cradioplum - 9 PT test and measures (my notes) Flashcards
1
Q
angina pain scale
A
used to grade the severity of angina
1-4
1 least amount of pain
4 severe pain
2
Q
what is the ankle brachial index (ABI)
A
compares systolic BP in the ankle and the arm
checking for peri artery disease
3
Q
what is the procedure for ABI
A
systolic BP in measured in both bra hial arteries and tib post artery
4
Q
how do we calculate ABI
A
divide the higher of the 2 BP in the ankle by the higher of the of the 2 BPs in the arm
5
Q
how do we interpret ABI
A
> 1.4 indicates rigid art and a need for an ultrasound to check for PAD
1.0 - 1.4 normal no blockage
.8 - .99 mild block
.4 - .79 moderate block - claudication w/ exercise
<.4 severe block - claudication at rest
6
Q
manuel arterial BP sounds
A
systolic - first sound you hear
diastolic - no more sounds
7
Q
what is considered a normal BP
A
120/80
8
Q
what is considered a elevated BP
A
120-129
<80
9
Q
what is considered a stage 1 HTN
A
130 -39
80-89
10
Q
what is considered a stage 2 HTN
A
> 140
> 90
11
Q
what is considered a stage 3 HTN
A
> 180
> 120
12
Q
when listening to heart sound the bell should be placed over what
A
bare skin
13
Q
how should the pt breath what listening to heart sounds
A
quite breathing
14
Q
S1
A
closing of the mitrial and tricupid valves
start of systole
lub
15
Q
what is systole
A
contraction of the ventricles
causes injection of blood into the pulmonary and aortic branches
16
Q
S2
A
dud
the aortic and pulmonary valves closing
the end of systole
17
Q
what is diastole
A
when the heart relaxes and fills with blood
18
Q
S3
A
lub dub dub
indication of cardiomyopathy or CHF
heard in artial contraction
19
Q
is S3 heart sound normal in any population
A
yes children
20
Q
what is cardiomyopathy
A
any disorder that effecting the heart
21
Q
what is a S4 heart sound
A
la lub dub
indication of stiff or low complience contraction
22
Q
what is a mumur
A
Turbulence of blood flow through the heart
often 2/2 distruption of blood flow past a stenotic or regurgitant valve
blowing
23
Q
what is a Systolic murmur
A
Lub whoosh dub
o Aortic stenosis
24
Q
what is a diastolic murmur
A
Lub dub whoosh
o Aortic or pulmonic regurgitation and mitral stenosis
25
where do we listen for S2 heart sounds
aortic valves: at the R 2nd intercostal interspace
pulmonary valve: at the L 2nd intercostal interspace
26
where do we listen for S1 heart sounds
tricusipd valve: lower L sternal border of 4th and 5th ICS
mitrial: apex of the heart, 5th ICS midcalvicular line
27
what is the procedure for listening to heart sounds
pt supine - HOB 30deg
pt breathing normally
place the diaphram of the scope at the 4 places -listening for S1 and S2 sounds
28
S1 and S2 pitch and duration
S1: lower pitch w/ longer duration
S2: higher pitch w/ shorter duration
29
where do we feel the apical pulse
the 5th ICS midclavicular line
30
why do we care about the apical pulse
it is an accuratee measure of HR
31
abdominal aortic aneurysm palpation - procedure
pt supine, examiner facing the pt head and shoulders
PT places both fingertips on both sides of the abd - just above the belly button and to the left
press firmly down and palpate
32
what is a normal finding w/ AAA testing
pulse width 1 inch or 2 fingertips
33
what is a abnormal finding w/ AAA testing
wide pulsation (>4cm) or lateral pulsations
width is the more important finding
34
AAA ausultation procedure
pt supine w/ knees bent
PT standing to side
scope is place above and left ot the belly button
35
what is an abnormal fincindg for AAA ausultation
burits or swooshing sound
36
what is bruits sound
a whooshing sound indicating a narrowed artery
37
what is pitt edema a sign of
indication of chronic and prolonged swelling, where the fluid is not being held within the vascular system but rather spending time in the interstitial spaces
-
38
what is the procedure when looking at pitting edema
hold down for 15-30 secs
release
grade edema on rate of return and depth
39
what kind of edema time is an indication for HF
> 40secs
40
what is the procedure for LE and and UE limb circumference measuring
LE: measure circumference at the knee or the tibial tuberosity, then repeat the measurement 10cm above and below
UE: measure at the styloid process, then repeat above and below
41
what is the capillary refill test used for
to test the distal blood flow
blockage in the peri arterial system
PAD or HF
42
what is the procedure for the capillary refill test
pt seated with hands at the level of the heart (upper) or in long sitting (lower)
depress the nail the nail for 5 secs - over the big toe or the distal finger
look for the time for it to refill
43
for the capillary refill test what is the timing
finger > 3 secs
toe > 5 secs
44
what is purpose of carotid artery ausculation
screen for possible carotid art blockage
progressive vascular disease, HTN, or cardiac disease along with symptoms of lightheadedness or dizziness may require screening for carotid artery blockage.
