Cardio-respiratory Flashcards

Question

What is a normal SpO2 value?

Answer 1

95-100% ** Below 90% we want to have further investigation + supplement of O2

Answer 2

- Breathing pattern - Ratio of inspiration:expiration - Depth

Answer 3

Diaphragmatic - 70% of time Lateral costal - 30% of time Apical - 0% of time

Answer 4

Obstructive - 1:3 or more Normal - 1:2 Restrictive - 1:1

Answer 5

Shallow or normal

Answer 6

- Funnel chest - Pigeon chest - Kyphoscoliosis - Barrel chest

Answer 7

Sternum goes inward - Congenital

Answer 8

Sternum pokes forward - Congenital

Answer 9

Combination of kyphosis and scoliosis - Congenital or functional

Answer 10

Result of chronic hyperinflation

Answer 11

It can affect mechanics of ventilation and ventilation/perfusion matching.

Answer 12

- Color (pallor) - Cyanosis (blue lips) - Nasal flaring

Answer 13

- Acc muscle use (often with apical breather or over use of SCM muscle) - Jugular venous distension (R side HF indicator)

Answer 14

- Capillary refill (2 to 4 sec) - Clubbing (nails together check for hole) - Color - Edema - Muscle wasting

Answer 15

- Effective (strength) - Productive (if sputum come out) - Persistent (freq) - Wet (productive) or dry (unproductive)

Answer 16

- Quantity - Color - Consistency - Thick = fibrosis - Odor - Foul smell = bronchiectasis or lung abscess

Answer 17

- Any trouble speaking or breathing

Answer 18

Pulmonary edema

Answer 19

1) Chest wall expansion 2) Diaphragmatic excursion 3) Edema 4) Pain and crepitus 5) Tracheal positioning 6) Tractile fremitus

Answer 20

1) Manual method 2) Circumferential method

Answer 21

More of a Dx tool. Looking if mvt is symmetric Place thumb together and ask pt to take deep breath. Ax 3 regions; - Upper lobe (sterno-costal) - Middle lobe (vertebro-costal) - Nipple line - Lower lobe (lateral costal) - Around T10

Answer 22

Measurement. Get baseline. Track progress. Common locations of measurement: - Axilla - 10th rib Take 3 measurement and record the best of 3.

Answer 23

- Manual method - Circumferential method - Diaphragmatic percussion

Answer 24

Hand placed on apex of belly during inspiration.

Answer 25

Place tape at level of apex of belly and instruct pt to first exhale and then max inhale. Measure/see the difference.

Answer 26

- Pitting vs Non-pitting - Level (how far it as extend)

Answer 27

- R side HF - Pregnancy - Lymphedema - Systemic diseases

Answer 28

When we palpate, there's an indentation, but when we remove the pressure the indentation persist = Fluids retention

Answer 29

Indentation doesn't occur (or very rare)

Answer 30

The problem is more likely to be musculoskeletal than angina.

Answer 31

Is a crunchy sound.

Answer 32

Between the sterno-costal joints. Take 2 fingers and run it down between the trachea to see if there's any deviation. If there's an Inc volume = pushes away If there's a Dec volume = ipsilat.

Answer 33

With palm of hand or ulnar side we palpate and feel the vibration of the number 99. If there's an Inc of sound = more dense tissues If there's an Dec of sound = hyperinflation or inc distance between lungs/chest wall

Answer 34

1) Dx percussion 2) Diaphragmatic excursion

Answer 35

- Determine the density of the underlying tissue. - Identify the normal or abnormal ventilation. - Identify the changes in lung density. ** Abnormality can only be detected 5 cm in depth. Dx percussion differs from Tx percussion

Answer 36

Strike the DIP Fast snap of the wrist Perform 2-3 strikes Better to perform on exposed skin

Answer 37

- Resonant - Dull - Hyper-resonant

Answer 38

Normal aerated lung tissue (air:tissue ratio normal)

Answer 39

Non-aerated lung tissue - more dense/consolidation (air:tissue ratio below normal)

Answer 40

Hyperinflated lung - more air (Hallow sound) (air:tissue ratio above normal)

Answer 41

- Pt sitting, access to the back - Make sure pt know how to properly use diaphragm - Pt max exhale and hold as the therapist percuss - Therapist marks when the dull sound is heard (diaphragm) - Then pt max inhale and hold as the therapist percuss down from the point of marking - Therapist makes a mark at the dull sound. Normal = 3-5 cm difference Diaphragm sits higher on R than L because the liver is on R.

Answer 42

1) Breath sounds 2) Voice sounds 3) Heart sounds

Answer 43

- Quiet environment - Stethoscope directly on skin Pt should take slow, deep breaths in and out through the mouth - Ear tips facing forwards inside ears - Bell for low frequency sounds (BP) - Diaphragm for high frequency sounds (bigger surface, pulmonary ax) - Sanitize stethoscope - Auscultation should be performed over entire lung space - At least one entire breath per region *** See manual for Pattern

Answer 44

The art of listening to sounds produced by the body.

Answer 45

3 parts (Upper lobe, middle lobe and lower lobe) Compared to 2 parts on L (Upper lobe and lower lobe)

Answer 46

- Vesicular - Bronchovesicular - Bronchial

Answer 47

- Crackles (rales) - Wheezes (rhonchi) - Pleural friction rub - Stridor

Answer 48

- Indicates normal lung - Soft and low-pitched - I:E = 3:1 - Heard over peripheral lung tissue Normal breath sound

Answer 49

- Mixture of bronchial and vestibular - I:E = 1:1 - I is soft and low-pitched - E is loud and high-pitched - Heard over main stem bronchi in 1st and 2nd intercostal spaces and posteriorly between the scapulae Normal breath sound

Answer 50

- Loud, high-pitched, hollow quality - Louder on E - I:E = 1:1 or 1:2 - Distinct pause between I and E - Heard over the trachea and manubrium Normal breath sound

Answer 51

- Short and explosive - Abnormal breath sound

Answer 52

Timing: Inspiratory vs expiratory Quality: Coarse vs fine

Answer 53

- Air moving retained secretion causing intermittent opening and closing of airway. - Wet (from fluids) - Inspiration and/or expiration - Any area of the lung

Answer 54

- Sudden opening of collapsed alveoli - Dry - Inspiration - Basal lung

Answer 55

- Musical - Can be affected by coughing - Abnormal breath sound

Answer 56

- Long, low-pitched, leathery creaking sound - Produced by frictional resistance between layers - Pain may be associated to pleural friction rub - May be confused with pericardial rub from heart - To differentiate ask pt to hold their breath, if rub persist then it is a pericardial rub, if rub sound disappears, it is a pleural friction rub. - Abnormal breath sound - Extrapulmonary sound

Answer 57

- Loud, musical, high-constant pitch - Audible from a distance without stethoscope - Most prominent during inspiration - Due to turbulent air flow (upper airway obstruction or narrow airway) - Abnormal breath sound

Answer 58

Are produced as a result of loss of selective filtering of high frequency sounds. 3 technique to Ax. Only one is necessary as all 3 test for the same thing.

Answer 59

- Egophony - Whispered pectoriloquy - Bronchophony

Answer 60

Pt repeat the letter E as we auscultate. If we hear A = consolidation (can be water, blood, pus...).

Answer 61

Whisper word change from muffled (normal tissue) to clearer over consolidation.

Answer 62

Instead of whispering we ask pt to talk normally. Inc intensity and clarity = consolidation

Answer 63

- To evaluate the mechanical function of the lungs - Prend en contre l'age, sex, race, grandeur et poids - Value are compared to predicted values to see if pt falls within normal or as an obstructive/restrictive disease

Answer 64

- Volume - Capacity - Flow - Diffusion studies - Respiratory muscle strength

Answer 65

- Determine if pt present with respiratory condition (obstructive/restrictive/combination) - Determine severity - Determine response to bronchodilator tx - Outcome measure to determine progression of disease, effectiveness of tx and medications

Answer 66

Sample of blood (needle or catheter)

Answer 67

Measure the amount of arterial gases and acidity (pH) of arterial blood.

Answer 68

35-45 mmHg

Answer 69

22-26 mEq/L

Answer 70

80-100 mmHg

Answer 71

Acidity Below 7.35 is acidic Above 7.45 is base/alkalosis A measure of hydrogen ion concertation in the blood which indicates the alkalinity or acidity of the blood.

Answer 72

Refers to partial pressure of carbon dioxide. Pt hypoventilating leads to inc PaCO2 (higher than 45 mmHg) = Respiratory acidosis Pt hyperventilating leads to dec PaCO2 (lower than 35 mmHg) = Respiratory alkalosis

Answer 73

Bicarbonate Higher than 26 = Metabolic alkalosis Lower than 22 = Metabolic acidosis Higher than 26 = Base Lower than 22 = Acidic

Answer 74

Mild hypoxemia = 60-80 mmHg Moderate hypoxemia = 40-60 mmHg Severe hypoxemia = lower than 40 mmHg TRUC ----- Severe - Moderate - Mild - Normal 40-60-80-100

Answer 75

- Uncompensated - Partially compensated - Compensated

Answer 76

pH level is abnormal with 1 component (PaCO2 or HCO3) abnormal and the other normal.

