Cardiopulm Final (Both Cardio & Pulm) Flashcards

Question

What is the normal range of Mean Arterial Pressure?

Answer 1

70-110mmHG **- 60-65 is critical**

Answer 2

No palpable pulse

Answer 3

Faint, but detectable pulse

Answer 4

Slightly more diminished pulse than normal

Answer 5

Normal pulse

Answer 6

Bounding pulse

Answer 7

The primary aim is to gauge how well blood is circulating through the smaller blood vessels in the body - Apply pressure to the **pad** (NOT NAIL) of a finger or toe for 5-10 seconds

Answer 8

Measuring the pulse for 30 seconds and multiplying it by (2) is sufficient for most populations. That being said: - Always seek to take full minute to obtain a resting value in someone with an irregularly irregular rhythem - Consider shorter-time measurements if seeking a time-sensitive pulse rate (e.g., 10-15 seconds if trying to establish rate during or immediately after exertion/exercise)

Answer 9

- When there is severe tachycardia --The lag in time as the blood rushes from the heart into the larg arteries may make radial palpation challenging - Arrythmias (e.g., artrial fibrillation, premature ventricular contractions) --With some arrythmias, ventricular contractions may be too weak to empty into the aorta and cause a palpable peripheral pulse. In this scenario, radial assessment may underestimate actual heart rate (a show a pulse deficit)

Answer 10

- Bell: low-frequency sounds; use light pressure or else it turns into a diaphragm. Use bell with soft placement for assessment of S3 and S4 - Diaphragm: High-freqency sounds; use with firm pressure

Answer 11

- Cuff size and placement --Too small cuffs overestimate BP --Too large cuffs underestimate BP - LE positioning - Speaking moving or having arm unsupported during assessment - Time spent in resting after most recent exertion

Answer 12

Less than 120mmHG (systolic) and Less than 80mmHG (diastolic)

Answer 13

120-129mmHG (Systolic) and Less than 80mmHG (Diastolic)

Answer 14

130-139mmHG (Systolic) OR 80-89mmHG (Diastolic)

Answer 15

140 or higher mmGH (Systolic) OR 90 or higher (Diastolic)

Answer 16

Higher than 180mmHG (Systolic) and/or Higher than 120mmHG (Diastolic)

Answer 17

- Inform the patient of the reading - Education the patient on lifestyle modification - Document blood pressure

Answer 18

- Inform the patient of the reading - Education the patient on lifestyle modification - Continue current medication regimen - Document blood pressure

Answer 19

*wait 5 minutes and recheck* - Inform patient of reading - Determine medication compliance, if appropriate - Monitor during therapy intervention - Document blood pressure - Recheck at next therapy visit --If still in abnormal range, notify physician --If in safe range, continue to monitor

Answer 20

- Inform patient of reading - Determine medication compliance, if appropriate - Contact physician - Obtain medical clearance prior to initiating exercise - Document blood pressure

Answer 21

*Wait 5 minutes and re-check* - Inform patient of reading - Determine medication compliance, if appropriate - Contact physician - Physician determines next steps - Hold Exercise - Document blood pressure

Answer 22

- Inform patient of reading - Determine medication compliance, if appropriate - Contact physician - Physician determines next steps - Send to emergency, if unable to contact physician - Hold Exercise - Document blood pressure

Answer 23

The average pressure tending to push blood through the circulatory system, and it reflects tissue perfusion pressure | [(2 x DBP) + SBP] / 3 (This is the equation)

Answer 24

This may indicate inadequate tissue perfusion and should, in a majority of circumstances, lead the clinician to modify the pts position and/or activity to increase MAP right away ## Footnote This is also a value the medical team will often use to manage pharmacology (e.g., prescribing vasopressors to increase BP)

Answer 25

Barely perceptible depression (pit)

Answer 26

Easily indentified depression (EID, skin rebounds to it original counter within 15 sec)

Answer 27

EID (Skin rebounds to its original within 15 to 30 sec)

Answer 28

EID (rebound >30 sec)

Answer 29

This is characterized by a sinoatrial (SA) node discharge rate less than 60bpm with normal P waves and QRS complexes

Answer 30

- Rest - Sleep - Well-trained athletes due to increased vagal tone and stroke volume - With some medications (e.g., beta- or calcium channel-blockers)

Answer 31

Its characterized by a sinoatrial (SA) node discharge rate greater than 100bpm with normal P waves and QRS complexes - This most often results from increased sympathetic and/or decreased parasympathetic (vagal) tone

Answer 32

Depolarization of both atria. The P wave is the first ECG Deflection

Answer 33

The QRS complex indicates **ventricular depolarization** - The R wave is the initial positive deflection - The Negative deflection before the R wave is the Q wave - The negative deflection after the R wave is the S wave ## Footnote This typically takes 0.06-0.10sec

Answer 34

Both represent Ventricular Repolarization - The S-T segment extends from the S wave to the beginning of the T wave - The T-wave represents the repolarization of both ventricles

Answer 35

The region between two waves

Answer 36

A duration of time that includes one segment and one or more waves

Answer 37

They are sensitive indicators of the oxygen supply status of the ventricular myocardium

Answer 38

This is the electrical transmission from the atria to the ventricles ## Footnote This typically takes 0.12-0.20sec

Answer 39

Ventricular Depolarization (Ventricular systole) - The measurment between each R-R wave give you sense on how regular or irregular the rhythm is

Answer 40

Rapid heart rhythm originating above the hearts ventricles, typcially involving the atria or atrioventricular node

Answer 41

Areas where the heart contracts itself; outside the normal conduction pathway. - They typically have weaker contractions

Answer 42

Abnormal heart rhythm that is characterized by a series of **three or more consecutive ectopic beats originating in the atria**

Answer 43

This is characterized by a rapid, **organized**, and **regular atrial rhythm**. It has a unique *re-entrant circuit*, **usually in the right atrium**, which leads to the classic "Sawtooth" patten seen on the ECG - Usually has a rate of 250-350bpm - Usually has more than 1 P wave before every QRS complex ## Footnote Re-entrant Circuit: Self-sustaining electrical pathway in the heart in which the impulse continues to circle through the tissue, causing repeated stimulation and a rapid heartbeat

Answer 44

The most common type of Serious Arrhythmia. This is characterized by a very fast and disorganized atrail rhythm, resulting from multiple ectopic foci and/or multiple reentry circuits generating electrical impulses in a chaotic manner. This leads to irregular rhythm known as "irregularly irregular" pulse. - **Erratic quivering or twitching of the atrial muscle**

Answer 45

- Atrial Flutter is a more organized and REGULAR atrial rhythm - Atrial Fibrillation, has no true P waves are found. The AV node acts to control the most of the impulses that initiate QRS complex; therefore a totally irregularly irregular rhythm exist

Answer 46

Atrial Fibrillation - There are no true P waves

Answer 47

Atrial Flutter - The P waves are organized and in rhythm, it also makes a "Sawtooth" like pattern

Answer 48

Although they are not, in and of themselves, considered lifethreatening, they can lead to serious and potentially life-threatening complications if not properly managed: - Stroke risk due to blood stasis - Induce heart failure via tachycardia-induced cardiomyopathy

Answer 49

**Cardioversion**: A medical procedure that aims to restore a normal heart rhythm **Medications**: - Rate control medications: Beta-blockers and calcium channel blockers - Rhythm control medications: Antiarrhythmic drugs work by altering the electrical signals in the heart to maintian a normal rhythm - Anticoagulant: Prevent the formation of blood clots in the heart

Answer 50

This occurs when an ectopic focus (or foci, in the case of mulifocal PCVs) creates an impulse from somewhere in one of the ventricles. It occurs early in the cardiac cycle before the SA node actually fires ## Footnote The QRS complex is **wide and bizarre** and occurs earlier than normal sinus beat would have occurred. There are no P waves. - It is wide because of slow cell to cell connections rather than through the normal rapidly conducting His-Purkinje system

Answer 51

- When they are paired together - When they are mulifocal in orgin - When they are more frequent than 10 per minute at rest - When they are more present in triplets or more

Answer 52

They may experience reduced exercise tolerance, becoming fatigued more quickly or find that their usual level of physical activity is more strenuous than before. - Sx like palpitations, SOB, or even chest pain can be exacerbated by exercise

Answer 53

Pulse oximeters may not be accurate due to the irregular rhythm. Instead consider assessment of the physical pulse for a full minute. - If unsure about the ability to take radial pulse, with the stethoscope assess it apically.

Answer 54

Trigeminy - Theres a PVC every 3rd

Answer 55

Bigeminy - There is a PVC everyother

Answer 56

Couplet - Theres 2 PVCs in a row

Answer 57

Triplet - There are 3 PVCs in a row

Answer 58

This is defined as a series of three or more PVCs in a row in the ventrial. *Thats why the QRS makes sense to be wide and bizzare because thats for ventricular depolarization*

Answer 59

VT can be tolerated at lower HR, it is a highly dangerous arrhythmia because it can **progress to Ventricular Fibrillation (VF)**, particularly in the setting of decreased myocardial contractility (e.g., after an MI)

Answer 60

- Erratic quivering of the ventricular muscle and a **cessation** of cardiac output - VF can further deteriorate to asystole if not treated

Answer 61

Disorders of the heart's rhythm due to an obstruction - a block - in the electrical conduction system of the heart. There are 3 types of AV Blocks: - First Degree - Second Degree - Third Degree

Answer 62

A stable prolongation of the PR Interval to more than 200ms and represents delay in conduction at the level of the AV node

Answer 63

Mobitz Type 1 (Wenckebach): Progressive prolongation of the PR interval before an atrial impulse fails to stimulate the ventricle (e.g., a P wave is nonconducted and a QRS is dropped). Usually occurs at the level of AV node

Answer 64

Mobitz Type 2: Fixed PR interval with some P waves not conducted. Usually occurs below the bundle of His and may be a bilateral bundle branch block

Answer 65

This can be crucial indicator of myocardial ischemia or injury - Ischemia can also manifest as T-wave inversions or flattening

Answer 66

This is Ischmia, without subendocardial injury (i.e. necrosis of myocardium - cell death) can present as T-Wave Inversion

Answer 67

This is Ischmia, with subendocardial injury (i.e. necrosis of myocardium - cell death) can present as ST segment depression

Answer 68

Upsloping ST Segment depression ≥ 2.00 mm may represent Myocardial Ischemia, especially in the **presence of angina**. However this reponse has a low positive predictive value; **it is often categorized as equivocal**

Answer 69

Downsloping ST Segment Depression ≥ 1.00mm is a **strong indicator of myocardial ischemia**

Answer 70

ST-Segment Depression should be present in at least 3 consecutive cardiac cycles within the same lead. The level of the ST-segment should be compared relative to the end of the PR segment - Clinically significant ST-segment depression that occurs during **Post-exercise** recovery is an indicator of myocardial ischemia

Answer 71

ST-Segment elevation is generally considered a medical emergency requiring immediate intervention, *whereas ST-Segment depression may or may not be immediately life-threatening depending on the clincial contex* - ST-Segment Elevation MORE STRONGLY correlates with myocardial injury that has extended through the **full thickness of the myocardium** (i.e., transmural - "across the wall")

Answer 72

These create an artificial electrical voltage difference between 2 electrodes - Marked by a pacer spike on ECG

Answer 73

Thromboembolic Events

Answer 74

- Lack of Spike - Spike in wrong location

Answer 75

Immediately after permanent pacemake placement: - Ipsilateral AROM should be < 90° for 4 weeks - Arm sling may be used

Answer 76

Used to manage uncontrollable, life-threatening ventricular arrythmias by sensing the heart rhythm and defibrillating the myocardium - Knowing the discharge rate allows for safe prescription of exercise --**Stay ~20-30 bpm under this rate**

Answer 77

- This is increasingly used as bridge to AICD placement or heart transplant - Gives a warning alarm

Answer 78

No, only if they are in V-Fib or V-Tach

Answer 79

Associated with Ischemia or with Hemodynamic instability, these are more likely to cause a poor outcome than isolated arrhythmias

Answer 80

Associated with increased risk for Cardiac Arrest

Answer 81

Prevent sudden death due to Ventricular Tachycardia

Answer 82

Having a "Normal" VO2 (around >85% predicted for your age, gender etc.) essentially **rules out** significant cardiovascular and pulmonary disease ## Footnote The greater the amount of oxygen consumed at peak exercise, the more fit the individual

Answer 83

There is an increase with progressive workloads at a rate of ~10bpm per 1 MET ## Footnote MET: A unit that describes how much oxygen someone is consuming at rest For ex: If a person is doing an exercise at 2 METS of intensity, this means that the exercise is having the person consume twice the amounnt of oxygen as they perform at rest

Answer 84

- Systolic BP (SBP): Gradual rate of rise (~10mmHG/MET) until reaching steady state - Diastolic BP (DBP): Increases or decreases withing 10mmHG

