midterm Flashcards
(135 cards)
1
Q
the ____ is the last 20% of blood blouses into ventricles
A
atrial kick
2
Q
amount of blood before the AV node fires is
A
end diastolic volume
3
Q
stroke volume is _____ related to afterload
A
inversely
4
Q
whats dzs increase afterload
A
HTN
pulmonary HTN
PVD
CAD
COPD
aortic stenosis
pneumonia
5
Q
how do the dz’s increase the afterload
A
decrease the ejection fraction = makes the heart work harder
6
Q
S3 is heard from ______
A
rapid filling of ventricles
7
Q
S4 is heard from
A
atrial kick
8
Q
systolic murmurs can be caused by
A
aortic/pulmonic stenosis
mitral valve prolapse
mitral/tricuspid regurgitation
9
Q
diastolic murmurs can be caused by
A
aortic/pulmonic regurgitation
mitral stenosis
10
Q
early diastolic murmurs begin ______ & terminate before _____
A
w/ S2
S1
11
Q
late diastolic murmurs begin _____ and terminate ____
A
just after S2
before S1
12
Q
what dzs are correlated w/ mid systolic murmurs
A
aortic/pulmonic stenosis
13
Q
what associates w/ holosystolic
A
mitral regurgitation
14
Q
what associates w/ late systolic
A
mitral valve prolapse
15
Q
which associates w/ early diastolic
A
aortic/pulmonic regurgitation
16
Q
which correlate with mid to late diastolic
A
mitral stenosis
17
Q
ischemic cardiac pain is related to
A
exertion
crescendo/decrescendo in nature
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
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
20
Q
class 3 heart failure
A
marked limitation of physical activity
comfortable at rest but less than ordinary
physical activity fatigue and dyspnea
21
Q
class 4 heart failure
A
unable to carry out any physical activity w/o discomfort
sxs of cardiac insufficiency at rest
22
Q
which of the classes can we not treat
A
class 4
23
Q
NY heart association classification of fatigue, dyspnea or angina
class 1
A
a pt w/ asymptomatic heart dz
24
Q
class 2 fatigue, dyspnea or angina
A
sxs occur on exertion
but pt is able to manage the usual tasks of life
25
class 3 fatigue, dyspnea or angina
sxs develop when doing simple housework
26
class 4 fatigue, dyspnea or angina
sxs occur at rest
27
which of the classes of fatigue, dyspnea or angina can PT not treat
class 3 and 4
28
sxs of angina
pressure
heaviness
tightness
over the middle of the chest (substernal), over the heart, shoulders, arm, throat, jaw or teeth
29
stable angina
precipitated only by exertion and pain free at rest
30
what can relieve stable angina
rest
nitroglycerin x3
31
unstable angina
occurs w/ less exertion or even at rest
lasts longer
becomes less responsive to medication
32
when does prinzmetal's angina typically occur
first thing in the morning when the blood is thick
waking the pt
33
which type of angina can we not treat
unstable angina
34
what is the most common cause of myocarditis
strep infection
35
pericarditis causes
decreased stroke volume
increased global ST wave
36
endocarditis causes
increased global ST wave
37
kawasaki is
inflamed coronary artery
childhood
38
ischemia is _____
injury is ___
infarct is
temp loss of blood supply
occluded vessel
cell death
39
____ is reversible
ischemia
40
ischemia would cause what to the EKG waves
T wave inversion
ST segment depression
41
injury would cause
ST segment depresses then rises
42
infarct would cause
Q wave representing full thickness MI
43
Full thickness MI causes what
large Q wave
44
when measuring voltage for a pt with a transplant, where do you look on the ECG
look at II and V5
45
for a transplant, the R wave should be tallest at
V5
46
what should you do at every visit with a pt who has has a transplant
measure the height and voltage of the ECG
47
what does V2 on lead placement look at
right ventricle
48
V5 on the lead placement looks at
left ventricle
49
lead II looks at
left ventricle
50
during exercise you want to monitor
lead II and V5
left ventricle
51
which leads have an inverted T wave
AVR
V1
52
3 P waves per QRS complex indicates
atrial flutter
53
what're some post op complications
flail chest
dehiscence
pleural effusion
pneumonia
arrhythmias
wound infection
atelectasis
cardiac arrest
54
flail chest
wires rupture
cannot have CPR
55
dehiscence
wound opens up
56
more post op complications
cardiac tamponade
CHF
emphysema
hemothorax
hypercapnia
pulmonary embolism
respiratory arrest
distress and subcutaneous emphysema
brachial plexus injury
peroneal nerve palsy
57
cardiac tamponade
blood in pericardial sac
58
how long are peripheral lines left in
48-72 hours
59
peripheral lines
pain meds
fluids
60
peripheral lines may occlude with
joint movement
61
how long is a triple lumen catheter/central venous line in for
4-7 days
62
where is the triple lumen catheter inserted
subclavian
jugular
femoral vein
63
with triple lumen catheters, PTs should be careful of
neck/UE stretches
hip flexion (if in femoral vein)
avoid left side lying and rolling
64
PTs can perform ________ w/ triple lumen catheters
PROM
AAROM
65
central venous pressure line
measures fluid balance of R side of heart
66
what is normal in a central venous pressure line
0-6
67
where is the central venous pressure line located
sub clavicular with tip above atrium
68
PT implications of central venous pressure line
avoid L side lying
rolling may cause PVCs
69
what can PTs perform with central venous pressure line
PROM
AAROM
70
where is the swanz ganz catheter placed
jugular or subclavian vein
