Cardiovascular / Pulmonary Care in the Acute Setting

Question 1

Vital signs tell us about the patient’s?

Answer 1

Vital signs tell us about the patient’s baseline health status.

• Objective measures used throughout course of intervention to determine improvement or decline in the health status.

Question 2

Core Vital Signs

Answer 2

• Heart Rate
• Respiratory Rate
• Blood Pressure (30 mmHg over occlusion test)
• Edema

(The Guide to PT practice states that recording the core vital signs is the very minimum assessment of the cardiovascular/pulmonary system on Every New Patient.)

Question 3

Normal blood pressure

Answer 3

Systolic = less that 120

and

Diastolic = less than 80

Question 4

Elevated blood pressure

Answer 4

Systolic = 120-129
and
Diastolic = less than 80

Question 5

High Blood Pressure blood pressure (Hypertension) Stage 1

Answer 5

Systolic = 130-139
or
Diastolic = less than 80-89

Question 6

High Blood Pressure blood pressure (Hypertension) Stage 2

Answer 6

Systolic = 140 or higher
or
Diastolic = 90 or higher

Question 7

Hypertension Crisis
(Consult doctor immediately)

Answer 7

Systolic = Higher than 180
and/or
Diastolic = Higher than 120

Question 8

Orthostatic hypotension is?

Answer 8

• Orthostatic hypotension is a condition in which your blood pressure suddenly drops when you stand up from a seated or lying position.
• An important part of fall risk assessments.

Question 9

Orthostatic Hypotension

3 positive for Orthostatic Hypotension, supine to sitting/standing:

Answer 9

• Positive: SBP decrease of 20 mmHg or more.
• Positive: DBP decrease of 10 mmHg or more.
• Positive: HR increase of 10 bpm or more.

1 min and 5 min

Question 10

Pitting Edema?

Answer 10

PT systems review

Question 13

Pitting Edema:

Descriptor = Trace 1+

Depth of Indentation = ?

Description/rebound time = ?

Answer 13

Descriptor = Trace 1+

Depth of Indentation = Slight

Description/rebound time = Barely perceptible indentation, Quick rebound

Question 13

Pitting Edema:

Descriptor = Mild 2+

Depth of Indentation = ?

Description/rebound time = ?

Answer 13

Descriptor = Mild 2+

Depth of Indentation = 0.0-0.6 cm

Description/rebound time = Easily identifiable indentation, skin rebounds <15 seconds.

Question 13

Other than the core vital signs, what are some of the screening tests (Cardiovascular & Pulmonary Systems).

Answer 13

• Temperature
• Oxygen saturation
• Peripheral arterial blood flow (pulse)
• Perceived exertional effort
• Walking effort/speed
• Pain

Taken in a relaxed envirment

Question 13

Pitting Edema:

Descriptor = Moderate 3+

Depth of Indentation = ?

Description/rebound time = ?

Answer 13

Descriptor = Moderate 3+

Depth of Indentation = 0.6-1.3 cm

Description/rebound time = Easily identifiable indentation, skin rebounds in 15-30 seconds.

Question 13

Pitting Edema:

Descriptor = Severe 4+

Depth of Indentation = ?

Description/rebound time = ?

Answer 13

Descriptor = Severe 4+

Depth of Indentation = 1.3-2.5 cm

Description/rebound time = Easily identifiable indentation, skin rebounds in>30 seconds

Question 14

Describe the 4-Point Pulse Scale.

Answer 14

3+ and 4+ = abnormal

Question 15

Common cardiovascular/pulmonary health conditions requiring hospitalization?

Answer 15

• Acute Coronary Syndrome
• Rhythm and Conduction Disturbances
• Valve Disease
• Congestive Heart Failure
• Obstructive & Restrictive Pulmonary Conditions

Question 16

Acute Coronary Syndrome?

and common treatments.

Answer 16

• Myocardial oxygen deprivation causing angina (reported chest pain) and potentially tissue ischemia (.
• CAD (coronary artery disease)
• MI (myocardial infarction)

Common treatments:
PTCA = Percutaneous transluminal coronary angioplasty
stent =
CABG = Coronary artery bypass grafting

Question 17

What are some rhythm and conduction disturbances, and treatments.

