CardioPulm Flashcards
(111 cards)
1
Q
Define: Afterload
A
The forces that impede the flow of blood out of the heart, primarily the pressure in the peripheral vasculature, the compliance of the aorta, and the mass and viscosity of blood.
2
Q
Stroke Volume and Cardiac Output: Define and Normal Ranges
A
SV: volume of blood ejected by each contraction of L ventricle. Normal = 60-80 ml
CO: amount of blood pumped from left or right ventricle per minute. SV x HR = CO. Normal: 4.5-5.0 L/min Men (women are less). 4.5-5 L is normal blood volume…
3
Q
Define: Venous Return
A
The amount of blood that returns to the right atrium each minute. Venus return MUST equal CO when averaged over time.
4
Q
Define: Preload
A
The tension in the ventricular wall at the end of diastole. It reflects the venous filling pressure that fills the left ventricle during diastole.
5
Q
Anatomic Dead Space Volume (VD)
A
air that occupies non-respiratory conducting airways
6
Q
Expiratory Reserve Volume
A
max volume of air exhaled after normal tidal exhalation.
~15% of Total lung volume.
7
Q
Forced expiratory volume
A
max air exhaled in a specified period of time: 1st, 2nd, and 3rd seconds of a forced vital capacity maneuver.
8
Q
Forced Vital Capacity
A
volume of forced max air expired after a forced max inspiration.
9
Q
Functional Residual Capacity
A
air in lungs after normal exhalation. FRC=ERV+RV.
~40% of total lung volume
10
Q
Inspiratory Capacity
A
Max volume of air inspired after a normal tidal exhalation.
IC=TV+IRV
~60% of Total Lung Volume
11
Q
Inspiratory Reserve Volume
A
max air inspired after normal tidal inspiration.
~50% of total lung volume
12
Q
Minute Volume Ventilation
A
volume of air expired in one minute.
VE = TV x Respiratory rate (RR)
13
Q
Peak Expiratory Flow
A
max flow of air during the beginning of a forced expiratory maneuver.
14
Q
Residual Volume
A
volume of gas remain in in lungs at end of max expiration.
~25% of total lung volume
15
Q
Tidal Volume
A
total volume inspired and expired with each breath during quiet breathing.
~ 10% fo total lung volume
16
Q
Total Lung Capacity
A
volume in lungs after mac inspiration.
TLC = RV+VC, or TLC = FRC+IC
17
Q
Vital Capacity
A
volume change between max inspiration and max expiration.
VC = TV+IRV+ERV
~ 75% of total lung volume.
18
Q
Dilated Cardiomyopathy Meds and Surgerys
A
Med: Ace inhibitors, beta lockers, digoxin, diuretics.
SURG: biventricular pacemaker, implantable cardioverter-defibrillator.
19
Q
Hypertrophic Cardiomyopathy Meds and Treatment
A
Meds to slow HR and stabilize rhythm. Lopressor, calcium channel blockers.
Surgery: septal myextomy, septal alcohol ablation, pacemaker, defibrillator.
20
Q
Restrictive cardiomyopathy meds and treatment
A
Med: focus on improving sx. diuretics, antihypertensives, antiarrhythmics.
Surgery: ventricular assit device, heart transplant.
21
Q
Atrial Septal Defect
A
DEF: hole in wall separating right and left atria. (foramen ovale)
- S/S: heart murmur, SOB, fatigue, swelling legs, lung infections, stroke, cyanosis.
- TX: surgery.
22
Q
Coarctation of the aorta
A
- DEF: aorta i narrowed near ductus arterioles.
- S/S: pale skin, sweating, SOB. high BP in arms, low in legs. intermittent claudication, weakness, headache.
- TX: surgical repair or balloon angioplasty
23
Q
Patent Ductus Arteriosus
A
- DEF: blood shunted from pulmonary artery directly to descending aorta.
