Cardiopulm PT Tests and Measures Flashcards
Angina pain scale
1: Mild, barely noticeable
2: Moderate, bothersome
3: Moderately severe, very uncomfortable
4: Most severe or intense pain ever experienced
ABI procedure
Use sphygmomanometer and Doppler ultrasound device
Measure brachial and tibialis posterior arteries on both sides
Divide higher ankle measurement over higher brachial measurement
ABI Interpretation
1.3+ Rigid arteries, need ultrasound test to check for peripheral artery disease
1-1.3 Normal
0.8-0.99 Mild blockage
0.4-0.79 Moderate blockage, may have intermittent claudication during exercise
<0.4 Severe blockage, may have claudication at rest
BP Measurement Procedure
- Use appropriate size cuff (if in doubt, use larger cuff)
- Bladder should encircle 80% of arm in adults, 100% of arm in children
- Inflate to above anticipated systolic pressure
- Deflate 2-3 mmHg/second
Korotkoff sounds
1: First appearance of sounds = SBP
2: Sounds get softer/longer
3: Sounds get crisper/louder
4: Sounds get muffled/softer
5: Sounds disappear = DBP
BP Interpretation (age 3-17)
Normal: SBP and DBP <90th percentile
Pre-HTN: SBP and DBP 90-94 percentile
Stage 1 HTN: SBP and DBP 95-99 percentile
Stage 2 HTN: SBP and DBP >99 percentile
BP Interpretation (adults)
Normal: <120/80
Pre-HTN: 120-139/ 80-89
Stage 1 HTN: 140-159/ 90-99
Stage 2 HTN: >160/100
Auscultation Procedure
- Hold bell directly on bare skin, enough pressure to provide a skin seal
- Patient breathes quietly through nose (heart sounds). Through the mouth and slightly deeper than normal for lung sounds.
- Listen over designated auscultatory sounds (4 for heart, 16 for lungs)
4 Auscultation areas for heart
Aorta: 2nd intercostal, right sternal border
Pulmonary Artery: 2nd intercostal, left sternal border
Mitral Valve/Apex: 5th intercostal space, medial to left midclavicular line
Tricuspid Valve: 4th intercostal space, left sternal border
Heart Sounds (Normal)
S1: Ventricular Systole (AV valves closing) - Lower pitch and longer duration
S2: Ventricular diastole (semilunar valves closing) - Higher pitch and higher duration
^Both sounds are high frequency
Heart Sounds (Abnormal)
S3 (Normal in children - “physiologic” 3rd heart sound): Vibration of distended ventricle walls during diastole. AKA Ventricular gallop. Can indicate HF.
S4: Vibration of ventricular wall with ventricular filling. Associated with HTN, stenosis, myocardial infarction, hypertensive heart disease. AKA atrial gallop.
Murmurs: Vibrations of longer duration than the heart sounds. Due to disruption of blood flow past a stenotic or regurgitant valve.
Tracheal/Bronchial Breath Sounds
(Normal)
- Loud, tubular
- Inspiration < expiration, slight pause between the two
*Bronchial sounds over distal airways are abnormal – indicate consolidation/ compression of lung tissue. E.g. pneumonia
Vesicular Breath Sounds
(Normal)
- High pitched, breezy
- Heard over distal airways
- Inspiration > expiration, no pause between the two
Crackles (Rales)
- More often during inspiration
- Restrictive or Obstructive Disorders
- Wet: Movement of fluid during inspiration
- Dry: Sudden opening of closed airways
Pleural Friction Rub
- Dry, crackling during inspiration and expiration
- Indicates inflamed visceral and parietal pleurae rubbing together
- Heard over spot where the patient feels pleuritic pain
Ronchi
- Continuous, low pitch sound (“snoring” or “gurgling”)
- During inspiration and expiration
- Air passing through airway that is obstructed
Stridor
- Continuous high-pitched wheeze
- Inspiration and Expiration
- Indicates upper airway obstruction
Wheeze
- Continuous musical/ whistling sound of a variety of pitches
- Variable from minute to minute and area to area
- Turbulent airflow and vibration of walls of small airways
Voice Sounds
Normal: muffled.
