Cardiopulmonary & Lymph

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Cardiopulmonary & Lymph
2012-12-29 20:35:11
Boards Review

Cardiopulmonary & Lymph
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  1. Different parts of the heart
    • apex: lowest part of the heart
    • base: upper part of the heart
    • endocardium: lines interior of heart chamber
    • epicardium: contains coronary arteries and veins, autonmic nerves, lymphatics
    • myocardium: contractile middle layer forming heart wall
    • pericardium: connective tissue sac surrounding outside of heart & vessels
  2. Flow of blood through hearts
    inferior vena cava (lower body & viscera) & superior vena cava (head, neck, & arms) --> right ventricle -->tricuspid valve --> right atrium --> pulmonary valve --> pulmonary artery --> lungs --> pulmonary vein --> left ventricle --> mitral valve --> left atrium --> aortic valve --> give da body some blood
  3. Heart Picture
  4. Cardiac conduction & innervation system
    • SA node: normal pacemaker of heart
    • AV node: back up pacemaker
    • AV merges with bundle of His¬† and then terminate in purkinge fibers which then spreadys impulse throughout the ventricles so they contract together
    • Sympathetic influence: epinephrine & norepinephrine make heart beat FASTER and STRONGER
    • Parasympathetic influence: acetylcholine from vagus nerve SLOW heart rate through influence on SA node
  5. Cardiac Cycle Terms
    (atrial/ventricular systole/diastole, preload, afterload, SV, CO, venous return)
    • atrial systole: R and L atria pushing blood into ventricles
    • atrial diastole: between atrial contraction- atria repolarization
    • ventricular systole: contraction of right & left ventricle pushing blood into pulm. arteries & aorta
    • ventricular diastole: period between ventricular contractions- ventricular repolarization
    • preload: tension in ventricular wall at end of diastole
    • afterload: forces impeding flow of blood out of heart
    • stroke volume: volume of blood ejected by each contraction of L ventricle
    • cardiac output: amount of blood pumped from L or R ventricle per minute (SV x HR)
    • ejection fraction: % of blood emptied from ventricle during systole, normal EF is 60-70%
    • venous return: amount of blood returning to R atrium each minute
  6. Components of blood
    • plasma: liquid component of blood (water, electrolytes and protein), helps regulate blood pressure & temp
    • red blood cells: 40% blood volume, contain hemoglobin, enables O2 to bind to blood, anemia = too low, polycythemia = too high and blood is too thick
    • blood platelets (thrombocytes): assist in blood clotting, thrombocytopenia = too low increasing risk for bruising, thrombocythemia = too high and increase risk for thrombosis
    • white blood cells: protect aainst infection
  7. Muscles of Inspiration
    • Primary muscle: diaphragm- chest expansds longitudinally & lower ribs elevate
    • internal & external intercostals: muscles elevate the ribs
    • Accessory muscles: SCM, scalenes, pec major & minor, serratus anterior
  8. Muscles of Expiration
    • passive recoil
    • forceful breathing: rectus abdominis, internal/external oblique, transverse abdominis
  9. Right Lung Lobes
    • Upper: apical, anterior, posterior
    • Middle: medial and lateral
    • Lower: superior, medial basal, anterior basal, lateral basal, posterior basal
  10. Left Lung Lobes
    • Upper: superior (anterior segmental & apicoposterior segment) and inferior (lingular- superior & inferior))
    • Lower: superior, lateral basal, posterior basal, anteromedial basal
  11. Lung Volumes (graph)
  12. Aneurysm
    • abnormal dialation of blood vessel (thoracic or abdominal aorta or brain)
    • cause: weakness of wall of vessel (chronic hypertension) or connective tissue disease (marfans), or trauma
    • S/S: pulsations near navel for AAA, cerebral aneurysm has stiff neck, N/V, diploplia
    • treatment: antihypertensive meds
  13. Angina Pectoris
    • stable angina: predictable level of exertion, responds to rest or nitro
