-SQA-SCOTTISH QUALIFICATIONS AUTHORITY Hanover House 24 Douglas Street GLASGOW G2 7NQ NATIONAL CERTIFICATE MODULE DESCRIPTOR -Module Number- 0099111 -Session-1989-90 -Superclass- PB -Title- PRINCIPLES OF PHYSIOLOGICAL MEASUREMENT: CARDIOLOGY/RESPIRATORY (x1 1 / 2 ) -DESCRIPTION- Purpose This module enables the student to acquire a knowledge of cardiovascular and pulmonary anatomy and physiology, the origin of physiological signals, the means of measuring physiological parameters, their changes and the effects of disease. The module is designed to enable the student to apply this knowledge and will complement the practical skills required as defined in an appropriate in-service Training Manual. Preferred 69031 Instrumentation and Measurement Techniques 1 Entry Level 69037 Instrumentation and Measurement Techniques 2 69071 Human Physiology Learning Outcomes The student should: 1. explain the functional anatomy of the cardiovascular system; 2. describe the methods used in clinical practice to investigate the structure and function of the cardiovascular system; 3. describe the use of electrocardiography to detect disorders of cardiac function; 4. describe the techniques used to counteract abnormalities of cardiac rhythm. 5. describe the anatomy and histology of the lungs and the anatomy of the thoracic cage;
6. explain the processes of respiration and the effects of exercise on the cardiorespiratory system; 7. describe the methods used in clinical practice to investigate the mechanical properties of the lungs and the efficiency of gas exchange; 8. summarise the changes in lung function expected in common pulmonary disorders. Content/ Corresponding to Learning Outcomes 1-8: Context 1. Histology of the blood, erythrocytes, leucocytes, thrombocytes and plasma. Microanatomy of blood vessels and relationship with blood circulation and gaseous exchange. Functions of formed elements of the blood. Role of the blood in gaseous exchange, nutrition, disposal of waste products, defence against infection, blood clotting. Anatomy/microanatomy of endocardium, myocardium, pericardium, chambers, valves, great vessels. Role of valves, chambers, vessels and circulation of blood through the heart. Systemic and pulmonary circulations. Autonomic nervous control of the heart. Origin and course of the left and right coronary arteries, their branches and distribution areas of blood to the myocardium; the venous return by way of the coronary sinus. Initiation and spread of an electrical impulse through the conduction pathways of the heart. Time relationship between the electrical and mechanical events of the cardiac cycle. Principle and use of the sphygmomanometer (mercury or acoustic); significance of Korotkov sounds; 'Normal' range of results; normal abnormal blood pressure ranges hypotension and hypertension. Principle and purpose of echocardiography, to identification of normal cardiac anatomy. Principle of Doppler ultrasound equipment for determining velocity and direction of blood flow. -2 -
2. Indirect measurement of blood pressure by sphygmomanometry. Principle of the method of catheterisation for the direct measurement of blood pressure and of the oxygen content of the blood in the heart and great vessels. Significance of Korotkov sounds, normal and abnormal blood pressure ranges. Application of the Fick principle to the measurement of cardiac output and of left-to-right shunts. Application of echocardiography (cardiac ultrasound) to demonstrate the internal structure and function of the heart (M-mode and cross-sectional). Application of the Doppler principle to blood pressure and flow in the heart and great arteries. Application of angiography to demonstrate the structure and function of the heart and great vessels (also coronary arteries) by means of X-ray contrast medium. - left and right ventricular hypertrophy - myocardial infarction Use of ambulatory ECG recording; interpretation of 'normal' and 'abnormal' ambulatory ECG recordings. The use and value of the ECG in monitoring the heart during stress tests. 3. Application of the Einthoven triangle and Wilson's central terminal to the production of bipolar and unipolar electrocardiograms. Use of electrocardiography to demonstrate the electrical events and by inference the mechanical events of the cardiac cycle. Application of electrocardiography to the diagnosis of some abnormalities of heart rhythm (sinus bradycardia and tachycardia; supraventricular tachycardia; first, second, and third degree atrioventricular (AV) block; AV nodal rhythm; atrial and ventricular premature systoles; atrial flutter and fibrillation; ventricular tachycardia and fibrillation). Application of electrocardiography to the diagnosis of left and right ventricular enlargement and of myocardial infarction. The use of ambulatory ECG recording. The application of electrocardiography to exercise stress testing. -3 -
