Week 2 Flashcards
1
Q
What are the measurements taken at the systemic veins?
A
- Jugular venous distention
- Venous pulse
- Central line
- Central venous pressure
- PvO2
2
Q
What are the measurements taken at the systemic arteries?
A
- Pulse palpation for HR, heart rhythm, patency of blood vessel
- BP
- Pulse oxygen or O2 saturation
- Arterial line: BP, PaO2, cardiac output or index
3
Q
What are the measurements taken at the R heart?
A
- ECG
- Heart rate
- Heart rhythm
- Heart sounds
4
Q
What are the measurements taken at the pulmonary arteries?
A
- Swan Ganz catheter: pulmonary artery BP, and pulmonary capillary wedge pressure
5
Q
What are the measurements taken at the lungs using inspired air?
A
- Breath frequency
- Tidal volume
- Lung sounds
6
Q
What are the results of physiologic measures used to do?
A
- The need to refer the patient to a physician
- Establish intervention goals
- Developing an intervention plan
- Assess the individual response to intervention
7
Q
What is body mass index (BMI)?
A
A measure of body composition
8
Q
What are high BMI values associated with?
A
• Hypertension • Dyslipidemia (abnormalities of blood lipids) • Type 2 diabetes • Coronary heart disease • Stroke • Gallbladder disease • Osteoarthritis • Sleep apnea and respiratory problems • Cancer – Endometria – Breast – Prostate – Colon cancer
9
Q
What comorbidities have a high BMI has the primary risk factor?
A
- Dyslipidemia (abnormalities of blood lipids)
- Type 2 diabetes
- Coronary heart disease
10
Q
What percent of the USA population is overweight or obese?
A
66.3%
11
Q
When should BMIs be assessed?
A
As part of the initial examination of all patients older than 2 years old, regardless of the reason for the visit
12
Q
What BMI percent is considered overweight for children?
A
Greater than 85%
13
Q
What BMI percent is considered obese for children?
A
Greater than 95%
14
Q
For individuals over 20, what BMI is considered underweight?
A
Less than 18.5
15
Q
For individuals over 20, what BMI is considered normal?
A
18.5-25
16
Q
For individuals over 20, what BMI is considered overweight?
A
25-30
17
Q
For individuals over 20, what BMI is considered obese?
A
30 and above
18
Q
What are some approaches that have been shown to be effective in reducing BMI?
A
- Increased physical activity
- Behavior modification
- Dietary modification
19
Q
What is blood pressure?
A
The force driving the blood through vascular system
20
Q
In what situations is a catheter placement in the artery used to measure BP?
A
In the acute setting with more severely ill patients
21
Q
When is resting BP measured?
A
At initial evaluation
22
Q
What are the signs and symptoms of hypotension or hypertension?
A
– Headache (usually occipital and present in the morning) – Vertigo (dizziness) – Flushed face – Spontaneous epistaxis (nosebleed) – Blurred vision – Nocturnal urinary frequency
23
Q
What is considered an elevated BP?
A
Greater than 200/110 mmHg at rest
24
Q
When is BP considered a medical emergency?
A
No BP or an extremely low BP
25
What is the minimum and maximum BP for patients age 3-6?
Minimum: 80/50
Maximum: 116/76
26
What is the minimum and maximum BP for patients age 6-9?
Minimum: 84/55
Maximum: 122/78
27
What is the minimum and maximum BP for patients age 10-13?
Minimum: 84/55
Maximum: 126/82
28
What is the minimum and maximum BP for patients age 14-19?
Minimum: 90/60
Maximum: 142/86
29
What is the minimum and maximum BP for patients age 20-60?
Minimum: 90/60
Maximum: 150/90
30
What is the minimum and maximum BP for patients age ?60?
Minimum: 90/60
Maximum: 160/95
31
What is the optimal BP for adults?
<120 and >80
32
What is the normal BP for adults?
120-129 and 80-84
33
What is the high normal BP for adults?
130-139 or 85-89
34
What is considered stage 1 HTN for adults?
140-159 or 90-99
35
What is considered stage 2 HTN for adults?
160-179 or 100-109
36
What is considered stage 3 HTN for adults?
>/=180 or >/= 110
37
What are the symptoms of orthostatic hypotension?
