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Basecamp Cardiopulm

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Airway Clearance Techniques breathing strategies, manual and mechanical techniques, and postural drainage
Atelectasis/pneumothorax Lung collapse
Active Cycle of Breathing ACB; FKA forced expiratory technique; Phases: breathing control, thoracic expansion and forced expiratory technique
Hemoptysis Coughing up blood
Empyema Accumulation of pus in pleural cavity
Orthopnea SOB/Dyspnea that occurs when lying flat
Coronary Arteries Right Coronary, Posterior Interventricular, Anterior Interventricular, Circumflex and Left Coronary Artery
Coronary Veins Small cardiac, middle cardiac, and great cardiac
Vessel Wall Anatomy tunica interna, endotheliaum, subedothelial layer, elastic layer, Tunica media, elastic layer and tunica externa
% of blood supply that is Venous 67%; that can distend more readily
Coronary Sinus Large venous channel that collects all coronary blood and dumps it into R atrium
Right coronary Artery Originates at cusp of aorta; supplies blood to ventricles, R atrium and SA node
Posterior Interventricular (descending) Coronary Artery Supplies posterior third of interventricular septum
Anterior Interventricular (descending) Coronary Artery Supplies blood to anterior and lateral parts of the heart, front 2/3 of the interventricular septum; 45-55% of blood to L ventricle comes from here.
Circumflex Coronary Artery Branches off L Coronary Artery; supplies blood to posterior heart
Left Coronary Artery supplies blood to ventricles and left atrium
Small Cardiac Vein Receives blood from posterior portion of R atrium and ventricle
Middle Cardiac Vein Inferior interventricular vein; ascends from the apex within posterior groove; empties into coronary sinus
Great Cardiac Vein found in anterior groove and empties into sinus on posterior heart
MET Scale Light <3 Moderate 3-6 Vigorous >6
Hypercapnia High levels of HCO3- (Bicarbonate) in blood; carbon disoxide poisoning; increases breath rate
Eucapnia Normal level of carbon dioxide in the blood
% of oxygen at Sea level 21%
Typical medication for hypertension ACE inhibitors
Orthostatic Hypotension due to a loss of vasoconstriction control and reduced mm tone
Pulmonary Edema produces what lung sound? Fine crackling in distal airways
Pneumothorax produces what lung sound? Absent (collapsed)
Bronchophany - Voice Sound Increased vocal resonance with greater clarity and loudness of spoken word; abnormal transmission of sound from lungs or bronchi; clearly audible "99" may indicated increased lung density
Egophany - Voice Sound In creased resonance of voice sounds during lung auscultations; often caused by lung consolidation and fibrosis; higher pitches are hear and lower pitches are lost; the e sound turns into an a sound
Whispered Pectoriloquy - Voice Sound Increased loudness of whispering noted during lung auscultations; normally not heard with healthy lung tissue
Crackle - Lung Sound Formerly Rales; abnormal, discontinuous, high pitched popping sound; heard more often during inspiration; associated with restrictive or obstructive lung disease
Stridor - Lung Sound Continuous high pitched wheeze with in and ex piration; adventitious breath sound that occurs with alterations or turbulence in breath sounds
Pleural Friction Rub - Lung Sound Dry, crackling sound during in and ex piration; occurs when inflamed visceral and parietal pleurae rub together
Rhonchi - Lung Sound Continuous low pitch sounds like "snoring or gurgling"; Caused by air passing through an airway that is obstructed by inflammatory secretions or liquid
Wheeze - Lung Sound high pitched whistling sounds associated with obstructive lung disorders; sounds are more prominent with inspiration
Vesicular Breath Sounds High pitched, breezy; more distal
Bronchial Breath Sounds Tubular, hollow, echoing; More proximal
Laminar Air Flow Optimal air flow through the lungs; external and internal pressure equalize; not audible with a stethoscope
Fowler's Position High - long sitting with hips/bedseated at 90 degrees Standard - 45-60 degrees Semi -30-45 degrees Low - 15-30 degrees
Benefits of Diaphragmatic Breathing Decreased respiration, decreased use of accessory mm's of inspiration; Increase tidal volume; decrease respiratory flow; improvement of dyspnea; improve tolerance for activity
Inspiratory Muscle Training (IMT) Attempts to strengthen diaphragm and intercostal mm's; using a device inspiraing against resistance
Flow Resistive Breathing Use a resistive device to inhale from and increase difficulty by decreasing size of mouth peice
Paced Breathing and Exhale with Effort Break activities into parts and take breaks between the parts; exhale during work, inhale during easier or rest portions
