Cardiopulm Exam Flashcards
Do PTs routinely perform a CP screen on their patients?
No, but we should
Do PTs routinely take VS on patients?
Yes
What is Normal HR?
60-90 bpm
What HR is considered sinus tachycardia?
> 100 bpm
What are some things that can cause sinus tachycardia?
Anxiety, exercise, fever, anemia, hypoxia, meds
What HR is considered sinus bradycardia?
<60 bpm
What population is sinus bradycardia seen in?
Athletes and people who take beta blockers
How do you measure pulse rate?
Palpating peripheral artery
Where is the most accurate measurement for HR?
Auscultation of cardiac apex
Pulse deficit is…
The difference between the HR and pulse rate
When you have a pulse deficit, this means that…
Some heart beats have not caused sufficient blood flow to reach periphery
A pulse deficit is common in what population?
People with AFib or other dysrhythmias
HR ranges for newborn
120-170 bpm
HR ranges for 1 year old
80-160 bpm
HR ranges for 3 yo
80-120 bpm
HR ranges for 6 yo
75-115 bpm
HR for 10 yo
70-110 bpm
Where else can you take pulse rate?
Dorsalis pedis
Radial
Rating scale for pulse: 4+
Bounding
Rating scale for pulse: 3+
Increased
Rating scale for pulse: 2+
Brisk, expected
Rating scale for pulse: 1+
Diminished, weaker than expected
Rating scale for pulse: 0
Absent
Unable to palpate
BP-JNC8
BP values for healthy individuals is _______ except those >60 years old, it is ________
<140/90
<150/90
What do the JNC 8 guidelines advise?
Higher BP goals and less use of several types of antihypertensive meds
If your BP cuff is too short or too narrow, you may have a _________ reading
False high
What kind of cuff nears to be recalibrated regularly?
Aneroid
When taking BP, brachial artery should be at what level?
Heart level
A pressure difference of more than _____ mmHG suggests arterial compression or obstruction on the side with the lower pressure
10-15
A fall of SBP or DBP of 10 mmHg or more, especially when accompanied by symptoms indicates ___________ with the HR increasing by _______ bpm
Orthostatic hypotension
10-20 bpm
What is the minimal level of MABP?
65 mmHg
What is the normal range of MABP?
60/70-110 mmHg
How do you calculate MAP?
[SBP +2(DBP)] / 3
_____ is seen as perfusion pressure for organs in the body
MAP
Activity contraindications include when:
SBP is _____ or _____
DBP is ______
> 200 or <80
> 100
Terminate activity if SBP is ____ and DBP is _____
SBP >250
DBP >110
How do you calculate pulse pressure?
SBP-DBP
What do the values for pulse pressure range from?
30-50 mmHg
Pulse pressure ______ with age
Increases
Pulse pressure is considered abnormal if greater than _______mmHg in adults
60
If pulse pressure is low, it is a marker of low ___ in adults with heart failure
Q
Increased pulse pressure indicates ___________
Vascular wall stiffness
Predicts CV events
Increased pulse pressure can be found in……
Aortic valve disorders
Severe anemia
Overactive thyroid
What are better predictors of mortality? SBP, DBP, or PP?
SBP and DBP
Lung sounds: crackles (rales) are heard during what phase of breathing?
Inspiration
Fluid in the alveoli or caused by the opening of previously closed alveoli and small airways
Crackles
Patients in an exacerbation of CHF will have what kind of lung sound?
Crackers
This lung sound is associated with airway obstruction- constriction or mucous
Wheezes (rhonchi)
Wheezes (rhonchi) are heard during what breathing phase?
Exhalation
What is the normal ventilation rate in adults?
12-16 breaths/min
Tachypnea is considered a rate higher than ____
20 breaths/min
Bradypnea is a rate lower than ____
10 breaths/min
Dyspnea is the patients subjective report of ____
discomfort
______ means increased rate and volume
Hyperventilation
_____ is decreased rate and volume
Hypoventilation
_______ is difficulty breathing while the patient is supine with easing of breathing with a more vertical position
Orthopnea
Ventilation in newborn
30-80/min
Ventilation in 1 year
20-40/min
Ventilation in 3 years
20-30/min
Ventilation in 6 years
16-22/min
Ventilation in 10 years
16-20/min
Ventilation in 17 years
12-20/min
Adult ventilation
10-20/min
Types of ventilation issues
Orthopnea Hyperventilation Abdominal paradox Rib retractions Hypoventilation
Cessation after expiration interrupted by eventual inspiration or becomes fatal
Apnea
Cyclic waxing and waning of depth of breathing with periods of apnea- seen in severe CNS lesions
Cheyne-Stokes
Irregular breathing with slow, shallow breaths and periods of apnea - seen in meningitis
Biot’s breathing
Clusters of normal breaths separated by irregular pauses- seen in high medullary or low pontine lesion
Cluster breathing
Marked continuous hyperventilation with increased rate and depth of breathing to eliminate excess CO2 - diabetic ketoacidosis
Kussmaul
What will be seen in the hands if you have a high dose bronchodilator?
