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Respiratory Assessment > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Stridor

A
  • continuous musical sound because falls under a wheeze, may not need stethoscope to hear.
  • caused by laryngeal spasm and mucosal edema
  • can be life threatening by completely blocking airway
  • Heard on inspiration, trying to inhale and cant
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2
Q

Wheezes vs Stridor

A
  • Wheezes are airflow through obstructed airways caused by bronchospasms or mucosal edema (refer to lungs or lobes)
  • Stridor is rapid airflow through obstructed airway by inflammation, mucosal swelling or foreign body obstruction.
  • read where theyre assessing patient, based on location
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3
Q

Pleural friction Rub

A
  • Discontinuous sound by grating of pleural linings rubbing together
  • “creaking leather” or grating type of sound
  • Usually confined to one area
  • Patient may have pain on inspiration
  • rubbing hands together will get similar sound
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4
Q

Abnormal Voice Sounds

A
  • Bronchophony
  • Whispered pectoriloquy
  • Egophony
  • Snoring
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5
Q

Bronchophony

A
  • Clear, distinct voice sound heard over dense, airless tissue as patient speaks out loud.
  • As patient says “99” and the listener hears a muffled “99” sound
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6
Q

Whispered Pectoriloquy

A
  • Clear, distinct voice sound heard over consolidated, airless tissue as the patient whispered and still hear it
  • Patient says “1-2-3 and you can hear it clearly
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7
Q

Egophony

A
  • Voice sound that has a nasal quality when heard over consolidation as patient says “E”
  • Sounds like “A or Aaay”
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8
Q

Snoring

A
  • Not a breath/Lung sound
  • Frequently associated sleep apnea
  • Not everyone who snores has sleep apnea though
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9
Q

Sleep Apnea Characteristics

A
  • Large necks
  • Enlarged tonsils,
  • Sudden awakening
  • daytime sleepiness
  • obesity
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10
Q

Topography

A

Using surface land marks to help identify areas of lung tissue

  • Imaginary Lines
  • Important landmarks
  • Fissures
  • Tracheal bifurcation
  • diaphragm
  • lung borders
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11
Q

Imaginary Lines: Anterior

A
  • Midsternal

- Right and Left midclavicular

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12
Q

Imaginary Lines: Lateral

A
  • Midaxillary
  • Posterior axillary
  • Anterior axillary
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13
Q

Imaginary Lines: Posterior

A
  • Midspinal

- Right and left scapular line

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14
Q

Important Landmarks: Anterior

A
  • Suprasternal Notch
  • Angle of Louis or Sternal Angle
  • Xiphoid
  • Ribs
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15
Q

Important Landmarks: Posterior

A

Spinal process C7
Spinal process T1
Scapula

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16
Q

Fissures

A

Right and Left Oblique fissures (divides lungs into upper and lower)

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17
Q

Left side lung separates

A

Left upper lobe

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18
Q

Right side of lung separates

A

right upper lobe (RUL), Right middle lobe (RML), and Right lower lobe (RLL)

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19
Q

Horizontal Fissure

A

Right side only

-Divides RML from RUL and RLL

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20
Q

“Wedge” refers to

A

RML

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21
Q

Tracheal Bifurcation

A

“Carina”
Positioning
-Anteriorly at sternal notch
-Posteriorly at T4

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22
Q

Superior Lung Borders

A
  • anterior chest lungs extend 2-4 cm above the medial third of the clavicle
  • Posterior: extends to T1
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23
Q

Inferior Lung Border

A

Anterior: chest extend to approximately the 6th rib at the midclavicular line
Posterior: varies with ventilation between approximately T9-T12

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24
Q

Lateral Lung Border

A

8th rib

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25
Q

Abdomen Divided into 4 quardrants

A

Right upper
Right lower
Left upper
Left Lower

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26
Q

Body Types

A

Cachectic
Debilitated
Failure to thrive

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27
Q

Cachectic

A

Marked by malnutrition: wasting

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28
Q

Debilitated

A

Weak, feeble, lack of strength (with weakness and loss of energy)

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29
Q

Failure to thrive

A

Physical and developmental delay

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30
Q

Sign

A

-an objective finding
-something you observe or measure
Example: fever, measurement, perfusion

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31
Q

Symptom

A

Subjective

  • patient complaints
  • example: pain SOB, trouble breathing dyspnea
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32
Q

