NPTE Cardiopulmonary
Normal right atrial pressure
0-8 mm Hg`
Average hemoglobin for women
12-16 g/100 mL of blood
Normal hemoglobin for females
12.0 - 15.8 gm/dl
Prehypertensive
120-139, 80-89
Angina Pain Scale
1 = mild, barely noticeable 2 = moderate, bothersome 3 = moderately severe, very uncomfortable 4 = most severe or intense pain ever experienced
Systolic murmurs
Occur between S1 and S2
Rating of perceived exertion (borg)
13-14 = 70% of MHR 11-13 = upper limit of prescribed training heart rates early in cardiac rehab
Range of normal hemoglobin for adult men
13.3 - 16.2 gm/dl
Normal hemoglobin for males
13.3 to 16.2 gm/dl
Stable angina
Occurs at a predictable level of exertion, exercise, or stress and responds to nitroglycerin
What is consolidation?
Area of the lung that is filled with fluid. This fluid may be edema, inflammatory exudate, pus, water, or blood.
When is compression therapy contraindicated by the ankle-brachial index?
Less than .8
Inspiratory Capacity
The maximal volume of air that can be inspired after a normal tidal exhalation. IC = TV + IRV. 60% of total lung volume
Inspiratory Reserve Volume
The maximal volume of air that can be inspired after normal tidal volume inspiration. IRV is approximately 50% of total lung volume.
Peak Expiratory flow
The maximum flow of air during the beginning of a forced expiratory maneuver
Stage 1 hypertension
140-159, 90-99
A physical therapist classifies an obtained sputum sample as purulent. Which medical condition would MOST likely be associated with this type of sputum? 1. asthma 2. lung abscess 3. pulmonary edema 4. tuberculosis
2) Lung abscess
S4 heart sound
Occurs late in diastole just before S1 (la-lub-dub). Associated with atrial contraction and increased resistance to ventricular filling. This heart sound is reffered to as atrial gallop.
What does the COPD respiratory rate look like?
Longer expiration phase 1:3 or 1:4 compared to 1:2
Claudication scale
1 Definite discomfort or pain, but only initial or modest levels 2 Moderate discomfort or pain from which the patient's attention can be diverted 3 Intense pain from which the patients attention cannot be diverted 4 Excruciating and unbearable pain
Low vs high hematocrit
Low hematocrit - blood loss, anemia, vitamin or mineral deficiencies High hematocrit - dehydration polycythemia vera (overproduction of RBCs)
Leukopenia
Low number of WBC, increase risk of infection
Thrombocytopenia
Low number of platelets, increases the risk of bruising and abnormal bleeding
When can crackles be heard?
Often in the bases of lungs with interstitial lung disease - atelactasis, pneumonia, bronchiectasis, pulmonary edema
Decreased breath sounds and increased fremitus are often associated with?
Pulmonary edema, consolidation, and atelactasis
The lub of the lub dub when listening to heart sounds
S1 (onset of ventricular systole)
The dub of the lub-dub
S2 (onset of ventricular diastole)
A patient has a resting blood pressure of 120/80 mm Hg. During an activity with a metabolic equivalent level of 4, which of the following blood pressure responses is MOST likely associated with poor left ventricular function? 1. 108/78 mm Hg 2. 129/76 mm Hg 3. 138/83 mm Hg 4. 164/84 mm Hg
1) 108/78
Increased residual volume is LEAST likely to be a finding in pulmonary function testing of a patient with which of the following conditions? 1. Atelectasis 2. Bronchiectasis 3. Chronic bronchitis 4. Emphysema
1) Atelectasis
A woman has been walking on a treadmill for 10 minutes at 3.5 miles (5.6 km) per hour and 0° elevation when she reports a new onset of midthoracic back pain, aching in the right biceps muscle, fatigue, weakness, and nausea. Which system is MOST likely implicated? 1. Cardiovascular 2. Gastrointestinal 3. Musculoskeletal 4. Neuromuscular
1) Cardiovascular
The medical record indicates a patient has been diagnosed with chronic respiratory alkalosis. The MOST consistent laboratory finding with this condition is: 1. elevated arterial blood pH, low PaCO2 2. low arterial blood pH, elevated PaCO2 3. elevated arterial blood pH, elevated PaCO2 4. low arterial blood pH, low PaCO2
1) Elevated arterial blood pH, low PaCO2
A patient reports a recurrent pattern of chest pain while walking each day. Which of the following measurements will BEST enable the physical therapist to estimate the myocardial oxygen demand at the onset of symptoms? 1. Heart rate and systolic blood pressure 2. Rate of perceived exertion and systolic blood pressure 3. Rate of perceived exertion and oxygen saturation 4. Oxygen saturation and heart rate
1) Heart rate and systolic blood pressure
A patient is referred to physical therapy for right shoulder pain. Which of the following findings suggests that physical therapy intervention may not be appropriate? 1. Pain that subsides with right sidelying 2. Tenderness to palpation at the origin of the biceps tendon 3. Trigger points at the right rib 2-3 intercostal space 4. Pain with resisted shoulder lateral (external) rotation
1) Pain that subsides with right sidelying
A patient who had a left thoracotomy yesterday is currently receiving 2 L/minute of supplemental oxygen via nasal cannula. The patient, lying supine in bed, begins to cough. A physical therapist can help to MINIMIZE the patient's incisional pain associated with coughing by: 1. placing the patient's hands firmly over the incision. 2. assisting the patient into a right sidelying position. 3. increasing the supplemental oxygen to 3 L/minute. 4. encouraging the patient to suppress the cough.
