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PCM III Test 1** > HYHO DYSPNEA SPE3-1 > Flashcards

HYHO DYSPNEA SPE3-1 Flashcards

1
Q

What are the three broad categories of dyspnea?

A
  1. CV
  2. Resp
  3. Other (anemia, psych…)

*85% of cases are CV/Resp related

*hx taking determines which category

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2
Q

A pt. with COPD would report their feeling of dyspnea as?

A

inability to take a deep breath

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3
Q

Stable angina is rarely described as?

A

painful

*mainly described as tightness, sqeezing, pressure, choking

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4
Q

What are common PE findings of COPD pts?

A
  • barrel chest
  • limited rib motion
  • lung expansion with limited exhalation
  • percussion –> generalized hyperresonance
  • decreases breath sounds, wheezes, voice sounds, fremitus
  • prolong expiration
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5
Q

If you are testing for COPD, you have your pt walk with a ____ to monitor ____ with activity. This helps to replicate sx of dyspnea. Repeat auscultation at end of walk may reveal ____ not present at rest.

A

If you are testing for COPD, you have your pt walk with a pulse oximeter to monitor O2 desaturation with activity. This helps to replicate sx of dyspnea. Repeat auscultation at end of walk may reveal wheezes not present at rest.

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6
Q

What are the peak flow assessment results in a pt with COPD?

A
  • FEV1/expected FEV1 < 70%
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7
Q

What are the steps in dyspnea dx? (flow chart)

A
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8
Q

If dyspnea is due to anemia, what will you see on exam?

A
  • generalized pallor
  • conjunctival pallor
  • bounding pulses

*obtain CBC to evaulate anemia; severe anemia can cause cardiac sx, fatigue, dyspnea

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9
Q

What will you see on CXR of a COPD pt?

A
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10
Q

What is the sympathetic/parasympathetic innervation of the:

a. Heart
b. Lungs
b. Lungs - chapman’s points

A

a. S - T1-6; P - vagus n.
b. S - T 1-7; P - vagus n.

c. Anterior 2nd, 3rd, 4th ICS along sternum;
Posterior Lateral T2 Spinous process, Intertransverse space between T2-3, T3-4 & T4-5

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11
Q

What are the biomechanical goals of OMT for COPD pts?

A

improve thoracic cage compliance and skeletal motion

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12
Q

What are the neurological goals of OMT for COPD pts?

A

normalize autonomic tone

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13
Q

What are the resp-circ goals of OMT for COPD pts?

A

maximize efficiency of the diaphragm and enhance lympatic return

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14
Q

What are the met-energy-immune goals of OMT for COPD pts?

A

enhance self-regulatory and self-healing mechansisms

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15
Q

What are the behavioral goals of OMT for COPD pts?

A

improve psychosocial components of health

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16
Q

What drugs are used for sx managment in COPD?

A
  • Short acting inhaled bronchodilators for rescue (albuterol, ipratropium) –> improves FEV1
  • Long acting bronchodilators for those with persistentsymptoms (salmeterol, tiotropium)

LAMAs improve symptoms and reduce exacerbations > LABA

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17
Q

Side Effects of

a. Beta agonists
b. Anticholinergics

A

a. tremor, tachycardia
b. dry mouth

18
Q

How can we help our pts stop smoking?

A
  • address cessation at every follow up
  • provide them with Smoking QuitLines
  • Medication (varenicline, SNRI)
19
Q

What is included in primary prevention management of COPD?

A
  • annual flu vaccine
  • pneumococcal vaccine (PCV13 followed by PPSV23)
  • Tdap
20
Q

What is included in secondary prevention management of COPD?

A

Screening for COPD, early detection of disease

*On the HYHO, it says that avoiding dust and fumes is a prevention: but Dr. Howell said thats a mistake and thats actually a tertiary prevention

21
Q

What is included in tertiary prevention management of COPD?

A
  • smoking cessation
  • pulmonary rehab
22
Q

What are three complications of COPD?

