Cardiopulmonary and Lymphatic PT Flashcards
(126 cards)
1
Q
Where can you locate the apex and base of the heart? (surface anatomy)
A
The apex of the heart is located at the 5th intercoastal space (mid clavicle) and the base of the heart is located at the second intercoastal space. (hint- 25 the year of biological dads bday-he had enlarged heart)
2
Q
Tricuspid Valve
A
Between the right atrium and right ventricle
3
Q
Bicuspid (mitral valve)
A
Between the L atrium and L ventricle
4
Q
Role of Valves
A
To prevent blood from returning to the chamber it was previously in. e.g. The mitral valve prevents blood from back flowing into the L atrium.
5
Q
Diastole
A
Period when repolarization is taking place. AKA when the chambers are refilling with blood. (There is atrial and ventrical diastole)
6
Q
Systole
A
Period when contraction takes place to push blood out of chamber. (There is atrial and ventricle systole)
7
Q
Preload
A
Refers to the tension in the ventricular wall at the end of diastole.
8
Q
Afterload
A
Refers to the forces that impede the flow of blood out of the heart, primarily the pressure in the peripheral vasculature, the compliance of the aorta, and the mass and viscosity of blood.
9
Q
Stroke Volume (SV)
A
Volume of blood ejected by each contraction of the left ventricle. Normal SV ranges from 60 to 80 ml depending on age, sex, and activity.
10
Q
Cardiac Output (CO)
A
The amount of blood pumped from the left or right ventricle per minute. It is equal to the product of stroke volume and heart rate. Normal CO for an adult male at rest is 4.5 to 5.0 L/min with women producing slightly less. CO can increase up to 25 L/min during exercise.
11
Q
Does CO increase or decrease with exercise?
A
CO increases with exercise because more blood is being pumped out of the ventricles per minute to meet the demands of the body.
12
Q
What happens to CO with increase in age?
A
CO decreases with age secondary to decreased HR.
13
Q
What factors affect CO?
A
increased age with decrease CO, exercise with increase CO, disease with decrease CO
14
Q
Expiratory Reserve Volume (ERV)
A
The maximal volume of air that can be exhaled after a normal tidal exhalation.
15
Q
Forced Expiratory Volume (FEV)
A
The maximal volume of air exhaled in a specified period of time: usually the 1st second of a forced vital capacity maneuver.
16
Q
Functional Residual Capacity (FRC)
A
The volume of air in the lungs after normal exhalation. FRC=ERV + RV
17
Q
Inspiratory Capacity (IC)
A
The maximal volume of air that can be inspired after a normal tidal exhalation.
18
Q
Inspiratory Reserve Volume (IRV)
A
The maximal volume of air that can be inspired after normal tidal volume inspiration.
19
Q
Peak Expiratory Flow (PEF)
A
The maximum flow of air during the beginning of a forced expiratory maneuver.
20
Q
Residual Volume (RV)
A
The volume of gas remaining in the lungs at the end of a maximal expiration.
21
Q
Tidal Volume (TV)
A
Total volume inspired and expired with each breath during quiet breathing.
22
Q
Total Lung Capacity (TLC)
A
The volume of air in the lungs after a maximal inspiration; the sum of all lung volumes.
23
Q
Vital Capacity (VC)
A
The volume change that occurs between maximal inspiration and maximal expiration. VC=TV+IRV+ERV. VC is approximately 75% of total lung volume.
24
Q
PH
A
7.35-7.45 (acidic is less then 7.35 and basic is more then 7.45)
25
PaCO2
35-45mmHg. This value affects PH in the body. If PaCO2 is elevated then there is more CO2 in body making you more acidic. Visa Versa
26
PaO2
90-100mmHg. This value provided info about how well the lungs are functioning to oxygenate the blood.
27
HC03
22-26mEq/L. This value is used to determine if its a metabolic or respiratory issue. If this value changes then its a metabolic issue. If this value is within the norm then its a respiratory issue.