Answer 77

pH is abnormal with the other components (PaCO2 or HCO3) also being abnormal. (BOTH)

Answer 78

pH is normal but the other components (PaCO2 or HCO3) are abnormal. (BOTH)

Answer 79

Trouble getting air out. Characterized by inc airway resistance and obstruction affecting expiratory airflow.

Answer 80

- Chronic bronchitis - Emphysema - Asthma - Bronchiectasis

Answer 81

- Smocking - Air pollution - Genetic (alpha-1 antitrypsin deficiency) - Infection - Aging - Allergy

Answer 82

Affect cillias Inhibate cillias motarory - causing obstructive disease + asthma

Answer 83

Air like projecting Help clear the lungs Help move secretion

Answer 84

- Dec forced expiratory flow - Inc air trapping

Answer 85

Dec elastine = lungs doesn't recoil as much

Answer 86

Chronic bronchitis, edema and asthma

Answer 87

Productive cough on most days for 3 months/year for 2 consecutive year. = Inc + retaining mucus.

Answer 88

- Hypertrophy + hyperplasia of mucous glands and goblet cells (Inc mucus) - Dec # of cillia (secretion retention) - Chronic inflammatory changes in brochial walls - Dec gas exchange

Answer 89

Long term irritation of tracheobronchial tree 1. Smocking 2. Pollution

Answer 90

- Blue bloater - obese and cyanotic - Mucus white, yellow, green - Inc JVP and ankle edema

Answer 91

Tactile fremitus - Dec air trapping, Inc secretion retention - Ankle edema

Answer 92

- Hyper-resonant - air trapping - Dull secretion retention

Answer 93

- Dec BS - Early inspiratory wet crackles - Wheezing

Answer 94

Large dec PaO2 and Inc PaCO2

Answer 95

Cardiomegaly and white haziness

Answer 96

Enlargement of the airway distal to the terminal bronchioles accompanied by destruction of their walls. Floppy lung - Alot of air trap inside

Answer 97

- Centrilobar - Panlobar

Answer 98

- More common - Affects respiratory bronchioles - M more than F - Rare among non-smockers - Common with pt with chronic bronchitis

Answer 99

- Affect terminal and respiratory bronchioles - M more than F - Due to alpha-antitrypsin deficiency

Answer 100

- Bullae may be found in these pt - Dev from obstruction of ai flow during expiration - Leads to hyperinflation - destruction of alveolar walls - dec elastic recoil, inc dead space, dec gas exchange

Answer 101

- Smocking - Pollution - Alpha-antitrypsin - panlobar

Answer 102

- Pink puffer - Thin and wasted (muscle atrophy) - Barrel chest - I:E prolonged - 1:3 - Pursed lip breathing - Inc acc respiratory muscle use (30% diaphragm, 70% acc muscles) - Signs of respiratory distress (leaning over)

Answer 103

- Tactile fremitus - Dec (less vibration) - Chest wall expansion - Dec

Answer 104

- Hyper-resonant (vide)

Answer 105

- Dec BS - May have dry crackles

Answer 106

- Dec PaO2 (moderate hypoxemia) - Normal or Inc PaCO2

Answer 107

- Inc black area (hyperinflated + dec lung tissue) - Flattened diaphragm (hyperinflated) - Flattened ribs (no angles) - Narrow mediastinum (thin elongated heart)

Answer 108

Chronic inflammatory condition of the airways characterized by hyper-responsiveness of the airways to various stimuli results in narrowing the airways.

Answer 109

- Acute attack - Dec threshold of airway smooth muscle reactivity - Leads to bronchospasm, bronchial wall edema and inflammation, and inc secretions within the lumen of the airways - Narrow airways inc airway resistance (both in and out)

Answer 110

- Intrinsic - Extrinsic

Answer 111

- Drugs - Exercise - Inhaled irritants - Respiratory infection - Stress - Weather

Answer 112

- Animals - Dust - Feather - Food - Mold - Pollen

Answer 113

- Chest tightness - Dyspnea - Inc acc respiratory muscle use - Other signs of respiratory distress

Answer 114

- Tactile fremitus - Dec (air trapping) - Chest wall excursion - Dec

Answer 115

- Hyper-resonant (air trapping)

Answer 116

- Dec BS (breath sound) - wheezing - Possible crackles

Answer 117

- Dec PaO2 - Inc PaCO2 in sever cases - Dec pH

Answer 118

Hyper-resonant

Answer 119

- Irreversible, abnormal dilation of bronchi and bronchioles resulting in airflow obstruction and secretion retention - Commonly associated with chronic inflammation and infection airways - Considered an extreme form of chronic bronchitis - Can be obstructive or restrictive

Answer 120

- Destruction of bronchial wall causing permanent dilation of airways - Ciliated walls replaced by non-ciliated, mucus-secretion cells - Pooling of infected secretions leading to recurrent infections - May cause atelectasis distal to obstruction

Answer 121

- Post infection - Congenital disorders - Bronchial obstruction

Answer 122

- Thin and fatigued - Clubbing - Inc acc respiratory distress - Severe cough - Other sings of respiratory distress - Inc mucus

Answer 123

- Tactile fremitus - Depends on lungs changes - Chest wall excursion - Dec (air trapping)

Answer 124

Depends on lungs changes

Answer 125

- Dec BS - Wheezing - possible coarse crackles

Answer 126

- Dilated airways - Dark lung fields in areas of trapping - Flattened diaphragm - May or may not see areas of consolidation or atelectasis - High resolution CT is more commonly used to help dx bronchiectasis

Answer 127

- Parenchymal diseases - Pleural diseases - Chest wall deformities - Neuromuscular diseases

Answer 128

- Disease that restrict the lung from expending fully - Trouble getting the air in - Dec compliance - Dec neg pressure - Dec air entry RESULTING in; - inspiratory problem - dec volume of air in the lungs (dec ventilation) - With an restrictive diseases - Inc work of breathing RESULTING in; - inc RR - inc acc muscle use - inc pressure required to maintain lung expansion and ventilation - inc fatigue

Answer 129

- Interstitial pulmonary fibrosis (IPF) - Sarcoidosis - Atelectasis - Acute respiratory distress syndrome (ARDS)

Answer 130

- Thickening of the interstitium of the alveolar walls which progress to fibrosis or scaring of the lungs - Bilat. disease

Answer 131

- Dec lung compliance (inc airway resistance on inhalation) - Inc elastic recoil - Inc fibroblasts results in inc collagen leading to fibrosis or scaring - Dec diffusion capacity

Answer 132

- Idiopathic (most common) - Environmental exposure to inorganic dust, toxic gases, certain drugs - May be genetic factors - Some connective tissue disorders are associated with IPF (RA) - Abnormal healing of the wounds

Answer 133

- Dyspnea - Inc RR + shallow breathing - Dry unproductive cough - Clubbing - Cyanosis - Dec chest expansion

Answer 134

- Tactile fremitus - Inc (feel more vibration, thicker)

Answer 135

- Dull (because thicker)

Answer 136

- Late fine dry inspiratory crackles (sounds like pulling a Velcro)

Answer 137

- Dec PaO2 - Dec PaCO2

Answer 138

- Small contracted lungs - Raised diaphragm - Diffuse reticular marking (mainly in lower lobe) - High resolution CT is more commonly used to help assess the severity of IPF. Ground glass opacities is a key feature seen in IPF using HRCT.

Answer 139

Disease involving a lot of granuloma (collection of inflammatory cells all over that forms a lump) dev in the lungs, skin, lymph nodes and other organs Etiology - unknow Not super common Most of the time it resolve by itself

Answer 140

- Unilat disease - Collapse of alveoli or lung tissue (may have sub-segmental, segmental or lobar distribution)

Answer 141

- Obstruction (mucus plug, tumor, foreign body - it blocks the air from getting to any area distal) - Dec nitrogen (Nitrogen help to maintain alveoli open) - Dec surfactant (Inc surface tension) - Surfactant is a substance that usually dec surface tension so the alveoli stays open - Compression - from the substance - Hyperventilation - Hypoventilation - often post-opp because pt don't take slow deep breath

Answer 142

- Dyspnea - Cyanosis - Inc RR + shallow breathing - Ipsilat tracheal deviation

Answer 143

Tactile Fremitus - Dec Chest wall expansion - Dec on affected side

Answer 144

Dull directly over compressed tissue

Answer 145

- Dec BS or absent - Fine dry inspiratory crackles

Answer 146

- Dec PaO2 - good blood flow, poor ventilation

Answer 147

- Ipsilat shift of mediastinum - Inc density in area of atelectasis - elevated hemi-diaphragm

Answer 148

- Not an specific disease, it can be trigger by a lot of pathologies - An acute lung injury characterized by respiratory distress, sever hypoxemia and inc permeability of the alveolar-capillary membrane

Answer 149

- Inc permeability of capillaries due to injury - leads to edema in 1- interstitial space and then into 2 - alveoli -3 - diff breathing - Dec surfactant production leading to inc alveolar surface tension causing dec lung compliance - V/Q mismatch - R to L shunt - arterial hypoxemia (blood passing threw without picking any O2) - Rapid fibrosis in later disease progression

