Other Cardiovascular conditions

Question 1

what lung sounds go with CHF? why?

Answer 1

rales/crackles fluid in alveoli

Question 2

what heart sounds goes with CHF?

Answer 2

S3- hallmark! non-compliant LV

Question 3

what is pulsus alternans?

Answer 3

alteration of strong/weak pulse in femoral and radial arteries= depressed myocardial fxn

Question 4

What condition is marked by end-inspiratory dry rales?

Answer 4

IPF!

Question 5

what will a chest X ray show if there is pneumonia?

Answer 5

> bacterial pneumonia= lobar consolidation in one or more lobes
viral pneumonia= fluffy shadows
necrotizing pneumonia= cavities

Question 6

what will breath sounds sound like over pneumonia?

Answer 6

bronchial sound over lobar pneumonia, or absent/dull percussion

Question 7

differentially diagnose between bacterial and viral pneumonia based on S&S

Answer 7

bacterial= high fever, productuve cough, pleuritic pain
viral= moderate fever, nonproductive cough, myalgias
*both come with dyspnea and tachypenea

Question 8

pulmonary effusion, types:

Answer 8

accumulation of fluid in the pleural space
>transudate= low protein
>exudate= high protein

Question 9

what pulmonary pathology is verified by presence of kerly B. lines?

Answer 9

pulmonary edema

Question 10

what lung sounds go with chronic bronchitis

Answer 10

ronchi and wheezing

Question 11

which types of pulmonary patients assume the tripod position for ease of breathing?

Answer 11

COPD

Question 12

what diagnosis goes with a radiograph with netlike shadows and rales/crackles and rhonchi, blood streaked sputum, large amounts of purulent phlegm and sinusitis?

Answer 12

bronchiectasis

Question 13

what causes bronchiectasis?

Answer 13

irreversible dilation of one or more bronchi with chronic inflammation and infection

Question 14

what is literflow vs. FIO2?

Answer 14

literflow= liters of gas per minute (speed at which gas is moving)
FIO2= fraction of inspired oxygen (part of a whole)

Question 15

when do u need to use a bubbler/humidifier?

Answer 15

for flowrates greater than or equal to 4 liters per minute

Question 16

if using upwards of 24 Lpm, what type of mask do u use?

Answer 16

a Venti-mask

Question 17

what does a non rebreathing mask do?

Answer 17

100% O2 non-invasively

Question 18

downside to non-rebreathers?

Answer 18

can’t humidify them- also can’t eat with it on, need NC for meals

Question 19

FIO2 range for all purpose nebulizers?

Answer 19

21%-100%

Question 20

IPAP and EPAP

Answer 20

> inspiratory positive airway pressure

>expiratory positive airway pressure

Question 21

IPAP+EPAP=??

Answer 21

CPAP

Question 22

what is used as a priming mechanism to enhance coughs?

Answer 22

huff breaths!

Question 23

PS/ CPAP?

Answer 23

Pt. initiates breath with a preset inspiratory pressure to aid in WOB. – pressure support, continuous pressure – constant flow of positive pressure to help

Question 24

A/C:

Answer 24

Tidal Volume and RR rate are preset. Can take added breath at preset Vt. – minimum minute ventilation – can be generated by patient whenever they want – pressure applied when he breathes. Also set up a predesired parameters but can be over ridden. Can become hyperventilation. (respiratory alkalosis)

Question 25

SIMV:

Answer 25

Partial ventilatory support with some mandatory breaths. – synchro intermittent mandatory ventilation – patient spontaneously breaths – positive pressure with breath – pt controlled RR, given to decrease breathing work – preset TV with each breath plus mandatory breaths in between

Question 26

APRV:

Answer 26

(Airway Pressure Release Ventilation). Release in pressure to allow expiratory phase. Helpful in ARDS when compliance is reduced.

Question 27

how is alveolar recruitment treated?

Answer 27

>incentive spirometry (visual aid devices/games), >positive epiratory pressure therapy (PEP) >Intermittent positive pressure breathing (IPPB)= most aggressive

Question 28

what is Lupus?

Answer 28

systemic lupus erythematosus (SLE): multi-system autoimmune disease, increased production of autoantibodies, immune complexes cause diffuse, widespread inflammation in the joints, skin,brain, kidney, heart. Ppl usually die from heart or pulmonary complications.

