Screening for cardiovascular and pulmonary dysfunction Flashcards
What does the history and interview give you in regards to cardio/pulmonary
- 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
What types of questions should be used during the history and interviewing process
- Try to use open-ended questions, then closed-ended questions, funnel/strain this information, may use paraphrase technique to clarify
What are some potentially relevant information for patients with chronic disease o CVP dysfunction?
- 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
what are some examples of information given in the past medical history/family history in regards to CVP dysfunction
- Smoking History
- Pulmonary/Respiratory History
- Cardiovascular History
- Other comorbidities
What are some examples of information give in the social history that could be useful
- culture
- environment
- opportunities/challenges
- support system
- prior treatments
- structured questionaries can provide more information
Defining criteria for risk factors: age
- men ≥ 45
- women ≥ 55 years
Defining criteria for risk factors: family history
- 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
Defining criteria for risk factors: smoking
Current smoker or those who have quit within previous 6 months
Defining criteria for risk factors: HTN
- Systolic BP ≥140mmHg or diastolic ≥90 mmHg,
- confirmed on at least 2 consecutive occasions,
- currently on HTN medication
Defining criteria for risk factors: dyslipidemia
- Low-density lipoprotein >130 mg/dL,
- high-density lipoprotein <40 mg/dL,
- on lipid-lowering medications,
- total cholesterol >200 mg/dL
Defining criteria for risk factors: impaired fasting glucose
Fasting blood glucose ≥100 mg/dL confirmed by measurements on at least two separate occasions
Defining criteria for risk factors: obesity
- 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.
Defining criteria for risk factors: sedentary lifestyle
- 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)
What to observe in your patients when screening or CVP dysfunction
- 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.
Lordosis, kyphosis, scoliosis
- This can affect where the heart and lungs sit and therefore how they function
- Lungs may not be able to expand as well
Pectus excavatus
costal cartilage/ribs curve in causing the chest to look sunken in around sternum
Pectus carinatum
costal cartilages and sternum are rigid and curve out
barrel chest/hypertrophied accessory muscles
- 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
Dyspnea
labored breathing
apnea
absences of breathing
Tachypnea: vs Bradypnea:
Tachypnea: RR > 20
Bradypnea: RR<12
Cheyne-stokes respirations:
- near death patients
- Goes low volume, high volume and speeds up and slows down
- Can also stop of a second
Paradoxical respirations:
- chest rises and abdomen goes in
- either chest wall or abdomen does not move outward with inspiration.
orthopnea
- related to body position
Paroxysmal Nocturnal Dyspnea
- 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
Hyperventilation/Hypocapnia vs Hypoventilation/ Hypercapnia
Hyperventilation/Hypocapnia – low CO2
Hypoventilation/ Hypercapnia – increased CO2
Cyanosis
- Lack of blood
- Blue in central
- Take a pulse ox
- Related to perfusion
Digital clubbing
- Loss of angle between nail bed and DIP
- Related to chronically low oxygen
dry cough/non productive (causes general)
- Irritation
- Smoking
- Cold air
- Asthma
- Medications
- Airway abnormality: pressure in interstitial not in alveoli
- Heart failure
Wet cough/productive cough
what can cause this
- Acute viral disease
- Chronic pulmonary disease
- Heart failure
- Pneumonia
- Post nasal drip
- Infection - viral/bacterial
Edema and is relationship to CVD
- 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
Grading edema
- 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
Jugular venous distension
- A sign of right sided heart failure
- Jugular vein is distended
- Backload into vena cava
- Distended to increase in pressure
Vertigo - descriptors
- Spinning, swaying
- Tilting
- Could also say wooziness, giddiness
presyncope
- Lightheadedness
- Near blackout
- Near fainting
- Near syncope
- Can describe as: wooziness, giddiness
Syncope is associated with what?
Syncope - associated with dangerous arrhythmias, orthostatic hypotension, poor ventricular function, CAD, Vertebral artery (basilar) insufficiency (VBI)
Disequilibrium
Imbalance
Instability
LOB
Off balance
Unsteadiness
lightheadedness - possible causes/underyling issues
- hypotension,
- cerebral ischemia,
- hyper- or hypoventilation,
- hyperglycemia
Dizzy - causes
can be vestibular, vision, meds, BP, or decreased cardiac output
fatigue
- definition
- causes
- Defined as tiredness that is disproportional to effort and often unrelieved with rest.
- Cardiac disease, medications, nutrition, deconditioning, depression, etc.
What are some causes of fatigue
metabolic/endocrine
Infectious
Cardiac and pulmonary
Medications
Psychiatric
Sleep problems
Vitamin deficiencies
Other
Palpitations of the heart
- 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
when to refer with palpitations
- last for a long period,
are combined with
- pain,
- SOB,
- fainting,
- severe lightheadedness
- history of sudden death in the family, seek medical attention.
Chest pain or discomfort: what to assess?
- onset
- location
- Duration
- characteristics
- accompanying symptoms
- radiation
- treatment
*OLD CART
Onset of chest pain
- Is it sudden or insidious?
- Cardiogenic pain is usually of sudden onset.
- Precipitated by?
*Often brought on by exertion, stress, emotions, meals
Location of chest pain
- Substernal area,
- left pectoral area,
- left arm,
- left shoulder,
- neck, jaw,
- shoulder blades
Duration of chest pain
usually minutes
characteristics of chest pain
- Pressure,
- heaviness,
- tightness unchanged with breathing,palpation, or motion
accompanying symptoms:
of cardiogenic chest pain
- dyspnea,
- fatigue,
- lightheadedness,
- diaphoresis,
- weakness,
- nausea
*often accompany cardiogenic chest pain
Radiation of symptoms
Cardiogenic pain can radiate throughout the upper body
Treatment of chest pain
What relieves the pain? If pain is relieved by rest or nitroglycerin, then pain is likely cardiogenic
Non-cardiogenic causes of chest pain
Myocardial infarction
obstruction of the blood supply to a region of the heart, typically by a thrombus or embolus, causing local death of the tissue.
MI
1. Location
2. radiation
3. nature of pain
4. duration
5. other symptoms (accompanying)
6. precipitating factors
7. factors giving relief
- Location: substernal or across chest
- Radiation: neck, jaw, arms
- Nature of pain: dull or heavy discomfort with a pressure or squeezing sensation (more intense)
- Duration: longer than 30 minutes:
- Other symptoms: perspiration, weakness, nausea, pale gray color
- Precipitating factors:often none
- Factors giving relief: nitroglycerin (vasodilator) may give some or no relief
Myocardial ischemia
chest discomfort (angina) that occurs when the heart gets insufficient oxygen.
myocardial ischemia
1. Location
2. radiation
3. nature of pain
4. duration
5. other symptoms (accompanying)
6. precipitating factors
7. factors giving relief
- Location: substantial or across chest
- Radiation: neck, jaw, arms
- Nature of pain: dull or heavy discomfort with a pressure or squeezing sensation
- Duration: 3-8 minutes:
- Other symptoms: usually none
- Precipitating factors: extremes in weather, exertion, stress, meals
- Factors giving relief: stopping physical activity, reducing, stress, nitroglycerin (vasodilator)
rate pressure product
- 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
heart failure
- 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
Right sided heart failure
- 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
Left sided heart failure
- Decreased cardiac output: activity intolerance and signs of decreased tissue perfusion
- 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
Intermittent claudication
Equivalent of angina
Occurs in the LE
Principle RPP applies
Normal vital signs response to exercise
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
