S1 L1.1: Subjective Assessment Flashcards
T/F: PPTA still has no special interest group for cardiopulmonary PTs
False
Currently, there is currently a subgroup specialization for Cardiopulmonary PTs in PPTA.
Elements of Patient Management
The process of obtaining a history, performing a systems review, and selecting and administering tests and measures to gather data about the patient/client.
a. Examination
b. Evaluation
c. Diagnosis
d. Prognosis ( c Plan of Care)
e. Intervention
f. Outcomes
a. Examination
Elements of Patient Management
Determination of the level of optimal improvement that may be attained through intervention and the amount of time required to reach that level.
a. Examination
b. Evaluation
c. Diagnosis
d. Prognosis ( c Plan of Care)
e. Intervention
f. Outcomes
d. Prognosis (c Plan of Care)
Elements of Patient Management
Results of patient/client management, which include the impact of physical therapy interventions to the patient.
a. Examination
b. Evaluation
c. Diagnosis
d. Prognosis ( c Plan of Care)
e. Intervention
f. Outcomes
f. Outcomes
Elements of Patient Management
Both the process and the end result of evaluating examination data, which the physical therapist organizaes into defined clusters, syndromes, or categories to help determine the prognosis and the most appropriate intervention strategies.
a. Examination
b. Evaluation
c. Diagnosis
d. Prognosis ( c Plan of Care)
e. Intervention
f. Outcomes
c. Diagnosis
Elements of Patient Management
Purposeful and skilled interaction of the physical therapist with the pt/client using various physical therapy methods and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis.
a. Examination
b. Evaluation
c. Diagnosis
d. Prognosis ( c Plan of Care)
e. Intervention
f. Outcomes
e. Intervention
Elements of Patient Management
A dynamic process in which the physical therapist makes clinical judgements based on data gatehred during the examination.
a. Examination
b. Evaluation
c. Diagnosis
d. Prognosis ( c Plan of Care)
e. Intervention
f. Outcomes
b. Evaluation
Elements of Patient Management
The _____ is a comprehensive screening and specific testing process that leads to a diagnostic classification.
Initial Examination
Elements of Patient Management
T/F: Examination includes subjective and objective assessment
True
Elements of Patient Management
The _ specifies the interventions to be used and their timing and frequency.
Plan of Care
Elements of Patient Management
a. Decision to reexamine
b. Process of reexamination
- May also identify the need for consultation with or referral to another provider
- Based on new clinical findings or on lack of patient progress
- B (Process of Reexamination)
- A (Decision to Reexamine)
4 Sources of History Taking
- Patient/Family/Caregiver Interview
- History & Data Forms
- Medical Chart Review
- Information from Other Health Care Providers
What do you do if the patient is not viable to answer the question during the interview?
a. Wait until the patient can answer
b. Interview the family/caregiver
c. Proceed with the other patient examinations
b. Interview the family/caregiver
Questions to probe when a pt has Hypertension in their medical history?
- Clinically diagnosed?
- Controlled/uncontrolled type?
- Given medications and respective intake
Questions to probe when a pt has Diabetes in their medical history?
- Clinically diagnosed?
- Type 1 or 2?
Questions to probe when a pt has Asthma in their medical history?
- Was it aquired since birth or when only triggered?
Chief Complaint
This is aso known as “Air Hunger” and is considered as one of the most common symptoms of cardiac and pulmonary diseases.
Dyspnea
(Shorttness of Breath)
Chief Complaint
Which of the ff are TRUE regarding Dyspnea:
a. Occurs when the body’s requirement for breathing is less than the body’s capacity to provide it
b. Gas exchange is compromised
c. Unconsious breathing.
Only B is correct.
The body’s requirement for breathing exceeds the body’s capacity to provide it thus having the pt be conscious of their breathing.
Chief Complaint
T/F: An affectation in the phrenic nerve can cause Dyspnea
True.
Phrenic Nerve innervates the diaphragm (C3-C5)
Chief Complaint
Possible locations that can cause abnormalities in the ventilatory system?
- Thoracic Cage
- Lungs
- Heart
- Kidneys
Chief Complaint
Dyspnea should be assessed based on _ of the appearance and progression
Time course
Chief Complaint
a. Acute Dyspnea
b. Dyspnea on Exertion (DOE)
c. Paroxysmal Nocturnal Dyspnea (PND)
d. Functional Dyspnea
Dyspnea during functional (extreme) exercises (aggravating factor and subsides during rest
Dyspnea on Exertion (DOE)
Chief Complaint
a. Acute Dyspnea
b. Dyspnea on Exertion (DOE)
c. Paroxysmal Nocturnal Dyspnea (PND)
d. Functional Dyspnea
Inability to breath/SOB when pt is sleeping. Onset of dyspnea 2-3 hours after the onset of sleep
Paroxysmal Nocturnal Dyspnea
Chief Complaint
What position relieves Paroxysmal Nocturnal Dyspnea?
Upright position (Which is why pt often wakes up in the middle of the night.
