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CardioPulmoaryPT1 > COMPS:Exam of CV or Pulm Pt: Exam 1 > Flashcards

COMPS:Exam of CV or Pulm Pt: Exam 1 Flashcards

1
Q

Med Chart review first up…

A

PT consult

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2
Q

Med chart review:

Activity orders by MD

A
  • bed rest
  • bathroom priv’s
    • NO > MET lvl 2
  • OOB TID== out of bed 3x/day
  • Ad lib–> pt can do w/e they want
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3
Q

Dx and date of event

Primary dx

Secondary Dx

Date of event

A
  • primary
    • ​when, what, how many times
  • secondary
  • date of event
    • ​determines timeline
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4
Q

Symptoms:

Cardiac ischemic symptoms

Typical MALE

A
  • SOB
  • chest pain
    • press, tight, sharp
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5
Q

Symptoms:

Cardiac ischemic sx’s

Atypical female

A
  • indigestion (GERD)
  • palpitations
  • throat pain
  • diff swallowing
  • burning
  • shoulder pain
    • B/L
  • mid back pain
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6
Q

symptoms:

Peripheral ischemic symptoms

arterial

A
  • claudications
  • non-blanchable tissue
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7
Q

symptoms:

Pulmonary sx’s

A
  • SOB
  • Dyspnea on exertion (DOE)
  • sputum production
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8
Q

Medications:

look @ doc.

WHY does pt need that med ?

Pt. Presentation ex.

A
  • EX: beta blocker (most common cardiac med)
    • ​just had HA in past due to high BP
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9
Q

Meds:

think about SE’s of meds

A
  • ex. Beta Blocker
    • blunts HR response
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10
Q

Meds:

pharmaceutical interaction w/ PT/exercise

Meds w/ SHORTER half-life

ex’s and when should you do PT?

A
  • pain meds, opioids
  • PT RIGHT AFTER taking meds
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11
Q

Pharma intercation w/ PT/Exercise

ex. nebulizer or MDI

A
  • PT FIRST then nebulizer or MDI
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12
Q

Risk factors:

CV disease

A
  • HTN
  • smoking
  • elevated serum CHO
    • LDL: total CHO ratio
  • genetics/family hx heart dis.
  • stress/Type A personality
  • sedentary
  • older
  • MALE
  • obese
  • T2D

Modifiable: HTN, smoking, stress, sedentary, obese

NONmodifiable: age, sex, genetics/family hx

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13
Q

Social hx: self-abusive social habits
ETOH abuse

A

linked to cardiomyopathy

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14
Q

Social hx: self-abusive social habits

Smoking

A

causes COPD

emphysema & chronic bronchitis

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15
Q

Social hx: self-abusive social habits

Illicit Drugs:

A
  • EX. Cocaine
    • Direct Coronary damage:
      • ​coronary aa spasms
        • ​EVEN AFTER 1 USE
          • ​HA, arrythmias
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16
Q

Lab Tests: some ex’s

A
  • Cardiac Enzymes
    • ​Troponin (CTNI)—-> MI
        • ==> dx past HA
  • Blood lipids
    • ​CHO + triglycerides
  • CBC
    • ​Hb
    • Hct
    • WBC
    • BUN
    • Cr
    • BNP
  • ABGs
  • Cultures
  • -Coagulation studies–> how well blood is clotting
    • ​INR
    • APTT
    • PTT
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17
Q

Dx tests:

ex’s

A
  • chest x ray
  • ECHO/TEE (transesophageal)
  • CT scan
  • cardiac cath/angiography
  • PFT—> Pulm Function Test
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18
Q

O2 Therapy:

the Device

A
  • Nasal Cannula
    • ​in nose for O2 delivery
      • 2 L NC== 29-53% FiO2
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19
Q

O2 Therapy:

O2 Delivered

cannula vs. mask

A
  • O2 Delivered:
    • Liters vs. FiO2
      • ​ex. 60% mask vs. 28% NC
        • ​basically….mask will be MORE
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20
Q

O2 Therapy:

MD order for O2 sats or system delivery…

A
  • “Maintain O2 sats >88% w/ exertion”
    • ​PTs can’t admin meds/touch the O2 machine
    • ​MD has O2 order in chart
    • IF O2 order NOT doc’d —-request INC/DEC in O2
    • IF Emergency
      • ​INC O2
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21
Q

Sx Procedures:

what should you note?

