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Cardiopulm > Week 2 CV Exam & Assessment > Flashcards

Week 2 CV Exam & Assessment Flashcards

1
Q

Chart review

A

Orders
Medications
Medical events
Teams involved in care
Vitals
Labs
Imaging
Surgeries
Time on bypass/on pump
DNR/I
Family
Prior notes
Infection
I&O
CM/SW notes
Orientation
Premorbid status
# of readmits, LOS, outcomes
Time OOB
Pain

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2
Q

Normal blood pressure

A

<120/<80

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3
Q

Elevated blood pressure

A

120-129/<80

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4
Q

Stage 1 hypertension

A

s 130-139
or
d 80-89

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5
Q

Hypertension stage 2

A

s >140
or
d > 90

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6
Q

Hypertension crisis

A

s > 180
and/or
d >120

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7
Q

Normal HR

A

60-100 bpm

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8
Q

Tachycardia HR

A

> 100 bpm

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9
Q

Bradycardia HR

A

< 60 bpm

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10
Q

SpO2 normal

A

> 90%

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11
Q

SpO2 for COPD

A

88-92 %

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12
Q

Concerning Vital signs in CV

A

BP: >180/90 or < 90/60; MAP <60
HR: <50, uncontrolled arrhythmia, >120 at rest
SpO2: <88-90% at rest, change in O2 demand/device
RR: <10 or >30 at rest

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13
Q

What factors might cause bradycardia in a CV patient

A

Heart block
Adverse drug reaction
Metabolic dysfunction
Post-op status
Medications
Myocarditis
Lab abnormalities
Respiratory pattern

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14
Q

What factors might cause tachycardia in a CV patient

A

Anemia
Hypotension
Infection
Anxiety
ETOH use
Fear
Pain
Substance use

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15
Q

What factors might cause hypoxia in a CV patient

A

VQ mismatch
Hypoventilation
Heart/lung disease
Infection (COVID, pneumonia)
Anemia
PE
Sleep apnea

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16
Q

What factors might cause hypertension in a CV patient

A

Lifestyle factors
Pain
Obesity
Tobacco use
Age
Comorbidities (CKD, diabetes)

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17
Q

What might cause hypotension in a CV patient

A

Medications – diuretics, pain meds, CV meds
Acute blood loss
Diastolic dysfunction
Bradycardia
Shock
Position changes
Dehydration
Arrhythmias

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18
Q

Vital signs absolute contraindications

A

New onset a fib
Non-sustained v tach
Complete heart block
Increasing frequency of PVC burden
Increased ventricular arrhythmias
New-onset chest pain
Uncontrolled arrhythmias causing hemodynamic instability or acute/subacute symptoms
Unstable angina
Use of pacing pads or temporary non-sutured pacemaker (especially femoral access)
VT storm (3+ episodes vtach in 24hr)
Pending pacemaker interrogation

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19
Q

Vital signs relative contraindications

A

Cardiac signs/symptoms dependent on baseline
Decrease in heart rate with activity
Orthostasis with increasing workload or activity level
A fib with rate control, >130-140 bpm

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20
Q

Cardiac enzymes and biomarkers can help indicate

A

damage to myocardial tissue

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21
Q

B type natriuretic peptide (BNP)

A

odds ratio ~ 30 for CHF

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22
Q

Creatine phosphokinase

A

release with muscle tissue damage

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23
Q

CK-MB

A

Cardiac muscle

Increases 3-6hr after MI; peaks 18-24hrs; normalizes after 2-3 days
Less sensitive than troponin
Can also be elevated with PE, CO poisoning, hypothyroidism

