Test 3 Flashcards
1
Q
risk factors for cardiovascular and pulmonary disease
A
hypertension
smoking
family history of disease
older age
obesity
diabetes
sedentary lifestyle
2
Q
family’s ability to supply care and it’s financial resources. improves patient ability to respond to disease
A
support system
3
Q
cardiac enzymes
A
creatine phosphokinase
lactate dehydrogenase
4
Q
blood lipids
A
cholesterol
triglycerides
5
Q
Complete blood count
A
Hb
hematocrit
WBC
6
Q
ABG’s: low oxygen but not below _____ on room air: supplemental O2 with exercise
A
60 mmHg
7
Q
resting pO2 _______ or saturation _____ supplemental O2
A
8
Q
bronchodilator meds for patients with
A
decrease flow rates or volumes
9
Q
Inspection components
A
general appearance
facial expression
effort of breathing
neck
chest
phonation/cough/sputum production
posture
positioning
extremities
10
Q
general appearance
A
level of consciousness
body type
body posture
body position
skin tone
presence of all equipment
11
Q
level of consiousness
A
can patient understand the treatment plan
alert
agitate
confused
semi comatose
comatose
12
Q
Indirect measure of nutrition and indication of level of exercise tolerance
A
Body type
13
Q
body type
A
obese: decrease tolerance and increased WOB
cachectic
normal
14
Q
weakness from wasting muscles
A
cachectic
15
Q
body position
A
tripod position (increased WOB)
supine
use of pillows
semi fowlers
16
Q
skin tone
A
cyanotic look - may need oxygen supplement
17
Q
indicate a need for change in the treatment
A
facial expression
distress/fatigue
18
Q
signs of distress
A
nasal flaring
sweating
paleness
19
Q
use of face and neck muscles and movement of lips to breath
need to teach them
A
effort of breathing
pursed lip breathing
20
Q
evaluation of neck
A
sternocleidomastoid
jugular venous distention
21
Q
shortening- due to chronic forward bent posture of head and trunk hypertrophy- when used extensively
A
sternocleidomastoid
22
Q
indication of increased volume in the venous system, early sign of right sided heart failure
A
jugular venous distention
23
Q
jugular venous distention patient sitting or recumbent in bed - head elevated at least ______ if veins distend above______
A
45 deg the level of the clavicle
24
Q
congenital chest defects
A
pectus excavatum
pectus carinatum
25
results of chronic hyperinflation seen in evaluation of hest
rib angle
increase intercostal spaces broader anteriorly
diaphragm is stretched, flatter and less active
26
accessory muscles that hypertrophy and seen in the evaluation of the chest
scalenes
trapezius
intercostals
27
temporary cessation of breathing, especially during sleep
apnea
28
normal, good, unlabored ventilation
eupnea
29
refers to an abnormally slow breathing rate
bradypnea
30
abnormally rapid breathing
tachypnea
31
increased depth of breathing when required to meet metabolic demand of body tissues
hyperpnea
32
COPD 1:4 vs normal 1:2
prolonged expiration
33
is shortness of breath (dyspnea) that occurs when lying flat
orthopnea
34
Hyperventilation is rapid or deep breathing that can occur with anxiety or panic
hyperventilation
35
an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes
cheyne-stokes
36
factors to look at for cough
strength
depth
length of cough
37
long spasmodic cough
bronchospasm
38
ICD is beneficial for individuals with
LVEF \<30%
39
frothy sputum
dyspnea - heart failure
pulmonary edema
40
productive cough fro more than 3 months consecutively and for at least 2 years
chronic bronchitis
41
digital clubbing
tissue hypoxia
42
decreased circulation due to cold, vasospasm, peripheral vascular disease, reduced cardiac output
cyanosis
43
calves: blue/purple
peripheral vascular disease
44
irreversible renal function systemic disease psychosocial or cognitive instability absence of support active infection history of non compliance active substance use morbid obesity lack of adequate financial coverage
contraindications for heart and lung transplantation
45
decreased sound transmission with auscultation of lungs
air trapped
46
used to listen to high pitched sound
diaphragm
47
used to listen to accentuated low frequency sounds, filters high pitched, place lightly on the skin
bell
48
mediate percussion sounds
resonance - normal dull - liver, other dense tissues, consolidation, tumors hyperresonant - empty stomach and hyperinflation (air trapping)
49
rapid rise in HR means
sever deconditioning
50
normal oxygen saturation response to activity
