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Cardiopulmonary - Midterm > midterm > Flashcards

midterm Flashcards

1
Q

the ____ is the last 20% of blood blouses into ventricles

A

atrial kick

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2
Q

amount of blood before the AV node fires is

A

end diastolic volume

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3
Q

stroke volume is _____ related to afterload

A

inversely

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4
Q

whats dzs increase afterload

A

HTN

pulmonary HTN

PVD

CAD

COPD

aortic stenosis

pneumonia

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5
Q

how do the dz’s increase the afterload

A

decrease the ejection fraction = makes the heart work harder

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6
Q

S3 is heard from ______

A

rapid filling of ventricles

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7
Q

S4 is heard from

A

atrial kick

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8
Q

systolic murmurs can be caused by

A

aortic/pulmonic stenosis

mitral valve prolapse

mitral/tricuspid regurgitation

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9
Q

diastolic murmurs can be caused by

A

aortic/pulmonic regurgitation

mitral stenosis

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10
Q

early diastolic murmurs begin ______ & terminate before _____

A

w/ S2

S1

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11
Q

late diastolic murmurs begin _____ and terminate ____

A

just after S2

before S1

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12
Q

what dzs are correlated w/ mid systolic murmurs

A

aortic/pulmonic stenosis

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13
Q

what associates w/ holosystolic

A

mitral regurgitation

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14
Q

what associates w/ late systolic

A

mitral valve prolapse

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15
Q

which associates w/ early diastolic

A

aortic/pulmonic regurgitation

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16
Q

which correlate with mid to late diastolic

A

mitral stenosis

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17
Q

ischemic cardiac pain is related to

A

exertion

crescendo/decrescendo in nature

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18
Q

class 1 heart failure

NY health association classification (CHF)

A

no limitation of physical activity

physical activity does not cause fatigue

palpitation or dyspnea

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19
Q

class 2 heart failure

A

slight limitation of physical activity

comfortable at rest, but ordinary physical activity results in fatigue

palpitation and dyspnea

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20
Q

class 3 heart failure

A

marked limitation of physical activity

comfortable at rest but less than ordinary

physical activity fatigue and dyspnea

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21
Q

class 4 heart failure

A

unable to carry out any physical activity w/o discomfort

sxs of cardiac insufficiency at rest

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22
Q

which of the classes can we not treat

A

class 4

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23
Q

NY heart association classification of fatigue, dyspnea or angina

class 1

A

a pt w/ asymptomatic heart dz

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24
Q

class 2 fatigue, dyspnea or angina

A

sxs occur on exertion

but pt is able to manage the usual tasks of life

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25
Q

class 3 fatigue, dyspnea or angina

A

sxs develop when doing simple housework

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26
Q

class 4 fatigue, dyspnea or angina

A

sxs occur at rest

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27
Q

which of the classes of fatigue, dyspnea or angina can PT not treat

A

class 3 and 4

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28
Q

sxs of angina

A

pressure

heaviness

tightness

over the middle of the chest (substernal), over the heart, shoulders, arm, throat, jaw or teeth

