CR Ax

Question 1

What questions need to be asked in patient presenting with a cough?

Answer 1

If the cough is productive, see below:

i) colour (pink, brown, red hemoptysis, yellow, green, white/clear)
ii) quantity (cups or spoonfuls)
iii) smell
iv) viscosity

Question 2

How is dyspnea measured in an Ax?

Answer 2

Borg Scale for Perceived Breathlessness (0-10).

Question 3

State the normal ranges for ABGs.

Answer 3

pH = 7.35-7.45
HCO3 = 22-26 mEq
pCO2 = 35-45mmHg
pO2 = 80-100mmHg

Question 4

Dx:
pH = 7.32
pCO2 = 10mmHg
HCO3 = 15mEq

Answer 4

Partially compensated metabolic acidosis.

Question 5

Dx:
pH = 7.36
pCO2 = 20mmHg
HCO3 = 15mEq

Answer 5

Compensated metabolic acidosis.

Question 6

List things to note on inspection.

Answer 6

i) lines (HR, RR, BP, SpO2)
ii) facial expression/nasal flaring/diaphoresis
iii) cyanosis (mouth and extremities)
iv) jugular vein distension
v) accessory muscle use
vi) paradoxical breathing
vii) apical/chest/diaphragmatic
viii) chest (barrel? xiphoid?)
ix) clubbing
x) edema

Question 7

Describe the process of Ax chest expansion.

Answer 7

i) Ask pt to inhale deeply
ii) Feel for symmetry
iii) Front and back of each lobe X 2

Question 8

Describe the process of Ax tactile fremitus.

Answer 8

i) Ask pt to say “1, 2, 3” or “99”
ii) Use hypothenar eminence to feel for vibration
iii) Per each segment X2

Question 9

Describe the changes that may be noted when palpating for tracheal position.

Answer 9

Will move toward areas of low pressure (ex. atelectasis, collapse) and will move away from areas of high pressure (ex. pneumothorax, pleural effusion etc.).

Question 10

How long should you Ax RR for?

Answer 10

30s min.

Question 11

List three factors that affect ABGs?

Answer 11

i) alveolar ventilation
ii) V/Q matching
iii) FiO2

Question 12

Describe the process of Ax percussion.

Answer 12

i) Tap distal phalanx of non-dominant hand w/ dominant hand
ii) go between intercostal spaces
iii) listen for dull, resonant, or hyper-resonant.
iv) apex to base

Question 13

At which rib level does the diaphragm normally lie?

Answer 13

Expiration: R 5th rib, L 5th intercostal space

excursion affected by lower lobe pneumos or phrenic nerve damage

Question 14

Describe the process of Ax breath sounds.

Answer 14

i) Ask pt to take deep breaths.
ii) Auscultate over every lung segment ideally - at LEAST over every lobe (6 spots in front, 11 in back) (11 front, 14 back).
iii) At least two breaths per segment
iv) describe as vesicular if normal, vBS if decreased, or BBS over _ lobe.

Question 15

Describe a bronchial breath sound.

Answer 15

I:E, louder. Indicates density in the area.

Question 16

List the possible adventitia sounds and what they mean.

Answer 16

i) high pitch wheeze: bronchospasm
ii) low pitch wheeze: upper airway secretions
iii) coarse crackles: lower airway secretions or pulmonary edema
iv) fine crackles: atelectasis
v) stridor: upper airway obstruction
vi) pleural rub: pleural effusion
vii) crunches: subcutaneous emphysema

Question 17

Describe the process of Ax vocal sounds and what potential findings mean.

Answer 17

i) Whispered pectoriloquy: pt whispers “1,2,3”. If audible/transmits well, sign of density
ii) egohany: pt says “e”, if sounds like “a”, sign of density.
iii) broncophany: pt says “1,2,3”, if louder on one side then density, if quieter one side then block in pleural space.

Question 18

List the average length of time for ABG compensation of the respiratory and renal system.

Answer 18

i) Buffer - 4-5 hours
ii) respiratory: min - hours
iii) renal: 1-5 days (longer = max effect)

Question 19

What are the average sodium levels and important considerations?

Answer 19

135-145 mmol/L.

i) hyponatremia: confusion, dizzy, hypotension, syncope
ii) hypernatremia: dehydration, pulmonary edema, HTN

Question 20

What are the average potassium levels and important considerations?

Answer 20

3. 5-5.0 mmol/L.
   i) hyperkalemic: chance of MI w/ v-fib
   ii) hypokalemic: weakness, depression, nausea, vomiting confusion, alkalosis

Question 21

What are the average calcium levels and important considerations?

Answer 21

2. 1-2.6 mmol/L.
   i) more: shortened QT segment
   ii) less: longer QT segment

Question 22

What are the average magnesium levels and important considerations?

Answer 22

0. 7-1.2 mmol/L
   i) more: nausea, vomiting, weakness
   ii) less: cramps, overactive reflexes, tremors

Question 23

What are the average glucose levels and important considerations?

Answer 23

3.8-6.9 okay. 3.8-5.5 is average.

Question 24

What are the average albumin levels and important considerations?

Answer 24

35-55 g/L.

i) more: dehydration
ii) less: malnutrition, kidney/liver disease

Question 25

What are the average Hb levels and important considerations?

Answer 25

135-180 g/L. 120-160 for females.

i) more:
ii) less: anemia

Question 26

What are the average RBC levels and important considerations?

Answer 26

4.3 - 5.9 X1012/L.

Question 27

What are the average platelet levels and important considerations?

Answer 27

150,000-400,000 platelets/ microL.
Thrombocytopenia is lower. Thrombocytosis is higher.
INR is how fast it clots and 0.8-1.3 is normal

Question 28

What are the average WBC levels and important considerations?

Answer 28

4000-11,000 per microL.

Question 29

What are the average hematocrit levels and important considerations?

Answer 29

45-52% men, 38%-45% women.