COMPS:Exam of CV or Pulm Pt: Exam 1 Flashcards
(112 cards)
1
Q
Med Chart review first up…
A
PT consult
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
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
4
Q
Symptoms:
Cardiac ischemic symptoms
Typical MALE
A
- SOB
- chest pain
- press, tight, sharp
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
6
Q
symptoms:
Peripheral ischemic symptoms
arterial
A
- claudications
- non-blanchable tissue
7
Q
symptoms:
Pulmonary sx’s
A
- SOB
- Dyspnea on exertion (DOE)
- sputum production
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
9
Q
Meds:
think about SE’s of meds
A
- ex. Beta Blocker
- blunts HR response
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
11
Q
Pharma intercation w/ PT/Exercise
ex. nebulizer or MDI
A
- PT FIRST then nebulizer or MDI
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
13
Q
Social hx: self-abusive social habits
ETOH abuse
A
linked to cardiomyopathy
14
Q
Social hx: self-abusive social habits
Smoking
A
causes COPD
emphysema & chronic bronchitis
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
-
EVEN AFTER 1 USE
-
coronary aa spasms
-
Direct Coronary damage:
16
Q
Lab Tests: some ex’s
A
-
Cardiac Enzymes
-
Troponin (CTNI)—-> MI
- ==> dx past HA
-
Troponin (CTNI)—-> MI
-
Blood lipids
- CHO + triglycerides
-
CBC
- Hb
- Hct
- WBC
- BUN
- Cr
- BNP
- ABGs
- Cultures
-
-Coagulation studies–> how well blood is clotting
- INR
- APTT
- PTT
17
Q
Dx tests:
ex’s
A
- chest x ray
- ECHO/TEE (transesophageal)
- CT scan
- cardiac cath/angiography
- PFT—> Pulm Function Test
18
Q
O2 Therapy:
the Device
A
-
Nasal Cannula
-
in nose for O2 delivery
- 2 L NC== 29-53% FiO2
-
in nose for O2 delivery
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
-
ex. 60% mask vs. 28% NC
-
Liters vs. FiO2
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
21
Q
Sx Procedures:
what should you note?
A
- Procedure/Sx
- Surgical approach/precautions
- Complications during sx OR post-op comps?
22
Q
Looking @ rehab:
A
OT
Speech
Rec tx
PM&R consults
23
Q
When should we be checking Vital Signs??
A
on admission
over past 24hrs
most CURRENT
24
Q
Vital signs:
on admission
over past 24hrs
most current
A
- EKG monitoring
- BP
- RR
- HR
25
Nutritional Intake:
* PO; per os; **By mouth**
* **Enteral**
* ****entering stomach or GI tract
* **Parenteral**
* **IV**
* **bypassing eating/digestion**
26
PLOF:
* bed bound
* req'd 24 hrs assist/supervision/fall risk
* equip pt already owns
* employment
27
Interview pt and family...... completed when??
AFTER thorough **Chart Review**
* **effective communication**
* **fill in any gaps**
* **consider CP status**
28
Systems Review:
what is it?
BRIEF exam of ALL SYSTEMS that would **affect pts performance**
29
Systems review:
**Cognition**
**Affect**
* **Cognition:**
* ****lang, attn, learning style
* **Affect:**
* ****behavior
30
Systems review:
## Footnote
**CV/Pulm**
Edema
BP monitor
31
Systems review:
## Footnote
**MSK System**
* GROSS sym of mm's
* appeared gen ht, wt,
* strength/ROM
32
Systems review:
## Footnote
**NMSK System**
motor control
tone
balance
vis. tracking
33
Systems Review:
## Footnote
**Integumentary**
skin
wounds/skin check
texture
34
EXAMINATION of Pt
## Footnote
**gen appearance**
LOOK @ pt
35
EXAMINATION:
## Footnote
**Lvl of Consciousness**
Richmond Agitation-Sedation Scale
ADD PICS SEE LECTURE
36
EXAMINATION:
## Footnote
**Lvl of Confusion**
use CAM-ICU Scale OR
look for **Delirium (NO attn to tasks)**
**ADD PICS**
37
EXAM:
## Footnote
**Body Type:**
obese
normal
**Cachectic (med. too thin)**
38
EXAM:
## Footnote
**Posture**
* 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**
39
EXAM:
## Footnote
**Skin Tone**
**\*look @ lips\***
* Cyanosis
* **partial press and 02 sat DEC'd**
* **Dusky**
* **gray**
* **Pale**
* **less pink flush**
40
EXAM:
**Facial signs of distress**
Nasal flaring
41
EXAM:
## Footnote
**Neck**
**Jugular veins**
* **JVD**
* ** look @ jugulars**
* **TOO MUCH CVP in vein**
* **heart failure**
* **something is backing up**
42
EXAM:
## Footnote
**NECK**
**SCM**
* Hypertrophic
* **== overuse of SCM as an Accessory mm**
43
EXAM:
**Chest/Breathing**
* 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
44
EXAM:
## Footnote
**Rib Angles**
* \<90deg
* \>90deg
45
EXAM:
Musculature
**MM's of Inspiration**
Diaphragm + Ext. Intercostals
* Exhale should be **passive**
* **Look for if there is EXCESSIVE use of SCM when INHALING \*\*\*\*\***
46
EXAM:
Musculature
**Accessory mm's of INSPIRATION**
* SCM
* Scalenes
* Upper traps
* Pec major/minor
* Serratus Ant.
