Lindsey Jones 1B- Patient Data
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| show | ((PaCO2-PECO2)/PaCO2 )* 100, Range 20-40%
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| show | (FIO2*7) – (PaCO2 +10)
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| show | PAO2- PaO2, RANGE 25-65mmHg
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| show | (Hb*1.34*SaO2) + (PaO2 * .003), range 17-20%
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| show | (Hb*1.34*SvO2) + (PvO2 * .003), range 12-16%
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| show | CaO2-CvO2, Range 4-5%
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| show | ((A-aDO2)*.003 ) / ((A-aDO2)*.003+C(a-v)O2), Range 3- 5 %
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| show | VO2 / (C(a-v)O2 * 10) , range 4-8 L/min
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| show | CO / BSA, RANGE 2.5 - 4 L/m/m2
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| Types of Chest X-rays : AP(Anterior to posterior) | show 🗑
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| Types of Chest X-rays : PA(Posterior to Anterior) | show 🗑
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| show | Helps to visualize the lungs as a 3-dimensional body
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| Types of Chest X-rays : Lateral decubitus | show 🗑
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| show | Any diagonal or non-traditional angle. Increases 3-dimensionality of lung, helpful in spotting internal issues such as masses, blebs, or lesions.
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| Neck X-rays : Lateral Neck | show 🗑
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| show | 1. Use a A-P chest radiograph. 2. Determined by radio-opaque line on the ET tube. 3. End of line should be 2cm above the carina (or 1 inch)
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| show | should be in the pleural space
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| show | 1)tip should rest in the right atrium or vena cava 2)distal end in the pulmonary artery, not wedged(i.e. balloon not inflamed.)
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| Placement X-rays : Nasogastric tube positioning | show 🗑
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| Normal Chest X-ray description | show 🗑
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| Radiological Description : Trachea shift from midline-Associated Problem | show 🗑
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| Radiological Description : Obliterated costophrenic angles-Associated Problem | show 🗑
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| Radiological Description : Flattened diaphragm-Associated Problem | show 🗑
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| Radiological Description : Radiolucent-Associated Problem | show 🗑
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| Radiological Description : Fluffy infiltrates-Associated Problem | show 🗑
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| Radiological Description : Wedge - shaped infiltrates-Associated Problem | show 🗑
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| show | Pneumonia
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| Radiological Description : Butterfly or Batwing Pattern-Associated Problem | show 🗑
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| Radiological Description : Plate like or patchy infiltrates-Associated Problem | show 🗑
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| Radiological Description : Ground glass or Honeycomb pattern- Associated Problem | show 🗑
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| show | ARDS/IRDS
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| show | pleural effusion
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| Diagnostic Radiology : V/Q studies | show 🗑
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| show | Used to visualize 1.lung masses,lesions,or nodules 2. during scanning metals are not to be used directly.
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| Diagnostic Radiology : Magnetic Resonance Imaging (MRI) | show 🗑
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| Diagnostic Radiology : Bronchogram | show 🗑
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| show | 1. Radiographic assessment of esophagus while the pt. swallows food mixed with radiopaque paste. 2. Used to determine risk for aspiration by visualizing any food entering tracheal& protection of tracheal opening during swallowing.
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| K+ Potassium | show 🗑
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| Na+ Sodium Major: | show 🗑
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| show | Major: Extracellular Anion. Normal: 80-100 mEq/L range HYPERchloremia: (Metabolic ACIDOSIS ) Hypochloremia: (Metabolic alkalosis)
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| show | Changes in Total CO2 content reflect changes in blood base. Normal: 22-26 mEq/L range HIGH HCO3- (Metabolic ALKALOSIS) Low HCO3- (Metablolic acidosis)
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| show | 1. Both indicates kidney function. 2. Ceratine is more accurate than BUN. 3.Acceptable range- 8-25 mg/dl. 4. Acceptable range- 0.7-1.3 mg/dl.
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| show | 1. Required for blood clotting. 2. Acceptable value - 150,000-400,000 units/mm3
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| Coagulation Studies : PT (Prothrombin time) | show 🗑
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| Coagulation Studies : APTT(Activated partial thomblastin time) | show 🗑
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| Complete Blood Count(CBC) : Hb | show 🗑
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| show | 1. cells that carry Hb. 2.Acceptable range-4-6 mill/cu mm.
