Random Review CARDIOPULMONARY Flashcards
1
Q
What does the ABI do?
A
Compares systolic BP at the ankle and arm to check for peripheral artery disease
2
Q
What is the formula for ABI?
A
ABI = Ankle/Brachial
3
Q
Interpret an ABI >1.4
A
- Indicates rigid arteries
- Use ultrasound test to check for peripheral artery disease
4
Q
Interpret an ABI 1.0-1.3
A
Normal
5
Q
Interpret an ABI 0.8-0.99
A
- Mild blockage
- Beginning of PAD
6
Q
Interpret an ABI 0.4-0.79
A
- Moderate blockage
- May have intermittent claudication during exercise
- Compression is contraindicated
7
Q
Interpret an ABI <0.4
A
- Severe blockage, suggests severe PAD
- May have claudication pain at rest
- Compression is contraindicated
8
Q
Normal blood pH
A
7.4 (7.35-7.45)
9
Q
Normal PaCO2 Arterial Blood Gas
A
40 mmHg (35-45)
10
Q
Normal PaO2 Arterial Blood Gas
A
97 mmHg (80-100)
11
Q
Normal HCO3- Arterial Blood Gas
A
24 mEq/L (22-26
12
Q
SaO2 Arterial Blood Gas
A
95-98%
13
Q
Acidemia
A
Elevated acidity of arterial blood (pH <7.35)
14
Q
Alkalemia
A
Decreased acidity of arterial blood (pH >7.45)
15
Q
Eucapnia
A
Normal level of CO2 in arterial blood (PaCO2 35-45 mmHg)
16
Q
Hypercapnia
A
Elevated level of CO2 in arterial blood (PaCO2 >45 mmHg)
17
Q
Hypocapnia
A
Low level of CO2 in arterial blood (<35 mmHg)
18
Q
Hypoxemia
A
Low level of O2 in arterial blood (<80 mmHg)
19
Q
Mild Hypoxemia
A
60-79 mmHg
20
Q
Moderate Hypoxemia
A
40-59 mmHg
21
Q
Severe Hypoxemia
A
<40 mmHg
22
Q
Hypoxia
A
low levels of O2 in tissue despite adequate perfusion of the tissue
23
Q
Normal RBC count
A
Males: 4.3 - 5.6 x10^6/mL
Females: 4.0 - 5.2 x10^6/mL
24
Q
Normal WBC count
A
3.54 - 9.06 x10^3/mm^3
25
Normal platelet count
165 - 415 x10^3/mm^3
26
Total cholesterol values
Desirable --> <200 mg/dL
Borderline --> 200-239 mg/dL
High --> >240 mg/dL
27
Which cholesterol is "good", which one is "bad"?
HDL --> good
LDL --> bad
28
LDL cholesterol values
Optimal --> <100 mg/dL
Near optimal --> 100-129 mg/dL
Borderline --> 130-159 mg/dL
High --> 160-189 mg/dL
Very high --> >/= 190 mg/dL
29
HDL cholesterol values
Low --> <40 mg/dL
High --> >/= 60 mg/dL
30
Triglyceride cholesterol values
Desirable --> <150 mg/dL
Borderline --> 150-199 mg/dL
High --> 200-499 mg/dL
Very high --> >/= mg/dL
31
Tracheal and bronchial sounds
- Loud, tubular sounds normally heard over the trachea
- Inspiration shorter then expiration w/ a pause between
32
Note about bronchial sounds
- When heard over distal airways they are abnormal
- Indicate consolidation or compression of lung tissue
33
Vesicular breath sounds
- High pitched/breezy sounds distally
- Inspiration longer than expiration w/ no pause
34
Types of abnormal breath sounds
- Adventitious
- Crackle (rales)
- Pleural friction rub
- Rhonchi
- Stridor
- Wheeze
- Bronchial
- Decreased/diminished sounds
- Absent sounds
35
Adventitious
- Abnormal breath sounds that are heard in addition to the expected breath sounds
- heard w/ inspiration and/or expiration that can be continuous or discontinuous
36
Crackle (rales)
- Discontinuous, high-pitched popping sound heard usually during inspiration
- Associated w/ restrictive or obstructive respiratory disorders
- Can be "wet" or "dry"
37
Wet crackle
Usually represents the movement of fluid or secretions
38
Dry crackle
Sudden opening of closed airways
39
Conditions to think of when you hear crackles
- Atelectasis
- Fibrosis
- Pulmonary edema