4. Application of electrical defibrillation and cardioversion. Application of artificial pacemakers to the support of patients with disordered heart rhythm, hazards and safety precautions; types of pacemaker system:- fixed rate, variable rate, demand and dual chamber, hazards and safety precautions. 5. Gross anatomy of nose, pharynx and larynx. Anatomy of trachea, bronchi, bronchioles; respiratory bronchioles, alveolar ducts and alveoli; pulmonary arteries, capillaries and veins. Histology of conducting airways and alveoli. Gross anatomy of diaphragm, ribs, intercostal muscles and pleura. 6. Movements of diaphragm and ribs; expansion and relaxation of lungs with consequent movement of air. Resting ventilation, respiratory rate and tidal volume. Gaseous diffusion between alveoli and capillaries, capillaries and tissues. Transport of 02 and CO2 in blood in simple solution and as oxyhaemoglobin and bicarbonate respectively. Effect of over or under ventilation and perfusion of the alveoli on the exchange of 02 and CO2. Brain stem; reticular formation, input via chemoreceptors (central and peripheral) and other pathways (pain, lung receptors). Measurement of O2 consumption and CO2 production from analysis of mixed expired gas. Increase in ventilation and cardiac output, O2 consumption and CO2 production during exercise. 7. Mode of operation of Peak Flow Meter (Wright Peak Flow Meter or Mini Wright Peak Flow Meter) and its use to obtain Peak Expiratory Flow (PEF). Action of Spirometers ie. dry bellows and water sealed spirometers and their use in recording Forced Expiratory Volume in one second (FEVI) and forced Vital Capacity (FVC). Calibration of Peak Flow meters and spirometers. -4 -
Principles of operation of helium and carbon monoxide analysers; steady state helium dilution technique, principles involved and explanation of how a spirometer, kymograph and He analyser are used to measure Functional residual capacity (FRC) and subdivisions of lung volumes including Residual Volume (RV) Vital Capacity (VC), Total Lung Capacity (TLC) and RV/TLC ratio. Necessity for addition of 02 to and removal of CO2 from the closed circuit. Principle of operation of 02 and CO2 analyser. Introduction to measurement of thoracic gas volumes by body plethysmography. Observe measurement of lung volumes by steady state helium dilution or thoracic gas volumes by body plethysmography. Difference between an FVC and a VC. Single breath gas transfer for carbon monoxide (Tco) principle of gaseous diffusion and use of spirometer, carbon monoxide and helium analysers and special gas mixture to estimate Tco. Meaning of Pa02, PaC02 and hydrogen ion concentration. Principle of operation of blood gas (P02 and 02) and ph electrodes. Necessity for anaerobic handling of arterial blood samples. Importance of adequate gas mixing within the lung, surface area for gas exchange, pulmonary circulation and haemoglobin for gas exchange. 8. Prediction of normal values for pulmonary function from regression equations. Factors to be taken into account including ethnic origin, sex, age and height. Normal values for PEF, FEV1, FVC and FEV/FVC%, RV, TLC and RV/TLC% and Tco. Normal ranges for Pa02, PaC02 and hydrogen ion concentration. Meaning of airways obstruction(eg. asthma, bronchitis and emphysema) and restrictive disorders (e.g. fibrosing alveolitis, asbestosis, neuromuscular disorders). Likely changes in airways obstruction including development of obstructive ventilatory defects (reduction in FEV1 and FEV/FVC ratio) overinflation of lungs (increase in RV and RV/TLC%) maintenance or reduction in Tco. Hypoxaemia and hypercapnia. Likely changes in restrictive disorders including development of restrictive ventilatory defects (proportional reduction in FEVI and FVC) reduction in lung volumes (TLC, VC and RV) and maintenance or reduction of gas transfer. -5 -
