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NPTE > Cardiopulmonary > Flashcards

Cardiopulmonary Flashcards

(93 cards)

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1
Q

What’s the preload?

A

Amount of blood in left ventricle at end of diastole (LVEDV)
–> RIGHT BEFORE CONTRACTION

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2
Q

What’s the afterload?

A

Force the LV must generate to overcome aortic pressure and open Aortic Valve

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3
Q

Stroke volume

A

Amount of blood ejected with each contraction
55-100mL

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4
Q

Ejection fraction

A

% of blood ejected from total volume of ventricle
Normal= 55-75%
Decreased <40% indicates heart failure

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5
Q

Normal CV response to exercise

A

O2 up linearly
HR up linearly
SBP up linearly
DBP limited changes +-10mmHg
Tidal Volume and Resp rate up

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6
Q

Isolated UE vs. LE exercise response

A

UE>LE response in HR/BP in exercises
-> more mass in LE + UE exercises causes vasoconstriction in LE-> incr. HR/BP

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7
Q

Abnormal Responses to Exercise
(Yellow Flag)

A

Moderate to severe/increasing angina
Marked dyspnea 3-4/4
Dizziness/lightheadedness/ ataxia
Cyanosis/ excessive fatigue/ claudication/ blunted BP response/ hypertensive BP(>240/10)/ SBP drop of 10-15/significant EKG change

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8
Q

Normal Vagus Nerve activation causes

A

Parasympathetic inner action
Decrease BP/HR

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9
Q

Abnormal causes for Vagus Nerve activation

A

Valsalva Maneuver
Carotid sinus massage
Excessive Pain (shock)

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10
Q

“If it’s less than 8, don’t ambulate”, refer to?

A

Hemoglobin

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11
Q

“Tri before you bi”, refers to

A

Tricuspid and bicuspid valve

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12
Q

Normal Heart Rate newborn

A

120-140

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13
Q

Normal Heart rate >18years

A

60-100

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14
Q

S1 sound

A

=normal Heart sound
AV valve closure (=onset systole)

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15
Q

S2 Heart sound

A

= normal
Semilunar valve/pulmonary-aortic closure
= Onset diastole

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16
Q

S3 sound

A

=abnormal
Extrasound in early diastole
CHF/Athletes
Ventricular Gallop

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17
Q

S4 heart sound

A

= 2nd abnormal heart sound
Occurs in late diastole (atrial gallop)
- MI or hypertension
(Atrial Gallop)

