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RET 2934 > Chapter 3 > Flashcards

Chapter 3 Flashcards

Patient assessment (125 cards)

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1
Q

What color is yellow sputum indicative of1 ? What
does it contain?

A

Infection; WBCs and purulent sputum

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2
Q

What bacterial organism should be suspected if
your sputum is green and foul smelling?

A

Pseudomonas infection

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3
Q

List nine causes of dyspnea?

A
  1. Increase airway resistance
  2. Upper airway obstruction
  3. Asthma and other chronic lung diseases
  4. Decreased lung compliance
  5. Pneumothorax
  6. Pleural effusion
  7. Abnormal chest wall
  8. Anxiety state, when there is no physiologic
    explanation
  9. Pulmonary fibrosis
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4
Q

What does orthopnea mean, and in which
patients is it normally found.

A

Dyspnea while lying down
Seen in patients with heart failure caused
by increased congestion in lungs while
lying down
Also found in patients with emphysema,
because of diaphragmatic movement
during ventilation

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5
Q

Define Kussmals breathing and identify which
patient’s most often exhibit the breathing
pattern?

A

An increase rate and depth of breathing affects
patients with severe metabolic acidosis (diabetic
ketoacidosis).

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6
Q

List 3 conditions in which asymmetric chest
movement may be observed?

A

Atelectasis
Pneumothorax
Chest deformities

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7
Q

Describe paradoxical respirations and name one
condition in which it is most commonly
observed?

A

Chest moves in on inspiration and out on
expiration.
Flail chest
Fractured sternum or ribs

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8
Q

Define pedal edema and it’s cause?

A

Fluid in the ankles
Chronic pulmonary disease
Cor pulmonale
JVD

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9
Q

Name a condition that the trachea shifts to the
affected side.

A

Atelectasis

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10
Q

Name one condition that causes the trachea to
shift to the unaffected side.

A

Tension pneumothorax

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11
Q

Which muscles are used for normal ventilation?

A

Diaphragm & external intercostals

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12
Q

What causes barrel chest appearance in patients
with COPD?

A

Increased tone and development of accessory
muscles

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13
Q

Name 2 conditions in which a hyperresonant
note would be heard?

A

Emphysema & Pneumothorax

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14
Q

Name 2 conditions in which a dull percussion
note would be heard?

A

Atelectasis & Pleural effusion

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15
Q

List 4 conditions that result in heart murmurs?

A
  1. Aortic valve disease
  2. Mitral valve disease
  3. Pulmonic valve stenosis
  4. Tricuspid valve insufficiency
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16
Q

List normal values for the following electrolytes:
sodium, potassium, chloride.

A

Sodium: 135-145 mEqL
Potassium: 3.5-5 mEqL
Calcium: 98-107 mEqL

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17
Q

Why would decreased sodium and potassium
levels make weaning a patient from a vent more
difficult?

A

Because patient may not have adequate muscle
strength to wean correctly.

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18
Q

What does an elevated BUN level indicate?

A

Renal failure

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19
Q

How does the respiratory system compensate
when glucose levels increase in a diabetic
patient?

A

With alveolar hyperventilation

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20
Q

List normal values for RBCs, HB, HCT, & WBCs?

A

RBC: 4-6 million mm³
HB: 14-18 g/dL (males), 12-15g/dL
(females)
HCT: 40-54% (males), 35-49% (females)
WBC: 4,500-11,000 mm³

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21
Q

What does a decrease in HB, HCT, & RBC count
indicate?

A

Inadequate 02 capacity

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22
Q

Name 2 conditions that cause a decrease in
platelet count?

A

Bone marrow diseases & disseminated
intravascular coagulation (DIC)

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23
Q

Patients with a decrease platelet count and
increased prothrombin time (PT) are at greater
risk of what occurrence?

A

Hemorrhaging

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24
Q

What information should you obtain for the
patient interview?

A

Chief complaint
Symptoms that the patient has had and
when they started
Past medical problems
Occupation
Medications currently prescribed
Allergies
Exercise tolerance and daily activities
Living environment
Nutritional status
Social support systems available
Smoking history
Alcohol or drug use