Answer 85

- A SBP ≥ 210 mmHG in men and ≥ 190 mmHG in women during exercise is often considered a hypertensive response - A DBP ≥ of 110 mmHG is often considered a hypersensive response

Answer 86

- A decrease of SBP by > 10 mmHG with or without a preliminary increase is considered abnormal and often associated with myocardial ischemia, left ventricular dysfunction, and an increase risk of subsequent cardiac events | This is a serious concern

Answer 87

- Medical Clearance is not necessary - Light to moderate-intensity exercise recommended - May gradually progress to vigorous-intensity exercise follwing ACSM guidelines ## Footnote Medical clearance is approval from a healthcare progessional

Answer 88

Performing planned structured physcial activity for at leat 30 minutes at a moderate intensity at least 3 days per week for the last 3 months ## Footnote Anyone who does not meet that criteria is said to not be a regular exercise participant

Answer 89

- Medical Clearance Recommended - Following medical clearance, light to moderate-intensity exercise recommended - May gradually progress as tolerated following ACSM guidelines

Answer 90

- Medical Clearance Recommended - Following medical clearance, light-moderate intensity exercise recommended - May gradually progress as tolerated following ACSM guidelines

Answer 91

- Medical clearance is not necessary - Continue moderate or vigorous-intensity exercise - May gradually progress following ACSM guidelines

Answer 92

- Medical clearance for moderate-intensity exercise NOT necessary - Medical clearance (within the past 12 months if no change in S/S) recommended before engaging in vigorous-intensity exercise - Continue with moderate-intensity exercise - Following medical clearance, may gradually progress as tolerated following ACSM guidelines

Answer 93

- **Discontinue exercise and seek medical clearance** - May return to exercise following medical clearance - Gradually progress as tolerated following ACSM guidelines

Answer 94

- S/S of decompensated Cogestive Heart Failure - > 10 PVCs/minute **at rest** - Mutlifocal PVCs, unstable angina, and ECG changes associatd with ischemia/injury - Dissecting aortic aneurism - New Onset (< 24 hrs) A-fib with rapid ventricular response (RVR) > 100bpm (at rest) - 2nd degree-heart block coupled with ventricular tachycardia - 3rd degree heart block - Chest pain with new ST segment changes on ECG

Answer 95

- **Resting** tachycardia (especially if new) - **Resting** SBP > 160 or DBP > 90 (Escpecially if new) - **Resting** SBP < 80 - Ventricular ectopy **at rest** - MI or extension of infarction within previous 2 days - Uncontrolled Metabolic Disease (e.g., DM) - Psychosis or other unstable psychologic condition

Answer 96

- 220-age= predicted max HR (PMHR) (This may overestimate true HRmax in young adults and underestimate true HRmax in persons older than 40) - 208-(0.7 x age) (This more accurately identifies true HRmax among healthy adults across the life span, Still has a wide variation of 10-12bpm) -With this, you also multiply by 85% (.85) to get the endpoint bpm

Answer 97

164-(0.7 x age)

Answer 98

- Pt request to stop - A predetermined physiologic or other end-point has been reached - Technical failure of any monitoring equipment - Excessive dyspnea (using 0-10 Borg scale; will depend on case by case level) - Sustained ventricular tachycardia - Changes to cardiac rhythm as assessed by ECG, palpation or auscultion - SpO2 drops below prescribed levels - ST-Stegmetn depression ≥ 1 mm or reports of sx that could be angina - Max tolerable (Grade 3) claudication pain - Decreased in SBP > 10 mmHG or if SBP decreases from resting value obtained in same postural position prior to testing - Consider cut off at a exaggerated BP response (SBP > 210 mmHG or Diastolic >115 mmHG; this will vary case-by-case)

Answer 99

We can likely estimate peak workload to be **1-2 stages above near-maximal performance** to provide information for exercise prescription

Answer 100

- Ischemia leads to necrosis of cardiac tissue in the affected area **within minutes** of coronary artery occlusion - Initiation of an inflammation response that involves the release of various inflammation mediators and signals the recruitment of WBCs to the site of injury - The **overall pumping efficiency of the heart decreases** as the affected part of the **heart may become hypokinetic or akinetic**

Answer 101

- The inflammatory response continues with the removal of dead cells and debris, preparing the groundwork for healing and scar formation. - The area surrounding the necrotic tissue may become edematous and hemorrhagic due to the disruption of microvasculature. - Fibroblasts begin to proliferate at the site of injury, laying down the extracellular matrix that will form the basis of the scar tissue.

Answer 102

- The development of a fibrous scar begins as granulation tissue and collagen deposition begins to form by about the end of the first week. - **This area remains vulnerable to mechanical stress** due to the ongoing remodeling and **relatively weak tensile strength** of the new tissue. - The shape and size of the ventricle begins changes through a remodeling process

Answer 103

- Over the next several weeks, the scar tissue continues to **mature and strengthen, replacing the necrotic tissue**. - The collagen fibers reorganize, and the **scar contracts**. The process of ventricular remodeling can continue for months after an MI. - This can involve hypertrophy (thickening) of the unaffected myocardium in an attempt to compensate for the lost muscle function

Answer 104

Can lead to impaired systolic and diastolic dysfunction and arrythmias

Answer 105

- Remaining Left Ventricular function (**MOST IMPORTANT**) - Complications - Infarction size - Presence of disease in other coronary arteries which leave other parts of myocardium still at risk

Answer 106

- Factors like the **extent of myocardial damage**, the **location of the infarct**, the **speed of medical intervention**, and the **overall health of the patient**. ## Footnote Increased levels of habitual physical activity before hospitalization for heart-related conditions are associated with better short-term cardiovascular outcomes

Answer 107

**Immediate and appropriate medical treatment**(e.g., reperfusion therapy) is crucial to minimize the risk of these complications. Long-term management, including **lifestyle changes and medication**, is also essential for reducing future risks. ## Footnote Patients with an "uncomplicated" profile will more often experience notably reduced rates of morbidity and mortality after their initial cardiac events

Answer 108

*Most Common* - We will see pump dysfunction of failure

Answer 109

Elevated HR originating from the SA node

Answer 110

- After an MI, the heart may become less efficient at pumping blood due to damage to the myocardial tissue. **The body compensates by increasing the HR to maintain adequate cardiac output and perfusion to vital organs**. This compensatory mechanism can **result in persistent sinus tachycardia**

Answer 111

- Cardiac output may fall due to the **markedly reduced ventricular filling time** (affecting pre-load) In these cases, look for signs of: - Hypotension - Acute Altered Mental Status (AMS) - Ischemic chest discomfort due to increasing myocardial oxygen demand but reduced coronary blood flow - Acute Heart Failure (e.g., fluid back up with pulmonary edema, dyspnea)

Answer 112

Monitoring Mean Arterial Pressure (MAP) - MAP = [(2 x DBP) + SBP] / 3 - **Normal Values 70-110 mm Hg** - A MAP **less than 60 mmHg** may indicate inadequate tissue perfusion and should, in a majority of circumstances, lead the clinician to modify the pt’s position and/or activity to increase MAP right away

Answer 113

Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs

Answer 114

- Shortness of breath, especially when lying flat - Rapid, shallow breathing - Coughing, noting any presence of frothy sputum that may be tinged with blood - Audible “crackles” or wheezing upon auscultation of the lungs ## Footnote Continuous monitoring of respiratory rate, oxygen saturation, and subjective reports of dyspnea during therapy sessions is critical for any patient who has pulmonary edema. Immediate action should be taken if signs of worsening pulmonary edema are observed.

Answer 115

A disease that causes progressive hardening and narrowing of medium and large arteries including the coronary, cerebral, and peripheral arteries - Due to the build up of plaques made up of lipids, cholesterol, calcium and cellular debris

Answer 116

- < 140/90mmHG - < 130/85mmHG if renal insufficiency or heart failure present - < 130/80mmHG if diabetic - Initiate drug therapy if lifestyle modification is ineffective physical activity - The Goal: At least 30 min of moderate intensity (40-60% of max) activity, most days of the week

Answer 117

Goal: - LDL < 160mg/dL if ≤1 risk factor for CHD present - LDL < 100mg/dL if ≥ 2 risk factors present and CHD risk is ≥ 20% or if person is diabetic - Drug therapy may also be indicated if triglycerides are >150mg/dL or HDL is < 40mg/dL for men or < 50mg/dL for women ## Footnote CHD = Coronary Heart Disease

Answer 118

Goal: - Normal fasting plasma glucose (110mg/dL) and near normal HbA1c (7%)

Answer 119

Venticular Tachycardia and Ventricular Fibrillation, leading to the cessation of CO, are the usual cause of death

Answer 120

Prompt delivery of **quality** cardiopulmonary resuscitation with AED **within 10 min** and entry into medical system is *their only chance of survival*

Answer 121

There will be Ischemia

Answer 122

- Sensation of Cardiac ischemia produced by an imbalance between myocardial oxygen supply and demand -Its often the reason the patients seek initial medical attention

Answer 123

The onset of this imbalance is generally **predictable** at a certain workload - **Relieved** by resting, reducing the intensity of the activity and/or taking sublingual nitroglycerin ## Footnote Beyond physical exertion and emotional stress, cold weather and heavy meals are also known precipitants of angina

Answer 124

- **Anywhere above the waist** but most likely in the chest, neck or jaw

Answer 125

Diffuse ache, squeezing, tightness, fullness, heaviness, burning or pressure - It is **not** usually described as focal, sharp or stabbing

Answer 126

Substernal (e.g., Levine's Sign) or chest tightness or indigestion that radiates, sometimes into the arm or into the jaw or neck

Answer 127

Tightness or discomfort posteriorly between the scapula or with Sx of indigestion, nausea, SOB or simply excessive fatigue

Answer 128

Neuropathy with impaired sensory afferentn conduction (e.g., as in diabetes)

Answer 129

Have the patient stop and assume a resting position, then consider the following: - Do the Sx relieve with rest? True stable angina pain should only increase with increases in myocardial oxygen demand and decrease with cessation of exercise/activity and/or nitroglycerin - Does the patient have risk factors for atherosclerosis? - Could the patient have a MSK chest injury? -Does palpating the painful area, deep breathing or AROM of the thorax/UEs increase sx? Any changes in sx with palpation, deep breathing, AROM of UEs argues against MI source of pain ## Footnote **Chest pain that does not relieve with rest should be considered an emergency**

Answer 130

They should **ideally** be referred to cardiology and be assessed with Cardiopulmonary Exercise Testing (CPX or CPET) or at least an Exercise Tolerance Test (ETT) or a chemical stress test

Answer 131

A submaximal exercise test that utilizes target HRs (e.g., 85% of the age-predicted Maximal HR) via walking or cycle protocols

Answer 132

This warrents **Termination** of testing and follow up with the medical team for ECG-guided, graded exercise testing and/or Holter Monitoring

Answer 133

The Anginal Threshold is the point during physical exertion at which cardiac ischemia occurs due to insufficient oxygen supply to the heart muscles

Answer 134

The exercise intensity should be prescribed at a HR andn work rate *below this point* , with an **upper limit of a minimum of 10 beats/min below the HR** at which the ischemia was initailly identified

Answer 135

This is a range of conditions associated with **sudden**, reduced blood flow to the heart

Answer 136

Typically associated with an atherosclerotic plaque rupture in an already blocked artery Primarily related to 3 heart conditions: - Unstable Angina - Non-ST-Segment elevation MI (NSTEMI) - ST-Segment elevation MI (STEMI) | The NSTEMI and STEMI are types of heart attacks

Answer 137

The presence of S/S of an inadequate blood supply to the myocardium that **doesn't follow a predictable pattern like stable angina**, which typically occus with exertion and alleviates with rest

Answer 138

Unlike Stable Angina, which is often triggered by physical exertion or stress, unstable angina can occur **spontaneously without a clear trigger or with a lower level activity**

Answer 139

While stable angina usually response well to rest and sublingual nitroglycerin, Unstable Angina might not respond as effectivley to these interventions (e.g., relief may be less complete or of shorter duration)

Answer 140

This involves a combination of clinical assessments, ECGs and Blood Test. - ECG may show changes indictative of schemia (ST-segment depression and/or T-wave inversion) - Blood test for cardiac biomarkers- proteins and enzymes that suggest myocardial damage- are usually negative

Answer 141

It may progress to Acute Myocardial Infarction (AMI) if the underlying pathophysiology is not promptly corrected

Answer 142

A clincial event resulting in myocardial necrosis due to ischemia

Answer 143

*typically more intense compared to those of unstable angina* - Sweating - Weakness - Lightheadedness - Palpitations - This can also lead to a dramatic sympathetic nervous system response due to a sudden drop in cardiac output

Answer 144

A clinical event resulting in myocardial necrosis due to ischemia

Answer 145

- Non-ST Segment Elevation Myocardial Infarction (NSTEMI) - ST-Segment Elevation Myocardial Infarction (STEMI)