Answer 150

- Shock - Severe pneumonia - Severe trauma - Sepsis (infection) - Aspiration

Answer 151

- Severe dyspnea (often require ventilation) - Cyanosis - Inc RR + shallow breathing

Answer 152

Tactile fremitus - Inc

Answer 153

- Inspiratory crackles - Diffuse wheezes

Answer 154

- Severe dec PaO2 - Dec PaCO2

Answer 155

Patchy infiltrated in periphery of lungs

Answer 156

- Pneumothorax - Pleural effusion

Answer 157

An abnormal collection of air in the pleural space (outside of the lungs/alveoli)

Answer 158

Loss of neg pressure in pleural cavity causes expanded rib-cage and/or collapsed lung Pressure outside of the lungs make it hard to expand, then collapse

Answer 159

- Trauma to chest wall - Complication of invasive procedure (can cause a hole) - Idiopathic - Rupture of respiratory structure (bullea rupture) - Complication from mechanical ventilation (+ve pressure)

Answer 160

- Spontaneous pneumothorax - Traumatic pneumothorax - Tension pneumothorax

Answer 161

- Dev suddenly due to rupture in air containing structure - Most common young men - Primary (bleb/bullea) vs secondary (sec to another disease)

Answer 162

- Due to penetrating (stabbing, gunshot wound) or non-penetrating (contusion) injury to the chest wall

Answer 163

- Tear in pleura that acts as a one-way valve (air out but not in) - Medical emergency - acute life-threatening situation

Answer 164

- Sings of respiratory distress (especially with tension type) - Dyspnea - Inc RR - Chest pain (most common sign) - Dry cough

Answer 165

Tactile fremitus - dec (a lot of air trapping)

Answer 166

Hyper-resonant

Answer 167

Dec or absent BS

Answer 168

- Blackened area around lungs - flattened hemi-diaphragm

Answer 169

Unilat disease An abnormal collection of fluid in pleural space ** Don't mistake for pulmonary edema = fluids inside the lungs **

Answer 170

Inc production or dec clearance of fluids

Answer 171

Exudative and Transudative

Answer 172

Secondary to infection, cancer, or disease

Answer 173

- May have dyspnea - Inc RR - May have chest pain (especially with deep breathing and coughing) - Dry cough

Answer 174

- Tactile fremitus - Dec - Chest wall excursion - Dec on side of effusion

Answer 175

Dec, absent directly over effusion, may hear pleural friction rub

Answer 176

- Dec PaO2 - Dec PaCO2

Answer 177

- White in the aera of inc fluid in pleural space - Contralateral tracheal deviation with large effusion - Blunting or loss of distinction of the costophrenic angle (angle between the diaphragm and chest wall)

Answer 178

- Chest wall diseases - Bony deformities

Answer 179

Various deformities of the bony structures of the body. Affecting the bone - affecting the lung expansion.

Answer 180

- Ankylosing spondylitis - Congenital deformities - Kyphosis - Pectus carinatum - pigeon chest - Pectus excavatum - funnel chest - Scoliosis

Answer 181

- Idiopathic - Neuromuscular disease - Congenital

Answer 182

- Dyspnea - SOBOE (on excursion) - Abnormal thorax shape

Answer 183

- Tactile fremitus - Depends on the chest deformity (DEC) - Chest wall expansion - Depends on the chest deformity (DEC)

Answer 184

Depends on the chest deformity (Normal)

Answer 185

Depends on the chest deformity (Normal)

Answer 186

- Dec PaO2 if inc WOB

Answer 187

Depends on bony deformity, possible atelectasis in lower lobes.

Answer 188

- ALS - Guillian-Barre syndrome - Multiple sclerosis - Muscular dystrophy - Myasthenia Gravis - Parkinson's disease - Poliomyelitis - SCI

Answer 189

- Diaphragm - Intercostals - Abdominals - Acc muscles of ventilation

Answer 190

- Primary muscle of ventilation - Innervation: phrenic nerve C3-4-5 - Dependent on the intercostal and abdominal muscles

Answer 191

- Innervation: T1-T12 - Acts to stabilize the rib cage - Internal intercostals = active exhalation - External intercostals = inhalation (quiet and forceful) - External intercostal muscles are primary muscles of ventilation

Answer 192

- Innervation T6-L1 - Stabilize inferior border of the rib cage - Inc intra-thoracic pressure for a strong effective cough

Answer 193

- Erector Spinae - Pectoralis Major and Minor - Serratus Anterior - Scalene (ant, middle, post) - SCM - Trapezius - Lats - QL

Answer 194

- Present as a lung disease more than anything else - Affect a lot of organ in the body - Systemic hereditary disease of the exocrine glands (secrete something at the surface, EX - sweat glandes, salvatory glandes, mucus glandes) of the body - Results in copious amount of thick secretions - Dec lifespan

Answer 195

- Most commonly manifest in lungs, liver, kidney and intestine - Ion transport dysfunction: Inc electrolyte (Na & Cl) content in sweat - Inc obstruction of exocrine ducts by thick secretion - Inc secretion retention in lungs leads to recurrent lung infection, fibrosis/scarring, cystic dilations of the bronchi - Malabsorption of nutrients - pancreas deficiency - diff producing good amount of enzymes (enzyme use to absorb nutrients)

Answer 196

- Autosomal-recessive gene that affects the exocrine glands - Dx in childhood (impaired growth and dev)

Answer 197

- Low weight (despite healthy appetite, possible osteoporosis) - Inc RR - Barrel chest - Clubbing - Chronic productive cough - because producing a lot of mucus - Copious amounts of mucopurulent or purulent mucus (often with blood in sputum)

Answer 198

Tactile fremitus: Can be obstructive, restrictive, mixed Inc if secretion Dec if trapping air

Answer 199

Can be obstructive, restrictive, mixed Hyper-resonant Dull

Answer 200

- Dec BS - Inspiratory/expiratory crackles - Wheezing

Answer 201

- Pneumonia - Tuberculosis

Answer 202

- Secretion retention - Acute inflammation of the lungs associated with alveolar filling by exudates (consolidation) - Common complication and cause of morbidity and mortality in hospitalized pt - Longer the stay in hospital - greater risk of pneumonia - Leading cause of death in Canada

Answer 203

- Infectious agent (virus or bacteria) or irritant reaches the lungs triggering inflammatory reaction - May also be as a result of an auto-immune disease

Answer 204

May be viral, bacterial, fungal or other - Aspiration - Contact (trauma or chest tube) - Inhalation (droplet) - Hematogenous (circulation) - Inc risk: Infant, elderly, those with chronic cardiac or respiratory disease, immunosuppressed pt

Answer 205

- Dyspnea - Cyanosis - Inc RR + shallow breathing - Cough (productive = bacterial, non-productive = viral) - Fever (high fever = bacterial, moderate fever = viral)

Answer 206

Tactile fremitus - Inc (consolidation)

Answer 207

- Wet inspiratory crackles (a lot of secretion) - Bronchial or bronchovesicular BS (normal BS heard somewhere it shouldn't be heard)

Answer 208

- Dec PaO2 - May have dec PaCO2

Answer 209

- Air bronchograms - Opacities in surrounding alveoli

Answer 210

- Airborne disease - Primary affects the lungs and other organ - An infectious, systemic, inflammatory disease

Answer 211

- Mycobacterium tuberculosis (bacteria) ** Most infection don't have sympts, may lay dormant then reactivate when immune system weakens

Answer 212

Cough more than 2 weeks - Dry cough (early) - Productive cough (mucus/blood)

Answer 213

- Fever - Fatigue - Night sweats - Weight loss (poor appetite) - May have swollen lymph nodes (fighting infection)

Answer 214

TB infection - TB skin test - TB blood test TB disease - CXR (infiltrates and cavitation typically in the upper lobes) (May have pleural involvement and/or parenchymal fibrosis) - Sputum sample - Medical hx - Physical examination

Answer 215

- Meds 6-12 months - Prevent exposure to other - Placed in a -ve pressure room - Anyone entering the room must follow universal precautions and wear N-95 mask - Secretion clearance techniques - Deep breathing - Coughing

Answer 216

Small: Air collects between the lung and the chest wall. Large: A lot of air collects and pushes on the lungs and heart. + tracheal deviation. Tx - Trapped air is removed by using a chest tube.

Answer 217

- Inc permeability of the pleural surface leading to inc fluid, proteins, white blood cells and immune cells into the pleural space - Fluid is cloudy (opaque) - Caused by inflammation, infection or cancer

Answer 218

- Inc hydrostatic pressure in pleural capillaries - Fluid is clear and has very few proteins

Answer 219

Pigeon chest

Answer 220

Funnel chest

Answer 221

- Acute coronary syndrome - Congestive heart failure - Pulmonary edema - Pulmonary embolism - Peripheral vascular disease

Answer 222

= Impairments in the blood supply to the heart.

