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Cardiopulmonary Flashcards

(130 cards)

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1
Q

Target heart rate using percent max HR

A

lower: HRmax x 55%
upper: HRmax x 90%

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2
Q

Heart rate reserve

A

lower: [(HRmax - HRrest) x 40%] + HRrest
Upper: x 85%

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3
Q

Normal CP response to acute aerobic exercise

A
  • increased oxygen consumption
  • increased CO
  • increased blood flow
  • linear increase in SBP with increasing workload
  • no change or decrease in DBP
  • increased respiratory rate and tidal volume
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4
Q

Precautions/Contraindications to postural drainage

A
  1. IC pressure >20 mmHG
  2. head and neck injury (until stabilized)
  3. active hemorrhage with hemodynamic instability
  4. recent spinal surgery or acute spinal injury
  5. active hemoptysis
  6. empyma
  7. bronchopleural fistula
  8. pulm. edema associated with CHF
  9. large pleural effusion
  10. PE
  11. confused or anxious patients
  12. rib fracture
  13. surgical wound or healing tissue
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5
Q

Contraindications to trendelenburg position

A
  1. uncontrolled HTN
  2. distended abdomen
  3. esophageal surgery
  4. recent gross hemoptysis related to lung carcinoma treated surgically or with radiation
  5. uncontrolled airway at risk for aspiration (feeding tube, recent meal)
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6
Q

Autogenic drainage

A
  • controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage or coughing
  • requires patience to learn
  • not suitable for young children or patient who are not motivated or easily distracted
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7
Q

Active Cycle of Breathing

A
  • always couples breathing exercise with the huff cough

- 3 phases: breathing control, thoracic expansion, forced expiratory technique

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8
Q

Bullectomy

A

surgical procedure that removes large air spaces (“bullae” that form when alveoli are destroyed by emphysema.

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9
Q

Bullectomy

A

surgical procedure that removes large air spaces (“bullae” that form when alveoli are destroyed by emphysema.

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10
Q

ABI procedure and scoring

A
  • take SBP in (B) UE and (B) LE
  • divide higher of 2 BPs in the ankles by the higher of rht 2 in the arms
  • > 1.3 - rigid arteries, check for PAD
  • 1.0-1.3 = normal
  • 0.8-0.99 - mild blockage, beginning PAD
  • 0.4-0.79 - moderate blockage, may have intermittent claudication
  • > 0.4 - severe blockage, severe PAD, may have claudication at rest
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11
Q

BP procedure

A
  • cuff should encircle 80% of the arm in adults and 100% in children
  • cuts off brachial artery
  • deflate cuff no more than 2-3mmHG per second
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12
Q

Hypertension classifications

A

Normal: 160/>100

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13
Q

Borg RPE

A 
7 - very, very light
9-very light
11-fairly light
13-somewhat hard
15-hard
17-very hard
19-very, very hard
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14
Q

Modified BORG RPE

A 
0-nothing
1-very weak
3-moderate
5-strong
7-very strong
10-maximal
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15
Q

Expected outcomes with diaphragmatic breathing

A
  1. decrease RR
  2. decrease use of accessory muscles
  3. increase tidal volume
  4. decrease respiratory flow rate
  5. subjective improvement of dyspnea
  6. improve tolerance for activity
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16
Q

Pursed lip breathing

A
  • helps prevent airway collapse in patient’s with emphysema
  • decreases RR
  • reduces dyspnea
  • maintains a small positive pressure in the bronchioles
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17
Q

Expected outcomes with pursed lip breathing

A
  1. decrease RR
  2. relieve dyspnea
  3. reduce arterial PaCO2
  4. improve tidal volume
  5. improve o2 sats
  6. prevent airway collapse
  7. improve activity tolerance
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18
Q

Positioning for segmental breathing

A
  • sitting for basal atelectasis
  • sidelying with affected lung uppermost
  • postural drainage positions with affected lung uppermost to assist with secretion removal
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19
Q

Expected outcomes of segmental breathing

A
  1. increase chest wall mobility
  2. expand collapsed alveoli via airflow through collateral channels
  3. assist with secretion removal
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20
Q

Expected outcomes of sustained maximal inhalation with incentive spirometer

A
  1. absence of or improvement in signs of atelectasis
  2. decreased RR
  3. resolution of fever
  4. normal pulse rate
  5. normal chest Xray
  6. improved paCo2
  7. increased forced vital capacity and peak expiratory flows
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21
Q

