Rehab techniques exam 1

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KatyRichman
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Rehab techniques exam 1
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2015-10-16 14:19:13
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  1. What carries blood TO the heart?
    veins
  2. What carries blood AWAY from the heart?
    arteries
  3. What is the function of the lungs?
    • oxygenate venous blood
    • expel CO2 and waste from cellular metabolism
  4. What do normal, healthy lungs look like?
    lift, soft, spongy, elastic, conical in shape, and pink
  5. How are the lungs attached to the heart and trachea?
    root of the lungs
  6. what is the root of the lung?
    group of structures that enter and leave the lungs
  7. what makes up the root of the lung?
    • left and right main bronchus
    • pulmonary, bronchial, lymphatic vessles
    • nerves
  8. what is the point at which the structures forming the root of the lungs enter and leave the lung?
    hilum
  9. where is the hilum of each lung located?
    medial surface
  10. What and where is the apex of the lung?
    • superior end of each lung
    • 3cm superior to the clavicle, above the first rib
  11. What is the base of the lung?
    concave inferior surface
  12. what are the 3 surfaces of the lungs?
    • costal: lateral
    • mediastinal: medial 
    • diaphragmatic: inferior
  13. How many lobes does the right lung have?
    3; superior, medial, inferior
  14. what are the names and locations of the fissures that divide the right lung?
    • oblique: divides superior and middle from inferior
    • horizontal: divides superior from middle
  15. how many lobes does the left lung have?
    2; inferior and superior
  16. what is the name of the fissure on the left lung?
    oblique
  17. what is the projection of the left lung and where is it located?
    • lingula
    • cardiac notch: distal aspect of superior lobe
  18. How many segments does each lung have?
    10
  19. where does the pathway for gas exchange begin after it enters through the nose/mouth?
    trachea
  20. what does the trachea bifurcate into?
    right and left main bronchus
  21. Where does the right main bronchus go?
    passes directly into the hilum
  22. How does the left main bronchus get to the hilum?
    pass around aortic arch, esophagus, and thoracic aorta
  23. The right and left main bronchi further divide to be come what?
    secondary bronchi (lobar branches)
  24. How many lobar (secondary) branches are to the left and to the right?
    • left: 2
    • right: 3
  25. the lobar branches further divide to become what?
    tertiary bronchi (segmental bronchi)
  26. how many tertiary bronchi does each lung have?
    10
  27. the tertiary bronchi (segemental) further divide to become what and how many?
    • terminal bronchioles
    • 20-25
  28. The terminal bronchioles further divide to become __________ that have how many ____________.
    • respiratory bronchioles
    • 2-11
    • alveolar ducts
  29. each alveolar duct has ___ alveolar sacs.
    5-6
  30. what does the actual gas exchange occur and where is it located?
    alveoli; the alveoli line the alveolar sacs.
  31. each lung has a large pulmonary artery carrying _________ blood from the ________ ventricle of the heart.
    • de-oxygenated
    • right
  32. each lung has 2 pulmonary veins carrying ___________ blood back to the ______ atrium of the heart.
    • re-oxygenated
    • left
  33. Bronchial arteries arise from the ____________ and carry blood where?
    • thoracic aorta
    • carries blood to and from the lungs and bronchi
  34. What veins drain the blood supplies by the bronchial arteries?
    bronchial and pulmonary
  35. what is movement of air through the airways?
    ventilation
  36. what is gas exchange within the body?
    respiration
  37. what is total lung capacity (TLC)
    volume of air in the lungs at full respiration
  38. the total lung capacity is made up of what 4 volumes?
    • tidal volume
    • inspiratory reserve
    • expiratory reserve
    • residual volume
  39. what is the amt. of air inspired or expired during normal resting ventilation?
    tidal volume
  40. what is additonal air that can be inspired after tidal volume inspiration?
    inspiratory reserve volume
  41. what is additonal air that can be expired after a tidal volume expiration?
    expiratory reserve volume
  42. what is the amount of air that remains in the lungs when the ERV has been expired?
    residual volume
  43. what does capacity mean?
    the sum of two or more volumes
  44. what is the inspiratory capacity?
    • tidal volume (TV) + inspiratory reserve volume (IRV)
    • volume of air that can be inspired beginning from a tial exhalation
  45. what is the functional reserve volume?
    • residual volume (RV) + expiratory reserve volume (ERV)
    • volume of air that remains in the lungs at the end of a tidal exhalation
  46. what is the vital capacity?