Answer 223

- Myocardial ischemia - Myocardial infarction

Answer 224

- Insufficient blood flow to myocardium - Typically presents with angina - No sympts = silent myocardial ischemia

Answer 225

- Angina - Stable angina - Unstable angina

Answer 226

- Type of chest pain/pressure that you get as a result of coronary artery disease or insufficient blood flow to the heart - Diffuse retrosternal pressure, heaviness, tightness or constriction in the chest caused by reduced blood flow to myocardium - Pt may clench their fist over their sternum (Levine sign) - May radiate to the L jaw, L arm, and/or upper back between the scapula

Answer 227

- Precipitated by activities that inc myocardial oxygen demand (physical activities, sexual activities, emotional stress...) - Relived by rest or nitroglycerin

Answer 228

- Occurs at rest without any precipitating factors or with minimal exertion - Not relieved by rest and may or not be relieved with nitro Requires immediate medical attention (high risk of myocardial infarction)

Answer 229

- Heart attack - acute injured myocardial tissue - Death of cardiac muscle due to lack of blood flow - Caused by a sudden complete occlusion of 1 or more coronary arteries

Answer 230

- By there symptoms - ECG changes - Cardiac biomarkers

Answer 231

- Angina - Anxiety - Diaphoresis - Dyspnea - Dizziness - Fatigue - Nausea

Answer 232

- Check the cardiac biomarkers by blood work - ECG

Answer 233

- If ischemia - ST-segment depression - Inverted T-wave - Small acute MI with small injury to myocardial tissue - No ST-segment change - Referred to as non-ST segment elevation myocardial infarction (NSTEMI) or non-Q-wave myocardial infarction (NQMI) - Large acute MI with injury to myocardial tissue - ST-segment elevation - Pathological Q-wave - Referred to as ST segment elevation myocardial infarction (STEMI) or Q-wave myocardial infarction (QMI)

Answer 234

- Troponin I - Troponin T - Myoglobin - Creatine kinase - Myocardial Band (CK-MB)

Answer 235

- Surgery - Medication

Answer 236

- Percutaneous Transluminal Coronary Angioplasty (PTCA) - Stent - Coronary Artery Bypass Graft (CABG) - Donor vessels (saphenous vein, internal thoracic artery, radial artery of nondominant)

Answer 237

- Beta blockers - Dec HR - Calcium channel blockers - Nitrates - Angiotensin-converting enzyme (ACE) inhibitors - Angiotensin receptor blockers (ARB) - Supplemental oxygen ** They all dec the BP **

Answer 238

- Improve exercise capacity - Improve exercise efficiency - Improve exercise tolerance - Improve self management - Improve QOL

Answer 239

Exercise, education, lifestyle modification program designed to optimize physical, psychological, social and vocational function.

Answer 240

- Phase 1: Acute/Inpatient Phase - Phase 2: Subacute/Conditioning Phase - Phase 3: Intensive Rehabilitation Phase - Phase 4: Maintenance Phase

Answer 241

- Traditionally begun in acute hospital setting - Role of PT: prepare for D/C, monitor activity tolerance, support risk factor modification techniques, provide emotional support, build self-efficacy and educate the pt on how to recognize adverse signs/sympts with activity, and collaborate with other members of the team. Focus of interventions is on assessing hemodynamic responses to activity, and independence in functional mobility activities. - Vital signs should be monitored before, during and after. - Intensity should be low level.

Answer 242

- Typically begins after D/C in the outpatient setting - Conditioning exercises are done with close cardiac monitoring

Answer 243

- Exercise in large groups - Resistance training typically initiated in this phase

Answer 244

- Pt is encouraged to continue exercise training in a group setting or self-monitored program

Answer 245

Level 1 (1 METs) - Pt in ICU medically stable for 24 hours - Bed rest but allow gentle AROM exercises of UE/LE and deep breathing exercises Level 2 (2METs) - Allow sitting up in a chair for meals, performing ADLS and walking to the bathroom/inside the room (up to 50 ft) a few times a day Level 3 (3 METs) - Ambulate up to 250 ft a few times a day Level 4 (4 METs) - Performing ADLs independently and ambulate up to 1000 ft a few times a day - Allow climbing of 1 flight of stairs

Answer 246

- Activity guidelines - Self-monitoring - Symptom recognition and response - Nutrition - Medication - Sexual activity - Psychological/social issues

Answer 247

Pt and family members should understand specific activity guidelines including planned exercised session, leisure time and rest.

Answer 248

- Teach pt to monitor the intensity of their activities by; palpating pulse, HR monitor, RPE scale - Includes awareness of other signs/sympts that may suggest exercise intolerance (dyspnea, confusion, light-headed)

Answer 249

- Pt should be able to recognize specific cardiac sympts and know how to respond - Pt should know when to call their physician or go to the hospital - Info on action that should be taken should be provided

Answer 250

- Pt meet with nutritionist to discuss their dietary habits Recommendation: Reduce fat intake, monitor salt and fluid (CHF)

Answer 251

- Pt should receive info on effects, side effects, dosage and timing - Pt should disclose all supplements and herbal remedies being taken - Pt should understand which non-prescribed drugs may have -ve interactions with prescribed and should be avoided

Answer 252

- Encourage to verbalize their concern to each others - Likely ready once their energy level is satisfying for them, they can walk outdoors and climb stairs comfortably - Is like any other physical activity, planning, pacing and warm-up contribute to more comfort/better outcome

Answer 253

- Physio should recognize psychosocial - PT plays an IMP role in reassuring pt that the sympts are normal du to cardiac event - Pt should seek guidance and counseling - Referral to mental health professional - PT work with pt for a pt centered approach to dev goals, outcome and plan of care that matches the client needs, values and level of function

Answer 254

Syndrome characterized by impairment in the hearts pump function - Problem pumping the blood out of the heart Collection of S+S that create this Dx (Not actually a disease) Now pt are living longer

Answer 255

- Leading cause of cardiac deaths in North America - Most frequent cardiac diagnosis for hospital admission - M more than F

Answer 256

2 types; based on structure and based on function Based on structure: - Left-sided heart failure - Right-sided heart failure - Biventricular heart failure

Answer 257

Lt heart failure is so bad = backup in lungs = pulmonary artery is full (too much pressure) = R ventricule as too much pressure = Rt heart failure

Answer 258

- Cardiac muscle dysfunction - Cardiac dysrhythmias (altered electrical function) - Cardiomyopathies (myocardial cells damage) - Long term CAD - Hypertension - Valve abnormalities - Pericardial pathology ** If you have any of those --- Inc risk of dev CHF **

Answer 259

LSHF: - Dyspnea - Fatigue - Weakness - Pulmonary edema (fluids in lungs) - Paroxysmal nocturnal dyspnea (sudden episode of SOB at night) - Orthopnea (SOB when lying down) RSHF: - Dyspnea - Fatigue - Weakness - Jugular vein distension - Peripheral edema - Pitting edema - Fluid weight gain - Ascites (excess fluids in belly area)

Answer 260

- Positioning to reduce orthopnea (semi-faller) - Relaxed breathing ex's (diaphragmatic breathing - Demande moins d'énergie) - Supplemental oxygen - Progressively inc ambulation - Progressively return to exercise - Cardiac rehabilitation program ** The rest is more medical - out of our scope **

Answer 261

Abnormal accumulation of fluid in the lungs. Fluid moves from the pulmonary capillaries --- interstitial space --- alveolar space

Answer 262

- Inc capillary membrane permeability (normally shouldn't allow easy exchanges) - Inc capillary hydrostatic pressure - Dec capillary osmotic pressure - Lymphatic insufficiency (normal will drain fluids)

Answer 263

- Cardiogenic pulmonary edema - Non-cardiogenic pulmonary edema

Answer 264

- High pressure (inc pulmonary capillary hydrostatic pressure) - Backflow of blood in the system due to kidney, heart muscle or valve damage leading to inc blood accumulation in pulmonary capillaries which inc pulmonary capillary hydrostatic pressure - LSHF

Answer 265

- Low pressure - Inc permeability of the pulmonary capillaries and alveolar endothelium due to trauma or toxins - ARDS

Answer 266

- Dyspnea - Inc work of breathing - Cyanotic - Orthopnea - Cough with pink frothy sputum

Answer 267

Tactile fremitus: Normal or inc

Answer 268

- Dec BS - Fine inspiratory crackles - Coarse crackles

Answer 269

- Cardiomegaly (Inc size) - Enlarged pulmonary vessels - White fluffy/hazy airspace - Kerley B lines (short hori. line near the pleural space)

Answer 270

- A blood clot that has been lodged in a pulmonary artery - Commonly associated with DVT in the lower extremities (blood cloth in calf) - If DVT dislodge and makes it way to lungs = Pulmonary embolism - Life-threatening

Answer 271

- Pulmonary embolus obstructs blood flow to an area of the lungs - If blood flow to lung tissue completely blocked, can lead to infarction and necrosis of lung tissue - Very large embolism can lead to inc pulmonary artery resistance --- inc work load of R ventricle - RHF

Answer 272

- Immobilization (post-op) - Secondary inc coagulation - Other: CHF, Hx of DVT, obesity, pregnancy, trauma, varicose veins

