Caridopulmonary Evaluation: Intro To Chest Radiographs Flashcards
What is the adult resting HR?
60-80 bpm
What is the adult resting BP?
SBP: 80-120
DBP 60-80
What is the adult resting O2?
97-100%
What is the child resting HR?
80-100 bpm
What is the child resting BP?
SBP: 80-100
DBP: 50-60
What is the child resting O2?
97-100%
What should we expect HR to do with exercise?
Increase. Amount is dependent on patient’s physical status
What changes in HR should you see as exercise begins, or intensity changes?
Quick increase at first, then steady increase then finally level off
What changes in BP should you see as exercise begins, or intensity changes?
SBP should increase and then level off, DBP should increase slightly or remain the same
What changes in O2 should you see as exercise begins, or intensity changes?
Should remain the same
What should you do at the beginning of every evaluation?
Get vital signs so you know what their normal is
What is the fourth vital sign?
Perceived exertion
What are some tools we can use for perceived exertion?
Borg rate of perceived exertion
Dyspnea scale
Talk test
What do HTN and CHF meds normally do?
Hypotension
What do anticoagulantes (blood thinners) normally do?
Always risk of hemorrhage
What should patients with angina always bring?
Nítrate
What do we need to consider with patients taking beta blockers?
HR is not an appropriate indicator of exercise tolerance
What can Ca+ channel blockers cause?
Hypotension
What could Ace inhibitors cause?
Allergic response
What should asthmatic patients bring to PT?
The it inhaler
What do patients on long term corticosteroids (COPD0 have risk of?
Decreased bone density
What are some fundamentals of a cardiopulmonary screen?
Assess patient’s PMH, not cardiopulmonary pathologies and frequency of complications/exacerbation
Keep in mind multiple risk factors (HTN, CAD, DM, ESRD, PVD, past surgeries)
Screen patients meds and keep a copy for reference
Check basic musculature, bony thorax, AROM
Check resting vitals
Check heart and breath sounds
Check exercising vitals as appropriate or as needed
When do we do endurance testing?
Whenever possible prior to exercise/walking
What are some endurance tests?
10 meter walk velocity test
Timed up and go
Six minute walk test
1 mile walk test
What is the point of endurance testing?
Give you quantitative measures for endurance goals, can use as a generic cardiopulmonary screening tool. Can be used to determine a patients endurance for a specific task
What are some general screening things to check?
Epigastric pain
SOB
Fatigue
Dizziness
Palpations
What are some cardiac red flags?
Pain or pressure in sub-ser al area, shoulder, UE, jaw, epigastric region
Pain or pressure with associated malaise, fever, chills, or change in heart sounds
Edema and/or rapid weight gain
Abnormal vital sign response to exercise
Moderate to extreme SOB with minimal exertion
What are some pulmonary red flags?
Persistent cough: productive or non-productive
Sudden onset of SOB, or no known etiology of SOB, but has persisted for several days
Thoracic cage pain
SOB, with or without thoracic pain, but also has malaise, fever, cough
Chest or back pain that is deep, nagging, and wakes the patient up at night
What percent of MIs are silent?
20-25%
What are some things to consider to differentiate chest pain?
Location of pain- general, localized, pinpoint
Changes with movement, coughing, deep breathing, valsalva maneuver
Constant/intermittent
Response to activity
Radiation to other areas
T/F: cardiac chest pain tends to be more localized and pinpoint
True
What kind of cardiac chest pain can we expect if it is related to ischemia?
Usually burning, pressure, cramping, and comes on with exertion and eases with rest
If pain doesn’t ease with rest and follows a certain pain location what can this normally be?
A heart attack
If pain is associated with breathing what generally is seen?
Usually increased with deep breathing, coughing, and decreased with leaning forward or sometimes side lying on that side that had pain
What chest pain is usually indicative of lung cancer?
Pain is usually very deep
Nagging or aching pain described
Does not change much with motion
SOB with all activity/exertion
Wakes pt up at night
May or may not have cough
What are some things to consider to differentiate back pain?
Constant/intermittent
Radiation to other areas
Changes with movement, valsalva maneuver
Neurologic involvement
Response to activity
What are cardiopulmonary causes of back pain?
Localized- typically scapular area either centrally or equal but not usually unilateral or uneven. Tends to be worse with deep breathing, coughing, trunk rotation and decreases with flex
What are some things to consider to differentiate LE pain?
Radiation from spine
Constant/intermittent
Response to activity and then to rest
Possible neuropathies
Sudden onset or more chronic
DVT- no Homan’s sign- not reliable (use clinical prediction rule)
what do we see in some cardiopulmonary causes of LE pain that are typically related to circulatory insufficiency?
Burning or cramping
Tends to be in the muscle belly, not a dermatomal pattern
Pain will typically come on with exertion and ease with rest
what do we see in some cardiopulmonary causes of LE pain that are typically related to a DVT?
Pain is usually sudden onset or over 1-2 days
Usually groin, popliteal fossa, or calf
Pain is “nagging” not neurologic description
What are some things to consider to differentiate shoulder or neck pain?
Sudden onset or more chronic
Location of pain- general, localized, pinpoint
Constant/ intermittent
Neurologic involvement
Response to ROM and activity
What are some cardiopulmonary causes of shoulder pain?
Tends to be post, bilateral scapula area
Usually if shoulder pain they will have chest and/or back pain too
If you see ipsilateral shoulder pain from a pulmonary condition, they’ll also have chest pain over area of lung issue
What are some signs of activity intolerance?
Chest pain
Increased cough or temperature
Increased dyspnea at rest
Altered mental status
Increasing weakness or fatigue
When should the patient seek medical attention?
Patient has anginal symptoms not relieved by nitrates (as prescribed)
Synocpal episode with irregular pulse
Recent weight gain with LE edema and dyspnea
New onset calf pain (DVT)
Sudden weakness and/or increased fatigue
Increase in HR or BP above acceptable ranges, without return to baseline after rest
Frequent asthma attacks or decreased effectiveness of inhalers
New onset of a feeling of palpations and yo palpate irregular pulse rate
Shoulder or spine pain that increases with coughing or deep breathing
Rapid HR with decreasing BP
What is the standard view of chest X-rays?
A-P
Lateral view
How does air appear on X-rays?
Dark gray or black
How do bones appear on X-rays?
Light gray, darker white
How does fluid appear on X-rays?
White
How does other soft tissue appear on X-rays?
Grayish
What are some features to look for on chest X-ray?
Clavicle height, rib positioning, costal cartilage or rib-eternal junction
Diaphragm position
Amount of air
Look for lines, EKG wire etc
What do we want to see with the diaphragm on a chest X-ray?
Nice dome shape
Costophrenic angle
Right side should be about 1cm higher than left
What is the costophrenic angle?
Where the diaphragm meets the chest wall at the lateral edge
