CCE Flashcards
Acute MI/ Unstable Angina History
– Pain does not change with deep breath or change in position, but can increase with exertion. – Chest, jaw, arm pain/pressure can radiate or not. – Shortness of breath, dyspnea on exertion. – Nausea, vomiting, diaphoresis, ankle swelling.
Acute MI/ Unstable Angina PE
- CV exam (including heart exam, checking JVD, carotid pulses, bruit, peripheral pulses (radial and feet)
- check for peripheral edema
- lung exam
- abdominal exam
Acute MI/ Unstable Angina Findings
- troponin
- CXR
- ECG
- stress test
Acute MI/ Unstable Angina S&S
Chest pain travels to shoulder, arm, back, neck or jaw
- in center or L side of chest and lasts for more than a few minutes
- SOB, nausea, faint feeling, cold sweat, feel tired
- occur due to CAD -> rupture of atherosclerotic plaque
- risk factors: HTN, smoking, diabetes, lack of exercise, obesity, hypercholesterolemia, poor diet
Acute MI/ Unstable Angina Treatment
- Aspirin (immediate & long-term treatment)
- Nitroglycerin or opioids (help with chest pain)
- supplemental O2 (w/ low O2 levels and SOB)
- Angioplasty or thrombolysis
- Bypass surgery (with blockages of multiple coronary arteries & diabetes)
Aortic Dissection History
-Often complain of tearing, crushing pain shooting straight through to the back
– Long standing hypertension common.
Aortic Dissection PE
- CV exam (including heart exam, checking JVD, carotid pulses, bruit, peripheral pulses (radial and feet)
- check for peripheral edema
- lung exam
- abdominal exam
Aortic Dissection Findings
Widened mediastinum on CXR. Unequal peripheral pulses. S4 gallop.
Aortic Dissection S&S
- risk factors: aging, atherosclerosis, blunt trauma to chest, HTN
- sudden onset chest pain (sharp, stabbing, tearing, ripping) that can move to the back
- anxiety & feeling of doom; faint/dizzy; heavy sweating; pale skin; rapid, weak pulse; SOB & orthopnea
- weak pulse in one arm compared to other (also different BPs)
Aortic Dissection Treatment
- Surgery
- beta-blockers (treat HTN)
- strong pain relievers
Pulmonary Embolus/ DVT History
– Chest pain is usually pleuritic, shortness of breath with minimal exertion, sudden
onset, may or may not have cough/hemoptysis and low grade temperature but typically no temps over 101.
– Long air/car trip, +FHx miscarriage/CVA, Oral contraceptive use, smoker
-Dizziness/faint.
Pulmonary Embolus/ DVT PE
-CV exam (including heart exam, checking JVD, carotid pulses, bruit,
peripheral pulses (radial and feet)
-check for peripheral edema
-lung exam
-abdominal exam
Add calf tenderness, Homan’s sign, fever for SOB
-Homan’s sign not commonly used
-> pain in calf on forceful and abrupt dorsiflexion of pt’s foot at the ankle while the knee is extended
Pulmonary Embolus/ DVT Findings
CXR usually NORMAL, but can have atelectasis, pleural effusion. Lung sounds usually normal. Typically have tachycardia & tachypnea. May have hypotension or low O2 sat.
Pulmonary Embolus/ DVT S&S
- risk factors: stasis (extended travel or bed rest), hypercoagulability (estrogen, smoking, polycythemia, genetic, surgery), damage to vessel walls (prior DVT, trauma to lower leg)
- chest pain that worsens when taking a deep breath
- maybe cough/ hemoptysis
- SOB worsens w/ activity
Pulmonary Embolus/ DVT Treatment
- PREVENTION!
- anticoagulation (warfarin)
- thrombolytic therapy (tissue plasminogen activator/ tPA)
Congestive Heart Failure History
– Have shortness of breath and DOE. May or may not have cough with
pink frothy sputum (no frank hemoptysis), chest congestion, edema. Don’t usually have chest pain unless also having/recently had an MI.
– Usually have orthopnea, and feel better sitting up – ask them how many pillows they use to sleep with.
– May or may not have PND (paroxysmal nocturnal dyspnea), peripheral
edema.
Congestive Heart Failure PE
-CV exam (including heart exam, checking JVD, carotid pulses, bruit,
peripheral pulses (radial and feet)
-check for peripheral edema
-lung exam
-abdominal exam
Add calf tenderness, Homan’s sign, fever for SOB
-Homan’s sign not commonly used
-> pain in calf on forceful and abrupt dorsiflexion of pt’s foot at the ankle while the knee is extended
Congestive Heart Failure Findings
CXR with congestion and/or pleural effusion. High B natiuretic peptide. JVD, heart murmurs, peripheral edema. SOB with movement and position.
