Acute W2 Flashcards
ABG, IPPA (135 cards)
1
Q
What is direct contact transmission?
A
Physical contact between an infected person and a susceptible person, transferring microorganisms.
Includes touching, kissing, sexual contact, and contact with body lesions.
2
Q
What are some examples of frequent touch surfaces that can lead to indirect contact transmission?
A
- Door knobs, door handles, handrails
- Tables, beds, chairs
- Washroom surfaces
- Cups, dishes, cutlery, trays
- Medical instruments
- Computer keyboards, mice
- Pens, pencils, phones, office supplies
- Children’s toys
These surfaces are known as fomites.
3
Q
What does droplet contact transmission involve?
A
Transfer of diseases through droplets contacting surfaces of the eye, nose, or mouth.
Generated by coughing, sneezing, or talking.
4
Q
True or False: Airborne transmission allows microorganisms to remain suspended in air for long periods.
A
True
This type of transmission requires organisms to survive long outside the body.
5
Q
What is fecal-oral transmission?
A
Ingestion of contaminated food and water leading to infection in the digestive system.
Microorganisms multiply in intestines and are shed in feces.
6
Q
What are common vectors for disease transmission (vector-borne)
A
- Mosquitos
- Flies
- Mites
- Fleas
- Ticks
- Rats
- Dogs
Mosquitos are the most common vector.
7
Q
Fill in the blank: Hand hygiene refers to _______.
A
[removing or killing microorganisms on the hands]
8
Q
What are the key moments for hand hygiene according to WHO?
A
- Before touching a patient
- Before clean/aseptic procedures
- After body fluid exposure/risk
- After touching a patient
- After touching patient surroundings
This approach is known as ‘My 5 Moments for Hand Hygiene’.
9
Q
How long should hand hygiene be performed for optimal effectiveness?
A
Min 20s, 45-60 seconds for max effectiveness
This can be done with soap and water.
10
Q
What are the PPe require for droplet precautions?
A
*gloves
Gown
Mask with face shield
## Footnote
These may be combined with contact transmission.
11
Q
What are the PPE requirements associated with airborne transmission?
A
*negative pressure room
N95
Gown
Gloves
Precautions must be in place until lesions dry/crust.
12
Q
What is the correct order for doffing personal protective equipment (PPE)?
A
- Hand hygiene
- Gloves
- Gown
- hand hygiene
- Mask
- Eye wear
Hand hygiene should be performed after removing each item.
13
Q
What should be done to ensure a snug fit when putting on a mask?
A
Form the soft metal strip around the bridge of the nose and secure it with ties or loops.
Ensure the bottom of the mask covers the chin.
14
Q
Fill in the blank: Gloves should be worn _______ the gown.
A
[over the gown]
15
Q
What is the proper technique for removing goggles?
A
Take off from the back, avoiding contact with the front.
Normal eyeglasses are not sufficient for eye protection.
16
Q
What is hypoxemic respiratory failure?
A
Gas exchange failure characterized by arterial hypoxemia without an increase in CO2
Common causes include pneumonia, ARDS, obstructive lung disease, and pulmonary embolism.
17
Q
What is hypercapnic respiratory failure?
A
Ventilation issue resulting in too much CO2 in the blood and decreased O2
Causes include depression of the respiratory center by drugs, airway obstruction, and weak respiratory muscles.
18
Q
Define Ventilation/Perfusion (V/Q) ratio.
A
The ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli
Optimal V/Q matching is equal to 1.
19
Q
What does a low V/Q ratio indicate?
A
A shunt where alveoli are perfused with blood but fail to ventilate
Example: COPD.
20
Q
What does a high V/Q ratio indicate?
A
Deadspace where air is inhaled but cannot participate in gas exchange
Example: Pulmonary embolism, emphysema.
21
Q
What is the normal pH range for arterial blood?
A
7.35-7.45
Deviations can indicate acidosis or alkalosis.
22
Q
What does a low PaCO2 indicate?
