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NBRC TMC Study Guide > Patient Assessment > Flashcards

Patient Assessment Flashcards

1
Q

What are the four life functions

A

Ventilation
Oxygenation
Circulation
Perfusion

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2
Q

What is the best bedside assessment to tell if someone isnt oxygenating

A

Their heart rate increases

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3
Q

What is the most common problem between the four life functions

A

Oxygenation

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4
Q

What can low Urine (less that 40 mL per hour) output indicate

A

Poor perfusion

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5
Q

What is sensible water loss

A

Water that can be measured, examples are urine and vomiting

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6
Q

What is insensible water loss

A

Cannot be measured, water lost through sweating, lungs

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7
Q

What will you observe if fluid intake exceeds fluid output

A

Weight gain, electrolyte imbalance, increased hemodynamic pressures, decreased lung compliance

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8
Q

What do changes in the CVP indicate

A

Changes in fluid balance

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9
Q

Decreased CVP indicates what? And how is it treated

A

Hypovolemia, treated with fluid therapy

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10
Q

Increased CVP indicates what? How is it treated ?

A

Hypervolemia, treated with diuretics

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11
Q

What should you associate CVP with

A

Fluid in body

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12
Q

Orthopnea

What is it associated with?

A

Difficulty breathing except when in the upright position.

Associated with CHF

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13
Q

General malaise

What is it associated with?

A

Run down, nausea, weakness, fatigue, headache

Associated with electrolyte imbalance

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14
Q

Dyspnea? How are dyspnea grades measured

A

A feeling of shortness of breath or difficulty breathing.

Grade I - V the highest is V- dyspnea at rest.

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15
Q

What kind of questions do you want to ask in a patient interview?

A

Open ended questions.

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16
Q

What do you look at in a physical examination

A

General appearance, age, height, weight, nourishment

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17
Q

Edema

A

Presence of excessive fluid in the tissue known as pitting edema.

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18
Q

Peripheral edema ?

What is it associated with?

A

Swelling of the extremities, often seen in arms and ankles.

Associated with CHF and Renal Failure

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19
Q

Ascites?

What is it associated with?

A

Swelling of the abdomen

Associated with liver failure

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20
Q

What is clubbing of fingers and what is it associated with

A

Natural curvature of finger nails increases, making them appear large and round. It is due to chronic hypoxemia, usually COPD

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21
Q

Venous distention is associated with

A

CHF

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22
Q

What is capillary refill used for and how long should it take

A

Indication of peripheral circulation, it should take 3 seconds to come back

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23
Q

How is ashen, or pallor described

A

Decrease in color, anemia. Acute blood loss

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24
Q

Erythema

A

Redness of skin ]

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25
Q

Pectins carinatum

A

Anterior protrusion of the sternum

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26
Q

Precuts excaratum

A

Depression of the part of or the entire sternum

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27
Q

Kyphosis

A

Convex curvature of the spine (hunchback)

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28
Q

Scoliosis

A

Curvature of the spine, leans to one side

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29
Q

Cheyne-stokes breathing

What is it associated with

A

-

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30
Q

Biots breating

What is it associated with

A

-

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31
Q

Kussmauls breathing

What is it associated with

A

-

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32
Q

Apneustic breathing

A

-

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33
Q

Hypopnea

A

-

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34
Q

What is wheezing associated with and how is it treated

A

Bronchospasm, treated with bronchodilator

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35
Q

Unilateral wheeze, how is it treated

A

Foreign body obstruction, assessed with rigid bronchoscopy.

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36
Q

Strider

A

Upper airway obstruction

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37
Q

Strider with supraglottic swelling.

How to treat it ?

A

Epiglottitis, racemic epinephrine

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38
Q

Strider with subglottic swelling

How is it treated?

A

Croup or post extubation. Treated with racemic epinephrine

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39
Q

How do you treat marked strider? And what is it?

A

It’s very severe strider, you intubate immediately

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40
Q

What is pleural friction rub? What is it associated with? How is it treated?

A

Course, grating, raspy, crunchy sound.
Associated with pleurisy, TB, pneumonia, pulmonary infarction, cancer, etc.

Treated with steroids, or antibiotics if infection is present

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41
Q

What do you recommend if you hear S3 and/or S4 heart sounds?

