Procedure guide Flashcards
What is NOD?
Name
Occupation
Duty (why are you here?)
What are some introduction questions for patients?
Name, Age, Gender,
If possible - who brought you in today?
ID by wristband to double check who your patient is
What is the chief compliant?
(CC)
The main reason for the patients visit
What are common symptoms for someone with respiratory issues?
(that we look for)
Cough
Sputum
Pain
SOB
Orthopnea (the sensation of breathlessness in the recumbent position, relieved by sitting or standing)
What is the recumbent position?
Anyone that is basically lying down.
What questions would you ask when identifying: the history of present illness?
When did it start?
What does it feel like? (Burning, clenching, radiating…etc)
How often does it happen?
Where is it?
Limitations of activity due to it?
Anything to make it better or worse?
What questions would you ask when identifying: past medical history?
Allergies
Medication
Surgeries
Previous hospital visits
childhood diseases
What questions would you ask when identifying: Tobacco use.
Are you using it currently?
When did you quit?
For how long?
How many packs per day? (packs per day x years)
Any other drug use? like cannabis or vaping?
Is there an interest in quitting? have you attempted to quit?
how do you calculate cigarette pack years?
multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked.
What questions would you ask when identifying: Family history
Relatives with diseases?
What concerns are there with occupational/environmental history?
Anything that could affect health due to work
What are SpO2 normal values?
(blood oxygen levels)
Anything greater than 92% - can vary depending on doctors orders though.
Start doing this at the beginning of the interview.
When do you check for Respiratory rate (RR)
During heart rate check. While “checking for pulse”, also be checking for RR normal
Normal RR = 12-20 Br/Min
What is a normal heart rate?
60-100 bpm
How do you check temperature?
Using a temporal thermometer, start at mid forehead and press button as you move down the side of face until you reach ear (very vascular area)
Normal is 37 degrees +- 0.5
How should you check blood pressure?
Walk patient through what you are doing, ask permission. Warn about it squeezing.
Normal = ~120/80
What do you do after setting patient on oxygen
Determine duration of flow.
_____psi x (conversion factor) = _______L / (flow rate) = minutes until empty
suprasternal notch
hollow U-shaped depression just above the manubrium, in between the clavicles
palpate for depression at the base of the neck
Sternal angle
Directly below the suprasternal notch.
Palpate down the manubrium until you feel ridge between the gladiolous and manubrium
2nd rib
Locate the sternal angle
2nd rib is located at this level of the manubrium
Manubrium
Palpate depression at the base of the neck
Bone felt at the top is manubrium
Gladiolus
Palpate down manubrium
Once you feel below sternal angle is gladiolus
Xiphoid
Palpate base of gladiolus
Depression at the bottom of gladiolus is xiphoid
C7
Patient extends neck and head forward
Most prominent spinous process is C7
T1-T12
Starts just below C7
Articulates with ribs 1-12
Oblique fissure
Anterior: Start at 6th rib at midclaviculaar
Line extends laterally and upwardly until it crosses the 5th rib at midauxillary line
Posterior: extends to the T3
” 6, 5, 3 “
horozontal fissure
RIGHT side only
Anterior: extends from 4th rib at sternum edge
Extends to 5th rib midauxillary line (meets with oblique here)
“4-5”
Your patient is very young and is refusing to keep the pulse oximeter on their finger what should you do?
Try alternative pulse oximetry locations such as earlobe, forehead, and toe
Why is the end tidal co2 measure 3-5 mmHg lower
Dead space
A 14 year old male patient arrives highly agitated and mumbling before you start assessing GCS what part of the patient’s history would be helpful
History of existing condition. They may be on the autism spectrum.
A patient has blue fingers, what do you suspect?
What lab result would confirm your hypothesis?
You would have ___ difficulty if the patient also had anemia
Peripheral cyanosis, also known as acrocyanosis
Hemoglobin that is reduced by more than 5.0 g/d
Increased difficulty
Anemia can mask cyanosis
Trachea moves away from these 3 diseases?
Pneumothorax
Pleural effusion
Tumors
A patient comes in with 2 cm JVD is this normal or abnormal
Normal
Abnormal JVD is measurements greater than 3-4 cm
Retractions are seen in ________ lung disorders.
Restrictive lung disorders like Pneumonia and ARDS
If there was a 3 year old and a 30 year old, the ____ year old would be more likely to have retractions in the _______, _____, ____________.
3 year old because of their flexible thorax
Retractions in the
substernal, supraclavicular, intercostal
You see a patient splinting their chest most likely they are experiencing _____ chest pain
You look at their history they have come out of a post-operative thoracic procedure. A good reason to encourage incentive _______ because they are increased risk for _______________
Pleuritic chest pain aka. pleurisy
Incentive spirometry
increased risk for atelectasis or pneumonia
What is the difference in pectus carinatum, pectus excavatum, kyphoscoliosis ? How are they corrected
carinatum - sternum protrudes out anteriorly
excavatum- sternum depressed
Kyphosis- abnormal AP (hunchback of Notre dame)
Corrected by surgery
What are symptoms of a Pneumothorax and what is its treatment?
Symptoms:
SOB
Acute chest pain
Decrease in BP and SPo2
Increase in HR
Treatment = needle decompression.
Is pneumonia restrictive or obstructive?
restrictive
