Screening of the Cardiovascular and Pulmonary Systems Flashcards
cardiopulm systems checklist
- Dyspnea
- Cough (duration, positional, productive, sputum)
- Palpitations
- Syncope
- Sweats
- Edema
- Cold distal extremities
- Skin discoloration
- Open wounds/ulcers
- Clubbing of the nails
- Wheezing, stridor
dyspnea
difficult/uncomfortable breathing
Often associated with chronic heart and lung disease
• Can be related to activity, exertion, or body position
orthopnea/recumbent dyspnea
eased when sit/stand/prop
possible causes Congestive heart failure Mitral valve disease Rarely: Severe asthma, Emphysema, Chronic bronchitis Neurologic diseases
platypnea/sitting upright dyspnea
eased when recumbent
possible causes Status postpneumonectomy Neurologic diseases Cirrhosis (intrapulmonary shunts) Hypovolemia
Trepopnea/multiple dyspnea
eased in side lying
possible causes
- congestive heart failure
dyspnea screening questions
When did the shortness of breath (SOB) begin?
Did the SOB begin suddenly or slowly over time?
Do you wake up suddenly at night with severe SOB (paroxysmal
nocturnal dyspnea)?
Do you know why the SOB started?
Is the SOB constant?
Does SOB occur with exertion only? At rest? Or when in certain
positions, such as lying flat (orthopnea) or when sitting up
(platypnea)?
cough
– pulmonary or cardiovascular concern
• Nocturnal may indicate heart failure, side effect of medications
• Chronic if 3 weeks or longer
• Most common causes: smoking, allergies, postnasal drip
• Yellow, red/bloody, green sputum suggest pathology
screening questions for cough
What is the duration?
What is the cause (from the patient’s perspective)?
Is it constant and persistent or intermittent?
Is the cough related to position or posture?
Is it a productive cough (including color and odor of sputum)?
Is there pain accompanying the cough?
Associated symptoms (dyspnea, items from the general health checklist)?
Palpitations
- Described as “fluttering, jumping, pounding, irregular, skipping”
- Follow-up questions about frequency and duration
- Associated symptoms: chest pain, syncope, lightheadedness, dyspnea
Syncope
- Sudden loss of consciousness loss of postural tone spontaneous recovery
- Causes: reduced blood flow to brain, metabolic or psychogenic origin
- Increase >70yrs…increased fall risk
Sweats/diaphoresis
- Common with acute myocardial infarction
- Pain/tightness into L UE, jaw, neck, epigastric, midthoracic regions
- Diaphoresis + described pain pattern = increased concern
- Elevated concern if risk factors for cardiac disease
edema/cold distal extremities/skin discoloration
- Peripheral edema and tissue changes
- Observed at any point during assessment
- Associated with many serious pathologies:
- Venous insufficiency
- Congestive heart failure
- Deep vein thrombosis (DVT)
- Pulmonary hypertension
Screening questions for adema
What was the onset of the edema (slow versus fast)?
Is it related to dependent limb position?
Is it related to time of day—morning versus end of the day?
Are there any other associated symptoms or signs, e.g., pain, cyanosis, jaundice,
redness of the limb(s), clubbing of the nails, cough?
Exam findings for edema/cold extremities/skin discoloration
- Confirmation via palpation and/or observation of limb
- Findings: pitting edema, local tenderness, altered skin temperature, color variance
- Circumferential measurements for edema
- Unilateral edema marked by difference of 1+cm above ankle or 2+cm at midcalf
Open wounds/ulcers
vascular compromise
diabetes
infections
skin cancer
clubbing of the nails
- Distal phalanx appears rounded and bulbous
- Nail plate is convex-shaped
- Abnormality associated with:
- Chronic hypoxia
- Lung cancer
- Cystic fibrosis
- Congenital heart defects
- Graves disease
- Overactive thyroid
wheezing/stridor
- Abnormal respiratory sounds
- Audible to ear
- Wheezing is high-pitched noise, due to partial airway obstruction
- Stridor is high-pitched sound due to obstruction of larynx or trachea
- Additional signs of general and pulmonary distress
- Auscultation to identify sounds, see if position change affects sounds
wheezing/stridor screening questions
Have you noticed this noise? Do you know why the sound exists? How long has it been present? How often does it occur? What are the precipitating factors (e.g., odors, food, animals, exertion, emotions)? Are there any associated symptoms?
hypertension symptoms
- Facial flushing
- Headaches
- Altered vision
- Dizziness
- Nosebleeds
- Shortness of breath
- Chest pain
- Unsteady, “rubbery” legs
- Feeling “faint”, syncope
orthostatic hypotension symptoms
lightheadedness
unsteady legs
feeling faint
management: - lie down - ankle pumps modify standing activities - notify medical personnel as needed
atherosclerosis risk factors
Age
- Men ≥45 years old Women ≥55 years old
Family History
- Myocardial infarction, coronary revascularization, or
sudden death before:
• 55 years in father/other male first-degree relative
• 65 years in mother/other female first-degree relative
Cigarette Smoking
- Current smoker or recently quit (within previous 6 mo)
Physical Inactivity
- ≤90 min/wk mod intensity or ≤150 min/wk light intensity
Obesity
- Body mass index ≥30 kg/m2
Hypertension
- Systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg on BP
- based on an average of ≥2 readings obtained on ≥2
- occasions or taking antihypertensive medication
Dyslipidemia
- Low-density lipoprotein (LDL) ≥130 mg/dL or
- High-density lipoprotein (HDL) <40 mg/dL
Diabetes
- Fasting plasma glucose ≥126 mg/dL
Congestive heart failure symtoms
- Increased fluid retention
- Weight gain
- Dependent pitting edema
- Increased fatigue with activity
- Distention of the jugular veins
Management • Pharmaceutical intervention • Dietary modifications • Healthy lifestyle • Regular medical assessment/follow-up