Ectomorhpic

A

-slight development, body linear and delicate with sparse muscular development

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33
Q

Endomorphic

A
  • soft, roundness throughout the body
  • large trunk and thighs
  • tapering extremities
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34
Q

Mesomorphic

A

-Preponderance of muscle, bone, and connective tissue, with heavy hard physique of rectangular outline
(between endomorphic and ectomorphic)

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35
Q

Sthenic

A
  • Average height
  • well developed musculature
  • wide shoulders
  • flat abdomen
  • oval face
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36
Q

Hypersthenic

A
  • Short
  • Stocky
  • may be obese
  • shorter, broader chest
  • thicker abdominal wall
  • Rectangular-shaped face
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37
Q

Hyposethenic

A
  • Tall
  • Willowy
  • Musculature poorly developed
  • Long, flat chest
  • abdomen may sag
  • long neck
  • Triangular face
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38
Q

Common Respiratory Signs and Symptoms

A
  • cough
  • Sputum production
  • Dyspnea and labored breathing
  • Tachypnea
  • Wheeze
  • Hemoptysis
  • Chest pain and/or cardiac arrhythmias
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39
Q

Frequent Associated Complaints

A
  • Hoarseness
  • Syncope (fainting)
  • Peripheral edema (pitting edema)
  • Fever, chills, night sweats
  • Restlessness and agitation
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40
Q

Cough

A
  • Most common symptom of Respiratory disease
  • is not consistent
  • Considered abnormal bc it is a Protective reflex for the lungs.
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41
Q

3 Phases of Cough

A
  1. Inspiratory Phase
  2. Compression Phase
  3. Expiratory Phase
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42
Q

Cough: Inspiratory Phase

A
  • Opening of glottis followed by a large deep breath

- some patients may find it difficult to do this

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43
Q

Cough: Compression Phase

A
  • Exhalation against a closed glottis, contraction of muscles: increases pressure
  • May be difficult if the patient is paralyzed or an artificial airway placed
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44
Q

Cough: expiratory phase

A
  • sudden opening of glottis

- Expulsion phase: push everything out

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45
Q

Cough Effort

A

Describe as:

  • Strong, Weak, Moderate
  • Effective or Ineffective (sound/feel better after?)
  • Depends on the amount of air inspired and amount of pressure generated
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46
Q

Cough Effectiveness Depends on…?

A
  1. Muscle Strength
  2. Ability to close glottis correctly
  3. Patency of airways
  4. Amount of Lung Recoil
  5. Quantity and Quality of Mucous
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47
Q

Sputum Production

A

-You’ll either have to look at the sputum or ask your patient questions about it.

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48
Q

Sputum

A

-Saliva and mucous together coughed up from the respiratory tract, typically as a result of infection or other disease

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49
Q

Phlegm

A

interchanged with sputum
-not medical term
secretions coughed up through mouth

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50
Q

Describing Sputum

A
  • Color
  • Consistency
  • Quantity
  • Odor
  • Presence of Blood or other matter
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51
Q

Sputum: Color

A

Normal is clear—> to white

  • change in color (such as yellow, tan, or green) indicates an infection
  • COPD is yellow and thick
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52
Q

Sputum: Consistency

A
  • THick or thin
  • Tenacious (sticky)
  • Gelatinous (does it wiggle?)
  • Viscous (very thick?)
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53
Q

Sputum Quantity

A
  • Scant (barely any)
  • small
  • moderate
  • Copious (abundant)
  • Large
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54
Q

Sputum Odor

A

Is it foul smelling? think INFECTION

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55
Q

Sputum: present of Blood

A 
Plugs or Casts?
Frank blood? (red actively bleeding)
BLood Tinged? (Speckles of blood) 
Blood streaked?
* hemoptysis could be result of trauma, aspiration, pulmonary disease, busted blood vessel
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56
Q

Hemoptysis

A

coughing up blood

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57
Q

Sputum Analysis

A
  • Clear, colorless like egg white
  • Frothy White or Pink
  • Purulent (discharging pus)
  • Mucoid (mucous)
  • Black
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58
Q

