Patient Assessment Flashcards
Crackles
When air move through excessive fluid or secretions in the airways, when collapsed alveoli pop open during inspiration.
May clear when the patient coughs
Wheeze
Musical sounds heard from the chest of the patient with intrathoracic airway obstruction, narrowed or compressed airway as air passes through at a high velocity.
Causes:
-Bronchospasm
-Mucosal edema
-Increased mucus production
-Foreign object obstruction
Stridor
Heard over the larynx and trachea during inhalation when upper airway obstruction is present because the upper airway tends to narrow during significant inspiratory efforts.
-May be heard without the aid of a stethoscope
-Epiglottitis or Croup
-Inflammation after extubation
Diminished
The intensity of sound created by turbulent flow through the bronchi is reduced with shallow or slow breathing patterns.
-Major sedation
-Obstructed airways (mucus plugs)
-Hyperinflated lung tissue (Emphysema)
-Obesity
-Pneumothorax
Fluid (Pleural effusion)
Pleural Friction Rub
As creaking or grating sound that occurs when the inflamed pleural membranes (pleurisy) rub together.
Very rare but may be heard in patients with pneumonia, pulmonary fibrosis, pulmonary embolism or after thoracic surgery.
Rhonchi
Low-pitched wheezes or snore-like sounds indicating an obstruction or an increased amount of secretions in the airways.
-Usually caused by Pneumonia, Cystic Fibrosis or COPD
Inspection
-Note breathing patterns
-Cyanosis
-Skin turgor
-JVD
Peripheral cyanosis
Bluish color to the extremities (fingers, toes, tip of nose, lips and ear lobes).
This is related to inadequate circulation, cold patient, anxious patient, venous obstruction.
Central cyanosis
Central cyanosis results from a decreased concentration of oxygen in arterial blood and may be the result of advanced lung disease or CHF.
Jugular venous distention
Highly suggestive of right heart failure in older patients. When inspecting the patient, be sure to make a neck vein assessment.
Apnea
The complete absence of spontaneous ventilation.
Eupnea
Normal, spontaneous breathing
Biot’s breathing
Short episodes of rapid, uniformly deep inspirations followed by 10 to 30 seconds of apnea. Described in patients with meningitis.
Hyperpnea
Increased depth and volume of breathing with or without an increased frequency.
Hyperventilation
Increased alveolar ventilation causing an increase in the PaCo2 to increase.
Hypoventilation
Decreased alveolar ventilation causing a decrease in the PaCo2.
Cheyne-stokes breathing
10 to 30 seconds of apnea, followed by a gradual increase in the volume and frequency of breathing until another period of apnea occurs.
-Associated with cerebral disorders or CHF.
Kussmaul’s breathing
Both an increased depth and and rate
-Commonly associated with diabetic ketoaciodosis (DKA)
Orthopnea
A condition in which the patient becomes dyspneic when laying down.
Agonal respirations
Gasping respirations is an abnormal brainstem reflex breathing pattern.
-Possible causes include cerebral ischemia or extreme hypoxia.
Palpation
Touching the patient to evaluate for the presence of pathology.
Evaluation of:
Crepitus
Fremitus
Thoracic expansion
Crepitus
Feels like crackling under the skin caused by subcutaneous emphysema. (Air underneath the dermal layers)
A full O2 cylinder contains what psig of pressure?
2200 psig
H cylinder holds what cu ft. of oxygen?
244 cu ft. (6900 L) of oxygen
E cylinder holds what cu ft. of oxygen?
22 cu ft. (622 L) of oxygen
Green cylinder
Oxygen
Brown cylinder
Helium
Gray cylinder
Carbon dioxide
Light blue
Nitrous oxide
Ethylene
Red
Air
Yellow
CO2/O2
Gray and green
He/O2
Brown and green
What are regulators used for?
Regulators are attached to the cylinder valve to regulate flow and reduce cylinder pressure to a working pressure.
Indications for O2 therapy
- Hypoxemia
- Labored breathing or dyspnea
- Increased myocardial work
Signs and symptoms of hypoxemia
- Tachycardia
- Dyspnea
- Cyanosis (unless anemia is present)
- Impairment of special senses
- Headache
- Mental disturbance
- Slight hyperventilation
Complication of O2 therapy 1
Respiratory depression:
COPD patients who are chronically hypoxic are most affected.
Maintain the PaO2 between 50 and 65 for these patients.
Complication of O2 therapy 2
Atelectasis:
High O2 can wash out Nitrogen in the lung and reduce the production of surfactant.
Maintain FIO2 below 60%
Complication of O2 therapy 3
Oxygen toxicity:
High oxygen toxicity may lead to ARDS. Maintain FIO2 below 60%.
Complication of O2 therapy 4
ROP
Caused by high PaO2 levels in infants. Maintain PaO2 levels below 80 in infants. Normal is 50 to 70.
Exam Note 1
When giving a patient 60% or higher FIO2, who is ventilating adequately (normal PaCO2) but has hypoxemia, place them on CPAP unless excessive pressures are not safe. (ICP, hypotension or a low CO) In this case, increase the FIO2.
Exam Note 2
If a question states that a patient has been exposed to CO poisoning, always select a device that delivers 100% oxygen by a non-rebreather, CPAP or ET tube flow-by
The blood carries Hb in 2 ways:
- Bound to hemoglobin
- Dissolved in plasma
-The sum of these 2 mechanisms equals the total arterial O2 content of blood which is the most effective method for determining the O2-carrying capacity of the blood.
Transtracheal catheter
Inserted directly into the trachea through an incision between the 2nd and 3rd tracheal rings.
-Delivers 22% to 35% FIO2 at flow rates of 1/4 to 4 LPM
Nasal cannula
Delivers 24% to 40% O2 at flow rates of 1/4 to 6 LPM (at about a 4% increase for every 1 LPM increase.