1) Placing the patient's hands firmly over the incision
A physical therapist completes a respiratory assessment on a patient in an acute care hospital. The examination reveals decreased breath sounds and decreased fremitus. This finding is MOST indicative of: 1) pleural effusion 2) pulmonary edema 3) consolidation 4) atelactasis
1) Pleural effusion
A physical therapist is instructing a patient who has pneumonia in home postural drainage positioning for the superior segments of the lower lobes. Which of the following positions is MOST appropriate? 1. Prone lying on a bed with two pillows under the pelvis 2. Sitting on a chair, leaning forward over a folded pillow 3. Lying supine on a bed with pillows under the knees 4. Sitting in a recliner, leaning slightly backward
1) Prone lying on a bed with two pillows under the pelvis
A physical therapist is positioning a patient for postural drainage. To BEST drain the posterior segment of both lower lobes, the patient should be placed in which of the following positions? 1. Prone, head down at a 45° angle 2. Supine, flat surface 3. Sidelying, head elevated at a 30° angle 4. Sitting, leaning forward
1) Prone, head down at a 45 degree angle
A patient who is performing a vigorous treadmill test is MOST likely to have an immediate increase in which of the following physiologic responses? 1. Respiration rate to raise blood pH levels 2. Respiration rate to lower blood pH levels 3. Rate of excretion of hydrogen ions by the kidneys to raise blood pH levels 4. Rate of excretion of hydrogen ions by the kidneys to lower blood pH levels
1) Respiration rate to raise blood pH levels
A 90-year-old patient with chronic heart failure has been nonambulatory and has resided in a nursing home for the past year. The patient was recently admitted to the hospital after an episode of dehydration. Which of the following plans for prophylactic respiratory care is MOST appropriate? 1. Turning, coughing, and deep breathing every 1 to 2 waking hours 2. Vigorous percussion and vibration 4 times/day 3. Gentle vibration with the foot of the bed elevated 1 time/day 4. Segmental postural drainage using standard positions throughout the day
1) Turning, coughing, and deep breathing every 1 to 2 waking hours
Lingula left upper lobe
1/4 from supine on right side, foot of bed elevated 12 inches. Percussion and vibration are performed over the left chest between the axilla and the left nipple
Posterior segment of the right upper lobe
1/4 turn from prone on the left side - head and shoulders raised on a pillow - percussion and vibration are performed around the medial border of the right scapula
How many bronchopulmonary segments are there?
10 bronchopulmonary segments in the right lung, 8 bronchopulmonary segments in the left lung
What percent of interstitial fluid is the lymphatic system responsible for collecting?
10-20%
A patient with right upper extremity lymphedema following a radical mastectomy discusses the cause of lymphedema with her physician. The physician explains that both the venous system and the lymphatic system are responsible for collecting and transporting interstitial fluid. What percentage of interstitial fluid is collected by a normally functioning lymphatic system? 1) 15% 2) 35% 3) 55% 4) 75%
15%
Normal platelet count
150,000 to 450,000 platelets per microliter of blood
Normal platelet count
150,000-400,000
A physical therapist reviews a laboratory report for a 41-year-old male diagnosed with chronic obstructive pulmonary disease. Which of the following would be considered a normal hemoglobin value? 1. 10 gm/dL 2. 15 gm/dL 3. 20 gm/dL 4. 25 gm/dL
2) 15 gm/dl
A physical therapist is working with a patient who has multiple medical issues and has just finished chemotherapy. Which of the following tests is MOST appropriate to measure changes in this patient's endurance over time? 1. 10-meter walk for time 2. 6-minute walk 3. Timed Up and Go 4. Maximum VO2 assessment
2) 6 minute walk
A patient has difficulty palpating the carotid pulse during exercise. The patient should be instructed in alternate methods of self-monitoring, because repeated palpation is likely to result in: 1. an increase in the heart rate. 2. a decrease in the heart rate. 3. an irregular heart rhythm. 4. an increase in blood pressure.
2) Decrease in the heart rate
A patient's pulmonary function tests reveal that the patient has a forced vital capacity (FVC) of 4.0 liters and a forced expiratory volume in 1 second (FEV1) of 3.5 liters. These results would be MOST anticipated with a diagnosis of: 1. cystic fibrosis 2. idiopathic pulmonary fibrosis 3. chronic bronchitis 4. emphysema
2) Idiopathic pulmonary fibrosis
During auscultation of the chest wall, a physical therapist notes an area of decreased breath sounds. Which of the following additional findings would support the suspicion of consolidation? 1. Tympanic sound with percussion 2. Increased fremitus 3. Hypertrophy of accessory muscles 4. High-pitched wheezes
2) Increased fremitus
A patient with muscular dystrophy was removed from mechanical ventilation 1 day ago. The patient is currently unable to independently clear secretions, despite receiving instruction in the bronchopulmonary hygiene techniques of positioning, percussion, shaking, and vibration. Which of the following interventions is MOST appropriate to help this patient clear the secretions? 1. Nasotracheal suctioning 2. Manual costophrenic assist 3. Supplemental oxygen 4. Inspiratory muscle training
2) Manual costophrenic assist
When providing patient education in cardiac rehabilitation, which of the following signs and symptoms of exertional intolerance should the physical therapist emphasize? 1. Anginal pain, insomnia, sudden weight gain, leg stiffness 2. Persistent dyspnea, dizziness, anginal pain, sudden weight gain 3. Persistent dyspnea, anginal pain, insomnia, weight loss 4. Anginal pain, confusion, leg numbness, weight loss
2) Persistent dyspnea, dizziness, anginal pain, sudden weight gain
A patient is doing active and resistive exercises on a mat table in the physical therapy department. After 15 minutes, the patient becomes short of breath, begins coughing, and expectorates pink, frothy sputum. At this point, the physical therapist should first stop the treatment, then NEXT: 1. assess vital signs, let the patient rest a few minutes with the feet elevated, and then resume with a less vigorous program. 2. sit the patient up, assess vital signs, and call a nurse or physician for further instructions. 3. lay the patient supine, transfer the patient to a stretcher, and return the patient to the nursing unit. 4. lay the patient down flat, call for assistance, and begin cardiopulmonary resuscitation.
