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CP Assessment Flashcards

1
Q

Mointoring measurement of vital signs and clinical assessement are?

A

Essential skills

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2
Q

What is the Signs of the heart care?

A

1- Heart rate
2- Respiratory rate
3- Blood pressure
4- Temperature
5- Oxygen saturation

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3
Q

Assessment for heart care?

A

1-Observation
2-Palpation
3-Ausculation
4-percussion

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4
Q

H ow often should we check the vital signs?

A

at the time of the initial examination

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5
Q

Temperature

What is the factors effecting body temperature?

A

Infection
Disease
Exposure

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6
Q

Normal Range of Temperature?

A

36.5/37.5 C

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7
Q

Temperature sites? شلون اخذ الحرارة

A

1-Oral (best for adult/ 15min post smoking/ hot or cold
drink,food)
2- Axillary (Noninvasive/ good for children)
3-Rectal ( used when it unsafe/ inaccurate by the mouth)
4- Ear ( easy/ rapid)

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8
Q

Most common Temperature site?

A

Oral site

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9
Q

Sometimes false reding?

A

Ear sites

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10
Q

The 2 important factors influencing HR?

A

Stroke volume and compliance of arterial wall

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11
Q

H R: The rate at which the heart beats, or contracts. Any contraction (even if it doesn’t result in appreciable blood flow through the arteries) is part of heart rate.

A

Yes

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12
Q

HR is expressed in ………..and regulated by ……….

A

beat per min , AUtonomic nervous system

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13
Q

Best Measures for HR by?

A

Ausculating the cardiac apex

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14
Q

Cardiac apex? وين موجود

A

5th intercostal space

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15
Q

What we are looking when we check HR?

A

Rate
Rhythm
Strength

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16
Q

What is the Max. HR during exercise?

A

220 bpm

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17
Q

HR is measured for one minute (irregular rhythm)

A

15 second * 4
• 30 seconds * 2

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18
Q

Normal adult HR

A

60-100 bpm

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19
Q

Tachycardia
Bradycardia measurment?

A

Tachycardia > 100 bpm
Anexiety, fever, anemia, hepoxia, cardiac disoders
* Medication ( Bronchodilators)

Bradycardia < 60 bpm
Athlets
*Medication (beta blockers)

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20
Q

Perepheral puse?

A

is a pulse located in the periphery of the body (7 sites: radial,brachial, popliteal, posterior tibial, and dorsalis pedis arteries)

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21
Q

Apical pulse

A

(central pulse): it is located at the apex of the heart

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22
Q

Pulse volume?