Suggested Learning and Teaching Approaches Students should follow an activity based learning approach where possible. Equipment, processes and procedures relevant to the theoretical work being covered should be reinforced by films, videos and slides and visits to hospital premises. Exemplars should be available for the student to appreciate the standard of work required. The student must be informed of the tasks which contribute to summative assessment. Any unsatisfactory aspects of performance should be discussed with the student as and when they arise. Assessment Procedures Acceptable performance in the module will be satisfactory achievement of all the performance criteria specified for each Learning Outcome. The following abbreviations are used below: LO Learning Outcome Instrument of Assessment Performance Criteria LO1 EXPLAIN THE FUNCTIONAL ANATOMY OF THE CARDIOVASCULAR SYSTEM (a) (b) (c) (d) describes the anatomy and functions of the blood; identifies the anatomy and functions of the heart and great vessels; explains the anatomy of the coronary circulation; outlines the anatomy of the electrical conduction system of the heart. Restricted Response Questions The student will be set restricted response questions which test the knowledge of the anatomy and functions of the blood, the heart and great vessels, the coronary circulation and the electrical conduction system of the heart. The restricted response questions will be allocated to each as follows: (a) 3 b) 10 (c) 3 (d) 6-6 -
Satisfactory achievement of the Learning Outcomes will be based on the student making the following number of correct responses: (a) 2 (b) 8 (c) 2 d) 4 LO2 DESCRIBE THE METHODS USED IN CLINICAL PRACTICE TO INVESTIGATE THE STRUCTURE AND FUNCTION OF THE CARDIOVASCULAR SYSTEM (a) (b) (c) (d) (e) uses a sphygmomanometer; describes the use of cardiac catheterisation; explains the use of echocardiography to visualise the internal anatomy of the heart; describes the application of Doppler ultrasound; identifies the main features of angiography. 1 Practical Exercise The student will be set a practical exercise involving the use of a sphygmomanometer. The student will be required to demonstrate an ability to use a sphygmomanometer in a competent manner and to interpret correctly the results obtained for a subject resting and after exercise. The practical exercise may be carried out in conjunction with a suitably-constructed checklist. 2 Restricted Response Questions The student will be set restricted response questions which test knowledge of the principles involved in cardiac catheterisation echocardiography, Doppler ultrasound, and angiography. Questions will be allocated to each as follows:- (b) 4 (c) 6 (d) 4 (e) 4 Satisfactory achievement of the Learning Outcome will be based on the student successfully achieving (a) and answering correctly the following number of questions:- (b) 3 (c) 4-7 -
(d) 3 (e) 3 LO3 DESCRIBE THE USE OF ELECTROCARDIOGRAPHY TO DETECT DISORDERS OF CARDC FUNCTION (a) uses an electrocardiograph; (b) relates the waves and intervals of the normal electrocardiogram to the mechanical and electrical events of the cardiac cycle; (c) recognises the electrocardiographic appearances representing some common abnormalities of cardiac function; (d) explains the recording and analysis of an ambulatory electrocardiogram; (e) describes the use of the electrocardiogram in stress testing. 1 Practical Exercise The student will be set a practical exercise to test the knowledge and skills required to use an electrocardiograph in a competent manner. The student will be required to identify P, QRS and T waves on the electrocardiogram. 2 Restricted Response Questions The student will be set restricted response questions to test knowledge of the use of electrocardiography in the detection of disorders of cardiac function. The restricted response questions will be allocated as follows:- (b) 7 (c) 7 (d) 3 (e) 3 Satisfactory achievement of the Learning Outcome will be based on the student carrying out the practical exercise in a competent manner, identifying P, QRS and T waves correctly and making the following correct number of responses:- (b) 5 (c) 5 (d) 2 (e) 2-8 -
