Cardio Flashcards
Auscultation protocol (5)
- Expose area (obtain consent) offer draping/robe
- Slightly deeper breath than normal, open mouth
- Check in with pt every 3-4 breaths
- Points
- Interpretation
Auscultation- 6 anterior points (12 total)
Supraclavicular (UL)
2nd ICS parasternal (UL)
3rd ICS parasternal (middle lobe/lingula)
4th ICS parasternal (middle lobe/lingula)
5th ICS midclavicular (LL)
6th ICS midaxillary (LL)
Auscultation 7 posterior points (14 points)
Above spine of scapula (UL)
At spine of scapula (border between UL/LL)
Below spine of scapula (this & below is all LL)
Inferior pole medial
Inferior pole lateral
Rib 10 medial
Rib 10 lateral
Auscultation- Interpretation
Normal breath sounds
- Bronchovesicular (I:E = 1:1)
-Supraclavicular, 2nd ICS, above spine of scapula
- Vesicular (I:E = 2:1)
- All other lung fields
Abnormal breath sounds
- Wheezes (COPD)
- Crackles (more common on inspiration) (pneumonia)
Teach a patient an airway clearance technique (NOT a cough).
Perform a respiratory assessment on a patient admitted for acute respiratory infection.
IPPA (inspection, palpation, percussion, ausculation)
Inspections
Skin colour
Skin moistness
Accessory muscle usage
Jugular distention
clubbing
Asthma- What is it?
Inflammatory disorder of airways; Hyper-responsiveness of airways to various stimuli resulting in
symptoms of wheezing, SOB, chest tightness and coughing
Asthma- What factors cause intermittent narrowing of airways?
due to pollen, moulds, house dust, animal hair, stress, vigorous activity, nervousness, hot or cold air,
high humidity, etc.
This condition can also sometimes be inherited
When the body comes in contact with these allergens, there is a release of certain chemicals in the
body. These chemicals then go and attack the receptors in the airways, which then cause the reduction
or constriction of the circumference of the airways. This then results in an “asthmatic attack”
Asthma- Why does exercise cause an attack?
When the above symptoms occur in response to strenuous exercise, it is known as exercise-induced
asthma. Exercise causes a change in body temperature and there is also a release of chemical mediators
into the blood stream, which then act on the airways, and cause bronchial constriction, as described
above, and result in an asthmatic attack.
The symptoms usually occur 5-15 min after the onset of activity and subside 25-30 min after the exercise
is stopped. If S&S occur, obtain breathlessness position, breathing control and use meds
Asthma- What can be done to prevent attacks?
1) Perform warm-up exercises and maintain an appropriate cool down period after exercise.
2) If the weather is cold, exercise indoors or wear a mask or scarf over your nose and mouth.
3) Avoid very vigorous activities
4) Pacing of high demand activities and train lungs through activity
5) Avoid coming in contact with other allergens during exercise. Avoid exercising outdoors when pollen
counts are high (if you have allergies), and avoid exercising outdoors when there is high air pollution.
6) Aerobic training and breathing exercises to increase lung compliance and ability to perform vigorous exs
7) Can take inhaled corticosteroids before and during. Refer to physician for advice and prescription.
8) Restrict exercise when you have a viral infection
What can be done when the child is having an exercise induced asthmatic attack?
1) Terminate activity immediately, come into a resting position and attain a forward-bent relaxed position. Rest for at least an hour and symptoms should subside in 25-30 min
2) Advised to perform pursed-lipped breathing, alternating with deep breaths (5 by 5)
3) If prescribed by doctor, can administer bronchodilator or inhaler
Can the child continue to play sports?
1) The child should be able to continue to play sports because:
(( Check if correct It is a self liming condition which occurs in young children to the age of
adolescence ))
2) Can take a prophylactic inhaler prescribed by doctor to prevent attacks
Advised to take many breaks during the game to prevent over exacerbation of symptoms
Advised to take part in an aerobic training program and perform breathing exercises to increase
lung compliance and lung capacities
Rx for Pulmonary edema
(NOT with chest PT/secretion clearance techniques!)
Increase mobility, suppl O2, vasodilators to decr venous load and diuretics to decr fluid overload
Rx for Pleural Effusion
DB&C, positioning, mobility
Rx for Pneumonia
antibiotics, antifungals (if fungal infection), airway clearance techniques, rest, positioning, supp O2, IV
fluids, mobilization
Rx Cystic Fibrosis
Airway clearance techniques (aggressive bronchial drainage, percs & vibes), gradual incr in exercise,
Active cycle of Breathing, autogenic drainage
o Medical: bronchodilators, aggressive antibiotics
o Use of acapella/flutter/PEP (generally after bronchodilators) – 6 sets of 15 breaths, 4x/day
Sets and reps for a PEP
6 sets of 15 breaths, 4x/day
How many cycles of ACBT and autogenic drainage?
ACBT 3-5 cycles/ day
Autogenic drainage: 30-45 mins/day
when assessing the posterior portion of a patient, how should they be positioned?
arms crossed over the other (opens up the shoulder blades)
Take manual BP and verbalize findings to examiner. Follow-up questions were ways for patient to monitor themselves during exercises.
Manual BP – sanitize stethoscope & cuff, ask if they know their normal BP? Feel for the brachial pulse and position the sethescope. Inflate to 160 – slowly release the pressure first clear sound is systolic, absence of sound is diastolic
Ways a patient can monitor self: RPE, Talk Test, HR monitory, SOB scale
Normal 120/80, Hypo 90/60, Hyper 140/90
Termination: >250/ or >/115 (or drop in BP despite increased workload >10/ systolic)
