final exam

emergency cardiac situation (call nurse)

• asystole

• vfib

• vtach

• mobitz ii

• third degree av block

stop PT for the following cardiac pathologies

• afib w/ RVR

• alfutter if medical Rx or cardioversion is pending

• PVCs if > 6 PVC, multifocal, occurs in pairs

• SVT

be careful w/ the following cardiac pathologies during PT

• brady

• tachy

• sinus pause

• controlled afib

• first degree AV block

• wenkebach

troponin values (T and I)

• T < 0.1

• I < 0.03

what labs do you look @ for cardiac pathologies

• troponin (1st ALWAYS!)

• CK-MB

• BNP

normal Hgb (males and females)

• M: 14-18

• F: 12-16

normal Hct (males and females)

• M: 42-52

• F: 37-47

what electrolytes affect cardiac rhythm

Na+ and Mg+

which electrolyte is life threatening if it’s low

Mg+

emphysema

Permanent damage and enlargement of the acini (distal to terminal bronchioles) with destruction of alveolar walls, leading to air trapping, hyperinflation, and a flattened diaphragm

chronic bronchitis

Inflammation of the airway's mucosal lining leading to narrowing, obstruction, and excessive mucus production.

presentation of R HF

• nausea

• GI distress/fullness

• abdominal pain and distension

• fatigue/weakness

• JVD

• peripheral edema

• weight gain

presentation of L HF

• extertional dyspnea

• orthopnea

• paroxysmal noctural dyspnea

• fatigue/restless/anxiety

• pulmonary congestion

• tachy

• cyanosis/hypoxia

what do u do for tamponade pts as a PT

CALL NURSE

sternal precautions

• no bilat UE flexion > 90° → unilat is OK

• no pushing/pulling > 10#

• no driving

• encourage splinted cough & incentive spirometry

PPM/ICD precautions

• no shoulder flexion > 90°

• no lifting/pulling > 10#

• avoid scrubbing Sx site → pat dry w/ towel

• no bathing/swimming for 4 wks

• no modalities over site

primary inspiration muscle

diaphragm

what is active and passive during ventilation

• active = inspiration

• passive = exhalation

PaO2

measures the amount of oxygen gas dissolved directly into the plasma portion of blood

what is the cause of hypoxia

hypoventilation → diffusion impairment

nasal cannula FiO2 %

• RA

• 1 L

• 2 L

• 3 L

• 4 L

• 5 L

• 6 L

• RA - 21

• 1 L - 24

• 2 L - 28

• 3 L - 32

• 4 L - 36

• 5 L - 40

• 6 L - 44

how much FiO2 does a non-rebreather/partial non-rebreather provide

60-99

how much FiO2 does a trach collar provide

21-100 @ 10-12 L/min

how much FiO2 does a high flow nasal cannula provide

100% O2 w/ flow of 20-70 L/min

what airway support provides PEEP

high flow nasal cannula

what does PEEP do

keeps alveoli open

how to perform upper lobe chest excursion

• hands on anterior chest

• thumbs meet @ sternal angle

• fingers over traps

how to perform middle lobe chest excursion (and what ribs r u contacting)

• hands on anterior chest, inf to pecs

• thumbs @ midline

• bucket hands @ 7-10th ribs

how to perform lower lobe chest excursion (what level rib should u be @)

• hands on posterior chest @ level of 10th rib

• thumbs @ midline

• fingers in axilla

where do rhonci sounds happen

proximal airways (bronchi)

where do crackles sounds happen

distal airways

what adventitious sound is an emergency

stridor

what type of sounds does consolidation cause

enhanced sounds

what type of sounds does increased air cause

decreased sounds

what types of sounds does lack of airflow cause

absent or misplaced sounds

what disease can u see digital clubbing

restrictive lung disease

test for definitive Dx of pulmonary embolism (PE)

V/Q scan

test for absolute Dx of pulmonary embolism (PE)

angiography

what is considered pHTN

• at rest

• during exercise

• at rest: > 25

• during exercise: > 30

how to Tx lung cancer

• median sternotomy

• thoracotomy

where can incisions be made w/ thoracotomy and what structures is it made in btw

• posterolateral

• anterolateral

• clamshell

• incision is btw ribs and intercostal muscles

how much time do u want to start w/ pt intervention

5 mins

what is the main limiting factor in COPD

dyspnea

what is the target HR for these pts

• medical: resting HR + 20

• post-op: resting HR + 30

what condition is increased incidence of sudden death w/ exercise

pHTN

what are considered traditional ACT/chest PT

• postural drainage

• percussion

• vibration

• coughing and huffing

• breathing exercise

• suctioning

what does high volume high velocity huffing help

proximal airways

what does low volume low velocity huff

distal airways

what breathing technique should i use for a pt w/ bronchiectasis

low volume low velocity huff

what does lateral costal expansion help kick start

inhalation

what is the highest level of temporary support

ECMO

vasovagal

transient reflex causing SA node slowing → hypotension

sinus pause

SA node stops firing

what do pharmacologic stress tests do

dilates vasculature

what does ablation help with

arrhythmias

name the procedures associated with the following conditions

• aortic stenosis

• aortic regurgitation

• mitral stenosis

• mitral regurgitation

• aortic stenosis: TAVR

• aortic regurgitation: valve repair/replacement

• mitral stenosis: balloon valvuloplasty, surgical repair

• mitral regurgitation: mitral clip

what does pleurodesis treat

• recurrent pneumothorax

• recurrent pleural effusion when chest tubes failed

indications for VATS

• eval and biopsy of pleural or lung lesions

• resection of lung nodules or masses

• pleural effusion drainage and pleurodesis

• lung wedge resection or lobectomies

• management of pneumothorax

what are considered the atrioventricular valves and when do they close

• tricuspid and mitral (bicuspid)

• S1 “LUB”

what BNP levels can indicate HF

• under 50

• over 50

• under 50: > 450

• over 50: > 900

when do coronary arteries fill

diastole

which is always a pathological heart sound

S4

how to diagnose bronchiectasis

CT scan

where is the incision for pneumonectomy

5th ICS

where is thoracentesis incision made for tension PTX

2nd ICS

tamponade symptoms

• JVD

• hypotension

• muffled heart sounds

what procedure treats afib

maze procedure

location of aortic auscultation

• 2nd ICS

• R sternal border

location of pulmonary auscultation

• 2nd ICS

• L sternal border

location of tricuspid auscultation

• 4th ICS

• lower left sternal border

location of mitral auscultation

• 5th ICS

• mid-clavicular line