Patient Assesment Flashcards
1
Q
What are the four critical life functions?
A
Ventilation
oxygenation
circulation
perfusion.
2
Q
What is ventilation?
A
Ventilation is moving air in and out of the lungs.
3
Q
What is oxygenation?
A
Oxygenation is getting oxygen into the blood.
4
Q
What is circulation?
A
Circulation is moving the blood through the body.
5
Q
What is perfusion?
A
Perfusion is getting oxygen into the tissue.
6
Q
What assessments will determine how well a patient is ventilating, six things
A
Respiratory rate
tidal volume 
chest movement
breath sounds
PaCO2
EtCO2
7
Q
How would the therapist determine if a patient has a problem with oxygenation?
A
Heart rate
color
sensorium
PaO2
SPO2
8
Q
How do we measure circulation what are the three vital signs?
A
Heart rate
strength
cardiac output
9
Q
How do we measure perfusion, what are the five vital signs?
A
Blood pressure
sensorium
temperature
urine output
hemodynamics dynamics
10
Q
When you have an emergency what are the four priorities list them in order?
A
First priority ventilation
oxygenation
circulation
perfusion
11
Q
What is the most common problem out of the four life functions?
A
Oxygenation
12
Q
Patient chart review
What are the five things needed and patience admission notes?
A
Admitting diagnosis
history of present illness
chief complaints
past medical history
current medical history
13
Q
Patient chart review
What are signs?
A
objective information, Things you can see or measure (example color cause edema blood pressure etc.)
14
Q
Patient chart review
What are symptoms give some example?
A
Subjective information things the patient must tell you (example dyspnea nausea muscle weakness)
15
Q
What are the nine things included in patient chart review?
A
Admission notes 
signs and symptoms
occupation employment history or hobbies
allergies or allergic reaction
prior surgery Illness injury
vital signs
physical Examination
tobacco use
advance directive
16
Q
Calculation for Pack yours ?
A
of packs/day x # of years smoked.
17
Q
What is the definition for advance directive?
A
Set of instructions documenting what treatment a patient would want if he or she was unable to make medical decisions.
18
Q
List and describe the four types of advance directives?
A
DNR do not resuscitate
DNI do not intubate
LivingWell
Durable power of attorney
19
Q
What is a living will define it?
A
Describes treatment patient would want if he or she became Terminally ill.
20
Q
What are the four things that have to be included in a Respiratory order?
A
Type of treatment
frequency
medicadosage
physician signature
21
Q
What are the four type patient laboratory reports?
A
ABG
Pulmonary function testing
imaging reports
basic lab assessments
22
Q
What is normal urine output?
A
40 mL per hour approximately 1 L per day
23
Q
What is sensible water loss?
A
Urine 
vomiting
24
Q
What is insensible water loss?
A
Lungs and skin
25
What findings might indicate that patient’s food intake has exceeded his urine output?
Weight gain
Electrolyte imbalance
increased hemodynamic pressure decrease lung compliance (stiff Lung)
26
What is normal Central venous pressure (CVP)
2-6 mm Hg
27
What does decrease central venous pressure CVP indicate?
Hypovolemia (recommended fluid therapy)
28
Changes in Value you can indicate hypovolemia?
Increase CVP recommended fluid therapy
29
 what are the six activities of daily living ADL
Dating
eating
dressing
toilet use
transferring
urine and bowl continents
30
ADL are evaluating using what system?
Katz scoring system
31
Orthopnea
Difficulty breathing except in a preposition example CHF
32
General malaise
Rundown feeling, nausea, weakness, fatigue, headache, example (electrolyte in balance)
33
Dyspnea
SOB, difficulty breathing
34
Dysphagia
Difficulty swallowing and hoarseness
35
What are the four factors to consider when conducting a patient interview?
1. Asking open ended question
2. Communicate using simple language(Kiss method)
3. Utilize picture, diagram
4. Begin to identify patient major problems
36
Define patient learning Needs?
1. Process of influencing patient behavior and producing the change and knowledge attitude and skills necessary to maintain or improve Health.
2. Assessment of patient and family learning needs to determine what learning needs to occur and how the learning can best occur.
37
What criteria is a patient’s ability to learn based on?
1. cultural and religious value
2. Emotional barriers
3. Desire and motivation to learn
4. Physical and cognitive limitations
5. Language barriers
6. age and educational level
38
What criteria is a patient’s nutritional status based on?
1. usual food intake
2. Food likes and dislikes
3. Appetite
39
Peripheral edema And pathology associated with and recommend a therapy?
Excess fluid and tissue mostly in arms and ankles
Pathology CHF
Recommended Therapy diuretics
40
Ascities Definition?
Pathology associated with it?
