Physical Therapy Tests and Measures Flashcards
Angina Pain Scale
1 - Mild, barely noticeable
2 - Moderate, bothersome
3 - Moderately severe, very uncomfortable
4 - Most severe or intense pain ever experienced
Ankle-Brachial Index (ABI)
Compares systolic BP at ankle and arm to check for peripheral artery disease.
BP taken at both brachial and posterior tibial arteries while Doppler ultrasound is used.
Higher BP in ankle divided by higher BP in arm.
> 1.30 Indicates rigid arteries and need for an ultrasound test to check for PAD
1.0-1.30 Normal; no blockage
0.8-0.99 Mild blockage; beginnings of PAD
0.4-0.79 Moderate blockage; may be associated with intermittent claudication during exercise
<0.4 Severe blockage suggesting severe peripheral artery disease; may have claudication pain at rest
Blood Pressure
Bladder should encircle 80% of arm in adults and 100% of children <13 y.o. If bladder too small, false high readings will result.
Normal BP: <120/80 Elevated 120-129 and <80 Stage 1: 130-139 or 80-89 Stage 2: at least 140 or at least 90 Hypertensive Crisis: >180 and/or > 120
Heart Sounds - Aortic area
2nd intercostal space at the R sternal border
Heart Sounds - Pulmonic area
2nd intercostal space at the L sternal border
Heart Sounds - Mitral area
5th intercostal space, medial to the L midclavicular line
Heart Sounds - Tricuspid area
4th intercostal space at the L sternal border
S1
Lub
Closure of the mitral and tricuspid (AV) valves at the onset of ventricular systole.
High frequency sound with lower pitch and longer duration than S2
S2
Dub
Closure of aortic and pulmonic (semilunar) valves at onset of ventricular diastole.
High frequency sound with higher pitch and shorter duration than S1
S3
Vibrations of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole.
Normal in healthy young children.
Abnormal in adults; may be associated with heart failure; called ventricular gallop.
S4
Vibration of the ventricular wall with ventricular filling and atrial contraction.
May be associated with hypertension, stenosis, hypertensive heart disease, or MI. Called atrial gallop.
Heart Murmurs
Vibrations of longer duration than the heart sounds.
Often due to disruption of blood flow past a stenotic or regurgitant valve.
Sounds can be soft, blowing, or swishing.
Tracheal and bronchial sounds
Loud, tubular sounds normally heard over the trachea.
Inspiratory phase is shorter than expiratory phase with a slight pause between them
Vesicular breath sounds
High pitched, breezy sounds normally heard over the distal airways
Inspiratory phase longer than expiratory phase with no pause between them
Adventitious breath sounds
Abnormal sounds heard with inspiration and/or expiration that can be continuous or discontinuous.
Crackle (rales)
Abnormal, discontinuous, high-pitched popping sound heard more often during inspiration (wet crackles) or from sudden opening of closed airways (dry crackles).
Pleural friction rub
Dry, crackling sound heard during both inspiration and expiration
Occurs with inflamed visceral and parietal pleural rub together
Heard over spot where patient feels pleuritic pain
Rhonchi
Continuous low-pitched sounds with a “snoring” or “gurgling” quality that may be heard during both inspiration and expiration
Caused by air passing through obstructed airway due to inflammatory secretions or liquid, bronchial spasm or neoplasms in smaller or larger airways.
Stridor
Continuous high-pitched wheeze heard with inspiration or expiration
Upper bronchial obstruction
Wheeze
Continuous “musical” or whistling sound composed of a variety of pitches.
Heard during inspiration and/or expiration but variable from minute to minute and area to area
Turbulent airflow and vibrations of walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm, or foreign body.
Abnormal Bronchial breath sounds
Abnormal when heard where vesicular sounds are normally present. Possibly due to pneumonia.
Absent breath sounds
May indicate pneumothorax or lung collapse.
Bronchophony
Increased vocal resonance with greater clarity and loudness of spoken words
May indicate consolidation, atelectasis, or fibrosis.
Egophony
Form of bronchophony in which the spoken long “E” sound changes to a long, nasal-sounding “A”
Whispered pectoriloquy
Recognition of whispered words, like “1, 2, 3”
Body Mass Index (BMI)
Weight (kg) / height (m^2) or weight (lb) / height (in^2) x 703.
<18.5 Underweight 18.5-24.9 Normal 25-29.9 Overweight 30-34.9 Obesity class 1 35-39.9 Obesity class 2 40 or more Obesity class 3
Capillary Refill Time
Full color returns in < 2 seconds = normal refill time
> 2 seconds = abnormal refill time and capillary blood flow compromise (arterial occlusion, hypovolemic shock, hypothermia)
Claudication Test
Pt walks on flat track at max speed or treadmill at 2.0 mph at a constant grade between 0-12%.
