Ch 7 Cardiovascular and Pulmonary Examination

Question 1

Cardiovascular and Pulmonary Examination

Answer 1

Cardiopulmonary
Assessment of vital signs
Baseline indicators of physiological status
Abnormal measures warrant immediate medical referral in some cases

Question 2

Core Vital Signs

Answer 2

Collect baseline values for every new patient
Pulse
Respiration
Blood pressure
Used as objective measures throughout a course of treatment to indicate improvement or decline in health status

Question 3

Heart Rate - Pulse

Answer 3

Number of times the heart contracts in a given period of time
Typically beats per minute (bpm)

Question 4

Rhythm - Pulse

Answer 4

Regularity of contractions

Question 5

Force - Pulse

Answer 5

Strength of left ventricle contraction
Indicates the volume of blood in the peripheral vessels

Question 6

Pulse Rate

Answer 6

Normal adult: 60-100 bpm
Tachycardia: > 100 bpm
Bradycardia: < 60 bpm

Question 7

Pulse rhythm

Answer 7

Regular: Typical intervals
Irregular: Variable intervals

Question 8

Pulse Force

Answer 8

0: Absent
1+: Weak or diminished
2+: Normal
3+: Increased force
4+: Bounding
Thready: Weak force with rapid rate

Question 9

What are the most common pulse points?

Answer 9

Carotid and radial artery

Question 10

When should you monitor pulse?

Answer 10

Before, during, and after exercise

Question 11

Respiration Rate (RR)

Answer 11

Number of times the chest rises and falls in a given period of time
Typically breaths per minute (breaths/min)

Question 12

Respiration rhythm

Answer 12

Regularity of respiratory cycles

Question 13

Respiration depth

Answer 13

Much less than the full capacity of the lungs to expand

Question 14

RR Values

Answer 14

Normal adult: 12-20 breaths/min
Tachypnea: > 20 breaths/min
Bradypnea: < 12 breaths/min

Question 15

Respiration rhythm Descriptors

Answer 15

Regular: Typical intervals
Irregular: Variable intervals

Question 16

Respiration depth Descriptors

Answer 16

Deep: Very obvious chest rise and fall
Normal: Observable chest rise and fall
Shallow: Barely perceptible chest rise and fall

Question 17

How do you assess respiration?

Answer 17

Observe chest rising and falling
Patient should be unaware

Question 18

Common respiratory difficulties

Answer 18

Dyspnea: Short of breath
Orthopnea: Difficulty breathing while lying flat
Paroxysmal nocturnal dyspnea: Sudden dyspnea and orthopnea while sleeping
Apnea: Absence of breathing, often while sleeping

Question 19

BP - Systole

Answer 19

Arterial pressure when the left ventricle contracts

Question 20

BP - Diastole

Answer 20

Arterial pressure when the heart is at rest between contractions

Question 21

How is BP indicated?

Answer 21

Indicated by systolic pressure/diastolic pressure
Measured in millimeters of mercury (mmHg)

Question 22

Hypertension

Answer 22

Increased arterial wall tension leading to higher than normal blood pressure

Question 23

Hypotension

Answer 23

Lower than normal blood pressure

Question 24

Orthostatic hypotension

Answer 24

Rapid drop in blood pressure when changing positions

Question 25

Normal BP

Answer 25

90/60 to 119/79 mmHg

Question 26

Hypotension

Answer 26

< 90/60 mmHg

Question 27

Hypertension

Answer 27

Prehypertension: 120/80 to 139/89 mmHg Stage I hypertension: 140/90 to 159/99 mmHg Stage II hypertension: ≥ 160/100 mmHg Hypertensive crisis: ≥ 180/110 mmHg Requires immediate medical attention

Question 28

BP - Normal exercise response

Answer 28

Systolic pressure rises and levels off Diastolic pressure rises by no more than 10 mmHg Slight differences between arms

Question 29

Temperature

Answer 29

Not a routine test Abnormal core body temp may require medical attention Normal: 98.6°F (37°C) Assessment: Oral Tympanic membrane (ear)

Question 30

Edema

Answer 30

Observable swelling from fluid accumulation, outside of joint capsules Accumulates in interstitial spaces Between cells, vessels, and other structures Effusion Fluid accumulation within a joint capsule or cavity Injury or inflammation

Question 31

Peripheral Edema

Answer 31

Most common sites observed in physical therapy are legs and feet Pitting Visible indentation remains when finger is pressed into area and removed Nonpitting No indentation remains when pressure is removed

Question 32

Common Causes of Pitting Edema

Answer 32

Heart disease Kidney and liver disease Chronic venous insufficiency Deep vein thrombosis Immobilization and inactivity Cerebrovascular accident Spinal cord injury

Question 33

Pitting Edema Assessment

Answer 33

Trace (1+): Slight indentation, skin rebounds quickly Mild (2+): 0.0-0.6 cm indentation, skin rebounds in < 15 sec Moderate (3+): 0.6-1.3 cm indentation, skin rebounds in 15-30 sec Severe (4+): 1.3-2.5 cm indentation, skin rebounds in > 30 sec

Question 34

Oxygen Saturation

Answer 34

Degree to which hemoglobin is bound to oxygen in circulating blood Corresponds with many conditions that require hospital admission

Question 35

Oxygen Saturation: Assessment

Answer 35

Measured via arterial blood gas (ABG) analysis or pulse oximetry Normal: 97-99% Cardiovascular/pulmonary disease: 90-95% Oxygen levels measured below 88% at rest may require supplemental oxygen

Question 36

Ankle-Brachial Index (ABI)

Answer 36

Identify the presence or severity of impaired arterial blood flow (ischemia) to extremities Reduced blood flow can lead to peripheral arterial disease (PAD) Risk factor for myocardial infarction (MI), stroke, or lower extremity wounds Compares blood pressure measures taken from an arm and a leg