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
What are 11 risk factors for cardiovascular disease?
Age (>45 men, >55 female)
Family Hx - sudden death, MI or coronary revascularization
Physical activity level
Obesity (BMI >30, waist circumference >102 male, >88 in female)
Pre-diabetes
Dyslipedemia (LDL >130, HDL < 40, on statins, total cholesterol >200)
Hypertension
Stress/psychosocial
Smoker (current, quit within 6 months, second hand)
Alcohol consumption (>14/week male, >9 per week female)
Diet
What is the risk classification for exercise pre-screening?
High risk - symptomatic or known diseases
Mod risk - >2 CV risk factors
Low risk - < 2 CV risk factors
What are the criteria to terminate exercise or exercise testing? (10)
1) Request to stop exercise
2) Failure of heart rate to increase with increased exercise intensity
3) Onset of angina or angina like symptoms
4) Drop in systolic BP of >10 from baseline despite increased workload
5) Systolic BP >250 or diastolic >115
6) SOB, wheezing, cramping in LL, claudication
7) Noticeable change in heart rhythm
8) Signs of poor perfusion
9) Severe fatigue
10) Faulty equipment
What are FITT guidelines for aerobic and resistance exercise?
Aerobic: F - 3-5x/week I - 60-85% HR max (high risk 50-75%) T - 75min vigorous, 150min moderate T - brisk walk, stairs, bike riding, aquatics Resistance: F - 2-4x/week (non consecutive) I - 60-85% 1RM or 5-7/10 RPE T - 8-12 reps, 3 sets T - free weights, calisthenics, bands
What are exercise considerations/education areas?
Progress sets/reps before intensity Rest periods between sessions Stop if experiencing symptoms Educate on how to monitor symptoms Exercise with supervision, partner or have cell phone
