Chapter 2 Flashcards
1
Q
Body Temp
A
37C 98.6F
2
Q
Heart Rate
A
60-100bpm
3
Q
RR
A
12-20 bpm
4
Q
Body temp is measured to
A
assess for signs of inflammation or infection
5
Q
Body Temp is regulated by
A
hypthalamus
6
Q
Hyperthermia/ Febrile causes
A
(Increased temp) causes vasodilation and blood to be shunted to the surface of the skin to be cooled. Body metabolism increases, thus producing heat, consuming more O2, burning more caleries, causing dehydration, ect
7
Q
Febrile is a shift to the
A
right
8
Q
Hypothermia
A
Decreased temp
9
Q
Hypothermia causes
A
vasoconstriction and blood to be shunted to the inner body core to warm vital organs. Decreased body metabolism, conserves oxygen, ect…
10
Q
Hypothermia is a shift to the
A
left
11
Q
For every 1 degree Celsius elevation in temp, pts oxygen
A
consumption increases 10%
12
Q
Afebrile
A
normal body temp
13
Q
When is putting a body in hypothermic state used
A
surgery, stroke or myocardial recover, ect
14
Q
Common therapeutic interventions for hypothermia
A
Remove wet clothing, dry clothing, slowly increase room temp, warm blankets, warming pads, limbs close to body, cover head, supply warm oral or IV fluids
15
Q
Measurement sites of body temp
A
oral, rectal, ear (tympanic), axillary, transdermal= forehead
16
Q
9 sites for taking pulse
A
Temporal, Carotid(neck), Apical (ausculation; with steth), Brachial; inside arm, Radial (wrist), Femoral: inner legs (code ABG, artery), Popliteal, Posterior Tibia, Dorsal Pedal-foot
17
Q
Normal pulse for infants
A
100-160
18
Q
Bradycardia
A
slow heart rate, less than 60
19
Q
Tachycardia
A
fast heart rate,
20
Q
asystole
A
no heart rate
21
Q
Tachycardia is common with patients you are giving
A
sympathomimetics to (albuterol)
22
Q
Sinus
A
Regular Heart Rhythm
23
Q
Abnormal heart rhythms caused by
A
disruption in sinus control
24
Q
Ectopy
A
Extra beats
25
arrhythias
Irregular heart beats
26
dysrhythmia
abnormality in physiological rhythm
27
An increase in rate may occur when and decrease when
occur during inspiration and decrease in rate during expiration. Can be a NORMAL VARIANT, but is still an arrhythmic pattern
28
Scale to Rate Pulse Quality
```
0= Absent- not detected
1+= Weak, thready, easy obliterated by strong pressure
2+= Pulse difficult to palpate
3+= Normal pulse
4+= Bounding, easily palpated, difficult to obliterate
```
29
Pulsus Alternans
Every other beat is different in strength due to heart failure
30
Pulses Paradoxus
Stronger on inspiration and weaker on expiration due to thoracic pressure changes
31
Cheyne Stokes
abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, followed by a gradual decrease that results in a temporary breathing. Repeats with each cycle usually taking 30 seconds to 2 minutes
32
Blood pressure
1. Blood flow 2. Resistance
33
Blood flow
Stroke volume, cardiac output
34
Things that affect blood flow negatively
poor myocardial contractility, hypovolemia, bradycardia, vascular dilation (shock)
35
Resistance
Vessel size, blood viscosity - B/P abnormalities
36
Hypertension
systolic > 140mmHg, Diastolic > 90 mmHg
37
Primary Hypertension
of unknown cause
38
Secondary Hypertension
of known cause (obesity, arteriosclerosis, sleep apnea, ect)
39
Hypotension
<90/60
40
Hypotenision may
result in poor tissue oxygenation. Vasodilation, hypovolemia, left ventricular failure
41
Oxygen Saturation
Fifth Vital sign
42
Normal Oxygenation
80- 100 mm Hg
43
Mild Hypoxemia
60-79 mmHg
44
Moderate hypoxemia
40-60 mmHg
45
Severe Hypoxemia
less than 40 mmHg
46
Signs and symptoms of inadequate oxygenation in the central nervous system
Apprehension (early), Restless/ irritability (early), Confusion/lethargic (early or late), Combativeness (late), Coma (late)
47
Signs and symptoms of inedequate oxygenation in the respiratory
Tachypnea (early), Dyspnea on exertion (early), Dyspnea at rest (late), Accessory muscles (late), Intercostol retractions (late), Breaths in sentences (late)
48
Signs and symptoms of inadequate oxygenation in the cardiovascular
Tachycardia (early), mild hypertension (early), Arrythmias (E/L), Hypotenision (late), Cyanosis (late), Skin is cool/clammy (late)
49
Other signs and symptoms of inadequate oxygenation
