Review For A&p Exam #3

Front 1

What kind of bicarbonate level do you have for a pt. with longstanding COPD?

Back 1

High

Front 2

What are the normal values for pH?

Back 2

7.35 to 7.45 (absolute is 7.4)

Front 3

What are the normal values for PaCO2?

Back 3

35-45

Front 4

What are the normal values for PaO2?

Back 4

80-100

Front 5

What are the normal values for HCO3?

Back 5

22-26

Front 6

What values will you see in Acute Ventilatory Failure?

Back 6

low pH, high CO2 & normal Bicarb

Front 7

What causes Metabolic alkalosis?

Back 7

common in acutely ill patients-acid/base imbalance that is iatrogenic in origin (resulting from the use of diuretics,low salt diet & gastric drainage)

Front 8

What causes Metabolic Acidosis?

Back 8

decreased tissue oxygenation/diffusion, increased sugar(DKA), renal failure, loss of bicarb(diahreah-hyperchloremic)

Front 9

PaO2 mild

Back 9

70-61

Front 10

PaO2 moderate

Back 10

60-56

Front 11

PaO2 severe

Back 11

55 or less

Front 12

What are the primary causes low O2 levels(hypoxemia)?

Back 12

V/Q mismatch, shunt, alveolar hypoventilation, diffusion impairment, perfusion/diffusion impairment, decreased inspired O2 & venous admixture

Front 13

Hypoxemia mild

Back 13

60-79

Front 14

Hypoxemia moderate

Back 14

40-59

Front 15

Hypoxemia severe

Back 15

40 or lower

Front 16

Tissue Layers of the Heart

Back 16

epicardium myocardium endocardium

Front 17

What chamber has the most muscle mass?

Back 17

the left ventrical

Front 18

Where is the mitral valve located & what does it do?

Back 18

(bicuspid) Lft side of the heart to prevent backflow into the left atria

Front 19

Where is the pulmonary valve located & what does it do?

Back 19

the pulomary semilunar valve is on the rt side of the heart stop backflow into the right atria

Front 20

Where is the bicuspid valve located & what does it do?

Back 20

mitral valve is the bicuspid valve it is located on the lft side of the heart and prevents backflow

Front 21

Describe briefly Frank Starling's law

Back 21

the inherent ability of the heart to increase its force of contraction as increasing amounts of blood flow into it ( rubber band) (this is how the heart changes stroke volume)

Front 22

Path of the blood cell back to the heart (beachy chapter 6 pg109-110)

Back 22

the rt venterical receives mixed venous blood through the tricuspid valve from the rt atrim and pumps it though the pulmonic valve deoxygenated blood flows through the pulmonary arteries and arterioles to an immense alverolar capillary bed were it is re-oxygenated. then through the pulmonary veines into the left atrium to the mitral valve (bicuspid) to the left venterical to the systemic arties to the arterioles and cappillary beds supplying o2

Front 23

Difference between high pressure & low pressure systems (think venous & artery) chpter 6 beachy pg 110

Back 23

pulomonary circulation is low pressure low resistance it is about one tenth compared to the systemic. the systemic system is much higher pressure

Front 24

Figuring Cardiac Output: P1V1=P2V2

Back 24

?use an example from lecture

Front 25

What is normal Cardiac Output?

Back 25

5 L/min (range of 4-8) HR x SV= cardiac output

Front 26

What does ejection fraction refer to?

Back 26

70 l/m stroke volume/120 ml or 65% (egan's pg 206 says 75 for stroke volume)

Front 27

1st heart sound

Back 27

closure of the AV valves (tricuspid and mitral)(lub)

Front 28

2nd heart sound

Back 28

closure of the similunar valves (dub)

Front 29

Define ischemia

Back 29

tissue hypoxia from decrease in blood flow (starving for O2)
(ischemia = angina pectoris)

Front 30

Define angina

Back 30

pain felt from hypoxia(decreased oxygen in tissue)

Front 31

When does the most coronary perfusion occur?

