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Chapter 2 Flashcards

1
Q

Body Temp

A

37C 98.6F

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2
Q

Heart Rate

A

60-100bpm

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3
Q

RR

A

12-20 bpm

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4
Q

Body temp is measured to

A

assess for signs of inflammation or infection

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5
Q

Body Temp is regulated by

A

hypthalamus

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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

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7
Q

Febrile is a shift to the

A

right

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8
Q

Hypothermia

A

Decreased temp

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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…

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10
Q

Hypothermia is a shift to the

A

left

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11
Q

For every 1 degree Celsius elevation in temp, pts oxygen

A

consumption increases 10%

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12
Q

Afebrile

A

normal body temp

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13
Q

When is putting a body in hypothermic state used

A

surgery, stroke or myocardial recover, ect

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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

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15
Q

Measurement sites of body temp

A

oral, rectal, ear (tympanic), axillary, transdermal= forehead

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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

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17
Q

Normal pulse for infants

A

100-160

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18
Q

Bradycardia

A

slow heart rate, less than 60

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19
Q

Tachycardia

A

fast heart rate,

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20
Q

asystole

A

no heart rate

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21
Q

Tachycardia is common with patients you are giving

A

sympathomimetics to (albuterol)

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22
Q

Sinus

A

Regular Heart Rhythm

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23
Q

Abnormal heart rhythms caused by

A

disruption in sinus control

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24
Q

Ectopy

A

Extra beats

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25
Q

arrhythias

A

Irregular heart beats

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26
Q

dysrhythmia

A

abnormality in physiological rhythm

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27
Q

An increase in rate may occur when and decrease when

A

occur during inspiration and decrease in rate during expiration. Can be a NORMAL VARIANT, but is still an arrhythmic pattern

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28
Q

Scale to Rate Pulse Quality

A 
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
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29
Q

Pulsus Alternans

A

Every other beat is different in strength due to heart failure

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30
Q

Pulses Paradoxus

A

Stronger on inspiration and weaker on expiration due to thoracic pressure changes

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31
Q

Cheyne Stokes

A

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

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32
Q

Blood pressure

A
  1. Blood flow 2. Resistance
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33
Q

Blood flow

A

Stroke volume, cardiac output

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34
Q

Things that affect blood flow negatively

A

poor myocardial contractility, hypovolemia, bradycardia, vascular dilation (shock)

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35
Q

Resistance

A

Vessel size, blood viscosity - B/P abnormalities

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36
Q

Hypertension

A

systolic > 140mmHg, Diastolic > 90 mmHg

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37
Q

Primary Hypertension

A

of unknown cause

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38
Q

Secondary Hypertension

A

of known cause (obesity, arteriosclerosis, sleep apnea, ect)

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39
Q

Hypotension

A

<90/60

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40
Q

Hypotenision may

A

result in poor tissue oxygenation. Vasodilation, hypovolemia, left ventricular failure

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41
Q

Oxygen Saturation

A

Fifth Vital sign

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42
Q

Normal Oxygenation

A

80- 100 mm Hg

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43
Q

Mild Hypoxemia

A

60-79 mmHg

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44
Q

Moderate hypoxemia

A

40-60 mmHg

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45
Q

Severe Hypoxemia

A

less than 40 mmHg

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46
Q

Signs and symptoms of inadequate oxygenation in the central nervous system

A

Apprehension (early), Restless/ irritability (early), Confusion/lethargic (early or late), Combativeness (late), Coma (late)

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47
Q

Signs and symptoms of inedequate oxygenation in the respiratory

A

Tachypnea (early), Dyspnea on exertion (early), Dyspnea at rest (late), Accessory muscles (late), Intercostol retractions (late), Breaths in sentences (late)

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48
Q

Signs and symptoms of inadequate oxygenation in the cardiovascular

A

Tachycardia (early), mild hypertension (early), Arrythmias (E/L), Hypotenision (late), Cyanosis (late), Skin is cool/clammy (late)

