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RRT > Patient assessment > Flashcards

Patient assessment Flashcards

1
Q

Lethargic

A

lack of energy
“somnolent , sleepy”

consider sleep apnea or excessive O2 therapy

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2
Q

Obtuned

A

drowsy state
(risk of aspiration)

may have decresed cough or gag reflex

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3
Q

somnolent

A

sleepy, drowsy

consider sleep apnea or excessive O2 therapy

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4
Q

Stuporous

A

confused

responds inappropriately, drug over dose, intoxication

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5
Q

emotional state

Panic

could mean?

A

sever hypoxemian, tension pneumothorax, status asthmaticus

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6
Q

emotional state

combative, irritable, anger

A

electrolite imbalance

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7
Q

subjective symptoms

orthopnea

A

difficulty breathing except in the upright position (CHF)

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8
Q

General malaise

A

run down feeling, nausea, weakness, fatigue, headache

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9
Q

Accumulation of fluid in the abdomen

A

Ascites

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10
Q

Ascites is caued by

A

liver failure

(fluid in the abdomen)

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11
Q

Erythema

A

redness of the skin. May be caused by capillary congestion, inflammation, or infection

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12
Q

Eupnea

A

normal respiratory rate

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13
Q

increased respiratory rate

A

tachypnea

>20

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14
Q

decreased respiratory rate

A

bradypnea
(oligopnea)

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15
Q

cessation of breathing

A

Apnea

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16
Q

Hyperpnea

A

increased respiratory rate, increased depth, REGULAR rhythm

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17
Q

hyperpnea cause by

increase rate, increased depth, regular rhythem

A

metabolic disorders / CNS disorders

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18
Q

bradypnea is caused by

A

sleep, drugs, alcohol, metabolic disorders

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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

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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

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21
Q

Apneustic

A

prolonged gasping inspiration followed by extremely short, insufficient expiration

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22
Q

Cause of cheyene-stokes

A

increased intracranial pressures, brainstem injury, drug overdose

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23
Q

increased RR and depth with irregular periods of apnea. each breath has the same depth

A

Biot’s

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24
Q

Cause of Biot’s

A

CNS problems

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25
Q

Kussmaul’s

A

increasing RR (>20), increased depth, irregular rhythm, breathing sounds labored

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26
Q

cause of Kussmaul’s

A

hypoxemia, metabolic acidosis, renal failure, diabetic ketoacidosis

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27
Q

increasing RR (>20), increased depth, irregular rhythm, breathing sounds labored

A

Kussmaul’s breathing

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28
Q

flat sound

A

atelectasis

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29
Q

dull sound

A

fluid filled organs. Pleural effusion,or pneumonia

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30
Q

tympanic

A

increased volume in lungs. normally heard over air filled stomach

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31
Q

hyperresonant

diagnosis

A

pneumothorax, emphesema

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32
Q

adventitious

A

abnormal breath sounds

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33
Q

Vesicular

A

normal breath sounds

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34
Q

hypopnea

A

shollow or slow breathing

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35
Q

steeple sign

Picket fence, Pencil point

A

croup

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36
Q

thumb sign

A

epiglottitis

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37
Q

Hyperlucency

diagnosis

A

COPD, asthma attack, pneumothorax

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38
Q

Heart murmurs

A

sounds cused by turbulent blood flow. cused by heart valve defects or congenital heart abnormalities

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39
Q

Heart sounds

Bruits

A

sounds made in an artery or vein when blood flow becomes tubulent or flows at an abonormal speed.

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40
Q

the right hemidiaphragm is at the level of

what rib?

A

ninth anterior rib

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41
Q

Pacemaker wires/ electodes should be positioned…

A

in the right ventricle

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42
Q

Pulmonary artery catheters should appear in …

A

the right lower lung field

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43
Q

Central venous catheters should rest in

A

the superior vena cava or right atrium

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44
Q

Central venous catheters are inserted through

A

subclavian or jugular vein

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45
Q

Nasogastric tubes / feeding tubes are positioned in the…

A

stomach, 2-6 cm below the diaphragm

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46
Q

Fluffly infiltrates

A

Pulmonary edema

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47
Q

Butterfly / Batwing pattern

A

Plumonary edema

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48
Q

terminology

ground glass appearance

A

ARDS

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49
Q

terminology

Honeycomb pattern

A

ARDS / IRDS

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50
Q

diffuse bilateral radiopacity

A

ARDS or IRDS

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51
Q

description

Scattered densities / thin-layer densities

A

atelectasis

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52
Q

Pulmonary edema treatment

A

Diuretics
Digitalis
Digoxin

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53
Q

terminology

Patchy infiltrates

A

Atelectasis

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54
Q

terminology

Platelike infiltrates
Crowded pulmonary vessels

A

atelectasis

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55
Q

Atelectasis treatment

A

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

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56
Q

description

reticulogranular

A

ARDS / IRDS

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57
Q

Pleural effusion treatment

A

Thoracentesis
Antibiotics and steroids
chest tubes

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58
Q

terminology

air bronchogran

A

Pneumonia

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59
Q

terminology

cavity formation

A

TB

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60
Q

terminology

Blunting/obliteration of costophrenic angle

A

Pleural effusion

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61
Q

Basilar infiltrates with meniscus

A

pleural effusion

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62
Q

Spiral CT scan can diagnose

A

pulmonary emboluse

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63
Q

What to avoid during ICP monitoring

A

hypotension

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64
Q

pulmonary angiography is used to diagnise

A

pulmonary embolism

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65
Q

Exhaled nitric oxide (FEno) testing

A

used to monitor the patient’s response to anti-inflammatory (corticosteroid) treatment