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| Complete Blood Count(CBC) : WBC | show 🗑
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| show | 1. used on infants 2. electrode placed on skin & should be moved every 4 hrs. or causes burns on the skin 3. only accurate if perfusion is happening - correlates with the blood gas values.
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| Urine: Urinalysis | show 🗑
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| Sputum:Gram stain | show 🗑
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| Sputum:Culture | show 🗑
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| Sputum: Sensitivity | show 🗑
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| show | Used to detect the organism associated w/ TB (mycobacterium TB)
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| Sputum: clear | show 🗑
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| show | chronic bronchitis
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| Sputum: Yellow | show 🗑
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| show | stagnant sputum- Bronchiectasis, pseudomonas.
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| Sputum: Red | show 🗑
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| Sputum: Brown | show 🗑
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| Sputum: Pink frothy | show 🗑
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| Ventilation : Definition | show 🗑
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| Ventilation : Physical signs of ventilation | show 🗑
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| show | 1. Intercostal & Sternal retractions - associated with upper airway obstruction 2. Accessory muscle use.
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| Ventilation : lab signs of ventilation | show 🗑
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| show | Oxygenation probs. r imp. than circulation&perfusion. consider those 1st. consider CPR. If an object is blocking airway, dont start chest compression eventhough pt.'ve lost HR.U continue to remove object for ventilation becoz 1st priority is ventilation.
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| Oxygenation : Physical signs of oxygenation | show 🗑
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| Oxygenation : Lab signs of oxygenation | show 🗑
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| Circulation: signs | show 🗑
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| show | 1. BP 2. Sensorium 3. Urine Output (best indicator of perfusion)
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| show | Hemodynamics
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| Visual Inspection : General Appearance | show 🗑
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| show | Hypoxemia.
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| Visual Inspection : Color - ashen/pallor | show 🗑
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| Visual Inspection : Color- jaundice | show 🗑
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| Visual Inspection : Color - erythema | show 🗑
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| show | good oxygentaion.
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| show | seen in pt. with COPD or chronic air-trapping such as cystic fibrosis.
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| show | curvature of the spine. Kyposis is hunchback. Scoliosis curvature. PFT will show restrictive component.
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| Visual Inspection : respiratory rate and pattern- Eupnea | show 🗑
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| show | RR over >20 bpm
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| show | RR less <8 also know as Oligopnea.
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| Visual Inspection : respiratory rate and pattern: Hperpnea | show 🗑
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| Visual Inspection : respiratory rate and pattern: Apnea | show 🗑
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| show | Increased RR,depth and irregular rhythm. Associated w/diabetic ketoacidosis/ metabolic acidosis.
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| Visual Inspection : respiratory rate and pattern: Biots breathing | show 🗑
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| Visual Inspection : respiratory rate and pattern: cheyne-stokes | show 🗑
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| show | 1. External intercostals 2. Diaphragm
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| Visual Inspection : Acessory muscle use - associated with ventilatory difficulty | show 🗑
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| Visual Inspection : Nasal flaring | show 🗑
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| Visual Inspection : Presence and nature of a cough | show 🗑
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| show | 1. COPD. 2. Flail chest(broken ribs. 3. Pneumothorax. 4. ET tube advanced too far into one lung. 5. Significant atelectasis.
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| show | 1. Thorax moves out on inspiration. 2. Abdomen moves out on inspiration.
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| show | 1. Increased angle of the nail bed. 2. Associated w/ chronic hypoxemia (COPD).
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| Visual Inspection: Venous distension | show 🗑
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| Visual Inspection: Diaphoresis(Heavy sweating) | show 🗑
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| show | 1. Found in extremities esp. in the lower legs. 2. Associated w/CHF and any fluid-shift disease.
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| show | 1. It is caused by Bronchoconstriction. 2. Bilateral wheeze is treated w/ a bronchodilator. 3. Unilateral wheeze could be caused by a foreign body obstructiob or a bronchial mass as seen w/ lung cancer and treat w/ bronchoscope.
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| show | 1. secretions in the large airways. 2. Often remedied by suctioning.
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| show | 1. Secretions in the middle-sized airways. 2.Treated w/ CPT including postural drainage. 3. Fine crackles/rales indicates atelectasis- treat w/ hyperinflation therapy.
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| show | 1. Upper airway obstruction. 2. Possible foreign body aspiration. 3. If mild- Treat w/cool mist and hydration. 4. If moderate-treat w/racemic epinephrine. 4. If severe-intubate the pt. 5. If foreign body-perform bronchoscopy. Croup and epiglottis occurs.