Accumulation of fluid an abdomen
Liver failure
41
Clubbing and pathology associated with it?
Angle of fingers and nail beds increased
Pathology chronic hypoxemia, suggesting pulmonary disease
42
venous distention pathology associated with it?
CHF, Syndrome exhalation in patient with obstructive lung disease
43
Capillary refill?
Indication of peripheral circulation
44
Diaphoresis and pathology associated with it?
Heavy sweating
Pathology,
heart failure, Fever infection
45
Ashen, Pallor indication?
Decrease in color, indicates anemia, blood loss
46
Erythema definition and indication?
Redness in skin
Indicates capillary congestion inflammation or infection
47
Cyanosis definition and indication?
Blue or blue gray and color indicates hypoxia reduced hemoglobin
48
Chess configuration
Kyphosis
Leaning forward, convex curvature
49
Scoliosis
Lean side to side, lateral Carracher of the spine
50
Barrel chest
Air trapped in lung for long period of time
COPD
Increase in AP diameter
51
Describe symmetrical chess movement
Bilateral equal chest rise and fall doing breathing
52
List five underlining pathologies that can contribute to a patient displaying asymmetrical chest movement
Post Long resection, post pneumonectomy
Atelectasis-Forward
Pneomthorax-Away
Flail chest-Paradoxical chess movement
Endotracheal tube insertion in right or left main stem bronchi

53
Eupnea
Normal respiratory rate, depth and Rhythm
54
Tachypnea
Increased respiratory rate greater than 20 breaths per minute
Condition
Hypoxia, fever, pain, CNS problem
55
Bradypnea
Decrease woke up breathing less than 12 breaths per minute
Condition
Sleep, drive, alcohol, metabolic disorder
56
Cheyenne-strokes 
Gradual increase then decrease of breathing with 60 seconds of apnea lasting 30 to 180 seconds
Condition
Increased intracranial pressure
Brainstem injury
Drug overdose
57
Kussmaul’s breathing
Increase respiratory rate and depth with a regular rhythm
Condition
Metabolic acidosis
Renal failure
Diabetic keto acidosis
58
What causes hypertrophy of the accessory muscles what type of patient might this be present in?
Increase in muscle size
COPD
59
Wasting away of muscle is also referred to as?
Atrophy
Cachexia
60
Describe the four neck pathologies the might complicate endotracheal intubation?
Short receding mandible
Enlarged tongue
Bulk neck
Limited range of motion of the neck
61
What is the normal range for a patient’s heart rate?
60 through 100 per minute
62
What times would be used to describe a heart rate of 160 per minute? What would this indicate? Recommendation?
Tachycardia
This would indicate
Hypoxemia, anxiety, stress
Recommendation
Oxygen therapy
63
What terms would be used to describe a pulse of 52 per minute? What would this indicate? Recommended therapy?
Bradycardias
Indicates
Heart failure, stroke, code/Emergency
Recommendation
Atropine
64
What is and what does paradoxical pulse/pulsus Paradoxus indicate?
Change in heart rate and blood pressure with every breath
Indicate
Severe air trapping,status asthmaticus, Tension pneumothorax, cardiac tamponade

65
Tracheal deviation pool to abnormal side(Towards pathology)?
A. Pulmonary atelectasis
B. Pulmonary fibrosis
C. Pneumonectomy
D. Diaphragmatic paralysis
66
Tracheal deviation push to normal side(Away from pathology)
A. massive plural effusion
B. Tension pneumothorax
C. Neck or thyroid tumor
D. Large mediastinal mass
67
What is tactile fremitus?
Vibration that has felt by the hand on the chest wall.
68
What is meant by tenderness?
Any place of body that has incision, chest tube, bruises, fractured bone, burns
69
What is meant by crepitus and what condition is associated with?
Bubble under skin
Indicates subcutaneous emphysema
70
Define resonant?
Normal air filled long (Gives Hollow sound)
71
Define flat?
Normal heard over sternum
72
Define dull?
Hurd over fluid filled organ
Ex: Heart, liver
Or
Plural effusion, pneumonia
73
Define tympanic?
Normally hurt over air filled stomach
Drums like sound
Indicates volume when heard over the lung
74
Define hyperresonant
Booming sound
Pneumothorax
Emphysema
75
What is the difference between vascular and adventitious breath sounds?
Vascular breath sounds: Normal breath sounds
Adventitious breath sounds: Abnormal breath sounds
76
What is Kopany and what does it indicate?
Says E but sounds like A
Indicates consolidation
77
What breath sounds would be expected in a patient with pulmonary edema?
CHF/pulmonary edema
78
Grade one dyspnea?
Dyspnea occurs after unusual exertion
79
Grade 2 dyspnea?
Breathless, after going uphill or stairs.