A
  • Procedure/Sx
  • Surgical approach/precautions
  • Complications during sx OR post-op comps?
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22
Q

Looking @ rehab:

A

OT

Speech

Rec tx

PM&R consults

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23
Q

When should we be checking Vital Signs??

A

on admission

over past 24hrs

most CURRENT

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24
Q

Vital signs:

on admission

over past 24hrs

most current

A
  • EKG monitoring
    • BP
    • RR
    • HR
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25
Q

Nutritional Intake:

A
  • PO; per os; By mouth
  • Enteral
    • ​entering stomach or GI tract
  • Parenteral
    • ​IV
      • ​bypassing eating/digestion
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26
Q

PLOF:

A
  • bed bound
  • req’d 24 hrs assist/supervision/fall risk
  • equip pt already owns
  • employment
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27
Q

Interview pt and family…… completed when??

A

AFTER thorough Chart Review

  • effective communication
  • fill in any gaps
  • consider CP status
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28
Q

Systems Review:

what is it?

A

BRIEF exam of ALL SYSTEMS that would affect pts performance

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29
Q

Systems review:

Cognition

Affect

A
  • Cognition:
    • ​lang, attn, learning style
  • Affect:
    • ​behavior
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30
Q

Systems review:

CV/Pulm

A

Edema

BP monitor

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31
Q

Systems review:

MSK System

A
  • GROSS sym of mm’s
  • appeared gen ht, wt,
  • strength/ROM
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32
Q

Systems review:

NMSK System

A

motor control

tone

balance

vis. tracking

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33
Q

Systems Review:

Integumentary

A

skin

wounds/skin check

texture

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34
Q

EXAMINATION of Pt

gen appearance

A

LOOK @ pt

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35
Q

EXAMINATION:

Lvl of Consciousness

A

Richmond Agitation-Sedation Scale

ADD PICS SEE LECTURE

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36
Q

EXAMINATION:

Lvl of Confusion

A

use CAM-ICU Scale OR

look for Delirium (NO attn to tasks)

ADD PICS

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37
Q

EXAM:

Body Type:

A

obese

normal

Cachectic (med. too thin)

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38
Q

EXAM:

Posture

A
  • Scoliosis
    • directly affects lung function
  • Kyphosis
    • T spine hunching
  • Pro position or tripod
    • ​using mm’s origin as insertion
  • Sitting OR Semi-fowler
    • slightly elevated HOB
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39
Q

EXAM:

Skin Tone

*look @ lips*

A
  • Cyanosis
    • partial press and 02 sat DEC’d
  • Dusky
    • ​gray
  • Pale
    • ​less pink flush
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40
Q

EXAM:

Facial signs of distress

A

Nasal flaring

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41
Q

EXAM:

Neck

Jugular veins

A
  • JVD
    • ​ look @ jugulars
      • ​TOO MUCH CVP in vein
        • ​heart failure
          • ​something is backing up
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42
Q

EXAM:

NECK

SCM

A
  • Hypertrophic
    • == overuse of SCM as an Accessory mm
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43
Q

EXAM:

Chest/Breathing

A
  • lateral symmetry R to L
  • AP symmetry
    • normal AP ratio is 1/2 transverse diameter
      • ​Depth==1/2 width
        • ​Depth=Width –> Barrel Chested
  • Sternal Position
    • Pectus excavatum
      • ​sunken chest
    • Pectus carinatum
      • ​pigeon chest
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44
Q

EXAM:

Rib Angles

A
  • <90deg
  • >90deg
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45
Q

EXAM:

Musculature

MM’s of Inspiration

A

Diaphragm + Ext. Intercostals

  • Exhale should be passive
  • Look for if there is EXCESSIVE use of SCM when INHALING *****
46
Q

EXAM:

Musculature

Accessory mm’s of INSPIRATION

A
  • SCM
  • Scalenes
  • Upper traps
  • Pec major/minor
  • Serratus Ant.
  • Rhomboids
  • Lat Dorsi
  • Thoracic extensor spinae mm’s
47
Q

EXAM:

Musculature

MM’s of EXPIRATION

A

Abdominals + Internal Intercostals

48
Q

EXAM:

Inspiration to Expiration ratio

NORMAL

A

1: 2
insp: exp

49
Q

EXAM:

Insp to Exp

ABNORMAL

A
  • Pursed lip breathing
    • prolooooonged expiration
      • ​TOO MUCH AIR/Obstruction
      • indicates Patho condition
50
Q

EXAM:

breathing RATE

APNEA

A

NO BREATHING

51
Q

EXAM:

Breathing RATE

Eupnea

A

ideal breathing

12-20bpm

52
Q

EXAM:

Rate

Bradypnea

A

<12 bpm

53
Q

EXAM:

RATE

Tachypnea

A

>20 bpm

54
Q

EXAM:

DEPTH

Hyperpnea

A

INC depth

NORM rate

55
Q

EXAM:

DEPTH

Dyspnea

A

INC depth

INC rate

56
Q

EXAM:

Positional breathing

ORTHOPNEA

A
  • diff breathing in supine pos. vs standing
    • ​dx w/ CHF
  • pillow test
57
Q

EXAM:

Severe breathing probs:

Paradoxical Breathing

A
  • OPP of normal (see below)
    • greater abd pressure OR collapsed lung
      • ​Inhale: abd/thorax DEC in size
      • Exhale: thorax INC size
58
Q

EXAM:

Severe breathing probs:

Kussmaul Breathing

A
  • indicates metabolic acidosis
    • ​pH = acidic due to DEC in bicarb
    • Dyspnea
59
Q

EXAM:

Severe Breathing probs:

Cheyne-Stokes

A
  • Terminal breathing pattern:
    • Sm VT, Lg VT, Sm VT
      • Apnea
60
Q

EXAM:

Severe Breathing probs:

Biot’s

A
  • Neuro issue
    • dyspnea, apnea, dyspnea
  • Hospice breathing
61
Q

EXAM:

Dyspnea

A
  • @ rest
  • W/ Exertion
  • One Word Dyspnea
    • ​only say one word and then need to take another breath
      • ​Stevie!!!
62
Q

EXAM:

Coughing

Effectiveness vs. Ineffectiveness

A
  • Effectiveness:
    • ​ability to FORCEFULLY exhale & dislodge obstruction if there is one
  • Ineffectiveness:
    • ​cannot contract abd’s to forcefully EXHALE
63
Q

EXAM:

Cough

Productive vs. NONproductive

A
  • Is there any sputum to get up AND did they get it up?
64
Q

EXAM:

Cough

Mucoid

A
  • flu like
  • short lived
  • clear, transparent, colored
  • NOT OPAQUE
65
Q

EXAM:

Purulent

A
  • Flu like
  • becomes chronic
  • MORE OPAQUE
  • THICKER
66
Q

EXAM:

COUGH

Fetid

A

odor

copious

67
Q

EXAM:

Cough

Frothy

A
  • Assoc’d w/ ORTHOPNEA
    • ​Cough up interstitial fluid OR liquid
68
Q

EXAM:

Cough

Hemoptysis

A
  • blood
  • some type of injury in pulmonary lining
69
Q

EXAM:

Cough

Violent cough/Aspiration

A
  • when fluid goes IN lungs instead of esophagus
70
Q

EXAM:

Extremities

Digital clubbing

fingers!!!

