Cardio Assessment Flashcards
Pulse Oximetry
put the device on the end of the finger looks at haemoglobin saturation can be affected by nail vanish, cold used to monitor and make sure pt safe can be indicator of respiratory failure
Pulse Oximetry Results
normal = >95% if low, total O2 may be inadequate if lower = impaired capacity of lungs to transport O2 into the blood COPD = resting levels 88-92% Asthma = may drop to 90% below 90% = O2 therapy
Blood Pressure
Check if mobilisation is safe
Cuff inflation compresses brachial artery
systole = blood under pressure from cardiac contractions and atrial wall expands
diastole = heart relaxing, atrial walls recoil = pulse
pt should be resting, upright in a chair, feet flat, not talking
arrow facing down the brachial artery
take twice
BP results
normal = 90/65 - 140/95
circulatory heart disease should be less than 130/80
postural hypertension = decrease of 5mmHg between sitting and standing
CF = lower due to excessive salt loss in sweat
bronchiectasis = higher systolic
COPD = higher blood pressure
hypotension = <90/60
hypertension = >140/90
Auscultation
pt breathe in through nose out through mouth
compare L & R straight away
start in upper lobes
move to the side and go high under armpit for middle lobe
lower lobe = bra strap line at the back and a bit higher to mid scapula
listen to one full respiration at each site
listen for equal breath sounds, quality, freq, duration
louder in upper lobes
Auscultation sounds
normal = louder top and central, expiration shorter and quieter, pause between in and out
diminished sounds = obstruction or restrictive so less air not breathing deeply enough
COPD = wheezing from narrowed airways, crackles on inspiration, bubbles, deep sound on tapping for emphysema
asthma = wheeze, rales, stridor
pneumonia = scattered late inspiratory crackles, hearing exhalation the whole way out, bronchial sounds, bubbling
CF = crackles
bronchiectasis = ronchi, scattered wheeze, squeaks on inspiration, crackles
Palpation
feel for equal, thoracic expansion both AP and lateral
feel for fremitus through vibrations from secretions in the upper chest
Observation
airways: obstruction, wheezing, rhythm, artificial airways, chest rise and fall
breathing: chest shape, abdominal and chest movements, work of breathing, pattern, voice sounds
circulation: colour, sweating, dehydration, skin elasticity, capillary refill time, peripheral oedema, skin turgor, pulse, rhythm quality
disability: walking aids, MSK, general
Observation results
respiratory rate: 12-18 per min pulse = 50-100bpm mainly abdominal breathing for rest look for pursed lips or fixed arms for WOB nose breathing rhythmical and silent
Observation for case scenarios
COPD: barrel shaped chest, pursed lip breathing, blue discolouration, weight loss, accessory muscle usage, weak cough, increased RR, enlarged thorax, fremitus
asthma: accessory muscle usage, abdominal breathing, increased RR, increased HR, audible wheeze
CF: distended abdomen, dry skin, nasal inflammation, accessory muscle usage, sharp retractions of abdomen, clubbing finger nails, blue tinge
bronchiectasis: clubbing, blue lips, fingernail beds paler than skin
pneumonia: rapid breathing, fever, lethargy
surgery: iv lines, wound care, RR, skin discolouration, chest wall movement, fremitus
Chest X-ray
Alignment: straight on, trachea midline, spinous processes in the middle, heart 2/3rd to the R
Bones: fractures, ribs, scapula, spine, scoliosis
Cardiac: 1/3rd on L, 2/3rd R, half thorax diameter, sharp boarders, 1/3rd diaphragm
Diaphragm: costophrenic angles, higher on L due to liver, gastric bubbles
Expansion: count the ribs, 6 at the front, 10 at back
Fields: should expand whole thorax, compare L and R, lung markings, vasculature, air
Gadgets: wires, ecg, pacemakers etc
soft tissue: e.g. breast, surgical emphysema, obese, oedema, pleural fluid
Chest X-ray results
COPD: enlarged lungs, flattened diaphragm, air pockets in lungs, narrow elongated heart
Pneumonia: consolidation (patchy white) from fluid, loss of diaphragm shadow
CF: lots of white areas from sputum
Bronchiectasis: coarsened lung markings, whiter areas, potential anatomical enlargement
surgery: collapsed lung, decreased lung volume, sternal wires, stitches or sutures, chest drains, ecg dots, potential poor alignment
Peak Flow
used for asthma monitoring and diagnosis
maximum speed of expiratory flow
form a tight seal around mouthpiece, done in standing, hold horizontal, deep breath in and blow out as hard as you can, don’t have to continue going
compare to predicted values for age and height, should be within 80%
normal 400-700
asthma = 20% variability over 2-4 weeks
Spirometry
diagnosis of lung diseases
total volume
how quickly can blow out in one forced breath
measures FEV1/FVC ratio
sit up straight, deep breath in, blow into mouth piece as hard and as fast as possible, then continue blowing air out for as long as possible
encourage pt to breath all the way out
know age, race, gender, height, weight for predicted values
should rep x 3
Spirometry results
obstructive = FEV1 decreased below 80%, FVC decreases slightly. ratio below 70%
restrictive = FEV1 AND FVC reduced below 80%. ratio normal. pneumonia
normal lungs = >70% ratio and 80% for each value
can blow most air out in 1 second
