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What is Tidal volume? amount of air that is inhaled and exhales during normal resting breathing
What is Residual volume? Volume of air remaining in the lungs following a full or max expiration
What is Expiratory Reserve Volume? Air that can be forcefully breathed expelled following a normal inspiration
What is inspiratory reserve vol? am of air that can be forcefully breathed in following normal inspiration
Forced vital capacity?equals? am of air that is under volitional control. Euals the IRV+TV+ERV
What is Forced Expiratory Vol-1? At least what % of FVC is expelled to be considered normal? am air of air that can be forcefully expelled in 1 sec following a full inspiration at least 75% of FVC normally is expelled within 1sec
Total lung vol? equals? the sum of the residual volume and FCV. TV+ERV+RV
Functional residual capacity?equals? the vol of air remaining in the lungs following a normal expiration. ERV+RV
What does atelectasis present with: pulm sx ,cardio sx, percussion, breath sounds. what is often associated with it? Presents with pain on affected side, dyspnea, cyanosis, drop in BP, tachycardia, diminished or absent breath sounds, dull or flat percussion, fever, reduced chest excursion. Often associated with infection
When are vesicular sounds present? throughout ALLL inspiration and beginning expiration.
What results from hyperventilation: CO2 levels, other gen sx and what mm are affect in the UE? depletion of CO2=respiratory alkalosis with accompanying sx such as fall in BP, vasocontriction, syncope, anxiety, and WRIST CRAMPing
If pt has a perfusion problem what position should they be in? with the involved side down
Sputum what do the following types of sputum indicate: foul smell, purulent, frothy, mucoid, hemoptysis foul smell= anaerobic infection,purulent(yellow/green)=infection, frothy= pulmonary edema, mucoid(thick/clear) indicative of cystic fibrosis or conditions with chronic cough, hemoptysis= bllod in sputum.
How is the blood return to the heart affected by valsalva maneuver? decreased return of blood to heart due to incr intrathoracic pressure
Anticoagulants: 2 examples, purpose, precaution during what rx, administer to pt with? Examples: coumadin & heparin. Purpose: incr blood clotting time. Caution: may result in hemoptysis during percussion and shaking. Admin to: pt with DVT
If pt has a perfusion problem what position should they be in? with the involved side down
Sputum what do the following types of sputum indicate: foul smell, purulent, frothy, mucoid, hemoptysis foul smell= anaerobic infection,purulent(yellow/green)=infection, frothy= pulmonary edema, mucoid(thick/clear) indicative of cystic fibrosis or conditions with chronic cough, hemoptysis= blood in sputum.
How is the blood return to the heart affected by valsalva maneuver? decreased return of blood to heart due to incr intrathoracic pressure
Anticoagulants: 2 examples, purpose, precaution during what rx, administer to pt with? Examples: coumadin & heparin. Purpose: incr blood clotting time. Caution: may result in hemoptysis during percussion and shaking. Admin to: pt with DVT
If pt has a perfusion problem what position should they be in? with the involved side down
Sputum what do the following types of sputum indicate: foul smell, purulent, frothy, mucoid, hemoptysis foul smell= anaerobic infection,purulent(yellow/green)=infection, frothy= pulmonary edema, mucoid(thick/clear) indicative of cystic fibrosis or conditions with chronic cough, hemoptysis= blood in sputum.
How is the blood return to the heart affected by valsalva maneuver? decreased return of blood to heart due to incr intrathoracic pressure
Anticoagulants: 2 examples, purpose, precaution during what rx, administer to pt with? Examples: coumadin & heparin. Purpose: incr blood clotting time. Caution: may result in hemoptysis during percussion and shaking. Admin to: pt with DVT
Brochodilators: 4 examples, purpose, precaution during what rx, administer to pt with? epinephrine, alupent, ventolin, proventil. Purpose: relax smooth muscle and open airway lumen to assist in breathing. Used with pts that often need them prior to ex or athletics to reduce the neg effects of disease process such as asthma
Corticosteriods: 2 examples, purpose, precaution during what rx, administer to pt with? Prenisone & cortisol. Purpose: decr edme and inflammation associated with chronic obstructive pulmonary disease. S/E: osteoporosis, muscle wasting and slow wound healing are problematic
Ab breath sounds: When are crackles(rales) heard? What pathology accomany basilar rales? Heard during inspiration. Basilar rales: often accompany L ventricular congestive heart failure.
