Quiz 2 Flashcards
Quiz 2 is on cardio-pathology, a little bit on evaluation, and auscultation
10 ?’s on Quiz 2
BELOW ARE FLASHCARDS ON THE EXAM/EVALUATION POWER POINT
ok
T or F: When doing an exam or evaluation, you need to know normative values in order to pick up on “red flags”
True
What are some Cardio-Pulm “red flags”
- SOB (shortness of breath)
- Dizziness, lightheaded (orthostatic hypotension)
- HTN (hypertension)
- Heavy chest / chest pain (angina)
- Dyspnea (heavy difficult breathing)
- Increased RR, HR, BP
- Orthopnea (difficulty breathing laying flat)
- Paroxysmal Nocturnal Dyspnea (PND)
- Cyanosis (blue coloring from difficulty breathing / lack of O2) … digital clubbing
- Distended jugular veins (backup fluid/blood from heart failure)
- Etc…
Review two statements below … and explain:
EVERY patient is a multi-system patient
EVERY patient is a cardiopulmonary patient
With that said, what are the MAIN systems we as a PT will primarily work with:
Don’t just look at problem, diagnosis, or musculoskeletal. Every issue has a cardio-pulm element, and look at cura personalis … the whole person and big picture.
- Muscular
- Skeletal
- Neuro
- Integumentary
- Cardio-pulm
- (Communication / Cognition)
** NO MATTER WHAT, with EVERY PATIENT, you will ALWAYS do what:
- VITALS
- Observation
When you are observing, what are you looking for:
- Appearance
- Cyanosis (blue skin)
- Breathing (labored, heavy, SOB)
- Dyspnea
- Talking (breathlessness)
- RR
- Jugular vein distention
- Posture (symmetry, deformities)
- Pain
- Cognition
What is Cyanosis:
What is Body Habitus:
What is Cachectic: (how to remember)
What is Panniculus: (how to remember)
Cyanosis: A BLUISH discoloration of the skin, tongue, or nails resulting from POOR CIRCULATION or inadequate oxygenation of the blood. (Cyanide is pale blue color … really :)
Body habitus: The physique or body build (strong and healthy or weak and frail, overweight) (Good body habits = good physique)
Cachectic: Body wasting away due to poor health (CASH = wasting away)
Panniculus: Excessive abdominal body fat (PAN handle around belly)
What is Digital Clubbing:
Why?
Enlargement of tips of fingers / toes. Nails emerge.
This is from prolonged cyanosis. Lack of O2 (POOR CIRCULATION) over long time means nail will deteriorate.
What is pursed lip breathing:
Why would someone do it?
Pursed-lip breathing (inhale/exhale against resistance with mouth).
If you create more pressure by closing more of the lips/mouth (by closing lips slightly) is pushes larynx open more which opens the airways allowing more air to get in, and more of the trapped air to forcefully get pushed out.
What is COPD:
If a patient had COPD, what are a few signs you’d notice that would indicate this:
COPD: Chronic obstructive pulmonary disease. It is a general term for many obstructive disorders/conditions of difficulty breathing (pneumonia, asthma, bronchitis, emphazima) where an object gets lodged in airway, or more commonly the airways get inflammed, mucous buildup, or airway / alveoli get damaged.
- Pale skin (cyanosis)
- SOB
- Difficulty breathing (dyspnea)
- Difficulty talking
- Wheezing, coughing
- Coughing up sputum
- Protruding SCM muscles (help compensate to breath)
- Posture
- Fatigued
What is Pectus excavatum:
What is Pectus carinatum:
(how to remember)
Caved IN chest/sternum between pecks (go IN to the cave)
Sternum protrudes out – chest out (go OUT to the carnival)
(go IN to the cave)
(go OUT to the carnival)
What is Professorial posture:
Why would someone do it?
Leaning Forward / flexed with UEs braced on knees or other support surface.
To open up thoracic cavity because they can’t breathe well.
Review:
Kyphosis:
Lordosis:
Scoliosis:
(How to remember)
Kyphosis: Thoracic spine is protruding BACK
Lordosis: Lumbar spine sticks forward
Scoliosis: Curved spine laterally
(L = L … Lordosis = Lumbar = Lower on back, and Lords need to be out in front).
