Test weeks 4-8 Flashcards

Question

Ventricular Tachycardia

Answer 1

``` Regular 180 - 190 bpm QRS prolonged P wave not seen *decreased CO, BP, cardiovert ```

Answer 2

``` Irregular 300+ bpm QRS not recognizable Pwave not seen DEFIBRILLATE! heart is quivering ```

Answer 3

``` Rhythm flat Rate 0 QRS none P wave none *carry out cpr, check leads! ```

Answer 4

an impulse is blocked as it travels through the bundle branches

Answer 5

branch defective so that the electrical impulse cannot travel through it to the right ventricle, activation reaches right ventricle by proceeding from the left ventricle Travels through septal and right ventricular muscle mass

Answer 6

Activation of left ventricle is delayed, which results in the left ventricle contracting later than the right ventricle LBBB is seen in lead V5 and V6

Answer 7

AVN firing faster than SN resulting in a regular narrow complex rhythm Maybe demonstrate retrograde P waves, or not present rates 40 - 60 bpm LOOKS NORMAL, OR PWAVE MISSING OR INVERTED

Answer 8

``` Palpitations Fatigue Light Headed Dyspnea Poor exercise tolerance ```

Answer 9

Detects arrythmias not seen on resting EKG Take home EKG outpt procedure Provides continuous electrical recording 24-48 hrs Activity, Sleep, Rest Combines EKG during ADL

Answer 10

``` Non-invasive, uses sound waves Observes heart structures Function of the heart ventricular and valve Blood flow, direction, amount ```

Answer 11

Pericardial effusion/pericarditits Valvular heart disease Cardiac tumors/blood clots Septal wall defects - VSD, ASD, congenital

Answer 12

M-Mode echocardiogram 2D Color doppler (red and blue indicate flow direction) Trans-esophageal (TEE) (better visualization, no bones or lungs, visualize back of the heart)

Answer 13

Graded or steady exercise test with EKG and pulmonary gas exchange assessment Mouthpiece or face mask collects exhaled gas

Answer 14

Minute vent SpO2, ABG, PETCO2, Vd/Vt CO2 production, O2 consumption FVC and FEV1 measurements pre and post exercise

Answer 15

HR and rhythm, BP

Answer 16

``` Explain dyspnea and limiting activity Rule out cardiac disease w/lung disease Establish occupational disability Rule out exercise induced hypoxemia Obtain baseline exercise level ```

Answer 17

Pre-evaluation assessment - Pulmonary rehab - Cardio - thoracic surgery - Fitness program - Endurance training

Answer 18

``` Physical limitations -Arthritis, osteoarthritis of lower extremities -Recent surgery of lower extremities -Hip, knee, joint pain Cerebral vascular disease Syncope Pulmonary Related -FEV1 < 30% predicted -PaO2 < 40 mmHg on RA -PaCO2 > 70 mmHg -Recent pulmonary embolus -Severe pulmonary hypertension ```

Answer 19

``` Cardiac Related -recent MI -Unstable chest pain suspicious of cardiac pain Uncontrolled hypertension -SBP > 200 mmHg, DPB > 110 mmHg COPD exacerbation Rapid atrial or vent arrhythmias Recent systemic embolus Severe CorPulmonale ```

Answer 20

2 experienced clinicians and MD - BLS/ACLS certified - RT - RN - Exercise physiologist

Answer 21

Ve increases directly with increasing workload and increase in CO2 production -Predicted Ve max (MVV) = FEV1 x 35 Measured by electronic flow transducer At rest 6 - 12 lpm -during exercise >/= 100 lpm (avg sedentary) ->/= 200 lpm conditioned athlete

Answer 22

Volume consumed or used during exercise Single best measure of work being performed -Normal resting Vo2 is 3.5 ml/min -To measure Vo2, exhaled gas is accumulated Vo2 = FeO2-FeCO2/FiO2

Answer 23

Amount of oxygen being consumed to perform a particular activity Resting metabolism = 1 MET (Vo2 3.5 ml/kg) Healthy sedentary should be able to work up to 7 METS

Answer 24

Highest amount of oxygen extracted by the body from the volume of air breathed into the lungs -Level at which symptoms become overwhelming

