Acute Care Flashcards
(235 cards)
1
Q
IPPA: Inspection –> Head
A
- Facial expressions
- Orientation level: who, what, where
- Speech: slurred, SOB,
- Skin: pallor, cyanosis, scars
- Lips: colour, pursed lip breathing
2
Q
IPPA: Inspection –> Neck
A
- Accessory muscle use
- Apical breathing
3
Q
IPPA: Inspection –> Chest
A
- Scars
- Chest wall deformities: barrel chest, pigeon chest, kyphosis, scoliosis
- Muscle wasting
- Type of breather: apical, diaphragmatic, accessory muscle use, intercostal indwelling
- Chest movement/breathing pattern: normal is 12-20
4
Q
Types of Breathing: Eupnea
A
Normal
5
Q
Types of Breathing: Tachypnea
A
Abnormally rapid breathing
6
Q
Types of Breathing: Hyperpnea
A
Increased depth and rate of breathing
7
Q
Types of Breathing: Bradypnea
A
Abnormally slow breathing
8
Q
Types of Breathing: Apnea
A
Pauses in breathing
9
Q
Types of Breathing: Cheyne Stroke
A
Hyperpnea and then apnea
10
Q
IPPA: Inspection –> Limbs
A
- Colour (venous return)
- Clubbing of fingers
- Edema: location and amount
- Cough: weak vs strong, productive vs non-productive
- Sputum: colour, smell, amount, texture
11
Q
Sputum Colour Meaning: Green, brown, white, red/pink, yellow
A
Green and yellow: infection
Brown: old blood
Red/pink: new blood
White: normal
12
Q
IPPA: Palpation –> Chest Wall Expansion
A
- Instruct patient to take deep breaths on inspiration and expiration
- Note differences in thumbs from side to side
- Compare R vs L side
13
Q
IPPA: Palpation –> Anterior
A
- Upper region: thumbs on parasternal border and anchor fingers around shoulder
- Mid region: nipple region
- Lower region: lower ribcage
14
Q
IPPA: Palpation –> Posterior
A
- Upper region: thumbs down sides of spine and anchor fingers around shoulder
- Mid region: at inferior angle of scapula
- Lower region: lower rib cage
15
Q
IPPA: Palpation –> Tactile Fremitus
A
- Feeling vibrations and assessing secretion retention.
- Use ulnar border of both hands
16
Q
IPPA: Palpation –> Tracheal Position
A
- Using two fingers go above jugular notch and finger width on each side should be equal
17
Q
IPPA: Palpation –> Rate
A
- Respiratory rate
- Heart rate
- Blood pressure
18
Q
IPPA: Percussion
A
Pt extends middle finger over intercostal space with left hand and taps middle phalange with right middle finger and listens to sounds
19
Q
IPPA: Percussion –> Sounds
A
Normal: resonant
Dull: consolidation, pleural fluids, pulmonary edema
Hyperresonant: hyperinflation (COPD, acute asthma attack, pneumothorax)
20
Q
IPPA: Percussion –> Locations
A
- Upper: above 2nd rib
- Middle: 4th or 5th interspace, lateral to sternum or spine
- Lower: 9th or 10th interspace
21
Q
IPPA: Auscultation
A
- 11 spots on front, 14 on back
- Directly over skin
- Not over bone
- Breathe in and out through MOUTH
- Slow and deep breaths
- Check for dizziness every 2-3 breaths
- Compare bilaterally
22
Q
Pulmonary Function Tests: Overview
A
Quantitative evaluation to distinguish 2 broad categories of disorders
Static or dynamic lung volumes
23
Q
Pulmonary Function Tests: Tidal Volume
A
- Volume inspired and expired with each normal breath
- Increase in TV during exercise by tapping into IRV and ERV
24
Q
Pulmonary Function Tests: Inspiration Reserve Volume
A
- Maximum volume that can be inspired over the inspiration of a normal (tidal) breath
- Used during exercise 2-3L
25
Pulmonary Function Tests: Expiratory Reserve Volume
- Maximal volume that can be expired after the expiration of a normal (tidal) breath 1L
26
Pulmonary Function Tests: Residual Volume
- Volume that can remain in the lungs after a maximal expiration
- Cannot be measured by spinrometry
27
Pulmonary Function Tests: Inspiration Capacity
- Volume of maximal inspiration (inspiration reserve volume + tidal volume)
28
Pulmonary Function Tests: Functional Residual Capacity
- Volume of gas remaining in lung after normal expiration
- Cannot be measured with static spirometry (because includes residual volume)
29
Pulmonary Function Tests: Vital Capacity
- Volume of maximal inspiration and expiration
- Inspiration reserve volume + tidal volume + expiration reserve = inspiration capacity + expiration reserve volume
30
Pulmonary Function Tests: Total Lung Capacity
- The volume of the lung after maximal inspiration
- Sum of all four lung volumes, cannot be measured statically with spirometry because includes residual capacity
31
Pulmonary Function Tests: Dead Space
- Volume of respiratory apparatus that does not participate in gas exchange
~ 300 mL
32
Anatomical Dead Space
- Volume of the conducting airways
- Approximately 150 mL
33
Physiological Dead Space
- Volume of lung that does not participate in gas exchange
- In normal lungs this equals anatomical dead space
- May be greater in lung disease
34
Force Expiratory Volume in 1 Second (FEV1)
- Volume of air that can be expired in 1 second after maximal inspiration
- Is normally 80% of forced vital capacity
- In restrictive lung diseases both FEV and FVC decrease so the ratio remains greater than or equal to .80
- In obstructive lung diseases, the FEV1 is reduced more than FVC so the ratio of FEV1/FVC is less than .80
35
Simple Spirometry
- Generates flow volume loop
- Measures FVC and FEV1
- Standard measure of pulmonary function
- Can provide graphic representation of numerous pulmonary disorders
36
Arterial Blood Gases: Overview
- Used to assess effectiveness of gas exchange and in the diagnosis of acute respiratory conditions
- Body is always trying to maintain homeostasis
- Trying to keep pH between 7.35 and 7.45