Chief Complaint
Paroxysmal Nocturnal Dyspnea (PND) is d/t _
Pulmonary Congestion
Chief Complaint
a. Acute Dyspnea
b. Dyspnea on Exertion (DOE)
c. Paroxysmal Nocturnal Dyspnea (PND)
d. Functional Dyspnea
Associated chest pain (which can be d/t spontaneous pneumothorax or embolism), chest trauma, decompensating left ventricle, possible heart failure.
SOB is even present during rest.
Acute Dyspnea
Chief Complaint
a. Acute Dyspnea
b. Dyspnea on Exertion (DOE)
c. Paroxysmal Nocturnal Dyspnea (PND)
d. Functional Dyspnea
Present at rest but absent during exertion/exercise. It is short-term and more common in women.
Functional Dyspnea
Chief Complaint
Assessed based on Body Position;
a. Orthopnea
b. Platypnea
c. Trepopnea
SOB in one lateral position (in side lying position). This is common for pt c unilateral lung problem and mitra stenosis.
c. Trepopnea
Chief Complaint
Assessed based on Body Position;
a. Orthopnea
b. Platypnea
c. Trepopnea
SOB in recumbent (supine) position and is relieved when backrest is elevated.
a. Orthopnea
Congestive heart failure, Chronic pulmonary diseases
Chief Complaint
Document; “I cannot sleep well lying flat on bed but I can sleep well if I have 3 pillows.”
3-pillow orthopnea
Chief Complaint
Assessed based on Body Position;
a. Orthopnea
b. Platypnea
c. Trepopnea
SOB when assuming sitting from supine. Happens with pts with pulmonary fibrosis, hypoxemia, and ventilation-perfusion mismatch (less O2/Hemoglobin=mismatch)
b. Platypnea
DYSPNEA SCALE (Grade 0-4)
Walks slower than people of the same age on level ground d/t SOB or has to stop for breath when walking at own pace on level ground
GRADE 2
DYSPNEA SCALE (0-4)
Too breathless to leave the house or during dressing or undressing
GRADE 4
DYSPNEA SCALE (0-4)
Not troubled by breathlessness except with strenuous exercise
GRADE 0
DYSPNEA SCALE (0-4)
Stops for breath after walking 100m or after few mins on level ground
GRADE 3
DYSPNEA SCALE (0-4)
Troubled by SOB when hurrying on level ground or walking up a slight hill
GRADE 1
Another way to measure the SOB where O2 and HR are directly proportional with one another (6-20)
Borg RPE
As PTs settle at the yellow score (__) while avoid red scale (__) when doing exercises.
- 12-16
- 17-20
2nd most common symptom/CC
Chest Pain
T/F: Not all chest pain is related to angina
TRUE
Differential diagnosis should be precise and done well to make sure it is not just traumatic pain on the chest instead of an actual angina
For CP pts, there is a greater chance that the chest pain is brought by ___ which may lead to ____ which may lead to ____.
Ischemia > Chest Pain > Myocardial Ischemia > Myocardial Infarction
TYPES OF CHEST PAIN
a. Ischemic Chest Pain
b. Stable Angina
c. Unstable Angina
d. Prinzmetal Angina
e. Microvascular Angina
Less serious type of angina where the heart must work harder during physical exertion but lasts a short time ( >5mins). May feel like gas or indigestion.
b. Stable Angina
TYPES OF CHEST PAIN
a. Ischemic Chest Pain
b. Stable Angina
c. Unstable Angina
d. Prinzmetal Angina
e. Microvascular Angina
Due to coronary microvascular disease at the distal segments or spasms on the walls of small arteries
e. Microvascular Angina
TYPES OF CHEST PAIN
a. Ischemic Chest Pain
b. Stable Angina
c. Unstable Angina
d. Prinzmetal Angina
e. Microvascular Angina
A diffuse retrosternal pain that immediately needs to be resolved. It presents (+) Levine Sign and discomfort or heaviness in the shoulder, jaw, arm, elbow, and upper back
a. Ischemic Chest Pain
TYPES OF CHEST PAIN
a. Ischemic Chest Pain
b. Stable Angina
c. Unstable Angina
d. Prinzmetal Angina
e. Microvascular Angina
A more serious type of angina that occurs during acute coronary syndrome. This causes a blot clot on heart artery which may lead to a heart attack
c. Unstable Angina
TYPES OF CHEST PAIN
a. Ischemic Chest Pain
b. Stable Angina
c. Unstable Angina
d. Prinzmetal Angina
e. Microvascular Angina
Occurs at rest and observed on younger pts.It is caused by spasms in the coronary arteries.
d. Prinzmetal Angina
What is the positive presentation of the Levine Sign
Fist close to the heart because of chest pain
TYPES OF CHEST PAIN
a. Ischemic Chest Pain
b. Stable Angina
c. Unstable Angina
d. Prinzmetal Angina
e. Microvascular Angina
Sx can be associated with dyspnea, sweating, indigestion, dizziness, syncope, and anxiety
a. Ischemic Chest Pain
What occurs when oxygenation is problematic to a patient
The body will not be able to supply an adequate amount of oxygen anymore
T/F: The heart muscle does not require its own supply of oxygen.