A

Recommend echocardiogram. (Ultrasound of heart)

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42
Q

What is the term for increased blood pressure?

What causes it?

How do you treat it ?

A

Hypertension

Cardiac stress

Give oxygen therapy

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43
Q

What is the term for decreased blood pressure?

What is it caused by?

How is it treated?

A

Hypovolemia

CHF

Fluids

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44
Q

When looking at an X-ray, what would crowding ribs indicate?

A

Atelectasis

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45
Q

When looking at an X-ray, what would straight or horizontal ribs indicate?

A

Air trapping

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46
Q

Describe lateral decubitus position in X-ray. What is it valuable for to detect?

A

Patient lies on the side of the pathology. It is good to use to detect a small pleural effusion because it will move with gravity

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47
Q

What does the apical lordotic detect?

A

T.B. Usually presents on top of the lungs

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48
Q

When would you use a lateral neck X-ray?

How can you tell the difference between the two pathologies?

A

If croup or epiglottitis are suspected.

Croup= steeple sign/picket fence/pencil point

Epiglottitis= thumb sign. Epi= on top of vocal cords

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49
Q

What is hypertrophy and what is it associated with

A

An increase in muscle size . Associated with COPD

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50
Q

What is atrophy and what is it associated with

A

Muscle weakness

Paralysis

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51
Q

What are retractions associated with in both adults and and infants?

A

Airway obstruction in adults, respiratory distress in infants

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52
Q

Mallampati classification system. What does it indicate

A

A system used to identify how difficult an airway will be to intubate. Works in classes 1-4. Four being the most difficult to visualize. 1 being the best class for intubation. 1 sees all four landmarks.

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53
Q

What is the most important thing to palpate in an exam

A

Pulse.

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54
Q

What is indicative of an adverse reaction to a treatment or medication?

A

A Change in heart rate of 20 beats per minute or more.

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55
Q

What is pulses paradoxus
What does it indicate?
What diseases is it associated with

A

Pulse/blood pressure varies with respiration.

May indicate severe air trapping.

Associated with status asthmaticus, tension pneumothorax, cardiac tamponade.

56
Q

What disease would pull the trachea toward pathology?

A

Pulmonary atelectasis

Pneumonectomy

Diaphragmatic paralysis

57
Q

When percussing, what does a flat and/or dull note mean?

A

Less air, atelectasis, pleural effusion, pneumonia

58
Q

When percussing, what does tympanic and/or hyperresonant mean?

A

Extra air, COPD, pneumothorax.

59
Q

What is egophony

A

When patient says “E” but it sounds like “A”

Associated with consolidation, pneumonia.

60
Q

What are course crackles and what do they indicate

A

Rhonchi that clear with cough

Indicate large airway secretions

61
Q

What are medium crackles, what should you recommend for treatment

A

Middle airway secretions, recommend bronchial hygiene

62
Q

What are fine crackles and how can they be treated

A

Fluid in the alveoli. CHF/pulmonary edema

Can be treated with oxygen, positive pressure ventilation, positive inotropic agents, diuretics.

63
Q

Describe pulmonary edema in an X-ray

What treatment would you recommend

A

Fluffy infiltrates, butterfly or batwing pattern.

Diuretics= digitalis, digoxin

64
Q

Describe atelectasis in an X-ray

How is it treated

A

Patchy infiltrates, plate like infiltrates.

Lung expansion therapy, SMI/IS, IPPB, CPAP, PEEP

65
Q

Describe IRDS/ARDS in X-ray

A

Ground-glass appearance, honeycomb pattern, diffuse bilateral radiopacity.

Treat with Oxygen, Low Vt, or PIP, PEEP, CPAP

66
Q

Pleural effusion on X-ray

What do you treat it with

A

Blunting, obliteration of costraphrenic angle, basiler infiltrates with miniscus (curving to top), concave superior interface/border.