to remain in normal range
51
patient with chronic pulmonary dysfunction of congestive heart failure ________ with activity
desaturate their oxygen from hemoglobin
52
no exercise is sat drops to
86 or below
53
patient need a longer warm up and cool down period monitor exercise tolerance using vitals and RPE scale
post op treatment considerations
54
diaphragm ascends into chest by _____ with anesthesia _______ is significantly reduced
2cm TLC
55
during surgery _________ occurs when lung tissue and surrounding structures are being physically manipulated
compression atelectasis
56
during surgery airway resistance is increased with
breathing circuits
valves
tracheal tubes
57
during surgery airways can become obstructed with
blood
fluid
bronchospasm d/t irritation of airways
58
diaphragmatic procedures performed through \_\_\_\_\_
lateral or thoracoabdominal incision
59
operative side elevated (1/4 turn from prone) uppermost arm elevated forward and flexed at elbow and behind head incision downward between 4th thoracic vertebrae and the scapula
posterolateral thoracotomy
60
muscle considerations for posterolateral thoracotomy
serratus anterior divided close to origin to preserve function avoid long thoracic nerve
61
operative side elevated (1/4 turn from supine) uppermost arm elevated forward and place beneath the back
anterolateral thoracotomy
62
muscle considerations for anterolateral thoracotomy
retracts the latisissmus dorsi
63
sidelying, operative side up arm abducted, flexed at elbow and rotated
lateral thoracotomy
64
muscle considerations for lateral thoracotomy
latissiumus dorsi is not incised but moved either anteriorly / posteriorly and fibers of serratus anterior incised careful preservation of long thoracic nerve
65
frequently used incision for cardiothoracic surgery pt is supine extends below xiphoid process sternum is divided along its midline sternal retractor holds incision open sternum closed with stainless steel sutures
Median Sternotomy
66
why ventilate
impending or established respiratory failure inadequate ventilation and or oxygenation
67
use an inflatable device to increase lumen size use a peripheral access site into coronary arteries to site of lesion contrast dye to assess blood flow risk associated with these procedures short length of stay
coronary artery revascular procedures
68
used when lesion does not completely occlude lumen on coronary artery lesion penetrated, balloon placed at distal aspect of catheter and inflated presses central portion of lesion outward against wall of artery if needed, can start with smaller catheters and progress to larger ones to increase lumen size
percutaneous transluminal coronary angioplasty (PTCA)
69
tiny spring like devices placed into stenotic lesion once positioned, inflated and remain in place increase luminal diameter to restore blood flow
endoluminal stents
70
artery becomes completely occluded venous grafts come from either or both saphenous veins median sternotomy performed, pt on heart/lung machine graft placed above and below lesion site chest wall closed and recovery process begins
coronary arty bypass graft (CABG)
71
the need to deliver positive pressure ventilation protection of the respiratory tract from aspiration of gastric contents almost all situations involving neuromuscular parlysis surgical procedures involving the cranium, thorax or abdomen
indications for intubation
72
electronic pulse generator creates an artificial action potential electrical voltage difference between the two electrodes controls some arrhythmias (2nd or 3rd degree blocks, tachycardia, bradycardia) used to eliminate hemodynamic compromised d/t inadequate cardiac outbut
cardiac pacemaker
73
similar to pacemaker but designed to correct life-threatening arrhythmias detects and corrects all tachycardias, bradycardias and ventricular fibrillation Implanted into the pt and a seperate programmer used to change the function
Implantable cardioverter defibrillator
74
ICD is beneficial for individuals with
LVEF
75
prevent stroke caused by atherosclerotic plaques surgical incision along anterior border of SCM pt left with incision scar on lateral aspect of neck
carotid endarterectomy
76
candidates for carotid endarterectomy
symptomatic pt with carotid stenosis \> or equal to 70%
symptomatic pt with stenosis of 50-69% of carotid artery (modest benefit)
asymptomatic pt with stenosis of 60% or greater
