RRT Questions: Patient Evaluation Flashcards by James Inciardi

What kind of gas analyzer uses a battery?

Polargraphic gas analyzer.

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How much urine does a person normally produce?

What should you consider if urine production is low?

At least 40 mL per hour.

If low, consider renal failure or bad perfusion.

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If a patient has general malaise, consider this general diagnosis.
Also check this lab value.

Neuromuscular problem.

Potassium.

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Diaphoresis (especially night sweats) is commonly seen in this lung problem:

Tuberculosis.

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Cheyne-Stokes breathing is assocated with ___.

Head trauma or head bleeding. (Also could be drug overdose.)

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If a patient is cachectic, think these two diseases.

HIV or cancer

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If a patient is in C-spine precautions, what kind of bronchoscope would you use?

Flexible bronchoscope.

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If you are suctioning and the heart rate increase by 20, what should you do?

Stop and tell the doctor. (Even if heart rate goes up but it’s still between 60 and 100.)

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In a patient with atelectasis, fibrosis, pneumonectomy, or diaphragmatic paralysis, the trachea will be pulled (towards / away from) the affected side.

Towards. (These are diseases that affect the inside of the lung.)

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In a patient with massive pleural effusion, tension pneumothorax, neck or thyroid tumors, or a large mediastinal mass, trachea will be pulled (towards / away from) the affected side.

Away from. (These are diseases that are on the outside of the lung.)

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If the lung sounds “Resonant” on percussion, think:

Normal, air filled lung. Gives a hollow sound.

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If the lung sounds “Flat” on percussion, think:

Areas of atelectasis. (Could also be muscle or bone)

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If the lung sounds “Dull” on percussion, think:

Pleural effusion or pneumonia will give this thudding sound. This is also heard over fluid-filled organs such as the heart or liver.

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If the lung sounds “Tympanic” on percussion, think:

Increased lung volume. Also heard over air-filled stomach.

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If the lung sounds “Hyperresonant” on percussion, think:

Pneumothorax or emphysema. This is a booming sound.

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A patient with medium rales should receive:

CPT, not suctioning. These are middle airway secretions.

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If you hear “Unilateral Wheeze”, think:

Obstruction. Needs bronchoscope.

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What is the normal level of the right hemidiaphragm?

What should you consider if it’s higher?

Normally at sixth anterior rib.

If higher, think ascites or atelectasis.

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What is the most common type of CXR position?

AP (Anterior-Posterior). Film is behind the back.

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What kind of CXR is done on standing patients?

PA (Posterior-Anterior). Film is touching the chest with back to the Xray.

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What kind of CXR is done to shoot between the ribs?

Why is this done?

Oblique position. This aids in localizing lesions.

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If the patient’s CXR shows a “Maniscus”, think:

Pleural effusion.

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The tip of the endotracheal tube should be positioned below the vocal cords and no closer than __ centimeters or __ inches above the carina.

2 cm or 1 inch.

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When you hear “Steeple Sign”, think:

It can be seen from (anterior / side)

Croup. Seen from anterior

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Croup is (viral or bacterial) and is (subglottic or supraglottic).

Viral, subglottic.

Epiglottitis is (viral or bacterial) and is (subglottic or supraglottic)

Bacterial, supraglottic.

When you hear "Thumb Sign", think: | It can be seen from (anterior / side)

Epiglottitis. Seen from the side

Radiology terminology: When you hear "Radiolucent", think:

Normal air for lungs.

Radiology terminology: When you hear "Radiodense or opacity", think:

Normal bones or organs. | Opacity could also mean consolidation.

Radiology terminology: When you hear "Infiltrate", think:

Atelectasis

Radiology terminology: When you hear "Consolidation", think:

Pneumonia or pleural effusion.

Radiology terminology: When you hear "Hyperlucency", think:

COPD, asthma attack, pneumothorax. (Indicates extrapulmonary air)

Radiology terminology: When you hear "Vascular Markings", think:

Increased with CHF and absent with pneumothorax.

Radiology terminology: When you hear "Diffuse", think:

Spread throughout. (Atelectasis / pneumonia)

Radiology terminology: When you hear "Opaque", think:

Consolidation (Fluid or solid) | Could also mean normal organs or bone.

