DD Chapter 6

Past medical history - personal or family history of CAD, HD, angina, or MI. assess menstrual history: a menopausal or postmenopausal woman with a high risk of HD may develop symptomatic CAD Clinical presentation - if findings from clinical evaluation do not seem consistent with TMJ assess the effect of using a stationary bike or treadmill without UE exertion on jaw pain. Increased pain or symptoms with increased LE exertion may be a sign of cardiac involvement Associated signs and symptoms - assess for coincidental nausea, diaphoresis, pallor, or dyspnea during painful or symptomatic periods. look for recent history of SOB at night, extreme fatigue, lethargy, and weakness.

A 48 year old woman with TMJ syndrome has been referred to you by her dentist. How do you screen for the possibility of medical (specifically cardiac) disease?

The onset of MI can be precipitated by working with arms above head. Ischemia or infraction may be the cause of his symptoms. Assess vital signs and changes in vital signs with increased workload and assess the effect of increasing the workload of the LE only. Evaluate for thoracic outlet syndrome

A 55 year old male grocery store manager reports that he becomes extremely weak and breathless when he is stocking groceries on overhead shelves. What is the possible significance of this complaint?

Myocardial ischemia is a deficiency of blood supply to the heart muscle that is usually caused by narrowing of the coronary arteries Angina pectoris is the chest pain that occurs when the heart is not receiving an adequate supply of blood, therefore, has insufficient quantities of oxygen for the workload Myocardial infraction is death of the heart tissue when blood supply to that area is interrupted

Briefly describe the difference between myocardial ischemia, angina pectoris, and MI

emphysema

Pursed lip breathing in the sitting position while leaning forward on the arms relieves symptoms of dyspnea for the client with:

-pleuritic pain - have patient hold breath and reassess symptoms, reduction or elimination of symptoms with breath holding or valsalva suggests pulmonary or cardiac source of symptoms -pain or palpation (musculoskeletal) -pain with changes in position (musculoskeletal or pulmonary)

What are the 3Ps? what is the significance of each?

fatigue, dyspnea, edema, nocturia

What are the primary signs and symptoms of CHF

monitor vital signs, and palpate pulses. evaluate past and current medical history for the presence of CAD. any suspicion of thoracic aneurysm must be reported to physician immediately

What should you do if a client complains of throbbing pain at the base of the neck that radiates into the interscapular areas and increases with exertion?

Palpations are considered WNL when they occur at a rate of less than 6 per minute. Palpations lasting for hours or occurring in association with pain, SOB, fainting, or severe lightheadedness require medical evaluation. Palpations in any person with a history of unexplained sudden death in the family require medical referral. Palpations can also occur as adverse effect of some medications, through the use of drugs such as cocaine, as the result of an overactive thyroid, or because of caffeine sensitivity. Palpations as a recurring symptom should always be reported to a physician

When are palpations clinically significant?

All of the above -45 minutes before exercise -when symptoms of chest pain do not subside with 10-15 minutes of rest -as soon as chest pain begins

When would you advise a client in physical therapy to take his/her nitroglycerin

Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed

Which of these statements is most accurate?

Examine the client for the presence of cyanosis, orthopnea, and tachycardia; for changes in renal function (decreased urination during the day but increased urination at night) and for spasmodic cough triggered by lying down at night. These might be indicators of CHF. Take note if the patient is taking NSAIDs and digitalis together, these can cause ankle swelling

You are seeing an 83 year old woman for a home health evaluation after a motor vehicle accident that required a long hospitalization followed by transition care in an intermediate care nursing facility and now home health care. She is ambulating short distances with a wheeled walker, but she becomes short of breath quickly and requires lengthy rest periods. At each visit the client is wearing slippers and a house coat, so you suggest she start dressing each day as if she is intending on going out. She replies she no longer fits into her loosest slacks and cannot tie her shoes. Is their any significance to this client's comments, or is this consistent with her age and obvious deconditioning?

all of the above -arterial and occlusive disease -arterial and venous disorders -acute and chronic arterial disease

peripheral vascular disease includes: