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Scorebuilders NPTE Heart/Pulmonary Tests and Measures Review
Terms in this set (132)
Angina Pain Scale
- graded on a scale of 1-4
- used to determine intensity of angina pectoris
Ankle-Brachial Index (ABI)
ratio of the ankle systolic pressure to the brachial systolic pressure; an objective measurement of arterial disease that provides quantification of the degree of stenosis
How is ABI calculated?
Divide higher of the 2 blood pressure measurements in the ankles by the higher of the two measurements in the arm (ankle/arm)
ABI grading scale
> 1.30 - rigid arteries and need for ultrasound to check for peripheral artery disease
1.0-1.30 - normal; no blockage
0.8-0.99 - mild blockage
0.4-0.79 - moderate blockage; may be associated with intermittnet claudication
< 0.4 - severe blockage; claudication pain at rest
Ausculation area for aortic valve
2nd intercostal space at the right sternal boarder
Pulmonary valve auscultation location
2nd intercostal space at the left sternal border
Mitral valve ascultation
5th intercostal space, medial to the left midclavicular line
Tricuspid valve auscultation location
4th intercostalspaceat the left sternum border
S1 sound (lub)
- 1st heart sound (closure of the mitral and tricuspid valves at the onset of ventricular systole)
- high frequency sound with lower pitch and longer duration than S2
- 2nd heart sound - closure of the aortic and pulmonic (semilunar) valves at the onset of ventricular diastole
- high frequency sound with higher pitch and shorter duration than S1
- 3rd heart sound - vibrations of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole
- Normal in healthy children
- abnormal in adults; may be associated with heart failure
What is another name for the S3 sound?
S4 heart sound
- 4th heart sound - pathological sound of vibration of the ventricular wall with ventricular filling and atrial contraction
- may be associated with hypertension, stenosis, hypertensive heart disease or MI
What is another name for S4 heart sound?
What is a heart murmur?
- vibrations of longer duration than the heart sounds
- often due to disruption of blood flow past a stenotic or regurgitant valve
- described as soft, blowing or swishing
tracheal and bronchial sounds
- loud, tubular sounds normally heard over the trachea
- inspiratory phase is shorter than expiratory phase and there is a slight pause between them
Vesicular breath sounds
Normal breath sounds made by air moving in and out of the alveoli.
- high pitched, breezy sounds normally heard over distal airways
-inspiratory phase is longer than expiratory phases and there is no pause between them
Adventitious breath sound
abnormal sound heard with inspiration and/or expiration that can be continuous or discontinuous
- including sibilant wheezes (formerly wheezes), sonorous wheezes (formerly rhonchi), fine and course crackles (formerly rales), pleural friction rubs, and stridor
- abnormal, discontinuous, high-pitched popping sound heard more often during inspiration
- may be associated with restrictive or obstructive respiratory disorders
What does crackles indicate during breathing?
- movement of fluids or sections during inspiration (wet crackles) or occurs from the sudden opening of closed airways (dry crackles)
Crackles during the latter half of inspiration typically represent what diagnoses?
atelectasis, fibrosis, pulmonary edema or pleural effusion
Low pitched crackles
crackles due to the movement of secretion
- heard during inspiration and/or expiration
- like the sound of hairs being rubbed together between thumb and forefinger
Where are crackles heard?
in the bases of the lungs with interstitial lung disease, atelectasis, pneumonia, bronchiectasis and pulmonary edema
Pleural Friction rub
dry, crackling sound heard during both inspiration and expiration
- occurs when inflamed visceral and parietal pleurae rub together
where is pleural friction rub heard when auscultating?
over the spot where the patient feels pleuritic pain
- continuous low-pitched sounds described as having a "snoring" or "gurgling" quality that may be heard during both inspiration/expiration
What causes rhonchi sounds?
air passing through an airway which is obstructed by inflammatory secretions or liquid, bronchial spasm or neoplasms in the smaller (sibilant rhonchi) or larger (sonorous rhonchi) airways
continuous high pitched wheeze heard with inspiration or expiration
What does stridor indicate?
upper airway obstruction
high-pitched, musical/whistling, squeaking adventitious lung sound (variety of pitches)
When can wheezing be heard?
both inspiration/expiration but variable from minute to minute and area to area
What causes wheezing?
arise from turbulent airflow and the vibrations of the walls or small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm or foreign body
Bronchial breath sounds
abnormal breath sounds when heard in locations that vesicular sounds are normally present. pneumonia may produce these sounds
Decreased or diminished breath sounds
less audible sound may indicate severe congestion, emphysema or hypoventilation
Absent breath sounds may indicate
pneumothorax or lung collapse
What does spoke words sound like when listening to lung sounds?