80
Grade 3 dyspnea?
Dyspnea while walking and normal speed.
81
Create four dyspnea?
Dyspnea slowly walking short distance.
82
Grade 5 dyspnea?
Dyspnea at Rust, shaving dressing, etc.
83
What is patience, ability to learn based on?
Cultural and religious values
Emotional barriers
Desire, motivation to learn
Physical and cognitive limitations
Language barriers
Age and education level
84
What are the five preferred learning styles?
Visual
Auditory
Hands-on
Lecture
Discussion
85
What are the four patient/family history?
History of present illness
Past medical history
Family history
Social history
86
What does general appearance include in physical assessment of patient?
Age, height, weight, nourishment, etc.
87
What are the two types of edema?
Peripheral edema, ascities
88
How does peripheral edema present itself?
1 presence of excessive fluid in the tissue known as pitting edema
2 occurs primarily in arms and ankle
3 it is caused by either heart failure or renal failure
4 rated as +1 +2 +3
89
What is the recommend therapy for peripheral edema?
Diuretic therapy
90
What is ascites?
Accumulation of fluid in the abdomen generally caused by liver failure
91
What causes clubbing of fingers?
Caused by chronic hypoxia. Presence suggest pulmonary disease.
92
What causes jugular vein distention?
1 Venus distention
2 occurs with congestive heart failure
3 seen during exhalation in patients with obstructive lung disease
93
What are the four reasons the patient will become diaphoretic
1 heart failure
2 fever infection
3 anxiety, nervousness
4 tuberculosis
94
What is normal skin color?
Pink, tan, brown, black
95
Well would cause a patient skin color to be abnormal?
Anemia or acute blood loss
96
What causes a person skin color to become jaundice?
Increased bilirubin levels in blood and tissue
97
What causes a person skin color to become Erythema?
Redness in the skin. Due to capillary congestion, inflammation or infection.
98
What causes her skin color to become cyanosis?
Blue or blue gray appearance
Caused by hypoxia from increase amount of reduced hemoglobin
99
What is practice Carinatum?
Anterior protrusion of the sternum
100
What is pectus Excavatum?
Depression of part of or the entire sternum
101
What is kyphosis?
Convex curvature of the spine (lean forward)
102
What is scoliosis?
Lateral curvature of the spine (lean side to side like an S)
103
What is Kyphoscoliosis and what does it cause?
Combination of kyphosis and scoliosis that causes a restrictive pattern(reduce lung volume)
104
What is barrel chest, what causes it, and what does it do to the A-P diameter of the chest?
Resolved of air trapping in the lung for long period of time
Usually do too chronic obstructive pulmonary disease (COPD)
Increases A-P diameter
105
What is symmetrical chest movement?
On both side of the chest, move and equal distance at the same time
106
What is asymmetrical chest movement?
When the chest does not move at an equal distance at the same time
107
What are the five things that might cause asymmetrical chest movement
1 post, lung resection, post pneumonectomy
2 atelectasis
3 pneumothorax
4 fail chest
5 endotracheal tube insertion in right or left main stem bronchi
108
What is Eupnea breathing pattern?
Normal respiratory rate, depth and rhythm between 12 to 20
109
What is Tachypnea breathing pattern?
Increase respiratory rate greater than 20 bpm
110
What causes tachypnea?
Hypoxia, fever, pain, CNS problem
111
What causes bradypnea(oligopnea)?
Decrease respiratory rate less than 12
Caused by sleep, drugs, alcohol, metabolic disorder
112
Define apnea?
Stop breathing
113
Define hyperpnea?
What are its causes?
Increase respiratory rate, increase depths with regular rhythm
Cause metabolic disorder/CNS disorder.
114
Define CHEYNE – STOKES, and it causes?
Gradual increasing and decreasing rates and depth in a cycle lasting between 30 to 180 seconds with periods of apnea testing up to 60 seconds
Cause : increase cranial pressure, brain stem injury, drug overdose
115
Define BIOT’s and cause?
Increase respiratory rate and depth with an irregular periods of apnea. Each bread has same depth.
Cause : CNS problems
116
Define Kussmaul’s, cause?
Increase respiratory rate increase steps, irregular rhythm, breathing sounds labored
Cause : metabolic acidosis, renal failure, diabetic ketoacidosis.
117
Define APNEUSTIC, and cause?
Prolong, gasping inspiration, followed by extremely short, insufficient expiration.
Cause : problem with respiratory center, trauma, or tumor.
118
What are the three normal muscles of ventilation?
1 diaphragm
2 external intercoastal
3 exhalation is normally passive
119
What are the accessory muscles of ventilation?
1 internal intercoastal,scalene, sternocleidomastoid, pectoralis major
2 abdominal muscle(oblique, rectus abdominis, etc.)
