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Cardiopulm 2 > FINAL PRACTICAL > Flashcards

FINAL PRACTICAL Flashcards

1
Q

patient examination

A

Look at your patient:

  • comfortable? facial expression?
  • posture, shape of chest?
  • extremities: hairy? scars?
  • fingers: clubbing?

Vital signs

Breath/lung, heart, voice sounds

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2
Q

Vital sounds

A

“signs of life”
measures taken to assess the most basic body functions

1: Heart rate
2: Respiratory rate
3: Blood pressure
4: Temperature
5: Pain
6: Gait speed

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3
Q

normal resting heart rate

A

60-100 bpm

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4
Q

bradycardia

A

resting <60 bpm

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5
Q

tachycardia

A

resting >100 bpm

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6
Q

HR locations

A 
Carotid
Brachial
Radial
Femoral
Popliteal
Tibial
Dorsal Pedis
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7
Q

HR response to exercise

A

normal: HR increases proportionally to workload (~10 bpm per MET (unless on beta blocker))

HR returns to baseline following 2 minutes of rest

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8
Q

abnormal HR response to exercise

A

flat/blunted: little/no increase

Bradycardic: >10 bpm drop (severe CAD)

Tachycardic: excess rise (deconditioned, dehydrated, decreased SV)

sudden change >20-40 bpm for >3 minutes at rest, during activity, or following a change in position (refer to MD)

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9
Q

factors affecting HR

A 
aging
anemia
autonomic dysfunction
caffeine
cardiac muscle dysfunction
drugs
fear
fever
hyperthyroidism
infection
pain
sleep disturbances
emotions
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10
Q

pulse rhythm

A

Regular

Irregular

  • regularly irregular (usually AFIB-pre beat or skips a beat)
  • irregularly irregular (can only take an average for HR)
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11
Q

pulse strength

A
  • indication of circulating blood volume and strength of LV ejection
  • increases slightly with inspiration and decreases with expiration
  • Paradoxic= amplitude fades with inspiration and strengthens with expiration (notify MD- occurs with COPD)
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12
Q

pulse strength grades

A 
0= absent
1=weak
2=normal
3= full
4= aneurismal/bounding
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13
Q

tips for taking HR

A
  • check in 2 places in older adults and those with DM (pulse diminishes with age- esp distally)
  • if diminished or absent, listen for bruit (indicates narrowing)
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14
Q

RPE

A

rate of perceived exertion, measures total feeling of exertion and fatigue

alternative tool to measure exercise intensity. useful for patients whose HR is affected with meds

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15
Q

inspiratory muscles

A

diaphragm
external intercostals
interchondrial intercostals

accessory: scales/SCM

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16
Q

expiratory muscles

A

abdominals

internal intercostals

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17
Q

lung compliance

A
  • related to elasticity of tissues. measured by pressure-volume curve
  • decreases: lungs become stiffer and more difficult to expand.
  • increases: lungs become easier to distend and more compliant

chest wall compliance and lung compliance can change lung volumes

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18
Q

ventilation

A

=movement of oxygen in and out of lungs

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19
Q

factors affecting ventilation

A

chest wall mechanics:

  • kyphosis
  • scoliosis
  • posture
  • hyperinflation
  • arthritis

pulmonary mechanics:

  • airway inflammation, constriction, degeneration
  • increased dead space (scar tissue, emphysema)
  • ventilation/perfusion

gas exchange mechanics

  • pulmonary HTN
  • pulmonary edema
  • CHF
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20
Q

normal respiration rate

A

12-20 bpm

increase in rate and depth proportional to workload

max RR achievable with exercise ~50 bpm

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21
Q

respiration rate precaution

A

> 35 with exercise

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22
Q

respiration rate contraindication

A

> 45 to exercise

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23
Q

assessing RR

A

can use talk test and/or dyspnea index

minute ventilation= RR x TV

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24
Q

factors affecting RR

A

changes in lung compliance
airway resistance
body position
changes in lung volumes and/or lung capacity

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25
Q

tips for taking RR

A
  • take right after HR while still holding wrist
  • if unlabored and regular, take for 30s X 2

Observe:

  • rate, excursion, effort and pattern
  • accessory ms.
  • breathing: silent/noisy
  • puffed cheeks, pursed lips, nasal flaring, asymmetrical chest expansion
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26
Q

chest breather

A

?

