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171 Cards in this Set

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Describe the baroreceptor reflex
Baroreceptor Reflex senses increased arterial pressure and acts to vasodilate through inhibition of vasomotor centers, and decreases heart rate and strength of contraction through vagal stimulation
Describe the Bainbridge reflex
Occurs when mechanoreceptors respond to increased pressure and stretch in right atrium. It stimulates vasomotor centers to increase sympathetic input and heart rate. Can also influence a decrease in heart rate when heart is beating too fast
Describe the chemoreceptor reflex
It responds to need for increased depth and rate of ventilation. Located on carotid and aortic bodies and detect lack of oxygen (increase in CO2 arterial levels)
What sound is S1?
Lub
The closing of mitral and tricuspid valves and onset of systole
What sound is S2?
Dub
Aortic and pulmonic valves closing and onset of diastole
What sound is S3?
-S3 is ventricular Gallop d/t noncompliant left ventricle
-Heard in Congestive Heart Failure\
-heard as extra beat at end
What sound is S4?
-sound of vibration of ventricular wall with atrial filling
-heard as extra beat before
-A/W hypertension, MI, stenosis
What is normal cardiac output for adult males at rest?
5.6 L/min
What is cardiac index?
Amount of blood pumped out of heart per minute per square meter of body mass
Norm: 2.5-4.2 L/min/meter squared
What percent of body weight is blood?
7-8% of their body weight
What is preload?
end volumetric pressure that stretches the left or right ventricle prior to contraction
What is afterload?
tension or stress developed in the wall of the left ventricle during ejection aka, it is the 'load' against which the heart MUST contract to eject blood
What is the norm range for LDL cholesterol?
60-120
What is the norm range for HDL cholesterol?
40-80
What is the norm range for PaO2 in blood?
80-100mm Hg
What is norm range for SaO2?
95-98%
What is norm WBC count?
4,500 to 11,000
What is norm platelet count?
150,000 to 400,000
What is norm RBC count adult?
4.2 to 6.2 million
What is norm hemoglobin adult?
12-18
What is norm hematocrit adult?
37-54
What is the purpose of a cardiac cath for angiography?
to see narrowing or occulsions of arteries through use of dye
What is the purpose of regular cardiac catheterization?
Measure intracardiac, transvalve and pulmonary artery pressures
Measure blood gas pressures to determine CO and evaluate shunting
What is a Swan Ganz catheter used for?
measures pulmonary artery pressure, pulmonary capillary wedge pressure, CO, and mixed venous saturation
-evaluates pulmonary vascular resistance and tissue oxygenation
What diagnostic test helps identify tumors and pericardial effusion?
Transthoracic Echocardiography
What is primary purpose of ECG?
Diagnose location, extent, and acuteness of myocardial ischemia and infarction
-also assesses cardiac rhythm
What are the benefits of Holter monitoring?
continuous ambulatory ECG monitoring done by tape recording cardiac rhythm up to 24 hrs
-evaluates cardiac rhythm, efficacy of medications, symptoms, pacemaker function, and correlates symptoms with activity
What is purpose of phonocardiography?
records cardiac sounds, times the events of cardiac cycle and confirms auscultatory findings
What does radionuclide angiography assess?
ventricular wall motion and ejection fraction evaluated
-abnormal blood flow/congenital defects detected
What is the difference between technetium 99 hot spot imaging and thallium 201 cold spot imaging?
thallium 201 evaluates myocardial ischemia and infarction during peak exercise
Which diagnoses do you see with depressed QRS?
heart failure, ischemia, pericardial effusion, obesity, COPD
What do you typically see with elevated QRS complex?
hypertrophy of myocardium
What does a Q wave indicate?
Previous MI
What does ST segment elevation indicate?
Acute MI
What does A fib look like?
Irregularly irregular rhythm
No P waves, no rate
quivers
Name common causes of A fib
HTN, CHF, CAD, rheumatic heart disease, cor pulmonale, pericarditis, illegal drug use.
What does Supraventricular Tachycardia look like?
-Rate varies 160-250 bpm
-Regular rhythm
-originates from above AV node
-starts and stops without cause
Name common causes of supraventricular tachycardia
mitral valve prolapse, cor pulmonale, digitalis toxicity, rheumatic heart disease
What does PAC look like?
-P Wave premature and abnormal
-Rate normal between 60-100
-Irregular rhythm that is regular, ie skips every third beat
-Can be indicative of ischemia or valve pathology
What are common causes of PAC?
intake of caffeine, emotion stress, smoking, CAD, electrolyte imbalance, infection, CHF
What does V Tach look like?
-Rate usually >100bpm, regular rhythm
-No P wave or it appears after QRS
-Requires immediate medical attention
Name common causes of V Tach
Post MI, rheumatic heart disease, CAD and cardiomyopathy
What does V fib look like?
-No regular rate or rhythm
-Emergency that requires immediate medical intervention
Name common causes of V fib
long-term or severe heart disease, post MI, hypercalcemia, hypokalemia, and hyperkalemia
What does Multi-focal V tach look like?
-Rate >150bpm, Irregular
-No P waves, QRS is wide
-requires immediate medical intervention
Name common causes of multifocal v tach
hypokalemia, hypomagnesemia, hypothermia, and drug induced through anti-arrhythmic medications
What does PVC look like?
Occurs when ectopic foci in ventricles of Purkinje fibers fires and supersedes normal conduction
One ectopic foci=same waveform
Multi ectopic foci=different wave forms
Rate is normal, 60-100, regularly irregular (skips every 3rd beat)
P wave is absent, ST segment is distorted, QRS complex occurs early
Couplet=two skips in a row, Bigeminy=skip every other beat, trigeminy=skip every third beat
Name common causes of PVC
intake of caffeine, emotional stress, CAD, digitalis toxicity, cardiomyopathy, MI
What does complete heart block (3rd degree) look like?
Regular rhythm
Atrial rate > ventricular rate
Requires immediate medical intervention (pacemaker)
Name common causes of 3rd degree heart block
infection, electrolyte imbalance, CAD, anteroseptal MI, impairment with AV conduction system
what is normal blood pressure for infant?
60-90/30-55
What is normal blood pressure for children?
90-110/50-70
What is norm BP for adult?
under 120/under 80
what is value for adult pre-hypertension?
120-139/80-89
What is value for adult stage 1 hypertension?
140-159/90-99
what is value for adult stage 2 hypertension?
>/=160 over 100
what is normal heart rate for infant?
100-130 bpm
What is normal HR for child?
80-100 bpm
What is normal HR for adult?
60-100 bpm
What is norm for ABI scale?
1
What does ABI rating of .5-.9 indicate?
Arterial occlusion
Impairment with wound healing
Therapeutic exercise beneficial
What does ABI rating of < .5 indicate?
Severe arterial occlusion
Exercise is unrealistic
Poor to no wound healing
Name the scales for pulse assessment grading
0 absent
1+ diminished
2+ normal
3+ moderately increased
4+ markedly increased
What is norm respiratory rate for infants?
30-50 respirations per minute
What is norm respiratory rate for adults?
12-20
Name factors that influence HTN
age, level of physical fitness, genetic disposition, smoking, sedentary life, obesity, and DM.
What is METs that indicate vigorous exercise?
Over 6 METs