Consolidation, atelectasis, fibrosis improve transmission of vibrations through lung tissue.
Bronchophony (99)
Egophony (E sounds like A)
Whispered pectoriloquy
Voice sounds somewhat more valuable than breath sounds for detecting pulmonary consolidation, infarction, atelectasis.
BMI Interpretation (adults)
< 18.5 Underweight 18.5-24.9 Normal 25-29.9 Overweight 30-34.9 Obesity (Class 1) 35-39.9 Obesity (Class 2) 40+ Obesity (Class 3)
Overestimates body fat in athletes
Underestimates body fat in older adults who’ve lost muscle
BMI Interpretation (<18 years old)
85-95 percentile: At risk for becoming overweight
>95th percentile: Overweight or obese
Capillary Refill
Normal: Full color returns in <2 seconds
Claudication Cause
Occurs when skeletal muscle O2 demand during exercise exceeds blood O2 supply.
Location of sxs often corresponds to site of most proximal stenosis
- butt/hip/thigh = aorta or iliac arteries
- calf = femoral, popliteal arteries
- ankle/foot = tibial or peroneal arteries
Claudication Test Procedure
Patient walks on a flat track at max speed
OR
Patient walks on a treadmill at 2.0 mph at a constant grade between 0-12%
Initial Claudication Distance = pain-free walking distanc
Absolute Claudication Distance = Max distance walked when test is terminated due to pain
Also measure walking speed
Grading scale for claudication pain
1: Mild
2: Moderate, patient can be distracted
3: More intense, patient’ can’t be distracted
4: Excruciating and unbearable
Borg Dyspnea Scale
0-10
Homan’s Sign
Passively DF ankle with knee straight
Positive: Pain in calf or popliteal space
Insensitive and nonspecific
Mediate Percussion
Percuss at each intercostal space, compare bilaterally
Normal in lung: “resonance” sound
Tympany = echoing sound. Indicates pneumothorax
Measuring HR procedure
Regular rhythm: 15 seconds x4
Irregular rhythm: 60 seconds
Pulse scale
0: Absent
1: Small/ reduced
2+: Normal
3+: Large/bounding
PFT Results for Obstructive Impairment
- Decreased expiratory flows
- FEV1/FVC <70% primary indicator of obstructive impairment
- asthma, emphysema, chronic bronchitis
PFT Results for Restrictive Impairment
- Reduced lung volumes
- Relatively normal expiratory flow rates
- FVC reduced, FEV1/FVC is normal or >80%
- Interstitial lung disease, pleural disease, obesity, pregnancy, neuromuscular disease, tumor, chest wall deformity.
SpO2 when to stop activity
<90% in acutely ill patients
<85% in patients with chronic lung disease
Rate Pressure Product
Index of myocardial O2 consumption and coronary blood flow.
Easy to measure physiologic correlate to onset of angina
= HR x SBP
Reported as 2-digit number x10^3
RPE Interpretation
13-14: 70% HR max
11-13: Upper limit for prescribing intensity early in cardiac rehab.
4 Parameters to consider for respiratory assessment
Rate
Rhythm
Depth
Character (effort, sounds produced)
Normal respiratory rhythm
Inspiration: Expiration ratio is 1:2
Respiratory rhythm with COPD
Inspiration: Expiration 1:3 or 1:4
Biot’s breathing pattern
Irregular breathing
Breaths vary in depth and rate, periods of apnea
Often associated with increased ICP or damage to medulla
Kussmaul’s breathing pattern
Deep and fast breathing
Often associated with metabolic acidosis
Waist circumference vs. Waist to hip ratio
No advantage of one over the other
Waist circumference indicating increased risk for disease
> 102 cm/ 40 in for men
> 88 cm/ 35 in for women