Answer 273

- Acute onset of dyspnea - Inc RR - *** Chest pain *** - May have cough with bloody sputum (hemoptysis)

Answer 274

- Dec PaO2 - Dec PaCO2 - Inc pH

Answer 275

Infarcted area of lung appears white (rare)

Answer 276

Using CT scan or V/Q scan

Answer 277

- Prophylactic post-op - Anti-coagulant meds (not PT scope) - Bed exercises (such as ankle pumps) - Early mobilization (better than bed ex's) - Compression stocking (preventive) - If PE or DVT is suspected or confirmed: - Discontinue exercise and mobilization until further notice - Notify nurse or surgeon - Document - Inc anti-coagulant meds - Thrombolytic meds

Answer 278

- Disorders of the blood vessels (arteries and veins) - Primarily due to atherosclerosis (hardening and narrowing of the arteries) - Significant narrowing of vessels must occur before there is enough occlusion of blood flow to produce sympts

Answer 279

- Leg pain (intermittent claudication) - Coldness in affected leg - because of poor circulation - Dec pulses in lower limb - because of poor circulation - Dec mobility and function of limb due to pain - Possible numbness - nerve damage - Possible pain and paleness of leg with elevation (Buerger's test - like SLR) - Dec hair growth - because of poor circulation - Skin breakdown - Ulceration - Gangrene

Answer 280

- Pain or cramping in the buttock or legs (mainly calf) as a result of poor circulation to the affected area - Inc pain with inc activity due to inc energy demands on the muscle that has poor circulation - Dec pain at rest (even in standing) - Must differentiate between intermittent claudication vs neurogenic claudication

Answer 281

- Progressive inc of activity and aerobic exercise - to inc tolerance to walk - May stimulate the dev of collat. blood vessels - Education (risk factors and self management) - Self-ax of skin, educate skin-care

Answer 282

Intermittent: Also known as vascular claudication Pain with WB - walking Static (stop), no pain (standing or sitting) Neurogenic: Also known as spinal stenosis - nerve roots are compressed as they exit the interverbal foreman Inc pain with lsp extension Dec pain with lsp flexion Pain with WB - walking Feels better in sitting LSP IMPACT

Answer 283

Compressive socks, because there's already poor circulation it will only make it worst.

Answer 284

- Bacteria - Virus - Fungi - Protozoa

Answer 285

- Hand hygiene - Gloves - Gowns - Face protection (mask, goggles)

Answer 286

- Should take at least 15 sec - Use alcohol-based hand rub preferred method when not visibly soiled - Wash hand with soap and water visibly soiled with blood or other fluids

Answer 287

- When in contact with blood or body fluids, non-intact skin or contaminated items - Change between pt and between sites - Be aware of touching self, cloths and environment - Wash hand after removal

Answer 288

- If your clothing may get soiled - Wash hand after removal

Answer 289

- For all coughing pt - Procedure where splashing, spray, sneeze may occur

Answer 290

- Before touching a pt - Before clean/aseptic procedures - After body fluid exposure/risk - After touching pt - After touching pt surrounding

Answer 291

Don 1. Sanitize 2. Gown 3. Mask 4. Eye protection 5. Gloves Doff 1. Gloves 2. Gown 3. Sanitize 4. Goggles 5. Mask 6. Sanitize

Answer 292

- Contact - Droplet - Airborne

Answer 293

- Transmission of organisms via skin-to-skin contact or indirect physical contact with infected environmental surfaces

Answer 294

- Transmission of organisms through droplets generated from the respiratory tract (coughing, sneezing, talking) - Droplets travel short distances and settle on surfaces - Deposit on the nasal or oral mucosa of the new host

Answer 295

- Transmission of organisms which have become aerosolized and remain suspended in the air - Inhaled by susceptible host - Special ventilation systems are required to control of airborne transmission of microorganisms

Answer 296

Room: Private room or group pts with the same infection Pt transport: Minimize transport of pt

Answer 297

Room: Private Pt transport: Mask pt when transport is necessary

Answer 298

Room: Private room with -ve pressure system and ensure door is closed Transport: Mask pt when transport is necessary

Answer 299

- Methicillin-Resistant Staphylococcus Aureus (MRSA) - Vancomycin-Resistant Enterococcus (VRE) - Extended Spectrum Beta Lactamases (ESBL) - Clostridium Difficile (C-Diff) - Norovirus - Uncontained diarrhea/drainage

Answer 300

- Hand hygiene prior to pt encounter - Gloves required for all pt and pt environment contact - Long sleeved gown required if skin or clothing will come into contact with pt or pt environment - Use dedicated equipment or disinfect prior to use with other pts - Hand hygiene after pt encounter

Answer 301

- Mumps - Rubella - Pertussis (whooping cough) - Influenza (droplet and contact) - Pneumonia (droplet and contact) - Meningitis (droplet and contact) - Acute Respiratory Illness (droplet and contact)

Answer 302

- Hand hygiene prior to pt encounter - Mask on pt when outside room or for duration of clinic visit - Mask and eye protection for anyone within 2 meters of pt - Hand hygiene after pt encounter - Clean and disinfect equipment and surface

Answer 303

- TB if evidence of respiratory disease - Disseminated Shingles (airborne and contact) - Measles - SARS - Varicella (airborne or contact)

Answer 304

- Airborne infection isolation room (-ve pressure room) - Mask on pt when outside room - Fit tested N95 respirator and eye protection for all health care workers - Only immune staff to have contact with pts with measles or varicella

Answer 305

Remove an irreversibly damaged area of the lung.

Answer 306

- Pneumonectomy - Lobectomy - Segmental resection - Wedge resection - Lung volume reduction surgery or bullectomy

Answer 307

- Median Sternotomy (Cut through the sternum) - Thoracotomy (Cut in intercostal space of ribs)

Answer 308

Removal of a lung Avoid lying with surgical side up until further notice from surgeon

Answer 309

Removal of a lobe of a lung

Answer 310

Removal of a segment of a lobe

Answer 311

Removal of a portion of a lung

Answer 312

Removal of large emphysematous tissue

Answer 313

- Commonly performed for lung resections or to remove an irreversibly damaged area of the lung - Posterolateral thoracotomy is most common procedure - Incision follows the path of the 4th intercostal space - Chest tubes are placed to evacuate air and fluid from pleural space

Answer 314

- Latissimus dorsi - SA - External intercostals - Internal intercostals - Trapezius - Rhomboids

Answer 315

- Lying on side of chest tube is NOT CI, as long as the tube is not kinked or pulled (often avoided but pts) - IMP to change positions as with all surgeries in order to avoid pressure ulcers

Answer 316

- Deep breathing - Supportive cough - Lines - Scar management - infection prevention - Relaxation - Bed mobility - Positioning - Transfers - Early mobilization

Answer 317

- Aspiration - Inc pain - Phrenic nerve impairment - Atelectasis - Ulcers - DVT

Answer 318

- A thrombus (blood cloth) that forms in a deep vein of the body - Typically the calf/leg - Thrombus may partially or completely block blood flow - Thrombus may potentially dislodge and travel to the lungs (pulmonary embolism), heart or brain = fatal - Venous stasis due to immobility post-op can inc the risk of DVT. along with hypercoagulation and changes to blood vessel wall

Answer 319

- Leg pain - Tenderness - Ankle edema - calf swelling - Dilated veins - Positive Homan's sign (DF of ankle)

Answer 320

- Early mobilization - Ankle pumps - Anti-coagulants - Graduated compression stockings

Answer 321

- Stop tx, which may be CI until further notice - Alert surgeon, doctor or nurse (they will do a droppler ultrasound) - Document findings

Answer 322

- Specialized thoracic surgery involving the heart and great vessels - Pt is placed on an extracorpal membrane oxygenator (bypass machine) due to interrupted blood flow during procedure

Answer 323

- Heart surgery - CABG (Coronary Artery Bypass Graft) - Saphenous vein graft (mobility and leg exercises restricted until further notice) - Internal thoracic artery graft - Radial artery graft - Valve replacements (aortic and mitral valve replacement) - Heart transplant - Surgery on great vessels - Aortic aneurysm repair - Abdominal aortic aneurysm (AAA) repair (laparotomy)

Answer 324

Limit UE exercise while sternal incision are healing - No pushing (pec activation - insertion) - No pulling - No lifting one arm above 90 deg - No hand behind back - No driving for 4 weeks (hori. abd, activate pecs) - No lifting more than 10 lbs for 6 weeks

Answer 325

- Improves breathing - Chest mobility - Secretion clearance - Assists GI function/bowel mobility - Improves conditioning and activity tolerance - Allow increased independence - Improves mood - Prevents: - Aspiration - Thrombus formation - Muscle atrophy - Contractures - Pressure sores - Neuropathy

Answer 326

Machine that takes over the function of the lungs and heart. Surgeons oxygenate the blood and pumps it out of the body so that the heart can be silent and they can do the surgery.