- Pleural effusion
- Pneumonia
- Bronchiectasis
40
Pleural friction rub
- Dry, crackling sound during inspiration and expiration
- Because of inflamed visceral and parietal pleurae rubbing together
- Heard over the spot of pleuritic pain
41
Rhonchi
- Continuous low-pitched sounds
- "Snoring" or "gurgling" heard during both inspiration and expiration
- Caused by air passing through obstructed airways
42
Stridor
- Continuous high-pitched wheeze heard w/ inspiration or expiration
- Indicated upper airway obstruction
43
Wheeze
- Continuous "musical" or whistling sound w/ a variety of pitches
- Comes from turbulent flow and and the vibration of the walls of small airways
44
Bronchial breath sounds
- Abnormal when in places that vesicular sounds are supposed to be heard
- Can indicate pneumonia
45
Decreased/diminished sounds
Less audible sounds can indicate severe congestion, emphysema, or hypoventilation
46
Absent sounds
May indicate pneumothorax or lung collapse
47
Voice sounds
Spoken sounds are usually muffled, whispered words are faint
- Bronchophony
- Egophony
- Whispered pectorlioquy
48
Egophony
- A form of bronchophony
- Spoken long "E" sounds like a long, nasal-sounding "A"
49
Bronchophony
Increased vocal resonance w/ greater clarity and loudness of spoken words
50
Increases in volume and distinctness in voice sounds indicate ___?
Consolidation, atelectasis, or fibrosis
51
Whispered pectorlioquy
Recognition of whispered "1,2,3"
52
Stethoscope placement for listening to the aortic area
2nd intercostal space at the R sternal border
53
Stethoscope placement for listening to the pulmonic area
2nd intercostal space at the L sternal border
54
Stethoscope placement for listening to the mitral area
5th intercostal space, medial to the L midclavicular line
55
Stethoscope placement for listening to the tricuspid area
4th intercostal space at the L sternal border
56
S1 heart sound
- "Lub"
- First heart sound
- From closure of the AV valves
- Lower pitch and longer duration than S2
57
S2 heart sound
- "Dub"
- Second heart sound
- From closure of the aortic and pulmonary valves
- Higher pitch and shorter duration than S1
58
S3 heart sound
- Vibrations of the distended ventricle walls from passive flow of blood from the atria during the rapid filling phase of diastole
- Normal in healthy young children
- Abnormal in adults, associated w/ heart failure (aka ventricular gallop)
59
S4 heart sound
- Sound of vibration of the ventricular wall w/ ventricular filling and atrial contraction
- May be associated w/ hypertension, stenosis, hypertensive heart disease or myocardial infarction
- AKA atrial gallop
60
Heart murmurs
- Vibrations of longer duration than the heart sounds
- Often due to disruption of blood flow
- Sounds like soft blowing or swishing
61
Normal respiratory rate for newborns-1 year
30 to 60 breaths/minute.
62
Normal respiratory rate a toddler (age 1-3 years)
24 to 40 breaths/minute
63
Normal respiratory rate for a child in elementary school (age 6-12 years)
18 to 30 breaths/minute
64
Normal respiratory rate for an adult (age 18 years and older)
12 to 20 breaths/minute
65
What does the P wave represent?
Atrial depolarization
66
What does the PR interval represent?
- Time for atrial depolarization and conduction from the SA node to the AV node
- Normal duration is 0.12-0.20 seconds
67
What does the QRS complex represent?
