Patient assessment Flashcards
1
Q
Lethargic
A
lack of energy
“somnolent , sleepy”
consider sleep apnea or excessive O2 therapy
2
Q
Obtuned
A
drowsy state
(risk of aspiration)
may have decresed cough or gag reflex
3
Q
somnolent
A
sleepy, drowsy
consider sleep apnea or excessive O2 therapy
4
Q
Stuporous
A
confused
responds inappropriately, drug over dose, intoxication
5
Q
emotional state
Panic
could mean?
A
sever hypoxemian, tension pneumothorax, status asthmaticus
6
Q
emotional state
combative, irritable, anger
A
electrolite imbalance
7
Q
subjective symptoms
orthopnea
A
difficulty breathing except in the upright position (CHF)
8
Q
General malaise
A
run down feeling, nausea, weakness, fatigue, headache
9
Q
Accumulation of fluid in the abdomen
A
Ascites
10
Q
Ascites is caued by
A
liver failure
(fluid in the abdomen)
11
Q
Erythema
A
redness of the skin. May be caused by capillary congestion, inflammation, or infection
12
Q
Eupnea
A
normal respiratory rate
13
Q
increased respiratory rate
A
tachypnea
>20
14
Q
decreased respiratory rate
A
bradypnea
(oligopnea)
15
Q
cessation of breathing
A
Apnea
16
Q
Hyperpnea
A
increased respiratory rate, increased depth, REGULAR rhythm
17
Q
hyperpnea cause by
increase rate, increased depth, regular rhythem
A
metabolic disorders / CNS disorders
18
Q
bradypnea is caused by
A
sleep, drugs, alcohol, metabolic disorders
19
Q
Cheyne-stokes
A
gradually increasing then decreasing rate and depth in a cycle lasting from, 30-180 seconds, with periods of apnea lasting up to 60 sec
20
Q
gradually increasing then decreasing rate and depth in a cycle lasting from, 30-180 seconds, with periods of apnea lasting up to 60 sec
A
Cheyne- stokes
21
Q
Apneustic
A
prolonged gasping inspiration followed by extremely short, insufficient expiration
22
Q
Cause of cheyene-stokes
A
increased intracranial pressures, brainstem injury, drug overdose
23
Q
increased RR and depth with irregular periods of apnea. each breath has the same depth
A
Biot’s
24
Q
Cause of Biot’s
A
CNS problems
25
Kussmaul's
increasing RR (>20), increased depth, irregular rhythm, breathing sounds labored
26
cause of Kussmaul's
hypoxemia, metabolic acidosis, renal failure, diabetic ketoacidosis
27
increasing RR (>20), increased depth, irregular rhythm, breathing sounds labored
Kussmaul's breathing
28
flat sound
atelectasis
29
dull sound
fluid filled organs. Pleural effusion,or pneumonia
30
tympanic
increased volume in lungs. normally heard over air filled stomach
31
hyperresonant
| diagnosis
pneumothorax, emphesema
32
adventitious
abnormal breath sounds
33
Vesicular
normal breath sounds
34
hypopnea
shollow or slow breathing
35
steeple sign
| Picket fence, Pencil point
croup
36
thumb sign
epiglottitis
37
Hyperlucency
| diagnosis
COPD, asthma attack, pneumothorax
38
Heart murmurs
sounds cused by turbulent blood flow. cused by heart valve defects or congenital heart abnormalities
39
# Heart sounds
Bruits
sounds made in an artery or vein when blood flow becomes tubulent or flows at an abonormal speed.
40
the right hemidiaphragm is at the level of
| what rib?
ninth anterior rib
41
Pacemaker wires/ electodes should be positioned...
in the right ventricle
42
Pulmonary artery catheters should appear in ...
the right lower lung field
43
Central venous catheters should rest in
the superior vena cava or right atrium
44
Central venous catheters are inserted through
subclavian or jugular vein
45
Nasogastric tubes / feeding tubes are positioned in the...
