- increased airway resistance - upper airway obstruction - asthma and other chronic lung diseases - Decreased lung compliance - pulmonary fibrosis - pneumothorax - pleural effusion - abnormal chest wall - anxiety state

Ch. 3 Assessment of The Pulmonary Patient Flashcards by Kiesha Alexis

A patient is experiencing cardiac arrhythmias and muscle weakness. An arterial blood glass determines that the patient is in a metabolic alkalosis. Which of the following is the most appropriate laboratory value to assist at this time?

A. WBC
B. BUN
C. Plasma protein
D. Potassium

Potassium

Hypokalemia can cause cardiac dysrhythmias and muscle weakness.

How well did you know this?

Not at all

Perfectly

Term used to describe a condition in which a patient has difficulty breathing while in a supine position is which of the following?

Orthopnea

How well did you know this?

Not at all

Perfectly

Patient enters the emergency department and on initial examination the respiratory therapist observed paradoxical chest movement. Which of the following should the therapist suspect?

A. Pulmonary edema
B. PNA
C. Flail chest
D. Pleural effusion

Flail chest

paradoxical chest movement occurs when the chest wall moves IN on inspiration and OUT on expiration. Commonly see in pts with chest trauma, flail chest, or paralysis of the diaphragm

How well did you know this?

Not at all

Perfectly

Perfusion in the extremities is determined by which of the following methods?

A. obtaining ABG studies in determining PaO2 levels
B. assessing the patient’s SPO2
C. Assessing capillary refill
D. Palpating brachial pulse

Assessing capilary refill

How well did you know this?

Not at all

Perfectly

While Palpating the Chest the respiratory therapist determined that there is decreased fremitus over the right lower lobe. This may be a result of which of the following?

Pneumothorax
Pleural effusion
PNA

A. 1 only
B. 2 only
C. 1 and 2 only
D. 2 and 3 only

1 and 2 only

How well did you know this?

Not at all

Perfectly

Chest x-ray film obtained after intubation shows that the tip of the ET tube is resting at the fourth rib. Which of the following action should be taken?

A. The Tube should be advanced 2 CM
B. Tube should be advancing to equal breath sounds are heard
C. The tube should remain at this level
D. Tube should be withdrawn 3 cm

The tube should be withdrawn 3 cm

The carina is located on a chest film at the level of the fourth rib. In this question, the tip of the tube is resting ON the carina. The tube needs to be withdrawn until the tip is resting 2 to 5 cm above the carina

How well did you know this?

Not at all

Perfectly

The RT is reviewing the chart of patient suspected of having CHF. This condition would be best indicated with an elevation in which of the following cardiac biomarkers?
A. Troponin
B. Myoglobin
C. Creatine kinase (CK)
D. B-type natriuretic peptide (BNP)

B-type natriuretic peptode (BNP)

CHF is indicated if BNP increases above 500 pg/mL. (Myoglobin, CK, and tropnin are biomarkers that indicate ischemic myocardial damage)

How well did you know this?

Not at all

Perfectly

A patient is suspected of suffering acute myocardial infarction. Which of the following Lab values will be increased the patient’s blood?

A. Hematocrit
B. CK-MB
C. BNP
D. Albunium

CK-MB

CK-MB is a heart-specific isoenzyme that is produced when myocardial damage has occurred

How well did you know this?

Not at all

Perfectly

The RT Notes a RR of 36 breaths/min in an adult patient’s chart. The patient’s breathing pattern is best described by which of the following?

A. Hyperventilation
B. Dyspnea
C. Hypoventilation
D. Tachypnea

Tachypnea

How well did you know this?

Not at all

Perfectly

The RT is assessing a patient with severe emphysema and observes pedal edema and JVD. The therapist should note in the patient’s chart that these are signs most likely the result of?

A. systemic hypertension
B. hypercapnia
C. Pulmonary infection
D. right ventricular hypertrophy

right ventricular hypertrophy

How well did you know this?

Not at all

Perfectly

What does yellow sputum indicate?

infection (purulent sputum)

How well did you know this?

Not at all

Perfectly

Green sputum

old retain secretions

How well did you know this?

Not at all

Perfectly

Green and foul smelling indicates?

Pseudomonas infection (bronchietasis)

How well did you know this?

