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Respiratory Care Seminar‼️ > Ch. 3: Assessment of the Cardiopulmonary Patient > Flashcards

Ch. 3: Assessment of the Cardiopulmonary Patient Flashcards

1
Q

Ch. 3: Assessment of the cardiopulmonary patient

A patient is experiencing cardiac dysrhythmias and muscle weakness. An arterial blood gas determines that the patient is in metabolic alkalosis. Which is the most appropriate value to assess at this this time?

A

Potassium

Hypokalemia can cause cardiac dysrhythmias and muscle weakness.

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2
Q

Ch. 3: Assessment of the cardiopulmonary patient

The respiratory therapist is assessing a patient with severe emphysema and observes pedal edema, and jugular venous distention. The therapist and note in the patient’s chart that the signs are most likely the result of:

A

Right ventricular hypertrophy

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3
Q

Ch. 3: Assessment of the cardiopulmonary patient

What elevated cardiac biomarker is associated with CHF?

A

BNP (>500pg/mL)

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4
Q

Ch. 3: Assessment of the cardiopulmonary patient

A patient is suspected of suffering acute myocardial infarction. What lab value would you expect to be increased in the patient’s blood?

A

CK-MB

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5
Q

Ch. 3: Assessment of the cardiopulmonary patient

What is nonproductive coughs caused by? (5)

A
  1. Irritation of the airway
  2. Acute inflammation of the respiratory mucosal membrane
  3. Presence of a growth
  4. Pleural irritation
  5. Irritation of the tympanic membrane
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6
Q

What does green foul smelling sputum indicate?

A

Psuedomonas infection

Commonly seen with bronchiectasis

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7
Q

What does red sputum indicate?

A

Contains fresh blood

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8
Q

What does brown sputum indicate?

A

Old blood

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9
Q

What does yellow purulent sputum indicate?

A

Infection, contains WBCs

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10
Q

What does white sputum indicate?

A

Normal mucus

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11
Q

What does pink frothy sputum indicate?

A

Pulmonary edema

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12
Q

The patient’s complaint of difficult or labored breathing

A

Dyspnea

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13
Q

Croup or epiglottitis?

Bark-like cough usually indicates ___________.

A

Croup

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14
Q

What oxygen delivery device is best suited for patients that are mouthbreathers?

A

Venturi

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15
Q

Causes of dyspnea

A
  1. Increased airway resistance
  2. Upper airway obstruction
  3. Asthma and other chronic lung diseases
  4. Decreased lung compliance
  5. Pulmonary fibrosis
  6. Pneumothorax
  7. Pleural effusion
  8. Abnormal chest wall
  9. Anxiety state
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16
Q

Define orthopnea.

A

Dyspnea while laying down

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17
Q

In what type of patients is orthopnea usually seen?

A

CHF, Emphysema

Usually see in patients with heart failure and is caused by increased congestion of the lungs while lying down.

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18
Q

Define paroxysmal nocturnal dyspnea

A

Sudden onset of SOB after being in bed for several hours

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19
Q

Where is paroxysmal nocturnal dyspnea typically seen?

A

Cardiac patients

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20
Q

Massive hemoptysis is defined as _________ mL of blood-tinged sputum in 3 hours or ____________.

A

Massive hemoptysis is defined as 400 mL of blood-tinged sputum in 3 hours or as more than 600 mL in 24 hours.

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21
Q

What are some causes of hemoptysis?

A
  1. Pneumonia
  2. TB
  3. Bronchiectasis
  4. Lung abscess
  5. Fungal lung infection
  6. Mitral valve stenosis
  7. Trauma
  8. Valvular heart diseases
  9. Neoplasms
  10. Pulmonary embolism
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22
Q

Define eupnea.

A

Normal rate and depth of respirations

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23
Q

Normal respiratory rate ranges

A

Adults: 12-30 breaths/min
Children: 15-25 breaths/min
Newborn: 35-45 breaths/min

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24
Q

When may bradypnea be seen?

A

Respiratory center depression, like head trauma or drug overdose

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25
Q

Cstat equation

A

VT/Pplat-PEEP

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26
Q

What x-ray view is used to identify free fluid in the chest (E.g: plueral effusion or blood)?

A

Lateral decubitus

Also helpful in determining the presence of a pneumothorax.

Lay patient on the left, if a right pneumothorax is suspected.

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27
Q

True or false.

There will be no tracheal shift if whatever is affecting the lung is bilateral.

A

True

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28
Q

What is the proper terminology for the following description and where is it commonly found?

Bat wings or or butterfly

A

Kerley B lines

Found in pulmonary edema (CHF)

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29
Q

What are known drugs for increasing cardiac output?

A
  1. Digitalis
  2. Digoxin
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30
Q

Define hypopnea.

