Patient assessment Flashcards
Natural factors which increase body temperature
Late afternoon is highest point but ovulation, exercise and first 5 months of pregnancy increase temperature as well!
Les’ preferred normal temperature range for patients?
36.5-37.5 degrees C
What point of day has lowest body temperature?
The morning
What temperature method is recommended for peds?
Axillary
Common temperature taking methods
Tympanic, axillary and oral
Normal HR
Tachy HR
Brady HR
60-100 normal
Over 100 is tachy
Under 60 is bradycardia
Define
Bigeminy and trigeminy
And what your first step would be upon discovering one
Trigeminy beats in groups of 3
Bigeminy is beats in groups of 2
Needs an ECG
Name the categories of pulse grade
4+ pulse strong and impossible to occlude 3+ pulse difficult to occlude 2+ brisk or normal pulse 1+ thready or weak pulse 0 no pulse
3 key factors when reporting pulse
Rate rhythm and grade
define: Tachypnea bradypnea hyperpnea hypopnea
tachypnea- RR above normal
Bradypnea RR below normal
hyperpnea- minute volume increased
hypopnea- minute volume decreased
2 factors to report for breathing?
RR and rhythym/pattern
define the values for the following:
normal BP
hypertension
hypotension
normal= 120/80 hypertension= 140/90 or over hypotension= less than 90/60
optimal bladder arm coverage %
in adults
in peds
adutls is 80%
peds is 100%
which korotokoff phases are used to asses BP?
phase 1- systolic pressure
phase 5 diastolic
what can succesfull patient centered care proportedly improve?
patient safety
communication
compliance with treatment plan
what are the 4 stages of patient client interaction?
1- chart review. clarify in your mind and with charts what your role is today.
2- introdctory stage. establish rapport with the patient
use their name formally until they tell you not too
3-initial assesment. identify patients baseline condition and need for treatment as physician has ordered
4-follow up stage. communicate with the patient for a moment. “do you have any questions for me” on way out always look back and do one final glance over patient and room.
3 categories of space
intimate 0-2 ft
personal 2-4
social 4-12
tips to express genuine concern
face patient square on
use eye contact
be an active lsitener
consider appropriate touch
what does the acronym PQRST stand for
and when should we use it?
Provocative "what caused it" Qualtiy or quantity "burning, sha R region/radiation S severity "out of 10 T timing "since when does it hurt" it is for pain
what acronym is used for a primary survey?
SAMPLE
what does sample stand for?
Symptoms allergies medication Past history last meal events prior
what are to factors which can be used in predictive medicine?
family history
or
occupational/ environemental histoy
3 key things to review on patient file before meeting them
admission note-describes pertinent facts ot their admission
physicians orders- lists treatments and hterapies
progress reports- descrie the patients response to treatment
define DNR
do no resusitate
aka do not attempt to revive patient
common in elderly
define and distinguish between symtpoms and signs
signs are objective “measureable imperical data”
symptoms are subjective what the patient says
what is a cough and what causes it?
a protective reflex triggered by stimulation of cough receptors.
primary symptoms of cardiopulmonary disorders
cough sputum production hemoptysis SOB chest pain
your patient grimaces when they are being interiveiwed post op. She is suffering some confusion about her responses. What could be impeding her communication skills? self-concept listening habits pain and anxiety hearing impairment
pain and anxiety
active listening is most essential of what stage of the clinical encounter?
the initial assesment stage
what are the 4 stages of the clinical encounter
introductory stage
initial assesment stage
treatment and monitoring
follow up
patient is having difficulty learning to use their enhaler. after many attempts they stil cannot use it independently and properly. what should your next step be?
request permission from doctor to find more acceptable delivery system
cease attempts and give up
push the patient to try harder and practice more
chart trx as not given and return later
request permission from patients doctor to find more acceptable delivery route
what space is appropriate to develop patient rapport
social
why should you always log off your computer when leaving the computer?
