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167 Cards in this Set
- Front
- Back
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COPD includes
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Emphysema
Chronic Bronchitis Asthma Cystic Fibrosis |
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Emphysema is characterized by...
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abnormal enlargement of terminal air spaces
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Chronic Bronchitis is a chronic/recurrent productive cough on most days for a minimum of
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3 months per year in not less than 2 successive years.
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In Chronic Bronchitis there are frequent problems with?
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Upper respiratory tract complicated by right ventricular heart failure.
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What is cystic fibrosis?
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Genetically determined systemic disease of the exocrine glands.
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What does a treatment program for COPD include? (5)
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1. Bronchopulmonary hygiene
2. Humidity and bronchodialator treatment 3. O2 therapy 4. Breathing exercises 5. Physical reconditioning |
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Patients become dependent on _______ as a result of ______ failure.
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ventilators, respiratory
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Three causes of respiratory failure?
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1. Complications of neuromuscular disease
2. Trauma 3. Cardiopulmonary disease |
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Side effects of mechanical ventilation? (9)
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1. pulmonary infection
2. tracheal damage 3. lung tissue damage due to excessive pressure 4. decrease BP and CO 5. poor nutrition 6. Psychological depression 7. poor patient motivation 8. lack of restful sleep 9. lack of mobility |
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Goals of rehab for ventilator dependent pt? (2)
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1. Wean pt from ventilator
2. Prepare family to live with pt who is ventilator dependent. |
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Decreased ventilation results from? (3)
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1. Decreased strength
2. Decreased thoracic mobility 3. Inadequate bronchial hygiene |
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SCI pts have limited amounts of _____ ________ for normal ventilation.
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muscle strength
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An evaluation of a SCI pt should include (5)?
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1. Respiratory rate
2. Breathing pattern 3. Vital Capacity 4. Chest mobility 5. Cough effectiveness |
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Normal respiratory rate for adults?
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12-20 per min.
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During maximal inspiration the chest is enlarged in 3 diameters, what are those?
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1. Transverse
2. Anteroposterior 3. Vertical |
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How is chest expansion measured?
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Full forced expiration to full forced inspiration.
Measured at axilla. |
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The range of vital capacity in SCI pts is from ___ to ___% depending on level of lesion.
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25-80
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What muscle is the primary muscle of substitution in pts with diaphragm weakness?
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SCM
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___ ____ position increases resistance to diaphragm for diaphragm strengthening.
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head down
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Goals for PT treatment of surgical pt (6)
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1. Promote pulmonary hygiene
2. Restore ROM and strength 3. Prevent phlebitis 4. Modify pain 5. Provide pt education 6. Decrease patient anxiety |
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What is a coronary artery bypass graft (CAGB)?
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Promotes increased circulation to the cardiac muscle.
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Valvular surgery?
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Most common is valve replacement.
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Aneyrysmectomy?
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Repair areas of muscle weakness, which can result in bulging.
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Pericardiectomy?
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Remove parts of cardiac tissue to relieve constricting pressure on heart.
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Repair of atrial septal defect?
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Common congenital lesion
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Repair of ventricular septal defect?
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Most frequent congenital circulatory lesion.
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Tetralogy of fallot?
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1. Ventricular septal defect
2. Pulmonary artery stenosis 3. Deviation of aorta away from left atrium 4. Right ventricular hypertrophy |
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Atelectasis?
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Incomplete expansion of lungs due to collapse of alveoli caused by hypoventilation.
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Cardiac temponade?
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Limitation of ventricular filling during diastole due to fluid collection within pericardial sac.
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Cardiogenic shock results from?
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Sudden decrease in cardiac output.
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Hemothorax?
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Collection of blood in pleural cavity usually due to trauma.
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Hypercapnia?
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Increased CO2 in arterial blood due to hypoventilation or circulatory deficiency.
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Hypoxia?
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Low O2 content within tissues of body.
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Pleural effusion?
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Accumulation of fluid in pleural space.
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Pneumothorax?
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Accumulation of gas or air in thoracic cavity.
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What does a high larynx enable a newborn to do?
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Breathe and swallow simultaneously. Makes newborns obligatory nose breathers.
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5 anatomical differences of neonate?
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1. HIgh larynx.
2. Lympathic tissue may be enlarged. 3. Airway size and structural suppose are decreased. 4. Collateral ventilation channels are decreased. 5. Rib cage configuration is more circular. |
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Neonates have decreased _____ of lungs.
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compliance (distensibility)
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Neonates have _____ respiratory patterns.
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irregular
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Neonates compensate for respiratory difficulties with _______ ___ rather than depth of ventilation.
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increasing rate
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_% of sleep is in REM for neonates.
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80
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The diaphragm of a neonate has __% of type I slow twitch fatigue resistance fibers compared to __% in adults.
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25, 50
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What is stridor?
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In neonates, high pitch sound during inspiration.
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Head bobbing occurs in infants to attempt to use _____ muscles to assist in ventilation.
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accessory
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Barrel shaped chest?
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Air entrapped in lungs.
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Pectus excavatum?
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Depression of sternum due to prolonged periods of sternal retractions in first months of life.