- Ventricular depolarization and atrial repolarization
- Normal duration is 0.06-0.10 seconds
68
What does the QT interval represent?
- Time for both ventricular depolarization and repolarization
- Normal duration is 0.20-0.40 seconds
69
What does the ST segment represent?
Isoelectric period following QRS when the ventricles are depolarized
70
What does the T wave represent?
Ventricular repolarization
71
Normal sinus rhythm
60-100 bpm
72
Sinus bradycardia
<60 bpm
73
Sinus tachycardia
>100 bpm
74
Sinus arrhythmia
A sinus rhythm that quickens and slows at the SA node, results in a beat-to-beat variation in rate
75
Sinus arrest
- A sinus rhythm w/ intermittent failure of either SA node impulse formation or AV node conduction
- Results in the occasional complete absence of the P or QRS waves
76
Atrial dysrhythmias
- Premature atrial contractions
- Atrial flutter
- Atrial fibrillation
77
Premature atrial contractions
- Occurs when an ectopic focus in the atrium initiates an impulse before the SA node
- P wave will be premature and have abnormal configuration
78
Clinical significance of PACs
- Common and generally benign
- May progress to atrial flutter, tachycardia or fibrillation
79
Atrial flutter
- Ectopic, rapid atrial tachycardia
- Atrial rate of 250-350 bpm
- Ventricular rate depends on AV node conduction
80
What does atrial flutter look like on an ECG?
Saw-tooth shaped P wave
81
Clinical significance of atrial flutter
- Occurs w/ valvular disease, ischemic heart disease, cardiomyopathy, hypertension, acute myocardial infarction, chronic obstructive lung disease, and pulmonary emboli
- S/S- palpitations, lightheadedness, and angina due to a rapid rate
- Stagnation of blood may predispose to thrombi in the atria
82
Atrial fibrillation
A common arrhythmia where atria are depolarized 350-600 bpm
83
What does atrial fibrillation look like on an ECG?
ECG shows characteristically irregular undulations of ECG baseline w/o discrete P waves
84
Clinical significance of atrial fibrillation
- Can occur in healthy hearts
- Coronary artery disease, hypertension, and valvular disease
- S/S- Palpitations, fatigue, dyspnea, lightheadedness, syncope, and chest pain
- Stagnation of blood may predispose to thrombi in the atria
85
Degrees of atrioventricular conduction blocks
- 1st degree
- 2nd degree
- 3rd degree
86
1st degree atrioventricular conduction blocks
PR interval is longer than 0.2 seconds, but relatively consistent from beat to beat
87
Clinical significance of 1st degree atrioventricular conduction blocks
- No symptoms or significant change in cardiac function
- PR interval may become prolonged for many reasons including medications that suppress AV conduction
88
2nd degree atrioventricular conduction blocks
- AV conduction disturbance, impulses b/t the atria and ventricles fail intermittently
89
Types of 2nd degree atrioventricular conduction blocks
- Mobitz type I (Wenckebach)
- Mobitz type II
90
Clinical significance of Mobitz type I 2nd degree atrioventricular conduction blocks
- Progressive prolongation of PR interval until one impulse is not conducted
- Generally benign
91
Clinical significance of Mobitz type II 2nd degree atrioventricular conduction blocks
- Consecutive PR intervals are the same and normal, followed by nonconduction of 1+ impulses
- More serious
- May progress to 3rd degree heart block
92
3rd degree atrioventricular conduction blocks
- All impulses blocked at the AV node
- None transmitted to the ventricles
93
Clinical significance of 3rd degree atrioventricular conduction blocks
- Medical emergency, PT is contraindicated
- When ventricular rate slows, cardiac output drops and patient may faint
- Common causes: degenerative changes of the conduction systems, digitalis, heart surgery, and acute MI
94
Ventricular arrhythmias
- Premature ventricular complex
- Ventricular tachycardia
- Ventricular fibrillation
- Ventricular asystole
95
