Week 5 Cardiopulm Study Questions

Front 1

WHAT DOES THE CHEMISTRY PANEL INCLUDE?

Back 1

Sodium- 135-145
Potassium 3.8-5.3
Chloride 100-108
CO2 22-29
BUN 6.0-21.0
Creatinine 0.6-1.2
Glucose 70-100

Front 2

LIST CRITICAL VALUES OF 5 MAJOR LABS.

Back 2

Sodium <120 >160

Potassium <3.0 >6.0

Chloride <70 >120

CO2 <10 >40

Glucose <50 >450

Front 3

GIVE THE PT IMPLICATIONS FOR ABNORMAL SODIUM.

Back 3

Possible increased confusion and cognitive issues.
-Hypernatremia: irritable, lethargic
-HYPONatremia: lethargic, muscle cramping, confused,

Front 4

GIVE THE PT IMPLICATIONS FOR ABNORMAL POTASSIUM.

Back 4

Critical to neuromuscular and CARDIAC function; risk for tetany and dysrhythmias and MI....PVCs->V Tach
-If Hypokalemic, NO PT until level is adjusted.

Front 5

GIVE THE PT IMPLICATIONS FOR ABNORMAL CREATININE.

Back 5

Usually does not contraindicate; renal symptoms may.
-Increased levels of creatinine may cause: fatigue, muscle weakness, n/v, impaired mental awareness, drowsiness and confusion
-Decreased levels of creatinine may cause: lethargy, apathy, nausea, cramps, muscle twitching, confusion.

Front 6

GIVE PT IMPLICATIONS OF ABNORMAL BUN VALUES.

Back 6

Usually does not contraindicate, renal symptoms may.
-Increased levels of BUN from dehydration can cause dizziness and light headedness with activity and sometimes confusion.

Front 7

WHAT DOES THE CBC (COMPLETE BLOOD COUNT) INCLUDE?

Back 7

WBC 3.4-9.6

HEMOGLOBIN (Hgb) 11.1-15.0

HEMATOCRIT (HCT) 31.8-43.2%

PLATELETS 162-380K

Front 8

WHAT ARE PT IMPLICATIONS OF ABNORMAL PLATELETS?

Back 8

-If too much clotting, a thrombus can form.
-If too little clotting, bleeder!
50-140 low intensity resistive and aerobic exercises (0 grade)
30-50 AROM exs, Ambulation and Ad Lib
<20, Risk of spontaneous bleeding, increased bleeding time,. Can do minimal AROM- PT may be contraindicated, No teeth brushing

Front 9

WHAT IS THE DIFFERENCE BETWEEN PROTHROMBIN TIME AND PARTIAL THROMBOPLASTIN TIME.

Back 9

-PROTHOMBIN TIME tests the EXTRINSIC system of clotting cascade. Connected to INR. If on coumadin (blood thinner), want to bleed slower. (want INR to be 2-3).

-PARTIAL THOMBOPLASTIN TIME Tests INTRINSIC system of clotting cascade. Look at Heparin (blood thinner) for PTT. If on Heparin, want 60 sec PTT

Front 10

WHAT IS INR?

Back 10

International Normalized Ratio- used to correct for differences in the laboratory reagents used to test PROTHROMBIN time by various labs. Typically want 1-2 for value.

Front 11

WHAT IS DIFFERENCE BETWEEN UNIVERSAL PRECAUTIONS AND CONTACT PRECAUTIONS?

Back 11

Universal is regular precautions (wash hands, wear gloves with fluid, gown with fluid, mask/eye protection with fluid.)

Contact precautions includes universal but also: pt in private room, and gloves when entering room. Gown when entering room if think clothing will have substantial contact with the patient.

Front 12

WHAT IS DIFFERENCE BETWEEN DROPLET AND AIRBORNE PRECAUTIONS?

Back 12

Droplet Precautions: universal plus pt in private room AND must wear mask/gown when working WITHIN 3 FT OF Pt.

Airborne Precautions: Universal plus pt in private room and monitor negative air changes, 6-12 air changes per hour. Door closed and pt in room. Wear respiratory protection when entering the room- gloves, gown, mask.

Front 13

WHAT IS DIFFERENCE BETWEEN FULL CODE, DNR, AND DNI?

Back 13

Full Code: All reasonable efforts will be made to save a life- CPR, intubation, feedings, Meds

DNR: No CPR, no chest compressions, no shocks

DNI: Do Not Intubate=No mechanical ventilation.

Front 14

LIST DIFFERENCES BETWEEN ACUTE REHAB AND SNF REHAB.

Back 14

-ACUTE: Min of 3 hrs/day (2 out of 3 services), Neuro diagnoses, more aggressive therapy to get you home

SNF: Min of .5-2hrs/day, Cardiopulm pts, longer, slower therapy.

Front 15

LIST BARRIERS TO REHAB.

Back 15

-Prior Functional Level

-Social Barriers: caregivers, support system

-Psychological/Cognitive Barriers: home accessibility

-Rehab Barriers: will they benefit from aggressive therapy? Can they handle 3hrs/day?

Front 16

LIST COMPONENTS OF PT SYSTEMS REVIEW

Back 16

CARDIOPULMONARY, INTEGUMENTARY, MUSCULOSKELETAL, NEUROMUSCULAR

Front 17

LIST IMPORTANT CATEGORIES OF TESTS AND MEASURES FOR A CARDIOPULM PT.

