Pta Boards Cardiopulmonary 001

Front 1

ABG (norms)

pH (acid base)

PaCO2 (ventilation co2 pressure)

PaO2 (oxygenation of arterial blood)

HCO3

SaO2 (oxygen saturation of hemoglobin )

Back 1

7.4 (7.35-7.45)

40 mmHg (35-45 mmhg)

97 mmHg (80-100 mmhg)

24 mEq/L (22-26)

95-98%

Front 2

hematocrit

percentage of red blood cells in total blood volume

low, anemic, blood loss, vitamin or mineral deficiency

high, dehydration, or polcythemia

Back 2

adult males 0.338-0.464

adult females 0.354-0.444

Front 3

LDL cholesterol

opt

borderline

high

Back 3

100 mg/dL

130 -159 mg/dL

160-189 mg/dL

Front 4

HDL cholesterol

low

high

Back 4

<40 mg/dL

> 60 mg/dL

Front 5

partial throboplastin time PTT

prothrombin time PT

Back 5

test how quick blood clots

Front 6

anticoagulant agents

action

Back 6

inhibit platelet aggregation and thrombus formation

Front 7

anticoagulant agent indication

Back 7

▪post percutaneous transluminal coronary angioplasty andcoronary artery bypass graft ,

surgery;

▪prevention of venous thromboembolism and cardioembolic events

▪in patients with atrial fibrillation and prosthetic heart valves

Front 8

anticoagulant agents

side effects

Back 8

hemorrhage, increased risk of bleeding, gastrointestinal distress (oral medication only)

Front 9

antihyperlipidemia agents

action

indications

Back 9

▪Action: the most commonly used, the statins, inhibit enzyme action in cholesterol synthesis, break down low-density lipoproteins, decrease triglyceride levels, and increase high-density lipoprotein levels

▪Indications: hyperlipidemia; atherosclerosisi prevention of coronary events in patients with existing coronary disease, diabetes or peripheral vascular disease

▪Side effects: headache, gastrointestinal distress, myalgia, rash

Front 10

anti hyperlipidemia agents

side effects

Back 10

headache, gastrointestinal distress, myalgia, rash

Front 11

beta blocker agents

Back 11

▪Action: decrease myocardial oxygen demand by decreasing heart rate and contractility by blocking beta-adrenergic receptors

Indications: hypertension, angina; arrhythmias heart failure; migraines essential tremor

Side effects: bradycardia, arrhythmias, fatigue, depression, dizziness, weakness, blurred vision

Front 12

calcium channel blocker agent

Back 12

▪Action: decrease the entry of calcium into vascular smooth muscle cells resulting in diminished myocardial contraction, vasodilation, and decreased oxygen demand of the heart

Indications: hypertension; anginai arrhythmias; congestive heart failure

Side effects: dizziness, headache, hypotension, peripheral edema

Front 13

dietetic agent

Back 13

Action: decrease blood pressure by increasing the excretion of sodium and urine

Indications: hypertensioni edema associated with heart failures pulmonary edema; glaucoma

Side effects: dehydration, hypotension, electrolyte imbalances, polyuria, increased low density lipoproteins, arrhythmias

Front 14

Nitrate Agents

Back 14

Action: decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels

Indications: angina

Side effects: headache, dizziness, orthostatic hypotension, reflex tachycardia, nausea, vomiting

Front 15

Positive inotropic agents

Back 15

Action: increase myocardial contraction force and velocity, decrease the heart rate, decrease conduction velocity through the AV node, and decrease activation of the sympathetic nervous system

Indications: heart failure: atrial fibrillation

Side effects: arrhythmias, gastrointestinal distress, dizziness, blurred vision

Front 16

Thronbolytic Agents

Back 16

Action: dissolve clots through conversion of plasminogen to plasmin

Indications: acute myocardial infarctio, pulmonary embolism, ischemic stroke; arterial or venous thrombosis

Side effects: hemorrhage (specifically intracranial), allergic reaction, arrhythmias