2) Sit the patient up, assess vital signs, and call a nurse or physician for further instructions
Which of the following movement patterns is MOST likely to be present in a patient who exhibits abdominal paradoxical breathing? 1. Synchronous upward and outward motion of the abdomen and upper chest 2. Upward and outward motion of the upper chest and inward motion of the abdomen 3. Upward and outward motion of the abdomen and inward motion of the upper chest 4. Excessive upper chest motion with decreased use of the sternocleidomastoid and scalene muscles
2) Upward and outward motion of the upper chest and inward motion of the abdomen
A patient recently admitted to an acute care hospital is referred to physical therapy. The physical therapist documents the following clinical signs: pallor, cyanosis, and cool skin. These clinical signs are MOST consistent with: 1. cor pulmonale 2. anemia 3. hypertension 4. diaphoresis
2) anemia
A physical therapist reviews the medical record of a 52-year-old male status post myocardial infarction. The patient is currently in the coronary care unit and is scheduled to begin cardiac rehabilitation tomorrow. Which potential complication of a myocardial infarction is the patient MOST susceptible to? 1) heart failure 2) arrhythmias 3) thrombus formation 4) heart structural damage
2) arrhythmias
A patient rehabilitating from a bone marrow transplant is referred to physical therapy for instruction in an exercise program. The physical therapist plans to use oxygen saturation measurements to gain additional objective data related to the patient's exercise tolerance. Assuming the patient's oxygen saturation was measured as 95% at rest, which of the following guidelines would be the MOST appropriate? 1. discontinue exercise when the patient's oxygen saturation is below 95% 2. discontinue exercise when the patient's oxygen saturation is below 90% 3. discontinue exercise when the patient's oxygen saturation is below 85% 4. discontinue exercise when the patient's oxygen saturation is below 80%
2) discontinue exercise when the patient's oxygen saturation is below 90%
A physician orders an electrocardiogram (ECG) for a patient diagnosed with congestive heart failure. The medical record indicates the patient is currently taking digitalis. What effect would you expect digitalis to have on the patient's ECG? 1) sinus tachycardia 2) lengthened PR interval 3) lengthened QT interval 4) elevated ST segment
2) lengthened PR Interval
Partial Thromboplastin Time (PTT)
26.3 to 39.4 seconds
Pulmonic Area (heart sounds)
2nd left intercostal space
Aortic heart sound
2nd right intercostal space
A physical therapist uses metabolic equivalents (METs) as a method to establish exercise intensity for a 36-year-old female. The patient is recreationally active and has no relevant past medical history. Which MET level would be MOST consistent with the patient's anticipated maximal aerobic capacity? 1) 3 METs 2) 6 METs 3) 10 METs 4) 15 METs
3) 10 METs
While walking on a treadmill during Phase II cardiac rehabilitation following coronary artery bypass surgery, a patient reports the new onset of chest pain and dyspnea. The physical therapist should instruct the patient to: 1. continue walking while the therapist monitors the patient's vital signs. 2. continue walking at 50% slower speed while the therapist calls the physician. 3. cease walking while the therapist reassesses the patient's vital signs. 4. cease walking while the therapist activates the emergency medical system.
3) Cease walking while the therapist reassesses the patients vital signs
A physical therapist is examining a patient prior to administering a graded exercise test. Which of the following findings is a relative, but NOT absolute, contraindication to exercise testing? 1. Acute infections such as pneumonia 2. Acute pulmonary embolus 3. Chronic infections such as hepatitis 4. Ventricular arrhythmia
3) Chronic infections such as hepatitis
For a patient who takes a thiazide medication (hydrochlorothiazide), which of the following combinations of signs may indicate an adverse effect of the medication? 1. Agitation, dizziness, dyspnea, and hyperventilation 2. Abdominal cramps, agitation, dyspnea, and numbness 3. Clammy skin, dizziness, hyperventilation, and hypotension 4. Abdominal cramps, clammy skin, hypotension, and numbness
3) Clammy skin, dizziness, hyperventilation, and hypotension 3. Thiazide diuretics enhance secretion of sodium and potassium in the urine, leading to hyponatremia and hypokalemia (Ciccone, p. 319). Clammy skin and hypotension are signs of hyponatremia, and dizziness and hyperventilation are signs of hypokalemia (Goodman, p. 207).
Normal erythrocyte count
4.3- 5.6 million for males 4.9 - 5.2 million for females
Normal blood volume
4.5 to 5.0 L
A physical therapist is preparing to perform a bed to chair transfer with a patient who underwent an extensive surgery 24 hours ago and is taking an angiotensin-converting enzyme (ACE) inhibitor. During this transfer, the physical therapist should monitor the patient for the possibility of a: 1. Rise in systolic and a drop in diastolic blood pressure. 2. Rise in systolic and diastolic blood pressure. 3. Drop in systolic and diastolic blood pressure. 4. Drop in systolic and a rise in diastolic blood pressure.