Diaphoresis, Decrease in urinary output, General fatigue
50
Common Clinical Manifestations observed during inspection
Abnormal Ventilatory pattern findings, use of accessory muscles of inspiration and expiration, pursed lip breathing, nasal flaring, substernal or intercostal retractions, abnormal chest shape and configuration
51
Palpitation
Tactile and vocal fremitus, Chest symmetry of expansion, Tracheal positioning
52
Systemic Examination of the Chest and Lungs
Inspection, Palpitation, Percussion, Auscultation
53
Tactile fremitus
Assessment of the lungs by vibration intensity felt on chest wall
54
Vocal Fremitus
Vibrations heard by a stethoscope on the chest wall with certain spoken words
55
Percussion- dull
consolidation
56
Percussion- hyperresonant
increased air (empysema, pneumothorax)
57
Diaphramatic excusion
flat diaphragm (emphysema)
58
Auscultation
Normal breath sounds/ abnormal breath sounds
59
Normal breath sounds- bronchial
Heard over trachea, High in pitch, Loud intensity
60
Normal Breath sounds- Bronchovesicular
heard over upper portion of anterior sternum, between scapulae, Moderate pitch and intensity
61
Normal breath sounds- Vesicular
Heard over peripheral lung regions, high in pitch and soft in intensity
62
Abnormal breath sounds- Crackles/ rales
(atelectasis) fine medium or coarse.
63
Coarse crackles=
Rhonchi. Discontinuous, low pitched, rumbling, bubbling, or gurgling sounds that start early during inspiration and extend into exhalation
64
Wheezing
(bronchospasms). Continuous high pitched, musical whistles that are generally heard on expiration
65
Stridor
(croup). Continuous, loud, high pitched sound caused by an upper obstruction in the trachea or larynx. Generally heard during inspiration. Can be loud enough to hear without steth
66
Pleural Friction
Creaking shoe. heard throughout inspiration and expiration over the area where the patient complains of pain
67
Diminished or absent
Air trapping
68
Normal tidal volumes
3-4ml/lb or 7-9 ml/kg
69
I:E ratio
(1:2) abnormal long or short expiratory times
70
Lung compliance= restrictive disease
Decrease in tidal volume, increase in RR
71
Airway resistance
Asthma= Increase tidal volume, decrease RR
72
Peripheral chemoreceptors located
in aortic arch and carotid
73
Pulmonary reflexes
A. Hering- Breuer reflex B. Deflation Reflex C. Irritant Reflex D. JuxtaPulmonary ( J Receptors)
74
Hering-Breuer reflex
Triggered to prevent over inflation of the lung
75
Deflation Reflex
Serves to shorten exhalation when the lung is deflated
76
Irritant Reflex
Cough (glottis shuts and opens letting out diaphragm pressure)
77
Juxtapulmonary (J receptors)
innervated by fibers of the vagus nerve, respond to events such as pulmonary edema, pulmonary emboli, pneumonia, CHF, and barotrauma
78
Pain/ Anxiety/ and fever Receptors
Baroreceptors
79
Inspiratory Muscles
Scalene, Sternocleidomastoid, Pectoralis Major, Trapezius
80
Expiratory Muscles
Rectus Abdominals, External Oblique, Internal Oblique, Transversus abdominis
81
Nasal Flaring
Often seen in neonates and infants in respiratory distress
82
Pleural Pain
Sharp, sudden, stabbing pain, generally with inspiration or deep inspiration= rule out heart
83
Pleural pain may be caused by
chest wall inflammation, pleural inflammation, chest wall muscles, ribs fractures
84
Pleuritic chest pain is a characteristic feature of the following resp diseases
Pneumonia, pleural effusion, pneumothorax, lung cancer, fungal disease, tuberculosis
85
Abnormal Extramity findings
Altered skin color, Presence of digital clubbing, Presence of Peripheral edema, presence of distended neck veins, flailed chest
86
Digital clubbing
Chronic hypoxemia (low O2- cystic fibrosis patients)
87
Cyanosis
Central- Mouth/ mucosal
| Peripheral- fingers
88
Peripheral edema
Fluid overload, heart failure- pushing on skin and refils slowly.. poor BP/ circulation
89
Distended neck veins
CHF, cor pulmonale, pneumothorax
90
Flailed chest
multiple rib fractures- intubated so ribs can refuse
91
Non productive cough
Irritation of the airway, inflammation, mucus accumulation, tumors, irritation of the pleura
92
Productive cough
Asses cough stregnth, Frequency, pitch, and loudness, amount , consistency, color, odor, ect...
