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PHTY 800 > Week 8 - Basic CR Assess./Impairments > Flashcards

Week 8 - Basic CR Assess./Impairments Flashcards

Major CR assessments, Vital signs, Resp. signs/symptoms, Objective exam,

1
Q

3 main parts to a CR Assessment

A

pre-interview, subjective exam, + objective exam

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2
Q

Info gathered in the pre-interview

A

-Current/past history
-Social history (smoking, occupation, social support)
Meds
-Present condition (lab reports- ABG’s[pao2, HCO3 etc.], vitals, cardiac test, CXR)
-Provisional Diagnosis(PDx)- brief summary of condition by DR.
-Plan

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3
Q

Subjective exam info

A

Gain details on history + symptoms (something that the patient experiences, complains of or feels)

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4
Q

Objective exam info

A

Provides a group of signs (a physical manifestation of a disease/obj. measure)
- Ventilatory support/SaO2, Observation, Palpation, Auscultation, Cough, CXR, Spirometry, ABG’s

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5
Q

Ventilatory Support + SpO2

What needs to be assessed & what should we note when measuring Sp02

A

Assess’ need for oxygen therapy/define resp. impairments

When measuring Sp02 always note: level of oxygen/type [N/p or mask]

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6
Q

Sign: SpO2 (range, what is it, how is it measured)

A
  • 95-100%
  • Measures % of HB that is bound w/ O2 & the O2 carrying capacity of blood
  • Measured via pulse oximeter (Sp02) or blood sample (Sa02)
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7
Q

Observation (Face)

A

Level of consciousness
Expression (pain/distress)
Colour

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8
Q

Cyanosis (colour of face)

What is the symptom + what is it caused by + what does it correlate with?

A

Blue-ish appearance of skin/mucus membranes

- Caused by low 02 in tissues near skin surface, correlates w/ low Sp02 (<85%)

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9
Q

Observation (Body- posture)

A

supine, SOOB, leaning fwd., RIB(resting in bed)

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10
Q

HR ( normal range/comments)

A
  • 60-100bpm
  • > 100 = tachycardia
  • <60 = brachycardia
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11
Q

BP (normal range)

A
  • 100-140 (SBP)

- 60-90 (DBP)

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12
Q

High BP

A

> 140/90 - hypertension

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13
Q

Low BP

A

< 100/60 - hypotension

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14
Q

RR (normal range/comments)

A
  • 12-16 b/min
  • High (tachypnoea) (>20breaths/min) - rapid/shallow breaths
  • increased RR + depth = Hypernoea - rapid/deep breaths, hyperventilation
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15
Q

Temp (normal range)

A

36.5-37.4 (afebrile)

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16
Q

Low grade fever

A

37.5-38.2

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17
Q

Febrile

A

fever - indicates infection

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18
Q

High grade fever

A

> 38.2 febrile

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19
Q

Observation- Chest wall shape:

A

Normal/Barrel(rib cage staying partially expanded due to COPD)
Pigeon(middle chest sticking out) / funnel (caved in chest)
Scoliosis/kyphosis

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20
Q

Observation (Breathing pattern + Rate)

A

consequences of rapid/shallow breathing = decreased alveolar ventilation (decreased fresh gas reaching alveoli + increase in old gas remaining in lungs)
decrease Pa02, increased PaC02

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21
Q

Observation (Fingers-Peripheral Cyanosis)

Symptom + causes

A

Blue-ish fingers/toes

Causes: low O2 saturation or inadequate circulation (low CO/DVT)

22
Q

Observation (Fingers- Clubbing)

Symptom/what is it/what is it commonly seen in

A

Nail bed (Concave–> convex)

  • Bulbous enlargement of the soft tissue of terminal phalanx of the digit.
  • Commonly seen in diseases of heart + lungs that result in less O2 in the blood.
23
Q

Observation (Peripheral Oedema)

What causes it/what is it a sign of?

A

Observable swelling from fluid accumulation in body tissues

- Peripheral/pedal (lower body swelling) + sacral(in the back) oedema can be a sign of R sided heart failure.

24
Q

Objective (Palpation)

- Movement pattern/what else do you palpate?

A

Common breathing: (compare L/R)
- Lateral Basal Expansion (LBE)
- AP movement
- Abdominal movement
Trachea (secretions vibrating thru chest wall
Accessory mm use (palpable/tactile fremitus)

25
Q

Auscultation (Normal Breath Sounds)

Mechanism/where is it heard/sounds/inspiration

A
  • Mechanism: Airflow in the trachea/larger airways, lessened by lung tissue in periphery.
  • Heard over the chest wall
  • Sounds: soft, low pitched / quieter as you descend the lungs
  • Inspiration is longer(2x) + louder than expiration
26
Q

Auscultation (Bronchial Breath Sounds)

Mechanism/sound/normal v abnormal

A
  • Mechanism: movement of air in/out of trachea/larger airways.
  • Sound: Loud, harsh, high-pitched, hollow (present on inspir./expir.)
  • Normal when heard over tracheal wall
  • ABNORMAL when heard over chest wall (lung tissue getting consolidated)
27
Q

