Physical Examination Flashcards
Normal heart rate…
60-100 bpm
Bradycardia =
Less than 60bpm
Tachycardia =
More than 100bpm
Normal respiratory rate…
12-20 breaths/min
Bradypnea=
Less then 12 breaths/min
Tachypnea=
More then 20 breaths/min
What is orthopnea?
Inability to breathe when in a reclining/supine position
What is DOE?
Dyspnea on exertion
What is the resp rate for a newborn?
35-40 breaths /min
Best position to measure BP?
Pt sitting upright with L arm exposed and supported at the level of the heart
Normal BP
120/80 mmHG
Hypotension=
90/60 mmHg
Hypertension =
140/90 mmHG
Orthostatic hypotension
Drop pf SBP by 20mmHG from lying ^upright
Normal O2 sats
94% above
Requires supplemental O2 of sats are…
Below 88%
Funnel chest
Pectus excavatum
Pigeon chest
Pectus carinatum
Barrel chest
AP:lateral
Clubbing is associated with
Chronic deficiency of O2
Sputum with foul smell is only found in these two conditions…
Bronchiectasis and lung abscess
What colour is the sputum for pulmonary edema,
Pink frothy
Tracheal positioning:
Increase of volume or pressure…
Pushes the mediastinum away
Tracheal positioning:
Decrease of volume or pressure…
Shifts the mediastinum ipsilateral(same side)
Tactile fremitus:
More dense tissue
Increase tactile fremitus
Tactile fremitus:
Less dense tissue
Decrease tactile fremitus.
Ex: air (not dense)
Indicates air in the chest wall… hyperresonant or dull?
Hyperrosonant
Indicates consolidation or pleural fluid in the chest wall… hyperresonant or dull?
Dull
Ph normal values
7,35- 7,45
Less the 7,35 :acidosis
More then 7,45: alkalosis
PaCO2( partial pressure of Co2 )normal values
35-45 mmHG
Less then 35: alkalosis
More then 45: acidosis
HcO3 normal values
22-26 mEq/l
Less then 22: acidosis
More then 26: alkalosis
PaO2( partial pressure of oxygen in the aeterial blood) normal values…
80-100mmHG
Mild hipoxemia: 60-80
Moderate hipoxemia: 40-60
Severe hipoxemia :less then 40
Ph level abnormal
One component (PaCO2 or HCO3) abnormal and the other normal
Umcompensated
Ph level abnormal
The other two components are also abnormal (PaCO2 or HCO3) …
Partially compensated
Ph level is normal
The other two component (PaCO2
HCO3) are abnormal…
Compensated
Normal Ratio of inspiration and expiration
1:2
Ratio of inspiration and expiration for obstructive disease?
1:3
Ratio of inspiration and expiration for restrictive disease?
1:1
What does IPPA stand for?
Inspection, Palpation, Percussion, Auscultation
Eupnea
Normal respiratory rate (12-20 breaths per minute in
Normal respiraty rate in infants
30-50 breaths per minute
Orthostatic hypotension
Drop of SBP by 20 mmH from going from lying to upright
Pallor
Pale color of the skin
What does poor capillary refill indicate?
Poor peripheral perfusion
Hypoxemia
Low oxygen in arterial blood
Hypoxia
Low oxygen at the tissue level
Subcutaneous emphysema
Gas or air trapping under the skin
Coarse crackles typically indicate the presence of
Sputum/Secretions
Stridor is caused by:
Turbulent air flow such as large obstructions in upper airways (e.g., foreign body aspirations)
or narrowing of upper airways (e.g., allergic reaction, tumor compressing upper airway)
3 techniques to assess voice sounds
Egophony, Whispered pectoriloquy, Bronchophony
Foul smelling sputum can be present in which condition (s)?
Bronchiectasis and lung abcess
Nasal flaring may be a sign of
Respiratory distress
Which PPE should be used if you may have to touch blood, bodily fluids, non-intact skin, or contaminated items?
Gloves
Which PPE should be used if your face may be exposed to a splash, spray, cough, or sneeze?
Mask and eye protection/face shield
Which PPE should be used if your skin or clothing may be exposed to splashes or items contaminated with blood or bodily fluids?
Gown
MRSA is transmitted through
transmission
Contact
Tuberculosis is transmitted through
transmission
Airborne
Pneumonia is transmitted primarily through transmission
Droplet
Pneumonectomy
Removal of a lung
Lobectomy
Removal of a lobe of a lung
Wedge resection
Removal of a portion of a lung (not limited to an anatomical region) e.g., removing a small tumor
Bullectomy
Removal of a large emphysematous tissue
Thorocotomy
A surgical procedure to gain access to the thoracic cavity
What are potential complications of pulmonary surgery?
Aspiration, increased pain, phrenic nerve impairment, atelectasis, ulcers, DVT
Which muscles are incised in a posterolateral thorocotomy?
Latissimus dorsi, serratus anterior, external intercostals, internal intercostals, trapezius, and rhomboids
What are the signs and symptoms of a DVT?
Leg pain, tenderness, ankle edema, calf swelling, dilated veins, positive Homans sign( calf pain w DF)
How is the Homans’ test performed?
The patient’s foot is passively (and forcefully) dorsiflexed with the knee extended.
Some sources also state to simultaneously squeeze the calf with the other hand. Pain in the calf indicates a positive test for DVT.
What should you do if you suspect your patient has a DVT?
Stop treatment which may be contraindicated until further notice, alert the surgeon/doctor/nurse, document your findings
Which vessels may be used for a Coronary Artery Bypass
Graft (CABG)?
Saphenous Vein, internal thoracic artery (aka internal mammary artery), radial artery.
What does a bypass machine (aka ECMO) do?
Blood is pumped outside of your body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body.
What are the sternal precautions during the first 6-8 weeks post-op?
No pushing, no pulling, no lifting one arm above 90° (some sources say you can),
no hand behind back
, no driving (first 4 weeks),
no lifting > 10lbs (some sources say 5lbs).
What are non-invasive forms of adminstrating mechanical ventilation?
Nasal mask, complete face mask
What are potential complications of mechanical ventilation?
Barotrauma
, volutrauma
, ventilator acquired peumonia,
diaphragm atrophy
, hemodynamic compromise
The process of decreasing mechanical ventilation is known
as
Weaning
What are some alternative methods of communication when a client is intubated?
Writing, hand signals, communication boards
