Subjective - Xtian Flashcards
sources of information
pt but if unable caregiver or family
medical charts or from HCPs
discuss dyspnea
air hunger - MC
when requirement for breathing is unable to provide by body
usual causes of dyspnea
inc awareness of breathing
inc work of breathing
abnormal ventilatory system
kinds of dyspnea based on time, appearance and progression
acute
dyspnea on exertion
PND
functional dyspnea
kinds of dyspnea based on body pos
orthopnea
platypnea
trepopnea
mMCR dyspnea scale
0: no trouble except strenous ex
1: SOB when hurry on level or slight hill
2: walks slower on level and stops
3: stops p 100 m or few mins
4: cant leave house or SOB during dressing
discuss borg ratings of RPE
6-20: interval type
linear c O2 and HR
discuss borg category ratio of RPE
ratio for pt c sx during training
0-10
ischemic chest pain or angina
diffuse and retrosternal
heavy on shoulder, jaw, arm, elbow and upper back
assoc c dyspnea, sweating, indigestion, dizzy, syncope and anxiety
(+) levine sign
stable angina or angina pectoris
heart works harder - 5 min or less
relieved by rest or nitroglycerin
feels like gas or indigestion
assoc c emotion, temp, heavy metal, smoking
unstable angina
acute coronary syndrome - blood clot
resting or sleeping and longer than stable
rest and medicine do no relieve
leads to heart attack
prinzmetal or variant angina
at rest or midnight and early morning
younger pt - spasm in coronary arteries
relieved by meds
microvascular angina
spasm of small arteries
10-30 mins
pleuritic chest pain
superficial and close to thoracic cage
worse c inhale, laughing and coughing
pulmonary HTN
mimics angina pectoris
during exertion or c dyspnea
not relieved by nitrates
pericardial chest pain
midline pain worse c deep inspiration, coughing, swallowing or lying
felt on heart beat
relieved by sitting, leaning forward and lying on R
esophageal chest pain
substernal pain on 1 or both arms
relieved by antacids or nitroglycerin
chest wall pain
intermittent c varying intensity
trauma on chest wall
tietze syndrome - local tender
pancoast syndrome - rad to shoulder, scap or medial arm
angina rating scale
1: mild barely noticable
2: moderate bothersome
3: mod severe and very uncomfy
4: most severe or intense
discuss cough
productive vs non
tracheobronchitis
cough c sore throat, runny nose and eyes
lobar pneumonia
cough preceded by upper respi infection
dry to productive
bronchopneumonia
acute bronchitis c dry or productive cough
viral pneumonia
paroxysmal cough
excaxerbation of chronic bronchitis
chronic productive cough; mucoid sputum to purulent
chronic bronchitis
productive cough more than 3 months for 2 years concesuctive both
mucoid to mucopurulent
brnochiecstasis
cough copious, foul and purulent
tuberculosis
persistent cough for wks months
blood-tinged
tumor cough
non to productive
wks to mo
hemoptysis
foreign bodies cough
upper: cough c asphyxia
lower: non prod c wheeze
smoking cough
more in morning
slight productive
cardiac cough
from postural changes and relieved by upright
non prod
nocturnal or episodic
wheezing
on expi
assoc c dyspnea or pulmonary edema
palipitations
pounding, fluttering or racing HR
from stress, exercise or meds
edema
pedal or bipedal - CHF
ascites - inc abdominal girth
altered renal function
goal in ICU
hemodynamic stab and optimal oxygen
optimal function
monitoring systems on ICU
ECG
atrial and venous lines
intra cardiac monitor
ICP
considerations on ICU
IV lines
chest tubes
VAD
fluid and electrolyte sx on head and neck
excess: distended neck vein and edema
loss: thirsty and dry mucous membrane
fluid and electrolyte sx on extremities
excess: pitting edema
loss: weakness, tingling, tetany
fluid and electrolyte sx on respiration
excess: dyspnea, orthopnea, prod cough and moist breath sounds
loss: change in rate and depth of breathing
fluid and electrolyte sx on circulation
excess: HTN, jugular pulse visibile, dysrhythmia
loss: irreg pulse rate, rhythm, OH, sinus tachy
fluid and electrolyte sx on skin
excess: warm, moist, cool and taut
loss: dry and dec turgor
fluid and electrolyte sx on abdomen
excess: inc girth and fluid wave
loss: cramps
signs of acidosis
hypercapnia
comatoes
bicarb deficit
hyperkalemia
signs of alkalosis
hypocapnia
numbness and convulsion
bircarb excess
hypokalemia
blood gassess
SaO2 vs SpO2
assessing arousal
GCS, RAS
electroencephalogram
discuss thoracic srugery
consider healing, LOM and weakness
approaches and if muscle sparing
anterolat
posterolat
median sternotomy
effects of vasodilators
hypotension, dizzy and syncope
effects of NSAIDS and ACE inhib
elevated BP
effects of NSAIDS and digitalis
fatigue, confusion, arrythmia
effects of diuretics
weakness and spams
dizzy
HA
incoordination
nausea
effects of beat blockers
monitor RPE and bradycardia
effects of aplha 1 blockers
hypotension and reflex tachycardia
effects of ACE inhib
rash, dry cough
effects of Ca channel blockers
swelling of feet and ankle
hypotension
HA
nausea
effects of nitrates
HA
dizzy
tachycardia
OH
effects of anticoagulants
hematoma
nose bleed
effects of thrombolytic
if DVT resolves
effects of beta 2 receptor agonists
asthma
effects of theophylline or aminophylline
toxic effects
effects of steroids
cushing’s
test for pulmonary function
spiromety
pH values
< 7.35: acidosis
> 7.45: alkalosis
pCO2 valuse
less than 35: alkalosis
more than 45: acidosis
HCO3 values
more than 26: alkalosis
less than 22: acidosis
pO2 values
less than 80 - hypoxemia
O2 sat values
< 70% vital function in affected
discuss chest x rays
dark p air
dark gray - fats
light gray - muscles
white - bones
compare CT scan to MRI
both high quality
CT: ionizing
MRI: non-ionizing
other clinical tests done
EKG
CBC
classification of smokers
0: none
1-20: light
21-40: mdoerate
> 40: heavy
packs per day x time taken = pack years
social drinking
celebrate/past time
conformity drinking
to fit in
enhancement drinking
seeks to get drunk
coping drinking
to forget worries
abuser drinking
extreme consumption
alcoholic drinking
addiction to alcohol
moderate drinker
1 drink a day for women
1-2 for men
heavy drinker
more than 3 drinks any day or 7 drinks a wk for more than 65 yo
more than 4 drinks any day or 14 drinks a wk for less than 65
binge drinker
4 or more drinks in 2 hrs for women
5 or more for men
effects of opioid
arrhytmia
stroke
endocarditis
effects of metamphetamine
CHF
arrythmia
damge to heart muscles and vessels
type 1 and 2 diet
1: fruits, veggies, fish, poultry and lean meat
2: sat fats, cholesterol, salt, caffeine
