Cardio Clinical skills Flashcards
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
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
What are you looking for with observations
normal breathing that is equal on both sides
What is the pump and bucket handle movemetns
pump handle - upper ribs moving anteriorly
bucket handle - lower lateral ribs moving upwards
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
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%
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
why is sp02 important
if its too low - problems with retained secretions or reduced volume?
issues with taking oxygen into bloodstream
what are precautions for bp
trauma/fracture to arm, inability to reach arm, open wounds, etc
what is normal pulse rate
60-100bpm
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
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
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
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
what would you see in an asthma xray
hyperinflation of the lungs
thickening of bronchiole wall
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