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49
Q

Other signs and symptoms of inadequate oxygenation

A

Diaphoresis, Decrease in urinary output, General fatigue

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50
Q

Common Clinical Manifestations observed during inspection

A

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
Q

Palpitation

A

Tactile and vocal fremitus, Chest symmetry of expansion, Tracheal positioning

52
Q

Systemic Examination of the Chest and Lungs

A

Inspection, Palpitation, Percussion, Auscultation

53
Q

Tactile fremitus

A

Assessment of the lungs by vibration intensity felt on chest wall

54
Q

Vocal Fremitus

A

Vibrations heard by a stethoscope on the chest wall with certain spoken words

55
Q

Percussion- dull

A

consolidation

56
Q

Percussion- hyperresonant

A

increased air (empysema, pneumothorax)

57
Q

Diaphramatic excusion

A

flat diaphragm (emphysema)

58
Q

Auscultation

A

Normal breath sounds/ abnormal breath sounds

59
Q

Normal breath sounds- bronchial

A

Heard over trachea, High in pitch, Loud intensity

60
Q

Normal Breath sounds- Bronchovesicular

A

heard over upper portion of anterior sternum, between scapulae, Moderate pitch and intensity

61
Q

Normal breath sounds- Vesicular

A

Heard over peripheral lung regions, high in pitch and soft in intensity

62
Q

Abnormal breath sounds- Crackles/ rales

A

(atelectasis) fine medium or coarse.

63
Q

Coarse crackles=

A

Rhonchi. Discontinuous, low pitched, rumbling, bubbling, or gurgling sounds that start early during inspiration and extend into exhalation

64
Q

Wheezing

A

(bronchospasms). Continuous high pitched, musical whistles that are generally heard on expiration

65
Q

Stridor

A

(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
Q

Pleural Friction

A

Creaking shoe. heard throughout inspiration and expiration over the area where the patient complains of pain

67
Q

Diminished or absent

A

Air trapping

68
Q

Normal tidal volumes

A

3-4ml/lb or 7-9 ml/kg

69
Q

I:E ratio

A

(1:2) abnormal long or short expiratory times

70
Q

Lung compliance= restrictive disease

A

Decrease in tidal volume, increase in RR

71
Q

Airway resistance

A

Asthma= Increase tidal volume, decrease RR

72
Q

Peripheral chemoreceptors located

A

in aortic arch and carotid

73
Q

Pulmonary reflexes

A

A. Hering- Breuer reflex B. Deflation Reflex C. Irritant Reflex D. JuxtaPulmonary ( J Receptors)

74
Q

Hering-Breuer reflex

A

Triggered to prevent over inflation of the lung

75
Q

Deflation Reflex

A

Serves to shorten exhalation when the lung is deflated

76
Q

Irritant Reflex

A

Cough (glottis shuts and opens letting out diaphragm pressure)

77
Q

Juxtapulmonary (J receptors)

A

innervated by fibers of the vagus nerve, respond to events such as pulmonary edema, pulmonary emboli, pneumonia, CHF, and barotrauma

78
Q

Pain/ Anxiety/ and fever Receptors

A

Baroreceptors

79
Q

Inspiratory Muscles

A

Scalene, Sternocleidomastoid, Pectoralis Major, Trapezius

80
Q

Expiratory Muscles

A

Rectus Abdominals, External Oblique, Internal Oblique, Transversus abdominis

81
Q

Nasal Flaring

A

Often seen in neonates and infants in respiratory distress

82
Q

Pleural Pain

A

Sharp, sudden, stabbing pain, generally with inspiration or deep inspiration= rule out heart

83
Q

Pleural pain may be caused by

A

chest wall inflammation, pleural inflammation, chest wall muscles, ribs fractures

84
Q

Pleuritic chest pain is a characteristic feature of the following resp diseases

A

Pneumonia, pleural effusion, pneumothorax, lung cancer, fungal disease, tuberculosis

85
Q

Abnormal Extramity findings

A

Altered skin color, Presence of digital clubbing, Presence of Peripheral edema, presence of distended neck veins, flailed chest

86
Q

Digital clubbing

A

Chronic hypoxemia (low O2- cystic fibrosis patients)