S/S: can be asymptomatic, tachycardia, respiratory distress, poor eating, weigh loss, congestive heart failure.
TX: diuretics and indomethacin, surgery.
24
Q
Ventricualr Septal Defect
A
- DEF: hole in septum separating right/left ventricles. too much blood pumped to the lungs.
- S/S: cyanosis, failure to thrive, fast breathing, fatigue, swelling of legs, tachycardia.
TX: surgery
25
Tetralogy of Fallot
- DEF: 4 heart defects: (1) VSD, (2) pulmonary stenosis, (3) right ventricular hypertrophy; (4) aorta overriding the ventricular septal effect.
- S/S: synosis, SOB, fainting, clubbing of digits, heart murmur.
TX: surgery.
26
Cor Pulmonale
- AKA: pulmonary heart disease, hypertrophy of RIGHT ventricle (caused by altered function of lungs)
- S/S - SOB, palpitations, atypical chest pain, swelling of LE, dizziness, syncope.
- TX: diuretics/anticagulation, supplemental O2.
27
Coronary Artery Disease
- narrowing/blockage of coronary arteries.
- S/S - angina, SOB, may not be felt until lumen is >70% occluded.
- TX: improve lifestyle, DRUGS (anti platelet agents (aspirin), ACE inhibitors, angiotensin 2 blockers, statins), Surgery.
28
Endocarditis
- inflammation of endothelium lining heart and cardiac valves. caused by bacteria
- S/S: fever, chills, murmur, SOB, skin petechiae, blood in urine
- TX: antibiotics. surgery
29
Heart Failure
- heart cannot maintain normal cardiac output. weak ventricles. typically begins with LEFT ventricle.
S/S: SOB, swelling LE, S3/S4 hear sound, weight gain.
Tx: medication (including digitalis to increase strength of contraction), lifestyle change, surgery
30
Heart Murmur
- abdnormal swishing or whooshing. turbulent blood flow through a damaged or narrowed heart valve. hole in wall.
- S/S: cyanosis, limb edema, SOB, enlarged neck veins, weight gain, chest pain, dizziness/fainting
TX: medications or surgery
31
Hypertension Number Classifications
Normal - 160/100
32
Hypertension S/S and TX
- early sign S4 heart sound
- significant CNS symptoms, cardiovascular symptoms, and renal involvement.
TX: lifestyle mod, MEDS (diuretics, beta blockers, calcium channel blockers, ACE inhibitors, angiotensin 2 blockers, vasodilators)
33
Myocardial infarction
- heart attack. causes irreversible necrosis.
- S/S: chest pressure, SOB, arm/shoulder/neck/back pain, nausea, vomiting, dizziness, sweating, palpitations.
- TX: med/surgery.
34
Myocarditis
- inflammation/weakness of myocardium. can lead to s/s of heart failure.
- S/S: arrhythmias, chest pain, SOB, signs of fever.
TX: focuses on underlying causes.
35
Pericarditis
- when pericardium becomes inflamed, the fluid between layers increases (pericardial effusion).
- S/S: chest pain, SOB, dry cough, anxiety, fatigue, fever.
- TX: severe cases will nee to prevent cardiac tamponade, when fluid in the pericardium creates pressure on the heart preventing proper filling with blood. tx removes fluid.
36
Peripheral Arterial Disease
- primarily caused by alter in the structure and function of the aorta and its branches.
- S/S: aching, numbness/pain (butt, thigh, calf, or foot at rest or when walking). distal hair loss, poorly healing wounds, hypertrophic nails.
TX: lifestyle changes, if intermittent claudication, tx includes revascularization procedures and surgery.
37
Rheumatic Fever
- inflammatory disease after untreated strep throat/scarlete fever.
S/S: inflammed joints, fever, heart palpitations, SOB, skin rash.
- TX: antibiotics and anti-inflammatory.