    • IRV + TV + ERV
    • all the volume of air in the lungs under voluntary control
  47. What is COPD?
    • chronic obstruction pulmonary disease
    • chronic bronchitis ( blue bloaters)
    • emphysema (pink puffers)
  48. T/F: asthma and CF can be classified as COPD?
    true
  49. what is defined by excessive mucus production with airway obstruction
    chronic bronchitis
  50. What damage is caused from chronic bronchitis, and what happens after the damage has been done?
    • damage to the endothelium impairs the mucociliary response
    • unable to clear mucous from the airways which further causes inflammation and secreations
  51. what is defined as destruction of airways distal to the terminal bronchiole?
    emphysema
  52. How does emphysema harm the airways?
    gradual destruction fo the alveolar septae and the pulmonary capillary bed with decreased ability to oxygenate blood.
  53. how does the body respond to chronic bronchitis?
    decreasing ventilation and increasing cardiac output. Rapidly circulating poorly oxygenated blood.
  54. how does the body respond to emphysema?
    • lowering cardiac output and increasing ventilation
    • limited blood flow thru the lung, muscle wasting (tissue hypoxia), weight loss
  55. What are the types of risk factors for COPD?
    • environmental: smoking, occupational exposures, outdoor pollutants
    • host: hyperactive airways, lung growth, genetic (antitrypsin deficiency)
  56. what is COPD a combo of?
    chronic airway inflammation and remodeling
  57. what are the s/s for COPD (3)?
    • chronic cough
    • expectoration
    • exertional dyspnea
  58. what are the more progressed s/s of COPD? (5)
    • barrel chested due to hyperinflation
    • hypertrophy of accessory breathing muscles
    • cyanosis
    • digital clubbing
    • breath sounds (expiratory wheeze, crackles)
  59. what is chronic airway inflammation associated with airways hyperresponsiveness that results in bronchspasms?
    asthma
  60. what are the two types of asthma?
    • allergic (extrinsic): most common; dander, pollen, etc..
    • nonallergic (intrinsic): cold air, infections, fumes, etc..
  61. what is the clinical presentation of a asthma exacerbation?
    cough, dyspnea, wheezing, accessory muscle breathing
  62. what is the chronic disease that affects the excretory glands of the body?
    cystic fibrosis
  63. What does CF lead to?
    • narrowing of the airways
    • hyperinflation, infection, tissue destruction
  64. What does a restrictive lung disease make difficult?
    lung expansion
  65. what can cause a restrictive lung disease?
    • radiation therapy
    • inhalation of noxious gases
    • asbestos
    • pulmonary fibrosis (idiopathic, scarring of lung tissue)
  66. Management of lung diseases include what?
    • stop smoking
    • O2 therapy
    • medications
    • surgery (lung transplant)
    • physical therapy
  67. what are some of the goals with PT and patients with pulmonary disorders?
    • increased cardiovasuclar endurance
    • increase strength, power and endurance of muscles (skeletal and pulmonary)
    • improved airway clearance
    • energy conservation
    • pt. education
    • improve ADL's
  68. What is the typical PT prescription?
    • 40-60% of VO2 max
    • Karoven formula:
    • -lower: 220-age X .40
    • -upper: 220-age X .80
    • 20-30 duration
  69. The modified borg rating scale for perceived dyspnea is on a scale of what?
    • 0-10
    • 0: nothing at all
    • .5: very, very slight slight SOB
    • 1: very mild SOB
    • 2: mild SOB
    • 3: moderate SOB or diff
    • 4: somewhat severe
    • 5: strong/hard breathing
    • 6-7: severe SOB or very hard breathing
    • 8-9: extremely severe
    • 10: shortness of breath so severe you need to stop.
  70. What are the three main functions of blood?
    • transport nutrients, oxygen, waste and hormones
    • help maintain the stability of interstitual fluid
    • distribute heat
  71. what are the 2 components of blood and what makes them up?
    • formed elements: RBC's, WBC's platelets
    • plasma: H2O, amino acids, lipids, vitamins, hormones, electrolytes, cellular waste
  72. describe an erythrocyte
    RBC that is concave to increase surface area, that contains hemeglobin that binds to oxygen, that only has a nucleus early in life and has no mitochrondria, and creates ATP through glycolysis.
  73. what is the average lifespan of a RBC?
    120 days
  74. What two vitamins significantly influence RBC production?
    B12 and folic acid
  75. What does hemoglobin synthesis and RBC production require in common?
    iron
  76. what is deficiency in RBC's?
    anemia
  77. What are leukocytes and what do they do?
    white blood cells that protect against disease
  78. what two hormones regulate WBC production?
    • colony stimulating factor
    • interleukins
  79. What are the two main types of WBC's and what makes them different?
    • granulocytes
    • agranulocytes

