Ultimate Review Pt. 2 Flashcards
common circulatory pulse locations
carotid, brachial, radial, ulnar, femoral, popliteal, post tib, dorsalis pedis
cardiac lab testing
hematocrit, hemoglobin, partial thromboplastin time, platelet count, prothombin time, white blood cell count
hematocrit
percentage of packed RBC in total blood volume.
hemoglobin
iron containing pigment of RBC. function is to carry oxygen from lungs to tissues. used to assess blood loss, anemia, and bone marrow suppression. low hemoglobin=blood loss, high hemoglobin=hemoconcentration caused by polycythemia or dehydration
partial thromboplastin time
used to monitor oral anticoagulant therapy or to screen for selected bleeding disorders. more sensitive than prothrombin time in detecting minor deficiencies.
platelet count
refers to number of platelets per mL of blood. important for blood coagulation, homeostasis, blood thrombus formation. low platelet counts increase risk of bruising and bleeding. high platelet counts increase the risk of thrombosis
prothrombin time
most commonly used to monitor oral anticoagulant therapy or to screen for selected bleeding disorders. examines extrinsic coagulation factors V, VII, X, prothrombin, and fibrinogen
WBC count
refers to number of white blood cells per milliliter of blood. commonly used to identify presence of infection. increase=after hemorrhage, surgery, coronary occlusion or malignant growth
clinical chemistry values
cholesterol: under 200 (LDL 60-180, HDL 30-80). Oxygen= partial pressure (PaO2): 80-100 mm Hg, saturation: 95-98%. pH: arterial blood: 7.35-7.45
ECG
measures electrical activity of heart
P wave
atrial depolarization
PR interval
time required for conduction from SA node to AV node. time btwn atrial and ventricular depolarization. normal .12 to .2 seconds
QRS complex
ventricular depolarization and atrial repolarization
QT interval
electrical systole that is measured by time elapsed from start of Q wave to end of T wave. normally .32 to .40 secs
ST segment
delay before repolarization of ventricles; useful in assessing myocardial ischemia
T wave
ventricular repolarization
depressed QRS
heart failure, ischemia, pericardial effusion, obesity, COPD
ectopic foci
location where abnormal myocardial depolarization originates
elevated QRS
hypertrophy of myocardium
Q wave
previous MI
ST sgmt elevation
acute MI
A fib
irregular atrial rhythm, no rate, no P waves, F waves absent, quivers noted, ventricular rhythm varies. common causes: hypertension, CHF, CAD, rheumatic heart disease, cor pulmonale, pericarditis, drug use
supraventricular tachycardia
rate varies btwn 160-250 bpm, regular rhythm, originates from a location above AV node, will start and stop w/o cause. common causes: mitral valve prolapse, cor pulmonale, digitalis toxicity, and rheumatic heart disease
premature atrial contractions (PAC)
occurs when ectopic focus in atrium fires and supersedes the SA node. P wave is premature with abnormal configuration, rate normal btwn 60-100 bpm, irregular rhythm can be regularly irregular such as consistently skipping every 3rd beat, can be indicative of ischemia or valve pathology. common causes: caffeine, emotional stress, smoking, and pathologies like CAD, electrolyte imbalance, infection and CHF.
ventricular tachycardia (VT)
rate usually above 100 bpm. rhythm usually regular. no P wave or it appears after QRS complex with retrograde conduction. requires immediate medical attention. common causes: post MI, rheumatic heart disease, CAD and cardiomyopathy
v fib
no regular rate or rhythm, emergency, requires immediate medical attention. causes: long term or severe heart disease, post MI, hypercalcemia, hypokalemia, and hyperkalemia.
multifocal v tachycardia
rate over 150 bpm, irregular rhythm, no P waves, QRS complex is wide, requires immediate medical intervention. causes include: hypokalemia, hypomagnesemia, hypothermia, and drug induced through antiarrhythmic medications.
premature v contractions (PVC)
occur when an ectopic focus in the ventricles or Purkinjue fibers fires and supersedes normal conduction. focal PVCs occur from one ectopic foci and have the same waveform. rate is normal between 60-100 bpm, P wave is absent, ST sgmt is distorted, and QRS complex occurs early. irregular rhythm that can be regularly irregular such as consistently skipping every 3rd beat. common causes: caffeine intake, emotional stress, smoking, CAD, digitalis toxicity, cardiomyopathy, and MI.
complete heart block (3rd degree AV block)
regular rhythm, atrial rate is higher than ventricular rate, requires immediate medical intervention (pacemaker). causes include: infection, electrolyte imbalance, CAD, anteroseptal MI, impairment with the AV conduction system.