Radiology terminology: When you hear "Fluffy infiltrates", think:

Pulmonary edema (Diffuse whiteness)

Radiology terminology: When you hear "Butterfly or Batwing pattern", think:

Pulmonary edema (Diffuse whiteness)

Radiology terminology: When you hear "Patchy Infiltrates", think:

Atelectasis (Scattered densities)

Radiology terminology: When you hear "Plate-like Infiltrates", think:

Atelectasis (Thin-layered densities)

Radiology terminology: When you hear "Ground-Glass Appearance", think:

ARDS

Radiology terminology: When you hear "Honeycomb", think:

ARDS

Radiology terminology: When you hear "Diffuse Bilateral Radiopacity", think:

ARDS

Radiology terminology: When you hear "Air Bronchogram" think:

Pneumonia

Radiology terminology: When you hear "Cavity Formation in Upper Lobe", think:

Tuberculosis.

CT Scan: CT stands for ___ ___. It is a/an ___ through a plane of the body. It's used to detect ___, ___, and ___.

Computerized Tomography. An X Ray through a specific plane of the body to be examined. Used to detect masses, nodules, and lesions.

What is a spiral CT scan used for?

Detects pulmonary embolus.

What is an MRI?

Two dimensional views of an organ or structure. | Aneurysms, major thoracic vessel problems.

An EEG will detect brain ___ and ___. | Also detects ___ and disorders related to ___.

Brain tumors, brain injuries | Seizures and sleep disorders.

What does an ultrasonography of the heart (echocardiogram) detect?

Valve disease, myocardial disease, cardiac blood flow problems, cardiac anomalies (tetralogy of fallot)

What is the normal ICP value?

5-10 mm Hg.

When and how should you treat increased ICP?

Treat if greater than 20. | Hyperventilate until PaCO2 is 25-30.

Mannitol is used to decrease ICP. It does not work very well if the patient is ___.

Does not work as well if pt is acidotic.

Sputum color is clear. This indicates:

Normal

Sputum color is mucoid (white/gray). This indicates:

Chronic Bronchitis

Sputum color is yellow. This indicates:

Bacterial infection. (Give antibiotics)

Sputum color is green. This indicates:

Gram negative bacteria.

Sputum color is brown or dark. This indicates:

Old blood

What does a sputum culture detect?

Identifies the bacteria present.

What does a sputum sensitivity detect?

Identifies what antibiotics will kill the bacteria.

What does a sputum gram stain detect?

Identifies whether bacteria is gram positive or gram negative. !!REMEMBER that this test is really fast. Do this test while waiting for a sputum culture.

What does an acid fast stain detect?

Identifies presence of tuberculosis.

If there is green sputum, you should consider that the infection is ___ in nature. Give this antibiotic:

Nosocomial. | Give gentamyacin.

What is normal clotting time?

Up to 6 minutes.

What type of monitor, worn under the clothes, detects cardiac arrhythmias for 24-48 hours?

Holter monitor.

What is an oscilloscope?

Another term for EKG machine.

Cardiac pathology: Where is the most common place for a clot to occur?

Left anterior descending artery.

What is the normal percentage value of an ETCO2?

3-5%

If the ETCO2 is zero, that may mean that the patient is disconnected from the monitor. What should you do first (according to the test)?

Bag the patient.

What is a hemoximeter? What does it detect?

Same thing as a co-oximeter. | Detects carbon monoxide poisoning.

COhb stands for carbon monoxide in the hemoglobin. What is the normal COhb? What is the COhb for a smoker?

1-3% | Smoker: 5-15%

If a patient's COhb is less than __%, give oxygen. | If it is greater than __%, use a hyperbaric chamber.

Less than 20% | Greater than 20%

A pressure tranducer should be at the same level as the tip of the catheter. If it is too high, the reading will be erroneously ___. If it is too low the reading will be erroneously ___.

If too high, the reading will be low. | If too low, the reading will be high.

Normal PaCO2 | Normal PetCO2

PaCO2= 40 | PetCO2=34-36

If CavO2 is going up that means that cardiac output is going (up/down).

Down

An increase in PETCO2 would indicate a decrease in ___.

Ventilation

A decrease in PETCO2 would indicate an increase in ___.

Deadspace, PE, or hypovolemia