Chapter 2 (Part 4) Flashcards
Three test of Ausculation
- Bronchophony
- Egophony
- Whispered Pectoriloquy
Describes vocal resonance that is more intense and clearer than normal; 99; hollow (consolidation)
Bronchophony
Describes voice sounds that are distorted; letter E; distortion is produced by consolidation; from E to A
Egophony
Describes the ability to clearly and distinctly hear whispered sounds that should not normally be heard; 99
Whispered Pectoriloquy
Diagnostic Studies
Non-invasive
Invasive
Non-invasive
- Sputum Analysis (Culture and Sensitivity)
- Pulse oximeter
- Chest X-ray
- Thoracic Completed Tomography (CT scan)
Invasive
- Bronchoscopy
- Thoracentesis (Aspirated fluid accumulation)
Hematologic Studies
- Arterial Blood Gas (ABG)
- CBC
Test to assess oxygenation, ventilation,
and acid base status. Obtained through
arterial puncture of the radial, brachial
of femoral artery.
ABG
pH normal value
7.35-7.45
PCO2 normal value
35-45 mmHg
PO2 normal value
80-100 mmHg
o2 sat normal value
95%-100%
Is a basis screening test and one of the
most frequently ordered blood test
CBC
Nursing Plan
- Maintain Patent airway
- Improve pulmonary function
- Clear airway obstruction
- Plan activity
- Prevent associated complications
- Improve breathing pattern
Nursing Intervention
- Suctioning
- Give antibiotic
- Proper Positioning
- Encourage to increase oral fluid intake
- Assess for breath sounds, rate, rhythm
- Provide good ventilation
- Assess or monitor vital signs
- Chest physiotherapy
- Oxygen administration
- Encourage deep breathing exercise
Dissolve pleghm
Mucolytic
Expell the pleghm
Expectorant
Cough suppressant
Antitussive
Breathing difficulty associated with CHF,
MG, GBS obstruction, etc,.
Dyspnea
Is protective reflex; sputum production has many stimuli
Cough and Sputum production
Bluish discoloration; late indicator of hypoxia
Cyanosis
Found in chest/torso of the bay
Central cyanosis
Found in fingers
Peripheral cyanosis
Expectorate blood
Hemoptysis