LO4 DESCRIBE THE TECHNIQUES USED TO COUNTERACT ABNORMALITIES OF CARDC RHYTHM (a) (b) (c) describes the use of a defibrillator; outlines the use of electrical cardioversion; explains the elements and use of an artificial pacemaker system. Restricted Response Questions The student will be set restricted response questions to test knowledge of the techniques used to counteract abnormalities of cardiac rhythm. The restricted response questions will be allocated as follows:- (a) 4 (b) 4 (c) 8 Satisfactory achievement of the Learning Outcome will be based on the student make the following correct number of responses:- (a) 3 (b) 3 (c) 6 LO5 DESCRIBE THE ANATOMY AND HISTOLOGY OF THE LUNGS AND THE ANATOMY OF THE THORACIC CAGE (a) describes the gross anatomy of the upper respiratory tract; (b) explains the anatomy of the conducting airways, gas exchanging structures and pulmonary circulation; (c) describes the histology of the conducting airways and alveoli; (d) describes the gross anatomy of the thoracic cage. Structured Question The student will be set structured questions to test his/her knowledge of the anatomy and histology of the lungs, and the anatomy of the thoracic cage. The test will consist of 20 structured questions, allocated equally between (a)-(d). -9 -
Satisfactory achievement of the Learning Outcome will be based on the student answering four questions correctly for each. LO6 EXPLAIN THE PROCESSES OF RESPIRATION AND THE EFFECTS OF EXERCISE ON THE CARDIORESPIRATORY SYSTEM (a) describes the mechanical events involved in pulmonary ventilation; (b) states normal values for resting ventilation, respiratory rate and tidal volume; (c) explains the processes involved in gas exchange; (d) (e) explains basic mechanisms of control of breathing; explains the cardiorespiratory response to exercise and how it is determined. Structured Questions The student will be set structured questions to test knowledge of the processes of respiration and the effect of exercise on the cardiorespiratory system. The questions will be allocated to each as follows:- (a) 6 (b) 3 (c) 6 (d) 5 (e) 5 Satisfactory achievement of the Learning Outcome will be based on the student answering 4 questions correctly for (a), 2 for (b), 4 for (c), 4 for (d) and 4 for (e). LO7 DESCRIBE THE METHODS USED IN CLINICAL PRACTICE TO INVESTIGATE THE MECHANICAL PROPERTIES OF THE LUNGS AND THE EFFICIENCY OF GAS EXCHANGE. (a) (b) (c) (d) describes the equipment and techniques used to assess mechanical properties of the lungs; distinguishes between forced and relaxed vital capacity; describes the equipment and techniques used to assess efficiency of gas exchange; summarises factors which influence gas exchange in the lungs. -10 -
Restricted Response Questions The student will be set restricted response questions which will test knowledge of the methods used in clinical practice to investigate the mechanical properties of the lungs and the efficiency of gas exchange. The restricted response questions will be allocated as follows: (a) 10 (b) 2 (c) 10 (d) 5 Students will be required to label diagrams as part of their answers where appropriate. For (a), the student will be tested on (i) a water sealed or dry bellows spirometer (ii) the principle of operation of helium and carbon monoxide analyses (iii) relationship between tidal volume, FRC, RV, VC and TLC. Satisfactory achievement of the Learning Outcome will be based on the student answering the following number of questions correctly:- (a) 7 (b) 2 (c) 7 (d) 4 LO8 SUMMARISES THE CHANGES IN LUNG FUNCTION TO BE EXPECTED IN COMMON PULMONARY DISORDERS (a) (b) (c) (d) (e) explains how normal values for pulmonary function can be predicted; states typical normal values for pulmonary function in a healthy young adult; states normal ranges for arterial PO2, O2 and hydrogen ion concentration; states examples of common pulmonary disorders; for a variety of variables, states the expected direction of change in common pulmonary disorders. Restricted Response Questions -11 -
The student will be set restricted response questions which test knowledge of changes in lung function in common pulmonary disorders. -12 -
The test will consist of three restricted response questions for each. For (b), the student will be required to explain 3 out of the following:-pef, FEVI, FVC, RV, VC. For (d), 3 common pulmonary disorders should be stated. For (e) the student should state the direction of change for 3 of the following:- PEF, FEVI, FVC, RV and VC. Satisfactory achievement of the Learning Outcome will be based on the student answering 10 questions correctly, including at least two correct responses for each. Copyright SQA 1989-13 -