Not at all

Perfectly

Brown sputum indicates

old blood
(Lung infection)

How well did you know this?

Not at all

Perfectly

Red sputum indicates

fresh blood
(Hemoptysis: TB, Bronchietsis, lung abscess)

How well did you know this?

Not at all

Perfectly

Pinky frothy sputum indicates

pulmonary edema (CHF)

How well did you know this?

Not at all

Perfectly

Causes of Dyspnea

increased airway resistance
upper airway obstruction
asthma and other chronic lung diseases
Decreased lung compliance
pulmonary fibrosis
pneumothorax
pleural effusion
abnormal chest wall
anxiety state

How well did you know this?

Not at all

Perfectly

Paroxsymal nocturnal dyspnea is a

sudden onset of breath after being in bed for several hours

How well did you know this?

Not at all

Perfectly

Hemoptysis is ________ up blood from the respiratory tract

coughing

How well did you know this?

Not at all

Perfectly

What is massive hemoptysis defined as?

400 mL of blood ting sputum in 3 hours or as more than 600 mL in 24 hours and is considered a life threatening event

How well did you know this?

Not at all

Perfectly

Causes of hemoptysis?

PNA ( rarely on exam)
TB*
Bronchiectasis*
Lung abscess*
Fungal lung infection (histoplasmosis)
Neoplasms: bronchogeneic carcinoma
Pulmonary embolism
Valvular heart disease
Mitral valve diseases
Trauma (massive hemoptysis possible) *

How well did you know this?

Not at all

Perfectly

The _______ wall is the most common source of chest pain

thoracic

How well did you know this?

Not at all

Perfectly

The lung parenchyma is not sensistive to pain

Know

How well did you know this?

Not at all

Perfectly

The parietal pleura (layer lining the chest wall) is very sensistive to pain is usually the source of pain associated with (3)

pneumonias
pleurisy
other inflammatory disease

How well did you know this?

Not at all

Perfectly

Eupnea is the

normal rate and depth of respirations

Bradypnea is

less than the normal RR

Apnea is the

asbsence of breathing

Tachypnea is

faster than normal RR but with normal depth of breath

Hypopnea is

shallow respirations (about half of the normal depth)

Hyperpnea is

deep and rapid and labored breathing

Kusssmaul respiration is

increased rate and depth of breathing (metabolic acidosis)

Irregular breathing pattern charterized by short periods of deep, consistent volumes with periods of apnea and is associated w/ elevated ICP or meningitis

Biots

Deep, rapid breathing followed by apnea and associated with stroke, or head injury, PNA in elderly, CHF, or drug overdose

Cheyenne-Stokes respiration

Unequal expansion may indicate: (4)

1. Atelectasis 2. Pnemothorax 3. Chest deformities 4. Flail Chest

What is paradoxical respirations?

When the chest moves in on inspiration and out on expiration

Flail chest is the result of (3)

- chest trauma - fractured sternum - fractured ribs

An increased A-P diameter is called a ________ ________ and is indictive of chronic lung disease

barrel chest

Pedal edema refers to

an accumlation of fluid in the subcutaneous tissues of the ankles

Cyanosis is refered to as the

bluish discoloration of the skin and nail beds resulting from a **5 g/dL decrease in oxygenated hemoglobin (Hb)**

This is present when the oral mucosa and trunk are cyanotic and indicates inadequate tissue oxygenation. This is defined as

Central cyanosis

Peripheral cyanosis (acrocyanosis) is present when the

nail beds are cyanotic and may indicate poor perfusion caused by a decreased CO, hypotension, or cold temperature

Perfusion to the extremities may be determined by accessing capillary refill. This is performed by compressing the patient's finger nail for a short time then releasing it and observing the time it takes for blood flow to return to the nail bed.

KNOW

How long is normal refill time?

< 3 seconds

Vibrations felt on the chest wall as the pt speaks are called

tactile fremitus

Vibrations (fremitus) are decreased over (5)

- pleural effusions - fluid - pneumothorax - overly muscular - obese pts

Vibrations (fremitus) are increased over (3)

- atelectasis - PNA - lung masses

Palpating over subcutaneous air feels like crackling under the skin , which is referred to as

crepitus

What side does the trachea shift to with a pneumothorax?

