Lecture 4: Cardiac Exam/Assessment Flashcards
what is jugular venous dissension
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
components of peripheral vascular exam
Pulse (location matters)
Temperature (indicative of perfusion)
Pain (helps with diff dx of CVD vs MSK P!)
circulation (diaphoresis, Edema, cap refill)
describe the edema scale grading
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
how to perform capillary refill and normal values
- elevate foot or hand about heart
- press into nail bed until it turns white
- 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
how to assess for intermittent claudication
> 50 heel raises or continuous treadmill walk
- record time to onset of limb pain
- 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
what is the rubor of dependency test
test for arterial insufficiency
- elevate foot above head for 2 min
- 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
what is a bruit
vascular murmur
abnormal sound generated by turbulent blood flow in artery
caused by partial obstruction
what is the vascular bruit assessment
- locate artery and place stethoscope diaphragm over the most superficial portion
- ask pt to momentarily hold their breath
- listen for blowing, sloshing, or rushing sound (bruit)
S&S of DVT
pain, tenderness, swelling, warmth, redness
typically in LE
dislodging of clot burden can lead to acute PE
PT responsibility for VTE management
- prevent VTE
- assess for LE and UE DVT or PE
- contribute to health care team in decision making regarding initiation of safe mobility for pts with VTE
- educate pt and share decision making
- prevent long term consequences of DVT or PE
Action statement 1 from VTE CPG
advocate for culture of mobility and physical activity in all practice settings unless medical contraindications for mobility exist
Action statement 2 from VTE CPG (assess for risk in pts with…)
assess for risk of VTE in pts with reduced mobility
implement risk assessments and know risk factors
Action statement 3 from VTE CPG (about pt presentation)
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
Action statement 4 from VTE CPG (about high risk pts)
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
Action statement 5 from VTE CPG (if pt presents w/ LE S&S)
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
Action statement 6 from VTE CPG (if pt presents w/ UE S&S)
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
Action statement 7 from VTE CPG (related to PE)
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
what to look at in your mobility assessment
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)
when to use diaphragm vs bell with heart auscultation
diaphragm = best for normal sounds
bell = best for abnormal
where to listen to aortic valve
2nd R intercostal space at sternal border
where to listen to pulmonary valve
2nd L intercostal space at sternal border
where to listen to tricuspid valve
4th or 5th intercostal space at sternal border
where to listen to mitral valve
5th L intercostal space at mid clavicular line
heart mumurs are caused by
abnormally high rates of flow through valves
flow through stenotic valve or into an over dilated chamber
backwards flow through insufficient valve
diastolic vs systolic murmurs
systolic = most common; heard between S1-S2
diastolic = heard immediately after S2
