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Cardio-Pulmonary > Acute Cardiopulmonary Conditions - CH19 PPT > Flashcards

Acute Cardiopulmonary Conditions - CH19 PPT Flashcards

(71 cards)

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1
Q

what is the first thing needing to be addressed in acute cardiopulmonary conditions

A

pulmonary needs

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2
Q

what factors can contribute to functional loss

A

acute inflammation
severity of illness
marginal baseline function
corticosteroid exposure
neuromuscular blockers
prolonged immobilization

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3
Q

cardiovascular effects due to immobilization

A

increased basal HR
decreased max HR
Ohypotension
increased venous thrombosis risk
decreased total blood volume
decreased hemoglobin concentration

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4
Q

respiratory system effects due to immobilization

A

decreased vital capactiy
decreased residual volume
decreased PaO2
impaired ability to clear secretions
increased v/q mismatch

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5
Q

musculoskeletal system effects due to immobilization

A

decreased strength
decreased muscle girth
decreased effeciency of contraction
joint contractures / ulcers

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6
Q

CNS system effects due to immobilization

A

emotional/behavioral disturbances
intellectual deficit
altered sensation

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7
Q

metabolic system effects due to immobilization

A

hypercalcemia
osteoporosis

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8
Q

indications of airway clearance

A

impaired mucociliary transport
excessive pulmonary secretions
ineffective/absent cough

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9
Q

what happens to phlem when sedated

A

becomes thicker and more difficult to expel

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10
Q

goals of airway clearance

A

optimize airway patency (open airways)
increase v/q matching
promote alveolar expansion
increase gas exchange

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11
Q

simple forms of airway clearance

A

deep breathing
coughing techniques
mobility

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12
Q

explain when alternative airway clearance techniques should be used

A

if one has retained secretions or ineffective cough

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13
Q

what is postural drainage

A

positioning that allows for gravity to assist with draining of secretions from each lung segment

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14
Q

how does the segmental bronchus need to be arranged during postural drainage

A

perpendicular to the floor

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15
Q

explain priority of postural drainage positioning if multiple segments need treatment? explain dosage

A

most affected one
= 5 to 10 min per position

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16
Q

what do we want to encourage during postural drainage

A

deep breathing and coughing between positions

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17
Q

define manual percussion

A

rhythmical clapping with cupped hands over affected lung segments

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18
Q

rules of manual percussion

A

never over bone
never directly on skin
always be able to see face and vitals

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19
Q

explain vibration in relation with manual percussion

A

begin at the end of deep inspiration and oscillates through end of expiration

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20
Q

what does an effective cough consist of

A
  1. inspiration greater than tidal volume
  2. closure of glottis
  3. positive intrathoracic pressure via contraction of abdominals/intercostals
  4. opening of glottis and expulsion of inspired air
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21
Q

explain what huffing is

A

no, not air duster or paint

upright and stable, patient takes deep breath, holds it and forcefully exhales 2-3 burst of air w/o glottis closure