Fine tremor
What will hands be like if you have an irregular flapping tremor due to acute carbon dioxide retention
Warm and sweaty
Weakness and wasting of the small muscles in the hands may be an early sign of an _________ involving the _________
Upper lobe tumor
Involving the brachial plexus
(Pancoast’s Tumor)
Palmar erythema is a sign of ____
Liver disease
Finger pad is enlarged is called ____
Clubbing
Clubbing indicates what?
Chronic tissue hypoxia
What are the causes of clubbing?
Lung disease
Cardiac disease
Other
Exact cause - unknown
Cough color- red
Blood
Cough color- rust
Pneumonia
Cough color- purple
Neoplasm (smells)
Cough color- yellow/green
Infection
Cough color- pink
Pulmonary edema
Coughing only clears from the __________
6th or 7th generation up
Edema in CHF will accumulate _______
Bilaterally
Edema 1+
Barely perceptible depression
Edema 2+
Easily identified depression (EID)
Skin comes back within 15 seconds
Edema 3+
EID
Skin comes back within 15-30 sec
Edema 4+
EID
Edema rebounds in >30 seconds
Posture exam
Anterior chest muscles tight Hip flexors tight Forward head Rounded shoulders Protect incision site
Graphs can be taken from what (3) sites?
Radial artery
Saphenous vein
Left internal mammary artery
Diaphragm movement for breathing efficiency
2-3 inches with deep inspiration
Expansion, not descent
Palpation: Trachea:
Deviation occurs ______ (which way) when there is a loss of lung volume on one side - atelectasis, fibrosis, surgical excision of lung tissue
Towards the side of the lesion
Palpation: Trachea
Deviation occurs in what direction where there is an INCREASE in lung volume - pneumothorax, pleural effusion, herniation of abdominal viscera
Away from the side of the abnormality
Palpation: Chest wall
Look for these 5 things
Normal Pectus excavutum Pectus carinatum Symmetry of movement Pain
Pectus excavutum is
Funnel chest
Pectus carinatum is
Pigeon chest
BADCAT Alarming respiratory signs
B- breathing that is audible A- active accessory muscles D- dyspnea C- cyanosis or clubbing A- A-P diameter >1.0 T- tracheal deviation from midline
A measure of a persons body surface area; an indicator used to assess if a person is of health weight, OW, OB
BMI
Does BMI measure body fat?
No, but correlated
Does BMI predict mortality and morbidity?
Yes
Underweight BMI
18.5 or less
Normal BMI
18.5 to 24.9
Overweight BMI
25.0-29.9
Obese BMI
30-34.9
35-39.9
Extremely obese BMI
40 or greater
Facial characteristics during exericse
Distress Fatigue Nasal flaring Sweating Paleness Muscular effort to breathe
Examples of non modifiable risk factors
Age
Sex
Family history
Genetics
Modifiable risk factors
Smoking Diet Alcohol intake PA Dyslipidemias HTN Obesity Diabetes Metabolic syndrome
Dyspnea scale 1
Light, barely noticeable
Dyspnea scale 2
Moderate, bothersome
Dyspnea scale 3
Moderately severe, very uncomfortable
Dyspnea scale 4
Severe difficulty
Patient cannot continue
Clinical manifestations of respiratory muscle fatigue
Rapid, shallow breathing Paradoxical breathing Increased accessory muscle activity Dyspnea Hypoxemia Hypercapnia
NYHA Functional Class of Heart Disease: Stage I
Patient with cardiac disease but NO PA LIMITATIONS
6-10 METS
NYHA Functional Class of Heart Disease: Stage 2
Slight limitations
PA results in fatigue, dyspnea, palpitations, or anginal pain
4-6 METS
NYHA Functional Class of Heart Disease: Stage 3
Marked limitations of PA
Less than normal PA causes symptoms
2-3 METS
NYHA Functional Class of Heart Disease: Stage 4
Unable to carry out PA without discomfort
<2 METS
Clinical Prediction Rule for DVT includes:
Cancer (treatment within 6 months)
Paralysis, paresis, immobilization
Bedridden for more than 3 days because of surgery within 4 weeks
Localized tenderness along distribution of deep veins
Entire leg swollen
U/L calf swelling of greater than 3 cm
U/L pitting edema
Collateral superficial veins
Alternative Dx as likely as or more likely than DVT
Risk score interpretation (DVT): if you have >/= 3 points
High risk 75%
Risk score interpretation (DVT): If you have 1 to 2 points
Moderate risk 17%
Risk score interpretation (DVT): if you have <1 point
Low risk 3%
What grade on MRC breathlessness scale? Not troubled by breathlessness except on strenuous exercise
Grade 1
What grade on MRC breathlessness scale? Short of breath when hurrying on the level or walking up a slight hill
Grade 2
What grade on MRC breathlessness scale? Walks slower than most people on the level, stops after a mile or so, or stops after 15 min walking at own pace
Grade 3
What grade on MRC breathlessness scale? Stops for breath after walking about 100 yes or after a few minutes on level ground
Grade 4
What grade on MRC breathlessness scale? Too breathless to leave the house, or breathless when undressing
Grade 5
What is the abdominal paradox?
When the diaphragm doe not move right
Who are in rib retractions mainly seen in?
Children- skin between intercostals get sucked in
