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RET 2934 > Chapter 3 > Flashcards

Chapter 3 Flashcards

Patient assessment

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
Q

Non-productive cough is caused by:

A

Irritation of the airway
Acute inflammation of the respiratory
mucosal membrane
Presence of a growth
Irritation of the pleura

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26
Q

What does white sputum indicate?

A

Normal mucous

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27
Q

What does green sputum indicate?

A

Old retained secretions

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28
Q

What does brown sputum indicate?

A

Presence of blood

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29
Q

What does red sputum indicate?

A

Fresh blood

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30
Q

When a cough is productive what should you
record?

A

Amount
Consistency
Odor
Color

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31
Q

Sputum changes over how many hours?

A

24

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32
Q

What are the steps in sputum collection?

A
  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
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33
Q

Barlike cough indicates what?

A

Croup

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34
Q

Harsh dry cough indicates what?

A

Upper airway problems

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35
Q

Wheezing type cough indicates what?

A

Lower airway pathology

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36
Q

Chronic productive cough indicates what?

A

Chronic bronchitis

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37
Q

Frequent hacking cough and throat clearing
indicates what?

A

smoking or sinus viral infection

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38
Q

What is paroxsymal nocturnal dyspnea?

A

Sudden onset of shortness of breath after being
in bed for several hours.
Seen in cardiac patients

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39
Q

What is exertional dyspnea?

A

Shortness of breath on exertion
Seen in patients with cardiopulmonary
disease
Severity depends on amount of exertion
Determine what point patient experiences
exertion

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40
Q

What is massive hemoptysis?

A

400 mL of blood tinged sputum in 3 hours or
more than 600 mL in 24 hours

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41
Q

What are some causes of hemoptysis?

A

Pneumonia
TB
Bronchiectasis
Lung abscess
Fungal lung infection: histoplamosis
Neoplasms: bronchogenic carcinoma
Pulmonary embolism
Valvular heart diseases
Mitral valve stenosis
Trauma

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42
Q

What is eupnea?

A

Normal rate of breathing
Adults 12-20
Children 15-25
Neonates 35-45 (as high as 70 with
excitement)

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43
Q

How long does apnea last?

A

at least 10 seconds

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44
Q

What is hypopnea?

A

Shallow respirations with slow RR.
Accompanied by slow pulse rate, weak rapid
pulse, and patient with OSA.

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45
Q

What is hyperpnea?

A

Deep, rapid, labored breathing
Associated with conditions with inadequate 02
supply

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46
Q

What is Biots breathing?

A

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

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47
Q

What is Cheyne Stokes respiration?

A

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

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48
Q

Barrel chest is indicative of what?

A

Chronic lung disease

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49
Q

to of all clubbing is the result of
pulmonary disease.

A

75-85%

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50
Q

Digital clubbing is the result of?

A

Chronic hypoxemia

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51
Q

Cyanosis results from a decrease in
oxygenated hemoglobin?

A

5g/dL

52
Q

What is central cyanosis?

A

blueness of the oral mucosa and trunk due to
inadequate tissue oxygenation

53
Q

What is peripheral cyanosis?

A

blueness in nail beds; indicates poor perfusion
caused by decreased cardiac output,
hypotension, and cold temperature.

54
Q

What is lordosis?

A

Backward curvature of the lumbar spine,
resulting in hunchback appearance.

55
Q

What are some other names for pectus
carinatum?

A

pigeon breast & funnel chest

56
Q

What are some signs and symptoms of
kyphoscoliosis?

A
  1. Dyspnea
  2. Hypoxemia
  3. Hypercapnia
  4. Progressive respiratory insufficiency
  5. Cardiac failure
  6. Decreased lung capacity (restrictive
    disease)
57
Q

Vibrations are decreased over what?

A

pleural effusions, fluid, pneumothorax, and in
overly muscular or obese patients

58
Q

Vibrations are increased over what?

A

Atelectasis, pneumonia , and lung masses

59
Q

Palpating over subcutaneous air that feels like
crackling under the skin, is referred to as what?