* Rhomboids
* Lat Dorsi
* Thoracic extensor spinae mm's
47
EXAM:
Musculature
**MM's of EXPIRATION**
Abdominals + Internal Intercostals
48
EXAM:
## Footnote
**Inspiration to Expiration ratio**
**NORMAL**
1: 2
insp: exp
49
EXAM:
## Footnote
**Insp to Exp**
**ABNORMAL**
* Pursed lip breathing
* **prolooooonged expiration**
* **TOO MUCH AIR/Obstruction**
* **indicates Patho condition**
50
EXAM:
breathing RATE
**APNEA**
NO BREATHING
51
EXAM:
Breathing RATE
**Eupnea**
ideal breathing
12-20bpm
52
EXAM:
Rate
**Bradypnea**
\<12 bpm
53
EXAM:
RATE
**Tachypnea**
\>20 bpm
54
EXAM:
DEPTH
**Hyperpnea**
INC depth
NORM rate
55
EXAM:
DEPTH
**Dyspnea**
INC depth
INC rate
56
EXAM:
**Positional breathing**
**ORTHOPNEA**
* diff breathing in **supine pos. vs standing**
* **dx w/ CHF**
* **pillow test**
57
EXAM:
## Footnote
**Severe breathing probs:**
**Paradoxical Breathing**
* OPP of normal (see below)
* **greater abd pressure OR collapsed lung**
* **Inhale:** abd/thorax DEC in size
* **Exhale:** thorax INC size
58
EXAM:
## Footnote
**Severe breathing probs:**
**Kussmaul Breathing**
* indicates **metabolic acidosis**
* **pH = acidic** due to **DEC in bicarb**
* **Dyspnea**
59
EXAM:
## Footnote
**Severe Breathing probs:**
**Cheyne-Stokes**
* Terminal breathing pattern:
* Sm VT, Lg VT, Sm VT
* **Apnea**
60
EXAM:
**Severe Breathing probs:**
**Biot's**
* Neuro issue
* **dyspnea, apnea, dyspnea**
* **Hospice breathing**
61
EXAM:
## Footnote
**Dyspnea**
* @ rest
* W/ Exertion
* **One Word Dyspnea**
* ****only say one word and then **need to take another breath**
* **Stevie!!!**
62
EXAM:
**Coughing**
**Effectiveness vs. Ineffectiveness**
* **Effectiveness:**
* ****ability to FORCEFULLY **exhale & dislodge obstruction** if there is one
* **Ineffectiveness:**
* ****cannot contract **abd's to forcefully EXHALE**
63
EXAM:
**Cough**
**Productive vs. NONproductive**
* **Is there any sputum to get up AND did they get it up?**
64
EXAM:
## Footnote
**Cough**
**Mucoid**
* flu like
* short lived
* clear, transparent, colored
* **NOT OPAQUE**
65
EXAM:
**Purulent**
* Flu like
* becomes **chronic**
* **MORE OPAQUE**
* **THICKER**
66
EXAM:
## Footnote
**COUGH**
**Fetid**
odor
copious
67
EXAM:
Cough
**Frothy**
* **Assoc'd w/ ORTHOPNEA**
* Cough up **interstitial fluid OR liquid**
68
EXAM:
Cough
**Hemoptysis**
* blood
* some type of injury in **pulmonary lining**
69
EXAM:
Cough
**Violent cough/Aspiration**
* when **fluid goes IN lungs** instead of **esophagus**
70
EXAM:
**Extremities**
**Digital clubbing**
**fingers!!!**
* see pics in ppt
* **indicative of Chronic Pulm disease**
* ****not enough O2 to supply **making of fingernails**
* **turned in and down**
71
Exam:
## Footnote
**Arterial Disease**
**Looking for PAD**
* pain
* claudication
* pulses---NONE
* trophic changes
* wounds----no fluid
72
EXAM:
## Footnote
**Venous insufficiencies (CVI)**
**"Valvular Incompetence**
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
EXAM:
## Footnote
**Auscultation of Lungs**
**LISTEN to pts lungs**
* PRE and POST session
* bare skin
* **Monitor pt t/o to prevent falls and prevent hypervent and dizziness (subjective)**
74
Auscultation Sounds
## Footnote
**NORMAL**
**Bronchial/Tracheal**
* listen @ bifurcation of bronchi OR trachea
* **equal insp/exp**
* **tubular mvmt air**
* **loud**
* **high pitched**
75
Auscultation sounds
**NORMAL**
**Bronchovesicular**
* ANT segment of UPPER lobe
* NO PAUSE
* breathe t/o whole time
* 1/2 ICS ANT, T3/T4 POST
76
Auscultation sounds
## Footnote
**NORMAL**
**VESICULAR**
* periphery of lungs
* ANT/POST basal lobes
* Insp looooonger vs. EXP (1:3)
* low pitch swish
77
Auscultation:
## Footnote
**ABNORMAL**
* INCd
* sputum
* Diminshed
* **truncal adipose tissue**
* **emphysema**
* **COPD**
* **Absent**
78
Adventitous Lung Sounds:
## Footnote
**Wheezing (Rhonchi)**
* cont. high pitched sounds
* **bronchial spasm**
* **heard in ONE phase**
* **asthma**
79
Adventitious Lung sounds:
## Footnote
**Crackles (Rales)**
* light, airy, crack and pop (rice krispies)
* **airways opening and closing, secretions**
* **mvmt of secretions**
* **open/close peripheral airways**
* **COPD,**
80
Adventitious Lung sounds:
**Pleural Rub**
**sandpaper**
* involves pleural space
* sandpaper
* **indicates:**
* **pleural inflamm.**
81
Adventitious Lung sounds:
## Footnote
**Stridor**
**choking!!!**
**fart you can't hold in**
* **deals w/ Trachea**
* **monophasic**
* **long, squeaky**
82
EXAM:
Voice Sounds
* If (+) test---\> **ALL indicate consolidation**
* **feel vibration OR altered noise**
* ****egophony
* bronchophony
* whispering pectoriloquy
83
Auscultations of Heart Sounds
remember....
