Acute/Surgical Cardiopulm Patients

Question 1

Chest Tubes

Answer 1

-placed to suction air or fluid
-avoid pulling out, dont tip over, treat as drainage tube
-encourage upright positions, ambulation and deep breathing

Question 2

Anesthesia

Answer 2

-restrictive
-depresses breathing and diaphram contractions (intubation)
-decreases TLC, FRC, RV, lung compliance
-can cause collapse, shunting, atelectasis
-consider time under and O2 given during procedure
-airway obstructions from tubes/fluids

FRC
-causes alveolar collapse in supine

Question 3

PT Intervention Goal

Answer 3

-prevent bedrest issues
-weightbearing activites
-ADLs
-pulmonary toilet/normal breathing
-o2
-family support

Question 4

Incentive Spirometry

Answer 4

-ball rises as patient inspires
-helps inflate the lungs

Question 5

Positive Expiratory Decives: Acapella

Answer 5

-vibratory PEP therapy
-exhale through device and vibrations looses secretions
-10x followed by huffs and a cough

Question 6

Inspiratory Muscle Training

Answer 6

-use if pt can diaphragmatically breath w/o accessory muscles
-90-90-90 positioon, nose clippped, back supported
-lower pressures= weakness

Maximal Inspiratory Pressure:
-expire fully then maximal inspire
-can be used with sniff pressure

Maximal Expiratory: inspire fully then perfoorm maximal expiratory

Question 7

IMP Endurance

Answer 7

-15-20% MIP
-30min/day

Question 8

IMP Strength

Answer 8

-50-60% MIP
-train to failure 25-35 breaths

Question 9

High Frequency Chest Wall Oscillation

Answer 9

-vibration of chest wall to remove secretions

Question 10

Bed Rest Effects

Answer 10

Cardio:
-increased resting HR, risk of DVT
-decreased max HR, Vo2max

Respiratory:
-decreased vital capacity, inpaire toilet, increase V/Q mismatch

Question 11

Abnormal Response to Exercise

Answer 11

-HR increase 20-30 or drop below resting
-SBP increase 20-30 or drop by 10
-Spo2 drop
-High RR, accessory muscles

Question 12

Coronary Artery Bypass Graft

Answer 12

-CABG
-open heart surgery
-place another vessel from one spot to bypass blockage (radial arteries, saphenous veins, mammary arteries)

On pump: extensive, machine pumps for heart

Off pumo: minimally invase

Check:
-hemoglobin, hemocrit, xrays, nurses and drs, temporary pacemakers

Question 13

Sternal Precautions

Answer 13

-limit movement for 6-8 weeks
-gentle coughing
-move “in the tube”: keep arms to the side
-infection control/incision

Question 14

Intra Aortic Balloon Pump

Answer 14

-severe heart failure; shock
-restore CO and perfusion
-inserted in femoral (bedrest) and axillary (might be allowed to exercise) to ascending aorta
-balloon inflates and deflates to increase CO by 40%

Complications: dissectiono, perforation, ischemia, emboli

Question 15

Mechanical Circulatory Support

Answer 15

Bridge to recovery: allow organ to regain function

Bridge to Decision: determine if transplant candidate

Bridge to transplant: keep paitents alive before transplant

Destination Therapy: prolong survival and quality of life

Question 16

Fried Frailty Phenotype

Answer 16

-weight loos, low PA, slow gait, exhaustion, weakness

Question 17

Impella Device

Answer 17

-cathater based ventricular assist device
-increased blood flow from LV to aorta 2.2-6.2 L/min

Question 18

ECMO

Answer 18

-Veno-Arterial Ecmo: supports heart and lungs

-Veno-venous Ecmo: supports lungs

-cannot be turned off by PT

Question 19

LVAD

Answer 19

-Left ventricular assist device
-pump blood from LV to aorta
-has outer controller
-3-10L/m (drop in flow could be pump failure)
-Speed usually fixed (abnormal condition)
-10 Watts
-Pump Index (higher is better LV function

Complications:
-bleeding, infection, MAP

Question 20

Heart Transplant

Answer 20

Indications:
-CHF, Cardiomyopathy, low prognosis

Post op:
-infections, low response to activity, sternal precautions

Denervated heart:
-no ischemic pain
-higher RHR >90
-slower HR changes
-orthostatic HTN

Question 21

Lung Transplant

Answer 21

Single:
-Thoracotomy
Double:
-clamshell

Complications:
-pneumothorax, plural effusion, hypoventilation, phrenic n injury

Denervated Lungs:
-decreased cough reflex, ciliary mmt
-Increased infection risk, edema, mucous