Front 17

antihistamine agents

Back 17

Action: block the effects of histamine resulting in a decrease in nasal congestion, mucosal irritation, and symptoms of the common cold, sinusitis, conjunctivitis, and allergies

Indications: respiratory seasonal allergies; rhinitis and sneezing from the common cold; allergic conjunctivitis; motion sickness; Parkinson's disease

Side elects.: arrhythmias, orthostatic hypotension, gastrointestinal distress,dizziness, drowsiness, headache, blurred vision, fatigue; nausea, thickening of bronchial secretions

Front 18

anti inflammatory agents

Back 18

Action: prevent inflammatory-mediated bronchoconstriction by inhibiting production of inflammatory cells, suppressing release of inflammatory mediators, and reversing capillary permeability

Indications: bronchospasm, asthma

Side effects: Corticosteroids: damage of supporting tissues, skin breakdown, osteoporosis, decreased bone density, glaucoma, delayed growth, nasal irritation and dryness, sneezing, bloody mucus; Leukotriene modifiers: liver dysfunction; Mast-cell stabilizers: bronchospasm, throat and nasal irritation, cough, gastrointestinal distress

Front 19

Bronchodilator Agents

Back 19

Action: relieve bronchospasm by stimulating receptors responsible for bronchial smooth muscle relaxation or blocking receptors responsible for bronchoconstriction

Indications: bronchospasm, wheezing, and shortness of breath in asthma and COPD

Side effects: paradoxical bronchospasm, dry mouth, gastrointestinal distress, chest pain palpitations, tremor, nervousness, increased risk of asthma-related death (long-acting sympathomimetics only)

Front 20

Mucolytic agents

Back 20

Action: decrease the viscosity of mucus secretions by altering theircomposition and consistency

Indications: viscous mucus secretions due to pneumonia, emphysema, chronic bronchitis, and cystic fibrosis

Side effects: pharyngitis, oral mucosa inflammation, rhinitis, chest pain

Front 21

ABI

ankle brachial index

Back 21

compares systolic blood pressure at ankle and arm to check peripheral artery disease

Front 22

abi results

Back 22

>1.3 ridged arteries need ultrasound to test

1.0-1.30 normal

.8-.99 mild blockage(begin PAD)

.4-.79 moderate blockage (intermittent claudication during exercise)

<.4 severe blockage/PAD may have claudication pain at rest

Front 23

BP

hypertension values

Back 23

norm <120/<80 mmHg

elevated 120-129/<80 mmHg

stage 1 130-139/80-89 mmHg

stage 2 at least 140/at least 90 mmHg

htn crisis >180/>120 mmHg

Front 24

heart sounds

S1

S2

S3

S4

Back 24

(lub) closure of the mitral and tricuspid (atrioventricular) valves at the onset of ventricular systole

(dub) closure of the aortic and pulmonic (semilunar) valves at the onset of ventricular diastole.

3rd heart sound - vibrations of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole,

4th. heart sound.- pathological sound of vibration of the ventricular wall with ventricular filling and atrial contraction.

Front 25

heart murmurs

Back 25

are vibrations of longer duration than the heart sounds and are often due to disruption of blood flow past a stenotic or regurgitant valve; the sounds are variably described as soft, blowing or swishing

When the leaflets of the heart valves are thickened, the forward flow of blood is restricted; when the leaflets lose competency and fail to close tightly blood can flow backwards (regurgitation)

Front 26

abnormal breathing sounds

crackle (rales)

Back 26

an abnormal discontinuous high pitched popping sound heard more during inspiration may be associated with restrictive or obstructive respiratory disorders

p140

Front 27

rating of percieved exertion

original

Back 27

7 very very light

9 very light

11 fairly light

13 somewhat hard

15 hard

17 very hard

19 very very hard

Front 28

RPE revised scale

Back 28

0 nothing

.5 very very weak

1 very weak

2 weak

3 moderate

4 somewhere strong

5 strong

7 very strong

10 very very strong

Front 29

RPE interpretation

Back 29

13-14 rep 70% max heart rate on TM UBE

11-13 upper limit of prescribed HR for cardiac rehab

sub for HR when:

▪Ability to monitor HR is compromised (e.g. sensory deficits)

▪Patients begin an exercise based rehabilitation program without a preliminary exercise test

▪The HR' response to exercise is altered (e.g., cardiac transplant) Physical activities other than cardiorespiratory endurance activity are assessed

▪Clinical status or medical therapy changes

Front 30

respirator rate norms

newborn

1yo

10yo

adult

Back 30

33-45 breaths per min

25-35

15-20

12-20

respiratory rhythm

norm inspiration 1/2 as long as expiration 1:2

COPD longer expiration 1:3,1:4

Front 31

aerobic exercise

Precautions/Contra

Back 31

Appropriate screening or health appraisal should be performed prior to beginning exercise to identify known diseases, risk factors for coronary artery disease and other factors that will optimize adherence, minimize risk, and maximize benefits

Avoid Valsalva maneuver.

Front 32

aerobic target HR

Back 32

lower = HRmax x .55

upper = HRmax x .90

Front 33

normal cardio respiratory response to acute aerobic exercise

Back 33

Increased oxygen consumption due to increased cardiac output, increased blood flow, and oxygen utilization in the exercising skeletal muscles.

▪Linear increase in SBP with increasing workload (8 to 12 mmHg per MET)

▪No change or moderate decrease in DBP

▪Increased respiratory rate and tidal volume.

Front 34

airway clearance

indications

Back 34

▪Retained secretions in the central airways

▪Prophylaxis against postoperative pulmonary complications

▪Obtain sputum for diagnostic analysis

▪Difficulty clearing secretions

▪Atelectasis caused by or suspected of being caused by mucus plugging

Front 35

airway clearance

Precautions/Contraindications

Back 35

▪Intracranial pressure >20 mmHg

▪Head and neck injury until stabilized

▪Active hemorrhage with hemodynamic instability

▪Recent spinal surgery (e.g., laminectomy) or acute spinal injury

▪Active hemoptysis

▪Empyema, bronchopleural fistula

▪Pulmonary edema associated with congestive heart failure

▪Large pleural effusion, pulmonary embolism

▪Rib fracture with or without flail chest

▪Surgical wound or healing tissue

Front 36

postural drainage positions

Back 36

Apical segments right and left upper lobes: The patient is in a sitting position, leaning back 30-40 degrees

Posterior segment left upper lobe: The patient is turned 1/4 from prone on the right side with the head of the bed elevated 45 degrees and the head and shoulders raised on a pillow.

anterior segment R and L upper lobes:

pt supine bed horizontal

p148 149

Front 37

angina pectoris

Back 37

▪Results from diminished myocardial perfusion, most commonly caused by narrowing of one or more of the coronary arteries (e.g" due to embolism, atherosclerosis, inflammation)

▪Described as an uncomfortable or painful feeling of tightness, pressure, fullness or squeezing in the center of the chest

▪Medical management varies greatly with symptom severity and type stable versus unstable), focusing primarily on the underlying pathology

Front 38

Chronic Venous Insufficiency

Back 38

▪Typically affects the distal lower extremities and is characterized by venous incompetence and resultant venous hypertension

▪Symptoms including edema, feelings of heaviness, and dull, aching pain in the distal lower extremities, though itching and tingling sensations may also occur

▪Symptoms generally improve and may resolve fully with elevation, however, reappear once dependent positioning is resumed

Front 39

Congestive Heart Failure (CHF)

Back 39

▪Common etiologies contributing to CHF include:

arrhythmia, pulmonary embolism, hypertension, valvular heart disease, myocarditis, unstable angina, renal failure, and severe anemia

▪Left-sided heart failure is generally associated with signs of pulmonary venous congestion; right-sided heart failure is associated with signs of systemic venous congestion

▪Diminished cardiac output causes compensatory changes including increases in blood volume, cardiac filling pressure, heart rate, and cardiac muscle mass