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| show | 1. Indicates decresed air movement in the area. 2. Egophony- associated w/consolidation of secretions such as Pneumonia. 3. Bronchophony-Indicates consolidation. Whispered pectoriloquy is similar.
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| Bedside Assessment :Adventious(abnormal) Breath Sounds-friction rub | show 🗑
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| show | Normal breath sounds indicate normal lungs.
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| show | Done by tapping the knuckles while placed over the thorax.
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| Bedside Assessment : Breath Sounds-tones Percussion-resonant | show 🗑
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| show | found in cases w/significant air-trapping, such as COPD and with Pneumothorx.
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| Bedside Assessment : Breath Sounds-tones Percussion-Dull | show 🗑
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| show | When done over bones or consolidated lung tissue (not fluid) such as seen with atelectasis.
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| Bedside Assessment : Breath Sounds-Pulse-Acceptable range | show 🗑
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| Bedside Assessment : Breath Sounds-Pulse-Tachycardia | show 🗑
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| show | <60 bpm associated w/shock, Heart failure, seizure etc.
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| Bedside Assessment : Breath Sounds-Pulse-Pulses Paradoxus | show 🗑
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| Bedside Assessment : Breath Sounds-Ventilation-Tidal Volume(VT) | show 🗑
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| show | Should be @least 10ml/kg otherwise pt. needs ventilatory assistance.
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| Bedside Assessment : Breath Sounds-Ventilation-Maximum Inspiratory pressure(MIP/MIF/NIP/NIF) | show 🗑
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| Bedside Assessment : Breath Sounds-Tracheal Palpation-Deviation toward the problem | show 🗑
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| Bedside Assessment : Breath Sounds-Tracheal Palpation-Deviation away the problem | show 🗑
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| show | Normal - 120/80 mmHg.
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| Bedside Assessment : Breath Sounds-Blood Pressure- Decreased | show 🗑
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| show | Associated w/ anxiety, stress, cardiac problems and hypoxemia.
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| show | Normal- S1 and S2. Abnormal- S3 and S4 indicates cardiac dysfunction-ECG is indicated.
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| show | 1. Diagnosis 2. Chief complaint 3. objective information(signs) 4. subjective information(symptoms)
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| show | Exposure to pulmonary irritants
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| Patient History: Patient Medical Record - Smoking history | show 🗑
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| show | 1.Orientation-name,place,day,language 2.Resp. ability-Dsypnea present&Orthopnea 3.Emotional State a)angry-electrolyte imbalance b)panic-hypoxemia,asthma,pneumothorax c)Euphoria-ingestional error(drug overdose) 4.Social Support System 5.Proper ques. tech.
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| show | 1. Home environment 2. Current care plan 3. pain location, quality and persistance 4. triggers to dyspnea 5. family medical history
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| show | Computer Manages polarity(+ve/-ve) of each electrode. Helps in tracing hearts electro physiology
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| show | A lead may be an individual electrode or a a line of electricity between 2 electrodes. There are total of 12 electrodes.
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| ECG/EKG : recording equipment & supplies - 6 Chest leads | show 🗑
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| show | LeadI- Left arm to rt. Arm. LeadII-left leg to rt. Arm. LeadIIIleft leg to left arm. - AVR-rt. Arm. AVL-left arm. AVF-left leg.
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| ECG/EKG : recording equipment & supplies- +ve Lead | show 🗑
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| show | leads involving 2 electrodes, one must be +ve & other -ve. GUIDELINES:1.(Looking @ pt.), electrode most right is +ve. 2. electrode most downward is +ve. 3. Of lead I,right arm -ve,left arm +ve. 4.Of lead II,right arm -ve,left leg +ve.
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| ECG/EKG : recording equipment & supplies-Interpretations- 5 Rate Definition | show 🗑
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| show | Normal. All the bumps (PQRST)are there especially the P wave.
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| ECG/EKG : recording equipment & supplies- Rhythms- Sinus Tachycardia | show 🗑
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| show | <60 Treated w/ O2 and Atropine.
