HYHO SPE3-1 Flashcards
What are the three broad categories of dyspnea?
- CV
- Resp
- Other (anemia, psych…)
*85% of cases are CV/Resp related
*hx taking determines which category
A pt. with COPD would report their feeling of dyspnea as?
inability to take a deep breath
Stable angina is rarely described as?
painful
*mainly described as tightness, sqeezing, pressure, choking
What are common PE findings of COPD pts?
- barrel chest
- limited rib motion
- lung expansion with limited exhalation
- percussion –> generalized hyperresonance
- decreases breath sounds, wheezes, voice sounds, fremitus
- prolong expiration
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.
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.
What are the peak flow assessment results in a pt with COPD?
- FEV1/expected FEV1 < 70%
What are the steps in dyspnea dx? (flow chart)
If dyspnea is due to anemia, what will you see on exam?
- generalized pallor
- conjunctival pallor
- bounding pulses
*obtain CBC to evaulate anemia; severe anemia can cause cardiac sx, fatigue, dyspnea
What will you see on CXR of a COPD pt?
What is the sympathetic/parasympathetic innervation of the:
a. Heart
b. Lungs
b. Lungs - chapman’s points
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
What are the biomechanical goals of OMT for COPD pts?
improve thoracic cage compliance and skeletal motion
What are the neurological goals of OMT for COPD pts?
normalize autonomic tone
What are the resp-circ goals of OMT for COPD pts?
maximize efficiency of the diaphragm and enhance lympatic return
What are the met-energy-immune goals of OMT for COPD pts?
enhance self-regulatory and self-healing mechansisms
What are the behavioral goals of OMT for COPD pts?
improve psychosocial components of health
What drugs are used for sx managment in COPD?
- 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
Side Effects of
a. Beta agonists
b. Anticholinergics
a. tremor, tachycardia
b. dry mouth
How can we help our pts stop smoking?
- address cessation at every follow up
- provide them with Smoking QuitLines
- Medication (varenicline, SNRI)
What is included in primary prevention management of COPD?
- annual flu vaccine
- pneumococcal vaccine (PCV13 followed by PPSV23)
- Tdap
What is included in secondary prevention management of COPD?
- avoidance of dust and fumes
What is included in tertiary prevention management of COPD?
- smoking cessation
- pulmonary rehab
What are three complications of COPD?
- Progressive hypoxia - requires supplmental O2
- Exacerbations - drive by increased airway inflammation
- Respiratory failure - can occur during exacerbations
What is seen at end stage COPD?
- cachexia, weight loss, bitemporal wasting, and diffuse loss of subcutaneous adipose tissue
- pts will qualify for Hospice at this stage
Pt. presents with a tightness in their chest brought on by exertion. How will they physically demonstrate this condition?
fist over sternum
* stable angina: radiation to neck, jaw, back, shoulder, ulanr surface of arm (is painful); trapezius is spared
What actions can increase pleuritic chest pain?
cough, laughing, deep breaths
How do you listen to S3 and S4?
with the bell and pt in left lateral recumbant
If you are able to reproduce their chest pain with palpation, what does this eliminate?
cardiovascular causes of the sx
What does the ECG show with stable angina?
- 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
What may a stress echo show with stable angina?
wall motion abnormalities during increased workload
IF the baseline ECG is abnormal with stable angina, what is the next step?
radionuclide perfusion images, cardiac magnetic resonance (CMR) stress testing or PET imaging may be necessary to identify regional ischemia
Evaluation of patient with known or suspected IHD (flow chart)
What are contraindications of a stress test?
- rest angina within 48hrs
- unstable rhythm
- severe aortic stenosis
- acute myocarditis
- uncontrolled HF
- severe pulmonary HTN
- active infective endocarditis
What are the chapman points of the heart?
- *Anterior** 2nd ICS along sternal border
- *Posterior** Intertransverse spaces between T2-3
What are the goals of OMT in stable angina?
not indicated!!
inability to exercise for how long is high risk for coronary events? Strong consideration for interventional cardiac catheterization and _____.
< 6 minutes
*Strong consideration for interventional cardiac catheterization and recanalization of vessels ≥50% occlusion
Long acting nitroglycerin is not indicated…
for acute sx
What medications are given to manage sx of stable angina?
- nitroglycerin
- antiplatelets (aspirin OR clopidogrel)
- beta blockers, CCBs (dec O2 demand)
Side effects of the following:
- ASA
- Nitrates
- Beta blockers
- Dihidropyridine
- Nondihydropyridine
-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
What is included in secondary prevention in stable angina?
- asses patient for other CV symptoms
- screening for thyroid dysfunction, anemia, etc. that can increase cardiac workload and cause symptoms to reoccur
What is included in tertiary prevention in stable angina?
- 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
If not properly managed, stable angina can progress to?
- ACS/MO
- unstable angina
- CVA
- PVD
