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PCM 1 Midterm > LRE > Flashcards

LRE Flashcards

1
Q

Normal adult breathing

A

quiet and regular at respiratory rate: 14-20/min

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2
Q

Hypopnea

A

· Shallow and slow breathing

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3
Q

Bradypnea

A

· regular rhythm but slower than normal rate (RR< 14/min)

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4
Q

Hyperpnea

A

deep and fast rate of breathing (normal in excerise)

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5
Q

Tachypnea

A

· rapid breathing

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6
Q

Dyspnea

A

· short of breath

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7
Q

Hypoxia

A

decreased in the amount of O2, going to the tissues.

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8
Q

Apnea

A

· no breathing

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9
Q

Atelectasis

A

lung tissue collapses and affects alveoli from absorbing O2

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10
Q

Pleximeter finger

A

· àhyperextended middle fiber of non-dominant hand in percussion

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11
Q

Plexor finger

A

· “tapping” finger on dominant hand used for percussion

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12
Q

Medial to lateral lines on front of body:

A

· Midsternal lineàmidclavicular lineàanterior axillary line

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13
Q

Lines on back of body

A

Vertebral lineàscapular line

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14
Q

· Needle thoracentesis (decompression) is performed at the where?

A

2ndintercostal space, above the 3rdrib at the midclavicular line for decompression of tension pneumothorax, followed by test tube placement.

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15
Q

Chest tube insertion

A

occurs at the 4thand 5thintercostal space, anterior to the mid-axillary line. In males, the 5thintercostal space is right below the nipple and inframammary fold in females.

  • Chest tube should be inserted over the superior margin of the rib to avoid the bundle because the neurovascular bundle runs inferior to each rib.
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16
Q

Hypoxemia·

A

· O2 deficiency in blood

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17
Q

pulse oximeter allows us to calculate what?

A

SpO2 (peripheral arterial O2 saturation)- 5th vital sign by comparing the amount the amounts of red and infrared light.

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18
Q

bad waveform of spo02 is d/t what? (4)

A

improper placement,

hypoperfusion,

hypothermia,

motion artifact

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19
Q

end tidal CO2 aka

A

PETCO2

normally 35-40 mmHg

PO2 normal is 35-45 mmHg

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20
Q

Incentive spirometer (IS): 4 steps

A
  1. Move the slider on the outside of the large column to the level you want to reach
  2. Sit or stand and hold it leveled in front of you
  3. Breathe out normally, then close your lips tightly around mouthpiece
  4. Take a slow, deep breath. Breathe in as deeply as you can. The ball inside the large column will move up. Try to move the piston or ball as high up as you can or to the level your doctor recommended. When you can’t breathe in anymore, hold your breath for 2 to 5 seconds.

* can help with atelectasis

21
Q

Pulmonary Fx Test (PFT)

A

non-invasive test to show how well lungs are working and used to dx certain lund disorders (obstructive vs restrictive)

Spirometry- technique used to measure lung fx by measuring amount of air inhaled and exhaled

22
Q

clubbing

A
  • swelling of terminal phalanx causing loss of normal angle
23
Q

shape of chest

A

thorax wider than deep,

lateral diameter > AP diameter

24
Q

(Asymmetrical expansion can indicate

A

pleural effusion

25
Q

Retraction can indicated

A

COPD

severese asthma

upper airway obstruction (stridor)

26
Q

Unilateral lagging of chest

A

pleural disease (asbestosis ,trauma, or phrenic nerve damage

27
Q

Retractions include

A

supraclavicular retractions, substernal retractions, intercostal retractions

28
Q

Accessory muscles

A

: scalenes, sternomastoids, intercostals, abdominal m. Used in asthma, COPD, airway obstruction, viral illness (RSV)

29
Q

Palpation :1. Tenderness 2. Abnormalities in the skin 3. Respiratory expansion: __________ 4. tactile fremitis

A

to do so, place the thumbs at the level of the 10thrib, loosely grasping the lateral rib cage. Ask patient to deeply inhale. Watch the distance between the thumbs as they move apart during inspiration and feel for the range and symmetry of the rib cage as it expands and contracts.

30
Q

-Tactile fremitis

A

palpable vibrations transmitted through the bronchopulmonary tree–>chest wall as the patient speaks. Use the balls of hand or ulnar surface on both sides to compare them at the same time. Do this on the anterior or posterior chest wall. Say 99 or 1-1-1.