71
what do swanz ganz catheters measure
CO and heart fxn in critically ill pts
72
PT implications for Swanz ganz catheter
caution w/ movement
can do PROM and deep breathing exercises
73
arterial lines are located in
radial or femoral artery
74
complications w/ arterial lines
heavy bleeding if pulled out
avoid wrist ROM or hip flexion > 30 degrees
75
pacing wires are placed where
myocardium of atrium and ventricle
76
are pacing wires sutured in place
yes
77
when are pacing wires removed
3-4 days post op
78
normal O2 saturation
95-100%
79
what O2 level do you cut off PT
90%
80
what is a contraindication for ECG
cardiac arrythmias
81
where is a mediastinal drain located
distal to xiphoid
82
when can you ambulate with a mediastinal drain
if sutured
83
PT for mediastinal drain
PROM
AAROM
splinted coughing
deep breathing exercises
84
which type of catheter drains urine
foley catheter
85
w/ a foley catheter you should always
keep below the knees to avoid retrograde flow
86
precautions in CVICU
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
tx in CVICU
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
POD 1 exercises
deep breathing
incentive spirometer 6x/hr
splinted coughing
ankle pumps/circles 5x
heel slides
hip abd 5x
89
can you ambulate the pt POD 1
no
90
POD 2-5 exercises
deep breathing
incentive spirometer
splinted coughing
resp in sitting, TID (3x per day)
shoulder flexion
hip flexion
knee flex/ext
ankle pumps
91
reps for POD 2
5-10
92
reps for POD 3
10 reps
93
POD 4 reps
15
94
POD 5 reps
20
95
which PODs do you add trunk rotation in stand, and hip flexion in stand
4-5
96
ambulation POD 2
in room or 100-200 ft as tolerated w/ assist
BID
97
ambulation POD 3
200-300 ft
2-3x per day
98
ambulation POD
300-400 ft
2-3x per day
may evaluate on 3-4 steps
99
ambulation POD 5
5-10 min TID
stairs 4-8 steps
100
what is the norm for partial thrombophlebitis time
25-40 s
101
PTT contraindication for PT
> 60 s
102
what blood test is used to see how well your blood clots
international normalized ratio (INR)
103
to be cleared for PT (INR)
normal pt : 1.0
blood clot pt: 2-3
heart valve pt: 2.5-3.5
contraindication for PT:>4.0-6
104
what is the norm prothrombin time
12-15 s
105
contraindication for prothrombin time
> 20 s
106
norm potassium level to be cleared for PT
3.5-5
107
goals for phase 1 pts
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
contraindications to phase 1 pts
unstable angina
HTN,CHF, uncontrolled arrythmias
PE
heart block
acute infections
severe physical or emotional involvement
109
relative contraindications to exercise --> phase 1
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
relative contraindications to exercise --> phase 1(cont)
Profound fatigue
pulmonary artery pressure > 35 mmHg
frequent arrythmias
hemoglobin <8gm/100ml
hematocrit <26%
Fever >100 degrees F
111
absolute contraindications to exercise (Phase 1)
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
absolute contraindications to exercise (Phase 1) cont.
Symptomatic pericarditis, myocarditis, pericardial diffusion
Acute: PE (<2 days after event)
Thrombophlebitis, hypoglycemia
Digoxin toxicity
pending labs
Emotional distress
113
when performing exercising with a pt that had an MI, it is important to not exercise them
more than 20 beats above resting
114
how long must we monitor HR following an MI
1 month
115
what is the guideline from 4-8 wks (MI)
no more than 30 beats above resting
116
when performing exercising with a pt that had open heart surgert, it is important to not exercise them
more than 30 beats above resting
117
how long do we monitor HR for open heart surgery
1 month
118
what is the guideline from 4-8 weeks (open heart)
40 beats above resting
119
if the pt forgot to take meds
you cant exercise them
120
when a pt is experiencing:
excessive fatigue, SOB, dizziness, HR above target HR
flu, cold, fever
change in medical condition +/or meds
rest and decrease phsyical activity temp
121
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
stop exercise and contact MD
122
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%
moderate risk
123
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
low risk
124
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
high risk
125
A patient presents with sub-sternal pain, an ST segment up or down, with nitroglycerin relieving symptoms. What may the patient have?
angina and MI
126
A patient presents with sharp pain radiating to the traps, increases with breathing, global ST elevation. What may the patient have?
endocarditis
127
If the same patient has no effect to nitroglycerin but leaning forward gives relief. What might they have?
pericarditis
128
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?
aortic dissection
129
A patient is relieved by nitroglycerine, comes at HR relieved with rest, and ST changes. What might they have?
stable angina
130
A patient is not relieved by nitroglycerine, HR elevated with ROM, palpation, deep breaths, and has no ST changes. What might they have?
chest wall pain
131
sinus bradycardia can be treated with
atropine and pacing
132
to treat PVC you must tx the
underlying cause
133
tx for v-tach
lidocaine
procainamide
cardioversion
defibrillation once unconscious
134
V fib can be treated with
CODE
defibrillation
135
tx for a fib
digoxin
verapamil
anticoagulants
cardioversion