    • unstable angina: lasts longer, precipitated by less exertion, occurs spontaneously at rest, is progressive
    • prinzmetal (variant) angina: occurs with coronary artery spasms
    • S/S of angina: presure, heaviness, fullness, burning/aching behind sternum, pain in neck/back/jaw/shoulder, difficulty breathing
    • acute treatment: supplemental nitro (up to 3 every 5 minutes), rest, oxygen
    • chronic treatment: long acting nitrates, beta blockers, calcium channel blockers
  14. Atherosclerosis
    • progressive accumulation of fatty plaques on inner walls of arteries
    • cause: HTN, high cholesterol, smoking, DM
    • S/S: angina may occur, numbness/weakness of arms, slurred speech
    • treatment: lifestyle changes, surgery, exercises, diet, stress management
  15. Cardiomyopathy
    • group of conditions impairing the ability of the heart to contract and relax
    • S/S: breathlessness, leg/feet swelling, abdominal bloating, dizzy, lightheadedness
    • types: dilated, hypertrophic, restrictive)
  16. Chronic Venous Insufficiency
    • veins and valves in the LE are damaged and can't keep blood flowing back to heart, so veins remain filled with blood
    • cause: damaged valves inside the veins
    • S/S: leg swelling, varicose veins, cramping, itching
    • treatment: compression stockings (30-40 mmHg) & leg elevation
  17. Congenital Heart Defects
    • Atrial septal defect: hole in the wall of the heart seperating the R and L atria
    • Coarctation of the aorta: aorta narrowed near ductus arteriosus, usually have surgical repair
    • Patent ductus arteriosus: area that shunts blood from pulm. artery to descending aorta in utero does not close after birth
    • Ventricular septal defect: hole in the septum separating the R and L ventricles
    • Tetralogy of Fallot: 4 heart defects (ventricular septal defect, pulmonary stenosis, R ventricular hypertrophy, aorta overriding the ventricular septal defect
  18. Cor Pulmonale
    • pulmonary heart disease: hypertrophy of the R ventricle (R sided heart failure)
    • fatigue, palpitations, chest pain, LE swelling, dizziness, syncope
    • maintain SaO2> 90% and PaO2 >60 mmHg, use diuretics and anticoagulation
  19. Coronary Artery Disease
    • narrowing or blockage of the coronary arteries due to plaue from causing diminished blood flow
    • cause: damage to inner wall of coronary artery so plaque accumulates there then if that rupture platelets will clump there and block artery causing heart attach
    • risk factors: high LDL >130, low HDL <40, type 2 DM, smoking, inactivity, BMI >30, age (men >45, women >55)
    • S/S: angina, SOB, sometimes can't tell until 70% blocked
    • treatment: antiplatelet agents, ACE inhibitors, angiotensins II receptor blockers, statins
  20. Deep Vein Thrombosis
    • blood clot forms in deep veins
    • can break loose causing pulmonary embolism
    • S/S: pain, redness, warmth
    • treatment: anti-coagulants, thrombolytic agents, filts in the vena cava
  21. Endocarditis
    • inflammation of endothelium lining the heart & cardiac valves
    • causes: bacteria entering blood through needles, dental work, STD, IBS
    • S/S: fever, chills, heart murmur, fatigue, SOB, weight loss, blood in urine, skin petechiae
  22. Heart Failure
    • heart cannot maintain a normal CO to meet the body's demands for blood and O2, ventricles weak and can no longer pump because of excessive dialation
    • S/S: shortness of breath, fatigue, S3 heart sound
    • treatment: anticoagulants, antiHTNs, digitalis to increase strength of contraction
  23. Heart Sounds
    • aortic valve: 2nd R intercostal at sternal border
    • pulmonic valve: 2nd L intercostal space at sternal border
    • tricuspid valve: 4th L intercostal space at sternal border
    • mitral valve: 5th L intercostal space at midclavical area
    • S1: lub, closure of mitral and tricuspic, end of diastole
    • S2: dub, closure of aortic and pulmonary, end of systole
    • S3: ventricular gallop, normal in young kids- not in adults, associated with heart failure
