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Semester 5 PMCP Exam 3 > Exam and Eval 2 > Flashcards

Exam and Eval 2 Flashcards

1
Q

Cath, angio, ventriculo - procedure

A

insert catheter into brachial or femoral artery
pressures are measured
radiopaque contrast medium is injected followed and filmed

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2
Q

Electrophysiological mapping studies defines what

A

a specific area that may be initiating the arrhythmia by inducing it and attempting to restore the normal rhythm

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3
Q

When would elctrophysioloigcal mapping - what happens if the patient doesnt respond to antiarrhythmics

A

then ablation may be performed or ICD

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4
Q

Stress perfusion testing - usually done ___ on ___

A

upright on treadmill

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5
Q

Stress perfusion testing - what else can it be done with if patient can’t be on treadmill

A

bicycle

arm bike

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6
Q

Most common agents used for stress perfusion testing

if they can’t get them on treadmill or bike they can try to induce arrhythmia with these meds

A

Dipyridamole - VD
Adenosine - VD
Dobutamine - contraction of the heart

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7
Q

Indications for stress perfursion test

A 
Eval of chest pain
Determ severity of CAD
Eval surgical or med therapy or intervention
Eval arrhthmias
Eval HPTN with ex
Provide ex rx
Assess functional capacity
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8
Q

Stress perfusion testing involves systematically and progressively increaseing

A

O2 demand and evaluation responses to inc demand

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9
Q

Stress perfusion testing - when would you terminate

A 
patient asks you to 
light headed
color changes
HR rises more than age max
ECG change from baseline
Systolic not inc as it should
Drop of greater than 10 mmHg or more for one or both D and S then stop
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10
Q

Stress perfusion testing - what protocol is used

A

Bruce exercise test protocol

Balke exercise protocol

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11
Q

Pulmonary function tests - evaluation of

A

lung volumes and capacities, gas flow rates, diffusion, and gas distribution

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12
Q

Pulmonary function tests - pt can be classified into what three categories

A

Restrictive, obstructive, or combined

Also into low, moderate, or high immobility or disease

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13
Q

24 hour vitals

A

BP, O2, Urine, Temp, ECG, Pain

Look at how your patient has been throughout the day

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14
Q

Echocardiography uses what to evaluate the heart

A

reflected ultrasound

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15
Q

Echocardiography gives what

A

real time images of the heart

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16
Q

Echocardiography - we can obtain

A

size of ventricular cavity, thickness of septum, func of valves, motion of ventricular wall

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17
Q

Echocardiography can evaluate what problems

A 
Pericardial effusion
Cardiac Tamponade
Congestive cardiomyopathy
Regurgitation
Prolapse
Stenosis
Vegetation on valves
Masses
Thrombi
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18
Q

Echocardiography - is patient awake or under anesthesia

A

awake so they dont need bed rest after

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19
Q

Standard echocardiograpy is not helpful when

A

obestiy, pulm disease, chest deformities

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20
Q

Transesophageal Echocardiogram (TEE) - what is it good for

A

improved view of the back of the heart and mediastinum

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21
Q

CT scan identifies what

A

masses in the CV system or to detect aortic aneurysms or pericardial thickening associated with pericarditis

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22
Q

Common groups of meds - Anti angina

A

Ca channel blockers

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23
Q

Common groups of meds - anti arr

A

beta blockers, digoxin

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24
Q

Contraindications to exercise

A

look at them!!!

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25
Q

Physical exam - interview - mental status

A

ALERT
oriented to person, place, and time
Try to pull things off chart to assess this

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26
Q

Physical exam - interview - do they understand why you are there

A

tell them who you are and why you are there

know who ordered the eval

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27
Q

Physical exam - descritpion of present and previous sx

A 
be specific
chest discomfort
SOB
fatigue
palpitations 
light headedness
swelling
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28
Q

Resting exam - general appearance

A 
body type
facial expression
color
positioning
equipment
eval of neck (carotids and jug)
digital clubbing
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29
Q

Digital clubbing is often seen in who

A

someone who has had pulmonary dysfunction for a long time and who has had trouble with O2 sat