APT-M 2245
84
Auscultation of Heart Sounds
* **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
Normal Heart Sounds
* **S1: Lub**
* ****onset of **systole, AV valves**
* **S2: Dub**
* ****onset of **diastole: SL valves**
86
Abnormal Heart Sounds
## Footnote
**indicative of....**
TOO much fluid in heart OR
heart TOO rigid w/ fluid flowing thru
87
Abnormal Heart Sounds:
**S3**
**LUB DUB DUB**
**aka**
* **Ventricular Gallop**
88
S3 Lub dub dub
BEST heard where?
over Apex of heart w/ BELL of stethoscope
89
S3 lub dub dub
heard WHEN?
IMMED. following S2 **in early Diastole**
90
S3 lub dub dub
what is it?
rapid flow of blood into a **distended ventricle or stiff ventricle**
## Footnote
**Dx: CHF or cardiomyopathy**
91
S3 Lub dub dub
more commonly heard in what?
More common heard in **supine or left side-lying pos.**
**LESS LIKELY heard @ rest in sitting (bc gravity)**
92
S3 lub dub dub in children...
CAN BE NORMAL in healthy children/young adults due to **quick decel. of blood in ventricles**
93
S4 La-Lub-Dub aka
**Atrial Gallop**
94
S4
La-lub-dub
BEST heard where
over APEX of heart w/ BELL of stethoscope
95
Diaphgram ==
high pressure sounds
96
Bell==
LOW pressure sounds
97
S4 La-lub-dub
heard when?
**Late in Diastole during ATRIAL KICK**
**just BEFORE S1**
98
S4 SOUND La lub dub
what is it?
blood entering **stiff ventricle** in presence of a **pressure overload**
* DX:
* **Myocardial scarring**
* **MI**
* **CAD**
* **CABG**
* **hypertrophied LV due to HTN**
99
Palpation:
## Footnote
**mediastinum/tracheal pos. assessed Sitting UP then...**
Shift:
**TOWARDS** **involved side**
**AWAY from involved side**
100
Palpation:
Chest motion
* 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
Palpation:
## Footnote
**Fremitus**
**feeling for vibration**
* Normal
* INC'd
* consolidation or sputum
* DECd
102
Palpation:
**Percussion:**
**final comp. of chest exam**
* 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
Palpation:
Percussion:
final comp. of chest exam
**Normal vs. Dull vs. Tympanic**
* Normal
* Dull
* "Thud"
* **liver and other dense tissues**
* **Tympanic**
* ****long and hollow
* hear over **empty stomach, inflated chest**
104
EXAM:
## Footnote
**Activity Eval**
* 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
EXAM:
## Footnote
**Vitals**
**Heart rate**
* 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
VITALS:
**Blood Pressure**
* **Diff in extremities===**
* ****some **occlusion** in **one extremity**
* **w/ Exertion**
* **should INC**
* **AFTER exertion**
* **should slowly DEC**
107
VITALS
**O2 Sats**
stay ABOVE 88%
\***exercises should NOT be cont'd if O2sats drops TO or BELOW 88%**
108
Vitals:
## Footnote
**RR**
Normal== 12-20 bpm
109
Vitals:
USE BORG SCALE
* 10
* MAX effort
* 9
* VERY hard
* 7-8
* Vigorous
* 4-6
* Moderate
* 2-3
* Light
* 1
* VERY Light
110
EXAM:
CV/Pulm **special tests**
* 2 min walk
* 6 min walk
* 5x sit to stand
* 10m gait speed
* 30s sit to stand
* YMCA step
* Astrand-Rhyming Protocol
BALANCE!!!
111
Assess/Dx
PT develops a dx which is a **PT Dx**
## Footnote
**NOT medical Dx**
**\*\*\*\*\*\*\***
**THEN DO TX/POC!!!!!!!**
112