    • S4: atrial gallop, vibration of ventricular walls with filling & atrial contraction, happens with HTN, stenosis, MI
  24. Hypertension
    • Normal < 120/80
    • Prehypertensize¬† 120-139/80-89
    • Stage 1 hyper¬† 140-159/90-99
    • Stage 2 hyper >160/100
    • S/S: S4 heart sound early sign, cardiovascular symptoms, renal involvement
  25. Lymphedema
    • Accumulation of lymph in extremities
    • S/S: swelling with restricted motion of UEs and LEs, aching, heaviness, brawny, fibrous, non-pitting edema
    • treatment: reduce swelling, control pain, gentle active exercises, bandages, massage, compression (20-30 mmHg)
  26. Myocardial Infarction
    • S/S: pressure, squeezing, pain, SOB, upper body discomfort, shoulder/neck/back/jaw pain, N/V, palpitations
    • chest pain most common S/S
  27. Myocarditis
    • inflammation and weakness of the myocardium
    • can lead to heart failure
    • S/S: arrhythmia, chest pain, SOB, faitgue, fever
  28. Pericarditis
    • inflammation of pericardium of heart
    • as that becomes inflammed it increased the fluid between the two layers leading to pericardial effusion
    • cardiac tamponade: complication that can occur that creates pressure on the heart from excessive fluid in pericardium that prevents the heart from properly filling with blood
  29. Peripheral Arterial Disease
    • stenotic, occlusive, aneurysmal diseases of the aorta & peripheral arteries
    • causes: artherosclerosis & thromboembolic processees
    • S/S: fatigue, numbness/pain in butt/thigh/calf/foot, poorly healing wounds of LEs, distal hair loss
  30. Rheumatic Fever
    • complication from poorly treated strep throat- streptococcus
    • damages heart valves- causing heart failure
  31. Vavlular Heart Disease
    heart valve damaged causing regurgitation or stenosis of blood flow, blood leaks backward through damaged valve
  32. Acute Respiratory Distress Syndrome (ARDS)
    • sudden respiratory failure due to fluid accumulation in alveoli
    • fatal to 25-40% that get it, usually effects critically ill
    • fluid leaking from smallest blood vessels in the lungs into the alveoli
    • get oxygen into the lungs- first goal of treatment
  33. Asthma
    • chronic inflammation of airways caused increased hypersensitivity to various stimuli
    • S/S: wheezing, chest tightness, slight SOB
    • obstructive disease
    • increased respiratory rate & minute ventilation
    • PFTs show impaired flow rates
  34. Atelectasis
    • one or more lungs collapse or do not inflate properly
    • decreased breath sounds, SOB, increased breathing rate and HR
    • work on deep breathing, changing positions and airway clearance
  35. bronchial carcinoma
    • any epithelial carcinoma occuring in brochopulmonary tree
    • smoking is primary cause
    • S/S: new cough or changes in chronic cough, SOB, wheezing, weight loss, bone pain
  36. Bronchiectasis
    • progressive/irreversible obstructive lung disease producing abnormal dilation of bronchus from weakened bronchial walls
    • S/S: consistent productive cough, hemoptysis, weight loss, anemia, crackles, wheezing, loud breath sounds
    • excessive sputum production
  37. Bronchitis
    • inflammation of the bronchi characterized by hypertrophy of mucus secreting glands & insufficient oxygenation from mucus blocking
    • smoking is main cause of chronic bronchitis
    • treatment: warm/moist air, cough suppressants, acetaminophen/asprin
  38. COPD
    • bronchial tree is narrowed causing decreased airflow
    • emyphsema and chronic bronchitis are two main conditions
    • excessive mucus production, chronic cough, wheezing, SOB, fatigue, reduced exercise capacity
    • treatment: bronchodilators, inhaled steroids, oxygen, antibiotics
    • decreased FEV1, decreased FVC, increased FRC and RV
  39. Cystic Fibrosis
    • autosomal recessive disease of exocrine glands affecting lungs, pancreas, liver, intestines, sinuses, and sex organs
    • excessive amounts of thick, sticky mucus
    • salty tasting skin, persistent coughing, frequent lung infections, wheezing SOB, poor growth/weight gain
