Lab Midterm #3 Flashcards
Echo characteristics
- measures heart movement
- evaluates heart pumping and mechanical function
- uses ultrasound
- Doppler is used for blood flow across heart
- echo is performed by a cardiac sonographer
- 40-60 mins, no exposure to radiation
EKG definition
Test that determines the electrical system of the heart
Echo definition
Test that determines the mechanical system of the heart
EKG result
Produces a wave like diagram
Echo result
Produces a picture of the heart
EKG test procedure
Attach electrodes to the patient’s chest and several other places, EKG results will come to a machine via wires attached to electrodes
Echo test procedure
Apply a cool gel on the patient’s chest and wave a transducer that releases sound waves that will echo back and produce a picture of the heart
Transthoracic echo (tte) characteristics
- most common, non invasive or minimally invasive, injection (40-60 mins)
- used to
Check health of heart valves
How well heart is pumping blood
Measure blood pressure
Measure size and shape of heart chambers
Transthoracic echo (tte) diagosis
- aortic aneurysm
- aortic dissection
- blood clots
- ECK results
- congenital heart conditions
- heart failure
- heart valve disease
- hypertrophic cardiomyopathy
- cardiac tumors
Transesophageal echo (tee) characteristics
- invasive bc provider slides an endoscope down patient’s esophagus
- takes images of the heart within the body (90 min)
- used to
Follow up TTE
Check for blood clots before procedures
Confirm successful surgeries
Used for real time imaging procedures
Transesopahegal eco (tee) diagnosis
- aortic aneurysm
- blood clots
- cardiac tumors
- congenital heart disease
- heart valve disease
- infective endocarditis
- pericardial disease
Exercise stress echocardiogram characteristics
- increase HR and increase workload
- stress via exercise
- assess heart function when beating fast
- treadmill or stationary bike
Exercise stress echo diagnosis
- coronary artery disease
- cardiomyopathy
- congenital heart disease
- heart failure
- heart valve disease
- pulmonary hypertension
- aortic dissection
- endocarditis, myocarditis and pericarditis
- persistent chest pain
- recent heart attack
- severe aortic stenosis
- uncontrolled arrhythmia
2D ultrasound
Most common, images appear as slices on screen
Can be stacked to make 3D
3D ultrasound
Shows how well the heart pumps blood
Technique allows for heart to be seen at different angles
Doppler
How fast blood flows and in what direction
Color Doppler
Blood flow with colors representing different directions of flow
Towards transducer = red
Away from transducer = blue
Strain image
Shows changes in how heart muscles move
Can catch early signs of heart disease
Contrast imaging
Substance called contrast agent injected into the vein
Visible in the images, allowing to see details of the heart
Transducers
- Device that produces sound waves that bound off body tissue making echos
- transducer received the echo and sends them to a computer which turns them into a sonogram
- phased away transducer used to perform echo
Linear transducer characteristics
- frequency range: 5-10 MHz
- imaging depth: 9cm
- footprint: straight and wide
Linear transducer applications
- arterials/veins
- procedures
- pleura
- skin/soft tissues
- musculoskeletal
- testicles/hernia
- eyes
- breasts
Curve liner transducer characteristics
- frequency range: 2-5 MHz
- imaging depth: 30cm
- footprint: outwards and wide
Curve linear transducer applications
- gallbladder
- liver
- kidneys
- bladder
- abdominal aorta
- uterus/ovaries
Phased array transducer characteristics
- frequency: 1-5 MHz
- imaging depth: 35 cm
- footprint: small range but curve
Phased array transducer applications
- heart
- inferior vena cava
- lungs
- pleura
- abdomen
Sattigal plane
Transducer placed over chest and transducer is pointing up towards head
Transverse plane
Transducer placed subcostally (below rib cage) and indicator pointing towards right side of body
Coronal plane
Transducer placed along mid auxiliary line and indicator pointing toward axillary region
Long axis and short axis
Used when structures don’t lie in the planes
Parasternal long axis view (PLAX)
Where is the transducer and indicator placed?
- long axis of left ventricle
- transducer placed to the left of the sternum in the 3rd, 4th or 5th intercostal space with indicator towards right clavicle
Parasternal long axis view (PLAX)
What does it show?
