8) Cardiac Exam Flashcards Preview

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Flashcards in 8) Cardiac Exam Deck (76):
1

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

2

What is a normal HR?

60-90bpm

3

Sinus Tachycardia

HR>100bpm

4

Sx's of sinus tachycardia

*Anxiety
*Anemia
*Fever
*Hypoxia

5

Sinus Bradycardia

HR <60bpm

6

Who might normally have sinus bradycardia?

Athletes & pt's on beta-blockers

7

What does a pulse deficit mean?

Heart beats aren't pumping enough blood

8

W/what conditions is a pulse deficit common?

A-fib & dysrhythmia

9

Pulse Scale

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

10

What BP is considered pre-hypertensive?

120/80mmHg

11

True or False: BP should be similar bilaterally.

True

12

What does a BP discrepancy mean?

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

13

What does a BP fall of 10mmHg indicate?

Orthostatic hypotension

14

What indicates orthostatic hypotension?

A BP fall of 10mmHg or more

15

What BP indicates a medical emergency?

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

16

What is the lowest the MAP should be?

65mmHg

17

Based on BP, when is activity contraindicated?

*SBP >200 or <80

*DBP >100

18

When should you terminate exercise?

SBP >250 & DBP >110

19

How do you calculate pulse pressure?

SBP-DBP

20

What is the normal range for pulse pressure?

30-50mmHg

21

What happens to the pulse pressure as a person ages?

It incr

22

What does a low pulse pressure indicate?

Vascular wall stiffness & predicts CV events

23

W/what conditions is a low pulse pressure common?

*Aortic valve disorders
*Severe anemia
*Overactive thyroid

24

How should breath rate be measured?

W/the pt seated comfortably

25

What is a normal breath rate?

12-16/min

26

Tachypnea

>20 breaths/min

27

Bradypnea

<10 breaths/min

28

Dyspnea

Pt's subjective report of discomfort; SOB

29

Dyspnea Scale

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

30

Sequelae of ventilatory issues

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

31

What should you not forget to look at?

Pt's hands

32

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

Tremors

33

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

Acute CO2 retention

34

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

Pancoast Tumor

35

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

Pancoast Tumor

36

What is palmar erythema a sign of?

Liver CA

37

What is clubbing a sign of?

Hypoxia

38

What can BMI predict?

M&M

39

Non-modifiable risk factors for BMI

*Age
*Sex
*FHx
*Genetics

40

Modifiable risk factors for BMI

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

41

Emerging risk factors for BMI

*hsCRP
*CAC
*Fibrinogin
*Homocysteine
*Lipoprotein

42

What can facial characteristics indicate?

Pt's ability to breath

43

Adventitious Lung Sounds

Rales & Rhonchi

44

Rales

Fluid in alveoli or closed alveoli opening

45

What condition are rales common?

CHF

46

Rhonchi

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

47

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

If its productive & effective

48

What does red sputum mean?

Blood

49

What does rust color sputum mean?

Pneumonia

50

What does purple sputum mean?

CA

51

What does yellow/green sputum mean?

Infection

52

What does pink sputum mean?

Pulmonary Edema

53

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

*Color
*Consistency
*Smell
*Amount
*Frequency

54

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

55

What will be tight after heart surgery?

Anterior chest & hip flexors

56

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

Forward head & rounded shoulders

57

What will help protect a sternal incision?

Good posture

58

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

59

How much should the diaphragm move w/deep inspiration?

2-3"

60

Apnea

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

61

Cheyne-Stokes

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

62

What does cheyne-stokes indicate?

Severe CNS lesion

63

Biot's Breathing

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

64

What does Biot's breathing indicate?

Meningitis

65

Cluster Breathing

Clusters of normal breaths separated by irregular pauses

66

What does cluster breathing indicate?

Medullary or low pontine lesion

67

Kussmaul Breathing

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

68

What does Kussmaul breathing indicate?

Diabetic Ketoacidosis

69

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

Towards the side w/the lesion

70

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

Unilateral Loss of Lung Vol

*Atelectasis
*Fibrosis
*Surgical excision

71

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

Towards the healthy side

72

What conditions will the trachea deviate towards the healthy side?

Incr Lung Vol

*Pneumothorax
*Pleural effusion
*Abdominal viscera herniation

73

What is exercise tolerance indicative of?

Fxnl status

74

What does BADCAT stand for?

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

75

Clinical Manifestations of Respiratory Muscle Fatigue

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

76

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