Cardiopulm

Question 1

Ventilatory Capacities

Answer 1

-Tidal volume (TV): amount of air inhale and exhaled during NORMAL resting breathing

-Residual volume (RV): volume air remaining in lungs following MAX expiration

-Expiratory reserve volume (ERV): volume air that can be FORCEFULLY expelled after normal expiration

-Inspiratory reserve volume (IRV): volume of air FORCEFULLY breathed in following normal inspiration

-Forced vital capacity (FVC): amount of air under VOLITIONAL control

-Forced expiratory volume (FEV1): volume of air FORCEFULLY expelled in 1s following FULL inspiration. Normal is >75% exhaled within 1st second

-Total lung capacity: sum of RV and FVC (TV+IRV+ERV+RV)

-Functional residual capacity: volume of air REMAINING in lungs following NORMAL expiration (ERV+RV)

Question 2

Lymphatic Drainage Pathways

Answer 2

R lymphatic duct: R arm, R side of head, R side of thorax —> R subclavian vein

Rest of body —> thoracic duct —> L subclavian vein

Major Lymph Nodes:
-submaxillary, cervical, axillary, mesenteric, iliac, inguinal, popliteal, and cubital

Question 3

Blood Chemistry Levels

Answer 3

-PaO2: 75-100

-PaCO2: 35-45

-pH: 7.35-45

-Bicarb: 23-29

-Hematocrit: M 40-55%, F 37-47%, infant: 50-62%

-Hemoglobin: 12-16

Question 4

Lung Capacity dependent on disease severity:

Answer 4

Normal: >80% VC, >80% FEV1, >70% FEV1/FVC


Mild: 66-80 VC, 66-80 FEV1, 60-70 DEV1/FVC


Moderate: 50-65 VC, 50-65 FEV1, 45-59 DEV1/FVC


Severe: <50 VC, <50 FEV1, <54 DEV1/FVC

Question 5

Pulmonary Patient Positioning
–Sitting:

Answer 5

-vertical height and AP expansion greatest

-Mechanical compression is minimal
-Most comfortable

Question 6

Positioning– Prone:

Answer 6

• decreased AP expansion, bigger lateral expansion than upright

• Decreased FRC vs. siting

• Pathology of superior and posterior lower lobes have INCREASED O2 than supine

• Head down limited/avoided if increased ICP

Question 7

Positioning– Supine

Answer 7

• lateral diameter increased vs. upright; diaphragm moves to head= increased ab pressure

• FRC less than upright and prone

Question 8

Positioning– Side-lying

Answer 8

-Increased AP expansion, decreased lateral expansion

-FCR supine; greater in non-dependent lung

-Affected side position UP to improve ventilation/perfusion ratio with unilat condition

-Avoid prolong position if bronchopleural fistula as could leak

Question 9

METs for Functional Activities

Answer 9

1-2: sitting, feeding, reading, active/assisted exercise in supine, standing, walking 1mph


2-3: keyboard, walk 2mph/bike 5mph, light wooding, standing/light mat exercises, 2-3lbs


3-4: cleaning windows, walking 3mph/bike 6mph, golf, slow stairs, balance/mild resist activities


4-5: house painting, walking 3mph, cycling 8mph, raking leaves, dancing, resistance 10-15lbs


5-6: shoveling, walking 4mph, horseback, ice skating, set aerobics, ADLS are 5 METS

!
6-7: shoveling 10lbs, cycling 11mph


7-10+: jogging, running, heavy activity

Question 10

Cardiac Rehab Phase One

Answer 10

Inpatient 1-2wks 


-Activities: self care ADLs, arm/leg ROM, light weights, independent transfers, bedside sitting with progression to supervised ambulation

-Progress from 2 to 3-5 METs at discharge; goal is self-care and stairs

Question 11

Cardiac Rehab Phase Two

Answer 11

Subacute up to 3 months


-Activities: gradual increase in self-care, walking/job aerobics, return to work, and begin lifestyle changes

-Progression from 4-9 METs (9 is functional capacity at discharge)

-Guidelines: 3-4x/week, 30-60 mins with warm ups and cool down

Question 12

Cardiac Rehab Phase Three

Answer 12

Community exercise from 3-9 months (usually 12 weeks)


-Activities: aerobic exercises, low-level resistance, relaxation (has to be at 5 to start) progressed from supervised to self-regulated program

-Guidelines: Progress 50-80% of functional capacity, 3-4x/week, >45 min per session with careful monitoring of intensity/response to exercise