Atrial systole

A

-contraction of (R) and 9l) atria pushing blood into ventricles

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22
Q

Atrial diastole

A

-period between atrial contractions and atria repolarizing

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23
Q

Ventricular systole

A

-contraction of (R) and (L) ventricles

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24
Q

Ventricular diastole

A

-period of repolarization

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25
Normal stroke volume
60-80ml
26
Normal CO
4.5-5.0 L/min. can increase up to 25L/min during exercise
27
Left sided CHF
-associated with S/S pulmonary venous congestion
28
Left sided CHF
-associated with S/S pulmonary venous congestion
29
Right sided CHF
-associated with S/S systemic venous congestion
30
CHF compensatory changes
- due to decreased CO - increase in blood volume - increase in cardiac filling pressure - increase in HR - increase in cardiac muscle mass
31
MI risk factors
- family history - smoking - physical inactivity - stress - HTN - elevated cholesterol - diabetes mellitus - obesity
32
ACE inhibitors
-HTN, CHF Side effects: dizziness, hypotension, dry cough -"pril"
33
Antiarrythmic agents
Side effects: : dizziness, hypotension
34
Antihyperlipidemia agents
side effects: headache, GI distress, myalgia, rash
35
calcium channel blockers
Side effects: dizziness, headache, hypotension, peripheral edema HR and BP response to exercise will be diminished
36
calcium channel blockers
Side effects: dizziness, headache, hypotension, peripheral edema HR and BP response to exercise will be diminished
37
Nitrates
Side effects: headache, dizziness, orthostatic hypotnesion, reflex tachycardia, nausea, vomiting
38
Positive iontropic agents
Side effects: arrythmias, GI distress, diziness, blurred vision
39
CPR -adults
- compression - airway - breathing - rate: 100/min - depth: 2 inches (5cm) - 30: 2 - 1 breath every 6-8sec, 8-10 breaths/min
40
CPR - children
- depth: 1/3 AP depth, 2 inches (5 cm) - single rescuer 30:2 - 2 rescuers: 15:2
41
CPR - infants
- depth: atleast 1/3 AP (40%), 1.5 inches (4cm) | - 30: 2 if single, 15:2 if 2
42
P wave
-atrial depolarization
43
PR interval
-conduction from SA node to AV node (normal=0.12-0.2 seconds)
44
QRS
-ventricular depolarization and atrial repolarization (normal 0.06-0.1 seconds)
45
QT interval
-time for both ventricular depolarization and repolarization (0.2-04 seconds)
46
ST segment
-isoelectric period
47
T-wave
-ventricular repolarization
48
PACs
- premature atrial contraction - normally benign - p wave is premature and abnormal - may progress to atrial flutter, tachycardia or fibrillation - may occur with a normal heart and any type of heart disease
49
A-fib clinical significance
-S/S include palpitations, fatigue, dyspnea, lighteheadedness, syncope, chest pain
50
PVC
- unifocal or multifocal - bigemeny: normal sinus impulse followed by a PVC - trigeminy- PVC occurs after every 2 normal sinus impulses - common arrythmia that occurs in healthy and diseased hearts
51
V-tach
- 3 or more consecutive PVCS at a ventricular rate of .150beats/min - P waves are absent and QRS is wide - longer than 30 seconds is life threatening
52
V-fib
-no cardiac output
53
Signs of MI
ST segment depresion and elevation
54
Absolute indications to stop exercise testing
- drop in SBP >10 from baseline despite increase in work load - moderately severe angina - increases nervous system symptoms - signs of poor perfusion - sustained v-tach - 1.0 mm ST elevation without q-waves
55
Relative indications to stop exercise testing
- drop in SBP >10 from baseline without other evidence of ischemia - >2mm ST segment depression - arrhythmias other than sustained v-tach (including multifocal PVCs, supraventricular tachycardia, heart block, bradyarrhtyhmias) - fatigue, SOB, wheezing, leg cramps, claudication - development of bundle branch block - increasing chest pain - hypertensive response
56
Ventricular systole
-contraction of (R) and (L) ventricles. S1
57
Ventricular diastole
-period of repolarization. S2
58
Relative indications to stop exercise testing
- drop in SBP >10 from baseline without other evidence of ischemia - >2mm ST segment depression - arrhythmias other than sustained v-tach (including multifocal PVCs, supraventricular tachycardia, heart block, bradyarrhtyhmias) - fatigue, SOB, wheezing, leg cramps, claudication - development of bundle branch block - increasing chest pain - hypertensive response
59
Tricuspid valve
-prevents backflow into right atrium
60
Pulmonary valve
-prevents back flow into right ventricle
61
Mitral valve
-prevents back flow into left atrium
62
Aortic valve
-prevents backflow into left ventricle
63
S3
-vibrations of teh distended ventricle walls due to passive flow of blood from the atria during rapid filling phase of diastole
64
S4
-pathological sound with ventricular filling and atrial contraction
65
Metabolic alkalosis
- increased pH - PaCo2 WNL - increased HCO3 - S/S weakness, lethargy, early tetany
66
Metabolic acidosis
- decreased pH - PaCO2 WNL - decreased HCO3 - S/S secondary hyperventilation, N/V, lethargy, coma
67
Respiratory alkalosis
- increased pH - decreased PaCO2 - HCO3 WNL - caused by alveolar hyperventilation - s/s dizziness, syncope, tingling, numbness, confusion, cramping