  40. Emphysema
    • alveolar walls destroyed and alveoli turned into large, irregular pockets with gaping holes
    • elacstic fibers are destroyed so bronchioles cannot be help open so they collapse during exhalation causing permanently overinflated alveoli and dead space increased
    • S/S: SOB, wheezing, chronic coughing, orthopnea, barral chest, increased use of accessory muscle, increased RR, fatiuge
  41. Pleural Effusion
    • Build up of fluid in pleural space which can push against the lung and make it hard to breathe
    • caused by viral infection, pneumonia, PE, autoimmune disease
    • decreased breath sounds over effusion
    • mediastinal shift away from large effusion
  42. Pneumonia
    • inflammation of the lungs
    • S/S: fever, cough, SOB, sweating, shaking, chills, chest pain fluctuating / breathing, headache, muscle pain, fatigue
  43. Pulmonary Edema
    • fluid collects in the alveoli within the lungs making it hard to breathe
    • feeling of suffocating or drowning, wheezing/gasping, anxiety, restlestness, coughing, frothy-blood tinged sputum, rapid irregular pulse, severe drop in BP
  44. Pulmonary Embolism
    • one or more arteries in the lungs becomes blocked
    • S/S: sudden SOB, coughing up bloody or blood streaked sputum, cyanosis
  45. Pulmonary Fibrosis
    • microscopic damage (irreversible) to alveoli causes irreversible scarring of interstital tissue
    • normally tissue is very elastic but the scarring makes it very stiff and thick so breathing is difficult
    • S/S: SOB during or after physical activity, dry cough, fatigue, unexplained weight loss, crackles, clubbing, cyanosis
    • PFT= reduction in vital capacity, functional residual capactity, and total lung capacity
    • treatment: corticosteroids and immunosuppresive agents
  46. Restricitve Lung Dysfunction
    • abnormal reduction in lung expansion and pulmonary ventilation
    • S/S: dyspnea on exertion persistent, non-productive cough, increased RR, hypoxemia, abnormal breath sounds, decreased vital capacity
  47. Arterial Blood Gas Values
    • pH: 7.4 (7.35-7.45)
    • PaCO2: 40 mmHg (35-45)
    • PaO2: 97 mmHg (80-100) (<55mmHg need supplemental O2)
    • HCO3: 24 mEq/L (22-26)
    • SaO2: 95-98% (<88% need supplemental O2)
  48. Cardiac Biomarkers
    • Creatine phophokinase: appears in blood 4 hours after infarction, peaks at 12-24 hrs, and declines over 48-72 hours
    • cardiac troponin-l: remains elevated for 5-7 days
  49. Acidosis/alkalosis
    • Respiratory Acidosis: PaCO2 > 45mmHg, pH <7.40
    • Respiratory Alkalosis: PaCO2 <35mmHg, pH >7.40
    • Metabolic Acidosis: HCO3 <22, pH <7.40
    • Metabolic Alkalosis: HCO3 >26, pH >7/40
  50. Hematology Values
    • PTT: 26.3-39.4 seconds
    • Hemoglobin: 12-16 (<8 exercise contraindicated)
    • INR: 1-2
    • Total cholesterol: <200
    • LDL Cholesterol: <100
    • HDL Cholesterol: 40-60
    • Triglyceride: <150
  51. Heart/Lung Diagnostic Procedures
    • Angiography: examination of blood vessels injected with contrast, shows plaque in coronary arteries
    • Bronchoscopy: direct visualization of bronchial tree, identifying tumors, bronchitis, and bleeding
    • Cardiac Catheterization: catheter inserted into leg or arm with contrast dye showing narrowing or occlusion
    • Carotid US: sound waves examine & visualize the structure & function of carotid artereies
    • Chest Radiograph: visualizes location, shape/size of heart, lungs, blood vessels, ribs
    • CT Scan: x-ray machine creating a picture of organ & surrounding structures
    • Echocardiography: high frequency sound waves (non-invasive) evaluate the function of the heart
    • Electrophysiologic Testing: evaluates rhythm or electrical conduction abnormalities of the heart using catheters threaded through the heart
    • Fluoroscopy: continuous X-ray showing heart and lungs, gives high does of radiation, replace with echo
    • Invasive Hemodynamic Monitoring: intraarterial catheters & IV lines measure pressure, volume and temp (Swan Ganz measure pulm. artery pressure and left atrial pressure)