Answer 146

- The blood supply to the heart is reduced, usually due to a partial blockage of a coronary artery, causing some amount of heart muscle damage. - The ECG does not show ST-segment elevation but may display other signs of ischemia, such as ST-segment depression or T-Wave inversion (similar to stable or unstable angina) ## Footnote NSTEMIs are sometimes referred to as subendocardial infarctions as they only affect the inner layers of the heart muscle

Answer 147

- A more substanital blockage of a coronary artery leads to a significant portion of the heart muscle being deprived of oxygen - The ECG shows elevation in the ST segment, indicative of extensive heart muscle damage ## Footnote STEMIs are sometimes referred to as Transmural infarction because they typcially involve the full thickness of the heart muscle wall, from the endocardium to the epicardium

Answer 148

We may see characteristic changes to Cardiac Biomarkers such as **Troponin**, Creatine Kinase-MB, and/or Myoglobin can indicate heart muscle injury and are used to confirm diagnosis of AMI

Answer 149

If reperfusion occurs within about **20 minutes**, most of the at-risk area **can be salvaged**, meaning the heart muscle can recover without significant damage. This is the ideal scenario and underscores the importance of prompt medical intervention

Answer 150

If reperfusion occurs within about **2 to 4 hours**, there can be **partial salvage of the heart muscle**. **Some areas will become necrotic** with hemorrhage and contraction bands, which are signs of irreversible damage, but some muscle tissue remains viable albeit with post- ischemic dysfunction

Answer 151

Without reperfusion, **the entire area at risk progresses to a completed infarct, meaning all the tissue in the area becomes necrotic**. This results in the loss of muscle function in the affected area and can lead to serious complications, including heart failure and arrhythmias

Answer 152

- Establish of confirm a diagnosis of cardiac dysfunction of heart disease - Demonstrate the severity of coronary artery disease (CAD) or valvular dysfunction - Determine guidelines for optimal management of the patient, including medical and surgical management as well as program of exercise

Answer 153

- Involves 4 to 6 hours of bed rest for femoral access to prevent complications or - Wrist weight bearing restrictions for 24 to 72 hours if the radial artery is used

Answer 154

- Patients are usually on bed rest for approximately 4-6 hours when venous access is performed or for 6-8 hours when arterial access is performed - The extremity that provided access should remaining immobile with a sandbag over the access site to provide constant pressure to reduce the risk of vascular complications. Some hospital use a knee immobilizer as assist with immobilizing ## Footnote PT interventions should be modified or deferred within the parameters of these precautions. Normal mobility can progress after precautionary period

Answer 155

- A catheter with a small balloon at the tip is threaded through the blood vessels to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to compress the plaque against the arterial wall, thereby widening the artery and restoring blood flow. - Frequently, a stent—a small wire mesh tube—is also inserted to keep the artery open after the procedure - This treatment is commonly used in cases of CAD and ACS to alleviate symptoms and improve blood flow to the myocardium

Answer 156

- A catheter typically equipped with a cutting or grinding device is used to remove plaque from a blood vessel. - There are different types of atherectomy procedures, including rotational, directional, and laser atherectomy, each with its own specific technique for plaque removal. - **The objective is the same as with other PCI procedures**: to improve blood flow through the coronary arteries by removing or reducing obstructions caused by plaque buildup

Answer 157

- A blood vessel from another part of the body (i.e., a “graft”) is used to create a "bypass" around the blocked or narrowed section of a coronary artery. - This allows blood to flow more freely to the heart muscle, alleviating symptoms like angina and reducing the risk of heart attack - If uncomplicated, the typical length of stay (LOS) after a CABG is about 4-7 days

Answer 158

A technique which involves making a vertical incision down the middle of the chest and then dividing the sternum to provide direct and wide accessto the heart and surrounding structures

Answer 159

**Impacts**: - Surgery results in systemic effects altering body structure, function, activity levels, and participation in Activities of Daily Living (ADLs) **Restrictions**: - Though variations in restrictions and timelines by surgeons exist, **many restrict arm use for 6 to 12 weeks** to prevent wound infection or dehiscence. However, the concept of a fixed "amount of load" or "healing time" may be inappropriate, and patients are encouraged to resume load-bearing ADLs at their own pace, following the principle of **"Keep Your Move in the Tube"**

Answer 160

- Encourages active patient participation in functional tasks and ADLs, based on current evidence of its safety and benefits. - Based on biomechanical principles the relate to the load on the lever arm of the humerus across different positions -As weighted and resistive motions move away from the midline, the greater the stress on the sternum. This is movement outside “the tube”. - The implementation of "Keep Your Move in the Tube" should start immediately post-operation, emphasizing consistent messaging from the treatment team

Answer 161

- **Pain, discomfort, and some degree of swelling, redness, and drainage** at the incision site (chest and possibly leg if a graft was taken from there) is common. - **Feeling tired and weak** is common as the body is using a lot of energy to heal. - Patients may have **limited mobility and may need assistance** with movement. - Some degree of fluid retention and swelling, especially in the legs, can occur due to decreased physical activity. - **Shortness of breath**, especially if fluid accumulates in the lungs (i.e., due to pleural effusion), is not uncommon. - **Cognitive changes**, including memory loss, concentration issues, or other cognitive impairments, is not uncommon within a condition known as "postperfusion syndrome”. - **Mood swings, anxiety, or depression** can occur as a response to the stress of surgery and the recovery process

Answer 162

This is caused by an atherosclerotic narrowing of large- and medium-sized arteries of the lower extremities. It is a result of the same atherosclerotic processes that leads to coronary heart/artery disease

Answer 163

Symptoms arise when the atheroma: - Becomes so enlarged that it interferes with blood flow to the distal tissues - Ruptures and extrudes its contents into the bloodstream or obstructs the arterial lumen - Encroaches on the media, causing weakness of that layer and aneurismal dilation of the arterial wall

Answer 164

When the blood flow is not adequate to meet the demand of the peripheral tissues (e.g., during activity) the patient may experience symptoms of ischemia

Answer 165

- Intermittent Claudication -Resting claudication pain may be seen in advanced PAD - Skin changes -Loss of hair -Loss of temperature -Dry, Shiny skin -Thick toenails -Pale or bluish(cyanotic) appearance - Nonhealing wounds or ulcers - Plantarflexor atrophy - Decreased or absent pulses -Gangrene may be seen in advanced PAD

Answer 166

Initial discomfort (established, but minimal)

Answer 167

Moderate discomfort but attention can be diverted

Answer 168

Intense Pain (attention cannont be diverted)

Answer 169

Excruciating and unbearable pain

Answer 170

With ABI - A non-invasive test that compares the BP obtained with a doppler probe of the dorsalis pedis (or post. tib A.) to the BP in the higher of the 2 brachial pressures

Answer 171

Normal - Adequate Blood supply

Answer 172

Abnormal, suggest incompressible tibial arteries due to calcification/atherosclerosis, obse lower limbs

Answer 173

Borderline Occlusion | Abnormal

Answer 174

Mild disease - **< .90 is diagnostic for PAD** | Abnormal

Answer 175

Moderate Disease - Seek routine specialist referral | Abnormal

Answer 176

Severe Limb Disease - **Likely will have pain at rest**. Seek urgent specialist referral

Answer 177

- ABIs in this range are **associated gangrenous/necrotic extremities**. - Seek urgent specialist referral

Answer 178

*Individuals with PAD are unable to produce the normal increases in peripheral blood flow essential for enhanced oxygen supply to exercising muscles* - **Walking tests** such as incremental-ramping treadmill protocols or the 6-minute walk test are the preferred examination modes as they **closely approximate actual activity limitations**

Answer 179

- F: Minimally 3x / week ; preferably up to 5x / week - I: Moderate Intensity (40-59 VO2 R) to the point of moderate pain (i.e., 3 out of 4 on the claudication pain scale) or from 50-80% of maximum walking speed - T: 30-45 min (excluding rest) for a minimum of 12 weeks; may progress to 60 min - T: Weight bearing (i.e., free or treadmill walking) intermittent exercise with seated rest when moderate pain is reached and resumption when pain is completely alleviated

Answer 180

- F: At least 2x / week performed on nonconsecutive days - I: 60-80% 1RM - T: 2-3 sets of 8-12 reps ; 6-8 exercises targeting major muscle groups - T: Whole body focusing on large muscle groups; emphasis on lower limbs if time limited

Answer 181

Walking **should be performed** at a safe pace **with the intensity** of exercise (e.g., incline of a treadmill) **that causes the onset of claudication within 3-5 minutes**. - The patient should continue walking **until the claudication pain is unbearable and then rest until the claudication resolves**. This cycle should continue for the full duration of therapy

Answer 182

Exercising in a non-weightbearing posture is likely **not as effective**. However, if unable to perform treadmill exercise or if walking duration is so short that benefit is unlikely, consider alternative mode: -Seated aerobic arm exercise -Recumbent total body stepping (NuStep) -Lower extremity cycling - **Exercise at a under a moderate level of claudication symptoms (e.g., at 0 or 1 on scale) may not be as effective but could be considered to increase exercise compliance**. - Longer warm-up times are useful, particularly in colder environments. - Sensory considerations and foot care should be emphasized due to increased risk of peripheral neuropathy

Answer 183

- A localized, permanent enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal diameter. - This structural change can compromise the integrity of the aorta to cause serious systemic implications

Answer 184

It relates to a weakening of the aortic wall due to: - Build up of plaques - Structural degradation due to breakdown of elastin and collagen - Chronic inflammation

Answer 185

- **Pulsating Abdominal Mass**: Can be a **Hallmark**, warranting further investigation - **Abdominal and Back Pain**: that is severe, sudden in onset and located in the abdomen and back can indicate the rapid expansion of an aneurysm or imminent rupture - **LE Sx** - **Signs of Rupture**: Sudden, severe pain in the abdomen or back, often described as "tearing" or "ripping," accompanied by signs of shock (hypotension, rapid heart rate, clammy skin) is a medical emergency indicative of a ruptured aneurysm. This scenario requires urgent diagnostic imaging and surgical intervention to prevent fatal outcomes

Answer 186

- %HRR: 40-59% - %HR Max: 64-76% - RPE: Fairly light to somewhat hard (RPE 12-13)

Answer 187

- %HRR: 60-89% - %HR Max: 77-95% - RPE: Somewhat hard to very hard (RPE 14-17)

Answer 188

Find the bottom and top ends off the Predicted HR Max (PHRM) - Basically, PMHR (HRMax%) *For example if we want to do moderate intensity for a patient that is 60 y.o, the range for HR Max is 64-76%* - Assess PHRM: 208 - (0.7 x 60) = 166 PHRM - Find Zone: 64% of 166 = 106 bpm 76% of 166 = 126 bpm - The person should exercise between **106-126bpm** if they want to work at a "moderate" load

Answer 189

This considers resting HR - The equation: [RHR + X% (PMHR - RHR)] and [RHR + Y% (PMHR - RHR)] - This method is useful when considering the patient with higher resting HRs (e.g., someone with a very poor fitness) *For ex. if the patient is 70 y.o and has a RHR of 90bpm, and we want to do Moderate Intensity (64-76%)* - First get PHRM = 208 - (.7 x 70) = 159 - Then HRR (PMHR-RHR) = 159 - 90 = 69 - Find Zone: (HRmax) 159 (.64) = 101 159 (.76) = 121 - Find Zone: (HRR) 90 + 69 (.40) = 117 90 + 69 (.59) = 130

Answer 190

- **F**: At least 3x / week, -For most adults, spreading the exercise session across 3-5 days per week may be the most conductive strategy - **I**: Moderate Intensity (40-59 HRR) and/or Vigorous (60-89% HRR) intensity is recommended for most adults - **T**: 30-60 min per day (≥ 150 min a week) of moderate intensity; 20-60 min per day (≥ 75 min a week) of vigorous intensity exercise; or a combination of mod and vig daily to atain the targeted volumes of exercise; -(**Also 500-1000 MET-min/week**) - **T**: Aerobic exercise performed in a continuous or intermittent manner that involves major muscle groups is recommended

Answer 191

Consider making exercise programs that: - are more immediately rewarding - allow for social interaction - make the connection between the short-term cost and the long-term goal clear

Answer 192

**F**: 2-4 session/day for the first 3 days of the hospital stay **I**: Seated or standing resting HR + 20 bpm for individuals with MI and + 30 bpm for individuals recovering from heart surgery ; Upper limit ≤120 bpm that corresponds to an RPE ≤ 13 on a scale of 6-20 **T**: Begin with intermittent walking bouts lasting 3-5 min as tolerated ; progressively increase duration. The rest period may be a slower walk (or complete rest) that is shorter than the duration of the exercise bout ; Attempt to achieve a 2:1 exercise/rest ratio ; **Progress to 10-15 min of continuous walking** **T**: Walking. Other aerobic modes are useful in inpatient facilities that have accommodationss ## Footnote *Patients who demonstrate appropriate hemodynamic, ECG, and symptomatic responses to the self-care and ambulation evaluation can have their activity levels increased*

