Taylor final exam part 1

What is the normal heart rate?

60-100 beats per minute

What pulse rate is considered tachycardia?

Greater than 100 beats per minute

What pulse rate is considered bradycardia?

Less than 60 beats per minute

What is the flow of the electrical conduction system of the heart?

SA node → intranodal tracts → Bachman's bundle → AV node → Bundle of His → right and left bundle branches → Purkinje fibers

What does the P wave represent in the heart's electrical conduction?

Depolarization of the atria

What does the P-R interval represent?

AV conduction time; delay for filling of the ventricle

What does the QRS complex represent?

Depolarization of the ventricles and repolarization of the atria

What does the T wave represent?

Repolarization of the ventricles

What does the U wave represent?

Repolarization of the Purkinje fibers

What is the primary pacemaker of the heart?

SA node

What is the pacing rate of the SA node?

60-100 beats per minute

What is the secondary pacemaker of the heart?

AV node

What is the pacing rate of the AV node?

40-60 beats per minute

What are the causes of sinus tachycardia?

Pain, anxiety, fever, hypoxia, shock, medications, stimulants (caffeine and tobacco)

What are the characteristics of a normal sinus rhythm?

Atrial and ventricular rates are the same (60-100), normal ventricular rhythm, normal P wave precedes QRS, normal P interval (0.12-0.2), normal QRS (0.06-0.12)

What is the normal P-R interval?

0.12 - 0.2 seconds (3-5 small boxes)

What is resting potential in cardiac cells?

No electrical activity occurring; inside has more potassium ions, outside has more sodium and calcium ions

What is action potential in cardiac cells?

Depolarization leading to heart contraction; process of depolarization and repolarization

What is Einthoven's Triangle?

A method for lead placement in a 12 lead ECG

What do tall peaked P waves represent?

Right atrial hypertrophy

What do broad, notched P waves represent?

Left atrial hypertrophy

What do tall, peaked R waves represent?

Ventricular hypertrophy

What do significant Q waves represent?

Infarction

How does hypokalemia show on an ECG?

Inverted T wave

How does hyperkalemia show on an ECG?

Spiked T wave

What qualifies an ECG rhythm to be cardioverted?

SVT (Supraventricular Tachycardia)

What should you do if a patient has a sinus rhythm on the ECG but no palpable pulse?

Perform high-quality CPR, administer epinephrine, and search for reversible causes

What are prolonged P-R intervals indicative of?

Impulse delay or blockage through the AV node

What is cardioversion?

Use of electrical energy to restore normal heart rhythm

What is defibrillation?

Termination of ventricular fibrillation by delivering a direct electrical shock

What is transcutaneous pacing?

Temporary, non-invasive procedure using electrical pulses to treat slow heart rhythms

How is oxygen transported within the blood?

Through plasma (PaO2) and hemoglobin (HbO2)

What is the equation for CaO2?

(Hb x 1.34 x SaO2) + (PaO2 x 0.003)

What is the normal value for CaO2?

20%

What does the P[A-a]O2 represent?

Alveolar-arterial oxygen tension difference

What is the normal P[A-a]O2 value?

7-15 mmHg; should not exceed 30 mmHg

What is the normal PaO2/PAO2 ratio?

0.75 - 0.95

What is the critical value for the PaO2/PAO2 ratio?

<0.75

What is the normal PaO2/FiO2 ratio?

350 - 450

What indicates ARDS in the PaO2/FiO2 ratio?

<200

What indicates ALI in the PaO2/FiO2 ratio?

<300

What is the normal value for DO2?

1000

What is the normal value for VO2?

250

What does Qs/Qt indicate?

Shunt percentage; normal is <10%

What is the importance of looking at HbO2?

It illustrates the percentage of hemoglobin that is chemically connected to oxygen at a specific oxygen pressure.

Why is the P/F ratio not accurate with hypercapnia due to hypoventilation?

It does not accurately reflect oxygenation status.

What is lung compliance used for in ARDS?

It is used to assess lung function, typically measured as less than 200.

What makes lung compliance reliable?

FiO2 is under 50%.

What makes lung compliance unreliable?

High CO2 due to hypoventilation.

What is Cor pulmonale?

A condition associated with pulmonary arterial hypertension and right heart failure.

What are the three major causes of right heart failure?

Increased viscosity of blood, increased vascular resistance, and obliteration of the pulmonary capillary bed.

What is the a/A ratio used for?

To assess the severity of intrapulmonary shunting.

What is the P/F ratio used for?

To assess the severity of hypoxemic respiratory failure (ARDS).