120
Define hypertrophy?
Increase a muscle size occurs with COPD patients
121
Define atrophy?
Muscle wasting
122
What causes nasal?
Sign of respiratory distress and infants
123
What does a dry or nonproductive cough indicate?
Tumor in the lungs
124
What does a productive cough indicate?
Infection or chronic lung disease
125
What are four external evidence of difficult airway?
1 short, receding, mandible
2 enlarged tongue(macroglossia)
3 bulk neck
4 limited range of motion of the neck
126
What is normal heart rate?
What is tachycardia rate?
What is bradycardia rate?
Normal 60 to 100
Tachycardia greater than 100
Bradycardia less than 60
127
What does tachycardia indicate and what is recommended therapy?
Indicates hypoxemia, anxiety, stress
Recommendation oxygen therapy
128
What does bradycardia indicate What are our recommendations?
Indicate heart failure, shock, emergency
Recommendation atropine
129
What is paradoxical pulse/pulsus paradoxus?
Pulse/blood pressure varies with respiration, may indicate severe air trapping(status, asthmatics, tension pneumothorax, cardiac tamponade.
130
How do you determine tracheal position?
Palpation, place index finger in supra-sternal notch compare the space between the left clavicle and the left and border of the trachea.
131
What causes trachea to pull to abnormal side(towards pathology)?
Pulmonary atelectasis
Pulmonary fibrosis
pneumonectomy
Diaphragmatic Paralysis
132
What causes trachea to be pushed to normal side(away from pathology)?
Massive plural effusion
Tension thorax
Neck or thyroid tumor
Large medicinal mass
133
Define tactile fremitus?
Vibration felt by hand on chest wall
134
Vocal fremitus definition?
Voice vibration on the wall
135
Plural rub frimitus ?
A grating sensation felt on chest wall due to roughened plural surfaces, rubbing together
136
What is rhonchal fremitus (palpable Ronchi)?
Secretions in the airway
137
What is crepitus and what does it indicate?
Crepitus is bubble or air under the skin that can be palpitated, indicates presence of subcutaneous emphysema.
138
How is percussion performed?
Placing middle finger between two ribs and tapping middle finger first joint with the middle finger tip of your opposite hand.
139
When is resonant heard doing percussion?
normal air filled lungs
Gives a hollow sound
140
When is flat sound heard during percussion?
Over the sternum
muscle
areas of atelectasis
141
When is a dull sound heard during percussion?
Normally heard over fluid filled organs such as heart or liver
Plural effusion
Pneumonia will also cause a thudding sound
142
When is the tympanic sound heard during percussion?
Normally heard over airfield stomach
Don’t like sound and indicates increase the volume when heard over the lungs
143
When a hyperresident sound heard during percussion?
Booming sound heard in areas of the line where there is
Pneumothorax
Emphysema
144
What are normal breath sounds during auscultation?
Vesicular
145
When are bronchial breath sounds heard drawing auscultation?
Heard over trachea or bronchi, over the lung periphery indicates lung consolidation.
146
Define egophony?
Patient says E and it sounds like A
Indicates consolidation of lung tissue (pneumonia like condition).
147
Course crackles indicates (Ronchi that clears with a cough)?
Large airway secretion
Recommendation suction patient or encourage cough
148
Medium crackles indicate what and recommendation?
Middle airway secretion
Recommend bronchial hygiene
149
Find crackles indicate what during auscultation ?
Fluid in the Avioli
Recommend oxygen
Positive pressure therapy
Positive inotropic agents
Diuretics
150
Most common cause of wheezing and recommendation?
Caused by bronchial spasm
Recommended therapy bronco dilator therapy 
151
Most common cause of stridor and specific treatments ?
Upper airway Obstruction
Treatment : Topical decongestant(recemic epinephrine)
Suctioning/bronchoscopy foreign body aspiration
Intubation for severe swelling and epiglottitis

152
Superaglottic swelling?
Epiglottitis
153
Subglottic swelling?
Croup, post extubation
154
What is plural fiction rub, what is it associated with, and what are some recommendations for treatments?
Course grading, raspy or crunchy sound
Inflamed surface of vascular and partial pleural rubbing together
Associated with pleurisy, pulmonary infraction, cancer
Recommended treatment, steroid and antibiotics
155
What is the first heart sound(s1) created by?
Closure of the material and tricuspid valve at the beginning of ventricular contraction
156
When does the second heart sound(s2) occur?
Systole ends, ventricles, relax, and the pulmonic and aortic valves close
157
What does S3 heart sound indicate?
Heart failure
158
What does S4 heart sound indicate?
Uncontrolled hypertension or aortic stenosis
159
What are heart murmur sounds caused by?
