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PT Screening > Cardiopulmonary > Flashcards

Cardiopulmonary Flashcards

1
Q

History - Cardio

A
  • PMH
  • Family history
  • Living environment
  • Social/Health habits
  • Primary complaint (CV related or something else); Ex: DVT, Dyspnea, etc.
  • Functional status
  • Medications
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2
Q

Warning Signs: Suggestive of CVP Disease

A
  • Chest pain (Angina): Unstable vs stable
  • Currently on medications
  • Pacemaker or ICD
  • Hx of blood clots: either in extremity or lungs
  • Light-headed when getting up: Orthostatic hypotension
  • Unusual shortness of breath: dyspnea
  • Muscle pain with mild exertion: Intermittent claudication
  • Difficulty breathing at night: Paroxysmal nocturnal dyspnea
  • Edema in B LE
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3
Q

Chest pain (Angina): Unstable vs stable

A

Stable: Complain chest pain, provide rest, pain goes down or take a med and pain goes down

Unstable: Rest and meds don’t relieve pain

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4
Q

Currently on Medications

A

Beta blockers [reduce HR]
- Use RPE to measure reaction to exercise

Nitroglycerin
- Before exercise: MAKE SURE THEY HAVE TAKEN IT
- 3 Doses, 1 every 5 minutes to reduce symptoms. No change in symptoms call ER

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5
Q

Warning Signs - Cardio: During Exercise

A

No increase in HR with increase with workload

Decrease in SBP with increase in workload

Usual SOB

Poor color: Decreased Perfusion (Pale skin, no blood supply)

Ataxia

Confusion

Chest Pain or Leg Pain
- Decrease with rest (Symptoms come on during exertion levels. Thinking ischemia. Goes away with rest.)

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6
Q

Observation: Posture - Cardio

A

Breathless (Dyspnea scale) or labored breathing
- At rest vs activity

Specific postures
- Ex: Doesn’t like to lie down due to SOB (Orthopnea)
- Ex: Resting elbows on knees or hands on counter

Hypertrophy of secondary accessory muscles (SCM and scalenes)

Jugular vein distension

Scars around chest or back indicative of heart or lung surgery

Pacemaker

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7
Q

Observation - Cardio: Integument

A

Cyanosis: Blueish discoloration due to hypoxemia (due to hypoxemia (lips or nails)

Nail clubbing: due chronic cardiac or pulmonary disease

Hair loss on lower extremity: due to perioheral artery disease (PAD)

LE or UE Peripheral Edema: “pump failure”

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8
Q

Peripheral Edema

A

Most common in legs and feet

Pitting: Visible indentation remains when finger is pressed into area and removed

Nonpitting: no indentation remains when pressure is removed

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9
Q

Common causes of pitting edema:

A

Heart disease

Kidney and liver disease

Chronic venous insufficency

Deep vein thrombosis

Immobilization and inactivity (Cerebrovascular accident, Spinal Cord Injury)

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10
Q

Pitting Edema Assessment

A

Trace (1+)
Slight indentation, skin rebounds quickly

Mild (2+)
0.0-0.6 cm indentation, skin rebounds in <15 seconds

Moderate (3+)
0.6-1.3 cm indentation, skin rebounds in less than 15 seconds

Severe (4+)
1.3-2.5 cm indentation, skin rebounds in >30 seconds

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11
Q

Core Vital Signs - Cardio

A

Pulse

Respiration

BP

Temperature

Pain

Walking Speed

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12
Q

Core Vital Signs: Pulse

A

Where can you take it

Carotid, Brachial, Radial, Femoral, Popliteal, Dorsal Pedis, Posterior tibial A.

Assess three things: HR, Rhythm, Force

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13
Q

Pulse Rate

A

Normal: 60-100 bpm

Tachycardia >100

Bradycardia <60

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14
Q

Pulse Rhythm

A

Regular

Regularly irregular: Regular for 3 beats irregular for 1

Irregular: Not normal consistently

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15
Q

Core Vital Signs - Cardio: Respiration

A

Observe chest rising and falling

Patient should be unaware you are assessing

Common respiratory difficulties to assess for:
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
Apnea

Assess 3 things: Rate, Rhythm, Depth

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16
Q

Orthopnea

A

Difficulty breathing while laying flat

17
Q

Paroxysmal Nocturnal Dyspnea

A

Sudden dyspnea and orthopnea while sleeping

18
Q

Apnea

A

Absence of breathing, often with breathing

19
Q

Systole

A

Arterial pressure when the left ventricle contracts

20
Q

Diastole

A

Arterial pressure when the heart is at rest between contractions

21
Q

Normal Blood Pressure Assessment

A

Slight differences between arms

Normal exercise response
- Systolic pressure rises and levels off
- Diastolic pressure rises by no more than 10 mmHg

Pulse pressure = SBP – DBP
- Typically, about 30-40 mmHg
- For every 10mmHg rise in pulse BP – there is a 22% increase in the hazard ratio for CVD death.

