Chapter 16- Beside Assessment of the Patient Flashcards
Diagnosis
The process of identifying the nature ands cause of illnesses.
Differential diagnosis
Refers to a situation when many diseases share the similar signs and symptoms maike their exact cause unclear.
Signs
The objective manifestation of illnesses
Symptoms
The sensation or subjective experience of some aspect of an illness.
Factors affecting communication between the RT and the patient should include what?
- Sensory and emotional factors
- Envriomental factors
- Verbal and non Verbal communication
- Cultural values, beliefs, feelings, habitats and preoccupations of the RT and the patient.
Dyspnea
The general term to describe the sensation of breathing discomfort.
Breathing is a complex balance along these three factors?
- the nueral drive to breathe coming from the brainstem.
- the tension in the respiratory muscles.
- the corresponding displacement of the lungs and the chest wall.
Breathlessness
The unpleasant urge to breathe. Can be triggered by acute hypercapnia, acidosis or hypoxemia.
Orthopnea
Dyspnea when the person reclines
Platypnea
Dyspnea triggered by assuming an upright position.
Orthodeoxia
oxygen desturation on assuming an upright positon.
Trepopnea
Occurs when a patient with unilateral lung disease lies on the affected side.
What are the 4 major questions to be asked when a patient experiences dyspnea?
- What daily activites trigger it.
- How much exertion can the patient handle before they have to stop to catch their breath.
- Does the qaulity of dyspnea vary with different activities.
- When did your dyspnea become apparant , has it evolved over time, slowly or rapidly, Has there been a recent change in the dyspnea?
Psychogenic hyperventilation syndrome
Associated with panic disorders
Cough
A forceful expiratory maneuvuer that expels mucus, foregin materials from the airways.
Where are your cough receptors located?
The larynx, trachea and larger bronchi
4 factors necessary for an effective cough
- the ability to take a deep breath
- lung elastic recoil
-expiratory muscle strength
-level of airway resistance.
Atelectasis
a complete or partial collapse of the entire lung or area (lobe) of the lung
5 Important cough characteristics that an RT should know.
- if cough is dry or loose
-productive or non productive - acute or chronice
- freqency
- is it provoked by a particular position
How long does a chronic cough last
More than 8 weeks.
Phlegm
uncontaminated mucus from oral secreations
Sputum
Mucus expectorated from the mouth contains pus cells.
Purlent
suggesting a bacterial infection
What does purlent sputum look like?
Thick, coloured and sticky.
Fetid
Fowl smelling sputum
Mucoid
Clear thick sputum- commonly seen in ashtma patients
Hemopytsis
Coughing up blood, can be caused by broncheostasis, lung abcess and acute tb
Massive hempotysis
A medical emergency defined by coughing a variable volume of blood over a define time period. More than 300ml with 24 hours.
Non Massive hempotysis
Can occur in many conditions such as airway infections, pneumonia, lung cancer, TB, chest trauma and pulmonary embolism.
Infection- associated hemoptysis
Usually present as blood streaked, purulent sputum.
Hematemesis
Refers to blood vomited from the gastrointestinal tract often occurs in patients wth gastrointestinal dieases.
Pleuritic chest pain
Located laterally or posteriorly. Sharp stabbing pain that worsens with deep breaths.
Non-pleuritic chest pain
located in the center of the anterior chest and may raidate to the shoulder , neck or back. dull ache or pain not affected by breathing.
Angina
is chest pain or discomfort that occurs when part of your heart muscle does not get enough oxygen-rich blood.
Define fever
Elvated body temperature greater than 38.3 degress celcius or 101 Fahrenheit.
Pedal edema
Heart failure characterized by the lower extremities becoming swollen.
Pitting edmea
Finger pressure is applied and it leaves an indentation mark of the skin, the higher it occurs the more severe the heart failure.
Weeping edmea
When finger pressure is applies and it causes a small fluid leak.
How is smoking history recorded
In pack years.
How to calculate pack years.
number of packs smoke per day multipled by the amount of years they smoked.
Advance directive
DNR, DNI , AND (allow for natural death)
What are the 4 important indicators used when assesing a patients overall apperance.
- level of conciousness
-facial expressions - level of anxiety or distress
- Postioning
Cachexia
Weakness and malnutrition
Disphoresis
Sweating
Tripod sign
Patient with sever hyperinflation tend to sit upright while bracing their elbows on a table.
Senorism
The cognitive functioning level of a patient and level of conciousness.
What information do you need to collect for vital signs.
Body temperature, pulse rate, respiratory rate, blood pressure, pulse oximotery.
Hyperthermia/ Hyperpyrexia
Elevated body temperature.
