Cardiovascular, pulm and urinary Flashcards
what should be on your checklist if you suspect Cardiovascular and Pulmonary Systems?
- Dyspnea
- Cough (duration, positional, productive, sputum)
- Palpitations
- Syncope
- Sweats
- Edema
- Cold distal extremities
- Skin discoloration
- Open wounds/ulcers
- Clubbing of the nails
- Wheezing, stridor
what is Dyspnea
difficult/uncomfortable breathing
•Often associated with chronic heart and lung disease
•Can be related to activity, exertion, or body position
what are the types os dyspnea and casues ?
Type of Positional Dyspnea/ Position of Difficulty and causes
Orthopnea/Recumbent (eased when sit/stand/prop)
Congestive heart failure
Mitral valve disease
Rarely: Severe asthma, Emphysema, Chronic bronchitis Neurologic diseases
Platypnea/Sitting Upright (eased when recumbent) Status postpneumonectomy Neurologic diseases Cirrhosis (intrapulmonary shunts) Hypovolemia
Trepopnea/Multiple (eased in side-lying)
Congestive heart failure
SOmeone presents with difficulty breathing as you gather a subjective exam, what are screening questions?
Dyspnea – Screening Questions
When did the shortness of breath (SOB) begin?
Did the SOB begin suddenly or slowly over time?
Do you wake up suddenly at night with severe SOB (paroxysmal nocturnal dyspnea)?
Do you know why the SOB started?
Is the SOB constant?
Does SOB occur with exertion only? At rest? Or when in certain positions, such as lying flat (orthopnea) or when sitting up (platypnea)?
A patient has a cough, what systems are involved? what are types of coughs?
Cough – pulmonary or cardiovascular concern
•Nocturnal may indicate heart failure, side effect of medications
•Chronic if 3 weeks or longer
•Most common causes: smoking, allergies, postnasal drip
•Yellow, red/bloody, green sputum suggest pathology
Someone presents with a cough as you gather a subjective exam, what are screening questions?
Screening Questions
What is the duration?
What is the cause (from the patient’s perspective)?XIs it constant and persistent or intermittent?
Is the cough related to position or posture?
Is it a productive cough (including color and odor of sputum)?
Is there pain accompanying the cough?
Associated symptoms (dyspnea, items from the general health checklist)?
what are Palpitations? what are associated symptoms and what types of follow Qs should you ask ?
- Described as “fluttering, jumping, pounding, irregular, skipping”
- Follow-up questions about frequency and duration
- Associated symptoms: chest pain, syncope, lightheadedness, dyspnea
what is Syncope?
- Sudden loss of consciousness > loss of postural tone > spontaneous recovery
- Causes: reduced blood flow to brain, metabolic or psychogenic origin
- Increase k
who is at a greater risk for syncope ?
> 70yrs…increased fall risk
what is Diaphoresis? when is a concern?
- sweating
•Common with acute myocardial infarction
•Pain/tightness into L UE, jaw, neck, epigastric, midthoracic regions
•Diaphoresis + described pain pattern = increased concern
•Elevated concern if risk factors for cardiac disease
You notice edema, cold distal extremities and or skin discoloration, what are associated pathologies with these?
Associated with many serious pathologies:•Venous insufficiency
•Congestive heart failure
•Deep vein thrombosis (DVT)
•Pulmonary hypertension
what are screening Qs you would ask for edema, cold distal extremities and or skin discoloration?
What was the onset of the edema (slow versus fast)?
Is it related to dependent limb position? (sitting in office)
Is it related to time of day—morning versus end of the day?
Are there any other associated symptoms or signs, e.g., pain, cyanosis, jaundice, redness of the limb(s), clubbing of the nails, cough?
what can you do in objective exam to confirm edema?
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 by difference of 1+cm above ankle or 2+cm at midcalf
-make sure you can replicate measurement location
open wounds or ulcers may be indicative of:
- Vascular compromise
- Diabetes
- Infections
- Skin cancer
Clubbing of the Nails may be associated with:
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
what are the differences and definitions of Wheezing and Stridor
- Abnormal respiratory sounds
- Audible to ear
- Wheezing is high-pitched noise, due to partial airway obstruction
- Stridor is high-pitched sound due to obstruction of larynx or trachea
- Additional signs of general and pulmonary distress
- Auscultation to identify sounds, see if position change affects sounds
what are screening Qs for Wheezing and Stridor?
Have you noticed this noise? Do you know why the sound exists? How long has it been present? How often does it occur? What are the precipitating factors (e.g., odors, food, animals, exertion, emotions)? Are there any associated symptoms?
what are symtoms of HTN?
- Facial flushing
- Headaches
- Altered vision
- Dizziness
- Nosebleeds
- Shortness of breath
- Chest pain
- Unsteady, “rubbery” legs
- Feeling “faint”, syncope
what happens if HTN is left untreated
Untreated, can lead to CVA, MI, CHF, PVD, renal failure, neuropathy, retinopathy…. “silent killer”.
Orthostatic Hypotension Symptoms?
- Lightheadedness
- Unsteady, “rubbery” legs
- Feeling “faint”, syncope
Orthostatic Hypotension mgmt?
Management •Sit or lie down •Ankle pumps •Notify medical personnel as needed •Discontinue/modify standing activities
how can you screen for Atherosclerosis ?
age, fam hx cig smoking inactivity obesity HTN dislipisemia DM
what are Symptoms and mgmt for congestive heart failure
Symptoms •Increased fluid retention •Weight gain •Dependent pitting edema •Increased fatigue with activity •Distention of the jugular veins
Management •Pharmaceutical intervention •Dietary modifications •Healthy lifestyle •Regular medical assessment/follow-up