38
Acute Respiratory Distress Syndrome
- sudden failure due to fluid accumulation in the alveoli. severe SOB after original disease, fatal 25-40% of cases.
- S/S: SOB, rapid breathing, hypotension, confusion, cough, fever, extreme fatigue.
- TX: get O2 to lungs and organs. treat underlying condition.
39
Atelectasis
- collapse/ improper inflation of lungs.
- S/S: cyanoisis, SOB, increase RR, increase HR.
- TX: deep breathing, positioning, airway clearance,
40
Bronchial Carcinoma
- lung cancer. smoking, second hand smoking.
- S/S: new cough, coughing up blood, SOB, wheezing, weight loss, bone pain.
- TX: surgery, chemo, radiation
41
Bronchiectasis
- OBSTRUCTIVE lung disease, abnormal dilation of bronchus. irreversible. bronchial was weaken over time and allow for permanent dilation.
- productive cough hemoptysis (coughing up blood), weight loss, anemia, crackers, wheezes, loud breath sounds
- TX: meds (antibiotics, bronchodialators, expectorants, mucolytics.)
42
Bronchitis
- inflammation of bronchi. hypertrophy of the mucus recreating glands, increase mucus, mucus blockage causing insufficient oxygenation. productive cough over 3 months within 2 years.
- S/S: increase use of accessory muscles, wheezing, dyspnea, cyanosis, increase pulmonary artery pressure. worse in morning and with damp weather conditions.
TX: warm moist air.
43
Chronic Obstructive Pulmonary Disease (COPD)
- group of lung diseases the block airflow by narrowing of bronchial tree. Emphysema and Chronic Bronchitis. alveolar destruction, air trapping, INCREASED TLC, increase RV.
- S/S: mucus production, productive cough, wheezing, SOB, fatigue, reduced exercise capacity.
MEDS: bronchodilators, steroids, O2, antibiotics.
SX: lung volume reduction, bullectomy, lung transplant.
44
Cystic Fibrosis
- autosomal recessive genetic disease of exocrine glands. chromosome 7. body produces thick, sticky mucus causing lung infections, obstructs pancreas, and inhibits normal digestion/absorption of food.
- S/S: Salty tasting skin, poor growth/weight gain, greasy, bulky stools.
- TX: pancreatic enzyme replacements, mucolytics, bronchodilators.
45
Emphysema
- alveolar walls gradually destroyed, turn into large, irregular pockets with gaping holes. elastic fibers that hold open bronchioles are destroyed, so they collapse during exhalation. increase dead space.
- S/S: orthopnea, SOB, wheezing, coughing, accessory muscle use, increased RR, fatigue, decreased exercise capacity
- TX: bronchodilators, steroids, O2, antibiotics. Surgery. lifestyle modification.
46
DEF: Orthopnea
SOB when lying flat. relieved by sitting or standing.
47
Pleural Effusion
- build up of fluid in the pleural space, between lungs and chest cavity. if infected it is called empyema. caused by pleuritis.
- SOB. If infected: Dry cough, fever, chills.
- TX: non-steroidal anti-inflammatory drugs. chest tube to drain fluid.
48
Pneumonia
- inflammation of the lungs, caused by infection.
- S/S: fever, cough, SOB, sweating, shaking, chills, chest pain that fluctuates with breathing, headache, muscle pain, fatigue.
49
Pulmonary Edema
- fluid collects in the alveoli, difficult to breathe. acute is a medical emergency. LEFT SIDED HEART FAILURE.
- ACUTE S/S: extreme SOB, feeling of suffocation/drowning, wheezing, anxiety, restlessness, coughing, frothy, blood-tinged sputum, chest pain (if cardiac cause), rapid, irregular pulse.
50
Pulmonary Embolism
- most cases caused by blood clot from LE.
- S/S: sudden SOB, chest pain increases with (deep breathing, coughing, eating, or bending), bloody, blood streaked sputum. LE swelling, excessive sweating, rapid/irregular pulse, lightheadedness/fainting.