A

It is the force of blood with each beat

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23
Q

Respiratory Rate

A

Num of breath per min

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24
Q

Normal ( eupnea) for adult

A

12-20 breath per min

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25
Eupnea Apnea
Eupnea ( normal breath) Apnea( absence of breathing)
26
Effort/ Depth
Volume of air during inhalation andexhalation
27
effort/ depth Normal Shallow SOB
Normal ( deep and symmetrical) Shallow ( decreased volume) SOB ( rapid breathing)
28
Biot's
Period of apnea then deep irregular breath
29
Hyperpnea
Deeper breath not necassarly fast
30
Kussmaul's
Deep fast breathing Diabetes , keto
31
Cheyne-stokes
Period of apnea ( head injury affecting CNS)
32
How do we measure RR?
Patient should be distracted
33
Vital signs: Blood pressure
is the force exerted by the blood against the walls of the arteries in which it is flowing
34
BP expered in terms of
Milimeters of mercury (mmHg)
35
Systolic pressure
is the maximum of the pressure against the wall of the vessel following ventricular contraction
36
Diastolic pressure
is the minimum pressure of the blood against the walls of the vessels following closure of aortic valve (ventricular relaxation)
37
BP .....?
120/80 120 ( systolic) 80 ( dystolic)
38
Factors effecting BP
1- Sleep 2- Blood loss 3- Positioning 4- Medications 5- Diseases
39
BP Hypertension/ Hypotention
Hyper > 145/95 mmHg Hypo < 90/60 mmHg
40
BP> 5 what we call it
Postural hypertention
41
Vital sign Oxygen Saturation
Quick, continuous, non-invasive , safe, Normal : 96-100% adult
42
Pulse Oximeters can be attached to?
your fingers, forehead, nose, foot, ears or toes
43
if your oxygen saturation reads 92% on the pulse oximeter, it may be actually anywhere
From 90 to 94% لا حسبتها اعلى من ٢٪؜ او اقل من ٢٪؜ نزيد وننقص
44
Inaccurate Readings for Oxygen pulse
.O2 <70% or <80% • Poor circulation • Motion artifact • Very dark skin • Hypothermia • Nail polish/artificial nails • Abnormal hemoglobin: e.g. carboxyhemoglobin
45
Vital signs CPA ( Cardiopulmonary Assessment) Physical Examination?
Inspection Precusion Palpation Ausculation
46
INSPECTION
General Appearance Facial Expression Neck Chest Phonation Cough-sputum Extremities
47
General Appearance
Observation ( it should be done in asystematic manner ( head---> extremities))
48
Observation
1- Level of consciousness( Alert/ orientd/ confused/ comatos 2- Body Type (Obese, normal, cachectic) 3-Body posture/positioning(Kyphosis, scoliosis, leaning forward, semi-fowler) 4-Skin tone(Oxygenation and perfusion eganosis) 5-Equipment(All equipment / appropriate use)
49
Fascial Expression
Nasal Flaring Sweating Paleness Pursed-lip Breathing-----> Indication of chronic obstructive lung disease (air trapping)
50
Neck
Muscles: Hypertrophy/shortening of sternocleidomastoid Veins: JVD Clavicle: Shortening of the SCM and more prominent clavicles could be due to leaning forward posture of the head and trunk
51
Shortening of the Sternocleidomastoid and more prominent clavicles could be due to:
Leaning forward posture of the head and trunk
52
Chest The normal rate differs for infants through adults?
12-20
53
I:E ratio
Normally----> 1:2 Abnormal--->1:4
54
Barrel chest? Chest walls is held in a state of hyperinflation
Obstructive lung disease
55
Congential chest defect
Pectus exavatum( funnel) sternum depressed into chest محفور للداخل Pectus carinatum ( pigeon) portrusiin of the sternum منفوخ
56
Phonation
Interruption of speech for a breath---> dyspnea of phonation. e.g. one-word dyspnea,two word phonation
57
Extremities Cyanosis
•Cardiopulmonary dysfunction •Decrease circulation due to: • Cold • Vasospasm • Peripheral vascular disease • Decreased cardiac output
58
Digital Clubbing
Chronic tissue hypoxia---> hypoxemia-producing diseases
59
Abnormal Lung Sounds
1-Wheeze ( during inspiration or expiration) 2-Pleural Rub( during inspiration and expiration) 3-Crackles( Common during inspiration) / restriction or obstruction, Early or late inspiration
60
Ausculation (Heart)
• Aortic area • Pulmonary area • Tricuspid area • Mitral Valve
61
Palpation
Palpation is an assessment technique employed to refine the information previously gathered from the chart review, inspection, and auscultation.
62
Palpation Evaluation of:
• Mediastinum • Chest motion • Chest wall pain • Fremitus • Muscle activity • Circulation
63
Mediastinum
• Tracheal shift • Shift to the right or left !! • Tracheal shift could be due to surgery or diseases
64
Chest motion
• Upper, middle, and lower lobes • Breathing quietly and deeply • Measuring: • Amount of movement of the hands • Symmetrical movement • Timing of the movement
65
Fremitus( Vibration)
Voice Secretion Saying the number ( 44 in Arabic) • Increased fremitus---> secretion • Decreased fremitu---> Air
66
Muscle Activity
• With inspiration the tips of the thumbs ---> 5cm apart (diaphragmatic excursion)
67
Palpation Circulation
• Blood flow (pulses) • Brachial artery • Radial artery • Carotid artery • Femoral artery • Popliteal artery • Posterior tibial artery • Dorsalis pedis artery
68
Loud and hallow over an empty stomach, hyper-inflated chest
(pneumothorax)
69
Normal Diaphram excursion
3-5 cm

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