A
  1. Progressive hypoxia - requires supplmental O2
  2. Exacerbations - drive by increased airway inflammation
  3. Respiratory failure - can occur during exacerbations
23
Q

What is seen at end stage COPD?

A
  • cachexia, weight loss, bitemporal wasting, and diffuse loss of subcutaneous adipose tissue
  • pts will qualify for Hospice at this stage
24
Q

Pt. presents with a tightness in their chest brought on by exertion. How will they physically demonstrate this condition?

where does it radiate?

A

fist over sternum

* stable angina: radiation to neck, jaw, back, shoulder, ulanr surface of arm (is painful); trapezius is spared

25
Q

What actions can increase pleuritic chest pain?

A

cough, laughing, deep breaths

26
Q

How do you listen to S3 and S4?

A

with the bell and pt in left lateral recumbant

27
Q

If you are able to reproduce their chest pain with palpation, what does this eliminate?

A

cardiovascular causes of the sx

28
Q

What does the ECG show with stable angina?

A
  • likley normal in the absence of symptoms
  • findings may include changes consistent with previous MI (Q- waves), repolarization abnormalities (ST-segment and T-wave changes), LVH or rhythm abnormalities.

*during cardiac stress test, ST depressinos can be seen

29
Q

What may a stress echo show with stable angina?

A

wall motion abnormalities during increased workload

30
Q

IF the baseline ECG is abnormal with stable angina, what is the next step?

A

radionuclide perfusion images, cardiac magnetic resonance (CMR) stress testing or PET imaging may be necessary to identify regional ischemia

31
Q

Evaluation of patient with known or suspected IHD (flow chart)

A
32
Q

What are contraindications of a stress test?

A
  • rest angina within 48hrs
  • unstable rhythm
  • severe aortic stenosis
  • acute myocarditis
  • uncontrolled HF
  • severe pulmonary HTN
  • active infective endocarditis
33
Q

What are the chapman points of the heart?

A
  • *Anterior** 2nd ICS along sternal border
  • *Posterior** Intertransverse spaces between T2-3
34
Q

What are the goals of OMT in stable angina?

A

not indicated!!

35
Q

Inability to exercise for how long is high risk for coronary events? Strong consideration for interventional cardiac catheterization and

A

< 6 minutes

*Strong consideration for interventional cardiac catheterization and recanalization of vessels ≥50% occlusion

36
Q

Long acting nitroglycerin is not indicated…

A

for acute sx

37
Q

What medications are given to manage sx of stable angina?

A
  • nitroglycerin
  • antiplatelets (aspirin OR clopidogrel)
  • beta blockers, CCBs (dec O2 demand)
38
Q

Side effects of the following:

  • ASA
  • Nitrates
  • Beta blockers
  • Dihidropyridine
  • Nondihydropyridine
A

-ASA: bleeding, bruising; patient should be instructed to avoid other NSAIDs to minimize risk of bleeding, especially GI bleed.

-Nitrates: headache, flushing, hypotension, syncope, reflex tachycardia.

-Beta blockers: fatigue, depression, bradycardia, heart block, bronchospasm, postural hypotension

-Dihidropyridine: headache, ankle swelling, fatigue, flushing, reflex tachycardia

-Nondihydropyridine: bradycardia, heart conduction defect, low ejection fraction, constipation

39
Q

What is included in secondary prevention in stable angina?

A
  • asses patient for other CV symptoms
  • screening for thyroid dysfunction, anemia, etc. that can increase cardiac workload and cause symptoms to reoccur
40
Q

What is included in tertiary prevention in stable angina?

A
  • Cardia Rehab is a comprehensive approach to encourage weight loss, increase exercise tolerance and control risk factors
  • smoking cessation/abstinence
  • treatment of lipid disorders and other comorbidities that increase risk of atherosclerosis OR increase cardiac workload, such as anemia and thyroid dysfunction
41
Q

If not properly managed, stable angina can progress to?

A
  • ACS/MO
  • unstable angina
  • CVA
  • PVD

PCM III Test 1** (15 decks)

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