Answer 17

• **Atrial fibrillation/flutter **= A-fib happens when the SA node isn’t functioning properly and instead, multiple electrical impulses are firing in a disorganized manner, throughout the atria. The problem is that most of these impulses are not strong enough to create an effective contraction to shunt blood to the ventricles.
• Arrhythmia = Irregular heartbeat, is a problem with the rate or rhythm of your heartbeat.
• Ventricular Tachycardia = Abnormal heart rhythm, or arrhythmia. It occurs when the ventricles beats too fast to pump well and the body doesn’t receive enough oxygenated blood.
• AV block = Electrical signal that controls your heartbeat is partially or completely blocked. This makes your heart beat slowly or skip beats and your heart can’t pump blood effectively.
• BBB =

Treatments:
* Pharmaceutical
* Pacemaker (PPM)
* Mobilize?
* DME?
* Defibrillator (ICD)

Question 18

Stenosis, regurgitation, and prolapse are related to?

Answer 18

Valve Disease

• Over time, pumping dysfunction
  can cause heart failure
• Valve Replacement Surgery =
• Sternotomy Precautions = If they had open heart surgery

Question 19

Congestive Heart Failure

Decrease in Cardiac Output (CO) usually caused by?

Answer 19

Cardiomyopathy

Question 20

Cardiomyopathy can be caused by?

Answer 20

• Weight gain =
• Dyspnea = difficult or labored breathing
• Orthopnea = difficulty breathing when lying flat
• Paroxysmal nocturnal dyspnea (PND) = severe shortness of air that awakens the person from sleep
• Tachypnea = rapid breathing >20 breaths per minute
• Cough =
• Fatigue =
• Cyanotic extremities = bluish discoloration caused by decreased oxygenated blood
• Peripheral edema =
• Decreased activity tolerance =

Question 21

Congestive Heart Failure

Left sided heart failure causes?

Answer 21

pulmonary congestion (backflow into the lungs)

Question 22

Congestive Heart Failure

Right sided heart failure causes?

Answer 22

systemic congestion (backflow into the entire body)

Question 23

Congestive Heart Failure

BNP - Lab value that determines?

Answer 23

• BNP-lab value that determines severity of CHF.

BNP is a hormone produced by the left ventricle that is elevated in heart failure.

Question 24

Examples of Obstructive/Restrictive Pulmonary Conditions?

Answer 24

• Pneumonia = an infection that affects one or both lungs. It causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus.
• COPD / emphysema = Emphysema is one of the diseases that comprises COPD (chronic obstructive pulmonary disease). Emphysema develops over time and involves the gradual damage of lung tissue, specifically the destruction of the alveoli (tiny air sacs).

ARDS **(adult respiratory distress syndrome) = Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs.

• VTE (venous thromboembolism) = enous thromboembolism (VTE) is a medical condition that occurs when a blood clot forms in a vein. VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE).

COPD = Chronic obstructive pulmonary disease

Question 25

Medical Diagnostic Testing

PFTs = ?

Answer 25

• Pulmonary function test

Question 26

Medical Diagnostic Testing

What testing is used to diagnose DVT?

Answer 26

• **Ultrasound **=
• INR = International normalised ratio (INR) blood test tells you how long it takes for your blood to clot.
• D-dimer = protein in bloodstream that is released if DVT is present as body tries to anticoagulate itself. D-Dimer is not found in bloodstream normally

Question 27

Medical Diagnostic Testing

What testing is used to diagnose to diagnose PE?

Answer 27

• V/Q scan = uses a small amount of a radioactive substance called a tracer that helps look for disease in the body.
• D-dimer = protein in bloodstream that is released if DVT is present as body tries to anticoagulate itself. D-Dimer is not found in bloodstream normally

Question 28

Activity Guidelines

(look at the back)

Answer 28

Question 29

Post Sternotomy Precautions

Answer 29

• No lifting over 10 pounds
• No pushing/pulling with arms
• No shoulder flexion over 90 degrees
• No shoulder horizontal abduction (behind plane of body)
• Heart Hugger vest for cough
• Pillow for splinting