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87 Cards in this Set
- Front
- Back
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PQRST format for describing pain
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P = provocation (what worsens/relieves it)
Q = Quality R = Region/Radiation S = severity T = timing (intermittent/continuous, relationship with activities) |
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pericarditis pain differentiation
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sitting up and leaning forward relieves it
worse on inspiration/coughing duration = days |
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pulmonary embolism pain differentiation
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Sitting high upright relieves
worsened by deep inspiration/coughing duration = minutes to hours |
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dissecting aortic aneurysm pain differentiation
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no relief with nitro/rest
"tearing, ripping" |
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differentiating chest pain & actual acute myocardial infarction
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chest pain relieved by nitro/rest/oxygen
AMI is not |
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Pneumothorax pain differentiation
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"tearing, sharp"
worsened by breathing diminshed breath sounds effected side tracheal deviation |
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GI chest pain differentiation
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relieved by antacids/sitting up
worse by eating/supine |
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orthopnea
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patient is unable to lie flat d/t dyspnea
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paroxysmal nocturnal dyspnea
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patient awakens with feeling of suffocation 1-2 hrs after falling asleep
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effort syncope
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transient loss of consciousness occuring after heavy activity, may be d/t aortic stenosis/subaortic stenosis
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Stokes-Adams attack
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dramatic loss of consciousness r/t heart block/dysrhythmias
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hypersensitive carotid sinus syncope
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loss of consciousness caused by pressure applied on carotid sinus body of a patient with atherosclerotic and hypersensitive carotid arteries
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intermittent claudication
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hip/thigh/calf pain that occurs with exercise and ceases with rest may be indicative of peripheral arterial disease
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Variation of up to ____ mm Hg BP in arms is normal
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15 mm Hg
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narrow pulse pressure indicates
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vasoconstriction
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widened pulse pressure indicates
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vasodilation
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"blue bloaters"
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nickname for chronic bronchitis patients
blue d/t chronic hypoxemia bloated d/t chronic RV failure |
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Grades of edema pitting
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Grade 1+ = 0 - 1/4 inch
Grade 2+ = 1/4 to 1/2 inch Grade 3+ = 1/2 to 1 inch Grade 4+ = > 1 inch |
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splinter hemorrhages
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red to black linear streaks under nailbed that run from base to tip
may indicate bacterial endocarditis |
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Osler's nodes
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painful red SQ nodules on fingertips
may indicate embolization in infective endocarditis |
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de Musset's sign
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head bobbing with each heartbeat
indicates aortic aneurysm/regurgitation |
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How to evaluate JVD
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place patient HOB at 45 degree angle
note the angle of Louis patient turn head away from you Measure from top of JV pulsations to angle of Louis (measure height) |
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Normal JVD measurement from angle of Louis
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< 4 cm
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JVD is indicative of
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RV failure
Hypervolemia tension pneumothorax Cardiac tamponade |
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How do you estimate CVP off of jugular vein assessment?
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Add 5 cm to the height of neck vein distention
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where is mitral area auscultated
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fifth L. intercostal space midclavicular line
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where is tricuspid auscultated?
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5th L intercostal at left sternal border
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where is Erb's point and what is it?
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3rd L intercostal at L sternal border, where S2 is best heard
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Where is pulmonic valve best auscultated?
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2nd L intercostal, at L sternal border
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Where is aortic valve best auscultated?
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2nd R. intercostal at R sternal border
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heart events are louder on which side?
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Left
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Heart events are louder on which sides during expiration vs inspiration?
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Left = louder during expiration
Right = louder during inspiration |
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Where is S1 loudest?
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at apex
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Where is a split S1 best heard?
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tricuspid area
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What causes a split S1 heart sound?
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R. BBB
LV pacemaker L ventricular ectopy |
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A split S2 is best heard where?
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the pulmonic area
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Is split S2 ever normal?
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Yes, during inspiration
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Causes of split S2 (not just during inspiration)
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R BBB
LV ectopy LV pacemaker severe mitral regurg pulmonary stenosis pulmonary HTN ventricular septal defect |
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S3: when does it occur?