A

Shallow respirations (about half of normal depth) with slower than normal respiration rate

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31
Q

In what type of patients is hypopnea known to be normal?

A

Well-conditioned athletes and is accompanied by a slow pulse rate.

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32
Q

Define hyperpnea

A

Deep, rapid and labored breathing

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33
Q

What is hyperpnea associated with?

A

Conditions where there is an inadequate O2 supply.

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34
Q

Where is Kussmual respiration usually seen?

A

Patients with severe metabolic ketoacidosis

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35
Q

Define Kussmual respiration.

A

Increased rate and depth of breathing

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36
Q

Irregular breathing pattern characterized by short periods of deep, consistent volumes with periods of apnea. Apnea period may last 10-30 seconds

A

Biots respiration

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37
Q

What is Biot respiration associated with?

A

Increased ICP and meningitis

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38
Q

Identify the following breathing pattern

Deep, rapid breathing followed by apnea. Breaths begin slowly and shallowly and gradually increase to above normal volume and rate and then gradually diminish in volume and rate followed by apnea. Apnea period may last 10-30 seconds

A

Cheyne-Stokes respiration

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39
Q

What is Cheyne-Stokes respiration associated with?

A
  • Respiratory center depression caused by stroke or head injury
  • PNA in elderly
  • Drug overdose
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40
Q

An increased A-P diameter is called barrel chest and is indicative of what?

A

Chronic lung disease

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41
Q

Describe Mallampati.

A

1 is the best, you can see everything.
4 would be the most difficult to intubate, nothing can be seen.

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42
Q

What is digital clubbing the result of?

A

Chronic hypoxemia

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43
Q

The accumulation of fluid in the subcutaneous tissues of the ankles is called ______.

A

Pedal edema

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44
Q

What is the equation for the following?

Minute Ventilation

A

VE = RR x VT

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45
Q

What is the equation for the following?

Alveolar minute ventilation

A

VA = (VT - VD) x f

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46
Q

What is the equation for the following?

Cdyn

A

Cdyn = VT/(PIP-PEEP)

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47
Q

What is central cyanosis?

A

It is present when the oral mucosa and trunk are cyanotic.

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48
Q

What is peripheral cyanosis?

A

Nail beds are cyanotic

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49
Q

Normal capillary refill time is less than ___________.

A

3 seconds

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50
Q

Backward curvature of the lumbar spine, resulting in a “swayback” appearance.

A

Lordosis

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51
Q

Also called pigeon breast and results in the forward projection of the xiphoid process and lower sternum.

A

Pectus carinatum

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52
Q

Also called funnel chest and results in a funnel shaped depression over the lower sternum.

A

Pectus excavatum

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53
Q

What causes the barrel chest appearance?

A

Air trapping and subsequent hyperinflation. Loss of lung elasticity causes the lungs to move more outward. Also the increase tone and development of the accessory muscles used during COPD breathing

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54
Q

Muscles normally used for ventilation are the diaphragm and external intercostals, but the diaphragm of COPD patients is flattened, so they use ____________________ during normal ventilation.

A

Accessory muscles

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55
Q

Vibrations felt on the chest wall as the patient speaks are called ____________________.

A

Tactile fremitus

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56
Q

When are tactile fremitus vibrations decreased?

A
  • Pleural effusion
  • Fluid
  • Pneumothorax
  • Overly muscular or obese patients
57
Q

When are tactile fremitus vibrations increased?

A
  • Lung masses
  • Atelectasis
  • PNA
58
Q

Palpating over subcutaneous air feelings like crackling under the skin and is referred to as what?

A

Crepitus

59
Q

Tapping on the chest directly with one finger or indirectly by placing one finger on a chest area and tapping on that finger over different areas of the chest.

A

Percussion

60
Q

A loud low-pitched sound of long duration that is produced over areas that contain greater proportion of air than tissue.

A

Hyperresonance

61
Q

What are some examples of when you’d hear hyperresonance?

A
  • Air-filled stomach
  • Emphysema
  • Pneumothorax
62
Q

A low-pitched sound of long duration that is produced over areas with equal distribution of air and tissue.

A

Resonance

Example: Normal lung tissue

63
Q

A drumlike sound

A

Tymphany

Example: Tension pneumothorax

64
Q

Auscultation of breath sounds

If bronchial breath sounds are heard in other areas than the upper lung, what does it indicate?

A

Atelectasis or consolidation

65
Q

Adventitious breath sounds

A bubbling or crackling sound that can be heard during inspiration or expiration and that is produced by air flowing through airways containing secretions of fluids.

A

Crackles

66
Q

Auscultation of breath sounds

Where are early inspiratory crackles most commonly heard?