asystole
no rhythm, absence of P wave, QRS and T waves, can have abrupt onset, requires immediate medical attention. causes: failure of all pacemakers to initiate, conduction system failure, acute MI and ventricular rupture
systole
(upper number bp reading) contraction of cardiac muscle
diastole
(lower number bp reading) relaxation of cardiac muscle
atrial systole
atrial emptying of blood
atrial diastole
atrial filling of blood
ventricular systole
ventricular contraction that causes a rapid ejection of blood (emptying)
ventricular diastole
ventricular filling in combination with atrial contraction
hypertension
elevated arterial blood pressure both for systole and diastole.
korotkoff’s sounds
5 phases - sounds that are heard sounds over an artery when blood pressure is determined by the auscultatory method
bp prep and procedure
values are usually slightly higher in left UE vs. the right UE. inflate cuff to 20 mm Hg above reading where brachial pulse disappears. 1st sound indicates systolic pressure, last audible sound indicates diastolic pressure.
ABI: ankle-brachial index
test that measures arterial perfusion using a Doppler unit. blood pressures are measured in both UEs and LEs and highest LE systolic pressure is divided by brachial systolic pressure.
ABI scale
Normal=1.0. .5-.9=arterial occlusion, impairment with wound healing. less than .5=severe arterial occlusion.
peripheral pulse assessment grading system
0-3 scale: 0=absent, 3+=full, firm pulse. pulse amplitude classification: 0=absent, 1+=diminished thru to 4+=markedly increased
inspiration
to breathe air into the lungs
expiration
to breathe air out of the lungs
normal RRs:
12-18 per minute for adults, 30-50 per minute for infants
METS
metabolic equivalents: amount of oxygen consumed per kilogram of body weight per minute to perform a given activity. at rest a person consumes 3.5 ml/kg/minute.
MET chart
eating=1, dressing=2, light housework=2-4, dancing=4-5
borg’s rate of perceived exertion scale and the revised 10-grade scale
see page 121
left sided heart failure
affects pulmonary
right sided heart failure
causes swelling in extremities
target heart rate
max heart rate is determined by subtracting patient’s age from 220. normal training intensity ranges from 60-90% of age-adjusted max heart rate.
karvonen’s formula: heart rate reserve method
max heart rate is obtained by an exercise stress test and resting heart rate is subtracted from it. number is termed the heart rate reserve.
cardiac rehab indications
MI, angina (stable), CABG, cardiac surgery, high risk for CAD, hypertension, end stage renal disease, status post pacemaker insertion, cardiomyopathy, heart transplant, high risk for diabetes
contraindications to stop exercising during cardiac rehab
heart rate that increases over 50 bpm with low level activity, increasing bp, any ST segment chgs, severe LE claudication, angina, confusion, extreme fatigue, ventricular gallop
contraindications for cardiac rehab
uncontrolled atrial/ventricular arrhythmias, embolism, thrombophlebitis, orthostatic bp, acute infection, unstable angina, resting ST sgmt deplacement, uncompensated CHF
absolute contraindications for treatment of an unstable cardiac patient
third degree heart block, uncompensated CHF, PVCs of vent tachycardia at rest, multifocal PVCs, chest pain with ST sgmt changes, ECG changes that indicate ischemia, dissecting aortic aneurysm
cardiac rehab program
consists of 4 phases. 1st phase averages 3-5 days, 2nd phase 2-12 weeks, 3rd phase 6-8 weeks, 4th phase lasts throughout pt’s lifetime
phase 1
active ROM, ambulation, self care, in inpatient (hospital)
phase 2
begins after hospitalization, monitored closely. 2-3 visits per week. does not require ECG monitoring.
phase 3
continuation of phase 2. exercise training, phys fitness, endurance and risk factor modifications are goals in this phase. once a week visits
phase 4
lasts throughout patient’s life and is designed to promote optimal health. self monitoring of exercise, stable cardiac status, no contraindications to exercise, and at least a 5 MET capacity for activities
therapist’s role during inpatient cardiac rehab
provides constant monitoring of heart rate, blood pressure, and ECG interpretation before, during and after each session, use of exertion scale to identify intensity of exercise, promote proper technique and breathing patterns during exercise, progress activities based on METs tolerated
therapist’s role during outpatient cardiac rehab
initially close monitoring of ECG, heart rate, and blood pressure throughout session is required, constant measurement of vitals, exercise should be gradual in progression, isometrics are contraindicated
ADULT: CPR flow chart
no mvmt-phone 911-open airway, check breathing-if NO breathing, administer 2 breaths that make chest rise. if NO response, check pulse. if pulse, rescue breathing only at 10-12 breaths per minute. if NO pulse, begin CPR with 30 compressions and 2 breaths. continue to perform CPR until medical assistance arrives
Cardiopulmonary ABCs
Airway-maintain open airway. Breathing-rescue (look, listen, feel). Circulation-compressions: check pulse.
