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| Four critical life functions |
ventilation, oxygenation, circulation, perfusion |
| Which critical life function is first priority? |
Ventilation |
| What assessment would measure how well a patient is ventilating? |
oxygenation and perfusion |
| How would you know if a patient has a problem with oxygenation? |
heart rate, color, sensorium, PaO2 |
| What measurements would help you asses that a patient's circulations was adequate? |
Pulse/heart rate |
| What changes would indicate that a patient may not be getting good perfusion? |
blood pressure, sensorium, temp., |
| Difference between signs and symptoms: |
Signs: Objective information (color, pulse, edema, blood pressure) Symptoms: subjective info (dyspnea, pain, nausea) |
| Formula for Smoking Pack Years: |
# packs/day x # years |
| Normal urine output: |
40 cc/hour |
| What would occur if the intake exceeds output? |
Weight gain, electrolyte imbalance, increased blood pressure, decreased lung compliance |
| Orthopnea |
Difficulty breathing except when in the upright position |
| General Malaise |
run down feeling, nausea, weakness, fatigue, headache |
| Dyspnea |
shortness of breath or difficulty breathing |
| dysphagia |
Difficulty swallowing |
| Peripheral Edema |
Excessive fluid in the tissue caused by CHF and renal failure |
| Venous Distension |
occurs with CHF and seen with obstructive lung disease |
| Clubbing |
Angled nailbed and increased skin caused by hypoxemia |
| Capillary refill |
indicates peripheral circulation |
| Diaphoresis |
Heavy sweating. indicates heart failure, fever (infection), anxiety |
| Ashen/pallor |
decrease in skin color due to anemia or acute blood loss and vasoconstriction |
| Erythema |
redness, due to capillary congestion, inflamation, or infection |
| Cyanosis |
blue or blue-grey, caused by hypoxia from reduced hemoglobin |
| Kyphosis |
Hunch back or convex spinal curve |
| Scoliosis |
Lateral curvature of the spine |
| Barrel chest |
air trapping due to COPD |
| Kyphoscoliosis |
kyphosis and scoliosis causing severe restrictive impairment |
| Symmectrical chest movement: |
both sides of chest move at the same time |
| underlying pathologies that will cause asymmectrical movement |
Chronic lung disease, atelectasis, pneumothorax, Flail chest, ET tube in one lung |
| Eupnea |
Normal respiratory rate, depth, and rhythm |
| Apnea |
cessation of breathing |
| Hyperpnea |
Increased respiratory rate, increased depth, regular rhythm. Caused by metabolic disorder and CNS disorder |
| Cheyne-Stokes breathing |
gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 sec. with periods of apnea lasting up to 60 sec. caused by increased ICP, meningitis, drug overdose |
| Biots Breathing |
increased rate and depth with irregular periods of apnea, each breath has same depth. caused by CNS problem |
| Kussmauls breathing |
increased rate (usually of 20 bpm) increased depth, irregular rhythm, breathing sounds labored. caused by metabolic acidosis, renal failure, diabetic ketoacidosis |
| Apneustic Breathing |
prolonged gasping inspiration followed by extremely short, insufficient expiration. caused by problems with respiratory center, trauma or tumor |
| normal ventilation muscles |
Diaphragm and external intercostals |
| What are the muscles used to increase ventilation (accessory muscles)? |
Normal ventilation muscles, scalene, sternocleidomastoid, and abdominals |
| hypertrophy of muscles |
With COPD |
| Normal pulse rate: |
60-100 bpm |
| Tachycardia indicates |
Hypoxemia, anxiety, stress |
| bradycardia indicates |
heart failure, shock |
| Paradoxical pulse/ pulsus paradoxus |
pulse/blood pressure varying with respiration. may indicate severe air trapping |
| Causes of tracheal deviation pulled to abnormal side (toward pathology): |
Pulmonary atelectasis, pulmonary fibrosis, pneumonectomy, diaphragmatic paralysis, inside lung |
| Causes of tracheal deviation pushed to normal side (away from pathology): |
Massive pleural effusion, tension pneumothorax, enlarged lymph nodes, large mediastinal mass, neck or thyroid tumorsoutside lung |
| Tactile fremitus |
vibrations felt on chest wall |
| rhonchial fremitus |
secretions in the airways |
| Resonance |
Normal air filled lungs, gives a hollow sound |
| Flatness |
areas over the sternum, muscle or areas of atelectasis giving a full sound |
| Dullness |
areas over fluid-filled organs (heart or liver). pneumonia and pleural effusions will give this thudding sound |
| Tympany |
area over air-filled stomach. drum-like sound over lungs indicates increased volume |
| Hyperresonance |
pneumothorax or emphysema are present making a booming sound |