Metabolic Alkalosis- HC03 is >26
Metabolic Acidosis- HC03 is <22
28
SaO2
95-98%. This value is the percent of oxygen saturation of hemoglobin is provides information about how well the lungs are functioning to oxygenate the blood.
29
Cardiac Biomarkers
Certain enzymes leak out of the heart cells and into the blood after a MI. Cardiac enzyme studies measure the levels of creatine phosphokinase (CK) and the protein troponin in the blood. CK-MB is relatively specific test for MI. It appears in blood approximately four hours after infarction, peaks at 12-24 hours, and declines over 48-72 hours. Cardiac troponin-I is also a specific marker for infarction and remains elevated for 5-7 days unlike CK-MB.
30
Hematocrit (Hct)
is the percentage of RBC in the total blood volume. A low hematocrit may indicate anemia, blood loss, and vitamin or mineral deficiencies. A high hematocrit may indicate dehydration or polycythemia vera, a condition that causes an overproduction of RBC.
31
Partial Thromboplastin Time (PTT) and Prothrombin Time (PT)
PTT and PT tests measure how quickly the blood clots. The tests are commonly used to monitor oral anticoagulant therapy or to screen for selected bleeding disorders. PTT is more sensitive then PT in detecting minor deficiencies.
32
HDL cholesterol
The "good" cholesterol. Higher values of HDL are good because it helps carry away LDL and protective against atherogensis.
or = 60 is high
33
LDL cholesterol
"bad" cholesterol.
| <100 mg/dL is optimal
34
Total Cholesterol
240 is high
35
Triglyceride
The body converts any calories it does not need to use right away into triglycerides, which are stored in adipose tissue.
<150 mg/dL is desirable
200-499 mg/dL is high
36
Respiratory Alkalosis
PH is increased (greater then 7.45)
PaCO2 is decreased (less then 35)
HC03 is WNL (22-26)
Causes- Hyperventilation
37
Respiratory Acidosis
PH is decreased (Less then 7.35)
PaCO2 is increased (greater then 45)
HC03 is WNL (22-26)
Causes -Hypo-ventilation
38
Metabolic Alkalosis
PH is increased (greater then 7.45)
PaCO2 is WNL (35-45)
HC03 is increased (greater then 26)
Causes- Bicarbonate ingestion, vomiting, diuretics, adrenal disease
39
Metabolic Acidosis
PH is decreased (less then 7.35)
PaCO2 is WNL (35-45)
HC03 is decreased (less then 22)
Causes- Diabetic, lactic, or uremic acidosis, prolonged diarrhea
40
Pharmacologic Stress Test
A diagnostic procedure in which cardiovascular stress is induced by pharacolgic agents when contraindications to a routine exercise stress test exist, or when the patient is unable to exercise due to injury or another debilitating condition. It is used in combination with imaging modalities.
41
Pleuroscopy
Examination of the lung surfaces, pleura, and pleural space using a small video camera inserted between the ribs into the pleural space. A tissue sample may be taken to biopsy.
42
Positron Emission Tomography (PET)
is an imaging test in which a small amount of radioactive material is injected, inhaled, or swallowed, depending on the organ or tissue being studied. Increased radioactive material tends to accumulate in areas with high levels of chemical activity corresponding to areas of disease. This presents as a different color or brighter spots on the scan . A PET scan is useful in evaluating heart disease and cancer.
43
Thoracentesis
Removal of fluid from the pleural space with a needle for microbiolgic and cytologic studies.
44
Venography
A radiopaque dye is injected into a vein while an x-ray procedure creates an image of the vein to detect a clot or blockage.
45
ACE Inhibitor agents (Angiotensin-Converting Enzyme)
They decrease blood pressure and afterload by suppressing the enzyme that converts angiotensin I to angiotensin II.
Indications- hypertension, CHF
Side effects- hypotension, dizziness, dry cough, hyperkalemia, hyponatremia
Implications for PT- avoid sudden changes in posture due to the risk of dizziness and fainting from hypotension. Pts with CHF should avoid rapid increase in physical activity.