How does posture and/or positioning impact breathing?
What’s a simple exercise a pt can do to help with posture … thus help with breathing
Posture makes a HUGE difference in your ability to breathe, and breathe properly. If you are slunched over, your lungs can’t fully expand, and your diaphragm can’t fully contract (since abdominal contents would be scrunched as well) so your lungs can’t expand as much, which means less air in, less O2, less gas exchange, etc.
You could do some scapular retraction exercises to open up those lungs / thorax.
Know in general (don’t memorize) these terms in relation to cognition:
Conscious: Alert and functional cognitively
Confused: can’t think clearly
Delirious: Disturbed state of mind
Somnolent: Sleepy / drowsy (Somber)
Obtunded: dull the sensitivity out, deaden (ObtunDEAD = deaden)
Stuporous: lacks mental function - stupid
Comatose: deep uncounsiousness
Tremor: involuntary quivering
What is Jugular Venous Distension (JVD)
Why might someone have distended jugular veins?
Jugular veins are protruding out from neck and buldged
Lymphatic or cardiac problems where fluid is obviously backing up from heart into the neck.
When you are observing breathing, what are you looking for:
- SOB
- Diaphragm or upper chest breathing
- Labored / exerted or not
- What moves 1st, 2nd, or 3rd
- Breathless when they talk?
- Loud or soft breathing
- Adventitious sounds
- RR
- Thorax movement and expansion
- Dyspnea
- Cyanosis
If you are observing, what do you document
ONLY document things that are abnormal
Normal RR’s are:
Increased RR is called:
Decreased RR is called:
Increased HR is called:
Decreased HR is called:
Normal respiratory rates are: 12-20 b/p/m
More than 20 = Tachypnea
So less than 12 = Bradypnea
More than 100 bpm = Tachycardia
Less than 60 bpm = Bradycardia
Define these terms:
Pnea - Penia - Eupnea – Apnea – Tachypnea – Bradypnea – Dyspnea – Orthopnea - Paroxysmal Nocturnal Dyspnea -
Pnea - Breathing
Penia - lacking or less
Eupnea – normal breathing cycle (Euphoric)
Apnea – temporary halt in breathing
Tachypnea – rapid, shallow breathing pattern (20+ bpm)
Bradypnea – less than 12 bpm (slow breathing)
Dyspnea – sensation of breathlessness / difficulty breathing
Orthopnea - Difficulty breathing while laying down
Paroxysmal Nocturnal Dyspnea - can’t / difficulty breathing at night
What are the MAIN 4 vital signs:
What are some other vital signs:
Do you take vital signs once or many times?
First set of vitals taken is called:
MAIN 4:
- BP
- HR
- RR
- SpO2
OTHERS:
- Temp
- RPE
- Pain
- Dyspnea
- Urine Output
- Gait speed
Multiple times. Before, during, after, or if worried. Need at least 2 sets of vitals to show trending
Baseline vitals
Difference between HR and Pulse?
Normal HR range:
Bradycardia =
Tachycardia =
- HR is how many times the heart actually beats.
- Pulse is what you feel distal to the heart … when you feel blood going through an artery distal to the heart.
Normal: 60-100 beats/min
Bradycardia = slow (below 60) Tachycardia = fast (over 100)
O2 saturation measures what:
What is the range:
What is red flag range?
How much O2 is in blood
Should be 95-99% range.
Below 85-90% is red flag
What is RPD:
What is talk test:
What is Orthopnea:
What is Paroxysmal Nocturnal Dyspnea:
Rate of perceived dyspnea
You talk to patient to hear how they are doing with respiration … gives insight into respiratory health.
Orthopenea: you feel short of breath when laying down
Paroxysmal Nocturnal Dyspnea: You suddenly wake up at night and feel short of breath (probably a heart problem creates this)
Review … what is a MET
What are MET ranges?
“MET” is another name for metabolic equivalent; a measurement of ENERGY EXPENDITURE … exercise intensity based on oxygen consumption. More specifically, a single MET is defined as the amount of oxygen a person consumes (or the energy expended) per unit of body weight during 1 minute of rest.