| What is the difference between vesicular and adventitious breath sounds? |
vesicular breath sounds are normal, adventitious is abnormal |
| Egophony |
patient is instructed say "E" and it sounds like "A". indicates consolidation of the lung tissue |
| Coarse rales |
Secretions in large airways. Suction/ Cough |
| Medium rales |
middle airway secretions. CPT |
| Fine rales/crackles |
Alveoli fluids. Caused by CHF and pulmonary edema. IPPB, heart drugs, diuretics, O2 |
| Wheeze |
Bronchospasm. Bronchodilator (unilateral wheeze indicates foreign body obstruction) |
| Stridor |
Upper airway obstruction--epiglotitis, subglottic swelling, foreign obstruction. racemic epi., suction and/or bronchoscopy or intubation |
| pleural rub |
inflamed visceral and parietal pleural rubbing. steroids and antibiotics |
| First heart sound |
closure of the mitral valve and tricuspid valves |
| Second heart sound |
systole ends, pulmonic and aortic valves close |
| Third heart sound |
diastole. rapid ventricular filling immediately after systole |
| Fourth heart sound |
late in diastole and produced by active filling of ventricles |
| murmur |
heart valves stenotic or incompetent |
| Bruits |
turbulent blood flow |
| how to evaluate a murmur? |
echo-cardiogram |
| ET tube appear on an x-ray |
below vocal chords and 2 cm above the carina |
| What will quickly determine adequate ventilation before a chest x-ray is done? |
observation and auscultation |
| when are the costophrenic angles obliterated? |
with pleural effusion |
| Lateral position of chest x-ray |
projection from either side. determines epiglottitis, croup, foreign body |
| lateral decubitus on chest x-ray |
patient lying of the affected side, detects plueral effusions |
| describe a normal chest x-ray |
diaphragm dome-shaped, right hemidiaphragm is slightly higher than left and at level with 6th anterior rib, trachea is mid-line, bilateral radiolucency with sharp costophrenic angles |
| proper position of chest tube |
in the pleural space surrounding lung |
| proper position of nasogastric and feeding tube |
in the stomach and small bowel below diaphragm |
| position of pulmonary artery catheter |
right lower lung |
| position of pacemaker |
right ventricle |
| position of central venous catheter |
right or left subclavian or jugular vein and resting the vena cava or right atrium of the heart |
| Radiolucent |
dark pattern. normal for lungs |
| Radiodense |
white pattern, solid, fluid. normal for bones or organs |
| Infiltrate |
any ill defined radiodensity. atelectasis |
| Consolidation |
white solid area. pneumonia/pleural effusion |
| Hyperlucency |
extra pulmonary air. COPD, asthma attack, pneumothorax |
| Vascular markings (x-ray) |
lymphatics, vessels, lung tissue. increased CHF, absent with pneumothorax |
| Diffuse (x-ray) |
spread throughout. atelectasis/ pneumonia |
| Opaque (x-ray) |
Fluid/solid. consolidation |
| Fluffy infiltrates |
diffuse whiteness. Pulmonary edema |
| Butterfly pattern (x-ray) |
infiltrate butterfly shaped. pulmonary edema |
| patchy infiltrates |
scattered densities. atelectasis |
| plate-like infiltrates |
thin-layered densities. atelectasis |
| ground glass appearance (x-ray) |
ARDS/IRDS |
| Honeycomb Pattern (x-ray) |
ARDS/IRDS |
| Air Bronchogram |
pneumonia/edema |
| Peripheral wedge-shaped infiltrate |
pulmonary embolus/infarction |
| concave superior interface/border |
pleural effusion |
| basilar infiltrates with meniscus |
plueral effusion |
| main indication for a bronchography? |
obstructive lesions and bronchiectasis |
| hazards of bronchogram |
allergic reactions, impairment of respiratory state |
| Describe how V/Q scan is performed |
Ventilation--radioisotope xenon gas is inhaled and recorded. Perfusion--radioactive iodine is injected in vein and recorded when it reaches pulmonary circulation. |
| normal ventilation but abnormal perfusion indicates |
pulmonary emboli |
| the advantage of using an MRI over conventional x-ray? |
determine the precise position of tumors and involvement of surrounding structures |
| What type of ventilators are used with a MRI and Why? |
Fluidic (non-electric) vent. because the magnetic fields disrupt electronic devices |
| What does the CT provide the practitioner? |
cross sectional view (slices) of body structures and multiple levels |
| what types of pathologies would a CT indicate? |
Mediastinal mass, pleural and parenchymal masses, pulmonary nodules and lesions not visualized on chest x-ray |
| CBC measures |
All ingredients of blood: RBC, Hb, Hct, WBC |
| Describe RBC's |
carries Hb/O2. norm: 4-6. Low: anemia, blood loss. High: ploycythemia, chronic hypoxemia, COPD |
| Describe Hb |
Carries O2. Norm: 12-16. Low: anemia. High: polycythemia |