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Nasal flaring in infants does what?
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Decreases airway resistance
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What are retractions?
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Pulling inward of chest wall due to decreased compliance in neonates.
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Expiratory grunting in infants is an effort to?
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Increase ventilation.
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Pectus carinatum?
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Protrusion at the sternum.
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Plethora?
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Redness of newborns may by due to polyscthema (RBC)
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Apnea?
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Cessation of breathing for 20sec or more.
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Chest therapy for an infant? (2)
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1. Positioning for postural drainage.
2. Manual percussion and vibration. |
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2 goals of CAD treatment?
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1. Relieve symptoms
2. Slow progression of disease |
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Nitrates are commonly used to treat....
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angina caused by myocardial ischemia.
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Nitrates cause ______ by _______ smooth muscles in coronary and peripheral arteries,veins, bronchioles, GI tract, and uterus.
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Vasodilation, relaxing
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The vasodilation effect by nitrates causes a ______ myocardial O2 demand.
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decreased
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Nitrates given before exercise do what?
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1. Reduce workload
2. Improve exercise performance |
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Beta-blocking agents _____ myocardial O2 requirements by _____ HR, BP, and contractility.
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reduce, decreasing
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Beta-blocking agents are used in treatment of what (2)?
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1. Mild hypertension
2. Atrial/ventricular arrhythmias |
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Effects of beta-blocking agents on pts with CAD? (3)
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1. Increased exercise tolerance
2. Increased aerobic capacity 3. Decrease in resting and submax. HR and BP |
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Calcium channel blockers ____ flow of calcium ions across membranes of myocardial and vascular smooth muscle cells.
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inhibit
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Calcium channel blockers are used to treat?
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Angina and hypertension
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Indications for cardiac glycosides? (2)
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1. Treatment of congestive heart failure
2. Prevention of supraventricular arrhythmias. |
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Antiarrhythmics alter the ________ and ________ of the myocardium to correct ______ in electrical activity.
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conductivity, automaticity, abnormalities
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__% of pts with acute MI develop occlusive coronary thrombi within 1 hour.
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90
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Thrombolytic therapy for MI consists of administering drugs for what purpose?
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Dissolving thrombi which occur shortly after an acute MI.
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Antithrombotic drugs are used to prevent ______ and______.
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acute MI, myocardial ischemia
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Ticlopidine is an _____ agent.
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antiplatelet
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Heparin is an _______ agent.
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anticoagulant
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Abciximab prevents?
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Coronary vessel closure in pts who are at high risk.
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Warfarin (coumadin) inhibits?
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Vit. K-dependent activation of clotting factors formed in the liver.
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What is a percutaneous transluminal coronary angioplasty?
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(Balloon angioplasty)
Invasive but nonsurgical procedure used to dilate coronary arteries. |
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What is a directional coronary atherectomy designed to do?
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Enlarge coronary artery by excising and removing plaque from vessel walls.
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What does a laser angioplasty do?
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Delivers high temp. to vascular tissue for the purpose of smoothing vessel wall irregularities.
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Coronary stent goal?
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Prevent elastic recoil and enhance mechanical dilation.
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What is a coronary artery bypass grafting?
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Surgical revascularization of myocardium performed to relieve angina and improve survival.
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What is dynamic cardiac myoplasty?
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Lat. Dorsi is wrapped around failing L. ventricular to improve function.
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Survival rate of heart-lung transplant?
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57%
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Drug enhancement of bronchodilation is accomplished by ______ the sympathetic NS or ______ influence of parasympathetic NS.
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stimulating, blocking
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Drugs that assist SNS?
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Sympathomimetics
Methylxanthines |
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Drugs that assist PNS?
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Anticholinergics
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Cromolyn Sodium acts to?
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Stabilize mast cell membrane and prevent release of histamine.
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Depolarization flows from?
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base of heart to apex.
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Depolarization is the?
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Change of internal electrical potential of the cell from (-) to (+)
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Depolarization causes immediate?
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Myocardial contraction.
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Drugs that assist SNS?
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Sympathomimetics
Methylxanthines |
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In repolarization cells regain their?
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electronegative state
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Drugs that assist PNS?
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Anticholinergics
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In repolarization the heart is in a _____ state.
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relaxed
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Cromolyn Sodium acts to?
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Stabilize mast cell membrane and prevent release of histamine.
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Cardiac cycle?
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One complete depolarization and repolarization of cardiac muscle cells.
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SA node is natural _______ of heart.
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pacemakes
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Depolarization causes immediate?
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Myocardial contraction.
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In repolarization the heart is in a _____ state.
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relaxed
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What is first to depolarize in the heart?
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SA node
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SA node has the _______ resting membrane potential?
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lowest
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ECG contains (5)
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1. P wave
2. QRS complex 3. t wave 4. ST segment 5. PR interval |
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P wave is the first _____ deflection on ECG?
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positive
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The P wave represents?
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Depolarization of atrial muscle cells.
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P wave is __ mm or less in height and __ to ___ second duration.
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2.5, .08-.11
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QRS complex is the first ____ deflection known as the _ wave.
