Cardiopulm Exam Flashcards
(127 cards)
1
Q
Do PTs routinely perform a CP screen on their patients?
A
No, but we should
2
Q
Do PTs routinely take VS on patients?
A
Yes
3
Q
What is Normal HR?
A
60-90 bpm
4
Q
What HR is considered sinus tachycardia?
A
> 100 bpm
5
Q
What are some things that can cause sinus tachycardia?
A
Anxiety, exercise, fever, anemia, hypoxia, meds
6
Q
What HR is considered sinus bradycardia?
A
<60 bpm
7
Q
What population is sinus bradycardia seen in?
A
Athletes and people who take beta blockers
8
Q
How do you measure pulse rate?
A
Palpating peripheral artery
9
Q
Where is the most accurate measurement for HR?
A
Auscultation of cardiac apex
10
Q
Pulse deficit is…
A
The difference between the HR and pulse rate
11
Q
When you have a pulse deficit, this means that…
A
Some heart beats have not caused sufficient blood flow to reach periphery
12
Q
A pulse deficit is common in what population?
A
People with AFib or other dysrhythmias
13
Q
HR ranges for newborn
A
120-170 bpm
14
Q
HR ranges for 1 year old
A
80-160 bpm
15
Q
HR ranges for 3 yo
A
80-120 bpm
16
Q
HR ranges for 6 yo
A
75-115 bpm
17
Q
HR for 10 yo
A
70-110 bpm
18
Q
Where else can you take pulse rate?
A
Dorsalis pedis
Radial
19
Q
Rating scale for pulse: 4+
A
Bounding
20
Q
Rating scale for pulse: 3+
A
Increased
21
Q
Rating scale for pulse: 2+
A
Brisk, expected
22
Q
Rating scale for pulse: 1+
A
Diminished, weaker than expected
23
Q
Rating scale for pulse: 0
A
Absent
Unable to palpate
24
Q
BP-JNC8
BP values for healthy individuals is _______ except those >60 years old, it is ________
A
<140/90
<150/90
25
What do the JNC 8 guidelines advise?
Higher BP goals and less use of several types of antihypertensive meds
26
If your BP cuff is too short or too narrow, you may have a _________ reading
False high
27
What kind of cuff nears to be recalibrated regularly?
Aneroid
28
When taking BP, brachial artery should be at what level?
Heart level
29
A pressure difference of more than _____ mmHG suggests arterial compression or obstruction on the side with the lower pressure
10-15
30
A fall of SBP or DBP of 10 mmHg or more, especially when accompanied by symptoms indicates ___________ with the HR increasing by _______ bpm
Orthostatic hypotension
| 10-20 bpm
31
What is the minimal level of MABP?
65 mmHg
32
What is the normal range of MABP?
60/70-110 mmHg
33
How do you calculate MAP?
[SBP +2(DBP)] / 3
34
_____ is seen as perfusion pressure for organs in the body
MAP
35
Activity contraindications include when:
SBP is _____ or _____
DBP is ______
>200 or <80
>100
36
Terminate activity if SBP is ____ and DBP is _____
SBP >250
| DBP >110
37
How do you calculate pulse pressure?
SBP-DBP
38
What do the values for pulse pressure range from?
30-50 mmHg
39
Pulse pressure ______ with age
Increases
40
Pulse pressure is considered abnormal if greater than _______mmHg in adults
60
41
If pulse pressure is low, it is a marker of low ___ in adults with heart failure
Q
42
Increased pulse pressure indicates ___________
Vascular wall stiffness
| Predicts CV events
43
Increased pulse pressure can be found in......
Aortic valve disorders
Severe anemia
Overactive thyroid
44
What are better predictors of mortality? SBP, DBP, or PP?
SBP and DBP
45
Lung sounds: crackles (rales) are heard during what phase of breathing?
Inspiration
46
Fluid in the alveoli or caused by the opening of previously closed alveoli and small airways
Crackles
47
Patients in an exacerbation of CHF will have what kind of lung sound?
Crackers
48
This lung sound is associated with airway obstruction- constriction or mucous
Wheezes (rhonchi)
49
Wheezes (rhonchi) are heard during what breathing phase?
Exhalation
50
What is the normal ventilation rate in adults?
12-16 breaths/min
51
Tachypnea is considered a rate higher than ____
20 breaths/min
52
Bradypnea is a rate lower than ____
10 breaths/min
53
Dyspnea is the patients subjective report of ____
discomfort
54
______ means increased rate and volume
Hyperventilation
55
_____ is decreased rate and volume
Hypoventilation
56
_______ is difficulty breathing while the patient is supine with easing of breathing with a more vertical position
Orthopnea
57
Ventilation in newborn
30-80/min
58
Ventilation in 1 year
20-40/min
59
Ventilation in 3 years
20-30/min
60
Ventilation in 6 years
16-22/min
61
Ventilation in 10 years
16-20/min
62
Ventilation in 17 years
12-20/min
63
Adult ventilation
10-20/min
64
Types of ventilation issues
```
Orthopnea
Hyperventilation
Abdominal paradox
Rib retractions
Hypoventilation
```
65
Cessation after expiration interrupted by eventual inspiration or becomes fatal
Apnea
66
Cyclic waxing and waning of depth of breathing with periods of apnea- seen in severe CNS lesions
Cheyne-Stokes
67
Irregular breathing with slow, shallow breaths and periods of apnea - seen in meningitis
Biot's breathing
68
Clusters of normal breaths separated by irregular pauses- seen in high medullary or low pontine lesion
Cluster breathing
69
Marked continuous hyperventilation with increased rate and depth of breathing to eliminate excess CO2 - diabetic ketoacidosis
Kussmaul
70
What will be seen in the hands if you have a high dose bronchodilator?