Rhonchi: sound like? when heard? result of? present with which dx? sounds are continuous low-itch what are prominent during expiration. Result of ait passing through airways narrowed by inflammation, brochospasm, or secretion. Present with asthma and chronic bronchitis
Stridor: sound like and associated with? Sounds like continuous adventitous sound of inspiration associated with upper airway obstruction
Wheezes: sound like? associated with? high-pitch, sibilant and musical, often associated with asthma
Friction Rub: caused by? result of? accompanied by? caused by rubbing of pleural surfaces against each other, result of inflammation or neoplastic processes. May be accompanied by pain during inspiration.
COPD: with the following are they incr or decr? TLC, FRC, RV, VC, PaCO2, FEV1 How is Obstructive disease characterized? TLC, FRC, RV, PaCO2 all incr. VC and FEV1 decr. Obstruction characterized by the reduction in airflow with or without reduction of VC
Restrictive how does it affect following? TLC, FRC, RV, VC, PaCO2, FEV1 How is Restrictive disease characterized? LC, FRC, RV, VC, PaCO2,all decr and FEV1 is normal. Characterized by decr of VC with normal expiratory flows.
Asthma: type of cough and sputum, anxiety and severe bronchospasm can cause? dry or productive cough with mucoid sputum with plugs. Anxiety and severe bronchospasm can restrict airflow o extent that no wheezing is heard
What should be used prior to exposure to cold? What other meds are used with asthma? bronchodilators prior to being in the cold. Prednisone, nebulizers, and/or inhaler can be used to manage asthma
Bronchitis: what is it? breath sound and sputum? inflammation of the tracheobronchial tree with cough and sputum production for at least 3 months for 2 consecutive years. Breath sounds: wheezes and rhonchi sounds, Sputum: muciod or purulent sputum
Cystic Fibrosis: what is it? genetically inherited disease, characterized by thickening of secretions of all exo glands leading to obstruction. this can be presented as OBSTRUCTIVE OR RESTRICTIVE
Cystic Fibrosis:what are two types of frequent causes respiratory infection? In regards to lab tests what is postive? what types of sputum? staphlococcus aureus and pseudominas aeruginosa. Postive sweat electrolyte test. Sputum: large amounts of mucoid, mucopurulent or purulent sputum
What will have to be performed if in acute stage or if pneumonia develops? how often performed? percussion, vibration, shaking, postural drainage, performed many times per day.
Emphysema: What is it? Signs/Symp Permanent abnormal enlargement and destruction of air spaces distal to terminal bronchioles. S/S: barreled chest, accessory use of mm, decr breath sounds, w/ or w/o wheezing, dyspena. Rx: pursed lips during expiration, endurance exer
Restrictive diseases: what are the pleura alterations? alterations with pleura are the fibrotic changes within the pulmonary pleura associated with idiopathic pulmonary fibrosis, asbestosis, radiation pneumonitis and O2 toxicity.
Restrictive diseases: what are the chest wall alterations? Chest wall alterations: restricted motion of bony thorax with anklosing spondylitis, arthritis, scoliosis, pectus excavatum and chest wall skin burns or scleraderma
Restrictive diseases: what are the neuromuscular alterations? decr muscular strength results in an inability to expand the rib cage associated with MS, muscular dystrophy, parkinson's, SCI, or stroke
Flail Chest: waht is it? crepitation when? What are the paradoxial movement during ventilation? two or more fx ribs, usually due to blunt trauma. crepitation during ventilation over fracture site. Paradoxial: inspiration the flail section pulled inward and with expiration the flail section moves outward
Pneumothorax: What is it? S/S? air enters pleural space causing the lung to collapse due to loss of neg pressure. S/S decr breath sounds, tracheal deviation AWAY from affected side, hyperresonant and tympanic percussion sounds.
