Examination skills Flashcards
Orthostatic hypotension #s?
drop greater than 20bpm with a change in pos.
Procedure forOrthostatic hypotension?
♣ Rest 2-3 minutes supine
♣ Take baseline BP supine
♣ Take measurements sitting and standing
♣ Normal – slight decrease (less than 10) when standing
Cause of OH?
♣ Gravity –> blood pools –> baroreceptors –> brain centers increase HR and vasoconstrict BV
♣ Abrupt peripheral vasodilation w/o compensatory cardiac output
What to do for OH?
o Should put them in previous position –> do a different activity in that position –> try changing position later
ABI? how to perform?
♣ Pt must be supine for 10 minutes before measurements
♣ Measure systolic in both arms (brachial)
• Record 1st doppler sound as cuff is deflated
• Use highest of two arm pressures
♣ Measure systolic in both legs
• Record 1st Doppler sound as cuff is deflated
o Dorsalis pedis
o Posterior tibial
• Use highest ankle pressure for each leg
♣ Calculate ankle to brachial pressure (divide each ankle buy highest brachial)
Interpretation of ABI values?
Normal >.90
PAD
False negatives for ABI?
♣ Diabetes
• Vessels are poorly compressible
• Results in falsely elevated ankle pressure
• Heart Sounds
Heart sounds? Normal vs. Abnormal?
♣ Normal • S1: Lub = closure of atrioventricular valves • S2: Dub = closure of semilunar valves ♣ Abnormal Murmur- Woosh - valve problems • S3: lub Dub Dub - Heart failure S4: lub lub Dub
o auscultation of heart?
♣ Aortic valve: 2nd intercostal space on the right
♣ Pulmonic valve: 2nd intercostal space on the left
♣ Tricuspid valve: left inferior border of the sternum
♣ Bicuspid valve: mid-clavicular in 5th intercostal space
• Normal heart sound: lub-dub
• Abnormal heart sound: “whoosh”
• Lung Sounds
Lung sounds abnormal?
o Abnormal Sounds ♣ Wheeze during exhale • Caused airway narrowing • Asthma, COPD ♣ Crackle during inhale • Caused by fluid • Pneumonia, congestive heart failure o Patient presents with COPD or asthma – auscultate ♣ Use to find out where their mucous is a
Lung auscultation pattern?
♣ 7 listening points between C7-T10, bilaterally (between SP and scapula)
♣ 8 and 9 laterally at level of T10
♣ Active inhale and exhale at each point
• SaO2 w/ activity
o Measure
♣
o Normal vs. Abnormal
♣ Contraindication:
• Assess Breathing Pattern (Lab 3)
o Depth (Using tape measure) o Rate o Bucket Handle – ♣ Symmetry and depth o Pump Handle o Symmetry ♣ Anything that has to do with breath. Any respiratory problem. ♣ First place to start to assess if breathing is abnormal.
• Assess cough effectiveness
o Pneumonia, Cystic fibrosis
♣ Are you having a productive cough?
♣ Check to see if their cough is restrictive.
• PIP should say that they have blockage?
o Have Kleenex handy
o Have pt cough “show me how you have been coughing”
♣ Adequate inhale
♣ Glottal closure (sharp Cuh)
♣ Increase intraabdominal pressure
♣ Increase glottal opening (strong Huh)
o Determine effectiveness: if it is a productive cough, or auscultate
• Measure chest expansion with tape measure and/or symmetry (Lab 6)
o 3 Landmarks
♣ sternal angle (angle of Louie at 2nd rib)
♣ Xiphoid
♣ Between xiphoid and belly button
• Measure extremities for girth. Identify potential reasons for edema located in one or both extremities. What questions could you help clarify for edema?
o Pitting edema. ♣ 1+ disappears in 1-2 sec ♣ 2+ slight indentation 15 sec ♣ 3+ deep indentation 30 sec ♣ 4+ greater than 30 o use as outcome measure. o Can be caused by ♣ DVT ♣ Emphysema • Damage to lungs can sometimes lead to heart damage ♣ Right sided heart failure o Pulmonary edema ♣ Due to left sided heart failure and fluid in lungs ♣ Crackles on inhale
• Perform history intake on pt with cardiac
o Cardio ♣ Do you experience SOB or dizziness ♣ When do you experience SOB ♣ Do you have chest pain ♣ Do you have swelling in your lower extremeties o
Perform history intake pulmonary
♣ Are you a smoker
♣ Do you have a history of lung disease
♣ Do you experience excessive coughing
♣ Do you cough sputum? Blood?
♣ Do you frequenctly have to clear the throat
♣ Do you have more trouble breathing in or out?
♣ Does it feel like it is hard to breathe?
Do you feel like breathing limits your daily activities
Normal RR
Normal expanse of rib cage during breathing?
12-18
2.5 inches
Perform 6MWT
Purpose
o : assess functional capacity, especially for those with heart/lung disease
♣ Measures the distance walked on flat, hard surface for 6 minutes
6MWT
Contra
♣ Unstable angina during previous month (angina at rest or lower levels of exercise, outside normal patten)
♣ MI during previous month
♣ Relative: resting HR greater than 120, systolic more than 180, diastolic more than 100
6MWT
stop if?
♣ Chest pain, intolerable dyspnea, leg cramps, staggering, pale
♣ If stopped, pt should sit or lie supine
6MWT
how to perform?
♣ 100 ft. Hallway, marked every 3m, turnaround pt. marked with cone, starting/finishing line marked
♣ No warm up
• Steps
o Sitting in chair near starting position for at least 10 min before test
♣ Check for contraindications, appropriate clothing
o Have patient stand and rate Dypnea and fatigue (Borg)
o Instruct patient “purpose of this test is to walk was foar as possible for 6 minutes. You can slow down, lean against wall, stop, and rest as necessary. Walk and turn without hesitation. (Demonstrate) Rememver, the object is to was as far as possible for 6 minutes, no jogging or running.”
o When timer rings, “stop!” And bring chair to pt, mark spot
o Count laps
o Record post walk dyspnea and fatigue level
♣ “what if anything kept you from walking farther”
♣ Other
6MWT
Other
- No talking during the walk
* Even tone of voice and standard phrasing “you are doing well/keep up the good work/ you have _ minutes remaining
