Cardioresp Assessment Flashcards
What are the components of a cardiorespiratory subjective history? (11)
HPI PMH (resp, CV, other conditions, hx of ventilation or intubation) Meds Alcohol or tobacco use Social/Family Hx Occupation Cardioresp symptoms Pain Prior treatment Labs Chief Concern
What are cardioresp symptoms to ask about in subjective history?
SOB - at rest, at night, activity level, sleeping position and # of pillows?
Wheezing
Coughing/sputum - strong, productive, colour and consistency
Orthopnea
Chest pain - area, on exertion
Presence of angina equivalents - jaw pain, SOB, dizziness, nausea, light headedness, diaphoresis
Nausea
Syncope
What are things to look for when assessing circulation through inspection?
Skin colour - discolouration of distal extremity/nail bed; blue = decreased blood flow; red = ++ inflammation
Hair distribution - patchy can = arterial insufficiency
Varicose veins
Edema - b/l peripheral edema can be R sided heart failure - can be from trauma, lymphatic obstruction or venous insufficiency
Cellulitis
Petechiae
Skin lesions
Digital clubbing - poor arterial oxygenation or circulation
What are things to look for/do when palpating around the surgical area?
Temperature (cool = dec circulation, hot = infection?)
Homan’s sign
Allen’s test - compress radial and ulnar artery with 3 digits and pt clenches and unclenches fist 10 times; release ulnar (or radial) artery and see how long cap refill takes (more than 6s = positive)
Elevation pallor - for presence of arterial insufficiency or occlusion, elevate limb 30-40° for 15-60s and note colour changes (severe = pallor <25s; mod = pallor 45-60s; mild = pallor 40-60s). normally colour shouldn’t change
Cap refill - normal is less than 2s
What is the order for donning and doffing PPE?
Donning: sanitize, gown, mask, eye protection, gloves
Doffing: gloves, gown, sanitize, goggles, mask, sanitize
What are you looking for in the observation component of Inspection (IPPA)?
Head and neck - cyanosis, nasal flaring, PLB, use of accessory muscles, JVD; Thorax - indrawing, shape (barrel, pigeon, funnel), spinal deformity (scoliosis, kyphosis); Abdomen - scars, rigidity; Extremities - clubbing, edema, colour, vascularity (cap refill), muscle wasting; General Impression - respiratory distress, anxiety/confusion
What are you looking for in the mechanism of ventilation component of Inspection (IPPA)?
Breathing pattern - apical, diaphragmatic, lateral costal (diaphragmatic >70%; lateral costal <30%); Ratio of Inspiration:Expiration - normal = 1:2 or 1:3, obstructive = 1:4 or more (air trapping) restrictive = 1:1 rapid shallow breathing; Depth
What are you looking for in the thoracic AROM component of Inspection (IPPA)?
Flexion, extension, SF and rotation of thoracic spine
What are you looking for in the cough/huff component of Inspection (IPPA)?
Demonstrate cough into tissue (ensure strong double barrel cough - educate if not)
Look for: strength, productive, wet/dry, colour of sputum (pink/white frothy - pulmonary edema; yellow - mucopurulent (infection); green - purulent (infection)
What are possible findings for tactile fremitus?
No vibration = hyper inflated or fluid (above fluid will have vibrations)
Vibration = air filled
Increased vibration = consolidation
What are the 7 components of palpation? (IPPA)
1) Tracheal alignment
2) Areas of pain/tenderness
3) Chest wall expansion
4) Diaphragmatic excursion
5) Jugular Vein Pulse
6) Peripheral Artery Pulses
7) Tactile Fremitus
What are the possible findings for percussion?
Dull = high density tissue (i.e. pleural effusion, pneumonia, consolidation, atelectasis) Resonant = air filled Hyper-resonant = hollow (pneumothorax, hyperinflation)
What are adventitious lung sounds and their meaning?
Wheezes: High pitched = bronchospasm; Low pitched = secretions in the U/A
Crackles: Coarse = pulmonary edema or secretions in the lower airway; Fine = atelectasis (inspiratory) or pulmonary fibrosis (inspiratory/expiratory + fluid in airways)
Stridor: upper airway obstruction, heard on inspiration - emergency
Pleural Rub: fluid in the pleural space
Crunches: subcutaneous emphysema
What are the 2 voice sounds and their meaning?
Egophany - changes from E to A indicate consolidation or compressed lung tissue (increased density)
Whispered Pectoriloquy - if phrase is audible = increased density/consolidation
What are the components of informed consent for cardiac rehab?
Explanation and purpose
Risks of test - fainting, discomfort, exacerbation of symptoms, SOB
Benefits - info on safe exercise prescription, baseline, RTW info
Patient Responsibilities - health hx disclosure, prior symptoms, meds
Freedom of Choice - free to stop at any point
