OXYGENATION Flashcards
[PHYSICAL EXAMINATION]
area: generalize
tongue: involved
hand: warm
clubbing: present
O2 application: pulmonary cause
application of warming: not improved
mechanism: diminution of oxygen saturation
crt: less than 2 seconds
CENTRAL CYANOSIS
[PHYSICAL EXAMINATION]
area: localize
tongue: not involve
hand: cold
clubbing: not present
O2 application: not improved
application of warming: improved
mechanism: diminution of blood flow
crt: more than 2 seconds
PERIPHERAL CYANOSIS
[ASSESSMENT FINDINGS]
- relaxed posture
- normal musculature
- rate 10-18 breaths per minute, regular
- no cyanosis or pallor
-anteroposterior diameter less than transverse diameter
INSPECTION
[ASSESSMENT FINDINGS]
- symmetric chest expansion
- tactile fremitus present and equal bilaterally
PALPATION
[ASSESSMENT FINDINGS]
- resonant
PERCUSSION
[ASSESSMENT FINDINGS]
- vesicular over peripheral fields
- bronchovesicular over sternum and between scapulae
- infant & child: bronchovesicular
- no adventitious sounds
AUSCULTATION
[NORMAL BREATH SOUNDS]
- soft
- low pitched
- over most lung fields
- inspiration > expiration
VESICULAR
[NORMAL BREATH SOUNDS]
- medium pitched
- over main bronchus and right posterior lung
- inspiration > expiration
BRONCHOVESICULAR
[NORMAL BREATH SOUNDS]
- loud
- high pitched
- over manubrium only
- expiration > inspiration (extended in asthma)
BRONCHIAL
[NORMAL BREATH SOUNDS]
- very loud
- high pitched
- over trachea only
- inspiration > expiration
TRACHEAL
[ADVENTITIOUS SOUNDS]
- discontinuous
- fine/medium/coarse
- not cleared by coughing
- heard more on inspiration
- heard in atelectasis
CRACKLES/RALES
[ADVENTITIOUS SOUNDS]
- continuous
- foghorn
- low-pitched
- cleared on coughing
RHONCHI
[ADVENTITIOUS SOUNDS]
- continuous
- tea kettle high pitch
- usually diffuse and bilateral
- heard diffusely in asthma
- unilateral: foreign body
WHEEZES
[ADVENTITIOUS SOUNDS]
- pleural sound: leather rubbing together
- caused by inflamed pleura
- come and go depending on amount of fluid in pleural space
RUB
- acute or chronic
- RESPIRATORY: bronchospasm, bronchitis, pneumonia, pulmonary embolism, pulmonary edema, pneumothorax, upper airway obstruction
- CARDIOVASCULAR: acute myocardial infarction, congestive heart failure, cardiac tamponade, water bottle appearance on CXR
DYSPNEA
- treat the cause
- oxygen
- pulmonary rehabilitation
- treat anxiety
DYSPNEA TREATMENT
cough that last less than 3 weeks
ACUTE COUGH
cough that last to 3-8 weeks
PERSISTENT COUGH
cough that last greater than 8 weeks
CHRONIC COUGH
CAUSES
- URI
- pneumonia
- aspiration
- pulmonary embolism
- pulmonary edema
FOR SMOKERS: usually low-grade chronic bronchitis
: increased intensity lung cancer
FOR NONSMOKERS:
- postnasal drip, asthma, GERD, or ACE inhibitors
COUGH
care for underlying cause elimination of irritants
COUGH TREATMENT
- expectoration of blood originating below the vocal cords
- usually comes from bronchial arteries
HEMOPTYSIS
- high-pitched whistling sound made while breathing
- often associated with DOB
- may occur during expiration or inspiration
WHEEZING
- occurs when blood flow to the heart is impaired, leading to oxygen deprivation in the heart muscle
CHEST PAIN: ANGINA
Possible characteristics: PSCTF
Pressure
Squeezing
Crushing
Tearing
Fullness
S/S
Tiredness
SOB
Light-headed
CHEST PAIN
[DIAGNOSTICS]
- non invasive
- shows how well the lungs are working
- measure lung volume, capacity, rates of flow, and gas exchange
- identifies obstructive vs restrictive
PULMONARY FUNCTION TEST (PFT)
[DIAGNOSTICS]
- measurement of blood pH, arterial oxygen, and carbon dioxide tensions
ARTERIAL BLOOD GAS ANALYSIS (ABG)
[DIAGNOSTICS]
- non invasive
- monitor the oxygen saturation of hemoglobin (O2 Saturation)
PULSE OXIMETRY
[DIAGNOSTICS]
- involves a sample of sputum to diagnose respiratory disease, identify organism and abnormal cells
SPUTUM ANALYSIS
SPUTUM CULTURE
- expectorated from the trachea, bronchi, and/or lungs through the mouth
SPUTUM
SPUTUM CULTURE
- suctioned sputum from an endotracheal or tracheostomy tube
ENDOTRACHEAL
SPUTUM CULTURE
- wash collected from an area of the lung during a bronchoscopy
BRONCHOALVEOLAR LAVAGE
When to culture?