Treat with thoracentesis, chest tube, antibiotics, steroids

67
Q

Pneumonia on an X-ray

How is it treated

A

Air bronchogram, increased density from consolidation and atelectasis

Treat with antibiotics

68
Q

Tuberculosis on X-ray

How is it treated

A

Cavity formation, often in upper lobes,

Antitubercular agents — acid fast stain

69
Q

Pulmonary embolus on X-ray

How is it treated

A

Peripheral wedge-shaped infiltrates (may be normal)

Heparin, streptokinase

70
Q

What is a spiral CT scan with contrast used for

A

To diagnose pulmonary embolus

71
Q

MRI

A

Magnetic. Don’t take steel cylinders in, have extra tubing for patient . Non ferrous materials

72
Q

pulmonary ventilation/ perfusion scan (V/Q scan)

Normal ventilation scan with an abnormal perfusion scan indicates

A

Pulmonary embolism

73
Q

What is an EEG used to monitor

A

Evaluation of sleep disorders

74
Q

Pulmonary angiography is done only when ______ and ______ is inconclusive because of its high risk , what can it diagnose

A

V/Q and CT scan is inconclusive and a high clinical suspicion of pulmonary embolism

75
Q

What is an echocardiogram and what are the indications for one

A

Abnormal heart sounds

Indications= valvular disease/dysfunction, myocardial disease, abnormalities of cardiac blood flow, cardiac anomalies in infant.

76
Q

Therapy to reduce ICP

A

Hyperventilation— target paco2 is 25-30 torr will temporarily reduce ICP. Discontinue after 48 hours.

Lower jugular venous pressure- avoid neck flexion, head turning or trach ties too tight, minimize straining, retching, and coughing. Minimize PEEP

Sedation— narcotics and benzodiazepines.

  1. Mannitol (osmotic diuretic)
  2. Hypertonic saline
77
Q

What is exhaled gas analysis used for

A

Used to monitor the patients response to anti-inflammatory (corticosteroid) treatment.

78
Q

Exhaled carbon monoxide (FEco) testing is measured in smokers.
What are the degrees

A 
<7= non smoker
7-10= light smoker
11-20 = moderate smoker
>20 = heavy smoker
79
Q

If CVP is increased but nothing else is, what should be suspected

A

Right heart failure (cor pulmonale)

Tricuspid valve stenosis

80
Q

If wedge pressure and PAP is increased what should be suspected ?

A

Left heart failure
Mitral valve stenosis
CHF

81
Q

What would increased PAP and increased CVP indicate

A

Lung disorders, Pulmonary embolism, pulmonary hypertension, and air embolism

82
Q

Sinus arrhythmia

A

Sinus rhythm with irregular heart rate

83
Q

Sinus tachycardia

A

Sinus rhythm with a rate >100

84
Q

Sinus bradycardia

A

Sinus rhythm with rate lower than 60

Recommend atropine

85
Q

Atrial flutter

A

Sawtooth pattern

Recommend digoxin beta blocker , calcium channel blocker

86
Q

Atrial fibrillation

A

Recommend digoxin, beta blockers. Calcium channel blockers, anticoagulants, thrombolytics

87
Q

Premature ventricular contractions (PVC)

A

Oxygen, lidocaine, consider other causes.

GIVE OXYGEN FIRST

88
Q

Multi focal premature ventricular contractions

A

Much more dangerous that regular pvc’s. Treat with oxygen lidocaine consider other causes

89
Q

Ventricular tachycardia

A

V-tach, ventricular rhythm with rate greater than 100

90
Q

Ventricular flutter/fibrillation

A

V-fib, completely irregular ventricular rhythm.

Defibrillate, CPR, epinephrine, amiodarone

91
Q

Three stages of a heart attack and what do they mean

A
  1. Ischemia- reduced blood flow to the tissues.
  2. Injury- Acute damage to tissue
  3. Infarction- necrosis or death of tissue. May be recent or old
92
Q

How Do you treat a heart attack? What acronym helps you remember?

A

O- oxygen
M- morphine
A- aspirin
N- nitrogen

“O’ man”

93
Q

How is APGAR scored?