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22
Q

explain process of mechanical coughing aids

A

deep insufflations followed by deep exsufflations
– may add abdominal thrusts

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23
Q

what is a lavage

A

a saline flush that is intended to loosen mucous

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24
Q

when are therapeutic positioning paired with breathing strategies indicated

A

for those with diaphragmatic weakness/inhibition

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25
explain what we want height of bed to be at
35-45 degrees
26
how to facilitate inspiratory effort
pair inhalation with shoulder flexion, abduction and external rotation and an upward eye gaze
27
how to facilitate exhalation effort
shoulder extension, adduction and internal rotation with a downward eye gaze
28
explain the importance of posterior pelvic tilt
encourages diaphragmatic breathing pattern
29
what does a side-lying position facilitate
pressure on sacrum assists in lung expansion / secretion removal
30
what does prone position facilitate
mobilizing secretions greater volumes of ventilation increased PaO2
31
what does Trendelenburg position facilitate
secretion drainage of the lower lobes of the lung
32
purpose of pursed-lip breathing
decrease pt's dyspnea symptoms slow respiratory rate
33
define paced breathing
voluntary coordination of breathing during an activity
34
when to implement paced breathing
after pursed-lip and diaphragmatic breathing have been taught
35
explain stacked breathing
series of inhalations that build on the previous breath without expiration until max volume tolerate by patient is reached
36
what is diaphragmatic controlled breathing used to manage
dyspnea reduce atelectasis increase oxygenation
37
what is lateral costal breathing used to
address rib cage mobility and intercostal muscles
38
purpose of counter-rotation
increase tidal volume decrease respiratory rate increased thoracic mobility
39
when is inspiratory muscle training indicated
pt with decreased strength or endurance of diaphragm/intercostal muscles
40
goal of inspiratory muscle training
increase ventilatory capacity decrease dyspnea
41
what is the normal max inspiration / max expiration pressure
in = -80 cmH2O ex = 80 cm H2O
42
what should initial dosage be for inspiratory muscle training in those with COPD
30-40% of max inspiratory pressure 15-30 min a day
43
for those with failure to wean, explain inspiratory muscle trainining dosage
4 sets 6-10 reps @ highest tolerance 2 min breaks w/vent
44
for ICU patients, explain inspiratory muscle training dosage
50% max inspiratory pressure 5-6 sets a day 7x a week
45
for those with an SCI, explain inspiratory muscle training dosage
50% max inspiratory pressure once a day 4-5x a week RPE of 6-8
46
indication for pursed-lip breathing
dyspnea wheezing
47
indication of diaphragmatic breathing
hypoxemia tachypnea atelectasis excess pulmonary secretions
48
indications of lateral costal breathing
asymmetric chest wall expansion localized lung consolidation / secretions asymmetric posture
49
indication of inspiratory hold technique
hypoventilation atelectasis ineffective cough
50
indication of stacked breathing
hypoventilation atelectasis ineffective cough pain uncoordinated breathing pattern
51
indication for paced breathing
low endurance dyspnea upon exertion fatigue/anxiety tachypnea
52
indication for upper chest inhibiting technique
excessive use of accessory muscles during breathing
53
indication for trunk counterrotation techniques
impaired chest wall mobility hypoventilation impaired trunk muscle performance ineffective cough
54
indication of butterfly technique
impaired chest wall mobility hypoventilation impaired trunk muscle performance ineffective cough
55
chest wall stretching indication
impaired chest wall mobility hypoventilation paradoxical breathing impaired trunk performance ineffective cough
56
explain baropressure vs volume pressure damage to alveoli
baro = explosion of alveoli vol = alveoli fracture
57
explain timing of implementing a weaning schedule
if on a vent for more than 2-3 weeks
58
what are the criteria of a weaning protocol
resolution of initial event maximized status afebrile improving CXR manageable respiratory secretions ability to initiate breath spontaneously
59
methods of weaning
intermittent mandatory ventilation timed spontaneous breathing (t-piece) pressure support ventilation
60
explain intermittent mandatory ventilation
turning down/off of the vent, forcing pt to use inspiratory muscles
61
for those that are mechanically vented, what is important early in PT
mobilization - sitting, standing, transfers, walking with monitorization of vitals
62
explain borg scoring we hope to achieve/maintain during acute PT
11-13
63
explain duration exercise in acute care PT
all dependent upon vital response, but aim for intermittent bouts lasting 3-5 minutes
64
goals for acute PT in those with heart failure
reversing exercise intolerance / decreasing subsequent risk of clinical event
65
common exercise interventions for those with HF in acute care
interval walking program monitoring intensity using dyspnea scale strengthening / stretching exercises
66
for those with implantable cardioverter-defibrillators, what is needed before exercise
obtaining: programmed pacemaker modes HR limits ICD rhythm detection algorithms
67
for those with an ICD, what should peak HR be
10-15 bpm below programmed HR threshold
68
common interventions for those post heart transplant
interval walking program strengthening stretching -- all once medically stable
69
explain how to monitor intensity in post-op heart transplant populations
RPE -- HR fluctuations will not be normal -- highest HR during rest and lowest during exercise
70
what are the criteria that indicate progression to standing
when pt can sit bedside for 3-5 min unsupported and can perform knee extensions bilaterally with hemodynamic stability
71
explain interventions for those with an LVAD
can ambulate patient - cannot use HR response as a measure

Cardio-Pulmonary (22 decks)

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