Normal Sputum

A

Clear, colorless, like egg whites

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59
Q

Smoke or coal dust inhalation sputum

A

black

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60
Q

Cigarette smoker sputum

A

brownish

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61
Q

Spiration of foreign material Sputum

A

Sand or small stone

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62
Q

Pulmonary Edema Sputum

A

Frothy White or Pink

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63
Q

Infection, Pneumonia caused Sputum

A

Purulent (contains pus)

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64
Q

Emphysema, Pulmonary Tuberculosis, Early chronic bronchitis, Neoplasms, Asthma SPutum

A

Mucoid (white-gray and thick)

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65
Q

Pseudomonas species pneumonia & Advanced Chronic Bronchitis Sputum

A

Yellow or Green, copious(abundant in supply)

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66
Q

Dyspnea

A

Shortness of breath

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67
Q

Dyspnea: Preceding event/time of Day

A
  • Exertional Dyspnea
  • Did they just exercise before?
  • Does it happen in morning or night occurrence?
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68
Q

Dyspnea: Frequency

A
  • All the time or just at Night?
  • Is it occasional or daily?
  • If daily… all the time or only with certain activities?
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69
Q

Dyspnea: Duration

A
  • Acute: came on quickly

- Chronic: Been going on for some time, quite awhile

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70
Q

Dyspnea: Associated Symptoms

A

Coughing–>Dizziness
Chest pain
Diaphoresis (sweating)

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71
Q

Respiratory Symptom: Chest Pain

A
  • Pulmonary parenchyma and visceral pleura have no pain receptors
  • Even very large tumors may not cause pain
  • Pain receptors are present in the parietal pleura, major airways, diaphragm and other mediastinal structures
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72
Q

Location of Pain receptors in chest

A
  • Parietal pleura
  • major airways
  • diaphragm
  • other mediastinal structures
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73
Q

Chest pain is a result of….

A

Heart disease

  • Gastrointestinal disease (acid reflux)
  • Pulmonary disease
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74
Q

Chest pain: Determinants

A
  • Specific descriptors, Medical history important
  • Onset (when did it start)
  • Duration (how long have you had it?)
  • Location (where)
  • Radiation (does the pain move)
  • Frequency (brand new or often)
  • Severity
  • Precipitation (what were you doing when it occurred?)
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75
Q

Chest Wall Pain

A

Likely pain is always there

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76
Q

Muscle pain

A
  • acute injury (punched, truly cardiac? or chest wall pain)

- -Local tenderness

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77
Q

Costochondral Pain

A

frequently @ ribs/sternum joint

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78
Q

Pleural Pain

A
  • on inspiration
  • Localized
  • Usually increased pain with breathing, movement
  • patient splints (grabs affected area) when breathes and breathes shallowly
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79
Q

Cardiac Pain

A
  • Cardiac Pain will ensue on constantly while chest pain/pulm pain will only be on inspiratory or expiratory
  • crushing pain
  • usually left side, jaw, shoulder, arm
  • long duration
  • not associated with breathing or movement
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80
Q

Pleural Friction Rub vs Pericardial Friction Rub

A

LUNG VS HEART

  • Ask patient to breathe in and then hold breath.
  • if rub continues (when you listen with steth) its cardiac related
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81
Q

Hoarseness

A
  • Irritation/Inflammation of vocal cords
  • Associated with viral infections
  • cigarette smoking
  • chronic sinus drainage
  • tumors
  • vocal cord paralysis
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82
Q

Syncope

A

Dizziness

  • Temporary loss of consciousness
  • Can be caused by prolonged coughing
  • Valsalva/Vagal maneuver
  • other pain anxiety, orthostatic hypotension
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83
Q

Peripheral Edema (pitting edema)

A
  • Abnormal accumulation of fluid in soft tissue
  • Most often seen in ankles
  • Associated with kidney, cardiac, and or pulmonary disease
  • Rating Scale of +1 to +4
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84
Q

Fever

A

Often time results from infection

-Peripheral vasoconstriction occurs to conserve heat: chills and shivering

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85
Q

Chills

A

Usually associated with acute bacterial infection

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86
Q

Night sweats

A

Diaphoresis at night is common as body temperature drops

-however excessive sweating not normal, esp when bedding is soaked 5-8 times higher than normal.

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87
Q

Modified Borg

A

Level of Dyspnea: where does your shortness of breath fall 0-10

0: Nothing at all
5: Somewhat severe/strong
10: Maximal

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88
Q

Wong-Baker (faces)

A

Pain scale 0-10

0: no hurt
10: hurts!!

