PHTH 736 Exam 2 PDF

CABG - CAD: narrowing of arteries supplying the heart caused by plaque deposits - Hard plaque: builds up in coronary arteries, slows/stops blood flow (less O2 to heart MI) - Soft plaque: causes most MIs; inflamed part of artery that can rupture and body's attempt...

CABG - CAD: narrowing of arteries supplying the heart caused by plaque deposits - Hard plaque: builds up in coronary arteries, slows/stops blood flow (less O2 to heart MI) - Soft plaque: causes most MIs; inflamed part of artery that can rupture and body's attempt to heal rupture can cause a blood clot that stops blood flow - Angioplasty w/ stent: balloon and stent inserted into diseased artery balloon inflated and stent expanded balloon deflated and withdrawn - Sternal precautions (4-12 weeks; sternum takes 6-8 weeks to heal) - No lifting \>5-10lbs - No reaching behind back - No pushing/pulling through arms - No overhead reaching - No driving - Post-op considerations - Symmetrical and proper upright posture - Use pillow for splinted cough/sneeze - Showers allowed using mild soap and warm water if incisions are dry and healing - Lotions/ointments or dressings not recommended - Slight itching, numbness, or tightness of incision area is normal - Avoid lying prone - Keeps legs elevated when sitting for long periods of time (reduce swelling) - No driving - Signs of infection: increased drainage or opening of incision, increased redness or warmth around incision, malaise, fever \>100F - Day 1 post-op CABG: sit pt up on EOB and get them to stand helps resolve atelectasis, optimize gas exchange, maintain LE strength/mobility, and drain fluids into chest tube - Rocking technique to stand; bow technique to sit - Instruct on deep breathing exercises (diaphragmatic breathing) do 10 - Instruct on splinted coughing and huff cough - Encourage deep breathing and supported coughing each hour - Encourage foot/ankle and bilateral shoulder ROM exercises while in bed - Day 3-4 post-op CABG: pt should progress mobilization and climb 2 flights of stairs prior to discharge (can use one arm on railing but cannot pull) Cardiac Rehab - Cardiac rehab: supervised safe progression of exercise following cardiac pathology - Begins as inpatient and progresses to outpatient (6-12 weeks, 1-3 sessions/week) - Appropriate when no chest pain for 8+ hours, no resting dyspnea, stable ECG, and stable blood values (troponin and creatine kinase) - Active exercise 24 hours after CABG and 48 hours after MI - Program goals: establish long-term exercise program, safe independent completion, restore function, progress to 150 min of mod intensity exercise per week - Ask about medical hx, medications, exercise habits, barriers to exercise, and psychosocial hx - Pt education s/s of cardiac event, self-monitoring vitals, RPE monitoring, and exercise - Before starting session take vitals, BMI, weight, glucose readings if diabetic, MSK screen, functional tests (stress test and 6-min walk), risk stratification (obese, diabetic, smoking, sedentary) - Karvonen formula: target HR = (max HR -- resting HR) x % intensity + resting HR - Very light intensity = \4) - Antiplatelets: inhibit platelet aggregation/clumping - Indications: after MI, a-fib, prevent thrombus - Side effects: hemorrhage, thrombocytopenia, liver damage - Aspirin and Plavix - Statins: lower cholesterol - Side effects: statin-induced side effects (rhabdomyolysis, myalgia) - Lipitor, zocor - Pulmonary meds - Short-acting bronchodilators: rescue inhaler; relaxes smooth muscle - Indications: asthma and COPD management of breakthrough s/s of wheezing and dyspnea - Side effects: tachycardia, sympathetic stimulation (shakiness, excitement) - Atrovent, Ventolin HFA (albuterol) - Long-acting bronchodilators: 12-24 hours; consumed daily - Corticosteroids: suppress inflammation - Indications: short term mgmt. of COPD flare-up or long term mgmt. of COPD; asthma - Side effects: suppressed immune system, fluid retention, weight gain, muscle weakness, bone density concerns - Prednisone and Flovent - Combination meds (bronchodilator and corticosteroid) - Indications: COPD or asthma - Antibiotics: used to treat bacterial infections - COPD and cystic fibrosis - Mucolytics: mucus thinner - Indications: cystic fibrosis Pediatric Cardiopulm - Normal vitals - BP: adult (\100 bpm - s/s: palpitation, restlessness, chest discomfort, pain, agitation, anxiety - Sinus bradycardia: HR \