Final Frontier - Cardiopulmonary
Final Frontier - Cardiopulmonary Flashcards | Quizlet
Tidal volume -
air inspired during normal, relaxed breathing = 500 mL
Inspiratory reserve volume -
additional air that can be forcibly inhaled after the inspiration of a normal tidal volume
- 3000 mL
Expiratory reserve volume -
additional air that can be forcibly exhaled after the expiration of a normal tidal volume
= 1200 mL
Residual volume -
volume of air still remaining in the lungs after the expiratory reserve volume is
exhaled, always present in the lungs = 1200 mL
Total lung capacity -
maximum amount of air that can fill the lungs (TLC = TV + IRV + ERV + RV) = 6000
mL
Vital capacity -
total amount of air that can be expired after fulling inhaling (VC = TV + IRV + ERV) =
4800 mL (can be 4000-5000), approximately 80% of TLC but varies according to age
and body size
Inspiratory capacity -
maximum amount of air that can be inspired (IC = TV + IRV) = 3600 mL
Functional residual capacity -
amount of air remaining in lungs after a normal expiration (FRC = RV + ERV) = 2400
mL
In patients with COPD, which lung capacity and volume are increased? -
residual volume and functional residual capacity
COPD Gold Classification Stage I (mild) -
FEV1 (% predicted) = >80%
FEV1/FVC = <0.7
Symptoms: chronic cough +/- sputum production
COPD Gold Classification Stage II (moderate) -
FEV1 (% predicted) = 50-80
FEV1/FVC = <0.7
Symptoms: chronic cough +/- sputum production and dyspnea
COPD Gold Classification Stage III (severe) -
FEV1 (% predicted) = 30-50
FEV1/FVC = <0.7
Symptoms: chronic cough +/- sputum production and increased dyspnea
COPD Gold Classification Stage IV (very severe) -
FEV1 (% predicted) = <30
FEV1/FVC = <0.7
Symptoms: chronic cough +/- sputum production, even more increased dyspnea,
respiratory or R heart failure, weight loss
How do you clear secretions of a patient with COPD with a weak wet cough? -
huffing
Vesicular breath sound -
normal
inspiratory longer than expiratory
soft intensity
low pitch
heard over most of the lungs
broncho-vesicular breath sound -
normal
inspiratory = expiratory
intermediate intensity
intermediate pitch
heard between 1st and 2nd interspace anteriorly and between the scapulae
bronchial breath sound -
normal
expiratory longer than inspiratory
loud intensity
high pitch
heard over the manubrium
tracheal breath sound -
normal
inspiratory = expiratory
very loud
relatively high pitch
heard over trachea in the neck
Rhonchi -
abnormal
continuous low pitched rattling sounds that resemble snoring
heard in COPD, bronchiectasis, pneumonia, chronic bronchitis, or CF
Wheeze -
abnormal
high pitched sound heard in expiration, caused by airway obstruction
asthma, COPD, aspiration of foreign body
in severe constriction, it may be heard in inspiration as well
Crackles -
abnormal
brief, discontinuous, popping lung sounds that are high pitched
heard in both phases of respiration
CHF
Pleural rub -
abnormal
auscultation in the lower lateral chest areas
occurs with each inspiration and expiration
indication of pleural inflammation
bronchophony -
increased vocal resonance with greater clarity and loudness of spoken words
ex: "99"
egophony -
form of bronchophony in which the spoken long "E" sounds change to a long, nasal
sounding "A"
whispered pectoriloquy -
increased loudness of whispering
recognition of whispered words "1,2,3"
Fremitus -
vibration that is produced by the presence of secretions in the airways
Decreased fremitus indicates: -
more air in that area
Increased fremitus indicates: -
more secretions in that area
Clear sputum -
normal
Yellow sputum -
cold
green sputum -
bacterial infection
pink frothy sputum -
pulmonary edema due to heart failure
red sputum -
bleeding
brown sputum -
blood or dirt accumulated
black sputum -
fungal infection, smoking