Away or left from the affected aside (opposite of pneumothorax; PUSH)

What side does the trachea shift to with atelectasis?

Towards or right the affected side (same side as atelectasis; PULL)

Hyperresonance is a **LOUD** low-pitch sound of long duration that is produced over areas that contain a greater proportion of **AIR** than tissue

KNOW

What are examples of hyperresonance (4)

- air-filled stomach - emphysema (air trapping) - pneumothorax - COPD

Resonance is a **LOW** pitched sound of long duration that is produced over areas w/ **equal** distrubution of air and tissue. NORMAL LUNG TISSUE

KNOW

_____________ is a sound of medium intensity and pitch of short duration that is produced over areas that contains a higher proportion of **tissue or fluid** than air What are some Examples: (5)

Dullness - atelectaisis - consolidation - pleural effusion - pleural thickening - pulmonary edema

___________ is a sound of low amplitude and pitch that is produced over areas that contain a higher proportion of tissue than air. What are some Examples:

Flatness - massive pleural effusion - massive atelectasis - pneumonectomy

Tympany is a ________ sound What is an Example:

drum-like Tension pneumothorax

This is the most commonly used position for chest xray

Postero- anterior (P-A)

This position is often used for portable radiographs in the ICU

A-P

_________ image is obtained w/ the pt turned 45 degrees to either right and left This position is also used for...

Oblique v/q scanning

___________ __________ image is obtained w/ pt lying on his or her side (side-lying position) w the film resting on the posterior surface of the chest

Lateral decubitus

Lateral decubitus position is used to identify whether

free fluid (pleural effusion or blood) is present in the chest

Chest radiographs are usually obtained w/ the pt at maximal inspiration, which should show the lungs well aerated and diaphragm descended to about the level of the tenth rib

KNOW

ETT placement should rest about

2 to 5 cm above the carina

On an inspiratory film the carina is located at the level of the

fouth rib or fourth thoracic vetebra

How many ribs can be counted above the diaphragm to determine whether a maximal inspiration is present

10 ribs

Patients with hyperinflanted lungs (COPD) have flattened diaphragms

KNOW

Inadequate pumping action of the heart resulting from cor pulmonale, often seen in chronic lung disease, or left- sided heart failure (CHF)

Peripheral edema and venous engorgement

Sodium (Na+) normal value

135 to 145 mEq/L

Potassium (K+) normal values

3.5 to 5.0 mEq/L

Chloride (CI-) normal value

98 to 107 mEq/ L

Calcium (Ca) normal value range

8.6 to 10.5 mol/dL

Blood Urea Nitrogen (BUN) normal value

8 to 23 mg dL

An elevated BUN level is indictive of what ?

renal failure

Creatinine normal values

0.7 to 1.3 mg/dL

Glucose normal serum level

<100 mg/dL

Elevated levels observed in diabetic ketoacidosis; patient compensates w/ alveolar hyperventilation (kussmaul respirations)

KNOW

Red blood cells (RBC ) is also refered to as ________________, determines the adequacy of O2 transport

erythrocytes

RBC normal level

4 to 6 million/mm3

Hb normal level Males Females

14.0 to 18.0 g/dL in males 12 to 15 g/dL in females

Hb is the portion of the RBCs that carries O2 so it is an indicator of the O2 carrying capacity of the blood

KNOW

Hematocrit (Hct) normal levels Males Females

40% to 50% in males 35% to 49% in females

The Hct is the percentage of the total….

blood volume that is RBCs

White blood cells (WBCs) determines the presence or absence of _________. WBCs are also referred to as ___________

infection; leukocytes

WBCs normal levels

4500 to 11,500/mm3

An elevated WBC indicates what?

infection

Platelets normal level

150,000 to 400,000/mm3

What are platelets essential for?

coagulation (clotting)

Decreased platelet count may be the result of (2)

- bone marrow diseases - disseminated intravascular coagulation (DIC)

Prothrombin (PT) is a test to determine the...

clotting ability of the blood

Normal PT is

11.0 to 12.5 seconds

Partial thromboplastin time (PTT) normal value

60 to 85 seconds

Pts w/ decreased platelet counts or increased PT or PTT are at increased risk of

hemorrhaging

Chemicals such as creatine kinase (CK), myoglobin and troponin that appear in the blood as a result of

ischemic myocardial damage

B-type natriuretic peptide (BNP) is a biomarker used to help diagnose

CHF

A BNP level _______ indicates CHF

>500 pg/mL

When it comes to excessive muscle use in the COPD pts , what muscles are they referring to?

