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Cardiopulmonary PT > Skills Check Off > Flashcards

Skills Check Off Flashcards

1
Q

Describe the pulse grades.

A 
0: Absent
1+: Weak, thready
2+: Normal
3+: Full/ increased strength
4+: Aneurismal/ bounding
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2
Q

Whose pulses should be checked in 2 places?

A
  • Older adults

- Individuals with DM

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3
Q

How should the carotid pulse be taken?

A
  • Seated

- Head turned to palpated side

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4
Q

Should the femoral or radial pulse be stronger?

A
  • Femoral
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5
Q

What pulse can be congenitally absent?

A
  • Dorsal pedal
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6
Q

What causes barrel chest?

A

COPD/ overexpansion of lungs.

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7
Q

What is Pectus excavatum?

A

A divot in the chest.

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8
Q

What is pectus carnatum?

A

Bowing of the chest

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9
Q

What is a normal resting respiration rate?

A
  • 12 - 20 BPM
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10
Q

What respiration rate is a precaution to exercise? What is a contraindication to exercise?

A

35 < precaution

45 < contraindication

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11
Q

What is minute ventilation?

A
  • Respiratory rate * tidal volume
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12
Q

Below what % SaO2 should a patient not be exercised?

A

85 %

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13
Q

Below what SaO2 may supplemental O2 be required?

A

90 %

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14
Q

What can cause false readings of a pulse oximeter?

A
  • fingernail polish
  • acrylic nails
  • chemotherapy
  • anemia
  • cold skin
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15
Q

What a normal SBP and DBP response to exercise?

A

7 - 10 mmHg Systolic

Little not change in diastolic

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16
Q

What is a hypotensive response of SBP and DBP to exercise?

A

SBP: Decrease 10 - 20 mmHg
DBP: Decrease 10 < mmHg

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17
Q

What is a hypertensive response of SBP and DBP to exercise?

A

SBP: Excessive increase (Should never exceed >225 mmHg or 200 mmHg conservative)
DBP: Increase of 15 - 20 mmHg (Should never exceed 120 mmHg or 100 mmHg conservative

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18
Q

What is a flat or blunted response to exercise?

A

Little or no increase

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19
Q

What is pulse pressure?

A

SBP - DBP.

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20
Q

What is a normal pulse pressure?

A

20<

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21
Q

What is a low pulse pressure indicative of?

A

Low cardiac output

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22
Q

How long should you wait between BP readings?

A

1 - 2 minutes

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23
Q

What conditions contraindicate BP measurements? (5 conditions)

A
  • Above IV
  • Above AV shunt
  • Same side as breast surgery
  • Axillary surgery
  • Arm and hard are traumatized or diseased
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24
Q

Blood pressure below what level is a yellow flag in individuals over 70 yos?

A

70 mmHg

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25
Q

Over what period of time is a persistent drop in BP a yellow flag?

A

2 weeks.

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26
Q

Past what age is a persistent fall in BP a yellow flag?

A

75 yo

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27
Q

If a patient is 65 yo with a fall history, what SBP is a yellow flag?

A

140 mmHg

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28
Q

What amount of difference in BP bilaterally is a yellow flag?

A

10 mm Hg

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29
Q

What pulse pressure is a yellow flag?

A

Greater than 40 mmHg

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30
Q

What changes combined with a change in BP are yellow flags?

A
  • Dizziness
  • Nausea
  • Extreme sweating
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31
Q

What drop in SBP or DBP combined with a 10 - 20 % rise in HR may indicate orthostatic hypotension?

A

SBP: > 10 - 15 mmHg
DBP: > 10 mmHg

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32
Q

Whom should be monitored for orthostatic hypotension?

A
  • HTN

- Especially those on diuretics

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33
Q

What 4 things for should be assessed during an abdominal exam?

A
  • Rebound tenderness
  • Masses
  • Muscle guarding
  • Bounding pulse
  • Pain
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34
Q

What are the normal heart sounds?

A

S1: “Lub” –> Mitral and tricuspid valves closing at ventricular systole
S2: “Dub”; Aortic and pulmonic valves closing at onset of diastole

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35
Q

What is an S3 heart sound?

A
  • Ventricular gallop
  • Filling of ventricles immediately after the MV and TV open
  • Associated with heart failure
36
Q

What age may an S3 heart sound normally occur upto?

37
Q

What may be the cause of an S3 heartsound in older adults?

A
  • Noncompliant LV

- Associated with CHF

38
Q

What is an S4 heart sound?

A
  • Atrial gallop

- Vibration of ventricular wall with ventricular filling

39
Q

What is an S4 heart sound associated with?

A
  • HTN
  • Stenosis
  • Hypertensive heart disease
  • MI
40
Q

What is a heart murmur blood sound?