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89
Q

Richmond Agitation Sedation Scale (RASS)

A

Sedation scale

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90
Q

CAM or CAM-ICV

A
  • confusion assessment
  • used to assess level of delirium
  • refers to being used in intensive care unit
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91
Q

Glasgow Coma Scale

A

System for evaluating the patients level of consciousness. Allows for objective evaluation based on behavioral response in 3 areas

  • motor function
  • verbal function
  • eye opening response
  • useful in assessing trends in the neurologic function of patients who have been sedated, received anesthesia, suffered head trauma or are near coma
  • Scale from 3(deep coma death) to 15 (fully awake)
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92
Q

Most widely used instrument for quantifying neurologic impairment

A

Glasgow Coma Scale (GCS)

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93
Q

Glasgow coma scale ranges

A

Scale from 3(deep coma death) to 15 (fully awake)

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94
Q

Neurologic Integrity

A

Assessment of Consciousness

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95
Q

Level of consciousness

A

wakefulness and alertness

-Consciousness X3 (person, place, time)

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96
Q

Consciousness X3

A

person place time

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97
Q

Content of consciousness

A

Awareness and thinking

  • brain perfusion, oxygenation status
  • Do they understand?
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98
Q

Level of Consciousness/Sensorium

A
  1. Full Consciousness –>
  2. Lethargy –>
  3. Obtundation–>
  4. Stupor–>
  5. Coma
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99
Q

Full Consciousness

A

the patient is alert and attentive, follows commands, responds promptly to external stimulation if asleep, and once awake, remains attentive

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100
Q

Lethargy

A

the patient is drowsy but partially awakens to stimulation

-the patient will answer questions and follow commands but will do so slowly and inattentively

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101
Q

Obtundation

A

Difficult to arouse and needs constant stimulation to follow a simple command.
-Although there may be verbal response with one or two words the patient will drift back to sleep between stimuli

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102
Q

Stupor

A

patient arouses to vigorous and continuous stimulation, typically a painful stimulus is required. the only response may be an attempt to withdraw from or remove the painful stimulus

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103
Q

Coma

A

Patient does not respond to continuous or painful stimulation. there are no verbal sounds and no movement, except possibly by reflex

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5
Perfectly
104
Q

Decorticate Posturing

A

Brain tumor Results

-Rigidly flexes arms at elbows and wrists

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105
Q

Decerebrate Posturing

A

Result of Brain stem compression

-Internal rotation of arms

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106
Q

Plantar Reflex

A

Run something across foot
-typically bend down toe.
-Babinski should be absent in normal patients
(Abnormal toes fan upward)

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107
Q

Babinski

A

toes fan upward when you run something across the foot

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108
Q

Gag Reflex

A

Assess for level of aspiration

109
Q

Pupillary Reflex

A

PERRLA (pupils, equal, round, reactive, light, accommodation)

110
Q

PERRLA

A 
Pupils
Equal
Round
Reactive
Light 
Accommodation
111
Q

Mydriasis

A

Blown pupil

112
Q

Miosis

A

Pinpoint pupil

113
Q

Neurological Integrity: body Movement terminology

A

Ataxia

Gait

114
Q

Ataxia

A

Loss of muscle coordination

115
Q

Gait

A

manner of walking

116
Q

Cheynes-Stokes

A

An abnormal breathing pattern that consists of phases of Hyperpnea that regularly alternate with episodes of apnea.
-often caused by intracranial lesion

117
Q

Biot (Ataxic)

A

Breathing characterized by irregular periods of apnea alternating with periods in which four or five breaths of identical depth are taken

118
Q

General Assessment : HEENT

A 
Head
Ears
Eyes
Nose 
Throat
119
Q

General Assessment: Head

A

Facial expression
Tenderness
Scalp
Skin

120
Q

General Assessment: Ears

A
  • Can you hear okay?
  • Are they feeling blocked or clogged?
  • Have they been popping?
121
Q

General Assessment: Eyes

A 
PERRLA
Symmetrical?
Red or Itchy?
Discharge?
Drooping Eyelids?
122
Q

Ptosis (Blepharoptosis)

A

Drooping of eyelids

123
Q

General Assessment: Nose

A

Nasal Flaring

-Flared nostrils indicate respiratory distress, trying to get in air

124
Q

General Assessment: Throat

A

Pursed lips
SOB
Typically COPD patients

125
Q

Cyanosis

A

Blue discoloration

lack of O2

126
Q

Tracheal Position

A

Is it midline to sternal notch?

