Lecture 4: Cardiac Exam/Assessment

Question 1

what is jugular venous dissension

Answer 1

visible jugular vein swelling above the level of clavicle when pt is in semi-Fowler’s position

indicative of increased venous volume and R sided heart dysfunction

Question 2

components of peripheral vascular exam

Answer 2

Pulse (location matters)

Temperature (indicative of perfusion)

Pain (helps with diff dx of CVD vs MSK P!)

circulation (diaphoresis, Edema, cap refill)

Question 3

describe the edema scale grading

Answer 3

1+ = 2 mm depression, barely detectable, immediate rebound

2+ = 4mm deep pit; few seconds to rebound

3+ = 6 mm deep pit; 10-12 sec to rebound

4+ = 8 mm deep; >20 sec to rebound

Question 4

how to perform capillary refill and normal values

Answer 4

1. elevate foot or hand about heart
2. press into nail bed until it turns white
3. release pressure and record length of time until return to original color

normal = <2 sec

> 2 sec = vascular abnormality

can be normal in some areas and abnormal in others

Question 5

how to assess for intermittent claudication

Answer 5

> 50 heel raises or continuous treadmill walk

1. record time to onset of limb pain
2. monitor ankle SBP every 2 min

ankle SBP should rise and return to baseline after 2 or more min of exercise

> 22 mmHg drop is abnormal

Question 6

what is the rubor of dependency test

Answer 6

test for arterial insufficiency

1. elevate foot above head for 2 min
2. place foot suddenly in dependent position and see how long it takes foot to return to normal color

<15 sec = normal
15-30 sec = mod arterial insufficiency
30-60 = marked arterial insufficiency
>60 sec = extreme disease

Question 7

what is a bruit

Answer 7

vascular murmur

abnormal sound generated by turbulent blood flow in artery

caused by partial obstruction

Question 8

what is the vascular bruit assessment

Answer 8

1. locate artery and place stethoscope diaphragm over the most superficial portion
2. ask pt to momentarily hold their breath
3. listen for blowing, sloshing, or rushing sound (bruit)

Question 9

S&S of DVT

Answer 9

pain, tenderness, swelling, warmth, redness

typically in LE

dislodging of clot burden can lead to acute PE

Question 10

PT responsibility for VTE management

Answer 10

1. prevent VTE
2. assess for LE and UE DVT or PE
3. contribute to health care team in decision making regarding initiation of safe mobility for pts with VTE
4. educate pt and share decision making
5. prevent long term consequences of DVT or PE

Question 11

Action statement 1 from VTE CPG

Answer 11

advocate for culture of mobility and physical activity in all practice settings unless medical contraindications for mobility exist

Question 12

Action statement 2 from VTE CPG (assess for risk in pts with…)

Answer 12

assess for risk of VTE in pts with reduced mobility

implement risk assessments and know risk factors

Question 13

Action statement 3 from VTE CPG (about pt presentation)

Answer 13

when pt presents with conditions that independently increase the risk of VTE, PTs should have high suspicion for VTE and assess for additional risk factors

Question 14

Action statement 4 from VTE CPG (about high risk pts)

Answer 14

when a pt is identified as high risk for VTE, provide preventative measures and edu

educate on S&S, increased PA, hydration, mechanical compression, and referral for medical treatment

Question 15

Action statement 5 from VTE CPG (if pt presents w/ LE S&S)

Answer 15

when pt presents with unilateral pain, tenderness, swelling, warmth, and/or discoloration, establish a likelihood of LE DVT and take appropriate action

Wells criteria = predict likelihood LE DVT

Question 16

Action statement 6 from VTE CPG (if pt presents w/ UE S&S)

Answer 16

when a pt presents with unilateral pain, swelling, edema, cyanosis, and/or dilation of superficial veins, establish likelihood of UE DVT and take appropriate actions

increase prevalence of UE DVT in presence of indwelling central venous catheters

Constans criteria used for predicting UE DVT

Question 17

Action statement 7 from VTE CPG (related to PE)

Answer 17

when pt presents with dyspnea, chest pain, pre syncope or syncope, and/or hemoptysis, evaluate likelihood for PE and take appropriate action

Geneva score used to predict presence of PE

Question 18

what to look at in your mobility assessment

Answer 18

activity tolerance; what is normal and what is normal for that pt

pain; angina vs post sx? sensation loss can prevent normal pain response to abnormality

pt’s ability to maintain precautions or restrictions (i.e. sternal precautions or non weight bearing)

Question 19

when to use diaphragm vs bell with heart auscultation

Answer 19

diaphragm = best for normal sounds

bell = best for abnormal

Question 20

where to listen to aortic valve

Answer 20

2nd R intercostal space at sternal border

Question 21

where to listen to pulmonary valve

Answer 21

2nd L intercostal space at sternal border

Question 22

where to listen to tricuspid valve

Answer 22

4th or 5th intercostal space at sternal border

Question 23

where to listen to mitral valve

Answer 23

5th L intercostal space at mid clavicular line

Question 24

heart mumurs are caused by

Answer 24

abnormally high rates of flow through valves

flow through stenotic valve or into an over dilated chamber

backwards flow through insufficient valve

Question 25

diastolic vs systolic murmurs

Answer 25

systolic = most common; heard between S1-S2

diastolic = heard immediately after S2