- never, almost always viral
BRONCHITIS
When to culture?
- must ask for different culture medium when suspecting anaerobes, atypicals, pertussis, fungi
PNEUMONIA
[STAINS]
- too many squamous epithelial cells are indicative of oral mucosal contamination
GRAM STAIN
Gram stain:
- indicative of infection
NUMEROUS NEUTROPHILS
Gram stain:
- common in fungal, acid-fast, and other atypical bacterial infections
MACROPHAGES
Gram stain:
- indicate allergic reaction or parasitic infection
EOSINOPHILS
Gram stain:
- indicate direct attack (antibodies and lysosomes) of inhaled bacteria
MUCUS STRANDS
[STAINS]
- special stain to look for Mycobacterium
- low sensitivity, positive result = treatment
ACID FAST STAIN
[DIAGNOSTICS]
- guided by bronchoscopy or CT
- small pneumothorax always occurs as a result
LUNG BIOPSY
[DIAGNOSTICS]
- is injected beneath the skin
TUBERCULIN SKIN TESTING
Mantoux tuberculin skin test (PPD)
- will be negative but will stimulate memory T-cells
FIRST PPD
Mantoux tuberculin skin testing:
- the results will be positive
SECOND PPD
[IMAGING STUDIES]
- indications: CXR abnormality, lung tumor, mediastinal mass, aortic injury
When to use contrast:
- not usually needed for pulmonary imaging
COMPUTED TOMOGRAPHY
[IMAGING STUDIES]
- examines air flow and blood flow
- less radiation than CT
- involves inhalation and venous injection of a radiotracer
- detects areas of the lung that are being perfused
VENTILATION-PERFUSION SCANS (VQ SCANS)
[IMAGING STUDIES]
- can be diagnostic or therapeutic
- drain is promptly removed if there is no purulent fluid draining
- pleural fluid aspiration for obtaining a specimen
THORACENTESIS
[IMAGING STUDIES]
- uses powerful magnetic fields and radio waves to create pictures of the chest
- does not use radiation
MAGNETIC RESONANCE IMAGING
[IMAGING STUDIES]
- uses x-rays to visualize how lungs are working
- uses more radiation than a standard chest x-ray
CHEST FLOUROSCOPY
[IMAGING STUDIES]
- used to look at the air passages with a small camera
- used to determine location of pathologic lesions
BRONCHOSCOPY
- often used when referring to symptoms of an upper respiratory tract infection by nasal congestion, sore throat, and cough
VIRAL RHINITIS OR COMMON COLD
- referred to a febrile, infectious, acute inflammation of the mucus membrane of the nasal cavity
COLDS
- inflammation and irritation of the mucus membranes of the nose
RHINITIS
RHINITIS MEDICAL MANAGEMENT
- treatment of the cause = antibiotics
- decongestant
- antihistamine
- severe: corticosteroids
- inflammation of sinuses
SINUSITIS
Sinusitis Medical Management
- anti microbial agent: amoxicillin
- heated mist or saline irrigation
- inflammation of the sinuses that persists for more than 8 weeks in adult
- 2 weeks in children
Clinical Manifestations:
- facial pain
- impaired mucocilliary clearance and ventilation
- chronic hoarseness and cough
- chronic headache
CHRONIC SINUSITIS
- sudden inflammation of the pharynx
- febrile inflammation of throat
- lasts up to 3 to 10 days
Clinical Manifestations:
- fiery red pharngeal membrane and tonsils
- fever and malaise
- sore throat, hoarseness and cough
ACUTE PHARYNGITIS
Acute Pharyngitis Medical Treatment
- antibiotics: cephalosporin
- analgesic for severe sore and antitussive medicstions
- nutritional: liquid/soft diet
- persistent inflammation of the pharynx
- common in adults who work or live in dusty surrounding, use voice too much, suffer from chronic cough and habitually use alcohol and tobacco
CHRONIC PHARYNGITIS
- infection of tonsils
Clinical Manifestations
- sore throat, fever, snoring
- difficulty of swallowing
TONSILLITIS
Tonsillitis Medical Management
- for recurrent tonsillitis: tonsillectomy
- antimicrobial therapy: penicillin/7 days
- inflammation of larynx
- often occur as a result of voice abuse or exposure to dust, chemicals, smoke, and other pollutants
- cause of infection is almost viral
LARYNGITIS
