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SPC Cardio Assess

SPC Cardiopulmonary Assessment Unit 1 & 2

What is Sensorium? Level of consciousness. Oriented x 3(time, place, person) = normal
Decreased sensorium occurs with: Decreased cerebral perfusion, decrease CaO2, and drug OD
Open-ended questions: Promote rapport, 'why are you here?'
Closed-ended questions: For specific info, 'how many pack of cigs do you smoke/day?'
Types of info contained in Pt hx: Demographic: name, age, race, gender. Pt hx: review of systems, hx of present illness, past medical hx, family hx, occupational/environmental hx
What is ROS? Review of Systems: detailed questionaire pt fills out - subjective
What is HPI? History of Present Illness: detailed report by pt re: present condition
What is CC? Chief Complaint: primary reason for seeking medical attn
What is 'pack years'? # of packs smoked/day X # of years smoked
Sign vs Symptom Sign: objective - finding by examiner. Symptom: subjective - complaint by pt
Acute vs Chronic cough Acute < 3 weeks. Chronic > 2 weeks or recurrent
Mucoid Sputum Clear, thin = asthma
Frothy Sputum Pulmonary Edema
Purulent Sputum Thick, colored
Yellow/Green/Copious Sputum Cystic Fibrosis w/ pseudomonas infection
Rusty Sputum Streptococcal pneumonia
Fetid Sputum Foul smelling = lung abcess
Hypothermia causes Cold water drowning, head trauma w/ hypothalamus injury
Hyperthermia causes Infection, dehydration
Tachycardia causes > 100/min - hypoxemia, hypertension, fever, anxiety
Bradycardia causes < 60/min - complete heart block, endurance athletes, beta blockers
Tachypnea causes > 20/min - "J" receptor stimulation, metabolic acidemia, anxiety
Bradypnea causes < 10/min - drug o.d., head trauma, hypothermia
Hypertension causes > 150/90 - high SVR
Hypotension causes < 90/60 - hypovolemia, shock, CHF
Central Cyanosis Requires 5g/dl of desaturated Hb, effects lips & oral mucosa
Pursed lip breathing seen in COPD, prevents airway closure
What is Perrla? Pupils become round, reactive to light.
What is Mydriasis? Causes? Pupils become dilated & fixed. Atropine, brain death, cocaine OD
What is Miosis? Causes? Pinpoint pupils. Opiate OD, sunstroke
What is Ptosis? Causes? Drooping eyelids. Myasthenia Gravis
What is JVD? Common cause? Jugular Venous Distention: method quantifying R heart pressure. Cor Pulmonale
Suprasternal Notch Groove at the top of the Manubrium. Palpate to check for tracheal shifts.
Sternal Angle Angle of Louis - ridge at the junction of Manubrium & top of Sternum
Right Lung Fissures Horizontal(minor): RUL - RML Oblique(major): RML - RLL
Left Lung Fissures Oblique(major): LUL - LLL
Barrel Chest occurs With COPD pts
Flail Chest Double fracture of 3 or more adjacent ribs
Paradoxical Movement Chest wall goes in w/ inspiration, out w/ expiration
Restrictive Breathing Rapid, shallow, decreases WOB
Obstructive Breathing 'Pursed Lips', prolonged exhalation, active neck accessories w/ 'clavicular lift'
Abdominal Paradox Abdomen sinks in w/ inspiration, seen in COPD pts w/ impending ventilatory failure
Acrocyanosis Peripheral - nailbeds, due to poor perfusion, low CO, often in COPD pts
Central Cyanosis Oral mucosa, due to severe shunting
Vocal Fremitus Vibrations from vocal cords
Tactile Fremitus Palpation to assess vocal fremitus, pt repeats '99'
Increased Tactile Fremitus Denotes increased density(consolidation), pneumonia, atelectasis, fibrosis
Decreased Tactile Fremitus Denotes decreased density(air), pneumothorax, emphysema
Thoracic Expansion (Anterior) Anteriolateral, lower chest, thumbs at costal margins pointing toward xyphoid process
Thoracic Expansion (Posterior) Posteriolateral, thumbs @ T8 @ end-exhalation. At full inspiration movement is equal and approx 3-5cm
Thoracic Expansion - Bilateral Decrease causes COPD, neuromuscular diseases
Thoracic Expansion - Unilateral Decrease causes Lobar consolidation, atelectasis, pneumothorax, pleural effusion
Subcutaneous Emphysema Air w/in subq tissues, noted w/ pneumomediastinum & pneumothorax, feels like bubble wrap & sounds like rice crispies
Normal Percussion sound Easy to hear, low pitch
Hyperresonant sound & causes Louder & lower - sounds like an empty oil barrel. Pneumothorax. Hyperinflation from asthma, emphysema
Dullness sound & causes Muffled & flat - sounds like a full oil barrel. Atelectasis, pleural effusion, consolidation(pneumonia)
Vesicular sound Heard over peripheral lung area - soft & low pitched
Bronchial sound & causes Loud & high pitched. Denotes loss of alveoli - consolidation, atelectasis
Diminished sound & causes Low/quiet. Hypoventilation, hyperinflation, pneumothorax(absent), pleural effusion
Adventitious sound & causes Heard in the airways - crackles - 'velcro'. Fluid in the airways. Small airways = CHF. Large airways = secretions
Wheezing sound & causes Continuous. Small airways - high pitched = bronchospasm, asthma. Large airways - low pitched = obstruction, chronic bronchitis
Stridor sound & causes Continuous, loud, high pitched. Upper airway obstruction - croup, post-extubation
Hepatomegaly Liver girth is > 10cm @ midclavicular line. Assoc w/ Cor Pulmonale
Ascites Serous fluid in the peritoneal cavity. Assoc w/ cirrhosis, malnutrition, CHF
Clubbing Enlargment of terminal phalanges. Assoc w/ CF, bronchogenic cancer, COPD
Pedal Edema Fluid in the subq tissues of the ankles/feet. Assoc w/ CHF, Cor Pulmonale
Capillary Refill Press nailbed until area blanches, release, normal color should return < 3sec
Slow Capillary Refill assoc w/ Hypovolemia, CHF
Cold hands, feet assoc w/ Shock, hypovolemia
COPD inspection JVD, 'pursed lips', active neck accessories w/ 'clavicular lift', barrel chest, hepatomegaly, clubbing, acrocyanosis, pedal edema
COPD palpation Decreased tactile fremitus, thoracic expansion, bilateral decrease
COPD percussion & auscultation Hyperresonant. Diminished, wheeze
Consolidation palpation Increased tactile fremitus, thoracic expansion, unilateral decrease
Consolidation percussion & auscultation Dullness. Bronchial breath sounds
Tension Pneumothorax palpation Thoracic expansion, unilateral decrease, tracheal shift(away)
Tension Pneumothorax percussion & ausculation, etc Hyperresonant. Absent breath sounds. Blood pressure drops, peak vent pressure increases
Pleural Effusion palpation Tactile fremitus, absent, thoracic expansion, unilateral decrease, tracheal shift(away)
Pleural Effusion percussion & auscultation Dullness. Absent breath sounds
Cor Pulmonale inspection JVD, hepatomegaly, pedal edema
Shock/Hypovolemia Slow capillary refill, peripheral skin temp decreased
Created by: vgflgirl
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