Practice OPQRST Hx for chest pain.
Onset:
- Is it sudden or gradual?
- How did it begin?
- Where were you when it started?
- What were you doing at the time?
Provocation:
- What brought on the pain?
- Was it related to exertion or were you sitting/resting?
- Does anything make the pain better or worse?
Quality:
Describe the pain.
- Is it sharp, dull, heavy, squeezing, crushing?
Radiation:
- Does the pain travel anywhere else? Does the pain radiate down your arm, up your neck, or Into your back?
Severity:
- Rate the pain/discomfort on a scale of 1/10.
Timing:
- When did the pain start?
Define:
Paroxysmal Nocturnal Dyspnea
Shortness of breath that awakens the patient from their sleep.
Define:
Orthopnea
Shortness of breath while lying down.
Define:
syncope
Temporary loss of consciousness.
What medical conditions are commonly prescribed with digitalis?
- CHF
- Atrial flutter
- Atrial fibrillation
- SVT
What type of medication ends with “lol”?
beta-blockers
Eg. Atenolol, Bisoprolol, Metoprolol, Labetalol, Carvedilol, Nadolol.
What are the functions of beta blockers?
- Decrease the HR.
- Decrease the contractility of the heart.
- Decrease the blood pressure.
What is the function of diuretics?
It makes the kidneys excrete more sodium and water than usual.
It is used in patients with CHF or hypertension.
What are the functions of calcium channel blockers?
- Prevents coronary artery spasm.
- Decreases cardiac contraction.
Define:
orthostatic hypotension
An abnormal drop in blood pressure when standing.
What is the sound of a normal heart?
“lub” “dub”
This signifies S1 and S2.
What are the two abnormal heart sounds?
- S3: “lub-dub-ta”
- S4: “ta-lub-dub”
S3 – Often described as a “ventricular gallop”.
S4 – Often described as an “atrial gallop”.
Associated with stiff ventricles, e.g., in left ventricular hypertrophy.
When S1 heart sound is auscultated, what are you hearing?
Closure of tricuspid and mitral valves.
When S2 heart sound is auscultated, what are you hearing?
Closure of the pulmonic and aortic valves.
When S3 heart sound is auscultated, what are you hearing?
- Young adults: rapid filling of the ventricle
- Older adults: heart failure
When S4 heart sound is auscultated, what are you hearing?
Turbulent filling from ventricular stiffening.
It is very rare and heard just before S1.
Define:
pulsus paradoxus
It is characterized by a drop in systolic BP during inhalation.
>10 mmHg
Define:
pulsus alternans
A difference in the palpable strength of each heartbeat.
Define:
pulse pressure
The difference between systolic and diastolic pressure.
What conditions can result in different blood pressures between each arm?
- Aortic dissection
- Aortic aneurysm
How often should vital signs be obtained for critical and non-critical patients?
- critical: every 5 minutes
- non-critical: every 15 minutes