Back 31

during ventricular relaxation (diastole) pg 282 Beachy

Front 32

Describe ventricular filling(preload)

Back 32

ventricles relax, pressure accumulated in atria during ventricle contraction pushes av valves open and blood rushes in filling 80% RAPIDILY(passive) + during the last .1 sec the atria contract(KICK) filling the remaining 20%

Front 33

Describe the atrial kick

Back 33

slow filling phase that happens during the 0.1 sec of vetricular filling where atria contract and force the additional 20% into the ventricles(when this happens the atria pressure had decreased dramatically and is only slighty higher than ventricular pressure)

Front 34

Describe the anatomy of the heart

Back 34

think we should break this one up into all the parts

Front 35

Conduction pathway through the heart

Back 35

SA node->Av node->AV bundle(bundle of His)->bundle branches (left & right)-> Purkinje fibers

Front 36

word problem on Tachycardia & V tach

Back 36

heart rate of 100 beets a min or more otherwise normal

Front 37

Bradycardia

Back 37

heart rate of 60 beats a min. or less other wise normal

Front 38

1st degree block

Back 38

the pr interval is longer than .2 sec.will see a p and a qrs r-r is normal

Front 39

2nd degree block type I. or wenckebock

Back 39

pr get longer and than looses a qrs

Front 40

2nd degree block type II.

Back 40

multiple p`s for every QRS

Front 41

3nd degree block.

Back 41

A and V are paced independantly no relationship between the QRS

Front 42

A Fib.

Back 42

results when the aterial muscle quivera in an erratic pattern

Front 43

A Flutter.

Back 43

looks like saw tooth 250-350 beats a min. many p`s

Front 44

V fib.

Back 44

run of 3 or more PVC rate usally 100-250

Front 45

Ventriculer asystole

Back 45

flat line with out

Front 46

Define Automaticity

Back 46

the ability of the cells in the heart to depolarize without stimulations the cells of electerical excitation: pacemaker, SA node AV node purkinje fibers

Front 47

Define contractility

Back 47

ability to shorten muscle fibers(contract)

Front 48

Define rhythmicity

Back 48

the ability to depolarize spontaneously in a repetitive manner

Front 49

what dose each type of tissue of the heart consist of?

Back 49

epicardium= visceral pericardium
myocardium is the bulk of the heart muscle that raps around to creat greater force
endocardium lines the inner serviceof the harts chambers resembling smooth endotheilum lining of the blood vessels

Front 50

What does the P wave represent?

Back 50

Atrial depolarization

Front 51

What does the PR segment represent?

Back 51

tfrom the start of aterial contraction to the start of venticular replolarization (normal 0.20 seconds or less)

Front 52

What does the QRS segment represent?

Back 52

venterical depoliration max of .12 sec for normal (3 boxes)

Front 53

What does the T wave represent

Back 53

ventricucluar repolrization (refilling) (normally upright rounded)

Front 54

What can be detected by EKG's?

Back 54

assess posible MI`s heath screanning tool can detect hart blocks or abnormal inpussive of the heart

Front 55

What can't be detected by EKG's?

Back 55

\cannot perdict future MI`s or detected structural defects

Front 56

What causes Tachycardia?

Back 56

acute illness pain anxiety fevor hypovolemia hypoxemia(#1 cause)

Front 57

What causes Bradycardia?

Back 57

vasovagal response hypotension and syncope

Front 58

What are the lethal arrythmias?

Back 58

ventricular fibillation, ventricular tachycardia

Front 59

Define the blocks

Back 59

interference with normal conduction of the heart

Front 60

PMI placement

Back 60

(point of maximal impulse) the apical beat that is createdby the beating heart`s repeated impact on the inner chest wall can be felt or seen at the 5th intercostal space and midclavicular line

Front 61

Definition of afterload

Back 61

load against which an activated muscle must try to shorten; greater afterloads results in lower velocites

Front 62

Define Preload

Back 62

pressure stretching the ventricular walls at the onset of ventricular contraction

Front 63

What is the most dangerous cause of Hyperkalemia?