Benefits of pursed lip breathing Decreased respiratory rate, increased tidal volume and decreased sense of dyspnea, increased intrabronchial pressure => improved gas mixture in lungs
Segmental Breathing - Description AKA localized breathing or thoracic expansion exercise; Position: (sitting - basal atelectasis) side lying, affected lung superior; apply pressure in direction of rib movement w/ exhale and provides appropriate resistance to expansion during inhalation
Segmental Breathing - Benefits Increase chest wall mobility; expand collapsed alveoli via airflow through collateral ventilation channels; assist with secretion removal
Sustained Maximal Inhalation/ Incentive Spirometry - Benefits Absence of or improvement of atelectasis; decreased respiratory rate; resolution of fever; normal pulse rate; normal chest X ray; Improved PaO2; Increased forced vital capacity and peak expiratory flow
A clinical sign of inspiration mm fatigue is Reduced tidal volume; tachypnea; increased PaCO2; bradypnea and decreased minute ventilation
Tachypnea A clinical sign of inspiratory mm fatigue; abnormally rapid breathing
Variable manipulated when using and inspiratory muscle trainer Resistance
Pacing/Paced Breathing Breaking down an activity into parts to prevent the onset of dyspnea
Pleuroscopy AKA Thoracoscopy; minimally invasive; small incision is made in chest and a scope or tool is inserted to monitor or retrieve material from pleura or space
Cardiac Chatheterization Used to examine cardiac function, blockage in coronary arteries, and integrity of cardiac valves; goes through femoral, radial or brachial arteries; inject radioactive dye for imaging
CT Scan Computed Tomography; uses an x rya machine that rotates around pt laying on a table; creastes pictures of organ and surrounding structures
Venography Radiopaque is injected into veins with an x ray to detect a clot or blockage
PET Scan Positron emission tomography; radio active dye is injected into vein; imaging is done; used to check for various diseases
MRI Magnetic resonance imaging; uses magnetic feild and radio waves to create a 3D pic of heart and blood vessels and masses in mediastinum but not lungs
MPI Myocardial Perfusion Imaging (MPI); radionuclide stress test; nuclear stress test; redionuclide agent is injected at rest and maximal exercise; images are taken of heart and assessment of perfusion is made
Uses for carotid ultrasound Evaluate placement of a stent and evaluate state of coronary arteries
Echocardiogram Most valuable tool in determining severity of heart failure
Chest radiography Chest x-ray; can reveal fluid in lungs or pleural space; pneumonia; emphysema and cancer; cannot detect detail of blood vessels
Phonocardiography Plot high fidelity chart of the sounds and murmurs made by the hear
Angiography A radiologic examination in which a contrast medium is injected into the blood vessel to view on imaging
Bronchoscopy viewing of trachea, larynx and lower airways with a fiberoptic scope and camera
Thoracentesis Aspiration of excess fluid from pleural space with a needle; a chest tube is usually used for this as well
Swanganz Catheterization Pulmonary artery catheter; hemodynamic monitoring; flow directed, balloon tipped; measures pulmonary arterial pressure
Holter Monitor ECG used for ambulatory ECG testing; worn for 24-48 hours of monitoring
Pharmocologic Stress Test Used when exercise is contraindicated for a patient who needs cardio pulmonary evaluation
Contrast Dye Type of fluid used for cardiac catheterization
Flouroscopy X ray "movie" ; a continuous x ray beam is passed over the body so body part and motion can be monitored
Venography Gold Standard for diagnosing Deep Vein Thrombosis (DVT); invasive, painful and moderately risky; other techniques are used with higher risk patients; radiopaque dye injected into veins
Computed Tomography Angiogram Used to look for a pulmonary embolism or blood clot that could become one
Ventilation and perfusion scans are often used to rule out Pulmonary embolism
Maximal Exercise Stress Test - Relative Contraindications Drop in SBP of 10+ without other signs of ischemia; arrythmias; fatigue, SOB, cramps, claudication, changes in cardiac function, increased angina, hypertensive response
Maximal Exercise Stress Test - Absolute Contraindications SBP increase by more than 10, 3+/4 angina; increased nervous system symptoms; cyanosis; pallor; sustained ventricular tachycardia
Maximal Exercise Stress Test - Description The pt is required to exercise with progressive intensity while being measured for HR, BP, ECG, PRE and other s/s; evidence toward myocardial ischemia, electrical problems and so on
Cause of SBP drop during increased activity Ischemia (inadequate blood supply)
Overload Principle to improve its function a tissue or organ must be exposed to a stress or load greater than it normally encounters.