Examples- captorpril, enalapril, lisinopril, ramipril
46
Antiarrhythmic Agents
Divided into four classes:
1) sodium channel blockers- control cardiac excitation and conduction
2) Beta Blockers- inhibit sympatheic activity by blocking B-adrenergic receptors
3) Prolonged repolarization by inhibiting both potassium and sodium channels and are often considered the most effective antiarrhytmic agent
4)Calcium Channel Blockers- depress depolarization and slow conduction through the AV node
Indications- cardiac arrhythmias
Side effects- unique to the specific antiarrhythmic agent; exacerbation of cardiac arrhythmias, dizziness, hypotension
Implications for PT- encourage patients to adhere to the prescribed dosing schedule and immediately report and adverse reactions to the healthcare professional
Examples: Quinidine, Lidocaine, beta blockers, atenolol, amiodarone, diltiazem
47
Antihyperlipidemia
Statins are in this class.
| Examples are lipitor (atorvastatin), Zocor (simvastatin), and Tricor.
48
Beta Blockers
Decrease the myocardial oxygen demand by decreasing heart rate and contractility by blocking B-adrenergic receptors.
HR and BP response to exercise will be diminished. RPE may be used to monitor exercise intensity. Closely monitor pts during positional changes due to an increased risk for othrostatic hypotension.
end in "olol"
49
Calcium Channel Blockers
Decrease the entry of calcium into vascular smooth muscle cells resulting in diminished myocardial contraction, vasodilation, and decreased oxygen demand of the heart.
HR and BP response to exercise will be diminished. Monitor patient closely when moving to an upright position secondary to dizziness and/or othrostatic hypotension.
EX: Norvasc, Procardia, Verapamil, Diltiazem
50
Diuretic Agents
Increase the exertion of sodium and urine. This causes a reduction in plasma volume which DECREASES BLOOD PRESSURE.
Classifications include thiazide, loop, and potassium sparing agents, Lasix
Indications: hypertension, edema (associated with heart failure), pulmonary edema, gaucoma.
51
Nitrate Agents
Decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels.
Indications: angina pectoris
Ex: nitrostat (nitrogylcerin), Isordil, Amyl nitrite solution for inhalation
52
Digoxin
Increase the force and velocity of myocardial contraction, slow HR, and decrease conduction velocity through the AV node, and decrease the degree of activation of the sympathetic nervous system.
Indications: heart failure, atrial fibrillation
Implications for PT: monitor HR during activity, teach pt and family to take pulse,and seek health care providers advie for rates less then 60 bpm or more then 100 bpm.
53
Thrombolytic Agents
Facilitate clot dissolution through conversion of plasminogen to plasmin. Plasmin breaks down clots and allows occluded vessels to reopen to maintain bloodflow.
Indications: acute MI, pulmonary embolism, ischemic stroke, arterial or venous thrombosis.
The PT must be careful to avoid situations that may cause trauma due to altered clotting activity.
Examples: "ase"
54
Antihistamine Agents
block the effects of histamine resulting in a decrease in nasal congestion, mucosal irritation, and allergies.
Ex: benadryl, allegra, zyrtec, claritin
55
Corticosteroid
side effects include damage to supporting tissues, skin breakdown, osteoporosis, decreased bone density, gaucoma, and delayed growth.
Used for patients with asthma (an anti-inflammatory)
56
Ankle-Brachial Index (ABI)
Compares systolic BP at the ankle and arm to check for peripheral artery disease.