shoveling snow, swimming, mowing lawn
What are METs that indicate moderate exercise?
3-6 METs

dancing, light house work, light gardening, walking 4mph, sexual intercourse
What is regular Target Heart Rate formula?
220-age =max HR, then multiply that by intensity percentage you want to train at. Normal training intensity is 60-90% of age adjusted HR
What is Karvonen's Fromula: heart rate reserve method?
Max HR is obtained by exercise stress test
Then resting HR is subtracted from it, this equals heart rate reserve
Heart rate reserve then multiplied by both ends of prescribed range (HRR X 60% and HRR X 90%)
Resting HR then added to each of the two numbers to identify upper and lower limits of target HR
Name the symtoms of an MI
Severe chest pain
Chest heaviness
Radiating pain down one of both arms
Weakness
Nausea, Vomiting, Sweating
SOB
How is an MI diagnosed?
Abnormal ECG
and
Elevation in enzyme level creatine phosphokinase (CPK), Aspartate aminotransferase (AST), and Lactate Dehydrogenase
What are non-modifiable risk factors for cardiac pathology?
Age, increases
Sex Male > Female
Family history
Culture
What are general symptoms of cardiac pathology?
Chest pain
SOB
cardiac arrythmias (palpitations)
Faiting
Claudication
Cyanosis of lips/nailbeds
Fatigue
Edema
What are absolute contraindications for treatment of unstable cardiac patient? (7)
-3rd degree heart block
-Uncompensated CHF
-PVC's of ventricular tachycardia at rest
-Multifocal PVCs
-Chest pain with ST segment changes
-ECG changes that indicate ischemia
-Dissecting aortic aneurysm
What are absolute contraindications to exercise testing? (9)
-ECG changes that denote cardiac ischemia
-Recent MI <48 hrs
-Multifocal PVCs
-Uncontrolled heart failure
-Unstable angina
-Uncontrolled cardiac arrythmias
-Untreated heart block (2 or 3)
-Pulmonary embolism
-Acute infection
What are contraindications for cardiac rehab? (10)
-Uncontrolled atrial/ventricular arrhythmias
-Recent diagnosis of embolism
-Resting diastolic BP >110mmHg
-Thrombophlebitis
-Orthostatic BP >20mmHg drop
-Acute infection
-Resting ST segment displacement of >2mm
-Unstable angina
-Resting systolic BP >200mmHg
-Uncompensated CHF
What are the conditions that cause Right sided Heart failure?
-Mitral stenosis
-Pulmonary parenchymal or vascular disease
-Pulmonic or Tricuspid valve disease
-Infective endocarditis
What are the conditions that cause Left sided Heart failure?
-HTN
-CAD
-Aortic valve disease
-Cardiomyopathies
-congenital heart defects
-Infective endocarditis
-High output conditions
-Various connective tissue disorders
What is right sided heart failure?
Elevated end-diastolic right ventricular pressure
What is left sided heart failure?
Elevated end-diastolic left ventricular pressure
What is the clinical presentation of Right sided heart failure?
-Systemic congestion (enlarged liver, ascites, jugular venous distention, dependent pitting edema)
-Fatigue, oliguria, nocturia
-Pleural effusion R>L
-Anorexia and bleeding
-Unexplained weight gain
-Cyanosis (capillary stasis)
What is the clinical presentation of Left sided heart failure?
-Pulmonary congestion (pulmonary edema, dyspnea, orthopnea, paroxysmal noctural dyspnea, cough, bronchospasm)
-Fatigue, oliguria
-Cyanosis (central)
-Tachycardia
What type of exercise is contraindicated in cardiac rehab?
isometrics
What is the ratio of compressions to breaths for adult CPR?
30:2
How many compressions should you do for adult and child CPR?
100 compressions/min
What is the depth of compressions for an adult during CPR?
1.5-2 inches
What is the depth of compressions for child CPR?
1/3 to 1/2 the depth of chest
What is one rescuer ratio of compressions to breaths for child CPR?
30:2
What is the two rescuer ratio of compressions to breaths for child CPR?
15:2
What are the symptoms of CHF?
-Pulmonary edema
-Dyspnea when lying down (orthopnea)
-Cough (non productive)
-S3 gallop
-Exertional hypotension
-weight gain within hours
