Chapter 16 Part 1

Question 1

The four functions that are critical for life

Answer 1

1. Ventilation- moving air in and out of the lungs ( RR, VT, chest movements, breath sounds)
2. Oxygenation- getting oxygen into the blood (HR, color, PaO2, SpO2)
3. Circulation- moving the blood through the body ( HR, strength, cardiac input)
4. Perfusion- getting oxygen into the tissue (BP,temp, urine output)

Question 2

Signs vs Symptoms

Answer 2

signs: objective information things that we can see or measure (color, pulse, edema, blood pressure)

symptoms: subjective information things the patient tells us (dyspnea, pain, nausea, muscle weakness)

Question 3

Vital signs

Answer 3

HR: 60-100 BPM

RR: 12-20 BPM

BP: 120/80

Body Temp: 37 c

Question 4

Patient chart review what are we looking for?

Answer 4

occupation
allergies
prior surgeries
vital signs
why were they admitted
family history
physical examination

Question 5

physical examination components

Answer 5

inspection
palpation
percussion
auscultation

Question 6

Pack years Math

Answer 6

amount of cigarettes /20 (20 cigs in 1 pac) X years

ex: 45 cigs /20 x years

Question 7

Levels of consciousness

Answer 7

*Sensorium: level of consiousness and orientation to time, place, person, and situation
* reflects oxygenation status of brain
* if pt not alert- standard rating scale is used to objectively describe pt
1) Alert/Responsive: Normal
2) Lethargic/ Somnolent: Sleepy
3)Confused/ Stuporous: responds inappropriately
4) Semi-comatose: responds only to painful stimuli
5)Obtunded: Drowsy state
6) Coma

Question 8

Social space vs personal space

Answer 8

Social space: (4-12 ft) Introduce yourself

personal space: (2-4 ft) conduct interview

Question 9

Purpose of the interview

Answer 9

*to establish a rapport between the clinician and patient
*to obtain information essential for making a diagnosis
*to help monitor changes in the patients symptoms and response to therapy

Question 10

Dyspnea vs Breathlessness

Answer 10

Dyspnea:
*sensation of breathing discomfort by patient ( subjective feeling)
* most important symptom RT is called upon to assess and treat

Breathlessness:
*sensation of unpleasant urge to breathe
*can be triggered by acute hypercapnia, acidosis, and hypoxemia

Question 11

Characteristics of dyspnea

Answer 11

-orthopnia
-trepopnea
-peptopnia
*patients w/ asthma frequently complain of chest tightness
*patients w/ interstitial lung disease may complain of increased WOB, shallow breathing, and gasping
* patients with CHF may complain of feeling suffocated

Question 12

Cough characteristics

Answer 12

• most common, symptom observed input w/ pulmonary disease
  *dry, or loose, productive or non productive, acute or chronic and whether it occurs more frequently at particular times (day or night)

Question 13

Chronic cough (who is this most prevalent in)

Answer 13

-anyone who has had a cough last longer than 8
-weeks smokers

Question 14

Phlegm vs sputum

Answer 14

Phlegm: mucus from tracheobronchial tree NOT contaminated by oral secretion

Sputum: mucus from lower airway but IS expectorated through mouth

Question 15

where is the site to take temperature that is closest to core body temp?

Answer 15

rectal temp

Question 16

pitting vs weeping edema

Answer 16

pitting- indentation mark left on skin after applied pressure

weeping- small fluid lead accuses at point where pressure applied

Question 17

Sputum colors

Answer 17

Clear: Normal
Mucoid(white/gray): chronic bronchitis
yellow: presence of WBC, bacterial infection
green: stagnant sputum, gram- negative bacteria
brown/dark: old blood, anaerobic lung infection
bright pink: hemoptysis
pink frothy: pulmonary edema

Question 18

most common cause of lower extremity swelling

Answer 18

heart failure

Question 19

tachycardia causes

Answer 19

> 100 BPM
-exercise -fever
-fear -hypoxemia
-anxiety -hypercapnia
-low BP -certain medications
-anemia

Question 20

Pleuritic vs nonpleuritic chest pain

Answer 20

Pleuritic:
*located laterally or posteriorly
*Sharp and increases w/ deep breathing (pneumonia and pulmonary embolism)

Nonpleuritic:
*located In center of chest and may radiate to shoulder or arm; it is not affected by breathing
* often caused by angina, GERD, esophageal spasm, chest wall pain, and gall baldder

Question 21

bradycardia causes

Answer 21

<60 BPM
-hypothermia
-medication side effects
-traumatic brain injury TBI

Question 22

Pulsus paradoxes us most common in which patients

Answer 22

most common in patients with acute obstructive pulmonary disease, especially pt’s experiencing an asthma attack.

*significant decrease in pulse strength. (>10 mmHg) during spontaneous inspiration

Question 23

Hypothermia common cause

Answer 23

most common cause to hypothermia is long exposure to cold temps

Question 24

Jugular venous distention (JVD) (where do you find it and what is going on with your patient)

Answer 24

JVD- seen in patients with CHF and for pulmonate

Question 25

You are the RT at a small community hospital and are assigned to the ICU. You are called by the nurse stating that your patient is short of breath. What are your signs and symptoms of shortness of breath. a) nasal flaring b) pursed lip breathing c) respiratory rate of 17 d) Cyanosis of the lips

Answer 25

Nasal Flaring pursed lip breathing Cyanosis of the lips

Question 26

HT nurse calls and states that your patient is short of breath in room 102. You go to the patient's room and assess the patient, you see they are on 4 LPM nasal cannula SpO2 95%, HR 88, RR 18. You find out the patient has a history of asthma, HTN, COPD, CHF. The patient states they cannot breathe and please help me. What is the most common cause of pedal edema? a) liver failure b) kidney failure c) heart failure d) electrolyte imbalances

Answer 26

Heart failure

Question 27

tachypnea causes

Answer 27

>20 BPM -expiration -fever -hypoxemia -hypercapnia -metabolic acidosis -pulmonary edema -pain -anxiety -lung fibrosis

Question 28

The doctor order a sputum induction for your patient when you go into that patients room you observe they are on a 2 LPM nasal cannula with an SpO2 94%. When you are performing your patient assessment when performing auscultation, you hear course crackles. The patient states they have been coughing up yellow sputum. the doctor orders a sputum induction with hypotonic saline solution which is delivered with a small volume nebulizer. What is the cause of their sputum color? a) Bacterial infection b) anaerobic lung infection c) hemoptysis d) pulmonary edema

Answer 28

a) bacterial infection

Question 29

bradypnea causes

Answer 29

<1o BPM -TBI -heart attack -hypothermia -anesthetics -opiates -drug OD

Question 30

central cyanosis

Answer 30

-cyanosis of oral mucosa -internal cianosis -indicates respiratory failure due to low oxygen levels

Question 31

pursed lip breathing

Answer 31

seen in patients with COPD to prevent collapse of small airways