HIPAA
what are some important cultural beliefs to explore with patient during the assesment stage.
concepts of health and disease
responses to authority
gender and family roles
reliigous values
what is an ill advised way to decrease patient anxiety?
prescription of analgesic
what are 4 key elements of a good patient action plan?
a specific measurable goal
barriers to goal measurement
actions to achieve the goal
a follow uo mechanism
what piece of equipment is essential to protect yourself from airborne hazards?
properly fitting N95
what are your first steps after a patient poorly responds to the trx you have given after patient is stablilzed
speak with nurse, chart response and chart whoseover you notified
in setting up a postural drainage treatment what info could be important for you to obtain?
patients med sched
pt ideal body weight
pt meal schedule
med sched
meal sched
all of the following are acceptable for an RT to suggest to a pt with COPD except what?
help pt develop good action plans
training pt in self care techniques
recomending diet or nutrition changes
providing information about disease process
diet and nutrition change recomendations shouldnt be given
T or F
proper diagnosis and trx are determined to a great extent by the accuracy and detal of the patients history
T
in what section of the patient history can a detailed description of the patients current symptoms be found?
history of present illness
information obtained form the patient an which cannot be percieved by the observer is known as?
subjective data
where in patient info could you find potential history of exposrure to asbestos?
occupational history
subjective manifestations of the disease are commonly known as?
symptoms
define pertinent negaitve
a sign or symptom assocaited woith the disease or suspected disease process which the patient denies having.
DNR means?
do no resusitate
family history can be helpful in diagnosing which of the following? acute bronchitis cystic fibrosis pnuemothorax pulmonary edema
CF
which of the following could lead to a weak cough?
a. Reduced lung recoil
b. Bronchospasm
c. Weak inspiratory muscles
all of the above
A cough described as being persistent for more than 3 weeks would be called which of the following? acute paroxysmal chronic nocturnal
chronic
Which of the following problems associated with hemoptysis?
a. Tuberculosis
b. Lung carcinoma
c. Pneumonia
all of the above
A patient’s complaint of breathlessness or air hunger would be defined as which of the following?
a. Hemoptysis
b. Wheezing
c. Dyspnea
d. Cyanosis
dyspnea
What term is used to describe shortness of breath in the upright position?
a. Orthopnea
b. Platypnea
c. Eupnea
d. Apnea
platypnea
What term is used to describe shortness of breath in the upright position?
a. Orthopnea
b. Platypnea
c. Eupnea
d. Apnea
increase in lung compliance
What term is used to describe difficult breathing in the reclining position?
a. Apnea
b. Platypnea
c. Orthopnea
d. Eupnea
orthopnea
\
radiates to the neck
Which of the following may cause syncope?
a. Severe cough
b. Pulmonary embolism
c. Hypovolemia
d. All of the above
all of the above
define syncope
temporary loss of consciousness due to low BP
Which of the following is (are) true regarding dependent edema cause by lung disease?
a. It is caused by pulmonary vasodilation
b. Accompanying hepatomegaly may be present
c. It is caused by acute systemic hypertension
d. All of the above
accompanying hepatomegaly may be present
Chronic pulmonary hypertension may lead to which of the following clinical findings?
a. Pedal edema
b. Inspiratory crackles
c. Hepatomegaly
d. A and C
hepatomegaly and pedal edema
define hepatomegaly
swollen liver
Which of the following is associated with night sweats?
a. Tuberculosis
b. Congestive heart failure
c. Asthma
d. Interstitial pulmonary fibrosis
TB
Which of the following symptoms is least likely to be associated with GERD?
a. Pedal edema
b. Hoarseness
c. Coughing
d. Wheezing
pedal edema
In what decade of life is snoring and obstructive sleep apnea (OSA) most likely to be present in adult males?
a. 20 to 29 years
b. 30 to 39 years
c. 40 to 49 years
d. 50 to 59 years
50-59
all of the following are included in the measurement of vital signs, except which one?
a. Pulse
b. Respiratory Rate
c. Urinary output
d. Blood pressure
urinary output
Which of the following changes is consistent with a fever?