- Changes in acid and base concentrations are buffers to pH stays in range
37
Arterial Blood Gases: Two Systems
1. Respiratory - acute quick response - blowing out CO2
2. Renal - takes a few days - chronic diseases rely on this system
38
Arterial Blood Gases: Bicarbonate HCO3
- Important for buffering
CO2 + H2O <> H2CO3 <> H+ + HCO3
39
Arterial Blood Gases: Normal Values
7.35 - 7.45
When lower = metabolic or respiratory acidosis
When higher = metabolic or respiratory alkalosis
PaCO2 35-45 mmHg
By product of respiration, controlled by ventilation
HCO3 22-28
SaO2 95-100
PaO2 80-100
40
Arterial Blood Gases: Low PaCO2
Respiratory Alkalosis
- Caused by HYPERventilation (blowing off CO2)
- Pain/anxiety, mechanical ventilation, hypoxia (anemia, high altitude, right to left cardiac shunt), meningitis
- Lung disorders: pneumonia, PEm, PEd
- Sensation of dyspnea
- Drugs: catecholamines, theophylline and early stage of overdose
41
Arterial Blood Gases: High PaCO2
Respiratory Acidosis
- Caused by HYPOventilation (retaining CO2)
- Central respiratory depression: drug depression of respiratory center, hypoventilation due to severe obesity, sleep apnea
- Neuromuscular: GBS, myasthenia gravis, muscle relaxant drugs
- Lung or chest wall defects: chest trauma, restrictive lung disease, COPD, aspiration
Upper airway obstruction: laryngospasm, bronchospasm/asthma, carbon dioxide poisoning
42
Arterial Blood Gases: Low HCO3
Metabolic Acidosis
- Caused by increase in H+ or excess loss of HCO3
- Two biggest causes: ketoacidosis and renal failure (kidneys can't filter out H+)
- Loss of HCO3 - severe dirrahea (not able to absorb)
43
Arterial Blood Gases: High HCO3
Metabolic Alkalosis
- Caused by loss of H+ or increased HCO3
- Loss of gastirc acid from vomiting
- Diuretic: hypokalemia (potassium depletion)
- Burns: due to volume depletion
- Antacid overdose (Tums)
44
Arterial Blood Gases: Compensations
- Mechanisms will allow body to retain acids or bases to compensate for the primary acid-base disturbance
- Decrease in pH (acidosis): hyperventilation or reabsorb HCO3 in kidney
- Increase in pH (alkalosis): hypoventilation or retain access H+ in urine
45
Obstructive Lung Disease: Asthma Overview
- Chronic inflammation of airways characterized by variable airflow limitation and airway hyper responses
- Often reversible with bronchodilators
- Triad of asthma: allergies, eczema and asthma
46
Obstructive Lung Disease: Asthma Types
1. Extrinisic: allergic or atopic: specific trigger, usually childhood onset
2. Intrinisic: non allergic: no known cause/trigger, hypersensitivity to bacteria, virus, drugs, cold air, exercise and stress
3. Occupational: exposure of workplace irritants
47
Obstructive Lung Disease: Asthma S/S
- Wheezing
- Breathlessness
- Chest tightness
- Coughing
- Coarse breath sounds
- Accessory respiratory muscle use
48
Obstructive Lung Disease: Asthma Treatment
- Prevent triggers, control pharmacologically
- Exercise: keep patient up right, use inhaler, lean forward and teach pursed lip breathing
49
Obstructive Lung Disease: COPD Overview
- Chronic respiratory condition characterized by progressive airway obstruction that is not fully reversible
- Destruction of pulmonary vascular bed and hypoxic vasoconstriction - leads to pulmonary hypertension and cor pulmonale (right sided heart failure)
50
Obstructive Lung Disease: COPD - Two Types
- Emphysema or Chronic Bronchitis
51
Obstructive Lung Disease: COPD Emphysema
- Parenchymal destruction
- Destruction of air spaces distal to terminal bronchiole which causes merging of alveoli into larger airspace
- Reduced surface area needed for gas exchange
- Loss of airways and capillaries
- Elasticity of alveoli are compromised so airways collapse early and inspired air becomes trapped
- Decreased perfusion, hyperventilation (puts diaphragm at disadvantage)
52
Obstructive Lung Disease: COPD Chronic Bronchitis
- Small airway remodelling
- Productive cough lasting for three months/year for 2 consecutive years
- S/S: long term irritation of the trachea/bronchi, increased mucus production, decreased vital capacity
- Airway wall increases due to inflammation and scarring resulting in smaller airways to move air in, increase in mucus, damage to cilia increase inflection susceptibility, increase in airway smooth muscle contraction can cause increase in bronchoconstriction
53
Obstructive Lung Disease: COPD Affects
- Hyperinflation and gas exchange abnormalities
- Increase in airway resistance and premature collapse of the airway upon expiration - air trapping
- More air enter on inspiration than exits on expiration
- Hyperventilation leads to shorted inspiration muscles
- Alveolar destruction results in poor gas exchange
54
Obstructive Lung Disease: COPD Risk Factors
- Age of onset
- Smoking
- Occupational exposures
- Biomass smoke
- Genetic susceptibility
55
Obstructive Lung Disease: COPD S/S
- Airflow obstruction
- Dyspnea
- Chronic productive cough
- Wheeze
- Frequent exacerbations
- Fatigue
- Muscle weakness
- Deconditioned
56
Obstructive Lung Disease: COPD Diagnosis
- Spirometry is the most important test
- Can do CXR, CT scan, diffusing capacity
57
Obstructive Lung Disease: COPD Treatment
1) Pharmaceuticals: smooth muscle relaxant (bronchodilators) or reduce airway inflammation (corticosteroid)
2) O2 therapy: often used during exacerbations, 2-3 L/min normally good, goal to titrate lowest amount to keep SPO2 88-92%
3) Pursed lip breathing: helps to create back pressure to help keep airways open while exhaling, helps the residual volume decrease (avoid deep breathing exercises?)