Turbulent blood flow
Heart valve defect
Congenital heart abnormalities
160
What is bruits causes that sound?
Sound made in artery or vain When does Chloe becomes turbulent of flows at abnormal speed.
161
What is normal blood pressure?
120/80 mmHg
162
Systolic blood pressure and acceptable range?
90 - 140
163
What is diastolic acceptable blood pressure range?
60-90mmHg
164
What does increased blood pressure indicate?
Cardiac stress-hypoxemia
165
What does decreased blood pressure indicate?
Poor perfusion-hypovolemia, CHF
166
Proper exposure of x-ray will show what?
Intervertebral disc space through the shadow of the mediastinum
167
Under exposed x-ray image will?
Not allow visualization of the introvertebral disc through the heart shadow
168
Overexposure x-ray will ?
Show black lung parenchyma without blood vessels
169
When does the A-P diameter increase?
COPD
Barrel chest
Hyper inflation
170
When is the costophrenic angle obliterated?
Plural effusion
171
Crowding of ribs is associated with?
Atelectasis
172
Name the four signs of a normal chest x-ray/radiograph?
1. both hemidiaphragm are rounded (dume-shaped).
2. The right hemidiaphragm is slightly higher than the left.
3. The right hemidiaphragm is at a level of the six anterior rib.
4. trachea is midline, bilateral radiolucency, with sharp costophrenic angles.
173
How should space between the vertebrae in a chest x ray appear?
Equal, visible, and distinct.
174
The mediastinum found in what area, and may shift due what?
Found between the lung, heart, lymphatics, blood vessels and major bronchi are found.
Shift of MEDISTINUM occurs with plural, effusion or pneumothorax.
175
When does the A-P diameter increase?
Increase with COPD, barrel chest, hyper inflation 
176
What makes up the costophrenic angle?
What causes it to be able to it on a chest x-ray?
Costophrenic angle is made up by the outer curve of the diaphragm and the chest wall.
Angle are obliterated by plural effusion.
177
What are vascular markings?
Blood vessels, lymphatics, and lung tissue.
178
When is subcutaneous emphysema seen?
They are seeing the surrounding soft tissue around the chest and neck area.
179
What does crowding of ribs on a chest x-ray is suggesting?
ATELECTASIS 
180
Straight or horizontal ribs are characteristics of?
Air trapping
181
What does narrowing of major bronchi indicate?
May indicate bronchogenic carcinoma.
182
When is cardio Magaly scene and what type of patient?
Cardio mega is seen in CHF patients. It is in a large heart.
183
AP projection on x-ray?
Anterior to posterior imaging image receptor behind back.
184
PA projection on x-ray?
Text Ray travels from posture to anterior, image, receptor, touching the chest with patient back to x-ray
185
Natural projection on x-ray?
Image projected from right or left side, add a third dimension to structures.
186
Lateral the cubitus position on x-ray?
Patient laying on the affected side valuable for detecting small pleural effusion.
187
Apical lordotic X-ray?
Projection of the lung apices
188
End, expiratory image, x-ray?
Taken at end exhalation, detect, small pneumothorax, measures diaphragmatic excursion.
189
What should the position for endotracheal or tracheostomy to be?
Below the vocal cords
Approximately 2 to 6 above the corona
At the level of the aortic knob or aortic arch
190
Where should pacemaker wires/electrodes be normally positioned.
Positioned in the right ventricle
191
Where should pulmonary artery catheters appear?
In the right lower lung field
192
Central venous catheters should rest in what area?
Superior vena cava, or write a trim of the heart(fourth intercoastal space, right sternum)
193
Central venous catheters should rest in what area?
Superior vena cava, or write a trim of the heart(fourth intercoastal space, right sternum)
194
Where should chest tubes be located?
Plural space surrounding the lung
195
Where should nasal gastric tubes and feeding tubes be positioned?
In the stomach2-5 CM below the diaphragm.
196
When should a lateral neck x-ray be ordered and what could it identify?
Diagnose upper airway obstruction(croup, or epiglottis
197
How would croup(larybgoytaceobronchitis) appear on a x-ray?
X-ray reveal tracheal narrowing with subglottic swelling
1 steeple sign
2 picket fence sign
3 pencil point sign
4 Hourglass sign
198
How would a lateral neck x-ray of epiglottitis appear?
Superglotic narrowing with an enlarged flattened, epiglottis, and swollen aryepiglottic folds
1 thumb sign
199
Radiolucent description and diagnosis?
Dark pattern, air
Normal for lungs
200
Radiodense/opacity description and diagnosis?
White pattern, solid, fluid
Normal for bones and organs
201
Infiltrates description and diagnosis?
Any ill defined radiodensity, atelectasis.
202
Consolidation, description and diagnosis?