A
  • see pics in ppt
  • indicative of Chronic Pulm disease
    • ​not enough O2 to supply making of fingernails
      • ​turned in and down
71
Q

Exam:

Arterial Disease

A

Looking for PAD

  • pain
  • claudication
  • pulses—NONE
  • trophic changes
  • wounds—-no fluid
72
Q

EXAM:

Venous insufficiencies (CVI)

“Valvular Incompetence

A

Too much blood in venous system

  • varicose veins
  • pain
  • pulses
  • edema vs. periphal dependent edema
  • Hemosiderin staining
    • ​red Hgb stagnant in peripheral system
      • stains tissue
  • Wounds
    • Weeping
73
Q

EXAM:

Auscultation of Lungs

LISTEN to pts lungs

A
  • PRE and POST session
  • bare skin
  • Monitor pt t/o to prevent falls and prevent hypervent and dizziness (subjective)
74
Q

Auscultation Sounds

NORMAL

Bronchial/Tracheal

A
  • listen @ bifurcation of bronchi OR trachea
    • equal insp/exp
    • tubular mvmt air
    • loud
    • high pitched
75
Q

Auscultation sounds

NORMAL

Bronchovesicular

A
  • ANT segment of UPPER lobe
  • NO PAUSE
  • breathe t/o whole time
  • 1/2 ICS ANT, T3/T4 POST
76
Q

Auscultation sounds

NORMAL

VESICULAR

A
  • periphery of lungs
  • ANT/POST basal lobes
  • Insp looooonger vs. EXP (1:3)
  • low pitch swish
77
Q

Auscultation:

ABNORMAL

A
  • INCd
    • sputum
  • Diminshed
    • truncal adipose tissue
    • emphysema
    • COPD
  • Absent
78
Q

Adventitous Lung Sounds:

Wheezing (Rhonchi)

A
  • cont. high pitched sounds
    • bronchial spasm
      • ​heard in ONE phase
    • asthma
79
Q

Adventitious Lung sounds:

Crackles (Rales)

A
  • light, airy, crack and pop (rice krispies)
    • airways opening and closing, secretions
    • mvmt of secretions
    • open/close peripheral airways
  • COPD,
80
Q

Adventitious Lung sounds:

Pleural Rub

sandpaper

A
  • involves pleural space
  • sandpaper
  • indicates:
    • ​pleural inflamm.
81
Q

Adventitious Lung sounds:

Stridor

choking!!!

fart you can’t hold in

A
  • deals w/ Trachea
  • monophasic
  • long, squeaky
82
Q

EXAM:

Voice Sounds

A
  • If (+) test—> ALL indicate consolidation
  • feel vibration OR altered noise
    • ​egophony
    • bronchophony
    • whispering pectoriloquy
83
Q

Auscultations of Heart Sounds

remember….

A

APT-M 2245

84
Q

Auscultation of Heart Sounds

A
  • Aortic valve
    • ​2nd ICS on RIGHT (only one on RIGHT)
  • Pulm valve
    • ​2nd ICS on LEFT (direct. across Aortic)
  • Tricuspid valve
    • ​4th ICS next to sternum
  • Mitral Valve
    • ​5th ICS mid-clavicular line
    • apex beat
    • PMP
      • point of max impact
85
Q

Normal Heart Sounds

A
  • S1: Lub
    • ​onset of systole, AV valves
  • S2: Dub
    • ​onset of diastole: SL valves
86
Q

Abnormal Heart Sounds

indicative of….

A

TOO much fluid in heart OR

heart TOO rigid w/ fluid flowing thru

87
Q

Abnormal Heart Sounds:

S3

LUB DUB DUB

aka

A
  • Ventricular Gallop
88
Q

S3 Lub dub dub

BEST heard where?

A

over Apex of heart w/ BELL of stethoscope

89
Q

S3 lub dub dub

heard WHEN?

A

IMMED. following S2 in early Diastole

90
Q

S3 lub dub dub

what is it?

A

rapid flow of blood into a distended ventricle or stiff ventricle

Dx: CHF or cardiomyopathy

91
Q

S3 Lub dub dub

more commonly heard in what?

