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Cardiopulmonary PT > Screening for cardiovascular and pulmonary dysfunction > Flashcards

Screening for cardiovascular and pulmonary dysfunction Flashcards

1
Q

What does the history and interview give you in regards to cardio/pulmonary

A
  • can give you about 80% of the information that is needed
  • Listen for clues that indicate CVP dysfunction, but also listen to assess the patient understanding and knowledge of their disease
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2
Q

What types of questions should be used during the history and interviewing process

A
  • Try to use open-ended questions, then closed-ended questions, funnel/strain this information, may use paraphrase technique to clarify
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3
Q

What are some potentially relevant information for patients with chronic disease o CVP dysfunction?

A
  • Date of Birth/Age
  • Diagnoses
  • Patient goals
  • Risk factors
  • Past Medical History/ Family History
  • Cognitive Status
  • Medication
  • Health care utilization - access and use
  • Functional history
  • Social history
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4
Q

what are some examples of information given in the past medical history/family history in regards to CVP dysfunction

A
  • Smoking History
  • Pulmonary/Respiratory History
  • Cardiovascular History
  • Other comorbidities
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5
Q

What are some examples of information give in the social history that could be useful

A
  • culture
  • environment
  • opportunities/challenges
  • support system
  • prior treatments
  • structured questionaries can provide more information
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6
Q

Defining criteria for risk factors: age

A
  • men ≥ 45
  • women ≥ 55 years
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7
Q

Defining criteria for risk factors: family history

A
  • MI,
  • revascularization procedure,
  • sudden death before 55 years of age in father or other male first-degree relative
  • before age 65 in mother or other first-degree female relative
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8
Q

Defining criteria for risk factors: smoking

A

Current smoker or those who have quit within previous 6 months

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9
Q

Defining criteria for risk factors: HTN

A
  • Systolic BP ≥140mmHg or diastolic ≥90 mmHg,
  • confirmed on at least 2 consecutive occasions,
  • currently on HTN medication
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10
Q

Defining criteria for risk factors: dyslipidemia

A
  • Low-density lipoprotein >130 mg/dL,
  • high-density lipoprotein <40 mg/dL,
  • on lipid-lowering medications,
  • total cholesterol >200 mg/dL
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11
Q

Defining criteria for risk factors: impaired fasting glucose

A

Fasting blood glucose ≥100 mg/dL confirmed by measurements on at least two separate occasions

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12
Q

Defining criteria for risk factors: obesity

A
  • Body mass index >30 kg/m2,
  • waist girth >102 cm for men ( 40 inches) 88 cm for women (34inches)
  • waist/hip ratio ≥0.95 for men and ≥0.86 for women.
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13
Q

Defining criteria for risk factors: sedentary lifestyle

A
  • Not participating in at least 30 minutes of moderate-level activity at least 3days/week for at least 3 months
    **Suggested guidelines (150 min/week of moderate activity or 75 minutes of vigorous activity)
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14
Q

What to observe in your patients when screening or CVP dysfunction

A
  • General appearance/state of consciousness
  • skin color, signs of edema
  • body traits (obese, normal, cachetic)
  • postural abnormalities (kyphoscoliosis, thoracic kyphosis, pectus excavatum/pectus carinatum),
  • hypertrophied accessory breathing muscles,
  • general respiratory rate and pattern,
  • ease of phonation,
  • presence of jugular venous distention / digital clubbing,
  • presence of oxygen or medical devices, etc.
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15
Q

Lordosis, kyphosis, scoliosis

A
  • This can affect where the heart and lungs sit and therefore how they function
  • Lungs may not be able to expand as well
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16
Q

Pectus excavatus

A

costal cartilage/ribs curve in causing the chest to look sunken in around sternum

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17
Q

Pectus carinatum

A

costal cartilages and sternum are rigid and curve out

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18
Q

barrel chest/hypertrophied accessory muscles

A
  • Hallmark of COPD
  • Hyperinflation due to loss of elasticity (lungs do not return to normal)
  • Bucket handle of lower ribs is always present
  • Use of accessory muscles can cause hypertrophy - clavicle can become higher
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19
Q

Dyspnea

A

labored breathing

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20
Q

apnea

A

absences of breathing

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21
Q

Tachypnea: vs Bradypnea:

