cardiac evaluation Flashcards
Med record/chart review
- extract pertinent info to develop database on pt
- helps drive physical assessment
anginal equivalents
signs/symptoms that can indicate cardiac ischemia that aren’t traditional signs
Ex: fear of impending doom
T/F: anginal equivalents are more common in males than females
False
more common in females
Data Acquisition:
Med list
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
On an XR what strucures are lighter in color
The denser the material, the lighter it appears
air will be black
muscle, fat, and fluid will apear in shades of gray
Data Acquisition:
O2 recruitment
- does pt use supplemental O2
- can PT change flow rate?
- does order for O2 prescribe the flow rate?
When should a patient be considered for supplemental O2?
- resting PO2 < 60mmHG on room air or O2 % sat < 90%
When would a patient possibly require supplemental O2 w/exercise?
low PO2 but not below 60mmHg on room air or low PO2 on oxygen
T/F: minimally invasive surgery is dependent on which valve needs replacing and doesn’t requires sternal precautions
True
What to keep in mind regarding surgical complications
did they occur during the procedure or immediately afterwards?
Normal PaO2 on room air
80-100 mmHg
mildly hypoxemic PaO2
60-80 mmHg
moderately hypoxemic
40-60 mmHg
Severely hypoxemic
<40 mmHg
What to look for with a pacemaker range
- 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.
why does a defibrillator reset the heart when the high pacemaker value is reached?
prevent VFIB
what to keep in mind when reviewing vital signs
- how have they changed?
- assess if not recent and/or if needed
what to keep in mind when reviewing the hospital course of a patient
- what has been the patient’s clinical course since admission?
- complications increase risk for serious complications or death
physical exam:
general appearance
- body posture and position that may affect respiration
- skin tone may indicate general O2 level and peripheral perfusion
semi fowler position
decreases overload of fluid in system
position is 30 deg elevation of head of bed
professorial position
stabilizes upper ribs to allow full lung expansion
where is cyanosis most noticable?
at lips and fingernail beds
central cyanosis
caused by diseases of the heart or lungs, or abnormal hemoglobin
discoloration is systemic
peripheral cyanosis
caused by decreased local circulation and increased extraction of O2 in peripheral tissues
discoloration regional
facial expressions of distress, comfort, fatigue
- nasal flaring
- sweating
- paleness
- focused
- enlarged pupils
what to look for with effort of breathing
- how much work is patient putting into breathing
- how involved are accessory respiratory muscles?
- movement of the lips
pursed lip breathing
- 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
T/F: SCM muscles often hypertrophied in COPD cases
True
JVD
high blood pressure backflows from the vena cava into the jugular vein
Heart Sounds:
S1
- “lub”
- associated w/closure of mitral and tricuspid valves
- onset of ventricular systole
Heart Sounds:
S2
- “dub”
- associated w/closure of aortic and pulm valves
- start of ventricular diastole
Heart Sounds:
S3
- 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
T/F: S3 is considered normal when heard in a healthy child or young adult
True
When s3 is auscultated in older, physically inactive person or in presence of heart disease:
indicates loss of ventricular compliance
Heart Sounds:
S4
- 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
Where all should you assess patient’s CV response
- rest
- sitting
- standing
- ADLs
- ambulation
When assessing CV response, what all should you assess?
- HR
- BP
- Symptoms
- Heart rhythm (if possible)
- O2 saturations
evaluation is terminated if/when abnormal response is ID’d
Abnormalities in response to functional/physiological demand
- rapid rise in HR w/workload
- very flat rate of rise
- decrease in HR
- SP > 250 mmHg
- change in DP > 10 mmHg
- change in O2 saturation
O2 Desaturation
- falls below 90%
What exercises can help with desaturated patients?
LE exercises which utilize muscle pumps. Less taxing to CV system
Rubor Dependency (+) results
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)
ABI
> 0.9
normal
ABI
0.5-1
claudication
pain in calf w/ambulation
ABI
0.2-0.5
critical limb ischemia
- atrophic changes
- p! at rest
- wounds
ABI
< 0.2
severe ischemia
- gangrene/severe necrosis
T/F: HR rises sharply in the 1st minute post exercise
False
HR drops sharply in 1st min post exercise. should recover by around 20 bpm after
Pulse Ox considerations
- peripheral circulation status
- irregular HR
- mishandling of equipment
6 minute walk test
measures distance pt can quickly walk on flat, hard surface in 6 minutes
6MWT procedure
- rest quietly for 10 min and collect resting physiologic measures
- walk
- stop
- recovery
take physiologic measures for each step
Borg RPE scale:
very, very light
7
Borg RPE scale:
very light
9
Borg RPE scale:
fairly light
11
Borg RPE scale:
somewhat hard
13
Borg RPE scale:
hard
15
Borg RPE scale:
very hard
17
Borg RPE scale:
very, very hard
19
Borg RPE scale:
Max exertion
20
Don’t work this hard!
Physiological measurements pre/post 6MWT
- BP
- HR
- RR
Physiological measurements during/post 6MWT
- RPE
- Rate of breathlessness
- Arterial O2 saturation