51
Pulmonary Fibrosis
- microscopic damage to the alveoli causes irreversible scarring of the interstitial tissue. alveoli less flexible, difficult to breathe.
- S/S: SOB (esp during physical activity), dry cough, occurs when irreversible lung damage has already occurred. fatigue, unexplained weight loss, aching muscles/joints
- TX: combo of corticosteroids and immunosupresive agents, lung transplantation, O2, pulmonary rehab.
52
Restrictive Lung Dysfunction (RLD) general definition and S/S/ Treatment
- abnormal reduction in lung expansion and pulmonary ventilation. Caused by abnormal parenchyma, abnormal pleura, and disorders affecting ventilatory pump function.
- S/S: dyspnea on exertion, non-productive cough, increased RR, hypoxemia, decreased vital capacity, abnormal breath sounds, reduced exercise tolerance.
- TX: mechanical ventilation, O2, pulmonary rehab.
53
Specific Etiology of Restrictive Lung Dysfunction
- Abnormal parenchymal: (1) atelectasis, (2) pneumonia, (3) pulmonary fibrosis, (4) pulmonary edema, (5) ARDS
- Abnormal Pleura (1) pleural effusion, (2) pleural fibrosis, (3) pnemothorax, (4) hemothorax
- Disorders afecting ventilatory pump function (1) decrease in respiratory drive, (2) neurologic/neuromusc disease (3) muscle disease/weakness, (4) thoracic deformity, (5) connective tissue disorder (6) pregnancy, (7) obesity, (8) ascites
54
Normal PaCO2
35-45 mm Hg
55
Normal Pa02
80-100 mm Hg
56
Normal HCO3-
22-26 mEq/L
57
Normal SaO2
95-98%
58
Def: Eucapnia
normal level of CO2 in arterial blood.
Hyper/Hypocapnia = to much or too little.
59
Levels of Hypoxemia (level of PaO2
Mild: 60-79 mm Hg
Mod: 40-59 mm Hg
Severe: less than 40 mm Hg
60
Def: Hypoxia
low level of O2 in tissue, despite adequate perfusion of the tissue.
DO NOT CONFUSE WITH hypoxEMIA
61
Cardiac Biomarkers indicative of MI
- CK-MB: measures level of creatine phosphokinase, appears in blood 4 hours after infarction, and peas at 12-24 hours, declines of 48-72 hours.
- Cardiac Troponin-1: level of protein troponin. remains elevated for 5-7 days.
62
Hematocrit (Hct) changes may indicate...
- the percentage of red blood cell sin the total blood volume
- LOW: anemia, blood loss, vitamin/mineral deficiencies
- HIGH: dehydration, polycythemia vera (condition that causes overproduction of RBCs)
63
Normal Erythrocytes
Male: 4.3-5.6 x 10^6/ml
Female: 4.0-5.2 x 10^6/ml
64
Normal Total WBC count
3.54-9.06 x 10^3/mm^3
65
Normal Platelet Count
165-415 x 10^3/mm^3
66
Normal Partial Thromboplastin Time (PPT)
26.3-39.4 sec
67
Normal Hematocrit
Men: 38.8-46.4%
Women: 35.4-44.4%
68
Normal Hemoglobin
Male: 13.3 - 16.2 gm/dL
Women: 12.0 - 15.8 gm/dL
69
Normal Total Serum Cholesterol
Desirable: 240 mg/dL
70
Normal/High LDL cholesterol
Desirable: 160 mg/dL
71
Normal/High HDL cholesterol
Desirable: 60 mg/dL
72
Normal/High Triglyceride
Desirable: 200 mg/dL
73
Meds: Alpha Adrenergenic Antagonist Agents
- reduce peripheral vascular tone, block alpha 1 adrenergic receptors. dilation of arterioles and veins, decrease blood pressure
- PT: use caution when rising from sitting/lying. closely monitor during exercise
74
ACE inhibitor agents
- decrease blood pressure and after load, suppress enzyme that converts angiotensin 1 to angiotensin 2.
