BRTP01 Flashcards
Normal Heart rate
60-100 beats per minute
Normal range of respiratory rate
12-20 breaths per minute
Normal range of blood pressure
90/60 to 140/90
Average temperature
98.7 degrees F or 36.4- 37.2 degrees C
Apnea
Absence of breathing
Hyperpnea
Increased depth of breathing or air flow
Hypopnea
Decreased depth of breathing and air flow
Eupnea
Normal breathing
Hyperventilation
Increased ventilation that results in an abnormally low CO2 levels (less than 35)
Hypoventilation
Decreased ventilation that results in an abnormally high CO2 level ( greater than 45)
Bradypnea
Decrease in respiratory rate ( less than 12 breaths per minute)
Tachypnea
Increase in respiratory rate ( RR higher than 20 breaths per minute)
Capillary refill
Pressing nails and watching for color to return.
Color should return in less than 3 seconds
If greater than 3 seconds it indicates poor perfusion.
Common causes are low BP and decreased cardio output.
Sensorium
Mental status
Oriented to time, place, person
(Oriented x 3)
Alert
Awake, coherent, responsive
Lethargic
Awake but drowsy
Obtunded
How to stimulate to get response or to show eyes
Stuporous
Withdraw from pain
Ex: if you pinch hand they will pull hand back
Comatose
No response, nothing.
Tachycardia
Increase in HR (greater than 100 beats per minute)
Causes: Hypoxia Infection and fever Shock Anxiety, stress, fear Medications
Cheyne-Stokes respiration
Waxing and waning tidal volumes with periods of apnea. Usually a neuro issue or Congestive Heart Failure (CHF)
Kussmaul’s respiration
Rapid, deep breaths. Typically related to diabetic Keto acidosis. (Patient will be panting)
Biot’s respiration
Variable rate and depth of breaths with periods of apnea. Can be caused by meningitis, head injury, increase ICP, brain tumor. (Neurological issue) (panting w apnea)
Systolic pressure
Pressure when heart is contracting
Diastolic pressure
Pressure when heart is resting
Hypotension
Low blood pressure less than 90/60
Hypertension
High blood pressure above 140/90
Hypertension causes
Fear and anxiety Tachycardia, vasoconstriction Hypoxia (lack of O2 at tissues) Kidney disease Medications Poor lifestyle habits Heredity
Hypotension causes
Bradycardia Cardiac failure, vasodilation, or shock Hypovolemia/ dehydration Postural (orthostatic) hypotension Hypothermia Medications Tension pneumothorax
Pulsus paradoxus
Pulse that is weaker during inspiration
Air trapping, pneumothorax, pericardial effusion[cardiac tamponade], pericarditis
Pulsus alternans
Alternating weak and strong pulses
Associate this with cardiac arrhythmia
Also left ventricle failure
Fever (Pyrexia)
Elevated body temperature secondary to disease such as infection
Febrile
Body temperature above normal
Afebrile
Body temperature that is within normal limits
Hypothermia
Potentially dangerous drop in body temperature
Hyperthermia
Potentially dangerous increase in body temperature
Effects of hypothermia
Decreased metabolism
Decreased oxygen consumption and CO2 production
Bradypnea and hypoventilation
Bradycardia
(Lower temp lowers everything else)
Effects of hyperthermia
Increased metabolism Increased oxygen consumption Tachypnea and increased ventilation Tachycardia Coma, seizures, renal failure
Normal oxygen saturation (SpO2)
Normal is mid to upper 90’s
(96-99)
(Less than 90% indicates a level of hypoxemia typically in need of supplemental oxygen)
Palpation
Using hands to take pulses
Percussion
Using hands to tap and listen to body
Auscultation
Using a stethoscope to observe body
Tripod breathing
Leaning forward while bracing elbows on a table or furniture. Makes it easier to use accessory muscles
Orthopnea
Dyspnea (difficulty breathing) in the reclining position
Accessory muscles used when in respiratory distress
Intercostal ( between ribs)
Subcostal (below ribs)
Supraclavicular (above clavicles)
Suprasternal (above sternum)
Retractions
Inward depression of skin on inspiration caused by ventilatory muscles contracting to cause a decrease in intrathoracic pressure
Pursed lip breathing
Breathing through pursed lips to create a slight back pressure in airways to keep them from collapsing
Nasal flaring
Nares widen during inspiration and return to normal on expiration
Grunting
High pitched sound made by partially closing the glottis over trachea
(Helps keep alveoli open on exhalation)
(An attempt to maintain lung volume)
Diaphoresis
Profuse sweating
Cyanosis
A visible bluish tinge is the skin and mucous membranes
(Can be a sign of hypoxia)
(Can be hypoxia but not cyanotic)
Central cyanosis
Associated with hypoxia and mucous membranes
Lips and tongue will be blue
Acrocyanosis
Hands and feet are blue
Due to poor circulation and poor perfusion
Barrel chest
Increase in A-P diameter of chest
Pectus carinatum
Sternal protrusion
Pectus excavatum
Depression of part or all of sternum
Kyphosis
Abnormal A-P spinal curvature
Scoliosis
Abnormal lateral curvature
Digital clubbing
Progressive, painless enlargement of ends of fingers and toes ( usually linked to hypoxia, not always)
Jugular venous pressure (JVP)
Or
Jugular venous distention (JVD)
Large elevated vein in right side of neck
Usually caused by : right heart failure (cor pulmonale) Tension pneumothorax Lung disease Cardiac tamponade
Trachea shifts AWAY from affected side
Tension pneumothorax
Pleural effusion
Hemothorax
(All occur outside of lung)
Trachea shifts towards the affected side
Atelectasis
Pulmonary fibrosis
Occur inside lung
Subcutaneous emphysema
Sometimes called “sub q” or “crepitus”
Air leaks into subcutaneous layer of tissue
Fine air bubbles create crackling sensation
Classic sign of: Barotrauma Pneumothorax Trauma Surgeries (heart, thoracic, tracheostomies)
Tactile fremitus
Vibrations through chest wall when patient speaks
Vibrations decrease with extra air inside lungs, or fluid, or air in the plural space
Vibrations increase as lung tissue becomes more dense
Increased fremitus is found in?