    granulocytes have granules in the cytoplasm, whereas agranulocytes do not.
  80. What are the three types of granulocytes?
    • neutrophils: phagocytize small particles (pacman)
    • eosinphils: kill parasites and moderate allergic reactions
    • basophils: release hepatin and histamine
  81. what are the 2 types of agranulocytes?
    • monocytes: phagocytize larger particles (bigger pacman)
    • lymphocytes: provide immunity
  82. what WBC counts indicates leukocytosis?
    • acute infection
    • >11,000
  83. what WBC count indicates leukopenia?
    • flu, AIDS, etc...
    • < 4,000
  84. platelets are also called?
    thrombocytes
  85. how to platelets form?
    arize from big cells in red bone marrow called megakaryocyes that break apart releasing small amounts of cytoplasm  into the circulation
  86. which hormone controls the platelets?
    thrombopoetine
  87. T/F: platelets lack nuclei and are 1/2 the size of RBC's.
    true
  88. what are the three main functions of plasma?
    • transport nutrients, gases, and vitamins
    • regulate fluid and electrolyte balance
    • maintain favorable pH
  89. what are the 3 proteins found in plasma?
    • albumins: maintain osmotic pressure (water and BP)
    • globulins: alpha and beta; transport lipids and fat soluble vitamins
    •                 gama; type of antibody
    • fibrinogen: blood coagulation
  90. Waht are the 3 gases found in plasma?
    • oxygen
    • carbon dioxide
    • nitrogen
  91. what are the nutrients found in plasma?
    • amino acids
    • simple sugars
    • nucleotides
    • lipids
  92. what are the nonprotein nitrogenous substances found in plasma?
    • urea
    • uric acid
    • creatine
    • creatinine
  93. what are absorbed from the intestines or released as by-products from metabolism?
    electrolytes
  94. what is hemostasis?
    stoppage of bleeding
  95. what are the three ways in which hemostasis is accomplished? Which is the best line of defense?
    • blood vessel spasm (vasoconstriction/vasospasm)
    • platelet plug formation
    • blood coagulation (best line of defense)
  96. what is a vasospasm?
    cutting or breaking the vessel causes the smooth muscle to contract. Can completely close the ends of vessels
  97. what is platelet plug formation?
    platelets adhere to any rough surface of collagen in the connective tissue. They also adhere to each other forming a plug.
  98. Whether or not a clot forms is dependent upon the balance of what two groups of factors?
    • clot formation: formation of fibrin; prothrombin and fibrinogen combine together to form fibrin which creates a mesh-like structure to collect blood cells and platelets
    • clinical reference: PTT (prothrombin time) OR INR: 2-3
  99. What are the two types of blood clots?
    • thrombus: clot abnormally forming in the tissue
    • embolus: clot that forms and dislodges that is now being carried in the blood stream
  100. what are the three main blood vessels?
    • arteries
    • veins
    • capillaries
  101. What are the three tunics of the blood vessels?
    • tunica intima: inner lining of single layer of epithlial cells (capillaries)
    • tunica media: middle layer consisting mostly of smooth muscle
    • tunica adventitia: outer connective tissue layer or sheath
  102. What are the three types of arteries?
    • elastic (large): many elastic layers in their walls; aorta
    • muscular (medium): walls made up of circularly smooth muscle; femoral
    • small arteries and arterioles: narrow lumina and thick muscular walls
  103. What are the purpose of small veins?
    drain the capillary beds and join other smaller vessels to unite and form venous plexuses.
  104. what are the purpose of medium veins? What kind of valves do they have?
    • drain venous plexuses and accompany medium arteries.
    • venous valves; one way valves
  105. what are large veins characterized by and what is one example?
    • wide bundles of longitudinal muscle and well developed tunica adventitia
    • superior vena cava
  106. describe capillaries
    simple endothelial tubes arranged in beds that connect the arterial and venous system that allows for the exchange of materials with the interstitial fluid.
  107. what is muscle contraction in the limbs that function with the valves to move blood flow to the heart?
    musculovenous pump