93
Cough proceded by
1. deep inspiration 2. partial closure of the glottis 3. forceful contraction of the accessory muscles of expiration to expel air from the lungs
94
Which of the following pathologic conditions increases vocal fremitus
Atelectasis and Pneumonia
95
A dull or soft percussion note would likely be heard in which of the following pathologic conditions
Pleural thickening and atelectasis
96
Bronchial breath sounds are likely to be heard in which of the following pathologic conditions
Alveolar consolidation, and atelectasis
97
Wheezing is
Produced by bronchospasm, A cardinal finding of bronchial asthma, Usually heard as high pitched sounds
98
In which of the following pathologic conditions is transmission of the whispered voice of a patient through a stethoscope unusually clear
Alveolar consolidation, atelectasis
99
An individuals ventilatory pattern is composed of which of the following
Ventilatory rate, and Tidal volume
100
Which of the following abnormal breathing patterns is commonly associated with diabetic acidosis
kussmauls respiration
101
What is the average total compliance of the lungs and chest wall combined
0.1 L/cm H2O
102
When lung compliance decreases, which of the following is seen
1. Ventilatory rate usually decreases
2. Tidal Volume usually decreases
3. Ventilatory rate usually increases
4. Tidal Volume usually increases
2. Tidal Volume usually decreases, 3. Ventilatory rate usually increases
103
What is the normal airway resistance in the tracheobronchial tree
0.5 to 1.0 cm H2O/L/sec
104
When the systemic blood pressure increases, the aortic and carotid sinus baroreceptors initiate reflexes that cause which of the following
Decreased Ventilary rate and decreased heart rate
105
What is the anteroposterior-transverse chest diameter ratio in the normal adult
1:2
106
Which of the following muscles originate from the clavicle
Pectoralis Major muscles, Sternocleidomastoid muscles
107
Which of the following is associated with digital clubbing
Chronic infection, Local Hypoxia, Circulating vasodilators, Arterial Hypoxia
108
Which of the following is associated with pleuritic chest pain
Lung Cancer, Pneumonia, and Tuberculosis
109
During acute alveolar hyperventilation, which of the following occurs?
1. HCO Decreases 4. PaCO2 Decreases
110
When lactic acidosis is present, which of the following will occur
1. pH will likely be lower than expected for a particular PaCO2 4. HCO will likely be lower than expected for a particular PaCO2
111
What is the clinical interpretation of the following ABG values (in addition to hypoxemia)?
Acute Ventilatory Failure
112
A 74 year old man with a long history of emphysema and chronic bronchitis enters the emergency room in resp distress. His RR is 34 bpm and labored. His HR is 115 bpm and his BP is 170/120. what is the clinical interpretation of the following ABG values (in addition to hypoxemia)?
Acute Alveolar hyperventilation superimposed chronic ventilatory failure
113
What causes metabolic acidosis
Renal Failure
114
Using the general rule of thumb for the PaCO2/ HCO/pH relationship, if the PaCO2 suddenly increased to 90mmHg in a patient who norm has a pH of 7.40, a PaCO2 of 40 mmHg, and an HCO of 24mEq/L, the pH will decrease to approx what level
7.15
115
Lactic acidosis develops from which of the following
1. Inadequate tissue oxygenation, 4. Anaerobic metabolism
116
Metabolic Alkalosis can develop from which of the following
2. Hypokalemia 3. Hypochoremia
117
During acute alveolar hypoventilation, the blood
1. HCO increases 2. pH decreases 3. PCO2 Increases
118
During acute alveolar hyperventilation, the blood
3. HCO decreases 4. pH increases
119
In chronic hypoventilation, kidney compensation has likely occured when
1. HCO is higher than expected for a particular PaCO 4. pH is higher than expected for a particular PaCO2
120
Central Venous Pressure
0-8 mm Hg
121
Right Atrial pressure
0-8 mmHg
122
Mean pulmonary artery Pressure
10-20 mmHg
123
Pulmonary capillary wedge
4-12 mmHg
124
Cardiac output
4-6 L/min
