior border of the left and right scapulae
postural drainage
- anterior basal segments left and right lower lobes
- the patient is in supine with the foot of the bed elevated 18 inches
- percussion and vibration are performed over the lower robs on the left and right side
postural drainage
-Posterior basal segments left and right lower lobes
- the patient is in prone with the foot of the bed elevated 18 inches
- percussion and vibration are performed over the lower ribs on teh left and right side of teh chest
postural drainage
- lateral basal segments lower lobes
- patient is in sidelying with the foot of the bed elevated 18 inches
- percussion and vibration performed over the lower ribs
- the image shows the position for the lateral segment of the left lower lobe with the patient lying on the right side
- for the lateral segment of the right lower lobe, the pt lies on the left side