    • MRI: 3D images of heart & blood vessels to assess size and function of chambers
    • Myocardial Perfusion Imaging: redionuclide stress test shows how the heart muscle is perfused at rest and under exercise stress, shows reduced blood supply
    • Pharmacologic Stress Test: cardiovascular stress test induced by medications
    • Phonocardiography: graphic record of sounds produced by heart and vessels
    • Pleuroscopy: examines lungs surfaces, pleura, and pleural space
    • Positron Emission Tomography: small amount of radiogractive material is injected, inhaled or swallowd, and evaluates heart disease and cancer
    • Thoracentesis: removes fluid from pleural space
    • Venography: radiopaque dye injected in vein to detect clot or bloackage
    • Ventilation-Perfusion Scan: radioactive material to study airflow and blood flow within the lungs, diagnose pulmonary embolism
  52. Pharmacological Management of Heart and Vascular Disease
    *denotes precaution
    • Alpha adrenergic antagonist agents: reduce peripheral vascular tone, causing dilation, indicated for HTN, *orthostatic hypotension*
    • ACE inhibitor: decrease blood pressure and afterload, indicated for HTN & CHF, *postural hypotension*
    • Angiotensin II Receptor Antagonist: limits vasoconstriction & stimulation of vascular tissue, indicated for HTN and CHF
    • Antiarrhythmic Agents: sodium channel blockers, beta blockers, potassium blockers, calcium channel blockers, indicated for arrhythmias
    • Anitcoagulatn Agents: inhibit platelet aggregation and thrombus formation, *increased risk of bleeding*
    • Antihyperlipidemia agents: beark down LDL, decrease triglycerides and increase HDL, indicated for hyperlipidemia, atherosclerosis, *headache, GI issues*
    • Antithrombotic Agents: inhibit platelet aggregation and clot formation
    • Beta blocker Agents: decrease myocardial oxygen demand by decreased HR and contractility, indications for HTN/angina/arrhythmias/HF, *HR and BP response diminished*
    • Calcium Channel Blocker: decrease myocardial contraction, vasodialation & decreased O2 demand on heart, indicated for HTN/angina/arrhythmia/CHF, *HR and BP response diminished*
    • Diuretic Agents: reduces plasma volume decreasing BP; indicated for HTN/HF edema/pulm. edema, *electrolyte imbalance*
    • Nitrate Agents: decrease ischemia through dialation of peripheral vessels, indicated for angina, *orthostatic hypotension*
    • Positive Inotropic Agents: increase heart contraction & slow HR, indicated for HF and atrial fibrillation
    • Thrombolytic Agents: facilitate clot dissolution, indication for acute MI/PE/ischemic stroke
  53. Pharmocological Management of Airway and Lung Disease
    *denote precaution or PT implications
    • Antihistamine: blocks histamine resulting in decrease nasal congestion, mucosal irritation & symptoms of common cold, indicated for seasonal allergies/common cold, *postural hypotension*
    • Anti-Inflammatory: prevent inflammatory-mediated bronchoconstriction reducing airway edema, indicated for bronchospasm/asthma
    • Bronchodilator Agents: cause bronchial smooth muscle relaxation or by blocking the receptors that trigger bronchoconstriction, indicated for bronchospasm/wheezing/SOB in asthma & COPD, *want to take before going to PT*
    • Expectorant Agents: increase respiratory secretions to loosen mucus and increase sputum volume, *perform airway clearnace techniques*
    • Mucolytic Agents: decrease viscosity of mucus so they are easy to get out, indicated for pneumonia/emphysema/chronic bronchitis/cystic fibrosis, *perform airway clearance techniques
  54. ABI reading
    • compares systolic BP of ankle and arm
    • LEG/ARM
    • arm BP: taken over brachial artery
    • leg BP: taken over tibialis posterior arteries using sphygmomanometer and doppler US
    • >1.3= rigid arteries
    • 1-1.3= normal
    • .8-.99= mild blockage
    • <.4 severe blockage
  55. Lung Sounds
    • unclothed chest, breathe in and out through mouth, listen for one cycle