A
Respiratory alkalosis
Caused by hyperventilation due to various factors including anxiety and lung disorders.
23
Q
What does a high PaCO2 indicate?
A
Respiratory acidosis
Caused by hypoventilation due to conditions like obesity or CNS problems.
24
Q
What is the normal range for HCO3-?
A
22-28 mmol/L
Low levels indicate metabolic acidosis, high levels indicate metabolic alkalosis.
25
What does it mean if pH and PaCO2 move in opposite directions?
Respiratory disturbance
## Footnote
Indicates a primary respiratory issue affecting acid-base balance.
26
What does it mean if pH and HCO3- move in the same direction?
Metabolic disturbance
## Footnote
Indicates a primary metabolic issue affecting acid-base balance.
27
What is the normal range for PaO2?
80-100 mmHg
## Footnote
Low levels indicate varying degrees of hypoxemia.
28
What is the significance of SaO2?
Percentage of saturation of Hemoglobin (Hb) with oxygen
## Footnote
Normal range is 95-100%.
29
What are common causes of impaired oxygenation?
Decreased inspired oxygen, alveolar hyperventilation, diffusion impairment, shunt, V/Q mismatch
## Footnote
Addressing hypoventilation often involves sputum clearance and eliminating bronchospasm.
30
What compensatory mechanisms does the body use in acidosis?
Increase HCO3- or decrease H+
## Footnote
Hyperventilation can blow off CO2, and kidneys may reabsorb excess HCO3-.
31
What compensatory mechanisms does the body use in alkalosis?
Get rid of HCO3- or retain H+
## Footnote
Hypoventilation helps retain CO2.
32
What is the purpose of IPPA in assessment?
Inspection, Palpation, Percussion, Auscultation are used for a comprehensive physical examination
## Footnote
Each component provides different insights into the patient's respiratory status.
33
What is the significance of Jugular Vein Distention?
Indicates central venous pressure and potential right atrial issues
## Footnote
Assessed by having the patient at a 45-degree angle.
34
What does diminished or absent breath sounds indicate?
Less or no air circulating through the airways
## Footnote
Causes include pleural effusion, pneumothorax, and atelectasis.
35
What is the BORG Rating of Perceived Exertion Scale?
A scale from 1 to 10 used to assess exercise intensity
## Footnote
A score above 5 indicates high exertion.
36
What is the effect of prolonged antacid use?
Potential metabolic alkalosis due to excess HCO3-
## Footnote
Example: Loss of gastric acid from vomiting.
37
What are the signs of respiratory distress during inspection?
Tachycardia, tachypnea, changes in facial expression, and use of accessory muscles
## Footnote
Observations can indicate the severity of the respiratory condition.
38
What does crackles indicate in lung auscultation?
Discontinuous sound associated with conditions like atelectasis and retained secretions
## Footnote
Fine crackles may indicate interstitial pulmonary fibrosis.
39
What is the significance of vocal resonance tests?
Assessing for lung consolidation
## Footnote
Techniques include whispered pectoriloquy and egophony.
40
What is a common indication for pulmonary rehabilitation?
Dyspnea that interferes with lifestyle
## Footnote
Conditions include COPD, asthma, and post-surgery recovery.
41
What is an indication of lung consolidation?
Presence of pulmonary abnormalities
## Footnote
Lung consolidation may suggest conditions like pneumonia or other pulmonary infections.
42
What are some diseases included in pulmonary rehab?
* COPD
* Interstitial lung disease
* Asthma
* Cystic fibrosis (CF)
* Pre and post Lung Volume Reduction Surgery (LVRS)
* Lung transplant
43
What are indicators for pulmonary rehab?
* Dyspnea that interferes with lifestyle
* Reduced ability to perform exercise/ADLs/self-care
44
What should SpO2 levels not fall below during exercise in pulmonary rehab?
88%
45
What is the maximum BORG scale rating during exercise?
5
46
What are the symptom criteria for exercise in pulmonary rehab?
* No abnormal cardiac signs
* No pain, nausea, dizziness, headache
47
What does the BORG Rating of Perceived Exertion Scale measure?