a. Decreased respiratory rate
b. Increased pulse rate
c. Decreased oxygen consumption
d. Decreased blood pressure
increased pulse rate
Which of the following methods of temperature measurement is recommended for neonates?
a. Oral
b. Axillary
c. Rectal
d. Ear
axillary
What is the normal value of the resting pulse rate in the adult?
a. 30-60 beats/min
b. 60-100 beats/min
c. 80-120 beats/min
d. 100-150 beats/min
60-100 bpm
What is the normal range for respiratory rate for adults?
a. 6-10 breaths/min
b. 8-12 breaths/min
c. 12-20 breaths/min
d. 15-25 breaths/min
12-20 breaths
Which of the following causes tachycardia in the adult?
a. Hypothermia
b. Hypoxemia
c. Hypertension
d. Polycythemia
hypoxemia
Which of the following arterial sites is the most common for evaluating the pulse in the adult patient?
a. Pedal
b. Temporal
c. Radial
d. Femoral
radial
Which of the following causes tachypnea in the adult?
a. Hypothermia
b. Narcotic overdose
c. Metabolic acidosis
d. Hyperoxia
metabolic acidosis
Which of the following causes an erroneously low blood pressure measurement?
a. Inflation pressure held in the cuff between measurements
b. Use of blood pressure cuff that is too narrow
c. Not enough pressure used in the cuff during measurement
d. Tachycardia
not enough pressure used in the cuff during measurement
Hypotension may often be associated with all of the following, except which ones?
a. Reduced perfusion
b. Less oxygen delivery to the tissues
c. Excessive salt intake
d. Dehydration
excessive salt intake
The peak pressure in the arteries is known as which of the following?
a. Pulse pressure
b. Diastolic pressure
c. Systolic pressure
d. Pulse pressure
systolic pressure
- A decrease in the intensity of the palpated pulse during inhalation is a definition of which of the following?
a. Abdominal paradox
b. Pulse pressure
c. Pulsus paradoxus
d. Pulsus alternans
pulsus paradoxus
What is the normal range for pulse pressure?
a. 10-20 mmHg
b. 20-25 mmHg
c. 30-50 mmHg
d. 35-40 mmHg
35-40mmhg
If a patient experiences syncope when moving from the supine to the upright position, what is the likely cause?
a. Left ventricular failure
b. Postural hypotension
c. Excessive vasoconstriction
d. Pulsus paradoxes
postural hypotension
Which of the following is not a typical component to physical examination?
a. Inspection
b. Palpation
c. Auscultation
d. Interviewing
interviewing
Pursed-lip breathing is most often seen in patients with which of the following diseases?
a. Pulmonary fibrosis
b. COPD
c. Pneumonia
d. Congestive heart failure
COPD
Which of the following is an unlikely cause of diaphoresis?
a. Myocardial infarction
b. Fever
c. Pulmonary fibrosis
d. Exercise
Pulmonary fibrosis
In which of the following conditions is lymphadenopathy of the neck seen?
a. Infection of the upper airway
b. Asthma
c. Cystic fibrosis
d. Atelectasis
upper airway infection
define lymphadenopathy
disease fo the lymph nodes
Which of the following may cause an increased jugular vein distension?
i. Chronic hypoxemia
ii. Right-sided heart failure secondary to left-sided heart failure
iii. Right-sided heart failure alone
a. i and ii
b. ii and iii
c. i, ii and iii
c
What spinous process is most prominent with the patient sitting and with the head bent forward?
a. T1
b. C1
c. C7
d. S3
C7
At which of the following topographic locations is the bifurcation of the trachea located on the anterior chest?
a. Over the upper part of the manubrium
b. Beneath the sternal angle
c. The fourth rib at the sternum
d. Under the xiphoid process
beneath the sternal angle
The minor (horizontal) fissure begins at which of the following locations on the anterior chest?
a. Second rib at the sternal border
b. Fourth rib at the sternal border
c. Sixth rib at the sternal border
d. Seventh rib at the sternal border
fourth rib at the sternal border
An “inward depression of the sternum” describes which of the following thoracic configurations?