stomach, 2-6 cm below the diaphragm
46
Fluffly infiltrates
Pulmonary edema
47
Butterfly / Batwing pattern
Plumonary edema
48
# terminology
ground glass appearance
ARDS
49
# terminology
Honeycomb pattern
ARDS / IRDS
50
diffuse bilateral radiopacity
ARDS or IRDS
51
# description
Scattered densities / thin-layer densities
atelectasis
52
Pulmonary edema treatment
Diuretics
Digitalis
Digoxin
53
# terminology
Patchy infiltrates
Atelectasis
54
# terminology
Platelike infiltrates
Crowded pulmonary vessels
atelectasis
55
Atelectasis treatment
Lung expansion therapy
* SMI/IS
* IPPB
* CPAP
* PEEP
56
# description
reticulogranular
ARDS / IRDS
57
Pleural effusion treatment
Thoracentesis
Antibiotics and steroids
chest tubes
58
# terminology
air bronchogran
Pneumonia
59
# terminology
cavity formation
TB
60
# terminology
Blunting/obliteration of costophrenic angle
Pleural effusion
61
Basilar infiltrates with meniscus
pleural effusion
62
Spiral CT scan can diagnose
pulmonary emboluse
63
What to avoid during ICP monitoring
hypotension
64
pulmonary angiography is used to diagnise
pulmonary embolism
65
Exhaled nitric oxide (FEno) testing
used to monitor the patient's response to anti-inflammatory (corticosteroid) treatment
66
FEno is useful for monitoring patients with ...
astham, cystic fibrosis, COPD
67
# Exhaled nitric oxide
A decrease in FEno suggest
a decrease in airway inflammation
68
increased WBC indicates
bacterial infection
69
leukocytosis
increased white blood cells
70
decreased WBC indicates
a viral infection
71
leukopenia
decreased white blood cells
72
Mantoux Test
teberculin skin test
73
An elevated BNP =
CHF
74
# BNP
BNP levels for heart failure :
Mild
Mod
Severe
>300pg/mL
>600pg/mL
>900pg/mL
75
# Brain Natriuretic Peptide
Brain Natriuretic Peptide value
<100 pg/mL
76
# SPUTUM
Mucoid
white/ gray, chronic bronchitis
77
# SPUTUM
Yellow
presence of WBC , bacterial infection
78
# SPUTUM
Green
stagnant sputum, gram negative (bronchiectasis, pseudomonas)
79
# SPUTUM
Brown/ dark
old blood, anaerobic lung infection
80
# SPUTUM
Bright red
hemoptysis
81
# SPUTUM
Pink frothy
pulmonary edema
| excess fluid in the lungs
82
# Chest electrodes position
V1 -
4th intercostal spce on right side of stermum
83
# Chest electrodes position
V2-
4th intercostal space on left side sternum
84
# Chest electrodes position
V3 -
between V2 and V4
85
# Chest electrodes position
V4
5th intercostal space mid- clavicular line
86
# Chest electrodes position
V5 -
Between V4 and V6
87
# Chest electrodes position
V6
5th intercostal space, left mid-axillary line
88
Ischemia is indicated by
inverted T-wave
89
Injury is indicated by an
elevated S-T segment
90
Infarction is diagnosed by
significat Q waves
91
PetCO will be ___ than the arterial __
lower than the arterial PCO2
92
Peripheral wedge-shaped infiltrate
Pulmonary embolus
93
Blunting/ obliteration of costophrenic angle
pleural effusion
94
Basilar infiltrates with meniscus
Pleural effusion
95
Pulmonary embolus
Heparing
Streptokinase
96
# Pulmonary artery catheter
Proximal catheter port measures
CVP
97
# Pulmonary artery catheter
PAP is measured in what port?
| balloon deflated/inflated?
distal port with ballon deflated
98
# Pulmonary artery catheter
PCWP is mesured by what port?
| balloon inflated/ deflated?
distal w/ ballon inflated
99
to determin the health of the Right heart, look at ?
CVP and PAP
| inc. cvp , N pap = R heart problem
100
to determin if left heart is working look at ...
PCWP and C.O
| inc. pcwp , N co = left heart problem
101
elevated CVP = __problem
Right heart
102
elevated PAP = __problem
lung problem
103
elevated PCWP = __problem
left heart failure
104
Treatment for increased ICP >20mmHg
Hyperventilation
| target PaCO2 25-30
105
What lead is best for cardiac rhythem
Lead II
| Lt leg positive, Rt arm negative
106
SVR may change with
C.O / C.I
if other values remain constant
107
SVR incrases with
systemic hypertension and or vasoconstriction
108
PVR is increased with
hypoxia,
pulmonary hypertension
and lung disease
109
Assesment of the gestational age is important to differentiate between a premature infant and one that is just small fo his or her size
Dobowitz or Ballard method
110
used for pts requiring mechanical ventilation because the magnetic field would disrupt electronic devices
Fluidic (non electic, gas powered ventilators)
111
# MRI
Manual resuscitation equipment should have:
* Additional tubinbg
* valves made of non-ferrous (non-metallic) materials
112
noninvasive method for monitoring cardiac performance
echocardiogram
113
indications for EEG?