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| ECG/EKG : recording equipment & supplies- Rhythms- Premature ventricular contraction(PVC) | show 🗑
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| ECG/EKG : recording equipment & supplies- Rhythms- Asystole | show 🗑
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| ECG/EKG : recording equipment & supplies- Rhythms-Ventricular Fibrillation(v-fib) | show 🗑
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| show | treat w/ defibrillation if no pulse. Then treat w/defibrillation @ 360 joules.
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| ECG/EKG : recording equipment & supplies- Heart Blocks- 1st degree | show 🗑
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| ECG/EKG : recording equipment & supplies- Heart Blocks- 2nd degree | show 🗑
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| ECG/EKG : recording equipment & supplies- Heart Blocks- 3rd degree | show 🗑
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| ECG/EKG : recording equipment & supplies- Define Axis | show 🗑
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| ECG/EKG : recording equipment & supplies- Axis- Hypertrophy | show 🗑
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| show | It means that tissue is dead and electricity cannot flow through dead tissue. So axis deviates away from the infarct tissue.
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| ECG/EKG : recording equipment & supplies- 3 Myocardinal "I"s | show 🗑
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| show | 1. Lack of O2 to the cardiac Muscle. 2. T-wave is depressed and will show a -ve deflection.
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| ECG/EKG : recording equipment & supplies- Myocardinal Injury | show 🗑
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| show | 1. Dead tissue (old / fresh). 2. Will produce a permanent Q-wave (wide,ht.and depth)
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| show | 1. Maximum volume a patient can exhale after a maximal inhalation 2. It is to measure restrictive lung disease.
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| show | 1. Maximum volume a patient can forcefully exhale after a maximal inhalation & in least possible time 2.Important to measure FVC both volume & flow 3.FV1/FVC is a best indicator of obstruction 4.Range-normal-85% min. is 75%. Obstructive is present if <75%
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| PFT:Maximum Voluntary Ventilation(MVV) | show 🗑
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| PFT:Flow-volume Loop(FVL) | show 🗑
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| show | 1.PURPOSE to determine FRC&RV 2.procedure involves breathing 100% O2 while exhaled nitrogen is analyzed until depleted then a calculation is made to project lung volume.3.He&N analyzer must be caliberated. He should read 0% caliberated to room air.
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| PFT:Gas Distribution(SBN2) | show 🗑
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| PFT:Body Box (Plethysmography) | show 🗑
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| show | 1. Normal DLCO=25 mL CO/min/mmHg(STPD) 2. Poor DLCO usually found in restrictive disease affecting alveolar capillary membrane(ACM) eg. ARDS. Emphysema is only obstructive disease with poor DLCO 3.DLCO measures how well gases move across ACM.
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| show | 1. determines ability to provoke bronchoconstriction.
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| show | 1. needed to determine effectiveness of bronchodilator medications & help determine dosage. 2. Helpful in determining reversibility of bronchoconstriction.
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| PFT:Ventilatory response to CO2 | show 🗑
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| show | 1. FEV1/FVC - If less than 75% then pt. is Obstructive. If FV1/FVC is not available then check or FEV1 by itself and if FEV1- less than 80% then pt. is obstructive too.
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| show | 1. FVC- If less than 80% then pt. is Restrictive. If greater then not restrictive. Look@ SVC first. If not available then check FVC.
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| Diffusion impaired Vs Normal Diffusion | show 🗑
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| show | 1.Normal-80%. 2. Mild-60-80%. 3. Moderate-40-60%. 4. Severe- <40% .
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| show | Best Test = Highest (FEV1 + FVC)
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| Spirometer | show 🗑
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| show | C BABE-1.Cystic Fibrosis 2. Bronchiectasis 3. Asthma 4. Bronchitis 5. Emphysema
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| show | Emphysema
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| show | .
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| show | Right Atrium-->Tricupsid valve-->Right Ventricle -->Pulmonary Artery-->Lung Capillaries-->Pulmonary Vein-->Left atrium-->Bicuspid/mitral valve-->Left ventricle-->Systemic Vascular system(body&capillaries)….back to right atrium
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| show | 120/80 mmHg(mean-93 mmHg)
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| show | Mean BP =((1 x systolic) + (2 x diastolic)) / 3
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| 3 Mechanisms of BP | show 🗑
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| Normal Hemodynamic values(CVP,PAP,PCWP,CO,SV,EF,CI) :Means & Ranges | show 🗑
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| Central Venous Pressure(CVP) | show 🗑
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| Central Venous Pressure(CVP)-Other Names | show 🗑
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| show | 1. measurement taken with a transducer at the tip of a catheter placed in the pulmonary artery. 2. high with COPD patients. 3. best place to get a mixed-venous blood sample. 4. also know as Right Ventricular after load.
