CardioPulm Lab - Hemodynamic Assessment

what information would you want to know and gather from a medical chart in regards to a patient having a condition impacting the cardiopulmonary system?

medications (what ones and dosage), lab values (before and after being admitted), tests and results of EKGs and X-rays, stress test results, O2 prescription, pacemaker, smoking habits, the timeline from the cardiac event until now

what information would you want to know regarding the patient history in regards to a patient having a condition impacting the cardiopulmonary system?

anything stressful/major that happened recently that could have caused the cardiac event, family history of heart disease, activity level, how long they have had this for, medications and side effects

what is a systems review and why is it important?

going through all the systems because multiple systems can be affected or influence additional systems

risks of a cardiopulmonary event

family history of heart disease, diet, high blood pressure, cholesterol, obesity, activity level

what does blood pressure measure?

force exerted by the blood on the walls of the arteries

why is measuring blood pressure important?

demonstrates the efficiency of the blood flow through the body, demonstrates how hard the heart is working, and helps to guide treatment plan

what is considered normal blood pressure?

systolic less than 120, diastolic less than 80 mmHg

what is the procedure when testing BP on a patient with orthostatic hypotension?

take their BP and HR supine, then immediately after sitting for 2 minutes, then immediately after standing for 2 minutes

how much should you inflate the BP cuff on a patient?

at least 30 mmHg above their normal systolic

what is the rate in which you should deflate the BP cuff when taking a manual BP measurement?

2mmHg per second

if the BP cuff is too big what type of reading will you get?

lower reading

if the BP cuff is too small what type of reading will you get?

higher reading

prehypertension systolic

120-129

prehypertension diastolic

<80

stage I hypertension systolic

130-139

stage I hypertension diastolic

80-89

stage II hypertension systolic

>140

stage II hypertension diastolic

>90

most common sources of error in blood pressure measurement technique

cuff size and application, arm position, inflation/deflation method, time between repeated measures, body position (crossed legs), muscle tension

phase I of BP interpretation

systolic blood pressure; first appearance of clear tapping sounds corresponding to the appearance of a palpable pulse

phase II of BP interpretation

sounds become softer and longer

phase III of BP interpretation

sounds become crisper and louder

phase IV of BP interpretation

sounds become muffled and softer

phase V of BP interpretation

diastolic blood pressure; last audible sound before sounds disappear completely

upper extremity pulses

carotid, brachial, radial, ulnar

lower extremity pulses

femoral, popliteal, posterior tibial, dorsalis pedis

when you are measuring a patient's HR for the first time or if they have an irregular heart beat how long should you measure it for?

full 1 min

4 parameters of respiratory assessment

rate, rhythm, depth, character

rate parameter of respiratory assessment

number of breaths per minute

normal respiratory rate

12-20 breaths per minute

rhythm parameter of respiratory assessment

regularity of inspirations and expirations

normal inspiratory:expiratory ratio

1:2 - meaning that expiration takes twice as long as inspiration

depth parameter of respiratory assessment

volume of air exchanged with each breath

character parameter of respiratory assessment

effort and sound produced during breathing

apnea breathing pattern

absense of spontaneous breathing

Biot's breathing pattern

irregular breathing, breaths vary in depth and rate with periods of apnea

what can biot's breathing pattern be associated with?

increased intracranial pressure or damage to the medulla

bradypnea breathing pattern

slower than normal respiratory rate, <12 breaths per minute in adults

what may bradypnea be associated with?

neurol or electrolyte disturbance, infection, or high level of cardiorespiratory fitness

Cheyene-Stokes breathing pattern

decreased rate and depth of breathing with periods of apnea

when can Cheyene-Stokes breathing occur?

when there is damage to central nervous system

Eupnea

normal rate and depth of breathing

hyperpnea

increased rate and depth of breathing

hypopnea

decreased rate and depth of breathing

Kussmaul's

deep and fast breathing

what is Kussmaul's breathing associated with?

metabolic acidosis

paradoxical breathing pattern

chest wall moves in with inhalation and out with exhalation

what is paradoxical breathing caused from?

chest trauma or paralysis of the diaphragm

tachypnea

faster than normal respiratory rate, >20 breaths per minute in adults

what does a pulse oximeter estimate?

oxygen saturation of hemoglobin

how is pulse oximetry denoted?

SpO2

when would we consider the SpO2 to be low?

<90%

what is an unacceptable O2 goal for patients with lung disease?

<85%

cyanosis

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood

trophic changes

changes in tissue characterized by abnormal hair growth, thickened nails, dry scaly skin

clubbing

abnormal widening and thickening of the ends of the fingers and toes associated with chronic oxygen deficiency

clubbing often seen in what types of patients?

cystic fibrosis, lung disease, COPD

potential causes of pitting edema

heart failure, deep vein thrombosis

potential causes of non-pitting edema

thyroid and lymphatic involvement

1+ on pitting edema scale

mild pitting, slight indentation, resolves rapidly within 2-3 seconds after pressure released

2+ on pitting edema scale

moderate pitting, moderate indentation when pressure applied, resolves within 10-15 seconds after pressure released

3+ on pitting edema scale

severe pitting edema, deep and noticeable indentation when pressure applied, resolves within 1-2 minutes after pressure released

4+ on pitting edema scale

severe pitting edema, a very deep indentation when pressure applied, resolves within >2 minutes after pressure released

if someone is in bed and has jugular vein distension how should they be positioned in bed?

head of the bed elevated to 40˚

if you observe someone has jugular vein distension what should you do?

refer because it is an indication of heart failure

where do you measure waist circumference?

around abdomen at level of iliac crest at the end of normal exhalation

normal waist circumference for men

>102cm (>40in)

normal waist circumference for women

>88cm (>35in)

capillary refill time

the time it takes for blood to return to tissue

normal capillary refill time

full color returns in <2 seconds

abnormal capillary refill time

refill time > 2 seconds

what does an abnormal capillary refill time indicate?

capillary blood flow is compromised (arterial occlusion, hypovolemic shock, hypothermia)

why do patients lean forward onto their arms if they have dyspnea?

it slows the pec major and minor to lift the ribcage during inspiration

reverse trendelenberg position to relieve dyspnea

supine wth head above trunk and legs

fowler's position

a semi-sitting position with pillow under knees and the head of the bed raised 30˚

semi-fowler position

a semi-sitting position with pillow under knees and the head of the bed raised 45˚

hypertensive crisis systolic

>180

hypertensive crisis diastolic

>120