- whispered words are faint
- syllables non distinct except over main bronchi
What does an increase in loudness and distinctness in spoken words indicate when listening to lungs?
consolidation (atelectasis or fibrosis
increased vocal resonance with greater clarity and loudness of spoken words (99)
A form of bronchophony in which the spoken "Eee" is changed to "Ay," which has a nasal or "bleating" quality.
Most commonly this indicates pneumonia
whispered sounds heard loudly and clearly upon thoracic auscultation
"1, 2, 3"
How is BMI calculated?
weight (kg) / height (m^2)
Overweight categories: overweight 25-29.9, moderate (class 1) 30-34.9, severe (Class 2) >35-39.9, extreme obese (class 3) >/ 40
Capillary Refill time
time it takes for the capillary bed to refill after it is occluded by pressure is an indicator of impaired perfusion to the extremities
Procedure for Capillary refill
1. Apply firm pressure over a nail bed or bony prominence (chin, forehead, sternum) until nail or skin blanches
2. Release pressure
3.Observe the time for the nail or skin to regain full color
interpretation for Capillary refill test
Normal = full color returns in <2 seconds
Abnormal = refill time > 2 sec
When does claudication occur?
when skeletal muscle oxygen demand during exercise exceeds blood oxygen supply
- characterized by pain, cramping, aches, sense of fatigue, or other discomfort in the affected muscle group
Claudication test procedure and interpretation
walk on treadmill at 2mph at constant grade 0-12%
score initial claudication distance (pain-free), absolute claudication distance (max distance before terminated due to pain), and initial claudication distance (ICD pain-free walking distance)
- Grade 1 - discomfort of initial or modest levels
- Grade 2 - Mod discomfort from which attention can be diverted
- Grade 3 - Intense pain, attention cannot be diverted
- Grade 4 - Excruciating pain
Claudication location of symptoms
Pain location & area of stenosis:
buttock/hip/thigh - aortic or iliac obstruction
calf - stenosis of femoral and popliteal arteries
ankle or foot - tibial/peroneal arteries
uncomfortable awareness of breathing that may result from decreased oxygenation, hypoventilation, hyperventilation or increased work of breathing due to changes in respiratory mechanics or anxiety
How many views of the heart does a 12 lead ECG provide?
Anatomical location of ECG limb leads
Right arm (RA) = infraclavicular fossa medial to the R deltoid
Left Arm (LA) = infraclavicular fossa medial to L deltoid
Left Leg (LL) = left side of abdomen below the rib cage
R leg (RL) = right side of abdomen (ground electrode
Anatomical Location of chest electrodes for precordial leads
V1 = 4th intercostal space at R sternal border
V2 = 4th intercostal space at L sternal border
V3 = Midway between V2 and V4
V4 = 5th intercostal space at L midclavicular line
V5 = L anterior axillary line at V4 level
V6 = L midaxillary line at V4-V5 levels
Time for atrial depolarization and conduction from the SA node to the AV node
What is the normal duration for the PR interval?
ventricular depolarization and atrial repolarization
How long is a normal QRS complex?
ventricular depolarization and repolarization
How long is a normal QT interval?
isoelectric period following QRS when the ventricles are depolarized
normal sinus rhythm
Atrial depolarization begins in the SA node and spreads normally throughout the electrical conduction system with a heart rate between 60 and 100 beats/ minute
A sinus rhythm, but with quickening and slowing of impulse formation in the SA node resulting in a slight beat-to-beat variation of the rate
A sinus rhythm, except with intermittent failure of either SA node impulse formation or AV node conduction that results in the occasional complete absence of P or QRS waves
Premature Atrial Contraction (PAC)
caused by an ectopic focus in the atria that stimulates an atrial response before the SA node
- The P wave is premature a with abnormal configuration
What is the clinical significance of a PAC?