58
Obstructive Lung Disease: COPD Oxygen Therapy & Hypercapnic (reasons why)Obstructive Lung Disease:
- Clients are chronically hypercapnic and body has adjusted to this
- If more O2 then more CO2 and can contribute to more of an exacerbation
1) Poor ventilation/perfusion matching: poorly ventilated lung tissue will result in vasoconstriction, added O2 will decrease vasoconstriction so blood now goes to poor ventilation sites and can decreases the amount of CO2 that can be blown out
2) Haldane effect: hemoglobin canes more CO2 in deoxygenated blood so then more O2 then CO2 molecules are forced off hemoglobin, increase in PaCO2 in blood
3) Reduction in hypoxic drive: response to breathe when CO2 levels are high are blunted in COPD populations, low O2 levels tell them to breathe so if more O2 can lead to hypoventilation and CO2 accumulates in the body
59
Obstructive Lung Disease: COPD Pulmonary Function Test
- Increased functional residual capacity
- Increased total lung capacity
- Increased residual volume
- Forced expiratory volume in one second is less than 70% of the forced vital capacity
60
Obstructive Lung Disease: Cystic Fibrosis Overview and Cause
- Autosomal, recessively inherited genetic disorder
- Abnormality in chloride (Cl-) and sodium (Na+) ion that transports across the epithelium of the respiratory, digestive and genetial tracts
- Results in THICK MUCUS and scarring and formation of cysts in affected body organs
61
Obstructive Lung Disease: Cystic Fibrosis: Testing
- Family history, 2 copies of abnormal genes
- Sweat test: checking for Cl-
- Obstruction on lung function test
- Chest wall x-ray: linear opacities, thickened bronchial walls, consolidation due to atelectasis
62
Obstructive Lung Disease: Cystic Fibrosis: Clinical Presentation
- Respiratory symptoms are most common: recurrent chest infections, consolidation, atelectasis and thickening bronchial walls + breathlessness in later stages
- Finger clubbing
- Delayed puberty and skeletal maturity
- Infertility in males and reduced fertility in females
- Symptomatic steatorrhea (thickened fatty stools) due to pancreas dysfunction
- Diabetes
- Liver disease
- OP
- Chronic bacterial infections and progressive loss of lung function which leads to resp failure and ear;y death
63
Obstructive Lung Disease: Cystic Fibrosis: Medical Treatment
- Bronchodilators
- Aggressive antibiotics to treat infections
- Oxygen supplementation
- Lung transplants are common
64
Obstructive Lung Disease: Cystic Fibrosis: PT Treatment
- Airway clearance techniques
- Exercise: posture, strength and endurance
- Secretion removal (2-3x a day) - can time with bronchodilator use
65
Obstructive Lung Disease: Bronchiectasis: Overview
- Irreverisble destruction (necrosis) and DIALATION of the airways associated with chronic bacterial infection
- Excess mucus production results in narrowed airways
- Hx of repeated respiratory infections
- Can be caused by CF, TB, and endobronchial tumors
- Eventually alveoli are replaced with scar tissue due to chronic inflammation
- Auscultation: coarse crackles over affected lobes
- Treatment: bronchodilators, antibiotics, regular secretion clearance techniques
66
Restrictive Pulmonary Disease: Overview
- Interstitial lung disease
- Characterized by a loss in lung compliance: stiff and less compliant lungs (not airways)
- Can be due to intrinsic or extrinsic factors
- Disorders that are intrinsic typically have an increase in scarring (pulmonary fibrosis)
67
Restrictive Pulmonary Disease: S/S
- Dyspnea
- Severe O2 desaturation
- finger clubbing
- Dry/painful cough
- Rapid/shallow breathing
68
Restrictive Pulmonary Disease: Lung Function Test
- Small lung volumes = decrease in FEV1 and FVC (ratio will appear normal)
69
Restrictive Pulmonary Disease: Treatment
- O2 therapy, lung transplant. pulmonary rehab
70
Restrictive Pulmonary Disease: Intrinsic Causes
- Pulmonary fibrosis, no known cause, TB: inhaling harmful chemicals, radiation therapy, meds
- Idiopathic pulmonary fibrosis: scarring and fibrotic tissue
- Sarcoidosis: granulomatous (accumulations of macrophages that form nodules)
- Asbestosis: caused by inhaling harmful chemicals
- Pneumoconiosis (coal workers lung)
71
Restrictive Pulmonary Disease: Extrinsic Causes
- Neuromuscular: muscle weakness results in decreased respiratory muscle strength and reduced vital capacity and chest wall becomes stiff due to shallow breathing
- SCI lesion, polio, GBS, ALS
- Connective tissue disorders: immobility of joints
- Ankylosis spondylitis, RA
- Kyphosis
- Obesity
72
Pleural Effusion: Overview
- Accumulation of fluid in the pleural space due to disease which can impair breathing by limiting expansion of lungs
73
Pleural Effusion: 2 Types
- Transudate: high fluidity and low protein (thin and clear fluids), commonly due to heart failure
- Exudate: low fluidity and high protein/cells (thick pus and opaque), formation of fluid due to inflammation of pleura, caused by infection, disease (cancer)
74
Pleural Effusion: S/S
- SOB
- Chest pain
- Percussion: dull
- Ausculation: decreased or ABSENT breath sounds, may hear a pleural rub
- Chest Xray: may cause mediastinal shift to opposite side
75
Pleural Effusion: PT Treatment
- Chest tube drainage, deep breathing, segmental breathing, breath stacking
- NO CHEST SECRETION CLEARANCE - fluid is not in airways
76
Pulmonary Edema: Overview/Causes
- Increased fluid in extravascular spaces of the lungs
- Increased fluid in interstitial space
- Can initially occur only in interstitium and then progress to alveolar spaces
- May be due to: increased hydrostatic pressure due to heart failure or kidney failure OR increased alveolar permeability due to damage of the alveolar epithelium (drug-induced, ARDS, inhalation of noxious gas)
77
Pulmonary Edema: Medical Treatment
- Oxygen, MV, vasodilators, diuretics to decrease fluid overload
78
Pulmonary Edema: PT Treatment
- Deep breathing, breath hold/staking to allow for more O2 diffusion
- NO CHEST PT
79
Pulmonary Edema: S/S
- Presents as stiffer lungs
- Increased work of breathing and dyspnea
- Classic sign: cough that produced a frothy pink-tinged sputum
- Percussion: dull
- On auscultation: FINE CRACKLES, wheezing --> secretions are in the conducting (alveoli) and between alveoli (interstitial space)
- Chest X-ray: fluffy-looking white areas
80
Acute Lung Disease: Pneumonia: Cause
- Acute inflammation of the lungs in which some or all of the alveoli are filled with fluid or cells
- Normally airborne pathogens
- Leading cause of death from infection and 6th most common cause of death overall in Canada
- Hospital-acquired (nosocomial) pneumonia has a higher mortality rate than community-acquired pneumonia
81
Acute Lung Disease: Pneumonia: Types
1. Inhalation: bacteria, viral, fungal, toxic
2. hemotogenous: occurs more often in immunosuppressed people
3. aspiration: common in patients with swallowing disorders --> supine body position increase risk
82
Acute Lung Disease: Pneumonia: Risk Factors
- Exposure to infectious agents