Congestive Heart Failure S&S
- risk factors: CAD, HTN, alc abuse, disorders of heart valves
- > L vent hypertrophy -> edema
- drugs/foods that cause sodium retention -> worsening of CHF (NSAIDs, diabetes meds, Ca channel blockers)
- Congested lungs
- > DOE, dyspnea at rest or lying flat
- Fluid/water retention
- > edema
- dizziness, fatigue, weakness
- rapid/irreg heartbeats
Congestive Heart Failure Treatment
- fluid restriction & decrease in salt intake
- > diuretics (furosemide/ Lasix)
- ACE inhibitors
- diet and exercise, stop smoking, control HTN/cholesterol/diabetes
COPD exacerbation History
Shortness of breath, DOE, wheezing, change in sputum color/frequency/amount.
– Smoking history, barrel chest, pursed lip breathing, prolonged expiratory phase.
Typically no fever, and diffusely decreased breath sounds with or without
wheezing. May have clubbing, cyanosis.
– Ask about occupational exposures.
COPD exacerbation PE
-CV exam (including heart exam, checking JVD, carotid pulses, bruit,
peripheral pulses (radial and feet)
-check for peripheral edema
-lung exam
-abdominal exam
Add calf tenderness, Homan’s sign, fever for SOB
-Homan’s sign not commonly used
-> pain in calf on forceful and abrupt dorsiflexion of pt’s foot at the ankle while the knee is extended
COPD exacerbation Findings
CXR: flattened diaphragms, rightward shifted heart.
- purulent exudate w/o PNA
- lung fxn test
- spirometry
COPD exacerbation S&S
-risk factors: SMOKING
COPD exacerbation Treatment
- Smoking cessation, avoid dust
- diet and exercise
- O2 therapy
- Inhaled bronchodilators
- Corticosteroids
Pneumonia History
Cough, fever (typically over 101), change in sputum color/frequency/amount.
– Pleuritic chest pain, shortness of breath, DOE, look/feel toxic.
– +/- hemoptysis
Pneumonia PE
-CV exam (including heart exam, checking JVD, carotid pulses, bruit,
peripheral pulses (radial and feet)
-check for peripheral edema
-lung exam
-abdominal exam
Add calf tenderness, Homan’s sign, fever for SOB
-Homan’s sign not commonly used
-> pain in calf on forceful and abrupt dorsiflexion of pt’s foot at the ankle while the knee is extended
Pneumonia Findings
Elevated WBC (infection). Order a CXR. Crackles on auscultation.
-mucus test
Pneumonia S&S
- cough w/ sputum (rusty, green, or tinged with blood)
- fever
- tachypnea, SOB, tachycardia
- shaking & chills
- chest pain, gets worse with cough, breathe in
- nausea/vom
- tired
Pneumonia Treatment
- antibiotics
- fever reducers
- cough meds
GERD, PUD, GI bleeding History
Onset, location and character of pain (gradual vs sudden, colicky/constant,
diffuse vs localized quadrant pain).
– Pain affected by movement, position change, exercise, eating (any particular foods make it better or worse), defecating, urinating?
- Nausea, vomiting
(hematemesis, coffee grounds emesis), black (melena) or bloody (hematochezia) stool, diarrhea or constipation, skin color change (jaundice), sweating, fever,
weight loss, shortness of breath, chest pain, bone pain, night sweats, alcohol use
- OTC over the counter use of NSAIDs? History of any abdominal surgeries?
Any change in urine/bowel habits?
GERD, PUD, GI bleeding PE
Cardiovascular exam (including heart exam, checking JVD, carotid pulses, bruit, peripheral pulses, and check for peripheral edema), lung, and abdominal exams. Examine the skin for signs of liver disease (jaundice, telangiectasia, asterixis, palmar erythema, Dupuytren’s contracture.
GERD, PUD, GI bleeding Findings
GERD:
- ambulatory pH probe test
- XR of upper digestive system
- endoscopy
- manometry
GERD, PUD, GI bleeding S&S
GERD:
-risk factors: obesity, hiatal hernia, preggers, smoking, asthma, diabetes, delayed stomach emptying
- heartburn, may spread to throat
- chest pain
- dysphagia
- dry cough/ sore throat
- acid reflux (regurgitation of food/liquid)
- lump in throat sensation
PUD:
-risk factors: use of NSAIDs, excessive alcohol intake, smoking, infected with H. pylori, have other illness
- burning pain in middle or upper stomach btwn meals
- bloating, heartburn, nausea/vom
- severe: dark/black stool (bleeding), vom blood, weight loss
GERD, PUD, GI bleeding Treatment
- antacids (neutralize stomach acid)
- H2 receptor blockers (reduce acid production)
- PPIs (block acid production & heal esophagus)
- surgery to reinforce or strengthen LES
-maintain healthy weight, avoid food/drink triggers, eat smaller meals, elevate head of bed, stop smoking
PUD:
- avoid triggers
- PPI, antibiotics