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30
Q

pectus excavatum could

A

press on the heart and lead to arr

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31
Q

kyphotic posture can lead to

A

SOB

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32
Q

Barrel chest associated with

A

pulmonary dysfunction

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33
Q

If they have R sided heart failure what can happen

A

R sided jugular distention

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34
Q

Resting exam - ribs

A

may be more flat or horizontal rather than angled down - barrel chest

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35
Q

Breathing pattern - resp rate should be between

A

12 and 20 breaths per minute at rest

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36
Q

Eupnea

A

describes normal breathing cycle

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37
Q

Apnea

A

a temporary halt in breathing

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38
Q

Tachypnea

A

rapid, shallow breathing pattern - indicator of resp distress

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39
Q

Dyspnea

A

sensation of SOB and s seen in cardiopulm disorders

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40
Q

Posture and Chest Wall Configuration - Resting

A

Symmetry and configuration (ant/post and trans diameters)
Pectus excavatum
Pectus carinatum
rib angles less than 90 degrees

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41
Q

Posture and Chest Wall Configuration - dynamic

A

mm used for resp
breathing rate
insp to exp - exp should be twice as long (1-4 sec is COPD)
Paradoxical breathing pattern - using abs to push air out

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42
Q

Auscultation to evaluate

A

breath sounds - normal, abnormal, adventitious
heart sounds
voice sounds

43
Q

Palpation includes

A

feeling for accessory muscle use

and normal palpation

44
Q

Mediate percussion allows therapist to assess

A

density of underlying organs

45
Q

Mediate percussion tones - resonant

A

loud or high amplitude
low pitched
longer duration
heard over the lungs

46
Q

Mediate percussion tones - resonant - where do we want to hear these

A

airy spots

47
Q

Mediate percussion tones - dull -

A

low amplitude
medium to high pitched
short duration
heard over solid organs like liver or diaphragm

48
Q

Mediate percussion is also used to determine

A

diaphragmatic excursion

49
Q

Mediate percussion tones - flat

A

high pitched
short duration
heard over mm mass such as thigh

50
Q

Mediate percussion tones - tympanic

A

high pitched
medium duration
heard over hollow structures like stomach

51
Q

Mediate percussion tones - hypperresonant

A 
very low pitched 
prolonged duration 
heard over tissue with dec density 
abnormal in adults 
heard over lungs with emphysema
52
Q

Mediate percussion - how is it done

A

Middle finger of ondominant hand is placed firmly on the chest wall in an intercostal space and parallel to the ribs
The top of the middle finger of dominant hand strikes the distal phalanx of the stationary hand with a quick, sharp movement

53
Q

Where do you do mediate percussion -

A

only on the back

54
Q

Diaphragmatic excursion assess

A

movement of the diaphragm

55
Q

Diaphragmatic excursion - how is it done

A

patient holds a deep breath, lowest level of diaphragm coincides with where a resonant tone is last heard
Pt exhales, technique is repeated
Lower area of resonance should move higher

56
Q

Diaphragmatic excursion - normal distance is

A

3 to 5 cm

57
Q

Diaphragmatic excursion - normal breathing diaphragm should be

A

a little higher
3-5 cm in a healthy person - less for COPD
Deep breath first and then normal breathing

58
Q

Chest wall and diaphragm - assess the amount of diaphragm used for quiet breathing - patient is

A

supine

equal and upward movement of the rib cage

59
Q

Chest wall and diaphragm - assess the amount of diaphragm used for quiet breathing - with deep inspiration, the hands should travel

A

2-3 inches apart

60
Q

Tracheal position - pleural effusion the trachea moves

A

away

61
Q

Tracheal position - atelectasis trachea moves

A

towards

62
Q

Dyspnea of phonation - scale from

A

0-4

63
Q

Dyspnea of phonation - 0

A

no dyspnea

64
Q

Dyspnea of phonation - 1

A

mild, noticeable

1 breath in 15 words

65
Q

Dyspnea of phonation - 2

A

mild, some difficulty, 2 breaths in 15 words

66
Q

Dyspnea of phonation - 3

A

moderate difficulty, 4 or more breaths in 15 words

67
Q

Dyspnea of phonation - 4

A

severe difficulty

cannot continue

68
Q

Modified medical research council dyspnea scale - 0

A

i only get breathless with strenuous exercise

69
Q

Modified medical research council dyspnea scale - 1

A

I get SOB when hurrying on level ground or walking up a slight hill

70
Q

Modified medical research council dyspnea scale - 2

A

on level ground, i walk slower then some people my age because of SOB

71
Q

Modified medical research council dyspnea scale - 3

A

I stop for breath after walking about 100 yards or aftr a few min on level ground