A

Patients with emphysema, chronic bronchitis or asthma

67
Q

Adventitous breath sounds

When are late inspiratory crackles commonly (4)

A
  • Pulmonary edema
  • Atelectasis
  • Pneumonia
  • Restrictive lung disorders such as pulmonary fibrosis
68
Q

Adventitous breath sounds

Breath sounds with a musical quality that are produced as air flows through constricted airways

A

Wheezes

69
Q

WHEEZING

Airways become constricted as a result of __________. (4)

A
  • Bronchospasm
  • Mucosal edema
  • Excessive sputum
  • Presence of foreign bodies
70
Q

Adventitous breath sounds

Used to describe low-pitched, continous abnormal lung sounds.

A

Rhonchi

Continous low-pitched coarse crackles is called rhonchi

71
Q

Adventitous breath sounds

Most common during inspiration and produced as air passes through a narrowed upper airway structure such as the glottis.

A

Stridor

72
Q

A clickling or grating sound caused by friction that is produced as the parietal and visceral pleura rub against each other during the breathing process.

A

Pleural friction rub

73
Q

Auscultation of heart sounds

An abnormal sound heard over the heart, arteries, or veins that is caused by turbulent blood flow is called a __________.

A

Bruit

pg. 38

74
Q

Chest X-ray Interpretation

Well-defined, solid-appearing lungs that appear light

A

Consolidation

75
Q

Chest X-ray Interpretation

What is a common cause of consolidation?

A

Pneumonia

76
Q

Chest X-ray Interpretation

White areas that indicate fluids and solids. (Also referred to as opacity)

A

Radiopaque

77
Q

Chest X-ray Interpretation

Give an example of what would cause a radiopaque CXR image.

A
  • Pleural effusion
  • Pneumonia
78
Q

Chest X-ray Interpretation

Scattered or patchy white areas

A

Infiltrates

Caused by inflammatory proccesses that indicate atelectasis or disease

79
Q

Chest X-ray Interpretation

Dark areas caused by the presence of air

A

Radiolucency

Hyperlucency = emphysema, asthma or subcutaneous emphysema

80
Q

Chest radiograph postions

What is the most commonly used x-ray position?

A

P-A

Back to front!

81
Q

Chest X-ray Interpretation

This postion is used for portable radiographs in intensive care areas.

A

A-P

Front to back

The heart is more easily seen in this position.

82
Q

Chest X-ray Interpretation

The image is obtained from the side with the patient upright while the X-ray passes through the chest laterally

A

Lateral

83
Q

Chest X-ray Interpretation

What chest x-ray position allows for visualization of the lung parenchyma behind the heart and the bases of the lungs?

A

Lateral

84
Q

Chest X-ray Interpretation

This image is obtained with the patient turned 45 degrees to either the right or left.

A

Oblique

85
Q

Chest X-ray Interpretation

Which position is used to help diffrentiate a pulmonary or mediastinal lesion from structures that overlie it?

A

Oblique

Also used for V/Q scanning

86
Q

Chest X-ray Interpretation

In an upright position, the patient leans back at a 45-degree angle.

A

Apical lordotic

87
Q

Chest X-ray Interpretation

This position moves the shadow of the clavicles out the way for better visualization of the upper lobes of the lungs

A

Apical lordotic

88
Q

Chest X-ray Interpretation

This image is obtained with the patient lying on his or her side with the film resting on the posterior surface of the chest.

A

Lateral decubitus

89
Q

Chest X-ray Interpretation

Characteristics of an atelectasis X-ray.

A
  • Appears lighter than normal tissue
  • Elevated diaphragm
  • Mediastinal shift towards affected side
  • Decreased volume
  • Increased density
90
Q

Chest X-ray Interpretation

Pneumonia

A
  • Appears white
  • Consolidation of the entire lobe or more may cause mediastinal shift toward affected side
91
Q

Chest X-ray Interpretation

Pneumothorax

A
  • NO VASCULAR MAKINGS
  • Very dark
  • Tracheal shift AWAY from affected side
92
Q

Endotracheal tube placement

The tube should rest ____ above the carina.

A

2-5 cm

93
Q

Endotracheal tube placement

On an inspiratory film, the carina is located at the level of the ______ rib.

A

4th

94
Q

Diaphragm

Appears white on an x-ray film at the level of the ____ during maximal inspiration.

A

10th

95
Q

Diaphragm

The dome of the right hemidiaphragm is normally 1-2 cm higher than the lefe because of the space needed for the ___.

A

Liver

96
Q

Diaphragm

Elevation of one hemidiaphragm may be the result of ______.

A

Gas in the stomach or atelectasis

97
Q

Normal heart rate in an adult

A

60-100 beats/min

98
Q

Normal heart rate in a child

A

80-110 beats/min

99
Q

What is paradoxical pulse?

