Weekend 2 lecture 1 Flashcards Preview

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Flashcards in Weekend 2 lecture 1 Deck (23)
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1
Q

things to remember in a chart review

A
Hospital course
Chief complaint
Procedures during this hospitalization
Results from any special tests
Labs
2
Q

What to gather from patient interview

A
Cardiac risk factors
PMH/PSH:  for all body systems
Level of Mentation
Recognize early signs of hypoperfusion
Anginal equivalent
Specify any recurrent pain patterns
Baseline level of dyspnea
Use of 15 second count or borg scale of perceived dyspnea
3
Q

Borg Scale of Perceived Dyspnea

its a scale on 1-10 tell marks at 2, 5. 7, 10

A
No shortness of breath
.5	Slight SOB
1
2	Mild SOB
3	Moderate SOB
4
5 	Strong or hard breathing
6
7 	Severe SOB
8
9
10 	SOB so severe you need to stop and rest
4
Q

Evaluation of venous pressure

what veins to check

A

Jugular venous distention of the external jugular vein
Jugular venous distention of the internal jugular vein
Estimation of central venous pressure
Examination of veins in the dorsum of the hand

5
Q

What things do we observe very generally think like ROM, Edema etc.

A
Edema
Skin
Respiration
EKG
Urine output
6
Q

What is Pluse alternans

what are some factors that influence the arterial pluse

A

Several factors influence the arterial pulse: stroke volume, ejection velocity and systemic vascular resistance
Note pulse rate and rhythm
Compare HR counted at the apex and the peripheral pulse rate
Pulsus alternans: a regular alternation in the force of beats, so that a weak pulse regularly follows a strong pulse. The alternating pulse volume is produced when the stroke volume increase and then decreases from beat to beat.

7
Q

Whats a minmal pressure for the radial artery and or femoral or cartoid artery

Whats Pulsus parodoxus

A

Pulsus parodoxus: an exaggerated decrease in pulse volume during inspiration and increase in pulse volume during exhalation.
Typically if a pulse can be felt in the following areas there is a minimal systolic pressure as noted:
Radial artery 80mm Hg
Femoral artery 70mm Hg
Carotid artery 60mm Hg

8
Q

where is the point of maximal heart sound and what is it a good indicator of?

A

Chest wall excursion
Point of maximal impulse: the point where the cardiac impulse on the chest wall is felt the strongest
Apex beat or apical impulse: the most lateral and inferior point at which an examiner can see or feel the cardiac impulse
Good indicator of heart size
Thrills: palpable murmurs

9
Q

What are bruits:

A

Bruits: arise from turbulence in the arteries at their branching points or in areas where a blood vessel is narrowed
Supraclavicular arterial bruit: a low to medium pitched short, systolic crescendo-decrescendo murmur which is unaffected by respirations

10
Q

Describe the S1 sound

A

The first heart sound
Marks mitral (M1) and tricuspid (T1) closure. It is heard loudest at the mitral area. This sound defines the onset of sytole
How can I recognize the first heart sound when the heart rate is fast?
Palpate the carotid artery. S1 precedes the palpable arterial upstroke, whereas S2 immediately follows this pulse
Also, the apical impulse is coincidental with the onset of S2, whereas S2 follows the apical lift

11
Q

Describe the S2 sound

A

S2: The second heart sound
The second heart sound signals the end of ventricular systole. It is comprised of two components A2 and P2 which relate to aortic and pulmonic valve closure
Physiological splitting of S2
During expiration, A2 and P2 are heard as one because the interval between them is small. During quiet respiration, at the height of inspiration, the splitting of the two sounds is evident

12
Q

Describe the S3 sound

A

S3: ventricular gallop may originate from one or both ventricles
Related to a sudden deceleration of early diastolic ventricular inflow caused bya sudden limitation of expansion along the longitudinal axis of the ventricular wall
Right ventricular S3 becomes louder during inspiation due to the increased venous return to the right ventricle a a larger stroke volume
Left ventricular S3 remains unchanged or decreases in loudness during inspiration

13
Q

Describe the atrial gallop whatever the fuck that is aka

A

S4: atrial gallop, caused by vibrations created in the ventricles as they expand in the second phase of rapid diastolic filling when the atria contract. The S4 occurs after atrial contraction and before the S1.
A left-sided S4 is louder on expiration
A right-sided S4 is louder on inhalation

14
Q

Describe a summation gallop and a pericardial friction rub

A

Summation Gallop: occurs when the S3 and S4 sounds fuse. It is heard when heart the heart rate is >120, due to the fact that diastole shortens and results in the S3 and S4 being superimposed.
Pericardial Friction Rub: heard in patients with inflammation of the pericardial membrane or the pleural sac. This sounds like sandpaper being used, a match being struck, or leather squeaking.
Best auscultated over the third or fourth ICS at the left sternal border

15
Q

reasons for murmurs

A

Result from turbulent blood flow, which produces a series of vibrations in cardiac structures
Four main factors in the production of murmurs
High rates of flow through normal or abnormal valves

Backward flow through an incompetent valve, septal defect, or patent ducturs arteriosus
Decreased viscosity, which cauForward flow through a constricted or irregular valve, or into a thin or dialated vesselses increased turbulence and contributes to the production and intensity of murmurs

16
Q

ways to describe systolic and diastolic blood flow.

A
Systolic
Early 
Mid
Late
Holosystolic
Diastolic
Early
Mid
Late
Continuous
17
Q

Grading intensity of murmur

A

I: audible only with concentration
II: faint, but heard immediately
III: not loud, but somwhat louder than grade II
IV: loud, but still of intermediate intensity. Associated with a palpable thrill
V: very loud, and heard with only one edge of the stethoscope against the chest wall. Palpable thrill.
VI: so loud that it can be heard with the stethoscope off the chest wall. A palpable thrill is present.

18
Q

importance of cuff size

and alternative sites for measuring blood pressure

A
Importance of proper cuff size
Cuff too largefalse low reading
Cuff too smallfalse high reading
Alternative sites for measuring BP
Radial artery
Popliteal artery
Posterior tibial artery
19
Q

What is the Functional Independence Measure used to evaluate on a person what simple couple of things

A
Use of FIM tool
Bed mobility
Transfers
Ambulation/Gait
Stairs
20
Q

Different type of exercise tests

A
Dangling
Seated Exercise
Standing Exercise
Submaximal ETT
6 MWT
Shuttle walk test
Maximal ETT
Various modalities
21
Q

What is the key to asculutation and what method is used to measure the heart sounds

What is important to do when looking at the lungs

A

The key to auscultation is to be systematic!
Lungs: all fields of the lungs should be auscultated both anteriorly and posteriorly in a side to side manner.
Heart: use the inching method. You may begin at the apex and move up the sternal border to the aortic area or vice versa

22
Q

Where to palpate for the Aortic valve Pulmonary valve Tricuspid and the mitral valve

A

Arotric Arch - rigth 2nd intercostal space

Pulmonary - left 2nd intercostal space

Tricuspid- left 4th intercostal space or possibly in some people its rigth.

Mitral 5th intercostal space left mid clavicular line

23
Q

Blood Pressure

When measuring BP on a pregnant women what sounds do you want to use

what about when exercising

What when resting

A

Korokoff Sounds
At rest it is customary to use the first and the fifth korokoff sounds in adults
For pregnant women and children, one should use the first and the fourth korokoff sounds for resting BP
In exercise, it is proper to record the first, the fourth and the fifth korokoff sounds.
The other alternative for exercise is to use the first and the fourth korokoff sounds, just be sure to document this.