a. Kyphosis
b. Pectus excavatum
c. Flail chest
d. Barrel chest
pectus excavatum
What type of lung problem is associated with severe kyphoscoliosis?
a. COPD
b. Restrictive lung disease
c. Pneumothorax
d. Pulmonary fibrosis
restrictive lung disease
Which of the following best describes an apneustic breathing pattern?
a. Prolonged exhalation
b. Prolonged inhalation
c. Deep and fast
d. Absence of breathing
prolonged inhalation
What is indicated by the presence of retractions?
a. Heart failure
b. An increase in the work of breathing
c. Pneumothorax
d. Restrictive lung disease
increase WOB
Which of the following I:E ratios is consistent with a severe asthma attack?
a. 3:1
b. 2:1
c. 1:1
d. 1:3
1:3
Which of the following breathing patterns is associated with narrowing of the intrathoracic airways?
a. Prolonged inspiratory time
b. Prolonged expiratory time
c. Rapid and shallow
d. Rapid and deep
prolonged expiratory time
Which of the following indicate diaphragmatic fatigue?
i. Paradoxical pulse
ii. Abdominal paradox
iii. Respiratory alternans
iv. Biot breathing pattern
a. i and ii
b. ii and iii
c. iii and iv
2 and 3
Which of the following causes an increased tactile fremitus?
a. Atelectasis with a patent bronchiole
b. Pleural effusion
c. Emphysema
d. Obesity
atelectasis with a patent bronchiole
Which of the following causes a bilateral decrease in chest expansion?
a. Lung tumor
b. Pneumothorax
c. COPD
d. Pleural effusion
COPD
Which of the following causes an increase resonance to percussion of the chest?
a. Lobar consolidation
b. Pneumothorax
c. Pleural effusion
d. Atelectasis
pneumothorax
What clinical condition would cause the range of diaphragm movement to be reduced bilaterally?
a. Severe emphysema
b. Left lower lobe atelectasis
c. Congestive heart failure
d. Pneumonia
severe emphysema
Normal tracheal breath sounds are produced by which of the following mechanisms?
a. Turbulent airflow through large airways
b. Filtered sounds through lung tissue
c. Passage of air through secretions
d. Passage of air through narrowed airways
turbulent airflow through large airways
Which of the following terms is used to describe discontinuous adventitious lung sounds?
a. Wheeze
b. Crackles
c. Rhonchi
d. Stridor
crackles
The finding of late inspiratory crackles on auscultation of a patient might indicate which of the following?
i. Atelectasis
ii. Pulmonary fibrosis
iii. Bronchospasm
iv. Pneumonia
a. i only
b. i and iii
c. i, ii and iii
d. i, ii and iv
atelectasis, PF and pneumonia
What clinical condition is most closely associated with polyphonic wheezing?
a. Pneumonia
b. Pneumothorax
c. Asthma
d. Pulmonary fibrosis
asthma
Which of the following lung sounds is commonly heard in patients with upper airway obstruction?
a. Polyphonic wheeze
b. Fine inspiratory crackles
c. Coarse inspiratory and expiratory crackles
d. Inspiratory stridor
inspiratory stridor
Which of the following is the normal topographic location of the PMI?
a. Third intercostal space at the anterior axillary line
b. Fourth intercostal space at the anterior axillary line
c. Fifth intercostal space at the midclavicular line
d. Sixth intercostal space at the midsternal line
fifth intercostal space
what is PMI
point of maximal impulse; the location where the cardiac pulse can be palpated externally.
