Cardio And Respiratory

Front 1

pulse oxymetry reveals little about

Back 1

lung ventilation

Front 2

in respiratory failure, ABGs are necessary to obtain PaO2 and PaCO2. WHY?

Back 2

PaO2 shows oxygenation, PaCO2 shows ventilation

Front 3

hypoxemia, secondary to an intrapulmonary shunt is usually not responsive to high O2 concentrations, and the Pt will usually require WHAT?

Back 3

PPV (positive pressure ventilation). It will decreasse the work of breathing and reduce respiratory muscle fatigue, and may assist in opening collapsed airways and decreasing shunt.

Front 4

at all times, sucytioning is done cautiosly becase

Back 4

it may precipitate hypoxia

Front 5

NIPPV (noninvasive positive pressure ventilation-throu mask) may be used for Pts with

Back 5

acute and chronic respiratory failure

Front 6

During NIPPV a mask is placed tightly over PT's nose and mouth and the Pt breaths

Back 6

spntaneously while PPV is deivered

Front 7

BiPAP is a form of

Back 7

NIPPV (noninvasive positive pressure ventilation) when different possitive pressure levels are set for inspiration and expiration

Front 8

CPAP is a form of

Back 8

NIPPV in which constant positive pressure is delivered to the airway during inspiration and expiration

Front 9

NIPPV is most useful for managing what diseases?

Back 9

chronic respiratory failure (asthma, COPD) and neuromuscular disease (multiple sclerosis)

Front 10

People who refuse endotracheal intubation, but still desire some palliative ventilatory support can recieve support from what?

Back 10

NIPPV

Front 11

NIPPV is not appropriate for whom?

Back 11

for Pts who don't have respirations, have excessive secretions, have decreased level of consiousness, high O2 requirements

Front 12

What does cardiac output reflect?

Back 12

it reflects blood flow reaching the tissues

Front 13

what minimal systolic BP and MAP the Pt should have to maintain perfusion to vatal organs?

Back 13

SBP=90
MAP=60

Front 14

Minimal Hemoglobin level to ensure adequate O2 saturation of hemoglobin

Back 14

9 g/dl

Front 15

pulm. artery wedge pressure

Back 15

заклиненное давление ( измеренное с помощью катетера, введённого в сосуд )

Front 16

ARDS is present if the Pt has:

Back 16

1. refractory hypoxemia (PaO2<50 on FlO2>40% with PEEP >5 cm H2O and PaO2/FlO2<200)
2. chest Xray with new bilateral interstitial and alveolar infiltrates
3. a pulm. artery wedge pressure <18 and no evidence of heart failure
4. a predisposing condition for ARDS within 48 hours of clinical manifistation

Front 17

Oxygen toxicity increases when FlO2 (fraction of inspired oxygen) exceeds

Back 17

60% (3 times more than room air) or > for more than 48 hrs

Front 18

PEEP (positive end-expiratory pressure) can cause what adverse affect in ARDS Pt?

Back 18

can acuse overinflation of the alveoli and compression of the pulmonary bed, a reduction in blood return to the left side of the heart, and a dramatic drop in BP.
Also, high levels of PEEP or excessive inspiratory pressure can cause barotrauma (rupture of overdistended alveoli during mechanical ventilation)

Front 19

pulmonary artery wedge pressure is kept as low as possible without impairment of CO for ARDS PTs WHY?

Back 19

in order to limit pulmonary edema

Front 20

BiPAP (bilevel positive airway pressure) Indications:

Back 20

Pt must be able to breath spontaneously.
Indications: acute respiratory failure (острая дыхательная недостаточность) in Pts with COPD and heart failure, sleep apnea

Front 21

BiPAP (bilevel positive airway pressure) contraindications:

Back 21

Pt must be able to breath spontaneously. Contraindications:
schock (a state of bodily collapse or near collapse caused by circulatory failure or sudden lowering of the blood pressure, as from severe bleeding, burns), altered mental status, increased airway secretions

Front 22

Arterial oxygen saturation can be obtained by:

Back 22

blood test - ABGs (invasive) - SaO2
and by the means of pulse oxymetry (noninvasive) - SpO2
Normal > 95%
Ideally SaO2=SpO2

Front 23

What information SpO2 (oxygen satutration obtained by pulse oxymetry) does not provide?

Back 23

Pt's ventilation status and ABGs. Need blood test.