* Lightheadedness
* Rubbery legs
* Feelings of syncope
38
What are the management methods for orthostatic hypotension?
* Sit or lie down
* Ankle pumps
* Notify medical personnel as needed
* Discontinue standing activities
39
What are some of the comorbidities that can result from HTN?
* Stroke
* Myocardial infarction
* CHF
* Peripheral vascular disease
* Renal failure
40
In R sided CHF, there is elevated R atrial and systemic pressure. What does the elevated pressure lead to, when severe?
Engorgement and distention of the jugular veins
41
What are some of the S/S associated with CHF?
* Increased fluid retention
* Weight gain
* Dependent pitting edema
* Increased fatigue with activity
42
How can the rate and rhythm of blood pumped during myocardial contraction be sensed?
By lightly placing the fingertips over the skin covering peripheral arteries
43
How is the strength of peripheral pulse determined?
By the difference between systolic and diastolic BP or pulse pressure and the elasticity of blood vessels
44
Heart rate and rhythm at rest are usually ____.
Heart rate and rhythm at rest are usually *stable*.
45
Heart rate can increase or decrease in response to what?
Changes in energy demand
46
Why does heart rhythm usually remain stable?
The synarthrodial node
47
What are some factors that affect pulse and HR?
* Age: increased in infants and decreased in adults >65 years
* Gender: male
48
What is a dysrhythmia?
Alterations in rate or rhythm that produce variations in the time of myocardial infarction.
49
What are the factors that lead to dysrhythmia?
* Ischemia/hypoxia of the myocardium
* Sympathetic discharge: anxiety and exercise
* Acidosis
* Alterations in electrolytes (primary ↓K+ <3.2 mEq/dL)
* Excessive stretch of the myocardium E.g. CHF
* Pharmacologic agents
* Sympathomimetics: caffeine, antiarrhythmic drugs, and digitalis
50
What are the common sites for pulse palpation in order to measure pulse rate?
* Radial
* Brachial
* CaroBd
* Femoral
* Temporal
* Popliteal
* Posterior tibial artery
51
What is considered a regular pulse rhythm?
Pulse with a similar rate and volume
52
What is considered a regularly irregular pulse rhythm?
The periodic nature of the irregularity comes at a specific time (interpulse intervals are unequal, but the pattern is periodic and stable), such as bigeminy (one normal, one abnormal heart contraction) or trigeminy (two normal and one
abnormal heart contraction)
53
What is considered an irregularly irregular pulse rhythm?
No specific pattern, and rate and volume vary widely (interpulse intervals are unequal, and the pattern is unstable), such as A-fib or multiple premature ventricular contractions not in a row or sequence
54
When do we assess HR?
* Resting HR
* HR with activity
* Emergency situations
* Initial eval
55
What are the symptoms of cardiac decomposition?
* Angina
* Palpitation
* Dyspnea or shortness of breath
* Fatigue
56
What are the signs of cardiac decomposition?
* Dysrhythmias
* Syncope
* Dyspnea or shortness of breath
* Dependent edema hemoptysis
* Cyanosis
57
What is HR?
An objective, indirect measure of the status and condition of the cardiovascular system
58
What is HR during activity?
An objective, indirect measure of work intensity
59
In what fashion does HR change during activity?
In a linear fashion
60
How often should HR be measured during activity and why?
Every 10 secs, because of the rapidly declining behavior of HR after the cessation of activity
61
How many abnormal beats per min indicates a PVC?
More than 6 abnormal beats
62
What is ventilatory rate?
The rate and rhythm of air moved during ventilation
63
How can ventilatory rate be sensed?
By observing the chest rise and fall in correlation to time
64
What is an apnea breathing pattern?
No breathing
65
What is a tachypnea breathing pattern?
Rate greater than 20 breaths/min in an adult
66
What is a bradypnea breathing pattern?
Rate less than 12 breaths/min in an adult
67
What is a hyperpnea breathing pattern?
Normal rate but increased volume
68
What is a hypopnea breathing pattern?
Normal rate but decreased volume
69
What is a hyperventilation breathing pattern?
Increased rate and volume
70
What is a hypoventilation breathing pattern?
Decreased rate and volume
71
What is a cheyne-stokes breathing pattern?
Hyperventilation followed by
| hypoventilation, then apnea, with the cycle repeating
72
What is orthopnea breathing pattern?
