Cardio Pulm Considerations Flashcards
5 Vital signs for Cardio pulm to test
- HR
- RR
- BP
- Temp
- Pain
Reviews of CV&P Systems can show you:
- help ID symptoms overlooked
- reveal co-morbitities, disease, and adverse drug interactions
ex: repeated fall patient might have neuro, hypotenson, vestib issues, etc.
ex: patient on blood thinners might also take aspirin for aches and pains- bad interactions
PAR-Q
short checklist in INITIAL INTERVIEW
yes answer warrents MD consult
Extensive cardiovascular checklist things to consider
dyspnea (short breath) palpitations syncope pain w/ sweats cough (L vent fail=back pressure=pulm symptoms) chest pain (angina- above waist/jaw pressure pain) peripheral edema cold hands/feet open wounds skin discoloration
if YES– ask to describe, what provokes it, how does it behave?
Cardiovasc Special questions to ask during SUBJECTIVE exam
MD ever said you had heart disease/HTN?
Angina? Heart attack?
Rheumatic fever/heart disease (heart and bowels)
Abnormal ECG/excercise ECG
Pacemaker, cardioverter, defib
Meds?
Cardiac risk factors: obesity, HTN, smoking, little activity, diet (high LDL), fam history
Dyspnea symptoms/red flags
Sudden arousal at night with SOB;
RF: severe at rest suggests: pulmonary embolism, spontaneous phneumothorax (air/gas in pleural space)
RF: Orthopnea– SOB in supine lying
suggests: CHF, mitral valve regurg, asthma, COPD
Heart Palpitations symptoms/red flags
Frequency and Duration: look for patterns, longer durations decrease heart filling, decrease BP
RF:Associated symptoms: chest pain, lightheadedness, dyspnea, diaphoresis
Falls: blackouts and fainting (syncope) vs. trip/loss of balance
RF: Fam history: sudden deaths where heart stops?
Peripheral edema symptoms/red flags
associated with: venous insufficiency, CHF, deep vein thrombosis (unilateral), pulmonary HTN (higher resistance on R vent)
RF: Bilateral= system- CHF is likely; likely present in jugular veins
Pitting?
Slow vs. Fast onset?
associated signs: pain, cyanosis, jaundice, redness
Leg pain symptoms/RFs
Calf/posterior thigh pain with walking stairs/incline –> claudication= like angina for LE skeletal muscle
RF: Weak/absent femoral, popliteal, post tib, dorsalis pedis pulses
COLS Dry, thin, scaly skin= arterial issue
WARM edematous skin= venous issue
Pulmonary checklist
Dyspnea
Cough
Cyanosis/clubbing of nails
Wheezing (expiration)/stridor (upper airway obstruction)
lots of crossover with cardiovasc checklists– shows symptoms ALONE can’t tell what’s wrong
have to take sum of all parts
Pulmonary special questions during SUBJECTIVE exam
trouble breathing? diagnosed with lung disease? describe it TB? CXR? Broken nose/deviated septum, sleep apnea? Cough? dry of blood? weight gain/loss over ten lbs- fluid mismanagement would indicate heart probs swollen ankles? unusally tired?
For asthma patients: aggs and eases?
ex: excercise, irritants, allergies, anxiety, lower temp, lower humidity
Cough symptoms and RF:
chronicity > 3 weeks
causes: meds (ACE inhibitors), smoking, URI, asthma
Productive: color, ordor, consistency
RF: hemoptysis: blood red or pink froth
Digital clubbing
cyanotic nail beds
bulbous fingertips
associated with CHRONIC hypoxemia
- evaluate pulse oximetry (shows saturation of hemaglobin and HR)
Wheezing symptoms/RF
abnormal respiratory sound with audible ears
high pitched sound caused by partial obstruction of airways
ex: asthma, emphysema, etc/
RF: STATUS ASTHMATICUS- severe bronchoconstriction- intibate if too severe
Altered breathing/chest wall morphology
If accessory muscle hypertrophy- emphysema suggested
kyphoscoliosis- precipitates restrictive lung disease (getting air IN)
chest wider than it is deep- rounded barrell- professorial position- usually means COPD and ephesima
Sleep apnea- reported by significant other