Answer 327

Take 6-8 weeks to heal

Answer 328

-ve pressure Vs +ve pressure -ve pressure: Normale - The way our bodies uses ventilation +ve pressure: Pushing/forcing air in the lungs

Answer 329

The use of a machine or device to assist or replace spontaneous ventilation. Mechanical - Refers to a machine

Answer 330

Mostly used in hospital setting, especially in ICU

Answer 331

Ventilation = Mvt of air in and out of the lungs Respiration = Mvt of gaz across a membrane

Answer 332

Invasive (intubation): Going IN the body - Endotracheal tube (ETT) (Passage of artificial airway to pt trachea) - Mouth or nose - Tracheostomy (Incision in neck) Non-invasive: Nothing is getting in - Nasal mask (goes over nose) - Complete face mask (both nose and mouth)

Answer 333

Feeding tube that goes from the nose to the stomach

Answer 334

- Severe hypoventilation, hypoxia or hypoxemia - Apnea - Person is not breathing - Acute hypercarbia - Elevated CO2 - PaO2 lower than 50 mmHg with supplement O2 - RR higher than 30 breaths/min - Vital capacity less than 10L/min - Inspiratory force lower than -25 cm H2O - Central depression (nervous system as slow down) - Dec level of consciousness - Anesthesia or sedation - Head injury - Drug overdose - Dec work of breathing and respiratory muscle fatigue - Poor pulmonary hygiene (secretion clearance)

Answer 335

- Barotrauma - Volutrauma - Ventilator acquired pneumonia (VAP) - Diaphragm atrophy - Hemodynamic compromise

Answer 336

Is due to high pressure Can lead to an alveolar rupture (then to a pneumothorax)

Answer 337

Is from excessive volume Will cause an overdistension of alveolar

Answer 338

Result of intubation Micro aspiration (foreign object is being breath in leading to pneumonia) of gastric contents or oral secretions

Answer 339

As a result of disuse Mechanical ventilation is doing all the work After their off ventilation it can be hard to breath because the muscle are so weak

Answer 340

Hemodynamic - Refers to flow of the blood Overinflated lungs --- compression of great vessels --- dec venous return --- dec cardiac output

Answer 341

- Mandatory - Assisted - Spontaneous

Answer 342

Used when pt can't make adequate respiratory effort. Assisting their breaths. Disadvantage: - If RR is fast pt still get full tidal volume and it can lead to respiratory alkalosis and hyperinflated - Tidal volume and minimum # of mandatory breaths/min (RR) delivered by ventilator. This will deliver a minimum minute ventilation (amount of air getting in and out in a min). - Pt able to initiate inspiration but still receives preset tidal volume. - If pt does not initiate breath within a specific time period, the ventilator will deliver a breath to maintain the RR.

Answer 343

Pt is completely dependent Ventilation is initiated, controlled and ended by the ventilator

Answer 344

- Continuous positive airway pressure (CPAP)

Answer 345

Ventilation initiated by pt but controlled and ended by the ventilator

Answer 346

- Invasive - Non-invasive - Continuous mandatory ventilation (CMV)

Answer 347

Entire by pt Ventilation is initiated, controlled and ended by the pt but the volume and pressure of the breath delivered by the ventilator is based on pt demand.

Answer 348

- Tidal volume (Depth of breath) and preset respiratory rate delivered by ventilator - Ventilation provides total support (pt has no control) Mostly used for someone completely sedated and not breathing on its own.

Answer 349

- Continuous mandatory ventilation (CMV) - Assist control ventilation (ACV) - Synchronized intermittent mandatory ventilation (SIMV)

Answer 350

- Preset mandatory tidal volume and RR (usually set low so pt can initiat breath) delivered by ventilator - Pt able to breath spontaneously between ventilator breaths. - Spontaneous pt-initiated breaths are synchronized with ventilator

Answer 351

- Positive End Expiratory Pressure (PEEP) - Pressure Support Ventilation (PSV)

Answer 352

Always providing some sort of pressure Can be invasive or non-invasive - Pt spontaneous breaths are augmented with predetermined level of (+ve) pressure delivered throughout the entire respiratory cycle (inspiratory and expiratory phase) - Keeps airway open continuously in pts who can breathe spontaneously on their own, but require assistance keeping airway unobstructed - Commonly used as a weaning mode for those who are intubated or an attempt to postpone intubation - When used with mask is considered non-invasive ventilation - Helps prevent alveolar collapse, improve FRC, and enhance oxygenation - Used in pts with obstructive sleep apnea, adults with neuromuscular diseases, acute and chronic ventilatory failure, and children whit acute respiratory failure

Answer 353

Preventing alveoli to collapse When we exhale alveoli begin to close as the air is escaping but PEEP prevent it from closing all the way - A +ve pressure is applied to the lung at the end of the expiratory phase of ventilation - Helps keep alveoli open during expiration and reduces pulmonary shunting

Answer 354

- Pt-initiated breaths are augmented by the ventilator to maintain a constant preset inspiratory pressure - Pt initiates all breaths and controls the respiratory rate, and inspiratory time - Helps dec work of breathing A step to normal Working on getting out of ventilator Disadvantage: If the pt cant breath it's not safe because it wont activate (related to muscle weakness non-activated)

Answer 355

Inc physiological dead space Dec cardiac output Ventilator associated pneumonia Inc risk of barotrauma ** High level of PEEP can cause excessive alveolar distension (volutrauma) or pulmonary barotrauma ( Ex - Pneumothorax) **

Answer 356

Because the communication is altered when intubated or wearing a face mask we need to find ways to communicate - Writing - Hand signals - Communication board

Answer 357

- The process of dec mechanical ventilation - A spontaneous breathing trial while being closely monitored is typically performed to Ax readiness to begin weaning process We put them on low ventilation and see how they react

Answer 358

- Pre-exercise test evaluation - Maximal exercise test - Submaximal exercise tests

Answer 359

- Exercise stresses the body and may lead to adverse responses to the pt. Pre-screening pts prior exercises identifies whether a pt is at risk of an adverse response to exercises.

Answer 360

- Purpose: to screen for pts at risk of adverse effects with exercise who require further ax prior to starting an exercise program

Answer 361

- Detailed hx - Physical examination - Laboratory tests - Risk stratification processing - Test selection

Answer 362

- Age - Family history - Physical activity level - Obesity - Pre-diabetes - Dyslipidemia - Hypertension - Stress/psychosocial - Smoker - Alcohol consumption - Diet

Answer 363

Men older than 45 y.o Woman older than 55 y.o

Answer 364

Sudden death MI Coronary revascularization - Before 55 y.o in father/brother - Before 65 y.o in mother/sister

Answer 365

Not engaging in at least 30 min of moderate physical activity at least 3x/week in the last 3 months (any exercises that cause SOB but still allows to talk)

Answer 366

- BMI higher or equal to 30 kg/m2 - Waist circ (male higher 102 cm, woman higher than 88 cm)

Answer 367

- Any hx of diabetes - Any blood tests looking into glucose levels - If pt is unaware count as a risk if (older or equal to 45 y.o, BMI higher or equal to 25 kg/m2)

Answer 368

- LDL (Bad): higher or equal to 130 mg/dL - HDL (Good): lower than 40 mg/dL - Pt on statin meds - Total serum cholesterol: higher or equal to 200 mg/dL

Answer 369

- Systolic BP higher or equal to 140 mmHg and distolic BP higher or equal to 90 - Taking hypertension meds

Answer 370

- Depression/anxiety/stress levels - SF-36: QOL - Beck depression inventory: depression

Answer 371

- Current smoker - Quit within last 6 months - Exposure to second hand smoke

Answer 372

Male more than 14 drink/week Woman more than 9 drink/week

Answer 373

No specific guideline, just see if pt considering having good nutrition habits.

Answer 374

- Maximal functional work capacity - Submaximal functional work capacity - Endurance - Mvt economy - Onset of exertional sympts - Subjective - Dyspnea, chest pain, leg pain, cerebral sympts - Objective - EKG changes, HR and BP response - Effect of meds - Evaluate progress

Answer 375

- Exercise program - Meds

Answer 376

- Determine likelihood of adverse cardiovascular events - Determine surgical risk

Answer 377

- A recent significant change in resting ECG suggesting significant ischemia, recent MI (within 2 days) or other acute cardiac events - Unstable angina - Uncontrolled cardiac dysrhythmias causing sympts or hemodynamic compromise - Symptomatic severe aortic stenosis - Uncontrolled symptomatic HF - Acute pulmonary embolus or pulmonary infarction - Acute myocarditis or pericarditis - Suspected or know dissecting aneurysm - Acute systematic infection, accompanied by fever, body aches or swollen lymph glands

Answer 378

- Left main coronary stenosis - Moderate stenotic valvular heart disease - Electrolyte abnormalities - Severe arterial hypertension at rest SBP higher 200 mmHg DBP higher 110 mmHg - Tachydysrhythmia or bradydysrhythmia - Hypertrophic cardiomyopathy and other forms of outflow tract obstruction - Neuromotor, musculoskeletal or rheumatoid disorders that are exacerbated by exercise - High-degree atrioventricular block - Ventricular aneurysm - Uncontrolled metabolic disease - Chronic infectious disease - Mental or physical impairment leading to inability to exercise adequately