Images of the right ventricle, left atrium, left ventricle, mitral valve, aortic valve, aortic root, aortic outflow tract and surrounding pericardium
Parasternal short axis (PSAX)
Where is the transducer and indicator placed?
transducer in intercostal space in PLAX but rotated 90 degrees to be perpendicular to long axis of LV and tilted to the apex of the heart
Parasternal short axis (PSAX)
What does it show?
Examines shape and size of ventricles
- LV bigger than RV
- LV round and RV crescent shaped like a backwards D
Apical 4 chamber view (4C)
Where is the transducer and indicator placed?
-transducer placed at the point of max, impulse if patient has a palpable apical beat or placed at 5th intercostal space near anterior axillary line
- beam pointed put o head and marker at 3 o clock
Apical 4 chamber view (4C)
What does it show?
Identification of pericardial effusion, cardiac tamale, and RV dilation in pulmonary embolism
Subscostal 4 chamber view
Where is the transducer and indicator placed?
- patient is supine and knees slightly bent to reduce abdominal wall tension
- transducer below and to the right of xiphisternum
Subcostal 4 chamber view
What does it show?
- chronic obstructive pulmonary disease or people with mechanical ventilation
- shows inferior vena cava on a long axis
Pleural effusion
Buildup of fluid between the lungs and pleural membranes due to inflammation or congestive heart failure (CHF)
Pericardial effusion
The buildup of fluid between the heart and the pericardial membrane due to pericarditis (inflammation of pericardium)
What view can be used to identity pleural effusion?
PLAS
What view can be used to identify pericardial effusion?
sub4view
Cardiac/pericardial tamponade
Blood pressure drops and can be fatal bc pericardial efficiency puts pressure on the heart and prevents it from filling properly (diastolic collapse of ventricle)
Ejection fraction equation
EF = (SV/EDV) x 100
Normal EF percentage
> 50%
Moderately depressed EF percentage
30-50%
Severely depressed EF percentage
< 30%
Congestive heart failure (CHF)
- Heart cannot pump (systolic) or fill (diastolic) adequately
- decreased EF can be caused by aortic regurgitation and mitral valve stenosis
Patient foramen ovale (PFO)
Hole in the interatrial septum that should close after birth but remains open in some people
Atherosclerosis
- Depression of plaque in initial later of arterioles
- risk factors: hyperlipidemia, hypertension, smoking
- detected in carotid artery scan
Bicuspid aortic valve (BAV)
Aortic valve contains only two cups instead of three
Can lead to aortic regurgitation or aortic stenosis that can lead to heart failture
Blood pressure
- Force and pressure exerted on the walls of an artery
- systolic pressure and diastolic pressure measured in mm of mercery
How to measure blood pressure
Listen to hearty sounds in the brachial artery
Use a stethoscope or sphygmomanometer
Sphygomomanometer (2 typos)
- Aneorid or mercury filled
- aneroid needs to be calibrated since operation is due to a vacuum seal and seal may wear out
- reduce cost and safety
Stethoscope
- bend in the ear tips away from you
- sound directed to the tympanic membrane
- bell (low frequency sounds) —> small side
- diagram (high frequency sounds) —> large size
Korotkoff sounds
Phase 1
Faint tapping sound (systolic pressure)
Korotkoff sounds
Phase 2
Sound gets louder characterized by swishing sound
Korotkoff sounds
phase 3
Sound is very loud and clear
Korotkoff sounds
Phase 4
Sound becomes muffled and softer (diastolic pressure)
Korotkoff sounds
Phase 5
Sound disappears
Bp during exercise
- phase 4 muffling is better estimation for diastolic pressure
- possible for the heart sounds to never disappear
Bp measurement at rest
- choose right Bp cuff
- 5 min rest prior to BP
- sit in chair 2 feet on ground and back straight
- place arms t level of heart or chest
- stay still and don’t talk
- legs not crossed
- palpate brachial artery
- push hard to feel the pulse
- inflate 30-40 mmHg above anticipated systolic pressure
- deflate cuff at rate of 3-4 mm Hg/sec
Bp of male and female at rest
110 for women
120 for men
Affects of cuff size
If too big, Bp recorded will be erroneously low
If too narrow, cuff can overestimate bp
Affects of cuff tension
If you cannot get finger under cuff, too tight
Patient can shake off cuff it too lose
Normal systolic and diastolic bp
< 120
< 80
Elevated systolic and diastolic bp
120-129
< 80
High (hypertension stage 1) systolic and diastolic bp
130-139
80-89
High (hypertension stage 2) systolic and diastolic bp
140 or higher
90 or higher
Hypertensive crisis systolic and diastolic bp
> 180
120
Hypertension characteristics
- high bp
- associated to heart disease
- affects 43 million people
- kills 37K per year
- can lead to stroke, blood vessel damage, heart attack, kidney failure
Hypertension treatment
- healthy diet/exercise
- diuretics
- ACE inhibitors
- beta blockers
- vasodilators
Normal Bp during exercise characteristics
- systolic pressure elevates with each increase in workload
- due to stretch of LV pushing out more blood
- diastolic pressure remains the same of may decrease workload
- due to vasodilation of arteries
Abnormal Bp during exercise
- systolic pressure fails to elevate or declines with an increased workload due to heart disease that affect hearts ability to contract
- diastolic pressure increases due to high bp when heart is in disasole
How to determine respiratory rate?