Solid white area,
pneumonia, plural effusion.
203
Hyperlucency, description and diagnosis?
Extra air,
COPD, asthma attack, pneumothorax.
204
Vascular markings description and diagnosis?
Lymphatics, vessels, lung tissue
Increases with CHF absent with pneumothorax
205
Diffuse description and diagnosis?
Spread throughout
Atelectasis/pneumonia.
206
Diffuse description and diagnosis?
Spread throughout
Atelectasis/pneumonia.
207
Opaque description and diagnosis?
Fluid, solid
Consolidation
208
Pulmonary edema, terminology, description, and treatment?
Terminology
Fluffy, infiltrates, butterfly pattern, bat wing pattern
Description
Diffuse whiteness, infiltrate in a shape of a butterfly
Treatment
Diuretics, digitalis, digoxin
209
Atelectasis, terminology, description and treatment?
Terminology
Apache, infiltrates, plate like infiltrates, crowded, pulmonary vessels, crowded air, bronco program
Description
Scattered density, and layer density
Treatment
Lung expansion therapy, SMI, IPPB, CPAP, PEEP
210
ARDS or I RDS terminology description and treatment?
Terminology
Ground glass appearance, honeycomb pattern, diffuse bilateral radiopacity
Description
reticulogranular, reticuonodular
Treatment
Oxygen, low VT or PIP,CPAP, PEEP
211
Plural, effusion, terminology, description and treatment
Terminology
Lunn or obliteration of coastal phrenic angle, basilar infiltrates with meniscus, concave superior interface/border
Description
Fluid level on affected side, possible medicinal shipped to unaffected side
Treatment
HORACENTESIS, chest tube, antibiotics, steroids
212
Plural, effusion, terminology, description and treatment
Terminology
Lunn or obliteration of coastal phrenic angle, basilar infiltrates with meniscus, concave superior interface/border
Description
Fluid level on affected side, possible medicinal shipped to unaffected side
Treatment
HORACENTESIS, chest tube, antibiotics, steroids
213
Pneumonia, terminology, description, and treatment
Terminology
Air broncogram,
Description
Increase density from consolidation and atelectasis
Treatment
Antibiotics
214
Pulmonary embolus terminology description, and treatment
Terminology
Peripheral wedge shaped infiltrate
Description
May be normal
Treatment
heparin, STREPTOKINASE
215
Tuberculosis, terminology, description and treatment?
Terminology
Cavity formation
Description
Often an upper lobes
Treatment
Anti-tubercular Asians
216
What type of diagnosis is CT used for?
Takes images neurosis of the organs of body parts
Used to detect presence of mediastinal, coral and parenchymal masses, pulmonary nodules, and lesions, not visualized by chest x-ray
Also use the diagnosed bronchitis
With contrast die can diagnose pulmonary embolism
217
Magnetic residence imaging
Obtain two dimensional view of organs and structures without the use of radiation
Determine thoracic, aneurysms, congenital anomalies of the aorta and major thoracic vessels
Can determine the precise position of tumors soft tissue of normalities and woman surrounding structures
218
Pulmonary ventilation/perfusion scan V/Q scan
Radioisotope, ( xenon gas) location of the gas is recorded producing a photographic pattern of distribution
Any obstruction to prevent gas from filling that area
219
A normal ventilation scan with an abnormal perfusion scan indicates what?
Pulmonary embolism
220
Barium swallow or esophagram is used to perform to assassin diagnose what?
Abnormalities in the hypopharynx, esophagus, or stomach
221
A PET scan positron emission tomography is used to detect what?
Detect and diagnose diseases earlier than MRI or CT scan
Monitor patient’s response to treatment.
Useful and determining the presence of cancer, brain disorder, and heart disease
Can take between 15 to an hour and 20 minutes
222
How is bronchography Used?
Injection of radioopaque contrast, medium into the trachea bronchial tree.
223
What does bronchography identify?
By outlining the airway, it will identify obstructing lesions ( toumors ) bronchitis.
224
How does an EEG work?
Measure electrical activity as tiny fluctuations and voltage through the scalp. It is recorded as tracing on paper.
225
What type of condition does EEG diagnose? What are indications for an EEG?
Diagnosis neurological disorders
Indications for EEG:
A brain tumors
B traumatic brain injuries
C loss of brain function
D epilepsy/seizures
E evaluation of sleep disorder
226
What type of test does a pulmonary angiograph, what does a diagnose?
Pulmonary embolism
227
What are the indications for pulmonary angiograph?
Indication
A high clinical suspicion of pulmonary embolism
B inconclusive V/Q scan and/or CT scan
228
What is the procedure for pulmonary angiograph?
