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CVT Patient Assessment
CVT Patient Assessment
78
Medical
Professional
11/06/2012

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Cards

Term
non-tender
macular
discoloration on the finger
Definition
janeway lesion
Term
classic anginal pain lasts for less than?
Definition
15 minutes
Term
MI pain may not respond to?
Definition
rest or nitrates
Term
Ocasionally, chest pain due to esophagitis may respond to what?
Definition
nitrates
Term
Chest pain of several days duration is most likely not due to what?
Definition
myocardial ischemia or infarction
Term
Examples of radiating pain include?
Definition
–To the left arm, side of the neck, or a dull toothache in MI
–Between the shoulder blades in aortic dissection
–To right shoulder for gall bladder conditions or diaphragmatic irritation (Kehr’s sign)
Term
What are the Non-Modifiable risk factors?
Definition
–Age
–Gender
–Family history of atherosclerosis or heart disease
Term
Onyx heart valve
Definition
new aortic valve replacement currently in end stage of approval from FDA. Will be the only heart valve that will require not Anticoagulation therapy.
Term
Alcohol Use-
Definition
•Excessive use leads to alcoholic cardiomyopathy
•Atrial fibrillation in binge drinking (“holiday heart”)
•Increased triglyceride levels
•Increased adipose deposition
•Increased risk of malnutrition and electrolyte imbalances
Term
Syphilis may lead to
Definition
Aortic aneurysm and aortic regurgitation
Term
SCRIPT means what?
Definition
Site of auscultation (see above)
•Character (describe how it sounds: blowing, harsh, machinery-like, etc.)
•Radiation to neck, axilla, etc.
•Intensity
•Pattern
•Timing (systolic or diastolic)
Term
Murmur Intensity
Definition
–I: barely heard
–II: soft, but audible
–III: loud without a palpable thrill
–IV: loud with a palpable thrill
–V: loud even with stethoscope barely on chest wall
–VI: loud; audible with stethoscope off chest wall
Term
Pattern of Murmur
Definition
–Crescendo: increases in intensity
–Decrescendo: decreases in intensity
–Plateau: even intensity throughout murmur
Term
Greater than 10mmHg drop in systolic blood pressure during inspiration?
Pulsus Paradoxus
Definition
Cardiac Tamponade(Severe Asthma may cause this too)
Term
peripheral pitting edema scale
Definition
»1+ = slight pitting, no visible distortion
»2+ = somewhat deeper pit than 1+, but little or no detectable distortion; disappearance in 10-15 seconds
»3+ = pit is noticeably deep; the dependent extremity looks fuller and swollen
»4+ = the pit is very deep and lasts for up to 3-5 minutes; gross distortion of the dependent leg
Term
pulse classification scale
Definition
•0 = no palpable pulse
•1+ = weak, barely palpable
•2+ = normal, as expected
•3+ = strong, fuller than expected
•4+ = very strong, bounding
Term
•What worsens the symptoms
•What reduces the symptoms
Definition
Aggravating or alleviating characteristics
Term
Have the pt describe what they are feeling
Definition
Characteristics
Term
Sharp, Stabbing pain in the chest may be due to what?
Definition
pleuritic conditions or pericarditis
Term
A tearing sensation in the chest may be associated with what?
Definition
aortic dissection
Term
A burning sensation or pain that radiates to between the shoulder blades may indicate what?
Definition
aortic dissection
Term
A crushing or squeezing sensation in the chest may be an indication of what?
Definition
MI
Term
What type of radiation may the patient have with an MI?
Definition
Pain radiating to the left arm, side of the neck or a dull toothache
Term
Pain that radiates to the right shoulder may indicate what?
Definition
Gall bladder conditions or diaphragmatic irritation (Kehr's sign)
Term
Is there a particular time of day or circumstance when the symptoms come on?
Definition
Time
Term
Does the pain go anywhere?
Definition
Radiation
Term
Establishes a baseline as a means of evaluating effects of medications or other therapies
Definition
Severity (pain scale)
Term
What are some modifiable risk factors?
Definition
–Sedentary lifestyle
–Obesity
–Tobacco or other stimulant use
–Hypertension
–Hyperlipidemia (low HDL, high LDL and triglycerides)
–Diabetes mellitus
–Stress and personality type
–Estrogen deficiency (post-menopausal or post-hysterectomy)
Term
Excessive alcohol use leads to what condition?
Definition
Alcoholic cardiomyopathy
Term
Atrial fibrillation caused from binge drinking is called what?
Definition
holiday heart
Term
What can alcohol use cause?
Definition
•Increased triglyceride levels
•Increased adipose deposition
•Increased risk of malnutrition and electrolyte imbalances
Term
Job and level of stress? How long have they been in this position?
Definition
Occupational history
Term
orthopnea
Definition
difficulty breathing when lying flat
(usually a sign of heart failure)
Term
Levine's sign
Definition
