Chapter 3 Flashcards
Patient assessment
What color is yellow sputum indicative of1 ? What
does it contain?
Infection; WBCs and purulent sputum
What bacterial organism should be suspected if
your sputum is green and foul smelling?
Pseudomonas infection
List nine causes of dyspnea?
- Increase airway resistance
- Upper airway obstruction
- Asthma and other chronic lung diseases
- Decreased lung compliance
- Pneumothorax
- Pleural effusion
- Abnormal chest wall
- Anxiety state, when there is no physiologic
explanation - Pulmonary fibrosis
What does orthopnea mean, and in which
patients is it normally found.
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
Define Kussmals breathing and identify which
patient’s most often exhibit the breathing
pattern?
An increase rate and depth of breathing affects
patients with severe metabolic acidosis (diabetic
ketoacidosis).
List 3 conditions in which asymmetric chest
movement may be observed?
Atelectasis
Pneumothorax
Chest deformities
Describe paradoxical respirations and name one
condition in which it is most commonly
observed?
Chest moves in on inspiration and out on
expiration.
Flail chest
Fractured sternum or ribs
Define pedal edema and it’s cause?
Fluid in the ankles
Chronic pulmonary disease
Cor pulmonale
JVD
Name a condition that the trachea shifts to the
affected side.
Atelectasis
Name one condition that causes the trachea to
shift to the unaffected side.
Tension pneumothorax
Which muscles are used for normal ventilation?
Diaphragm & external intercostals
What causes barrel chest appearance in patients
with COPD?
Increased tone and development of accessory
muscles
Name 2 conditions in which a hyperresonant
note would be heard?
Emphysema & Pneumothorax
Name 2 conditions in which a dull percussion
note would be heard?
Atelectasis & Pleural effusion
List 4 conditions that result in heart murmurs?
- Aortic valve disease
- Mitral valve disease
- Pulmonic valve stenosis
- Tricuspid valve insufficiency
List normal values for the following electrolytes:
sodium, potassium, chloride.
Sodium: 135-145 mEqL
Potassium: 3.5-5 mEqL
Calcium: 98-107 mEqL
Why would decreased sodium and potassium
levels make weaning a patient from a vent more
difficult?
Because patient may not have adequate muscle
strength to wean correctly.
What does an elevated BUN level indicate?
Renal failure
How does the respiratory system compensate
when glucose levels increase in a diabetic
patient?
With alveolar hyperventilation
List normal values for RBCs, HB, HCT, & WBCs?
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
What does a decrease in HB, HCT, & RBC count
indicate?
Inadequate 02 capacity
Name 2 conditions that cause a decrease in
platelet count?
Bone marrow diseases & disseminated
intravascular coagulation (DIC)
Patients with a decrease platelet count and
increased prothrombin time (PT) are at greater
risk of what occurrence?
Hemorrhaging
What information should you obtain for the
patient interview?
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
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
What does white sputum indicate?
Normal mucous
What does green sputum indicate?
Old retained secretions
What does brown sputum indicate?
Presence of blood
What does red sputum indicate?
Fresh blood
When a cough is productive what should you
record?
Amount
Consistency
Odor
Color
Sputum changes over how many hours?
24
What are the steps in sputum collection?
- Explain to the patient the intent to collect a
sample - Good oral hygiene prevents the collection
from being contaminated by oral
secretions - The sputum sample must be from a deep
cough - Aerosolized hypertonic saline may help
facilitate coughing and secretion removal
Barlike cough indicates what?
Croup
Harsh dry cough indicates what?
Upper airway problems
Wheezing type cough indicates what?
Lower airway pathology
Chronic productive cough indicates what?
Chronic bronchitis
Frequent hacking cough and throat clearing
indicates what?
smoking or sinus viral infection
What is paroxsymal nocturnal dyspnea?
Sudden onset of shortness of breath after being
in bed for several hours.
Seen in cardiac patients
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
What is massive hemoptysis?
