``` 4+=Bounding 3+=Incr 2+=Brisk & expected 1+=Diminished & weaker than expected 0=Absent & unable to palpate ```

8) Cardiac Exam Flashcards by Danielle Kreda

What are the things to look at when doing a chart review?

Md’s orders
MHx
Consultations
MD’s notes
Nursing notes
Other HCP notes
Labs
Graphics
D/c plans

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What is a normal HR?

60-90bpm

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Sinus Tachycardia

HR>100bpm

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Sx’s of sinus tachycardia

Anxiety
Anemia
Fever
Hypoxia

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Sinus Bradycardia

HR <60bpm

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Who might normally have sinus bradycardia?

Athletes & pt’s on beta-blockers

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What does a pulse deficit mean?

Heart beats aren’t pumping enough blood

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W/what conditions is a pulse deficit common?

A-fib & dysrhythmia

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Pulse Scale

4+=Bounding
3+=Incr
2+=Brisk &amp; expected
1+=Diminished &amp; weaker than expected
0=Absent &amp; unable to palpate

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What BP is considered pre-hypertensive?

120/80mmHg

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True or False: BP should be similar bilaterally.

True

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What does a BP discrepancy mean?

The side w/the lower pressure has arterial compression or obstruction

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What does a BP fall of 10mmHg indicate?

Orthostatic hypotension

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What indicates orthostatic hypotension?

A BP fall of 10mmHg or more

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What BP indicates a medical emergency?

200/110 or really low/no BP w/lack of normal mentation

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What is the lowest the MAP should be?

65mmHg

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Based on BP, when is activity contraindicated?

SBP >200 or <80

* DBP >100

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When should you terminate exercise?

SBP >250 & DBP >110

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How do you calculate pulse pressure?

SBP-DBP

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What is the normal range for pulse pressure?

30-50mmHg

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What happens to the pulse pressure as a person ages?

It incr

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What does a low pulse pressure indicate?

Vascular wall stiffness & predicts CV events

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W/what conditions is a low pulse pressure common?

Aortic valve disorders
Severe anemia
Overactive thyroid

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How should breath rate be measured?

W/the pt seated comfortably

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What is a normal breath rate?

12-16/min

Tachypnea

>20 breaths/min

Bradypnea

<10 breaths/min

Dyspnea

Pt's subjective report of discomfort; SOB

Dyspnea Scale

1=Light, barely noticeable 2=Moderate, bothersome 3=Moderately severe; Very uncomfortable 4=Severe difficulty; Pt can't continue

Sequelae of ventilatory issues

* Orthopnea * Hyperventilation * Hypoventilation * Abdominal paradox * Rib Retractions

What should you not forget to look at?

Pt's hands

What will be frequently seen in pt's using high-dose bronchodilators?

Tremors

What do warm & sweaty hands w/an irregular flapping tremor indicate?

Acute CO2 retention

What is weakness & wasting of hand muscles an early sign of?

Pancoast Tumor

What is weakness & wasting of hand muscles an early sign of?

Pancoast Tumor

What is palmar erythema a sign of?

Liver CA

What is clubbing a sign of?

Hypoxia

What can BMI predict?

M&M

Non-modifiable risk factors for BMI

* Age * Sex * FHx * Genetics

Modifiable risk factors for BMI

* Smoking * Diet * Alcohol intake * Dyslipidemia * HTN * Obesity * DM * Metabolic syndromes

Emerging risk factors for BMI

* hsCRP * CAC * Fibrinogin * Homocysteine * Lipoprotein

What can facial characteristics indicate?

Pt's ability to breath

Adventitious Lung Sounds

Rales & Rhonchi

Rales

Fluid in alveoli or closed alveoli opening

What condition are rales common?

CHF

Rhonchi

Associated w/AW obstruction, constriction, or mucous; Generally heard on exhalation

What do you need to know about a pt's cough?

If its productive & effective

What does red sputum mean?

Blood

What does rust color sputum mean?

Pneumonia

What does purple sputum mean?

What does yellow/green sputum mean?

Infection

What does pink sputum mean?

Pulmonary Edema

What do you need to know about a pt's sputum?

* Color * Consistency * Smell * Amount * Frequency

Edema Scale

1+=Barely perceptible depression 2+=Easily ID'ed depression (EID); Skin rebounds in 15sec 3+=EID; Skin rebounds in 15-30sec 4+=EID; Skin rebounds in >30sec

What will be tight after heart surgery?

Anterior chest & hip flexors

What posture would you expect a pt to have after heart surgery?

Forward head & rounded shoulders

What will help protect a sternal incision?

Good posture

What needs to be done for an incision?

* Protect it-->Don't move the bandage! * Check for infection * Be mindful of tenderness * Consider location * Consider possible graft location

How much should the diaphragm move w/deep inspiration?

2-3"

Apnea

Cessation of breathing after expiration; Interrupted by eventual inspiration or the pt dies

Cheyne-Stokes

Cyclic waxing & waning of depth of breathing w/periods of apnea?

What does cheyne-stokes indicate?

Severe CNS lesion

Biot's Breathing

Irregular breathing w/slow, shallow breaths & periods of apnea

What does Biot's breathing indicate?

Meningitis

Cluster Breathing

Clusters of normal breaths separated by irregular pauses

What does cluster breathing indicate?

Medullary or low pontine lesion

Kussmaul Breathing

Marked continuous hyperventilation w/incr rate & depth of breathing to eliminate excess CO2

What does Kussmaul breathing indicate?

Diabetic Ketoacidosis

Which way will the trachea deviate towards when there's a unilateral loss of lung volume?

Towards the side w/the lesion

What conditions will cause the trachea to deviate towards the side of injury?

Unilateral Loss of Lung Vol * Atelectasis * Fibrosis * Surgical excision

When there's an incr lung volume, which side with the trachea deviate towards?

Towards the healthy side

What conditions will the trachea deviate towards the healthy side?

Incr Lung Vol * Pneumothorax * Pleural effusion * Abdominal viscera herniation

What is exercise tolerance indicative of?

Fxnl status

What does BADCAT stand for?

``` Breathing that is audible Active accessory muscle use Dyspnea Cyanosis & clubbing AP diameter >1 Tracheal deviation away from midline ```

Clinical Manifestations of Respiratory Muscle Fatigue

* Rapid shallow breathing * Paradoxical breathing * Incr accessory muscle activity * Dyspnea * Hypoxemia * Hypercapnia

NYHA Fxnl Classification of Heart Disease

1=Pt w/cardiac disease but has no PA limitations; 6-10METS 2=Slight limitations; PA results in fatigue, dyspnea, palpitations, or angina; 4-6METS 3=Marked limitations of PA-Low inetnsity PA causes sx's; 2-3METS 4=Unable to do PA w/out discomfort; <2METS

8) Cardiac Exam Flashcards

(76 cards)