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Pulm > Cardiopulmonary Assessment > Flashcards

Cardiopulmonary Assessment Flashcards

1
Q

Where to obtain Patient’s History?

A
  • Patient Chart
  • Medical Team
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2
Q

History of Present Illness

A
  • 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)
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3
Q

Past Medical History

A
  • Cardiac Risk factors (Smoker, Age, Family history, Cholesterol)
  • Comorbidities: Other relevant medical history
  • Medications: Pre admission
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4
Q

Social History

A
  • Prior level of function / current level of function
  • Living situation
  • Occupation
  • Social Support / Assistance
  • Pain level
  • Use of assistive device
  • Other barriers
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5
Q

History - Hospital Course

A
  • Surgical / Medical Course (Date & Type of surgery)
  • Ventilatory status
  • ICU stay
  • Current Medications
  • Pain control
  • EKG
  • Radiology
  • Ultrasound
  • Events during admission
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6
Q

Hospital lab info includes

A
  • CBC
  • Electrolytes levels
  • Cardiac enzymes - Tropononins (increase when have heart attack)
  • Cath, stress tests
  • Current symptoms / complaints
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7
Q

PICC Line

A
  • 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
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8
Q

Arteria Line

A
  • Call nurse if you see blood
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9
Q

Ventilator

A
  • Oropharyngeal 8 to 10 days
  • can move a ventilator patient if they are awake and alert
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10
Q

Chest tube

A
  • 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
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11
Q

Accessory use for breathing

A
  • SCM, scalenens, pecs, lats, traps
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12
Q

Breathing Rates

A

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

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13
Q

Pattern of Breathing - Normal excursion

A
  • Symmetrical
  • Inspiration: Expiration - 1: 2
  • No accessory muscle recruitment
  • NAD - no apparent distress
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14
Q

Pattern of Breathing - Abdominal Paradoxical Breathing

A
  • Negative pressure created secondary to obstructive disease
  • Diaphragm flattens → barrel chested
  • Abdominal moves inward, upper chest moves outward with inspiration
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15
Q

Pattern of Breathing - Upper Chest Paradoxical Breathing

A
  • Diaphragm contracts, abdominal and accessory muscles do not
  • Common in SCI below C5
  • Outward motion of abdomen, inward motion of upper chest with inspiration
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16
Q

Pattern of Breathing - Tripod Breathing

A
  • Anterior lean, elbows on table / elbows on knees
  • Accessory muscle use → largest recruitment pattern
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17
Q

Pattern of Breathing - Respiratory Distress

A
  • Accessory muscle use
  • Tachypnea → RR > 20
  • SOB
  • Cyanosis
  • Pursed lip breathing
  • Nasal flaring
  • Change in metal status
  • Apnea – breathing starts and stops (sleep apnea)
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18
Q

Body Type - Cachexia

A
  • Muscle loss / wasting
  • May or may not include loss of fat
  • Seen in chronic, progressive disease
  • Lack of appetite
  • Fatigue
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19
Q

Chest type: Normal Dimension

A
  • Thoracic cavity is elliptical in shape
  • Anterior - Posterior: Lateral Diameter → 1:2
  • Angulation of ribs is < 90 degrees
  • Ribs articulate posteriorly at 45 degrees
20
Q

Chest type: Barrel Chest

A
  • Angulation of ribs > 90 degrees
  • Ribs articulate posteriorly at < 45 degrees → more horizontal
  • Increased AP Diameter (ex – 1:1)
  • Common in COPD patients
21
Q

Chest Type: Pectus Excavatum

A
  • Depressed sternum
  • Funnel chest
22
Q

Chest Type: Pectus carinatum

A
  • Protruding sternum
  • Pigeon Chest
23
Q

Flail chest

A
  • chest moves inward with inspiration
  • due to broken ribs
24
Q

Kyphosis

A
  • Exaggerated thoracic curve
25
Q

Scoliosis

A
  • Curve can impact efficiency of respiratory musculature
26
Q

Systems Review: Neck

A
  • Lines: Typically a central line
  • JVD: Jugular venous distention
    a. Indicates right sided heart failure
    b. Assessed in sitting with neck turned
    c. Positive Test → vein distended above level of clavicle
  • Tracheal Deviations: ipsilateral and contralateral shifts
27
Q

Digital Clubbing

A
  • Widening and flattening of the nail bed secondary to pulmonary illness
    a. Hypoxemia secondary to poor gas exchange ( Occurs with CF, COPD, etc)
  • Angle between nail and distal phalange decreases
  • Distorted angle of nail bed
28
Q