Answer 193

**F**: Minimally 3 days/week; preferably up to 5 days/wk **I**: With an exercise test, use 40-80% of exercise capacity using HRR, VO2R or VO2 Peak ; Without an exercise test, use seated or standing resting HR +20 bpm to +30 bpm (OR do your own Exercise test) **T**: 20-60 min **T**: Arm ergometer, combination of upper and lower (Dual action) extremity cycle ergometer, upright and recumbent cycle ergometer, recumbent stepper, rower, elliptical, stair climber, treadmin

Answer 194

**F**: 2-3 non-consecutive days/wk **I**: Perform 10-15 reps of each exercise without significant fatigue; 40-60% of 1RM **T**: 1-3 sets ; 8-10 different exercise focused on major muscle groups **T**: Select equipment that is safe and comfortable for the individual to use

Answer 195

*Forward output of blood by the heart is insufficient to meet the metabolic needs to the body* - A syndrome with a variety of interrelated pathophysiologic phenomena of which **impaired ventricular function is the most important** - Results in a reduction of exercise capacity and other characteristic clinical manifestations

Answer 196

Generally idiopathic or genetic in nature, **involve pathologic processes in the heart muscle itself** (often in the mitochondria) which impair the heart’s ability to contract

Answer 197

**The result of another underlying condition or external factor affecting heart muscle function**. Can be classified according to the systemic disease that subsequently affects myocardial contraction (e.g., excessive alcohol consumption can lead to alcoholic cardiomyopathy)

Answer 198

This is impaired cardiac contractile function Causes: - Ischemic Heart disease (MI, Transient/persistent myocardial ischemia) - Dilated Cardiomyopathy (Idiopathic, viral, genetic, alcohol, etc){over enlarged ventricles, not enough myocardium} - Valvular Heart Disease (Aortic/Mitral valve stenosis or regurgitation)

Answer 199

Impaired filling of the left or right ventricle due to hypertrophy and/or changes in the composition of the myocardium Causes: - Left Ventricular Hypertorphy (e.g., as a result of chronically increased afterloads in HTN) - Restrictive Cardiomyopathy - Myocardial Fibrosis - Pericardial Effusion or Tamponade

Answer 200

*Due to significant overlap between systolic and diastolic dysfunction (i.e. many patients with HF suffer from both), it is common to categorize patients into having either*: - Heart Failure with **r**educed ejection fraction (HFrEF) -< 40% EF - Heart Failure with **p**reserved ejection fraction (HFpEF) -> 50% EF This type of categorization is: - useful, in part, because of the widespread availability of methods to measure LVEF (e.g., echocardiography) - used as a variable in many clinical HF trials - useful within medical management of individuals with HF | EF = Systolic / End-Diastolic volume (*review*)

Answer 201

In order to: - Increase myocardial contractility and HR - Produce arterial vasoconstriction (to help maintain arterial pressure) - Produce venous constriction (to increase venous pressure) - Increase blood volume (to increase preload/ventricular filling)

Answer 202

This will stimulate myocardial contractility, HR, and arterial/venous tone which results in an increase in central blood volume which serves to further elevate pre-load (to attempt to elevate CO). - **Over time though, the heart becomes insensitive to B-adrenergic stimulation**, which results in a decreased force of myocardial contraction and an inability to attain higher heart rates during physical exertion

Answer 203

- Left-sided heart failure where there is an uncompensated left ventricular pressure that leads to elevated pulmonary vascular pressures and then stress onto the right-ventricle -This is considered “**Biventricular Failure**” - Diseases of the lung parenchyma or pulmonary vasculature (e.g. COPD, interstitial lung diseases, lung infection, pulmonary embolism) -When right-sided heart failure is resultant of pulmonary processes, it is known as **cor pulmonale**

Answer 204

Sensation of dyspnea or observation of labored breathing while lying flat which is relieved by sitting up

Answer 205

Severe breathlessness that awakens the patient from sleep 1-3 hours after lying down

Answer 206

- Indicates a very compliant left ventricle. Thought to occur as blood passively fills a quickly distending left ventricle that makes contact with the chest wall during early diastole. - May be normal (“physiologic S3”), particularly in young people, but in the presence of other indicators of heart disease, it is one of the **most sensitive** indicators of significant ventricular dysfunction

Answer 207

- Represents “vibrations of the ventricular wall during the rapid influx of blood during atrial contraction” from an exaggerated atrial contraction. It is found in diseases with ventricles so thick to require a strong atrial contraction. As it is related to atrial systole, this sound is appreciated in late diastole. * Unlike S3, this extra heart sound is almost always abnormal.

Answer 208

**An indication of increased volume in the venous system and may be an early sign of right-sided heart failure**

Answer 209

*Breathing Signs* - Dyspnea and increased WOB - Orthopnea - Paroxysmal Noctornal Dyspnea (PND)

Answer 210

- Diaphoresis - Tachycardia/Tachypnea - Pulmonary Rales - S3/S3 (extra) heart sounds

Answer 211

- Jugular Venous Distension - Peripheral Edema

Answer 212

*systemic signs* - Anorexia - Right Upper Quadrant Discomfort (because of hepatic enlargement)

Answer 213

The presence of new or worsening signs/symptoms of dyspnea, fatigue, or edema that lead to hospitalization or unscheduled medical care (doctor visits or emergency department visits) **- This Typically requires hospitalization**

Answer 214

- If A-Line is dislodged, apply firm pressure and immediately notify RN - Major complications are: -Bleeding -Infection -Lack of blood flow to the tissue supplied by the artery

Answer 215

This is for the Aortic, Mitral or Tricuspid valve ## Footnote Also used for Coronary Bypasss

Answer 216

Aortic valve ## Footnote Also used for Coronary Bypasss

Answer 217

Mitral or Tricuspid ## Footnote Also used for Coronary Bypasss

Answer 218

Mitral or Tricuspid ## Footnote Also used for Coronary Bypasss

Answer 219

**F**: Minimally 3 days per week; preferably up to 5 days per week **I**: **Start at 40 to 50% and progress to 70-80% VO2 reserve (HRR)** **T**: Progressively increase to 20-60min a day **T**: Aerobic exercise: focusing on treadmill or free-walking and stationary cycling as capable

Answer 220

**F**: 1-2 nonconsecutive days **I**: **Begin at 40% 1RM for Upper Body and 50% 1RM for Lower Body**. Gradually increase to 70% 1RM over several weeks to months **T**: 1-2 sets of 10-15 reps focusing on major muscles **T**: Weight machines, dumbells, elastic bands and/or body weight can be used

Answer 221

New or worsening of Sx of Dyspnea, fatigue or edema that leads to hospitalization or unscheduled medical care (doctor visits or emergency department visits)

Answer 222

Involves the appreciation of the absolute indicators of decompensation that need to be assessed and documented in their own right.

Answer 223

This considers whether the **patient is on a stable temporal trajectory**and the relative changes in hemodynamic parameters **over time**. In other words, relative stability considers alterations that occur on a day-to-day or visit-to-visit basis relative to the patient’s baseline.

Answer 224

Absolute Relative Stability - This patient is not absolutely stable at rest, as their vital signs and symptoms at this visit show acute decompensation that is not evaluated based on previous sessions. **These signs and symptoms are serious on their own, regardless of his historical readings or conditions**. This patient's condition is critical, warranting immediate MD consultation and an emergency visit to address acute decompensation and potential respiratory distress

Answer 225

Relative Stability at rest - This patient appears relatively unstable at rest, as there is a **negative change over time from one visit to the next, relative to their individual baseline**, even though their BP is considered WNL. The patient may not require an emergency visit but likely benefits from an MD consult

Answer 226

Absolute Stability with Exercise - The patient's response to exercise is concerning **irrespective of his previous capacity or sessions**. Due to the acute and severe nature of the symptoms, the exercise should be stopped immediately, the intensity of future sessions should be reconsidered, and the patient may require an urgent medical consultation if their clinical status doesn’t improve with rest

Answer 227

Relative Stability with Exercise Despite being stable in the short term, they **show a decline in exercise tolerance across sessions**, indicating they are not relatively stable with exercise. The exercise prescription should be reassessed, potentially reduced, and the patient should consult with their physician to address the decline in her exercise capacity.

Answer 228

Patient Self-Assesses: - Difficulty breathing even at rest - Unrelieved SOB - Wheezing, chest pain or chest discomfort - Feeling faint - Confusion What to do: - Call physician immediately or immediate visit to the emergency department

Answer 229

Patient Self-Assesses: - Weight Gain > 2lbs in 1 day or 5lbs in one week - Increase swelling - Increase cough - Increase in SOB with activity - Increase in the number of pillows needed What to do: - Communicate with physician as the patient may need adjustment to medication

Answer 230

Patient Self-Assesses: - No SOB - No weight gain - No swelling - No chest pain - No decreased in ability to maintain activity level What to do: - Proceed with interventions, exercises, and activity as planned

Answer 231

A physical exam takes place, -We assess Pulmonary Crackles, S3 auscultations, and JVD - If the patient does not have any of these, -This may indicate need for an adjustment in meds and therefore warrents communication with the physician - If they do have these, -Overt decompensation: an immediate visit to the ED or call physician office immediately

Answer 232

Overt decompensation: an immediate visit to the ED or call physician office immediately

Answer 233

**Educate on and Facilitate Components of Chronic disease management** - PTs **MUST make appropriate nutrition referrals, perform medication reconciliation and provide appropriate education on preventative self-care behaviors to reduce risk of hospital readmissions** - These include: -Daily weight measurement to identify increases greater than 2 to 3 lbs in 24 hrs or 5 lbs over 3 days -Recognition of S/S of an exacerbation -Action plan with Red/Yellow/Green CHF tool -Following nutrition plan -Medication management/medication reconciliation

Answer 234

Continue and assess Stability with Exercise -Vitals with exercise -Recovery time -S/S of Exercise tolerance

Answer 235

MD consult Emergency Visit

Answer 236

Increase the intensity/Dose of Exercise

Answer 237

Reduce intensity/Dose of exercise and/or MD consult Emergency Visit

Answer 238

The absolute degree of change in hemodynamic parameters including but not limitied to a drop in BP or rapid increase in HR that might occur with exercise

Answer 239

The relative changes in exerices response that occur at the same intensity of exercise from one visit to the next

Answer 240

**Prescribe Aerobic Exercise Training** PTs **MUST** prescribe aerobic exercise training for patients with Stable, NYHA class 2 to 3 HF using the following parameters: - Time: 20-60 min - **Intensity: 50-90% of Peak VO2 or Peak work** - Frequency: 3 to 5 x a week - Mode: Treadmill or cycle ergometer or dancing ## Footnote Total energy expenditure during the program was the most important determinant of improvement in peak VO2

Answer 241

Utilize submax exercise testing to determine a baseline for cardiopulmonary fitness

Answer 242

**Prescribe High-Intensity Interval Exercise Training in Selected Patients** PTs **SHOULD** prescibe high intensity interval-based exercise (HIIT) for patients with stable, NYHA Class 2 to 3 HFrEF using the following parameters: - Time: >35 total minutes of 1 to 5 minutes of high-intensity (>90%) alternating with 1 to 5 minutes at 40% to 70% active rest intervals, with rest intervals shorter than the work intervals - **Intensity: >90 of peak VO2 or peak work.** - Frequency: 2 to 3 times per week. - Duration: at least 8 to 12 weeks. - Mode: treadmill or cycle ergometer ## Footnote Shorter HITT sessions may allow for the greatest long-term adherence

Answer 243

**Prescribe Resistance Training** Physical therapists **SHOULD** prescribe resistance training for the upper and lower body major muscle groups for patients with stable, NYHA Class I to III HFrEF using the following parameters: - Time: 45 to 60 minutes per session. - **Intensity: 60% to 80% 1RM, 2 to 3 sets per muscle group.** - Frequency: 3 times per week. - Duration: at least 8 to 12 weeks ## Footnote **Resistance training can be especially effective in patients that do not tolerate continuous or interval aerobic training or other therapeutic modalities.** Accommodating patient preference for mode of exercise may increase patient adherence, and thus resistance training should be offered as an option

Answer 244

This refers to the **delivery system** that presents oxygen‐rich air to the alveoli and removes CO2 from the blood/alveoli

Answer 245

Chest Rise and Respiratory Rate

Answer 246

CO2 levels are **mainly affected by Minute Ventilation** which can be described as the **amount of air that ventilated per breath (tidal volume)** and the **rate of breathing (TIDAL VOLUME x RESPIRATORY RATE)**

Answer 247

The patient’s ability to take in oxygen from the alveoli and distribute it to the tissues and organs of the body to maintain cellular activity.