| Describe Hct |
blood spun and measure the % of RBC's to original blood volume. Norm: 40-50%. Low: anemia. High: polycythemia |
| Describe WBC |
Fights bacterial infection. Norm: 5000-10000. Low: Leukopnia, viral infection. High: Leukocytosis, bacterial infection |
| Neutrophils |
major WBCs |
| Difference between Bands and Segs: |
Bands-- immature cells, 4% WBC, increased with bacterial infection. Segs-- Mature cells, 60% WBCs, decreased with bacterial infection |
| eosinophils are associated with? |
Asthma |
| electrolytes and their function |
elements required by the body for normal metabolism |
| Clinical Application of Electrolyte imbalance |
Muscle weakness, soreness, nausea and mental changes |
| Describe Potassium |
Major intracellular cation. Norm: 3.5-5.0 Low: Hypokalemia,metabolic alkalosis, excessive secretions, renal loss, flattened T wave. High: Hyperkalemia, metabolic acidosis, kidney failure, spiked T wave |
| Describe sodium |
major extracellular cation controlled by kidneys, Norm: 135-145. Low: hyponatremia, fluid loss |
| Describe chloride |
major extracellular anion. Norm:85-100. Hypochloremia, metabolic alkalosis. High: Hyperchloremia, metabolic acidosis |
| Describe Bicarbonate |
Total CO2 content. Norm: 22-26. Low: metabolic acidosis High: metabolic alkalosis |
| What does a BUN measure? |
kidney function |
| increase in creatinine indicates |
kidney failure |
| mucoid sputum indicates |
Chronic bronchitis |
| yellow sputum indicates |
bacterial infection |
| green sputum indicates |
bronchiectasis |
| red sputum indicates |
bleeding, tumor, TB |
| pink frothy sputum indicates |
pulmonary edema |
| Describe Bleeding time test |
puncture the skin and time how long it takes to stop bleeding. norm: up to 6 min. evaluates functions of platelets |
| What is an acid fast stain done for? |
myobacterium TB |
| Describe Platelet count |
forms clots in blood (coagulation). norm: 150,000-400,000. Decreased values are assoc. with decreased bone marrow function |
| Describe activated partial thromboplastin time |
length of time required for plasma to form a fibrin clot. norm: 24-32 sec. used for monitoring Heparin therapy |
| Describe prothrombin time |
used for monitoring Warfarin (coumadin) therapy. norm: 12-15 sec. |
| Describe Urinalysis |
reflects metabolic status and screening for kidney disease |
| Hemodynamics |
movement of blood or circulation/perfusion of blood |
| factors controll blood pressure |
heart, blood, vessels |
| Of the factors that control blood pressure, how would these cause an increase in blood pressure? |
Heart-- increase in rate/strength. Blood-- excessive fluid Vessels-- constriction |
| What are the 4 chambers of the heart and what are the 4 circulatory branches each chamber serves? |
Left Ventricle---systemic arteries (aortic valve). Right atria-- systemic veins (tricuspid valve) Right Vent-- pulmonic arteries (pulmonic valve). Left atria-- pulmonary veins (mitral valve) |
| Describe electrophysiology of the heart: |
impulse starts at SA, wave depolar. through atria causing contraction (P), received at AV where delayed (P-R), then sent through bundle of HIS, to Purkinje fibers, vent. depolar(QRS), after short delay(S-T) repolarize (T wave) |
| Treatment of tachycardia: |
give O2 and treat symptoms |
| treatment for bradycardia |
O2 and atropine |
| treatment for PVCs |
O2 and Lidocane |
| Treatment for pulseless V-tach |
defib 200 joules |
| treatment for V-fib |
defib 200 joules |
| What 2 factors will affect the direction of the axis? |
Hypertrophy and infarction |
| Describe 1st degree AV Block |
PR interval > 5 mm. |
| Describe 2nd degree AV block |
irregular rhythm, normal P wave, missing QRS complex |
| Describe 3rd degree AV block |
atrial rate > 60 bpm, ventricular rate < 40 bpm. no PR interval, widened QRS complex |
| Describe Ischemia |
reduced blood flow to the tissue,depressed or inverted T wave |
| Describe injury |
acute damage to heart tissue. elevated ST segment |
| Describe infarction |
necrosis or death of tissue. significant Q waves |
| term infant age |
38-42 weeks |
| preterm infant age |
< 38 weeks |
| post term infant age |
> 42 weeks |
| ET tube size for full term infant: |
3 mm |
| when is an APGAR score routinely done? |
at 1 min--neonatal survival, 5 min-- future neonatal damage |
| when should a transillumination test be recommended? |
with suspected pneumothorax |
| What is the new ballard score used for? |
estimation gestational age in low birth weight infants |
| normal new ballard score |
40 |
| what would indicate a right to left shunt? |
15 mmHg difference in pre- and post- ductal blood gas |
| What is a L/S Ratio test used for? |
Lung maturity |