1-3 MET’s is light activity
3-6 is moderate activity
6+ METS is vigorous activity
What are the 4 phases of coughing?
Which one is the most important step?
1) Inhalation
2) Holding
3) Pressure or force
4) Expulsion
(3 and 4 are often together)
Step 1 is most important. The effectiveness of the cough is directly related to the INHALATION. The more/better you inhale, the better your cough.
Why is hydration important for coughing?
i/o =
Hydration is important to get secretions up (they need to be wet). So the more they can stay hydrated the more they can cough properly and clear airways to help breathe.
input and output (of liquids into and out of body)
If you ask a patient to hold a vowel sound as long as they can, what are you doing?
How long should they at least be able to do that (below what level is a red flag?)
I am measuring their lung / pulmonary function and respiratory health (or lung VITAL CAPACITY). If someone can go 15 secs or longer, they are great or have good respiratory health.
But if they can barely hold a sound for 5 seconds, that is red flag showing weakness in lungs.
Remember and review auscultation.
- How would you auscultate heart?
- How would you auscultate lungs?
- With Lungs: after listening, then what do you do and what are the MAIN points to remember:
And what is Fremitus:
HEART:
- find sternal angle, then aortic is just to right of sternum (my right looking down on chest) in 2nd intercostal space; pulmonary is just to left of sternum in 2nd intercostal space; tricuspid is 5th intercostal space to left of sternum; mitral is 5th intercostal space left of sternum out 2 or so inches at midclavicular line.
LUNGS:
- There are 3 lobes on the RIGHT lung, so put stethoscope over each of 3 areas/lobes anteriorly, then listen laterally, and then posteriorly (although posterior you won’t get middle lobe)
- There are 2 lobes on LEFT lung (same as above)
- Listen for breathing, raspiness, crackling, condensation. Have them say “99” … it should sound muffled (clear means consolidation). Have them say “E” and it should sound muffled (not like an “A”)
- COMPARE right side to left side … remembering the left side is a bit muffled due to heart / mediastinum tissue
- Normal sounds during auscultation are MUFFLED. It is ABNORMAL to hear clear words / sounds.
Fremitus: If you don’t have a stethescope on you, you can do auscultating by palpating with your hands. Palpating chest / lobes of lungs for VIBRATION or sounds. Patient says the “99” of “E” and you feel vibrations. Anything not symmetrical or off, is red flag. Increased fremitus = consolidation. Decreased fremitus means absent breath sounds (emphasema or poor lung capacity)
Difference between continuous and discontinous with auscultating lung sounds:
Continuous
- Wheezes – high pitched, “shrill”
- Rhonchi – low pitched wheezes, “snoring”
Discontinuous
- Crackles or Rales
With regard to heart sounds, what are:
S1
S2
S3 (S3 = Ken-tu-cky)
S4
Where would you auscultate to hear S1, S2, S3?
These are the heart sounds:
S1: AV valves closing (lub)
S2: Semilunar valves closing (dub)
S3: Early diastole phase of rapid VENTRICULAR REFILLING. Quick sound right after S2 (Ken-tu-cky). Associated with CHF
S4: Late diastole right before atria contract (Ten-nes-see). Not heard often at all.
S1 down at Mitral valve (5th intercostal space 2 inches left of sternum)
S2 at aortic or pulmonary valve (just left of sternal angle 2nd intercostal space)
S3 and S4: Apex of heart (near mitral valve place)
Tital volume vs. vital capacity:
Tital volume: is normal breathing in
Vital capacity: is expire everything out, then maximal inspiration (TV + max inhalation and max exhalation .. or VC = TV + IRV + ERV).
BELOW ARE FLASHCARDS ON CARDIAC PATHOPHYSIOLOGY:
ok
1) What is the most common cause of hospitalization and death in the older Americans
2) T or F: Cardiovascular diseases claim more lives than all forms of cancer combined.
3) Is Chronic Heart Failure a synonymous term for CVD?
1) Cardiovascular Disease (CVD)
In 2008, cardiovascular deaths represented 30 percent of all global deaths, with 80 percent of those deaths taking place in low- and middle-income countries.