Which of the following locations is best for auscultating the mitral valve?
a. Third intercostal space at the anterior axillary line
b. Fourth intercostal space at the anterior axillary line
c. Fifth intercostal space at the midclavicular line
d. Sixth intercostal space at the midsternal line
fifth intercostal
What produces the sounds associated with the first heart sound?
a. Closure of the atrioventricular (AV) valves
b. Closure of the semilunar valves
c. Left ventricular muscle movement
d. Blood flow through normal valves
closure of AV valve
What clinical condition is most commonly associated with a gallop heart rhythm?
a. Pneumonia
b. Pericarditis
c. Congestive heart failure
d. Aortic stenosis
CHF
Which of the following may cause an increased P2 component of the second heart sound?
i. Pulmonary hypertension
ii. Pulmonary embolism
iii. Cor pulmonale
iv. Systemic hypertension
a. i and iii
b. ii and iii
c. i, ii and iii
d. i, ii, iii and iv
pulmonary hypertension
pulmonary embolism
cor pulmonale
Which of the following is/are associated with right heart failure?
i. Jugular venous distention
ii. Hepatomegaly
iii. Pedal edema
iv. Systemic hypertension
a. i only
b. i and ii
c. i and iii
d. i, ii and iii
jugular venous distension
hepatomegaly
pedal edema
what are the 3 phases of a cough?
inspiratory, compression and expiratory
is it advised to give anti-tussives to a patient with a productive cough? why or whynot?
it is ill advised, as they are assisting the body in expelling the infection, and thus to stop that impedes this process.
define and distinguish between acute and chronic and paroxysmal
acute- sudden onset, short course
chronic- over 3 weeks persistent
paroxysmal- periodic, prolonged episodes, which come and go
clear coloured sputum indicates what?
normal function
black coloured sputum indicates what?
smoke or coal dust inhalation
brownish coloured sputum indicates what?
cigarette smoker
frothy white or pink coloured sputum indicates what?
pulmonary edema
sand or small stone coloured sputum indicates what?
aspiration of foreign material-broncholithiasis-calcified ro ossified material in the bronchial lumen
purulent coloured sputum indicates what?
infection
purulent apple-green thick coloured sputum indicates what?
haemophilus influenzae infection
pink, thin, and blood streaked sputum indicates what?
streptococci or staphyloccoc infetion
red currant jelly purulent sputum indicates what?
klebsellia infection
rusty sputum indicates what?
pneumococci
yellow or green copious sputum indicates what?
pseudomonas species pneumonia
fetid or foul smelling sputum indicates what?
lung abscess, anaerobic infections or bronciectasis or aspiration
mucoid (white-gray and thick) sputum indicates what?
emphysema, pulmonary tuberculosis, early chronic bronchitis, neoplasms, asthma
grayish sputum indicates what?
legionnaires disease
silicone like casts in sputum indicates what?
bronchial asthma
blood streaked or bloody sputum (hemoptysis) indicates what?
bronchogenic carcinoma, TB, chronic bronchitis, coagulpathy, pulmonary contusion or abscess.
distinguish between hemoptysis and hematemesis
hemoptysis is blood in sputum, hematemesis is vomitted blood
SOB is the cardinal symptom ofd what disease?
cardiac disease
dyspnea scoring scale
modified borg scale
0- nothing
10 is maximal maximal effort
american thoracic society shortness of breath scale
0 no SOB
1 slight- troubled when wlaking uphill or vigourous walking on the flat
2 moderate- walks slower than people of same age due to breathlessness
3 severe- stops for breath after wlaking about 100 yards
4 very severe- too breathless to leave house, looses breath when dressing or undressing
define psychogenic dyspnea
SOB due to panic disorder or mental health, not related to physical exertion
define cardiac and circulatory dyspnea
inadequate supply of O2 to tissues primarily caused by exercising
define hyperventilation
rate and depth of breathing whihc exceeds the bodies curretn metabloc demand. results in hypocapnoia and decreased cerebral blood flow.
edema in the ankles and lower legs is most often casued by
RHF or LHF
define cor pulmmonale
right ventricular hypertrophy caused by increased diseased state or resistance in the pulmonary circulation
a patient has 1cm deep edema which takes 90 seconds to refill, they would be classified as what level on the pitting edema scale?