Is it deviated from normal?

127
Q

Tracheal Deviation Towards problem

A

atelectasis

128
Q

Tracheal deviation away from problem

A

Pneumothorax (air in chest)

Large Pleural effusion (fluid build up in pleural space)

129
Q

Accessory Muscle check

A

Check to see if they’re using any other muscles besides the diaphragm to breathe

  • Trapezius
  • Scalenes
  • Sternocleidomastoid
130
Q

Lymph Nodes

A

Normally nodes should NOT be visible or enlarged

131
Q

Jugular Vein

A

Visualize, if distended considered to be Right Heart Failure

-Right heart failure occurs with chronic left heart failure or chronic hypoxemia

132
Q

Distended Jugular Vein indicates…

A

Right heart failure

133
Q

Mottling

A

discoloration spots

134
Q

Capillary Refill

A

pressure to nail bed, let go and perfusion should continue at < or equal to 2 seconds

135
Q

Clubbing

A
  • loss of angle @ nail bed
  • Spongy nail bed
  • Increased depth of finger tip vs finger: associated with chronic hypoxemia
136
Q

Pitting Edema

A

Decreased venous return to heart as a result of right heart failure and/or pulmonary disease

  • Increased fluid retention due to cardiac or kidney dysfunction, IV fluid administration
  • Most Common place to check is the ankle (venous return bc gravity pulls down blood)
  • Scale +1 (2mm) to 4+ (8mm)
137
Q

Tripod Position

A
  • Sign of SOB
  • Can walk into their room and notice this based on their sitting
  • Chronically short of breath and helps patient breathe
138
Q

4 Step Assessment of Lungs and Thorax

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
139
Q

Tachypnea: Breathing pattern

A

Rapid rate of breathing

> 20 breaths per min

140
Q

Apnea: Breathing pattern

A

No Breathing

141
Q

Biot: Breathing pattern

A

Irregular breathing with long periods of apnea

142
Q

Cheyne-Stokes: Breathing pattern

A

Irregular type of breathing: breaths increase and decrease in depth and rate with periods of apnea

143
Q

Kussmaul: Breathing pattern

A

Deep and fast

144
Q

Apneustic: Breathing pattern

A

Prolonged inhalation

145
Q

Paradoxical: Breathing pattern

A

Injured portion of chest wall area moves in the opposite direction to the rest of the chest

146
Q

Bradypnea: Breathing pattern

A

an abnormal decrease in rate of breathing

< 12 breaths per min

147
Q

Orthopnea: Breathing pattern

A

Shortness of breath or trouble breathing while lying supine

148
Q

Dyspnea: Breathing pattern

A

Shortness of breath as perceived by the patient

149
Q

Hyperpnea: Breathing pattern

A

an increased rate/depth of breathing

150
Q

Normal AP diameter to transverse Diameter

A

1:2 (depth: width)

151
Q

Barrel Chest

A
  • Abnormal increase in anteroposterior chest diameter.
  • ratio 1:1
  • Likely COPD patient
152
Q

Pectus Carinatum

A

“Pigeon chest”

-a protrusion in the sterum

153
Q

Pectus Excavatum

A

“funnel Chest”

-a depression or inward abnormality of the sternum (caves in)

154
Q

Scoliosis

A

lateral Curvature

155
Q

Kyphosis

A

Forward curvature of spine

156
Q

Kyphoscoliosis

A

Both forward and lateral curvature

157
Q

Lordosis

A

Backwards curvature

158
Q

Tactile (Vocal) Fremitus

A

Patient says “99” each time you move your hands

  • feel with palm
  • describe as normal, increased, decreased or absent
159
Q

Increased Fremitus Due to…

A

Transmission of the vibration through an increased or solid density
-Pneumonia, lung tumor, atelectasis with patent bronchiole

160
Q

Decreased Fremitus Due to…

A

Transmission of vibrations due to air or fluid

  • Or to an area not in connection with a bronchus
  • Pneumothorax, COPD, Pleural Effusion, Atelectasis with obstructed bronchiole, Muscular or obese chest wall
161
Q