Premature ventricular complex
- Premature depolarization in ventricles due to ectopic focus
-
96
Unifocal Premature ventricular complex
Comes from the same ectopic focus and has the same configuration
97
Multifocal Premature ventricular complex
Comes from different ectopic foci and have different configurations
98
Clinical significance of PVCs
- Common arrhythmia that occurs in healthy and diseased hearts
- Patient may be asymptomatic or have palpitations
99
Common causes of PVCs
Anxiety, caffeine, stress, smoking, and all forms of heart disease
100
Ventricular tachycardia
- 3+ consecutive PVCs at a ventricular rate of >150 bpm
- P waves are absent and QRS complexes are wide and aberrant in appearance
101
Clinical significance of v-tach
- >30 seconds is life threatening and required emergency response
- Unable to maintain adequate BP, become hypotensive
- May turn into v-fib causing cardiac arrest
102
Common causes of v-tach
MI, cardiomyopathy, and valvular disease
103
Ventricular fibrillation
- Ventricles don't beat together, quiver asynchronously and ineffectively
- No cardiac output, patient faints
104
ECG for ventricular fibrillation
Characteristic fibrillatory waves w/ an irregular pattern that is either coarse or fine
105
Clinical significance of ventricular fibrillation
- Requires immediate defibrillation
- Medications to support circulation and intravenous antiarrhythmic agents may be used
106
Causes of ventricular fibrillation
Heart disease of any type, MI, and cocaine use
107
Ventricular asystole
- Ventricular standstill w/ no rhythm
- ECG records a straight-line
108
Clinical significance of ventricular asystole
- Emergency CPR and medications to stimulate cardiac activity
109
Common causes of ventricular asystole
Acute MI, ventricular rupture, cocaine use, lightning strikes, electric shock
110
Signs of myocardial ischemia and infarction
- ST segment depression
- ST segment elevation
- Q wave (longer than 0.04 msec, larger than 1/3 R wave amplitude)
- T wave inversion
111
Normal BP
<120/<80
112
Elevated BP
120-129/<80
113
Stage 1 Hypertension
130-139/80-89
114
Stage 2 Hypertension
140+/90+
115
Hypertensive Crisis BP
180+ and/or 120
116
Cardiac tamponade
Compression of the heart caused by fluid collecting in the sac surrounding the heart
117
Anatomic dead space volume (VD)
The volume of air that occupies the non-respiratory conducting airways
118
Expiratory reserve volume (ERV)
- The maximal volume of air that can be exhaled after a normal tidal exhalation
- ~15% total lung volume
119
Forced expiratory volume (FEV)
The maximal volume of air exhaled in a specified period of time
120
Forced vital capacity (FVC)
Volume of air expired during a forced maximal expiration after a forced maximal inspiration
121
Functional residual capacity (FRC)
- Volume of air after normal exhalation
- ~40% total lung volume
- FRC = ERC + RV
122
Inspiratory capacity (IC)
- The maximal volume of air that can be inspired after a normal tidal exhalation
- IC = TV + IRV
123
Inspiratory reserve volume (IRV)
- Maximal volume of air that can be inspired after normal tidal volume inspiration
- ~50% total lung volume
124
Minute volume ventilation (VE)
- The volume of air expired in one minute
- VE = TV x respiratory rate
125
Peak expiratory flow (PEF)
Maximum flow of air during the beginning of a forced expiratory maneuver
126
Residual volume (RV)
- The volume of gas remaining in the lungs at the end of a maximal expiration
- ~25% total lung volume
127
Tidal volume (TV)
- Total volume inspired and expired with each breath during quiet breathing
- ~10% total lung volume
128
Total lung capacity (TLC)
- Volume of air in the lungs after a maximal inspiration
- TLC = RV + VC
- TLC = TRC + IC
129
Vital capacity (VC)
- Volume change that occurs between maximal inspiration and maximal expiration
- ~75% total lung volume
130
What FEV1/FVC indicates obstructive impairment in the lungs?
