Skills Check Off Flashcards
(87 cards)
1
Q
Describe the pulse grades.
A
0: Absent 1+: Weak, thready 2+: Normal 3+: Full/ increased strength 4+: Aneurismal/ bounding
2
Q
Whose pulses should be checked in 2 places?
A
- Older adults
- Individuals with DM
3
Q
How should the carotid pulse be taken?
A
- Seated
- Head turned to palpated side
4
Q
Should the femoral or radial pulse be stronger?
A
- Femoral
5
Q
What pulse can be congenitally absent?
A
- Dorsal pedal
6
Q
What causes barrel chest?
A
COPD/ overexpansion of lungs.
7
Q
What is Pectus excavatum?
A
A divot in the chest.
8
Q
What is pectus carnatum?
A
Bowing of the chest
9
Q
What is a normal resting respiration rate?
A
- 12 - 20 BPM
10
Q
What respiration rate is a precaution to exercise? What is a contraindication to exercise?
A
35 < precaution
45 < contraindication
11
Q
What is minute ventilation?
A
- Respiratory rate * tidal volume
12
Q
Below what % SaO2 should a patient not be exercised?
A
85 %
13
Q
Below what SaO2 may supplemental O2 be required?
A
90 %
14
Q
What can cause false readings of a pulse oximeter?
A
- fingernail polish
- acrylic nails
- chemotherapy
- anemia
- cold skin
15
Q
What a normal SBP and DBP response to exercise?
A
7 - 10 mmHg Systolic
Little not change in diastolic
16
Q
What is a hypotensive response of SBP and DBP to exercise?
A
SBP: Decrease 10 - 20 mmHg
DBP: Decrease 10 < mmHg
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
18
Q
What is a flat or blunted response to exercise?
A
Little or no increase
19
Q
What is pulse pressure?
A
SBP - DBP.
20
Q
What is a normal pulse pressure?
A
20<
21
Q
What is a low pulse pressure indicative of?
A
Low cardiac output
22
Q
How long should you wait between BP readings?
A
1 - 2 minutes
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
24
Q
Blood pressure below what level is a yellow flag in individuals over 70 yos?
A
70 mmHg
25
Over what period of time is a persistent drop in BP a yellow flag?
2 weeks.
26
Past what age is a persistent fall in BP a yellow flag?
75 yo
27
If a patient is 65 yo with a fall history, what SBP is a yellow flag?
140 mmHg
28
What amount of difference in BP bilaterally is a yellow flag?
10 mm Hg
29
What pulse pressure is a yellow flag?
Greater than 40 mmHg
30
What changes combined with a change in BP are yellow flags?
- Dizziness
- Nausea
- Extreme sweating
31
What drop in SBP or DBP combined with a 10 - 20 % rise in HR may indicate orthostatic hypotension?
SBP: > 10 - 15 mmHg
DBP: > 10 mmHg
32
Whom should be monitored for orthostatic hypotension?
- HTN
| - Especially those on diuretics
33
What 4 things for should be assessed during an abdominal exam?
- Rebound tenderness
- Masses
- Muscle guarding
- Bounding pulse
- Pain
34
What are the normal heart sounds?
S1: "Lub" --> Mitral and tricuspid valves closing at ventricular systole
S2: "Dub"; Aortic and pulmonic valves closing at onset of diastole
35
What is an S3 heart sound?
- Ventricular gallop
- Filling of ventricles immediately after the MV and TV open
- Associated with heart failure
36
What age may an S3 heart sound normally occur upto?
40.
37
What may be the cause of an S3 heartsound in older adults?
- Noncompliant LV
| - Associated with CHF
38
What is an S4 heart sound?
- Atrial gallop
| - Vibration of ventricular wall with ventricular filling
39
What is an S4 heart sound associated with?
- HTN
- Stenosis
- Hypertensive heart disease
- MI
40
What is a heart murmur blood sound?
- "Whooshing" sound due to turbulent blood flow
41
What are the 3 categories of heart murmurs?
- High rates of flow through normal or abnormal valves
- Forward flow through stenotic or deformed valves
- Backflow through a valve
42
Where is the mitral valve ausciltated?
- Apex of heart at 5th intercostal space in line with the middle of the left clavicle
43
Where is the tricuspid valve ausciltated?
- Right margin of the sternum at the 5th intercostal space
| - May also be heard to the left of the sternal body
44
Does the tricuspid or mitral valve close first?
Mitral.
45
Where is the aortic semilunar valve ausciltated?
- To the right of the sternum at the 2nd intercostal space
46
Where is the pulmonary semilunar valve ausciltated?
- Left of the sternum in the intercostal space
47
Which of the semilunar valve closes first? How can the two sounds be better separated?
- Aortic valve closes first
| - Better separation can be heard with the patient taking a deep, slow breath
48
What 8 situations require modified positions for bronchial drainage?
- Increased ICP
- Decreased arterial oxygen tension (PaO2)
- Decreased cardiac output
- Decreased FEV1
- Decreased specific airway conductance
- Pulmonary hemorrhage
- Gastroesophageal reflux
- Severe dyspnea
49
What are 6 cardiovascular contraindications to manual techniques?