- Aspiration
- Impaired consciousness
- Alcohol abuse
- Post surgery
- Very old/very young/immunosuppressed
- Most are preceded by an upper respiratory infection followed by sudden and sharp chest pain
83
Acute Lung Disease: Pneumonia: S/S
- Coughs up green sputum
- Dyspnea, tachypnea, pleuritic pain, fever
- Dull sounds
- Presentation: typical - sudden onset, bacterial infection most common, fever, sputum, physical signs of consolidation... atypical - walking pneumonia - few symptoms, little sputum, minimal chest signs
- Auscultation: bronchial breath sounds (due to consolidation), decreased air entry over affected lobe, may have coarse crackles
84
Acute Lung Disease: Pneumonia: Treatment
- Poor gas exchange: deep breathing, positioning
- Pain from coughing: splinted coughing
- Secretion retention: mobilize, coughing, huffing, ACB
- Decreased mobility: bed exercises, mobilize, upright as much as possible
- Active infection: antibacterial/antibiotics/antifungal
- Prevent: vaccine, mobility, prevent aspiration (HOB 30)
85
Acute Lung Disease: Atelectasis: Causes
- Collapse of normally expanded and aerated lung tissue at any structural level involving all of part of lung
1. Blockage of bronchus/bronchiole: lung is prevented from expanding due to mucous or airway obstruction
2. Compression which prevents alveoli from expanding due to pneumothorax, pleural effusion, tumour
3. Post-anesthetic effects: breathing at low lung levels
4. Poor ventilation: due to paralysis, diaphragmatic disorders, hypoventilation
86
Acute Lung Disease: Atelectasis: S/S
- Dyspnea, tachypnea, cyanosis
- CXR: shifting of lung structures towards collapse
- Percussion: dull
- Auscultation: decreased breath sounds, fine crackles
87
Acute Lung Disease: Atelectasis: Treatment
- Suctioning/secretion removal techniques if due to secretion
- Chest tube if due to pneum/hemothorax or excessive pleural effusion
- Positioning, mobility, breathing exercises
88
Acute Respiratory Distress (ARDS): Overview
- Acute respiratory failure with severe HYPOXEMIA as a result of a pulmonary or systemic problem
- Lung injury with increased permeability of alveolar capillary membrane
- Leakages of fluid and blood into lung interstium and alveoli
89
Acute Respiratory Distress (ARDS): Risk Factors
- Severe trauma
- Aspiration
- Embolism
- Indirect: happen with viral infection or pneumonia
90
Acute Respiratory Distress (ARDS): S/S
- WHITE OUT on x-ray
- Increased RR
- Shallow breathing
- Severe dyspnea
- Cynosis
- Accessory muscle use
91
Acute Respiratory Distress (ARDS): Treatment
- PEEP to keep airways open
- Tackle underlying cause
- PRONE positioning
- Intubation and ventilation assistance
- Secretion clearance if needed (manual or mechanical vibration)
92
Acute Respiratory Distress (ARDS): Proning
- There are more surfaces available for gas exchange posteriorly
- When in supine, the posterior parts of the lungs are compressed
- Posterior lungs are better able to contribute to gas exchange - open up closed alveoli
93
Infant Respiratory Distress Syndrome
- Occurs in infant whose lungs are not fully developed
- Lack surfactant (helps lungs inflate with air and keeps sacs from collapsing)
- Risks: prematurity, c-section, multiple babies, blue baby, stop breathing, grunts
- Treatment: deliver artificial surfactant
94
Severe Acute Respiratory Syndrome
- Viral respiratory illness
- Unlike the flu, the patient will get pneumonia if they have SARS
95
Lung Abscess: S/S
- Purulent and foul-smelling sputum
- Cough
- Fever
- Chest pain
96
Lung Abscess: Treatment
- Prolonged antibiotic use
- Drainage of abscess
- Deep breathing exercises
- Supplemental O2
- Mobility
- Secretion removal
97
Tuberculosis: Overview
- Infection
- Inflammatory, systemic disease that affects lungs and may disseminate to involve kidneys, growth plates, meninges, avascular necrosis of hip joint, lymph nodes and other organs
- Spread through airborne droplets
98
Tuberculosis: S/S
- Productive cough 3+ weeks
- Wt loss
- Fever
- Night sweats
- Fatigue
- Bronchial breath sounds
99
Tuberculosis: Management
- 10 different drugs approved to treat
- Private negative pressure room
- PT can provide percussion and postural drainage
- Self protection
100
Chest Trauma: Pneumothorax
- Collapse of the lung due to air gathering in the pleural space
- Can be spontaneous, due to lung disease or due to a trauma
- Sudden chest pain and SOB
- Percussion: hyper-resonant
- Chest x ray: hyper lucent lung, mediastinal shift AWAY from side of pneumothorax
- Decreased breath sounds
- Tension pneumothorax can be quickly fatal, increases pressure on heart can cause it to stop beating
101
Chest Trauma: Hemothorax
- Collapse of lung due to blood gathering in the pleural space, usually due to trauma
- Diminished breath sound
102
Chest Trauma: Flail chest
- Multiple rib fracture with a free floating rib section
- On inspiration: flail segment sucks in --> lung, heart, mediastinum, shift away, reducing air entry into the unaffected lung
- On expiration: flail segment pushes outwards --> lung, heart, mediastinum push towards flail segment
- Results in inefficient ventilation and poor oxygenation
- Treatment: pain control, airway clearance, oxygen, intubation and ventilation if needed
103
Cardiovascular Diseases: Valvular Heart Disease
- Stenosis or fusion of valve leaflets --> valves fail to open completely which impedes forward-flow
- Regurgitations (insufficiency) --> valves fail to close in systole --> reverse blood flow
- Aortic and mitral valves are most commonly involved
104
Cardiovascular Diseases: Dilated Cardiomyopathy
- Increased mass of the heart leading to pumping difficulty (can fill but can't contract) so blood backs up into pulmonary circulation
- Most common type
- Stagnant blood increases risk of clotting
- Risk factors: increased volume of pregnancy, chronic alcohol use, chemo
105
Cardiovascular Diseases: Hypertrophic Cardiomyopathy
- Increased mass of heart with thickening of the ventricular wall
- Abnormalities in filling (limited due to stiff tissue)
- Genetically determined
- May lead to sudden cardiac death in young adults
- S/S: asymptomatic, angina, dyspnea, sudden death
106
Cardiovascular Diseases: Cardiac Tamponade
- Compression of the heart to blood or fluid accumulation in the pericardial sac
- May occasionally be the result of a puncture wound through the heart during procedure
- S/S: small decrease in systolic BP, low cardiac output (hypotension, shock, death), jugular vein distension, muffled heart sounds
107
Cardiovascular Diseases: Arteriosclerosis
- Stiffening of the arteries = thickening = reduced elasticity
- Artery wall thickens due to accumulation of atheroma's (WBCs + cholesterol + trigylercides)
- Weakened underlying artery
- At risk for: heart attack, stroke, aortic aneurism
108
Cardiovascular Diseases: Aortic Stenosis
- Calcification due to age or lipid accumulation
- Causes: heart murmur, hypertrophy, angina, syncope
109
Cardiovascular Diseases: Anerusim