Answer 248

This refers to an excess of pleural fluid in the pleural cavity caused by damage to pleura (e.g., by trauma, infection, malignancy) or when there is either excessive production of pleural fluid or the resorption capacity is reduced (e.g., lymphatic obstruction)

Answer 249

- Hemothorax (blood) - Empyema (pus) - Air (Pneumothorax)

Answer 250

The pleural space is **NOT** continuous with the airways

Answer 251

This is under Autonomic nervous system: - It increases in parasympathetic outflow that causes bronchoconstriction - It increases in sympathetic stimulation that causes bronchodilation

Answer 252

The volume in the lungs at maximal inflation, the sum of VC and RV

Answer 253

That volume of air moved into or out of the lungs during quiet breathing

Answer 254

The volume of air remaining in the lungs after a maximal exhalation

Answer 255

The volume of air breathed out after the deepest inhalation. Also called “Forced” Vital Capacity during Pulmonary Function Testing.

Answer 256

Volume of air that is exhaled during the 1st second of the FVC and reflects airflow of the large airways

Answer 257

This refers to the ease with which the lungs can expand during inhalation ## Footnote Some diseases change the lung's compliance which negatively affects respiratory mechanics and gas exchange

Answer 258

This describes the relationship between the amount of air reaching the alveoli (ventilation) and the amount of blood passing by the alveoli in the pulmonary capillaries (perfusion)

Answer 259

- Shunt is when blood bypasses the alveoli **without** gas exchange - Dead Space is when the areas of the lungs are ventilated but **not** perfused with blood

Answer 260

A patients position can help a optimize gas exchange in the lungs

Answer 261

These positions can be beneficial, especially in patients with conditions like COPD by **improving diaphragmatic movement and reducing the work of breathing**. Upright positioning can enhance ventilation to the lung bases, improving the V/Q match in these areas, which are more heavily perfused due to gravity

Answer 262

Mobilizing the patient as much as possible can also assist in improving V/Q matching. It promotes lung expansion, secretion clearance, and enhances overall lung function

Answer 263

These positions can **help mobilize secretions from specific lobes or segments of the lungs, enhancing ventilation to these areas and consequently improving V/Q matching**. For example, in patients with bronchiectasis or cystic fibrosis where mucus accumulation is a significant issue, postural drainage positions can facilitate mucus clearance, improve ventilation, and thus enhance V/Q matching.

Answer 264

The cardinal signs of bronchospasm include **wheezing**, a high-pitched whistling sound during exhalation, and **dyspnea**. Individuals often experience **chest tightness** and **persistent coughing** as reflex responses to airway irritation. **Visible use of accessory muscles** and **prolonged expiration** reflect the increased effort to breathe due to narrowed airways

Answer 265

A region of normally compressible lung tissue that has filled with liquid instead of air. Consolidation occurs through accumulation of infiltrates in the alveoli and adjoining ducts which can be made up of: - white blood cells (e.g., pus) - inhaled fluid (e.g., water) - blood (from bronchial tree or hemorrhage from a pulmonary artery)

Answer 266

**Fluid in the pleural space**, caused by various conditions including heart failure and infections, presenting with fluid collections at the lung bases and symptoms like dyspnea and pleuritic chest pain

Answer 267

**Fluid within the alveoli and interstitium** (spaces between the alveoli and the capillaries), often due to heart failure (cardiogenic), where increased pressure in the pulmonary capillaries causes fluid to leak out. Non-cardiogenic causes include acute respiratory distress syndrome (ARDS), where increased permeability of the alveolar-capillary barrier allows fluid to enter the alveoli

Answer 268

A pathological collapse or incomplete expansion of lung tissue, resulting in partial or complete loss of lung volume due to alveolar airspace closure ## Footnote Atelectasis can also happen when a person takes small, shallow breaths, which can happen due to pain, sedatives, or prolonged bed rest. Over time, this inadequate lung expansion can cause parts of the lung to collapse.

Answer 269

A consequence of **blockage of an airway**. Air retained distal to the occlusion is resorbed from nonventilated alveoli, causing the affected regions to become totally gasless and then collapse

Answer 270

This ensues when contact between the parietal and visceral pleurae is eliminated (e.g., as within pleural effusion or pneumothorax)

Answer 271

This occurs when a space occupying lesion of the thorax (e.g., pleural effusion or solid mass of the chest wall, pleura, or parenchyma) **presses on the lung and causes the lung volume to diminish to less than the usual resting volume** (i.e., the functional residual capacity)

Answer 272

When there is a **surfactant deficiency and there is a greater tendency of the alveoli to collapse**. Conditions include Acute Respiratory Distress Syndrome (ARDS), Pulmonary Embolus and Pneumonia

Answer 273

Post-op or bed ridden patients can respond to interventions like deep breathing, incentive spirometry, and coughing. **Prevention** should be goal for all hospitalization patients.

Answer 274

By increasing tidal volume (TV) and respiratory rate (RR). Together, TV (mL/cycle) x RR (cycles/min) = Minute Ventilation (mL / min)

Answer 275

Hyperpnea (increased depth of breathing) followed by increases to RR

Answer 276

- **Hyperventilation**: Increased rate and/or depth of ventilation where the body eliminates more carbon dioxide than is being produced. Common causes: -Metabolic Acidosis w/ Kussmaul’s breathing: -Anxiety, Fear - **Hypoventilation**: Decreased rate and/or depth of breathing which leads to increased concentration of CO2 and eventual hypoxia -Sedation, somnolence, neurologic depression of respiratory centers, metabolic alkalosis

Answer 277

Inward abdominal or chest wall movement within inspiration and outward movement with expiration. *This Generally follows orthopneic pattern* -*Laying supine exacerbates diaphragmatic weakness due to abdominal contents applying a greater pressure onto it in the supine position* Causes: - Diaphragmatic fatigue (e.g., as seen in severe COPD), trauma, or respiratory muscle weakness due to neurologic dysfunction: -Trauma to chest wall (i.e., flail chest) -Neurogenic vs Non-neurogenic

Answer 278

Periodic breathing pattern where each cycle has near-constant repsiratory rate but variable depth - In CHF, it is due to poor cardiac output and carries a poor prognosis - Can be seen in various CNS disorders that can increase sensitivity of the repsiratory centers to CO2

Answer 279

- At Axilla - upper chest/lobes - At Xiphoid - Middle chest/Lobe/Lingula - Halfway between Xiphoid and Umbilicus - Lower chest/Lobes Why a tape measurer? - Increases objectivity - Repeatable with better precision - Good for goal setting

Answer 280

Continuous, most frequently heard on exhalation and are associated with airway narrowing or obstruction - Example: bronchospasm

Answer 281

Mostly defined as continuous, snoring sound - Example: Large airway obstruction (e.g., secretions). Can often be cleared with cough.

Answer 282

Discontinuous, mostly during inspiration

Answer 283

Raspy breathing sound - “like to pieces of leather being rubbed together” - heard through inspiration and expiration - Example: Pleuritis, pleural effusion

Answer 284

This is a Sigmoidal Curve - Normally there is a drop of 5 - This means that small changes in PaO2 can lead to large changes in SaO2 at certain points on the curve - **Typically after 60 PaO2**, there is a steep drop off of SaO2

Answer 285

< 60 is the standard threshold for defining the Hypoxemia seen in Respiratory Failure

Answer 286

**No**, pulse oxymetry monitors the amount of oxygen saturation which can be normal as the body compensates by changing the RR to maintain oxygenation within early stages of a patient's health deterioration

Answer 287

- Quality: Harsh; High-Pitched - I:E Ratio: I=E - Location: Above supraclavicular notch, over the trachea

Answer 288

- Quality: Soft, low pitched - I:E Ratio: I > E - Location: Remainder of lungs ## Footnote These are "normal" breath sounds throughout the lung fields

Answer 289

- Quality: Loud; High-Pitched - I:E Ratio: I < E - Location: Just above clavicles on each side of the sternum, over the manubrium

Answer 290

We should expect replacement of air-filled lung by fluid filled or consolidated lung tissue

Answer 291

E to A changes in periphery

Answer 292

When spoken words may or may not become intelligible but the sound becomes louder

Answer 293

When words become clear and intelligible

Answer 294

The tissue is rich in air and poor in solid/fluid

Answer 295

The tissue ratio between air and fluid/solid is low - Hear with patients with: -Pneumonia (Alveolia are filled w/ fluid and blood cells) -Pleural Effusion (Serous fluid in pleural space) -Hemothorax (Blood in pleural space) -Abnormal Tissue (Fibrous, tumor)

Answer 296

The Air is more abundant than normal - Hear with patients with: -Pneumothorax (Air in pleural space: uni- or bi-lateral) -Lung Hyperinflation (e.g., with COPD, asthma)

Answer 297

This happens when the **lung volume or intrathoracic pressure on that side is decreased**. This can happen after a lobectomy or pneumonectomy or a large degree of atelectasis - When the shift goes to the affected side in the patient after a lobectomy or pneumonectomy, the **patient should be cautioned against lying on the affected side because this would only increase the mediastinal shift**

Answer 298

When there is **increased pressure on the same side**, as happens in a pleural effusion, a tumor, or an untreated pneuomothorax

Answer 299

Palpation proceeds with the **tip of the index finger** being placed in the **suprasternal notch**, first medially to the left sternoclavicular joint and pushed inward toward the cervical spine. Then the index finger is placed medial to the right sternoclavicular joint and pushed inward toward the cervical spine

Answer 300

Aggressive Treatment is usually indicated - If the shift is caused by a pneumothorax, a chest tube is usually inserted immediately. In the case of the large pleural effusion, a thoracentesis may be performed to drain the fluid or to evaluate the contents of the fluid or both

Answer 301

The patient should be **cautioned against lying on the affected side because this would only increase the mediastinal shift**

Answer 302

- Quality: Medium in loudness and pitch - I:E Ratio: I = E - Location: Next to the sternum, between scapulae

Answer 303

Anterior Segments of the Upper Lobes (R side) (1 ,2, 3 Intercostal space)

Answer 304

Right Middle Lobe (Spaces 4 and 5)

Answer 305

Anterior Basal Segments of the Lower Lobe (6th Intercostal space)

Answer 306

Lingula (4th and 5th intercostal space)

Answer 307

Posterior Basal Segments of the Lower Lobs (T10-T12)

Answer 308

Lateral Basal Segments of the Lower Lobe (Lateral to Inferior Lobe)

Answer 309

Superior Basal Segments of the Lower Lobes (Medial to Inferior Angle)

Answer 310

Posterior Segments of the Upper Lobe (Root of the spine of Scap)

Answer 311

Posterior Apical Segments of the Upper Lobe

Answer 312

When the partial pressure of oxygen in arterial blood (PaO2) falls below ~55-60 mmHG - A subsequent increase in minute ventilation occurs as well as a decrease in partial pressure of Carbon Dioxide (PaCO2). This results in a compensatory rise in HR/CO to increase O2 delivery to tissues

Answer 313

Pulmonary Hypertension, **Increasing the work on the Right Side of the heart**, leading to Right Heart dysfunction and subsequently failure (cor pulmonale)

Answer 314

- PaO2 < 55 mmHG or SaO2/SpO2 < 88% on room air or - PaO2 56-59 or SaO2/SpO2 89-90% with one or more: -Pulmonary Hypertension -Cor Pulmonary or Edema due to heart failure -Hematocrit >56%

Answer 315

Monitor and continue plan of care

Answer 316

Decrease/Stop activity, Position change, deep breathing, pursed-lips breathing, coughing

Answer 317

Monitor and continue plan of care

Answer 318

1. Adjust the flow as needed 2. Change O2 delivery method

Answer 319

If the Consult MD for revised order was denied, decrease activity level - If the SpO2 IS ≥ 90%, monitor and continue plan of care - If the SpO2 IS NOT ≥ 90%, stop activity and discuss with MD

Answer 320

This is Fraction of Inspired air, this represents the percentage of oxygen in atmospheric air - FiO2 = (Flow Rate x 0.04) + 0.20

Answer 321

- Delivers flows from 0.25 to 6 L/min - Generally recommended low flow NCs **NOT** used for flows > 6 L/min due to patient discomfort

Answer 322

- Best for patients needing > 6 L/min - More comfortable, can eat/drink/talk easier than with mask

Answer 323

Covers mouth and nose, useful for patients unable to breath through nose

Answer 324

- O2 system providing more specific O2 concentration than other devices - Easy system for mobilizing patients - Can provide O2 via face mask or tracheostomy tube

Answer 325

- Mask with O2 reservoir (bag) providing higher FiO2 - Advantage: Requires a lower flow of FiO2 from the tank for the FiO2 needed

Answer 326

- Can be used to manually ventilate patients during ambulation when a portable ventilator is not available, give supplemental O2 for suctioning etc. - For mobility, atracheostomy swivel connector with expandable tubing should be used to prevent extubation

Answer 327

O2 Tank Flow - Approx FiO2 1 L/min - 0.24 2 L/min - 0.28 3 L/min - 0.32 4 L/min - 0.36 5 L/min - 0.40 6 L/min - 0.44 ## Footnote FiO2 goes up by 0.04; Maxes at 0.44