- Pain in chest wall
- Unstable angina
- Hemodynamic lability
- Low platelet count
- Anticoagulation therapy
- Unstable or potentially lethal dysrhythmias
50
What are 7 musculoskeletal conditions that are precautions for manual techniques?
- Osteoporosis
- Prolonged steroid use
- Costal chondritis
- Osteomyelitis
- Osteogenesis imperfecta
- Spinal fusion
- Rib fracture or flail chest
51
What are 8 pulmonary conditions that are precautions for manual techniques?
- Bronchospasm
- Hemoptysis
- Severe dysnpea
- Untreated lung abscess
- Pneumothorax
- Immediately after removal of chest tube
- Pneumonia or other infectious processes
- Pulmonary embolism
52
What are 4 oncological conditions in which precaution should be used with manual techniques?
- Metastatic cancer to ribs or spine
- Carcinoma of the bronchus
- Resectable tumor
- Osteoporosis due to chemo
53
What 6 miscelanous conditions require caution when using manual techniques?
- Recent skin grafts
- Burns
- Open thoracic wounds
- Skin infections in thorax
- Subcutaneous emphysema, head and back
- Immediately following cataract surgery
54
What is the 13 step procedure for performing bronchial drainage?
- 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
Describe the percussion procedure.
- Percussion over thin cloth layer
| - 2 - 5 minutes over targeted segment
56
What may be performed following percussion? When should this adjunct treatment be performed?
- Vibration may be performed while the patient exhales
57
Describe the vibration procedure.
- 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
What action can be performed to "locate" the diaphragm?
- Quick sniffing with placed on abdomen
59
What type of patients on ventilators may diaphragmatic breathing be useful for?
Patients receiving:
- Assist
- Assist-control
- Intermittent mechanical ventilation
60
What 3 benefits does diaphragmatic breathing provide to patients on ventilators?
Maintains:
- Proprioception of diaphragm
- Rhythmicity of diagragm
- Relaxes abdomen
61
What is emphasized, and what is minimized in deep breathing exercises?
```
Emphasize:
- Diaphragmatic breathing
- Lateral costal expansion
Minimize:
- Upper chest expansion
```
62
What conditions are deep breathing exercises used for?
- Restrictive lung disease
- Post op
- Abdominal incision
63
Describe a deep breath with stacking technique.
- 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
How often should deep breathing with stacking be performed?
2 - 4 times per day.
65
What are 4 goals of deep breathing with stacking?
- Maximize ventilation of inspired air
- Increase inspiratory volume
- Decrease atelectasis
- Enhance huff or cough
66
Describe deep breathing with maximum end inspiratory hold.
- Slow sustained inspiration to full vital capacity
| - Hold for 3 - 5 seconds
67
What is the purpose of active cycle of breathing exercises?
- Removes phlegm from the lungs
68
Describe an active cycle of breathing technique.
- Practice diaphragmatic breathing
- Take 4 deep breaths with a 3 second inspiratory hold
- X2 or X3
- Forced expiratory technique or Huffs
69
What is ACBT used for?
- Cystic fibrosis
- COPD
- Chronic bronchitis
- Excessive secretions
70
What are the 3 phases of autogenic drainage?
- Unsticking
- Collection
- Evacuation
71
Describe the process of autogenic drainage.
- 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
What are some segmental breathing techniques?
- Place hand on an area, and coordinate chest wall movement with a downward hand movement to facilitate expansion
73
What are the 6 benefits of pursed lip breathing?
- Promotes relaxation
- Reduces dyspnea
- Relieves anxiety
- Prolongs expiratory phase
- Slows respiratory rate
- Delays closing of smaller airways
74
Describe pursed lip breathing.
- 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
Describe paced breathing.
- Combine diaphragmatic and pursed lip breathing with functional activites
76
What functional activities facilitate prolonged exhalations?
- Reading aloud
| - Singing
77
What is an incentive spirometer?
- Device used to help patient inhale slowly and prevent atelectasis
78
What patients may require support with coughing?
Patients with incisions.
79
Describe the drainage position for the apical segment of the upper lobes.
- Long seated against a pillow
- Slightly slumped forward
- Percussed over the trap
80
Describe drainage of the anterior segment of the upper lobes.
- Supine with pillow under legs
| - Percussed over upper pectorals
81
Describe drainage of the posterior segment of the upper lobes.
- 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
Describe drainage of the left upper lobe's lingual segment.
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
Describe drainage of the right middle lobe.
- 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
Describe drainage of the superior segment of the lower lobes.
- Prone with pillow propped underneath pelvis
- Head turned to opposite side
- Shoulders abducted, elbows flexed
- Percussed over inferior scapula
85
Describe drainage of the anterior basal segment of the lower lobe.
- 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
Describe drainage of the lateral basal segment of the lower lobes
- Side lying on unaffected side with pillow underhead and between legs
- Arm flexed overhead
- Percussed over lateral trunk
87
Describe drainage of the posterior basal segment of the lower lobes
- prone with pillows placed under pelvis and abdomen
- Arms abducted and elbows flexed
- Table elevated 18 inches at feet
- Percussed over lower back