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29
Q

stable angina

A

precipitated only by exertion and pain free at rest

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30
Q

what can relieve stable angina

A

rest

nitroglycerin x3

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31
Q

unstable angina

A

occurs w/ less exertion or even at rest

lasts longer

becomes less responsive to medication

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32
Q

when does prinzmetal’s angina typically occur

A

first thing in the morning when the blood is thick

waking the pt

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33
Q

which type of angina can we not treat

A

unstable angina

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34
Q

what is the most common cause of myocarditis

A

strep infection

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35
Q

pericarditis causes

A

decreased stroke volume

increased global ST wave

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36
Q

endocarditis causes

A

increased global ST wave

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37
Q

kawasaki is

A

inflamed coronary artery

childhood

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38
Q

ischemia is _____

injury is ___

infarct is

A

temp loss of blood supply

occluded vessel

cell death

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39
Q

____ is reversible

A

ischemia

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40
Q

ischemia would cause what to the EKG waves

A

T wave inversion

ST segment depression

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41
Q

injury would cause

A

ST segment depresses then rises

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42
Q

infarct would cause

A

Q wave representing full thickness MI

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43
Q

Full thickness MI causes what

A

large Q wave

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44
Q

when measuring voltage for a pt with a transplant, where do you look on the ECG

A

look at II and V5

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45
Q

for a transplant, the R wave should be tallest at

A

V5

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46
Q

what should you do at every visit with a pt who has has a transplant

A

measure the height and voltage of the ECG

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47
Q

what does V2 on lead placement look at

A

right ventricle

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48
Q

V5 on the lead placement looks at

A

left ventricle

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49
Q

lead II looks at

A

left ventricle

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50
Q

during exercise you want to monitor

A

lead II and V5

left ventricle

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51
Q

which leads have an inverted T wave

A

AVR

V1

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52
Q

3 P waves per QRS complex indicates

A

atrial flutter

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53
Q

what’re some post op complications

A

flail chest

dehiscence

pleural effusion

pneumonia

arrhythmias

wound infection

atelectasis

cardiac arrest

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54
Q

flail chest

A

wires rupture

cannot have CPR

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55
Q

dehiscence

A

wound opens up

56
Q

more post op complications

A

cardiac tamponade

CHF

emphysema

hemothorax

hypercapnia

pulmonary embolism

respiratory arrest

distress and subcutaneous emphysema

brachial plexus injury

peroneal nerve palsy

57
Q

cardiac tamponade

A

blood in pericardial sac

58
Q

how long are peripheral lines left in

A

48-72 hours

59
Q

peripheral lines

A

pain meds

fluids

60
Q

peripheral lines may occlude with

A

joint movement

61
Q

how long is a triple lumen catheter/central venous line in for

A

4-7 days

62
Q

where is the triple lumen catheter inserted

A

subclavian

jugular

femoral vein

63
Q

with triple lumen catheters, PTs should be careful of

A

neck/UE stretches

hip flexion (if in femoral vein)

avoid left side lying and rolling

64
Q

PTs can perform ________ w/ triple lumen catheters

A

PROM

AAROM

65
Q

central venous pressure line

A

measures fluid balance of R side of heart

66
Q

what is normal in a central venous pressure line

A

0-6

67
Q

where is the central venous pressure line located

A

sub clavicular with tip above atrium

68
Q

PT implications of central venous pressure line

A

avoid L side lying

rolling may cause PVCs

69
Q

what can PTs perform with central venous pressure line

A

PROM

AAROM

70
Q

where is the swanz ganz catheter placed

A

jugular or subclavian vein

71
Q

what do swanz ganz catheters measure

A

CO and heart fxn in critically ill pts

72
Q

PT implications for Swanz ganz catheter

A

caution w/ movement

can do PROM and deep breathing exercises

73
Q

arterial lines are located in

A

radial or femoral artery

74
Q

complications w/ arterial lines

A

heavy bleeding if pulled out

avoid wrist ROM or hip flexion > 30 degrees

75
Q

pacing wires are placed where

A

myocardium of atrium and ventricle

76
Q

are pacing wires sutured in place

A

yes

77
Q

when are pacing wires removed

A

3-4 days post op

78
Q

normal O2 saturation

A

95-100%

79
Q

what O2 level do you cut off PT

A

90%

80
Q

what is a contraindication for ECG

A

cardiac arrythmias

81
Q

where is a mediastinal drain located

A

distal to xiphoid

82
Q

when can you ambulate with a mediastinal drain

A

if sutured

83
Q

PT for mediastinal drain

A

PROM

AAROM

splinted coughing

deep breathing exercises

84
Q

which type of catheter drains urine

A

foley catheter

85
Q

w/ a foley catheter you should always

A

keep below the knees to avoid retrograde flow

86
Q

precautions in CVICU

A

pending test or lab results (contraindication for PT)

DVT/PE

blood transfusion

chest pain

changes in vitals

plan for surgery/post op

increase/decrease in body temp

difficulty breathing

dialysis

87
Q

tx in CVICU

A

ROM

pulmonary hygiene

deep breathing

exercises

splinted coughing

bed mobility

transfer

OOB to chain

UE and LE exercises (per protocol)

gait training

family education

88
Q

POD 1 exercises

A

deep breathing

incentive spirometer 6x/hr

splinted coughing

ankle pumps/circles 5x

heel slides

hip abd 5x

89
Q

can you ambulate the pt POD 1

A

no

90
Q

POD 2-5 exercises

A

deep breathing

incentive spirometer

splinted coughing

resp in sitting, TID (3x per day)

shoulder flexion

hip flexion

knee flex/ext

ankle pumps

91
Q

reps for POD 2

A

5-10

92
Q

reps for POD 3

A

10 reps

93
Q

POD 4 reps

A

15

94
Q

POD 5 reps

A

20

95
Q

which PODs do you add trunk rotation in stand, and hip flexion in stand

A

4-5

96
Q

ambulation POD 2

A

in room or 100-200 ft as tolerated w/ assist

BID

97
Q

ambulation POD 3

A

200-300 ft

2-3x per day

98
Q

ambulation POD

A

300-400 ft

2-3x per day

may evaluate on 3-4 steps

99
Q

ambulation POD 5

A

5-10 min TID

stairs 4-8 steps

100
Q

what is the norm for partial thrombophlebitis time

A

25-40 s

101
Q

PTT contraindication for PT

A

> 60 s

102
Q

what blood test is used to see how well your blood clots

A

international normalized ratio (INR)

103
Q

to be cleared for PT (INR)