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66
Q

FEno is useful for monitoring patients with …

A

astham, cystic fibrosis, COPD

67
Q

Exhaled nitric oxide

A decrease in FEno suggest

A

a decrease in airway inflammation

68
Q

increased WBC indicates

A

bacterial infection

69
Q

leukocytosis

A

increased white blood cells

70
Q

decreased WBC indicates

A

a viral infection

71
Q

leukopenia

A

decreased white blood cells

72
Q

Mantoux Test

A

teberculin skin test

73
Q

An elevated BNP =

A

CHF

74
Q

BNP

BNP levels for heart failure :
Mild
Mod
Severe

A

> 300pg/mL
600pg/mL
900pg/mL

75
Q

Brain Natriuretic Peptide

Brain Natriuretic Peptide value

A

<100 pg/mL

76
Q

SPUTUM

Mucoid

A

white/ gray, chronic bronchitis

77
Q

SPUTUM

Yellow

A

presence of WBC , bacterial infection

78
Q

SPUTUM

Green

A

stagnant sputum, gram negative (bronchiectasis, pseudomonas)

79
Q

SPUTUM

Brown/ dark

A

old blood, anaerobic lung infection

80
Q

SPUTUM

Bright red

A

hemoptysis

81
Q

SPUTUM

Pink frothy

A

pulmonary edema

excess fluid in the lungs

82
Q

Chest electrodes position

V1 -

A

4th intercostal spce on right side of stermum

83
Q

Chest electrodes position

V2-

A

4th intercostal space on left side sternum

84
Q

Chest electrodes position

V3 -

A

between V2 and V4

85
Q

Chest electrodes position

V4

A

5th intercostal space mid- clavicular line

86
Q

Chest electrodes position

V5 -

A

Between V4 and V6

87
Q

Chest electrodes position

V6

A

5th intercostal space, left mid-axillary line

88
Q

Ischemia is indicated by

A

inverted T-wave

89
Q

Injury is indicated by an

A

elevated S-T segment

90
Q

Infarction is diagnosed by

A

significat Q waves

91
Q

PetCO will be ___ than the arterial __

A

lower than the arterial PCO2

92
Q

Peripheral wedge-shaped infiltrate

A

Pulmonary embolus

93
Q

Blunting/ obliteration of costophrenic angle

A

pleural effusion

94
Q

Basilar infiltrates with meniscus

A

Pleural effusion

95
Q

Pulmonary embolus

A

Heparing
Streptokinase

96
Q

Pulmonary artery catheter

Proximal catheter port measures

A

CVP

97
Q

Pulmonary artery catheter

PAP is measured in what port?

balloon deflated/inflated?

A

distal port with ballon deflated

98
Q

Pulmonary artery catheter

PCWP is mesured by what port?

balloon inflated/ deflated?

A

distal w/ ballon inflated

99
Q

to determin the health of the Right heart, look at ?

A

CVP and PAP

inc. cvp , N pap = R heart problem

100
Q

to determin if left heart is working look at …

A

PCWP and C.O

inc. pcwp , N co = left heart problem

101
Q

elevated CVP = __problem

A

Right heart

102
Q

elevated PAP = __problem

A

lung problem

103
Q

elevated PCWP = __problem

A

left heart failure

104
Q

Treatment for increased ICP >20mmHg

A

Hyperventilation

target PaCO2 25-30

105
Q

What lead is best for cardiac rhythem

A

Lead II

Lt leg positive, Rt arm negative

106
Q

SVR may change with

A

C.O / C.I
if other values remain constant

107
Q

SVR incrases with

A

systemic hypertension and or vasoconstriction

108
Q

PVR is increased with

A

hypoxia,
pulmonary hypertension
and lung disease

109
Q

Assesment of the gestational age is important to differentiate between a premature infant and one that is just small fo his or her size

A

Dobowitz or Ballard method

110
Q

used for pts requiring mechanical ventilation because the magnetic field would disrupt electronic devices

A

Fluidic (non electic, gas powered ventilators)

111
Q

MRI

Manual resuscitation equipment should have:

A
  • Additional tubinbg
  • valves made of non-ferrous (non-metallic) materials
112
Q

noninvasive method for monitoring cardiac performance

A

echocardiogram

113
Q

indications for EEG?