Rhonchial Fremitus

A
  • Same hand technique as vocal fremitus
  • feeling for bubbling secretions
  • They need to cough
162
Q

Subcutaneous Emphysema

A
  • Presence of air in the subcutaneous tissues of the neck, chest, and face.
  • air goes up, feels like bubble wrap
163
Q

Percussion Definition

A

The act of tapping on a surface (chest wall) to evaluate underlying structure and evaluate diaphragmatic excursion
-compare side to side on bar skin

164
Q

Resonant

A

normal sound

165
Q

Tympanic

A

Increased sound

-Loud with high pitch and drum like

166
Q

Hyperresonant

A

Loud with low pitch and bumming

167
Q

Increased Resonance caused by …

A

Pneumothorax
Air trapping/emphysema
Hyperinflation
Gastric Bubble

168
Q

Dull

A

medium with medium pitch and thud like

169
Q

Flat

A

soft with high pitch, extremely Dull

170
Q

Decreased Resonance caused by…

A

Occurs over non-aerated tissue/Lung areas

-Consolidation, pneumonia, tumor, pleural effusion, hemothorax, atelectasis

171
Q

Remember “the more solid the area…..

A

…The duller the note (pitch)””

172
Q

Diaphragmatic Excursion

A
  • Comparing movement of diaphragm on inspiration and expiration
  • Normal 5-7 cm (2-3 in)
173
Q

What affects Diaphragmatic Excursion

A
  • Pneumothorax
  • Pleural Effusion
  • Consolidation
  • Phrenic nerve injury
  • Diaphragmatic weakness
174
Q

Auscultation

A

Breath sounds

-patient must sit up straight and breathe quietly and deeply through mouth

175
Q

4 Characteristics to Auscultation

A
  • pitch
  • amplitude (intensity or loudness)
  • Distinct characteristics (what sets it apart from normal)
  • Duration of inspirations vs Expiration
176
Q

Adventitous

A

abnormal sounds superimposed on basic underlying normal sounds

177
Q

3 types of breath sounds

A

normal
adventitious
abnormal

178
Q

Normal Breath sounds

A

Bronchial/Tracheal
Bronchovesicular
Vesicular

179
Q

Bronchial/Tracheal

A
  • pitch is high, intensity loud
  • Heard over the trachea and beginning of major airways
  • Description is hollow and tubular
180
Q

Bronchovesicular

A
  • moderate pitch, moderate intensity
  • Heard over major central airways, around upper part of the sternum and between scapulae
  • Description is breezy, tubular
181
Q

Vesicular

A
  • Low pitch, soft intensity
  • peripheral Lung areas: heard over most of chest except major airways
  • description: breezy, sound of wind in trees
182
Q

Absent breath sounds/Decreased

A

-Decreased from what you expected
-Decreased only on one side
-no breath sounds at all
Examples: Bilateral and Unilateral.

183
Q

Abnormal Breath sounds: Bilateral

A
  • COPD
  • Asthma
  • Morbid Obesity
184
Q

Abnormal Breath sounds: Unilateral

A
  • Pneumothorax
  • Large Pleural Effusion
  • Atelectasis
  • Intubation of breathing tube in only one lung
185
Q

Crackles (Rales)

A

Discontinuous Breath sound described..

  • by timing
  • as fine, medium, coarse
  • short explosive or popping sounds
  • Airways pop open due to fluid or secretion accumulation
186
Q

Causes of crackles

A
  • Congestive heart Failure
  • Pulmonary edema
  • Pneumonia/Consolidation
  • Atelectasis
187
Q

Wheeze

A

Continuous Breath sound

  • Musical sounds
  • air movement through narrowed airway
  • can be high pitched or low pitched
  • can be on inspiration and/or expiration
  • classified as fine, coarse, and loud
188
Q

Causes of wheeze …

A
  • Asthma
  • Foreign body obstruction
  • Tumors
  • Bronchitis
  • COPD
189
Q

Wheeze: Fixed Monophonic

A
  • Result of partially obstructed bronchus
  • narrowed airway but does not slow airflow
  • Tumor cant fix*
190
Q

Wheeze: Random Monophonic

A
  • Result of Airway narrowed by bronchospasm or mucosal swelling
  • High airway resistance: slowed air
  • deal with and can fix*
191
Q

