Ch 7 Cardiovascular and Pulmonary Examination Flashcards
Cardiovascular and Pulmonary Examination
Cardiopulmonary
Assessment of vital signs
Baseline indicators of physiological status
Abnormal measures warrant immediate medical referral in some cases
Core Vital Signs
Collect baseline values for every new patient
Pulse
Respiration
Blood pressure
Used as objective measures throughout a course of treatment to indicate improvement or decline in health status
Heart Rate - Pulse
Number of times the heart contracts in a given period of time
Typically beats per minute (bpm)
Rhythm - Pulse
Regularity of contractions
Force - Pulse
Strength of left ventricle contraction
Indicates the volume of blood in the peripheral vessels
Pulse Rate
Normal adult: 60-100 bpm
Tachycardia: > 100 bpm
Bradycardia: < 60 bpm
Pulse rhythm
Regular: Typical intervals
Irregular: Variable intervals
Pulse Force
0: Absent
1+: Weak or diminished
2+: Normal
3+: Increased force
4+: Bounding
Thready: Weak force with rapid rate
What are the most common pulse points?
Carotid and radial artery
When should you monitor pulse?
Before, during, and after exercise
Respiration Rate (RR)
Number of times the chest rises and falls in a given period of time
Typically breaths per minute (breaths/min)
Respiration rhythm
Regularity of respiratory cycles
Respiration depth
Much less than the full capacity of the lungs to expand
RR Values
Normal adult: 12-20 breaths/min
Tachypnea: > 20 breaths/min
Bradypnea: < 12 breaths/min
Respiration rhythm Descriptors
Regular: Typical intervals
Irregular: Variable intervals
Respiration depth Descriptors
Deep: Very obvious chest rise and fall
Normal: Observable chest rise and fall
Shallow: Barely perceptible chest rise and fall
How do you assess respiration?
Observe chest rising and falling
Patient should be unaware
Common respiratory difficulties
Dyspnea: Short of breath
Orthopnea: Difficulty breathing while lying flat
Paroxysmal nocturnal dyspnea: Sudden dyspnea and orthopnea while sleeping
Apnea: Absence of breathing, often while sleeping
BP - Systole
Arterial pressure when the left ventricle contracts
BP - Diastole
Arterial pressure when the heart is at rest between contractions
How is BP indicated?
Indicated by systolic pressure/diastolic pressure
Measured in millimeters of mercury (mmHg)
Hypertension
Increased arterial wall tension leading to higher than normal blood pressure
Hypotension
Lower than normal blood pressure
Orthostatic hypotension
Rapid drop in blood pressure when changing positions
Normal BP
90/60 to 119/79 mmHg
Hypotension
< 90/60 mmHg
Hypertension
Prehypertension: 120/80 to 139/89 mmHg
Stage I hypertension: 140/90 to 159/99 mmHg
Stage II hypertension: ≥ 160/100 mmHg
Hypertensive crisis: ≥ 180/110 mmHg
Requires immediate medical attention
BP - Normal exercise response
Systolic pressure rises and levels off
Diastolic pressure rises by no more than 10 mmHg
Slight differences between arms
Temperature
Not a routine test
Abnormal core body temp may require medical attention
Normal: 98.6°F (37°C)
Assessment:
Oral
Tympanic membrane (ear)
Edema
Observable swelling from fluid accumulation, outside of joint capsules
Accumulates in interstitial spaces
Between cells, vessels, and other structures
Effusion
Fluid accumulation within a joint capsule or cavity
Injury or inflammation
Peripheral Edema
Most common sites observed in physical therapy are legs and feet
Pitting
Visible indentation remains when finger is pressed into area and removed
Nonpitting
No indentation remains when pressure is removed
Common Causes of Pitting Edema
Heart disease
Kidney and liver disease
Chronic venous insufficiency
Deep vein thrombosis
Immobilization and inactivity
Cerebrovascular accident
Spinal cord injury
Pitting Edema Assessment
Trace (1+): Slight indentation, skin rebounds quickly
Mild (2+): 0.0-0.6 cm indentation, skin rebounds in < 15 sec
Moderate (3+): 0.6-1.3 cm indentation, skin rebounds in 15-30 sec
Severe (4+): 1.3-2.5 cm indentation, skin rebounds in > 30 sec
Oxygen Saturation
Degree to which hemoglobin is bound to oxygen in circulating blood
Corresponds with many conditions that require hospital admission
Oxygen Saturation: Assessment
Measured via arterial blood gas (ABG) analysis or pulse oximetry
Normal: 97-99%
Cardiovascular/pulmonary disease: 90-95%
Oxygen levels measured below 88% at rest may require supplemental oxygen
Ankle-Brachial Index (ABI)
Identify the presence or severity of impaired arterial blood flow (ischemia) to extremities
Reduced blood flow can lead to peripheral arterial disease (PAD)
Risk factor for myocardial infarction (MI), stroke, or lower extremity wounds
Compares blood pressure measures taken from an arm and a leg
