Patient Assessment Flashcards
What is another name for crepitus and what causes it?
Subcutaneous emphysema
Trauma, barotrauma, medical procedure, spontaneous pneumothorax
Increased tactile fremitus, or vibrations when talking, are felt in what disease states?
Vocal fremitus increases due to inflammation and consolidation like pneumonia and abscess
How is pitting edema classified, what disease states is it indicative of, and what is the recommended therapy
Stages 1-3+
CHF and renal failure
Diuretics
When pressed with your finger, Increased venous distention is noted above the clavicle in what disease processes?
Right heart failure
Fluid overload
Obstructive lung disease and air trapping
What life functions are tested with a capillary refill test and how quickly should the nailbed color return?
circulation and perfusion.
3 seconds
What is paradoxical movement of the chest wall called and what should you suspect
Flail chest
Trauma and underlying lung issues (ie pneumothorax)
What are some causes of hyperpnea, or deep breathing?
Metabolic disorder, CNS disorder
What is the difference between hypopnea and bradypnea and some reasons for both?
Shallow breathing-OSA
Slow breathing-sleep, drugs, alcohol, metabolic disorders
A deep and rapid breathing pattern that approaches 1:1 and that does not have periods of apnea? What is the classic diagnosis?
Kussmauls breathing
Diabetic keto acidosis
Metabolic acidosis
Hypoxemia
Renal failure
“The respiratory rate varies from normal to faster and may include short periods of apnea. It is most often seen with head injuries, but also can be seen with drug overdose, increased intracranial pressure, and congestive heart failure,
Cheyne stokes breathing
What are two ways to apply a forced expiratory technique to help with mobilizing secretions?
Mid inspiratory cough
Huff cough
A change from white or yellow sputum to green is indicative of what
 pneumonia
Green and foul smelling sputum is typical of what disease processes?
Lung abscess
Bronchiectasis
Cystic fibrosis
Where is the apical pulse normally palpated and what is it known as?
Area of the left midclavicular line in the fifth intercostal space
Point of maximum impulse
Intropy, or variable force, with each heartbeat is usually a sign of
Heart disease
What are the three subdivisions of tactile fremitus?
- Vocal fremitus
- Pleural rub fremitus-inflamed pleural surfaces
- Rhonchial fremitus-secretions
Bronchial, aka tracheal breath sounds, are heard over what areas and what would it indicate if they were heard over the lung periphery?
Trachea and bronchus
Consolidation
Increased vesicular breath sounds are normal in what patients?
Children
Debilitated adults
Late inspiratory, crackles are heard in patients with what conditions
pneumonia,
pulmonary edema, or fibrosis
How would you describe a harsh, monophonic? High-pitched inspiratory sound over the larynx?
Treatment?
Stridor
Racemic epinephrine
When stridor is heard on inspiration and expiration, is commonly caused by what?
Aspirated foreign body, tracheal stenosis, or laryngal tumor
What causes a galloping heart rate and what is the typical pathologic finding?
A third (s3) or fourth (s4) heart sound
Congestive heart failure
In a fetus, infection, fetal immaturity, congenital heart malformation, and the effect of maternal drugs can have what impact on the babies heart rate?
Tachycardia
Fetal asphyxia and distress can caused their heart rate to become?
Bradycardic
What will likely develop an a premature neonate without sufficient surfactant?
Respiratory distress syndrome
What is the L: S ratio, indicative of?
Lecithin/sphingomyelin ratio is the relative amount of these two surfactant components. In general, the more lecithin compared with sphingomyelin, the more mature, the lungs.
What is the second test involving the presence of surfactant called?
What is the significance?
PG or phatidylglycerol in the amniotic fluid
The presence of PG in the amniotic fluid always indicates lung maturity
What does transillumination of the chest in an infant identify?
Pneumothorax
What test on babies monitors upper chest movement, lower chest movement, xiphoid, retractions, nasal dilation, and expiratory grunt to determine respiratory distress
Silverman- Anderson score
An inflammation of the epiglottis and Superglottic structures is a medical emergency called?
What do you see an x-ray?
Epiglottitis
Thumb Sign
Loryngotracheobronchitis is also known as?
What’s seen on chest x-ray
Croup
Steepling or pencil sign
Besides chest x-ray, what are clinical indicators of epiglotitis versus Loryngotracheobronchitis?
An epiglottitis, the patient presents with a fever, drooling and difficulty swallowing. The white blood cells are elevated and has a rapid onset.
Inspection: hyper inflated chest with use of accessory muscles
Palpation: Decreased expansion/decreased fremitus
Percussion: hyperresonance/low diaphragm
Auscultation: long, expiratory time /wheezes
Asthma and COPD
Inspection: inspiratory lag on affected side
Palpation: decreased fremitus and trachea and heart shift toward affected side
Percussion: dullness 
Auscultation: absent breath sounds
 atelectasis (lobar)
Inspection: possible, inspiratory lag, splinting on affected side
Palpation: rhonchial fremitus
Percussion: dullness
Auscultation: bronchial breath sounds, bronchophony, pectoriloquy
Consolidation (pneumonia)
Inspection: inspiratory lag on affected side
Palpation: absent, crematories, trachea, and heart shifted away from affected side
Percussion: hyperresonance
Auscultation: absent breath sounds
Tension pneumothorax
Inspection: inspiratory lag on affected side
Palpatatuon: decreased fremitus
Percussion: dullness
Auscultation: absent breast sounds
Pleural effusion
What are the four life functions in order of importance?
Ventilation
Oxygenation
Circulation
Perfusion
If a persons CVP is less than 2 mm Hg, what is a possible treatment recommendation?