Answer 328

Highest % O2 is up to 0.75 FiO2 at 15 L/min

Answer 329

O2 Tank Flow - Approx FiO2 6 - 10 L/min - 0.35-0.50 (can vary)

Answer 330

O2 Tank Flow - Turn dial and provide O2 as stated on dial for need FiO2 Approx FiO2 - 0.24 - 0.50

Answer 331

O2 Tak Flow - Approx FiO2 6 L/min - 0.60 7 L/min - 0.70 8-10 L/min - 0.80+

Answer 332

Up to 1.00 FiO2

Answer 333

*The premis: The Position of Optial Physiologic function is Upright and moving* 1. Mobilizaton and Exercise 2. Body Positioning 3. Breathing control maneuvers 4. Coughing maneuvers 5. Relaxation and energy Interventions 6. ROM exercises (Cardiopulmonary indications) 7. Postural drainage positioning 8. Manual Techniques 9. Suctioning

Answer 334

To elicit an exercise stimulus that addresses one of the three effects on the various steps in the oxygen transport pathway or some combination ## Footnote Mobilizations and exercise, reduces stress on the pulmonary system during mobility and exercise

Answer 335

To elicit a gravitational stimulus that stimulates being upright and moving as much as possible: Active, active-assist, passive

Answer 336

To augment alveolar ventilation, to facilitate mucociliary transport, and to stimulate coughing

Answer 337

To minimize the work of breathing and of the heart and to minimize undue oxygen demand

Answer 338

To stimulate alveolar ventilation and altre its distrubution

Answer 339

To facilitate airway clearance using gravitational effects

Answer 340

To facilitate airway clearance in conjunction with specific body positioning

Answer 341

To facilitate the removal of airway secretions collected centrally

Answer 342

- Dyspnea on exertion – Use Dyspnea Scale with target of 4-6/10 rating during activity - Use pulse oximetry and monitor for signs of hypoxemia / respiratory distress - Consider physician orders for titrating supplemental oxygen to maintain SpO2 above > X% - Consider bronchodilator therapies before exercise training - Resistance training emphasis on function and musculature that support anti-gravity function and ADLs - Balance training due to common observation of falls in some populations with chronic pulmonary diseases (COPD, for example)

Answer 343

- V/Q Matching - When **standing**, gravity pulls the mediastinal and abdominal structures down, creating more space in the thoracic cavity, which allows further expansion of the lungs and greater lung volumes. This, along with the decrease in compression on the lung bases, allows for greater alveolar recruitment. - **Sitting** often leads to the somewhat reduced lung volumes compared with standing due to abdominal organs being higher, interfering with diaphragmatic motion. Second, the abdominal muscles are in a less optimal point in the length-tension curve, since the combination of hip flexion and higher position of the abdominal contents exert upward pressure. Third, the back of the chair may limit thoracic expansion. - **Supine** position negatively affects diaphragmatic strength and an increase in blood volume within the thoracic cavity can lead to congestion of the pulmonary vasculature, which reduces lung compliance. This makes the lungs stiffer and harder to expand during inspiration

Answer 344

- Pursed-Lip Breathing - Paced Breathing (Controlled exhalation during effortful movement) - Diaphragmatic Breathing - Lateral Costal Breathing - Inspiratory Hold Technique

Answer 345

Dyspnea at rest and/or with exertion, wheezing

Answer 346

Low Endurance, Dyspnea on exertion, tachypnea, fatigue, anxiety

Answer 347

Dyspnea, impaired lower lung expansion, hypoxemia, tachypnea, atelectasis, anxiety, excess pulmonary secretions. - Note: individuals with severe hyperinflation and flattened diaphragms will most likely not benefit from this technique because the muscle length tension relationship is abnormal and will not result in an appropriate movement of the diaphragm

Answer 348

Asymmetric Lateral chest wall expansion, localized lung consolidation or secretions

Answer 349

Hypoventilation, Atelectasis, Ineffective cough

Answer 350

- Initially we can start the patient in supine, although this requires the patient to breath against increased visceral organ resistance. Consider the sidelying position as better alternative for some - When the pt has mastered the breathing pattern in supine or sidelying progress to sitting, then standing then walking and finally stairs

Answer 351

Impaired mucociliary transport, excessive pulmonary secretions, ineffective or absent cough

Answer 352

- Pain Management - Inhaled Bronchodilaters ~30 minutes prior - Meal Timing: Before or at least 30 min after end of meal or tube feeding

Answer 353

- Simplest form is **deep breathing and applying techniques to improve coughing function** - These techniques should be used with **ALL** patients in inpatient care (e.g., acute care, skilled nursing facilites) to improve airway clearance or prevent pulmonary dysfunction. -However, **IF** an individual has retained secretions or has an ineffective cough, **THEN** alternatative airway clearance techniques should be used to mobilize the secretions and expel them from the airways to prevent futher pulmonary dysfunction ## Footnote Mobility (e.g. ambulation) is an additional airway clearance technique that should be used early

Answer 354

- Adequate Inspiration (greater than tidal volume) - Glottic Closure -Otherwise, its called a **huff** - Building up of intrathoracic pressure and intraabdominal pressure -Facilitated by abdominal and intercostal muscle contraction - Glottic opening and expulsion

Answer 355

- Consider cueing for upward gaze, scapular retraction, UE elevation as needed - "Take a deep breath in...in...in...in...in... and now hold it"

Answer 356

- Consider cueing for downward gaze, scapular protraction, UE depression and squeezing chest as needed

Answer 357

**Breathing Control (BC)**: - Relaxed, diaphragmatic breathing, normal tidal volume, 15-30 seconds **Thoracic Expansion Exercises (TEE)**: - Deep, slow breathing in the vital capacity range *This cycle alternates until the patient feels prepared to expectorate the accumulated secretions, then*: **Forced Expiratory Techniques (FET)**: - 1 or 2 **Huffs** - *Huffs may be better for airways prine to collapsing*

Answer 358

This is performed **at rest** and can be combined with breathing strategies (e.g., inspiratory hold) and/or performed in a postural drainage position with or without an application of percussion/vibration

Answer 359

- Segmental bronchi positioned perpendicular to the floor - If used exclusively, each affected segment position should be maintained 5-10 minutes -Prioritize most affected segment Note some general trends: - The more caudal the lung segment to be drained, the lower the head of bed is to be positioned - The lung segment to be drained is often positioned superiorly so it can drain toward to proximal airways at the midline

Answer 360

- Pulmonary Edema - Hemoptysis - Massive Obesity - Large Pleural Effusion - Massive Atelectasis

Answer 361

- Increased ICP - Unstable hemodynamics - Recent esophageal anastomosis - Recent spinal fusion or injury - Recent head trauma - Diaphragmatic hernia - Recent eye surgery

Answer 362

- Lumbrical hand positioning with firm hands and loose wrists - 2-5 minutes per segment followed by vibration (**exhalation only**) and coughing/huffing

Answer 363

- Marked increase in RR or BP - Decrease in SpO2 - Dyspnea or increased work of breathing - Mental status change - Cyanosis

Answer 364

- Meal Timing: before or way after eating - Nebulizer treatment may assist - Can coordinate with nursing /RT in the event that is needed for suctioning is anticipated ## Footnote RT = Respiratory therapist

Answer 365

- Uncontrolled bronchospasm - Osteoporosis - Rib fx - Metastatic CA to ribs - Tumor obstruction to airway - Anxiety - Coagulopathy - Convulsive or seizure disorder - Recent PM placement - Chest tube

Answer 366

- Hemoptysis - Untreated Tension Pneumothorax - Platelet count < 50,000 - Unstable hemodynamic status - Open wounds, burns in the thoracic area - PE - Subcutaneous Emphysema - Recent Skin grafts or flaps on thorax

Answer 367

This is intended to improve on impaired strength and/or endurance of the respiratory muscles S/S of those impairments include: - Decreased (chest expansion, breath sounds, tidal volumes) - Dyspnea - Uncoordinated breathing The Concepts of IMT are the same as muscles, we incorporate the concepts of **overload, specificity and reversibility** ## Footnote WIth IMTs, a major discrepancy may exist in the diagnosis for which this treatment is applied

Answer 368

7.35 - 7.45

Answer 369

35 - 45 (40) mmHg

Answer 370

80 - 100 mmHg

Answer 371

22 - 26 (24) mEq/L ## Footnote HCO3 is bicarbonate, its a buffer against acididty. It will raise pH if its too low

Answer 372

Blood becomes more acidic and pH goes down

Answer 373

pH goes up, the blood becomes more alkaline (basic), because there is more buffer introduced in the blood

Answer 374

The kidneys and lungs - The kideys are considered slow and the lungs fast

Answer 375

A condition of blood acidity due to a primary respiratory phenomenon - Causes the blood pH to go down

Answer 376

- Respiratory Depression (Anesthesia, Overdose, increased ICP) - Airway obstruction, decreased capillary diffusion (Pneumonia, COPD, ARDS, PE)

Answer 377

- Headache - Hyperkalemia - Dysrythmias (increased K+) - Drowsiness, dizziness, disorientation - Muscle weakness, hyperreflexia

Answer 378

- Hyperventilation (anxiety, fear, PE) *This will acutely lower CO2 in the blood*

Answer 379

- Hypokalemia - Numbness and tingling of extremities - Hyper reflexes and muscle cramping - Seizures

Answer 380

- Diabetes Ketoacidosis - Severe diarrhea - Renal failure - Shock

Answer 381

- Headache - Hyperkalemia - Nausea, vomiting, diarrhea - Changes in LOC (confusion, increased drowsiness) - Kussmaul respirations (compensatory hyperventilations)

Answer 382

- Severe vomiting - Excessive GI suctioning - Diuretics - Excessive NaHCO3

Answer 383

- Dysrhythmias (Tachycardia) - Compensatory Hypoventilation - Confusion (decreased LOC, dizzy, irriatble) - Tremors, Muscle cramps, tingling of fingers and toes - Hypokalemia

Answer 384

Both are higher with the obstructive lungs - Residual Volume is a **key characteristic** finding with obstructive lung disease

Answer 385

A **progressive** disease which features chronic **airflow** limitations that are typically caused by a **mixture** of parenchymal alveolar disease (emphysema) and small-airway disease (obstructive bronchiolitis) which commonly occur in **combination**, with **proportions varying from individual to individual**. However, **in some cases**, either emphysema or chronic bronchitis is clearly dominant ## Footnote Parenchymal: functional tissue of an organ (e.g. lung alveoli) as distinguished from the connective and supporting tissue

Answer 386

- Inhalation Factors - Genetics

Answer 387

- Hyperplasia of the mucus-secreting cells - Reactive airways - Terminal bronchiole destruction - Alveolar sac destruction ## Footnote All of which **reduce airflow out of the air sacs and the airways** and result in **hyperinflation** and **poor gas exchange** resulting in **ventilation/perfusion** (V/Q) **mismatch, hypoxemia, and oftentimes hypercapnia**

Answer 388

Inhalation exposure is often **the primary contributing factor to the cascade of airway and alveoli inflammatory responses that lead to disease**, especially in genetically susceptible individuals. ## Footnote Cigarette smoke impairs cilia function, and alveolar macrophages within the lung parenchyma can be permanently destroyed, increasing the risk of infection

Answer 389

- COPD Severity: Moderate - FEV1/FVC Ratio: < 0.70 - FEV Range: 50 - 79% of normal

Answer 390

- COPD Severity: Mild - FEV1/FVC Ratio: < 0.70 - FEV Range: ≥ 80% of normal

Answer 391

- COPD Severity: Severe - FEV1/FVC Ratio: < 0.70 - FEV Range: 30 - 49% of normal

Answer 392

- COPD Severity: Very Severe - FEV1/FVC Ratio: < 0.70 - FEV Range: ≤ 30% of normal OR < 50% of normal with chronic respiratory failure present

Answer 393

- Typically characterized by a **thin appearance** due to weight loss, which is a **result of the increased energy expenditure from the effort of breathing**. - May appear to be taking more effort to breathe, **Using accessory muscles to compensate for impaired diaphragmatic function secondary to lung hyperinflation**. - **Lips and nail beds may not show signs of cyanosis hence the term "pink"**, which indicates relatively well- oxygenated blood despite the difficulty in breathing. - **The "puffer" part of the term comes from the pursed-lip breathing that alters respiratory mechanics by increasing airway pressure**, which helps to prevent airway collapse during expiration

Answer 394

- Exhibit **persistent coughing and produce large amounts of sputum** - Typically presents with an **overweight body type due to a combination of factors including a reduction in exercise capacity and the body's attempt to increase its oxygen reserve capacity**. - Often exhibit **signs of cyanosis**, which gives rise to the term "blue". - The term **"bloater" refers to the bloating seen in the body, including potential fluid retention and swelling**, particularly in the lower extremities, due to right-sided heart failure that can complicate chronic bronchitis.