False.
It requires it own supply of oxygen. Once deprived, it willnow result in angina.
What can relieve a stable angina?
a. Rest
b. Nitroglycerin
c. Both
d. None
c. Both
How can chest pain be relieved with the use of nitroglycerin?
Placed under the tongue (sublingual)
How can you determine that the type of angina is stable using nitroglycerin?
When the reaction to the medication is immediate.
T/F: Smoking is a very strong risk factor in triggering a stable angina
True.
It can also be triggered by emotional stress, extremes of temp, and a heavy meal
Which of the ff is an indication of an unstable angina?
1. Occurs when a awake
2. Lasts longer than a stable angina
3. Rests and medicine (nitrates) relieve the pain
4. Pain usually lasts for 30mins
2 and 4
1. It occurs when resting or sleeping
3. Rests and medicine do not relieve pain
This artery is the blood vessel that supplies O2 and nutrients to the heart muscle
Coronary Artery
What occurs when there are spasms in the coronary artery?
It impedes the delivery of O2 and nutrients to the heart muscle
Diff Diagnosis of Chest Pain
a. Pleuritic Chest Pain
b. Pulmonary Hypertension
c. Pericardial Chest Pain
d. Esophageal Chest Pain
e. Chest Wall Pain
Substernal pain radiating on one or both arms and is relieved by sublingual nitroglycerin and antacids
d. Esophageal Chest Pain
Diff Diagnosis of Chest Pain
a. Pleuritic Chest Pain
b. Pulmonary Hypertension
c. Pericardial Chest Pain
d. Esophageal Chest Pain
e. Chest Wall Pain
Pain close to thoracic cage (superficial) and worsens sharply with inspiration, coughing, or laughing (Pain comes from the pleura and felt during the inflation of lungs)
a. Pleuritic Chest Pain
Diff Diagnosis of Chest Pain
a. Pleuritic Chest Pain
b. Pulmonary Hypertension
c. Pericardial Chest Pain
d. Esophageal Chest Pain
e. Chest Wall Pain
Midline pain felt from each heartbeat (pericardium) and is aggravated by deep inspiration, coughing, swallowing, or lying down. The pain is relieved by sitting up, leaning forward or lying on right side
c. Pericardial Chest Pain
Diff Diagnosis of Chest Pain
a. Pleuritic Chest Pain
b. Pulmonary Hypertension
c. Pericardial Chest Pain
d. Esophageal Chest Pain
e. Chest Wall Pain
This may mimic angina pectoris and occurs during exertion. This is associated with dyspnea and not relieved by nitrates.
b. Pulmonary Hypertension
T/F: Not all chest pain that does not react to nitrates is unstable angina
True. Look at other
symptoms of unstable angina
T/F: Pulmonary Hypertension is similar to stable angina
False. It is similar to both stable and unstable angina
Diff Diagnosis of Chest Pain
a. Pleuritic Chest Pain
b. Pulmonary Hypertension
c. Pericardial Chest Pain
d. Esophageal Chest Pain
e. Chest Wall Pain
This is an intermittent type with variable intensity. It may have a traumatic history on the chest wall
e. Chest Wall Pain
Syndrome that has chest wall pain that presents with local tenderness and costochondral of the 2nd-4th costochondral junction
Tietze Syndrome
This syndrome is a tumor on superior sulcus that compresses brachial plexus. It also presents with radiating pain in the shoulder, scapular or medial aspect of arm and hand
Pancoast Syndrome
Angina Rating Scale (1-4)
Moderately severe, very uncomfortable
Grade 3
Angina Rating Scale (1-4)
Moderate, bothersome
Grade 2
Angina Rating Scale (1-4)
Most severe or intense pain ever experienced
Grade 4
Angina Rating Scale (1-4)
Mild, barely noticeable
Grade 1
Type of cough that expels sputum
Productive cough
No sputum is expelled but may sometimes contain saliva
Non-productive
T/F: Cough may only be due to acute infections of the lungs
False. It may be due to acute or chronic infection of the lungs.
Acute Infection of the Lungs
Cough associated with sore throat, runny nose & eyes
Tracheobronchitis
Acute Infection of the Lungs
Cough preceded by Sx of upper respiratory infection; dry cough → productive
Lobar Pneumonia
Acute Infection of the Lungs
Starts as acute bronchitis; dry or productive cough
Bronchopneumonia
Acute Infection of the Lungs
Paroxysmal cough (sudden increase or occurrence of symptoms)
Viral Pneumonia
Acute Infection of the Lungs
Chronic productive cough; mucoid sputum → purulent (greenish or yellowsih sputum)
Exacerbation of Chronic Bronchitis
Chronic Infections of the Lungs
Chronic productive cough for more than 3 consecutive months for 2 successive years; mucoid → mucopurulent sputum
Chronic Bronchitis