Perceived exertion during exercise
48
What is the scale range for the BORG Rating of Perceived Exertion?
1 to 10 scale
49
What does a BORG scale rating of 5 indicate?
Hard exertion
50
What heart rate percentage corresponds to the BORG scale range of 12-16?
60-80% HRmax
51
What are the goals of inspiratory muscle training?
* Improve inspiratory muscle strength
* Improve endurance
* Decrease dyspnea
* Improve quality of life and exercise tolerance
52
Who are the ideal candidates for inspiratory muscle training?
* Patients with moderate to severe COPD who are medically stable
* People with weak muscles of inspiration
53
When should inspiratory muscle training not be used?
During acute exacerbation or right after an exacerbation
54
What are the training parameters for inspiratory muscle training?
* 30 minutes per day (may be spread out in 2-3 sessions)
* 4-6 days a week
* Slow progression of resistance levels
* Indefinitely for continued benefit
55
What are the effects of anaesthetic on respiratory function?
Atelectasis,
Decreased deep breathing, decreased tidal volume (TV), decreased respiratory drive, decreased functional residual capacity (FRC), increased closing volume, increased respiratory rate, suppressed reflexes (cough)
56
What are the effects of anaesthetic on cardiac function ?
Increased risk of MI & ischemia, hypo/hypertension, hypovolemia, dysrhythmias
57
What are the main goals of physical therapy treatment after anaesthesia?
Improved breathing and mobility.
- positioning, suctioning, deep breathing, splinted coughing, mobilization
58
What are the indications for oxygen therapy?
SaO2 less than 95%, PaO2 less than 80mmHg, to decrease work of breathing, to decrease myocardial work.
59
What is the fractional concentration of inspired oxygen (FiO2) for room air?
21%.
60
What are the types of oxygen delivery systems and what volumes can they go to?
* Nasal prongs: 1-6 L/min, FiO2 24-44%
* Simple mask: 6-10 L/min
* Partial re-breathing mask: 10-15 L/min
* Non re-breathing mask: Minimum flow of 10L/min
* Aerosol or Venturi face mask
* Tracheostomy mask.
61
What is the blood flow path through the heart?
Superior & Inferior Vena Cava --> R atrium --> Tricuspid Valve --> R ventricle --> Pulmonary valve --> lungs --> L atrium --> Mitral Valve --> L ventricle --> Aortic Valve --> Ascending aorta.
62
What is the normal pulse rate range?
60-100 bpm.
63
Define arteriosclerosis.
The thickening, hardening, and stiffening of arterial walls.
64
What is atherosclerosis?
A form of arteriosclerosis characterized by narrowing of arteries due to plaque buildup.
65
What can atheroma consist of?
* Cholesterol
* Lipids
* Calcium.
66
What are the consequences of atherosclerosis?
* Heart attack
* Stroke
* Aortic aneurism
* Peripheral vascular disease (PVD).
67
What is congestive heart failure (CHF)?
Inability of the heart to pump sufficient amounts of oxygenated blood to meet body demands.
68
What are the signs and symptoms of right-sided heart failure?
* Peripheral edema
* Shortness of breath
* Weakness/fatigue.
* jugular venous distension
* kidney & brain issue d/t Dec perfusion
69
What are the causes of left-sided heart failure?
* Diastolic dysfunction - ventricle does not relax completely
* Systolic dysfunction - weak L ventricle contraction.
70
What are common signs and symptoms of left-sided heart failure?
* Pulmonary edema
* Dyspnea
* Orthopnea
* Paroxysmal nocturnal dyspnea (PND).
71
What is the treatment for end-stage CHF?
Cardiac transplantation.
72
What are the guidelines for lifting after a sternotomy?
No lifting 10lbs below waist and 5lbs above waist for 6-8 weeks.
73
What is valvular heart disease?
Conditions involving the failure of heart valves to open or close properly.
74
What is aortic valve stenosis?
Calcification of the aortic valve leading to left systolic dysfunction.