3) Drop in systolic and diastolic blood pressure
A patient in an acute care hospital has a catheter inserted into the internal jugular vein. The catheter travels through the superior vena cava and into the right atrium. The device permits removal of blood samples, administration of medication, and monitoring of central venous pressure. The device is BEST termed: 1. arterial line 2. central venous pressure catheter 3. Hickman catheter 4. Swan-Ganz catheter
3) Hickman catheter
During an examination, a physical therapist finds that a patient with chronic obstructive pulmonary disease has a weak wet cough. Which of the following techniques is MOST appropriate to help this patient clear secretions? 1. Abdominal thrusts 2. Postural drainage 3. Huffing 4. Manual or mechanical percussion
3) Huffing
Echocardiographic testing revealed a significant decrease in a patient's anticipated cardiac output. Which variable would MOST likely contribute to this finding? 1. increase in heart rate 2. increase in preload 3. increase in afterload 4. increase in stroke volume
3) Increase in afterload
A long-distance runner comes to physical therapy with insidious onset of lower leg pain. The patient's examination results reveal weakness of toe flexion and ankle inversion. The physical therapist suspects vascular compromise associated with this presentation. Palpation at which of the following locations is MOST likely to reveal diminished arterial pulses in the patient? 1. Dorsal aspect of the foot 2. Posterior to the lateral malleolus 3. Posterior to the medial malleolus 4. Lateral aspect of the popliteal fossa
3) Posterior to the medial malleolus
A patient with idiopathic pulmonary fibrosis completed a 6-minute walk test and demonstrates the following results: total walking distance of 1200 ft (366 m) in 6 minutes, heart rate of 82 to 110 bpm (pretest to posttest), blood pressure of 125/80 to 145/85 mm Hg (pretest to posttest), respiratory rate of 18 to 40 breaths/minute (pretest to posttest), and oxygen saturation of 98% to 92% (pretest to posttest); an electrocardiogram showed normal sinus rhythm throughout the test. Based on these results, the physical therapist should determine that the patient has impaired: 1. aerobic capacity and endurance associated with cardiovascular pump dysfunction. 2. ventilation, respiration, and aerobic capacity associated with airway clearance dysfunction. 3. ventilation, respiration, aerobic capacity, and gas exchange associated with ventilatory pump dysfunction. 4. aerobic capacity and endurance associated with myocardial ischemia.
3) Ventilation, respiration, aerobic capacity, and gas exchange associated with ventilatory pump dysfunction
A patient with known cardiac disease experiences angina while exercising on a recumbent bicycle. The patient self-administers a nitroglycerin tablet to control the angina. Nitroglycerin helps to control this symptom by: 1. decreasing heart rate 2. inhibiting vasospasm of the coronary arteries 3. dilating peripheral arteries and veins 4. decreasing platelet aggregation
3) dilating peripheral arteries and veins
A physical therapist examines the breath sounds of a 55-year-old male diagnosed with pulmonary disease. The therapist identifies crackles during both inspiration and expiration. This finding is MOST representative of: 1) pleural effusion 2) pulmonary fibrosis 3) impaired secretion clearance 4) localized stenosis
3) impaired secretion clearance
A physical therapist working with a patient who is borderline hypotensive can minimize orthostatic hypotension by: 1. loosening tight legwear and footwear before gait training. 2. elevating the head during a hypotensive episode. 3. instructing the patient to perform ankle pumps before standing. 4. encouraging the patient to consume meals prior to therapy.
3) instructing the patient to perform ankle pumps before standing
A patient, who has many risk factors for coronary artery disease and is presently not taking any cardiac medications, is interested in beginning an exercise program at a gym to improve cardiac health. The BEST self-assessment of exercise intensity during the exercise sessions of this patient is: 1. change in systolic blood pressure. 2. MET (metabolic equivalent) level. 3. rating of perceived exertion. 4. respiratory rate.
3) rating of perceived exertion
Normal CO
4.5 to 5.0 L/ min
Normal female hematocrit
35 - 44%
PaCO2
35-45 mmHg
Average hematocrit for a woman
37% - 47%
Normal male hematocrit
38-46%
Normal hematocrit for males
39 - 46%
A physician orders compression garments for an ambulatory patient who has significant difficulty with lower extremity edema. How much pressure would typically be necessary to control lower extremity edema? 1. 10 mm Hg 2. 18 mm Hg 3. 25 mm Hg 4. 35 mm Hg
4) 35 mm HG
A 39-year-old male patient with a 20-year history of smoking reports cramping pain of the buttock, thigh, and calf that is worse when walking. Which of the following findings is MOST likely present? 1. Forward stooping while walking 2. Pain in the calf with abrupt dorsiflexion 3. Brown pigmentation of the lower extremity 4. Blood pressure that is greater in the arm than in the leg
4) Blood pressure that is greater in the arm than in the leg
A physical therapist is evaluating a patient who had a right lower lobe resection due to lung cancer 1 day ago. During auscultation of the patient's lungs, the therapist notes low-pitched crackles bilaterally. The patient's vital signs are heart rate of 99 bpm, blood pressure of 115/75 mm Hg, and pulse oximetry reading of 92% while receiving 2 L/minute of oxygen in sitting position at the edge of the bed. Which of the following actions should the therapist take NEXT? 1. Begin walking activities, with the patient receiving 4 L/minute of oxygen. 2. Contact the physician. 3. Perform active range-of-motion exercises with the patient at bedside. 4. Initiate bronchopulmonary hygiene.