A

1-10. Low score is bad

94
Q

How often is the apgar performed

A

At 1 minute after birth then every five minutes after that

95
Q

What is an exhaled gas analysis used for

A

Used to treat the patients response to anti inflammatory(corticosteroid) treatment

96
Q

Why is exhaled carbon monoxide measured (FeCo)

A

Measured in smokers to see the last time they smoked

97
Q

How to interpret patients smoking status (FeCO)

A

-non smokers = 0-7%
Light smoker = 7-10%
Moderate smoker = 11-20%

98
Q

What does a CBC measure

A

Red blood cells and white blood cells

99
Q

How much oxygen does hemoglobin carry

A

1.34 mL per gram

100
Q

How is hematocrit measured

A

Spins blood and measures % of RBC in original blood volume

101
Q

What does an increased WBC count indicate

A

Bacterial infection

102
Q

What does a decreased WBC count indicate

A

Viral infection

103
Q

What are bands

A

Bands are immature white blood cells. They are made in response to infection by the body to help fight off infection

104
Q

What are segments

A

Segments are mature neutrophils.

105
Q

Eosinophils

A

Type of white blood cell. Associated with allergies and asthma.

106
Q

What is HCO3 also referred to as

A

Total CO2 content

107
Q

What would general malaise indicate

A

Low electrolytes or imbalance

108
Q

What is hypokalemia

A

Low potassium. Metabolic alkalosis. Always recommend potassium.

109
Q

Low T-wave =

A

Low potassium

110
Q

High T-wave =

A

High potassium

111
Q

What is the most important lead to monitor

A

Lead 2. It goes down and to the left.

112
Q

What leads monitor the right heart

A

V1 and V2

113
Q

What leads monitor the left heart?

A

V5 and V6

114
Q

What life functions does hemodynamic monitoring cover?

A

measurement of blood pressure

3rd and 4th life functions.
Circulation and perfusion.

115
Q

What 3 factors control blood pressure and how?

A
  1. Heart- pumps and creates blood pressure
  2. Blood- amount of blood in circulation affects B/P
  3. Vessels- conditions of blood vessels will cause BP to change.
116
Q

In hemodynamics, if the heart rate drops what drug should you recommend?

A

Atropine

117
Q

In hemodynamics, if their heart rate increases what drug should you recommend

A

Atenolol, propanolol, labetolol.

118
Q

If there is an increase in the fluids in the body what should you recommend?

A

Diuretics

119
Q

If there is low fluid in the body what should be recommended

A

Blood products, fluids

120
Q

How does vessel constriction affect blood pressure

A

Increases blood pressure, treat with vasodilators such as nitroprusside, hydralazine, milrinone

121
Q

If vessels dilate what should you recommend for treatment

A

Vado constrictors such as epinephrine, phenylephrine, dopamine, and dobutamine

122
Q

What does a pressure transducer do

A

It converts physical energy to electric energy

123
Q

Where should a transducer be placed

A

Level with the tip of the catheter. If transducer is too high, the readings will be lower than actual reading

124
Q

How do you monitor anything in the left heart

A

PCWP

125
Q

What valves could you monitor with the PCWP

A

Mitral (bicuspid) valve

126
Q

How can perfusion be defined

A

The gradient of blood flow through the capillaries

127
Q

How would you monitor anything in the right heart

A

With the CVP pressure

128
Q

What does the CVP monitor

A

Fluids and right heart

129
Q

What can be seen in trans illumination

A

Pneumothorax

130
Q

What does the Silverman score show

A

Respiratory distress in infants. Scored 1-10, 10 being the worst score

131
Q

What is the normal score for a dubowiz or Ballard method? What does it measure

A

40 is normal. Measures gestational age. 42 would be post term

132
Q

What is phosphatidylglycerol (PG)? And what does it represent

A

It is a protein that appears in the baby’s lungs. It represents lung maturity. It shows up at 36 weeks gestation and rises until term. It is the MOST reliable indication of pulmonary maturity. Even in diabetes

133
Q

What is alveolar dead space

A

Air goes in but there is no blood to transport oxygen.

Seen in pulmonary embolism

134
Q

If ABG is normal but the capnograph dropped what can you suspect

A

Pulmonary embolism. Treat with heparin

135
Q

What is transcutaneous monitoring of PO2 and pco2 and what is the normal temp

A

Measures oxygen content. Done by heating the area around the electrode to 43-45C thus improving capillary blood flow (perfusion) and enhances gas movement through the skin

136
Q

How often should a transcutaneous monitor be changed

A

Should be changed every four hours. If redness or blistering occurs (erythema) the electrode should be moved to a new site more often

NBRC TMC Study Guide (3 decks)

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