A

More common heard in supine or left side-lying pos.

LESS LIKELY heard @ rest in sitting (bc gravity)

92
Q

S3 lub dub dub in children…

A

CAN BE NORMAL in healthy children/young adults due to quick decel. of blood in ventricles

93
Q

S4 La-Lub-Dub aka

A

Atrial Gallop

94
Q

S4

La-lub-dub

BEST heard where

A

over APEX of heart w/ BELL of stethoscope

95
Q

Diaphgram ==

A

high pressure sounds

96
Q

Bell==

A

LOW pressure sounds

97
Q

S4 La-lub-dub

heard when?

A

Late in Diastole during ATRIAL KICK

just BEFORE S1

98
Q

S4 SOUND La lub dub

what is it?

A

blood entering stiff ventricle in presence of a pressure overload

  • DX:
    • Myocardial scarring
      • ​MI
      • CAD
      • CABG
      • hypertrophied LV due to HTN
99
Q

Palpation:

mediastinum/tracheal pos. assessed Sitting UP then…

A

Shift:

TOWARDS involved side

AWAY from involved side

100
Q

Palpation:

Chest motion

A
  • Upper, middle, lower lobes
  • Document:
    • symmetry
    • extent of mvmt
  • Diaphragmatic:
    • ​best IDs diaphragmatic excursion is thumbs are on xiphoid and normal excursion is indicated by 2-3 inches in thumb mvmt
      • 5-7.6 cm
101
Q

Palpation:

Fremitus

feeling for vibration

A
  • Normal
  • INC’d
    • consolidation or sputum
  • DECd
102
Q

Palpation:

Percussion:

final comp. of chest exam

A
  • use middle finger of one hand flat on chest wall w/in ICS
  • other hand pos’d in DF w/ wrist as fulcrum
  • hand moves back n forth rapid success. w/ tip of middle finger on the chest wall
103
Q

Palpation:

Percussion:

final comp. of chest exam

Normal vs. Dull vs. Tympanic

A
  • Normal
  • Dull
    • “Thud”
      • liver and other dense tissues
  • Tympanic
    • ​long and hollow
      • hear over empty stomach, inflated chest
104
Q

EXAM:

Activity Eval

A
  • What can pt tolerate from activity standpoint and MET lvl standpoint
    • supine
    • EOB
    • standing
    • ADLs
    • stand-pivot
    • ambulating
    • stairs
  • When to terminate?
    • ​based on VITALS and subjective
105
Q

EXAM:

Vitals

Heart rate

A
  • palpate continously for 1 min or 60s EKG strip
    • ​MHR==220-age
    • ​MHR Elderly
      • ​Males== 205-1/2age
      • Females== 225-age
    • IF observe DEC HR w/ activity….
      • ​MONITOR FOR ARRYTHMIAS
106
Q

VITALS:

Blood Pressure

A
  • Diff in extremities===
    • ​some occlusion in one extremity
  • w/ Exertion
    • ​should INC
  • AFTER exertion
    • ​should slowly DEC
107
Q

VITALS

O2 Sats

A

stay ABOVE 88%

*exercises should NOT be cont’d if O2sats drops TO or BELOW 88%

108
Q

Vitals:

RR

A

Normal== 12-20 bpm

109
Q

Vitals:

USE BORG SCALE

A
  • 10
    • MAX effort
  • 9
    • VERY hard
  • 7-8
    • Vigorous
  • 4-6
    • Moderate
  • 2-3
    • Light
  • 1
    • VERY Light
110
Q

EXAM:

CV/Pulm special tests

A
  • 2 min walk
  • 6 min walk
  • 5x sit to stand
  • 10m gait speed
  • 30s sit to stand
  • YMCA step
  • Astrand-Rhyming Protocol

BALANCE!!!

111
Q

Assess/Dx

A

PT develops a dx which is a PT Dx

NOT medical Dx

*******

THEN DO TX/POC!!!!!!!

112
Q
A

CardioPulmoaryPT1 (12 decks)

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