Patient assess midterm study

SaO2/PaO2 adults - normal

PaO2 80-100 mm Hg, SaO2 >95%

SaO2/PaO2 adults mild

PaO2 60-79 mm Hg, SaO2 90-94%

SaO2/PaO2 severe

PaO2 <40 mm Hg, SaO2 <75%

Body temp - adults normal

36.5-37.5°C (98.6°F) for adults.

Body temp - adults mild hypothermia

34-36 C

Body Temp - adults deep hypothermia

<30 C

pulse rate norm - adults

60-100 bpm

blood pressure - adults

Normal: 120/80 mm Hg

Hypertension BP - adults

BP ≥ 140 mm Hg, DBP ≥ 90 mm Hg.

Hypotension BP - adults

BP < 90/60 mm Hg.

Mean arterial pressure (MAP)

≥ 65 mm Hg

Breathing patterns - too high/too low

• Hyperventilation: increased rate and depth

• Hypoventilation: Decreased rate and depth

Breathing: SOB when lying down

Orthopnea

Breathing: increased rate and depth, often in metabolic acidosis

Kussmaul’s

Breathing: Alternating fast and slow breathing with apnea

Cheyne-Stokes

Breathing: Fast, deep breaths with abrupt pauses

Biot's respiration

Pulse quality scale

0: Absent

1+: Weak, thready

2+: Difficult to palpate

3+: Normal

4+: Bounding

Respiratory Rate - adults

Eupnea (normal): 12-20 breaths/min

Bradypnea (slow): Less than 12 breaths/min

Tachypnea (fast): More than 20 breaths/min

Color

Jaundice - Yellowish skin color resulting from high bilirubin levels.

Pallor - Diminished skin color typically associated with anemia.

Cyanosis - Bluish hue to the skin that is due to hemoglobin that is poorly saturated with oxygen.

Plethora - Fullness of the blood vessels at the surface of the skin.

Glasgow coma scale

Ranges from 3 (deep coma) to 15 (full consciousness); less than 8 = intubate

Normal diaphragmatic excursion

Range is 3-5 cm in adults.

Wheeze is caused by ________________________

Bronchoconstriction

Unilateral Wheeze (Monophonic wheeze) can be caused by _____________________________ or a _______ ________ as seen with lung cancer.

Foreign body obstruction

Bronchial mass

Treat bilateral wheezing with a __________.

bronchodilator

whistling, high pitched sound on inspiratory or expiratory

Wheeze

if pt starts out diminished but the progress into audible wheezing, continue ______________ therapy

bronchodilator (means the bronchodilator is doing its job)

Rhonchi is _________________ in the large airways

Secretions

Rhonchi is often remedied by ____________

Suctioning

Coarse, low pitched, snoring, may clear w/ cough

Ronchi

scratchy, high pitched breath sounds

pleural rub

fine crackling, high pitched, end of inspiration, lung bases

Crackles (rales)

Crackles are found in individuals with _____________

CHF, or pneumonia (at the lobe impacted)

crowing sound caused by inflammation/edema of larynx and trachea

stridor

Stridor: if described with moderate treat with _________ _____________

Racemic Epi

Stridor causes

Supraglottic swelling - Think

Subglottic swelling- Think

acute epiglottis

Croup

What are causes of hyperresonant percussion sounds

Emphysema or pneumothorax, sometimes asthma

What causes dull or flat percussion sounds

pleural effusion, consolidation or atelectasis

Causes of color changes

A. Cyanosis -

B. Ashen or Pallor or Dusky -

C. Jaundice -

D. Plethora -

A. Hypoxemia

B. Anemia: Shock (Vasodilation)

C. Excessive Bilirubin

D. Vasodilation or hypercapnic

Chest Configuration

A. Increased A-P diameter - seen in

B. Scoliosis, Kyphosis, Kyphoscoliosis

C. how do you measure pt height?

A. COPD, Chronic air trapping, Cystic Fibrosis

B. Curvature of the spine

C. measure wingspan (arms out at sides)

Nasal Flaring

Relates to ventilatory difficulty in the newborn

abnormal secretions reasons

1 Frank blood

2 Dry and non-productive

3 Yellow sputum

1. Hemoptysis

2. Think lung cancer or foreign body or ACE inhibitors

3. Infection.

Digital Clubbing associated with ______________________

Chronic hypoxemia

Diaphoresis (Heavy Sweating) seen w/ what pulmonary conditions?

CHF, myocardial infarction, febrile conditions, and tuberculosis (night sweats).

Peripheral edema in ankles

CHF and any Fluid shifting disease, too much Lasix

Where are vesicular lungs sounds heard?

Over most lung fields, accentuated in thin and diminished in overweight individuals.

soft, low-pitched sounds ; short expirations

Where are bronchovesicular sounds heard?

Main bronchus area and upper right posterior

medium pitch, expiration = inspiration

Where are bronchial/tracheal sounds heard?

only over trachea; high pitch; loud, harsh sounds; expiration > inspiration

resonant percussion, normal fremitus, vesicular BS, crackles/occasional wheezes

left heart failure

dull/flat percussion, decreased fremitus, decreased BS, no adventitious or pleural rub

pleural effusion

dull percussion, increased fremitus (egophony), bronchial BS, crackles, ronchi

consolidation

resonant percussion, normal/decreased fremitus, prolonged exhalation, wheezes, crackles, ronchi

bronchitis

hyperresonant percussion, decreased fremitus, diminished breath sounds

Emphysema

hyperresonant percussion, decreased fremitus, decreased/absent breath sounds

pneumothorax

Dull percussion, decreased fremitus, decreased or bronchial breath sounds, crackles

atelectasis

resonant/hyperresonant percussion, normal/decreased fremitus, vesicular breath sounds, wheezes

asthma

resonant percussion, normal fremitus, vesicular breath sounds, crackles

pulmonary fibrosis

in vocal fremitus, if letter e sounds like letter a, if 99 is heard clearly in lungs, or whispered 123 is clearly audible, then pt has ____________

consolidation