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25
Non-productive cough is caused by:
Irritation of the airway Acute inflammation of the respiratory mucosal membrane Presence of a growth Irritation of the pleura
26
What does white sputum indicate?
Normal mucous
27
What does green sputum indicate?
Old retained secretions
28
What does brown sputum indicate?
Presence of blood
29
What does red sputum indicate?
Fresh blood
30
When a cough is productive what should you record?
Amount Consistency Odor Color
31
Sputum changes over how many hours?
24
32
What are the steps in sputum collection?
1. Explain to the patient the intent to collect a sample 2. Good oral hygiene prevents the collection from being contaminated by oral secretions 3. The sputum sample must be from a deep cough 4. Aerosolized hypertonic saline may help facilitate coughing and secretion removal
33
Barlike cough indicates what?
Croup
34
Harsh dry cough indicates what?
Upper airway problems
35
Wheezing type cough indicates what?
Lower airway pathology
36
Chronic productive cough indicates what?
Chronic bronchitis
37
Frequent hacking cough and throat clearing indicates what?
smoking or sinus viral infection
38
What is paroxsymal nocturnal dyspnea?
Sudden onset of shortness of breath after being in bed for several hours. Seen in cardiac patients
39
What is exertional dyspnea?
Shortness of breath on exertion Seen in patients with cardiopulmonary disease Severity depends on amount of exertion Determine what point patient experiences exertion
40
What is massive hemoptysis?
400 mL of blood tinged sputum in 3 hours or more than 600 mL in 24 hours
41
What are some causes of hemoptysis?
Pneumonia TB Bronchiectasis Lung abscess Fungal lung infection: histoplamosis Neoplasms: bronchogenic carcinoma Pulmonary embolism Valvular heart diseases Mitral valve stenosis Trauma
42
What is eupnea?
Normal rate of breathing Adults 12-20 Children 15-25 Neonates 35-45 (as high as 70 with excitement)
43
How long does apnea last?
at least 10 seconds
44
What is hypopnea?
Shallow respirations with slow RR. Accompanied by slow pulse rate, weak rapid pulse, and patient with OSA.
45
What is hyperpnea?
Deep, rapid, labored breathing Associated with conditions with inadequate 02 supply
46
What is Biots breathing?
irregular breathing pattern characterized by short periods of deep consistent volumes with periods of apnea. Apneic period may last 10-30 sec Associated with elevated ICP or meningitis
47
What is Cheyne Stokes respiration?
Deep rapid breathing followed by apnea. The breaths begin slowly and shallowly and gradually increase to above normal rate. Apnea will take 10-20 seconds
48
Barrel chest is indicative of what?
Chronic lung disease
49
to of all clubbing is the result of pulmonary disease.
75-85%
50
Digital clubbing is the result of?
Chronic hypoxemia
51
Cyanosis results from a decrease in oxygenated hemoglobin?
5g/dL
52
What is central cyanosis?
blueness of the oral mucosa and trunk due to inadequate tissue oxygenation
53
What is peripheral cyanosis?
blueness in nail beds; indicates poor perfusion caused by decreased cardiac output, hypotension, and cold temperature.
54
What is lordosis?
Backward curvature of the lumbar spine, resulting in hunchback appearance.
55
What are some other names for pectus carinatum?
pigeon breast & funnel chest
56
What are some signs and symptoms of kyphoscoliosis?
1. Dyspnea 2. Hypoxemia 3. Hypercapnia 4. Progressive respiratory insufficiency 5. Cardiac failure 6. Decreased lung capacity (restrictive disease)
57
Vibrations are decreased over what?
pleural effusions, fluid, pneumothorax, and in overly muscular or obese patients
58
Vibrations are increased over what?
Atelectasis, pneumonia , and lung masses
59
Palpating over subcutaneous air that feels like crackling under the skin, is referred to as what?
Crepitus
60
Hyperresonance
A loud, low-pitched sound of long duration produced over areas of air Ex. air-filled stomach, emphysema, pneumothorax
61
Resonance
Low-pitched sound of long duration Ex. Normal lung tissue
62
Dullness
Sound of medium intensity & pitch of short duration over areas of fluid Ex. atelectasis, consolidation, pleural effusion, pleural thickening, pulmonary edema.
63
Flatness
Sound of low amplitude Ex. massive pleural effusion & atelectasis, pneumonectomy
64
What is tympanny?
A drumlike sound Ex. tension pneumothorax
65
What is a vesicular breath sound?
Gentle rustling sound
66
What is a bronchial sound?
high-pitched sound
67
What is a bronchovesicular sound?
Combination of bronchial and vesicular
68
What is a tracheal sound?
Harsh and high-pitched Expiration is slightly longer than inspiration
69
What are adventitious breath sounds?
Abnormal breath sounds superimposed on normal breath sounds
70
What makes S3 heart sound?
Results from blood rushing into the ventricles during early ventricular diastole
71
What makes the S4 heart sound?
Results from atrial contractions
72
What is abnormal blood flow over the heart, arteries, and veins, caused by turbulent flow?
Bruit
73
What is an oblique CXR?
Image is obtained with patient turned in a 45 degree angle either right or left
74