Skin Integrity

A

i. Incision sites, coloring, ulcerations (venous vs. arterial)
ii. Capillary refill – rate blood fills capillaries
1. Normal – less than 2 seconds
2. Evaluated by having hands above heart level and testing blanching
3. Can indicate dehydration
iii. Edema (Pitting vs. Non-pitting)
IV. Cyanosis (Central vs. Pereipheral)

29
Q

Pitting Edema Grading (by the time skin takes to rebound)

A

1+ : slight depression
2+ : less than 15 seconds
3+ : 15-30 seconds
4+ : more than 30 seconds

30
Q

Central cyanosis

A
  • Problem with heart or lungs
  • R to L shunt ( irregular blood flow)
  • Hypoxemia < 85%
  • Blue lips
31
Q

Peripheral Cyanosis

A
  • Decreased cardiac output
  • Poor blood flow to the extremity
  • Blue finger tips
32
Q

Level of Consciousness

A

a. Alert and Oriented x4
i. Name, place, date, reason for admission
b. Sedated or interactive
c. Agitation level
d. Fatigue
e. Comatose
f. Richmond Agitation Sedation Scale (RASS)
i. 0 – normal; +4 – combative; -5 – unresponsive

33
Q

Heart rate

A
  • can be evaluated at carotide, brachial, radial, precordium (over heart)
  • If patient has an abnormal rate or rhythm (such as in atrial fibrillation), use auscultate precordium
    technique – monitor for 30s and x2
  • HR Parameters
    i. Normal – 60 – 99
    ii. Tachycardic > 99
    iii. Bradycardic < 60
34
Q

Blood Pressure - Non-invasive BP

A

i. Assess brachial pulse – medial to the biceps tendon
ii. Choose appropriate cuff size and location – no lines on BP eval side
1. A small cuff size can lead to a false high; a large cuff size can lead to a false low
iii. Line indicator up with brachial artery
iv. Place stethoscope over artery and pump to 30mmHg above the systolic pressure
v. release valve and let run at a rate of 2mm Hg/s

35
Q

Blood Pressure - Arterial Doppler

A

i. Used for measure MAP – mean arterial pressure
ii. Use gel and ultra sound head to assess arterial pulse
iii. Record value when pulse is heard on doppler
iv. Used with patients who have non-pulsatile BP – VAD or CHF

36
Q

Blood Pressure

A

i. Normal
1. SBP – 90 – 120
2. DBP – 60 – 80
ii. Hypotension
1. SBP < 90
2. DBP < 60
iii. Pre-Hypertension
1. SBP – 120 – 139
2. DBP – 80 – 89
iv. Hypertension
1. SBP > 140
2. DBP > 90

37
Q

Respiratory rate

A

a. Normal → 12 – 20 breaths per minute
b. Tachypneic → more than 20 breaths per minute
c. Bradypneic → less than 12 beaths per minute

38
Q

Ankle Brachial Index / ABI

A
  • Used to evaluate and diagnose PAD (peripheral arterial disease)
    o Signs and symptoms → limb will feel colder + shiny/hairless
  • Assess with brachial pulse and posterior tibialis artery or dorsalis pedis
  • Assess R and L sides
  • Right ABI
    o HIGHER right ankle pressure/higher arm pressure
  • Left ABI
    o HIGHER left ankle pressure/higher arm pressure
  • Interpretation of ABI
    o >1.30 → noncompressible
    o 0.91 – 1.30 → normal
    o 0.41 – 0.90 → mild to moderate PAD
    o 0.0 – 0.40 → severe PAD
39
Q

Cardiac Auscultation - Aortic valve

A
  • 2nd intercostal space RSB
40
Q

Cardiac Auscultation - Pulmonic valve

A
  • 2nd intercostal space LSB
41
Q

Cardiac Auscultation - Tricuspid Valve

A
  • 4th to 5th intercostal space LSB
42
Q

Cardiac Auscultation - Mitral Valve

A
  • Midclavuciular line 5th intercostal space
  • PMI ( point of maximal impulse)
  • Can feel the strongest pulse
43
Q

S1

A

“Lub”
- Closing of the AV valves
- Loudest at cardiac apex
- Beginning of systole
- Auscultated with diaphragm of stethoscope

44
Q

What are the two components at S1

A
  • Tricuspid & Mitral closing
45
Q

S2

A

“dub”
- at the end of systole, just before diastole
- Closing of the semilunar valves
- Loudest at aortic & pulmonic
- The aortic and pulmonic valves close, stopping blood from flowing back into the ventricles

46
Q

S3

A
  • Gallop
  • ## Faint, early diastolic sound (Lub - Dub - pah)

Pulm (7 decks)

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