-increased resting heart rate
What is nocturnal angina pectoris?
-May be related to CHF
-Angina that wakes a person up from sleep with same characteristics as angina from exertion.
What is coronary artery disease?
-Narrowing of blockage of the coronary arteries
-may produce ischemia and necrosis of myocardium
-Includes thrombus, vasospasms, atherosclerosis
What is Prinzmetal's angina?
-Angina that occurs at rest due to vasospasm.
-Can be severe and not readily relieved by Nitro.
What is infective Endocarditis?
-Caused by bacteria that causes inflammation of endothelium lining heart and cardiac valves.
-Damages mitral valve, then aortic/tricuspid valves.
-Can also occur after invasive medical/dental procedure
What is myocarditis?
Uncommon condition of inflammation to heart muscle itself, caused by infection
What is pericarditis?
inflammation of pericardium (outer membrane) of heart
-May be acute or chronic, painful or asymptomatic
What are symptoms of pericarditis?
Auscultation of pericardial friction rub
Pleuritic chest pain
ST segment elevation
cough and hoarseness
Fever, fatigue, weakness
What is rheumatic heart disease?
Damage to heart secondary to inflammation from rheumatic fever (caused by Strep)
What is expected damage from anterior heart infarct?
LAD
High risk of large infarction
Heart failure and sudden death
What is expected damage from Inferior heart infarct?
Right coronary artery
Right ventricular damage
AV block
Medium infarct possible
What is expected damage from Lateral heart and/or superior heart infarct?
Least overall damaage, minor impairment/complications
What causes Respiratory Distress Syndrome in infants?
immaturity of the lungs and inability to produce surfactant which results in alveolar collapse and atelectasis.
What do crackle sounds indicate?
atelectasis, fibrosis, pulmonary edema, or pleural effusion
What is bronchophony a test for?
consolidation in lower airways
what does Egophony indicate?
Fluid in air spaces or lung parenchyma
What is anatomic dead space volume?
Volume of air that occupies non-respiratory conducting airways
What is expiratory reserve volume?
Maximal volume expired after normal expiration
What is Forced expiratory volume?
Amount of air exhaled in the 1st, 2nd, and 3rd second of a forced vital capacity test
What is Forced Vital Capacity?
Amount of air forcefully expired after maximal inspiration
What is functional residual capacity?
Volume in the lungs after normal exhalation
What is inspiratory capacity?
Amount of air that can be inspired after a normal exhalation
3000-4000mL
What is inspiratory reserve volume?
Maximal volume of air inspired after normal inspiration
What is minute volume ventilation?
-Amount of air expired in one minute.
-Equal to product of tidal volume and respiratory rate.
What is peak expiratory flow?
Maximum flow of air during the beginning of a forced expiratory breath
What is residual volume?
lung volume remaining in the lungs at end of maximal expiration
What is tidal volume?
total volume inspired and expired per breath
Norm 500mL
What is Total Lung Capacity?
Lung volume measured at the end of maximal inspiration
What is vital capacity?
Max volume forcefully expired after a maximal inspiration
What percent of a pulmonary function test is considered abnormal?
Less than 80% of the reference value for age, gender, weight, height
How do you calculate Total Lung Capacity?
Inspiratory Reserve volume + Tidal volume + Expiratory reserve volume + residual capacity
How do you calculate Vital capacity?
Inspiratory Reserve Volume + tidal volume + expiratory reserve volume
How do you calculate Inspiratory capacity?
Tidal volume + Inspiratory reserve volume
how do you calculate functional residual capacity?
Expiratory reserve volume + residual volume
What is norm for tidal volume?
500mL
What is norm for Expiratory reserve volume?
1000mL
What is norm for Vital Capacity?
4000-5000mL
What is norm for Inspiratory capacity?
3000-4000mL