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negative, Q
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The Q ave is __ second duration and ___ size of the QRS complex
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.04, 1/3
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The Q wave is followed by the _ wave.
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R
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The R wave is the first ______ depolarization.
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upward
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The QRS complex represents?
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Ventricular depolarization.
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Amplitude of QRS is?
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20-30mm
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Duration of QRS?
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.06 to .10 seconds
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35mm or greater amplitude of QRS indicates?
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Ventricular hypertrophy
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5 mm or less amplitude of QRS may indicate (5)
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1. CAD
2. Emphysema 3. Marked obesity 4. Generalized edema 5. Pericardial effusion |
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ST segment begins at ________ and is know as?
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End of QRS complex, J point
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ST segment represents?
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Beginning of ventricular repolarization.
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Less than 1mm depression occurring .08 sec after J point may indicate?
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Ischemia/CAD
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T wave represents?
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Ventricular repolarization
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T wave is slightly _________.
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Asymmetrical
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T wave duration?
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.16 sec.
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Time during ST segment through first half of T wave known as?
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Absolute refractory period
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What is occurring during the absolute refractory period?
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No impulse will propagate through ventricles during this time.
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Leads I, II, and III are formed by?
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Triangle of right arm, left arm, and left foot.
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ECG paper runs at ___mm/sec?
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25
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Lead I, II, and III can give ___ to __ accuracy in diagnosis alone.
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80-90
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Lead I represents?
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difference in electrical potential between L and R arms
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Lead II represents?
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Difference in electrical potential between L leg and R arm
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Lead III represents?
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Difference in electrical potential between L leg and L arm.
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Leads I, II, and III are ______ while leads aVF, aVL, aVR are ________.
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bipolar, unipolar
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Leads aVF, aVL, aVR represent differences in?
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Electrical potential between 1 (+) lead and the average potential between two other leads.
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aVR represents?
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Difference between R arm and average of L arm and L leg.
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aVL represents?
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Difference between L arm versus average of L leg and R arm.
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aVF represents?
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Difference between L leg versus average of L and R arms.
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Method of determining rate on ECG strip? (2)
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1. Count QRS complex in 6sec strip and multiply by 10.
2. QRS on heavy dark line, on 3rd and 4th line in normal limits. |
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Calculation of irregular rhythms are best done by?
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Counting R waves that occur in 1 min.
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Sinus bradycardia is?
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Slow rhythm, less than 60beats/min.
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Sinus tachycardia?
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Rapid rhythm greater than 100beats/min.
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Sinus arrhythmia?
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Very irregular rhythms between 60-100beats/min.
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Wandering atrial pacemakers?
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Varying rhythm caused by changing focus of pacemaker.
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Premature atrial contractions?
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Earlier than expected depolarization from ectopic focus.
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Atrial fibrillation?
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Rapid atrial arrhythmia secondary to firing of multiple ectopic foci in the atria.
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Premature ventricular contraction?
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Most common of all arrhythmias.
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Ventricular fibrillation?
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Chaotic activity of ventricles.
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Heart block?
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Anatomic/functional interruptions to a normal conduction of an impulse.
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Sinoatrial block?
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impulse unable to reach atrial tissue from SA node.
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AV block?
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Delays through AV node or bundle of HIS.
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1st degree AV block?
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delayed impulse to ventricles
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2nd degree AV block?
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Progressively lengthening PR interval until AV node not stimulated. (no QRS complex)
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3rd degree AV block?
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Atrial and ventricular rhythms are independent of each other.
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Right bundle branch block?
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Block of right bundle branch slowing depolarization and contraction of R ventricle.
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Left bundle branch block?
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Block to L bundle branch with delayed L ventricular contraction.
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Small vectors of the axis represent?
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Ventricular depolarization
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Normal QRS vector points?
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Downward, to the left.
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Axis vector is normally between _ and __ degrees?
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0-90 (positive)
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With hypertrophy of a ventricle, the greater electrical activity displaces the vector where?
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To that side.
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Vector is displaced away from the?
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Area of infarct.
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P waves provide evidence of?
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Atrial hypertrophy
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If QRS is positive, the vector is pointing? (Lead I)
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to the left half of sphere.
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If QRS is negative, the vector is pointing? (Lead I)
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To the right half of sphere.
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Lead I axis,
Left hand side is____. Right hand side is _____. |
positive, negative
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aVF axis,
Lower half is _____. Upper half is _____. |
positive, negative
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VI lead is best source of information about?
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Atrial hypertrophy
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Infarction occurs when?
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Coronary artery to L ventricle becomes occluded, resulting in area without blood supply.
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Ischemia is characterized by?
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Inverted, symmetrical T waves
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Classic triad of acute MI?
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1. ischemia
2. injury 3. infarction |
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Infarction is present in?
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Q wave
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A treadmill is most accurate for determining?
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Vo2 max
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MET?
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Amount of O2 consumed at rest.
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HR is a better indicator of ________ __ ___________ than MET levels.
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myocardial O2 consumption
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Rate pressure product?
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HR x systolic BP
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Rate pressure product is an indirect measurement of?
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Coronary artery blood flow
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