Purpose of chest tube? pulls air/fluid out of pleural space, restores ned pressure and allow lung to inflate
With TB how long does it take for the meds to render the host and become noninfected> 2 weeks
Pulmonary Edema: what is it and what is it due from? excessive seepage of fluid from the pulmonary vascular system into the interstitial space. Due from L ventricular failure, aortic valvular disease, mitral valvular disease, inhalation of toxic fumes or narcotic overdose
S/S of Pulm Edema? What are the Rx? what type of med can be given? dyspena on exertion or paroxysmal nocturnal dyspnea, fatigue, pink frothy sputum, + chest x-ray, crackles. Rx. meds including o2 and diuretics along with decr salt intake and elevated head of bed
Pulmonary emboli: what is it? thrombus from peripheral venous sys lodges in the pulm art with subsequent obstruction of flow to lungs.
Pulm emboli: S/S with and without infraction without infraction: tachypnea, anxiety, restlessness, rales, wheezing, drc breath sounds. With infraction: chest pain, hemoptysis, pleural friction rub, fever, and + chest x-ray
What is the Rx for pulm emboli relating to meds? low-dose heparin, analgesics, pulm vasodilators
What is the most comfortable position for pt with pulmonary complications? upright/sitting
What position would pt with pulm dx in the superior and posterior segments of lower lobes may have increased oxygenation? place prone
What position is limited or avoided with incr intracranial pressure? head down position
How does supine affect the abdominal pressure? Due to position of diaphragm in supine it moves towards the head resulting in incr abdominal pressure
Following a thoracotomy or unilateral lung condition what position improves the t ventilation/perfusion ratio? sidelying with affected side os positioned up
How do you assist or stimulate a cough? compress trachea just above the sternal notch or encourage the pt to huff
What closes the glottis and what opens it? closes by coughing and opens by huffing
What are precautions for secretion removal? rib rx, costal chondritis, hemoptysis, blood coagulation, dysrhythmias, pain, severe dyspnea, pneumothorax w/ or w/o chest tube, incr bronchospasm
What is shaking? inspiration with a bouncing of the rib cage
How is vibration performed? Used in conjunction with? Performed with an isometric cocontraction of the arms applied to the thorax. Used in conjunction with shaking, percussion and postural drainage positioning.
How do you incr expiratory force or cough? by training the inspiratory mm using resistance during inspiration with devices or manually.
How would you improve gas exchange nd incr lung vol Use diaphragmatic breathing, segmental breathing and max inspiratory effort.
How would you decr dyspnea and incr efficiency? use pursed lip breathing, pacing of breathing w/ activity or exercise and diaphragmatic breathing
Anti-arrhymias list 4 and purpose of them lidocaine, Dilantin, Norpace, quinidine. Use to prevent of control cardiac arrhythmias that can be fatal.
Anti-cholinergic: list 1, what are they used for? what do they inhibit, and what are some side effects(S/E)? Atropine. They are used with IV for heart block or bradycardia. THey inhibit acetylcholine at the parasympathetic N, blocking VAGAL effects on SA and SV nodes of the heart. S/E: palpations, headache, restless, ataxia, dry mouth, blurred vision
Beta-adrenergic blocking agents(beta-blockers) list 2, What do they do? Why do they allow for incr tol to ex? propranolo(Indrel), atenolol. These drugs decr HR, BP, contractility and SV. They allow for incr ex tol by decr 02 demands of the heart. which is why RPE is used instead of HR when monitoring pts.
Calcium Channel Blockers what do they do? what is a S/E with them These drugs vasodilate and relieve coronary artery spasm. S/E: Could reduce flow to heart mm creating an ischemic response
What does digitalis do? slows HR and incr contractility
Nirtates are used for? name one reduce BP and preload, along with O2 demands of heart which causes a decr ischemia. Nirtoglycerin is the most widely used
Heart Block what is it and what drug is used for it? it is when the spread of electrical excitation to the heart mm is interrupted or slowed. ATROPINE is often given to pts
List three serum enzymes that appear in the circulation following the death of cardiac muscles cells creatine phosphate(CPK) lactate dehydrogenase (LDH), Serum glutamic oxalacetic transaminase (SCOT)
What does the R coronary art supply? R atrium and ventricle, AV node, SA node, interventricular septum, inferior wall of L ventricular
What does the L coronoary art supply? What does blockage typically lead to? Supplies anterior, superior, lateral walls of the left ventricle and the interventricular septum. Blocking usually leads to L ventricular failure and pulmonary edema.