A

normal pt : 1.0

blood clot pt: 2-3

heart valve pt: 2.5-3.5

contraindication for PT:>4.0-6

104
Q

what is the norm prothrombin time

A

12-15 s

105
Q

contraindication for prothrombin time

A

> 20 s

106
Q

norm potassium level to be cleared for PT

A

3.5-5

107
Q

goals for phase 1 pts

A

its safe

prevent the deleterious effects of bed rest

decrease anxiety/depression

decrease RFs w/ heart dz

maintain muscle strength

to prepare pts for d/c for home

108
Q

contraindications to phase 1 pts

A

unstable angina

HTN,CHF, uncontrolled arrythmias

PE

heart block

acute infections

severe physical or emotional involvement

109
Q

relative contraindications to exercise –> phase 1

A

Resting HR: >130 bpm or <40 bpm

Resting BP: S: >180, D: >100

ECG changes

hyper/hypokalemia

extreme dyspnea: resting

rate >35 breaths/min

110
Q

relative contraindications to exercise –> phase 1(cont)

A

Profound fatigue

pulmonary artery pressure > 35 mmHg

frequent arrythmias

hemoglobin <8gm/100ml

hematocrit <26%

Fever >100 degrees F

111
Q

absolute contraindications to exercise (Phase 1)

A

Resting BP: S: >200 mmHg D: >110 mmHg

profound orthostatic hypotension (drop in SBP >20 mmHg w/ symptoms)

rapid/prolonged atrial or

ventricular arrythmias

3rd degree heart block

112
Q

absolute contraindications to exercise (Phase 1) cont.

A

Symptomatic pericarditis, myocarditis, pericardial diffusion

Acute: PE (<2 days after event)

Thrombophlebitis, hypoglycemia

Digoxin toxicity

pending labs

Emotional distress

113
Q

when performing exercising with a pt that had an MI, it is important to not exercise them

A

more than 20 beats above resting

114
Q

how long must we monitor HR following an MI

A

1 month

115
Q

what is the guideline from 4-8 wks (MI)

A

no more than 30 beats above resting

116
Q

when performing exercising with a pt that had open heart surgert, it is important to not exercise them

A

more than 30 beats above resting

117
Q

how long do we monitor HR for open heart surgery

A

1 month

118
Q

what is the guideline from 4-8 weeks (open heart)

A

40 beats above resting

119
Q

if the pt forgot to take meds

A

you cant exercise them

120
Q

when a pt is experiencing:

excessive fatigue, SOB, dizziness, HR above target HR

flu, cold, fever

change in medical condition +/or meds

A

rest and decrease phsyical activity temp

121
Q

if the pt is experiencing:

chest tightness or pain

pain in jaw, arms, ears or teeth

vomiting, nausea, headache

irregular heartbeat

heavy sweating

SOB that doesnt subside in 15 min

A

stop exercise and contact MD

122
Q

Presence of angina or other significant symptoms at high levels of exertion > 7 METs

Mild to moderate level of silent ischemia during exercise testing or recovery

Functional capacity <5 METs

Non-exercise testing findings: resting EF= *40-49%

A

moderate risk

123
Q

Rest ejection fraction >50%

Uncomplicated MI or revascularization procedure

Absence of:
-complicated ventricular arrhythmias at rest
-CHF
-signs/symptoms of post-event/post-procedure ischemia
-clinical depression

A

low risk

124
Q

Rest EF <40%

History of cardiac arrest

Complex dysrhythmias at rest

Complicated MI or revascularization procedure

Presence of:
-CHF
-signs/symptoms of post-event/post-procedure ischemia
-Clinical depression

A

high risk

125
Q

A patient presents with sub-sternal pain, an ST segment up or down, with nitroglycerin relieving symptoms. What may the patient have?

A

angina and MI

126
Q

A patient presents with sharp pain radiating to the traps, increases with breathing, global ST elevation. What may the patient have?

A

endocarditis

127
Q

If the same patient has no effect to nitroglycerin but leaning forward gives relief. What might they have?

A

pericarditis

128
Q

patient presents with tearing knife-like pain, anterior to posterior, increases in supine position, large gap between SBP and DBP, and no mechanism of injury (MOI). What might they have?

A

aortic dissection

129
Q

A patient is relieved by nitroglycerine, comes at HR relieved with rest, and ST changes. What might they have?

A

stable angina

130
Q

A patient is not relieved by nitroglycerine, HR elevated with ROM, palpation, deep breaths, and has no ST changes. What might they have?

A

chest wall pain

131
Q

sinus bradycardia can be treated with

A

atropine and pacing

132
Q

to treat PVC you must tx the

A

underlying cause

133
Q

tx for v-tach

A

lidocaine

procainamide

cardioversion

defibrillation once unconscious

134
Q

V fib can be treated with

A

CODE

defibrillation

135
Q

tx for a fib

A

digoxin

verapamil

anticoagulants

cardioversion

Cardiopulmonary - Midterm (3 decks)

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