* brain tumors
* traumatic brain injury
* loss of brain function
* epilepsy/ seizures
| electroencephalography
114
Hypercapnia
pH <7.25
115
FAILING VENTILATORY MECHANICS
Mip <-20
RR <8
Minute ventilation <10L/min
VC<10mL/kg
VT <5mL/kg
MEP <40 cmH2O
Vd/Vt >60 %
Qs/QT >20%
RSBI >106
116
Too high of a PaO2 in COPD pt will cause then to have
decreased RR and decreased VT
May be described as stuporous
117
PaO2 for COPD pt
50-65
118
Nitric oxide
pulmonary vessel dilater
used in ARDS, chonic pulmonary hypertension, pul. embolis,
119
Hyperbaric oxygen therapy is used to treat
* CO poisoning
* decrease sickness (divers assending to quickly
* assist tissue grafts (skin)
120
Cardioversion is for treating
Non lethal arrhytmias :
Atrial fibrillation
Atrila flutter
Ventricular tachycardia (with pulse)
121
Cardioversion must be done with
synchronization set ON
to the R wave of the ECG
122
# SLEEP STudy
if decreased in nasal airflow and increased in respiratory effort (chest movement) is observed, the problem is
Obstructive sleep apnea
123
# sleep studies
if DECREASE in nasal airflow and DECREASE in respiratory effort (chest movement) is observed the problem is
Central sleep apnea
124
Emphysema is the only obstructive disease associated with
low DLco because it involves destruction of the alveoli
125
objective
signs, those things that can be measured
126
subjective
symptoms, those things that the patient must tell you
127
tabaccon use
| formula
pack years = #of packs a day x #of years smoked
| 4 packs a day x 10 years = 40 pack years
128
Normal urine output
40ml/hr
129
Decrease CVP
| indicates and treatment
hypovolemia
recommend fluid therapy
130
Increase CVP
hypervolemia
recommend diuretics
131
excessive O2 therapy will cause a COPD pt to be
lethargic, somnolent, sleepy
132
Dysphagia
difficulty swallowing
133
What does IPPA stand for
inspection
palpation
percussio
Auscultation
134
Peripheral edema is caused by
CHF
135
Give ____ for pitting edema
furosemide (lasixs)
136
heart failure
recommend
diuretics , positive inotropic agents
137
Atrophy
muscle waisitng, cachexia, starvation
loss of muscle tone and occurs in paralysis
138
a dry non-productive cough may indicate
tumor in lungs
139
a productive cough may indicate
an infection or chronic lung disease
140
tachycardia indicates
hypoxemia, anxiety, stress
| recommend oxygen therapy
141
paradoxical pulse/ pulsus paradoxus
pulse/blood pressure varies with respiration. May indicate severe air trapping (status asmaticus, tension pneumothorax, cardia temponade)
142
# Assessment by percussion
Flat
atelectasis
143
# Assessment by percussion
Dull
Plural effusion or pneumonia
144
# HEART SOUNDS
In adults: the presence of an S3 sound may sudgest
heart failure
145
Egophony
"E" but sounds like "A" = consolidation of the lung tissure = pneumonia-like condition
146
fine crackles are associated with
CHF / pulmonary edema
147
What to recommend for CHF/ Pulm. edema
1. oxygen
2. positive pressure therapy
3. positive inotropic agents
4. diuretics
148
a coarse grating, raspy or crunching sound
pleural friction rub
149
what to recommend for pleural friction rub
steroids and antibiotics
150
used to measure cuff pressure
sphygmonanometer
151
decreased blood pressure indicates
poor perfusion - hypovolemia, CHF
152
ARDS treatment
Oxygen
Low VT or PIP
CPAP
PEEP
153
Therapy to reduce ICP
hyperventilation
target: PaCO2 : 25-30
154
Sedatives and analgesia therapy for ICP monitoring
narcotics and benzo
155
FEco
* mon-smokers
* light smokers
* Mod smokers
* heavy smokers
* <7
* 7-10
* 11-20
* >20
156
what causes hypokalemia
refers to low K+: occurs with metabolic alkalosis, excessive excretion, vomiting, flattened T waves on ECG
157
Hyperkalemia occurs with
kidney failure
spiked T wave
metabolic acidosis
| referse to high K+
158
major extracellular cation controlled by the kidneys
Sodium
159
Hyponatremia occurs with
* fluid loss from diuretics
* vomiting
* diarrhea
* fluid gain from CHF
* Iv threapy
160
Hypernatremia relates to
dehydration
Na+ is retained in exhange for K+
161
Hypochloremia occurs with
metabolic alkalosis
162
Hyperchloremia occurs with
metabolic acidosis
163
evaluates kidney function
creatinine
Blood urea nitrogen (BUN)
164