4) Initiate bronchopulmonary hygiene
Which of the following postural drainage positions is MOST appropriate for a patient who has aspiration pneumonia in the right middle lobe and who had a craniotomy 2 days ago? 1. Right sidelying with one-quarter turn toward supine and the bed flat 2. Left sidelying with one-quarter turn toward supine with head of bed down approximately 20° 3. Right sidelying with one-quarter turn toward supine with head of bed down approximately 20° 4. Left sidelying with one-quarter turn toward supine and the bed flat
4) Left sidelying with one-quarter toward supine and the bed flat
A physical therapist assesses the vital signs of a patient with a blood disorder. The therapist records the patient's blood pressure as 150/85 mm Hg. Which condition is MOST likely the cause of the abnormal blood pressure measurement? 1. anemia 2. thrombocytosis 3. leukopenia 4. polycythemia
4) Polycythemia
A patient had a total knee arthroplasty 2 days ago. The patient now has a cough, chest pain, and a dull ache in the leg. Physical examination reveals diaphoresis and unilateral lower extremity pitting edema. The patient MOST likely has which of the following conditions? 1. Pleuritis 2. Pneumonia 3. Myocardial infarction 4. Pulmonary embolism
4) Pulmonary Embolism
A newborn's Apgar score represents evaluation of heart rate, color, and which additional clinical characteristics? 1. Respiration, temperature, and weight 2. Reflex irritability, temperature, and weight 3. Respiration, muscle tone, and weight 4. Respiration, muscle tone, and reflex irritability
4) Respiration, muscle tone, reflex irritability
Normal WBC count
4,000 and 11,000 per microliter of blood
Tricuspid valve
4th intercostal space at the left sternal border
Average serum WBC for women
5,000 - 10,000
Normal leukocyte count
5,000-10,000
Mitral area
5th intercostal space, medial to the left midclavicular line
Heart rate
60-100
pH
7.35-7.45
Original RPE scale
7= very, very light 9= very light 11=fairly light 13=somewhat hard 15=hard 17=very hard 19=very, very hard
PaO2
80-100 mmHg
SaO2
95-98%
LDL
< 100 is optimal, >160 is high, >190 is very high
Triglyceride
< 150 is desirable, 200-499 is high
BMI
< 18.5 Underweight 18.5 - 24.9 = normal 25.0 - 29.9 = overweight 30.0 - 34.9 = obesity class 1 35.0 - 39.9 = obesity class 2 > or = 40 = extreme obesity
Normal capillary refill time
< 2 seconds
Total cholesterol
< 200 is desirable, > 240 is high
HDL
< 40 is low, > or = to 60 is high
Normal BP
<120 <80
Ankle Brachial Index (score)
> or = 130 indicates rigid arteries and the need for an US test to check for peripheral artery disease 1.0-1.3 nomal/no blockage .8-.99 mild blockage; beginnings of peripheral artery disease .4-.79 moderate blockage; may have intermittent claudication with exercise <.4 Severe blockage suggesting severe peripheral artery disease; may have claudication pain at rest
Stage 2 hypertension
> or = 160/ > or = 100
Ventricular Septal Defect
A hole in the septum separating the right and left ventricles. If the hole is too large, too much blood will be pumped towards the heart which will lead to heart failure Sx may include if large enough and does not close: cyanosis of the lips, skin, and fingernails, poor eating habbits, fast breathing or breathlessness, fatigue, swelling of the legs, feet or abdomen, tachycardia
Decreased or diminished sounds
A less audible sound that may indicate severe congestion, emphysema, or hypoventilation
Hypertrophic cardiomyopathy
A condition in which the heart muscle becomes abnormally thick. Meds to slow heart rate and stabilize rhythm (Lopressor and calcium channel blockers)
Adventitious breath sounds
Abnormal breath sound heard over the lungs that can be continuous or discontinuous
Crackles (rales)
Abnormal breath sounds heard during auscultation of the lungs with a stethoscope. Crackles are extra sounds caused by the popping open of small airways blocked by secretions or fluid and may be heard during both the inspiratory and expiratory phases of the breathing cycle
Bronchial breath sounds
Abnormal breath sounds when heard in locations where vesicular sounds are normally present. Pneumonia may produce these sounds.
Restrictive lung diseases
Abnormal reduction in lung expansion and pulmonary ventilation Atelactasis, pneumonia, pulmonary fibrosis, pulmonary edema, ARDS, abnormal pleura (pleural effusion, pleural fibrosis, pneumothorax, hemothorax) and disorders affecting ventilatory pump dysfunction Non productive cough, increase RR, hypoxemia, decreased vital capacity, abnormal breath sounds, and reduced exercise tolerance.
Heart murmur
Abnormal swishing or whooshing sound heard by auscultation sometime during the cardiac cycle
Crackles (rales)
Abnormal, discontinuous, high-pitched popping sound heard more often with inspiration. Restrictive or obstructive disorders Typically represents the movement of fluid or secretions during inspiration (wet crackles) or occurs from the sudden opening of closed airways (dry crackles)
What is atelectasis?
Absence of gas in part or all of a lung due to a collapse of lung tissue
Absent breath sounds
Absent lung sounds may indicate pneumothorax or lung collapse.
Preload
Amount of blood in the ventricle at the end of the diastolic phase and is directly related to venous return, As preload increased, stroke volume (and thus cardiac output) will also increase.