22
Q

Orthostatic Postural Hypotension

A
  • Take BP in supine (5 minutes)
  • Then take BP standing ~1 minute
  • And again BP standing ~3 minutes
    *Postural hypotension is defined by
  • Decrease in systolic BP > or equal 15-20 mmHg OR
  • Ex: 120/80 to 100/80
  • Decrease in diastolic BP > or equal 10 mmHg OR
  • Lightheadedness/dizziness
  • 20 point increase in HR

With patients with a history of Orthostatic hypertension or other cardio disorders or immobilization take BP in sitting

23
Q

Core Vital Signs: Priority

A
  • MOST new patients at evaluation especially if they have warning signs
  • Reassess on a regular basis if abnormal values are found
24
Q

Vascular Assessment

A
  • Pulses
  • Edema
  • Pulse Oximetry: Assess for oxygen saturation
  • Auscultation of Carotid Artery: Assess for Bruitis
  • Assessment for DVT
  • Perfusion/Dehydration
  • Ankle Brachial Index
25
Q

Capillary nail refill test

A

Press on nail top and bottom, release, look for refill

26
Q

Rubor Dependency Test

A

When legs elevated, legs become pale, means no or reduced blood supply to lower leg

27
Q

Skin Turgor

A

Pull back of hand, looking for dehydration

28
Q

Pulse Oximetry: Oxygen Saturation

A

Oxygen Saturation: The % of hemoglobin (Hb) saturated with O2

Normal: 97-99%

Cardiovascular/Pulmonary Disease: 90-95%

90% and below: Hypoxemia may require supplemental oxygen

Oxygen Saturation can also be assessed by arterial blood gas (ABG) analysis

29
Q

Auscultation of Carotid Artery

A

Assess for bruit: often, but not always, a sign of arterial narrowing which is a risk factor for stroke

Place the BELL of the stethoscope over each carotid artery. You may use the diaphram if the patient’s neck is highly contoured.

Ask the patient to stop breathing momentarily

Listen for a blowing or rushing sound. Do not be alerted by heart sounds or murmurs transmitted from the chest.

30
Q

Assessment for DVT

A

Can occur in UE or LE

Especially concerned for patients who:
Have been inactive or bedridden for periods of time
Has undergone recent surgery

Use Wells’ CDR for DVT
If high probability, refer immediately for diagnostic US
Score is equal or less than 0: Low probability
Score 1-2: Moderate probability
Score equal or greater than 3: High probability

31
Q

Ankle-Brachial Index (ABI)

A

Compares blood pressure measures taken from the arms and the legs

Identify the presence or severity of impaired arterial blood flow (ischemia) to extremities

Reduced blood flow can lead to peripheral arterial disease (PAD)

Risk factor for myocardial infarction (MI), stroke, or lower extremity wounds

32
Q

Cardiac Assessment

A

Blood pressure

Pulses

Auscultation of heart sounds

Jugular vein distention (JVD)

EKG

33
Q

Ausculation of Heart Sounds

A

Assess 4 positions with the bell of the stethescope

Heart Sounds [S1 & S2]

Normal “Lub and Dub”: S1 and S2

S1 (Lub) = closure of Mitral and tricuspid

S2 (Dub) = closure of Aortic and Pulomnic

34
Q

Jugular Vein Distribution (JVD)

A

JVD is when the increase pressure of the superior vena cava causes the jugular vein to bulge, making it most visible on right side

Observe and measure the distance from pulsation to sternal angle with patient reclined 45 degrees

Abnormal if > 4 cm

Heart Failure (“pump failure”)

35
Q

Pulmonary Assesssment

A

Respiration

Auscultation of Lung Sounds

Auscultation of Tracheal Sounds

36
Q

Auscultation of Lung sounds

A

Normal: Normal quiet whishing of airflow

Bronchophoy: say 99

If you can clearly hear something than something is wrong

Abnormal sounds:
Crackles: Secretions in small or middle airways
Wheezes: High pitched whistle due to aie going through a narrowed or constricted airway

Decreased breath sounds can be due to:
Chronic Obstructive Pulmonary Disease (COPD)
Pneumothorax

37
Q

Auscultations of Tracheal Sounds

A

Assess inferior to the Thyroid cartilage

Normal: Loud, harsh, turbulent sound heard over the sternal notch

38
Q

Outpatient Setting, when prescribing exercise - Cardio

A

Assess risk and risk factors

Low risk
Men younger than 45, women younger than 55
Less than or equal to 1 Risk Factor and no symptoms

Moderate
Men older than 45, Women older than 55
2 or more RF

High
Known CV, pulmonary, metabolic disease or signs and symptoms of CV disease including:
Chest Pain
SOB with mild exertion
Syncope
Ankle Edema
Palpations

39
Q

Cardiovascular Risk Factors

A

Family Hx of CVD

Smoking

Hypertension

Dyslipidemia

Fasting Glucose

Obesity

Sedentary

PT Screening (21 decks)

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