- Localized abnormal dilation of the wall of a blood vessel --> may rupture
- Causes: atherosclerosis, trauma, congenital defects, infection
- MOST COMMON: abdominal aortic aneurism (AAA)
- False aneurism: breach in the vessel but still contained within the vessel
110
Heart Failure: Congestive Heart Failure
- Heart unable to pump blood at rate required by tissues of the body OR able to but at elevated filling pressures
- S/S: breathlessness, abnormal retention of sodium + water, edema w/ congestion of lungs OR peripheral circulation OR BOTH
- Rx: underlying causes, lifestyle modification, pacemaker
111
Heart Failure: Congestive Heart Failure: Types
1. Systolic: deterioration of contractile function
2. Diastolic: can't accommodate ventricular blood volume
112
Heart Failure: Left Sided Heart Failure (Congestive Heart Failure)
- Major causes: ischemic heart disease, hypertension, aortic and/or mitral valve disease, myocardial disease
- Result: damming in the pulmonary circulation
- S/S: SOB when lying, nocturnal gasp of breath when sleeping, decrease kidney and dyspnea, exertional dyspnea, pulmonary congestion --> cough, crackles, wheezes, pink sputum
- Pulmonary edema - causing dyspnea
- If recieve transplant --- keep BORG 11-13
113
Heart Failure: Right Sided Heart Failure: Cor Pulmonale
- Major causes: left-sided heart failure, chronic severe pulmonary hypertension (COPD, emphysema), infarct
- Result: damming of the blood in systemic and portal venous systems
- S/S: decrease flow to periphery, pitting edema, congestion of portal system (liver damage), kidney and brain issues, fatigue, weak
- Blood backs up on systemic circulation
- Cor Pulmonale: enlargement and failure of the RIGHT side of the heart due to chronic severe pulmonary hypertension
114
Cardiovascular Diseases: Ischemic Heart Disease
- Myocardial ischemia
- S/S: angina, MI, sudden cardiac death 90% due to atherosclerosis
115
Cardiovascular Diseases: Angina Pectoris
- Paroxysmal (sudden attack, short and frequent) recurrent episodes of chest discomfort
- Causes: transient ischemia of heart muscles --> due to obstruction and/or spasm of coronary arteries
- Can be stable (predicable, during hard work), unstable (more serious, not relieved by rest), prinzmetal (variant angina) occurs at rest
- Treatment medication, lifestyl modifications and risk reduction
116
Myocardial Infarct
- Blood stops flowing properly to part of heart muscles --> injury due to lack of O2
- Coronary artery to heart develops blockage due to unstable atheromas (WBCs, cholesterol + triglyercides)
- Most commonly LEFT VENTRICLE due to occulusion of the left coronary artery
117
Myocardial Infarct: Risk Factors
- Modifable: Smoking, diabetes, high cholesterol, HTN, obesity, left ventricle hypertrophy
-Non-modifable: age, genetics, gender
118
Myocardial Infarct: S/S
- Sudden chest pain
- L UE/neck pain
- May have: SOB, sweating, nausea, vomiting, abnormal heartbeats, anxiety
- M>F having symptoms
119
Myocardial Infarct: Treatment
- Asprin
- Nitroglycerin
- Angioplasty - open artery
- Thrombolysis - blockage removed w/ meds
- Bypass surgery (espeically with DM or multiple blockages) CABG
- PT Treatment: upper limb exercise depends on S/S RPE < 13, HR < 120 or resting HR plus 20 bpm
120
Lung Cancer: Overview and Types
- Can be caused by smoking or environmental exposures
1. Small cell (20-25%): develops in bronchial cell mucosa, spread rapidly (metastasized early)
2. Non-small cell: squamous cell (spread slow, arise in central portion near hilum, meta late), adenocarcinoma (35-40% - slow to mod spread, early meta to lungs, brain and organs), large cell (rapid spread, wide spread metas, kidney, liver, adrenals, poor prognosis)
121
Peripheral Arterial Disease
- Account for 95% of arterial occlusive diseases
- Underlying cause = atherosclerosis
- S/S: occur distal to site of narrowing or obstruction, intermittent claudication, acute ischemia (pallor, pain, paralysis, pulseless), ulceration and gangrene, skin (shiny, thin, hairless)
- Often occurs in feet
122
Peripheral Vascular Disease
- Underlying cause = atherosclerosis
- Obstruction of blood vessels supplying extremities + major abdominal organs
- Iliac, femoral and popliteal arteries in the legs
- Feel pain DURING physical activity
- S/S: intermittent claudication, decrease pulse, ulcers, cool skin, limited mobility, pain or loss of function of limb
- Walking program for IC: 5 minute warm up and cool down, short duration 2-3x a day, walk to maximum tolerable pain, resume ambulation once symptoms pass
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Peripheral Arterial Disease VS Chronic Venous Insufficiency
Feeling of skin:
PAD - cool to touch; CVI - warm to touch, swelling, fever
Colour and texture:
PAD - paler, shiny, thin, hairless; CVI - bluish/brownish, darker, thicker
Upon palpation:
PAD - pulses decreased or absent; CVI - dull ache, tightness, pain
PAD - Superficial ulcers (normally around lat mall) and paresthesia
CI- Venous statis ulceration over med mall
124
Thrombophlebitis
- Partial or complete occlusion of a vein by a thrombus with secondary inflammation
- Superficial or deep
- Phlebitis: inflammation of a vein, usually in leg
125
Deep Vein Thrombosis
- Can become pulmonary embolism
- S/S: tender calf, fever, dull ache, swelling, pain with DF
- Homan's sign: passive DF +ve = pain
- Risk factors: venous statis, venous drainage, hypercoagulability, trauma/surgery, pregnancy, obesity, cancer, smoking, genetic susceptibility
- Medical team could use Doppler Ultrasonography
- Medically treated by Heparin and Warfarin
126
Deep Vein Thrombosis: PT Treatment
- Ankle pumps, ambulation, bed mobility, AROM, PROM
- Mobilization depends on when medication has been administered to patient - check with doctors
127
Pulmonary Embolism
- Any thing that is lo in blood vessels (thrombus, air bubble, plaque)
- S/S: bloody sputum, dyspnea, increased respiratory rate, cyanotic, tachycardia, new chest pain, decreased O2 saturation
128
Pulmonary Embolism Treatment
- Early bed exercises and mobilization
- When a PE is suspected: breathing exercises, oxygenation, check with doctor
- Exercise won't make PE worse
- PE/DVT: no contraindications to basic stretching or strengthening, clot takes months to reabsorb, no high intensity or contact sports
129
Chronic Vein Insufficiency
- Inadequate venous return over a prolonged period
- Causes = DVT, trauma, obstruction
- Effect = damaged or destroyed valves lead to a venous statsis, progressive edema, thickening brown skin (blood pooling) and ulcers
- Rx: compression and/or elevation of limb
130
Varicose Veins
- Faulty valves cause abnormal dilation of veins
- Twisting and turning of veins
- At risk of thrombosis
131
4 Moments of Gand Hygiene
1. Before initial patient/patient environment contact
2. Before aseptic procedure
3. After body fluid exposure risk
4. After patient/patient environmental contact
132
Donning PPE
- Perform hand hygiene
- Put gown on
- Put on mask or N95
- Put on gloves
133
Doffing PPE
- Remove gloves
- Remove gown
