Cardio Clinical skills Flashcards by Navraj Gill

What do you do for observation for cardio?

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

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how do you calculate respiriatory rate

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

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What are you looking for with observations

normal breathing that is equal on both sides

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What is the pump and bucket handle movemetns

pump handle - upper ribs moving anteriorly

bucket handle - lower lateral ribs moving upwards

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How do you measure BP

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

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what is spO2

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%

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why is bp important

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

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why is sp02 important

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

issues with taking oxygen into bloodstream

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what are precautions for bp

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

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what is normal pulse rate

60-100bpm

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What is the A-G assessment for xrays

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

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What is auscultation

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

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What areas of the lungs are you listening to?

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

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

less lung sounds, and crackles

crackles are common in any areas that have retained secretions

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what would you see in an asthma xray

hyperinflation of the lungs
thickening of bronchiole wall

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what would you see in an COPD xray

flattened diaphragm
prominent hilum vessels
bullae - air space in lungs

what would you see in an Bronchiectasis xray

dilated bronchi and atelectasis

what would you see in an Lower lobe consolidation xray

opaque lower and middle portions of that side

obscuration of the hilum of that side

what would you see in an cystic fibrosis xray

hyper inflation

bronchial wall thickening

mucus plugging

what would you see in an Atelectasis xray

shift of mediastinum

opaqueness of lung

elevated diaphragm

WHat is active control of breathing

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

What creates mucus and what is its function

goblet cells

Protection of the epithelium
Removal of inhaled particles
Waterproofing
Humidification

How does each step of ACBT help

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

What are some contra indications to ACBT

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

what is relaxed breathing

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

WHat are the positions of ease for breathing

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

how do positions of ease help

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

what are the contraindications for positions of ease

unable to follow instructions fractures aneurysms active haemoptysis hypoxia heavy sedation increased pain

what is mobility for cardio

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

what are the contraindications to early mobilization

pt is unable to follow instructions fractures aneurysms hypoxia heavy sedation increased pain

how does oscillatory pep work

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

how do you use the acapella and flutter

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

when would you use the flutter vs acapella

flutter has to be used in an upright position, as it needs gravity to work acapella can be used in any positions

what are contra indications to pep

undrained pnemothorax heart faliure facial trama recent hemoptysis worsening bronchospasm inability to follow instructions

How does ACBT work

Utilizes the collateral airways to mobilize the sputum