- pectoralis - triclezius muscles (Tri-podding)

What causes barrel chest?

Air-trapping

Asymetrical Example:

one side is not expanding like the other. Can be caused by PNA

General malaise

A sense of being unwell, fatigue, weakness

Dysphasia

difficulty speaking

Dysphagia

difficulty swallowing

What pt population deals with polycythemia

COPD (Emphysema)

Atrophy (cachetic)

Muscles starts to deteriorate

What disease process has cheynne-stokes breathing (3)

- CHF - cerabral disorder - a bad case of PNA could lead to this

Biots breathing happens due to

increased ICPs

What is Somnolent and what can cause this?

Daytime sleepiness (can be caused be apnea during sleeping, or excessive CO2)

Ashen or pallor color is a result from

Critical hypoxemic

Diseases that could cause Hempotysis

- TB - Bronchietasis - Lung abscess

When it comes to excess use of muscles what do COPDers use (2)

- Trapezius - Pectoralis major muscles

Mallampati classification

requires visualization of the hypopharynx

Mallampati Class 1

full visibility of tonsils, uvula, and soft palate

Mallampati Class 2

Visibility of the hard and soft palates, upper part of the tonsils and uvula

Mallampati Class 3

Soft and hard palates and base of uvula are visable

Mallampati Class 4

Only the hard palate is visible

Levels 3 and 4 you are required to do a fiberoptic bronchoscopy or a video assisst device (Gladascope)

KNOW

Which one is more severe Bradycardia or Tachycardia?

Bradycardia

What would cause an irregular pulse (threading pulse)?

Sever dehydration (imbalance of fluid)

A pulse that becomes weaker on inspiration; it may be defined as a decrease in systolic pressure of more than 10 mm Hg during inspiration and may be seen in pts with....

Pulsus paradoxus - severe COPD - asthma - pericarditis - pulmonary embolism -CHF - cardiac tamponade

Subcutaneous emphysema

Extra air in the plueral space (crepitus)

Tracheal shifts towards the affective side in what diseases (4)

**Atelectasis** - pulmonary fibrosis - pnemonectiamie - paralyzed diaghram

What is egophony

"E" sounds like an "A"

What diseases will cause an increased fremitus? (3)

- Atelectasis - PNA - Lung mass

What causes decrease fremitus?

- pneumothorax - emphysema - plerual effusion

If a question given talks about an "E" sounding like an "A" then what dieases is that ?

PNA b/c of consolidation

If the E sound is decreased then it could be due to (3)

- pneumothorax - emphysema - obstructive bronchi

Rememeber crackles can respresent fluid or secretions

KNOW

Coarse crackles is considered rhonci which indicates

excesive amount of secretions.

Fine crackles is associated with

fluid; pulmonary edema or CHF

What can you do to treat coarse crackles /rhonchi? (3)

- suction - CPT - PEP

What can you do with a pt who has fine crackles?

- diuretics - pressure - oxygen

**Early** Inspiratory crackles happens in what pt pop? (3)

- Emphysema - Chronic Bronchitis - Asthma

**Late** inspiratory crackles happens in (4)

- pulmonary edema - Atelectaisis - PNA - Pulmonary fibrosis

What causes stridor?

- epiglottitis - foreign body aspiration

Wheezing can be heard in asthma and foreign body obstruction

KNOW

6 month- 3 years. Subglottic swelling, praying hands, steeple sign, cool mist, barky cough, parainfluzae virus, A-P neck film, Slow onset

croup

2- 6 y/o. Supraglottic swelling, thumb sign, lateral neck xray, intubation or traching in OR, H influenzae type B, High fever, drooling, low pitched stridor , NO COUGH, rapid

epiglottitis

CHF is directly related to BNP. If BNP is elevated >500 then the pt has CHF

KNOW

Tracheal shifts away from the affected side in what diseases? (4)

**Pneumothorax** - hemothorax - massive pleural effusion - Tumor (any large mass)