Fine tremor
71
What will hands be like if you have an irregular flapping tremor due to acute carbon dioxide retention
Warm and sweaty
72
Weakness and wasting of the small muscles in the hands may be an early sign of an _________ involving the _________
Upper lobe tumor
Involving the brachial plexus
(Pancoast's Tumor)
73
Palmar erythema is a sign of ____
Liver disease
74
Finger pad is enlarged is called ____
Clubbing
75
Clubbing indicates what?
Chronic tissue hypoxia
76
What are the causes of clubbing?
Lung disease
Cardiac disease
Other
Exact cause - unknown
77
Cough color- red
Blood
78
Cough color- rust
Pneumonia
79
Cough color- purple
Neoplasm (smells)
80
Cough color- yellow/green
Infection
81
Cough color- pink
Pulmonary edema
82
Coughing only clears from the __________
6th or 7th generation up
83
Edema in CHF will accumulate _______
Bilaterally
84
Edema 1+
Barely perceptible depression
85
Edema 2+
Easily identified depression (EID)
| Skin comes back within 15 seconds
86
Edema 3+
EID
| Skin comes back within 15-30 sec
87
Edema 4+
EID
| Edema rebounds in >30 seconds
88
Posture exam
```
Anterior chest muscles tight
Hip flexors tight
Forward head
Rounded shoulders
Protect incision site
```
89
Graphs can be taken from what (3) sites?
Radial artery
Saphenous vein
Left internal mammary artery
90
Diaphragm movement for breathing efficiency
2-3 inches with deep inspiration
| Expansion, not descent
91
Palpation: Trachea:
Deviation occurs ______ (which way) when there is a loss of lung volume on one side - atelectasis, fibrosis, surgical excision of lung tissue
Towards the side of the lesion
92
Palpation: Trachea
Deviation occurs in what direction where there is an INCREASE in lung volume - pneumothorax, pleural effusion, herniation of abdominal viscera
Away from the side of the abnormality
93
Palpation: Chest wall
| Look for these 5 things
```
Normal
Pectus excavutum
Pectus carinatum
Symmetry of movement
Pain
```
94
Pectus excavutum is
Funnel chest
95
Pectus carinatum is
Pigeon chest
96
BADCAT Alarming respiratory signs
```
B- breathing that is audible
A- active accessory muscles
D- dyspnea
C- cyanosis or clubbing
A- A-P diameter >1.0
T- tracheal deviation from midline
```
97
A measure of a persons body surface area; an indicator used to assess if a person is of health weight, OW, OB
BMI
98
Does BMI measure body fat?
No, but correlated
99
Does BMI predict mortality and morbidity?
Yes
100
Underweight BMI
18.5 or less
101
Normal BMI
18.5 to 24.9
102
Overweight BMI
25.0-29.9
103
Obese BMI
30-34.9
35-39.9
104
Extremely obese BMI
40 or greater
105
Facial characteristics during exericse
```
Distress
Fatigue
Nasal flaring
Sweating
Paleness
Muscular effort to breathe
```
106
Examples of non modifiable risk factors
Age
Sex
Family history
Genetics
107
Modifiable risk factors
```
Smoking
Diet
Alcohol intake
PA
Dyslipidemias
HTN
Obesity
Diabetes
Metabolic syndrome
```
108
Dyspnea scale 1
Light, barely noticeable
109
Dyspnea scale 2
Moderate, bothersome
110
Dyspnea scale 3
Moderately severe, very uncomfortable
111
Dyspnea scale 4
Severe difficulty
| Patient cannot continue
112
Clinical manifestations of respiratory muscle fatigue
```
Rapid, shallow breathing
Paradoxical breathing
Increased accessory muscle activity
Dyspnea
Hypoxemia
Hypercapnia
```
113
NYHA Functional Class of Heart Disease: Stage I
Patient with cardiac disease but NO PA LIMITATIONS
| 6-10 METS
114
NYHA Functional Class of Heart Disease: Stage 2
Slight limitations
PA results in fatigue, dyspnea, palpitations, or anginal pain
4-6 METS
115
NYHA Functional Class of Heart Disease: Stage 3
Marked limitations of PA
Less than normal PA causes symptoms
2-3 METS
116
NYHA Functional Class of Heart Disease: Stage 4
Unable to carry out PA without discomfort
<2 METS
117
Clinical Prediction Rule for DVT includes:
Cancer (treatment within 6 months)
Paralysis, paresis, immobilization
Bedridden for more than 3 days because of surgery within 4 weeks
Localized tenderness along distribution of deep veins
Entire leg swollen
U/L calf swelling of greater than 3 cm
U/L pitting edema
Collateral superficial veins
Alternative Dx as likely as or more likely than DVT
118
Risk score interpretation (DVT): if you have >/= 3 points
High risk 75%
119
Risk score interpretation (DVT): If you have 1 to 2 points
Moderate risk 17%
120
Risk score interpretation (DVT): if you have <1 point
Low risk 3%
121
What grade on MRC breathlessness scale? Not troubled by breathlessness except on strenuous exercise
Grade 1
122
What grade on MRC breathlessness scale? Short of breath when hurrying on the level or walking up a slight hill
Grade 2
123
What grade on MRC breathlessness scale? Walks slower than most people on the level, stops after a mile or so, or stops after 15 min walking at own pace
Grade 3
124
What grade on MRC breathlessness scale? Stops for breath after walking about 100 yes or after a few minutes on level ground
Grade 4
125
What grade on MRC breathlessness scale? Too breathless to leave the house, or breathless when undressing
Grade 5
126
What is the abdominal paradox?
When the diaphragm doe not move right
127
Who are in rib retractions mainly seen in?
Children- skin between intercostals get sucked in