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27
Q

diaphragmatic breather

A
  • SOB

- helps to be more conscious of breathing

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28
Q

pulse oximetry

A

=measures arterial oxygen saturation (SaO2) and pulse simultaneously

normal= >95%
don’t exercise: <85%

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29
Q

false pulse oximetry

A 
nail polish
acrylic nails
chemotherapy
anemia
cold skin
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30
Q

normal systolic BP with exercise

A

=7-10 mmHg/MET

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31
Q

abnormal SBP with exercise

A

HYPOTENSIVE: decreases 10-20mmHg with increased workload

FLAT/BLUNTED: little/no increase

HYPERTENSIVE: excess increase
(should never increase >225 mmHG)

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32
Q

normal diastolic BP with exercise

A

=little/no change with aerobic exercise

no more +/- 10 mmHg

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33
Q

abnormal DBP with exercise

A

HYPOTENSIVE: decrease >10 mmHg below resting

HYPERTENSIVE: increase 15-20 mmHg
should not exceed 120 mmHg

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34
Q

pulse pressure

A

=SBP - DBP

normal= >20
increases with age and with exercise

low PP indicates low CO in adults with acute heart failure.

increased PP indicates vascular wall stiffness and predicts heart failure in HTN patients

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35
Q

factors affecting BP

A 
age
blood vessel size
blood viscosity
force of heart contraction
meds
diet
distended bladder
time of recent meal
caffeine
nicotine
alcohol
anxiety
pain
high altitudes
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36
Q

yellow flags for BP

A
  • DBP 75 y/o
  • persistent rise/drop in BP over 2 weeks
  • steady fall over several years >75 y/o
  • lower SBP (65 w/ fall hx
  • PP difference >40
  • difference >10 from side to side
  • BP changes w/ other signs (dizzy, nausea, extreme sweating
  • sudden drop in SBP (>10-15) or DBP (>10) with 10-20% rise in HR- ORTHOSTATIC HYPOTENSION
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37
Q

normal temperature

A

98.7 F
37 C

fever= >100.4

38
Q

temp can vary by:

A
  • age
  • person
  • time of day
  • where taken on body
39
Q

elevated temps caused by:

A 
being active
being in high temps
eating
feeling strong emotions
menstruating
certain meds
teething
heavy clothing
40
Q

gait speed

A

walking speed has been related to dependence, hospitalization, rehab needs, discharge location, mortality

6 minute walk test
3 minute step test

41
Q

abdominal exam

A

inspect
auscultate
percuss
palpate (painful area last)

assess each quadrant:

  • check for rebound tenderness
  • check for masses
  • check for muscle guarding
  • check for bounding pulse
42
Q

BMI

A

weight (kg) divided by height (m) squared

underweight 30

43
Q

normal heart sounds

A

S1

S2

44
Q

S1 heart sounds

A

“lub”

mitral and tricuspid valves closing at onset of ventricular systole (muscular contraction phase of cardiac cycle- begins at end of diastole)

45
Q

S2 heart sounds

A

“dub”

aortic and pulmonic valves closing at onset of diastole (period of relaxation and filling)

46
Q

abnormal heart sounds

A

S3

S4

47
Q

S3 heart sound

A

“ventricular gallop”
associated with early rapid passive filling of the ventricles immediately after the MV and TV open.

most frequently associated with heart failure but may occur in children and young adults up to age 40.

abnormal in older adults; noncompliant LV, maybe associated with CHF

48
Q

S4 heart sound

A

“atrial gallop”
pathological sound of vibration of ventricular filling

associated with HTN, stenosis, hypertensive heart disease or MI

“atrial kick” indicates elevated atrial pressure

49
Q

murmurs

A

due to turbulent blood flow; usually heard as a “whooshing” sound

can be normal or pathological

50
Q

3 categories of murmurs

A

1: caused by high rates of flow through normal or abnormal valves
2: caused by forward flow through a stenotic or deformed valve
3: caused by backward flow though a valve (regurgitation)