1 MET =
Amount of oxygen consumed at rest and is equal to approximately 3.5 milliliters of oxygen per kilogram of body weight per minute
What is pleural effusion?
An accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity
What is pulmonary edema?
An accumulation of fluid in the alveolar spaces
Coarctation of the aorta
Aorta is narrowed near the ductus arteriosus, Can occur with other congenital defects: PDA, ventricular septal defect, and bicuspid aortic valve Sx: pale skin, sweating, shortness of breath are often noted soon after birth, later in life: high blood pressure in the arms, low blood pressure in the legs, sob during exercise, intermittent claudication, weakness, and headache
What do crackles represent that occur during the later half of inspiration?
Atelactasis, fibrosis, pulmonary edema, pleural effusion.
Cystic fibrosis
Autosomal recessive genetic disease of the exocrine glands that primarily affects the lungs, pancreas, liver, intestines, sinuses, and sex organs Causative factor is a mutation of the cystic fibrosis transmembrane conductance regulator on chromosome 7. Frequent greesy, bulky stools
ST segment
Beginning of ventricular repolarization and is generally isoelectric
HCO3-
Bicarbonate 22-26 mEq/L
Pleural Effusion
Build up of fluid in the pleural space between the lungs and chest cavity. The excess fluid can push the pleura against the lung making it hard to breathe and in some cases cause an atelactasis. If the fluid gets infected and turns into an abscess, the condition is called empyema Caused by pleuritis - inflammation of the visceral and parietal pleura
Rate pressure product
HR x SBP related to myocardial oxygen uptake and myocardial blood flow Can be used to guide exercise prescription for patients with angina - below the RPP with decrease the risk of developing angina
Obstructive ventilatory impairment
Chacterized by decrease expiratory flows with pulmonary function testing FEV1/FVC <70% suggest obstructive impairment (asthma, emphysema, copd)
What should you do if you suspect a patient has an acute pulmonary edema?
Call 911 - Sx include: extreme sob, difficulty breathing, profuse sweating, bubbly wheezing or gasping sound during breathing, cough that produces frothy sputum that may be tinged with blood, cyanotic skin color, rapid, irregular pulse, severe drop in blood pressure
Asthma
Chronic inflammation of the airways caused by an increased airway hypersensitivity to various stimuli
Asthma
Chronic inflammatory disease of the airways. Clinical features include cough, dyspnea, and wheezing
Which of the following factors is considered to be a primary risk factor for atherosclerosis? 1. Stress 2. Obesity 3. Cigarette smoking 4. Sedentary lifestyle
Cigarette Smoking
S2 heart sound
Closing of the aortic and pulmonary valves
S1
Closure of the mitral and tricuspid valves at onset of ventricular systole
Tetralogy of Fallot
Combination of four congenital abnormalities: ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, aorta overriding the ventricular septal defect Sx: cyanosis of the skin, sob and rapid breathing - especially during feedinf, fainting, clubbing of fingers and toes, poor weight gain, tiring easily during play, irritability and prolonged crying, heart murmur
Ankle Brachial Index (Summary)
Compares systolic blood pressures at the ankle and arm to check for peripheral artery disease Brachial arteries and both tibialis posterior arteries
Pulmonary Fibrosis
Condition in which microscopic damage to the alveoli causes irreversible scarring of the interstitial tissue. Normally, the tissue is highly elastic, expanding and contracting with each breath. Scarring makes the interstitial tissue thick and stiff and the alveoli less flexible, making breathing more difficult. SOB, dry cough (later in disease stage), fatigue, unexplained weight loss, aching muscles and joints
Patent ductus arteriosus (PDA)
Congenital heart defect in which the ductus arteriosus (normally shunts blood from the pulmonary artery directly to the descending aorta in utero) does not close after birth Sx: may present with tachycardia, respiratory distress, poor eating, weight loss, and congestive heart failure
Stridor
Continuous high-pitched wheeze heard with inspiration and expiration Indicated upper airway obstruction
Wheeze
Continuous musical or whistling sound composed of a variety of pitches Arise from turbulent airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm, or foreign body
Rhonchi
Continuous, low pitched sounds described as having a snoring or gurgling quality, both on inspiration and expiration Caused by air passing through an airway which is obstructed by inflammatory secretions or liquid, bronchial spasm or neoplasms in the smaller (sibilant rhonci) or larger (sonorous) airways
Chronic Bronchitis
Hypersecretion of mucus sufficient to cause a productive cough on most days for three months during two consecutive years
S4
Hypertension, stenosis, hypertensive heart disease, MI, often called atrial gallop
Absolute indications for terminating an exercise stress test
Drop in systolic by > 10 mm Hg despite increase in workload (with other evidence of ischemia) Moderately severe ischemia (3 on a scale of 4) Increase nervous system symptoms (ataxia, dizziness) Signs of poor perfusion (cyanosis, pallor) Sustained ventricular tachycardia 1.0 mm ST elevation in leads without diagnostic Q waves
Pleural friction rub
Dry, crackling sound heard during both inspiration and expiration Occurs when inflamed visceral and parietal pleurae rub together - heard over the spot the patient feels pleuritic pain
Anemia
Deceased RBC count - blood carries less oxygen, fatigue and weakness
What does ausculation usually reveal in pulmonary fibrosis?