77
low flow oxygen delivery
nasal cannula reduces hypoxemia and intrapulmonary shunting
78
high flow oxygen delivery
oxygen masks
79
systematic sequence for mobilization in post operative period
supine to turning in bed
sitting over the bed
standing
sitting in chair
walking
80
irreversible renal function systemic disease psychosocial or cognitive instability absence of support active infection history of non compliance active substance use morbid obesity lack of adequate financial coverage
contraindications for heart and lung transplantation
81
criteria for heart transplant, recommended:
coronary artery disease
cardiomyopathy
heart valve disease with congestive heart failure
severe congenital heart disease
poor quality of life: intractable angina and life threatening arrhythmias
82
criteria for lung transplant, recommended:
COPD/emphysema
idiopathic pulmonary fibrosis
cystic fibrosis
other (idiopathic pulmonary hypertension, sarcoidosis)
83
PT eval: cardiopulmonary assessment
breathing and ventilatory function airway clearance ascultations
84
PT eval exercise tolerance
max stress test submax treadmill or cycle 6 min walk test oxygen saturation/gas exchange
85
ABO blood compatible histocompatability brain death age less than 35-40 relatively healthy weight and thoracic dimensions match
donor selection
86
based on disease level, need for mechanical support and medicaiton determines how quickly patient gets transplant
recipient classification
87
types of surgical procedures for the heart
orthotopic heart transplant heterotopic heart transplant (old heart stays)
88
pulmonary hygiene and shest wall mechanics strength and ROM exercises: ADLs, MET levels 1-3, breathing education on precautions
postoperative treatment: acute inpatient
89
patient need a longer warm up and cool down period monitor exercise tolerance using vitals and RPE scale
post op treatment considerations
90
from hospital discharge up to 8-12 weeks post similar to phase 2 cardiac rehabilitation goals: strength aerobic conditioning independence with home exercise program education and self monitoring muscculoskeletal problem solving
post operative treatment: outpatient
91
heart transplant signs of rejection
flu like symptoms fever muscle aches dysarrhythmias
92
lung transplant signs of rejection
shortness of breath desaturation
93
device that receives blood from left ventricle and delivers to aorta. assists to pump blood through the body implanted below the heart, attaches at apex used to treat heart failure
left ventricular assist device (LVAD)
94
always record
exercise induced changes
95
how long can LVAD extend life
5-10 years
96
LVAD precautions
sternal (post implantation for 6 weeks or longer) no chest compressions gait belt placement fall risk with increased risk of breathing (Elevated INR 1.5-2.5)
97
alternatives to transplantation: lung
lung volume reduction surgery (LVRS) pressure release ventilation or biphasic positive airway pressure (BiPAP)
98
sphygmomanometer pressure transducer pressure transmitter monitor or recorder
hemodynamic monitoring and life-support continuous monitoring of blood pressure
99
systolic BP range
90-140
100
diastolic BP range
60-80
101
rapidly shuttles helium gas in and out of the ballon which is located in the descending aorta. the balloon is inflated at the onset of cardiac diastole and deflated at the onset of systole
pulmonary artery catheter and intra-aortic balloon counter pulsation (IABC)
102
why ventilate
impending or established respiratory failure inadequate ventilation and or oxygenation
103
intermittent manditroy ventilation (IMV) or synchronized intermittent mandatory ventilation (SIMV) pressure support ventilation (PSV) inspiratory hold positive end expiratory pressure constant positive airway pressure
modes of positive pressure ventilation
104
artificial opening into the trachea, through which a tube can be inserted
tracheostomy
105
"maintenance" long term outpatient cardiac rehab
phase 3 cardiac rehab
106
temporarily during some operations to protect the airway from inspiration and swelling permanently after laryngectomy provide airway access for some patients on ventilators after facial trauma
indications for tracheostomy
107
the need to deliver positive pressure ventilation protection of the respiratory tract from aspiration of gastric contents almost all situations involving neuromuscular parlysis surgical procedures involving the cranium, thorax or abdomen