A
  • “Whooshing” sound due to turbulent blood flow
41
Q

What are the 3 categories of heart murmurs?

A
  • High rates of flow through normal or abnormal valves
  • Forward flow through stenotic or deformed valves
  • Backflow through a valve
42
Q

Where is the mitral valve ausciltated?

A
  • Apex of heart at 5th intercostal space in line with the middle of the left clavicle
43
Q

Where is the tricuspid valve ausciltated?

A
  • Right margin of the sternum at the 5th intercostal space

- May also be heard to the left of the sternal body

44
Q

Does the tricuspid or mitral valve close first?

45
Q

Where is the aortic semilunar valve ausciltated?

A
  • To the right of the sternum at the 2nd intercostal space
46
Q

Where is the pulmonary semilunar valve ausciltated?

A
  • Left of the sternum in the intercostal space
47
Q

Which of the semilunar valve closes first? How can the two sounds be better separated?

A
  • Aortic valve closes first

- Better separation can be heard with the patient taking a deep, slow breath

48
Q

What 8 situations require modified positions for bronchial drainage?

A
  • Increased ICP
  • Decreased arterial oxygen tension (PaO2)
  • Decreased cardiac output
  • Decreased FEV1
  • Decreased specific airway conductance
  • Pulmonary hemorrhage
  • Gastroesophageal reflux
  • Severe dyspnea
49
Q

What are 6 cardiovascular contraindications to manual techniques?

A
  • Pain in chest wall
  • Unstable angina
  • Hemodynamic lability
  • Low platelet count
  • Anticoagulation therapy
  • Unstable or potentially lethal dysrhythmias
50
Q

What are 7 musculoskeletal conditions that are precautions for manual techniques?

A
  • Osteoporosis
  • Prolonged steroid use
  • Costal chondritis
  • Osteomyelitis
  • Osteogenesis imperfecta
  • Spinal fusion
  • Rib fracture or flail chest
51
Q

What are 8 pulmonary conditions that are precautions for manual techniques?

A
  • Bronchospasm
  • Hemoptysis
  • Severe dysnpea
  • Untreated lung abscess
  • Pneumothorax
  • Immediately after removal of chest tube
  • Pneumonia or other infectious processes
  • Pulmonary embolism
52
Q

What are 4 oncological conditions in which precaution should be used with manual techniques?

A
  • Metastatic cancer to ribs or spine
  • Carcinoma of the bronchus
  • Resectable tumor
  • Osteoporosis due to chemo
53
Q

What 6 miscelanous conditions require caution when using manual techniques?

A
  • Recent skin grafts
  • Burns
  • Open thoracic wounds
  • Skin infections in thorax
  • Subcutaneous emphysema, head and back
  • Immediately following cataract surgery
54
Q

What is the 13 step procedure for performing bronchial drainage?

A
  • Explain treatment to patient, and loosen clothing
  • Check position of lines and tubes
  • Take vitals
  • Auscultate over the treated segments
  • Have Pt cough
  • Position
  • Watch for signs of intolerance
  • Auscultate during treatment
  • Hold for 5 - 20 minutes depending on secretions and patient tolerance
  • Limit total treatment to 30 - 40 minutes
  • Treat most critical areas
  • Auscultate after treatment
55
Q

Describe the percussion procedure.

A
  • Percussion over thin cloth layer

- 2 - 5 minutes over targeted segment

56
Q

What may be performed following percussion? When should this adjunct treatment be performed?

A
  • Vibration may be performed while the patient exhales
57
Q

Describe the vibration procedure.

A
  • Hands on both, or one side of the chest
  • Pt inhales deeply, and then vibration is applied throughout exhalation
  • Perform for 6 - 8 breaths
  • If patient has tachypnea, alternate every other breath
58
Q

What action can be performed to “locate” the diaphragm?

A
  • Quick sniffing with placed on abdomen
59
Q

What type of patients on ventilators may diaphragmatic breathing be useful for?

A

Patients receiving:

  • Assist
  • Assist-control
  • Intermittent mechanical ventilation
60
Q

What 3 benefits does diaphragmatic breathing provide to patients on ventilators?

A

Maintains:

  • Proprioception of diaphragm
  • Rhythmicity of diagragm
  • Relaxes abdomen
61
Q

What is emphasized, and what is minimized in deep breathing exercises?

A 
Emphasize:
- Diaphragmatic breathing
- Lateral costal expansion
Minimize:
- Upper chest expansion
62
Q

What conditions are deep breathing exercises used for?

A
  • Restrictive lung disease
  • Post op
  • Abdominal incision
63
Q

Describe a deep breath with stacking technique.