A

A pulse that becomes weaker on inspiration. May be defined as a decrease in systolic pressure of more than 10 mm Hg during inspiration

If seen after chest truma or surgery, suggest cardiac tamponade.

100
Q

What is pulsus alternans?

A

An alternating pattern of strong and weak pulses

101
Q

Where is pulsus alternans commonly seen?

A

Patients with left ventricular failure and usually indicates PVCs.

102
Q

The measurement of the pressure within the arterial system

A

Blood pressure

103
Q

ADULTS

Normal blood pressure range

A

<120/80

104
Q

_ is the pressure measured during ventricular contraction.

A

Systolic pressure

105
Q

Diastolic or systolic pressure?

The most critical measurement because it is the lowest pressure that the heart and arterial system experience.

A

Diastolic

106
Q

What are some factors that affect blood pressure?

A
  • Blood volume
  • Blood viscosity
  • Heart’s pumping action
  • Elasticity of blood vessels
107
Q

Slightly higher temperature in children is normal as a result of ______.

A

Higher metabolic rate

108
Q

Define afebrile.

A

Normal body temperature

109
Q

Define febrile.

A

Person with a fever

110
Q

What does the Glasscow Coma Scale help determine?

A

Neurological impairment

Less than 8, intubate

111
Q

Serum Electrolytes

Normal sodium (Na+) range

A

135-145 mEq/L

112
Q

An elevated BUN level is indicative of ______.

A

Renal (liver) failure

113
Q

Apnea Test - Just read.

Blood gas values need to be normalized before the test. The patient is disconnected from vent and placed on 100% oxygen.

Spontaneous breathing, oxygenation and cardiac status are monitored.

A

MD will end the test when deterioration is observed or no breathing for 8-10 minutes.

114
Q

APNEA TEST

When is a postive apnea test indicated?

A

ABG values show that the PaCO2 has increased 20 torr above baseline level or reaches a level of 60 torr.

115
Q

Serum Electrolytes

Normal potassium (K+) range

A

3.5 to 5.0 mEq/L

Potassium (K+) is the major intracellular cation.

116
Q

Serum Electrolytes

Normal Chloride (CI-) range

A

98 to 107 mEq/L

Chloride (CI-) is the major anion in the body

117
Q

Serum Electrolytes

What is the normal range for calcium (Ca)?

A

8.6 to 10.5 mmol/ dL

118
Q

What are the muscles used for normal ventilation?

A

Diaphragm and external intercostals

119
Q

JUST KNOW THAT increased calcium and decreased potassium and sodium can make weaning difficult due to causing muscle weakness!

A

You’re going to pass :)

120
Q

What is the normal BUN level?

A

8-23 mg/dL

121
Q

When the kidneys fail to remove creatinine from the blood, the level increases, indicating what?

A

Renal (liver) failure

122
Q

What is normal creatinine level?

A

0.7-1.3 mg/dL

123
Q

Increased BUN and creatinine result in ____________ acidosis.

A

Metabolic

124
Q

Normal glucose serum level

A

<100 mg/dL

125
Q

Normal RBC levels

A

4 to 6 million/mm3 of blood

126
Q

Normal Hemoglobin Levels

A

Males: 14.0-18.0 g/dL
Females: 12-15 g/dL

127
Q

Normal hematocrit (Hct) levels

A

Males: 40-54%
Females: 35-49%

128
Q

Normal level of WBCs

A

4500-11,500/mm3 of blood

129
Q

Normal platelet count

A

150,000-400,000/mm3

They’re the smallest cells in the blood & are essential for clotting

130
Q

Normal PT (prothrombin time)

A

11.0-12.5 seconds

Used to determine clotting ability

131
Q

Normal partial thromboplastin time (PTT)

A

60-85 seconds

Used to determine clotting ability

132
Q

What are the cardiac biomarkers? (3)

A
  1. CK-MB
  2. Myoglobin
  3. Troponin
133
Q

Normal Urine Output

A

30 to 40 mL/hour

134
Q

What Glass Coma Scale numbers indicate moderate coma?

A

9-12

135
Q

What Glass Coma Scale numbers does not require ICU admission?

A

12-15

They higher the number, the BETTER!

136
Q

What Glass Coma Scale numbers indicate severe coma?

A

8-9

137
Q

Important note:

Remember than high FiO2 levels knocks out COPD respiratory drive

A

LPM should not exceed 4 if its not indicated by a low PaO2/SpO2

138
Q

Harsh and high-pitched sound heard over the trachea.
Expiration is slightly higher than inspiration

A

Tracheal breath sound

Respiratory Care Seminar‼️ (19 decks)

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