- Perform hand hygiene
- Remove eye protection
- Remove mask or N95
- Perform hand hygiene
134
Mechanical Ventilation: Invasive Positive Pressure Types
Intubated with endotracheal (nasal or oral) or tracheostomy
135
Mechanical Ventilation: Non-Invasive Positive Pressure Types
Complete face mask
136
Mechanical Ventilation: Intermittent Mandatory Ventilation
- Ventilator delivers a pre-set number of breaths per minute to the patient
137
Mechanical Ventilation: Pressure Support Ventilation
- Augment spontaneous respiration to decrease WOB
138
Mechanical Ventilation: Ventilatory Options: Positive End-Expiratory Pressure
- Applied to lungs during expiration
- Purpose to expand collapsed small airways and atelectatic alveoli to improve ventilation
139
Mechanical Ventilation: Ventilatory Options: Continous Positive Airway Pressure (CPAP)
- Applied PEEP when breathing spontaneously
- Used to treat sleep apnea
140
Mechanical Ventilation: Hazards of Conventional MV
- Mechanical failure
- Barotrauma (pneumothorax, subcutaneous emphysema)
- Ventilator-induced lung injury
- Pulmonary infection
- Cardiac arrhythmias
141
Mechanical Ventilation: PEEP Hazards
- Increase wasted ventilation (dead space)
- Decrease venous return = decrease cardiac output
- Damage (stress fracture)
142
Mechanical Ventilation: High Frequency Ventilation
- 180-900 breaths/min
- Could lead to: hypotension, pneumothorax, endotracheal tube obstruction
143
Mechanical Ventilation: Signs Pt Not Tolerating Weaning
- Increased tachypnea
- Drop in pH
- Increasing PaCO2
- Paradoxical breathing pattern
- SPO2 < 90%
- Increase HR and BP
- Agitation, panic, diaphoresis, cyanosis, arrhythmia
144
Breathing Exercises: Diaphragmatic Breathing
- Slowed inspiration with relaxed expiration
- Cycles of 3-4 breaths
- 10 reps/hour
- Hands placed on stomach
- Apply counter pressure over the abdomen
- Can combine with maximum end inspiratory hold
145
Breathing Exercises: Lateral Costal Breathing
- Slow inspiration
- Relaxed expiration
- Place hands on rib cage to encourage lateral costal breathing
146
Breathing Exercises: Pursed Lip Breathing
- Primarily used for COPD patients
- Helps blow off CO2, increase tidal volume, reduce respiratory rate, reduce dyspnea
- Breath in thru nose, exhale through pursed lips for twice as long
- Prevents collapse of airways
147
Breathing Exercises: Breath Stacking
- Stacking little breaths on top of each other until max capacity is reached
- Followed by relaxed exhale
- Often used with painful inhale and when there is weakness of the muscles used for breathing
- Used post op with painful breathing
148
Chest PT/Secretion Clearance: Cough
- Ideal for removing secretions
- Often reflexive
- Forceful and can be fatiguing
149
Chest PT/Secretion Clearance: Huffing or Forced Expiratory Technique
- Modified cough
- Huffing is best to remove secretions from smaller airways
- Not as forceful as a cough
150
Chest PT/Secretion Clearance: How to Teach Huff
- Slow deep breath in (hold 2-3 seconds)
- Mouth shaped in O
- Force air through mouth as if trying to fog mirror
- Keep back of throat open
- 2 huff coughs in a row
- Repeat 3-5 times
151
Chest PT/Secretion Clearance: Assisted Cough Indications and Contraindications
Indications: ineffective cough due to loss of neuromuscular function to expiratory muscles resulting in inability to generate sufficient expiratory flow rate, excessive or tenacious secretions
Contraindication: reputed diaphragm, inferior vena cava filter
Special consideration: pregnancy, aortic arch aneusim, cardiac instability, fragile or rigid rib cage, elevated ICP, post-surgical, thorax/spinal trauma
152
Chest PT/Secretion Clearance: Postural Drainage
- Favour gravity directed movement of secretions, used to drain individual segments of lungs
- Maintained for ~10 minutes
- Usually paired with percussion and vibration
153
Chest PT/Secretion Clearance: Postural Drainage: Precautions
- Untreated pneumothorax
- Hemoptysis
- Unstable cardio status
- Increased ICP
- Esophageal anastomosis
- Anursim
- P.E or CHF
- Pt agitated/upset
- Pulmonary emboli
154
Chest PT/Secretion Clearance: Percussions
- Use of cupped hand over affected lobe to shake loose secretions and allow easier sputum production
155
Chest PT/Secretion Clearance: Vibrations
- With palm of hands, vibrations applied over affected lobes during exhalation
156
Chest PT/Secretion Clearance: Rib Springing
- Chest compression followed by over pressure and quick release at end expiration
- Thought to cause a deeper subsequent inspiration
157
Chest PT/Secretion Clearance: Contraindications and Precautions for Percussion/Vibration/Rib Springing
- Fx rib
- Prone to hemorrhage
- Metastatic bone cancer
- Burns
- Increased ICP
- Bronchospasm
- Subcutenous emphysema of neck and thorax
- Poor/unstable CV condition
- Recent skin graft
- Pneumothorax
- Patient upset/agitated
- Tube feed - stop 30 minutes prior to treatment to minimize risk of aspiration
158
Chest PT/Secretion Clearance: PEP Mask
- One way breathing valve with creates resistance
- Keeps airways open allowing air to get behind mucus via collateral airways
- Helps push mucus forward to be secreted
- Patient exhales against resistance
159
Chest PT/Secretion Clearance: Oscillating PEP (Flutter or Acapella)
- Hand held device
- When patient breathes out through the device it oscillates/vibrates the small and large airways dislodging mucus
160
Chest PT/Secretion Clearance: Active Cycle Breathing
- Forced expiration and relaxing breathing
- Mobilized secretions towards upper airway with with huff cough
- Can be used with or without postural drainage positions
- How to: start with normal relaxed breathing, perform diaphragmatic breathing for 30 seconds with 3 second inspiration hold, huff 2-3 times, return to relaxed normal breathing
- Continue for 3-4 cyclesChest PT/Secretion Clearance:
161
Chest PT/Secretion Clearance: Autogenic Drainage (AD)
- Uses controled breahting to alter rate and depth of each breath to help clear secretions
- 3 stages: un-sticking, collecting, evacuating
162
Chest PT/Secretion Clearance: Exercise
- Mobilization helps with secretion clearance
- Individualized program is key
163
Chest PT/Secretion Clearance: Suctioning
- Removal of secretions and mucus from upper airways
- Hyper oxygenate before suctioning
- Only should be 10-15 seconds
- 4 possible passages: indwelling, tracheostomy tube, oropharyngeal, nasopharyngeal
- Indications: pt is unable to clear secretions, loss of airway control, lkung pathology, sputum sample
- Contraindications of nasophayngeal: nasal bleeding, croup, basal skull fracture, acute head/facial injury, CSF leak, nasal stenosis, nasal pathology
164
Respiratoy Failure: Hypoxemic
- Gas Exchange Failure
- Arterial hypoxemia - low blood O2, no increase in CO2
- Ventilation/perfusion mismatch
- Due to: pneumonia, ARDS, obstructive lung disease, pulmonary embolism
165
Respiratory Failure: Hypercapnic
- Respiratory Failure
- Too much CO2 in the blood leads to decreased O2 in blood