Difficulty breathing while horizontal, with easing of breathing with more vertical positioning
73
What is a dyspnea breathing pattern?
Labored or difficult breathing
74
How is ventilatory rhythm measured?
* Observe chest rise/fall in relation to time
* Assess for 30 seconds to 1 minute
* Compare to expected normal rate for pt’s age
* Perform further testing as needed.
75
What is an important clinical pearl to keep in mind while assessing a pt's ventilatory rhythm?
Because ventilation is under involuntary and voluntary control, awareness by the patient of the clinician’s observation may cause ventilation to be modified
from the usual resting pattern. A trick that is often used is to appear as though taking a pulse
measurement but actually to observe the rise and fall of the chest.
76
What are the resting breathing values of a neonate?
30-40 breaths/min
77
What are the resting breathing values of a 1 y/o?
20-40 breaths/min
78
What are the resting breathing values of a 4 y/o?
25-32 breaths/min
79
What are the resting breathing values of a 8-10 y/o?
23-30 breaths/min
80
What are the resting breathing values of a 12-14 y/o?
18-22 breaths/min
81
What are the resting breathing values of a 16 y/o?
16-26 breaths/min
82
What are the resting breathing values of a 18 y/o?
10-12 breaths/min
83
What are the resting breathing values of an adult?
10-20 breaths/min
84
What does a level 0 on the ranchos los amigos dyspnea scale mean?
On a single breath
85
What does a level 1 on the ranchos los amigos dyspnea scale mean?
Requires 2 breaths
86
What does a level 2 on the ranchos los amigos dyspnea scale mean?
Requires 3 breaths
87
What does a level 3 on the ranchos los amigos dyspnea scale mean?
Requires 4 breaths
88
What does a level 4 on the ranchos los amigos dyspnea scale mean?
Unable to count
89
What are the guidelines of what to do with patients with onset of chest pain or discomfort?
* Stop any activity and place patient in comfortable position (sitting or lying)
* Monitor vital signs
* Ask whether patient has been diagnosed with heart disease
90
When a patient that has been diagnosed with heart disease experiences onset of chest pain or discomfort, what should be done?
* Ask whether this symptom is usual or different
* Ask whether patient has medication (e.g., nitroglycerin)
* Allow administration of three tablets in a 10-minute period, and if symptoms do not resolve, get patient to emergency department or seek medical attention
91
When a patient that has NOT been diagnosed with heart disease experiences onset of chest pain or discomfort, what should be done?
* Ask patient to describe discomfort
* Ask what precipitated discomfort
* Ask whether discomfort is getting worse or better
* If signs and symptoms improve and do not appear to be musculoskeletal (movement or revealed by palpation) in origin, have patient see his or her physician
* If signs and symptoms are worsening, get patient to the ED
92
When a patient that has been diagnosed with lung disease experiences onset of chest pain or discomfort, what should be done?
* Ask whether this symptom is usual or different
* Ask whether patient has medication (inhaler)
* Allow use of inhaler and see whether symptoms resolve. If symptoms do not resolve and are worsening, get patient to the ED or seek medical attention
93
When a patient that has NOT been diagnosed with lung disease experiences onset of chest pain or discomfort, what should be done?
* Ask patient to describe the discomfort
* Ask what precipitated the discomfort
* Ask whether discomfort is getting worse or better
* If signs and symptoms are improving and do not appear to be musculoskeletal (movement or revealed by palpation) in origin, have patient see his or her physician
* If signs and symptoms are worsening, get patient to ED
94
What should be done if a pt's SpO2 is less than 90% in a patient?
* Stop performing any physical activity
* Check that the device is on properly
* Retake the measurement with the patient being still
* Notify medical personnel, if the measurement is valid
* Continue to monitor the patient
95
What should be done if a pt's SpO2 is less than 90% in a patient with lung disease?
The therapist should stop
activity if:
• Stop activity if SaO2 decreases by ≥5% of resting
value
• ≤88% in patients with right-sided heart failure
• Patients with lung disease with SaO2 <80%
96
Patients with lung disease with SaO2 of ____ use supplemental oxygen
Patients with lung disease with SaO2 of **<88%** use supplemental oxygen
97
During the hand inspection portion of the cardiovascular and pulmonary systems test, what are we looking for?
