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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
Q

CK-MM

A

skeletal muscle

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26
Q

Troponin

A

often considered gold standard for cardiac biomarker

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27
Q

BNP

A

increased levels with worsening category/classification of CHF

28
Q

BNP < 100 pg/ML

A

no presence of HF

29
Q

BNP 100-300 pg/mL

A

Class 1 HF

30
Q

BNP > 300 pg/mL

A

class 2 HF

31
Q

BNP > 600 pg/mL

A

class 3 HF

32
Q

BNP > 900 pg/mL

A

class 4

33
Q

Troponin

A

highly sensitive and specific

34
Q

troponin indicates

A

myocardial damage

35
Q

troponin times

A

Elevate 2-6 hours after injury
Peak 12-48 hours after injury
Decrease over 4-10 days
>0.10ng/dL can indicate MI

36
Q

What other factors can contribute to troponin elevation

A

kidney disease
COVID
PE
Burns
Rhabdo

37
Q

Hyperkalemia

A

high potassium

increase cardiac cellular excitability = VT or VF

38
Q

Hypokalemia

A

low potassium

TdP, ventricular tachyarrhythmias

39
Q

Sodium

A

impaired cognition, seizures, orthostatic hypotension, coma, lethargy, agitation

40
Q

Hypomagnesemia

A

Low magnesium

arterial/ventricular ectopy, TdP and VT

41
Q

Hypercalcemia

A

high calcium

short QT

42
Q

Hypocalcemia

A

low calcium

prolonged QT; scan -> ventricular arrhythmias such as TdP and VF

43
Q

FiO2

A

defer if > 60% in most cases/facilities

44
Q

Subjective interview

A

consent to treat
confirm chart info
orientation questions
patient goals
barriers to care
patient alert, pain meds, high Co2
how do they communicate

45
Q

Acute conditions

A

CV risk factors
Baseline mobility status
Symptoms preceding admission – DOE, SOB, edema, angina, etc.
Social history
Functional capacity – baseline, recent

46
Q

Chronic conditions

A

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
Q

Venous thromboembolism (VTE)

A

blood clot in a vein

48
Q

DVT/PE risk factors

A

Fracture
Immobility/bedrest
Major surgery
Heart/lung disease
Age
Hospitalization
Obesity
Presence of central venous catheter
Cancer
Clotting disorders
Prior DVT/PE

49
Q

S1 mechanism

A

closing of tricuspid and mitral valves at the start of systole

50
Q

Tricuspid valve location

A

4th intercostal space at left sternal border

51
Q

Mitral valve location

A

5th intercostal space at midclavicular line

52
Q

S2

A

closing of aortic and pulmonic valves at the end of ventricular systole

53
Q

Pulmonic valve location

A

btw 2nd and 3rd intercostal space of L border of sternum

54
Q

Aortic valve location

A

2nd and 3rd intercostal space on R border of sternum

55
Q

S3

A

early ventricular filling/start of diastole

over cardiac apex; often using bell of stethoscope in left side lying position

56
Q

S4

A

fast ventricular filling

over cardiac apex; often using bell of stethoscope

57
Q

Systemic/endocrine presentation

A

Obesity
Impaired glucose tolerance
Poor nutrition
Neuropathy

58
Q

Respiratory presentation

A

Dyspnea
Respiratory rate
Work of breathing
Accessory muscle use
Decreased pulmonary/secretion clearance
Decreased gas exchange
Impaired lung volumes

59
Q

Endurance/activity tolerance presentation

A

Fatigue
Decreased exercise/aerobic capacity
Decreased strength
Pain
Impaired balance

60
Q

Education

A

Decreased knowledge of medical condition/management
Challenges with adherence to medical management

61
Q

Cardiac presentation

A

blood pressure
HR
Angina
Heart rhythm

62
Q

Reasons for patient assessment

A

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
Q

Cardiac rehab

A

Community-dwelling patients who can tolerate daily rehab services and had recent cardiac medical event (MI), diagnosis (HF), or procedure (PCI, CABG)

64
Q

Home Health

A

Homebound patients with acute decline in medical/functional condition warranting 2-3x/wk therapy services in the home

65
Q

SNF

A

Patients who may tolerate lower level/frequency of therapy services

66
Q

Inpatient Rehab

A

Patients who can tolerate 3 hr/day of therapy services

67
Q

Long term acute care

A

Patients with complex medical needs such as wound care, ventilator/trach weaning, parenteral nutrition, certain medications.

Cardiopulm (11 decks)

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