51
Q

examine the chest

A 
observe body type
overall posture
chest type
look for symmetry
coloration
scars
abnormal movements
muscle contraction
52
Q

rib flares

A

trying to expand lung

53
Q

Schamroth’s sign

A

indicates clubbing

schamroth’s window

54
Q

intercostal indrawing

A

because breathing is so tough

intercostal spaces are drawn inwards on inspiration- especially with inspiratory effort

seen in patients with severe obstructive disease

55
Q

sign of respiratory problems

A

“BAD CAT”

Breathing that is audible
Active accessory muscles
Dyspnea

Cyanosis/ clubbing
Anterior/posterior diameter >1
Tracheal deviation from midline

56
Q

eupnea

A

normal respiratory rhythm

normal: expiration twice as long as inspiration

57
Q

dyspnea

A

labored or difficult breathing (usually associated with lung or heart disease and resulting in SOB

58
Q

hyperpnea

A

breathing that is regulated to meet an increase demand by the body for oxygen

59
Q

apnea

A

temporary cessation of breathing at the end of normal expiration

60
Q

apneusis

A

sustained, gasping inspiration followed by short, inefficient expiration which can continue to the point of asphyxia

associated with lesions in the respiratory center in the brain

cessation of breathing in the inspiratory phase

61
Q

respiratory arrest

A

failure to resume breathing following a period of apnea or apneusis

62
Q

cheyne strokes respiration

A

periodic type of abnormal breathing often seen in terminally ill or brain damaged patients.

63
Q

biot’s breathing

A

characterized by repeated sequences of deep gasps and apnea

64
Q

assessing depth and symmetry of movement

A

seated
normal findings: 3-5 cm expansion

positive findings:

  • <3 cm movement
  • unilateral delay suggests atelectasis, pneumonia, and post op guarding
65
Q

measuring thoracic excursion

A

standing, T5 and T10

instruct pt to take full inspiration and hold; fully exhales and holds

normal:

  • upper chest 3.6 cm (+/- 0.6)
  • lower chest 4.9 cm (+/- 0.6)

positive findings: <1.7 cm

66
Q

breath sounds

A

generated by the vibration and turbulence of air flowing in and out of the airways and lung tissue during inhalation and exhalation

67
Q

4 normal breath sounds

A

1: tracheal
2: bronchial
3: vesicular
4: bronchovesicular

68
Q

tracheal breath sounds

A

high pitched and loud heard over trachea alone

~wind blowing through a pipe

69
Q

bronchial breath sounds

A

heard adjacent to the sternum and over major airways
similar to tracheal sounds but not as loud

louder on expiration than inspiration

when heard in other areas, are abnormal
-may be due to consolidated, compressed or airless tissue

70
Q

vesicular breath sounds

A
  • low pitched and muffled
  • inspiration is louder, longer and higher pitched than expiration (very brief)
  • normal in all areas of lung except over trachea
71
Q

bronchovesicular breath sounds

A

inspiration/expiration are similar lengths at the same pitch with a slight break between the two

normal when heard adjacent to sternum at costo-sternal border or between scapulae at T3-T6

72
Q

normal lung sounds

A

have pt do at least 1 full breath when listening to each area

4 spots anteriorly
14 posteriorly

73
Q

5 abnormal lung sounds

A

1: bronchial
2: vesicular
3: fine crackles
4: wheezing/Rhonchi
5: coarse crackle

74
Q

abnormal bronchial lung sounds

A

when heard at a distance from large airways, it is considered abnormal

most likely indicated a consolidated lung

75
Q

vesicular lung sounds

A
  • sound heard over the chest at a distance from large airways
  • “soft” soft that has been compared to the sound of wind blowing through the leaves of a tree
  • longer inspiration than expiration
  • most common sound heard in the absence of lung disease
76
Q

fine crackle lung sounds

A

“discontinuous” intermittent, “explosive” sounds

high pitched, popping sound of airways opening

heard in atelectasis, interstitial pulmonary fibrosis and sometimes in healthy people