400 mL of blood tinged sputum in 3 hours or
more than 600 mL in 24 hours
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
What is eupnea?
Normal rate of breathing
Adults 12-20
Children 15-25
Neonates 35-45 (as high as 70 with
excitement)
How long does apnea last?
at least 10 seconds
What is hypopnea?
Shallow respirations with slow RR.
Accompanied by slow pulse rate, weak rapid
pulse, and patient with OSA.
What is hyperpnea?
Deep, rapid, labored breathing
Associated with conditions with inadequate 02
supply
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
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
Barrel chest is indicative of what?
Chronic lung disease
to of all clubbing is the result of
pulmonary disease.
75-85%
Digital clubbing is the result of?
Chronic hypoxemia
Cyanosis results from a decrease in
oxygenated hemoglobin?
5g/dL
What is central cyanosis?
blueness of the oral mucosa and trunk due to
inadequate tissue oxygenation
What is peripheral cyanosis?
blueness in nail beds; indicates poor perfusion
caused by decreased cardiac output,
hypotension, and cold temperature.
What is lordosis?
Backward curvature of the lumbar spine,
resulting in hunchback appearance.
What are some other names for pectus
carinatum?
pigeon breast & funnel chest
What are some signs and symptoms of
kyphoscoliosis?
- Dyspnea
- Hypoxemia
- Hypercapnia
- Progressive respiratory insufficiency
- Cardiac failure
- Decreased lung capacity (restrictive
disease)
Vibrations are decreased over what?
pleural effusions, fluid, pneumothorax, and in
overly muscular or obese patients
Vibrations are increased over what?
Atelectasis, pneumonia , and lung masses
Palpating over subcutaneous air that feels like
crackling under the skin, is referred to as what?
Crepitus
Hyperresonance
A loud, low-pitched sound of long duration
produced over areas of air
Ex. air-filled stomach, emphysema,
pneumothorax
Resonance
Low-pitched sound of long duration
Ex. Normal lung tissue
Dullness
Sound of medium intensity & pitch of short
duration over areas of fluid
Ex. atelectasis, consolidation, pleural effusion,
pleural thickening, pulmonary edema.
Flatness
Sound of low amplitude
Ex. massive pleural effusion & atelectasis,
pneumonectomy
What is tympanny?
A drumlike sound
Ex. tension pneumothorax
What is a vesicular breath sound?
Gentle rustling sound
What is a bronchial sound?
high-pitched sound
What is a bronchovesicular sound?
Combination of bronchial and vesicular
What is a tracheal sound?
Harsh and high-pitched
Expiration is slightly longer than inspiration
What are adventitious breath sounds?
Abnormal breath sounds superimposed on
normal breath sounds
What makes S3 heart sound?
Results from blood rushing into the ventricles
during early ventricular diastole
What makes the S4 heart sound?
Results from atrial contractions
What is abnormal blood flow over the heart,
arteries, and veins, caused by turbulent flow?
Bruit
What is an oblique CXR?
Image is obtained with patient turned in a 45
degree angle either right or left
What is an apical lordotic CXR?
Upright position patient leans back at a 45
degree angle.
What is Lateral decubitus CXR?
Patient lying on side and film resting on
posterior chest
Chest radiographs are taken with the patient at
with diaphragm descended at the ?
maximum inspiration; 10th rib
An overexposed x-ray appears?
darker
An underexposed x-ray appears?
Lighter
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
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.
What is pulse alternans?
Alternating pattern of strong and weak pulses,
seen in patients with left ventricular failure, and
indicates bigeminal premature ventricular
contractions
What is normal blood pressure for children?
Systolic pressure of 95 - 118
Diastolic pressure of 54-66
What is normal blood pressure for neonates?
Systolic pressure of 67-84
Diastolic pressure of 35-53
What are factors that affect blood pressure?
Blood volume
Blood viscosity
Hearts, pumping action
What does febrile mean?
Patient has a fever
What does afebrile mean?
