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| Airway Clearance Techniques | breathing strategies, manual and mechanical techniques, and postural drainage
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| Atelectasis/pneumothorax | Lung collapse
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| Active Cycle of Breathing | ACB; FKA forced expiratory technique; Phases: breathing control, thoracic expansion and forced expiratory technique
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| Hemoptysis | Coughing up blood
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| Empyema | Accumulation of pus in pleural cavity
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| Orthopnea | SOB/Dyspnea that occurs when lying flat
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| Coronary Arteries | Right Coronary, Posterior Interventricular, Anterior Interventricular, Circumflex and Left Coronary Artery
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| Coronary Veins | Small cardiac, middle cardiac, and great cardiac
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| Vessel Wall Anatomy | tunica interna, endotheliaum, subedothelial layer, elastic layer, Tunica media, elastic layer and tunica externa
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| % of blood supply that is Venous | 67%; that can distend more readily
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| Coronary Sinus | Large venous channel that collects all coronary blood and dumps it into R atrium
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| Right coronary Artery | Originates at cusp of aorta; supplies blood to ventricles, R atrium and SA node
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| Posterior Interventricular (descending) Coronary Artery | Supplies posterior third of interventricular septum
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| 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.
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| Circumflex Coronary Artery | Branches off L Coronary Artery; supplies blood to posterior heart
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| Left Coronary Artery | supplies blood to ventricles and left atrium
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| Small Cardiac Vein | Receives blood from posterior portion of R atrium and ventricle
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| Middle Cardiac Vein | Inferior interventricular vein; ascends from the apex within posterior groove; empties into coronary sinus
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| Great Cardiac Vein | found in anterior groove and empties into sinus on posterior heart
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| MET Scale | Light <3
Moderate 3-6
Vigorous >6
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| Hypercapnia | High levels of HCO3- (Bicarbonate) in blood; carbon disoxide poisoning; increases breath rate
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| Eucapnia | Normal level of carbon dioxide in the blood
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| % of oxygen at Sea level | 21%
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| Typical medication for hypertension | ACE inhibitors
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| Orthostatic Hypotension | due to a loss of vasoconstriction control and reduced mm tone
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| Pulmonary Edema produces what lung sound? | Fine crackling in distal airways
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| Pneumothorax produces what lung sound? | Absent (collapsed)
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| 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
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| 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
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| Whispered Pectoriloquy - Voice Sound | Increased loudness of whispering noted during lung auscultations; normally not heard with healthy lung tissue
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| Crackle - Lung Sound | Formerly Rales; abnormal, discontinuous, high pitched popping sound; heard more often during inspiration; associated with restrictive or obstructive lung disease
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| Stridor - Lung Sound | Continuous high pitched wheeze with in and ex piration; adventitious breath sound that occurs with alterations or turbulence in breath sounds
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| Pleural Friction Rub - Lung Sound | Dry, crackling sound during in and ex piration; occurs when inflamed visceral and parietal pleurae rub together
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| 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
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| Wheeze - Lung Sound | high pitched whistling sounds associated with obstructive lung disorders; sounds are more prominent with inspiration
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| Vesicular Breath Sounds | High pitched, breezy; more distal
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| Bronchial Breath Sounds | Tubular, hollow, echoing; More proximal
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| Laminar Air Flow | Optimal air flow through the lungs; external and internal pressure equalize; not audible with a stethoscope
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| Fowler's Position | High - long sitting with hips/bedseated at 90 degrees
Standard - 45-60 degrees
Semi -30-45 degrees
Low - 15-30 degrees
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| 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
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| Inspiratory Muscle Training (IMT) | Attempts to strengthen diaphragm and intercostal mm's; using a device inspiraing against resistance
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| Flow Resistive Breathing | Use a resistive device to inhale from and increase difficulty by decreasing size of mouth peice
