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PCE - Cardiopulmonary-Vascular > Assessment > Flashcards

Assessment Flashcards

1
Q

Components of a cardioresp assessment

A
  • History: risk factors, acuity and progression, PMHX
  • Symptoms
  • Physical exam
  • Dx tests
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2
Q

What are 6 common cardioresp symptoms

A
  • Dyspnea
  • Cough (productive vs nonproductive, hemoptysis)
  • wheeze: inspiratory, expiratory, low or high pitched
  • cyanosis: blue or purple in skin that has mucous membranes (nail beds, lips)
  • finger and toe clubbing: seen in conditions like COPD and CF due to chronic hypoxia
  • Decreased oxygen saturation: below 90% O2 you may need some supplementary O2
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3
Q

What is included in a physical exam

A

Inspection
Palpation
Percussion
Auscultation

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4
Q

What are 11 Diagnostic tests

A

a) flow volume loop
b) simple spirometry
c) plethysmography: just provides more details
d) diffusing capacity
e) respiratory muscle strength
f) methacholine and other challenge tests
g) chest x ray
h) VQ scan
i) bronchoscopy
j) blood tests and ABG’s
k) exercise testing

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5
Q

Contraindications to a flow volume loop

A

Any condition prohibiting a max maneuver

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6
Q

What does a simple spirometry test provide

A

FEV1 and FVC

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7
Q

Contraindications to simple spirometry tests

A
  • MI in last month,
  • recent stroke/abdominal/thoracic surgery
  • uncontrolled HTN
  • recent pneumothorax
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8
Q

Indications for a simple spirometry test

A

Dx lung disease
quantify extent of known disease
measure effect of occupational/environmental exposure
Ax for risk of respiratory complications during surgery, evaluate disability or impairment

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9
Q

What are the findings of a simple spirometry test if there is an obstructive pattern

A

Increased lung volumes
Decreased FVC
Very Decreased FEV1
Decreased ratio

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10
Q

What are the findings of a simple spirometry test if there is an restrictive pattern

A

Decreased lung volumes
Decreased FVC
Decreased FEV1
Ratio is normal or even increased

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11
Q

What do a diffusing capacity test provide the diagnosis of

A

Emphysema

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12
Q

What are methacholine and other challenge tests used to diagnos

A

Asthma and other occupational asthma

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13
Q

What is a VQ scan used to diagnose

A

Used for perfusion disorders (pulmonary embolism

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14
Q

What surface landmarks indicate the start and finish of the trachea

A

Cricoid cartilage to T4 spinous process

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15
Q

What is the clinical difference between the left and right bronchi

A

R bronchi is more steeply angled and gets more things caught in it

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16
Q

The sternal angle landmarks which structure of the trachea

A

Carina of trachea

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17
Q

What are the surface landmarks of the diaphragm

A

T8

18
Q

What muscles are responsible for quiet inspiration

A

Diaphragm and external intercoastal

19
Q

What muscles do forced inspiration

A

SCM
Scalene
Pec minor

20
Q

What structures do quiet expiration

A

Passive recoil of lung tissue

21
Q

What muscles do forced expiration

A

internal intercostals and abs

22
Q

What are key things to look for in inspection

A
  • lines, monitors (HR, RR, SPO2, BP)
  • position of patient
  • head: facial expression, orientation to place, person, and time x3, speech, skin (colour, sweat, temp), lips, nose (flaring),
  • neck (accessory muscle use, jugular vein distension),
  • chest (deformity, shape, muscle wasting), breathing type (apical, diaphragmatic, accessory muscle use), chest movement,
  • limbs (colour, clubbing, edema)
  • cough (weak vs strong, productive vs nonproductive)
  • sputum (colour, smell, amount, and texture)
23
Q

What is included in palpation

A
  • Chest wall expansion
  • Tactile femitus
  • Tracheal position
  • Rates: HR, BP, RR
24
Q

Procedure for looking at chest wall expansion

A

upper, middle, lower x2 (front and back), take deep breaths

25
Q

Procedure for tactile fremitus

A

use ulnar border of hands, feel for vibration

26
Q

How long do you measure HR for

A

15seconds

27
Q

How long do you measure RR for?

A

30-60seconds

28
Q

Procedure for percussions

A

middle finger over intercostals space with non-dominant hand, ax right vs left anterior to posterior upper, middle, and lower lobes

29
Q

Possible percussion findings

A

1) resonant (normal)
2) dull = consolidation, pleural fluid
3) hyper-resonant = air

30
Q

The diaphragm of the stethoscope picks up _____ best

The bell picks up ___ best

A

High pitch

Low pitch

31
Q

Procedure for auscultation

A
  • EXPOSE THE SKIN!!
  • instruct patient to take a deep inspiration/expiration, rest between breaths as needed
  • gold standard lobe points: 11 in front, 14 in the back
32
Q

WHat are the auscultation points

A

Review photo

33
Q

What are normal breath sounds

A
  • Vesicular
  • Bronchial – hollow, short pause between inspiration and expiration, normal over trachea (air travelling through larger airways)
34
Q

What are abnormal breath sounds and what do they generally indicate

A
  • Bronchial – consolidated pneumonia, lobar collapse

- Decreased or absent – over pleural effusion, hemothorax, pneumothorax, emphysema, contused lung, obese, elderly

35
Q

What are adventitious breath sounds

A
  • Crackles
  • Wheezes
  • Stridor
  • pleural rub
36
Q

What do inspiratory crackles indicate

A

Airway obstruction

37
Q

What do expiratory crackles indicate

A

Edema
Fibrosis
Partial consolidation

38
Q

What are different types of wheezes

A

inspiratory vs expiratory, high (uniformly narrowed) or low pitch (intermittently narrowed)

39
Q

What does a stridor sound like? what does it indicate?

A

loud musical constant pitch with laryngeal or tracheal obstruction

40
Q

What does pleural rub sound like? what does it indicate?

A

creaky, leathery sound due to pleural irritation

PCE - Cardiopulmonary-Vascular (14 decks)

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