Wheeze: Polyphonic

A
  • Result of Dynamic compression of large airways

- Usually heard on expiration

192
Q

No Wheeze could indicate…

A

Impending respiratory Failure

  • should be able to hear something
  • Absent or decreased breath sounds when you hear audible wheezing means GET HELP MEOW.
  • Airway is blocked
193
Q

Rhonchi

A

Continuous Breath sounds

  • low pitched
  • usually result of secretions
  • Must ask patient to cough then reassess lung sounds
194
Q

Pathogen

A

Microorganism capable of causing disease

195
Q

Virulence

A

ability of pathogen to cause disease

196
Q

Sterile

A

complete absence of all forms of microorganisms

197
Q

Asepsis

A

Absence of disease producing microorganisms

198
Q

Cross Contamination

A

Transmission of microorganism between places and or persons

199
Q

Cleaning

A

General washing
-hot water, soap , detergent, enzymatic cleaner
Removes cross contamination and visible materials

200
Q

Disinfection

A
  • Reduces # of potentially infectious material
  • clean before disinfection
  • *Does NOT kill spore forming bacteria
201
Q

Physical Disinfection

A

Pateruization

202
Q

Hypochlorite

A

Chlorine

-Household bleach.

203
Q

Sterilization

A

complete destruction of all microorganisms including spores

204
Q

Physical Sterilization

A

Autoclaving (steam)

Ionizing Radiation

205
Q

Chemical Sterilization

A

Use of

  • Ethylene Oxide
  • Hydrogen Peroxide gas plasma
206
Q

Fire Safety

A

RACE

Rescue, Activate, Contain, Extinguish

207
Q

Fire Extinguisher

A

PASS

Pull, Aim, Squeeze, Sweep

208
Q

MSDS

A

Material Safety Data Sheet

  • written form with information about the specific chemical
  • Must be on file and provide detailed information regarding the material, precautions and actions to take when necesary
209
Q

Safe Medical Devices Act of 1990

A

It requires that an injury caused by a medical device be reported to the manufacturer and or FDA.

210
Q

Device Tracking

A

Tracking information may be used to facilitate notifications and recalls ordered by the FDA in the case of serious risks to health presented by the devices

211
Q

Vital Signs

A
  • Heart Rate
  • Respiratory Rate
  • Blood Pressure
  • Temperature
  • are easy to obtain and give critical information about the patients status
212
Q

Another Vital Sign

A

Pulse Oximetry

213
Q

QAM

A

Every morning

214
Q

TID

A

3 times a day

215
Q

BID

A

2 times a day

216
Q

QHS

A

every night @ hour of sleep

217
Q

QH

A

Every hour

218
Q

Q2H

A

Every 2 hours

219
Q

Younger patients have Higher or Lower Heart Rates?

A

Higher

220
Q

Tachycardia rates

A

> 100 bpm

221
Q

Bradycardia Rates

A

< 60 bpm

222
Q

Heart Rate Rhythm

A

should be recorded as regular or irregular

223
Q

Quality or Strength of HR

A 
Rated using scale 0-4
0= absent
1= very weak "thready" barely feel
2= slightly reduced push harder to feel pulse
3= normal 
4= bounding full
224
Q

Normal quality of Heart Rate based on scale

A

3= Normal

225
Q

Central Sites for measuring pulse

A

Used when blood pressure is low

  • femoral
  • Carotid
  • Apical
226
Q

Peripheral sites for measuring pulse

A

Used for convenience as alternate sites or to evaluate peripheral circulation: extremities

  • Radial
  • Brachial
  • Temporal
  • Popliteal
  • Posterior Tibial (behind ankle)
  • Pedal (on top of foot
227
Q

Normal Adult Respiratory Rate

A

12-20 bpm

228
Q

Systolic

A

Top number
-Peak force exerted during contraction of the left ventricle
-main pumping
-

229
Q

Diastolic

A

bottom number

-Forced exerted when the ventricles of the heart are at rest

230
Q

Normal Blood pressure Valve

A

120/80 mm Hg

*always even numbers

231
Q

Normal Blood pressure range

A

Systolic: 90-140 mm Hg
Diastolic: 60-90 mm Hg

232
Q

Hypertension

A

Pressure greater than 140/90

233
Q

Hypotension

A

Pressure significantly lower than 120/80

234
Q

Errors in BP measurement

A
  • Too Narrow of a cuff
  • Cuff applied too loosely
  • Excessive pressure placed in the cuff during measurement
  • False high or low reading
  • Diminished or altered sound transmission
  • Human error of misreading
235
Q

