Supervised Clinical Practice – VI
Assignment No. 1
Submitted to: Dr. Fawad
Submitted by: Amal Nadeem & Tayyab Iqbal
Heart rate
A normal resting heart rate for adults ranges from 60 to 100 beats per minute. Generally, a lower
heart rate at rest implies better cardiovascular fitness. For example, a well-trained athlete might
have a normal resting heart rate closer to 40 beats per minute.
Count the beats for 15 seconds. Multiply the number of beats by 4.
Respiratory rate
The respiration rate is the number of breaths a person takes per minute.
Normal respiration rates for an adult person at rest range from 12 to 16 breaths per minute.
The rate is usually measured when a person is at rest and simply involves counting the number of
breaths for one minute by counting how many times the chest rises.
Aerobic capacity
Aerobic capacity is the highest amount of oxygen consumed during maximal exercise in
activities that use the large muscle groups in the legs or arms and legs combined.
Aerobic conditioning is regular physical training in aerobic activities over an extended period of
time.
Aerobic capacity is evaluated using estimates of VO2max
Fitness can be measured by the volume of oxygen you can consume while exercising at your
maximum capacity. VO2max is the maximum amount of oxygen in millilitres, one can use in
one minute per kilogram of body weight.
The best is to do it directly, by measuring the oxygen you consume while you exercise to
exhaustion.
To measure VO2 max, you wear a mask and heart rate monitor hooked up to a treadmill or
stationary bike. The mask is connected to a machine that collects and measures the volume of
oxygen you inhale, and the amount of air you exhale.
Next best is to estimate it while exercising to exhaustion; for example, based on the distance
covered during a 12-minute run.
Pulse oximetry
These conditions include:
chronic obstructive pulmonary disease (COPD) ,asthma ,pneumonia ,lung cancer ,anemia ,heart
attack or heart failure ,congenital heart defects
There are a number of different common use cases for pulse oximetry, including:




to assess how well a new lung medication is working
to evaluate whether someone needs help breathing
to evaluate how helpful a ventilator is
to monitor oxygen levels during or after surgical procedures that require sedation
ds
•
Normal findings on auscultation include:
•
Loud, high-pitched bronchial breath sounds over the trachea
•
Medium pitched bronchovesicular sounds over the mainstream bronchi, between the
scapulae, and below the clavicles
•
Soft, breezy, low-pitched vesicular breath sounds over most of the peripheral lung fields
Abnormal Breath Sounds
•
Crackles (or rales) are caused by fluid in the small airways or atelectasis. Crackles are
referred to as discontinuous sounds; they are intermittent, nonmusical and brief. Crackles
may be heard on inspiration or expiration. The popping sounds produced are created when air
is forced through respiratory passages that are narrowed by fluid, mucus, or pus.
•
Crackles are often associated with inflammation or infection of the small bronchi,
bronchioles, and alveoli. Crackles that don't clear after a cough may indicate pulmonary
edema or fluid in the alveoli due to heart failure or adult respiratory distress syndrome
(ARDS).
•
Wheezes are sounds that are heard continuously during inspiration or expiration, or during
both inspiration and expiration. They are caused by air moving through airways narrowed by
constriction or swelling of airway or partial airway obstruction.
•
acute asthmatic attack
•
Pleural friction rubs are low-pitched, grating, or creaking sounds that occur when inflamed
pleural surfaces rub together during respiration. More often heard on inspiration than
expiration, the pleural friction rub is easy to confuse with a pericardial friction rub. To
determine whether the sound is a pleural friction rub or a pericardial friction rub, ask the
patient to hold his breath briefly. If the rubbing sound continues, its a pericardial friction rub
because the inflamed pericardial layers continue rubbing together with each heart beat - a
pleural rub stops when breathing stops.
•
Stridor refers to a high-pitched harsh sound heard during inspiration. Stridor is caused by
obstruction of the upper airway, is a sign of respiratory distress and thus requires immediate
attention.
Rating of perceived exertion
•
Rating of perceived exertion (RPE) is a valuable and reliable indicator in monitoring your
exercise tolerance.
•
The RPE is a means of determining how hard you are exerting yourself, including
physiological (how hard you are breathing, how fast your heart is beating) and muscular
strain (how much you feel the exertion in your muscles).
Signs and symptoms of hypoxia
The most common hypoxia symptoms are:

Changes in the color of your skin, ranging from blue to cherry red

Confusion

Cough

Fast heart rate

Rapid breathing

Shortness of breath

Slow heart rate

Sweating

Wheezing
Pulse

Carotid

Brachial

Radial

Femoral

Popliteal

Dorsalis Pedis
Deep vein thrombosis (DVT)
Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a vein
located deep inside your body. A blood clot is a clump of blood that’s turned to a solid state.
Deep vein blood clots typically form in your thigh or lower leg, but they can also develop in
other areas of your body.
Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is
used to test for Deep Vein Thrombosis (DVT)
Technique

In performing this test the patient will need to actively extend his knee.

Once the knee is extended the examiner raises the patient’s straight leg to 10 degrees, then
passively and abruptly dorsiflexes the foot and squeezes the calf with the other hand.

Deep calf pain and tenderness may indicate presence of DVT.
Venous stasis
Venous stasis is a pooling of blood in the veins
Common in Vericose veins
Test Examination only
Lymphedema
Lymphedema, or lymphatic obstruction, is a long-term condition where excess fluid collects in
tissues causing swelling (edema).