indicates angina, a person pressing a closed fist to their chest to indicate constricting
Term
associated with nutritional and electrolyte imbalances, cancer
Definition
Cachexia
Term
What are the vital signs?
Definition
•Heart rate, rhythm, and quality
•Blood pressure
•Respiratory rate, rhythm, and quality
•Temperature
•Pulse oximeter
•Pain scale
Term
When delivering oxygen to an unconscious patient what FIO2 % should you use?
Definition
100%
Term
During which step of you unconscious patient exam will you get labs?
Definition
circulation
Term
Pectus excavatum (pigeon chest) common in what type of disease?
Definition
Marfan's syndrome
Term
Exaggerated pulsation of a part of the heart
Definition
heaves
Term
Barrel chest is common in what type of disease?
Definition
COPD
Term
Fine palpable vibrations
Definition
thrills
Term
Reproducible chest pain with palpation usually indicates
Definition
musculoskeletal etiology
Term
Apical pulse shifting towards the axilla (towards the left) indicates what?
Definition
possible left ventricular hypertrophy
Term
Apical pulse shifting towards the sternum (towards the right) indicates what?
Definition
right ventricular hypertrophy
Term
Best for hearing S1, S3, and S4 sounds
Definition
mitral area
(Apical area at 5th intercostal space along the mid- clavicular area)
Term
When listening to the heart an opening snap indicates what?
Definition
mitral stenosis
Term
When listening to the heart a mid-systolic click indicates what?
Definition
mitral valve prolapse
Term
When listening to the heart hearing friction rubs indicates what?
Definition
pleurisy or pericarditis
Term
When listening to the heart hearing muffled heart sounds indicates what?
Definition
pericardial effusion or cardiac tamponade
Term
Heart sound that is due to rapid filling of the ventricles.
Definition
S3
–May be normal in children, young adults, athletes, and in pregnancy
–Pathologic causes:
»MR or TR
»LV failure
»Dilated cardiomyopathy
»AMI
»Constrictive pericarditis (called a “pericardial knock”)
Term
Heart sound that is due to the contraction of atria against stiff ventricle.
Definition
S4
–May be normal in older patients and in athletes
–Pathologic causes:
»HTN (systemic and pulmonary)
»PS of AS
»AMI
»Hypertrophic cardiomyopathy
»Heart blocks (prolonged PRI)
Term
S1 – S2 – S3
Definition
ventricular gallop
Term
S4 – S1 – S2
Definition
atrial gallop
Term
S4 – S1 – S2 – S3
Definition
summation gallop
Term
What may pulmonary edema present with upon auscultation of the lungs?
Definition
rales or crackles
Term
What may congestive heart failure or asthma present with upon auscultation of the lungs?
Definition
wheezing
Term
What may pneumothorax, pleural effusion or sever atelectasis present with upon auscultation of the lungs?
Definition
decreased breath sounds
Term
How should you examine the neck?
Definition
•Auscultate carotid arteries for bruits
•Inspect jugular veins for distention
•Patient’s HOB at 45-degrees
•Observe for symmetry / amount of distention
Term
What are the causes of jugular vein distention?
Definition
–Unilateral: localized abnormality
–Ventricular failure
–Cardiac tamponade
–Constrictive pericarditis
–Tension pneumothorax
–Volume overload
–Tricuspid valve disease
–Pulmonic stenosis
–Pulmonary hypertension
–Superior vena cava obstruction
Term
Hepatomegaly may indicate what?
Definition
congestive heart failure
Term
Splenomegaly may indicate what?
Definition
infective endocarditis, congestive heart failure
Term
Renal artery stenosis is a common cause of what?
Definition
secondary hypertension
Term
What are some signs of endocarditis? (Hands)
Definition
Osler's nodes, Janeway lesions and Splinter hemorrhages under the nails
Term
Clubbing of the digits indicates what?
Definition
long-standing cyanosis
Term
What are some signs of venous stasis?
Definition
varicose veins or "stasis" ulcers
Term
Normal value for Sodium
Definition
135 to 145 mEq/L
Term
Normal value for Potassium
Definition
3.5 to 5.0 mEq/L
Term
Normal value for Calcium
Definition
4.5 to 5.5 mEq/L
Term
Normal value for Magnesium
Definition
1.6 to 2.1 mEq/L
Term
Normal value for Blood Urea Nitrogen (BUN)
Definition
6 to 23 mg/dl
Term
Normal value for Creatinine
Definition
0.7 to 2.1 mg/dl
Term

Describe which lab values go where

      |      |    /

      |      |    \

Definition

Na+|  Cl-     |  BUN      /Glucose

   K+ | HCO3- |creatinine\

Term

Describe which blood lab value goes where.

\__________/

/                 \

Definition

WBC \   Hemoglobin   / Platelets

        /   Hematocrit    \

Term
Normal value for Troponin I
Definition
Less than 1.5 ng/ml
Term
Noram range for Creatine Kinase MB
Definition
less than 16 IU/L
Term
Normal range for Prothrombin Time
Definition
11 - 15 seconds
--panic level:greater than 30 seconds
Term
Normal range for Partial Thromboplastin Time, Activated
Definition
25 to 35 seconds
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