Answer 25

``` Based on age, height, gender -Young adults 80 ml/kg -Seniors 30 ml/kg -Presence of disease < 30 ml/kg Vo2 max (act) / Vo2 max (pred) = % pred Normal is >/= 80% predicted ```

Answer 26

Reflection of metabolism during activity - measured via exhaled gas sampling - VcO2 = (FeCO2 - 0.0003) x Ve - VcO2 rises directly with workload - Ve rises directly with VcO2 and lactic acid production

Answer 27

Exercise increases metabolic need of the tissues for O2 (aerobic metabolism) - both the lungs and cardiac system must be able to meet these demands - Pulm system increase oxygen availability by increasing Ve (IRV) and Zone 1 and 2 perfusion - Cardiac system increases oxygen delivery by - -increasing HR and SV = Increasing CO

Answer 28

As workload is steadily increased, O2 consumption continues to rise until Vo2 max is reached - VcO2 continues to rise until the body cannot perform work aerobically - Body then switches to anaerobic metabolism (anaerobic threshold - AT)

Answer 29

Anaerobic metabolism - Producing work without oxygen - Producing more CO2 than consuming O2 - Occurs at about 60 - 70% of Vo2 and Ve Max - can only maintain continued exercise for a short duration (exhaustion) - Occurs where Ve rises sharply in contrast to VO2 consumption - Point where Ve breaks away from the linear relationship with Vo2

Answer 30

RER = VcO2/VO2 - Normal aerobic RER will be 0.7 - 0.9 - RER increases from 0.7 (at rest) with increasing workload as CO2 production increases ``` Anaerobic metabolism (AT) the RER will be > 1.0 due to CO2 production - Good indicator of maximal effort by patient during testing ```

Answer 31

- Use of standard walking treadmill (more natural) - Work (METS) are increased by - Increasing treadmill speed and grade - Graded levels are usually spaced 2-3 minutes - Work levels are increased until - Pt cannot tolerate - Abnormal response occurs - VO2 Max or HR Max achieved

Answer 32

Increase workloads expressed as "watts" - Wheel belt tension increased every 30 seconds to 4 minutes making pedaling more difficult In most people, cycling does not produce a high VO2 as the treadmill - set supports pt's weight - Pts with difficulty ambulating, obese pt

Answer 33

Treadmill - natural form of exercise, Higher Vo2 Max Cycle - Safer than treadmill, easier to monitor, easier to obtain ABG

Answer 34

Treadmill - Risk of accident, pt. anxiety, motion artifact, ABG difficulty Cycle - Legs fatigue more quickly, Lower VO2 Max

Answer 35

``` Baseline Data - 3 minute resting data Active exercise data - VO2, VCO2, Ve, HR, RR, SpO2, RER - Parameters taken at 1 minute intervals during staging Cool down and Recovery Care - ABG, spirometry, B2 if needed ```

Answer 36

Patient exhaustion, fatigue, dyspnea, pain Vo2 Max or AT has been reached Heart Rate and rhythm changes - Reaches predicted HRmax (220 - age) - ST segment decreases by 2 mm - Chest pain - Blood pressure changes - systolic drops by 20 mmHg or no increase - systolic > 250; diastolic > 120 mmHg

Answer 37

Predicted VE Max is reached - Ve will increase at onset of anaerobic metabolism due to the increased CO2 production Cardiac - Increase systolic blood pressure - Minimal to no increase in diastolic pressure - HR increases with Vo2 until max HR is reached

Answer 38

``` Increase in - SpO2 slightly - PaO2 - Lactic Acid - BP & HR - RR & Ve - Vo2 & VCO2 Decrease in - pH - Vd/Vt - PaCO2 ```

Answer 39

- Exercising causes HR to increase linearly | - HR will continue to increase linearly until max predicted HR is reached

Answer 40

HR will increase linearly with VO2, however it is greater at each level of VO2 (outside the normal range) BP and SpO2 will have a normal response

Answer 41

Pulmonary Limited Exercise - Vent limited - did not reach VO2 Max due to breathing impairment - Did not achieve anaerobic threshold - Ve max is greater than 70% of their MVV - Increased Vd/Vt - PaO2 will decrease - PA-aO2 will increase - EKG normal - HR max is less than 85% predicted HR at completion

Answer 42

Pt. should spend 5 minutes in warm up activities Pt. should exercise 20 min at target HR - target = (Max HR - Resting HR) .70 + Resting Pt. should spend 5 minutes in cool down activities

Answer 43

COPD pt will have increased - exercise tolerance - overall strength - oxygen use efficiency - quality of life Decreased dyspnea

Answer 44

Cardiac Disease Limited - Circulation (CO) Limited - HR max achieved sooner than Ve max or VO2 Max predicted - Ve max is less than 50% of their MVV - EKG shows arrhythmia, ST changes, or both - Systolic pressure drops - Diastolic pressure increases

Answer 45

Deconditioned subjects - have same response as CV except the EKG is normal - HR max reached before Vo2 max - Dyspnea limitation - Leg cramping

Answer 46

- Mental Status - Cranial nerve function - Motor system - Coordination - Sensory pattern - Reflexes Meaningful neurologic assessment requires adequate stimulation

Answer 47

- Afferent (periphery to CNS) - Efferent (CNS to rest of body) - Review brain - Brainstem

Answer 48

``` band on forehead monitors sedation LOC > 60 not sedated enough Brain waves measure electrical activity < 20 - 10 too much sedation ```

Answer 49

Midbrain Locus coeruleus Pons Medulla

Answer 50

Temperature

Answer 51

Level of consciousness

Answer 52

sleepy, but can awake and answer questions

Answer 53

needs more stimulation | can do simple commands

Answer 54

constant pain stimulation to answer | no commands

Answer 55

unresponsive to stimulation

Answer 56

Assesses the LOC after head injury tests verbal, motor, eye opening, etc. 12 - 15 good, non-icu <9 Coma Delirium - longer stay in icu, 60 - 80% of MV pts.