45
what is the procedure for carotid artery ausculation
pt seated or supine w/ head slightly turned away from the examiner
place stethoscope site at each site and perform the next steps at each
pt inhales and exhales and then hold breath for 15 secs
listen following exhalation
46
what are the four places that we look at for carotid artery ausculation
base of jaw
base of neck
subclavian artery
carotid birfurcation
47
what are wee looking for w/ carotid artery ausculation
carotid, systolic bruit > a blowing or swishing sound
48
what is the procedure for a tracheal shift test
the examiner palpates the position of the trachea with the PT index finger
49
what is the purpose of the tracheal shift test
assess the presence for a tracheal shift
50
tracheal shift - away from the primary abnormality
mass effect of a pleural effusion
collapsed lung
intrathoracic mass
51
chest wall motion - purpose
looking for sym in the chest wall movement
52
chest wall motion - procedure
place the thumbs in the following positions
- anterior at the midsternum
- anterior at the xiphoid process
- posterior at the T8 level
53
anterior at the midsternum is test what part of the lungs
the upper lobe
54
anterior at the xiphoid process is tesing what part of the lungs
right middle lobe
left lingual
55
posterior at the T8 level is testing what part of the lungs
lower lobe moton
56
what is a normal finding for chest wall motion
3-5 cm expansion for midline
57
Chest wall motion - COPD
reduction in movement bilaterally
58
Chest wall motion - unilateral lung collapse
non sym movement
59
Chest wall motion - unilateral delay
PNA
atelectasis
post op guarding
poor chest wall muscle function
60
what is diaphragmatic motion test procedure
pt supine
PT places hands over the costal moargin and thumbs meeting at the xiphoid process
ask the pt to take a deep breath
the PT hand show move equally apart, with the diameter increasing by 2-3 inch
61
what is the purpose of diaphragmatic motion testing
assesses the integrity of the diaphragm to engage in insipiration
62
what does a postive diaphragmatic motion test look like
unequal or little movement
63
what is the purpose of looking at lung sounds
this is the process of listening to air pass through the brochilio tree and the aveoli
used to confirm chart findings, percussion and ot tacile findings, and a reassessment tool
64
in what part of the lung do lung sounds increase
in areas of increased density
65
what is the procedure for lungs sounds
pt sitting
pt is ask to perform a deep breath through the mounth at each location
move from head to tail
first place scope a left of C7 (post) and manubrium (ant)
listen at one location and then move across the midline
66
lung sound and the scapula
keep medial to the scapular border
67
lung sounds - bronchial and trachea
loud tubular sounds over the trachea and the manubrium
equal inspiration and expiration phase
pause is heard between inspiration and expirations
68
lung sounds - bronchovesicular
softer the bronchial
no pause between inspiration and expiration
69
what is bronchovesicular
Anterior chest: Between the first and second intercostal spaces on the side of the chest next to the sternum
Posterior chest: Between the shoulder blades
70
what is vesicular
sounds heard of the lung tissues
over most of both lungs.
People can hear them most easily below the second rib at the base of the lungs
71
lung sounds - vesicular
soft rustling sound over more of the peri lung field
inspiration is longer the expiration
72
Voice transmission test - purpose
used to see if there is a consolidation in the lungs
73
Voice transmission test - procedure
place scope over area that is more likely impact then do >
- epgophony: pt says E
- bronchophony: pt says 99
- whispered pectoriloquy: pt whispers
74
Voice transmission test - what is a positive epgophony test
hear A
75
Voice transmission test - what is a positive bronchophony test
when the sound is heard loud
76
Voice transmission test - what is a positive whispered pectoriloquy test
whisper is heard loudly
77
Voice transmission test - louder sounds
over areas of consolidation
78
Voice transmission test - softer sounds
heard over areas of hyperinflamation, like COPD
79
mediated percussion - purpose
eval chnages in lung density by the sound produced
80
mediated percussion - procedure
middle finger is placed on intercostal space
other hand pull middle finger back to strike it on the chest wall
81
mediated percussion - findings
resonant sounds
dull sound
tympanic sounds
82
mediated percussion - resonant sound
heard over normal lung tissue
loud, low pitch, hollow sounds that is long in duration
83
mediated percussion - dull sound
heard over dense tissue - such a consilation or tumor or mass
medium, high pitched, thud like sounds of medium duration
84
mediated percussion - tympanic sound
heard over a hyperinflated lung region
very loud, high pitch or muscial pitch of medium duration
85
tactile fremitus - purpose
palpable vibration of the chest wall transmitted from the phonating larynx and can be increased or decreased in specific locations based on tissue density in the region being palpated.