A

Crepitus

60
Q

Hyperresonance

A

A loud, low-pitched sound of long duration
produced over areas of air
Ex. air-filled stomach, emphysema,
pneumothorax

61
Q

Resonance

A

Low-pitched sound of long duration
Ex. Normal lung tissue

62
Q

Dullness

A

Sound of medium intensity & pitch of short
duration over areas of fluid
Ex. atelectasis, consolidation, pleural effusion,
pleural thickening, pulmonary edema.

63
Q

Flatness

A

Sound of low amplitude
Ex. massive pleural effusion & atelectasis,
pneumonectomy

64
Q

What is tympanny?

A

A drumlike sound
Ex. tension pneumothorax

65
Q

What is a vesicular breath sound?

A

Gentle rustling sound

66
Q

What is a bronchial sound?

A

high-pitched sound

67
Q

What is a bronchovesicular sound?

A

Combination of bronchial and vesicular

68
Q

What is a tracheal sound?

A

Harsh and high-pitched
Expiration is slightly longer than inspiration

69
Q

What are adventitious breath sounds?

A

Abnormal breath sounds superimposed on
normal breath sounds

70
Q

What makes S3 heart sound?

A

Results from blood rushing into the ventricles
during early ventricular diastole

71
Q

What makes the S4 heart sound?

A

Results from atrial contractions

72
Q

What is abnormal blood flow over the heart,
arteries, and veins, caused by turbulent flow?

A

Bruit

73
Q

What is an oblique CXR?

A

Image is obtained with patient turned in a 45
degree angle either right or left

74
Q

What is an apical lordotic CXR?

A

Upright position patient leans back at a 45
degree angle.

75
Q

What is Lateral decubitus CXR?

A

Patient lying on side and film resting on
posterior chest

76
Q

Chest radiographs are taken with the patient at
with diaphragm descended at the ?

A

maximum inspiration; 10th rib

77
Q

An overexposed x-ray appears?

A

darker

78
Q

An underexposed x-ray appears?

A

Lighter

79
Q

What is peripheral edema and Venous
engorgement

A

Inadequate, pumping action of the heart,
resulting from core pulmonale often seen in
patients with chronic lung disease or CHF

80
Q

What is pulses paradoxus?

A

A pulse that becomes weaker on inspiration. It
may be defined as a decrease in pressure of
more than 10 mmHg during inspiration.

81
Q

What is pulse alternans?

A

Alternating pattern of strong and weak pulses,
seen in patients with left ventricular failure, and
indicates bigeminal premature ventricular
contractions

82
Q

What is normal blood pressure for children?

A

Systolic pressure of 95 - 118
Diastolic pressure of 54-66

83
Q

What is normal blood pressure for neonates?

A

Systolic pressure of 67-84
Diastolic pressure of 35-53

84
Q

What are factors that affect blood pressure?

A

Blood volume
Blood viscosity
Hearts, pumping action

85
Q

What does febrile mean?

A

Patient has a fever

86
Q

What does afebrile mean?

A

Patient has no fever

87
Q

Glasgow score of 12 to 15 does not require
what?

A

Admission to the ICU

88
Q

A score of 9-12 indicates what?

A

Moderate coma

89
Q

Glasgow coma score < 8-9 indicates?

A

Severe coma

90
Q

Glasgow coma scores < 8 requires what?

A

Intubation

91
Q

Physician will start a breathing test when there’s
no spontaneous breathing for how long?

A

8 to 10 minutes

92
Q

A positive apnea test will indicate if the ABG
results show what?

A

Increased CO2 above 20 torr of baseline OR
reaches level of 60 torr.

93
Q

What are some causes of hyponatremia?

A
  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
Q

what are some clinical symptoms of
hyponatremia?

A
  1. Muscle weakness
  2. Confusion
  3. More twitching progressing to convulsions
  4. Anxiety
  5. Alterations in levels of consciousness
95
Q

What are some causes of hypernatremia?