indications for intubation
108
disease or "state" in which pt's oxygen transport system fails increased secretions hypoxia altered mental state: unconsciousness changes in cardiac function pneumonia
acute cardiopulmonary dysfunction
109
when should you perform postural drainage
before exercise
110
increased basal heart rate decreased maximal heart rate and o2 consumption orthostatic hypotension increased venous thrombosis risk decreased total blood volume decreased hemoglobin concentration decreased blood flow
effects of acute cardiopulmonary dysfunction (hospitalization) on cardiovascular system
111
decreased vital capacity and residual volume decreased paO2 impaired ability to clear secretions increased ventilation-perfusion mismatch
effects of hospitalization on respiratory system
112
decreased muscle strength and girth decreased efficiency of contraction joint contractures decubitus ulcers
effects of hospitalization on musculoskeletal system
113
emotional issues behavioral disturbances cognitive function altered sensation joint position sense
effects of hospitalization on CNS
114
stages of a cough
inspirations greater than tidal volume closure of the glottis abdominal and intercostal muscles contract (+ intrathoracic pressure) sudden opening of glottis and air foreced out
115
post operative cough technique
series of coughs to reduce fatigue associated with maximal cough small breath small cough medium breath medium cough large breath large cough
116
active cycle of breathing technique
1. breathing control 2. thoracic expansion exercises 3. repeat breathing control followed by thoracic expansion exs, followed by breathing control 4. forced expiratory technique 5 follow with breathing control
117
goal of active cycle of breathing thechique
to be independent with secretions
118
breathing control for active cycle of breathing technique
diaphragmatic breathing at a normal tidal volume for 5.10 seconds
119
thoracic expansion exercises for active cycle of breathing technique
pt in postural drainage position, deep inhalation with relaxed exhalation at vital capacity range. can be coupled with percussion/vibration during exhalation
120
fetal heart sounds can be detected by
8-10 weeks gestation
121
maximize airway clearance
position for success maximize inhalation first ask for breath hold encourage maximal intrathoracic and intraabdominal pressures instruct in appropriate timing and trunk movements for expulsion make the procedure as active as possible for pt
122
manually assisted coughing techniques
costophrenic assist counter rotation assist
123
self assisted coughing techniques
prone on elbows, head flexion long sitting short sitting
124
overuse of accessory muscles (difficulty getting air out) treatment should consist of energy conservation, relaxations and pacing activity with breath control exercise is impt part of pulmonary rehab
control of breathing with primary lung disease such as asthma, bronchitis (increased work of breathing)
125
decreased inspiratory time and cough upper chest collapses but can use accessory muscles to balance upper/lower chest (increased vital capacity)
conrol of breathing for SCI (restrictive) - trouble getting air in
126
dyspnea scale
0- no dyspnea 1 - mild, noticable 2 - mild, some difficulty 3 - moderate difficulty, but can continue 4 - severe difficulty, cannot continue
127
angina scale
1+ - light, barely noticable 2+ - moderate bothersome 3+ - severe, very uncomfortable 4+ - most severe pain experienced, unbearable
128
can progress to hall walk if pt can tolerate
about 4 min of marching
129
always monitor recover time for
about 5 min after session to assess complications which may occur
130
always record
exercise induced changes
131
to restore and maintain and individual's optimal physiological, psychological, social and vocational status
mission of cardiac rehab
132
a comprehensive long term program involving medical evaluation, prescribed monitored exercise, and risk factor modification
cardiac rehabilitation
133
affects excretory glands of the body (lungs, pancreas, GI/digestive system, reproductive organs, sinuses and sweat glands) secretions are thicker/more viscous and can obstruct systems of the body dysfunction of pulmonary system most common cause of morbidity and mortality life expectancy 37.4
cystic fibrosis
134
fatty substance found in the human body and in foods that come from animals