>1.30 indicates rigid arteries and the need for an ultrasound test to check for peripheral artery disease
1. 0-1.30 Normal; no blockage
0. 8 -0.99 Mild blockage; beginning of peripheral artery disease
0. 4 - 0.79 Moderate blockage; may be associated with intermittent claudication during exercise
<0.4 Severe blockage suggesting severe PAD; may have claudication pain at rest
57
BP Classification
Normal 120/80
Prehypertensive 120-139/80-89
Stage 1 hypertension 140-159/90-99
Stage 2 hypertension >160/>100
58
Ausculations of Heart Sounds
Aortic Area-2nd intercostal space at the right sternal border
Pulmonic Area- 2nd intercostal space at the left sternal border
Mitral Area- 5th intercostal space, medial to the left midclavicular line
Tricuspid Area- 4th intercostal space at the left sternal border.
59
S1 Heart sound
(lub) closure of the mitral and tricuspid valves at the onset of ventricular systole.
60
S2 Heart sound
(dub) closure of the aortic and pulmonic (semilunar) valves at the onset of ventricular diastole.
61
S3 Heart sound
Vibrations of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of disastole
62
S4 Heart sound
pathological sound of vibration of the ventricular wall with ventricular filling and atrial contraction
63
Murmurs
are vibrations of longer duration than the heart sounds and are often due to disruption of blood flow past a stenotic or regurgitate valve; the sounds are variable described as soft, blowing or swishing.
Cause backwards flow of blood
64
Crackles (rales)
An abnormal, discontinuous, high-pitched popping sound heard more often during inspiration.
Associated with: restrictive or obstructive respiratory disorders
Crackles that occur during the latter half of inspiration typically represent atelectasis, fibrosis, pulmonary edema or pleural effusion.
Pulmonary edema
65
Pleural friction rub
Dry, crackling sound heard during both inspiration and expiration
Occurs when inflamed visceral and parietal pleurae rub together
66
Rhonchi
Continuous low-pitched sounds described as having a "snoring" or "gurgling" quality that may be heard during both inspiration and expiration.
67
Stridor
Continous high-pitched wheeze heard with inspiration or expiration
Indicates upper airway obstruction
68
Wheeze
Continuous "musical" or whistling sound composed of a variety of pitches.
69
P wave
atrial depolarization
70
PR interval
Time for atrial depolarization and conduction from the SA node to the AV node. Normal duration is 0.12 to 0.20 seconds
71
QRS complex
Ventricular depolarization and atrial repolarization.
72
QT interval
Time for both ventricular depolarization and repolarization.
73
ST segment
isoelectric period following QRS when the ventricles are depolarized
74
T wave
Ventricular repolarization
75
Sinus Arrest
A sinus rhythm, except with intermittent failur of either SA node impulse formation or AV node conduction that results in the occasional complete absence of P or QRS waves.
76
Premature atrial contractions (PAC)
Occur when an ectopic focus in the atrium initiates an impulse before the SA node. The P wave is premature with abnormal configuration
PACs are very common and generally benign, but may progress to atrial flutter, tachycardia or fibrillation.
May occur with a normal heart (from caffeine, stress, smoking, alcohol) and any type of heart disease.
77
Atrial Fibrillation
A common arrhythmia where the atria are depolarized between 350 and 600 times/min.
ECG shows characteristically irregular undulations of ECG baseline without discrete P waves
Occurs in healthy hearts and in pts with coronary artery disease, HTN, and valvular disease
Sx: palpitations, fatigue, dyspnea, syncope, chest pain.
Stagnation of blood may predispose to thrombi in the atria
78
1st degree AV block
PR interval is longer than 0.2 seconds, but relatively constant from beat to beat
79
2nd degree AV block
```
AV conduction disturbance in which impulses between the atria and ventricles fail intermittently.
Two types (Mobitz I and Mobitz II) - Mobitz II is more serious and may progress to 3rd degree AV block
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80
3rd degree AV block
All impulses are blocked at the AV node and none are transmitted to the ventricles.
Considered a medical emergency requiring a pacemaker.