75-80% of vital capacity
55-60% of total lung capacity
What is norm PaCO2 of arterial system?
35-45 mmHg
What is hypercapnia?
Increased CO2 in blood
What is Hypoxemia?
When PaO2 is less than 80mmHg
What are contraindications for percussion? (7)
-Over a fracture
-Over a spinal fusion site
-Over osteoporotic bone
-Unstable angina
-Low platelet count
-Anticoagulation therapy
-Pulmonary embolism
What are contraindications for postural drainage?
-Congestive Heart Failure
-pulmonary edema
-pleural effusion
-pneumothoax
-pulmonary embolism
-cardiac arrhythmia
-recent MI
-Unstable angina
What do abnormal bronchial sounds indicate?
pneumonia
What do decreased/diminished breath sounds indicate?
emphysema or hypoventilation
What do absent breath sounds indicate?
pneumothorax or lung collapse
What causes respiratory acidosis?
alveolar hypoventilation
What causes respiratory alkalosis?
alveolar hyperventilation
What causes metabolic alkalosis?
bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease
What causes metabolic acidosis?
diabetes, lactic or uremic acidosis, prolonged diarrhea
What are signs/symptoms of respiratory alkalosis?
dizziness, syncope, tingling, tetany, numbness
What are signs/symptoms of respiratory acidosis?
Early: anxiety, restlessness, dyspnea, HA
Late: confusion, somnulence, coma
What are signs/symptoms of metabolic alkalosis?
Vague: weakness, mental dullness, possibly early tetany
What are signs/symptoms of metabolic acidosis?
Secondary hyperventilation (Kussmaul's breathing)
nausea/vomiting
cardiac dysrhythmias
lethargy
coma
What is PCO2 level of respiratory alkalosis?
Less than 40 mmHg

