Cardiopulmonary Words Flashcards
Lung Sounds
Bronchophony
Egophony
Whispering Pectoriloquy
Bronchophony: increased vocal resonance with greater clarity and loudness of spoken words (e.g. 99)
Egophony: A form of bronchophony in which the spoken long “E” sound changes to a long nasal-sounding “A”
Whispering pectoriloquy: recognition of whispered words 1,2,3
Vesicular Breath Sound
Normal: a soft rustling sound heard throughout all of inspiration, and the beginning of expiration
Bronchial Breath Sounds
Hollow echoing sound normally found over the R Superior anterior Thorax and corresponds with an ara over R main stem bronchus.
Heard through all of inspiration and most of expiration
Crackles (Rales, Crepitations)
a crackling sound heard usually during inspiration that indicates pathology
- atelectasis
- fibrosis
- pulmonary edema
- Basilar rales often accompany L ventricular HF
Adventitous breath sounds: Wheezes
high-pitched, sibilant, musical
asthma
Adventitous breath sounds: Rhonchi
- continuous low-pitched, sonorous breath sounds that are more prominent during INSPIRATION.
- air passing through narrrow airways
- Common with asthma and chronic bronchitis
Wheezes
Musically pitched sound, usually heard during Expiration, caused by airway obstruction
- asthma
- COPD
- foreign body aspiration
Pleural Friction Rub
- dry crackling sound heard during both inspiration and expiration
- occurs when inflamed visceral and parietal pleurae rub together
- heard over spot where pt feels the pain
- result of inflammatoin or neoplastic processes
Stridor Breath Sounds
continuous high-pitched wheeze hear with inspiration and expiration
indicates upper airway obstruction
Types of Dyspnea
DOE
Orthopnea
Paroxsysmal Nocturnal Dyspnea
Dyspnea Borg Scale
- DOE = brought on by activity
- Orthopnea = inability to breathe in horizontal pos
- Paroxsysmal Nocturnal Dyspnea = sudden inability to breathe during sleep
- Dyspnea Borg Scale = 0-10
Raynaud’s Phenomenon
- an abnormal vasoconstrictor reflex
- exacerbated by exposure to cold or emotional stress
- affects mostly females
- tips of fingers develop pallor and cyanosis
- numbness, tingling and burning
Karvonen’s Method of Calculating THR
- HRmax = 220 - age
- THR =
[.65\*(HR<sub>max</sub>- HR<sub>rest</sub>) + HR<sub>rest</sub>] [.90\*(HRmax - HRrest) + HRrest]
Atelectasis
- shrunken and airless state of lung, acute, chronic, complete or partial often w/ infection.
- Presents with
- p! on affected side,
- dyspnea,
- cyanosis,
- drop in blood pressure,
- tachycardia,
- diminished or absent breath sounds,
- dull or flat percussion,
- fever
- reduced chest excursion on affected side.
Hyperventilation
increased inspiration/expiration as the result of an increased rate/depth of respiration
-
results in depletion of CO2 (resp alkalosis) with accompanying symptoms
- fall in BP, vasoconstriction, sometimes syncope, marked anxiety and wrist cramping
- **immediate treatment = breathing into paper bag until CO2 returns to normal **
perfusion
volume of blood circulated through lungs
gravity dependent
*if pt has perfusion problems, treatment should occur with the involved side down*
Sputum
Substance expelled by coughing or clearing the throat
- Foul smell = anaerobic infection
- purulent (yellow/green) = infection
- frothy = pulmonary edema
- mucoid (clear, thick) = cystic fibrosis or chronic cough
- hemoptysis = blood in sputum
ambulatory electrocardiography
“Holter Monitoring” ECG electrodes are placed on the chest and attached to a small battery powered monitor and carried in a pocket or in a small pouch around the neck. 24-48 hours or longer to evaluate cardiac rhythm, efficacy of medications, pacemaker function, paired with diary of pt symptoms.
angiography
- radiologic examination of blood vessels injected with a contrast medium.
- part of coronary catheterization
- demonstrates location of plaques in coronary arteries and the extent of occlusion)
Bronchoscopy
- direct visualization of the bronchial tree
- diagnostic and therapeutic purposes
- bronchoscope is a fiberoptic instrument that transmits an image to video camera
- tumors, bronchitis, foreign bodies and bleeding
Carotid Ultrasound
- procedure uses sound waves to examine and visualize the structure and function of the carotid arteries.
- indicate risk of stroke and evaluate placement of stent after ECA
Grading Scale for Edema
- 1+ = mild, barely perceptible indentation,
- 2+ = mod, easily indentible; returns to normal within 15 seconds; 1/4-1/2 inch pitting
- 3+ = severe. depression takes 15-30 seconds to rebound; 1/2-1 inch depression
- 4+ = very severe depression lasts for >30 sec; >1 in pitting
Trendelenburg Test
(retrograde filling test)
Determines competence of communicating veins and saphenous system
- pt supine w/ legs elevated 60 deg
- tourniquet placed on prox thigh
- patient asked to stand
- examiner notes whether vein fills in normal pattern ~30 seconds
Ankle Brachial Index (ABI)
Ratio of LE/UE SBP pressures
- UE = Brachial, LE = Post Tib & dorsal pedis
- Pt rest for 5 min in supine
- BP cuff occludes flow temporarily, listen for return of flow.
- Clinically sig change in ABI is >.15 or >.10 in symptomatic
- Significance:
- >1.4 = non-compliant arteries
- 1.0-1.4 = NORMAL
- .91-.99 = borderline
-
<.5 = exercise may not be beneficial
*
Pulse Assessment
0 = absent
1 + = diminished
2+ = easily palpable, normal
3+ = full pulse, increased strength
4+ = bounding
Mean Arterial Pressure MAP
the arterial pressure within the large arteries over time.
MAP = (SBP+2*DBP)/3
Average= 70-110 mmHg
Oxygen Saturation Terms
Hypoxemia
Hypoxia
Anoxia
- Hypoxemia = low oxygen sat/paO2
- Hypoxia = low oxygen levels in tissues
- Anoxia = complete lack of oxygen
Normal HR
Adults/Teenagers
Children
Newborn:
Adults: 60-100 (40-60 in aerobically trained)
Children: 60-140bpm
Newborn: avg 127; normal 90-164 bpm
Diagnostic Tests: Chest X-Ray
- lung fluids
- overall cardiac shape/size (cardiomegaly)
- aneurysm
Diagnostic Tests: Myocardial Perfusion Imaging
- ischemic heart disease, MI
- identifies, myocardial blood flow, areas of stress induced ischemia, old infarcts
- Thallium-201 Scan: injected via IV, radio-isotopes concentrate in normal tissue but not in ischemic or infarcted tissue (cold spots)
Diagnostic Tests: Cardiac Catheterization
passage of tiny tube from brachial or femoral artery through aorta into blood vessels with contrast medium and subsequent x-ray of coronary arteries
_**Allows determination of Ejection Fraction**_
Diagnostic Tests: Central Line (swan-ganz catheter)
catheter inserted through R side of heart & measures:
- central venous pressure CVP
- pulmonary artery pressure PA
- pulmonary capillary wedge pressure (PWP
Signs of Myocardial Ischemia and Infarction
-
_ST Segment Depression _
- subendocardial ischemia
- digitalis toxicity
- hypokalemia
-
_ST Segment Elevation _
- earliest sign of acute transmural infarction
- benign early repolariz. in normal heart
- _Inverted T-waves _