- common and generally benign but may progress to atrial flutter, tachycardia or fibrillation
- may occur with a normal heart (caffeine, stress, smoking, alcohol) and any type of heart disease
- ectopic, very rapid atrial tachycardia
- atrial rate 250-350
- ventricular rate dependent upon AV node conduction
- Saw tooth snapped P waves
Clinical significance of atrial flutter
- occurs with valvular disease (especially mitral valve), ischemic heart disease, cardiomyopathy, hypertension, acute MI, COPD, and pulmonary embolism
S/S atrial flutter
- palpitations, lightheadedness, and angina due to rapid rate
- common arrhythmia where the atria are depolarized between 350-600 times/min
- ECG shows characteristically irregular undulations of ECG baseline without discrete P waves
Clinical significance of a-fib
- Occurs in healthy hearts and in patients with coronary artery disease, hypertension, and valvular disease
- Stagnation of blood may predispose to thrombi in the atria
S/s of a-fib
Palpitations, fatigue, dyspnea, lightheadedness, syncope, and chest pain
1st degree heart block
p-r interval is longer than 0.2 sec but relatively constant from beat to beat
Clinical significance of 1st degree heart block
- no symptoms or significant change in cardiac function
- PR intervals may become prolonged for many reasons including medications that suppress AV node conduction
2nd degree heart block
- AV conduction disturbance in which impulses between the atria and ventricles fail intermittently
- 2 types
Mobitz type 1
PROLONGED PR interval -- Dropped QRS
pathopsyiology is impaired AV node conduction
- 2 P waves to 1 QRS
- Consecutive PR intervals are the same and normal followed by nonconductor of one or more impulses
- Could progress to 3rd degree heart block
3rd degree heart block
- all impulses are blocked at the AV node and none are transmitted to the ventricles
- The atria and ventricles are paced independently: atrial rate > ventricular rate
Clinical significance of 3rd degree heart block
- considered medical emergency requiring a pacemaker
- if ventricular rate is too slow, CO will drop and person will faint
Common causes of 3rd degree heart block
degenerative changes to conduction system, digitalis, heart surgery and acute MI
Premature ventricular complex
- premature depolarization arising in the ventricles due to an ectopic focus
- P wave is usually absent and QRS has wide and aberrant shape
arise from the same ectopic focus and have the same configuration
arise from different ectopic foci and have different configurations
every other beat is a PVC
every third beat of a normal sinus rhythm is a PVC
What is the clinical significance of PVC?
- common arrhythmia that occurs in health and diseased hearts
- pt may be asymptomatic or have palpitations
Common causes of PVC
anxiety, caffeine, stress, smoking, all forms of heart disease
Ventricular tachycardia (v-tach)
3 or more consecutive PVCs
at a ventricular rate of >150 BPM
P waves are absent
QRS complexes are wide and aberrant
Clinical significance of V-tach
- V-tach longer than 30 seconds is life threatening arrhythmia and requires immediate medical intervention
- Pt not able to maintain an adequate BP and eventually become hypotensive
- V-tach may degenerate into ventricular fibrillation causing cardiac arrest
Common causes of V-tach
MI, cardiomyopathy, valvular disease
Ventricular fibrillation (V-fib)
- ventricles do not beat in coordinated fashion (fibrillate or quiver asynchronously and ineffectively)
- no cardiac output
- pt becomes unconscious
- ECG shows fibrilatory waves with an irregular
pattern that is either coarse or fine
Clinical significance of v-fib
- lethal tachycardia (requires immediate defibrillation)
- additional measures: medication to support circulation and intravenous anti arrhythmic agents
Common causes of v-fib
heart disease, MI, and cocaine use
- Ventricular standstill with no rhythm
- Ecg records straight line pattern.
Clinical significance of ventricular asystole
- requires immediate CPR and medications to stimulate cardiac activity
Common causes of Ventricular asystole
Acute MI, ventricular rupture, cocaine use, lightening strikes, and electrical shock
What are the absolute indications for terminating an exercise stress test?