Answer 395

- Air trapping and hyperinflation on expiration - During Inspiration, the airways are pulled open, allowing gas to flow past the obstruction

Answer 396

Results in collapse of the airways and prevents normal expiratory flow

Answer 397

Its considered on of the most sensitive indicators of Hyperinflation - Best seen on the lateral chest radiograph and consist of a loss of height of the convexity of the hemidiaphragm - Draw a line connecting the sternophrenic angle and this arch height should be ≥2.5 cm - It is considered clearly pathological when measured less than 1.5 cm

Answer 398

- There is a shift from Type 1 to Type 2 Skeletal muscle fibers. - There is a reduction in aeroic metabolism and poor muscle endurance

Answer 399

As the disease progresses, **exhalation can become forced instead of passive**, increasing intraabdominal pressure and putting more stress on the pelvic floor. This can lead to pelvic floor dysfunction that can manifest as urinary incontinence in both males and female

Answer 400

- Use of Accessory Muscles to breath - Pursed-Lip breathing - Minimal or absent cough - Leaning forward to breath - Dyspnea on exertion (late sign)

Answer 401

The presence of a **chronic productive cough for 3 months in each of 2 successive years,** provided that other causes of chronic mucus production (CF, bronchiectasis, and tuberculosis [TB]) have been ruled out

Answer 402

- Excessive Body Fluids - Chronic cough - Shortness of breath on exertion - Increased sputum - Cyanosis (late sign)

Answer 403

- There is **decreased Elastic recoil, which increases lung compliance and decreases ventilation** -> increases work of breathing - There is destruction of capillary bed which decreases perfusion *The **decrease** in perfusion **and** ventilation causes a Matched V:Q Defect (relatively well-oxygenated blood unit late stages)* - There is **Alveolar detachment which causes air trapping on expiration** (we will see Pursed-lip breathing) -> we will see an increase in End-respiratory volume and an increase in RV and TLC and a decrease in VC -> **then causes barrel chest** *Also with Emphysema, the people will breath in normally and then they will have an issue getting the air out. Air trapping happens.*

Answer 404

- There is Airway obstruction, leads to Alveolar hypoxia. This then leads to V:Q Mismatch and/or Pulmonary Vasoconstriction -With **V: Q Mismatch** we will see **Hypoexamia** (may also cause cyanosis) -> Polycythemia. Also we will see **Hypercarbia** leading to respiratory acidosis -With **Pulmonary Vasoconstriction** we'll see Pulmonary Hypertension and this **leads to Decreased Left Ventricle output** leading to decreased circulating volume and Activation of RAAS, also we will see **Right Heart failure** leading to Cor pulmonale - There is Mucus Hypersecretion, leads to productive cough with copious sputum

Answer 405

- This starts off with an initiating factor (e.g., smoking, childhood repsiratory disease) - Leads to impaired innate lung defense, which exposes the lungs to infection, microbial colonization - If the Microbial Colonization becomes large enough and the immune system responds, the body creates Microbial Antigens - This then leads to Airway Epithelial injury, which will further damage the innate lung defense *And the cycle will continue to worsen*

Answer 406

Vesicular, but likely diminished, prolonged expiration

Answer 407

likely wheezing or rhonchi, possible crackles

Answer 408

Resonant (Normal)

Answer 409

In midline

Answer 410

Vesicular, but likely diminished, prolonged expiration

Answer 411

None, maybe wheezes during exacerbations (less than chronic Bronchitis)

Answer 412

Diffusely Hyperresonant

Answer 413

In Midline

Answer 414

- **Walking ability** (Endurance and speed): 2 or 6 MWT, ISWT, Incremental treadmill test, Seated or standing step test, 10 MWT, etc - **Balanc/Fall Risk**: BBS, FGA, DGI, TUG, 5xSTS / 30 sec chair rise - **Strength and Power**: Dynamometry, MMT, OMs like 5xSTS / 30 sec chair rise - **QOL**: Chronic Respiratory Questionnaire (CRQ), COPD Assessment Test (CAT), Saint George Respiratory Questionnaire (SGRQ), and Living with COPD questionnaire (LCOPD) ## Footnote The exercise prescription for individuals with lung disease, particularly those with moderate to severe disease, should be based on exercise testing

Answer 415

**A test duration of 8– 12 min is optimal in those with mild-to-moderate COPD, whereas a test duration of 5– 9 min is recommended for individuals with severe and very severe disease**.

Answer 416

**Individuals with moderate-to-severe COPD may exhibit oxyhemoglobin desaturation with exercise**

Answer 417

**F**: Minimally 3 days/wk ; perferably up to 5 days/wk **I**: Moderate to Vigorous Intensity (50-80% peak work rate or 4-6 on the Borg CR10 scale) **T**: 20-60 min per day at moderate to high intensities as tolerated. *If the 20 to 60 min durations are not achievable accumulate ≥ 20 min of exercise rest periods of lower intensity work or rest* **T**: Common Aerobic modes including walking (free or treadmill), stationary cycling and upper body ergometry ## Footnote UE activity is associated with high metabolic and ventilatory demand, and activities involving the arms can lead to irregular or dyssynchronous breathing. This is because some arm muscles are also accessory muscles of inspiration.

Answer 418

**F**: At least 2 days/wk performed on non-consecutive days **I**: - **Strength**: 60-70% of 1RM for beginners; ≥80% for experienced weight trainers - **Endurance**: < 50% of 1RM **T**: - **Strength**: 2-4 sets, 8-12 reps - **Endurance**: ≤ 2 sets, 15-20 reps **T**: Weight machines, free weights, or body weight exercise

Answer 419

- **Interval training** may be an alternative to standard continuous endurance training **for those who have difficulty in achieving their target exercise intensity/volume due to dyspnea, fatigue, or other symptoms**. Several randomized, controlled trials and systematic reviews have found **no clinically important differences between interval or continuous training** protocols in exercise capacity, HRQOL, and skeletal muscle adaptations following training. - **Intensity targets based on percentage of estimated HRmax may be inappropriate**, particularly in individuals with **severe** COPD where resting heart rate is often elevated and ventilatory limitations, as well as the effects of some medications, prohibit attainment of the predicted HRmax and thus its use in exercise intensity calculations. **Most individuals with COPD can accurately and reliably produce a dyspnea rating obtained from an incremental exercise test as a target to regulate/monitor exercise intensity**. - The use of oximetry is recommended for the initial exercise training sessions to evaluate possible exercise-induced oxyhemoglobin desaturation and to identify the workload a which desaturation occurred

Answer 420

- Maximizing pulmonary function using **bronchodilators** before exercise training in those with airflow limitation can reduce dyspnea and improve exercise tolerance. - Inspiratory muscle weakness is a contributor to exercise intolerance and dyspnea in those with COPD. **Inspiratory muscle training (IMT) may prove useful in those unable to participate in exercise training** or can be used as an **adjunct** for those who participate in an exercise program. IMT improves inspiratory muscle strength and endurance, functional capacity, dyspnea, and QOL, which may lead to improvements in exercise tolerance in those with COPD and asthma. - Individuals suffering from acute exacerbations of their pulmonary disease **should limit exercise until symptoms have subsided and rather focus on functional mobility**

Answer 421

- Exercise for individuals with associated **Pulmonary Arterial Hypertension** should consider: –Using ECG monitoring if there significant right ventricular dysfunction –Using supplemental oxygen to avoid hypoxemia which can worsen pulmonary artery pressures due to vasoconstrictive processes –Caution with higher-intensity exercise – particularly those involving the UE - that may increase intrathoracic pressures (e.g. through Valsalva maneuvers) - Flexibility exercises may help overcome the effects of postural impairments that limit thoracic mobility and therefor lung function during activity

Answer 422

– **F**: 3 day/week build to 6-7 days/week – **I**: 30-40% of Maximal Inspiratory Pressure (1 RM), build toward 60-70% – **T**: 15-30 min/day – **T**: Threshold, *x*, etc. Considerations: * Reduce load back 30-40% in context of exacerbation * Consider interval training if better tolerated

Answer 423

The Reversibility of airway obstruction following the use of bronchodilator medications

Answer 424

An “episodic” obstructive lung condition with periods of relatively normal lung function between episodes of **wheezing, dyspnea, chest tightness, and coughing**

Answer 425

A Chronic inflammatory disorder of the airways where **hyperresponsiveness and inflammation** are key components and acute exacerbations due to **viral** or **allergen** exposures can accumulate over time to induce **airway remodeling**

Answer 426

Depends on severity, maybe diminished or absent during asthma attack, prolonged expiration

Answer 427

likely wheeze, particularly during asthma attack, may also have rhonchi in the presence of mucus

Answer 428

Resonant (Normal) to hyperresonant during severe asthma attack

Answer 429

In midline

Answer 430

It involves the use of appropriate medications to educe inflammation, stabilize airways and relieve bronchospasm

Answer 431

Exercise (i.e., exercise-induced bronchioconstriction {EIB}), Inhalation of cold air, and exposure to allergens or viral respiration infections *Differentiation of EIB from exertional angina is performed by assessing the individual’s degree of difficulty in breathing (i.e. EIB would likely produce greater work of breathing compared to exertional angina)*

Answer 432

- Consider HR effects of asthma control medications (e.g., when using HR zones for exercise prescription) - Use of short-acting bronchodilators may be necessary before or after exercise to precent or treat EIB - Peak-flow meters can be used as a guide for medication management and medical care

Answer 433

Irreversible dilation of one or more bronchi with chronic inflammation and infection ## Footnote Associated with Cystic Fibrosis

Answer 434

- Bronchial wall injury/structural weakness of bronchial walls - Traction from adjacent lung fibrosis - Bronchial lumen obstruction

Answer 435

**Breathing Sounds**: - Bronchial (with episodes of pneumonia) ; Diminished or absent (with mucus plugging) **Adventitious Sounds**: Crackles over involved lobes ; Rhonchi during mucus retention **Mediate Percussion** - Dullness ## Footnote - It’s common for individuals with bronchiectasis to breathe very shallowly when their lungs are being auscultated to avoid triggering coughing episodes. As a result of shallow breathing, diminished breath sounds are detected in all lung fields

Answer 436

To reduce the number of exacerbations and improve QOL

Answer 437

- Airway Clearance Techniques as needed - Controlled breathing techniques coordinated with activity - Strength training, especially quadriceps muscle strength and endurance - Aerobic conditioning exercise - Inspiratory muscle training to improve strength and endurance of accessory muscles

Answer 438

Affects every organ that has epithelial tissue

Answer 439

Chronic airway obstruction and inflammation, thick tenacious mucus, and recurrent bacterial infections

Answer 440

Thick mucus that interferes with nutrient absorption and results in malnourishment and low weight

Answer 441

Exocrine pancreatic insufficiency, which affects both gastrointestinal function (fat maldigestion) and the growth and development of individuals with CF

Answer 442

Sinus Infection

Answer 443

Obstructive Azoospermia

Answer 444

Elevated sodium chloride levels in sweat

Answer 445

Failure of the airways to clear mucus normally

Answer 446

For severe and unrelenting chronic bacterial infections

Answer 447

Submucosal glands hypertrophy, goblet cells become more numerous, and small airways often become completely obstructed by secretions. **Bronchiolectasis and finally bronchiectasis are the outcome of repeated obstructive infection cycles**

Answer 448

1. Salty-tasting skin 2. Frequent lung infections 3. Wheezing and/or shortness of breath 4. Poor growth and slow weight gain despite a healthy appetite 5. Frequent greasy, bulky stools and/or difficult bowel movement

Answer 449

- **Lung sounds** are often unremarkable, except for diminution in the intensity of the breath sounds, which correlates with the degree of hyperinflation present. - **Adventitious breath sounds (e.g., crackles, wheezing)** are usually heard first over the upper lobes - **Increased respiratory rate** - **Digital clubbing** occurs in virtually all patients with CF, and its severity generally correlates with the severity of lung disease

Answer 450

- > 80% FEV1, normal ventilatory responses, possible slight reductions in arterial O2 levels - Recommend using same testing and training principles that would be used for a normal population

Answer 451

- FEV1 between 50-80%, exercise tolerance is limited by ventilation, possible SOB with ADLs or activities ~3-4 METs, mild-to-moderate hypoxemia at rest that worsens with exercise, may be restricting/modifying activity levels to prevent exacerbation of symptoms - Exercise tolerance should be assessed with exercise test to assess for vitals and ventilatory responses - Supplemental oxygen should be considered if there is exercise-induced hypoxemia

Answer 452

- FEV1 < 50%, dyspneic with most daily activities, may require intermittent or continuous supplemental oxygen at rest or with activity, may have elevated CO2 levels and/or right ventricular dysfunction - Exercise tolerance should be assessed with exercise test to assess for vitals and ventilatory responses - Interval training should be considered to build toward more continuous forms of exercise that may translate into daily activates that require sustained effort

Answer 453

A group of disorders characterized by **a reduction in lung expansion, leading to decreased lung volumes and impaired pulmonary ventilation**. This reduction is due to various factors such as stiffness of the lung tissue, limitations in chest wall movement, or neuromuscular dysfunction, all of which increase the effort required for breathing.