cholesterol
135
defined as an excessive accumulation of fat on the body creates problems with respiration and circulation added strain to the heart (increased work, blocked arteries)
obesity
136
associated risk factors for obesity
hypertension hyperlipidemia increased blood glucose levels patterns of sedentary lifestyle
137
interferes with the body's ability to produce adequate amounts of insulin needed for your body to use sugars and carbs are at higher risk for CAD
Diabetes
138
decreases HDL levels and collateral circulation and vessel size increases total cholesterol levels, glucose intolerance, body weight, blood pressure
physical inactivity
139
"inpatient" cardiac rehab
phase 1 of cardiac rehab
140
monitored "outpatient" cardiac rehab usually initiated 1-3 weeks after even usually lasts 3-4 mo
phase 2 cardiac rehab
141
"maintenance" long term outpatient cardiac rehab
phase 3 cardiac rehab
142
what do you monitor in cardiac rehab
ECG HR BP signs and symptoms
143
a type of chest pain, pressure or discomfort heart is not receiving enough oxygen due to narrowed coronary artery
angina
144
pathological limitations of airflow in the lungs generally is not reversible not only a fatal condition but is chronic in nature, making breathing difficult
pulmonary disease
145
for many people SOB affects
every aspect of daily living become fearful of physical activity and become less active with increased SOB
146
supervised progressive exercise/activity functionala and activities of daily living training energy conservation breathing retraining stress management medication education
components of pulmonary rehab
147
what diagnoses are covered for pulmonary rehab
COPD chronic bronchitis asthma emphysema
148
FITT
frequency intensity time (duration) type (mode)
149
considerations for exercise with angina
prolonged warm up and cool down ROM stretching low level aerobic activites upper body exercise may precipitate angina more readily
150
considerations for exercise with MI
warm up should last 5-10 min (stretching, light aerobic activity) aerobic activity should last 20-30 min (discontinue with S&S) cool down should last as long as it takes for HR to reach resting level
151
considerations for exercise with percutaneous cardiac intervention
exercise training can begin almost immediately progress more rapidly if no myocardial damage watch closely for potential reoccurrence manifested by S&S of ischemia
152
considerations for exercise with surgical CABG and Valve intervention
start lower level and progress at slower rate be cautious of sternal precautions, no upperbody exercises for 6-8 weeks post surgery
153
considerations for exercise with pulmonary diagnoses
be very aware of oxygen sat levels throughout intermittent bouts are generally used, anywhere 5-10 min with a 2-3 min rest upper body exercises are found to be more beneficial due to specificity
154
one of first functional organs within the growing fetus
cardiac system
155
contractions of the heart begin at
17 days gestation
156
fetal heart sounds can be detected by
8-10 weeks gestation
157
what percentage of blood flow in a fetus follows the pathway of adult circulation
12
158
fetal circulation has alternative pathway due to
fluid filled lungs
159
one way door in atrial septum closes withing first few hours of life
foramen ovale
160
vascular link outside the heart between PA and aorta allowing blood exit the PA and directly into the aorta for systemic circulation closes within first few weeks of life
ductus arteriosus
161
respiratory system begins to develop at
22-26 days of gestation
162
production of surfactant at about
20 weeks of gestation amount increases as gestational age progresses
163
adequate levels of surfactant are reached at
2 weeks before birth
164
newborns chest wall is primarily
cartilaginous increased compliance of rigcage muscles are primary stabilizers
165
helps with typical development of ribcage structure and function
upright antigravity head, nech and trunk control
166
conditions that impair ventilation in infants
asthma cystic fibrosis infant respriatory distress syndrome bronchopulmonary dysplasia
167
obstructive pulmonary disease characterized by episodic periods of reversible airway narrowing cause by airway inflammation, increased secretions and smooth muscle bronchoconstriction
asthma
168
shortness of breath, wheezing, cough, shest tightness induced by exercise no chronic inflammation may have without diagnosis of asthma