Question 29

what type of lung impairment is common after cardiac surgery?

Answer 29

left lower lobe atelectasis

Question 30

what is significant to know for PTs who are working with a patient who has had an anterior lateral thoracotomy?

Answer 30

pec major has been cut and serratus anterior seperated

Question 31

what mm are cut in a lateral thoracotomy?

Answer 31

serratus ant. and latissimus dorsi is moved around and messed with

Question 32

who is a candidate for a carotid endarterectomy?

Answer 32

>symptomatic pt with carotid stenosis of greater than or equal to 50-70% > or asymptomatic with stenosis of 60%

Question 33

what do pacemakers correct?

Answer 33

arrhythmias, 2nd or 3rd degree heart blocks, tachycardias and bradycardias

Question 34

which pacemakers are used with LBBB and severe heart failure

Answer 34

tripolar pacing system- leads in R atrium, R vent. and L vent.

Question 35

what is an implantable cardioverter defibrillator? (ICD/ shock box)

Answer 35

designed to correct-life threatening arrythmias- decects and corrects all tachycardias, bradycardias and V. fibs

Question 36

who benefits most from an ICD?

Answer 36

ppl with LVEF less than or equal to 30%

Question 37

absolute contraindications for organ transplant?

Answer 37

``` >active malignancy within 2 years >HIV >untreatable psychiatric condition > non operable CV condition >DM with microvascular disease >chest wall or spinal deformity ```

Question 38

relative contraindications for organ transplant

Answer 38

>irreversible renal dysfunction > severely limited functional status with poor rehab potential >morbid obesity

Question 39

how do they decide who gets an organ when one is available?

Answer 39

``` heart= person who needs it most lung= first come first serve basis ```

Question 40

PT after transplant?

Answer 40

``` transfers ambulation ADLs strength and ROM pulm. hygiene and chest wall mechanics ```

Question 41

how soon after an organ transplant can u do a PT eval?

Answer 41

12-36 hours

Question 42

how high can u push a patient after an organ transplant?

Answer 42

MET level 1-3

Question 43

what is normal MAP?

Answer 43

70-110 mmHg

Question 44

what is too low for MAP to provide adequate purfusion pressure?

Answer 44

less than 60 mmHg

Question 45

intermittent mandatory ventilation (IMV)

Answer 45

preset breath rate | pt can take optional breaths

Question 46

syndchronized intermittent mandatory ventilation (SIMV)

Answer 46

mandatory breaths plus optional ones with assistance | * avoid stacking because only mandatory if not breathing on their own

Question 47

pressure support ventilation (PSV)

Answer 47

when patient inhales the ventilator supports it

Question 48

inspiratory hold

Answer 48

provides a hold during inhalation, for hyperventilation and restrictive lung disease

Question 49

positive end expiratory pressure

Answer 49

applied at end of expiration to prevent alveolar collapse

Question 50

when is positive end expiratory pressure

Answer 50

emphysema ppl in shock pulmonary edema

Question 51

expiratory retard

Answer 51

prolongs expiration phase

Question 52

who needs expiratory retard?

Answer 52

COPD

Question 53

constant positive airway pressure- CPAP

Answer 53

constant pressure throughout inspiration and expiration to keep airway open (sleep apnea)

Question 54

when should bronchodilators and aerosolized antibiotics be taken in conjunction with postural drainage and percussion?

Answer 54

bronchodilators= BEFORE | aerosolized antibiotics= AFTER

Question 55

4 stages of an effective cough

Answer 55

1) inspiration greater tidal volume 2) closure of the glottis 3) abdominal and intercostal mm contract 4) sudden opening of glottis and air forced out

Question 56

what population of pts has trouble with coughing?

Answer 56

obstructive lung diseases

Question 57

``` technique for helping cough? Pump cough: breath holding: pursed lip breathing: diaphragmatic breathing: ```

Answer 57

3 huffs then 3 short coughs, repeat x3 until spontaneous coughing begins holding inhale may help too. pursed lip breathing helps ppl with obstructive disease by controling exhale

Question 58

small breath=? medium breath? large breath?

Answer 58

small breath= small cough medium breath= med. cough large breath= large cough