What indicates hypoventilation in the P/F ratio?

When the ratio is less than 0.55, FiO2 is greater than 0.30, and PaO2 is less than 100 mmHg.

What is the significance of cyanosis?

It indicates reduced oxygenation of arterial blood and hypoxia.

What does diaphoresis indicate in a patient?

Excessive sweating, common in acute respiratory distress or myocardial infarction.

What does a pupillary reflex assessment indicate?

Pupils should be equal, round, and reactive to light; abnormalities may indicate neurologic damage.

What does jugular venous distention indicate?

It is often a result of right-sided heart failure.

What does a tracheal shift indicate?

A shift from midline may indicate atelectasis, pneumothorax, or lung tumors.

What is the normal breathing rate for adults?

12-18 breaths per minute.

What does abdominal paradox indicate?

Diaphragm fatigue, common in patients with COPD.

What is respiratory alternans?

Alternating between belly breathing and accessory muscle use.

What does central cyanosis indicate?

Inadequate oxygenation of blood or congenital heart disease.

What is the significance of retractions in breathing?

They indicate increased work of breathing and respiratory distress.

What is the Hoover sign?

Abnormal movement of the ribcage in COPD patients during breathing.

What is the role of accessory muscles in breathing?

They assist in inhalation and exhalation when normal breathing is insufficient.

What does it mean if pupils are fixed and dilated?

It may indicate brain death or severe neurologic damage.

What does pinpoint pupils indicate?

It may indicate the influence of parasympathetic stimulants or opiates.

What is the significance of the I:E ratio in breathing?

It helps assess the breathing pattern and effectiveness of ventilation.

What is the role of the sternocleidomastoid muscle?

It is responsible for inhalation.

What does bulging of the chest indicate?

Severe air trapping and respiratory distress.

What is the effect of hypoxic vasoconstriction?

It increases vascular resistance in the pulmonary circulation.

What is the significance of Hb concentration in respiratory assessments?

It is necessary for calculating oxygen content in the blood.

What does the term 'diffusion limited' refer to?

Conditions affecting the lung or capillary membrane.

What does the term 'perfusion limited' refer to?

Conditions affecting the blood flow.

What is the importance of calculating PAO2?

It helps assess the partial pressure of oxygen in the alveoli.

What does the term 'shunt' refer to in respiratory physiology?

A situation where blood bypasses the lungs and does not get oxygenated.

What is palpation performed for?

To evaluate vocal fremitus, estimate thoracic expansion, and assess the skin and subcutaneous tissues of the chest.

How do you assess vocal fremitus?

Ask the patient to repeat the words 'ninety-nine' while palpating over the chest.

What does increased vocal fremitus indicate?

Pneumonia, lung tumor or mass, and atelectasis.

What conditions can cause decreased vocal fremitus?

Unilateral: bronchial obstruction, pneumothorax, and pleural effusion; Diffuse: COPD with hyperinflation, muscular, or obese chest wall.

What is rhonchial fremitus?

Palpable vibrations caused by thick secretions, often identified during inhalation and exhalation.

What does a dull percussion note indicate?

Low pitch or fluid presence, associated with pneumonia, effusion, or atelectasis.

What does hyperresonance in percussion suggest?

Increased resonance, indicating conditions like emphysema or pneumothorax.

What is the purpose of auscultation?

To listen to lung and heart sounds using a stethoscope.

What is hepatomegaly?

An enlarged liver, common in patients with Cor pulmonale.

What is ascites?

An abnormal collection of fluid in the peritoneal cavity.

What is clubbing a sign of?

Significant manifestation of cardiopulmonary disease.

What does cyanosis indicate?

A blue/gray/purplish appearance of the skin due to poor perfusion.

What is pedal edema?

Swelling in the feet due to fluid retention.

What is the normal capillary refill time?

2-5 seconds.

What does skin turgor assess?

Dehydration by checking if the skin returns immediately after being pinched.

What are tracheal breath sounds?

Loud, high-pitched sounds heard directly over the trachea with equal inspiratory and expiratory components.

What are crackles?

Discontinuous sounds heard most often on inspiration.

What are wheezes?

Continuous sounds heard most often on exhalation.

What does tachypnea refer to?

Rapid rate of breathing.

What is apnea?

No breathing.

What is Cheyne-Stokes breathing?

Irregular breathing with periods of apnea, often due to CNS diseases or congestive heart failure.

What is Kussmaul breathing?

Deep and fast breathing, often due to metabolic acidosis.

What is the function of the cerebrum?

Movement, level of consciousness, ability to speak and write, emotions, and memory.