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ventricular gallop, occurs in early diastole after S2
"Ken-tuc-ky" with K = S3 |
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S3 heart sound causes
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rush of blood into dilated ventricle
associated with mitral or tricuscpid regurg, septal defect, fluid overload,cardiomyopathy |
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S4 heart sound occurs when
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atrial gallop
occurs late in diastole before S1 "Ten-nes-see" with S4 = "Ten" |
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S4 heart sound cause
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caused by atrial contraction of blood into a noncompliant ventricle
Associated with MI, HTN, ventricular hypertrophy, AV blocks, severe aortic/pulmonic stenosis |
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How do you differentiate pericardial friction rub and pleural friction rub?
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have patient hold breath
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Causes of murmurs
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turbulence
increased flow across a normal valve forward flow over stenotic valve backward flow through regurg. valve |
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normal sodium serum
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135 - 145 mEq/L
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normal serum potassium
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3.5 - 5.5 mEq/L
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normal serum chloride
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96 - 106 mEq/L
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normal serum Calcium
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8.5 - 10.5 mg/dL
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normal serum phosphorus
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3- 4.5 mg/dL
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normal serum Magnesium
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1.5 - 2.2 mEq/L
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normal total CK (creatine kinase)
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55 - 170 units/L males
30 - 135 units/L females |
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LDH normal serum
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90 - 200 units/L
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normal myglobin serum
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< 110 ng/mL
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normal serum Troponin I and Troponin T
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I: < 1.5 ng/mL
T: < 0.1 ng/mL |
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normal serum cholesterol
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150 - 200 mg/dL
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normal serum triglycerides
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40 -150 mg/dL
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normal C reactive protein serum
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< 1 mg/dL
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normal serum BNP
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< 100 pg/mL
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Heart failure levels of BNP serum
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mild 100 - 300 pg/ml
moderate 300 - 700 severe > 700 |
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normal ABG paCO2 serum
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35 - 45 mm Hg
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normal ABG serum HCO3
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22-26 mM
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normal ABG paO2
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80-100 mm Hg
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normal ABG saO2q
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> 95%
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normal hematocrit serum
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40-52% males
35 - 47% females |
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normal Hgb serum
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13-18 g/dL males
12-16 females |
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normal WBC count
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3500 - 11000 cells/mm^3
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normal erythrocyte sed rate (ESR)
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up to 15 mm/hr males
20 mm/hr females |
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normal serum PT vs therapeutic
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12-15 seconds (therapeutic 1.5 - 2.5 x higher)
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normal serum PTT vs therapeutic
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60-90 seconds (therapeutic 1.5 - 2.5 x higher)
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normal serum ACT vs therapeutic
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70-120 seconds (therapeutic 150-190 seconds)
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normal serum INR vs. therapeutic
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< 2
a fib 1.5 - 2.5 DVT/PE 2-3 prosthetic valve 2.5 - 3.5 |
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normal serum platelets
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150,000 - 400,000 cells/mm^3
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Urine normal glucose
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negative
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urine normal ketones
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negative
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urine normal specific gravity
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1.005 - 1.03
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urine normal osmolality
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50 - 1200 mOsm/L
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Pallor of skin may indicate (3)
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anemia
SNS stimulation or sympathomimetic agents (i.e. neo, levo etc) |
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Arterial disease often causes lesions of _____ (body locations)
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toes, points of trauma
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venous disease often causes lesions of _____ (body location)
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ankles
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Clubbing
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loss of normal angle between nail bed and skin. Present if angle > 180
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pulsus magnus
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strong bounding pulses with rapid upstroke and downstroke
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causes of pulsus magnus (5)
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HTN
thyrotoxosis aortic insufficiency patent ductus arteriosus AV fistula |
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pulsus parvus
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small weak pulse
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causes of pulsus parvus (4)
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aortic stenosis
mitral stenosis constrictive pericarditis cardiac tamponade |
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pulsus alternans
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alternating pulse waves, every othe rbeat being weaker than preceding one
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causes of pulsus alternans
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characteristic of LV failure
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clinical manifestations of acute arterial occlusions (5 P's)
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pain
pallor pulselessness paresthesia paralysis polar (cold) |