Front 24

chest tube care:

Back 24

1. monitor for bubbling of the suction chamber of the chest tube drainage system and tidaling (прилив/отлив) in water-seal chamber to assure adequate ventilation
2. all tubing connections are securely attached and taped to prevent air leaks.
3. Keep the drainage container below chest level to prevent tension pneumothorax

Front 25

tension pneumothorax

Back 25

air can enter the pleural space but cannot excape via the route of entry. This leads to increased intrapleural pressure resulting in lung collapse. The increase in pressure also compresses the heart and vena cava, which impairs circulation

Front 26

exudate

Back 26

any fluid released from the body with a high concentration of proteins, cell and debris

Front 27

atelectasis hapens most offen after surgeries because of

Back 27

airway obstraction that results from retained exudates and secretions.

Front 28

To prevent atelectasis it is important to teach the Pt

Back 28

deep-breathing exercises (deep inspiration to prevent alveoli to collapsee)

Front 29

respiratory distress syndrome can be caused by

Back 29

(синдром дыхательной недостаточности) O2 toxicity

Front 30

SE of b-blockers:

Back 30

Metorpolol, Atenolol, Labetalol, Esmalol
bradycardia, fatigue, hypotension

Front 31

b-blockers contraindicated:

Back 31

pregnancy (2 and 3 trimester)
reactive airway disease (asthma)
heart block (conduction problem - AV node)

Front 32

Calcium Channel Blockers
names:

Back 32

Amlodipine
Nifedipine
Nicardipine
Diltiazem
Verapamil

Front 33

ACE inhibitors

Back 33

Captopril
Lisinopril
Enalaprilat

Front 34

Angiotensin II inhibitor

Back 34

Valsartan

Front 35

High doses of O2 cause

Back 35

damage of alvewolar-capillary membranes, inactivate pulmonary sarfactant, cause interstitial and pulmonary edema, and decrease compliance.
Can cause ARDS (acute respiratory distress syndrome)

Front 36

signs of pulmonary edema:

Back 36

Pt is anxious, pale, cyanotic.
Skin is clammy and cold from vasoconstriction caused by stimulation os CNS.
Severe dyspnea (Pt use accesory muscles of respiration, RR>30 breaths/min).
May be wheezing and coughing with production of frothy, blood-tinged sputum
Crackles, Wheezes, and rhonchi throughout the lungs.
HR is elevated.

Front 37

Loop diuretics do what?

Back 37

increase systemic vascular resistance (afterload) - they cause blood vessels to dilate
decrease preload (reducing blood volume)
cause electrolyte imbalance

Front 38

Nitropusside does what?

Back 38

potent vasodilator, reduces preload and afterload (venous and arterial dilation), thus myocardial contraction improves, increasinf CO and reducing pulmonary edema.

Front 39

complications of nitroprusside:

Back 39

rapid IV administration -hypotension
thiocyanate toxicity

Front 40

Morphine sulfate is used for

Back 40

treatment of pulmonary edema, because it reduces preload and afterload (the resistance against which the LV must pump).

Front 41

ACE inhibitors
major SE

Back 41

angioedema
hypotension
hyperkalemia (avoid foods high in potassium)
renal insuficiency
rebound hypertension with skipping doses

Captopril
Lisinopril
Enalaprilat

Front 42

Contraindications for use of b-blockers

Back 42

cardiogenic shock
heart block (AV node conduction problem)
sinus bradycardia (HR<60)
SBP<100
pregnancy
asthma

Front 43

SE of Beta-blockers

Back 43

edema
worsening of HF
hypotension
fatigue
bradycardia

Front 44

digitalis and low potassium level, low magnesium, high calcium level (because of diuretics)

Back 44

causes digitalis toxicity

Front 45

escape rhythm is ...

Back 45

a heart rhythm initiated by lower centers when the sinoatrial node fails to initiate impulses, when its rhythmicity is depressed, or when its impulses are completely blocked.

Front 46

Hemodynamic monitoring is ...

Back 46

the evaluation of the pressures in the heart and lungs.
This can only be done with special equipment and intensive care nursing.

Front 47

Transcutaneous (чeрескожный) pacing (also called external pacing) is...

Back 47

a temporary means of pacing (задавать темп) a patient's heart during a medical emergency.
It is accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract.

Front 48

Cardiac tamponade, also known as pericardial tamponade, is ...

Back 48

an emergency condition in which fluid accumulates in the pericardium (the sac in which the heart is enclosed).
If the fluid significantly elevates the pressure on the heart it will prevent the heart's ventricles from filling properly. This in turn leads to a low stroke volume. The end result is ineffective pumping of blood,

Front 49

Pulmonary Ventilation/Perfusion Scan (VQ scan)
is...

Back 49

A pulmonary ventilation/perfusion scan is a pair of nuclear scan tests that use inhaled and injected material to measure breathing (ventilation) and circulation (perfusion) in all areas of the lungs

Why is the Test Performed?