    • tracheal/bronchial: normal over trachea, bronchial over distal airways are abnormal and mean consolidation
    • vesicular: high pitch breezy sound, normal over healthy lung tisue, inspiratory longer than expiratory w/out pause
    • adventitious: abnormal, heard with inspiration/expiration, conintuous/discontinuous
    • crackle (rales): heard more often w/ inspiration, may be restrictive or obstructive, heard w/ atelectasis, fribrosis, pulm. edema, or pleural effusion
    • pleural friction rub: dry, crackling sound heard in inspiration/expiration, inflamed viscera & parietal plurae rub
    • rhonci: low pitched snoring or gurgling in inspiration/expiration, air passes through an airway that is obstructed by secretions or liquid
    • stridor: high pitch wheeze, inspiration/expiration, upper airway obstruction
    • wheeze: musical or whistling sound, inspiration/expiration, caused by vibrations of small airways from bronchospasm, edema, collapse, secretions, neoplasm
    • bronchial breath sounds: abnormal breath sounds heard where vesicular sounds are normally, usually pneumonia
    • absent breath sounds: pneumothorax *medical emergency*
    • decreased or diminished sounds: severe congestion, emphysema, hypoventilation
    • voice sounds: brochophony (99 with great clarity & loud), egophony (E sounds like A), whispered pectoriloquy (1,2,3 is understandable), all usually mean consolidation, atelectasis or fibrosis
  56. BMI
    • weight/height
    • 18.5-24.9= normal
    • 25-29.9= overweight
    • >40 extremely obese
  57. Capillary Refill
    • pressure over nail bed until blanches, release pressure
    • normal: full color < 2 seconds
    • abnormal: >2 seconds indicates compromised capillary blood flow
  58. Limb Edema
    • measurements every 5-10 cm
    • 7 circumferences measured
    • compare normal side to abnormal
    • mild lymphedema: <3 cm
    • severe: >5 cm
  59. Heart Rhythm Interpretation (graph)
  60. Waveform and Intervals of ECG
    • P wave: atrial depolarization
    • PR Interval: atrial depolarization, conduction from SA node to AV node (.12-.2 seconds)
    • QRS complex: ventricular depolarization and atrial repolarization
    • OT interval: ventricular depolarization and repolarization
    • ST segment: isoelectric period
    • T wave: ventricular repolarization
  61. Different ECG Rhythms
    • Premature atrial contraction: initiates impulse before the SA node, premature P wave, can progress to atrial flutter
    • Atrial Flutter: very rapid atrial tachycardia, 250-350 beats per minute, can cause palpitations, lightheadedness & angina
    • Atrial Fibrillation: atria depolarized to 350-600 times/min; occurs w/ coronary artery disease, HTN, and valvular disease
    • 1st Degree AV block: PR interval is longer
    • 2nd Degree AV block: impulses between the atria & ventricles fail intermittently (mobitz 1 and mobitz 2 (2 is more serious))
    • 3rd Degree AV Block: atria and ventricles are paced independently, atria rate > ventricular rate, *MEDICAL EMERGENCY*
    • Premature ventricular complex (PVC): premature depolarization arising in ventricles due to ectopic focus
    • V-tach: 3 or more consecutive PVCs at rate of >10, LIFE THREATENING
    • V-fibrillation: can come from V-tach, no cardiac output so patient becomes unconcious, MEDICAL EMERGENCY
    • Ventricular asystole: no rhythm, straight line, requires immediate defibrillation
    • ST depression: sign of ischema, digitalis toxicity, or hypokalemia
    • ST elevation: acute infarction
    • Q wave: significant or longer Q wave is indicative of MI
    • T wave inversion: occurs hours or days after MI
  62. Exercise Stress Testing TERMINATION
    • Absolute: drop in SBP > 10 with evidence of ischemai, moderately/severe angina, poor perfusion, sustained v-tach, 1.00 mm ST elevation
    • Relative: drop in SBP >10 w/out evidence of ischemia, >2mm ST segment depression, PVCs, fatigue, SOB, wheezing, HTN response >250/115)
    • Determine regular rhymthm by dividing 300 by R to R
  63. Pulse
    • Normal rhythm: 15 seconds x 4