About 2,150 Americans die each day from these diseases, one every 40 seconds.
2) TRUE
3) YES
Why is knowing about CVD important to a PT?
Almost 1 in 3 Americans have some form of CVD … it is so prevalent and most common cause of death.
People are living longer now, and most CVD is among geriatrics, and we’ll see geriatric patients all the time.
Majority of hospitalizations are from heart diseases, so PTs WILL treat patients with it, and need to know about s/s and how to treat.
And to know what to do / not to do with regards to exercise for these types of patients.
What is an LVAD:
LVAD = Left Ventricular Assistive Device … a machine that pumps the LV for you
What is #1 and #2 killer among women?
#1: CVD #2: Breast cancer
What is the Framingham Heart Study:
In 1948 there was little known about CVD. So they did a study. The researchers in Framinham Mass. enrolled the entire town in the study, and followed them, their lifestyle, weight, habits, diet, etc. So from this study, we learned about the relationship between genetics and CVD, and exercise (and other) impacts on CVD.
The study is still going (2nd generation was enrolled, and now the 3rd generation is), and we still are learning and don’t know everything about CVD.
This study has produced 1,200+ scholarly articles … and has provided the fundamental / foundational info. we have on CVD.
What are the risk factors for someone getting CVD:
- Age
- Genetics (gender, race)
- Family history
- Diet (sugars, sodium, cholesterol)
- Exercise / inactivity
- Obesity
- High BP (HTN)
- Diabetes
- Smoking
- Stress
What is acronym for Hypertension:
What is exact definition of Hypertension:
What is blood pressure:
What is difference between diastolic BP (DBP) and systolic BP (SBP):
What is new value for pre-hypertension?
HTN (or HBP)
High blood pressure. But … Persistent elevation of diastolic BP (>80mmHg), systolic BP (>130 mmHg), or both measured on at least 2 separate occasions at least 2 weeks apart.
Pressure exerted against artery walls when heart contracts / relaxes (systolic / diastolic)
Diastolic: pressure against arteries walls during diastole or heart relaxation
Systolic: pressure against arteries walls when heart is contracting.
130+/80+
Normal: Less than 120/80 mm Hg;
Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80;
Stage 1: Systolic between 130-139 or diastolic between 80-89;
Stage 2: Systolic at least 140 or diastolic at least 90 mmHg;
Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
What is the WHO
What is the CDC
World Health Organization
Center for Disease Control (and Prevention)
1) If you take someone’s blood pressure and it is high, what could be the reason?
2) IF you get a high BP measurement, does it mean they have HTN?
2A) If you measure BP once and it is high, what should you do to confirm it actually being high? Or how do you actually diagnose HBP?
1)
- White coat effect
- Drank a lot of caffeine before
- Are stressed / scared (sympathetic n.s. response)
- Ran in to the appt
- CVD, CAD, weak/overworked heart muscle
- Valve / Artery stenosis (atherosclerosis)
- Actual hypertension and HBP
2) No. BUT … remember that if you measure someone’s BP and it is high, be aware and concerned, but don’t freak out. They might have white coat factor, have drunk too much caffeine, are stressed, etc. Just be calm and take it again later in the appt to double check.
2A) So, take BP at least twice over a few days to double check to get a real value. To diagnose with high BP, must take BP on 2 separate occasions, 2 weeks apart. And PT’s don’t diagnose HBP
What is “primary hypertension”
How many of the cases of high BP fall under this category?
It is essential hypertension … do NOT know the cause. Probably heart issue, but we don’t know.
Most of them … 90-95% of the time
What is “secondary hypertension”
Secondary HTN = we know why you have HTN, its a result (secondary) to some other issue like … being pregnant, renal failure, just ran 10 miles, other diagnosis or disease, etc.
It is high BP that is secondary to some OTHER issue that causes the high BP.
1) What is Labile Hypertension:
2) Is this normal?
(how to remember)
1) Labile HTN =
A BP that FLUCTUATES and is not consistent. One day it is 150/80 but two days later it is 110/70. It goes all over the place. It fluctuates between hypertensive and normal BP readings.
2) Not really. Be concerned … you do NOT want to ignore it
(Remember: LAB results vary every time and are all over the place)