  • Decreased or absent–> COPD, changes in pleura (effusion, fibrosis or air), tumor.
  • Increased–> pneumonia
31
Q

percussion

A

helps to determine if the underlying structures are air-filled, fluid or solid. Penetrates 5-7 cm, so cant detect deep lesions. Technique

32
Q

peruccsion technique

A
  1. Hyperextend the middle finger of non-dom hand and firmly touch the skin (do not let another part of hand touch bc it will dampen out vibration)àpleximeter finger
  2. Tell pt to cross hands in front of them to pull scapula laterally, away from where you are percussing.
  3. Strike the DIP with a quick, sharp BUT RELAXED wrist motion of the dominant middle finger > plexor finger
  4. Start superiorly and percuss both sides of the chest, going to the base in a ladder like pattern. Can be done on anterior or posterior chest
33
Q

5 percussion sounds

A
  1. flat
  2. dull (effusion or emphysema)
  3. resonant (normal lungs are resonant; loud intensity, low pitch and long duration)
  4. hyperresonant (pneumothorax)
  5. tympanic (abdominal)
34
Q

Auscultation

The most important techniques in assessing airflow is to:

A
  • -Listen to the sounds made when breathing
  • -Listen for adventitious (added) sounds
  • -If an abnormality is detected–> listen for vocal resonance.
  • -Difficulties: clothes, gowns, chest hair can sound like adventitious sounds. Thus, listen on bare skin.
35
Q

Lateral displacement of trachea can occur w (4)

A

pneumothorax

pleural effusion

atelectasis

mass

36
Q

lower margin of the endotracheal tube on a CXR

A

t4

37
Q

· _______ intercostal space is the landmark for thoracentesis (not depression)

A

7th

38
Q

Barrel chest (seen in COPD)

A

increased AP diameter, resembling a barrel.

AP diameter increases with aging, but can be normal in infancer

39
Q

Traumatic fail chest

A

flail chest can be d/t multiple rib fractures

when you breathe in, the injured area caves in. when you breathe out, it moves out (opposite of what should happen

40
Q

diaphragmatic excursion

A
  1. Get patient to exhale completely and hold it
  2. Percuss to find the diaphragm, which is the spot where the lung tissue and dullness of structures below the lung meet
  3. Mark with a pen
  4. Tell patient to breathe normally
  5. Inhale completely and hold it
  6. find the diaphragm using the same technique
  7. Distance between the two is the diaphragmatic excursion. Normal= 3- 5.5 cm.

If dullness is higher than expected–> pleural effusion or a high diaphragm d/t atelectasis or phrenic nerve paralysis.

41
Q

If dullness is higher than expected–>

A

pleural effusion or a

high diaphragm

d/t atelectasis or phrenic nerve paralysis.

42
Q

normal breath sounds

A
  1. vesicular
  2. bronchovesicular
  3. bronchial
  4. tracheal
43
Q

Adventitial breath sounds

A
  1. crackles (rales)- discontinous crackles, high pitched. Suggest pneumonia or bronchitis
  2. wheezing- continous and prolonged and high ptiched, sounds like music. Suggests asthma and bronchiti
  3. rhonchi- low pitched and snoring. Suggest secretions in airways
  4. stridor- high pitched wheeze during inspiration. Indicates and obstruction of the larynx and needs immediate ATN!
  5. pleural friction rub- inflamed pleura. sounds like creaking when you breathe out.
44
Q

Bronchophony

A

words become louder and clearer

normally; muffled and indistinct when auscultating

45
Q

Egophony

A

ee sounds like an A

normall; sounds like an E

46
Q

Whispered pectoriloquy

A

whisper is louder and clearer during auscultation

normally, faint and not distinct

47
Q
  1. Identify the mnemonic for reading a chest x-ray
A

· A- adequate-assessment of quality [PIER] and airway

  1. Position, inspiration (should see 10-11 ribs), exposure and rotation

· B- bones and soft tissue

· C- cardiac size, valves

  1. Normal should be less than 50% of chest diameter of PA films and < 60% on AP

· D-diaphragms

· E (4) -effusions/endotracheal tube/EKG leads/wires

· F- Fields and fissures & foreign body

· G- great vessels/gastric bubble

· H- hilar masses

· I- impression

48
Q

clubbing is d/t

A
  1. CHF
  2. Interstitial lung dz
  3. IBD
  4. Bronchiectasis

5. fibrosis

  1. cancer

PCM 1 Midterm (11 decks)

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