- Clubbing
- Peripheral cyanosis
- Cigarette staining
- Splinter hemorrhages
98
During the radial pulse portion of the cardiovascular and pulmonary systems test, what are we looking for?
- Examine the rate and rhythm of the pulse
| - Allow at least 15 secs to identify the pulse rate
99
By identifying the radial pulse on both hands at the same time, what are we assessing?
Possible radial-radial delay
100
What is dermatitis/eczema?
Inflammation of the skin caused by allergy/contact, photosensitivity or unknown, genetic/allergic links
101
What are some viral infections of the skin?
Herpes, warts
102
What are some bacterial infections of the skin?
* Impetigo – staphylococci/strep
* Cellulities
* Abscess
103
What are some fungal infections of the skin?
Ringworm, athlete foot
104
What are some parasitic infections of the skin?
* Insect/animal contacts
| * Scabies, lice
105
What are the types of cancer that can cause an integumentary disorder?
* Benign/malignant tumors
| * Melanoma
106
What are the types of trauma that can cause an integumentary disorder?
* Contusion
* Ecchymosis
* Petechiae
* Abrasion
* Laceration
107
What are the types of immune disorders that can cause an integumentary disorder?
* Psoriasis
* Lupus etythematosus
* Polymiositis
* Scleroderma
108
Many immune disorders of
| the skin also affect ____
Many immune disorders of
the skin also *affect other
organ systems*
109
What is the pneumonic for the symptoms of scleroderma?
CREST
110
What do we do in the clinic to screen for integumentary disorders?
```
• Recent rash, nodule, new
mole, skin changes
• Unusual hair loss or
breakage
• Increased hair growth
• Nail bed changes
• Itching
• Skin turgor
• Current/past medications
```
111
What are the lab values that we look at for integumentary disorders?
```
• Nutrition (Pre-albumin, Albumin)
• Total lymphocyte count, WBC
• Coagulation
• Glycosylated hemoglobin
(HbA1c)
```
112
Changes in skin and nail beds may be the first sign of...?
* Inflammatory response in pulmonary malignancy
* Impaired circulation, vascular integrity
* Endocrine, autoimmune disorders
113
What is pruritus?
Severe itching of the skin
114
Pruritus is the 1st sign of what?
```
Dermatologic disease
• Infection
• Hepatic and/or gallbladder
disease/disorder
• Common in aging adults due to
changes contributing to irritated skin
```
115
What medications can cause
| photosensitivity leading to sunburn?
* Antibiotics: ciprofloxacin, oxycycline, sulfanamides and tetracycline
* Diaretic: Furosemide
* Cytotoxic: - fluorouracile
* Hypoglycemics: glipizide and glyburide
* NSAIDs: Ibuprofen, ketoprofen, naproxen
116
What medications can cause
| thinning, weakening of the skin or rash?
* Steroids
* Glucocorticoids
* Chemotherapies
* Any drug allergy
117
What is pre-albumin a marker of?
Marker of short-term nutritional
| status
118
What is albumin a marker of?
* Marker of longer nutritional status
| * Can be inaccurate in short-term
119
What is the function of coagulation labs?
* Ability to achieve hemostasis
| * Safe for sharp debridement?
120
What labs are used to assess overall health status?
* WBC, total lymphocyte count
| * HbA1c
121
What are the components of the observation portion of the physical examination of the integumentary system?
* Quality
* Pigmentation
* Presence of hair
* Color
* Edema
122
What are the components of the non- observation portion of the physical examination of the integumentary system?
* Temperature
* Texture
* Vascular exam
* Sensory testing
123
What are the characteristics of the aging integumentary system?
```
• Epidermal cell production slows
• Epidermal cells larger, more irregular
• Thinner skin
• Decrease in: Immune cells, melanocytes, sebaceous/sweat gland activity, vascular supply
and fat, collagen in underlying tissue
```
124
What are the things to look at during a melanoma examination?
- Asymmetry
- Border
- Color
- Diameter
- Evolve: moles that have changed over time
125
What are the general skin care recommendations for everyone, but most especially those with a skin disorder?
```
• Frequent inspections
• Promote cleaning
• Maintenance of dry, clean skin
• Use of topical agents
• Use of protective
• dressings
• Avoid activities and
procedures that intensify risk
```