If the ventricular rate is too slow, the CO drops and pt may faint
Common causes include degenerative changes of the conduction systems, digitalis, heart surgery, and acute MI
81
Premature ventricular complex (PVC)
On ECG, the P wave is usually absent and the QRS complex has a wide and aberrant shape. This is a common arrhyhmia that occurs in healthy and diseased hearts. (3 or more consecutive is considered ventricular tachycarida and is a medical emergency)
82
Ventricular tachycardia
3 or more consecutive PVCs at a ventricular rate of >150 bpm. P waves are absent and QRS complexes are wide and aberrant in appearance.
Longer then 30 sec is life threatening and immediate care. Pts are not able to maintain an adequate BP and eventually become hypotensive.
May degenerate into ventricular fibrillation causing cardiac arrest.
Common causes: MI, cardiomyopathy, and valvular disease.
83
Ventricular Fibrillation
Ventricles do not beat in a coordinated fashion, but fibrillate or quiver asynchronously and ineffectively.
No CO; pt becomes unconscious
ECG shows characteristics fibrillatory waves with an irregular pattern that is either coarse or fine.
Lethal and requires immediate defibrillation, antiarrhythmic drugs.
Common causes include any heart disease, MI, or cocaine use
84
ST segment depression
sign of subendocardial ischemia, but also can be due to digitalis toxicity or hypokalemia. >1mm
85
ST segment elevation
Sign of acute transmural infarction. Can also indicate a benign early repolarization pattern in a normal heart.
86
Exercise Stress Testing
Used to assess the patients ability to tolerate increasing intensity of exercise while ECG,BP,HR, and sx are monitored for evidence of MI, abnormal electrical conduction, or other abnormal signs and sx of exertion.
They may be used to evaluate disease severity and prognosis and to determine functional capacity, especially for exercise prescription and counseling. A number of exercises protocols are available using a treadmill, cycle ergometer or UE ergometer.
87
Absolute indications for terminating an exercising test:
Drop in SBP>10 mmHG (should increase)
Moderately severe angina (three on a scale of four)
Increasing nervous system sx (ataxia, dizziness)
Signs of poor perfusion (cyanosis, pallor)
Sustained ventricular tachycardia
1.0 mm ST elevation in leads without diagnostic Q waves
88
Relative indications for terminating an exercising test:
>2 mm ST segment depression
Arrhythmias (PVCs, supraventricular tachycardia, heart block or bradyarrhythmias)
Fatigue, SOB, wheezing, leg cramps, and claudication
Development of bundle branch block
Increasing chest pain
HTN response (SBP >250 and/or DPB > 115)
89
Pulses
Normal are strong and regular.
The pulse will be irregular with a cardiac arrhythmia and weak and difficult to palpate in PAD.
Higher intensity pulse will be present when stroke volume is increased (exercise, fever)
90
Dorsalis pedis
pulse between first and second metatarsal bones
91
Rating of Perceived Exertion (RPE)
is used to quantify the subject's overall sense of effort during activity. The reported RPE provides the therapist with an idea of the amount of strain or level of exertion the patient is experiencing.
From a scale of 6-20
6 being extremely easy and 20 being extremely hard.
RPE of 13-14 represents about 70% of maximum heart rate during exercise on a treadmill or cycle ergometer.
RPE of 11-13 corresponds to the upper limit of prescribed training heart rates early in cardiac rehab
RPE can substitue for HR in prescribing the intensity of exercise when:
-ability to monitor HR is comprised
-Pt begin an exercise-based rehab program without a preliminary exercise test
-The HR response to exercise is altered (cardiac transplant, beta-blockers)
Rating can be influenced by psychological state, environmental conditions, mode of exercise, and age.
92
Respiratory Rate, Rhythm, and Pattern
A complete assessment of respiration considers four parameters: rate, rhythm, depth, and character. Character refers to the effort and sound produced during breathing.