- <70%
- Characterized by decreased expiratory flows
131
Obstructive classification for FEV1/FVC
- >100% = possible normal variant
- 70-100% = mild obstruction
- 60-70% = moderate obstruction
- 50-60% = moderate to severe obstruction
- <50% severe obstruction
132
What FEV1/FVC indicates restrictive impairment
- Reduced lung volumes and relatively normal expiratory flow rates
- Inferred from spirometry when FVC is reduced and FEV1/FVC is normal or >80%
133
Have normative values been established for 6MWT?
Yes
134
Male/Female distances for 6MWT, ages 60-69
572/538
135
Male/Female distances for 6MWT, ages 70-79
527/471
136
Male/Female distances for 6MWT, ages 80-89
417/392
137
Common side effect of sublingual nitroglycerin tablet
- Used to treat angina
- Headache
- Diaphoresis
- Hypotension
- Xerostomia (sensation of oral dryness)
- Nausea
138
Diaphoresis
Sweating
139
Xerostomia
a condition in which the salivary glands in your mouth don't make enough saliva to keep your mouth wet
140
What is the gold standard for determining the presence of coronary artery disease?
Computed tomography angiogram (CTA)
141
Signs of a DVT
- Active cancer or w/in 6 months of care
- Recent paresis or immobilization of LE
- Bed ridden 3+ days or w/in 12 weeks of a major surgery
- Localized deep calf tenderness
- Entire LE swelling
- Calf swelling in affected leg >3 cm than other
- Pitting edema greater in affected leg
- Collateral superficial veins
142
How large of a decrease in systolic BP would lead to stopping exercise?
Decrease of 10 mmHg or more
143
Normal respiratory and heart rate for a newborn
- Respiratory rate: 30-90 breaths/min
- HR: 70-170 bpm (120 is the average)
144
With a patient that has a history of Afib, what is the best way to assess pulse rate?
- 2 fingers over radial pulse, count # of beats in 60 seconds
- The history of Afib lets us know the patient may have an irregular heart rhythm, so counting to 60 gives us the best data
145
What is the purpose of a Swan-Ganz catheter?
Hemodynamic monitoring of the heart
146
What is the most important management strategy for patients with asthma?
Appropriate use of medications
147
Signs of respiratory acidosis
- Altered mental status
- Hypoventilation
- Lethargy
148
What is the best location for auscultation of breath sounds?
B/t the scapula and spine on either side (T7-T9)
149
When does an embolic stroke occur?
- When clots migrate from the source to block more distal cerebral arteries
- Causes cessation of brain tissue perfusion and ischemia
150
Risk Factors for Embolic Stroke
- Hypertension
- Sleep apnea
- Obesity
- Atherosclerosis
- Diabetes
- Atrial fibrillation
- Smoking
- Sedentary lifestyle
- Excessive alcohol intake
151
Heart failure classification
- Class I
- Class II
- Class III
- Class IV
152
Class I heart failure
Pt has heart disease, but no limitations of physical activity
153
Class II heart failure
- Comfortable at rest
- Experiences fatigue, dyspnea, or anginal pain with ordinary levels of physical activity
154
Class III heart failure
- Comfortable at rest
- Experiences fatigue, dyspnea, or anginal pain with less than ordinary levels of physical activity
155
Class IV heart failure
- Unable to do any physical activity w/o discomfort
- May have anginal symptoms at rest
156
Wells Clinical Prediction Rule for DVT
= Score of 2+ indicates high probability of DVT
- Active cancer or w/in 6 months of care (+1)
- Recent paresis or immobilization of LE (+1)
- Bed-ridden 3+ days or w/in 12 weeks of a major surgery (+1)
- Localized deep calf tenderness (+1)
- Entire LE swelling (+1)
- Calf swelling in affected leg >3 cm (+1)
- Pitting edema greater in affected leg (+1)
- Collateral superficial veins (+1)
- Alternate diagnosis likely (-2)
157
What is respiratory distress syndrome?