exercise induced bronchospasm
169
affects excretory glands of the body (lungs, pancreas, GI/digestive system, reproductive organs, sinuses and sweat glands) secretions are thicker/more viscous and can obstruct systems of the body dysfunction of pulmonary system most common cause of morbidity and mortality life expectancy 37.4
cystic fibrosis
170
sustain greater ventilatory work less respiratory fatigue ability to affect work capacity not yet determined int eh literature
Resistive breathing device
171
low blood oxygen
hypoxemia
172
decreased oxygen supply to tissue
hypoxia
173
obstructive pulmonary disease (thought to occur as a result of RDS) need for ventilatory assistance at least 3 days and the need for supplemental oxygen at 28 days of life need for supplemental oxygen at 36 weeks gestational age radiographic abnomalities and chronic ventilation beyond initial period of RDS
Bronchopulmonary dysplasia (BPD)
174
alteration in chest wall mobility, lung compliance, muscle strength, ROM or skeletal formation can impact muscle alignment and restrict ribcage movement
musculoskeletal system impariments
175
opening in ventricular septum which allows blood to flow from LV to RV (left to right shunt) already oxygenated blood flows back from LV to RV to pulmonary arteries and back into the lungs, bypassing systemic system
ventricular septal defect (VSD)
176
opening in atrial septum oxygenated blood flows from LA to RA,, pulmonary artery and back to the lungs (Left to right shunts) less symptomatic than VSD
atrial septal defect (ASD)
177
ductus arteriosus does not close (alternative routine the fetus) blood flows from aorta to pulmonary artery, or from left to right causing oxygenated blood to return to the lungs
patent ductus arteriosus
178
murmur on cardiac auscultation poor feeders fatigue diaphoresis (excessive sweating) tachypnea (rapid breathing) decreased systemic blood flow
left to right shunts symptoms
179
HR in children
infant 100-140 child 80-120 adult 60-100
180
BP in children
infant 80/40 child 100/60 adult 120/80
181
RR in childen
infant 30-40 child 25-30 adult 12-18
182
non-invasive, creates a _______ pressure gradient around the patients body during inspiration; provided using a chest shell, poncho/wrap or tank
negative pressure ventilator negative
183
apnea weakening ventilatory effort decreased breath sounds asystole severe brady or tachycardia coma, nonresponsiveness limpness, no ability to cry
clinical selection criteria for mechanical ventilation
184
PaCO2 selection criteria for mechanical ventilation
newborn: \>60-65 mmHg child: \>55-60 mmHg rapidly rising \>5 mmHg
185
PaO2 selection criteria for mechinical ventilation
newborn
186
normal PaO2 newborn/infant
60-90 mmHg 80-100 mmHg
187
how fast air or fluid if removed
flow rate
188
diabetes family hx HTN obesity sedentary lifestyle smoking impariments; functional work capacity, aerobic capacity, dyspnea
pattern 6A
189
POC: ther Ex, risk management, diability mgmt, WOB mgmt past and current PT involvement in health and wellness, risk management/prevention
Pattern 6A
190
Impaired aerobic capacity/endurance with deconditioning
Pattern 6B
191
Diabetes, ischemic heart disease HIV, cardiomyopathy Cancer, CHF Parkinson's disease, PVD MS, pneumonia ALS, emphysema bronchitis, dyspnea and respiratory abnormalities diseases of the mitral and aortic valve
Pattern 6B
192
POC Ther Ex, risk management, disability mgmt, WOB mgmt/breathing strategies, balance, postural control, ADL training, devices/adapted equipment, work Outcomes: Aerobic capacity, Mm strength and endurance, Pain management, Balance and gait/assistive device, Impact on functional limitations (job, school, leisure activities, ADL surveys) physiologic response to increased O2 demand improved
Pattern 6B
193
Impaired Ventilation, Respiration/Gas Exchange and Aerobic Capacity Associated with Airway Clearance Dysfunction
6C
194
Cystic fibrosis, pneumonia, COPD, pneumoconiosis, pulmonary congestion, pulmonary fibrosis, injury to heart and lung,
6C
195
POC Ther Ex, disability mgmt, WOB mgmt/breathing strategies, relaxation techniques, flexibility ex’s, balance, postural control, ADL training, functional training programs (task adaptation) and manual/mechanical techniques and positioning Outcomes: Aerobic capacity, Mm strength and endurance, assistive device, impact on functional limitations, Supervision of activities/tasks/ADL’s, Independence of pt with postural drainage techniques, edema measures, Gait w/o negative physiologic response, Lung sounds, O2 sats, O2 use, QOL