  108. what are the three phases of cardiac rehab?
    • phase I: inpatient (acute)
    • phase II: outpatient (exercise training)
    • phase III: outpatient (maintenance)
  109. what are the goals of phase I cardiac rehab?
    • general mobility, ADL's
    • MET's 1-3
    • monitor vitals
  110. when might you see a swan ganz on a patient?
    first 1-3 days after heart surgery
  111. what are the lead placements for a heart monitor?
    • WHITE clouds over GREEN grass on the right
    • BLACK smoke over RED fire on the left
    • BROWN in the middle
  112. what is a typical treatment session with a patient in phase I CCU?
    • bed rest
    • dangle: 12-24 hrs post extubation
    • bed -> chair transfer after 12-24 hrs
    • in room mobility typically 48 hrs after
  113. what would a typical treatment include for a patient in phase I step down unit?
    • continued general mobility, ADL's
    • light ther-ex; bed and sitting exercises
    • progressive gait training
    • progressing toward 3 MET goal for DC
  114. is there evidence to support sternal precautions?
    no
  115. what are the sternal precautions?
    • no lifting, pushing or pulling > 10#
    • - heavy doors, pick up or transfer laundry, vacuum, sweep, weight bearing through UE for ambulation (RW)
    • no shoulder flexion past 90* or scapular adduction
    • -anything that would open up the chest; combing back of hair, arm of chair for sit -> stand's
  116. what are the contraindications to mobility? (8)
    • unstable angina
    • symptomatic heart failure
    • uncontrolled arrhythemia
    • moderate-severe aortic stenosis
    • uncontrolled DM
    • acute symptomatic illness or fever
    • uncontrolled tachycardia
    • resting BP of >200/110 (either systolic or diastolic)
  117. What do you look for to know when to stop a session with a cardiac patient? (10)
    • presistent dyspnea
    • dizziness or confusion
    • pain
    • excessive fatigue
    • pallor, cold sweat
    • nausea/vomiting
    • failure of systolic BP to rise as exercise continues (unless on beta blockers)
    • hypertensive BP response
    • progressive fall in BP of 10-15 mm Hg
    • significant change in cardiac rhythm
  118. what is phase II of cardiac rehab?
    medically monitored exercise program initiated 1-4 weeks post DC from hospital for 3X week up to 3 months.
  119. what is the formal exercise test given initally for phase II of cardiac rehab or given to deconditioned "normals"?
    low-level discharge GXT (LL-GXT)
  120. what do phase II cardiac rehab session include?
    • warm up on treadmill or bike
    • aerobic exercise on machines
    • resistance training
    • cool down/stretching
    • group format
    • telemetry
  121. what is phase III cardiac rehab designed to do?
    maintain and/or reintergrate the patient to community and home exercise
  122. what are the 5 great vessels that attach to the heart at the base?
    • superior vena cava: large vein that returns deoxygenated blood to the right atrium from above the heart and UE's.
    • inferior vena cava: large vein that return deoxygenated blood right atrium from the lower chest and below.
    • pulmonary artery: carries deoxygenated blood from the right ventricle to the lungs.
    • pulmonary veins: carry oxygenated blood from the left ventricle to the body through th aorta.
    • ascending aorta: sends head, neck, and UE's via the subclavian and carotid arteries.
    • descending aorta: carries blood to the lower body and visceral tissue
  123. where is the sternocoastal side of the heart?
    right atrium and ventricle
  124. where is the diaphragmatic side of the heart?
    left ventricle and small part of the right ventricle
  125. where is the pulmonary surface of the heart?
    mostly the left ventricle and cardiac notch area of the left lung
  126. where is the apex of the heart?
    tip of the left ventricle
  127. where is the base of the heart?
    posterior aspect of the heart form mostly by the left atrium and some by the right atrium.
  128. what are the three layers of the heart and what is it surrounded by?
    • epicardium: outermost layer; location of coronary arteries
    • myocardium: thickest layer of muscle wall that is responsible for heart contraction that is damaged during a MI.
    • endocardium: inner most layer that lines the cardiac chambers and valves