Auscultation (Normal breath sounds abnormally transmitted [decreased])
Mechanism/sound/interpretation

A
  • Mechanism: decreased gas flow causes less sound/ increased sound in periphery [something blocking]
  • Sound: decreased volume/intensity of normal BS
28
Q

Auscultation (Normal breath sounds abnormally transmitted [NO breath sound])
Mechanism

A
  • Mechanism: localised accumulation of air or fluid in the pleural space OR bronchus supplying an area of lung is obstructed..
29
Q

Auscultation (Normal breath sounds abnormally transmitted [BBS])
Why does it happen? + sound

A
  • Tissues between the central airways + the chest wall are altered so that they conduct sound very well.
  • Sound: loud, harsh, + hollow (preset on inspir/expir. w/ gap in betw)
30
Q

Auscultation (Wheeze)

Mechanism/sound

A
  • Mechanism: Oscillation or vibration of airflow thru narrowed opposing airway walls.
  • Sound: Continuous, high/low pitches musical tones.
    More pronounced on expiration (takes longer to expire out)
31
Q

Auscultation (Crackles)

Sounds + early/late

A
  • Sounds: popping, crackling sound, discontinuous
    More common on INSPIR.
    early - bronchioles open
    late - resp. bronchioles + alveoli open.
32
Q

Fine crackles interpretation

A

Atelectasis (partial lung collapse)
Fibrosis
Interstitial pulmonary oedema (fluid accumulates in the air sacs of the lungs)
Oedema

33
Q

Coarse crackles interpretation

A

Presence of secretions in airways
Resolving pneumonia
Pulmonary Oedema

34
Q

False crackles interpretaiton

A

Subcutaneous emphysema

Stethoscope moving across hair on skin

35
Q

Auscultation (Upper Respiratory Tract/Transmitted Noises (URTNs)
Mechanism/sound/interpretation

A
  • Mechanism: Air moving past secretions in the upper airways, which is transmitted throughout the chest wall
  • Sound: Loud crackling, bubbling noise
  • Interpretation: Excessive/ retained secretions in upper airways
36
Q

Auscultation (STRIDOR)

Mechanism/sound/interpretation

A
  • Mechanism: obstructed trachea/larynx
  • Sound: Inspiratory noise heard loudest over trachea / heard via steth.
  • Interpretation: MEDICAL EMERGENCY - UPPER AIRWAY OBSTRUCTION
37
Q

Objective (Cough)

Types

A
  • Moist v dry: tells us about secretions in airway
  • Strong v weak: Weak due to resp. mm/pain
  • Effectively expel?
  • Productive of sputum: colour, volume, viscosity.
38
Q

Lung movement (secretion)

A

Cough, mucociliary clearance

39
Q

Gas movement (secretion)

A

CO2 movement, O2 movement

40
Q

Paradoxical breathing (Hoover’s sign)

A

Causes the chest to contract during inhalation + expand during exhalation (normal breathing does the opp.)

41
Q

Intercostal in-drawing (retraction/recession)

A

Due to partial blockage in the upper airway/small airways in lungs + air can’t flow freely, pressure in this part of the body decreases.

42
Q

Pursed lip breathing

A

Increases use of diaphragm + decreases accessory mm recruitment
- Though to prevent tightness in airway by providing resistance to expiration.

43
Q

Tracheal tug

A

Downward pull of the trachea/larynx

44
Q

Midline laparotomy

A

Abdominal surgery, impacts use of abdomen when breathing

45
Q

Thoracotomy

A

Opening into thorax, unable to sit upright, may cut into intercostals, making it painful on movement of ribcage.

46
Q

Tactile fremitus

A

Secretions vibrating thru the chest wall - reduced secretion movement

47
Q

Interpretation of (Normal breath sounds abnormally transmitted [decreased])

A
  • Interpretation: shallow breathing, incomplete blockage of airway, atelectasis (partial lung collapse), hyperinflation, pleural abnormalities (effusion, thickening, pneumothorax)
48
Q

Interpretation of (Normal breath sounds abnormally transmitted [NO breath sound])

A
  • Interpretation: segmental/total lung collapse, pleural abnormalities, carcinoma (cancer that begins in tissue that lines the inner or outer surfaces of the body) /large sputum plug.
49
Q

Interpretation of (Normal breath sounds abnormally transmitted [BBS])

A

Interpretation:
-Consolidation or large mass
large cavity
- UL collapse (w/ bronchus open/obstructed)
-LL collapse (only when bronchus is still open to transmit -the sound)

50
Q

Interpretation of Wheeze:

A
  • Interpretation: secretions, bronchospasm, oedema, tumour/foreign bodies.
51
Q

Mechanism of fine crackles:

A
  • Mechanism (Fine): Sudden opening of closed small airways + alveoli on inspir., after collapsing due to fluid/lack of aeration during expir.
52
Q

Mechanism of coarse crackles:

A
  • Mechanism (coarse): Movement of air bubbles thru secretions.

PHTY 800 (8 decks)

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