aneurysm
weakening in wall of a vessel that produces a sac like area. 50% increase in normal vessel diameter with weakening of all layers of arterial or venous wall. most common sites include aorta, abdominal aorta, femoral, and popliteal arteries. surgical repair prior to rupture has a good prognosis; ruptured aneurysm is a medical emergency with high mortality rate. symptoms: abnormal heart beat, MI, stroke, renal failure, embolization, intermittent or constant pain
angina pectoris
when coronary arteries are unable to supply the heart with adequate oxygen. sudden onset is common once the myocardial oxygen demand is higher than the supply. CAD accounts for 90% of all angina.
nocturnal angina
angina that will wake someone up from sleep
prinzmetal’s angina
occurs while at rest secondary to CAD or spasm. can be severe and not readily relieved by nitroglycerin
stable angina
angina that usually occurs at predictable level of exertion, exercise or stress and responds to rest or nitro.
unstable angina
occurs at rest or with exertion and has changed intensity, frequency, and/or duration
symptoms of angina
temporary pain, sudden onset, pain may radiate, usually lasts one to five minutes, usually relieved with rest or nitroglycerin
atherosclerosis
condition of progressive accumulation of fatty plaques on inner walls of vessels that ultimately produces stenosis. begins in childhood and usually affects medium sized arteries. over time the plaque that produces stenosis inside the vessel can also block blood flow. heart attack or stroke can result from atherosclerosis
cardiomyopathy
group of conditions that affect the myocardium muscle itself, impairing the ability for the heart to contract and relax. 3 types are dilated, hypertrophic, and restrictive. symptoms: same as heart failure, neck vein distension, fatigue and weakness, possible chest pain, sudden death, exercise intolerance
CHF
congestive heart failure: results usually from coronary artery disease when heart is unable to maintain an adequate cardiac output. characterized by abnormal retention of fluid and results in diminished blood flow to tissue and congestion of the pulmonary and or systemic circulation. symptoms: pulmonary edema, dyspnea, cough (nonproductive), S3 gallop, exertional hypotension, weight gain within hours, increased resting heart rate.
CAD
coronary artery disease: narrowing or blockage of coronary arteries that may produce ischemia and necrosis of the myocardium. inability for vasodilation and as a result the arteries cannot meet the metabolic demands. will produce ischemia and ultimately necrosis. CAD includes thrombus, vasospasms, and atheroscelerosis. results from inheritance, environment, culture, nutrition and smoking. symptoms: appear after significant blockage is present, over 75%. pain in occluded artery’s region. if untreated, MI or death.
heart failure
inability of heart to maintain a proper cardiac output of 4 liters per minute while at rest. chronic hypertension is most common cause
infective endocarditis
inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis
MI: myocardial infarction
causes irreversible damage to a segment of heart muscle due to prolonged ischemia. causative factors include narrowing of coronary arteries due to atherosclerotic occlusion, poor coronary perfusion secondary to hemorrhage or occlusion or one of the major coronary arteries.
areas of MI
expected damage: anterior heart-left anterior descending artery, high risk of large infarction, heart failure, sudden death. inferior heart-rt coronary artery, right ventricle damage, AV block, medium infarct possible, lateral heart and/or superior heart-least area of muscle affected, usually least overall damage, minor impairment or complications
myocarditis
uncommon condition of inflammation to myocardium muscle usually due to infection. can be treated with antimicrobial therapy. if left untreated can quickly progress to a dilated cardiomyopathy with heart failure. symptoms: mild, low level chest pain, soreness, fatigue, palpitations
pericarditis
inflammation of the pericardium (outer membrane) of heart. condition may be acute or chronic. can be painful or asymptomatic. can be caused by infection, MI, radiation therapy, post cardiac surgery, aortic dissection. symptoms: auscultation reveals pericardial friction rub, pleuretic chest pain, diffuse ST segment elevation, retrosternal chest pain, cough and hoarseness, fever, fatigue and weakness, joint pain.