A

Tachypnea: RR > 20
Bradypnea: RR<12

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22
Q

Cheyne-stokes respirations:

A
  • near death patients
  • Goes low volume, high volume and speeds up and slows down
  • Can also stop of a second
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23
Q

Paradoxical respirations:

A
  • chest rises and abdomen goes in
  • either chest wall or abdomen does not move outward with inspiration.
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24
Q

orthopnea

A
  • related to body position
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25
Q

Paroxysmal Nocturnal Dyspnea

A
  • related to left sided Heart Failure/ Fluid overload in capillaries of lungs/ Usually occurs when patient lies down at night
  • Pressure backs up from ventricles into atrium then into pulmonary vein
  • The pressure back up leads to pulmonary edema
26
Q

Hyperventilation/Hypocapnia vs Hypoventilation/ Hypercapnia

A

Hyperventilation/Hypocapnia – low CO2
Hypoventilation/ Hypercapnia – increased CO2

27
Q

Cyanosis

A
  • Lack of blood
  • Blue in central
  • Take a pulse ox
  • Related to perfusion
28
Q

Digital clubbing

A
  • Loss of angle between nail bed and DIP
  • Related to chronically low oxygen
29
Q

dry cough/non productive (causes general)

A
  • Irritation
  • Smoking
  • Cold air
  • Asthma
  • Medications
  • Airway abnormality: pressure in interstitial not in alveoli
  • Heart failure
30
Q

Wet cough/productive cough

what can cause this

A
  • Acute viral disease
  • Chronic pulmonary disease
  • Heart failure
  • Pneumonia
  • Post nasal drip
  • Infection - viral/bacterial
31
Q

Edema and is relationship to CVD

A
  • B/L and in gravity depended places can be a sign of CVP disease
  • Part of CVP screening
  • Makes tissue boggy
  • Gets backed up due to the heart not pushing enough blood out/not completely overcoming afterload
32
Q

Grading edema

A
  • 1+ = 2mm depression - barely detectable immediate rebound
  • 2+ = 4 mm deep pit, a few seconds to rebound
  • 3+ = 6 mm deep pit, 10-12 seconds to rebound
  • 4+ = 8 mm, very deep put, >20 seconds to rebound
33
Q

Jugular venous distension

A
  • A sign of right sided heart failure
  • Jugular vein is distended
  • Backload into vena cava
  • Distended to increase in pressure
34
Q

Vertigo - descriptors

A
  • Spinning, swaying
  • Tilting
  • Could also say wooziness, giddiness
35
Q

presyncope

A
  • Lightheadedness
  • Near blackout
  • Near fainting
  • Near syncope
  • Can describe as: wooziness, giddiness
36
Q

Syncope is associated with what?

A

Syncope - associated with dangerous arrhythmias, orthostatic hypotension, poor ventricular function, CAD, Vertebral artery (basilar) insufficiency (VBI)

37
Q

Disequilibrium

A

Imbalance
Instability
LOB
Off balance
Unsteadiness

38
Q

lightheadedness - possible causes/underyling issues

A
  • hypotension,
  • cerebral ischemia,
  • hyper- or hypoventilation,
  • hyperglycemia
39
Q

Dizzy - causes

A

can be vestibular, vision, meds, BP, or decreased cardiac output

40
Q

fatigue
- definition
- causes

A
  • Defined as tiredness that is disproportional to effort and often unrelieved with rest.
  • Cardiac disease, medications, nutrition, deconditioning, depression, etc.
41
Q

What are some causes of fatigue

A

metabolic/endocrine
Infectious
Cardiac and pulmonary
Medications
Psychiatric
Sleep problems
Vitamin deficiencies
Other

42
Q

Palpitations of the heart

A
  • Related to irregular electrical activity
  • New onset: should be assess
  • Less than 6/min can be considered normal but should be checked
  • Examples: A-fib, PVC (pre ventricular contraction etc
  • Racing, bumping, flutter
  • may not feel this in a pulse unless its impacting the ventricle
43
Q

when to refer with palpitations

A
  • last for a long period,

are combined with

  • pain,
  • SOB,
  • fainting,
  • severe lightheadedness
  • history of sudden death in the family, seek medical attention.
44
Q

Chest pain or discomfort: what to assess?

