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Cardio 2 > screening in PT > Flashcards

screening in PT Flashcards

1
Q

The Screening Process

A

Take vital signs

  • Review the pain body chart
  • Review medications and their potential side effects against current signs and symptoms
  • Watch for red flag histories, risk factors, and associated signs and symptoms
  • Always ask a broad, open-ended question
  • Conduct the medical chart review
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2
Q

red flags of systemic illness

A

Gradual onset with no known cause

  • Gradual, progressive, cyclical onset
  • Constant/intense pain
  • Symptoms unrelieved by rest or
    change in position
  • Bilateral symptoms
  • Constitutional symptoms
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3
Q

Bilateral Symptoms

A
  • Pigmentation changes
  • Edema
  • Rash
  • Clubbing/nail bed changes
  • Weakness
  • Numbness/tingling
  • Burning
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4
Q

Constitutional Symptoms

A
  • Fever
  • Diaphoresis
  • Night sweats
  • Pallor
  • Fatigue
  • Nausea
  • Vomiting
  • Diarrhea
  • Dizziness/syncope
  • Weight loss
  • Headache
  • Visual changes
  • Bowel/bladder
  • Unusual vital signs
  • Warning signs of cancer * Dyspnea
  • Orthostatic hypotension
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5
Q
  • Diaphoresis
A

sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug.

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6
Q

Red Flag- Vital Signs

A

Correlate unusual vital signs with other signs and symptoms, such as:
* Pallor
* Perspiration
* Fatigue
* Palpitations

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7
Q

bad Resting heart rate

A

120 to 130 bpm

Anemic individuals may have increased normal resting pulse that
should be monitored

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8
Q

bad Resting systolic pressure

A

180 to 200 mm Hg

Precautions/Contraindications to Therapy

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9
Q

bad Resting diastolic pressure

A

105 to 110 mm Hg

Precautions/Contraindications to Therapy

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10
Q

other Precautions/Contraindications to Therapy

A

Marked dyspnea

Loss of palpable pulse or irregular pulse with symptoms of dizziness, nausea, or SOB

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11
Q

Pain of cardiac and diaphragmatic origin is often felt where

A

in the shoulder

because the heart and the diaphragm are supplied by the C5–6 spinal segment

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12
Q

Diaphragmatic irritation referral site

A

Shoulder, low back

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13
Q

Heart referral site

A

Shoulder, neck, upper back, TMJ

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14
Q

risk factor for heart disease

A

HTN
smoking
elevated cholesterol
family history
stress
sedentary lifestyle
older age
obesity
diabetes

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15
Q

classic cardiac symptoms

A

chest pain
tightness/pressure
SOB
palpations
indigestion
burning

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16
Q

classic pulmonary symptoms

A

SOB
dyspnea - labored breathing
wheezing
cough
increased work of breathing
sputum

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17
Q

what is the well criteria looking was

A

risk of DVT

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18
Q

what to look at when a pt is on oxygen

A

delivery of oxygen
amount of oxygen being delivered

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19
Q

can ECG tell you about the future

A

no

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20
Q

ECG and coronary anatomy

A

ECG does not tell you anything about coronary anatomy

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21
Q

Cardiac catheterization provides information about what

A

information about the coronary arteries and provides a dynamic assessment of cardiac muscle

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22
Q

risk factors for cardiovascular disease

A

age, gender, ethnicity

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23
Q

clinical presentation of cardiac issue

A

pain that is worse with exercise

cardiac pain pattern - shoulder, neck, upper back, and TMJ

absence of the 3p’s

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24
Q

what are the 3 P’s

A

palpation
pleura pain
postion

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25
Q

palpation of the 3P’s

A

if there is pain with palpation it could be skeletal

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26
Q

pleura pain of the 3P’s

A

pain when you are breathing and have to cough

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27
Q

Position of the 3P’s

A

change in position of the neck, truck, or shoulder - MSK pain

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28
Q

Stable angina and nitroglycerin

A

Relieved by nitroglycerin (30 sec to 1 min)

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29
Q

Stable angina presentation

A

Comes on at the same heart rate and blood pressure and is relieved by rest (lasts only a few minutes)