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| Pulmonary Capillary Wedge Pressure(PCWP) | show 🗑
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| Pulmonary Capillary Wedge Pressure(PCWP): Other Names | show 🗑
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| show | 1.expressed as vol. than pressure. 2.also expressed by Cardiac index CI=QT/BSA 3.relates condition of Lft.ventricle 4.measured by a computer thru thermal dilution. 5.calculated by Fick eq.& SV*HR. if QT is decreased - treat w/cardiac medications-Digitalis
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| show | the Vena Cava thru the Right Artery & Right Ventricle ending in the pulmonary artery
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| Hemodynamic Calculations: Systemic Vascular Resistance(SVR), Formula & Normal | show 🗑
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| show | ((Mean PAP-PCWP)/QT) x 80, normal: 200 dynes/sec/cm-5
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| show | helps to visualize(ultrasonically) function of the heart (in M-mode) including ejection fraction and assess general function of the left ventricle
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| show | Helps to visualize cardiac-related anatomy- especially when suspecting congenital heart and abnormalities
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| show | 1. Transpostion of the Great Vessels 2. Tetralogy of Fallot 3. Atrial septal defect (ASD) & Ventricular septal defect (VSD) 4. Patent ductus arteriosis (PDA) 5. Coarctation of the aorta.
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| show | 1. Ultrasonic procedure combined with a computer to compose two-dimensional and M-mode ECG 2. It is Non-invasive, safe, free of radiation.
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| show | 1. to determine adequacy of blood flow & pump function. 2. Examine size & disease state of cardiac tissue. 3. Inspect cardiac valve function
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| Intracranial Pressure (ICP) Monitoring: Acceptable Range, define Increased ICP | show 🗑
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| show | 1. Requires access to the brain through a hole in the skull. A) Subarachnoid bolt - metal screw-like device inserted into the subdural space. B) Ventricular Catheter - placed in a surgical hole in the skull.
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| Intracranial Pressure (ICP) Monitoring: Treatment & Prevention | show 🗑
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| Intracranial Pressure (ICP) Monitoring: Causes of increased ICP | show 🗑
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| Electroencephalography(EEG): Define | show 🗑
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| Electroencephalography(EEG): Indications | show 🗑
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| Pulmonary Angiography | show 🗑
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| Assessment of the Newborn upon Birth & Routine : APGAR | show 🗑
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| show | 1. Done after 1 min.(neonatal survival) & 5min(Future neonatal brain damage). 2. Scores between 0 & 10 3. The higher the score the better: a)7-10 points - Routine care b)4-6: support with O2,warmth & general simulation. 3. 0-3:CPR (heart/lungs or both).
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| show | 1. Normal Pulse:110-160bpm. 2. >170-tachycardia-give O2 3. Pulse can be taken brachially or femorally(not radially). 4. Any Cardiopulmonary challenge will cause will cause an increase in infant's heart rate (not an increase in contractility).
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| Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital Signs- RR & Pattern | show 🗑
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| Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital Signs - BP | show 🗑
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| Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital Signs - Temperature | show 🗑
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| Newborn Medical History : Perinatal History | show 🗑
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| Newborn Medical History : Gestational Age | show 🗑
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| show | 1.Normal: 3000 grams. 2. Low birth wt. - risk of complications. 3. Minimal surviable age and week - 26-28 weeks annd round 100 grams.
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| show | Blue extremities, pink body - called acrocyanosis.
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| show | sign of ventilatory distress 1)Retractions: a)Intercostal b)Subcostal c)Substernal d)Supraclavicular 2)Grunting:upon exhalation causes natural PEEP. 3) Nasal Flaring
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| Newborn Physical Assessment : Capillary Refill | show 🗑
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| Newborn Lab Assessment : ABG | show 🗑
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| Newborn Lab Assessment : ABG- How do you rule out a patent ductus arteriosis(PDA). | show 🗑
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| show | Range- greater>30mg/dL 2)for pre-term infants Range:greater>20mg/dL
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| show | 1) Normal- 2:1 2)relates to lung maturity 3)if 1:1 is bad administer pulmonary surfactant.
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| show | accurate lung maturity even in the presence of diabetes.
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| show | alternate indicator of lung maturity.
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