Answer 379

- Is administered by physician (Not in our scope) - Also known as stress test - Graded exercise tests (intensity progressively inc) - Used to predict VO2 max - Treadmill tests (Bruce protocol) Subject work at complete exhaustion

Answer 380

- May be administer by PT - Evaluative submaximal exercise tests - Is used as a measure of endurance and exercise capacity - 6MWT - Distance covered by pt walking at a comfortable pace for 6 min - Subject is allowed to take brake as needed - 2 practice trial are required - Variant (2MWT, 3MWT) - Disadvantage - HR, BP not monitored and the level of motivation impact scoring - Advantage - Easy to addmister, no equipment needed - Predictive submaximal exercise tests - (Locking at HR and BP) - Used to predict VO2 max - Treadmill tests (modified Bruce protocol) - Cycle ergometer tests

Answer 381

- Fatigue (physical or verbal) - Signs of poor perfusion - Lightheadedness - Confusion - Ataxia - Pallor - Cyanosis - Nausea - Cold or clammy skin - SOB - Wheezing

Answer 382

- Onset of angina or angina like sympts - Leg cramps or claudication - Drop in SBP - Higher/equal to 10-15 mmHg with an inc in work rate - Drops below the value obtained in the same position prior testing - Excessive inc in BP - SBP higher 200-250 mmHg - DBP higher 110-115 mmHg - Failure of SBP to rise as exercise continues - Failure of HR to inc with inc exercise intensity - Noticeable change in heart rhythm by palpation or auscultation or ECG

Answer 383

- Subject request to stop - Failure of testing equipment

Answer 384

- Exercise selection - Parameters - Monitoring - Safety - Indication to stop exercise

Answer 385

- Goals - Ability - Pt preference - Safety

Answer 386

- Goals - Evaluation - Established guidelines - Safety

Answer 387

FITT Frequency Intensity Time Type

Answer 388

- The level of difficulty of a given exercise or exercise session Intensity may be prescribed by... - RPE (rating perceived exertion) - HR max - VO2 max - Maximal oxygen uptake reserve VO2R - Max metabolic equivalents METS max - Standard intensity ranges based on the above methods (minus RPE) is 60-85% (some place 70%) - High risk intensity ranges based on the above methods (minus RPE) is 50-75% (some place 60%)

Answer 389

- # of days/week or time/day dedicated to an exercise or exercise program - Aerobic is recommended 3-5day/week at moderate to vigorous intensity

Answer 390

RPE 6-20 Multiply by 10 = HR 6 - 7 - Very very light 8 - 9 - Very light 10 - 11 - Fairly light 12 - 13 - Somewhat hard 14 - 15 - Hard 16 - 17 - Very hard 18 - 19 - Very very hard 20 - MAX Borg 0 - Nothing 0.5 - Very very slight (just noticeable) 1 - Very slight 2 - Slight 3 - Moderate 4 - Somewhat severe 5 - Severe 6 - 7 - Very severe 8 - 9 - Very very severe (almost max) 10 - MAX

Answer 391

- The type or mode of activity or exercise chosen Types of exercise may include ... - Aerobic exercise (walking, running, swimming, biking) - Aerobic metabolism - Resistance training ( strength - Anaerobic, endurance, power - Anaerobic)

Answer 392

- A measure of the amount of time or the reps/sets physical activity of the exercise session is performed - It is recommended that most adults accumulate 30-60 min of moderate intensity exercise per day (equal/more than 150 min/week) or 20-60 min of vigorous exercise per day (more/equal to 75 min/week) - Less than 20 min of exercise per day may still be beneficial for sedentary individuals - Duration of physical activity may be performed continuously or intermittent (10 - 10 - 10 min) in multiple sessions

Answer 393

- Adults should accumulate at least 150 min of moderate-vigorous intensity aerobic per/week - Suggest to add muscle and bone strengthening using major muscle groups at least 2 days/week ** For anyone older than 18 y.o **

Answer 394

- If pt is at any risk of adverse response to activity it is advise to be supervised - HR, BP, SpO2, dyspnea and other signs/sympts of respiratory distress should be monitored for pt at risk - Stable pt should be trained and educated on self-monitoring, maintaining intensity of exercise within appropriate limits and keeping record of details of exercise sessions prior to carrying out an exercise program indepently

Answer 395

- Appropriate screening and testing should take place prior to beginning an exercise program - All CI for exercise testing also apply to exercise training - All pts should refrain from using a Valsalva maneuver - Upper body exercise may inc SBP, hypertensive individuals should be cautious when performing any upper body exercises and avoid high intensive upper body exercises

Answer 396

- Optimize gas exchange at all levels - Improve pt condition - Dec sympts - Optimize function ** Pt status should be ax prior every tx session and re-ax after tx **

Answer 397

- Positioning - Breathing exercises - Airway clearance techniques - Forced expiratory techniques - Exercise

Answer 398

- V/Q matching - Dyspnea in COPD

Answer 399

- Unilat lung disease: Lie on unaffected side "Good lung down" - Gravity will bring all blood to good lung OPTIMIZE - Bilat. lung disease: Lie in prone - Pneumonectomy: Do not lie with affected side up "Bad lung down" - We don't want the saline to go in good lung - ARDS: Lie in prone

Answer 400

- Standing, leaning back against a wall with hands bearing onto thighs to unload thorax - Standing, leaning against a table - Sitting, leaning forward with elbows resting on thighs - Sitting, leaning forward against table Helping because unloading thorax + requires less energy so less oxygen = less SOB

Answer 401

V/Q = ventilation over perfusion ratio, optimal is 0.8 Cardiovascular pts may experience greater distress when placed in certain position. This distress can be explained by V/Q inequalities. Positioning is often the first step in every tx procedure.

Answer 402

- Deep diaphragmatic breathing - Pursed lip breathing for COPD - Inspiratory muscle training - Segmental breathing - Sustained maximal inspiration

Answer 403

- Teaching pts deep diaphragmatic breathing helps promote dec use of acc muscles of breathing and promote inc use of diaphragm muscle for breathing - Also known as belly breathing - Diaphragmatic breathing is more efficient (dec energy cost) than using acc muscle for breathing - Pt performs long slow breaths - Promotes relaxation - May use hands on belly to guide diaphragmatic breathing or may cue diaphragmatic breathing by instructing pt to take a quick sniff through the nose ** Not encourage for pt with COPD **

Answer 404

- Performed by taking a breath in through the nose and exhaling through tightly pressed pursed lips. Smell the roses, blow out the candles. - Exhalation phase should be 3x as long as inspiration (ex 2 sec in, 6 sec out) - Creates +ve back pressure that splints small airways open longer - Helps control and reduce RR - More efficient emptying of the lung (dec hyperinflation) - Improved gas exchange - Promotes relaxation ** Better for COPD pt **

Answer 405

- Resistive exercise training for the muscle of respiration aimed at inc the strength or endurance of respiratory muscles - Inspiratory muscle training is commonly performed using an inspiratory muscle trainer (IMT) Think of it like a weight training... Parameters: Strength - F: 2-4x/week, I: 60-85% PImax (max inspiration pressure), T: 8-12 reps 1-3 sets Endurance - F: 4-6x/week. I: 40-85% PImax, T: more than 15 mins (as tolerated)

Answer 406

- Localized breathing towards a segment of a lung that requires greater expansion or ventilation - Uses tactile input to inc expansion of specific areas - Questionable whether a person can expand a localized area of lung specifically while not expanding others

Answer 407

- Pt performs sustained maximal inspiration to TLC for 3-5 sec - Incentive spirometer (IS) is a method of performing a sustained maximal inspiration (SMI) using a device to measure flow or volume - Often used post-op to prevent atelectasis or airway closure - IS provides visual feedback and helps provide incentive/goal for pt which in turn helps with pt compliance 2 types: Flow meter: Instruct pt to keep the balls up and level as much as possible when inhaling Volume meter: Instruct pt to inhale deeply with constant flow keeping the flow indicator within the prescribed ranges

Answer 408

- Postural drainage - Percussion - Vibrations - PEP device - Independent breathing techniques - Suctioning

Answer 409

- Pt is placed in a position that allows drainage of secretion from bronchial airways via gravity - Often used in conjunction with percussions and vibrations - Pt maintains postural drainage position for 5-10 mins or longer (if tolerated) - The pt face and SpO2 should be monitored during tx - Signs of tx intolerance includes inc SOB, anxiety, nausea, dizziness, hypertension and bronchospasm ** Position may be modified when pt presents with a precaution or relative CI for traditional postural drainage positioning ** What ever lobe/segment is affected you want it up so that the gravity make it go down

Answer 410

- Intracranial pressure higher than 20 mmHg - Head and neck injury (spinal instability) until stabilized - Active hemorrhage whit hemodynamic instability - Recent spinal surgery or acute spinal injury - Active hemoptysis - Empyema - Bronchopleural fistula - Pulmonary edema associated with HF - Large pleural effusion - Elderly, confused or anxious pts - Rib fx - Surgical wound or healing tissue - Pulmonary embolism - Untreated pneumothorax