Associated with feelings of doom, cold sweats, shortness of breath

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30
Q

is stable angina palpable

A

no

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31
Q

stable angina effect on ECG

A

Often seen with ST-segment

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32
Q

Nonanginal discomfort (chest wall pain) Nitroglycerin

A

Nitroglycerin generally has no effect

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33
Q

Nonanginal discomfort (chest wall pain) timing

A

Occurs any time; lasts for hours

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34
Q

Nonanginal discomfort (chest wall pain) palpation

A

Muscle soreness, joint soreness, evoked by palpation or deep breaths

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35
Q

Nonanginal discomfort (chest wall pain) effect on ECG

A

No ST-segment depression

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36
Q
  • Angina and/or myocardial infarction (MI) pain location and presenstion
A

can appear as arm and shoulder pain

can be misdiagnosed as arthritis or other musculoskeletal pathologic conditions.- but this can be localized and reproduced

this is unaffected by position, movement, or breathing

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37
Q

Dyspnea on exertion is normally a result of what

A
  • Often the result of left ventricle dysfunction, failure to clear all blood from lungs resulting in pulmonary congestion and SOB
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38
Q

Paroxysmal nocturnal dyspnea

A

a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.

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39
Q

Orthopnea

A

sensation of breathlessness while living down horizontally, relieved by sitting or standing

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40
Q

PND and sudden, unexplained episodes of SOB often accompany

A

heart failure

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41
Q

Dyspnea caused by pulmonary disease not cardiac is often relieved by what

A

by specific breathing (pursed-lip breathing) or by specific body position (leaning forward on arms)

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42
Q

what is Syncope

A

Sudden loss of consciousness accompanied by an inability to maintain postural tone

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43
Q

cause of Syncope

A

Can be related to reduced oxygen delivery to brain

  • Cardiac and non-cardiac causes
  • Related to side effects of medications
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44
Q

Medical referral recommended for what kind of syncope

A

unexplained syncope

especially in presence of heart or circulatory problems or if risk factors for heart attack or stroke are present

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45
Q

Fatigue of cardiac nature often accompanied by what

A

associated symptoms

Fatigue beyond expectations during or after exercise is red flag, especially with no other explanation

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46
Q

A Cough can be associated with what

A

Usually associated with pulmonary disease, but can be pulmonary complication of cardiac disease

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47
Q

A cough, especially at night, can be associated with

A

heart failure and / or a side effect of calcium channel blockers

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48
Q

Cough specific associations with the heart

A

Left ventricular dysfunction, mitral valve dysfunction resulting in pulmonary edema or left ventricular heart failure-may also result in cough

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49
Q

Cyanosis suggest what

A

Suggests inadequate blood oxygen levels

Most often associated with cardiac and pulmonary problems

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50
Q

Central cyanosis

A

oxygen levels reduced in arterial
blood

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51
Q

Peripheral cyanosis

A

normal blood oxygenation but decreased or slow blood flow

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52
Q

Edema

A

An accumulation of fluid

red flag and a referral

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53
Q

PVD related pain

A

Pain in limb, pelvis, or buttock may be result of ischemia related to PVD

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54
Q

Deep vein thrombosis after surgery may develop and will present with

A

enlarged, warm, and painful leg

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55
Q

Vascular pain

A

often throbbing in nature and exacerbated by activity.

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56
Q

Vascular pain risk factors

A

older
personal or family history of heart disease.
hyperlipidemia
tobacco use
diabetes.

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57
Q

pleuropulmonary Causes of Chest, Breast or Rib Pain - past medical history

A
  • Cancer
  • Recent pulmonary infection
  • Recent accident or hospitalization
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58
Q

Red Flags for pleuropulmonary issues

A

Pain exacerbated by deep breathing and activity or a productive cough with bloody or rust-colored sputum

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59
Q

clinical presentation of Pain relief of pleuropulmonary issues

A
  • Pain is relieved by restricting expansion of the chest wall
60
Q

Symptoms that do not increase with pulmonary movements is indicative of

A

a MSK issue

61
Q

Symptoms increase with pulmonary movements and cannot be reproduced with palpation

A

a pleuropulmonary issues

62
Q

sign of asthma

A

ncreased chest pain with exercise

63
Q

Pain referred from the pulmonary system presents as

A

aggravated by respiratory movements

aggravated by supine position (may be pleuritic in origin b/c abdominal contents push up against the diaphragm)

64
Q

CP system systems review

A

heart rate, respiratory rate, blood pressure, and presence of edema

65
Q

what is a systems review

A

Brief examination of all systems that would affect the ability of the patient to “initiate, sustain, and modify purposeful movement for the performance of actions, tasks or activities that are important for function”

66
Q

MSK system system review

A

gross symmetry, gross ROM, gross strength, height, and weight

67
Q

NM system systems review

A

gross movement involving balance, gait, locomotion, transfers, and transition as well as motor control and motor learning

68
Q

Integumentary system systems review

A

pliability (texture), presence of scar formation, skin color, and skin integrity

69
Q

sternocleidomastoid muscles often hypertrophy with what

A

in chronic obstructive pulmonary disease owing to increased work of the accessory muscles to assist with breathing.