RR- child 1 y/o (25-35); adult (12-20)
Rhythm- norm is inspiration is half as long as expiration 1:2 ; COPD reflects a longer expiration phase so 1:3 or 1:4
93
Normal Cadiorespiratory Responses to Acute Aerobic Exercise
-Increased O2 consumption due to increased CO, increased blood flow, and O2 utilization in the exercising skeletal muscles
-Linear increase in SBP with increasing workload (8-12 mmHg per MET)
-No change or moderate decrease in DBP
Increased respiratory rate and tidal volume
94
Indications for airways clearance
- Retained secretions in the central airways
- Prophylaxis against postoperative pulmonary complications
- Obtain sputum for diagnositc analysis
- Difficulty clearing secretions
- Atelectasis caused by or suspected of being caused by mucus plugging
95
Active cycle of Breathing techinque
"forced expiratory technique"
assists in secretion clearance in pts with asthma.
Includes 3 phases: breathing control, thoracic expansion exercises, and forced expiratory technique.
96
Autogenic drainage (AD)
used to control breathing to mobilize secretions by varying expiratory airflow without using postural drainage positions or coughing. The theory is to improve airflow in small airways to facilitate the movement of mucus.
AD requires patience to learn, so this may not be suitable for young children and pts who are not motivated or easily distracted.
It can be performed anywhere and during activities of daily living since the pt is the only one able to perform it on themselves.
97
How long should someone be positioned for postural drainage?
2-3 minutes. The idea is to drain bronchial secretions from specific lung segments toward the central airways where they can be removed by cough or mechanical aspiration.
Tip: If you want to drain the L lung you will have the patient sidelying/turned on their R side to drain left lung into center. And visa versa
98
Contraindications for Postural Drainage
```
Intracranial pressure >20 mm HG
Head and neck injury until stabilized
Active hemorrhage with hemodynamic instability
Recent spinal surgery
Active hemoptysis
Empyema (collection of pus within a naturally existing anatomical cavity, such as the lung pleura)
Pulmonary edema assoc with CHF
Pulm embolism
rib fx
surgical wound or healing tissue
```
99
Trendelenburg(inverted) position is contraindicated for:
- Uncontrolled HTN
- Distended abdomen
- Esophageal surgery
- Recent gross hemoptysis related to lung carcinoma.
- Uncontrolled airway at risk for aspiration (e.g. tube feeding or recent meal)
100
Apical segments right and left upper lobes
The patient is in the sitting position, leaning back 30-40 degrees.
101
Posterior segment right upper lobe
The patient is turned 1/4 from prone on the left side with the bed horizontal and the head and shoulder raised on a pillow
102
Posterior segment left upper lobe
The patient is turned 1/4 from prone on the right side(weight is on R) with the head of the bed elevated 45 degrees and the head and shoulders raised on a pillow
103
Lingula left upper lobe
Lingula is the "tongue" on the inferior medial angle of L lung.
The patient turned 1/4 from supine on the right side with the foot of the bed elevated 12 inches.
104
Anterior segments right and left upper lobes
The patient is in supine with the bed horizontal
105
Right middle lobe
The patient is turned 1/4 from supine on the left side with the foot of the bed elevated 12 inches
106
Superior segments left and right lower lobes
The patient is in supine with the foot of the bed elevated 18 inches
107
Posterior basal segments left and right lower lobes
The patient is in prone with the foot of the foot of the bed elevated 18 inches
108
Lateral basal segments lower lobes:
The patient is in sidelying (depends on what lung you want to drain) with the foot of the bed elevated 18 inches.
109
Diaphragmatic Breathing
```
Is used to decrease use of accessory muscles and primarily use diaphragm for breathing.
It is expected to:
-decrease RR
-decrease use of accessory muscles
-Increase tidal volume
-decrease respiratory flow rate
-subjective improvements of dyspnea
-improved tolerance for activity
```
110
Paced breathing
is a strategy to decrease the work of breathing and prevent dyspnea during activity. It allows anyone who experiences SOB to become less fearful of activity and exercise.
111
Exhale with effort
is a breathing strategy employed during activity to prevent a pt from holding their breath.
112
Pursed-lip breathing
is a simple technique to reduce respiratory rate, reduce dyspnea, and maintain a small positive pressure in the bronchioles, which may help prevent airway collapse in patient with emphysema.
