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