    The heart is surround by a  double walled connective tissue sac called the pericardium that protects the heart from trauma and infection.
  129. what are the chambers of the heart?
    Atrium and ventricles
  130. What do the atria do?
    • right: receives deoxygenated blood from the body through the vena cava and the coronaries. Pumps blood forward through the tricuspbid valve.
    • left: receives oxygenated blood from the valveless pulmonary veins. pumps blood forward through the mitral valve.
  131. what do the ventricles do?
    • right: receives deoxygenated blood from the right atrium via tricuspid valve. pumps blood forward through the pulmonic valves to the lungs.
    • left: receives blood from the left atrium via the mitral valve that pumps blood forward through the aortic valve to the aorta to the systemic circulation.
  132. what creates the sounds heard during a heart exam with the steth?
    the closing of the valves
  133. what are the two types of atrioventricular valves and where are they located?
    • tricuspid: 3 cusps; btw right atria and ventricle
    • mitral (bicuspid): 2 cusps; btw left atria and ventricle
  134. what are the 2 types of semilunar valves and where are they located?
    • pulmonic: 3 cusps; btw the right ventricle and pulmonary artery
    • aortic: 3 cusps; btw the left ventricle and the aorta
  135. what is the coronary circulation?
    provided by the coronary arteries that originate from the aorta that are returned to the right atrium via the coronary veins.
  136. what is the left main artery?
    comes off the aorta and runs along the surface of the left atrium where it splits to become the left anterior descending artery and the left circumflex artery.
  137. which artery is known to be the widow maker?
    left anterior descending (LAD)
  138. what does the LAD supply?
    left ventricle, interventricular septum, right bundle branch, portion of the left bundle branch, and the area around the apex.
  139. what does the circumflex artery supply?
    left ventricle, posterior fascicle of the left bundle branch, and the left atrium.
  140. what comes off the aorta and goes around the heart in the opposite direction of the circumflex artery, going across the right ventricle and underneath the heart to feed the inferior muscle of the left ventricle?
    right coronary artery (RCA)
  141. what cardiac reflex is produced by a group of mechanreceptors that are found within the walls of the heart, intrathoracic vessels and large arteries that is activated with pressure exceeds 60mmHg and causes vasodilation secondary to inhibition of the vasomotor centers?
    barareceptor reflex
  142. what cardiac reflex responds to the need for increased depth and rate of ventilation that has receptors located on the carotid and aortic vessles that detect decreased O2 levels and respond to an increase of arterial CO2?
    chemoreceptor reflex
  143. what are specialized cardiac muscle cells and fibers that that initiate elctrochemical impulses and conduct them rapidly through the heart?
    cardiac conduction system
  144. what does the cardiac conduction system do?
    coordinates the cardiac cycle so that the atria contract together then ventricles contract together
  145. what is the "lub-dub" sound heard?
    • lub: diastole (bottom #) ventricles resting while atria fill
    • dub: systole (top #) ventricles are contracting

