cp exam 1/20 Flashcards
what age child treat BP same as adult?
13
what is mean arterial pressure?
Normal values?
arterial pressure in large arteries over time,
- depends on mean blood flow and arterial compliance
- normal 70-110mmHg
normal RR
- adult
- child
- newborn
adult 12-20 breaths/min
- child 20-30 breaths/min
- newborn 30-40 breaths/min
tachypnea
RR >=22 breaths/min
bradypnea
<=10 breaths/min
hyperpnea
increased depth and rate of breath
dyspnea
- on exertion
SOB
- SOB brought on by exercise or activity
dyspnea
- orthopnea
SOB i reclining or supine position
dyspnea
- paroxysmal nocturnal dyspnea
sudden inability breath during sleep
how to rate dyspnea?
lowest?
highest?
severe?
Borg dyspnea scale
low 0-10 highest
severe 5
normal O2 sat
95-100%
hypoxemia O2
<90%,
PaO2 60 mmHg
hypoxia
anoxia
low O2 level in tissue
no oxygen in O2
symptoms:
- diffuse, retrosternal pain
sensation tightness, achiness in chest
dyspnea
sweating
indigestion
dizziness, syncope
anxiety
ischemic cardiac pain - angina or MI
symptoms in women
- indegestion or gaslike pain
- dizziness, nausea
- unexplained weakness, fatigue
- discomfort or pain between shoulder blades
- recurring chest discomfot
- sense impending doom
ischemic cardiac pain - angina or MI
how to rate angina pain
- light, barely noticeable
- moderate bothersome
- most severe pain ever
1+
2+
4+
where can cardiac pain refer?
- shoulders
back
arm
neck, jaw
where can dissecting aortic aneurysm pain refer?
- back
diaphoresis associated with
+/- CO?
decreased CO
PAD associated with
+/- arterial pulses?
where to start exam?
decreased or absent pulse
examine bilateral start most distal
dependent rubor with what condition?
PAD
nail clubbing associated with what conditions?
- enlarged soft tissue at base of nails
- chronic O2 deficiency, chronic pulmonary disease, heart failure
PAD trophic changes
pale, shiny, dry skin loss of hair
decreased temp
what pathology associated with? abnormal pigmentation ulceration dermatitis gangrene
PAD
what pathology?
pain, cramping, LE fatigue during exercise
relieved by rest
- can occur in calf, thigh, hip, buttock
- can have pain at rest w less arterial blood supply, typically forefoot at night
intermittent claudication associated w PAD
how to measure change in volume of irregular body parts (can’t use measuring tape)
volumeter
edema grade?
mild, barely perceptible
<1/4 inch pitting
1+
edema grade?
moderate, easily identified depression
returns within 15 sec
1/4-1/2in
2+
edema grade?
very severe depression lasts >30 sec
>1 inch pitting
4+
causes of peripheral edema?
chronic venous insufficiecy
lymphedema
bilateral - CHF
which to test first - venous or arterial circulation?
venous, may invalidate some arterial tests
what test is this? why?
- pt standing, palpate one segment vein while percussing vein 20 cm higher
- if pulse wave felt by lower hand then intervening valves are incompetent
percussion test
competence of greater saphenous vein
what test is this? why?
- pt supine with legs elevated 60deg to empty venous blood
- tourniquet placed proximal thigh, occludes venous flow in superficial vein
- patient stands
- note if vein fill in normal pattern, approx 30 sec
trendelenburg test, retrograde filling test
- competence of communicating veins, saphenous system
what test is this? why?
- pt supine, passively elevate LE 45deg for 1 min
- place in dependent position
- observe time for veins to refill
- if >15sec then what?
venous filling time
- time to refill veins after emptying
- > 15 sec refill indicates venous insufficiency
what test is this? why?
- pneumatic device cuff placed around calf, attached to pressure transducer and microprocessor
- occlude venous return, allow arterial inflow
- record increasing volume w cuff and time to return to baseline w cuff delflation
- compare times in sitting, standing, up on toes
air plethysmography APG
- measure patency of venous system (open, unobstructed)
- measure volume
ABI test- measure what arteries
brachial, post tib, dorsalis pedis
ABI normal value?
borderline?
1-1.40
0.91-0.99 borderline
ABI - clinically sig change?
clin sig change >0.15 or
>0.1 in pt with symptoms
ABI <=0.5 means
severe arterial disease
risk for critical limb ischemia
may have pain at rest
what test? why?
elevate foot, then sit with foot hanging (dependent position)
observe chnage in skin color
rubor of dependency
- > 30sec for change indicates arterial insufficiency
- insufficiency - pallor when elevated, reactive hyperemia in dependent position
possible causes of leg cramps?
intermittent claudications, PAD
diuretic use
hypokalemia
what imaging to get info about lymph flow?
lymphangiography lymphoscintigraphy (xray)
what diagnostic imaging? show abnormalities of lung fluid overall cardiac shape and size possible cardiomegaly aneurysm
chest xray
what diagnostic imaging?
- diagnose, evaluate ischemic heart disease
- myocardial infarction
- identify myocardial blood flow, areas of stress-inducted ischemia, old infarcts
myocardial perfusion imaging
what diagnostic imaging?
non invasive test uses ultrasound
assess internal structures- size of chambers, wall thickness, EF, valve movement, septum, abnormal wall movement
echocardiogram
what diagnostic test?
insert catheter through vessels to R side heart
measures ventral venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure
swan ganz catheter
central line
what diagnostic test?
3D image of heart to examine
coronary arteris, aorta, pericardium, myocardium
cardiac MRI
what enzyme test for myocardial infarction
- troponin I or T along with symptom
(ischemia, new ST change on ECG, pathological Q waves on ECG, myocardial wall motion abnormality on imaging, intracoronary thrombus) - elevated CK (serum creatine kinase) or CPK (creatine phosphokinase)