- PT: avoid sudden changes in posture. heart failure pts avoid rapid increase in physical activity.
- ending in PRIL
75
Angiotensin 2 Receptor Antagonist Agent
- limit vasoconstriction and stimulation of vascular tissue.
| - PT - no implications
76
Positive Inotropic Agents
- increase force and velocity of myocardial contraction, slow the heart rate, decrease conduction velocity through the AV node.
- heart failure and a-fib
- PT: monitor heart rate, take pulse
EX: digoxin
77
Angine Pain Scale
1 - mild, barely noticeable
2 - moderate, bothersome
3 - moderalte severe, very uncomfortable
4 - most sever, intense pain ever
78
ABI
ankle/brachial index
- SYSTOLIC blood pressures, take 2 readings, use higher reading
- brachial and tibialis posterior
Measurements: >1.3 = rigid arteries/PAD; 1.0-1.3 = normal; 0.8-1.0 = mild blockage, beginning PAD, 0.4-0.8 = mod blockage/intermittent claudication;
79
Blood Pressure Stuff
- bladder encircle 80% adults, 100% kids
- too small = false high reading
- deflate 2-3 mm hg per second
- Phases: (1) clear tapping, (2) softer and longer, (3) crisper and louder, (4) muffled and softer (5) disappear completely, last audible sound.
80
Auscultation of Heart Sounds Procedure
- patient breathe through nose
- Listen to 4 areas
1. aortic area(2nd intercostol, R sternal boarder)
2. Pulmonic area(2nd intercostal, L sternal B)
3. Mitral Area (5th intercostal, medial to L midclavicular line)
4. Tricuspid area (4th intercostal, L sternal B)
- rate and rhythm, evaluate sound, extra sounds
81
S1 (lub)
- closure of the mitral/tricupsid valve, onset of ventricular systole
- high frequency, lower pitch and longer duration than S2
82
S2 (dub)
- closure of aortic and pulmonic valves, onset of ventricular diastole
- high frequency, higher pitch and shorter duration than S1
83
S3
- vibrations of the distended ventricle, passive flow of blood.
- normal in children, adults associated with heart failure
- ventricular gallop
84
S4
- pathological sound of vibration of the ventricular wall with ventricular filling and atrial contraction
- associated with hypertension, stenosis, myocardial infarction
- atrial gallop
85
Lung Auscultation/Normal Sounds
- patient breathe in and out through the mouth. deeper than normal.
- Tracheal/Bronchial sound: loud, tubular. inspiratory phase is shorter than expiratory with slight pause. Abnormal if heard in distal airways.
- vesicular sound: high pitched, breezy, heard over distal airways. inspiratory phase is longer than expiratory, no pause.
86
Crackle (rales)
- abnormal, discontinuous, high pitched popping sound (inspiration).
- Assoc. with restrictive AND obstructive disorders.
- movement of fluid (wet) or sudden opening of closed airway (dry)
87
Pleural Friction Rub
- dry, crackling sound during inspiration and expiration.
- inflamed visceral and parietal pleura rub together.
- heard over painful spot
88
Rhonchi
- continuous, low pitched sound snoring or gurgling, inspiration and expiration.
- air passing through an airway which is obstructed by inflammatory secretions, bronchial spasm.
89
Stridor
- continuous, high pitched wheeze with inspiration or expiration.
- upper airway obstruction
90
Wheeze
- continuous "musical, whistling sound, variety of pitches.
- inspiration/expiration, variable from minute to minute and area to area
- arise from turbulent airflow and vibrations of small airways due to narrowing by bronchospasm, edema, collapse, secretions, etc
91
Decreased/Absent sounds
Decreased: indicated severe congestion, emphysema, hypoventilation
Absent: pneumothorax or lung collapse
92
Voice Sounds
- should be muffled. clear sounds indicate consolidation, atelectasis, or fibrosis.