Specificity Principle The long term adaptations to the metabolic or physiologic systems derived from exercise are specific to the exercises performed and the muscles involved.
Bruce Protocol Stress test; athlete being tested reaches exhaustion as intensity is increased (incline and/or speed) every 3 minutes for 7 levels; the length of time on the TM is the test score and can be used to estimate VO2 max; tests risk of CAD
Aquatic Therapy - Physio Effects Increased venous circulation, Increased cardiac output, increased cardiac volume, decreased HR, decreased SBP, and decreased rate of oxygen uptake
What HR range is most appropriate for someone with MS? 60-75%; 3x per week
Effect of Upper Body Exercise VS Lower Body Exercise Upper body exercise increase HR and BP more significantly for any given workload than lower body exercise.
Which percentage of max HR would be most appropriate for a 72 yo pt with excellent cardiovascular health? 70-80%
To avoid heat illness in heat and humidity and athlete should? Keep target HR same with the understanding that they will reach it sooner; drink plenty of fluids, rest as needed
How will pulse rate change with Cardiac Arrythmia? Becomes Irregular
How will pulse rate change with peripheral artery disease? Becomes difficult to palpate; more difficulty with my distance from heart
Bounding HR pulse of large amplitude
Point of maximal impulse Apex of heart, in 5th intercostal space at mid-clavicular line; the contraction of the L ventricle is most pronounced
Best area to hear S2 heart sound Base of heart
Bruit (BROOT) loud blowing sounds due to narrowing/atherosclerosis; can be a pre cursor to aortic aneurysm
Sound of blood regurgitation from insufficient valve Swishing
Cardiac Biomarkers Enzymes that leak out of the cells of the heart following MI
Enzymes measured during cardiac enzyme study Troponin and creatine phosphokinase
Lab value indications of contraindication to exercise Hematocrit - <27%; hemoglobin - 8 g/dL or less; platelet count <50,000 mm^3; white cell count <500 mm^3
Hypovolemia Decreased level of blood volume in body; increased hematocrit, hypernatremia and protein levels
Hypervolemia Increased level of blood volume in body
International Normalized Ratio (INR) A calculation to standardize prothrombin time; ratio of pt prothrombin time and normal prothrombin time
Polycythemia Abnormal excess of erythrocytes; increased blood viscosity; sluggish circulation; vascular system becomes severely engorged and impairs circulation
Hypoxemia abnormally low concentration of O2 in blood
METS scale <3 - Light - Slow walking, toileting, sitting activities, cooking 3-6 - Moderate - 3-5 mph walking, sweep/vaccuum, gardening, tennis, sex, swimming >6 - Vigorous - 4.5 mph+ on foot, shoveling, carrying lifting heavy loads, digging, backpacking, bike
Karvonen Formula AKA Heart Rate Reserve (HRR); Formula to estimate target HR and METs appropriate for a pt; [(HRmax-HRrest) x %] + HRrest, take it at 40% and 85%
1 MET Equivalent sitting quietly; 3.5 mLO2/kg/min; milliliters of oxygen per kilogram of body weight per minute
METs for inpatient Inpatient - 1-4; discharge at 3-4
Tetraology of Fallot Combination of 4 heart defects at birth; rare; requires surgeries; includes R ventricular hypertrophy, pulmonary stenosis, ventricular septal defect and aortic communication with both ventricles
Congenital Heart Defects Atrial septal defect; ventricular septal defect (most common 25%); coarctation of the aorta; Patent ductus arteriousis; tetrallogy of fellot
Hypertrophic Cardiomyopathy Myocardium becomes thickened, makes harder for blood to leave heart, forcing the heart to work harder to pump blood; leading cause of sudden death in young athletes