Pulsus Paradoxus

A

-A Fall of systolic Blood pressure of >10 mm Hg during inspiratory phase

236
Q

Pulsus Paradoxus Found in patients with

A

Cardiac or lung problems

237
Q

Pulsus Alternans

A

-Alternating succession of strong and weak pulses

238
Q

Pulsus Alternans may be found in patients with

A

Cardiac problems

239
Q

Normal Body temperature

A

37 C

98.6 F

240
Q

Normal Body Temp Range

A

(97-99.5) F

(36.5-37.5) C

241
Q

Body Temperature is highest in …

A

late afternoon

242
Q

Body temperature is lowest in…

A

early morning

243
Q

Hyperthermia

A

Elevated body Temperature

-Fever is temperature elevated and the patients is said to “febrile”

244
Q

How does Fever effect O2 consumption….

A

Body consumes more O2 when there is a fever

245
Q

Hyperthermia Causes

A
  • Infection
  • Certain Medications
  • Hot environment
  • Neoplasms
  • Damage to Hypothalamus
246
Q

Hypothermia

A

Decreased body temperature

247
Q

Hypothermia Causes:

A
  • Exposure to cold
  • Protective Effect
  • Response for decreased Oxygen consumption
248
Q

Temperature Mesurements

A
  • Oral
  • Axillary
  • Rectal
  • Tympanic
  • SKin
249
Q

Clinical Impression based on..

A
  • Age
  • Weight
  • Height
  • Level of anxiety
  • Physical distress
250
Q

Calculating Predicted Body weight in MALE

A

106 + 6 (height-60)

251
Q

Calculating Predicted Body weight in FEMALES

A

105 + 5 (height -60)

252
Q

Medication labeling should include:

A
  • Name of Medication
  • Dosage
  • Diluent and Volume
  • Expiration time and or date
253
Q

Medication Safety 5 RIGHTS

A 
Right patient
RIght Drug/Fluid
Right Dose
Right Time
Right Route
254
Q

Modes of Transmission

A 
Contact
Droplet
Airborne 
Vehicle
Vectorborne
255
Q

MOT: Contact

A

Direct and indirect

  • HIV
  • Staph
  • Pseudomonas aeruginosa
  • Hepatitis B and C
256
Q

MOT: Droplet

A

Rhinovirus
SARS
Rubella

257
Q

MOT: Airborne

A

Legionellosis
TB
Varicella

258
Q

MOT: Vehicle

A

Waterborne: cholera
Foodborne: salmonellosis and Hepatitis

259
Q

Vector-Borne

A

Ticks: rickettsia
Lymes disease
Mosquitoes: malaria

260
Q

Standard Precautions

A

based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents

  • Include group of infection prevention practices that apply to all patients
  • Intended to protect patients as well ensuring that healthcare do not carry infectious agents to patients
261
Q

Standard Precautions include:

A
  • Hand hygiene
  • Gloves
  • Gown
  • Mask
  • Eye Protection
  • Face Shield
  • Safe needle practices
  • Safe handling of infected equip/linen
262
Q

Hand Hygiene compliance

A

Goal is 100%

BUT typically at 65-70% :/

263
Q

PPE

A

Personal Protective Equipment

264
Q

Types of PPEs

A 
Gloves
Gowns
Masks/Respirators
Goggles
Face Shields
head and feet coverings
265
Q

Special Respiratory Isolation Masks

A
  • Particulate respirators: N95 but must be fitted properly for this mask
  • Powered air purifying respirators PAPR
266
Q

PAPR

A

Powered Air Purifying Respirators

267
Q

Sequence for Donning PPE

A
  • Hair/shoe coverings
  • Gown
  • Mask or Respirator
  • Goggles or face Shield
  • Gloves
268
Q

Sequence for Removing PPE

A
  • Gloves first if not soiled
  • Head/shoe covering
  • Goggles or face shield
  • Gown
  • Mask or Respirator
269
Q

Sharps

A

Broken equipment or supplies are potential sharps if they are capable of penetrating the skin

Respiratory Assessment (1 decks)

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