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| 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
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| Benefits of pursed lip breathing | Decreased respiratory rate, increased tidal volume and decreased sense of dyspnea, increased intrabronchial pressure => improved gas mixture in lungs
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| 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
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| Segmental Breathing - Benefits | Increase chest wall mobility; expand collapsed alveoli via airflow through collateral ventilation channels; assist with secretion removal
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| 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
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| A clinical sign of inspiration mm fatigue is | Reduced tidal volume; tachypnea; increased PaCO2; bradypnea and decreased minute ventilation
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| Tachypnea | A clinical sign of inspiratory mm fatigue; abnormally rapid breathing
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| Variable manipulated when using and inspiratory muscle trainer | Resistance
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| Pacing/Paced Breathing | Breaking down an activity into parts to prevent the onset of dyspnea
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| 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
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| 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
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| CT Scan | Computed Tomography; uses an x rya machine that rotates around pt laying on a table; creastes pictures of organ and surrounding structures
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| Venography | Radiopaque is injected into veins with an x ray to detect a clot or blockage
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| PET Scan | Positron emission tomography; radio active dye is injected into vein; imaging is done; used to check for various diseases
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| 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
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| 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
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| Uses for carotid ultrasound | Evaluate placement of a stent and evaluate state of coronary arteries
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| Echocardiogram | Most valuable tool in determining severity of heart failure
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| Chest radiography | Chest x-ray; can reveal fluid in lungs or pleural space; pneumonia; emphysema and cancer; cannot detect detail of blood vessels
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| Phonocardiography | Plot high fidelity chart of the sounds and murmurs made by the hear
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| Angiography | A radiologic examination in which a contrast medium is injected into the blood vessel to view on imaging
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| Bronchoscopy | viewing of trachea, larynx and lower airways with a fiberoptic scope and camera
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| Thoracentesis | Aspiration of excess fluid from pleural space with a needle; a chest tube is usually used for this as well
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| Swanganz Catheterization | Pulmonary artery catheter; hemodynamic monitoring; flow directed, balloon tipped; measures pulmonary arterial pressure
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| Holter Monitor | ECG used for ambulatory ECG testing; worn for 24-48 hours of monitoring
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| Pharmocologic Stress Test | Used when exercise is contraindicated for a patient who needs cardio pulmonary evaluation
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| Contrast Dye | Type of fluid used for cardiac catheterization
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| Flouroscopy | X ray "movie" ; a continuous x ray beam is passed over the body so body part and motion can be monitored
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| 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
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| Computed Tomography Angiogram | Used to look for a pulmonary embolism or blood clot that could become one
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| Ventilation and perfusion scans are often used to rule out | Pulmonary embolism
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| 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
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| Maximal Exercise Stress Test - Absolute Contraindications | SBP increase by more than 10, 3+/4 angina; increased nervous system symptoms; cyanosis; pallor; sustained ventricular tachycardia
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| 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
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| Cause of SBP drop during increased activity | Ischemia (inadequate blood supply)
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| Overload Principle | to improve its function a tissue or organ must be exposed to a stress or load greater than it normally encounters.
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| 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.
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| 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
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| Aquatic Therapy - Physio Effects | Increased venous circulation, Increased cardiac output, increased cardiac volume, decreased HR, decreased SBP, and decreased rate of oxygen uptake
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| What HR range is most appropriate for someone with MS? | 60-75%; 3x per week
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| 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.