- observe rate by watching rise and fall of chest
- do without patients knowledge bc when they know they will breath faster
- factor in mental status and speech pattern
1 in/exhale = 1 breath
Normal respiratory rate
12-20 breaths per min
Concerning respiratory rate
< 10 or > 26 breaths per min
How to determine respiratory quality?
Look at tidal volume
Normal respiration characteristics
- Chest wall in outward extension
- No accessory muscle usage
- exhale 2x longer than inhale
- quite and no noise
Shallow respiration
Slight chest expansion during inhalation
Labored respiration
- Working hard to breath
- nasal flaring
- use of other muscles
- can lead to respiratory failture
Noisy respiration
All noisy breathing is obstructive breathing but not all obstructive breathing is noisy
How to measure HR?
- generated by contraction of LV
- dont use thumb bc it has it’s own pulse
- count 30 sec beats x 2
- located peripherally or centrally
- use radial pulse in all patients 1 yr or older (carotid) if peripheral cannot be found
- use brachial for under 1 yr
Normal, tachycardia, bradycardia, and srious injury HR
Normal 60-100bpm
Tachycardia >100
Bradycardia <60
Serious injury >130 and <45
Strong pulse
Bounding pulse, 3+
Weak pulse
Pulse doesn’t feel full, hard to palpate, threads, 1+
Regular pulse
Normal intervals, 2+
Irregular pulse
Irregular intervals might indicate cardiac disease
Skin assessment
- important indicator of bodies perfusion status
- nail beds, hands, soles of feet should be pink
White skin color
Vasoconstriction, blood loss, inadequate oxygenation
Blue/gray skin color
Inadequate oxygenation or perfusion, always indicated a serious problem but often observed late
Red skin color
Heat exposure, perineal vasodilation, late carbon monoxide poisoning
Yellow skin color
Liver diease
Gray/blue skin color
Seen in blotchy patterns or partings with blood poisoning in extremes
Temperature (normal and abnormal and tools)
- normal is 98.6F or 37F
- varies due to age, time of day and where temp taken
- forehead scanner 0.5-1F lower than oral
- 99.6F or temp 1-1.5F above normal is fever
Normal skin condition
Dry
Wet or moist skin
Shock, poisoning, heat related, cardiac or diabetic
Extremely dry skin
Spinal injury or severe dehydration
Capillary refill time procedure and for men, women, elderly
- count time for nail bed to turn back pink
- 2 sec for children and males
- 3 sec for female adults
- 4 sec for elderly
- longer refill time may indicate shock
Blood oxygen saturation (% SPO2)
Normal and hypoxia
- Hemoglobin blood that is saturated with O2
- measures other geese containing O2 connected to heme like CO
Normal is 97-100%
Hypoxia is <90%
Normal adult vital signs (resp rate, hr, spo2, bp, temp, cap refill)
12-20 breaths/min
60-100 bpm
97-100 SpO2
<120/80 Bp
+/- 98.6F temp
2 sec cap refill
Loss of consciousness
- alert, verbal, painful, unresponsive (AVPU)
- painful stimulation (trapezius pinch and eternal rub for cns and thumb index finger pinch for pns)
What postures indicate serious head injury?