- Most common respiratory disorder in premature infants
- Caused by deficient amount of pulmonary surfactant
158
Characteristics of respiratory distress syndrome
- Airless alveoli
- Inelastic lungs
- Respiration rate >60/min
- Nasal flaring
- Peripheral edema
159
Incidence of respiratory distress syndrome over the course of gestation
Increases w/ decreasing gestational age (i.e. more likely if the baby is premature)
160
Signs and symptoms of pneumothorax
- Dyspnea w/ pain reported in chest and shoulder, especially w/ rib fracture
- Considered a medical emergency
161
Symptoms of vascular claudication
- Pain is consistent w/ all spinal positions
- Pain is brought on by physical exertion
- Pain is relieved promptly by rest, usually w/in a few minutes
162
Phases of cardiac rehab
- Phase I- Inpatient Cardiac Rehab (acute)
- Phase II- Oupatient or HEP (subacute)
- Phase III- Community Exercise program (post-acute)
163
Components of each phase of cardiac rehab
- Time (post-infarct or post-op)
- RPE
- METS
164
Phase I- Inpatient Cardiac Rehab (acute)
- Time: <1 week for an uncomplicated MI
- RPE: <13 (6-20 scale)
- METS: progress from 2-3 initially to 3-5
165
Phase II- Oupatient or HEP (subacute)
- Time: 1-2 weeks after MI or surgery; up to 3 months post phase 1
- RPE: 14-16
- METS: 4-9
166
Phase III- Community Exercise program (post-acute)
- Time: 3-6 months up to 1 year after MI or surgery
- RPE: 14-16
- METS: 5+
167
Indications for airway suctioning
- Artificial airway
- Excessive pulmonary secretion
- Secretions that are unable to be cleared by any other less invasive measure
168
Less invasive airway clearance methods to attempt before suctioning
- Huffing
- Positioning that stimulates a cough
- Cough assist devices
169
What test best assesses a patients ventilation and gas exchange
- Arterial blood gases
- Something like pulse ox is to susceptible to error to be considered "best"
170
Abnormal systolic BP response to exercise
- Increasing by more than 20-30
- Decreasing 10+
171
Abnormal diastolic BP response to exercise
Increase of 10+
172
What is coarctation of the aorta?
- Involves obstruction of the left ventricular flow due to narrowing of the aorta
- Causes hypertension in the UE, normal to low pressure in LE
173
Symptoms of AV septal defects (AVSDs)
- In 15-40% of kids w/ DS
- Pulmonary hypertension
- Lung congestion
- Heart failure
- Surgery usually required in first few months of life
174
Ductus arteriosus
- Normal circulatory pathway b/t the descending aorta and the pulmonary artery in the fetus
- Normally closes in 5-14 days after birth
175
Symptoms of patent ductus arteriosus
- Associated w/ prematurity or DS
- Tachycardia
- Increased respiratory distress
- Poor weight gain
176
What is truncus arteriosus?
- Separation of the aorta and main pulmonary artery does not occur during fetal development
- Causes R and L ventricle to empty into the same large vessel
177
Symptoms of a pulmonary embolism
- Dyspnea
- Tachypnea
- Tachycardia
- Pleuritic chest pain
- Diffuse chest discomfort
- Apprehension, anxiety, restlessness
- Hemoptysis (bloody sputum)
- Fever
- Persistent cough
178
Risk factors for pulmonary embolism
- Obesity
- Varicose veins
- Recent orthopedic surgery
- Age
179
ST segment depressions that indicate MI
1.0-1.5 mm
180
Why would letting a patient self-select RPE during cardiac rehab be insufficient?
If left up to them, they may not reach the right intensity. In order for the rehab to be effective they'll have to work hard eventually
181
Heart and BP responses to dehydration
- Tachycardia (due to low blood volume)
- Hypotension
182
Uses for incentive spirometry
- Encourages full lung expansion
- Prevents atelectasis
- Encourages diaphragmatic breathing
- Stimulates a cough
- Encourages surfactant production
183
How often should incentive spirometry be used?