Front 40

Coronary artery disease

Back 40

▪Occurs as a result of atherosclerotic plaque buildup within the coronary arteries; develops slowly, often going unnoticed for years before producing symptoms

▪Risk factors include hypertension, diabetes, obesity, chronic kidney disease, elevated cholesterol and triglyceride levels, and a family history of the condition

▪Cardiac rehabilitation is recommended and upon completion, the patient should possess self-management skills associated with symptom recognition and reduction of risk factors

Front 41

Cor pulmonale

Back 41

▪Occurs when the right ventricle is unable to effectively pump blood due to the prolonged presence of pulmonary hypertension and increased right ventricular afterload

▪Initially, symptoms are primarily associated with the underlying pulmonary pathology; as the condition advances, spymptoms may include peripheral pitting edema and jugular vein distention

▪Most commonly diagnosed by means of clinical findings, medical history, echocardiogram, laboratory tests, chest x-ray, and electrocardiography

Front 42

cystic fibrosis

Back 42

▪Causes the exocrine glands to overproduce thick mucus which causes subsequent obstruction

▪Autosomal recessive genetic disorder (both parents are carriers of the defective gene) located on the long arm of chromosome seven

▪The most common cause of death is respiratory failure

Front 43

emphysema

Back 43

▪Results, from a long history of chronic bronchitis, recurrent alveolar inflammation or from genetic predisposition of a congenital alpha I :antitrypsin deficiency

▪Clinical presentation may include barrel chest appearance, increased subcostal angle, rounded shoulders secondary to tight pectorals, and rosy skin coloring

▪Symptoms of emphysema worsen with the progression of the disease and include a persistent cough, wheezing, difficulty breathing especially with expiration, and an increased respiration rate

Front 44

Hypertension

Back 44

▪A condition in which blood pressure is persistently elevated; measured as systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg

▪Symptoms may not be recognized until blood pressure becomes dangerously high producing a headache confusion, visual changes, fatigue, arrhythmia or tinnitus

▪Medical management is largely focused on risk reduction through modifiable risk factors and pharmacological intervention

Front 45

Myocardial infarction

Back 45

▪occurs when there is poor coronary Artery perfusion, ischemia and subsequent necrosis of the cardiac tissue usually due to thrombus, arterial blockage or atherosclerosis

▪Risk factors include patient or family history of heart disease, smoking, physical inactivity, stress, hypertension, elevated cholesterol, diabetes mellitus, and obesity

▪Clinical presentation may include deep pain or pressure in the substernal area with or without pain radiating to the jaw, the left arm or the back

Front 46

peripheral vascular disease

Back 46

▪Characterized by narrowing of the lumen of blood vessels causing a reduction circulation usually secondary to atherosclerosis

▪Risk factors include phlebitis, injury or surgery, autoimmune disease, diabetes mellitus, smoking, hyperlipidiemia, inactivity, hypertension, positive family history, increased age, and obesity

▪Patient education is paramount regarding the disease process, limb protection, foot and skin.care, and Risk factor reduction (smoking cessation, avoid cold exposure)

Front 47

Pulmonary Embolism

Back 47

▪Occurs most commonly as a result of venous thrombi that have detached and traveled from elsewhere in the body before lodging in a pulmonary artery

▪Symptoms include a sudden onset of dyspnea, coughing, hypoxia, and chest pain which may mimic myocardial infarction

▪Pulmonary angiogram is the most conclusive means of identifying, however, complication risks are high and so it is used only when other diagnostic methods are inconclusive

Front 48

restrictive lung disease

Back 48

▪Classification of disorders caused by a pulmonary or extrapulmonary restriction that produces impairment in lung expansion and an abnormal reduction in pulmonary ventilation

▪Pulmonary restriction of the lungs can be caused by tumor, interstitial pulmonary fibrosis, scarring within the lungs, pleural effusion, chest wall stiffness, structural abnormality, and respiratory muscle weakness

▪Pathogenesis includes a decrease in lung and chest wall compliance, decrease in lung volumes, and an increase in the work of breathing