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NPTE: Cardio/Pulm

Cardiovascular & Pulmonary Review

Normal pH, whole blood 7.35-7.45
Normal SaO2 Value > or equal to 95%
When does a person usually require supplemental O2? When SaO2 value is less than 88-90% or PaO2 < 58 mmHg
Normal adult value for WBCs? 5,000-10,000 cells/mm^3
Type of exercise for pt with WBC > 5,000 cells/mm3 Light exercise
Type of exercise for pt with WBC < 5,000 cells/mm^3 and a fever Exercise is contraindicated
Normal RBC value for adult male 4.7-6.1 10^6/mm^3
Normal RBC value for adult female 4.2-5.4 10^6/mm^3
Normal Hematocrit value for adult male 42-52%
Normal Hematocrit value for adult female 37-47%
Type of exercise for pt with < 25% Hematocrit value Exercise is contraindicated
Type of exercise for pt with > 25% but less than normal Hematocrit value Light exercise only
Normal Platelet count value 150,000-450,000 cells/mm^3
Define Atherosclerosis Thickening of blood vessel wall from focal accumulation of lipids, platelets, monocytes, plaque & other debris affecting moderate & large arteries not limited to coronary arteries
Define Angina Pectoris Pain in chest, jaw or L arm secondary to temporary, localized ischemia
Define Cor Pulmonale Failure or hypertrophy of R ventricle resulting from disorders of the lungs, pulmonary vessels or chest wall; lung pathology produces pulm artery HTN, usually chronic
List Signs Associated with R-sided Heart Failure Nausea, Anorexia, Wt gain, Fullness in Abdomen, Venous stasis, Peripheral edema
List Signs Associated with L-sided Heart Failure Weakness, Fatigue, SOB, DOE, Cough, Orthopnea, Crackles
When is heart failure termed "Congestive"? When edema is present
Define R-sided Heart Failure Reduced venous return to heart from systemic circulation due to failure of R Ventricle
Define L-sided Heart Failure Reduced Cariac Output with blood not being adequately pumped into systemic circulation due to inability of L Ventricle to pump
Medications to treat Congestive Heart Failure Diuretics, Digitalis
Effects of Digitalis Strengthens contraction of the heart, Slows HR, Helps eliminate fluid from the body, Increases urination
Effects of Diuretics Decrease vascular fluid volume, Decrease Preload & Afterload, Control HTN
Effects of Nitroglycerin Vasodilator, Reduce BP & preload, Reduce O2 demand of heart
Signs & Symptoms of MI Deep visceral pain of aching or pressure, radiating to jaw and L arm, more severe than angina & unimproved with nitroglycerin
Which medication will pt will most likely be given if they have a heart block? Atropine
Effects of Atropine Increases HR by inhibiting vagal influence on heart
Appearance of first degree AV block on ECG PR prolongation
Which type of AV block is a medical emergency? Third degree AV block = complete heart block
Which serum enzymes appear in circulation following cardiac muscle death? Creatine phosphate, Lactate Dehydrogenase, Serum Glutamic Oxalacetic Transaminase
A weak or thready pulse most likely indicates... Low stroke volume
A bounding, full pulse most likely indicate... Shortened ventricular systole & Decreased peripheral pressure
A bruit heard on auscultation most likely indicates... Murmur of arterial or venous origin indicating atherosclerosis
The first heart sound (S1) or lub sound is made by... Normal closure of mitral/tricuspid (AV) valves (beginning of systole)
The second heart sound (S2) or dub is made by... Normal closure of aortic/pulmonary valves (end of systole)
The Right Coronary Artery supplies... R atrium/ventricle, AV/SA nodes, interventricular septum & inf wall of L ventricle
If Right Coronary Artery is blocked, could cause... Arrhythmies (possibly fatal)
The Left Coronary Artery supplies... Ant, Sup, & Lat walls of L ventricle & interventricular septum
If Left Coronary Artery is blocked, could cause... L ventricular failure which leads to pulmonary edema
What are the CONTRAs to Cardiac Rehabilitation Program? Unstable angina, Resting SBP >200 or DBP > 110, Orthostatic BP drop >20 with symptoms, Acute systemic illness or fever, Uncontrolled atrial/vent arrhythmias, sinus tachycardia, active pericarditis/myocarditis, recent embolism, thromboembolism...
