cardiopulmonary skills - lab practical Flashcards
(61 cards)
1
Q
Kortokoff sounds tests for?
A
pulsating sounds heard through stethoscope when measuring BP
2
Q
What are Kortokoff sounds?
A
Pulsating sounds heard through stethoscope when measuring BP
3
Q
What does S1 represent in heart sounds?
A
1st heart sound, systolic, ‘lub’, closure of mitral and tricuspid valves
4
Q
What does S2 represent in heart sounds?
A
2nd heart sound, closure of semilunar valves, ends of ventricular systole
5
Q
What is a normal range for pulse oximetry?
A
95-100%
6
Q
How does COPD affect pulse oximetry readings?
A
Normal might be lower
7
Q
What can affect the accuracy of pulse oximetry readings?
A
- Nail polish
- Melanin
- Temperature (cold hands)
- Dehydration
8
Q
What is considered a normal resting pulse rate?
A
60-100 bpm
9
Q
What is the purpose of auscultation of the heart?
A
To listen to heart sounds at specific valve locations
10
Q
What does S3 indicate?
A
Low-pitched, extra heart sound during diastole, associated with rapid ventricular filling, can be a sign of heart failure
11
Q
What does S4 indicate?
A
Right before S1, increase resistance
12
Q
What are the components of pulmonary observation?
A
- Symmetry in chest rise
- Tracheal shift
- Diaphragmatic excursion
- Speech quality
- Breath odor
- Accessory muscles
13
Q
What does tracheal shift indicate?
A
Trachea shifts towards lower pleural pressure side; shifts away from pleural effusion, towards pneumonectomy
14
Q
What is the purpose of mediating percussion?
A
Assesses the density of underlying organs
15
Q
What does a ‘resonant’ sound indicate during percussion?
A
Heard over air-filled organs such as the lungs
16
Q
What does a ‘dull’ sound indicate during percussion?
A
Heard over solid organs such as the liver
17
Q
What is the normal diaphragm excursion range during inspiration?
A
3-5 cm
18
Q
What is the purpose of the Pitting Edema scale?
A
To suspect circulatory issues such as heart failure, venous insufficiency, or DVT
19
Q
What is the scoring for Pitting Edema?
A
- 1+ = immediate rebound (2mm)
- 2+ = slight delay in rebound (4mm)
- 3+ = >15 sec delay (6mm)
- 4+ = >30 sec delay (8mm)
20
Q
What does a positive Stemmer sign indicate?
A
Inability to pinch skin, presence of lower extremity lymphedema
21
Q
What does the Homans sign test assess? how do you test it?
A
Deep vein thrombosis (DVT)
- The gastrocnemius muscle is squeezed while the foot is dorsiflexed with force
- Limitations
- Not highly specific or sensitive for DVTs; high false positives and high false negatives
- DF pain can be due to muscle strains, cellulitis, or Baker’s cyst
22
Q
What is the Dyspnea Scale used for? what are the grades? (mMRC)
A
Measures perceived shortness of breath or breathing difficulty
23
Q
What is the normal respiratory rate for adults?
A
12-30 BPM
24
Q
What are the three types of normal lung sounds?
A
- Bronchial
- Bronchovesicular
- Vesicular
25
What does tactile fremitus assess?
What are the different sounds?
Presence of lung consolidation
bronchophony
whispering pectoriloquy
egophony
26
What is the purpose of Postural Drainage?
To help drain mucus from the lungs using gravity
27
What does the ABI scale measure?
Ankle-brachial index for assessing arterial disease
28
What does a score of <0.5 on the ABI scale indicate?
Severe arterial disease
29
What does the Rubor of Dependency test assess?
how do you assess it?
Tissue coloration changes due to arterial insufficiency
* Start supine w/ LE elevated > 45 degrees
* Observe for pale/painful limb (abnormal) during 1 min elevation
* Quickly transition elevated limb to dependent position
* Observe for rapid return of blood flow in limb
* Arterial insufficiency = presence of deep red limb discoloration >30 sec dependent position
* Negative = pink color
30
What is the purpose of the Trendelenburg Test?
To assess valvular competence in veins
31
What is pulse oximetry?
indirect measure of arterial oxygen in the bloodstsream
32
what could be indicated by a heart rate pulse that is jumping up/down ?
- this indicates an irregular rhythm
- the QRS compleses are occurring at uneven intervals
- if SpO2 is jumping, you are not getting a good reading
33
What is a 0 pulse reading?
no pulse- no circulation
34
what is a 1+ pulse reading?
diminished pulse - reduced stroke volume and ejection fraction, increased vascular resistance
35
What is a 2+ pulse reading?
normal pulse
- normal resting conditions, no pathologies
36
wht is a 3+ pulse?
moderately increased - slightly increased stroke volume and ejection fraction
37
what is a 4+ pulse?
markedly increased (bounding) - increased stroke volume and ejection fraction, can be diminishe with vasoconstriction
38
Auscultation of the heart - where do you find the aortic valve?
- 2nd right intercostal space
39
# Auscultation of the heart
where is pulmonic valve?
second left intercostal space
40
# Auscultation of the heart
where is erb's point?
3rd left intercostal space
41
# Auscultation of the heart
Where is tricuspid valve?
4th left intercostal space
42
# Auscultation of the heart
where is mitral valve?
5th left intercostal psace (midclavicular line)
43
what is ventriuclar contraction/emptying: closure of atrioventricular valve
S1 (lub) --> systolic phase
44
what is ventricular relaxation/filling (including coronary arteries: closure of semilunar valves)
S2(dub) --> diastolic phase
45
What closes during S1 (systolic)
mitral
tricuspid
46
what closes during S2 diastolic?