rheumatic heart disease
result of damage to heart secondary to inflammation from rheumatic fever. rheumatic fever can occur from strep bacteria and is classified as an autoimmune disease. can affect connective tissues. acute rheumatic fever has a low mortality rate. symptoms: carditis with chest pain, acute onset of polyarthritis, chorea, arthralgias and weakness, fever and palpitations
ped: cystic fibrosis
disease of exocrine glands that primarily affects respiratory and gi systems. cause: mutation of chromosome seven to include cystic fibrosistransmembrane conductance regulator (CFTR). cystic fibrosis is an autosomal recessive genetic disorder and a terminal disease. presents with increased secretion of thick mucus, gi distress, abnormal bowels, recurrent pulmonary infection, salty tasting skin, wheezing, productive cough, barrel chest, dyspnea, and progressive use of accessory muscles with respiration. trtmt includes antibiotics, supplements, pancreatic enzyme replacements, mucus thinning medications, bronchodilators. pt is essential and includes bronchial drainage, percussion, vibration, suctioning, breathing techniques, assisted cough, and ventilatory muscle training for optimal pulmonary function.
ped: patent ductus arteriosus
disorder where ductus arteriosus which normally shunts blood in utero from pulm artery to descending aorta, fails to close shortly after birth. causes: premature birth, respiratory distress syndrome, fetal alcohol syndrome, trisomy 13, and trisomy 18. presents: tachycardia, respiratory distress, poor nutrition, weight loss and congestive heart failure. initial treatment attempts to non surgically reduce the size of the ductus with use of diuretics and indomethacin when indicated. surgical repair may be necessary for a large ductus or when initial management fails.
ped: respiratory distress syndrome
pulmonary condition seen in neonates born before 37 weeks of gestation. rds is also known as hyaline membrane disease and is leading cause of death in the neonate. causes: immaturity of lungs and inability to produce necessary levels of surfactant. results in increased alveloary tension, alveolar collapse, atelectasis, and difficulty breathing. associated factors with rds include being the second born twin, c section delivery, hypoxia and acidosis. presents with: infant working hard to breathe and reinflate collapsed lung. tachypnea, flaring of nostrils, use of accessory muscles and respiratory distress are observed within one to two hours. untreated, the infant lacks oxygen and presents with metabolic acidosis and acute respiratory failure. treatment will vary and can include mechanical ventilation, supplemental oxygen, administration of artificial surfactant, nutritional support, bronchial drainage, and chest physical therapy.
ped: tetralogy of fallot
most common cyanotic heart defect where following four abnormalities exist: ventricular septal defect, right ventricular hypertrophy, aortic override of interventricular septum, pulmonary stenosis.
pharmacological interventions for cardiac management
include diuretic agents, beta-adrenergic blocking agents (betablockers), alpha-adrenergic blocking agents, antiotensin-converting enzyme inhibitor agents (ACE), angiotensin II receptor antagonist agents, nitrates, antiarrhythmic agents, calcium channel blocker agents
normal tracheal and bronchial sounds
loud and tubular sounds with a high pitch noted during inspiration and expiration, pausing between the two components
vesicular breath sounds
normal, soft, low pitched sounds heard over the more distal airways primarily during inspiration. during expiration the soft sound is diminished and only heard during beginning of expiration
abnormal breath sounds
sounds that are heard outside of their normal location or phase of respiration
adventitous breath sounds
abnormal breath sounds heard using a stethoscope with inspiration and/or expiration. these sounds can be continuous or discontinuous sounds
wheeze
continuous adventitious sounds comprised of a musical nature, constant pitch (high or low) and varying duration. usually heard during expiration but may also be present on inspiration. typically a sign of airway obstruction from retained secretions or due to bronchoconstriction. wheezes found with inspiration indicate a more severe airway obstruction
stridor
continuous adventitious sound comprised of a very high-pitched wheeze that can be heard with inspiration and expiration and also indicates upper airway obstruction. stridor that is heard without a stethoscope can indicate an emergency
crackles (formerly rales)
discontinuous adventitious sound heard with a stethoscope that bubbles or pops. crackles typically represent the movement of fluid or secretions during inspiration (wet crackles) or occur from the sudden opening of closed airways (dry crackles). crackles that occur during latter half of inspiration typically represent atelectasis, fibrosis, or pleural effusion. crackles secondary to the mvmt of secretions are usually low-pitched.