77
Q

wheezing/ rhonchi

A

continuous high, medium or low pitched whistling sounds

caused by airway narrowing (bronchospasms), secretions

heard on either inspiration or expiration or both

expiratory more common- associated with diffuse airway obstruction- CF, chronic bronchitis, asthma

78
Q

coarse crackle lung sounds

A

intermittent “bubbling” sound

caused by secretions in airways

not as high pitched as fine crackles

79
Q

voice sounds

A

used in examination of the chest to determine the presence/absence of consolidation (pneumonia, cancer, hemothorax, something dense filling the airspace)

1: egophony
2: bronchophony
3: whispered pectoriloquy
4: fremitus

80
Q

egophony

A
  • listen to chest with stethoscope all along different lobes
  • patient says the letter “E”

normal: sounds like muffled long E sound

presence of consolidation (pneumonia, cancer) will hear a higher pitched sound like “A”

“E to A changes”

81
Q

bronchophony

A
  • listen to stethoscope to symmetrical areas of the patient’s lungs
  • asks patients to repeat a work (99, 66)

normal: sound becomes less distinct (quieter) as move to periphery of lungs; muffled, indistinct sounds

presence of consolidation: voice remains loud or becomes louder in periphery; 99 sounds normal

may be noted as “increased breath sounds”

82
Q

whispered pectoriloquy

A

refers to the loudness of a whispered voice while listening to the lungs with a stethoscope
-ask pt to whisper “1,2,3” repeatedly

normal: whispered sounds would be faint or not heard

presence of consolidation: they are heard

83
Q

voice fremitus

A
  • vocal or tactile fremitus is the vibration produced by the voice and transmitted to the chest wall
  • PT evaluated fremitus by comparing the intensity of the vibrations detected by each hand during quiet breathing and speech

normal: equal and moderate vibrations are noticed during speech
increased: indicates a loss or decrease in ventilation in the underlying lung
decreased: indicates increased air within the lung bc sound is similarly transmitted more poorly through a hyper-inflated lung

84
Q

tactile fremitus

A

pt seated
-place ulnar hand over posterior thorax between SP and scapula

pt repeats “99” and PT notes bilateral differences

repeat on anterior chest at supraclavicular area, lateral to sternum below T4

85
Q

percussion

A

?

86
Q

6 MWT

A

submax tests
better reflects function activities/ADLs

used to assess: pts who have heart and lung disease, functional status, and predictor of mortality and morbidity

does not replace cardiopulm exercise testing, stress testing or VO2 max testing (complementary test)

87
Q

patient preparation

A
  • comfortable clothing should be worn
  • appropriate shoes for walking should be worn
  • patients should use usual walking aids
  • pt’s medical regimen should be continued
  • a light meal is acceptable before
  • pts should not have exercised vigorously w/in 2 hours before test
  • *pt should sit at rest in a chair, located near the start, for at least 10 min before the test starts. during this time, check for contraindications, measure pulse and BP, and make sure that clothing and shoes are appropriate.
  • pulse oximetry
  • Borg scale
  • pt rate their baseline dyspnea and overall fatigue using the Borg scale
88
Q

object of the 6 MWT

A

to walk as far as possible for 6 minutes. you will probably get out of breath or become exhausted. you are permitted to slow down, stop and rest as necessary.

*to walk AS FAR AS POSSIBLE for 6 min, but don’t run or jog

89
Q

3 step protocol

A

step height= 16.25”

step for 3 minutes

females: 22 complete step ups per min (88bpm metronome)
males: 24 complete step ups per min (96 bpm metronome)

take pulse for 30s immediately after test and multiple by 2

90
Q

can’t clear airway, susceptible to:

A
  • obstruction (due to heavy secretions)
  • inflammation
  • infection
  • atelectasis
  • abnormal ventilation/perfusion relationships
  • deterioration of arterial blood gas values

Cardiopulm 2 (13 decks)

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