68
Respiratory acidosis
- decreased PH - increased PACO2 - HCO3 WNL - caused by alveolar hypoventilation - s/s anxiety, restlessness, dyspnea, headache, confusion, coma
69
Expiratory reserve volume
- max volume of air that can be exhaled after normal tidal exhalation - 15% of total lung volume
70
-Forced expiratory volume
- max volume exhaled in a specified period of time | - usually 1st, 2nd and 3rd second of forced vital capacity
71
Functional residual capacity
- volume of air in lungs after normal exhalation - ERV + RV - 40% of total lung volume
72
Inspiratory capacity
- max volume of air that can be inspired after normal tidal exhalation - TV +IRV - 60% of total lung volume
73
Inspiratory reserve volume
- max volume of air that can be inspired after normal tidal volume inspiration - 50% total lung volume
74
Peak expiratory flow
-max flow of air during teh beginning of a forced expiratory maneuver
75
Residual volume
- volume of gas remaining in teh lungs at the end of a maximal expiration - 25% of total lung volume
76
Tidal volume
- total volume inspired and expired with each breath during quiet breathing - 10% of total lung volume
77
Total lung capacity
- volume of air in lungs after maximal inspiration - RV + VC - FRC + IC
78
Vital capacity
- volume change that occurs between maximal inspiration and maximal expiration - TV + IRV + ERV - 75% of total lung volume
79
Vital capacity
- volume change that occurs between maximal inspiration and maximal expiration - TV + IRV + ERV - 75% of total lung volume
80
Apical segment drainage
-sitting position, leaning back 30-40 degrees
81
Posterior segment (R) UL
- turned 1/4 from prone on (L) side with bed horizontal and head/shoulders raised on a pillow
82
Post. segment (L) UL
-1/4 from prone on the (R) with head of bed elevated 45 degrees and head and shoulders raised on pillow
83
Lingula (L) UL
-turned 1/4 from supine on the (R) with foot of bed elevated 12 inches
84
Anterior segment (R) and (L) UL
-supine with bed horizontal
85
(R) middle lobe
-turned 1/4 from supine on (L) with foot of bed elevated 12 inches
86
Superior segments (L) and (R) LL
-prone with bed horizontal
87
Anterior basal segment ((L) and (R ) LL
-patient supine with foot of bed elevated 18 inches
88
Posterior basal segment (L) and (R) LL
-prone with foot of bed elevated 18 inches
89
Lateral basal segments lower lobes
-SL with foot of bed elevated 18 inches
90
RR adult
12-20
91
RR newborn
33-45
92
RR 1 year
25-35
93
RR 10 years
15-20
94
Normal respiratory rhythm
Inspiration: Expiration = 1:2 | For COPD its 1:3 or 1:4
95
Heart apex
-5th intercostal space and (L) midclavicular line
96
Normal CO
4.5-5.0 L/min. can increase up to 25L/min during exercise | HRxSV
97
Left sided CHF
- associated with S/S pulmonary venous congestion - edema - low CO
98
Right sided CHF
- associated with S/S systemic venous congestion | - jugular vein distention and peripheral edema
99
Heart apex
-5th intercostal space and (L) midclavicular line
100
HR pacing
- SA node: 60-100bpm - AV node: 40-60bpm - purkinje tissue: 20-40bpm
101
frank starling
-the greater the diastolic filling (pre-load), the greater the quantity of blood pumped
102
Non-modifiable CVD risk factors
- age (men>45, women>55) | - family history (1st degree male relative women until menopause)
103
Modifiable CVD risk factors
- total cholesterol (40) | - HGA1c
104
Postural tachycardia syndrome
-sustained HR increase >30 bpm within 10 mins of standing
105
Auscultation (aortic valve)
2nd right intercostal space at sternal border
106
Auscultation (pulmonic valve)
2nd left intercostal space at sternal border
107
Auscultation (tricuspid valve)
4th left intercostal space at sternal border
108
Auscultation (mitral valve)
5th left intercostal space at midclavical area
109
Stable angina
- exertional angina | - relieved with rest or nitroglycerin
110
Unstable angina
- chest pain increases in severity, frequency, duration | - any time without precipitating factors
111
Transmural MI
- full thickness | - ST elevated (STEMI)
112
Nontransmural MI
- partial thickness | - non-ST elevated (NSTEMI)
113
Left sided CHF
- associated with S/S pulmonary venous congestion - edema - low CO - dry cough, dyspnea - orthopnea - rales/wheezing
114
Right sided CHF
- associated with S/S systemic venous congestion - jugular vein distention and peripheral edema - weight gain - ascites - liver engorgement - S3 heart sounds
115
Nontransmural MI
- partial thickness | - non-ST elevated (NSTEMI)
116
Arm ergometry
- HR higher - stroke volume lower - SBP/DBP higher
117
Post-MI early rehab
-70% max HR until 6 weeks post MI
118
REad through pulmonary disease
ok
119
Glucose
under 70, over 300
120
Bicarbonate
22-26
121
Hemoglobin
122
Platelets
less than 10,000
123
WBC
124
Hematocrit
125
Right sided CHF
- associated with S/S systemic venous congestion - jugular vein distention and peripheral edema - cor pulmonale - weight gain - ascites - liver engorgement - S3 heart sounds
126
Hemoglo
127
Hematocrit
128
Auscultate the apex of the heart in...
(L) sidelying
129
phase 2 cardiac rehab HR
45-65% calculated HRreserve
130
Avoid valsalva maneuver because...
slowing of pulse and risk of fainting

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