3+ moderate for 0.6-1.3 cm and 1-2 minute refill
the pitting edema scale
1-trace slight with rapid refill
2-mild 0-0.6 cm with 10-15 second refill
3-moderate 0.6-1.3 cm with 1-2 minute refill
4- severe 1.3cm+ with 2min + refill
common causes of fever (pulmonary diseases)
empyema (pus in lungs), TB, pnuemonia, legionaires
most common cause of snoring and sleep apnea is?
obesity
peak ages for male and females for OSA
50-59 male and 60-64 female
signs and symptoms of CHF eyes skin brething lung sounds sputum colour BP change etc
dilated pupils- sympathetic response
pale skin
dyspnea SOB from pulmonary congstion
orhtopnea
crackels and wheezes
frothy pink andor white sputum
decreased blood pressure ;leads toincrease pulse
vomiting as peristalsis slows and stomach backs up
dependant edema
fall O2 sats
jugular vein distension from venous congestion
S3 gallop
decreased urine output
enlarged spleen and liver from veinous buildup impedes diaphragmatic excursion.
importance of vital signs
establish a baseline, observe trends and determine general patient status
what are the 4 classic VS?
temp, pulse, RR and BP
what are the other vital signs considered 5th vital
pain and pulse ox
what are some clinical patient signs of hypoxemia
impaired coordination cool extremities diaphoresis decreased mental function increased WOB and use of accesory muscles tahcycardia arrhytmia initial increase in BP
how does having a fever impact O2 and CO2 in the body?
O2 consumption increases 10% per degree celsius fever increase
CO2 production increases aswell
aside from exposure to cold, when else can we find hypothermia?
head injury patients to reduce ICP?
how does hypothermia affect O2 and CO2 in the body?
decreases O2 consumption and decreases CO2 production
define pulsus paradoxus
drop in systolic pressur eby 10 mmhg during inspiration
define pulsus alterans
beat to beat change in the stregnth of cardiac contraction, caused by chagning preload.
define apnea
lack of spontaneous breaths
define eupnea
normal rate of breathing
define bradypnea
less than normal rate of breathing
define tachypnea
rapid rate of breating
define hypopnea
decreased depth of breathing
define hypernea
increased depth of breathing with or without an increased rate
describe cheyne stokes breathing pattern
crescendo and decrescendo followed by apnea periods
decribe biots breathing
quick shallow breaths folllowed by apnic periods
describe kussmauls breathinf
deep and laboured breathing pattern
describe apnuestc breating
inspirations followed by inadequate expiraitons, causd by severed or damaged pons?
normal BP range
stage 1 hypertension
stage 2 hypertension
stage 3 hypertension
120-139/80-89
140-159/90-99
160-179/100-109
180+/ 110+
define isolated systolic hypertension
systolic over 140mmhg and diastolic less than 90 mmhg
define the term ausculatory gap in terms of BP
a range in the korotakoff sounds where no audible noise is heard although noise is heard above and below the range
why must one remove glasses of patient wile assesing pupil response?
light could be amplified by lenses and/or lense could distort pupil size.
why must you take a pulse as you increase cuff pressure wile taking BP?
to minimize hyperinflation
how do normal temperature ranges vary from oral, redctal and axillary? (according to Welch Allyn) in degrees celsius
axillary- 34.7-37.3
oral 35.5-37.5
rectal- 36.6-38.0
thermoscan- 35.8-38.0
distinguish between the 4 different scores for eyes in the glasgow coma scale
4 spontaneously open
3 open in response to speech
2 open in reposnse to pain
1 do not open at all
distinguish between the 5 different scores for verbal responses in the glasgow coma scale
5 oriented 4 confused 3 inappropriate words/makes no sense 2 incomprehensible sounds 1 no sounds
distinguish between the 6 scores for motor response in the glasgw coma scale
6 obeys verbal command 5 localizes pain 4 withdraws from apin 3 flexion to pain 2 extension to pain 1 none
someone is considered to be ina coma with a GCS score of what or less?
7
where is the tracheal bifurcation located in the front?
sternal angle/angle of louis
what are reasons for jugular venous distension?
CHF-right sded
where on chest are vesicular breaths found normally?
on the lungs surface?
cause and sound of friction rubs
caused by pleuritis and sound squeaky
what anatomy is responsible for each of the heart sounds?
lub- AV valve closing
dub- pulmonic and aortic valves closing