Unilateral:
Pneumonia
Atelectasis
Consolidation
Bilateral:
Pulmonary edema (fluid in lungs equally) Acute respiratory distress syndrome (ARDS)
Decreased fremitus is found:
Unilateral:
Pneumothorax
Pleural effusion
Bronchial obstruction
Bilateral:
Thick chest walls (high amounts of fat or muscle)
Chronic obstructive pulmonary disease (COPD)
Resonant sound
Indicates good aeration, will be moderately low pitched
Dull sound
Indicates poor aeration/ solid tissue/ fluid-filled
Hyperresonant
Hyperinflated or excessive air
Increased resonance
Louder and lower than normal sound
Tympany
Drum-like sound
Increased resonance
Interchangeable with hyperresonance
What causes DULL sounds? (Decreased resonance)
Pneumonia
Atelectasis
Tumors
Pleural fluid
What causes HYPERRESONANT sounds? (Increased resonance)
Unilateral- Pneumothorax or bleb
Bilateral- hyperinflated lungs as in an asthma exacerbation or emphysema
(Also referred to as tympany)
Diaphragmatic excursion
Comparing the level of the diaphragm on inspiration and expiration
Should be 3-5 cm
Abnormal diaphragmatic excursion can be caused by what?
Phrenic nerve injury Paralysis Pneumonia Neuromuscular diseases Tension pneumothorax Hepatomegaly
Best position for lung auscultation?
Fowlers position (sitting upright)
Normal breath sounds: BRONCHIAL
Over the trachea
High in pitch
Loud in intensity
Normal breath sounds: BRONCHOVESICULAR
Around upper part of the sternum (main stem bronchi) and between scapulae
Moderate in pitch and intensity
Normal breath sounds: VESICULAR
Over parenchyma/ periphery (most of lung)
Low in pitch and soft in intensity
Adventitious breath sounds
Abnormal breath sounds
Foreign, acquired; occurring in unusual places
Adventitious breath sound example to know:
Example:
Bronchial breath sounds heard in a lung base (in the parenchyma) is abnormal and suggests pneumonia or consolidation.
Fine crackles
Also known as “rales” or just “crackles”
Heard on inspiration
Sounds like rubbing hair between fingers
Doesn’t clear with cough
Indicates alveolar secretions/ fluids or opening of alveoli on inspiration
Fine crackles are associated with which diseases and disorders?
Atelectasis
Pulmonary edema
Fibrosis
(Think inside of lungs)
Coarse crackles
Also known as “rhonchi”
Low in pitch, continuous sound
More common on expiration but can be heard on inspiration
Sounds like rumbling or snoring
Can clear with cough
Indicates secretions moving in airways
Course crackles are associated with which disease?
Bronchitis
Severe pneumonia
Wheezes
Usually heard on expiration but can be inspiratory
High pitch, musical, and continuous
Doesn’t clear with cough
Caused by increased airflow through narrowed airway
Wheezing is related to why disease?
Asthma Bronchitis Congestive heart failure (CHF) Pulmonary edema Foreign body (more likely to have monophonic wheeze)
Diminished or decreased breath sounds causes?
Shallow breathing Severe obesity Chronic lung disease Pleural effusion/ fluid (may be completely absent) Pneumothorax (may be completely absent)
Pleural friction rub
Creaking or grating sound
Caused by rubbing or inflamed, rough pleural surfaces
Can sound like coarse crackles but will NOT clear with cough
Localized to one area and can be painful
Pleural friction rub is caused by?
Pleurisy, pneumonia, pulmonary embolus (PE)
Stridor
High pitched monophonic sound CROWING sound
Caused by rapid airflow through upper airway
Most commonly acute but could be chronic
Indicates upper airway construction or partial obstruction
Stridor is related to what disease
Partial upper airway obstruction caused by croup
Epiglottis
Postextubation laryngeal edema
Foreign body
Atelectasis
Complete or partial collapse of lung or live of lung.
Collapses at alveolar level (from inside the lung)
Pneumothorax
Collapsed lung from outside pressure
Air leaks into pleural space
Pleural effusion
Abnormal amount of fluid around lungs
Fluid between pleural space
Blunted costophrenic angle
Pointed angle in base of lung collapses or is obliterated due to pleural effusion
