Checkout 1 Flashcards
Stethoscope Diaphragm
-high frequency sounds
Stethoscope Bell
-low frequency sounds
S1
-first heart sound (higher frequency)
-closure of M1 and T1
-best heard in Mitral Area
S2
-second heart sound (lower frequency)
-closure of semilunar valves valves
-best heard in Aortic Area
Aortic Area
-right sternal border
-2nd intercostal space
-S2 best heard
Pulmonic Area
-left sternal border
-2nd intercostal space
Tricuspid Area
-left sternal border
-4th intercostal space
Mitral Area
-left side under nipple
-apex of heart
-5th intercostal space
-S1, S3, S4 best heard
Apical Pulse
Listen to apex of heart for 1 min
S3
-could be abnormal (heart failure, late diastole) or normal (pregnancy/children)
-extra heart sound after S2
-“kenTUCKy”
-caused by rapid filling of ventricle
-listen with bell @ apex
S4
-always abnormal (HTN, MI, atrial kick of blood into stiff ventricle diastolic bad)
-right before S1
-gallop
Respiratory Cycle
Inspiration: 1/3, faster and louder
Expiration: 2/3, slower and softer
Vesicular Breath Sounds
-most of lung area
-inspiratory longer than expiatory
-soft
Brocho-Vesicular Breath Sounds
-near midline around upper spine and sternum
-inspiratory equal expiatory
Bronchial Breath Sounds
-above manubrium
-loud
-inspiratory shorter than expiatory
Lung Auscultation Areas
2 for each lobe
-anterior right (apical, upper,middle,lower(basal)),
-anterior left (apical, upper, lingua, lower(basal)
-posterior: apical, upper, superior lower, basal
Lung Ascultation Checkout Steps
- Explain (I’m going to be usuing this stethescope to listen to your lungs and see how well they are working)
- Position them properly
- Drapes for modesty
- Listen to front and back
Heart Ascultation Checkout
- Explain (I’m going to be usuing this stethescope to listen to your heart and see how well it’s working)
- Position them properly
- Drapes for modesty
- Listen to A, P, T, M switching stethiscope to bell for apical, S3 and S4
Patient Position
-feet on floor
-back support
-measured in both arms
-remove shirt/sleeve
-arm level with RA
-sleeve an inch above cubital fossa
BP Steps
- Explain procedure
- Determine cuff size
- Drape appropriately
- Positions Patient Properly
- take radial pulse for 60s (deflate at 2mmHg/sec if >60 or 2mmHg/bear if <60bpm)
- Palpate radial pulse and inflate cuff until pulse disappears
- re-inflate cuff 30mmHg above previous pressure
- deflate at 2mmHg/sec if >60 or 2mmHg/beat if <60bpm
Patient Postition Options
Standing:
Supine:
Sitting: Arm at right atria
Pulses to Find
-Brachial: medial elbow crease
-Radial: under thumb
-Abdominal Aorta: left of belly button
-Femoral: Crease of leg
-Popliteal: behind knee
-Posterior Tibial: Behind med malleolus
-Dorsalis pedis: midfoot, btwn big and 2nd toe
Pulse Grading
0: absent
1+: faint
2+: dimished
3+: normal
4+: Bounding
Bruit Check
-check for swishiing sound from vascular pathology
-Check: Carotid, bachial, ab aorta, femoral
Pulses Assessment Checkout
- Explain (I will be checking your pulses today to see how hard your heart is working)
- Drape (I will be using this cover to maintain your privacy while i check your pulses
- Palpate and grade
- Asculate large arteries
Venous Insufficinecy S/S
-moist skin, swelling, discoloration
-allieviated with elevation
-aggrevated when legs down
Signs of Deep Vein Thombosis
-Unilateral cramping, unilateral signs of inflammation (red, heat, pain, swelling)
Phlebitis Examination
-meauring thigh or calf for a bilateral increase in size, heat, pain, redness,
-feet standing a foot apart
-significant if measuring 1.5 (male) or 1.2 (female) difference in size
Lowenberg Cuff Test
-wrap cuff around uppe calf below knee
-inflate grradually to 80mmHg and ask about discomfort
-discomfort with <40 is abnormal (do both)
Venous Filling Time
-use a pen to mark superficial veins of foot
-elevate feet and do ankle pumps at 60 degrees for 1-2 mins
-sit patient up and time venous refilling
-12-20s
Arterial Insufficiency S/S
-cyanosis, paleness, coldness, lack of hair
-alleiviated with feet down
-agrrevated with feet elevated
Buerger’s Test
-elevate ONE leg to 45 degrees for 3 minutes
-return to sitting and watch as the skin turns blue and then red
-should take 1-2 minutes forr the color to be equal
Capillary Nail Refill test
-have patients hold hand above heart
-apply pressure to nail bed until white
-release until redness returns
-2 seconds
->2s sign of dehydration, shock, peripheral artery disease
Performance Test Checkoff
- Explain Procedure
- Take vitals (HR, lung, heart)
- Put gait belt on patient
- Set up test
- Demonstrate test to patient
- Stay near Pt
- Do post test vitals
- Interpret test
Timed Up and Go
-balance assessment, fall risk
-time it takes from standing to sitting
-Take vitals (HR, lung, heart)
-patient stands from chair without using the arms
-walks to the cone 3m away
-comes back and sits down
2x
-12s or more
10m Walking Test
-detect frailty and speed
-cones 10m apart and 2m and 8m
-Take vitals (HR, lung, heart)
-have Pt walk and only measure 6m
-can do fastest possible w/o running
-find m/s and average each score
3x
6min Walk Test
-endurance, vo2, speed
-30 meters (20m if not possible)
-Take vitals (HR, lung, heart)
-place cones and count laps for 6 minutes (measure the distance from cone for last)
5 Times Sit to Stand
-Take vitals (HR, lung, heart)
-sit in chair and cross arms over chest
-stand and sit 5 times as quickly as possible
->15s bad
30 Second Sit to Stand
-leg endurance, fall risk
-Take vitals (HR, lung, heart)
-sit in chair and cross arms over chest
-stand and sit as quickly as possible in 30s
-<13.6 disability, 15 cutoff for falling
2 Minute Walk Test
-endurance, speed, post surgical
-10-15 meters
-Take vitals (HR, lung, heart)
-place cones and count laps for 2 minutes (measure the distance from cone for last)
2 Minute Step Test
-functional abilities, stairs
-Take vitals (HR, lung, heart)
-Pt facing wall
-measure iliac crest to patella and put it against the wall
-go halfway and instruct Pt to step with both legs as fast as possible for 2 minutes
-measure how often the right knee passes line
-can use chair for balance
-<65 steps lower functional ability
Chair Step Test
-endurance, if standing is a barrier
-measure resting HR
-tape 6 (2.3 MET), 12 (2.9MET, and 18 (3.5) inches of tape on a wall
-have patient in chair full extension away from wall
-have them tap to the beat of of 60bpm for 3 min each round
-take HR each round