Answer 454

- Decreased lung volumes - Decreased breath sounds - Tachypnea - Increased work of breathing - V/Q mismatching (with hypoxemia when severe)

Answer 455

* Dry inspiratory crackles * Decreased diffusing capacity * Cor Pulmonale

Answer 456

- Cough (often dry) - Wasted, emaciated appearance -Normally, ~ 5% of O2 is used to support work of breathing; in RLD, this can increase to ~ 25%. -This larger fraction of total body metabolic energy diverted to respiratory muscles leaves a smaller fraction available for working limb muscles during exercise

Answer 457

- There is decrease strength of respiratory muscles, this increases O2 consumption in respiratory muscles and a decrease in MVV (Max. voluntary ventilation). - There is a decrease in chest wall compliance, this also increases O2 consumption in respiratory - The incresae in O2 consumption in respiratory muscles lead to increase minute ventilation, an increase in work of breathing, and may increase respiratory muscle fatigue **This all leads to a Decrease in Pulmonary Efficiency**, this signifies a decline in the respiratory system's capability to meet the bodies demands, especially during stress or illness

Answer 458

- As Alveolar compliance decreases, the elastcity of the alveoli diminishes, this results in an increase RV -There is trapped air that contirbutes to higher physiological dead space (where gas exchange does not happen). With this air trapping, VC also decreases. s trapped in the lungs. This reduction in vital capacity signifies decreased lung efficiency and capacity for ventilation. Poor V/Q matching occurs as areas of the lung become under-ventilated relative to their blood supply, leading to hypoxemia. - There's also a noted decrease in the diffusing capacity of the lung for carbon monoxide (DLco), which implies that the transfer of gases from the alveoli to the blood is less efficient, often due to a loss of alveolar surface area. With these changes comes a decrease in the optimal V/Q matching. Consequently, there's a mild but significant reduction PaO2

Answer 459

Diminished over absent

Answer 460

If obstruction is partial, wheezing or crackles may be heard due to air passing through or around the obstruction

Answer 461

Possibly shifted **toward** the affected side if severe

Answer 462

Diminished over absent

Answer 463

Typically absent, as the lung tissue is compressed and is not moving through the area

Answer 464

Possibly shifted **away** the affected side if severe

Answer 465

- Obesity requires additional oxygen - Produces additional CO2 - Decreases the compliance of the thorax and therefore increases the work of breathing - (In the abdominal) exerts pressure on the abdominal contents and diaphragm *-Results in decreased lung expansion and early closure of the small airways and alveoli, especially at the bases or the dependent regions of the lung. These areas are hypoventilated relative to their perfusion, which can markedly increase the ventilation–perfusion mismatching and result in hypoxemia*

Answer 466

< 70 degrees do not tend to produce pulmonary Sx

Answer 467

>120 degrees are commonly associated with severe RLD and respiratory failure

Answer 468

May cause some respiratory dysfunction, and respiratory sx may increase with age as the angle increases and as the changes associated with aging affect the lung

Answer 469

- Breathing will be shallow due to pain and muscular splinting - Underlying hemothroax (if present) can lead to acute and chronic restriction

Answer 470

- Injury to the free-floating segment ribs - Long-term pulmonary disability following flail chest wall deformity, dyspnea on exertion, and mild restrictive pulmonary dysfunction for months to years

Answer 471

– Bruising of the lung tissue, which can lead to inflammation, edema, and hemorrhage within the lung parenchyma. The injured lung tissue may become stiff and less compliant, making it more difficult for the lungs to expand, leading to a restrictive pattern on pulmonary function tests. – ~50-70% develop pneumonia

Answer 472

Pain management and reestablish normal breathing or at least a level of ventilation that can support necessary activities (e.g. ADLs) using deep breathing, positioning, and supported coughing

Answer 473

An inflammatory process of some part of the lung where gas exchange occurs that usually begins with an infection in the lower respiratory tract - Leads to decreased functional lung volume as consolidated air spaces do not inflate as easily (reflecting decreased compliance)

Answer 474

- Community-acquired PNA -Streptococcus PNA or pneumococcus is the most common type - Hospital-acquired PNA (HAP) -Represents the second most common type of nosocomial infection in USA (exceeded by UTI) - Health-care-associated PNA (HCAP) - Ventilatory-associated PNA (VAP)

Answer 475

**Abrupt onset**, Lobar consolidation, **high fever**, chills, moderate-to-severe respiratory distress, **focal auscultatory findings**,**productive cough**, pleuritic pain, and **elevated WBC**

Answer 476

Gradual onset, preceding upper airway symptoms, diffuse/bilateral auscultatory findings, low-to-moderate fever, and normal WBC, nonproductive cough

Answer 477

Crackles, maybe a pleural friction rub if pneumonia has extended to pleural surface

Answer 478

(+) Test for transmitted voice sounds

Answer 479

- Mobilization can help redistribute blood flow to better Ventilated areas of the lungs, improving the match between ventilation and perfusion and thereby enhancing oxygenation. - Movement and increased respiratory rate help in mobilizing secretions, facilitating their clearance from the respiratory tract. - Exercise can increase the need for deeper breaths and subsequently stimulate the cough reflex to clear mucus

Answer 480

- Consider the role of positioning to optimize V/Q matching, such as sitting up or lying on the side that is less affected to maximize air entry into the healthier lung segments. - Educate the patient on the importance of frequent changes in position to prevent atelectasis and to promote lung expansion and secretion clearance.

Answer 481

- Consider techniques to enhance alveolar ventilation (diaphragmatic breathing, lateral costal breathing, etc.) - Paced breathing might be used during activities to reduce dyspnea and improve efficiency.

Answer 482

Effective coughing techniques can be taught to help clear secretions, as pneumonia often leads to increased mucus production

Answer 483

Positioning the patient to facilitate gravity-assisted drainage of secretions from different lobes of the lungs can help to clear mucus that may be obstructing airways, especially in bacterial pneumonia where there is often a significant productive cough ## Footnote This is used when Mobilization, Body position, Breathing/Coughing manuvers dont work

Answer 484

Manual chest physiotherapy, including percussion and vibration, can be utilized to loosen pulmonary secretions, making them easier to expectorate ## Footnote This is used when Mobilization, Body position, Breathing/Coughing manuvers dont work

Answer 485

These decreases reach their greatest values 24-48hrs after surgery - Lung Volumes then return to relatively normal values in 5 days - Full recovery may take 2 weeks

Answer 486

We assess Static Functioning of Respiratory System: SpO2, RR, Dyspnea and Work of Breathing

Answer 487

1. Mobilize the patient out of bed 2. Teach patient deep breathing exercises and huff/cough with wound support as needed

Answer 488

1. Position the patient in a stable, supported upright posture 2. Teach patient deep breathing exercises andn huff/cough with wound support as needed - We then Reassess Static Functioning of Respiratory System: SpO2 RR, Dyspnea, and Work of Breathing

Answer 489

We progress toward the LIPPSMAck POP ambulation protocol

Answer 490

Consider Positive Expiratory Pressure Device and/or Nebulization. If this fails, consider postural drainage +- P&V and/or consult with RT or nursing for suctioning - If ineffective, contact physician

Answer 491

When air is in the pleural space communicates freely with the outside environment - Effective negative pleural space pressure cannot be maintained, the patient’s ability to move air into the lungs is severely diminished.

Answer 492

This means air can enter the pleural space BUT cannot escape into the external environment. **This is an acute life-threatening situation** - As air continues to enter and becomes trapped in the pleural space, the intrapleural pressure rapidly increases. This causes the lung on the involved side to collapse. The mediastinal structures are **pushed away from the affected side**

Answer 493

Decreased or absent

Answer 494

None, maybe a pleural rub

Answer 495

Hyperresonant

Answer 496

Possibly shifted **away** from affected side if severe

Answer 497

*Although not a primary lung parenchyma disease* - This can lead to RLD pattern due to the physical limitation on lung expansion caused by **the presence of fluid**

Answer 498

The fluid in the pleural space **exerts pressure on the lungs**, **preventing them from fully expanding during inhalation and reducing the volume available for the lung to expand**, leading to a reduction in lung volume such as vital capacity (VC) and Total lung capacity (TLC)

Answer 499

The compression of the lung tissue can also adversely affect the efficiency of gas exchange by collapsing alveoli, further contributing to the Sx of dyspnea

Answer 500

Decreased or absent

Answer 501

None, maybe a pleural rub

Answer 502

Possibly shifted **away** from affected side if severe

Answer 503

An increase in the pulmonary capillary hydrostatic pressure, often secondary to left ventricular failure

Answer 504

Has a multitude of causes, including: - increased capillary permeability - lymphatic insufficiency

Answer 505

With fluid in the alveoli and the interstitium, lung compliance is decreased ➡️ ventilation–perfusion mismatching is increased ➡️ gas exchange is disrupted ➡️ the work of breathing is increased ➡️ and there is RLD and in severe cases acute respiratory failure. - Breath sounds usually reveal crackles.

Answer 506

- This is a complication of venous thrombosis in which blood clots or thrombi travel from a system vein through the right side of the heart and into the pulmonary circulation where they lodge in branches of the pulmonary artery

Answer 507

Dyspnea, Hemoptysis, and Pleuritic Chest Pain ## Footnote Hemoptysis, meaning coughing up blood or blood-tinged sputum from the respiratory tract

Answer 508

A group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs) - This causes interstitial fibrosis and impairment of lung function

Answer 509

- Connective tissue related - Sarcoidosis - Hypersensitivity - idiopathic

Answer 510

May experience acute respiratory deteriorations, with development of new or worsening dyspnea and increased oxygen requirements - Typically referred to as "Acute Exacerbations", with a median survival of only 3-4 months post-event

Answer 511

The goals of treatment in IPF are essentially to reduce the symptoms, slow disease progression, prevent acute exacerbations, and prolong survival - Meticulous attention to breathing techniques and verbal reinforcement during activity **may help reduce subject anxiety** and enhance the quality of the measurements

Answer 512

When idiopathic granulimatous inflammatory disorder affects many systems (multi-system disease) in the body, especially the lung. *These granulomas can be found in the lungs, lymphs, eyes and skin* - Over time, these granulomas can lead to fibrosis, which is the formation of scar tissue. Fibrosis is less elastic than healthy lung tissue, leading to a decrease in lung compliance

Answer 513

Reduces lung compliance, impairs gas exchange, and contributes to restrictive lung disease, often leading to hypoxemia and dyspnea

Answer 514

- Alveolitis (earlies feature found) - Formation of round or oval granulomas - Pulmonary Fibrosis

Answer 515

When the lungs become less elastic, this occurs as a result of a disease that causes inflammation, leading to increased pulmonary vascular permeability, increased lung weight and loss of aerated tissue

Answer 516

- The lungs become less elastic due to inflammation, edema and the eventual development of fibrotic tissue, making them more difficult to expand during inhalation - A ⬇️ in VC, functional residual capacity (FRC) and TLC) follows,. - Furthermore a build up of fluid, inflammatory cells and fibrotic tissue within the alveolar space impairs gas exchange, leading ultimately to hypoxemia and hypercapnia and respiratory failure

Answer 517

Type 1 pneumocyte, which are essential for the gas exchange process, are injured, disrupting the alveolar-capillary barrier, allowing fluid from the capillaries to leak into the alveolar space

Answer 518

Injuries to the endothelial cells of the blood vessels leads to increased permeability

Answer 519

This is mechanical ventilation that uses a mask instead of an artificail airway with the purpose of assisting the patient with the ventilatory needs when short-term venilatory support is needed

Answer 520

- Continuous Positive Airway Pressure (CPAP) - Bilevel Positive Airway Pressure (BiPAP) Both of these methods helps treat respiratory conditions by maintaining airway patency, improve oxygenation, reduce respiratory effort, and/or enhance sleep quality. **Neither are a contraindiation against mobilization and/or exercise**

Answer 521

Airway Adjuncts are used to provide a conduit for ventilation, oxygenation, and suctioning and can be used with bag-mask ventilation.

Answer 522

Oropharyngeal airways can hold the tongue away from the back of the throat and maintain airway patency

Answer 523

Nasopharyngeal Airways are positioned to the base of the tongue and are generally better tolerated because it is less likely to stimulate gag reflex in the semiconscious or alert patient

Answer 524

*Can be inserted through oral cavity of nose* Indications include: - Inability to maintain airway patency for adequate ventilation and secretion clearance - Risk of aspiration - Anticipation of deteriorating course leading to respiratory failure **The position and security of the ETT should be considered before, during, and after mobilization**

Cardiopulm Final (Both Cardio & Pulm) Flashcards

(566 cards)