Patient Assessment Flashcards
OLDCART (Acronym for HPI: History of Present Illness)
- Onset
- Location/Radiation
- Duration
- Character
- Aggravating Factor
- Reliving Factors
- Timing / Severity
This gives a framework for approaching patient complaints in a problem oriented fashion.
Airborne Transmission
PPE: N-95 mask, gloves Patient in negative laminar air flow room. TB Varicella (Chicken pox)
Droplet Transmission
Microorganisms > 0.5µm Generated by coughing, sneezing, talking, and procedures involving suctioning airways, bronchoscopy. Generally limited to a radius of 3ft. from patient. PPE: Gown, surgical mask, gloves.
Vehicle Transmission
transmission of microorganisms via inanimate objects, termed fomites.
Vector transmission
It involves an intermediate host. The host can be an insect, an animal, or a plant. One disease transmitted in this manner is Rocky Mountain spotted fever, which is carried by a tick.
Vital Signs
Temperature (T) Pulse (P) Respiratory Rate (R) Blood Pressure (BP) Pulse oximetry (SpO2)**
Body Temp
Adults: 35.5 to 37.5°C (96 to 99.5°F) Newborn: 36.1 to 37.7°C (97 to 99.9°F) Children: 37.2°C (98.9°F)
Hypoxemia
- abnormally low level of oxygen in the blood
- oxygen deficiency in arterial blood
- hypoxemia can lead to hypoxia: in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level.
- Hypoxemia may cause:
- tachypnea, shortness of breath, headache, restlessness, dizziness, rapid breathing, chest pain, confusion, high blood pressure.
4 classifications of Normal Breath Sounds
Vesicular: low-pitched and soft
Bronchial: loud, higher pitch
Bronchovesicular: combination of vesicular and bronchil
Tracheal: above clavicular notch, harsh and high-pitched.
Vesicular breath sounds (Normal breath sound)
- low-pitched soft sounds.
- whispering or rustling
- inspiratory > expiratory phase.
- no pause between inspiration and expiration.
- sound is heard over the majority of the lung periphery (except over the right apex anteriorly)
- generated by turbulent airflow in the lobar and segmental bronchi.
Bronchial breath sounds (normal)
- loud, higher pitch
- expiratory > inspiratory phase
- short pause b/t phases
- hollow sound
- heard over manubrium of sternum
- generated by turbulent air vibrating in the trachea
Bronchovesicular breath sounds (normal)
- combination of both vesicular and bronchial sounds
- somewhat muted
- NO pause b/t inspiration and expiration
- inspiratory phase = expiration phase in length
- heard over sternum and second intercostal space, b/t scapulae and over right apex of lung
Tracheal breath sounds (normal)
- heard over trachea
- above clavicular notch
- harsh and high pitched
- expiratory > inspiratory phase
- produced by high-velocity turbulent air
Abnormal breath sounds (adventitious sounds)
- Crackles
- Wheezes
- Rhonchi
- Rubs
Wheezes
- caused by bronchoconstriction
- Unilateral wheezes (or monoponic wheeze) could be caused by a foreign body obstruction or a bronchial mass (seen w/lung cancer): treat w/bronchoscope
- Bilateral wheezes: treat w/bonchodilator
- First step may be to get a chest x-ray, then bronchodilator
- If patient starts out diminished but then progresses into audible wheezing, continue bronchodilator therapy.
short-term illnesses like inflammation,bronchiolitis, bronchitis, pneumonia, anaphylaxis, or obstruction.
Long-term illnesses include emphysema, GERD, heart failure, lung cancer or sleep apnea.