•The ventilation scan is used to evaluate the ability of AIR to reach all portions of the lungs.
•The perfusion scan measures the supply of BLOOD through the lungs.
•A ventilation and perfusion scan is most often performed to detect a pulmonary embolus. It is also used to evaluate lung function in people with advanced pulmonary disease such as COPD

Front 50

Electrophysiological (or "EPS") testing is

Back 50

a procedure used to analyze the electrical system of the heart.
In this procedure, catheters are inserted into the heart via a vein in the groin. Unlike a cardiac catheterization, in which catheters are inserted into the artery, catheters in an EP study generally are inserted only into the vein. No X-Ray contrast dye is used during an EP study.
During the EPS, doctors insert special electrode catheters (soft wires) into large veins in your groin. These catheters follow the vein all the way into the heart. Once inside the heart, the doctors are able to study the abnormal heat beats or rhythms.
Many patients who undergo EPS testing have curable arrhythmias and are candidates for radiofrequency catheter ablation.

Front 51

Catheter ablation is a

Back 51

procedure used to selectively destroy areas of the heart that are causing a heart rhythm problem. During this procedure, thin, flexible wires are inserted into a blood vessel in the thigh, groin, neck, or elbow and threaded up through the blood vessel and into the heart under X-ray guidance. The wires allow the doctor to record the electrical activity of your heart and determine what kind of heart rhythm problem you have.

Then, your doctor will find the tiny areas that are causing the rhythm problem. The wires are used to send energy to those areas in the heart. This energy is in the form of heat or freezing cold. The heat or cold destroys, or ablates, the heart tissue. Destroying this tissue can cure your heart rhythm problem.


Catheter ablation is done in a hospital where the person can be carefully monitored. The procedure is done with an electrophysiology (EP) study, which can identify specific areas of heart tissue where the fast heart rate may start or where abnormal electrical pathways are located inside or outside the atrioventricular (AV) node. This allows doctors to pinpoint exactly what tiny area of heart muscle to destroy.

Front 52

Catheter ablation can be called different names based on the type of energy used to create the heat or cold.

Back 52

If heat from radio waves is used, it is called radiofrequency catheter ablation. If cold temperatures are used, it is called cryoablation.

Front 53

angina decubitus occurs

Back 53

when a person is lying down

Front 54

Silent ischemia is

Back 54

lack of the blood flow and oxygen to the heart, but when this occurs with no pain or major symptoms (prevelaent in diabetics).
Asymptomaticmyocardial ischemia

Front 55

Prinzmetal's angina usually occurs when

Back 55

a person is at rest.
May occur in the absence of CAD
ussually occurs in response to coronary artery spasm

Front 56

hemoptysis is

Back 56

coughing up blood from the respiratory tract; usually indicates a severe infection of the bronchi or lungs

Front 57

the classic triad of pulmonary emboli

Back 57

dyspnea, chest pain, and hemoptysis
occurs only with 20% of Pts

Front 58

The dosage of heparin is adgusted according to

Back 58

the activated partial tromboplastin time (aPTT)

Front 59

warfaqrin dose is adjusted according to

Back 59

international normalized ratio (INR)

Front 60

fibrinolytic agents do what?

Back 60

dissolve the pulmonary emboli and the source of the thrombus in the pelvis or deep leg vein

Front 61

Splinter hemorrhages are

Back 61

narrow, red to reddish-brown lines of blood beneath the nails. They run in the direction of nail growth
sign of endocarditis

Front 62

petechiae are ...

Back 62

pinpoint-sized red dots under the surface of the skin
sign of endocarditis

Front 63

Osler's nodes are ...

Back 63

painful, red, raised lesions on the palms and soles. They are associated with a number of conditions, including infective endocarditis

Front 64

Janeway's lesions are

Back 64

non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are signs of infective endocarditis

Front 65

Roth's spot:

Back 65

A hemorrhage in the retina with a white center. Originally associated with bacterial endocarditis,

Front 66

Uremia is

Back 66

The presence of excessive amounts of urea and other waste products in the blood.
One of the causes of pericarditis

Front 67

Reperfusion injury

Back 67

refers to damage to tissue caused when blood supply returns to the tissue after a period of ischemia

Front 68

What is the best practice for patients with ST-segment-elevation myocardial infarction (STEMI)?

Back 68

The opening of the affected artery with percutaneous coronary intervention (PCI), preferably within 90 minutes and ideally within 60 minutes of presentation

Front 69

treatment for hemodynamically unstable (no pulse) monomorphic V-tachicardia:

Back 69

IV amiodarone, lidocaine, followed by cardioversion