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CAPE: Med Cond 1 > Examination > Flashcards

Examination Flashcards

1
Q

(1) interview

A

History
Risk factor assessment
Description of usual activity (NYHA classification)
Medications and side effects
Pain/PMH/family hx/diet/MD/stress

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2
Q

(2) cardiac examination

A

Supine:
Vital signs
- ECG identification/interpretation
- HR
- RR
- SpO2 (check pleth and radial pulse!)
Surgical incisions
Lines and tubes
Pulse rate and quality
Blood pressure
Explain RPE scale to pt.

Seated:
Blood pressure
Pulse ox
Heart sounds
Other (pain, angina, JVD, breathing pattern)

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3
Q

Risk factor assessment

A

Modifiable vs. non-modifiable

Exposures
- What do you do for work?

Smoking history
- How much/when/still?
- positive reinforcement

Activity/exercise history
- Do you exercise?
- What activities do you participate in?

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4
Q

Modifiable risk factors

A

HTN
hypercholesterolemia
smoking
diabetes
physical inactivity
obesity
diet
other (stress, personality type, inflammation)

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5
Q

Non-modifiable risk factors

A

Age, sex, genetics, family history

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6
Q

NYHA Classification - Class 1

A

Limitation: mild

CVD present
No physical activity limitations
Ordinary activity does not cause undue fatigue, palpitation, dyspnea, or angina

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7
Q

NYHA Classification - Class 2

A

Limitation: mild

CVD present
Slight limitation of PA
Comfortable at rest
Ordinary PA results in fatigue, palpitation, dyspnea, or angina

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8
Q

NYHA Classification - Class 3

A

Limitation: moderate

CVD present
Marked limitation of PA
Comfortable at rest
Less than ordinary activity causes fatigue, palpitation, dyspnea, or angina

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9
Q

NYHA Classification - Class 4

A

Limitation: severe

CVD present
Inability to carry on any PA w/o discomfort
Symptoms of HF or angina present at rest
Discomfort increases w/ PA

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10
Q

MRC Breathlessness Scale - Grade 0

A

I only get breathless with strenuous exercise

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11
Q

MRC Breathlessness Scale - Grade 1

A

I get short of breath when hurrying on level ground or walking up a slight hill

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12
Q

MRC Breathlessness Scale - Grade 2

A

On level ground, I walk slower than people of the same age because of breathlessness, or I have to stop for breath when walking at my own pace on level ground

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13
Q

MRC Breathlessness Scale - Grade 3

A

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

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14
Q

MRC Breathlessness Scale - Grade 4

A

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

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15
Q

Pulse rate and quality

A

Indicates efficacy of circulation
Distinguish b/t pulse and HR
Can confirm accuracy of technology (pulse ox)

Quality
- 3+ = full, bounding
- 2+ = normal
- 1+ = weak, thready
- 0 = absent

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16
Q

Blood pressure

A

Normal: less than 120 and less than 80

Elevated: 120-129 and less than 80

HTN stage 1: 130-139 or 80-89

HTN stage 2: >/= 140 or >/=90

HTN crisis: higher than 180 and/or higher than 120

Avoid lines and tubes

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17
Q

MAP

A

MAP = DBP + 1/3 (SBP-DBP)
- normal: 70-110 mmHg
- prolonged <60 mmHg may result in organ ischemia

18
Q

Aortic heart sounds

A

2nd ICS; right sternal border

19
Q

Pulmonic heart sounds

A

2nd ICS; left sternal border

20
Q

Mitral heart sounds

A

5th ICS; left midclavicular line
Two steps up from xyphoid process; lateral

21
Q

Tricuspid heart sounds

A

4th or 5th ICS; left sternal border
Two steps up from xyphoid process; directly off of sternum

22
Q

Abnormal heart sounds

A

S3: HF (decompensated)
S4: MI; HTN

23
Q

Pulse oximetry

A

SpO2 > 89%

Inaccurate if weak or non-pulsatile or irregular pulse
- palpate pulse to confirm
- review pleth

Do not provide oxygen if SpO2 > 89%

24
Q

Modified Borg Scale

A

1 = very easy
3 = moderate
5 = hard
7 = very hard
10 = very, very hard

25
Q

(2) pulmonary examination

A

Supine:
ECG
Vitals (HR, BP)
Respiratory rate/I:E ratio
Pulse ox
Observe breathing pattern
Lines and tubes
Percussion

Seated:
BP
Pulse ox
Breath sounds
Palpation (including chest excursion and tactile fremitus)
MRC breathlessness scale

26
Q

I:E ratio

A

Normal: 1:2
Obstructive disease: >/= 1:3
Restrictive disease: 1:1

27
Q

Observe and describe breathing pattern

A

Comfortable vs distressed
Rapid, shallow
Abdominal paradox

Cheyne-Stokes (oscillation b/t apnea and tachypnea)

Kussmaul’s breathing (consistent very deep breathing at normal or increased rate)

28
Q

Areas of auscultation: breath sounds

A

3 anterior, 3 posterior, 1 lateral

Anterior:
RUL
RML –> below rib 4
RLL –> lateral

LUL
LLL –> below rib 6, lateral

Posterior:
Spine of scapula divides upper and lower R/L lobes

29
Q

Normal breath sounds: bronchial

A

Loud, high pitched, harsh
Heard over and around trachea
E > I

30
Q

Normal breath sounds: bronchovesicular

A

Heard around sternum, b/t scapula, anterior RUL

31
Q

Normal breath sounds: vesicular

A

Medium pitch and loudness
Heard over the majority lung periphery
I > E

32
Q

Abnormal breath sounds

A

Bronchial:
- Normal sound in abnormal place
- Indicates fluid filled areas

Diminished

Crackles
- air bubbling through fluid or secretions
- collapsed alveoli popping open

Wheezes
- difficulty forcing air out

33
Q

Audible breath sounds (no stethoscope)

A

Stridor
Grunting
Gurgling
Wheezing

34
Q

Palpation

A

Trachea position
Areas of chest pain
Hypertrophy/tenderness of accessory mm.
Chest wall shape and movement
Tactile fremitus

35
Q

Tactile fremitus

A

Caused by partial airway obstruction
- secretions in airway
- bronchoconstriction
- tumors

36
Q

SOB - Modified Borg Dyspnea Scale

A

1 = very slight
3 = moderate
5 = severe
7 = very severe
10 = maximal

37
Q

Endurance testing

A

6MWT
Step tests (seated)
Incremental shuttle walk test

38
Q

ABG normal values: pH

A

7.35-7.45

Changes due to increases/decreases in CO2/HCO3

39
Q

ABG normal values: PaCO2

A

35-45

Increases w/ hypoventilation

40
Q

ABG normal values: PaO2

A

80-100

41
Q

ABG normal values: HCO3

A

22-28

Balances CO2 to maintain ideal pH

CAPE: Med Cond 1 (5 decks)

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