87
Q

Cyanosis

A

Central- Mouth/ mucosal

Peripheral- fingers

88
Q

Peripheral edema

A

Fluid overload, heart failure- pushing on skin and refils slowly.. poor BP/ circulation

89
Q

Distended neck veins

A

CHF, cor pulmonale, pneumothorax

90
Q

Flailed chest

A

multiple rib fractures- intubated so ribs can refuse

91
Q

Non productive cough

A

Irritation of the airway, inflammation, mucus accumulation, tumors, irritation of the pleura

92
Q

Productive cough

A

Asses cough stregnth, Frequency, pitch, and loudness, amount , consistency, color, odor, ect…

93
Q

Cough proceded by

A
  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
Q

Which of the following pathologic conditions increases vocal fremitus

A

Atelectasis and Pneumonia

95
Q

A dull or soft percussion note would likely be heard in which of the following pathologic conditions

A

Pleural thickening and atelectasis

96
Q

Bronchial breath sounds are likely to be heard in which of the following pathologic conditions

A

Alveolar consolidation, and atelectasis

97
Q

Wheezing is

A

Produced by bronchospasm, A cardinal finding of bronchial asthma, Usually heard as high pitched sounds

98
Q

In which of the following pathologic conditions is transmission of the whispered voice of a patient through a stethoscope unusually clear

A

Alveolar consolidation, atelectasis

99
Q

An individuals ventilatory pattern is composed of which of the following

A

Ventilatory rate, and Tidal volume

100
Q

Which of the following abnormal breathing patterns is commonly associated with diabetic acidosis

A

kussmauls respiration

101
Q

What is the average total compliance of the lungs and chest wall combined

A

0.1 L/cm H2O

102
Q

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
A
  1. Tidal Volume usually decreases, 3. Ventilatory rate usually increases
103
Q

What is the normal airway resistance in the tracheobronchial tree

A

0.5 to 1.0 cm H2O/L/sec

104
Q

When the systemic blood pressure increases, the aortic and carotid sinus baroreceptors initiate reflexes that cause which of the following

A

Decreased Ventilary rate and decreased heart rate

105
Q

What is the anteroposterior-transverse chest diameter ratio in the normal adult

106
Q

Which of the following muscles originate from the clavicle

A

Pectoralis Major muscles, Sternocleidomastoid muscles

107
Q

Which of the following is associated with digital clubbing

A

Chronic infection, Local Hypoxia, Circulating vasodilators, Arterial Hypoxia

108
Q

Which of the following is associated with pleuritic chest pain

A

Lung Cancer, Pneumonia, and Tuberculosis

109
Q

During acute alveolar hyperventilation, which of the following occurs?

A
  1. HCO Decreases 4. PaCO2 Decreases
110
Q

When lactic acidosis is present, which of the following will occur

A
  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
Q

What is the clinical interpretation of the following ABG values (in addition to hypoxemia)?

A

Acute Ventilatory Failure

112
Q

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)?

A

Acute Alveolar hyperventilation superimposed chronic ventilatory failure

113
Q

What causes metabolic acidosis

A

Renal Failure

114
Q

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

115
Q

Lactic acidosis develops from which of the following

A
  1. Inadequate tissue oxygenation, 4. Anaerobic metabolism
116
Q

Metabolic Alkalosis can develop from which of the following

A
  1. Hypokalemia 3. Hypochoremia
117
Q

During acute alveolar hypoventilation, the blood

A
  1. HCO increases 2. pH decreases 3. PCO2 Increases
118
Q

During acute alveolar hyperventilation, the blood

A
  1. HCO decreases 4. pH increases
119
Q

In chronic hypoventilation, kidney compensation has likely occured when

A
  1. HCO is higher than expected for a particular PaCO 4. pH is higher than expected for a particular PaCO2
120
Q

Central Venous Pressure

121
Q

Right Atrial pressure

122
Q

Mean pulmonary artery Pressure

A

10-20 mmHg

123
Q

Pulmonary capillary wedge

124
Q

Cardiac output

Pathophysiology (9 decks)

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