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24
Q

CK-BB

A

Brain tissue

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25
CK-MM
skeletal muscle
26
Troponin
often considered gold standard for cardiac biomarker
27
BNP
increased levels with worsening category/classification of CHF
28
BNP < 100 pg/ML
no presence of HF
29
BNP 100-300 pg/mL
Class 1 HF
30
BNP > 300 pg/mL
class 2 HF
31
BNP > 600 pg/mL
class 3 HF
32
BNP > 900 pg/mL
class 4
33
Troponin
highly sensitive and specific
34
troponin indicates
myocardial damage
35
troponin times
Elevate 2-6 hours after injury Peak 12-48 hours after injury Decrease over 4-10 days >0.10ng/dL can indicate MI
36
What other factors can contribute to troponin elevation
kidney disease COVID PE Burns Rhabdo
37
Hyperkalemia
high potassium increase cardiac cellular excitability = VT or VF
38
Hypokalemia
low potassium TdP, ventricular tachyarrhythmias
39
Sodium
impaired cognition, seizures, orthostatic hypotension, coma, lethargy, agitation
40
Hypomagnesemia
Low magnesium arterial/ventricular ectopy, TdP and VT
41
Hypercalcemia
high calcium short QT
42
Hypocalcemia
low calcium prolonged QT; scan -> ventricular arrhythmias such as TdP and VF
43
FiO2
defer if > 60% in most cases/facilities
44
Subjective interview
consent to treat confirm chart info orientation questions patient goals barriers to care patient alert, pain meds, high Co2 how do they communicate
45
Acute conditions
CV risk factors Baseline mobility status Symptoms preceding admission – DOE, SOB, edema, angina, etc. Social history Functional capacity – baseline, recent
46
Chronic conditions
Use of home O2 Baseline cognitive status Home medications and in-hospital changes Frequency of healthcare use Functional capacity Social history Prior PT - HH, inpatient, cardiac rehab
47
Venous thromboembolism (VTE)
blood clot in a vein
48
DVT/PE risk factors
Fracture Immobility/bedrest Major surgery Heart/lung disease Age Hospitalization Obesity Presence of central venous catheter Cancer Clotting disorders Prior DVT/PE
49
S1 mechanism
closing of tricuspid and mitral valves at the start of systole
50
Tricuspid valve location
4th intercostal space at left sternal border
51
Mitral valve location
5th intercostal space at midclavicular line
52
S2
closing of aortic and pulmonic valves at the end of ventricular systole
53
Pulmonic valve location
btw 2nd and 3rd intercostal space of L border of sternum
54
Aortic valve location
2nd and 3rd intercostal space on R border of sternum
55
S3
early ventricular filling/start of diastole over cardiac apex; often using bell of stethoscope in left side lying position
56
S4
fast ventricular filling over cardiac apex; often using bell of stethoscope
57
Systemic/endocrine presentation
Obesity Impaired glucose tolerance Poor nutrition Neuropathy
58
Respiratory presentation
Dyspnea Respiratory rate Work of breathing Accessory muscle use Decreased pulmonary/secretion clearance Decreased gas exchange Impaired lung volumes
59
Endurance/activity tolerance presentation
Fatigue Decreased exercise/aerobic capacity Decreased strength Pain Impaired balance
60
Education
Decreased knowledge of medical condition/management Challenges with adherence to medical management
61
Cardiac presentation
blood pressure HR Angina Heart rhythm
62
Reasons for patient assessment
Helps determine discharge planning Can reduce risk of readmission Improves patient participation in in-hospital mobility Facilitates role of PT in interprofessional decision-making processes
63
Cardiac rehab
Community-dwelling patients who can tolerate daily rehab services and had recent cardiac medical event (MI), diagnosis (HF), or procedure (PCI, CABG)
64
Home Health
Homebound patients with acute decline in medical/functional condition warranting 2-3x/wk therapy services in the home
65
SNF
Patients who may tolerate lower level/frequency of therapy services
66
Inpatient Rehab
Patients who can tolerate 3 hr/day of therapy services
67
Long term acute care
Patients with complex medical needs such as wound care, ventilator/trach weaning, parenteral nutrition, certain medications.

Cardiopulm (11 decks)

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