Recommended to be used 10x per hour
184
Raynaud's Phenomenon
- Episodic spasms of small arteries and arterioles, resulting in abnormal vasoconstrictor reflex
- Exacerbated by exposure to cold or emotional stress
- Occlusive disease is usually not a factor
185
Symptoms of Raynaud's phenomenon
Fingertips develop:
- Pallor
- Cyanosis
- Numbness
- Tingling
186
Who is most often affected by Raynaud's phenomenon?
Females
187
Arteriosclerosis obliterans
- AKA atherosclerosis
- Chronic occlusive arterial disease of medium and large vessels
- Usually affects LE's
188
Grading peripheral pulses
0 --> nonpalpable pulse,
1+ --> barely detectable pulse
2+ --> slightly diminished but greater than 1+,
3+ --> normal pulse and should be easily palpable
4+ --> “bounding”
189
Use of inhaled steroids vs inhaled bronchodilators in managing asthma
- Inhaled steroids are the first choice to prevent inflammation
- Inhaled bronchodilators relieve symptoms after bronchoconstriction and inflammation have already occurred
190
Target HR % for moderate intensity
70% HR max (technically 50-70, but 70% in healthy adults is better I guess)
191
Target HR % for vigorous intensity
70-85%
192
Etiology of percarditis
- usually idiopathic
- Infection (like COVID)
- Myocardial injury
- Autoimmune disorders
193
Symptoms of percarditis
- Often asymptomatic
- Chest pain
- Dyspnea
- Increased temperature
- Malaise
194
Pain pattern of percarditis
- Usually relieved by sitting upright or leaning forward
- Can last hours-days
- Located in substernal area, can radiate to neck, upperback, and left arm
195
Normal prothrombin time
11-12.5 seconds
196
Normal troponin levels
0.01-0.04 ng/mL
197
How does celiac disease impact anemic status?
Celiac disease can lead to GI malabsorption, which leads to anemia
198
Orthostatic hypotension
- Decrease in SBP of 20
- Decrease in DBP of 10
This has to occur w/in 3 minutes of transition from supine > sit or sit > stand
199
Signs and Symptoms of Vertebrobasilar Artery Insufficiency
Dizziness
Diplopia
Dysarthria
Dysphagia
Ataxia
Nausea
Numbness
Nystagmus
Severe headache
200
Nutritional Issues Caused By Cystic Fibrosis
Blockages in the gastrointestinal tract
Deficiency of fat-soluble vitamins such as A, D, E, K
Weight loss/failure to thrive
Thin extremities and muscle wasting
Diabetes mellitus
Malnutrition
Iron-deficiency anemia
201
Best strategies for managing peripheral vascular disease
- Reduction of cardiovascular risk factors
- Improvement of walking ability
202
What is the Y axis on a flow volume chart?
Flow
203
What is the X axis on a flow volume chart?
Lung volume
204
How does the flow volume chart change with restrictive lung diseases?
- Flow is unchanged
- Volume is less
205
How does the flow volume chart change with obstructive lung diseases?
- Flow is limited
- Lung volume is normal/increased
206
Which lung diseases are obstructive?
- Chronic obstructive pulmonary disease (COPD) (includes emphysema and chronic bronchitis)
- Asthma
- Bronchiectasis
- Cystic fibrosis
207
Which lung diseases are restrictive?
- Idiopathic pulmonary fibrosis
- Sarcoidosis
- Scleroderma
208
Capillary refill test
Measures arterial flow of the small, distal vessels
209
Normal time for capillary refill
<3 seconds
210
What is associated w/ hyperresonance sound w/ mediate percussion?
- Air is more abundant than normal for a specific area of the lungs
- Associated w/ pneumothorax
211
What can happen as a result of a mucus plug?
- Can cause a ventilation-perfusion mismatch
- Results in hypoxia
212
What is an early sign of hypoxia?