Decreased breath sounds
Dilated cardiomyopathy
Dysfunctional heart muscle because of an enlarged heart (Left ventricle gets enlarged and weakened) - Ace inhibitors, beta blockers, digoxin, and diuretics, may get biventricular pacemaker
Pulmonary function testing
Exhales into spirometer mouthpiece as hard and as fast as possible for 6 seconds until no more air can be expelled - 3 maneuvers, have predicted norms
Sinus Tachycardia
Fast heart rate (greater than 100 bpm) that has its origin in the SA node
Pulmonary edema breath sound
Fine crackles as air bubbles through fluid in the distal small airways
Pulmonary edema
Fluid collects in the alveoli within the lungs, making it difficult to breathe. Acute pulmonary edema is a medical emergency. Left-sided heart failure Extreme sob, difficulty breathing, drowning sensation, wheezing or gasping for breath, anxiety, restlessness, a sense of apprehension, coughing, frothy blood tinged sputum, reapd irregular pulse
Hypervolemia
Fluid overload, refers to increased blood plasma. Causes of hypervolemia include excess intake of fluids (IV or blood transfusion), and sodium or fluid retention (heart failure, kidney disease) sx: swelling in the legs, ascites, fluid in the lungs
Sputum associated with pulmonary edema
Frothy
Diastolic murmurs
Hear between S2 and S1
Five parameters of Apgar Score
Heart rate, color, respiration, muscle tone, and reflex irritability
What are primary risk factors for athersclerosis?
High blood pressure, cigarette smoking, and hyperlipidemia
Leukocytosis
High number of WBC, indicate an infection or leukemia
Thrombocythemia
High number of platelets, increases the risk of thrombosis, which may result in a stroke or heart attack
Tuberculosis
Highly contagious infectious disease spread via airborne transmission
Atrial Septal Defect
Hole in the heart seperating the right and left atria - foramen ovale doesnt close like it should at birth. Blood flows from the left to the right atrium and is called a shunt. Sx can range from none to: heart murmur, sob, fatigue, swelling of the legs, feet, or abdoomen, heart palpitations, lung infections, stroke, cyanosis of skin
How does digitalis prolong the PR interval?
Increasing conduction time through the AV node
Myocarditis
Inflammation and weakness of myocardium, which leads to the myocardium becoming thick and swollen - leads to symptoms of heart failure
Bronchitis
Inflammation of the bronchi characterized by hypertrophy of the mucus secreting glands, increased mucus secretions, and insufficient oxygenation due to mucus blockage. Chronic cough for 3 months over the course of two consecutive years Cigarrette smoking is the primary cause of chronic bronchitis Persistent cough with production of thick sputum, increased use of accessory muscles of breathing, wheezing, dyspnea, cyanosis, and increased pulmonary artery pressure. Cough that is worse in the morning and in damp weather and may experience frequent respiratory infections.
Pneumonia
Inflammation of the lungs, caused by bacterial, viral, fungal, or parasitic infection
Segmental breathing
Intended to improve regional ventilation in patients with pulmonary disease and to prevent and treat pulmonary complications after surgery. This technique combines positioning with tactile and verbal cueing and resistance to enhance expansion of a specific lung segment to facilitate chest wall motion and increase ventilation
What types of sounds are heard with pleural effusion?
Lungs sounds are usually decreased, but a pleural friction rub may be heard if the pleural surfaces are inflamed
S3 heart sound
May occur in healthy children and young adults, physiologic third heart sound. (lub-dub-dub). It also indicates a loss of ventricular compliance in the presence of heart disease or heart failure. In this case it is called ventricular gallop.
Complete Blood Count
Measures red blood cells count, total white blood cell count, white blood cell differential, hemoglobin, and hematocrit
Digitalis
Medication given to increased the force of myocontractility and is often prescribed with patients with heart failure
Hypoxemia (PaO2)
Mild 60-79 Moderate 40-59 Severe <40
S1 heart sound
Mitral and tricuspid valve closing
Emphysema
Obstructive pulmonary disease characterized by destruction of alveoli leading to hyperinflation of the lungs. A barrel-shaped configuration of the thorax is a common clinical feature of the diseae, Have increased air trapping with increased total lung capacity, barrel chest configuration of the thorax. Alveolar walls are gradually destroyed and the alveoli are turned into large, irregular pockets with gaping holes in the walls. In addition, the elastic fibers that hold open the bronchioles are destroyed, so that they collapse during exhalation, not letting air escape from the lungs. Alveoli are permanently overinflated and dead space increases within the lungs. Smoking is the leading cause.
Homan's sign for DVT
Passively DF the foot at the ankle with the foot straight + if produces pain in the calf or popliteal space
Lateral basal segments lower lobes
Patient is in sidelying with the foot of the bed elevated 18 inches, percussion and vibration performed over the lower ribs.
Superior segments left and right lower lobes
Patient is prone with the bed horizontal. Percussion and vibration below the inferior border of the left and right scapulae
Anterior segments right and left upper lobes
Patient is supine with bed horizontal, percussion and vibration are performed below the clavicles
Posterior segment of the left upper lobe
Patient is turned 1/4 from prone on right side, head of the bed elevated 45 degrees, head and shoulder raised on pillow, percussion and vibration are performed around the medial border of the left scapula
Right middle lobe
Patient turned 1/4 from supine on the left side with the foot of the bed elevated 12 inches, percussion and vibration are performed over the right chest between the axilla and the right nipple
What population is the S4 heart sound common with?