    sounds heard from closing of one way valves to prevent back flow.
  146. what is the SA node?
    • located in the upper right corner of the right atrium
    • pacemaker of the heart
  147. what is the AV node?
    • responsible for delaying the impulses that reach it, allowing the ventricles to fill completly as the atria contracts.
    • does not have a pacemaker, but the tissue around it does. (junctional tissue)
  148. what is the bundle of his?
    resumes the rapid conduction of the impulses throughout the ventricles that divide into the right and left branches
  149. what are the purkenjie fibers?
    network of nervous tissue that extends through the ventricles
  150. what is elevated arterial blood pressure both for systole and diastole?
    hypertension
  151. what is a type of arterioscleriosis that is caused by accumlation of fatty deposits  in the inner layer of arteries?
    atherosclerosis
  152. what results from impaired left ventricular functioning and/or malfunction of the heart to pump enough blood to meet the bodys needs that is usually a type of CAD?
    congestive heart failure (CHF)
  153. what is CAD and what may it produce?
    • coronary artery disease
    • narrowing or blockage of coronary arteries
    • may produce ischemia and necrosis of myocardium. Difficulty with vasodilation and arteries cannot meet metabolic demands
  154. what is irreversible damage of heart segment due to ischemia that can be caused by narrowing of the artery or atherosclerosis?
    myocardial infarction MI
  155. what is arrhythmia and what are the 3 types?
    • impaired electrical impulse formation or conduction
    • benign atrial fibrilation (a-fib)
    • malignant ventricular tachycardia and ventricular fibrillation (v-tach or v-fib)
  156. what can a-fib cause?
    HTN, CHF, CAD, pericarditis, cor pulmonale, rheumatic heart disease, drug use
  157. what is claudication?
    pain that is caused by lack of oxygen
  158. what are the s/s of MI? (7)
    • severe chest pain
    • chest heaviness
    • radiating chest pain in the jaw or down one or both arms
    • weakness
    • nausea/vomiting
    • diaphoresis
    • SOB
  159. what are the s/s of a cardiac pathology? (10)
    • chest pressure
    • dyspnea
    • fatigue
    • syncope
    • palpitations
    • cough
    • cyanosis of lips or nail beds
    • peripheral edema
    • jugular vein distension
    • claudication
  160. what is cardiac output?
    • amount of blood measured in liters (4-6 is normal) that is pumped out of the heart through the aorta each minute that should increase as exercise load increases
    • CO= HR x SV (stroke volume)
  161. what is venous return?
    amount of blood that comes from the veins to the right atrium each minute
  162. what is the cardiac index?
    • amount of blood pumped out of the heart per minute per square meter of body mass
    • range of 2.5 to 4.2 liters/min/meter
  163. what is the normal blood volume for adults?
    7-8% of body weight
  164. what is the stroke volume?
    amount of blood ejected from the ventricles with each myocardial contraction that is influenced by preload, afterload, and contractility.
  165. what is preload? What can it be affected by?
    • force required to stretch muscle to its pre contraction length
    • blood volume, posture, venous return, filling time, pressure elasticity of heart muscles.
  166. what is afterload and what is it affected by?
    • force muscle contracts during ejection. 
    • affected by BP in aorta, aortic stenosis, stiffness of myocardium, viscosity of blood
  167. what is contractility?
    changes in muscle performance not ascribed to length or load
  168. what is the normal heart rate for children and adults?
    • children: 80-100
    • adult: 60-100
  169. what is brady and tachy cardia?
    • brady: slow HR below 60 consistantly
    • tachy: fast HR above 100 consistantly
  170. what does a strong, regular heart beat mean?
    adequate force and consistent beats
  171. what does a weak heart beat mean?
    poor force with contraction
  172. what does an irregular heart beat mean?
    inconsistency with regard to strength and beat of heart.
  173. where can you take pulses? (7)
    • carotid
    • brachial (upper arm and cubital fossa)
    • radial
    • femoral
    • popliteal
    • dorsal pedal (1st and 2nd metatarsals)
    • posterior tibial (medial malleolus)
  174. what is drop of systolic BP >20mmHg with positional changes with s/s of lightheadness, dizziness, and LOB
    orthostatic hypotension
  175. what is absence of pink, rosy color and may mean a decrease in O2?
    pallor
  176. with is excessive cool, clammy skin?
    diaphoresis
  177. what is hematocrit? what does it identify? what are the s/s of high/low? what are the adult norms?
    • percentage of RBC in total blood volume
    • hydration, polycythemia, anemia
    • low- weak, chills, dyspnea
    • high- increase risk of thrombus
    • males- 40-54
    • females- 37-47
  178. what is hemaglobin? what does it identify? What are the adult norms?
    • function to carry oxygen from lungs to the tissues
    • low- anemia, hemorrhage
    • high- polycthemia, dehydration
    • males-14-18
    • females- 12-16
  179. what does a high and low platelet count indicate? what is norm?
    • high: increased risk for thrombus
    • low: increased risk brsing and bleeding
    • norm: 150,000-400,000
  180. what does a WBC tell you and what does an increased WBC typically secondary to? What are the norms?
    • identify: infection allergens, bone marrow integrity or degree of immunosupression
    • secondary: hemorrhage, surgery, coronary occlusion, malignant growth
    • norms: 4,500-11,000
  181. what are the absolute contraindications for Tx of unstable cardiac patient? (7)
    • 3rd degree heart block
    • uncompensated CHF
    • PVC's of ventricular tachycardia at rest
    • multifocal PVC's
    • chest pain with ST segment changes
    • ECG changes that indicate ischemia