75
What are the signs and symptoms of aortic insufficiency?
Rapid increase in left ventricle pressure leading to pulmonary edema.
76
What characterizes stable angina?
Predictable chest pain that occurs during exertion and is relieved by rest.
77
What is myocardial ischemia?
Decreased blood flow to heart tissue leading to angina.
78
What are non-modifiable risk factors for cardiovascular disease?
* Age
* sex
* Family history.
79
What are modifiable risk factors for cardiovascular disease?
* Smoking
* Diabetes
* High cholesterol
* Hypertension
* Obesity.
80
What is the most frequent location for myocardial infarction?
Left ventricle due to occlusion of left coronary artery.
81
What does the P wave in an ECG represent?
Atrial depolarization.
82
What is cardiomyopathy?
Heart muscle disease resulting in decreased cardiac output.
83
dilated cardiomyopathy can lead to ——.
Heart failure due to left ventricle dilation.
84
What is cardiac tamponade?
Compression of the heart due to blood or fluid buildup in the pericardial sac.
85
What is infective endocarditis?
Inflammatory destruction of heart tissue usually caused by bacterial infection.
86
What is an aneurysm?
Localized abnormal dilation of a blood vessel wall.
87
What are the signs and symptoms of deep vein thrombosis (DVT)?
* Dull ache
* Tightness/pain in calf
* Swelling.
88
What is intermittent claudication?
Pain during activity that is alleviated by rest.
89
What is the distinguishing feature of arterial insufficiency compared to venous insufficiency?
Diminished or absent pulse.
90
What is Deep Vein Thrombosis (DVT)?
Thrombosis: blood clot that can become a pulmonary embolism (thrombo-embolism)
91
What are the risk factors for DVT?
* Venous stasis (e.g., prolonged sitting/immobilization)
* Venous damage
* Hypercoagulability
* Trauma/surgery
* Pregnancy
* Obesity
* Cancer
* Smoking
* Genetic susceptibility
92
What are common signs and symptoms of DVT?
* Dull ache
* Tightness/pain in calf and tenderness on palpation
* Swelling
* May have a fever
* Pain with Dorsiflexion
93
What is HOMAN’S SIGN?
Calf pain on passive Dorsiflexion of the foot
94
What is the most appropriate test for DVT?
Rapid screening with Doppler Ultrasonography
95
What are the medical treatments for DVT?
* Heparin: immediate response, injection/IV use
* Warfarin (Coumadin): long-term treatment, oral medication, slower onset
96
What is the timeframe to mobilize someone with DVT after starting anticoagulation?
Depends on the type of medications being administered; check with physician for mobilization orders.
97
True or False: It is unsafe to mobilize patients with DVT.
False
98
What should patients being treated for venous thrombosis watch for?
New leg pain, swelling, and/or redness
99
What is a pulmonary embolism (PE)?
Passage of ANY material capable of getting lodged in a blood vessel (thrombus, air bubble, plaque)
100
What are the signs and symptoms of a pulmonary embolism?
* Bloody sputum
* Dyspnea
* Increased respiratory rate and work of breathing
* Cyanotic
* Tachycardia
* New chest pain
* Decrease oxygen saturation
101
What is a Ventilation/Perfusion Scan used for?
Diagnosis of pulmonary embolism (shows area of poor perfusion in lungs)
102
What are key treatments once a PE is suspected?
* Education
* Deep and segmental breathing
* Oxygenation
103
What should be monitored when mobilizing a patient with PE?
* Oxygen saturation
* Heart rate
* Blood pressure
* Chest pain
104
What considerations are there for rehab of a patient with DVT/PE?
* No contraindications to basic stretching or strengthening
* Avoid potentially harmful activities while on anticoagulation
* Discuss travel decisions with doctors
105
What are the differences in skin characteristics between peripheral arterial disease and venous insufficiency?
* Peripheral arterial disease: Cool to touch, pallor, paler, shiny, thin, hairless
* Venous insufficiency: Warm to touch, swelling, bluish-brownish, darker, thicker
106
What findings are associated with DVT leading to chronic venous insufficiency?
