Midterm 1 Flashcards
What is the normal temperature in an adult
36.5-37.5
What is the normal heart rate in an adult
60-100
What heart rate is tachycardia
> 100
What heart rate is bradycardia
<60
Where do you measure pulse
Right radial artery
Where do you measure pulse in a hypotension patient
Central pulse. Carotid, femoral.
What arrhythmia is unfavourable
irregularly irregular
What is Bigeminy
rhythm coupled in pairs
What is trigeminy
rhythm coupled in threes
Pulse grade
4+: Bounding 3+: Increased 2+: Brisk 1+: Diminshed 0: Absent
What is Tachypnea
Rate above normal
What is Bradypnea
Rate below normal (uncommon)
What is Hyperpnea
Minute volume increased (uncommon)
What is Hypopnea
Minute volume decreased
Stages of Patient Clinician Interaction
- Chart review stage
- Introductory stage
- Initial Assessment stage
- Treatment and monitoring stage
- Follow-up stage
Social Space
4-12 ft from patient
Personal Space
2-4 ft from patient
Intimate Space
0-2 ft from patient
Expressing Genuine Concern
Face patient squarely Use eye contact appropriately Maintain an open posture Consider an appropriate use of touch Be an active listener
Pulsus Alternan
Alternating between strong and weak beats.
Standard Safety Precautions
Hand hygiene, gloves, gown, face masks, eye protections, patient care equipment, needles and sharps, patient resuscitation devices
Chief Complaint
The reason a patient is seeking medical care
Symptoms associated with lung disease
cough, dyspnea, chest pain, and wheezing
History of present illness
Narrative description of each symptom described in the chief complaint
Symptoms in HPI reviewed for
Onset, location, severity, quantity, quality, duration, course, aggravating factors, and alleviating factors
PQRST mnemonic
P: Provocative/palliative: What causes it? What makes it better? What makes it worse?
Q: quality/quantity: How much is involved? How does it look/feel/sound?
R: region/radiation: Where is it? Does it spread?
S: severity scale: Does it interfere with activities? (scale of 1-10)
T: timing: When did it begin? How often does it occur? Is it sudden or gradual?
What is included in the past history
Illness, surgeries, accidents, allergies, medications, habits, general health
What is SAMPLE?
To remember important questions S: symptoms A: allergies M: Medications P: Past history L: Last meal E: Events leading up to the problem
Some diseases with hereditary link
asthma, lung cancer, cystic fibrosis, emphysema, and sleep apnea
What is the admission note
Written by attending physician. Important facts related to the patient’s admission.
What are physicians orders
written by physician. List of treatments, therapies, and monitoring techniques
What are progress notes
Written by physicians and other health care providers each day. Shows patient’ response to treatment.
What are signs vs. symptoms
Signs: Objective
Symptoms: Subjective
Primary symptoms of cardiopulmonary disorders
Cough, sputum production, hemoptysis, SOB, chest pain
Cough nervous system pathways
Afferent: Vagus, glassopharyngeal, trigeminal
Efferent: smooth muscles of larynx and tracheobronchial tree via phrenic and spinal nerves
Phases of cough
inspiratory
compression
expiratory
Types of cough
Acute: sudden, severe and short course
Chronic: Persistent, >3 weeks
Paroxysmal: Periodic, prolonged, forceful episodes
Associated symptoms of cough
wheezing, stridor, chest pain, dyspnea.
Black Sputum
smoke or coal dust inhalation
Brownish sputum
Cigarette smoker
Frothy white or pink sputum
pulmonary edema
Sand or small stone in sputum
Aspiration of foreign material, broncholithiasis
Purulent sputum
infection
Apple green, thick sputum
Haemophilus influenzae
Pink, thin, blood streak sputum
Streptococci and staphylococci
Red currant jelly sputum
Klebsiella species
Rusty
Pneumococci
Yellow or green, copious sputum
Pseudomonas species pneumonia, advanced
Foul odor sputum
lung abscess, aspiration, anaerobic infection, bronchiectasis
Mucoid sputum
Emphysema, pulmonary tuberculosis, early chronic bronchitis, neoplasms, asthma
Grayish Sputum
Legionnaires
Silicone like casts
Bronchial asthma
Mucopurulent sputum
as above with infection, pneumonia, cystic fibrosis
Blood streaked or hemoptysis
Bronchogenic carcinoma, tuberculosis, chronic bronchitis, coagulopathy, pulmonary contusion or abscess.
Causes of hemoptysis
Bronchopulonary, cardiovascular, hematologic, or systemic disorders
Tuberculosis or fungal infections.
What constitutes massive hemoptysis
400 ml/3h or 600 ml/24hr
What is hematemesis
Vomiting blood.
Cardinal symptom of cardiac disease
Shortness of breath
What is Dyspnea
Subjective experience of breathing discomfort
How do you score dyspnea
Modified borg scale- subjective
ATS SOB scale- objective
Clinical types of dypnea
Cardiac and circulatory: primarily during exercise.
Psychogenic: Panic disorder
Hyperventilation: rate, depth exceed body’s metabolic need. Results in decreased cerebral blood flow.
Causes of dyspnea
WOB abnormally high for given level of exertion: asthma, pneumonia
Ventilatory capacity is reduced: neuromuscular disease
Drive to breathe is elevated: hypoxemia, acidosis, exercise
What is dependent edema?
Abnormal accumulation of fluid. Same as peripheral edema.
When would there be a pulmonary disease without fever?
high dose corticosteroids
immunosupressants
immunocompromised (leukemia, AIDS)
What pulmonary infections would cause fever?
Lung abscess, empyema, tuberculosis, pneumonia
What is remittent fever? What infections are associated with it?
It is a fever that remains above baseline throughout the day despite having a rise and fall.
Mycoplasma pneumonia, legionnaires disease, acute viral infections
Headache and lung disease
Cerebral hypoxia and hypercapnia
Altered mental state and lung disease
hypercapnia can affect alertness to coma
Incidences of OSA/SDB
10-12% in children
10-30% in adults
Explain the complex presentation of CHF
see diagram
What are vital signs used to do?
Determine the general status of the patient
Establish a baseline
monitor response to therapy
Observe for trends
Determine the need for further evaluation or intervention
What are the four vital signs?
Temperature, pulse, respirations, bp
How often to take vitals?
On admission, at beginning of each shift, before and after procedure, any time patient condition changes, based on protocol or physicians orders, as often as necessary for patient safety
General clinical impression
information about personality, hygiene, culture and reaction to illness
What temperature indicates infection
> 39
Normal pulse pressure
35-45 mmHg
Poor peripheral perfusion occurs at what pulse pressure
<30 mmHg
Hypertension
> 140/90
Hypotension
<90/60
In what phase would an auscultatory gap occur?
II or III
systolic pressure decrease on inspiration
normal: 2-4 mmHg
Pulsus Paradoxus: >10 mmHg drop