    • dissecting aortic aneurysm
  182. what does multifocal mean?
    multiple electrical pulses generated from different locations that are uncoordinated.
  183. what are the relative contraindications to stop exercising with cardiac patients? (9)
    • abnormal heart rate that increases >50 bpm
    • BP  200/110
    • decrease in systolic pressure >10 during low level exercise
    • any ST segement changes
    • severe LE claudication
    • angina
    • confusion
    • extreme fatigue
    • ventricular gallop
  184. what do the horizontal lines on the EKG graph represent?
    • time
    • 1 sm square: .04 seconds
    • 5 sm squares: .20 seconds
    • 5 sets of 5 sm squres: 1 whole second
  185. what do the vertical lines on the EKG graph represent?
    voltage
  186. what is a 12 lead EKG used for?
    • diagnostic tool
    • ischemic process, chamber size, axis determination, drug effects, BBB, rhythm identifcation
  187. what is the period between cardiac cycles called?
    baseline or isoelectric period
  188. what is each P/QRS/T complex considered?
    1 cycle or "beat"
  189. when a waveform positive and negative?
    • positive: deflected above baseline
    • negative: deflected below baseline
  190. what is a P wave?
    • 1st upward deflection
    • caused by depolarization of the atria
  191. what is the P R interval?
    • represents the time required for electrical impulse to leave the SA node and travel through the atria, AV node, bundle branches and purkenjie fibers.
    • normal is .12-.20
  192. what is the QRS complex?
    • ventricle depolarization
    • Q wave: septal depolarization; 1st downward deflection
    • R wave: 2nd upward deflection
    • S wave: 2nd downward deflection
    • normal is <.10 (2.5 boxes)  <.12= BBB
  193. what is the ST segment?
    the end of ventricular depolarization and the beginning of ventricular repolarization.
  194. what is the T wave?
    • represents the later phase of ventricular repolarization
    • may be upright, inverted, elevated or depressed.
  195. what is the QT interval?
    • time btw onset of ventricular depolarization and the end of ventricular repolarization
    • measured for length; norm-<.38
  196. What are the supraventricular rhythms? (10)
    • normal sinus rhythm
    • sinus bradycardia
    • sinus tachycardia
    • atrial flutter
    • atrial fibrilation
    • junctional (nodal) rhythm
    • 1st degree AV block
    • 2nd degree AV block (mobitiz I) (wekenbach phenomenon)
    • 2nd degree AV block (mobitiz II)
    • 3rd degree AV block
  197. what are the ventricular rhythms?
    • ventricular tachycardia
    • ventricular fibrillation
    • premature ventricular contraction (PVC)
  198. describe normal sinus rhythm
    • Rate: 60-100
    • P waves present & regular
    • QRS regular, following each P
    • PR & QRS interval normal
  199. describe tachycardia
    • Rate: > 100
    • P waves present & regular
    • QRS regular, following each P
    • PR & QRS interval normal
    • Causes: Increase in SA node autoaticity pain, emotion, exertion, fear, fever, CHF, caffeine, nicotine
  200. describe bradycardia
    • Rate: < 60
    • P waves present & regular
    • QRS regular, following each P
    • PR & QRS interval normal
    • Causes: decrease in SA node automaticity Vagal response (parasympathetic), SA node hypoxia, well trained athletes
    • Treatment: remove source of vagal stimulation
  201. describe atrial flutter
    • Rate: 240-360
    • P waves present as “F” waves “Saw tooth” pattern
    • QRS present PR interval not measurable, QRS interval normal
    • Causes: advanced age, CAD, Rheumatic HD, Constrictive pericarditis, Cor Pumonale, MI, Drugs
  202. describe atrial fibrillation
    • Rate: 350- 600
    • Irregular rhythm (multiple foci)
    • P waves: absent! Replaced by wavy line
    • QRS usually normal
    • PR interval not able to measure
    • Called the arrhythmia of the elderly
    • MAY CAUSE EMBOLIC STROKE# 1 cause of recurrent stroke
  203. describe a junctional rhythm
    • Rate: difficult to determine
    • P waves: not present (impulses originate from site of AV junction)
    • QRS regular
    • Causes: Sinus node disease, Increased vagal tone, Inferior MI, May be normal on a temporary basis
    • Treatment: treat underlying cause, may need pacemaker
  204. describe first degree AV block
    • P waves present
    • QRS regular, following each PPR interval
    • PROLONGED- >.20Causes: impulse from SA node delayed on way to AV tissue CAD, RHD, Digoxin, Beta blockers
    • Treatment: usually none
  205. describe 2nd degree AV block (mobitiz type I)
    • P waves: more numerous than QRS complexes
    • QRS normal
    • PR interval Begins to lengthen with each complex until a P wave occurs but no QRS cyclic
    • Rarely progress to higher forms of block Causes: Inferior MI, RHD, Digoxin, Beta Blockers, CAD
    • Treatment: none if Qc is not compromised
  206. describe 2nd degree AV block (mobitiz type II)
    • Ratio of P waves to QRS is altered 2,3,4 P waves to 1 QRS
    • Intervals will be normal when QRS follows P wave
    • Causes: MI, CAD, RHD, Digoxin toxicity, Beta blockers
    • Treatment: w/ MI prophylactic pacemaker, MAY PROGRESS TO COMPLETE HEART BLOCK
  207. describe a PVC
    • Underlying rhythm is “normal” Early beat occurs
    • QRS is wide & bizarre
    • Interval of early QRS is > .11P wave is absent
    • Generally followed by compensatory pause
    • Characterized by # and frequency of PVC’s
    • -Bigeminy, trigeminy, quadrigeminal, couplets, triplets
    • Cause: Ischemia, Cardiac disease, Electrolyte imbalance, Digoxin toxicity, Caffeine, stress, overexertion, Acute MI
  208. describe v-tach
    • Rate: 100-250 (ventricular)
    • P wave is absent
    • QRS is wide and bizarre
    • Single focus
    • Causes: Ischemia, Acute MI, Electrolyte imbalance, cardiac disease, CHF, cardiomyopathy, idiopathic
    • LIFE THREATENING
    • Treatment: Meds, O2, Defibrillation


