Week 2 CV Exam & Assessment Flashcards
Chart review
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
Normal blood pressure
<120/<80
Elevated blood pressure
120-129/<80
Stage 1 hypertension
s 130-139
or
d 80-89
Hypertension stage 2
s >140
or
d > 90
Hypertension crisis
s > 180
and/or
d >120
Normal HR
60-100 bpm
Tachycardia HR
> 100 bpm
Bradycardia HR
< 60 bpm
SpO2 normal
> 90%
SpO2 for COPD
88-92 %
Concerning Vital signs in CV
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
What factors might cause bradycardia in a CV patient
Heart block
Adverse drug reaction
Metabolic dysfunction
Post-op status
Medications
Myocarditis
Lab abnormalities
Respiratory pattern
What factors might cause tachycardia in a CV patient
Anemia
Hypotension
Infection
Anxiety
ETOH use
Fear
Pain
Substance use
What factors might cause hypoxia in a CV patient
VQ mismatch
Hypoventilation
Heart/lung disease
Infection (COVID, pneumonia)
Anemia
PE
Sleep apnea
What factors might cause hypertension in a CV patient
Lifestyle factors
Pain
Obesity
Tobacco use
Age
Comorbidities (CKD, diabetes)
What might cause hypotension in a CV patient
Medications – diuretics, pain meds, CV meds
Acute blood loss
Diastolic dysfunction
Bradycardia
Shock
Position changes
Dehydration
Arrhythmias
Vital signs absolute contraindications
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
Vital signs relative contraindications
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
Cardiac enzymes and biomarkers can help indicate
damage to myocardial tissue
B type natriuretic peptide (BNP)
odds ratio ~ 30 for CHF
Creatine phosphokinase
release with muscle tissue damage
CK-MB
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
CK-BB
Brain tissue
CK-MM
skeletal muscle
Troponin
often considered gold standard for cardiac biomarker
BNP
increased levels with worsening category/classification of CHF
BNP < 100 pg/ML
no presence of HF
BNP 100-300 pg/mL
Class 1 HF
BNP > 300 pg/mL
class 2 HF
BNP > 600 pg/mL
class 3 HF
BNP > 900 pg/mL
class 4
Troponin
highly sensitive and specific
troponin indicates
myocardial damage
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
What other factors can contribute to troponin elevation
kidney disease
COVID
PE
Burns
Rhabdo
Hyperkalemia
high potassium
increase cardiac cellular excitability = VT or VF
Hypokalemia
low potassium
TdP, ventricular tachyarrhythmias
Sodium
impaired cognition, seizures, orthostatic hypotension, coma, lethargy, agitation
Hypomagnesemia
Low magnesium
arterial/ventricular ectopy, TdP and VT
Hypercalcemia
high calcium
short QT
Hypocalcemia
low calcium
prolonged QT; scan -> ventricular arrhythmias such as TdP and VF
FiO2
defer if > 60% in most cases/facilities
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
Acute conditions
CV risk factors
Baseline mobility status
Symptoms preceding admission – DOE, SOB, edema, angina, etc.
Social history
Functional capacity – baseline, recent
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
Venous thromboembolism (VTE)
blood clot in a vein
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
S1 mechanism
closing of tricuspid and mitral valves at the start of systole
Tricuspid valve location
4th intercostal space at left sternal border
Mitral valve location
5th intercostal space at midclavicular line
S2
closing of aortic and pulmonic valves at the end of ventricular systole
Pulmonic valve location
btw 2nd and 3rd intercostal space of L border of sternum
Aortic valve location
2nd and 3rd intercostal space on R border of sternum
S3
early ventricular filling/start of diastole
over cardiac apex; often using bell of stethoscope in left side lying position
S4
fast ventricular filling
over cardiac apex; often using bell of stethoscope
Systemic/endocrine presentation
Obesity
Impaired glucose tolerance
Poor nutrition
Neuropathy
Respiratory presentation
Dyspnea
Respiratory rate
Work of breathing
Accessory muscle use
Decreased pulmonary/secretion clearance
Decreased gas exchange
Impaired lung volumes
Endurance/activity tolerance presentation
Fatigue
Decreased exercise/aerobic capacity
Decreased strength
Pain
Impaired balance
Education
Decreased knowledge of medical condition/management
Challenges with adherence to medical management
Cardiac presentation
blood pressure
HR
Angina
Heart rhythm
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
Cardiac rehab
Community-dwelling patients who can tolerate daily rehab services and had recent cardiac medical event (MI), diagnosis (HF), or procedure (PCI, CABG)
Home Health
Homebound patients with acute decline in medical/functional condition warranting 2-3x/wk therapy services in the home
SNF
Patients who may tolerate lower level/frequency of therapy services
Inpatient Rehab
Patients who can tolerate 3 hr/day of therapy services
Long term acute care
Patients with complex medical needs such as wound care, ventilator/trach weaning, parenteral nutrition, certain medications.
