Cardiopulmonary Assessment Flashcards
Where to obtain Patient’s History?
- Patient Chart
- Medical Team
History of Present Illness
- Presenting Diagnosis (Syncopal episode, Onset of symptoms, decreased exercise tolerance, Elective surgery, Emergent surgery, increasing SOB)
- Pt symptoms
- Timing and onset of symptoms (How and when symptoms occur)
Past Medical History
- Cardiac Risk factors (Smoker, Age, Family history, Cholesterol)
- Comorbidities: Other relevant medical history
- Medications: Pre admission
Social History
- Prior level of function / current level of function
- Living situation
- Occupation
- Social Support / Assistance
- Pain level
- Use of assistive device
- Other barriers
History - Hospital Course
- Surgical / Medical Course (Date & Type of surgery)
- Ventilatory status
- ICU stay
- Current Medications
- Pain control
- EKG
- Radiology
- Ultrasound
- Events during admission
Hospital lab info includes
- CBC
- Electrolytes levels
- Cardiac enzymes - Tropononins (increase when have heart attack)
- Cath, stress tests
- Current symptoms / complaints
PICC Line
- Peripherally inserted central catheter (PICC) line
- Directly to heart
- used for longer period of time for continuous infusions
- Goes to SVC or IVC and terminates at the right atrium
- Allows medication to be circulated throughout the body through the heart pump
Arteria Line
- Call nurse if you see blood
Ventilator
- Oropharyngeal 8 to 10 days
- can move a ventilator patient if they are awake and alert
Chest tube
- can mobilize patient
- Tube is between parietal and visceral pleura of the lung draining out air and fluid that can collect in that space
- Post surgical pts / pneumothorax, pleural effusion
- Note the volume and color in the tube before and after exercising
Accessory use for breathing
- SCM, scalenens, pecs, lats, traps
Breathing Rates
a. normal: 12-20 breaths per minute
b. Tachypneic: More than 20 breaths per minute
c. Bradypneic: less than 12 breaths per minute
d. Dyspneic: trying to catch breath
Pattern of Breathing - Normal excursion
- Symmetrical
- Inspiration: Expiration - 1: 2
- No accessory muscle recruitment
- NAD - no apparent distress
Pattern of Breathing - Abdominal Paradoxical Breathing
- Negative pressure created secondary to obstructive disease
- Diaphragm flattens → barrel chested
- Abdominal moves inward, upper chest moves outward with inspiration
Pattern of Breathing - Upper Chest Paradoxical Breathing
- Diaphragm contracts, abdominal and accessory muscles do not
- Common in SCI below C5
- Outward motion of abdomen, inward motion of upper chest with inspiration
Pattern of Breathing - Tripod Breathing
- Anterior lean, elbows on table / elbows on knees
- Accessory muscle use → largest recruitment pattern
Pattern of Breathing - Respiratory Distress
- Accessory muscle use
- Tachypnea → RR > 20
- SOB
- Cyanosis
- Pursed lip breathing
- Nasal flaring
- Change in metal status
- Apnea – breathing starts and stops (sleep apnea)
Body Type - Cachexia
- Muscle loss / wasting
- May or may not include loss of fat
- Seen in chronic, progressive disease
- Lack of appetite
- Fatigue
Chest type: Normal Dimension
- Thoracic cavity is elliptical in shape
- Anterior - Posterior: Lateral Diameter → 1:2
- Angulation of ribs is < 90 degrees
- Ribs articulate posteriorly at 45 degrees
Chest type: Barrel Chest
- Angulation of ribs > 90 degrees
- Ribs articulate posteriorly at < 45 degrees → more horizontal
- Increased AP Diameter (ex – 1:1)
- Common in COPD patients
Chest Type: Pectus Excavatum
- Depressed sternum
- Funnel chest
Chest Type: Pectus carinatum
- Protruding sternum
- Pigeon Chest
Flail chest
- chest moves inward with inspiration
- due to broken ribs
Kyphosis
- Exaggerated thoracic curve