72
Q

Modified medical research council dyspnea scale - 4

A

am too breathless to leave the house or I am breathless when dressing

73
Q

Cough - what do we need to assess

A

Cough control
Cough quality
Presence of secretions
Sputum

74
Q

Cough - what do we need to assess - cough control

A

take a deep breath in, glottis closes, abdominals contract, and glottis opens to expel

75
Q

Cough - what do we need to assess - presence of secretions - what is normal

A

100mL a day (about a teaspoon)

76
Q

Cough - what do we need to assess - sputum

A

odor, color, how much

77
Q

Cough control - voluntary

A

you ask them to cough and they do

78
Q

Cough control - spontaneous

A

maybe from nasal drip or can be indicative of inc fluid in their system or pulm dysfunction or reflux
Reflex response to normal stimulus

79
Q

Cough control - reflex

A

associated with eating or drinking - maybe need to ask for speech therapy
Nervous cough or throat clearing
Beware of why they are coughing

80
Q

Cough quality

A

strong and effective (normal)

weak and ineffective (abnormal; reduced exp flow rate) - weak abdominal or resp mm

81
Q

Cough - Presence of secretions - wet and productive

A

Secretions are present

82
Q

Cough - Presence of secretions - wet and non productive

A

secretions retained

cough elicitation or suctioning necessary

83
Q

Cough - presence of secretions - dry and non productive

A

secretions absent

pulmonary fibrosis they aren’t coughing anything out

84
Q

Cough - Sputum - quantity

A

100 mL

85
Q

Cough - sputum - color - what do we want

A

we want clear

86
Q

Cough - sputum - color - gren

A

infection

87
Q

Cough - sputum - color - blood tinged

A

TB

Irritation

88
Q

Cough - sputum - color - frothy

A

heart failure

pulmonary edema

89
Q

Cough - sputum - color - dark red blood

A

pulmonary infarct

carcinoma

90
Q

Cough - sputum - tenacity is what -

A

thickness

91
Q

Cough - sputum - odor

A

infection

or from smoking

92
Q

Rubor dependency test - is looking at what

A

how fast your arteries fill

93
Q

Venous filling test is looking at what

A

the veins filling

94
Q

Trendelenberg test - looking at what

A

more extensive for circulation

apply tourniquet and see if saphenous fills

95
Q

Homans sign

A

assessing for possibel DVT - not very reliable though

96
Q

Angina scale - when do you stop acitivty

A

1

97
Q

Angina scale - 1 =

A

light, barely noticeable

98
Q

Rate of perceived exertion - where do we want our patients

A

12 or 13

99
Q

s/s of exercise intolerance

A 
Chest discomfort
Dyspnea
Dizziness
Syncope
Pallor
Change in facial expression
Level of fatigue
Nausea 
Change in mental status
Claurdication or otehr pain
S3 heart sounds
Sys over 200
Dias over 110 
HR 20 -30 beats above resting
100
Q

Warnign signs

A 
Low anginal threshold
Resting tachycardia
Excessive SOB
Slow recovery
Excessive fatigue lasting 1-2 hours after activity 
Inc arrhythmia 
Lack of HR or BP response
Pain
Fever over 100
Hgb at 9
101
Q

Community distance - need to walk

A

100-150 ft

102
Q

For every 1 day you lay in bed you lose how many days of strength

A

3

103
Q

Ejection fraction - with decreased LV function -

A

wont tolerate as much because of dec EF - as get down below 25% we may not even be working with them or if we are - just transfers

Semester 5 PMCP Exam 3 (6 decks)

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