A
  • onset
  • location
  • Duration
  • characteristics
  • accompanying symptoms
  • radiation
  • treatment
    *OLD CART
45
Q

Onset of chest pain

A
  • Is it sudden or insidious?
  • Cardiogenic pain is usually of sudden onset.
  • Precipitated by?
    *Often brought on by exertion, stress, emotions, meals
46
Q

Location of chest pain

A
  • Substernal area,
  • left pectoral area,
  • left arm,
  • left shoulder,
  • neck, jaw,
  • shoulder blades
47
Q

Duration of chest pain

A

usually minutes

48
Q

characteristics of chest pain

A
  • Pressure,
  • heaviness,
  • tightness unchanged with breathing,palpation, or motion
49
Q

accompanying symptoms:

of cardiogenic chest pain

A
  • dyspnea,
  • fatigue,
  • lightheadedness,
  • diaphoresis,
  • weakness,
  • nausea
    *often accompany cardiogenic chest pain
50
Q

Radiation of symptoms

A

Cardiogenic pain can radiate throughout the upper body

51
Q

Treatment of chest pain

A

What relieves the pain? If pain is relieved by rest or nitroglycerin, then pain is likely cardiogenic
Non-cardiogenic causes of chest pain

52
Q

Myocardial infarction

A

obstruction of the blood supply to a region of the heart, typically by a thrombus or embolus, causing local death of the tissue.

53
Q

MI
1. Location
2. radiation
3. nature of pain
4. duration
5. other symptoms (accompanying)
6. precipitating factors
7. factors giving relief

A
  1. Location: substernal or across chest
  2. Radiation: neck, jaw, arms
  3. Nature of pain: dull or heavy discomfort with a pressure or squeezing sensation (more intense)
  4. Duration: longer than 30 minutes:
  5. Other symptoms: perspiration, weakness, nausea, pale gray color
  6. Precipitating factors:often none
  7. Factors giving relief: nitroglycerin (vasodilator) may give some or no relief
54
Q

Myocardial ischemia

A

chest discomfort (angina) that occurs when the heart gets insufficient oxygen.

55
Q

myocardial ischemia
1. Location
2. radiation
3. nature of pain
4. duration
5. other symptoms (accompanying)
6. precipitating factors
7. factors giving relief

A
  1. Location: substantial or across chest
  2. Radiation: neck, jaw, arms
  3. Nature of pain: dull or heavy discomfort with a pressure or squeezing sensation
  4. Duration: 3-8 minutes:
  5. Other symptoms: usually none
  6. Precipitating factors: extremes in weather, exertion, stress, meals
  7. Factors giving relief: stopping physical activity, reducing, stress, nitroglycerin (vasodilator)
56
Q

rate pressure product

A
  • Predictor of angina onset:
  • RPP = HRxSBP
  • Used to determine the workload of the heart
  • Angina often occurs at the same RPP
  • Related to activity level
57
Q

heart failure

A
  • Diagnosis that denotes the hearts inability to move blood FORWARD
  • Leads to increased pressure or congestion in the heart and vasculature behind the faulty ventricle
  • This increased pressure in the vasculature leads to fluid moving from the capillaries into the interstitial spaces
  • Leads to pulmonary edema
58
Q

Right sided heart failure

A
  • Congestion of peripheral tissues
  • Dependent edema and ascites (fluid buildup in abdomen
  • GI tract congestion: anorexia, GI distress, weight loss)
  • Liver congestion: signs related to impaired liver function
59
Q

Left sided heart failure

A
  1. Decreased cardiac output: activity intolerance and signs of decreased tissue perfusion
  2. Pulmonary congestion: pulmonary edema (V/Q affected)
    - Impaired gas exchange: cyanosis and sings of hypoxia
    - Pulmonary edema
    ~ Orthopnea: laying down increases preload
    ~ Cough with frothy sputum
    ~ Paroxysmal nocturnal dyspnea
60
Q

Intermittent claudication

A

Equivalent of angina
Occurs in the LE
Principle RPP applies

61
Q

Normal vital signs response to exercise

A

Heart rate response:
Sedentary: goes up at a more rapid rate
Trained = gradual increase
Respiration: increase rate and depth
SpO2: normal normal >95 should remain unchanged

Cardiopulmonary PT (25 decks)

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