hypocapnia, hyperventilation
What is PCO2 level of respiratory acidosis?
Greater than 40 mm Hg

hypercapnia, hypoventilation
What is pH level of acute alveolar hyperventilation?
pH>7.5
What is pH level of acute ventilatory failure?
pH <7.3
What is the trendelenburg position?
supine with bottom of bed elevated 45 degrees

used for lower lobe drainage, and to increase blood pressure
What is reverse trendelenburg position?
Supine with head raised above trunk and lower extremities

used with pts with cardiac conditions
easiest for breathing for diaphragm
What is Semi-fowlers position?
Supine with HOB elevated 45 degrees and pillows under knees

used with pts with CHF/cardiac conditions
What is bronchial drainage position for Apical segments upper lobes L and R Anterior?
Lean back against pillow;clap above clavicles between neck and shoulder
What is the bronchial drainage position for Apical segments upper lobes L and R posterior?
Lean forward onto pillow;clap on both sides of back over scapula
What is bronchial drainage position for upper lobes anterior segment L and R?
Supine; clap on both sides just below clavicles and above nipple line
What is bronchial drainage position for upper lobes L posterior segment?
Right sidelying, 1/4 turn forward, clap over left scapula
What is broncial drainage position for upper lobes R posterior segment?
Left sidelying; 1/4 turn forward, clap over right scapula
What is the bronchial drainage position for upper lobe Left Lingula?
Right sidelying, bottoms of bed elevated 14-16 inches, 1/4 turn back; clap over left nipple
What is the bronchial drainage position for Right middle lobe?
Left sidelying; bottom of bed elevated 14-16 inches, 1/4 turn back; clap over selected lobe
What is the bronchial drainage position for Lower lobes, superior segments left and right?
Prone; clap over middle of back at tip of scapula
What is bronchial drainage position for lower lobes lateral basal segments L and R?
Sidelying; elevate bottom of bed 20 inches, clap at lower ribs
What is the bronchial drainage position for lower lobes anterior basal segments L and R?
Supine; elevate bottom of bed 18-20 inches, clap at lower ribs both sides
What is the bronchial drainage position for lower lobes posterior basal segment L and R?
Prone, elevate bottom of bed 18-20 inches, clap at lower ribs both sides
What is the correct body position to practice diaphragmatic breathing?
supine with head and trunk elevated 45 degrees (semi fowlers)
What is the purpose of segmental breathing?
Prevent accumulation of fluid and increase chest mobility by directing inspired air into predetermined areas
What are signs/symptoms of bronchiectasis?
consistent productive cough
hemoptysis
weight loss
anemia
crackles, wheezes, loud breath sounds
What are signs/symptoms of chronic bronchitis?
increased pulmonary artery pressure
thick sputum
increased accessory muscle use
persistent cough, wheezing
dyspnea and cyanosis
How is COPD diagnoses?
FEV 1 test
What is Cor Pulmonale?
Sudden dilation of right ventricle due to pulmonary embolus. Symptoms mimic CHF

right sided heart failure will occur if not treated
What are signs/symptoms of emphysema?
barrel chest
dyspnea
chronic cough
increased respiration rate
increased use of accessory muscles
What is restrictive pulmonary disease?
Lungs failure to fully expand due to weakened diaphragm, structural inability to expand, and decrease in elasticity of lung tissue

RESULTS IN DECREASE OF ALL LUNG VOLUMES
What are conditions associated with restrictive pulmonary disease?
scoliosis, atelectasis, pneumonia, adult respiratory distress syndrome