Fluid therapy
If a patient’s CVP is greater than 6 mmHg what is the treatment recommendation?
Diuretics
What are the four steps to the physical examination of a patient?
Inspection
Palpation.
Percussion
Auscultation
What should a respiratory therapist consider when a patient is lethargic somnolent or sleepy?
Sleep apnea
Excessive O2 with retainer
When a patient seems anxious or nervous, which should respiratory therapist consider may be the cause?
respiratory distress or hypoxemia
General malaise, angry, combative, or irritable patients could potentially be suffering from
Electrolyte imbalance
What is the potential emotional state of patients with severe hypoxia or with a tension pneumothorax or status asthmaticus
Panic
What is orthopnea and what condition could it demonstrate?
Difficulty breathing except in the upright position
CHF
How many stages of dyspnea are there and what stages the worst?
Five stages with five being the worst. Stage 5 is dyspnea at rest
Diaphoresis, or extreme sweating, can indicate heart failure, infection, anxiety, or tuberculosis (night sweats). As a respiratory therapist, what would you suggest for each?
Heart failure – diuretics and positive inotropic agents infection fever – antibiotics
Nervousness – sedatives
Tuberculosis – anti tubercular drugs
What are a three reasons a patient look pale, or pallor, in a patient assessment
Anemia
Acute blood loss
Vasoconstriction
What causes cyanosis, or discoloration of skin and mucous membranes, in patient inspection?
Caused by hypoxia from an increased amount of reduced hemoglobin (5g )
Normal respiratory rate depth and rhythm is called. What and what is the normal rate?
Eupnea
12 to 20 breaths per minute
Over 20 breaths per minute is called tachypnea. What’s could be the cause?
Hypoxia
Fever
Pain
CNS problem
Normal sleep, drugs, alcohol, and metabolic disorders can all lead to what type of breathing
Bradypnea, less than 12 breaths/minute
Biots breathing is caused by a CNS problem and is different than Cheyne Stokes breathing in which way?
Each breath has the same depth
An apneustic pattern is marked by prolong, gasping inspiration fall by extremely short, insufficient expiration. What are some causes?
Problem with respiratory center, trauma or tumor
What makes cachexia different than normal muscle loss.
It’s due to a underlying condition, like COPD, CHF or AIDS
When the chest moves inward during inspiratory efforts instead of outward, it’s called retractions and what does it indicate in an adult? How about a newborn?
Severe airway instruction in adults
Respiratory distress in newborns
Nasal flaring in newborns indicates what?
Respiratory distress
What could a dry or nonproductive cough complaint indicate
Tumor in the lungs
What is macroglossia?
Enlarged tongue
What classes of Mallampati are considered difficult and what should be utilized?
Class three and class four are considered difficult airways and you should use a fiber optic bronchoscope or a video assist device
Tachycardia could indicate hypoxemia anxiety or stress. Which should a respiratory therapist recommend recommen
Oxygen therapy
Bradycardia can indicate heart failure, shock or a code emergency. What should respiratory therapist recommend?
Atropine
How many beats per minute change indicates an adverse reaction in a patient
20
What is paradoxical pulse/pulses paradoxus mean?
Pulse/blood pressure varying with respiration. May indicate severe air trapping. (status asthmaticus, tension pneumothorax, or cardiac tamponade.)
What causes a tracheal deviation away from the pathology?
Massive pleural fusion
Tension, pneumothorax,
Neck, or thyroid tumor
Large mediastinal mass
What causes a tympanic or hyper resonant sound in diagnostic chest percussion?
Air trapping
Emphysema
Pneumothorax
During egophany, if a spoken E or 99 sounds different during auscultation, what does it indicate?
Consolidation
Terms that referred to increased intensity or transmission of the spoken voice and indicate consolidation and pneumonia are called?
Broncoohony
Whispered pectoriloquy
What are the three types of crackles, where is the fluid, and treatment recommendations
Coarse Crackles (rhonchi) large airway secretions/cough or sxn.
Medium crackles-middle airway secretions/bronchial hygiene
Fine crackles-fluid in the alveoli and associated with CHF or pulmonary edema/O2’s, IPPB, positive inotropic, diuretics
What would you suspect and recommend for treatment with a unilateral wheeze?
Foreign body obstruction
rigid bronchoscopy
What are the three things that can cause stridor, or crowing Inspiratory sound and how would treat?
Supraglottic swelling/epiglotitis/racemic epi/intubation if severe or marked
Subglottic swelling/croup/cool aerosol
Foreign body obstruction-bronchoscopy
A low pitched snoring type of sound, on inhalation, that usually arises from the vibration of fluid or the vibration of tissue that is relaxed or flabby. What is the treatment?
Stertor
CPAP
What is the diagnosis and treatment for a coarse grating, rasping, crunching sound heard on oscillation, and what is the cause and treatment?
Pleural friction rub
Caused by inflamed visceral or parietal pleura rubbing together. Maybe associated with pleurisy, TB, pneumonia, pulmonary infarction, cancer, etc.
Steroids antibiotics.
What are normal cardiac heart sounds and what do you recommend if they’re not normal?
S1-caused by the closure of the mitral and tricuspid valves at the beginning of the ventricular contraction.
S2- sound heard when systole ends when the ventricles relax and the pulmonic and aortic valves close
Tx-echocardiogram
Narrowed bronchi could indicate what?
Bronchogenic carcinoma
An increased cardiac shadow indicates cardiomegaly, and what the two potential causes 
Congestive heart failure
pericardial effusion
What can cause the pulmonary artery to enlarge?
Pulmonary hypertension
Embolism