    • Irregular rhythm: 60 seconds
    • Child: take at brachial artery (normal 80-100 bpm)
    • Adult: take at radial (normal (60-100)
    • 2+ = normal pulse, 3+ = bounding, 1+ =reduced
  64. Pulmonary Function Testing
    • measures volume of air during inhalation and exhalation
    • FEV1/FVC <70% is indicator of obstructive impairment
    • 70-100%= mild obstruction
    • FEV1 (forced expiratory voulme in 1 second)
    • Restrictive ventilatory: reduced lung volume (total lung capacity, FVC, FEV1) with normal expiratory flow, FEV1/FVC >80%
  65. Respiration
    • adult: 12-20 breaths
    • child: 15-20 breaths
    • newborn: 33-45 breaths
    • normal: inspiration:expiration, 1:2
    • COPD: longer expiration, 1:3 or 1:4
  66. RPE
    • 6-20 scale, or 0-10 (6 or 0 = nothing)
    • 13-14 represents 70% of max HR
    • 11-13 represent upper limit of cardiac rehab
  67. Waist Circumference
    • measure around abdomen at iliac crest
    • increased risk for type 2 DM, CV disease >40 inches for men, >35 inches for women
    • if waist circumference is greater than above values then person should be listed one risk category above that for BMI
  68. Airway Clearance Techniques
    • Active Cylce of Breathing: relaxed breathing x 10 seconds, thoracic expansion by 3-4 deep & slow inhalations w/ passive exhalation (can have percussion or vibration on exhale), forced expiratory technique by one or 2 huffs at mid to low lung volumes
    • Autogenic draining: three phases- unsticking phase (slow breathing through nose at low-lung volumes follow by 2-3 second hold then exhale into expiratory reserve volume), collecting phase (breathe at tidal volume interspersed by 2-3 second hold), evacuating phase (deeper inspiration fro low to mid inspiratory reserve volume & breath holding followed by huff)
    • Cough: inhale maximally, close breath & hold 2-3 seconds, then cough 2-3 times w/ slightly open mouth
    • Huff: inhald deeply through open mouth, Ha Ha Ha
    • Flutter or Acapella (high frequency airway oscillation): put device in mouth, inhale to 75% full breath and breathe x 2-3 seconds, exhale through device for 3-4 seconds, remove device and cough
    • Postural drainage, percussion, vibration
  69. Breathing Exercises
    • Diaphragmatic breathing: get in semi-fowlers position, sniffing can help, put hand on chest and diaphragm and feel diaphragm lift, *CONTRAINDICATION- mod to severe COPD & hyperinflationof lungs
    • Inspiratory muscle training: strengthen diaphragm & intercostal muscles, and breathe in through device, 5-15 minutes a day
    • Paced breathing: prevent pt from holding breath, inhale during resting or less active and exhale during movement
    • Purse Lipped Breathing: reduce respiratory rate and dyspnea, maintaining small positive pressure, in semi fowlers breathe in through nose and out through puckered lips
    • Segmental breathing: Sidelying with affected lung up then put firm pressure at end of exhalation to help with chest wall mobility and expand collapsed alveoli
    • Sustained Max Inhalation with incentive spirometer: exhale then inhale around mouthpiece breathing in slowly & deeply, encourage use of diaphragm & not upper chest
  70. Relieving Dyspnea
    • forward leaning with arm support
    • reverse trendelenburg (head above LEs)
    • semi-fowler: head of bed elevated with pillow under knees
  71. Heat Related Illness
    • heat stroke: disorientation, dizziness, apathy, HA, N/V, hyperventilation
    • heat exhaustion: low BP, elevated HR and RR, wet and pale skin
    • heat syncope: decreased HR and RR, pale skin, weakness, vertigo
    • heat cramps: localized muscle spasms
  72. Elevation
    • reduces partial pressure of oxygen in air, causing decreased arterial oxygen levels
    • increased ventilation and HR and decrease in performance
  73. Basic Life Support Components
    • compression, airway, breathing
    • compression rate: 100/min
    • compression depth: 2 inches for adults and kids (1/3 AP depth for kid and infants)
    • airway: head tilt, chin lift
    • breaths: 30:2