6C
196
Impaired Aerobic Capacity/Endurance Associated with Cardiovascular Pump Dysfunction or Failure
6D
197
Diseases of valves, HTN heart disease, MI, pericarditits, cardiomyopathy, conduction disorders, cardiac dysrhythmias, heart failure, aortic aneurysm
6D
198
POC Ther Ex, disability mgmt, balance/neuro re-ed, task specific performance training, relaxation flexibility ex’s, balance, postural control, ADL training, functional training programs (task adaptation) and return to work, movement efficiency and energy conservation Outcomes Aerobic capacity, Mm strength and endurance, Assistive device, impact on functional limitations, supervision of activities/tasks/ADL’s, Edema measures, Gait w/o negative physiologic response, QOL
6D
199
minimize risk, maximize benefit
risk screening
200
FITT
specificity of training
201
most beneficial for secondary prevention of CHD
cardiorespiratory fitness
202
Most challenging task in designing the exercise program: Requires individualization, Monitoring/supervision Expressed as a percent of functional capacity: VO2 max, Age adjusted maximum heart rate (AAMHR)
exercise Intensity for Cardiorespiratory (CR) Fitness
203
exercise prescription for intensity for CR fitness start at
40-50% THRR
204
high intensity aerobic exercise promotes
respiratory muscle strength older adult with lung disease are unlikely to sustain these intensities
205
sustain greater ventilatory work less respiratory fatigue ability to affect work capacity not yet determined int eh literature
Resistive breathing device
206
sound made by the closure of the AV valves
S1
207
sound made by teh closure of the aortic and pulmonic vlaves
S2
208
low frequency abnormal diastolic sounds that occur when there is rapid ventricular filling
S3 and 4
209
occurs early in diastole
S3
210
occursas as the atria contract (late in diastole ) during the atrial kick
S4
211
perform therapuetic percussion for how long
2-3 min in each position
212
how many times should you perform vibration
2-3 times
213
with CPT always re auscultate after
anything comes up
214
sitting is the best position for
volitional cough
215
contraindications for postural drainage
look at sheet
216
location of apex of lungs
sternal portion of 1st rib
217
location of diaphragm
7th and 8th rib
218
location of R and L upper lobes
between ribs 2 and 4
219
location of lower lobes
8th rib
220
location of R middle lobe
T2-T4 around 5th and 6th rib
221
enclosed, empty space; negative pressure
vacuum
222
application of negative pressure
suction
223
how fast air or fluid if removed
flow rate
224
3 major factors affect flow rate
amount of negative pressure (set on regulator) resistance of the suction system viscosity of the material being suctioned
225
to achieve maximum flow with suction
increase negative pressure use short lengths of large bore tuping suction watery fluids
226
suctioning the airway pressure preterm infants infants children adults
40-60 mmHg 60-100 mmHg 60-100 mmHg 80-120 mmHg
227
indication; pts are unable to clear their own secretions non sterile procedure ok to delegate to unlicensed staff or assistive personnel
oropharyngeal suction
228
indication: pts are unable to clear their own secretions suction catheter with thumb control is passed through the nare to the back of the throat may involve a nasal airway nonsterile procedure may delegate to unlicensed staff or assistive personnel
nasopharyngeal suction
229
Indication: unable to clear secretions and oropharyngeal suction ineffective, suspected aspiration assessment of need: auscultate chest, monitor heart rate and respiratory rate, heart rhythm, oxygen sat, skin color/perfusion, assess effectiveness of cough
tracheal suction
230
indications of tracheostomy
upper airway obstruction long term airway management helps ventilator weaning
231
to facilitate/improve speech allows increased volumes of air to be forced up through the larynx during exhalation to improve swallow function - restoring more normal airflow restores some of the protective mechanisms of normal swallow
fenestrated "talking trach"
232
suction technique involves single use suction catheters
open
233
techique utilizes a catheter in sleeve device that is incorporated into the ventilator tubing
closed