What is an apical lordotic CXR?
Upright position patient leans back at a 45 degree angle.
75
What is Lateral decubitus CXR?
Patient lying on side and film resting on posterior chest
76
Chest radiographs are taken with the patient at with diaphragm descended at the ?
maximum inspiration; 10th rib
77
An overexposed x-ray appears?
darker
78
An underexposed x-ray appears?
Lighter
79
What is peripheral edema and Venous engorgement
Inadequate, pumping action of the heart, resulting from core pulmonale often seen in patients with chronic lung disease or CHF
80
What is pulses paradoxus?
A pulse that becomes weaker on inspiration. It may be defined as a decrease in pressure of more than 10 mmHg during inspiration.
81
What is pulse alternans?
Alternating pattern of strong and weak pulses, seen in patients with left ventricular failure, and indicates bigeminal premature ventricular contractions
82
What is normal blood pressure for children?
Systolic pressure of 95 - 118 Diastolic pressure of 54-66
83
What is normal blood pressure for neonates?
Systolic pressure of 67-84 Diastolic pressure of 35-53
84
What are factors that affect blood pressure?
Blood volume Blood viscosity Hearts, pumping action
85
What does febrile mean?
Patient has a fever
86
What does afebrile mean?
Patient has no fever
87
Glasgow score of 12 to 15 does not require what?
Admission to the ICU
88
A score of 9-12 indicates what?
Moderate coma
89
Glasgow coma score < 8-9 indicates?
Severe coma
90
Glasgow coma scores < 8 requires what?
Intubation
91
Physician will start a breathing test when there's no spontaneous breathing for how long?
8 to 10 minutes
92
A positive apnea test will indicate if the ABG results show what?
Increased CO2 above 20 torr of baseline OR reaches level of 60 torr.
93
What are some causes of hyponatremia?
1. Renal failure 2. CHF 3. Excessive fever or sweating 4. Long-term diuretic administration 5. Inadequate sodium intake 6. Excessive water digestion 7. Severe burns 8. GI fluid losses (vomiting, diarrhea)
94
what are some clinical symptoms of hyponatremia?
1. Muscle weakness 2. Confusion 3. More twitching progressing to convulsions 4. Anxiety 5. Alterations in levels of consciousness
95
What are some causes of hypernatremia?
1. Excessive water loss (sweating diarrhea) 2. Renal failure 3. In adequate water intake 4. Mannitol diuresis 5. Corticosteroid administration
96
What are some clinical symptoms of hypernatremia?
1. Confusion 2. CNS dysfunction 3. Seizure activity 4. Coma
97
What are some causes of hypokalemia?
1. Diuretic therapy 2. Adrenocorticosteroid administration 3. Vomiting diarrhea 4. Burns 5. Severe trauma
98
What are some clinical symptoms of hypokalemia?
1. Muscle weakness 2. Cardiac arrhythmias 3. ST Segment depression on ECG 4. Decreased GI tract motility resulting in abdominal distention
99
What are some causes of hyperkalemia?
1. Acidosis 2. Renal insufficiency 3. Tissue necrosis 4. Hemorrhage
100
What are some clinical symptoms of hyperkalemia?
1. Paralysis 2. ECG abnormalities 3. Cardiac arrhythmias
101
What are some causes of hypochloremia?
1. Vomiting, diarrhea 2. Furosemide diuresis
102
What are some clinical symptoms of hypochloremia?
1. muscle spasm 2. Coma
103
What are some causes of hyperchloremia?
1. Respiratory alkalosis 2. Metabolic acidosis 3. Dehydration 4. Administration of excessive amount of sodium chloride and potassium
104
What are some clinical symptoms of hyperchloremia?
1. Headache 2. Malaise 3. Weakness 4. Unconsciousness 5. Coma
105
What are some causes of hypocalcemia?
1. Severe trauma 2. Renal failure 3. Severe pancreatitis 4. Vitamin D deficiency 5. Parathyroid hormone deficiency
106
What are some clinical symptoms of hypocalcemia?
1. Muscle spasm 2. Abdominal cramping 3. Convulsions 4. Prolonged QT interval on ECG
107
What are some causes of hypercalcemia?
1. Hyperthyroidism 2. Vitamin A or intoxication 3. Hyperparathyroidism 4. Sarcoidosis 5. Cancer metastasis in the bone
108
What are some clinical symptoms of hypercalcemia?
1. Muscle weakness 2. Fatigue 3. Mental depression 4. Anorexia
109
What is the normal BUN level?
8 to 23 mg/dL
110
What is the normal creatinine level?
0.7 to 1.3 mg/dL
111
What is the normal glucose level?
Anything < 100 mg/dL
112
What is normal platelet level?
150,000 to 400,000 mm³
113
What is normal PT?
11 to 12.5 seconds
114
What is normal PTT?
60 to 85 seconds
115
With acute myocardial infarction, CK-MB increases within hours after symptoms first appear?
4-6
116
The level peaks in 24 hours and returns to normal in days.
2-3
117
Myoglobin increases hours after the onset of symptoms?
2-4
118
Myoglobin reaches peak levels within hours.
6-12
119
Myoglobin returns to normal in hours?
24-36 hours
120
BNP level > 500 pg/mL indicates what?
CHF
121
Proteinuria is usually a sign of?
Kidney disease
122
Glucosuria is commonly found in patients with?
Diabetes
123
Ketonuria is found in patients with?
Starvation Diabetes alcohol intoxication
124
Hematuria is found in patients with?
Renal & genitourinary disorders
125
Normal urine output is?
30-40 mL/hr

RET 2934 (13 decks)

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