Assessment Flashcards
Components of a cardioresp assessment
- History: risk factors, acuity and progression, PMHX
- Symptoms
- Physical exam
- Dx tests
What are 6 common cardioresp symptoms
- Dyspnea
- Cough (productive vs nonproductive, hemoptysis)
- wheeze: inspiratory, expiratory, low or high pitched
- cyanosis: blue or purple in skin that has mucous membranes (nail beds, lips)
- finger and toe clubbing: seen in conditions like COPD and CF due to chronic hypoxia
- Decreased oxygen saturation: below 90% O2 you may need some supplementary O2
What is included in a physical exam
Inspection
Palpation
Percussion
Auscultation
What are 11 Diagnostic tests
a) flow volume loop
b) simple spirometry
c) plethysmography: just provides more details
d) diffusing capacity
e) respiratory muscle strength
f) methacholine and other challenge tests
g) chest x ray
h) VQ scan
i) bronchoscopy
j) blood tests and ABG’s
k) exercise testing
Contraindications to a flow volume loop
Any condition prohibiting a max maneuver
What does a simple spirometry test provide
FEV1 and FVC
Contraindications to simple spirometry tests
- MI in last month,
- recent stroke/abdominal/thoracic surgery
- uncontrolled HTN
- recent pneumothorax
Indications for a simple spirometry test
Dx lung disease
quantify extent of known disease
measure effect of occupational/environmental exposure
Ax for risk of respiratory complications during surgery, evaluate disability or impairment
What are the findings of a simple spirometry test if there is an obstructive pattern
Increased lung volumes
Decreased FVC
Very Decreased FEV1
Decreased ratio
What are the findings of a simple spirometry test if there is an restrictive pattern
Decreased lung volumes
Decreased FVC
Decreased FEV1
Ratio is normal or even increased
What do a diffusing capacity test provide the diagnosis of
Emphysema
What are methacholine and other challenge tests used to diagnos
Asthma and other occupational asthma
What is a VQ scan used to diagnose
Used for perfusion disorders (pulmonary embolism
What surface landmarks indicate the start and finish of the trachea
Cricoid cartilage to T4 spinous process
What is the clinical difference between the left and right bronchi
R bronchi is more steeply angled and gets more things caught in it
The sternal angle landmarks which structure of the trachea
Carina of trachea
What are the surface landmarks of the diaphragm
T8
What muscles are responsible for quiet inspiration
Diaphragm and external intercoastal
What muscles do forced inspiration
SCM
Scalene
Pec minor
What structures do quiet expiration
Passive recoil of lung tissue
What muscles do forced expiration
internal intercostals and abs
What are key things to look for in inspection
- lines, monitors (HR, RR, SPO2, BP)
- position of patient
- head: facial expression, orientation to place, person, and time x3, speech, skin (colour, sweat, temp), lips, nose (flaring),
- neck (accessory muscle use, jugular vein distension),
- chest (deformity, shape, muscle wasting), breathing type (apical, diaphragmatic, accessory muscle use), chest movement,
- limbs (colour, clubbing, edema)
- cough (weak vs strong, productive vs nonproductive)
- sputum (colour, smell, amount, and texture)
What is included in palpation
- Chest wall expansion
- Tactile femitus
- Tracheal position
- Rates: HR, BP, RR
Procedure for looking at chest wall expansion
upper, middle, lower x2 (front and back), take deep breaths
Procedure for tactile fremitus
use ulnar border of hands, feel for vibration
How long do you measure HR for
15seconds
How long do you measure RR for?
30-60seconds
Procedure for percussions
middle finger over intercostals space with non-dominant hand, ax right vs left anterior to posterior upper, middle, and lower lobes
Possible percussion findings
1) resonant (normal)
2) dull = consolidation, pleural fluid
3) hyper-resonant = air
The diaphragm of the stethoscope picks up _____ best
The bell picks up ___ best
High pitch
Low pitch
Procedure for auscultation
- EXPOSE THE SKIN!!
- instruct patient to take a deep inspiration/expiration, rest between breaths as needed
- gold standard lobe points: 11 in front, 14 in the back
WHat are the auscultation points
Review photo
What are normal breath sounds
- Vesicular
- Bronchial – hollow, short pause between inspiration and expiration, normal over trachea (air travelling through larger airways)
What are abnormal breath sounds and what do they generally indicate
- Bronchial – consolidated pneumonia, lobar collapse
- Decreased or absent – over pleural effusion, hemothorax, pneumothorax, emphysema, contused lung, obese, elderly
What are adventitious breath sounds
- Crackles
- Wheezes
- Stridor
- pleural rub
What do inspiratory crackles indicate
Airway obstruction
What do expiratory crackles indicate
Edema
Fibrosis
Partial consolidation
What are different types of wheezes
inspiratory vs expiratory, high (uniformly narrowed) or low pitch (intermittently narrowed)
What does a stridor sound like? what does it indicate?
loud musical constant pitch with laryngeal or tracheal obstruction
What does pleural rub sound like? what does it indicate?
creaky, leathery sound due to pleural irritation