Scoring:
Initial claudication distance (ICD) = pain-free walking distance
Absolute claudication distance (ACD) = maximum distance walked when test is terminated due to pain
Speed of walking
Grading scale for claudication pain:
Grade 1 - Definite discomfort or pain but only of initial or modest levels
Grade 2 - Moderate discomfort or pain from which pt’s attention can be diverted
Grade 3 - Intense pain from which pt’s attention cannot be diverted
Grade 4 - Excruciating and unbearable pain
Location of obstruction
Pain in buttock, hip, or thighs = aorta and iliac arteries
Pain in calf = femoral and popliteal arteries
Pain in ankle or foot = pain in tibial or peroneal arteries
Borg Dyspnea Scale
0-10 from No breathlessness to maximal
3 is moderate and 5 is severe breathlessness
Sinus arrythmia
Sinus rhythm but with quickening and slowing of impulse formation in the SA node resulting in slight beat-to-beat variation of rate.
Sinus arrest
A sinus rhythm but with intermittent failure of either SA node impulse formation or AV node conduction that results in occasional complete absence of P or QRS waves.
Premature atrial contractions (PAC)
When an ectopic focus (abnormal pacemaker site) in the atrium initiates an impulse before the SA node.
P wave is premature with abnormal configuration.
Very common and generally benign but may progress to atrial flutter, tachycardia, or fibrillation.
May occur from caffeine, stress, smoking, alcohol, and any type of heart disease.
Atrial flutter
Atrial tachycardia, atrial rate of 250-350 bpm. Ventricle rate depends on AV node conduction.
Saw tooth shaped P waves.
Occurs with valvular disease (especially mitral), ischemic heart disease, cardiomyopathy, hypertension, acute MI, chronic obstructive lung disease, and pulmonary emboli.
Signs & symptoms include palpitations, lightheadedness, and angina.
Stagnation of blood can predispose to thrombi in the atria.
Atrial fibrillation
Common arrhythmia where atria are depolarized between 350-600 bpm.
Irregular undulations of ECG baseline without discrete P waves.
Occurs in healthy hearts and those with coronary artery disease, hypertension, and valvular disease.
Symptoms include palpitations, fatigue, dyspnea, lightheadedness, syncope, and chest pain.
Stagnation of blood can predispose to thrombi in the atria.
1st degree atrioventricular block
PR interval longer than 0.2 seconds but relatively constant from beat to beat.
No symptoms or significant changes in cardiac function.
May be caused by medications that suppress AV conduction.
2nd degree atrioventricular block
Impulse between atria and ventricles fail intermittently.
2 major types: Mobitz type I block (Wenckebach block) and Mobitz type II block.
Mobitz I - progressive prolongation of PR interval until one impulse is not conducted (generally benign)
Mobitz II - consecutive PR intervals are the same and normal followed by nonconduction of one or more impulses (more serious condition)
3rd degree atrioventricular block
Complete heart block, all impulses blocked at AV node and none transmitted to ventricles.
Atria and ventricles paced independently; atrial rate > ventricular rate.
Medical emergency requiring pacemaker.
May faint if ventricular rate too slow.
Causes include degenerative changes of the conduction systems, digitalis, heart surgery, and acute MI.
Premature ventricular complex (PVC)
Premature ventricular depolarization due to an ectopic focus.
P wave usually absent and QRS complex has a wide and aberrant shape.
Bigeminy - Normal sinus impulse followed by a PVC.
Trigeminy - PVC occurs after every two normal sinus impulses.
Common arrhythmia that occurs in healthy and diseased hearts.
Pt may be asymptomatic or have palpitations.
Causes include anxiety, caffeine, stress, smoking, and all forms of heart disease.
Ventricular tachycardia (v-tach)
3 or more consecutive PVCs at a ventricular rate of > 150 bpm
P waves absent and QRS complexes are wide and aberrant
V-tach longer than 30 seconds is life-threatening and requires immediate medical interventions
Pt unable to maintain adequate blood pressure and eventually become hypotensive
May progress to ventricular fibrillation, causing cardiac arrest
Causes include MI, cardiomyopathy, and valvular disease
Ventricular fibrillation (v-fib)
Ventricles do not beat in coordinated fashion but fibrillate or quiver asynchonously and ineffectively
No cardiac output; patient becomes unconscious
ECG shows fibrillatory waves with irregular pattern
May require immediate defibrillation
Medications to support circulation and intravenous antiarrhythmic agents
Causes include heart disease of any type, MI, and cocaine use
Ventricular asystole
Ventricular standstill with no rhythm
ECG records a straight-line pattern
Requires immediate CPR and medications to stimulate cardiac activity
Causes incline MI, ventricular rupture, cocaine use, lightning strikes, and electrical shock
ST segment depression
Subendocardial ischemia, digitalis toxicity, or hypokalemia
Segment is evaluated as a deviation from baseline in mm.
ST segment elevation
Earliest sign of acute transmural infarction
Can also indicate benign early repolarization pattern in a normal heart
Deviations from isoelectric baseline expressed in mm.
