Cardio Examination (Tests); Heart Sounds Flashcards
During the patient interview it is important to determine what right off the bat?
Patients Overall Cognition:
- Orientation
- Memory
- Learning Needs
- Comprehension
What is important to gain to establish appropriate patient interventions?
Information regarding the patients:
- Lifestyle
- PLOF
- Recreational interests
- Goals
What is Normal Resting HR?
60-100 BPM
- Relative Stability: testing HR at rest daily to determine their normal.
- Typically taken with peripheral pulse, but if that is too difficult can take apical pulse, by auscultating the heart at the 5th intercostal space, midclavicular line
What is the traditional increase in HR per increase in Metabolic Equivalent (MET) Level?
HR increases 10 BPM per MET level increase.
What is normal resting respiratory rate in adults?
12-20 breaths per minute
What resting respiratory rate may signify instability?
Respiratory rates greater than 30 breaths/minute
Arterial BP is a product of what two values?
Cardiac Output and Total Peripheral Resistance (TPR)
BP = CO x TPR
- An increase in either of these will increase BP, a decrease in either of these will decrease BP.
During increasing exercise intensity what factor is primarily responsible for increasing BP? CO or TPR
Cardiac Output
What is Pulse Oximetry readings used for?
Determining pulmonary respiration or gas exchange at the level of the alveolar capillary interface
What pulse oximetry reading may indicate hypoxemia?
Readings less than 90%
What is the Perceived Level of Dyspnea Scale?
Scale of 1-10
(0 = Nothing at all; 10 - maximal)
What is the Dyspnea Scale?
5-point ordinal scale:
(0 = No dyspnea; 4 = severe difficulty, cannot continue)
What is Paroxysmal Nocturnal Dyspnea and what disease is it an important sign for?
Patient reports experiencing sudden episode of SOB at night
- Important sign for an exacerbation of Heart Failure
What is Orthopnea?
Shortness of breath that increases in recumbent position. (Supine)
With patients with heart failure, to sleep at night they may do what adaptation to avoid symptoms of Orthopnea?
Increase the number of pillows to sleep at night.
(The number of pillows required can be used to gauge the severity of heart failure)
What is the Levine Sign?
Patient clenching their fist over the sternum, in patients with a presentation of angina.
- Has a high diagnostic accuracy for ischemia
Where can Angina present (referred areas).
Pain or Heaviness:
- Shoulder
- Jaw
- Arm
- Elbow
- Upper Back between Scapulae
What is the Angina Scale?
5-point ordinal Scale
0 = No Angina
4 = Worst pain ever experienced, infarction pain
What are the normal heart sounds heard during auscultation and what do they correspond to?
S1: (Lubb); Closure of the mitral and tricuspid valves. Marking the beginning of ventricular systole
S2: (Dubb); Closure of the aortic and pulmonic valves. Marking the end of ventricular systole.
Where are the heart sounds auscultated and what do they correspond with?
Aortic Valve: 2nd Intercostal Space, R Sternal Border
Pulmonic Valve: 2nd Intercostal Space, L Sternal Border
Tricuspid Valve: 4th Intercostal Space, L Sternal Border
Mitral Valve: 5th Intercostal Space, Midclavicular Line
APT 2245
Lung Auscultation: Lung regions and associated sounds
Vesicular (soft, low-pitched); Peripheral Aspects of the Lungs
Bronchial (loud,high-pitched); Centrally along the manubrium of the sternum
Patients with LV heart failure will often have what type of adventitious sounds?
Crackles or Rales (Terms are used interchangeably)
- Occurring primarily late in inspiration
- often heard over the lung bases.
What is Jugular Venous Distension and what does this indicate? Testing Procedure?
Heart Failure presenting with backup of fluid in venous vasculature.
Testing Procedure:
- Patient placed in 45-degree semi-recumbent position
- Head turned away from side being evaluated
How can peripheral edema be measured and what is the Pitting Scale?
Via girth Measurements
Where can S1 and S2 Heart sounds be heard equally?
Erb’s Point; 3rd intercostal space