- Depression of respiratory center by drugs
- Acute upper/lower airway obstructions (COPD)
- Weak/impaired respiratory muscles
166
Ventilation/Perfusion Ratio: The Basics
- Optimal V/Q matching = 1
- Ventilation: the exchange of gases (O2 and CO2) at the level of the lungs. Exchange of O2 and CO2 in alveoli with external environment
- Perfusion: the amount of blood that reaches the alveoli via the capillaries which enables movement of O2 and CO2 across the alveolar and capillary membrane
167
Ventilation/Perfuction Ratio: Shunt
- Low V/Q ratio
- Alveoli are perfused with blood as normal but ventilation fails to supply perfused region
- COPD
168
Ventilation/Perfusion Ratio: Deadspace
- High V/Q ratio
- Air is inhaled and unable to take part in gas exchange
- Pulmonary embolism, emphysema
169
Breath Sounds: Normal (Vesicular)
- Soft and low pitch
170
Breath Sounds: Diminished or Absent
- Less or no air circulating through the airways
- Causes: pleural effusion, hemothorax, pneumothorax, emphysema, obses/elderly, pulmonary fibrosis, atelectasis
171
Breath Sounds: Bronchial
- Hollow, high pitch, harsh
- Heard when air is travelling through large airways
- Abnormal if heard anywhere else but the trachea
- Causes: consolidation (pneumonia), lobar collapse
172
Breath Sounds: Advenitious: Crackles
- Fine: atelectasis, interstital pulmonary fibrosis
- Coarse: retained secretions
- Early inspiration: diffuse airway obstruction
- Late inspiration: edema, fibrosis, and partial obstruction
173
Breath Sounds: Advenitious: Wheeze
- High/medium: bronchospasm (asthma, COPD)
- Low: retained secretions in larger airways
174
Breath Sounds: Stridor
- Loud muscle sound of constant pitch assoicated with laryngeal or tracheal obstruction
175
Breath Sounds: Pleural Rub
- Creaking leathery sound due to pleural irritation
- Pleural effusion
176
Breath Sounds: Vocal Resonance
- Indicator of lung consolidation
- Whisper: if can hear whisper loud and clear
- Broncophany: 99 or toy boat, greater intensity and clairty
- Egophany: "e" in normal voice is heard as "a"
177
Pulmonary Rehab: Diseases, indicators, intensity
Diseases: COPD, interstitial lung disease, asthma, cystic fibrosis, pre and post lung volume reduction surgery, lung transplant
Indicators: dyspnea that interferes with lifestyle, reduced ability to perform exercise/ADLs/self care
Intensity: SPO2 of 89 or above, BORG 5 or below, no abnormal cardiac signs, no pain, dizziness or headaches
178
BORG Rating of Perceived Exertion
1-10
5 = hard
7-20
12-16 = between 60-80% HRmax
179
Inspiratory Muscle Training: Goals, Patients, Parameters
Goals: improve strength, decrease dyspnea, improve QOL
Patient selection: moderate to severe COPD, people with weak inspiration muscles, not after exacerbation
Training: 30 mins/day, 4-6 days a week, slow progression of resistence levels, continue foreva
180
Anaesthetic: Effects, PT Treatment
Effects: decrease deep breathing, decrease tidal volume, supressed reflexes, decreased respiratory drive, decrease functional residual capacity, increase closing volume, increase respiratory rate
Result in: increased risk of infection, decrease LOC, increased WOB
PT Treatment: improve breathing and mobility --> positioning, suctioning, deep breathing, splinted coughing, percussion, vibration, mobilization
181
Oxygen Therapy: Indications
- SaO2 less than 95% or PaO2 less than 80mmHG
- To decrease WOB
- To decrease myocardial work
182
Fractional Concentration of Inspired Oxygen (FiO2)
- Room air 21%
- 21% of inspired room air is oxygen
183
Low Flow O2 vs High Flow
Low: O2 to an inspired TV (up to 15L/min)
High: provide O2 sufficent to supply entire inspired TV
184
Nasal Prongs
- Low/variable flow
- Supplies 1-6 L/min
- FiO2 24-44%
- Actual FiO2 for a given flow rate is dependent on TV, RR and placement
185
Simple Face Mask
- Low/variable flow
- Supplies 6-10 L/min
- Actual FiO2 for a given flow rate is dependent on TV, RR and placement
- Should NOT be used with flow rates less than 5L/min
186
Partial Re-Breathing Mask
- Supplies 10-15 L/min
- With reservoir bag
- ~40-60% FiO2
- Actual FiO2 for a given flow rate is dependent on TV, RR and placement
187
Non Re-Breathing Mask
- Minimum flow of 10 L/min
- Used in emergencies
- Mask draws O2 from reservoir bag with one way valve that directs exhaled
air out of mask
- Actual FiO2 for a given flow rate is dependent on TV, RR and placement
188
Aerosol or Venturi Face Mask
- Blends O2 with humidity
- FiO2 24-50 L/min
- FIXED & high flow
189
Face Tent
- Used for individuals with poor tolerance for nasal prongs or face mask
190
Tracheostomy Mask
- Used to deliver humidity and oxygen
191
Atrial/Ventricular Septal Defects: General Presentaion
- Fatigue.
- Heart palpitations.
- Inability to exercise.
- Shortness of breath.
- Stroke.
192
Cardiomyopathy: General Presentation
- Disease of cardiac muscles
- SOB, activity intolerance (vauge presentation)
- Muscles are stretched or appear strong (does not do a good job of filling)
193
Endocarditis: General Presentation
- Life-threatening inflammation of the inner lining of the heart's chambers and valves
- High temperature.
- Headaches.
- Shortness of breath, especially during physical activity.
- Cough.
- Tiredness (fatigue)
- Muscle and joint pain
194
Haemophilia: General Presentation
- Unexplained and excessive bleeding from cuts or injuries, or after surgery or dental work.
- Many large or deep bruises.
- Unusual bleeding after vaccinations.
- Pain, swelling or tightness in your joints.
- Blood in your urine or stool.
- Nosebleeds without a known cause.
195
Sickle Cell Disease: General Presentation
- Shortness of breath.
- Wheezing.
- Rapid shallow breathing (tachypnea)
- Cough, which may contain blood.
- Fever.
- Chest or back pain.
- Vaso-occlusive pain.
(Acute Chest Syndrome)
196
Acute Hypoxemia Respiratory Failure: General Presentation
- Shortness of breath or feeling like you can't get enough air (dyspnea).
- Rapid breathing (tachypnea).
- Extreme tiredness (fatigue).
- Fast heart rate or heart palpitations.
- Spitting or coughing blood or bloody mucus
- Excessive sweating.
- Restlessness.
197
Bronchopulmonary Dysplasia: General Presentation
- In infants: problem with how lung tissue develops
- Breathing that is fast or difficult.
- Shortness of breath.
- Pauses in breathing that last for a few seconds
- Nostrils flare while breathing.
- Grunting while breathing.
- Wheezing.
- Skin pulling in between the ribs or collar bones
198
Environmental - Pneumonitis, Silicosis: General Presentation
- P: fever, chills, muscle aches, headache and cough
- S: persistent cough, shortness of breath and difficulty breathing
199
Sarcoidosis: General Presentation
- Fatigue
- Fever
- Inflammation of the eyes and pain, burning, blurred vision, and light sensitivity.
- Night sweats.
- Pain in the joints and bones.
- Skin rashes, lumps, and color changes on face, arms, or shins.
- Swollen lymph nodes.
200
Pulmonary (interstitial) Fibrosis
- Lung disease where lung tissue becomes damaged or scarred.