Bronchophony: increased vocal resonance with greater clarity and loudness, 99.
Egophony: E sounds like A
Whispered Pectoriloquy: 1, 2, 3, clear when whispered.
93
Classification of Lymphedema
Mild: 5 cm diff
- a difference of two or three centimeters between four comparative circumferences on bilateral upper extremities is evidence of lymphedema.
94
Respitory Rate Norms (newborn, 1 year, 10 years, adult)
Newborn: 33-45 bpm
1 year: 25-35 bpm
10 years: 15-20 bpm
adult: 12-20 bpm
95
Normal/abnormal respiratory rhythm
Normal: inspiration is half as long as expiration. 1:2 ratio
COPD: longer expiration, 1:3/4.
96
def: apnea
absence of spontaneous breathing
97
def: biot's breathing
irregular breathing. vary in depth and rate, periods of apnea. ICP/medulla damage
98
def: cheyne-strokes (periodic) breathing
decreasing rate and depth, periods of apnea. CNS damage
99
def: Eupnea breathing
normal rate and depth of breathing
100
def: Kussmauls breathing
deep and fast breathing. metabolic acidosis
101
def: paradoxical breathing
chest wall moves in with inhalation, out with exhalation. due to chest trauma or paralysis of diaphragm.
102
Active Cycle of Breathing
- assit secretion clearance in patients with asthma
- breathing control, thoracic expansion exercise, forced expiratory technique.
- used with the huff cough
103
Autogenic drainage
- controlled breathing to mobilize secretions, without postural drainage or coughing.
- improve airflow in small airways
- hard for young children/non-motivated patients.
- can be performed independently.
"unstick, "collecting" and "evacuating" phases
- 30-45 min tx
104
Directed cough and huffing
- huffing: forced expiratory maneuver with glottis open. (fogging glasses with breath)
- less velocity than cough, but decreased potential for airway collapse.
- reinforced with adduction of arms to self-compress the chest wall.
105
High -frequency airway oscillation
- handheld devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize secretions in the airways.
106
Diaphragmatic breathing
- semi-fowler's position
- sniffing can be used to facilitate contraction of the diaphragm.
- have pt place on hand on upper chest and the other just below rib cage.
- breath through nose, stomach moves out, exhale through pursed lips, keep chest sill throughout.
107
Inspiratory Muscle Training (IMT)
- flow resistive breathing and threshold breathing. (using mouth piece). decreasing diameter increases the resistance to breathing, provided that breathing rate, total volume and inspiratory time are kept constant.
- threshold breathing: build up of negative pressure before flow occurs through a valve that opens at a critical pressure. consistent and specific pressure
108
Paced Breathing and exhale with effort
- paced breathing is a strategy to decrease the work of breathing and prevent dyspnea during activity.
- become less fearful of activity
- prevent from holding breath during activity
109
Pursed-lip breathing
simple technique to reduce respiratory rate, reduce dyspnea, and maintain a small positive pressure in the bronchioles.
- help preven airway collapse in patients with emphysema
- use when SOB
- make candle flame flicker for 4 count when exhaling.
110
Segmental Breathing
- localized breathing/thoracic expansion exercise
- improve regional ventilation
- facilitation/inhibition of chest wall movement through hand placement, verbal cues, and coordination of breathing.
- apply firm pressure at end of exhalation to chest wall overlying the area to be expanded.
- inhale against hands, reduce hand pressure during inhalation.
111
Positions to Relieve Dyspnea
- forward leaning with arm support = pts with lung disease
- Reverse Trendelenburg (supine with head above trunk and LE): decreases weight of the abdominal contents on the diaphragm.
- Semi-fowler's position: supine with head of bed elevated 45 degrees and pillows under knees. CHF and cardiac conditions.