Tachycardia
213
Stable angina
chest pain or discomfort that most often occurs with activity or emotional stress
214
Unstable angina
Is unpredictable and occurs at rest
215
Safe positioning for therapeutic exercise in patients w/ congestive heart failure
Maintain sitting or at least semi-recumbent positions
216
Dyspnea with congestive heart failure indicates what is occurring?
Increased fluid buildup
217
At what point should a patient with a cardiopulmonary condition not engage in rehab?
If they are symptomatic at rest. Additional criteria should be met to determine if it is a medical emergency
218
Afterload
- the pressure against which the heart has to contract to pump blood into the aorta
- inversely proportional to stroke volume
219
Preload
- the volume of blood returning to the heart
- directly proportional to the stroke volume
220
At what ABI is compression contraindicated?
<0.8
221
How to determine pressure applied when taking BP
- determine the amount of pressure needed to occlude flow at the radial artery (a distal site)
- The therapist should take the actual blood pressure 30 to 60 seconds after occluding the radial artery
- When taking the actual blood pressure, the therapist should inflate the cuff 15 to 20 mmHg MORE than required to occlude the radial artery.
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How far above the antecubital fossa should the BP cuff be applied?
2.5 cm superior
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Arm positioning when taking BP
Supported by the PT at the level of the heart
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How to tell if cardiac ischemia is present based on ECG
- ST segment will be depressed
- T wave may be inverted
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How to tell if an acute myocardial infarction is present w/ ECG
ST elevation
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Systolic murmur
- Occur b/t S1 and S2, closer to S1
- Can be due to aortic stenosis or mitral regurgitation
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Diastolic murmur
- Occur immediately after S2
- Can be due to aortic and pulmonary valves allowing regurgitation or mitral stenosis
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What is likely to occur w/ kids who have a congenital heart defect?
- Defect can result in acute and/or chronic hypoxia from shunting and mixing oxygenated and unoxygenated blood
- Tachycardia would occur to match the increased demand for oxygen during activity and play
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Pneumoperitoneum
the presence of air or gas in the abdominal (peritoneal) cavity
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ileus
- temporary lack of the normal muscle contractions of the intestines
- Abdominal surgery and medications that interfere with the intestine's movements are common causes
- Bloating, vomiting, constipation, cramps, and loss of appetite occur
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Buerger disease
- typically found in people who smoke
- caused by inflammation that results in occlusion of the arteries and veins of the arms and legs
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symptoms of Buerger disease
- sores on the toes and fingers
- pain
- tingling in the extremities
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Cryotherapy and peripheral vascular disease
Due to induced vasoconstriction and increased blood viscosity, cryotherapy may make already poor circulation worse
DON'T DO IT
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Most common post-op pulmonary complications
- Atelectasis
- Pneumonia
- Pulmonary edema
- Pulmonary emboli
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Is pulmonary fibrosis considered a post-op pulmonary complication?
No
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Metoprolol is what kind of medication?
- Beta blocker
- Cardioprotective
- Reduces HR and reduced cardiac output
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Exercise hypertension
- >/= 90th percentile from relative normative data
- >/= 190 mmHg for females
- >/= 210 mmHg for males
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At what point should exercise tolerance testing be stopped due to BP?
>250 mmHg
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The diaphragm of the stethoscope is used for hearing which heart/lung sounds?
S1 and S2
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The bell portion of the stethoscope is used for hearing which heart/lung sounds?
S3 and S4
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Upper chest paradoxical breathing pattern
chest expands during inhalation and the abdomen is drawn inwards and then during exhalation the abdomen is pushed outwards
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Effect of beta blockers
- Slow HR and decrease force of contraction
- Attenuates (lowers) HR increases normally seen w/ exercise
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Homan's sign
- Discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight
- Sign of DVT
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Relationship b/t 6MWT and cardiopulmonary event
The shorter distance walked indicates higher likelihood of a cardiac event
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After taking beta blockers, would a drop of 20-30 bpm be of concern?
No, this amount of decrease would be expected