yellowish-green, thick -
purulent, infection
fetid -
foul-smelling
mucoid -
whitish color
normal PaCO2 -
35-45 mmHg
normal pH -
7.35-7.45
normal HCO3 -
22-26 mEq/L
PaCO2 acidic -
>45
HCO3 acidic -
<22
HCO3 alkaline -
>26
PaCO2 alkaline -
<35
Metabolic acidosis causes -
DKA, diarrhea, renal failure, shock, salicylate OD, sepsis, lactic acidosis
Metabolic acidosis symptoms -
bicarbonate deficit, decreased BP, muscle twitching, warm flushed skin
(vasodilation), N/V/D, changes in LOC, kussmaul respirations,
HYPERVENTILATION, headache, mental dullness, deep respiration, stupor, coma,
HYPERKALEMIA, cardiac arrhythmia
Metabolic alkalosis causes -
severe vomiting, excessive GI suctioning, loss of gastric secretions, antacid
(mistaken angina pain for GERD), diuretics, excessive NaHCO3, low potassium
levels
Metabolic alkalosis symptoms -
excessive bicarb, depressed respirations, mental confusion, dizziness,
numbness/tingling in digits, tetany, convulsion, HYPOKALEMIA, cardiac arrhythmia
and agitation (tachycardia), muscle cramping/tremors, HYPOVENTILATION, N/V/D,
restlessness followed by lethargy, confusion (decreased LOC, dizzy, irritable)
Respiratory acidosis causes -
HYPOVENTILATION due to drug OD, chest trauma, pulmonary edema (L sided
heart failure), airway obstruction, COPD, pneumonia, atelectasis, decreased
respiratory stimuli (anesthesia, drug OD)
Respiratory acidosis symptoms -
HYPERCAPNIA (too much carbon), HYPOVENTILATION --> hypoxia, rapid shallow
respirations, decreased BP with vasodilation, dyspnea, headache, visual
disturbance, confusion, drowsiness, dizziness, disorientation, muscle weakness,
coma, depressed tendon reflexes, HYPERKALEMIA, vfib
Respiratory alkalosis causes -
HYPERVENTILATION d/t anxiety or PE, high altitude, pregnancy, fever, hypoxia,
excessive tidal volume in vented patients, mechanical ventilation
Respiratory alkalosis symptoms -
seizures, deep rapid breathing, HYPERVENTILATION, tachycardia, decreased or
normal BP, numbness tingling of extremities, lethargy and confusion,
lightheadedness, N/V, HYPOCAPNEA, tetany, convulsions, HYPOKALEMIA, cardiac
arrhythmia
Normal BP -
less than 120/80
Elevated BP -
Systolic between 120-129 and
Diastolic < 80
Stage 1 BP -
systolic between 120-129 or
diastolic between 80-89
Stage 2 BP -
systolic at least 140 or
diastolic at least 90
hypertensive crisis -
systolic over 180 and/or diastolic over 120
initial altitude CV changes -
increased HR, BP, CO
no change in SV
CV changes with aquatic therapy -
SV increases
increased venous pooling
VC decreases
VO2 max decreases/stays same
HR decreases
CO increases
SBP decreases
Beta blockers -
compete with epinephrine and norepinephrine for beta adrenergic receptors in the
heart
reduce HR and contractility
lower the myocardial oxygen demand
patients with CAD and HTN
lower HR during submax and max exercise
RPE 6-9 -
50-60% max HR
RPE 10-12 -
60-70% max HR
RPE 13,14 -
70-80% max HR
RPE 15,16 -
80-90% max HR
RPE 17-20 -
90-100% max HR
formula for cardiac output -
CO = HR x SV
end-diastolic volume (EDV) -
preload; volume of blood in the ventricles at the end of diastole
MAP/average aortic blood pressure -
afterload; pressure the heart must pump against to eject blood
2 factors that affect SV -
contraction strength and EDV
what affects the strength of ventricular contraction (contractility) -
circulating epinephrine and norepi
direct sympathetic stimulation of the heart
Aortic heart sound -
2nd IC space, R sternal border
Pulmonic heart sound -
2nd IC space, L sternal border
Tricuspid heart sound -
4th IC space, L sternal border
Mitral heart sound -
5th IC space, midclavicular line
S1 -
lub; closing of mitral and tricuspid, onset of systole
S2 -
dub; closing of aortic and pulmonary, onset of diastole
S3 -