- aortic
- pulmonary
47
How do you assess thoracic expansion?
Upper Thorax
Stand in front of patient
Place hands on shoulders over upper traps
Mid Thorax
Stand in front of patient
Place hands around rib cage
OR hands on anterior with fingers over clavicle
Posterior Thorax
Stand behind patient
Place ‘V’ hands around ribs cage at latissimus dorsi
Costal Margins
Stand in front of patient
Place ands at costal margins
48
what is the purpose of performing the stermmer sign
test for presence of lower extremity lymphedema
49
manual pulses
where is the temproal pulse? carotid? apical? brachial? radial? ulnar? femoral? popliteal? posterior? tibialis? dorsal pedis?
* Temporal – anterior/superior to ear
* Carotid – between SCM and trachea
* Apical – 5th intercostal space
* Brachial – medial to antecubital fossa
* Radial – proximal to thenar, medial to brachioradialis
* Ulnar – groove proximal to pisiform
* Femoral – femoral triangle
* Popliteal – Medial to biceps femoris (long head); knee passively flexed
* Posterior Tibialis – posterior-inferior to medial malleolus
* Dorsal Pedis – between 1st and 2nd MTP
50
What do you need to make sure when taking manual BP?
Blood Pressure medications?
Have patient:
Rest for 10 minutes
Uncross legs
Don't talk
Rest arm at heart level
Locate Artery
Sitting
Right/left brachial artery
Supine
Right/left brachial artery
Right/left posterior tibialis/dorsal pedis artery
51
capillary refill test
* Non-invasive diagnostic test
* Non-arterial or venous specific
* Quick assessment of peripheral perfusion (arms or legs)
* Normal: <2-3 seconds
52
What are the sternal percautions
* No lifting >10 lbs
* No pushing/No pulling
* No bilateral upper extremity movements after midline
* Splinting techniques with coughing, sneezing, or increased pain
* Risk Factors for delayed healing
* Infection
* Smoking
* Diabetes
* Large bogy habitus
* Steroids
* Low ejection fraction
* Poor nutrition
* Not adhering to sternal precautions = non-union
53
normal lung sounds
Bronchial (tracheal) area:
Bronchovesicular areas:
vesciular areas:
* Bronchial (tracheal) area: Sounds should be strong, loud, and higher pitched.
* Bronchovesicular areas: Sounds will be loud, but not as loud.
* Vesicular areas: There should be a gentle whooshing sound.
54
# tactile fremitus
What is a positive bronchophony?
Bronchophony:
* Can be heard during auscultation when lung consolidation is present.
* Bronchophony is positive if the patient says the word “99” during auscultation, and there is increased clarity instead of the normal muffled sounds.
* When consolidation is present, it causes the transmission of higher-frequency vocal vibrations, which enhances the clarity and resonance of the words that are spoken.
55
# tactile fremitus
what is a positive whispering pectoriloquy?
* Exaggerated form of bronchophony.
* Consolidation is present if the patient whispers “99” and it sounds clear with auscultation.
56
What is a positive egophony?
Egophony:
* Voice sound that can be heard with auscultation when lung consolidation is present.
* This is positive if the patient is instructed to say “E” during lung auscultation, but an “A” sound is heard instead.
57
how do you auscultate the lungs?
* Start below the clavicle (mid- clavicle), and move over to the other side
* Then move down to the second intercostal space, and move over again
* Keep going down in a uniform pattern.
* Note:
* Bare skin as much as possible
* Breath in and out with each location
58
purpose of postural drainage? Clinical relevance?
* Purpose: To help drain mucus from the lungs using gravity.
* Performed when patient is lying or sitting in different positions to facilitate drainage of secretions from various lung segments.
* Clinical Relevance: Typically for patients who have Cystic Fibrosis.
59
ABI scale
ABI Scale:
* 1.4 = Calcification may be present
* >1.0 = probably no arterial disease
* 0.81-1.00 = no significant arterial disease,or mild/insignificant
* 0.5-0.80 = moderate disease
* <0.5-= Severe disease
* <0.3 = Critical ischemia
60
how to perform ABI?
* Acquire a handheld doppler, ultrasound gel, and manual BP cuff
* Make sure that they are supine and not speaking for 10 minutes prior to test and during procedure
* Palpate for brachial artery
* Apply blood pressure cuff to upper arm
* Find pulse with Doppler and transducer
* Pump up BP cuff until pulse signals disappear and slowly lead off until you hear the brachial signal.
* Record the measurement.
* Repeat the same process for the ankle signal at the dorsalis pedis and posterior tibial artery
* Take 2 ankle signal measurements and record the highest reading (dorsal pedis and posterior Tibialis artery)
* Compare UE signal to highest LE signal by finding the ABI or ratio between the Ankle and brachial blood pressure
61
how do you perform trendelenbrug test?
* Purpose: assesses valvular competence (rule out/in retrograde flow of veins)
* From supine, limb is extended to 90º for 1 minute
* Blood from venous system is emptied
* Then apply tourniquet
* Tourniquet functions to occlude venous flow
* Pt transitions to standing (watch for OTH s/s)
* After 30 sec in standing remove tourniquet
* Normal venous filling = <30 sec
* Superficial filling with tourniquet in place = incompetent communicating veins
* Additional filling after tourniquet is removed = incompetent saphenous valves