Hypothermia
Body temperature is below normal.
Pulsus paradoxus
Is a significant decrease in pulse strength during spontaous inspiratorion that ca be qaulifed with a blood pressure cuff.
Pulsus alterans
Is an altering sucession of strong and weak pulses that suggest ledt sided heart failure.
What is the normal respiratory rate in a healthy adult
12 to 18 breathes an minute
Tacypnea
Breathing greater than 20 breaths per minute
Bradypnea
Breathing less than 10 breaths a minute.
Arterial blood pressure
forced exercted by the heart against the systemic arteries as blood moves through them.
Arterial systolic pressure
is the peak force exerted in major arteries during contraction of the left ventricle.
Diastolic pressure
is the force in the major arteries remianing after the relaxation of the ventricles.
In a normal adult what is the range for systolic pressure
90 to 140 mmHG
In a normal adult what is the range for Dyastolic pressure
60 to 90 mm HG
Hypertension
Arterial blood pressure, persistently greater than 140/90 mm Hg.
Hypotension
Low blood pressue
lymphadenopathy
Enlarged lymph nodes
Pectus Crainatum
abnormal pertusion of the sternum
Pectus excavatum
Depression of part or the entire sternum
Kyphosis
Spinal deformity in which the spine has an abnormal anterior posieror curvature.
Scoliosis
Spinal deformity when the spine has a lateral curve
Kyphoscoliosis
Combination of kyphosis and scroliosis.
Retraction
Inward sinking of the chest wall during inspiration.
What are the three types of retraction?
- Intercostal
-Supraclavicular
-subcostal
Tracheal tugging
downward movement of the thyroid cartilage towards the chest during inspiration in concert with sternocleidomastoid recuitment.
Kassmaul breathing
Observed during severe metabolic acidosis where by patients breath rapdily and deeply simliar to a normal person during strenous exercise.
Cheyen Stokes respiration
Is when the respiratory rate and tidal volume gradually increases in intensity and then gradually decrease to produce apnea which can last several seconds.
Biot Respiration
occurs with damage to the medulla resulting in chacotic breathing patterns, characterized by frequent irregularity in both rate and tidal volume
Agonal breathing
Intermittent prolonged gasps
Apnesutic breathing
Chracterized by a prolonged inspiratiory pause at full inspiration lasting for 2 to 3 seconds.
Central neurogenic hyperventilation
Chracterized by persistent hyperventilation driver by abnormal neural stimuli.
Central neurogenic hypoventilation
Means respiratory centers do not respond appropriately to ventilatory stimuli such as CO2 .
Hoover sign
Contraction of a flat diaphragm tends to draw in the lateral costal instead of normal outward expansion.
Respiratory alternans
Where the diaphragm and the rib cage muscles alternately power breathing in an attempt to rest each muscle group.
Abdominal paradox
Occurs when the diagphragm is drawn upwards with insparotry effort of the intercostal musles.
Vocal fremitus
Vibrations created by the vocal cord during speech
Tactile fremitus
when vocal fremitus vibrations are felt on the chest wall
Subcutaneous emphysema
Fine airbubbles leaking into tissue create crackling sound and sensation when paplitated.
Tympanic
Percussion over normal lung fields produces easily heard, moderlay low pitched, resonate sound .
Pneumothorax
When the pleural space contains large amounts of air.
For basic parts of a stethoscope
- A bell
- A diaphragm
- tubing
- ear pieces
Tracheal breath sounds
Loud tubular quality are heard when ausculatating the trachea, equal duration between inspiration and expiration.
Bronchovesiular breath sounds
heard around the upper half of the sternum between the sacpular, slightly lower in pitch also have equal inspiratory and expiratory sounds
Vesicular breath sounds
heard over normal lung parencgyma , characterized bya soft muffeled sound qaulity that is lowe in pitch and intensity.
Adventitous lung sounds
Additional sounds or vibrations produced by air movement through diseased airways.
Wheezing
Continous adventitious lung sounds
Stridor
A loud high sound associated with upper airway obstructio and often heard without a sethoscope.
Lung Sounds
Audible vibrations primarily generated by turbulent airflow in larger airways
What the two sources of diminished breath sounds
Diminished airflow velocity or when sound transmission through the lung or chest wall is blunted.
Crackles
Inspiratoy sound produced when airflow moves secreations of fluid in the airways or when collasped airways pop open during inspiration.
What is another name for Corse crackles
Rhonchi
Plueral ficton rub
Typically heard during inspiraton and is usually localized to a discreete site on the chest wall.
How long should digital perfusion be in a Capillary refill test?
3 seconds or less
