Procedure guide

Question 1

What is NOD?

Answer 1

Name
Occupation
Duty (why are you here?)

Question 2

What are some introduction questions for patients?

Answer 2

Name, Age, Gender,

If possible - who brought you in today?

ID by wristband to double check who your patient is

Question 3

What is the chief compliant?
(CC)

Answer 3

The main reason for the patients visit

Question 4

What are common symptoms for someone with respiratory issues?

(that we look for)

Answer 4

Cough
Sputum
Pain
SOB
Orthopnea (the sensation of breathlessness in the recumbent position, relieved by sitting or standing)

Question 5

What is the recumbent position?

Answer 5

Anyone that is basically lying down.

Question 6

What questions would you ask when identifying: the history of present illness?

Answer 6

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?

Question 7

What questions would you ask when identifying: past medical history?

Answer 7

Allergies
Medication
Surgeries
Previous hospital visits
childhood diseases

Question 8

What questions would you ask when identifying: Tobacco use.

Answer 8

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?

Question 9

how do you calculate cigarette pack years?

Answer 9

multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked.

Question 10

What questions would you ask when identifying: Family history

Answer 10

Relatives with diseases?

Question 11

What concerns are there with occupational/environmental history?

Answer 11

Anything that could affect health due to work

Question 12

What are SpO2 normal values?
(blood oxygen levels)

Answer 12

Anything greater than 92% - can vary depending on doctors orders though.

Start doing this at the beginning of the interview.

Question 13

When do you check for Respiratory rate (RR)

Answer 13

During heart rate check. While “checking for pulse”, also be checking for RR normal

Normal RR = 12-20 Br/Min

Question 14

What is a normal heart rate?

Answer 14

60-100 bpm

Question 15

How do you check temperature?

Answer 15

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

Question 16

How should you check blood pressure?

Answer 16

Walk patient through what you are doing, ask permission. Warn about it squeezing.

Normal = ~120/80

Question 17

What do you do after setting patient on oxygen

Answer 17

Determine duration of flow.

_____psi x (conversion factor) = _______L / (flow rate) = minutes until empty

Question 18

suprasternal notch

Answer 18

hollow U-shaped depression just above the manubrium, in between the clavicles
palpate for depression at the base of the neck

Question 19

Sternal angle

Answer 19

Directly below the suprasternal notch.
Palpate down the manubrium until you feel ridge between the gladiolous and manubrium

Question 20

2nd rib

Answer 20

Locate the sternal angle
2nd rib is located at this level of the manubrium

Question 21

Manubrium

Answer 21

Palpate depression at the base of the neck
Bone felt at the top is manubrium

Question 22

Gladiolus

Answer 22

Palpate down manubrium
Once you feel below sternal angle is gladiolus

Question 23

Xiphoid

Answer 23

Palpate base of gladiolus
Depression at the bottom of gladiolus is xiphoid

Question 24

C7

Answer 24

Patient extends neck and head forward
Most prominent spinous process is C7

Question 25

T1-T12

Answer 25

Starts just below C7
Articulates with ribs 1-12

Question 26

Oblique fissure

Answer 26

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 “

Question 27

horozontal fissure

Answer 27

RIGHT side only
Anterior: extends from 4th rib at sternum edge
Extends to 5th rib midauxillary line (meets with oblique here)
“4-5”

Question 28

Your patient is very young and is refusing to keep the pulse oximeter on their finger what should you do?

Answer 28

Try alternative pulse oximetry locations such as earlobe, forehead, and toe

Question 29

Why is the end tidal co2 measure 3-5 mmHg lower

Answer 29

Dead space

Question 30

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

Answer 30

History of existing condition. They may be on the autism spectrum.

Question 31

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

Answer 31

Peripheral cyanosis, also known as acrocyanosis

Hemoglobin that is reduced by more than 5.0 g/d

Increased difficulty
Anemia can mask cyanosis

Question 32

Trachea moves away from these 3 diseases?

Answer 32

Pneumothorax
Pleural effusion
Tumors

Question 33

A patient comes in with 2 cm JVD is this normal or abnormal

Answer 33

Normal
Abnormal JVD is measurements greater than 3-4 cm

Question 34

Retractions are seen in ________ lung disorders.

Answer 34

Restrictive lung disorders like Pneumonia and ARDS

Question 35

If there was a 3 year old and a 30 year old, the ____ year old would be more likely to have retractions in the _______, _____, ____________.

Answer 35

3 year old because of their flexible thorax

Retractions in the
substernal, supraclavicular, intercostal

Question 36

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 _______________

Answer 36

Pleuritic chest pain aka. pleurisy

Incentive spirometry

increased risk for atelectasis or pneumonia

Question 37

What is the difference in pectus carinatum, pectus excavatum, kyphoscoliosis ? How are they corrected

Answer 37

carinatum - sternum protrudes out anteriorly

excavatum- sternum depressed

Kyphosis- abnormal AP (hunchback of Notre dame)

Corrected by surgery

Question 38

What are symptoms of a Pneumothorax and what is its treatment?

Answer 38

Symptoms:
SOB
Acute chest pain
Decrease in BP and SPo2
Increase in HR

Treatment = needle decompression.

Question 39

Is pneumonia restrictive or obstructive?

Answer 39

restrictive