Exam 2: Cardiovascular & Pulmonary Exam & Eval

before touching the patient

chart review and first impression

what should you ask a patient about on exam?

history, symptoms, risk factors

observe patient...

breathing, skin, edema, mobility

what measurements are taken for every exam?

vitals (HR, BP, RR, SPO2, pulse, perfusion

listen/palpate...

lung sounds, cardiac sounds, edema, pulses

why do you stress the system?

see what happens with movement and activity

what is decided during an exam?

continue, modify, stop, refer

what conditions are screened for cardiovascular and pulmonary health?

orthopedic, neurologic, pediatrics, sports, pelvic health, acute care, home health

what impairments are identified resulting in movement dysfunction?

impairments to oxygen transport system

oxygen transport pathway

respiratory system (lungs), circulatory system (heart), muscles/organs (tissues)

subjective topics to question

symptoms, pattern, risk/context

CVP symptom questions

chest discomfort, SOB, dizziness, palpitations, cough, swelling, fatigue, pain, trouble sleeping, edema

CVP pattern questions

experienced at rest or exertion, new or baseline, better or worse, nighttime symptoms

CVP risk/context questions

cardiac/pulmonary history, smoking or exposure, medication, recent hospitalization, family history, functional decline at early age, DM

CV risk factors

smoking, substance abuse, hypertension, DM, sedentary, obesity, cholesterol, diet, stress

objective tests

bloodwork, imaging, EKG, pulmonary function test, grader exercise test or stress test

blood work for CV screening

ABG, CBC, BMP (basic metabolic panel)

imaging for CV screening

x-ray, CT, MRI, ECHO, cardiac catheterization

diagnostic EKG

12 lead

what should a first year PT be able to do with medical test results?

recognize, locate, understand implication, ask when unsure

what does hemoglobin affect?

exercise tolerance due to O2 carrying capacity

ECG gives information about...

rhythm

Echo gives information about...

cardiac structure and function

pulmonary function test gives information about...

pulmonary function

CXR/CT gives information about...

lung and heart structure

ABG gives information about...

oxygenation, ventilation, acid-base

beta blocker

blunted HR response

diuretic

volume loss, orthostasis, frequent urination

antihypertensive medicine

hypotension, dizziness

anticoagulant

increased bleeding, bruising risk

bronchodilator

improved airflow, tremor, tachycardia

Corticosteroid

weakness/bone concerns with prolonged use

dysphagia

swallowing impairments

populations with aspiration/gagging

seen in patients with low tone, poor mouth closure, CVA, prolonged intubation

aspiration and gagging can lead to...

pulmonary impairments

populations with reflux

babies with low tone, adults with GERD

symptoms of reflux

cough, frequent throat clearing, lead to pulmonary impairments

difficulties with food consistencies (liquids or solids) may require...

special diet

who to consult for dysphagia

speech language pathologists

need _____ calories to provide nourishment to the cells

sufficent

nutrient/anthropometric assessment

weight, body composition, waist/hip ratio, BMI

what is needed for mucociliary clearance

adequate hydration

what percent of mucous blanket is water content?

90%

need adequate volume for ____ volume

stroke

you need hydration for all body systems to function, what are those body systems?

gastrointestinal, kidneys, brain, skin, vasculature

what is common in patients with CVP impairments

sleep dysfunction

what questions should be asked about sleep dysfunction?

number of pillows, hours of sleep, waking at night number of times and causes, tiredness, snoring

examples of sleep dysfunction

chronic nighttime hypoxemia, paroxysmal nocturnal dyspnea, orthopnea, prinzmetal angina, sleep apnea

what can help with treating sleep dysfunction

sleep study to determine need for oxygen, CPAP, sleep guard

objective observation

posture, breathing pattern, edema, skin condition, obesity, frailty, lines, tubes, drains, supplemental oxygen

normal posture

barrel chest

kyphosis

pectus excavatum

pectus carinatum

integumentary observation

skin color

MMRC dyspnea scale grade 0

not troubled by dyspnea unless on strenuous exercise

MMRC dyspnea scale grade 1

dyspnea when hurrying or walking up hill

MMRC dyspnea scale grade 2

dyspnea when walking on level (stop after 15 min)

MMRC dyspnea scale grade 3

severe dyspnea when walking on level (stop after a few minutes)

gait observation

walk in or wheelchair, assistive device, gait deviations, balance impairments, transitional movements, level of fatigue, SOB

when to monitor vital signs

at rest, with exercise, post exercise

heart rate abnormalities

bradycardia, tachycardia, irregular

blood pressure considerations

hypotensive, hypertensive, interarm difference

what to look out for when assessing respiratory rate and oxygen saturation?

tachypnic or SpO2

data provided by watches

HR, ECG, walking speed, VO2 estimate, atrial fibrillation

normal resting HR

60-100 bpm

bradycardia

tachycardia

>100 bpm

resting heart rate

heart pumps the lowest amount of blood needed

red flag resting HR

>120

cardiac output

HR x SV

increased HR, decreased SV

less efficient pumping

pathologies related to cardiac output

heart failure, cardiomyopathy, myocardial infarction, valvular disease

karvonen formula for target HR

[(HRmax − HRrest) × % intensity + HRrest

estimated heart rate max

220-age

heart rate reserve

max heart rate - resting heart rate

normal heart rate response increases _________ and __________ to workload increase during exercise in healthy adults

significantly

proportionally

how long does it take a normal heart rate response to recover to baseline?

within minutes

the inability to appropriately increase HR during exercise

abnormal heart rate response

what is an abnormal heart rate response associated with?

heart disease and worse prognosis

what is a delayed decrease in HR during the first minute of recovery adter exercise a powerful indicator of?

overall mortality

what is the effect of beta blockers on the heart rate response?

blunts the HR response

bad heart rate recovery

good heart rate recovery

>12 bpm

rapid deceleration (>12 bpm) =

greater fitness and survival

delayed deceleration (

poor fitness and survival

the better the heart and cardiovascular system, the more _____ the deceleration in HR

rapid

the poorer the heart and cardiovascular system, the more ____ the deceleration in HR

delayed

exercise guidelines: HR rise

20-30 bpm over resting HR

exercise guidelines: who has lower exercise tolerance

fatigued, elderly, cardiovascular compromised

exercise guidelines: what should be the max HR for people with low exercise tolerance

40-60%

exercise guidelines: healthy patients exercise tolerance

60-80% max HR

exercise guidelines: caution with resting HR in adults

>110 bpm

exercise guidelines: cardiac dysrhythmias

past and current

exercise guidelines: signs and symptoms of cardiovascular stress

- difficulty breathing

- chest pain

- dizziness/lightheaded

- diaphoretic

depending on severity of response/signs and symptoms...

- decrease intensity

- stop and allow patient to rest to monitor improvement of symptoms

- pursed lips or deep breathing

what to do if symptoms worsen or don't improve?

- do not leave patient unattended

- call RN or MD

- call rapid response or hospital code for change in status

- call 911

- have family bring them to MD/ER

borg scale

easy-moderate: 6-11 (0-3)

hard: 12-15 (4-6)

very hard: 16-20 (7-10)

what do the borg scale numbers correlate to?

HR (ex: 6 = 60)