A
  • Sit on edge of bed or chair in upright position
  • Relax shoulders
  • Take a deep breath and hold it for 1 second
  • Sip in air; larger breaths ontop of smaller
  • Hold for 1 second
  • Repeat until lungs are filled
  • Hold for 3 - 10 seconds
  • Slowly exhale through pursed lips
64
Q

How often should deep breathing with stacking be performed?

A

2 - 4 times per day.

65
Q

What are 4 goals of deep breathing with stacking?

A
  • Maximize ventilation of inspired air
  • Increase inspiratory volume
  • Decrease atelectasis
  • Enhance huff or cough
66
Q

Describe deep breathing with maximum end inspiratory hold.

A
  • Slow sustained inspiration to full vital capacity

- Hold for 3 - 5 seconds

67
Q

What is the purpose of active cycle of breathing exercises?

A
  • Removes phlegm from the lungs
68
Q

Describe an active cycle of breathing technique.

A
  • Practice diaphragmatic breathing
  • Take 4 deep breaths with a 3 second inspiratory hold
  • X2 or X3
  • Forced expiratory technique or Huffs
69
Q

What is ACBT used for?

A
  • Cystic fibrosis
  • COPD
  • Chronic bronchitis
  • Excessive secretions
70
Q

What are the 3 phases of autogenic drainage?

A
  • Unsticking
  • Collection
  • Evacuation
71
Q

Describe the process of autogenic drainage.

A
  • Practice breaths expanding lower chest
  • Take long expiration to expiratory reserve volume
  • Take a tidal breath
  • Continue until a popping, wheezing, or gurgling is heard
  • Move to higher level (mid-level, not full)
  • Listen for popping, wheezing, or gurgling
  • Take deeper breath for highest lung volume
  • Huff or clear
72
Q

What are some segmental breathing techniques?

A
  • Place hand on an area, and coordinate chest wall movement with a downward hand movement to facilitate expansion
73
Q

What are the 6 benefits of pursed lip breathing?

A
  • Promotes relaxation
  • Reduces dyspnea
  • Relieves anxiety
  • Prolongs expiratory phase
  • Slows respiratory rate
  • Delays closing of smaller airways
74
Q

Describe pursed lip breathing.

A
  • Breathe in through nose for a count of 1 - 2
  • Exhale gently through pursed lips for a 4 count
  • Exhalation should be 2 - 3 times longer than inhalation
75
Q

Describe paced breathing.

A
  • Combine diaphragmatic and pursed lip breathing with functional activites
76
Q

What functional activities facilitate prolonged exhalations?

A
  • Reading aloud

- Singing

77
Q

What is an incentive spirometer?

A
  • Device used to help patient inhale slowly and prevent atelectasis
78
Q

What patients may require support with coughing?

A

Patients with incisions.

79
Q

Describe the drainage position for the apical segment of the upper lobes.

A
  • Long seated against a pillow
  • Slightly slumped forward
  • Percussed over the trap
80
Q

Describe drainage of the anterior segment of the upper lobes.

A
  • Supine with pillow under legs

- Percussed over upper pectorals

81
Q

Describe drainage of the posterior segment of the upper lobes.

A
  • Seated on a chair backwards with a pillow padding the chair
  • Patient leans forward and turns away from targeted segment
  • Patient reaches across the body and holds the affected side’s shoulder
  • Percuss over scapula
82
Q

Describe drainage of the left upper lobe’s lingual segment.

A

Right sidelying with a pillow supporting the head and proping up the left trunk

  • Table raised 14 inches at the feet
  • Trunk percussed over axillary line
83
Q

Describe drainage of the right middle lobe.

A
  • Left sidelying with pillow supporting the head, and a pillow propping up the right trunk
  • Table elevated 14 inches at the feet
  • Trunk percussed along axillary line
84
Q

Describe drainage of the superior segment of the lower lobes.

A
  • Prone with pillow propped underneath pelvis
  • Head turned to opposite side
  • Shoulders abducted, elbows flexed
  • Percussed over inferior scapula
85
Q

Describe drainage of the anterior basal segment of the lower lobe.

A
  • Side lying on unaffected side with pillow propped between legs (top leg flexed)
  • Shoulder flexed overhead
  • Sidelying arm placed against body
  • Table elevated 18 inches at feet
  • Percuss over axillary line inferior to level of pectorals
86
Q

Describe drainage of the lateral basal segment of the lower lobes

A
  • Side lying on unaffected side with pillow underhead and between legs
  • Arm flexed overhead
  • Percussed over lateral trunk
87
Q

Describe drainage of the posterior basal segment of the lower lobes

A
  • prone with pillows placed under pelvis and abdomen
  • Arms abducted and elbows flexed
  • Table elevated 18 inches at feet
  • Percussed over lower back

Cardiopulmonary PT (10 decks)

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