Cardio Clinical skills

Question 1

What do you do for observation for cardio?

Answer 1

Observing if the PT is talking in full or broken sentences

noisy breathing

cyanoisis? (test with Capillary refill)

Airway (open/closed)

Observe the posture and chest rising and falling with breathing

Palpate if related to the case given; includes pump-handle movement and chest diaphragm expansion (equal expansion)

is there vibrations on the chest wall

Question 2

how do you calculate respiriatory rate

Answer 2

count number of normal breaths by watching chest rise and fall over a min, should be between 12-18

observe any asymmetry in the breathing

Question 3

What are you looking for with observations

Answer 3

normal breathing that is equal on both sides

Question 4

What is the pump and bucket handle movemetns

Answer 4

pump handle - upper ribs moving anteriorly

bucket handle - lower lateral ribs moving upwards

Question 5

How do you measure BP

Answer 5

wrap cuff around left arm - should be snug but not too tight (should be 2fingers of space available), and then press button.

top number is systolic bp, normal is 120mmHg, and represents the pressure as the heart contracts and sends blood through arteries

bottom number is diastolic bp, normal is 80mmHg, and it represents the arteriole pressure as the heart is filling up with blood

pulse pressure is the difference between the two, and it represents the force generated by the heart alone

Question 6

what is spO2

Answer 6

measure of the percentage of oxygen saturation in the blood

clip on index finger and press start button

works by shining light and measuring how much passes through

normal is 95-100

for those with COPD normal levels are 88-92%

Question 7

why is bp important

Answer 7

if its too low - cant consider early mobilization due to risk of fainting

can be an indicator of cardiac issues or developing athleroscosis, which can lead to severe conditions

Question 8

why is sp02 important

Answer 8

if its too low - problems with retained secretions or reduced volume?

issues with taking oxygen into bloodstream

Question 9

what are precautions for bp

Answer 9

trauma/fracture to arm, inability to reach arm, open wounds, etc

Question 10

what is normal pulse rate

Answer 10

60-100bpm

Question 11

What is the A-G assessment for xrays

Answer 11

Alignment - spinous processes in the middle of trachea

Bones - locate clavicle, scap, spinous processes, and ribs

Cardiac - costocardiac angle should be 1/3 of the costophrenic angle

diaphragm - right costophrenic angle should be higher due to liver

expansion- lungs should be expanded out to 6th rib

fields - identify bloodvessels

gadgets - any gadgets

Question 12

What is auscultation

Answer 12

listening to breathing

compare left to the right and get pt to take a deep breath

get pt to round shoulders when doing from back

Question 13

What areas of the lungs are you listening to?

Answer 13

Upper - apexes of lungs

superior lobes at 3-4 ribs

middle lobes and lingula on left side

inferior lobes

back its apexes, then superior lobes, then inferior lobes, and finally bases

Question 14

What sounds would you hear with someone with COPD in a certain area

Answer 14

less lung sounds, and crackles

crackles are common in any areas that have retained secretions

Question 15

what would you see in an asthma xray

Answer 15

hyperinflation of the lungs
thickening of bronchiole wall

Question 16

what would you see in an COPD xray

Answer 16

flattened diaphragm
prominent hilum vessels
bullae - air space in lungs

Question 17

what would you see in an Bronchiectasis xray

Answer 17

dilated bronchi and atelectasis

Question 18

what would you see in an Lower lobe consolidation xray

Answer 18

opaque lower and middle portions of that side

obscuration of the hilum of that side

Question 19

what would you see in an cystic fibrosis xray

Answer 19

hyper inflation

bronchial wall thickening

mucus plugging

Question 20

what would you see in an Atelectasis xray

Answer 20

shift of mediastinum

opaqueness of lung

elevated diaphragm

Question 21

WHat is active control of breathing

Answer 21

starting with breathing control for 20-30s, followed by 3-4 deep breathing thoracic expansions, then breathing control again and deep breathing again, then forced expiratory huff

Question 22

What creates mucus and what is its function

Answer 22

goblet cells

Protection of the epithelium
Removal of inhaled particles
Waterproofing
Humidification

Question 23

How does each step of ACBT help

Answer 23

relaxed breathing - in thru nose out thru mouth, helps open up aiirways

deep breathing - helps mobilize mucus and get air behind mucus

huffs - helps expire mucus

Question 24

What are some contra indications to ACBT

Answer 24

osteoporosis
rib fractures
worsening bronchiospasm
unconscious or confused pts
non normal breathing

Question 25

what is relaxed breathing

Answer 25

put pt in a position of ease for breathing and have them practice slow breathing (in thru nose out thru mouth)

Question 26

WHat are the positions of ease for breathing

Answer 26

High side lying - lying on side propped up with pillows, supporting head and neck, with knees slightly bent

forward lean sitting - sitting at table, leaning forwards from waist with head and neck on pullow, and arms on table , can also be done with no table in front and having arms in lap with front leaninf over

forward lean standing - standing and leaning forwards onto chair or windowsil

standing with back support - lean with your back against a wall and your hands by your side, have feet about 1 foot from wall and apart

Question 27

how do positions of ease help

Answer 27

side lying - patients with a flat diaphragm will benefit from positions that use pressure from abdominal contents to support dome shape for fibre

forward sitting lean - provides a stretch onto diaphragm fibres to encourage dome shape

aim to reduce the work of breathing and improve the efficiency of ventilationn

Question 28

what are the contraindications for positions of ease

Answer 28

unable to follow instructions

fractures

aneurysms

active haemoptysis

hypoxia

heavy sedation

increased pain

Question 29

what is mobility for cardio

Answer 29

aiding pt from lying to sit on edge of bed

sit to stand

transfer from bed to chair

early mobilization helps with lung secretions by loosening and mobilizing the secretions

Question 30

what are the contraindications to early mobilization

Answer 30

pt is unable to follow instructions

fractures

aneurysms

hypoxia

heavy sedation

increased pain

Question 31

how does oscillatory pep work

Answer 31

provides resistance on expiration, which create oscillations. these oscillations mobilize secretions in collateral channels and prevents airway collapse

increases gas pressure behind mucus through collateral ventilation and temporarily increase functional residual capacity

Question 32

how do you use the acapella and flutter

Answer 32

take a deep breath
form tight seal around mouth
hold for 2-3 seconds
breath out through acapella with a non forceful, sustained exhalation
repeat 8-10 times and include breathing control

cough at the end

Question 33

when would you use the flutter vs acapella

Answer 33

flutter has to be used in an upright position, as it needs gravity to work

acapella can be used in any positions

Question 34

what are contra indications to pep

Answer 34

undrained pnemothorax

heart faliure

facial trama

recent hemoptysis

worsening bronchospasm

inability to follow instructions

Question 35

How does ACBT work

Answer 35

Utilizes the collateral airways to mobilize the sputum