Virchow's Triad 3 main causes of DVT: impaired venous flow, endothelial injury and hypercoagulopathy
Which ventricle has more pressure? Left ventricle
Cardiomyopathy Types and Tx Dilated, Hypertrophic and restrictive; medications, surgically implanted devices and some times heart transplant
Pericarditis Often associated with chest trauma; swelling and irritaiton of pericardium
Congestive Heart Failure + Pulmonary Crackles Change or cease current activity; fluid in lungs => heart pump function not working any better
Myocardial injury is potentially reversible for how long? 30 minutes; beyond that it progresses for 6-12 hours from onset
What condition is results from compression of the heart by fluid? Pericarditis leads to peridcardial effusion as fluid fills sac, pressure keeps the heart pump from functioning effectively
Prolapsed heart valve Usually the mitral valve (L); stiffens or thickens and does not close evenly and allows for blood regurgitation and a heart murmur
Acute respiratory distress Syndrome Fatal in 25-40% of cases; fluid collects in air sacs and oxygen exchange is impeded
Bronchiectasis Disease causing weakening and expansion of bronchial walls
Another name for Aspirin Acetylsalicylic Acid
Adrenergic drugs Work on nervous system
Cholenergic drugs work on PSNS
Bainbridge Reflex Mechanorceptor reflex that inhibits Parasympathetic activity resulting in increased HR
FEV1/FVC Forced expiratory volume 1/forced vital capacity; volum eof air forcefully exhaled in 1 sec/volume of air that can be maximally forcefully exhaled; <80% indicates dysfunction;<70% is the primary indicator of an obstruction
Vital Capacity equation inspiratory reserve volume + tidal volume + expiratory reserve volume; IRV + TV + ERV
Pulmonary Capacities by % Tidal Volume -10% Expiratory Reserve Volume - 15% Residual Volume - 25% Inspiratory Capacity - 60% Vital Capacity - 75% Total Lung Capacity - 100%
Total Lung Capacity equation TLC = residual volume + vital capacity; TLC = RV + VC; 4,000-6,000 mL
Normal Tidal Volume (10% of TLC) 500 mL; quiet breathing
Maximum Voluntary Ventilation (MVV) Max amount of air a subject can breath in 12 sec; expressed in liters/ min
Forced Expiratory Volume (FEV) Max volume of air exhaled in a specific time, usually 1-3 sec
Residual Volume (RV) Volume of air left in lungs after max exhale; 25% TLC
Vital Capacity (VC) Max amount of air that can be exhaled after it has been inhaled; 75%
Vital Capacity equation VC = Tidal Volume + inspiratory reserve volume + expiratory reserve volume; TV + IRV + ERV
Inspiratory Reserve Volume Amount of air that can be inhaled after max inhale; 55-60% of TLC
Functional Residual Capacity (FRC) equation FRC = ERV + RV; volume of air in lungs after normal exhale; 40% TLC
Intrapleural Pressure at Rest Environmental and internal pressures are equal; environmental pressure is ~ 760 mm Hg, so intrapleural pressure is also
BORG Associated with RPE scale
Indications for using RPE Pacemaker; sensory deficits
Hypopnea Decreased respiration rate AND decreased depth
Hyperpnea Increased breath rate AND increased depth
Kussmauls deep and fast breathing often associated with acidosis; "air hunger"
Cheynestokes decreasing rate and depth of breath with periods of apnea
Eupnea Quiet effortless breathing
Apnea absence of spontaneous breathing
Biots Irregular breathing; associated with increased intracranial pressure or medulla injury
Doorstop breathing normal rate and rhythm with abrupt cessation when restriction occurs (pleurisy; pleuritis)
Created by: ashleighobrien



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