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| Which percentage of max HR would be most appropriate for a 72 yo pt with excellent cardiovascular health? | 70-80%
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| 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
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| How will pulse rate change with Cardiac Arrythmia? | Becomes Irregular
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| How will pulse rate change with peripheral artery disease? | Becomes difficult to palpate; more difficulty with my distance from heart
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| Bounding HR | pulse of large amplitude
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| Point of maximal impulse | Apex of heart, in 5th intercostal space at mid-clavicular line; the contraction of the L ventricle is most pronounced
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| Best area to hear S2 heart sound | Base of heart
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| Bruit | (BROOT) loud blowing sounds due to narrowing/atherosclerosis; can be a pre cursor to aortic aneurysm
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| Sound of blood regurgitation from insufficient valve | Swishing
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| Cardiac Biomarkers | Enzymes that leak out of the cells of the heart following MI
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| Enzymes measured during cardiac enzyme study | Troponin and creatine phosphokinase
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| 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
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| Hypovolemia | Decreased level of blood volume in body; increased hematocrit, hypernatremia and protein levels
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| Hypervolemia | Increased level of blood volume in body
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| International Normalized Ratio (INR) | A calculation to standardize prothrombin time; ratio of pt prothrombin time and normal prothrombin time
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| Polycythemia | Abnormal excess of erythrocytes; increased blood viscosity; sluggish circulation; vascular system becomes severely engorged and impairs circulation
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| Hypoxemia | abnormally low concentration of O2 in blood
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| 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
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| 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%
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| 1 MET Equivalent | sitting quietly; 3.5 mLO2/kg/min; milliliters of oxygen per kilogram of body weight per minute
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| METs for inpatient | Inpatient - 1-4; discharge at 3-4
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| 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
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| Congenital Heart Defects | Atrial septal defect; ventricular septal defect (most common 25%); coarctation of the aorta; Patent ductus arteriousis; tetrallogy of fellot
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| 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
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| Virchow's Triad | 3 main causes of DVT: impaired venous flow, endothelial injury and hypercoagulopathy
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| Which ventricle has more pressure? | Left ventricle
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| Cardiomyopathy Types and Tx | Dilated, Hypertrophic and restrictive; medications, surgically implanted devices and some times heart transplant
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| Pericarditis | Often associated with chest trauma; swelling and irritaiton of pericardium
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| Congestive Heart Failure + Pulmonary Crackles | Change or cease current activity; fluid in lungs => heart pump function not working any better
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| Myocardial injury is potentially reversible for how long? | 30 minutes; beyond that it progresses for 6-12 hours from onset
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| 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
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| 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
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| Acute respiratory distress Syndrome | Fatal in 25-40% of cases; fluid collects in air sacs and oxygen exchange is impeded
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| Bronchiectasis | Disease causing weakening and expansion of bronchial walls
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| Another name for Aspirin | Acetylsalicylic Acid
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| Adrenergic drugs | Work on nervous system
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| Cholenergic drugs | work on PSNS
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| Bainbridge Reflex | Mechanorceptor reflex that inhibits Parasympathetic activity resulting in increased HR
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| 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
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| Vital Capacity equation | inspiratory reserve volume + tidal volume + expiratory reserve volume; IRV + TV + ERV
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| Pulmonary Capacities by % | Tidal Volume -10%
Expiratory Reserve Volume - 15%
Residual Volume - 25%
Inspiratory Capacity - 60%
Vital Capacity - 75%
Total Lung Capacity - 100%
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| Total Lung Capacity equation | TLC = residual volume + vital capacity; TLC = RV + VC; 4,000-6,000 mL
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| Normal Tidal Volume (10% of TLC) | 500 mL; quiet breathing
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| Maximum Voluntary Ventilation (MVV) | Max amount of air a subject can breath in 12 sec; expressed in liters/ min
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| Forced Expiratory Volume (FEV) | Max volume of air exhaled in a specific time, usually 1-3 sec
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| Residual Volume (RV) | Volume of air left in lungs after max exhale; 25% TLC
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| Vital Capacity (VC) | Max amount of air that can be exhaled after it has been inhaled; 75%
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| Vital Capacity equation | VC = Tidal Volume + inspiratory reserve volume + expiratory reserve volume; TV + IRV + ERV
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| Inspiratory Reserve Volume | Amount of air that can be inhaled after max inhale; 55-60% of TLC
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| Functional Residual Capacity (FRC) equation | FRC = ERV + RV; volume of air in lungs after normal exhale; 40% TLC
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| Intrapleural Pressure at Rest | Environmental and internal pressures are equal; environmental pressure is ~ 760 mm Hg, so intrapleural pressure is also
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| BORG | Associated with RPE scale
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| Indications for using RPE | Pacemaker; sensory deficits
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| Hypopnea | Decreased respiration rate AND decreased depth
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| Hyperpnea | Increased breath rate AND increased depth
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| Kussmauls | deep and fast breathing often associated with acidosis; "air hunger"
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| Cheynestokes | decreasing rate and depth of breath with periods of apnea
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| Eupnea | Quiet effortless breathing
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| Apnea | absence of spontaneous breathing
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| Biots | Irregular breathing; associated with increased intracranial pressure or medulla injury
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| Doorstop breathing | normal rate and rhythm with abrupt cessation when restriction occurs (pleurisy; pleuritis)
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