CV exam & assessment

Question 1

what are some things you want to chart review on your patient before seeing them in the hospital?

Answer 1

orders/precautions/restrictions
medications
medical events/procedures
consulted vs. primary providers
imaging
vitals
labs
pain
prior documentation - baseline/tolerance of PT
other discipline documentation
prior hospitalizations
nursing mobility

Question 2

once you enter the patient’s room, what are some things you want to visually inspect?

Answer 2

A&O
body type
posture
positioning
skin
external monitoring/support equipment
facial characteristics
appearance of extremities

Question 3

what is jugular venous distension?

Answer 3

visible internal jugular vein swelling above the level of the clavicle when pt is in semi-Fowler’s position (45deg HOB) - can see it more on the right side

Question 4

what does jugular venous distension indicate?

Answer 4

increased venous volume and R sided heart dysfunction

Question 5

components of peripheral vascular exam:
1. pulse
– _____ matters
2. temperature
– indicative of _____
3. pain
– helps differentiate ___ vs ____
4. circulation
– (3) things

Answer 5

– location
– perfusion
– CV vs MSK pain
– diaphoresis, edema, capillary refill

Question 6

edema scale:
– 1+ =
– 2+ =
– 3+ =
– 4+ =

Answer 6

– 2 mm depression, immediate rebound
– 4 mm deep pit, few seconds to rebound
– 6 mm deep pit, 10-12 sec. to rebound
– 8 mm very deep pit, >20 sec to rebound

Question 7

how do you test capillary refill?

Answer 7

1. elevate foot or hand above heart level
2. press into nail bed until it turns white
3. release pressure and record length of time until return to original color

Question 8

normal capillary refill time:
vascular abnormality capillary refill time:

Answer 8

< 2 sec
> 2 sec

Question 9

what are two ways to test for intermittent claudication?

Answer 9

> 50 heel raises
OR
continuous treadmill walking
record time to onset of limb pain and monitor ankle SBP every 2 minutes

Question 10

normal response to intermittent claudication tests:
abnormal response:

Answer 10

• ankle SBP should rise and return to baseline after >/= 2 minutes of exercise
• > 22 mmHg drop

Question 11

what does the rubor dependency test test for?

Answer 11

arterial insufficiency

Question 12

how do you conduct the rubor dependency test?

Answer 12

1. elevate foot above the head for 2 minutes
2. place foot suddenly in dependent position and time how long it takes foot to return to normal color

Question 13

rubor dependency test findings:
< 15 sec:
15-30 sec:
30-60 sec:
> 60 sec.

Answer 13

• normal
• moderate arterial insufficiency
• marked arterial insufficiency
• extreme disease

Question 14

what do you listen for during a vascular bruit assessment?

Answer 14

abnormal sound generated by turbulent blood flow in an artery, most often caused by an obstruction (narrowing or arterial plaque buildup)

Question 15

how do you perform a vascular bruit assessment?

Answer 15

1. locate artery and place stethoscope diaphragm over the most superficial portion
2. ask patient to momentarily hold their breath
3. listen for blowing, sloshing or rushing sound (aka bruit)

Question 16

DVT:
– a common type of ____
– S&S
– typically occurs in ____
– dislodging the clot can lead to an acute ____

Answer 16

– venous thromboembolism (VTE)
– pain, tenderness, swelling, warmth, redness
– lower extremity
– pulmonary embolism (PE)

Question 17

what is the role of PTs in managing a VTE?
- _____ VTE
- assess LE & UE for ____
- contribute in decision making regarding _____
- ___ patients
- ____ long term consequences of DVT or PE

Answer 17

• prevent
• DVT or PE
• initiation of safe mobility for patients with VTE
• educate
• prevent

Question 18

what is action statement #1 of the VTE CPG?

Answer 18

advocate for mobility and physical activity
- inc. physical activity dec. likelihood of VTE but doens’t define how much activity is required

Question 19

what is action statement #2 of the VTE CPG?

Answer 19

screen your patients for VTE risk
- helps identify who would benefit from further info on risk reduction
- if we know risk factors, we can better identify those patients who are at risk

Question 20

what is action statement #3 of the VTE CPG?

Answer 20

if pt has conditions that independently increase risk of VTE (active cancer, thrombophilia, clotting disorders, acute COVID-19) PTs should take preventative measures

Question 21

what is action statement #4 of the VTE CPG?
- educate on?

Answer 21

for high risk VTE patients, provide preventative measures & education
- S&S, inc. physical activity, hydration, mechanical compression when indicated, referral for medical treatment

Question 22

what is action statement #5 of the VTE CPG?

Answer 22

take action when S&S are present for LE DVT
- S&S: unilateral pain, tenderness, swelling, warmth, discoloration

Question 23

what is the most standardized screening tool to predict the likelihood of LE DVT?
– scoring system:

Answer 23

the Wells Criteria
- >/= 2 points –> DVT “likely”
- < 2 points –> DVT “unlikely”

Question 24

what is action statement #6 of the VTE CPG?

Answer 24

take action when S&S present for UE DVT
- S&S: unilateral swelling, pain, edema, cyanosis, dilation of superficial veins

Question 25

in the presence of an indwelling central venous catheter, what is the patient at increased risk for?

Answer 25

UE DVT

Question 26

what is the screening tool to predict an UE DVT?

Answer 26

Constans Criteria

Question 27

what is action statement #7 of the VTE CPG?

Answer 27

take action when S&S present for PE
- S&S: dyspnea, chest pain, presyncope or syncope, hemoptysis

Question 28

what screening tool is used to predict presence of PE?

Answer 28

Geneva Score

Question 29

what are you assessing in your mobility assessment?

Answer 29

1. activity tolerance - know normal & your patient’s normal
2. angina vs. post-surgical pain vs. sensation loss diminishing pain response
3. ability to maintain precautions or restrictions - sternal precautions, NWB for vascular wounds

Question 30

what piece on your stethoscope is best for hearing:
– normal sounds
– abnormal sounds

Answer 30

– diaphragm (wide part)
– bell (narrow part)

Question 31

locations for assessing heart valve auscultation:
– aortic:
– pulmonary:
– tricuspid:
– mitral:

Answer 31

– 2nd R intercostal space at sternal border
– 2nd L intercostal space at sternal border
– 4th or 5th L intercostal space at sternal border
– 5th L intercostal space at mid-clavicular line

Question 32

what is happening during the S1 heart sound?

Answer 32

closure of AV valves
start of ventricular systole

Question 33

what is happening during the S2 heart sound?

Answer 33

closure of SL valves
start of ventricular diastole

Question 34

if you hear a S3 heart sound, what is that indicative of?
– normal or abnormal?

Answer 34

abnormal (“lub-dub-dub”)
indicative of ventricular dysfunction in heart failure
heard after S2

Question 35

if you hear a S4 heart sound, what is that indicative of?
– normal or abnormal?

Answer 35

abnormal (“la-lub-dub”)
indicative of resistance to ventricular filling
heard before S1

Question 36

what 3 things cause heart murmurs?

Answer 36

1. abnormally high rates of flow through valves
2. flow through stenotic valve or into an over-dilated chamber
3. backwards flow through insufficient valve

Question 37

what is the most common heart murmur?
- heard between which heart sounds?

Answer 37

systolic murmur
heard between S1 and S2

Question 38

what type of murmur is heard immediately after S2?

Answer 38

diastolic murmur