Abnormal Q wave
Marker of infarction; signifies loss of positive electrical voltages due to necrosis.
Significant or abnormal Q wave is longer than 0.04 msec and larger than 1/3 the amplitude of the R wave.
T wave inversion
Occurs hours or days after an MI as a result of a delay in repolarization produced by the injury.
May also occur with R and L bundle branch blocks, after a CVA, and normal juvenile T wave pattern in children and some adults.
Exercise Stress Test
ECG, BP, HR, and symptoms are monitored while exercise intensity is increased to monitor tolerance. Negative test indicates low probability of coronary artery disease. Positive test indicates high probability of coronary artery disease. Can determine aerobic exercise prescription.
Homan’s sign for DVT
Passively DF the ankle with knee straight. Positive if pain in the calf or popliteal space.
Mediate Percussion
Act of tapping surface of body to identify areas of altered density. Use middle finger to strike intercostal spaces anteriorly and posteriorly, comparing sounds from each space from left to right.
Sounds of tissue of high to low density:
Flat or dull - Sound elicited by percussion of thigh muscles; in the upper lung, suggests neoplasm, atelectasis, or consolidation.
Resonance - percussion sound from normal air-filled lung
Hyperresonance - Emphysematic lung, pulmonary emphesema, or pneumothorax
Typany - hollow sound; indicates large pneumothorax
Palpation of Peripheral Artery Pulses
Infant 100-130 bpm Child 80-100 bpm Adult 60-100 bpm Bradycardia < 60 Tachycardia > 100
Volume or Amplitude of Pulse 3+ = Large or bounding pulse 2+ = Normal or average pulse 1 = Small or reduced pulse 0 = Absent
Pulmonary Function Testing (PFT)
Measures volume or flow of air during inhalation and exhalation.
Pt exhales into spirometer as hard and as fast as possible for 6 seconds until no more air can be exhaled.
Obstructive ventilatory impairment:
- Decreased expiratory flows
- FEV1/FVC <70%
- Pathologies include asthma, emphysema, and chronic bronchitis
Restrictive ventilatory impairment:
- Reduced lung volumes (TLC, TVC, FEV1) and relatively normal expiratory flow rates
- FVC reduced and FEV1/FVC is normal or >80%
- Pathologies include interstitial lung disease, pleural diseases, chest wall deformities, obesity, pregnancy, neuromuscular disease, and tumor
Pulse Oximetry
Estimates percent of arterial oxygen saturation of hemoglobin.
SpO2 is +/-4% of actual arterial O2 saturation.
If SpO2 <90% in acutely ill patients or <85% in patients with chronic lung disease, activity should be stopped.
Rate Pressure Product (RPP)
Index of myocardial oxygen consumption and coronary blood flow. Can be compared with onset of angina or development of ECG abnormalities.
RPP = HR X SBP
Usually reported as a 2 digit number x 10^3
May be used to prescribe exercise, keeping intensity below RPP value to reduce risk of angina
Rate of Perceived Exertion (RPE)
Original 6-20 scale and revised 0-10 Borg scales.
RPE of 13-14 represents about 70% of maximum heart rate during exercise. RPE of 11-13 represents the upper limit of prescribed training heart rates early in cardiac rehab.
Respiratory Rate, Rhythm, and pattern
Assessment of respiration looks at rate, rhythm, depth, and character (effort and sound)
Rate: Newborn 33-45 breaths/min 1 year 25-35 breaths/min 10 years 15-20 breaths/min Adult 12-20 breaths/min
Rhythm:
Normal: Inspiration half as long as expiration 1:2
COPD: Longer expiration phase, 1:3 or 1:4
Depth: Deep or shallow than normal tidal volume
Character of respiration:
Normal is quiet and effortless
Labored uses accessory muscles
Wheezes and crackles abnormal
Apnea
Absence of spontaneous breathing
Biot’s
Irregular breathing, vary in depth and rate with periods of apnea. Often associated with increased intracranial pressure or damage to the medulla.
Bradypnea
Slower than normal RR, <12 breaths/min. May be associated with neurologic or electrolyte disturbance, infection or high level or cardiorespiratory fitness.
Cheyne-Stokes (periodic)
Decreasing rate and depth of breathing with periods of apnea. Can occur due to CNS damage.
Kussmaul’s
Deep and fast breathing; often associated with metabolic acidosis.
Paradoxical
Chest wall moves in with inhalation and out with exhalation. Due to chest trauma or paralysis of the diaphragm
Six-Minute Walk Test (6MWT)
May use additional O2 and ADs during test. 3 walks with 15 min of rest in between are recommended. Can rest as needed. Provide standard words of encouragement. Record distance walked and number of rest breaks needed.
Waist Circumference
Measuring tape placed at level of iliac crest at end of normal exhalation. Increased risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease associated with circumference > 102 cm (40 in) for men and 88 cm (35 in) for women.
Individuals with waist circumferences greater than these values should be considered one risk category above that defined by their BMI.