70
Q

The increased size of the abdomen in obesity (or pregnancy) restricts what in breathing

A

the full downward movement of the diaphragm during inspiration and restricts lung tissue at rest, therefore creating a restrictive effect on the lung.

71
Q

barrel Chets wall is seen with what disease

A

COPD

72
Q

Semi-Fowler’sPosition

A

defined as a body position at 30° head-of-bed elevation

73
Q

ProfessorialPosition

A

taken by people who have COPD

74
Q

Jugular venous distention ( JVD) observed with what

A

heart failure

75
Q

Apnea

A

absence of ventilation

76
Q

Bradypnea

A

slowrate, regular rhythm

77
Q

Tachypnea

A

fast rate, shallow depth, regular rhythm

78
Q

Cheyne-Stokes

A

increasing then decreasing depth, period of apnea interspersed, seen in critically ill

79
Q

Apneustic

A

slow rate, deep inspiration followed by apnea, irregular rhythm, brainstem disorders

80
Q
  • Dyspnea
A

rapid rate, shallow depth ,regular, accessory muscle use

81
Q

Digital clubbing due to what

A

chronic tissue hypoxia

82
Q

Arterial BP is general indicator of what

A

function of
heart as a pump (systolic/diastolic)

83
Q

Evaluation of oxygen saturation should be done in what kind of patients

A

Should be evaluated in patients with heart
failure, pulmonary HTN, pulmonary disease

84
Q

warmth in a area is indicative of

A

inflammation or infection

85
Q

cool is indicative of

A

reduced blood flow

86
Q

assess the 5P’s

A
  1. Pain,
  2. paresthesia’s,
  3. paralysis,
  4. pulse,
  5. pallor

indicative of blood flow

87
Q

Capillary Refill Time Test (CRTT) purpose

A

screen for poor peripheral circulation

88
Q

Capillary Refill Time Test (CRTT) procedure

A

Depress nail bed for 5 seconds so they blanch or turn white

Positive findings for poor circulation include:
a. Finger ≥ 3 seconds
b.Toe ≥ 5seconds

89
Q

grade 0 of pulse

A

absent

90
Q

grade 1+ of pulse

A

palpable but diminished

91
Q

grade 2+ of pulse

A

palpable and brisk (normal)

92
Q

grade 3+ of pulse

A

increased

93
Q

grade 4+ of pulse

A

increased and bounding

94
Q

Cardiac Palpation Sites purpose

A

Assess for visible pulsations outside of
the norms

95
Q

Cardiac Palpation Sites procedure

A

Supine with bed elevated to 30 degrees OR Left lateral decubitus position

Palpate all areas with pads of fingers, followed by heel of hand

96
Q

Cardiac Palpation - * Thrills

A

Murmur

97
Q

Cardiac Palpation - Heaves

A

Cardiac Hypertrophy

98
Q

Cardiac Palpation - Pain

A

MSK origin

99
Q

Cardiac Palpation - Deformities

A

pectus cranium or excavatum

100
Q

Aortic Area

A
  • 2nd R intercostal space
101
Q

Pulmonary Area

A

2nd L intercostal space

102
Q
  • Right Ventricular Area
A

3-5th intercostal space, L sternal
border

103
Q

Left Ventricular Area

A

4-5th intercostal space, medial to midclavicular line

  • Apical Region

right below the nipple

104
Q

S1

A

1st heart sound

closing of the mitral and tricuspid valve leaflets “lub”

Marks the beginning of systole

rate is comparable to palpable pulse

105
Q

systole

A

when the heart muscle contracts and pumps blood from the chambers into the arteries.