A
  1. Excessive water loss (sweating diarrhea)
  2. Renal failure
  3. In adequate water intake
  4. Mannitol diuresis
  5. Corticosteroid administration
96
Q

What are some clinical symptoms of
hypernatremia?

A
  1. Confusion
  2. CNS dysfunction
  3. Seizure activity
  4. Coma
97
Q

What are some causes of hypokalemia?

A
  1. Diuretic therapy
  2. Adrenocorticosteroid administration
  3. Vomiting diarrhea
  4. Burns
  5. Severe trauma
98
Q

What are some clinical symptoms of
hypokalemia?

A
  1. Muscle weakness
  2. Cardiac arrhythmias
  3. ST Segment depression on ECG
  4. Decreased GI tract motility resulting in
    abdominal distention
99
Q

What are some causes of hyperkalemia?

A
  1. Acidosis
  2. Renal insufficiency
  3. Tissue necrosis
  4. Hemorrhage
100
Q

What are some clinical symptoms of
hyperkalemia?

A
  1. Paralysis
  2. ECG abnormalities
  3. Cardiac arrhythmias
101
Q

What are some causes of hypochloremia?

A
  1. Vomiting, diarrhea
  2. Furosemide diuresis
102
Q

What are some clinical symptoms of
hypochloremia?

A
  1. muscle spasm
  2. Coma
103
Q

What are some causes of hyperchloremia?

A
  1. Respiratory alkalosis
  2. Metabolic acidosis
  3. Dehydration
  4. Administration of excessive amount of
    sodium chloride and potassium
104
Q

What are some clinical symptoms of
hyperchloremia?

A
  1. Headache
  2. Malaise
  3. Weakness
  4. Unconsciousness
  5. Coma
105
Q

What are some causes of hypocalcemia?

A
  1. Severe trauma
  2. Renal failure
  3. Severe pancreatitis
  4. Vitamin D deficiency
  5. Parathyroid hormone deficiency
106
Q

What are some clinical symptoms of
hypocalcemia?

A
  1. Muscle spasm
  2. Abdominal cramping
  3. Convulsions
  4. Prolonged QT interval on ECG
107
Q

What are some causes of hypercalcemia?

A
  1. Hyperthyroidism
  2. Vitamin A or intoxication
  3. Hyperparathyroidism
  4. Sarcoidosis
  5. Cancer metastasis in the bone
108
Q

What are some clinical symptoms of
hypercalcemia?

A
  1. Muscle weakness
  2. Fatigue
  3. Mental depression
  4. Anorexia
109
Q

What is the normal BUN level?

A

8 to 23 mg/dL

110
Q

What is the normal creatinine level?

A

0.7 to 1.3 mg/dL

111
Q

What is the normal glucose level?

A

Anything < 100 mg/dL

112
Q

What is normal platelet level?

A

150,000 to 400,000 mm³

113
Q

What is normal PT?

A

11 to 12.5 seconds

114
Q

What is normal PTT?

A

60 to 85 seconds

115
Q

With acute myocardial infarction, CK-MB
increases within hours after symptoms
first appear?

A

4-6

116
Q

The level peaks in 24 hours and returns to
normal in days.

A

2-3

117
Q

Myoglobin increases hours after the onset
of symptoms?

A

2-4

118
Q

Myoglobin reaches peak levels within
hours.

A

6-12

119
Q

Myoglobin returns to normal in hours?

A

24-36 hours

120
Q

BNP level > 500 pg/mL indicates what?

A

CHF

121
Q

Proteinuria is usually a sign of?

A

Kidney disease

122
Q

Glucosuria is commonly found in patients with?

A

Diabetes

123
Q

Ketonuria is found in patients with?

A

Starvation
Diabetes
alcohol intoxication

124
Q

Hematuria is found in patients with?

A

Renal & genitourinary disorders

125
Q

Normal urine output is?

A

30-40 mL/hr

RET 2934 (13 decks)

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