Review Lecture 8 Flashcards
If a patient has a pulse pressure over 80, what does this mean?
Heart is working too hard!
If a patient has a rate pressure product above ________ at rest, don’t get them up!
10,000
If a patient has a pulse pressure under 40 what does this mean?
heart is failing/ low blood volume/ shock
SaO2 vs SpO2
SaO2 is the actual amount of oxygen in blood
SpO2 is the peripheral estimate found using a pulse-ox
If there is a drop of greater than __% in SpO2, you can assume theres a true drop in SaO2
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
If a patient’s SpO2 is under __ don’t work with them!
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.
If you walk into a room of a patient with low SpO2, what can you expect to see?
High respiration rate over 30
Angioplasty + atherectomy + Stenting
are all what kind of procedures?
percutaneous
True or false: Coronary artery bypass is a percutaneous procedure
False, it is an open procedure
Why can revascularization of the heart lead to myocardial stunting
Too much blood reintroduced too fast (irritants)
sudden high influx of potassium ions -> Arrythmias
If you get a patient who has recently had cardiac revascularization, what can you expect to see on their monitor?
PVCs, some may be normal. Note changes in frequency
If you see a triplet = BAD
With S3 heart sound end diastolic volume is ______
increased
Sternal precautions can be explained to a patient as…
Move in the tube
True or false: There are standard universal sternal precautions
False all hospitals will have their own
Abdominal incision/ thoracotomy (posteriolateral/anteriolateral) procedures may make it difficult to ______
Breathe due to the incision of the intercostals
These patient’s need to be retrained on how to breathe deeply
Abdominal incision/ thoracotomy (posteriolateral/anteriolateral) make the lungs suspectible to infection why?
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. “
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.
3-4 days
Bleeding
Valve replacement procedure failed? What do you expect
You’ll hear swishing/ heart murmur, they are lightheaded/dizzy
Dont work with someone who has balloon pump in _________. Possibly not even bed exercises using that leg.
Balloon pump
Note:
Axillary artery / subclavian its ok but take extra caution not to pull it out.
Is preload greater in supine or standing?
supine
When someone takes a deep breath and it expands thorax -> _______ preload
increases
Muscle contraction -> _____ preload
increases
Dilating veins -> _____ preload
constricting veins -> ____ preload
dilating- decreases
constricting- increases
Factors that affect afterload:
Stroke volume
contractility of myocardium
sympathetic nervous system
Frank starling law.
Right heart failure -> ____ lbs of weight gain common, liver failure, swelling in extremities
2-3lbs
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 -> _________ -> ________
renin -> angiotensin 1 -> angiotensin 2
What are 2 effects of angiotensin 2?
Angiotensin 2 constricts arteries and causes ADH to be excreted
What is Orthostasis
when u stand up rapidly the blood pressure drops
ACE inhibitors can cause a dangerous side effect called….
Angioedema (swelling of tongue)
Patients with reduced ejection fraction need to take _______ medications
Patients with reduced ejection fraction need to take** positive inotropic** medications
Dejoxin medication - what do u have to think about when patient first starts taking it or they increase dose
GI issues/Neurological issues/ issue is they may feel sick
Dejoxin _________ the PR interval
Increases AKA it slows down heart rate
Note: TAKE HR FOR FULL MINUTE. Not 15 seconds and multiply.
Sympathomimetics and
Phosphodiesterase inhibitors
do what?
Imitate the sympathetic nervous system
(Positive ionotropic)
Intrinsic rates of conduction are based on ______ in the heart
Location
Patient’s with lung conditions might have trouble with exercise in hot or cold environments if theyre on __________
Non selective beta blockers
What are potential side effects of diuretics?
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
What do you do if a chest tube comes out?
Cover hole with something clean if its available, if not use your hand
When is pressure support from a ventilator too high to work with a patient?
15-20
If FiO2 is greater than ___ do not work with the patient
60
Note: FiO2 is the concentration of oxygen patient is inhaling. Normal air is 21%
If someones FiO2 is 80% (very high) Partial pressure of Oxygen in their blood is ______
Low