- Drop in SBP > 10mmHg from baseline
- moderate severe angina (3 on scale of 4)
- increasing nervous system symptoms (ataxia, dizziness)
- signs of poor perfusion
-sustained ventricular tachycardia
- 1.0 mm ST elevation leads without diagnostic Q waves
Relative Indications for Terminating Exercise Testing
- Drop in SBP > 10mmHg from baseline
- >2mm St segment depression
- Arrhythmias other than sustained ventricular tachycardia
- fatigue, SOB, wheezing, leg cramps, and claudication
- development of bundle branch block or intraventricular conduction delay
-Increasing chest pain
Hypertensive response (SBP > 250mmHg and/or DBP>115mmHg)
What does a negative exercise test indicate? Positive?
low probability of coronary artery disease
high probability of coronary artery disease
What is Homan's sign? What does this indicate?
- pain on passive dorsiflexion of ankle with knee straight
- Possible DVT
The act of tapping the surface of the body to identify areas of altered density
Flat or Dull percussive sounds in upper lope are associated with what 3 diseases?
neoplasm, atelectasis or consolidation of the lung
What is a normal percussion sound for the lungs?
- intermediate sound between resonance and tympany
- percussion note emitted by the emphysematous lung
- Suggests pulmonary emphysema or pneumothorax
A hollow drum-like sound
When does a tympany sound only occur in the lungs?
Where are common sites to palpate pulse?
brachial, carotid, dorsal pedis, femoral, popliteal, posterior tibial, radial, and temporal
What is a pulmonary function test?
measures the volume or flow of air during inhalation and exhalation
Obstructive ventilatory impairment
- decreased expiratory flow
- airway narrowing during exhalation causes a disproportionate reduction of maximal air flow compared to the maximal volume displaced from the lungs
- FEV1/FEV < 70%
Obstructive ventilatory impairment pathologies
asthma, emphysema, chronic bronchitis
Restrictive ventilatory impairment
- reduced lung volume (TLC, FVC, FEV1) and relatively normal expiratory flow rates
- Inferred from spirometry when FVC is reduced and FEV1/FVC is normal or >80%
Restrictive ventilatory impairment pathologies
interstitial lung disease, pleural diseases, chest wall deformities, obesity, pregnancy, neuromuscular disease, tumor
Rate Pressure Product (RPP)
- also called the double product
- index of the myocardial oxygen consumption and coronary blood flow
- best for figuring out physiological correlate to onset of angina pectoris
How do you calculate RPP?
- HR and SBP are measured during same exercise workload
RPP = (HR x SBP)
- reported at 2 digit # x 10^3
What RPE numbers represent 70% max heart rate during exercise?
When is RPE an appropriate use to measure intensity of exercise?
- when ability to monitor HR is compromised
- its begin an exercise-based rehab program without prelim testing
- HR response is altered
- Physical activities other than cardiorespiratory endurance activity are assessed
- Clinical status or medical therapy changes
What is a normal respiratory rhythm?
Inspiration is half as long as expiration
I:E ratio = 1:2
What is a CODP respiratory rhythm?
I:E ratio reflect a longer expiration phase 1:3; 1:4
absence of spontaneous breathing
- irregular breathing
- breaths vary in depth and rate with period of apnea
- associated with increased intracranial pressure or damage of medulla
What pathologies are associated with bradypnea?
neurologic or electrolyte disturbance, infection, or high level of cardiorespiratory fitness
- Decreased rate and depth of breathing with periods of apnea
- can occur due to CNA damage
increase in depth and rate of breathing
decreased rate and depth of breathing
deep and fast breathing; often associated with metabolic acidosis
Chest moves inward during inhalation and outward during exhalation
What causes paradoxical breathing?
due to chest trauma or paralysis of the diaphragm
How do you measure waist circumference?
in standing, a measuring tape is placed snugly around the abdomen at the level of the iliac crest at the end of a normal exhalation
What waist circumference identifies males/females as at-risk of type 2 diabetes, dyslipidemia, hypertension, and CVD?
M = >102 centimeters (>40 in)
F = >88 centimeters (>35in)
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