* Dull ache
* Tightness
* Pain
* Superficial ulcers (usually lateral malleolus)
* Paresthesias
* Venous stasis ulceration over medial malleolus
107
What causes orthostatic hypotension from bed rest?
Decreased venous tone leading to pooling of blood in the lower extremities upon standing
## Footnote
This results in reduced blood return to the heart, decreasing ventricular filling and cardiac output.
108
What are the signs and symptoms of orthostatic hypotension?
* Dizziness
* Light headedness
* Fatigue
* Blurred vision
* Muscle weakness
* Syncope
109
What is the diagnostic criterion for orthostatic hypotension?
Drop in BP: SBP >20 mmHg OR DBP >10 mmHg when standing
110
What is the optimal position for a patient demonstrating signs of orthostatic hypotension?
Supine
111
What treatment can assist with standing in severe cases of orthostatic hypotension?
Tilt table with progressive vertical positioning
112
What is cardioversion?
Uses electrical charge to stop a rapid rhythm originating in the atriums
113
What is defibrillation?
Electrical charge used to stop a rapid life-threatening rhythm originating in the ventricles
114
What is a coronary angiogram?
X-ray of the heart and major blood vessels; dye is injected to look for blockages
115
What does CABG stand for?
Coronary Artery Bypass Graft
116
What does CABG do?
Re-routes blood around blockages in the coronary arteries
117
What is the recommended initial load for upper extremities post-CABG?
30-40% 1RM
118
What is stroke volume?
Amount of blood ejected with each stroke
119
How is cardiac output calculated?
CO = HR x SV
120
What are the normal values of cardiac output at rest for males and females?
M = 5L; F = 4L
121
What is blood pressure?
Force exerted by the blood against the arterial walls during a cardiac cycle
122
What is the formula for blood pressure?
BP = CO x TPR (Total Peripheral Resistance)
123
What defines normal blood pressure?
SBP <120 and DBP <80
124
What is considered hypertensive blood pressure?
SBP > 139 and DBP > 89
125
What happens to blood pressure during exercise?
* SBP increases with workload
* DBP may decrease or stay the same
126
What are absolute contraindications to exercise?
* Acute MI
* Unstable angina
* Serious arrhythmias
* Acute pericarditis, myocarditis, endocarditis
* Uncompensated or uncontrolled heart failure
* Severe aortic stenosis
* Severe left ventricular dysfunction
* Acute PE
* Aortic aneurysm
* Uncontrolled systemic HTN
* Uncontrolled asthma
* Acute DVT/thrombophlebitis
* ICP > 20 mmHg
127
What are relative contraindications to exercise?
* Significant arterial HTN (resting DBP > 110; SBP > 200)
* Pulmonary HTN
* Brady/Tachycardia
* Moderate valvular disease
* Uncontrolled metabolic disease (e.g., Diabetes)
* Unstable asthma
* Diabetic patient with autonomic denervation of heart
128
What does the Rate of Perceived Exertion (RPE) scale measure?
Exercise effort and the way you feel during exercise
129
What is the maximum heart rate formula?
220 - age = Max HR
130
What is the Karvonen Formula used for?
To calculate training zones based on both maximum and resting HR
131
What are the precautions for a chest tube?
* Do NOT lift above the site of insertion
* Do NOT lay or roll onto chest tube
* Disconnection can lead to pneumothorax, infection
132
What is the purpose of a Foley/Urinary Catheter?
Self-retaining catheter held in place by inflated balloon in urethra
133
What are the indications for a lumbar drain?
* Reduce intracranial pressure (ICP)
* Monitor CSF chemistry, cytology, and physiology
* Provide temporary CSF drainage in patients with infected cerebrospinal fluid shunts
134
What is the purpose of Patient-Controlled Analgesic (PCA)?
Self-administered IV opioid
135
What are the precautions for using an epidural?
* Do NOT pull out
* Drop in BP, infection, headache