bronchial breath sounds
abnormal breath sounds when heard in locations that vesicular sounds are normally present. pneumonia may produce these sounds
decreased or diminished sounds
less audible sound may indicate severe congestion, emphysema or hypoventilation
absent breath sounds
may indicate pneumothorax or lung collapse
voice sounds: egophony:
while auscultating lung segments the patient repeatedly says the letter “e”. if it sounds like an “a” fluid is expected in the air spaces or lung parenchyma.
voice sounds: bronchophony:
patient repeatedly says “99”. if word is clearly audible in distal lung fields the test is positive for consolidation. if word is less audible, softer or weaker sounding, test is positive for hyperinflation
voice sounds: whispering pectoriloquy:
while auscultating lung segments the patient repeatedly whispers words. clearly audible and less audible words indicate the same findings as bronchophony testing.
pulmonary function testing
series of tests to determine pulmonary function
anatomic dead space volume (VD)
volume of air that occupies the non respiratory conducting airways
expiratory reserve volume (ERV)
max volume expired after normal expiration
forced expiratory volume (FEV)
amount of air exhaled in the 1st, 2nd, and 3rd second of a forced vital capacity test
forced vital capacity (FVC)
amount of air forcefully expired after a max inspiration
functional residual capacity (FRC)
volume in lungs after normal exhalation
inspiratory capacity (IC)
amount of air that can be inspired after a normal exhalation
inspiratory reserve volume (IRV)
max volume inspired after normal inspiration
minute volume ventilation (VE)
amount of air expired in one minute. equal to the product of the tidal volume and the RR
peak expirator flow (PEF)
max flow of air during the beginning of a forcd expiratory breath.
residual volume (RV)
lung volume remaining in the lungs at the end of a max expiration
tidal volume (TV)
total volume inspired and expired per breath
total lung capacity (TLC)
lung volume measured at the end of a max inspiration
vital capacity (VC)
max volume forcefully expired after a max inspiration
pulmonary function reference values
a value is usually considered abnormal if it is less than 80% of the reference value
total lung capacity (TLC)=
inspiratory reserve volume (IRV) + tidal volume (TV) = expiratory reserve volume (ERV) = residual capacity (RC)
vital capacity (VC)=
inspiratory reserve volume (IRV) + tidal volume (TV) + expiratory reserve volume (ERV)
inspiratory capacity (IC)=
tidal volume (TV) + inspiratory reserve volume (IRV)
functional residual capacity (FRC)=
expiratory reserve volume (ERV) + residual volume (RV)
typical lung volumes and capacities
…
tidal volume
500 mL
expiratory reserve volume
1000 mL
vital capacity
4000-5000 mL
inspiratory capacity
3000-4000 mL 75-80% of vital capacity, 55-60% of total lung capacity
forced expiratory volumes
…
FEV1 (forced expiratory volume in one second)
83% of VC
FEV2 (forced expiratory volume in 2 seconds)
94% of VC
FEV3 (forced expiratory volume in 3 seconds)
97% of VC
gas pressure
mm Hg: see chart on page 132
arterial blood gases (ABG)
uses as a tool to determine the effectiveness of alveolar ventilation. expressed as the partial pressure of the gas.
PaO2
partial pressure of oxygen within arterial system, usually 95-100 mmHg.
PaCO2
partial pressure of carbon dioxide within arterial system, normally 35-45 mm Hg.
range of acid-base balance or pH
7.35-7.45
hypercapnia
increased amount of CO2 in blood
hyperkalemia
increased amount of potassium in blood
hypocapnia
decreased amount of CO2 in blood
hypoxemia
when PaO2 is less than 80 mm Hg
physical signs observed in various pulmonary disorders
see chart on page 133
respiratory alkalosis
pH is high, PaCO2 is low. caused by alveolar hyperventilation. symptoms: dizziness, syncope, tingling, numbness, early tetany
respiratory acidosis
pH is low, PaCO2 is high. caused by alveolar hypoventilation. early symptoms: anxiety, restlessness, dyspnea, headache. late symptoms: confusion, coma
metabolic alkalosis
pH is high, PaCO2 is normal. causes: bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease. symptoms: weakness, mental dullness, possibly early tetany
metabolic acidosis
pH is low, PaCO2 is normal. causes: diabetic, lactic, or uremic acidosis, prolonged diarrhea. symptoms: secondary hyperventilation, nausea, vomiting, cardiac dysrhythmias, lethargy and coma
pH normal value
7.4
PCO2
40 mm Hg
PO2
97 mm Hg
HCO3
24 mEq/L
% Sat
95-98%
values of metabolic alkalosis
pH greater than 7.45
values of metabolic acidosis
pH lower than 7.35
