Review Lecture 8

Question 1

If a patient has a pulse pressure over 80, what does this mean?

Answer 1

Heart is working too hard!

Question 1

If a patient has a rate pressure product above ________ at rest, don’t get them up!

Answer 1

10,000

Question 2

If a patient has a pulse pressure under 40 what does this mean?

Answer 2

heart is failing/ low blood volume/ shock

Question 3

SaO2 vs SpO2

Answer 3

SaO2 is the actual amount of oxygen in blood

SpO2 is the peripheral estimate found using a pulse-ox

Question 4

If there is a drop of greater than __% in SpO2, you can assume theres a true drop in SaO2

Answer 4

3%

This is because the error rate of SpO2 is 2-3%

Example: If it says their SpO2 is 93, they could really be at 90

Question 5

If a patient’s SpO2 is under __ don’t work with them!

Answer 5

88%

Why? Because this is where a steep drop in the hemoglobin saturation curve occurs. Meaning oxygen starts rapidly leaving hemoglobin to increase the partial pressure of oxygen in the blood.

Question 6

If you walk into a room of a patient with low SpO2, what can you expect to see?

Answer 6

High respiration rate over 30

Question 7

Angioplasty + atherectomy + Stenting
are all what kind of procedures?

Answer 7

percutaneous

Question 8

True or false: Coronary artery bypass is a percutaneous procedure

Answer 8

False, it is an open procedure

Question 9

Why can revascularization of the heart lead to myocardial stunting

Answer 9

Too much blood reintroduced too fast (irritants)

sudden high influx of potassium ions -> Arrythmias

Question 10

If you get a patient who has recently had cardiac revascularization, what can you expect to see on their monitor?

Answer 10

PVCs, some may be normal. Note changes in frequency

If you see a triplet = BAD

Question 11

With S3 heart sound end diastolic volume is ______

Answer 11

increased

Question 12

Sternal precautions can be explained to a patient as…

Answer 12

Move in the tube

Question 13

True or false: There are standard universal sternal precautions

Answer 13

False all hospitals will have their own

Question 14

Abdominal incision/ thoracotomy (posteriolateral/anteriolateral) procedures may make it difficult to ______

Answer 14

Breathe due to the incision of the intercostals

These patient’s need to be retrained on how to breathe deeply

Question 15

Abdominal incision/ thoracotomy (posteriolateral/anteriolateral) make the lungs suspectible to infection why?

Answer 15

Because patient cannot clear out phlegm

PTs will teach patient to clear out phlegm. “Least amount of cough that can get out the most phlegm. “

Question 16

Percutaneous procedures can also be to replace valves, not only to revascularize.

Incision into the femoral vein in the leg is necessary for these procedures. For the next ________ days we need to be careful about ____________. No vigorous leg exercise or lots of walking.

Answer 16

3-4 days

Bleeding

Question 17

Valve replacement procedure failed? What do you expect

Answer 17

You’ll hear swishing/ heart murmur, they are lightheaded/dizzy

Question 18

Dont work with someone who has balloon pump in _________. Possibly not even bed exercises using that leg.

Answer 18

Balloon pump

Note:
Axillary artery / subclavian its ok but take extra caution not to pull it out.

Question 19

Is preload greater in supine or standing?

Answer 19

supine

Question 20

When someone takes a deep breath and it expands thorax -> _______ preload

Answer 20

increases

Question 21

Muscle contraction -> _____ preload

Answer 21

increases

Question 22

Dilating veins -> _____ preload

constricting veins -> ____ preload

Answer 22

dilating- decreases

constricting- increases

Question 23

Factors that affect afterload:

Answer 23

Stroke volume
contractility of myocardium
sympathetic nervous system
Frank starling law.

Question 24

Right heart failure -> ____ lbs of weight gain common, liver failure, swelling in extremities

Answer 24

2-3lbs

Question 25

With a failing heart, the RASS system causes kidneys to increase water reabsorption via Renin (caused by sympathetic nervous system when it senses blood pressure)

renin -> _________ -> ________

Answer 25

renin -> angiotensin 1 -> angiotensin 2

Question 26

What are 2 effects of angiotensin 2?

Answer 26

Angiotensin 2 constricts arteries and causes ADH to be excreted

Question 27

What is Orthostasis

Answer 27

when u stand up rapidly the blood pressure drops

Question 28

ACE inhibitors can cause a dangerous side effect called….

Answer 28

Angioedema (swelling of tongue)

Question 29

Patients with reduced ejection fraction need to take _______ medications

Answer 29

Patients with reduced ejection fraction need to take** positive inotropic** medications

Question 30

Dejoxin medication - what do u have to think about when patient first starts taking it or they increase dose

Answer 30

GI issues/Neurological issues/ issue is they may feel sick

Question 31

Dejoxin _________ the PR interval

Answer 31

Increases AKA it slows down heart rate

Note: TAKE HR FOR FULL MINUTE. Not 15 seconds and multiply.

Question 32

Sympathomimetics and
Phosphodiesterase inhibitors
do what?

Answer 32

Imitate the sympathetic nervous system

(Positive ionotropic)

Question 33

Intrinsic rates of conduction are based on ______ in the heart

Answer 33

Location

Question 34

Patient’s with lung conditions might have trouble with exercise in hot or cold environments if theyre on __________

Answer 34

Non selective beta blockers

Question 35

What are potential side effects of diuretics?

Answer 35

Loop diuretic -> Hypokalemia

If they just started the medication -> Dehydration/hypotension/ heart rate can spike upwards with activity

As they lose potassium due to diuretic –> arythmias

Question 36

What do you do if a chest tube comes out?

Answer 36

Cover hole with something clean if its available, if not use your hand

Question 37

When is pressure support from a ventilator too high to work with a patient?

Answer 37

15-20

Question 38

If FiO2 is greater than ___ do not work with the patient

Answer 38

60

Note: FiO2 is the concentration of oxygen patient is inhaling. Normal air is 21%

Question 39

If someones FiO2 is 80% (very high) Partial pressure of Oxygen in their blood is ______

Answer 39

Low