(And characteristics)
Decoraticate posturing - arch back, arms flexed in
Decelerate posturing - full body extension
What does level of distress measure?
- anxiety, sorrow, pain
- orientation - person, place, time, situation
What does airway, breathing, circulation (ABCs) measure?
- is airway open
- rate and quality of breathing
- pulse rate, skin color, temp
Physical exam of head and pupils
- pupils equal, responsive to light, accommodating (dilate when focusing on close objects)
- normal pupil looks like circles and should be constricted when focusing on close objects
Signs of abnormal pupils - dilated, unequal, constricted, nonreactive
Dilated = cardiac arrest
Unequal = stroke/head trauma
Constricted = nervous system disorder
Non reactive = cardiac arrest, brain injury, drug overdose
Neck exam
- is the trachea midline
- jugular vein distention (JUD)
Chest examination
- show good rise and fall of chest
- abnormal lung sounds?
- arrythmia
Abdomen examination
- soft and supple?
- Markle test (heel drop test)
Pelvis examination
Incontinence (loss of control)
Back examination
Check for PTA (palpate)
Lower extremities examination
- circulatory, motor, sensory (CMS)
- range of motion
- pedal edema
- check babinski reflex (sign of CNS disorder)
Upper extremities examination
- circulatory, motor, sensory (CMS)
- range of motion
- pronation arm drift (stroke)
- av fistula = dialysis patient
General considerations during examination
- medical alert jewelry
- implanted medical devices
- transdermal medial patches
- surgical scars
- IV drug abuse scars
patient history
- what is bothering them
- who called 911 and whu
Diet
- what kind of diet (normally)
- alc (how many)/week
- % processed food
- smoke? How many/week
Physical activity/exericse
- what kind
- how many days/week
- what intensity
- how long
Medical history
- patients med history
- medications taking
- allergies
- family med history
Pain assessment
- any acute/chronic pain
- 1-10 pain sale
- location of pain
- when did it start, what were they doing
- characteristics of pain
- does anything make the pain better or worse
Minute ventilation
- amount of air a person inhales and exhales in 1 min
- minute ventilation = tidal volume x breaths in min
- avg adult = 500ml x 12 min = 6000 ml/min
Alveolar ventilation
- air moved in and out of alveoli in 1 min
- alveolar ventilation = (tidal volume - dead space) x breaths per min
- avg adult = (500ml - 150ml) x 12 = 4200ml/min
Measuring respiration during exercise test
- document number of breaths/min at baseline, following first stage, and following final stage
- make not of quality and depth of breathing during each stage (shallow/deep, chest rising and falling)
Measuring HR during exercise
Distance between 2 waves
Big boxes - 30/big boxes
Small boxes - 1500/small boxes
Exercise test procedure
- warm up (maintain stable HR of 100bpm)
- 1 stage of exercise protocol for 2 min
- subsequence stages every 2 minutes increasing watts
- final stage for 2 minuets with highest intensity possible
Bory rating of perceived exertion (RPE)
- subjective method of quantitatively measuring the intensity of physical activity
- subjects rate hope hard they feel their body is working
Ischemic heart disease characteristics during exercise
- shortness of breath, rapid heart rate, extreme exertion with light intensity, systolic pressure doesn’t increase but diastolic does
- symptoms: chest pain, shortness of breath, abnormally high or low bp, st segment changes, abnormal heart rhythm, dizziness and fatigue
Obstructive pulmonary disease characteristics during exercise
- extreme shortness of breath, rapid breathing, cough and chest tightness, normal HR sinus rhythm, extreme exertion with heavy intensity
- symptoms: short breath, rapid breathing, dry/persistent cough, wheezing, chest tightness, rapid hr, use of accessory resp muscles, excessive sweating
Determining work
- work = force x distance
Force in resistance (kg)
Distance in meters and is 6 meters
Work to power conversion
Watts = work/6 watts/kgm/min
Healthy exercise vital signs at rest (resp rate, hr, bp, rpe)
12-20 breaths/min
60-100 bpm
Systolic 120mm Hg or less
Diastolic 80mm Hg or less
RPE = no exertion
Healthy exercise vital signs after exercise (resp rate, hr, bp, rpe)
Increase rate and depth
Increase HR
Increase systolic pressure
Same or decreased diastolic pressure
RPE = light to somewhat hard based on intensity