  209. What type of rhythm?
    1st degree heart block


  210. what type of rhythm?
    3rd degree AV block

  211. what type of rhythm?
    atrial flutter


  212. what type of rhythm?
    atrial flibrillation


  213. what type of rhythm?
    bradycardia

  214. what type of rhythm?
    junctional

  215. what type of rhythm?
    • 2nd degree AV block
    • mobitz type I

  216. what type of rhythm?
    • 2nd degree AV block
    • mobitz type II

  217. what type of rhythm?
    normal sinus

  218. what type of rhythm?
    PVC

  219. what type of rhythm?
    tachycardia

  220. what type of rhythm?
    v-fib

  221. what type of rhythm?
    v-tach
  222. what are techniques used to mobilize or loosen secretions in the lungs and airways to facilitate removal?
    chest physiotherapy
  223. what does chest physiotherapy include?
    • chest percussion
    • postural drainage
    • chest vibration
    • diaphragmatic breathing
    • pursed lip breathing
    • assisted coughing
  224. what is defined as placing the patient in various positions to facilitate removal of secreations using gravity?
    postural drainage
  225. what are the contraindications for postural drainage?
    • Head and neck injury until stabilized
    • Active hemorrhage with hemodynamic instability
    • Elevated intracranial pressure (ICP)
    • Rib fractures
    • Recent spinal surgery
    • Acute spinal injury
    • Active hemoptysis
  226. cupping with action at the wrist is a technique called _______ to facilitate removal of secreations from the lungs and airways.
    percussion
  227. what position would you place the patient to drain the  upper lobes; right and left apical segments?
    • supine with elevated head (30*)
    • percussion between clavicle and scapula
  228. what position would you place the patient to drain the upper anterior lobes?
    • flat supine
    • percussion between the clavicle and 4th rib
  229. what position would you place the patient in to drain the posterior upper lobes?
    • long sit leaning forward (30*) with arms across pillow
    • percussion between clavicle and scapula posteriorly
  230. how would you position the patient to drain the right middle lobe?
    • 1/4 rotation forward on pillow (under left side) from supine, foot of bed elevated 12"
    • percussion antero-lateral btw 4th and 6th ribs
  231. how would you position the patient to drain the lingula?
    • 1/4 rotation forward on pillow (on right side) from supine, foot of bed elevated 12"
    • percussion antero-lateral btw 4th and 6th rib
  232. how would you position the patient to drain the superior segment up the lower lobe?
    • prone, pillow under abdomen
    • percussion from inferior tip of scapula to 8th rib
  233. how would you position the patient to drain the anterior basal segment of the lower lobes>
    • supine, pillow under bent knee, foot of bed elevated 18"
    • percussion anterior chest btw 6th and 8th ribs
  234. how would you position the patient to drain the lateral basal segment of the lower lobes
    • prone, pillow under hips, foot of bed elevated 18"
    • percussion from inferior tip of scapula to 10th rib
  235. what do you want to follow every percussion treatment with?
    cough
  236. what do you look at when looking at sputum?
    • color
    • consistency
    • amount
  237. why do we do pulmonary function tests?
    • examine how much gas is in the lungs
    • how much and how well the patient can move gas in and out
  238. what do we call the pulmonary function test?
    spirometry
  239. what lung volume dependent upon?
    what is it not dependent upon?
    • is: age, race, gender, height, thorax size (very important)
    • NOT: weight
  240. what is the normal amount of gas during a normal inspiration?
    500cc
  241. what is the normal residual volume?
    1000-1200cc
  242. what is the normal functional residual capacity?
    2400cc
  243. what is the normal total lung capacity?
    5900cc or 6 liters
  244. why do we listen to breath sounds?
    • to determine normal and abnormal
    • diagnosis and treatment
  245. how many points on the anterior to you auscultate?
    7
  246. how many points on the posterior do you auscultate?
    10
  247. what are the 4 normal breath sounds?
    • tracheal
    • bronchial
    • bronchialvesicular
    • vesicular
  248. what do tracheal breath sounds sound like?
    when are they normal and abnormal?
    • high pitched, tubular, hollow
    • normal: over trachea
    • abnormal: over lung field
  249. how do bronchial breath sounds sound?
    when are they normal and abnormal?
    • hollow, tubular sounds; not as harsh as tracheal
    • normal: over sternum
    • abnormal: over lung field
  250. how do vesicular breath sounds sound like?
    • heard over the lung fields
    • soft, low sounds, rustling
  251. what are the abnormal breath sounds? (adventitious)
    • Absent
    • Wheezing
    • Crackles
    • Rhonchi
    • Stridor
    • Pleural Rub
    • Mediastinal Crunch
    • -Hamman’s Sign
  252. when might you hear absent breath sounds?
    • trauma
    • phneuothorax
    • asthma
  253. when might you hear wheezing?
    • chocking
    • asthma
    • aspiration
  254. when might you hear coarse crackles and fine crackles?
    • course: fluid in alveoli
    • fine: atelectasis
  255. when might you hear rhoncus?
    when there are secretions in the airways
  256. when might you hear stridor?
    • loud high pitched wheeze
    • croup or foreign body
  257. you know the pleura is inflamed when you hear what?
    pleural friction rub
  258. what is the hammans sign?
    mediastinal crunch

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