Cardiovascular and pulmonary screen

Question 1

Dyspnea

Answer 1

Difficult/unctrollable breathing

• often associated with chronic heart and lung disease
• Can be related to activity, exertion, or body position

Question 2

Dyspnea: oprthonea/recumbant

Eases and possible causes?

Answer 2

Eased when sit/stand/prop

Possible causes: CHF, mitral valve disease
Rarely: severe asthma, emphysema, chronic bronchitis, neurologic disease

Question 3

Dyspnea: Platypnea/sitting upright (difficult upright breathing)
Eases and possible causes?

Answer 3

Eased when recumbent

Possible causes: Postpneumonectomy, neurologic diseases, cirrhosis (intrapulmonary shunts), Hypovolemia

Question 4

Dyspnea: Trepopnea/Multiple

Eases and possible causes?

Answer 4

Eased in side lying

CHF

Question 5

Dyspnea Screening questions

Answer 5

When did the SOB begin?
Did SOB begin suddenly or over time?
Do you wake up suddenly at night with severe SOB (paryoxymal nocturnal dyspnea)?
Do you know why SOB started?
Is SOB constant?
SOB occur with exertion only? Or when certain positions?

Question 6

Cough

Answer 6

Pulmonary or CV concern
Nocturnal may indicate HF, side effects of medication

Chronic = 3 weeks or longer

most common causes: Smoking, allergies post nasal drip

Colors = possible pathology

Question 7

Cough Screening questions

Answer 7

What is the duration?
What is the cause?
Is it constant, persistent intermittent?
Is cough related to position or posture? 
Productive (color and odor?)
Is there pain? 
Associated symptoms?

Question 8

Palpitations

Answer 8

Described as fluttering jumping, poundings irregular skipping

Follow up questions about frequency and duration

Associated symptoms: Chest pain, syncope, lightheadedness, dyspnea

Question 9

Syncope

Answer 9

Fainting

Sudden loss of consciousness - loss of postural tone - spontaneous recovery

Causes: Reduced blood flow to brain, metabolic or psychogenic origin

Increased > 70 years old increased fall risk

Question 10

Sweats/Diaphoresis

Answer 10

Common with acute myocardial infarction
Pain/tightness into L UE jaw, neck, epigastric, mid-thoracic regions

Diaphoresis + described pain pattern = increased concern

Elevated concern if risk factors for cardiac disease (personally or family)

Question 11

Edema Cold Distal Extremities/ Skin Discoloration

Answer 11

Peripheral edema and tissue changes 
Observed at any point during assessment 
Associated with many serious pathologies 
- venous insufficiency
- congestive HF
- DVT
- Pulmonary hypertension

Question 12

Edema Screening Questions

Answer 12

What was the onset of the edema?
Is it related to dependent limb position?
Is it related to time of day? - morning vs end of day?
Any other associated symptoms or signs

Question 13

Edema Cold Distal Extremities/ Skin Discoloration

Answer 13

Confirmation via palpation and/or observation of limb

Findings: Pitting edema, local tenderness, altered skin temperature, color variance, circumferential measurements for edema
- unilateral edema marked difference 1+cm above ankle or 2 cm at mid calf

Question 14

Open woulds/Ulcers

Answer 14

Vascular compromise
Diabetes
Infections
Skin Cancer

Question 15

Clubbing of nails

Answer 15

Distal phalanx appears rounded and bulbous

Nail plate is convex shaped

Abnormality associated with

• Chronic hypoxia
• Lung Cancer
• Cystic fibrosis
• Congenital heart defects
• Graves Disease
• Overactive thyroid

Question 16

Wheezing/Stridor

Answer 16

Abnormal respiratory sounds
Audible to ear
- Wheezing is high pitched, due to partial airway obstruction
- Stridor is high pitched due to obstruction of larynx or trachea

Additional signs of general and pulmonary distress

Auscultation to ID sounds, check if positions change sounds

Question 17

What screening questions do you ask for Wheezing/Stridor?

Answer 17

Have you noticed this noise?Do you know why the sounds exists?
How long has it been present?
How often does it occur?
What are the precipitating factors? (odors, food animals, exertion, emotions?
Any associated symptoms?

Question 18

What are symptoms of HTN?

Answer 18

facial flushing
Headaches
Altered vision
Dizziness
Nosebleeds
SOB
Chest pain
Unsteady, "rubbery" legs
Feeling faint, syncope

Question 19

What are the BP readings for Stage 1, 2, and HTN crisis?

Answer 19

• Stage 1: 130-139/<60
• Stage 2: >140/ >90
• HTN Crisis: >180/ >120

Question 20

What can untreated HTN lead to?

Answer 20

CVA
MI
CHF
PVD
Renal Failure
Neuropathy
Retinopathy

“Silent killer”

Question 21

Orthostatic Hypotension Symptoms

Answer 21

Lightheadedness
Unsteady “rubbery legs”
Feeling “Faint”, syncope

Question 22

Orthostatic Hypotension management

Answer 22

Sit or lie down
Ankle Pumps
Notify Medical personnel as needed
Discontinue/modify standing activities

Question 23

Atherosclerosis Risk Factors

Age, Fam history, Cigarette smoking, Physical activity

Answer 23

Men > 45 Women > 55

Fam history: Myocardial infarction, coronary revascularization, Sudden death before: 55 in father, 65 in mother or 1st degree relative for both

Current smoker or recently quit (within previous 6 months)

PA: <90min/wk mod intensity or <150 min/week light intensity

Question 24

Atherosclerosis Risk Factors

Obesity, HTN, Dyslipidemia, Diabetes

Answer 24

Obesity: BMI > 30 kg/m2

HTN: Systolid >140mmHg and/or diastolic > 90mmHg on BP based on an avg of >1 readings obtained on >2 occasions or taking HTN medications

Dyslipidemia: LDL > 130 or HDL <40mg/Dl

Diabetes: Fasting plasma glucose >126 mg/dL

Question 25

CHF Symptoms

Answer 25

Increased fluid retention
Weight gain
Dependent pitting edema
Increased fatigue with activity 
Distention of the jugular veins

Question 26

CHF management

Answer 26

Pharmaceutical intervention
Dietary modifications
Healthy lifestyle
Regular medical assessment/follow up