Adverse responses leading to exercise discontinuation in cardiac pts SBP >orequal to 220, DBP >orequal to 110, Decr in SBP >20 mmHg, Signif vent/atrial dysrhythmias, ST displacement(2mm horiz/downsloping), >+3PVCs, 2nd or 3rd degree heart block
Signs & Symptoms of Exercise Intolerance in Cardiac pts Angina, marked dyspnea, EKG changes suggestive of ischemia; such as multi-focal PVCs, V-tach, ST segment elevation, 3 or more PVCs
ST segment downsloping depression of 2-3mm or more indicates Ischemia
ST segment elevation indicates New infarct or injury or pericarditis
Ventricular tachycardia will have what appearance on EKG? Run of 3 PVCs or more (showstopper)
Define Hyperventilation Increased inspiration/expiration of air as a result of an increase in rate and/or depth of respiration; results in decreased CO2 (resp alkalosis)
Signs & Symptoms of Hyperventilation Increased RR, Decreased BP, vasoconstriction, possible syncope, marked anxiety, wrist cramping
Sputum that has foul smell indicates what & can be associated with which pathology? Anaerobic infection; COPD, Pneumonia, TB
Sputum that is Purulent (yellow/green appearance) indicates what & can be associated with which pathology? Infection; Bronchitis, Cystic Fibrosis
Sputum that is frothy is associated with... Pulmonary edema
Sputum that is mucoid (clear/thick) is indicative of... Cystic fibrosis or conditions with chronic cough; Asthma, Bronchitis
Define Hemoptysis Blood in sputum
Pulmonary Functions that are decreased in Obstructive Diseases Vital Capacity & FEV1
Pulmonary Functions that are decreased in Restrictive Diseases Total Lung Capacity, Forced Respiratory Capacity, Residual Volume, Vital Capacity, PaCO2
Define Cystic Fibrosis Genetically inherited, thickening of secretions of all exocrine glands
Signs & Symptoms of Cystic Fibrosis Freg resp infections, inability to gain wt, positive sweat electrolyte test, rales, wheezing, productive large amounts of mucoid, may have hemoptysis
Define Crackles "rales" discontinuous sounds heard primarily during inspiration; L ventricular CHF
Define Rhonchi continuous, low pitched, sonorous breath sounds most prominent in expiration; freq present with asthma & chronic bronchitis
Define Stridor continuous adventitious sound of inspiration assoc with upper airway obstruction
Define Wheezes continuous breath sounds high-pitched, sibilant, musical, often assoc with Asthma
In a pneaumothorax, the trachia will deviate.... Away from the affected side
Effects of Pursed-Lip Breathing Prolongs exhalation to slow breathing rate, Relieves SOB, Reduces work of breathing
Effects of Glossopharyngeal Breathing Means of increasing inspiratory capacity when mm are severely weak, Increases vital capacity
Effects of Segmental Breathing Facilitates expansion of adjacent regions of thoracic cavity that may have decreased ventilation
Diaphragmatic Breathing most likely taught to pts with... Hyperventilation, Anxiety, & Stuttering
Glossopharyngeal Breathing most likely taught to pts with... High Spinal Cord Injury
Pursed Lip Breathing most likley taught to pts with... Emphysema
Effects of Diaphragmatic Breathing Improves gas exchange & increases lung volume
Normal PaO2 values 75-100 mmHg
Techniques to Improve gas exchange & Increase lung volumes Diaphragmatic breathing, Segmental Breathing, Maximal Inspiratory effort
Techniques to Decrease Dyspnea & Increase Efficiency Pursed lip breathing, Pacing of breath with activity or exercise, Diaphragmatic breathing
Techniques to Increase Expiratory force or cough Train inspiratory muscles using resistance during inspirations, manually or with devices
One MET equals... 3.5 mL of O2 per gram of body wt OR 200-250 mL of O2/min
Total Normal Cholesterol Values should be... < 200 mg/dL
Describe Phase I (acute)of Cardiac Rehabilitation Intensity: initially 2-3 METS, 3-5 METs by discharge Freq: 2-3xs/day Duration: short exercise sessions
Describe Phase II (subacute, OP or Home program) Cardiac Rehabilitation Intensity: D/C at 9 METs Freq: 3-4xs/wk Duration: 30-60 mins with 5-10min warm-up & cool-down
Describe Phase III (post-acute, community exercise program) of Cardiac Rehabilitation Intensity: must function at 5 METs in order to begin this phase; progress to 50-80% functional capacity Freq: 3-4xs/wk; Duration: 45 min per session Type: progress supervised to self-regulated
Define Vital Capacity The maximum amount of air that can be exhaled after maximum inhalation
Define Total Lung Capacity Vital Capacity + Residual Volume The maximum volume lungs can be expanded with greatest possible inspiratory effort
Residual Volume Air remaining in lungs after maximum expiratory effort
Functional Residual Volume The volume of gas in lungs at resting expiratory level
Forced Vital Capacity The amount of air that can be forced out of the lungs after maximum inspirations
Expiratory Reserve Volume The amount of additional air that can be pushed out after the end expiratory level of normal breathing
Inspiratory Reserve Volume The additional air that can be inhaled after normal tidal breath
Inspiratory Capacity The maximal volume that can be inspired following normal expiration
Functional Residual Capacity Amount of air left in lungs after tidal breath out
Normal FEV1/FVC Ratios... Are closer to 1 OR > 70%
Created by: zimrizzle