A. Catheter is inserted into the femoral vein through the right heart into the pulmonary artery
B . Contrast injected with multiple x-rays to identify any filling defects
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How is cardiac catheterization performed?
Insertion of a catheter and to chamber of vessel of the heart
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What type of procedures can be done through cardiac catheterization?
Once catheters in place, it can be used to perform a number of procedures, including
A. angioplasty
B. Percutaneous coronary intervention (PCI) angiography
C. Balloon septostomy.
D. Electoral physiology studies
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What are diagnostic indications or cardiac catheterization?
A. Confirm presence of suspected heart pathology.
B. Measure severity of pathology and its effects on the heart
C. measure intracardiac and intravascular blood pressure
D. Obtain tissue samples for biopsy.
E. In various agents for measuring blood flow in the heart
F. Detect quantify the presence of intracardiac shunt
G. In contrast, study shape of heart vessels, chambers, and how they change as the heartbeats
H. Reopen foreman ovale
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What is normal ICP?
5-10 mmHg
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When is treatment for ICP indicated?
ICP >20 mmHg
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What therapies can be used to lower ICP
A. hyperventilation: PaCO2 25-30 torr (causes temporary vasoconstriction D/C after 48hrs)
B. Lower jugular venous pressure ( elevated bed >30degrees, minimize peep)
C. Sedate anagesia
D. Osmotic agents to remove fluid
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What is Cerebral perfusion pressure (CPP) mean?
Pressure gradient that that determines cerebral perfusion
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What is normal CPP what is the formula?
70-90 mmHg
Formula CPP=MAP-ICP
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What does exhaled nitric oxide ( FE no) Testing measure and monitor ?
Measures nitric oxide, concentration and patience, exhale breath.
Monitors response to anti-inflammatory
Monitors patient with asthma, cystic fibrosis, or COPD
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What does a decrease in capital FE no suggest?
Decrease in airway inflammation.
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What does exhaled carbon monoxide FE co testing monitor?
Absence and cigarettes smoker
It’s a small portable device
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What is FE co value in heavy smokers, moderate smokers, light, smokers, and non-smokers.
Heavy smokers = >20 ( 5 min)
Moderate smokers = 11-20 ( 5 min)
Light smokers = 7-10
Non smokers = <7 and certainly under 10
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Excelled CO can also be elevated and what type of patients?
Obstructive sleep apnea patient
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Red blood cells
Normal value?
Low RBC occurs with what?
Hi RBC occurs with what?
Normal value = 4-6 mill/ mm3
Low RBC (anemia) it with blood loss and hemorrhage
Hi RBC( polycythemia) occurs with chronic tissue hypoxia (i.e. COPD.)
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Normal Hb, what does low and high indicate
Normal:4-6
Low: anemia
High: polycythemia
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Normal Hematocit, what does low and high indicate?
Normal hct:40-50%
Low: anemia
High: polycythemia
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Normal white blood cells (WBC), what does high and low indicate?
Normal:5,000 - 10,000 per mm
Increased WBC( leukocytosis) bacterial infection
Decreased WBC ( leukopenia) viral infection
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Types of WBC?
Neutrophils: bands and sags
Bands: 4% new wbc increase with bacterial infection
Sags: 60% old wbc decrease with bacterial infection
Eosinophils:associated with asthma 2% of WBC, increase with allergic reaction
Monocytes: increase with TB 3% WBC
Basophils 1% WBC
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What are coagulation studies, what are their indications?
Tests that evaluate clotting mechanisms of the body.
Indications:
Eval for preoprative pt for blinding risk
Eval bleeding signs/ symptoms
Diagnosis disseminated intravascular coagulation (DIC)
Monitor anticoagulant therapy
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How is clothing time determined and normal value?
Determined by puncturing the skin and measuring how long it takes to stop bleeding.
Normal value: up to 6 min
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When is platelet count ordered?
What does it measure?
Normal value?
What is a decreased value associated with?
When coagulation defect is suspected
Measures number,size, shape of platelets
Normal:150,000-400,000
Decreased value is associated with decreased bone marrow function and sepsis
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Activated partial Thromboplastin Time (APTT)
Normal value?
What type of therapy does it monitor?
Measures length of time required by plasma to form a fibrin clot
Normal value 24-32
Used for monitoring heparin therapy
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What is prothrombin time (PT) used to monitor?
Normal value?
Monitor warfarin(Coumadin)therapy
Normal value 12-15
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What is normal platelet count?
150000 - 400000
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A decreased platelet count indicates what?
Decrease in Bone marrow and sepsis
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A decreased platelet count indicates what?
Decrease in Bone marrow and sepsis
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What is ischemia
Reduced blood flow to tissue
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What is urinalysis?
What is blood in the urine associated with?
Screening test for kidney disease
Blood in urin is associated with kidney trauma
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What is troponin?
