HYHO SPE3-1 Flashcards by Maren Osterholt

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

How well did you know this?

Not at all

Perfectly

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

inability to take a deep breath

How well did you know this?

Not at all

Perfectly

Stable angina is rarely described as?

painful

*mainly described as tightness, sqeezing, pressure, choking

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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

FEV1/expected FEV1 < 70%

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What will you see on CXR of a COPD pt?

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are the biomechanical goals of OMT for COPD pts?

improve thoracic cage compliance and skeletal motion

How well did you know this?

Not at all

Perfectly

What are the neurological goals of OMT for COPD pts?

normalize autonomic tone

How well did you know this?

Not at all

Perfectly

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

maximize efficiency of the diaphragm and enhance lympatic return

How well did you know this?

Not at all

Perfectly

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

enhance self-regulatory and self-healing mechansisms

How well did you know this?

Not at all

Perfectly

What are the behavioral goals of OMT for COPD pts?

improve psychosocial components of health

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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: ## Footnote - 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