ventricular gallop, ventricular filling, assoc with heart failure, low frequency brief
vibration occurs during early diastole during rapid diastolic filling period
S4 -
atrial gallop, abnormal, ventricular filling and atrial contraction
RPP/double product -
indication of myocardial oxygen demand/metabolic demand on heart
P-wave -
atrial depolarization
QRS wave -
ventricular depolarization/contraction
ST -
ventricular repolarization/refilling/relaxation
PR interval -
time from atrial contraction to ventricular contraction
to calculate HR from ECG strip -
count off 30 large boxes = 6 seconds (1 large box = 0.2 seconds)
then count the number of R waves in 6 seconds and multiply by 10
1st degree heart block definition -
delay in conduction
2nd degree heart block definition -
partially blocked conduction
3rd degree heart block definition -
fully blocked conduction
1st degree block -
AV nodal disease
PR interval >0.2 seconds (increase in PR interval)
each P is followed by a QRS
seen in athletes with increased vagal tone (activity)
generally wont progress, benign
continue exercise
normal PR interval -
</= 0.2 seconds
2nd degree AV block/Mobitz -
one or more (but not all) of the atrial impulses fail to conduct to the ventricles
2 types: type 1/Wenckebach and type II
in both types a P wave is blocked from initiating a QRS complex
2nd degree block type 1/Wenckebach -
PR interval gets progressively longer each beat until finally a QRS is dropped
a pattern can be discerned
disease of the AV node
drug therapy: Digitalis
monitor exercise
2nd degree AV block type 2/Mobitz II -
PR intervals are constant/normal and a QRS is dropped intermittently and suddenly
no pattern can be discerned
disease of the bundles of His and purkinje fibers
glycopyrrolate or IV isoproterenol
STOP EXERCISE
3rd degree AV block -
atrial rate is dependent of the ventricular rate (P wave and QRS march out
separately
no relationship at all of the PR intervals
the PR interval is constantly changing
QRS is usually wide and bizarre because it is ventricular origin
STOP IMMEDIATELY AND REFER
atrial tachycardia -
100-250 bpm
atrial flutter -
250-350 bpm
atrial fibrillation -
400-600 bpm
premature atrial contraction (PAC) -
a single complex occurs earlier than the next expected sinus complex
after the PAC, sinus rhythm usually resumes
P waves may have different shape in the PAC
PR interval varies in the PAC but otherwise normal (0.12-0.20 sec)
QRS is normal (0.06-0.10 sec)
premature ventricular contraction (PVC) -
heartbeat initiated by the purkinje fibers (skipped beat or palpitations)
ventricles contract before the atria and cannot be filled optimally
no P, wide bizarre QRS
PVCs that occur 3 or more in a row is called ventricular tachycardia (ectopic focus)
bigeminy -
1 normal beat followed by 1 PVC
slow down intensity but keep going; not dangerous
trigeminy -
2 normal beats followed by 1 PVC
less dangerous than bigeminy
multifocal PVC -
more than 1 PVC is present and 2 do not appear similar in configuration
couplet -
2 consecutive PVCs together with no normal beat between them
triplet -
3 PVCs in a row; STOP IMMEDIATELY VERY DANGEROUS
3 PVCs can lead to -
vtach
ST segment depression -
myocardial ischemia
ST segment elevation -
myocardial infarction
hypocalcemia -
QT interval prolonged primarily by lengthening ST segment
hypercalcemia -
QT interval shortening
large peaked T wave
hypokalemia -
ST segment depression
decrease in T wave amplitude (flattened)
prominent U waves
QU prolonged
hyperkalemia -
tall peaked T waves (narrow)
QRS duration increases as potassium level increases
P waves decrease in amplitude as potassium level increases
hypomagnesemia -
prolonged QT interval
prolonged PR
T wave inversion
T wave low or inverted (occasional U wave)
ST depressed
hypermagnesemia -
wide QRS
tall T waves
increased PR and QT