106
Q

S2

A

2nd heart sound

produced by the closing of the aortic and pulmonic valve leaflets “dub”

*Marks the beginning of diastole

107
Q

S2 location

A

Aortic valve @ 2nd R interspace

Pulmonic Valve @ 2nd L interspace

108
Q

S1 location

A

Tricuspid Valve @ Lower L
sternal border 4-5th ICS

Mitral Valve @Apex of heart, 5th ICS midclavicular line

109
Q

S3

A
  • Additional “dub” (lub, dub, dub)
  • Heard early in ventricular filling
  • Normal in children
  • Cardiomyopathy or CHF in adults
110
Q

S4

A

Additional “la” (la, lub, dub)

Heard during atrial contraction

Associated with stiff, low compliant ventricle

111
Q

Systolic murmur

A
  • “lub” whoosh “dub”
  • associated with aortic stenosis
112
Q

Murmurs

A

Turbulence of blood flow through

113
Q
  • Diastolic murmur
A

“lub” “dub” whoosh

  • associated with aortic and pulmonic regurgitation & mitral stenosis
114
Q

where do we find the apical pulse

A

Apex of heart, 5th ICS midclavicular line

Palpated or auscultated

115
Q

what is the apical pulse a good representation of

A

measure of heart rate

116
Q

Edema - Pitting examination

A

Apply digital pressure of or 15-30s over
bony prominence

Release and determine soft (pitting) vs indurated (non-pitting) edema

117
Q

Edema resolving > 40s suggestive of what issue

A

heart failure

118
Q

Carotid Artery Auscultation purpose

A

Screen for possible carotid artery blockage

119
Q

sites for Carotid Artery Auscultation

A

Angle of jaw, Carotid bifurcation, Base of neck, Subclavian artery

120
Q

Carotid Artery Auscultation positive finding

A

(+) carotid, systolic bruit, is a blowing or swishing sound

121
Q

Tracheal Shift Purpose

A

assess for the presence of a tracheal shift

122
Q

Tracheal Shift procedure

A

examiner would palpate the position of the trachea with their index finger

123
Q

Tracheal Shift- what cause the trachea to shift away from the primary abnormality

A

mass effect of a large pleural effusion, pneumothorax, or intrathoracic mass will

124
Q

Tracheal Shift- what cause the trachea to shift towards from the primary abnormality

A

collapse of a lung caused by bronchial obstruction

125
Q

Chest Wall Motion examination purpose

A

Note symmetry, superior, A/P & Lat motion

126
Q

Normal finding with Chest Wall Motion

A

3-5 cm expansion from midline

127
Q

Chest Wall Motion - COPD

A

reduction in expansion or movement bilaterally

128
Q

Chest Wall Motion - unilateral lung collapse

A

non-symmetrical movement

129
Q

Chest Wall Motion - unilateral delay suggests

A

atelectasis, pneumonia, post- operative guarding or poor chest wall muscle function

130
Q

Diaphragmatic Motion examination purpose

A

Asses the integrity and capability for the
diaphragm to engage in inspiration

131
Q

Diaphragmatic Motion normal motion

A

normal = 2-3 inches separation

132
Q

Tactile Fremitus purpose

A

Assess areas of increased or decreased fremitus

A vibration felt when an examiner palpates a body part

133
Q

Tactile Fremitus positive finding

A

+) increased to decreased fremitus or sound transmission during contralateral comparison

  • warrants further investigation, as may have consolidation or poor ventilation in area
134
Q

Mediate Percussion purpose

A

Evaluate changes in lung density by
sounds produced

  • Be aware of other areas outside the lungs, such as organ tissue or bowel regions
135
Q

when do Lung sounds increase

A

in areas of increased tissue density

Ex. Consolidation-lung tissue becomes firm and solid due to exudates

136
Q

Bronchial/Tracheal lung sounds

A

Loud tubular sounds over the trachea and manubrium

Pause will be heard from inspiration and expiration

Equal inspiratory and expiratory phase

137
Q

Bronchovesicular

A

Softer vs bronchial, and in 2nd intercoastal space

No pause between inspiration and expiration

138
Q

Vesicular sounds

A

Soft rustling sounds over more distal
airways in the peripheral lung fields

Inspiration longer than expiration

139
Q

Bronchial heard where vesicular sounds should be

A

Fluid or secretion

140
Q

Decreased breath sounds

A

Hypoventilation or severe congestion

141
Q

Absent breath sound

A
  • Collapsed lung or severe consolidation
142
Q

Wheeze/ Rhonchi

A

Airway obstruction from bronchoconstriction or retained secretions with expiration

  • Present with inspiration indicates significant obstruction
143
Q

Stridor

A

tremely high-pitched wheeze with upper airway obstruction heard both inspiration and expiration
* medical emergency

144
Q

Crackles/ Rales

A

Discontinuous sound of

  • bubbling or popping sound with
    presence of fluid or sudden open/closing of airway
145
Q

Voice Transmission Tests

A

to discover if consolidation is present in the lungs

Cardio 2 (12 decks)

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