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Cardiopulm > cardiac evaluation > Flashcards

cardiac evaluation Flashcards

1
Q

Med record/chart review

A
  • extract pertinent info to develop database on pt

- helps drive physical assessment

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2
Q

anginal equivalents

A

signs/symptoms that can indicate cardiac ischemia that aren’t traditional signs

Ex: fear of impending doom

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3
Q

T/F: anginal equivalents are more common in males than females

A

False

more common in females

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4
Q

Data Acquisition:

Med list

A

what meds and why?

  • in the outpatient setting patients should always be asked to bring list of OTC meds and herbal supplements or the actual containers
  • review for duplicates
  • consider AE
  • are drugs working
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5
Q

On an XR what strucures are lighter in color

A

The denser the material, the lighter it appears

air will be black

muscle, fat, and fluid will apear in shades of gray

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6
Q

Data Acquisition:

O2 recruitment

A
  • does pt use supplemental O2
  • can PT change flow rate?
  • does order for O2 prescribe the flow rate?
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7
Q

When should a patient be considered for supplemental O2?

A
  • resting PO2 < 60mmHG on room air or O2 % sat < 90%
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8
Q

When would a patient possibly require supplemental O2 w/exercise?

A

low PO2 but not below 60mmHg on room air or low PO2 on oxygen

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9
Q

T/F: minimally invasive surgery is dependent on which valve needs replacing and doesn’t requires sternal precautions

A

True

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10
Q

What to keep in mind regarding surgical complications

A

did they occur during the procedure or immediately afterwards?

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11
Q

Normal PaO2 on room air

A

80-100 mmHg

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12
Q

mildly hypoxemic PaO2

A

60-80 mmHg

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13
Q

moderately hypoxemic

A

40-60 mmHg

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14
Q

Severely hypoxemic

A

<40 mmHg

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15
Q

What to look for with a pacemaker range

A
  • note the low and high values
  • If high value is reached, will shock (defibrillation) to reset heart
  • stop PT if getting too close to high range.
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16
Q

why does a defibrillator reset the heart when the high pacemaker value is reached?

A

prevent VFIB

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17
Q

what to keep in mind when reviewing vital signs

A
  • how have they changed?

- assess if not recent and/or if needed

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18
Q

what to keep in mind when reviewing the hospital course of a patient

A
  • what has been the patient’s clinical course since admission?
  • complications increase risk for serious complications or death
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19
Q

physical exam:

general appearance

A
  • body posture and position that may affect respiration

- skin tone may indicate general O2 level and peripheral perfusion

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20
Q

semi fowler position

A

decreases overload of fluid in systme

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21
Q

professorial position

A

stabilizes upper ribs to allow full lung expansion

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22
Q

where is cyanosis most noticable?

A

at lips and fingernail beds

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23
Q

central cyanosis

A

caused by diseases of the heart or lungs, or abnormal hemoglobin

discoloration is systemic

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24
Q

peripheral cyanosis

A

caused by decreased local circulation and increased extraction of O2 in peripheral tissues

discoloration regional

25
Q

facial expressions of distress, comfort, fatigue

A
  • nasal flaring
  • sweating
  • paleness
  • focused
  • enlarged pupils
26
Q

what to look for with effort of breathing

A
  • how much work is patient putting into breathing
  • how involved are accessory respiratory muscles?
  • movement of the lips
27
Q

pursed lip breathing

A
  • increases positive pressure in lungs to let stale air escape easier
  • this changes the pressure gradient
  • educate patient while hooked to pulse ox for quick results you can show them
28
Q

T/F: SCM muscles often hypertrophied in COPD cases

A

True

29
Q

JVD

A

high blood pressure backflows from the vena cava into the jugular vein

30
Q

Heart Sounds:

S1

A
  • “lub”
  • associated w/closure of mitral and tricuspid valves
  • onset of ventricular systole
31
Q

Heart Sounds:

S2

A
  • “dub”
  • associated w/closure of aortic and pulm valves
  • start of ventricular diastole
32
Q

Heart Sounds:

S3

A
  • 2nd dub
  • occurs early in diastole while ventricle is rapidly filling
  • often called ventricular gallop
  • CHF/fluid overload. fluid rushes in to hit ventricle wall
33
Q

T/F: S3 is considered normal when heard in a healthy child or young adult

A

True

34
Q

When s3 is auscultated in older, physically inactive person or in presence of heart disease:

A

indicates loss of ventricular compliance

35
Q

Heart Sounds:

S4

A
  • occurs late in diastole, just before S1
  • atrial gallop
  • associated w/increased resistance to ventricular filling
  • stiffness/hypertrophy during filling. Atria trying harder to push blood out against resistance
36
Q

Where all should you assess patient’s CV response

A
  1. rest
  2. sitting
  3. standing
  4. ADLs
  5. ambulation
37
Q

When assessing CV response, what all should you assess?

A
  1. HR
  2. BP
  3. Symotoms
  4. Heart rhythm (if possible)
  5. O2 saturations

evaluation is terminated if/when abnormal response is ID’d

38
Q

Abnormalities in response to functional/physiological demand

A
  1. rapid rise in HR w/workload
  2. very flat rate of rise
  3. decrease in HR
  4. SP > 250 mmHg
  5. change in DP > 10 mmHg
  6. change in O2 saturation
39
Q

O2 Desaturation

A
  • falls below 90%
40
Q

What exercises can help with desaturated patients?

A

LE exercises which utilize muscle pumps. Less taxing to CV system

41
Q

Rubor Dependency (+) results

A

deep red color after 30 seconds returning leg to dependent position

(also potentially if chalky when raised and then color doesn’t return or returns slowly in dependent position)

42
Q

ABI

> 0.9

A

normal

43
Q

ABI

0.5-1

A

claudication

pain in calf w/ambulation

44
Q

ABI

0.2-0.5

A

critical limb ischemia

  • atrophic changes
  • p! at rest
  • wounds
45
Q

ABI

< 0.2

A

severe ischemia

- gangrene/severe necrosis

46
Q

T/F: HR rises sharply in the 1st minute post exercise

A

False

HR drops sharply in 1st min post exercise. should recover by around 20 bpm after

47
Q

Pulse Ox considerations

A
  • peripheral circulation status
  • irregular HR
  • mishandling of equipment
48
Q

6 minute walk test

A

measures distance pt can quickly walk on flat, hard surface in 6 minutes

49
Q

6MWT procedure

A
  1. rest quietly for 10 min and collect resting physiologic measures
  2. walk
  3. stop
  4. recovery

take physiologic measures for each step

50
Q

Borg RPE scale:

very, very light

A

7

51
Q

Borg RPE scale:

very light

A

9

52
Q

Borg RPE scale:

fairly light

A

11

53
Q

Borg RPE scale:

somewhat hard

A

13

54
Q

Borg RPE scale:

hard

A

15

55
Q

Borg RPE scale:

very hard

A

17

56
Q

Borg RPE scale:

very, very hard

A

19

57
Q

Borg RPE scale:

Max exertion

A

20

Don’t work this hard!

58
Q

Physiological measurements pre/post 6MWT

A
  1. BP
  2. HR
  3. RR
59
Q

Physiological measurements during/post 6MWT

A
  1. RPE
  2. Rate of breathlessness
  3. Arterial O2 saturation

Cardiopulm (20 decks)

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