86
tactile fremitus - procedure
place palms or ulnar border of hand surface between the scapula and the SP
pt is asked to say 99
PT looks for bilateral difference
move down and do this again
87
tactile fremitus - positive finding
increased or decreased sound or fermitus in contralateral comparison
this warrents further investigation as the pt may have a consolidation or a poor ventilated area
88
when is postural drainage indicated
therapeutic technique that uses gravity and airflow to help drain mucus from the lungs
89
what is the procedure for postural drainage
start the treatment session by using auscultations to find the area of interest
use medical decices and med to decreased the thickness of the septum
put pt in postion
STOP to allow for cough
STOP after 3-5mins per lobe and ausulatate again
reapeat
90
postural drainage upper lobes
elevate HOB, supine
91
postural drainage mid lungs
supine 0-deg
92
postural drainage left lung
lay on right side
opposite for right lung
93
postural drainage inferior lobe
decrease HOB (EX: -30 deg)
94
chest percussion: purpose
aimed at loosening retained secretions when the pt is in a postural drainage position
95
chest vibration: when it used
used on exhalation
used in postural drainage position
used to clear secreations
96
chest vibration: procedure
hand over hand and vibrate over area of interest
97
teaching an effective cough
max inspiration w/ spinal extension and opening of the chest wall
max intrathoracic and intra-abdominal pressure w./ forward flexion while perfroming the cough
- pt may perform self abd thrust
orient pt to timing of these events
98
huff and cough technique - purpose
helps to loosen secretions and may induce a cough
good for post surgical pts
99
huff and cough technique - procedure
- sit up straight with chin tilted and mouth open
- take a slow deep breath to fill the lungs
- hold breath for 1-3 secs
- open mouth and force air out of your lungs w/ mouth open as if trying to fog up a mirror
- repeat this two more times
- follow with a strong cough
- do this cycle 4 -5 times
100
what is the active - what is the purpose
a series of manuvers performed by a pt used to emphasize independence in sercretion clearence
101
what is the purpose fo PBL
decreasing a patient’s symptoms of dyspnea, generally slow respiratory rate and decrease airway collapse in patients, especially those with COPD.
102
what are the indications for PBL
dyspnea
wheezing
slows the RR and may decrease airway collapse
103
what showed the PBL ratio by
1:2 progressed to 1:6
104
sniffing - indications
making sure the pt knows how it active the diaphragm
105
sniffing - procedure
place fingers below the xiphoid
sniff several times
observe the abd and the lower costal expansion with each sniff
have the pt progress with prolonging the sniff
106
diaphragmatic breathing - indication
hypoxemia
tachypnea
atelactsis
anxiety
other conditions w/ pulmonary weakness
107
what is the purpose of diaphragmatic breathing
improve the diaphragms involvement with inhalation
decrease chest breathing and increase belly breathing
108
diaphragmatic breathing - procedure
pt sitting or supine
place the dominent hand of the abd and other hand over the chest (mid sternal)
instruct the pt to take a deep breath through the nose - tell the to try to get the dominent hand to move
ND-hand: not moving
109
diaphragmatic breathing - muscle energy/ quick stretch when is it used
used when the pt is having a hard time activating the D or coordinating the movement
110
diaphragmatic breathing - muscle energy/ quick stretch procedure
prior to inspiration do a quick scoop up and under the thorax
instruct the pt to breath into your hand
111
lower costal expansion - purpose
also used for diaphram movement
112
lower costal expansion - procedure
belt or PT hand around the costal region
place hand over the pt anterior lateral rib cage
instruct pt to breath into hands
113
segmental breathing - purpose
encourages expansion of a specfic part of the lungs that has been under ventilated
prevents lung shut down or collaspe
114
segmental breathing - indications
assymetrical chest wall expansion with absence of breath sounds
localized consolidations
lung collapse
115
segmental breathing - procedure
PT overlays hand over are of interest
instruct pt to breath deeply through nose trying to direct air to this particular area
PT allows expansion in that area
pt hold breath for 2-3 secs at the end of inspiration, then exhale
have pt do this one their own as HEP
116
inspiration hold and stacked breathing - indications
poor ventilated areas
improve cough capabilities
hypoventilation, collasped lung, ineffective cough
117
inspiration holds - procedure
prolonged holding of breath at max inspiration
breath held for 2-3 secs and then exhale
118
Stacked breathing - procedure
series of deep breaths that build up on each other without expiration
each inspiration is held by a hold