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18
Q

Elevated Blood Pressure

A

120-129 AND <80

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19
Q

Stage 1 Hypertension

A

130-139 OR 80-89

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20
Q

Stage 2 Hypertension

A

> 140 OR >90

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21
Q

Normal Clotting time

A

INR = 0,8-1,2

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22
Q

Therapeutic clotting time

A

2.0-3.0

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23
Q

Normal white blood cell count

A

5.0-10.0

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24
Q

Leukocytosis

A

Increased WBC count
>11
Infections, leukemia, sickle cell…

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25
Leukopenia
Low WBC <4.0 Viral inf./chemo/ autoimmune diseases
26
Neutropenia
Lowest WBC count <1,5 0,5-1 = moderate <0,5 = severe Radiation/ infections/stem cell disease
27
Platelet counts
Normal 140-440 Low <150 risk of bleeding High >450 risk of clotting
28
Hemoglobin normal
Normal 15 Male 14-17 Female 12-16
29
Increased Hemoglobin can be caused by?
Burns, COPD, CHF, Severe dehydration
30
Decreased Hemoglobin/Anemia can cause ?
Blood cell destruction
31
Hematocrit normal
~45 Male 42-52% Female 37-47%
32
Which blood count abnormality can cause Orthostatic Hypotension?
A low hematocrit 25%
33
A Pt with increased Hematocrit can be at risk for?
Spontaneous blood clotting >60%
34
When is Cardiac Rehab indicated?
Stable angina Stable post-MI CABG Heart transplant Valve surgeries Stable heart failure PAD,CAD
35
Abnormal Responses to Exercise? (Indication to Terminate)
-SBP drop of 10-15mmHg -Hypertensive BP response >200 OR 110mmHg -Moderate to severe increasing angina -Marked dyspnea -Dizzy/lightheaded/ataxia -Cyanosis/pallor EKG changes significant
36
Contraindications to begin Cardiac Rehab
ORTHOSTATIC BP drop of >20 + sympt Uncontrolled hypertension Aortic Stenosis Uncontrolled arrhythmias 3rd Degree AV block w/o pacemaker Uncontrolled PE/DVT
37
What to use for Intensity in Cardiac Rehab?
Borg RPE Scale Rate pressure product Exercise tolerance test (ETT) -Bruce Pro 6min walk test
38
RPE Scale
6-20 (x10=HR) 2-4-5-4
39
RPE 6-7
No exertion Extremely light
40
RPE 8-11
Very light Light
41
RPE 17-20
Very hard Extreme hard
42
RPE range for Cardiac rehab (aerobic)
12-15 Modified 4-6
43
Cardiac Rehab intensity Inpatient/acute stay
4-6 MET's HRrest +20-30 HR <120 total RPE <13
44
RRP - Rate Pressure Product calculation
HRxSBP
45
RPE 12-16
Somewhat hard Hard
46
Cardiac Rehab II - intensity Outpatient
- <90% of ischemic symptom onset (Ischemic Rate Pressure Product) -Target 55-90%HRmax - RPE 12-16 - MET's 5-9
47
Cardiac Rehab intensity III - Community Program
Self-regulated Maintenance/progression 6-12 months
48
Signs of insufficient Cardiac Output/Ischemia
Angina Pectoris SOB/Dyspnea Excessive Fatigue Claudication Cyanosis Dizzy/lightheaded/ataxia
49
Karvonen Method - used for
Used to calculate target heart rate
50
Karvonen Method - Calculation
Target HR= %HRreserve + HRrest --> 1.) HRreserve=HRmax-HRRest 2.) %HRreserve= HRx40-85%
51
Cardiac Rehab Strength Training Intensity
10-15 reps comfortable 40-60% 1RM 11-13 RPE Large Muscle Groups Exhale with exertion Symptoms management
52
Precautions post-sternectomy
NO!!! UE Lifting >10lbs Pushing/pulling Scapular adduction UE resistance above 90° No UE assistance STS Splint when coughing/sneezing
53
Beta Blockers
-olol Decrease HR Decrease Cardiac Stress
54
ACE Inhibitors
-pril Decrease BP Decrease load of heart
55
Calcium Channel Blockers
-pine/verapamil/diltiazem Vasodilation -> decr. BP + Decr HR
56
Nitroglycerin Use + protocol
Angina Pectoris 3x5min, then ER (=MI)
57
Cardiac Glycosides
For Congestive Heart Failure Digitoxin --> increase contraction force --> decr HR & slows Ca-Po pump !!! Toxicity/arrhythmias
58
59
Elevated Blood Pressure
120-129 AND <80
60
Stage 1 Hypertension
130-139. OR >80-89
61
Stage 2 Hypertension
>140. OR >90
62
Symptoms left sided CHF
Fatigue Dyspnea S3 Sound Crackles in lung Orthopnea Pulmonary edema
63
Symptoms right sided CHF
Fluid weight gain Peripheral edema Fatigue
64
DVT symptoms
Often asymptomatic Pain local Unilateral swelling, tenderness, pain Warmth & discoloration
65
What assessment to use for DVT?
Wells Criteria
66
Wells criteria - clinical characteristics +1
Active cancer Immobilization of LE Bedridden for > 3 days Major surgery last 12 weeks Legs or calf swollen > 3cm Previous DVT history
67
We'll criteria - clinical characteristics -2
Alternative diagnose
68
Clinical probability of DVT (Wells criteria)
>2 = likely < = Unlikely
69
What side effect can occur with heparin/coumadin/warfarin?
Secondary osteoporosis with prolonged use
70
Blood Markers for MI / cardiac Enzymes & proteins
Creatine Kinase Lactic dehydrogenase Troponin Myoglobin
71
Cardiac Output
Amount of blood discharged from left or right ventricle per minute Normal= 4-5 L/min CO=HR x stroke Volume
72
Ejection Fraction
Percentage of blood empties from left Ventricle during systole -> measure if LV function
73
74
Left Ventricular End Diastolic Pressure
Pressure in LV Düring Diastole Normal= 8-12mmHg -> measured w/ Swan-Ganz Katheter
75
Rate Pressure Product
Marker for Myocardial Oxygen Demand RPP= HR x SBP
76
Baroreceptors - location and function
Control heart rate A.) wall aortic arch and carotid sinus B.) circulatory reflex: response to BP changes
77
Physiological reaction on decreased BP
Sympathetic stimulation - coronary vasoconstr+ periph dilation
78
Physiological reaction to increased BP
Parasympathetic stimulation -> decr HR + force of contraction -> sympathetic inhibition - decr periph resistance
79
Chemoreceptors - location & function
Carotid body - senses changes in O2, CO2, pH(lactic acid)
80
What chemical blood changes cause increase in BP?
Increase CO2 Decreased O2 Decrease in pH/increase in lactic acid
81
What chemical blood changes cause decrease in HR?
Increase in O2
82
Grading of Peripheral Pulses
0= absent 1+= finished 2+= normal/easy palpable 3+= increased strength/full 4+= bounding
83
Pitting Edema Scale
1+= mild, <1/4inch pitting 2+= moderate, easy indented, RTN in 15sec, 1/4-1/2inch pitting 3+= severe, depression 15-30sec RTN, 1/2-1inch pitting 4+= very severe, >30sec, >1inch pitting
84
ABI - grading
>1.4. = non-compliance arteries 1.00-1.44= normal 0.91-0.99= borderline <0.90. = abnormal <0.5. = severe arterial disease, critical Ischemia, pain at rest
85
Normal Blood Gas Values - ABGs -> SpOs
95-100% <88-90% supplemental O2
86
Normal Blood Gas Values - ABGs -> PaO2
80-100mmHg Increased: hyperoxygenation/ Decreased: cardiac decomp/ COPD
87
Normal Blood Gas Values - ABGs -> PaCO2
35-45mmHg Increased: COPD, hypoventilation Decreased: hyperventilation, pregnancy, PE, anxiety
88
Normal Blood Gas Values - ABGs -> pH
7.35-7.45 Increased: resp. & metabolic alkalosis Decreased: resp & metabolic acidosis
89
Activity restriction post MI
5METs / 70% of age predicted HRmax For 4-6weeks post MI
90
CPR single person for infants - ratio of chest compression to rescue breaths
30:2
91
Target Range for Maximal Inspiratory pressure training
40-75%
92
General inflammation markers of polimyalgia rheumatica
Erythrocyte Sedimentation rate C-reactive protein
93
Hoffmans Sign
Snap middle finger from dorsal Positive: add index+ thumb UMN disorder

NPTE (8 decks)

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