Patient has no fever
Glasgow score of 12 to 15 does not require
what?
Admission to the ICU
A score of 9-12 indicates what?
Moderate coma
Glasgow coma score < 8-9 indicates?
Severe coma
Glasgow coma scores < 8 requires what?
Intubation
Physician will start a breathing test when there’s
no spontaneous breathing for how long?
8 to 10 minutes
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.
What are some causes of hyponatremia?
- Renal failure
- CHF
- Excessive fever or sweating
- Long-term diuretic administration
- Inadequate sodium intake
- Excessive water digestion
- Severe burns
- GI fluid losses (vomiting, diarrhea)
what are some clinical symptoms of
hyponatremia?
- Muscle weakness
- Confusion
- More twitching progressing to convulsions
- Anxiety
- Alterations in levels of consciousness
What are some causes of hypernatremia?
- Excessive water loss (sweating diarrhea)
- Renal failure
- In adequate water intake
- Mannitol diuresis
- Corticosteroid administration
What are some clinical symptoms of
hypernatremia?
- Confusion
- CNS dysfunction
- Seizure activity
- Coma
What are some causes of hypokalemia?
- Diuretic therapy
- Adrenocorticosteroid administration
- Vomiting diarrhea
- Burns
- Severe trauma
What are some clinical symptoms of
hypokalemia?
- Muscle weakness
- Cardiac arrhythmias
- ST Segment depression on ECG
- Decreased GI tract motility resulting in
abdominal distention
What are some causes of hyperkalemia?
- Acidosis
- Renal insufficiency
- Tissue necrosis
- Hemorrhage
What are some clinical symptoms of
hyperkalemia?
- Paralysis
- ECG abnormalities
- Cardiac arrhythmias
What are some causes of hypochloremia?
- Vomiting, diarrhea
- Furosemide diuresis
What are some clinical symptoms of
hypochloremia?
- muscle spasm
- Coma
What are some causes of hyperchloremia?
- Respiratory alkalosis
- Metabolic acidosis
- Dehydration
- Administration of excessive amount of
sodium chloride and potassium
What are some clinical symptoms of
hyperchloremia?
- Headache
- Malaise
- Weakness
- Unconsciousness
- Coma
What are some causes of hypocalcemia?
- Severe trauma
- Renal failure
- Severe pancreatitis
- Vitamin D deficiency
- Parathyroid hormone deficiency
What are some clinical symptoms of
hypocalcemia?
- Muscle spasm
- Abdominal cramping
- Convulsions
- Prolonged QT interval on ECG
What are some causes of hypercalcemia?
- Hyperthyroidism
- Vitamin A or intoxication
- Hyperparathyroidism
- Sarcoidosis
- Cancer metastasis in the bone
What are some clinical symptoms of
hypercalcemia?
- Muscle weakness
- Fatigue
- Mental depression
- Anorexia
What is the normal BUN level?
8 to 23 mg/dL
What is the normal creatinine level?
0.7 to 1.3 mg/dL
What is the normal glucose level?
Anything < 100 mg/dL
What is normal platelet level?
150,000 to 400,000 mm³
What is normal PT?
11 to 12.5 seconds
What is normal PTT?
60 to 85 seconds
With acute myocardial infarction, CK-MB
increases within hours after symptoms
first appear?
4-6
The level peaks in 24 hours and returns to
normal in days.
2-3
Myoglobin increases hours after the onset
of symptoms?
2-4
Myoglobin reaches peak levels within
hours.
6-12
Myoglobin returns to normal in hours?
24-36 hours
BNP level > 500 pg/mL indicates what?
CHF
Proteinuria is usually a sign of?
Kidney disease
Glucosuria is commonly found in patients with?
Diabetes
Ketonuria is found in patients with?
Starvation
Diabetes
alcohol intoxication
Hematuria is found in patients with?
Renal & genitourinary disorders
Normal urine output is?
30-40 mL/hr