- Stiff and thickened tissue makes it difficult to breathe
- Symptoms worsen overtime
201
Pulmonary Contusion: General Presentation
- Bruise of a lung, which causes bleeding and swelling
- Chest pain, dyspnea, coughing, and hypoxemia
202
Interstitial Heart Disease
- Heart weakening caused by reduced blood flow to your heart
- Chest pain, especially after physical exertion.
- Dizziness or fainting.
- Heart palpitations, which may feel like your heart fluttering or skipping beats.
- Shortness of breath.
- Swelling in your feet or ankles.
203
Lines: Chest Tube
- Line in chest wall cavity to evacuate air or drain blood or fluid
- Precautions: do not lift above site of insertion, do not lay or roll over chest tube, disconnection can lead to pneumothorax or infection
204
Lines: Foley/Catheter
- Do not lift abouve bladder
- Displacement can lead to inflammation, pain, discomfort
205
Lines: Aterial Line (ART Line)
- Thin catheter inserted into an artery used to directly monitor BP and administer medication and obtain ABGs
- Do NOT dislodge - will result in high pressure bleed
206
Lines: Peripherally Inserted Central Catheter (PICC)
- Thin catheter inserted into arm, leg or neck and positioned in a large vein that carries blood to heart.
- Used long terms for medications
-Have to wait to mobilize before PICC is confirmed by X ray
207
Line: ECG
- Monitor cardiac rhythm and rate
208
Line: NG Tube
- Tube that goes from patient's nose to stomach
- Turn tube feed off before PT treatment
209
Line: G tube and J tube
- Tubes for feeding
- Directly into stomach or intestines
210
Line: Total Parental Nutrition
- Bypasses the GI tract
- Fluids are given into a veain with central venous catheter
211
Line: Lumbar Drain
- Drains CSF
- Helps to reduce ICP, monitor CSF and temporary drainage of CSF
212
Line: JP Drain
- Drain wounds
213
Lines: Patient Controled Analgesic
- Self administered IV opioid
214
Lines: Epidural
- Need placed between vertebrae into epidural space
- DO NOT pull out
215
DO NOT mobilize if...
- Mean Arterial Pressure < 65 or > 110
- BP: drop systolic pressure > 20mmHg or rises >110 mmHg for diastolic
- HR: < 40 or > 130
- Uncontrolled HTN or active bleeding
- Acute or unstable cardiac status
- Pulmonary embolus
- DVT
- SPO2 < 88
- RR < 5 or > 40
- FiO2 > 60%
- Ventilator issues
- Uncontroled asthma
- ICP increase > 20 mmHg
216
Joint Replacement Recommendations
- Encourage AROM, add in end range PROM to improve joint ROM
- Manage inflammation
- Teach walking with aid
217
Hip Replacement Precautions for Post-Lap Approach
- No flexion above 90 degrees
- No IR
- No adduction past midline
- Initially WB as tolerated with walker
218
Knee replacement precautions
- Kneeling
- Deep squating
219
Atherosclerosis
- Slow progressive condition of build up of plaque
- Made up of cholesterol, lipids, calcium
220
Incisional Guidelines: Sternotomy
- No lifting 10lbs below waist and 5lbs overhead for 6-8 weeks
- No pushing with arms to stand
- No pushing or pulling more than 5lbs
- Teach splinting a pillow over insertion
221
Incisional Guidelines: Thoracotomy
- No lifting 10lbs above waist
222
Electrocardiogram (ECG)
- Electral flow of currents in the heart
- P wave: artial depolarization (atria contract and pump blood to ventricles)
- QRS: ventrical depolarization (ventricles contract)
- S-T segment: time where entire myocardium is depolarized
- T wave: ventricle repolarization
223
Orthostatic Hypertension
- Pooling of blood in LE upon standing due to decrease in venous tone
- Less blood returning to heart = decreased cardiac output
- Due to lower CO, heart rate will increase to meet demand
- S/S: light headedness, dizziness, fatigue, blurred vision, muscle weakness, syncope
- Diagnoses: drop in BP measured by SBP > 20 or DBP > 10
- Treatment: optimal position is supine, tilt table is severe, tolerance can be improved by medications, regulary physical activity, being upright and compression stockings
224
Cardiovascular System Terms
- Stroke volume: amount of blood ejected with each stroke
- Cardiac output: amount of blood pumped by heart during one minute... CO = SV x HR
- CO in males = 5 L, in females = 4L
- Blood pressure: systolic - pressure on aterial walls, diastolic - peripheral resistance during relaxion
- SBP will increase as workload increases
- DBP may decrease or stay the same
225
Cardiopulmonary Exercises Testing: Contraindications
- Acute MI
- Unstable angina
- Serious arrhythmias
- Acute pericarditis, endocarditis
- Uncompensated or uncontrolled heart failure
- Severe aortic stenosis
- Uncontrolled asthma
- Acute DVT
226
Cardiopulmonary Exercise Testing: Relative Contraindications
- Significant aterial HTN
- Pulmonary HTN
- Brady/tachycardia
- Moderate valvular disease
- Unstable asthma
- Diabetic with autonomic denervation
227
Cardiopulmonary Exercise Testing: Cessation of Test
- Fall of SBP lower than rating
- SBP > 300 or DBP > 140
- SaO2 less than 85
- Heart instability
- Failure of HR or SBP to rise or fall
- Severe SOB
- Increasing angina symptoms
- Sudden onset of sweating/pallor/cynosis
- Adverse change in pt attitude
228
Cardiac Rehab Program: Goals
Goals:
- Restore optimal function
- Prevent progression of underlying process
- Reduce risk of sudden death and re-infarction
Benefits:
- Reduction in CAD factors
- Improvement in Cardiorespiatory Function
- Improves physical abilities
- Improved mental and emotional capacities
- Improved financial and societal factors
229
Cardiac Rehab Program: RPE
1-2: Warm up
3-4: Target for first 6 weeks
5-6: For some, they can work at his level if symptom free
7-10: Slow down!
230
Cardiac Rehab Program: Prescription + Progression
- Use BORG
- Do not increase more than one variable a week
- 3-5x a week
- Lower resistance, higher reps
- Aware of overexertion
- Avoid: valsalva, extensive upper bodu activity, isometric/static exercise
- Use heart rate reserve if making a calculation
231
Infection Transmission
- Contact (direct or indirect)
- Droplet (cough, sneeze, talks)
- Airborne
- Fecal-oral (contaminated food or water)
- Vector-borne
232
Hand Hygiene
- Before touching patient
- Before clean/aseptic procedures
- After body fluid exposure/risk
- After touching patient
- After touching patient's surroundings
233
Contact Precautions
- NO mask
- YES gown and gloves
- MRSA, VRE, C-diff
234
Droplet Precautions
- YES mask, gloves, gown
- Adenovirus pneumonia, influenza, mumps, whooping cough, rubella
235
Arborne Precautions
- YES N95 mask, gown, gloves