Back 17

-AEROBIC CAPACITY/ENDURANCE
-CIRCULATION
-CHEST WALL MOBILITY
-VENTILATION/RESPIRATION
-PAIN

Front 18

LIST ALL 8 CATEGORIES OF DIAGNOSES OF CV/P PER THE GUIDE.

Back 18

1. Prevention/Risk Reduction CV/P disorders.

2. Impaired aerobic capacity/end due to deconditioning.

3. Impaired ventilation...airway clearance dysfunction.

4. Impaired aerobic capacity/end...CV pump dysfunction

5. Impaired ventilation...vent pump or failure.

6. Impaired ventilation...respiratory failure.

7. Impaired ventilation....neonate.

8. Impaired circulation...a/w lymph dysfunction.

Front 19

LIST COMMON GOALS FOR CARDIOPULM PT.

Back 19

-Pt employs effective use of breathing strategies.

-Pt mobilizes and clears secretions w/ each visit to decrease the work of breathing and symptoms.

-Pt is independent with HEP, aerobic training, posture/flexibility program, airway clearance program

-Pt will demonstrate improvement in social/leisure activities.

-Pulmonary function _____ will be improved by _____.

Front 20

LIST COMMON INTERVENTIONS FOR CARDIOVASCULAR AND PULMONARY PATIENTS.

Back 20

-Bronchopulmonary hygiene or airway clearance.
-Breathing strategies
-Respiratory muscle training
-Exercise Capacity Training
-Posture/Strength/Flexibility Training
-Instruction on HEP

Front 21

WHAT ARE NORMAL BLOOD GASES?

Back 21

PO2 = 70-100mmHg
PCO2= 35-45 mmHg
pH = 7.35-7.45
BiCarb (HCO3)= 21-28
SaO2 = 95%-100%

Front 22

WHAT IS THE DIFFERENCE BETWEEN RESPIRATORY AND METABOLIC ACIDOSIS?

Back 22

Respiratory Acidosis is a problem with CO2 causing the pH change.

Metabolic Acidosis is a problem with Bicarb causing the pH change.

Front 23

AT WHAT LEVEL OF FiO2 WOULD A Pt HAVE TO BE ON A MECHANICAL VENTILATOR?

Back 23

30-40%

Front 24

WHEN DOES A Pt QUALIFY FOR SUPPLEMENTAL OXYGEN?

Back 24

-If PaO2 is >55mmHg, and SaO2 is >88% OR if pt. has:
-Peripheral edema secondary to CHF
-Cor Pulmonale/ Pulm HTN

Front 25

WHAT ARE NORMS FOR SATURATION AND PaO2 LEVELS?

Back 25

97% Saturation = 97 PaO2 (normal)

90% Saturation = 60 PaO2 (caution/danger)

80% saturation = 45 PaO2 (severe hypoxia)

Front 26

WHAT IS NORMAL TIDAL VOLUME AND VITAL CAPACITY?

Back 26

Tidal Volume= 500mL or 5L - amt of air breathed in or out during normal ventilation

Vital Capacity: 4.8L Amt of O2 you can forcefully breathe out after maximal inspiration.

Front 27

WHY DO WE WANT TO MEASURE FVC?

Back 27

-To see if the pt has a restrictive disease

Front 28

WHY DO WE WANT TO MEASURE FEV1?

Back 28

-To see if pt has obstructive disease, can they exhale out 80% of vital capacity?

Front 29

WHY MEASURE PEFR?

Back 29

measure how FAST you can forcefully expire.

Front 30

WHY MEASURE MIP?

Back 30

measure how strong/pressure you can exert against a resistance.

Front 31

5 STEPS FOR DETERMINING PFTs.

Back 31

1. Determine if pts FVC is within normal limits.
2. Determine if FEV1 is within normal limits. (should be 80% of FVC)
3. If both normal, PFTs are normal and done.
4. If FEV1 and/or FVC is low, presence of disease is likely,
5. If disease, go to % Predicted for FEV1/FVC.

If % Predicted for FEV1/FVC is 88-90% or higher, it's a RESTRICTIVE disease.

If % Predicted for FEV1/FVC is 69% or lower, it's an OBSTRUCTIVE disease.

Front 32

LOW FEV1 SHOWS...

Back 32

OBSTRUCTIVE DISEASE

Front 33

LOW FVC TENDS TO SHOW...

Back 33

RESTRICTIVE DISEASE

Front 34

WHAT ARE THE RANGES FOR SEVERITY OF DISEASE IF FEV1 IS LOW?

Back 34

MILD 70-79% of predicted
MOD 60-69% of predicted
MOD-SEV 50-59% of predicted
SEVERE 35-49% of predicted
V. SEVERE below 35% of predicted

Front 35

MVV=

Back 35

FEV1 x 35

Front 36

WHAT ARE SOME EFFECTS OF AGE ON STROKE VOLUME AND EJECTION FRACTION WITH EXERCISE?

Back 36

Stroke Volume- Reduced 15%-25% from age 20 to age 80


Ejection Fraction- Reduced 15% from age 20 to age 80

Front 37

WHAT IS THE ONE VALUE THAT INCREASES WITH AGE AND MAX UPRIGHT EXERCISE BY 150%?

Back 37

LV end diastolic volume

Front 38

HOW DOES REGULATION OF RESPIRATION CHANGE WITH AGE?

Back 38

Ventilatory response to hypercapnia (decreased CO2) and hypoxia (decreased oxygen) decrease with age

Decreased ability to protect airway (at risk for asiprating/pneumonia, glottis doesn't close as well so can't cough as well. Have pt eat food in head flexed position).