Angina Pectoris: can be managed with which types of drugs? Nitroglycerin, system vasodilator such as Ca channel blocker
What is Cor pulmonale? What ventricle is affected by pulm HTN? failure or hypertrophy of the right ventricle resulting from disorders of the lungs, pulm vessels or chest wall. R ventricle is affected by pulm HTN
What thyroid condition can cause heart failure? hyperthyroidism
Angina Pectoris: can be managed with which types of drugs? Nitroglycerin, system vasodilator such as Ca channel blocker
What is Cor pulmonale? What ventricle is affected by pulm HTN? failure or hypertrophy of the right ventricle resulting from disorders of the lungs, pulm vessels or chest wall. R ventricle is affected by pulm HTN
What thyroid condition can cause heart failure? hyperthyroidism
What two drugs are often used to treat heart failure? what does each one do? Digitalis(Digoxin) which increases the cardias pumping and ability to decrease HR. Diurectics(Lasix) decr vascular fluid vol, decr preload and afterload and control HTN
What are S/S of MI? Deep visceral pain equal to aching or pressure, radiating to the jaw and L arm. Similar to angina but will NOT improve with nitroglycerin
How long do you palpate an irregular pulse? 1-2 mins
What is a weak thready pulse from? due to low SV
What is a bounding full pulse from? due to shortened ventricle systole and decr peripheral pressure.
What is a bruit from? an abnormal sound or murmur of arterial or venous origin indicating atherosclerosis
Describe the following sounds: when are they heard and what is closing: S1, S2. Which ones are abnormal and what do they indicate? S1: norm closure of MV & TV beginning of systole. S2: norm closure of AV and PV end of systole. S3 indicates CHF and S4 indicates MI or chronic HTN
What are dx test to test the L ventricular function? L catherizaton or angiogram and echocardiogram
With norm cardiac cycle what does they following mean with ECGs: Pwave, QRS, ST seg, T wave Pwave artial depol QRS: ventric depol ST seg: begining of vent repol , T wave equal ventri repol
Ventricular Tachycardia what is a good inidcation on a ECG? what is present with the following areas? QRS and P wave? Wide QRS, No P wave and there will be three or more PVCs occurring sequentially
Ventricular fibrillation what does the activity look like?What is missing? erratic activity with QRS complexes missing
1st degree AV blocks what is abnormal on the ECG? Prolonged PR interval
if second degree AV is present what is decreased and what is needed? Dropped beats and MD referral needed
3rd degree AV block indicates? What med does it require asap? miss matched atrial and ventricle conduction. decr CO and needs pacemaker. Atropine is required
ST depression indicates> ischemia if down-slopping >2-3 mm
ST elevation indicates? new infract or injury or pericarditis
Wide QRS waves occurs with and due to? occurs with bundle branch heart blocks which is due to abnormal delays for failure to conduct the electrical signal from the atria to the ventricles
What is submaximal ETT used for? to evaluate the early recovery of pts after MI, coronary bypass, or coronary angioplasty
Phase One of cardiac rehab: starts when? Which area of limbs and size of mm do you start with? less than one week for an uncomplicated MI. Start from distal to proximal ex and start with small mm progress to large mm
Phase one: what are functional goals for d/c? trans IND, able to perform stairs, self care activities
Phase one: met level initially and at d/c? duration & frequency? What is the average length of phase one? 2-3 METS progress to 3-5METS by D/C. Short ex sessions 2-3x/day. 3-5 days phase one lasts-typically only when pt is in hospital
Phase Two: starts & ends?aerobic ex goal? MET goal throughout? freq, duration and METS at D/C starts:1-2 wks after surgery lasting up to 3 months. Aerobic ex goal: walk-jog or step aerobic to tol. MET during phase 4-9. freq:3-4x/wk, duration: 30-60 mins with 5-10 mins warm up/cool down. DC MET level 9
Termination of ex: ST displacement of 2mm or greater, ventric tachycardia or 3or more consecutive PVCs. Drop in SBP >20, Rise in SBP >220 and DBP>110
Created by: PT