Patients with hypertension, history of MI, and coronary bypass surgery
Hematocrit
Percentage of RBCs in total blood volume
Bronchiectasis
Permanent, abnormal dilation of one of more bronchi caused by destruction of the elastic and muscular components of the bronchial walls. Common clinical features include recurrent pulmonary infections with cough and copious amounts of mucopurulent sputum Obstructive lung disease that presents with productive cough, hemoptysis, weight loss, anemia, crackles, wheezes, and loud breath sounds
Decreased breath sounds and decreased fremitus are most likely caused by?
Pleural effusion or pneumothorax
Polycythemia
RBC count is high, blood is too thick, increasing the risk of stroke and heart attack
Cardiomyopathy
Refers to a group of conditions that affect the myocardium, impairing the ability of the heart to contract and relax.
COPD
Refers to a group of lung diseases that block airflow due to narrowing of the bronchial tree. Emphysema and chronic bronchitis are the two main conditions that make up COPD. Alveolar destruction and subsequent air trapping. Increased total lung volume and residual volume Excessive mucus production, chronic productive cough, wheezing, sob, fatigue and reduced exercise capacity
Hypovolemia
Refers to decreased blood volume, specifically the volume of plasma
Apical segments of right and left upper lobes
Sitting, leaning back 30-40 degrees - percussion and vibration above the clavicles
Acute Respiratory Distress Syndrome
Sudden respiratory failure due to fluid accumulation in the alveoli. Occurs in people who are already critically ill or who have significant injuries. Severe SOB develops within a few hours to a few days after the original disease or trauma
Bruit
Swishing sound that occurs in the presence of narrowing of an artery. It is characteristic finding of PVD on auscultation
What happens to systolic BP as workload increases?
Systolic blood pressure should increase with increasing workload by approximately 10 mm Hg per 1 metabolic equivalent (MET) increase in workload
Forced Expiratory Volume
The maximal amount of air exhaled in a specific period of time: usually the 1st, 2nd, and 3rd second of a forced vital capacity maneuver
Expiratory Reserve Volume
The maximal amount of air that can be exhaled after a normal tidal exhalation - 15% of the total lung volume
QT interval
The depolarization and repolarization time of the ventricles and extends from the beginning of the QRS complex to the end of the T wave
Afterload
The force that the left ventricle must generate during the systolic phase and is directly related to the resistance in the aorta and peripheral arteries. As afterload increases, stroke volume (and thus CO) will decrease.
Posterior basal segments left and right lower lobes
The patient is prone with the foot of the bed elevated 18 inches. Percussion and vibration are performed over the lower ribs on the left and right side
Anterior basal segments left and right lower lobes
The patient is supine, foot of bed elevated 18 inches, percussion and vibration are performed over the lower ribs on the left and right side
Vital Capacity
The volume change that occurs between maximal inspiration and maximal expiration. VC = TV + IRV + ERV. 75% of total lung volume 3-5 liters
Forced Vital Capacity
The volume of air expired during a forced maximal expiration after a forced maximal inspiration
Minute Volume Ventilation
The volume of air expired in one minute. VE= TV x RR
Total Lung Capacity
The volume of air in the lungs after a maximal inspiration; the sum of all lung volumes (TLC = RV + VC, TLC = FRC + IC
Functional Residual Capacity
The volume of air in the lungs after normal expiration. FCR = ERV + RV, 40% of total lung volume
Residual Volume
The volume of gas remaining in the lungs at the end of a maximal expiration. RV is approximately 25% of total lung volume
Tidal Volume
Total volume inspired and expired with each breath during quiet breathing, approximately 10% of total lung volume
What is pulmonary fibrosis?
Type of restrictive lung dysfunction characterized by changes to the alveoli and lung architecture from an inflammatory process. The inflammatory changes cause scarring and fibrotic lesions in the lungs which result in decreased lung compliance, lung volumes, diffusing capacity, increased pulmonary arterial pressure, and work of breathing.
Unstable angina
Usually is more intense, lasts longer, is precipitated by less exertion, occurs spontaneously at rest, is progressive, or any combination of these features.
Blood flow
Venous blood from the superior and inferior vena cava enters the right atrium and is pumped through the tricuspid valve into the right ventricle. The tricuspid valve closes while the right venticle contracts to pump blood through the pulmonary valve and into the pulmonary arteries serving the right and left lungs respectively. After picking up oxygen and releasing carbon dioxide in the pulmonary capillaries, oxygenated blood returns via the pulmonary veins to the LA. Contraction of the LA forces blood through the mitral valve into the LV. The mitral valve closes when the LV contracts to pump blood through the aortic valve into the aorta where it is distributed into the coronary circulation and systemic circulation
S3
Ventricular gallop - may be associated with heart failure
Restrictive Cardiomyopathy
Walls of the heart are rigid but not thickened. Medications focus on improving symptoms and may include diuretics, antihypertensives, and antiarrhythmics
Purulent Sputum
Yellowish-greenish in color and often indicative of infection
Is pursed lip beneficial for obstructive lung disease?
Yes
A PaCO2 less than 35 indicates mm Hg indicates?
alveolar hyperventilation
A PaCO2 greater than 50 mm Hg indicates?
alveolar hypoventilation - ventilatory failure
Causes of hypovolemia
bleeding, dehydration from vomiting, diarrhea, sweating, severe burns, and diuretic medications used to treat hypertension
Sputum associated with tuberculosis?
blood-tinged due to damage of the respiratory tract caused by excessive coughing
Normal breath sounds
bronchial, bronchovesicular, vesicular
S2
closure of the aortic and pulmonary valves (semilunar) at the onset of ventricular diastole
ABG results are written in what order?
pH > PaCO2 > PaO2 > HCO3-