-This should reduce arterial PaCO2, improve oxygen saturation,prevent airway collapse in pts with emphysema, and increase activity tolerance.
113
Segmental breathing
Localized breathing to a certain part of the lung.
Position the patient:
-sitting position for basal atelectasis
-sidelying with affected lung uppermost
-postural drainage positions with affected lung uppermost to assist with secretion removal
The PT applies firm pressure at the end of exhalation to the pts chest wall overlying the area to be expanded. Pt inhales deeply and slowly expanding the rib cage under the PT hands. The PT then reduces hand pressure during pts inhalation.
It expected to increase chest wall mobility, expand collapsed alveoli, assist with secretion removal
114
Positions to Relieve Dyspnea
Depends on the circumstances at the time.
-The forward leaning position often provides relief of dyspnea to pts with lung disease. Forward lean with arm support optimizes the length-tension relationship of the diaphragm and allows the pec minor and major to assit in elevating the ribs during inspiration.
115
Semi-Flowers Position
places pt in supine with head of the bed elevated to 45 degrees and pillows under the knees for support and maintenance of a proper lumbar curve. This position is used often for pts with CHF or other cardiac conditions.
116
MET (Metabolic Equivalents)
6 METS = Vigorous
Walking 3 mph = 3-5 METS
Jogging 5 mph = 8 METS
Running 7 mph = 11.5 METS
117
CPR sequence
Compression - Airway - Breathing
Compression rate at least 100/min
Compression depth at least 2 inches
Airway = head tilt - chin lift
Compression to ventilation ratio= 30:2
1 breath every 6-8 seconds (8-10 breaths/min)
118
L sided heart failure
signs and sx of pulmonary venous congestion (pulmonary edema)
119
R sided heart failure
signs and sx of systemic venous congestion (peripheral edema in dependent position)
120
Congestive Heart Failure (CHF)
Common etiologies include arrhythmia, pulmonary embolism, HTN, valvular heart disease, myocarditis, unstable angina, renal failure, and severe anemia
121
Decreased Cardiac Output can cause:
compensatory changes including an increase in blood volume, cardiac filling pressure, heart rate, and cardiac muscle mass
122
Cystic Fibrosis
Causes the exocrine glands to overproduce thick mucus which causes subsequent obstruction
It is an autosomal recessive genetic disorder
It is a terminal disease
123
Emphysema
Emphysema is called an obstructive lung disease because the destruction of lung tissue around smaller sacs, called alveoli, makes these air sacs unable to hold their functional shape upon exhalation
Results from long history of chronic bronchitis, recurrent alveolar inflammation, smoking
Clinical presentation- may include barrel chest appearance, increased subcostal angle, rounded shoulders secondary to tight pec, and rosy skin coloring. (pink puffers)
Sx: worsen with progression; include persistent cough, wheezing, difficulty breathing esp with expiration, and increased RR.
124
Myocardial Infarction (MI)
poor coronary artery perfusion, ischemia, and subsequent necrosis of the cardiac tissue.
Risk factors include patient or family history of heart disease, smoking, physical inactivity, stress, HTN, elevated cholesterol, DM, and obesity
Clinical presentation: deep pain or pressure in the substernal area with or without pain radiating to the jaw or into the L arm or the back.
125
Peripheral Vascular Disease (PVD)
narrowing of the lumen of blood vessels causing a reduction in circulation usually secondary to atherosclerosis.
126
Restrictive Lung Disease
Classification of disorders caused by a pulmonary or extrapulmonary restriction that produces impairment in lung expansion and an abnormal reduction in pulmonary ventilation.
Pulmonary restrictions can be caused by tumor, interstitial pulmonary fibrosis, scarring within the lungs, pleural effusion, chest wall stiffness, structural abnormality, and respiratory muscle weakness.
Pathogenesis includes a decrease in lung and chest wall compliance, decrease in lung volumes, and an increase in the work of breathing.