Answer 411

Head lower than torso and legs

Answer 412

- Pt in whom inc intracranial pressure is to be avoided - Uncontrolled hypertension - Distended abdomen - Esophageal surgery or GERD (acid reflux) - Uncontrolled airway at risk for aspiration ** We can do postural drainage but as to lie flat

Answer 413

- Traditional secretion mobilization technique which uses rhythmical force of a therapist or caregivers' hands in a cupped position against the thorax of a pt - Percussions are performed over specific lung segments believed to have inc secretion retention with the aim of loosening or dislodging the bronchial secretions from the airways so that they may be expelled through the central airways via coughing or suctioning - In preparation for percussion, a thin towel or hospital gown should cover the area of skin to be percussed for comfort and to avoid erythema - Sound should be HOLLOW, slapping sound indicate that your hand positioning may not be in the correct cupped position. This may cause erythema and discomfort for the pt - Percussion should be rhythmic with equal force applied by both hands - Avoid bony prominences (scapula, spine, clavicula, ribs), breast tissue and directly over the heart - The pt face and SpO2 should be monitored during tx - Pt may perform self-percussion on areas that can be reached comfortably - Mechanical percussion devices may be used to dec caregiver strain or pt strain when performing percussions

Answer 414

- Severe osteoporosis - Rib fx - Pulmonary embolism - Pneumothorax - Anticoagulation therapy - Malignancy - Burns/skin grafts - Open wounds - Inc intracranial pressure - Subcutaneous emphysema - GI bleeding

Answer 415

- Traditional secretion mobilization technique in which a vibratory force is applied while applying pressure over a pt chest wall over the involved lung segment - Performed only on exhalation - It is proposed that vibrations enhance mucociliary transport from periphery to central airways - Mechanical vibration devices may be used to dec caregiver strain or pt strain when performing vibration For baby we can use a electric tooth brush

Answer 416

- Severe osteoporosis - Rib fx - Pulmonary embolism - Pneumothorax - Anticoagulation therapy - Malignancy - Burns/skin grafts - Open wounds - Inc intracranial pressure - Subcutaneous emphysema - GI bleeding

Answer 417

- +ve expiratory flow device are hand-held devices that create back pressure to splint airways while exhaling through the device - Back pressure created by PEP device allow for air to pass through inter-alveolar connections with pressure to dislodge or move mucous proximally - Can be used with aerosolized medication - Performed longer or equal to 15 min, 2-3x/day

Answer 418

- Coarse - Fine

Answer 419

Large amplitude, low frequency force (2Hz)

Answer 420

Low amplitude, high frequency force (12-20Hz) Usually better tolerated

Answer 421

- Low pressure PEP - High pressure PEP - Non-Oscillating PEP devices - Oscillating PEP devices - Flutter

Answer 422

- 10-20 cm H2O - More commonly used - Provides equal effectiveness as high-pressure PEP, but with a lower presumed risk of pneumothorax

Answer 423

- 50-120 cm H2O - PEP mask is used - Less commonly used due to inc risk of pneumothorax

Answer 424

TheraPEP, Threshold PEP - Smooth flow. Creates a back pressure in a similar way as pursed lip breathing.

Answer 425

Acapella, Flutter, Cornet, Quake, Bubble PEP - Provides accelerated expiratory flow rates and interrupts airflow through oscillation of airways which loosens secretions and helps move them centrally

Answer 426

Plastic pipe with a steel ball and perforated cover - Moving ball end up: Inc pressure - Moving ball end down: Dec pressure * Only device which is position dependent

Answer 427

- Active cycle of breathing technique (ACBT) - Autogenic drainage (AD)

Answer 428

- Used to help clear bronchial sections using 3 ventilatory phases: Breathing control (BC), thoracic expansion exercises (TEE), and forced expiratory techniques (FET) Repeated cycles of 3 ventilatory phases: 1. Breathing control: Gentle tidal volume breathing (relaxed upper chest and shoulders) - Breathing normal 2. Thoracic expansion exercises: Deep inspiration (deep diaphragmatic breaths). This phase loosens the secretions. May be accompanied by percussion or vibration. 3. Forced expiration technique: 1 or 2 huffs or coughs.

Answer 429

- Is performed using varying expiratory flow at various lung volumes to help mobilize secretions from peripheral airways into central airways to be expelled through huffing or coughing - 3 phases: Unstick, Collect, Evacuate - Breathing is always done through the nose using diaphragmatic breathing - At the end of one cycle perform 2-3 huffs/coughs followed by deep breathing to prevent collapse of airways - Tx time 30-45 min/session once a day

Answer 430

- Easy to use - Dec risk of bronchospasm - Easy to learn - Accessible - Promote independent - Doesn't require a professional

Answer 431

- Need to carry device - Social stigma Afraid to draw attention or to everybody now

Answer 432

- No dec in O2/no desaturation - Don't need equipment - Can do anywhere at anytime

Answer 433

- Take time (10-30 min) - Some pt prefer PT Tx

Answer 434

Exhaling to low volumes (ERV) will mobilize mucus (5-6 reps, 3 sec hold)

Answer 435

Mucus will collect when breathing in mid lung volumes (5-6 reps, 3 sec hold)

Answer 436

Evacuation of mucus occurs when breathing into larger lung volumes (5-6 reps, 3 sec hold). May perform expectoration via huff or cough at end

Answer 437

- A lot of concentration - Cognitive demand high - Not efficacy for children - Some pt prefer passive tx - Require good proprioception, tactile skills

Answer 438

A procedure to remove secretions through insertion of catheter or device via the nasopharynx, oropharynx or an artificial airway General indications: - To remove secretions or stimulate cough when pt is unable to do so independently - Suctioning should be performed when clinically indicated, not routinely (visible secretion in airways, chest auscultation findings - crackles, pt describe feeling some secretion, +ve tactile fremitus, SOB, ABG's - hypoxemia or hypercarbia, chest rx)

Answer 439

- Nose/mouth - Nose/mouth with artificial airway - Endotracheal tube or tracheostomy tube

Answer 440

- Severe dec O2 saturation less 92% - Inc ICP - Hemoptysis - Malignant arrhythmia - Hyperinflation post-CABG and head injury

Answer 441

- Infection - Mucosal (tracheal and bronchial) trauma - Hypoxia/hypoxemia - Hemodynamic instability - Laryngospasm/bronchospasm - Atelectasis - Pneumothorax - Inc ICP - Pain - Anxiety

Answer 442

- Infection control measures (Sterile environment/equipment, handwashing, PPE) - Hyperoxygenation - Hyperinflation - Limit suctions time (no greater than 10-15 sec per pass) and allow recovery time between each pass (30 sec between each pass) - Meds and sedation prior procedure

Answer 443

- Improved breath sounds - Removal of secretions - Improved blood gas (ABG's) data or pulse oximetry (SpO2) - Dec work of breathing (dec RR or dyspnea)

Answer 444

1) Cough 2) Huff 3) Assisted cough 4) Cough assisted machine

Answer 445

A cough is a forced expiratory technique with a closed glottis that may be used to help expel secretions 4 stages of coughing: 1. Inspiration - Adequate inspiratory volumes for a cough are approx. 60% of predicted VC 2. Glottal closure 3. Compression - Active contraction of abdominal and intercostal muscles causing an inc intrathoracic pressure distal to the glottis 4. Expulsion - Opening of the glottis and forceful expulsion of air Cueing = Strong double barrel cough (2 cough) Closed glottis = Cough Open glottis = Huff

Answer 446

- Is a forced expiratory technique with an open glottis that may assist to mobilize and clear secretions from airways - A deep breath is followed by a forced exhalation with mouth and glottis open - Huffing is preferred to coughing in pt with obstructive lung diseases due to the risk of small airway collapse from the high intra-thoracic pressure created with coughing (Regression of a cough) Huff from mid to low lung volumes = Clearing peripheral airways Huff from mid to high lung volume = Clearing proximal airways Cue = Imagine you are trying to fog up a pair of glasses

Answer 447

- Costophrenic assist - Heimlich - Type assist (abdominal thrust)

Answer 448

- Therapists hands are placed on the costophrenic angles of the rib cage - Therapist times pt's next exhalation and applies a quick manual stretch down and towards pt's navel. This quick stretch facilitates a stronger contraction of the diaphragm and intercostals for the inhalation which follow - The pt holds their breath for 3 sec and then coughs maximally with the therapist provide a sustained pull pressure on the costophrenic angle

Answer 449

- Therapist places the heel of their hand over the epigastric area (underneath xiphoid process). Avoid the xiphoid process. - The pt is instructed to take a deep breath in and hold for 3 sec. - The pt is instructed to cough on the count of 3 and the therapist provides a quick pressure up and in (J stroke) as in a heimlich maneuver. ** CI for those with GERD or recent abdominal surgery **

Answer 450

- Stimulates a cough and pulling of sections from the airways through alternating =ve and -ve pressures. - Is used with a mask, mouthpiece or tracheostomy adaptor. - +ve pressure created by the machine delivers a large volume of air on inspiration - The machine creates a rapid reversal to -ve pressure, which stimulates a cough

Cardio-respiratory Flashcards

(491 cards)