A
  • brain tumors
  • traumatic brain injury
  • loss of brain function
  • epilepsy/ seizures

electroencephalography

114
Q

Hypercapnia

A

pH <7.25

115
Q

FAILING VENTILATORY MECHANICS

A

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
Q

Too high of a PaO2 in COPD pt will cause then to have

A

decreased RR and decreased VT
May be described as stuporous

117
Q

PaO2 for COPD pt

A

50-65

118
Q

Nitric oxide

A

pulmonary vessel dilater
used in ARDS, chonic pulmonary hypertension, pul. embolis,

119
Q

Hyperbaric oxygen therapy is used to treat

A
  • CO poisoning
  • decrease sickness (divers assending to quickly
  • assist tissue grafts (skin)
120
Q

Cardioversion is for treating

A

Non lethal arrhytmias :
Atrial fibrillation
Atrila flutter
Ventricular tachycardia (with pulse)

121
Q

Cardioversion must be done with

A

synchronization set ON
to the R wave of the ECG

122
Q

SLEEP STudy

if decreased in nasal airflow and increased in respiratory effort (chest movement) is observed, the problem is

A

Obstructive sleep apnea

123
Q

sleep studies

if DECREASE in nasal airflow and DECREASE in respiratory effort (chest movement) is observed the problem is

A

Central sleep apnea

124
Q

Emphysema is the only obstructive disease associated with

A

low DLco because it involves destruction of the alveoli

125
Q

objective

A

signs, those things that can be measured

126
Q

subjective

A

symptoms, those things that the patient must tell you

127
Q

tabaccon use

formula

A

pack years = #of packs a day x #of years smoked

4 packs a day x 10 years = 40 pack years

128
Q

Normal urine output

A

40ml/hr

129
Q

Decrease CVP

indicates and treatment

A

hypovolemia
recommend fluid therapy

130
Q

Increase CVP

A

hypervolemia
recommend diuretics

131
Q

excessive O2 therapy will cause a COPD pt to be

A

lethargic, somnolent, sleepy

132
Q

Dysphagia

A

difficulty swallowing

133
Q

What does IPPA stand for

A

inspection
palpation
percussio
Auscultation

134
Q

Peripheral edema is caused by

A

CHF

135
Q

Give ____ for pitting edema

A

furosemide (lasixs)

136
Q

heart failure
recommend

A

diuretics , positive inotropic agents

137
Q

Atrophy

A

muscle waisitng, cachexia, starvation
loss of muscle tone and occurs in paralysis

138
Q

a dry non-productive cough may indicate

A

tumor in lungs

139
Q

a productive cough may indicate

A

an infection or chronic lung disease

140
Q

tachycardia indicates

A

hypoxemia, anxiety, stress

recommend oxygen therapy

141
Q

paradoxical pulse/ pulsus paradoxus

A

pulse/blood pressure varies with respiration. May indicate severe air trapping (status asmaticus, tension pneumothorax, cardia temponade)

142
Q

Assessment by percussion

Flat

A

atelectasis

143
Q

Assessment by percussion

Dull

A

Plural effusion or pneumonia

144
Q

HEART SOUNDS

In adults: the presence of an S3 sound may sudgest

A

heart failure

145
Q

Egophony

A

“E” but sounds like “A” = consolidation of the lung tissure = pneumonia-like condition

146
Q

fine crackles are associated with

A

CHF / pulmonary edema

147
Q

What to recommend for CHF/ Pulm. edema

A
  1. oxygen
  2. positive pressure therapy
  3. positive inotropic agents
  4. diuretics
148
Q

a coarse grating, raspy or crunching sound

A

pleural friction rub

149
Q

what to recommend for pleural friction rub

A

steroids and antibiotics

150
Q

used to measure cuff pressure

A

sphygmonanometer

151
Q

decreased blood pressure indicates

A

poor perfusion - hypovolemia, CHF

152
Q

ARDS treatment

A

Oxygen
Low VT or PIP
CPAP
PEEP

153
Q

Therapy to reduce ICP

A

hyperventilation
target: PaCO2 : 25-30

154
Q

Sedatives and analgesia therapy for ICP monitoring

A

narcotics and benzo

155
Q

FEco
* mon-smokers
* light smokers
* Mod smokers
* heavy smokers

A
  • <7
  • 7-10
  • 11-20
  • > 20
156
Q

what causes hypokalemia

A

refers to low K+: occurs with metabolic alkalosis, excessive excretion, vomiting, flattened T waves on ECG

157
Q

Hyperkalemia occurs with

A

kidney failure
spiked T wave
metabolic acidosis

referse to high K+

158
Q

major extracellular cation controlled by the kidneys

A

Sodium

159
Q

Hyponatremia occurs with

A
  • fluid loss from diuretics
  • vomiting
  • diarrhea
  • fluid gain from CHF
  • Iv threapy
160
Q

Hypernatremia relates to

A

dehydration
Na+ is retained in exhange for K+

161
Q

Hypochloremia occurs with

A

metabolic alkalosis

162
Q

Hyperchloremia occurs with

A

metabolic acidosis

163
Q

evaluates kidney function

A

creatinine
Blood urea nitrogen (BUN)

164
Q
A

RRT (12 decks)

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