Back 63

Chronic Renal Disease, hemorrhage, tissue necrosis, nonsteroidal antiinflammatory drugs

Front 64

What is the most dangerous cause of Hypokalemia?

Back 64

Diuretics, steroid therapy, renal tubular disease, vomiting

Front 65

What is the rate of the SV node?

Back 65

70-80bpm

Front 66

What is the rate of the AV node?

Back 66

40-60bpm

Front 67

Are there any other pacer rates we need to know?

?Purkinje rate

Back 67

Perkinjie fibers 15-39bpm
15-40bpm

Front 68

prolapse

Back 68

protudes pokes out

Front 69

dichotic notch

Back 69

vascular recoil helps push blood forward in the arteries during venticular diastole creating it

Front 70

stroke volume

Back 70

70ml of blood contraction ejects leaving behind 40-50ml (the end of systolic volume)

Front 71

the ejection fraction (normally)

Back 71

aproximately 60%

Front 72

Ventricular filling

Back 72

is preload

Front 73

Alveolar Hyperventilation Superimposed on Compensated Respiratory Acidosis

Back 73

A pt with COPD and compensated resp acidosis (can be mistaken for compensated metabolic alkalosis)
* Hypoxia = increased alveolar ventilation

Front 74

Define excitability

Back 74

the inclination to depolarize spontaneously

Front 75

4 key properties of cardiac tissue

Back 75

1. automaticity
2 .rhythmicity
3. excitability
4. contractility

Front 76

Parasympathetic stimulus
(Vagal Response)

Back 76

releases acetycholine which
-decreases SA node firing
-decreases AV node excitability: AV block
-increasing outward diffusiom of K+

Front 77

Sympathetic stimulus
(flight or fight)

Back 77

releases norepinephrine
-increasing SA node firing
-increasing permeability to Na+ and Ca+

Front 78

Define conductivity

Back 78

ability of myocardial tissue to propagate electrical impulses (textbook def)

Front 79

Define contractility

Back 79

Property of muscle tissue to shorten in response to a stimulus, usually electrical (textbook def)

Front 80

Define automaticity

Back 80

term denoting the heart's ability to generate its own intrinsic electrical rhythm (textbook def)

Front 81

Heart wall

Back 81

1. epicardium-visceral pericardium
2. myocardium-heart muscle forming the bulk of the heart wall
3. endocardium- line the inner surfaces of the hear

Front 82

Right Atria chamber

Back 82

recieves deoxygentated blood from superior vena cava, inferior vena cava, and coronary sinus

Front 83

Left Atria chamber

Back 83

recieves oxygenated blood from pulmonary veins

Front 84

Right Ventricle Chamber

Back 84

pumps blood into the pulmonary circulation to the left atria

Front 85

Left Ventricle chamber

Back 85

pumps blood into the systemic circulation to the right atria

Front 86

atrioventricular valves

Back 86

one-way valves in which both atria channel their blood through into the ventricles
1. tricuspid=right AV-valve & 2. mitral (bicuspid)= left AV-valve
*prevent backflow during ventricular contraction

Front 87

interatrial septum

Back 87

-seperates the two atria
-prevents mixing of oxygentated and deoxygentated blood
*small depression in this septum marks former location of the foramen ovale

Front 88

pulmonary semiluminar valve

Back 88

right ventricle pumps blood through this valve into the pulmonary trunk
*prevent backflow into the ventricle during ventricular relaxation

Front 89

aortic semiluminar valve

Back 89

left ventricle pumps blood through this valve into the aorta
*prevents backflow into the ventricle during ventricular relaxation

Front 90

interventricular septum

Back 90

seperates the right and left ventricles, preventing mxiing of oxygentated and deoxygentated blood.

Front 91

fibrous annuli

Back 91

a tough set of connected trings forming a semi-rigid framework to which the heart valves and cardiac muscle are attached nforming the skeleton of the heart
-directs blood from apex to base
-responsible for heart valve function during cardiac cycle

Front 92

Of all the electrolytes involved in heart contractility, which is the one we are most concerned with imbalances?

Back 92

Potassium (K+)