What does it indicate?
What does troponin level of >0.1 ng/ml mean for pt?
Protein found in myocardial cells
Damage to heart muscle
troponin level of >0.1 ng/ml place pt at high risk for death from MI
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What is recommended for elevated troponin?
Oxygen, morphine, aspirin, nitroglycerin
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Wh at is Brain natriuretic peptide ( BNP)?
Normal value?
What does serum BNP help identify?
Secreted by cardiac muscle when heart failure develops or worsen
Normal value <100 pg/ mL
Help determine if pt problem is CHF or COPD
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What level of BNP indicate CHF?
>300pg/ ml mild heart failure
>600 pg/ ml Moderate heart failure
>900 pg/ ml Sever heart failure
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What is recommended for elevated BNP
Directics, positive inotropic agents
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What are the two types of allergic test?
Skin -prick or scratch test
Intracutaneous test
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What is oscilloscope?
ECG monitor
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What is a holster monitor?
Event monitor Soren by pt for 24 to 48 hrs to detect any ECG abnormalities.
Effectiveness of anti-arrhythmia drugs
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What is the normal axis of electrical activity of the heart?
Down and left
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What is hypertrophy, which way will axis shift?
Increased electrical activity
Axis will shift twords hypertrophy
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What is infarction, which way will axis shift?
Dead tissue, no electrical activity
axis will shift away from from infarction
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Lead I
Rt. Arm negative
Lt. Arm positive
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Lead ll
Rt. Arm negative
Lt.leg positive
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Lead lll
Lt. arm negative
Lt. leg positive
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AVR
Rt. Arm positive
Everything else negative
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AVL
Lt. arm positive
Everything else negative
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AVF
Lt. leg (foot) positive
Everything else negative
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V1 and V2 measures what side of heart?
Right heart
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V3 and V4 measure which side of heart?
Ventricular septum
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V5 and V6 measure which side of heart?
Left heart
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Normal heart rate
Bradycardia
Tachycardia
Flutter
Fibrillation
Normal: 60-100
Bradycardia: <60
Tachycardia: >100
Flutter: >200
Fibrillation=to fast to count
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What is ischemia?
How is it identified on a ECG?
Reduced blood flow to tissue
Depressed or inverted T wave
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What is injury?
How is injury indicated on a ECG?
Acute damage to tissue
Usually caused by ischemia
Indicated by elevated ST segment
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What is infarction?
How is it indicated in ECG?
Necrosis or death of tissue, usually
caused by ischemia and injury
Diagnosed by significant Q wave
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Term infant
Preterm infant ( premature)
Post term
Term Infant: 38-42
Preterm: before 38 term
Post term: after 42 term
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When is page score taken?
1 minute and 5 minute
284
What does APGAR stand for?
A=appearance
P=pulse
G=Grimace
A=activity
R=respiratory
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What does score of
0-3, 4-6, 7-10
0-3=resuscitate
4-6=support
7-10=routine care
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When is transformation used in babies?
When pneumothorax is suspected.
A the chest will light up
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Normal Baby temperature?
36.5
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Normal heart rate for term infant?
Tachycardia?
Bradycardia?
110-160
170 and greater
Less than 100
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Normal respirator for term indents?
30-60 bpm
Respiratory pause 5 to 10 sec
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Short apnea
10 - 20 sec may be normal
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Long apnea?
Abnormal
20 sec or greater
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Normal BP for infant?
Normal BP for preterm infant?
60/40
50/30
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Normal birth weight
Term
Preterm
Term 3000
28 week gestation Preterm 1000
Lower birth weight is associated with respiratory problem
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Dobowitz or Ballard method measures what?
What is normal score for term baby?
What does high or low score indicate?
Gestational age
Normal term baby score of 40
Higher than 40 indicates post term infant
Lower than 40 indicates pre- term infant
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What would indicate if a pt has ductus arteriousus with a right to left shunt?
If the pre-ductal (right radial artery) PaO2 is 15 torr higher than the post-ductal (umbilical artery)
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What is normal blood glucose in term infants and premature infants?
Term infants 30 mg/dL
Premature infants greater than 20 mg/dL
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Lecithin/ sphingomyelin (L/S) ratio is used to indicate what?
What is normal ratio?
A ratio less that 2 indicates high risk of hyaline membrane disease ( HMD)and IRDS ( respiratory distress syndrome)
2:1 ratio is good
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Factors that control blood pressure
Heart
Blood
Vessels
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How many chambers in the heart?
Which circulatory branches does each chamber serve?
Left ventricle?
Right atrium?
Right ventricle?
Left atrium?
Left ventricle= systemic arteries
Right atrium= systemic vein
Right ventricle = pulmonary artery
Left atrium = primary vein
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