Patient Assessment Part 2 - Test Review Flashcards
What are the 4 techniques that are performed during a chest physical examination?
Inspection (observation), palpation, percussion, auscultation
What can be assessed by the technique “Inspection”?
What you can see or observe about a patient
What can be assessed by the technique “Palpation”?
Areas of tenderness, symmetry of excursion, tracheal position, capillary refill, tactile
fremitus
What signs could the patient exhibit if they had an increased work of breathing
(WOB)?
Accessory muscle use, JVD, pursed lip breathing, nasal flaring, intercostal
retractions, diaphoresis (diaphoretic) at rest, sitting in tripod position, unable to
speak in complete sentences
hemoptysis
coughing up blood
diaphoresis
sweating
pneumothorax
air in pleural space
atelectasis
collapsed lung
sensorium
refers to level of consciousness of pt.
dypsnea
difficulty breathing as observed by
the patient
anterior
front
posterior
back
lateral
side down
orthopnea
difficulty breathing when lying
dysphagia
difficulty swallowing
erythema
redness of skin
pedal edema
swelling of ankles-feet
peripheral edema
swelling of extremities
What is cyanosis and what is it caused by?
Blue or blue gray discoloration of skin and mucous membranes caused by
desaturated hemoglobin in blood- indicates inadequate tissue perfusion
What type of breathing pattern is associated with a diabetic ketoacidosis?
Kussmauls
Biot’s
irregular rate & depth with irregular periods of apnea
Kussmaul’s
increase in rate and depth with no pauses- diabetic ketoacidosis
Cheyne Stokes
gradual increase then gradual decrease in depth and rate of
breathing followed by periods apnea
Eupnea
normal breathing pattern 12-20 bpm
Hyperpnea
increase in depth- deeper breathing- increase Tidal volume (Vt)
Hypopnea
decrease in depth-shallow breathing- decreased tidal volume (Vt)
Apnea
absence of breathing
Bradypnea
slow than normal RR <12 bpm
Tachypnea
faster than normal RR > 20 bpm
Hyperventilation
decreased PaC02 levels- caused by an increase in ventilation
What is paradoxical breathing?
An Area of the Chest wall moves in with inhalation and out with exhalation- opposite of what is normal-typically seen with chest wall trauma- broken ribs
What is Flail Chest?
An Area of the Chest wall moves in with inhalation and out with exhalation- opposite of what is normal- typically seen with chest wall trauma- broken ribs
If a patient has an increased A-P (anterioposterior) diameter this is called what & what causes this?
Barrel chest caused by chronic COPD- air trapping
What is it called when the patient has a lateral curvature of the spine?
scoliosis
What is it called when the patient has a curvature of the upper spine
(anteroposterior spine)?
kyphosis
What is it called when the patient has a lateral & anteroposterior curve of the spine?
kyphoscoliosis
What is pectus excavatum & what is another name for this?
Inward curvature of sternum- Funnel chest
What is pectus carinatum & what is another name for this?
Outward projection of sternum- pigeon chest
What is lordosis?
Swayback- inward curvature of lumbar spine
Describe digital clubbing & what causes this?
Abnormal thickening of ends of fingers- angle between nailbed & skin decreases
Caused by chronic hypoxemia
How do you check capillary refill & what does it assess?
Compress or pinch the tip of the patients finger until color disappears, then release
and count the number of seconds it takes for the color to return- normal return of
color should be less than 5 seconds
Assesses perfusion to extremities
How is symmetrical chest movement determined?
Place hands on patient chest wall with thumbs touching- have patient take a deep
breath- observe movement of thumbs- look for equal movement in your hands-
thumbs
What could cause asymmetrical chest movement?
Consolidation (pneumonia), pleural effusion, atelectasis, pneumothorax
What is tactile fremitus?
Feel for vibrations on patient chest wall when they say 99
What could cause tactile fremitus to increase & decrease?
Increased with secretions, fluid, atelectasis
Decreased with pneumothorax, COPD- extra air, pleural effusion
What is subcutaneous emphysema?
Air felt under the skin- crepitus crackling sensation
What could cause the trachea to shift away from an affected side?
Problem outside the patient’s lung- pneumothorax, pleural effusion
What could cause the trachea to shift toward an affected side?
Problem inside the lung- atelectasis
What is an objective term and give some examples:
Something healthcare worker measures or observe- vital signs, lab values,
Breathsounds, x-rays, etc.
What is a subjective term and give some examples:
Something the patient tells you- I’m nauseous, chest pain, etc.
Resonance
Normal lung tissue
Hyperresonance
Over areas containing trapped air- COPD, pneumothorax
Dullness
Over areas of the lung that has a greater portion of tissue or fluid than air-
pneumonia, consolidation, atelectasis
Flatness
Same as Dullness
Tympany
Air filled stomach- tension pneumothorax
What are the four critical life functions?
Oxygenation, ventilation, circulation, perfusion
How is perfusion assessed?
BP, sensorium, temperature, urine output, hemodynamics
How is circulation assessed?
HR & strength of heartbeat, cardiac output
How is oxygenation assessed?
HR, color, sensorium
How is ventilation assessed?
RR, Vt, chest movement, breathsounds
What will a decreased peripheral perfusion affect?
Urinary output-decreased output, sensorium- confused, peripheral pulses- patient
feels cold and clammy, decreased 02 to tissues- cyanosis
List the life functions in order of priority during an emergency:
1- Ventilation
2- Oxygenation
3- Circulation
4- perfusion
What information is important to obtain when interviewing patient?
Signs & symptoms, past medical history, allergies, smoking history, family history
Be able to calculate smoking history in pack years? Example: patient has smoked for
25 years and smokes 2 ½ packs a day.
years smoked x packs per day EX: 25 X 2.5 = 62.5 pk yr smoking history
When describing a sputum sample what should be included?
Color, odor, quantity (amount), consistency (thick, loose, etc), presence of blood
AFB test
tuberculosis
Gram stain test
Type of microorganism- Gram – or Gram +
C/S- Culture & sensitivity test
Which antibiotic will treat the infection
Prone
laying on stomach- face down UPWARD
supine
laying on back- face
fowler’s
sitting position
semi-fowler’s
sitting position
Trendelenburg
head down, feet up
