NBRC flashcards

kettering study guide, lecture notes and respiratory coach

What are the four life functions?

Ventilation, Oxygenation, Circulation, Perfusion

How can we measure ventilation?

Respiratory rate, tidal volume, chest movement, breath sounds, PaCO2, ETCO2

How can we measure oxygenation?

heart rate, color sensorium, PaO2, SpO2

How can we measure circulation?

heart rate and strength, cardiac output

How can we measure perfusion?

blood pressure, sensorium, temperature, urine output, hemodynamics

What is required if any of these life functions are absent?

resuscitation

When in a emergency which one of these life function are the most important?

ventilation

The most common problem is with …

oxygenation

Signs

objective information, you can see or measure

Symptoms

subjective information, things the patients must tell you

What are the main vital signs?

respiration, pulse, blood pressure, temperature, SpO2

Formula: Pack Years

# of packs/day x # of years smoked

What should you assume about someone with a pack year of 20 years or more?

a diagnosis of COPD

What is included in a physical examination?

inspection, palpation, percussion, auscultation

Advance Directives

Set of instructions of what a patient would want if he/she was unable to make medical decisions

Normal: Urine Output

40 - 60 mL/hr

If intake exceeds output, what could that result in?

weight gain, electrolyte imbalance, increased hemodynamic pressure (ie. blood pressure), and decreased lung compliance

Changes in CVP can indicate..

changes in fluid balance

Normal: CVP

2-6 mmHg

Decreased CVP indicates

hypovolemia (too little fluid)

What would you recommend for hypovolemia?

fluid therapy

Increased CVP indicates

hypervolemia (too much fluid)

What would you recommend for hypervolemia?

diuretics

Medication Reconciliation

ensuring a patient’s medication list is as accurate and up-to-date as possible

How often should the process of Medication Reconciliation be completed?

within 24 hours of admission to the hospital

What could cause a lethargic, somnolent, or sleepy consciousness?

sleep apnea or excessive O2 therapy with a in a patient with COPD

What could cause a stuporous or confused consciousness?

drug overdose or intoxication

What may also be associated with an obtunded or drowsy state?

decreased cough/gag reflex and a risk of aspiration

Orthopnea

difficulty breathing except in the upright posistion

What disease usually presents with orthopnea?

Congestive heart failure (CHF)

Dyspnea

a feeling of shortness of breath or difficulty in breathing

The higher the grade of dyspnea

the worst it is

4 parts of physical examination of the patient

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

Peripheral edema

excessive fluid in the tissues

What causes peripheral edema?

CHF and renal failure

What should be recommended for peripheral edema?

diuretic therapy

Ascites

fluid in the abdomen

What is ascites caused by?

liver failure

What is clubbing of the finger and toes caused by?

chronic hypoxemia and suggestive of pulmonary disease (ie COPD)

Positive inotropic agents

causes heart to beat faster

Normal: Hemoglobin

12 - 16 g

Eupnea

normal respiratory rate, depth and rhythm

Normal: Respiratory rate

12 - 20 breaths/min

Tachypnea

increased respiratory rate

Causes for tachypnea

hypoxia, fever, pain, CNS problem

Oligopnea

decreased respiratory rate

causes for oligopnea

sleep (normal), drugs, alcohol, metabolic disorders

Hyperpnea

increased respiratory rate, increased depth, regular rhythm

cause for hyperpnea

metabolic disorder/CNS disorders

Cheyne-Stokes

gradually increasing then decreasing rate and depth in a cycle lasting from 30 - 189 seconds, with periods of apnea lasting to 60 seconds

causes for Cheyne-Stokes

increased intracranial pressure, brainstem injury, drug overdose

Biot’s

increased respiratory rate and depth with irregular periods of apnea. Each breath has the same depth.

causes for Biot’s

CNS problem

Kussmaul’s

increased respiratory rate (usually over 20 breaths/min.), increased depth irregular rhythm, breathing sounds labored

causes for Kussmaul’s

hypoxemia, metabolic acidosis, renal failure, diabetic ketoacidosis

Apneustic

prolonged gasping inspiration followed by extremely short, insufficient expiration

causes for apneustic

problem with respiratory center, trauma or tumor

Hypopnea

shallow or slow breathing

Normal muscles of ventilation

Diaphragm, external intercostals, and exhalation is normally passive

Accessory muscles of ventilation

internal intercostal, scalene, sternocleidomastoid, pectoralis major and abdominal muscles (oblique, rectus abdominus, etc)

Mallampati Classification: Class 1

soft palate, uvula, fauces, pillars visible

Mallampati Classification: Class 2

soft palate, uvula, fauces visible

Mallampati Classification: Class 3

soft palate, base of uvula visible

Mallampati Classification: Class 4

hard palate only visible

What Mallampati Classification class is considered a difficult airway?

Class 3 and 4

What Mallampati Classification class is considered the best airway to manage?

Class 1

What must you utilize for a difficult airway?

Fiberoptic bronchoscope and video assist device

What are the signs of respiratory distress?

retractions and nasal flaring

Normal: Pulse

60-100 per minute

Indication of tachycardia

hypoxemia, anxiety, stress

Recommendations for tachycardia

oxygen therapy

Indication of bradycardia

heart failure, shock, code/emergency

Recommendation for bradycardia

O2 therapy first and atropine

When is the trachea pulled to abnormal side (toward pathology)?

Pulmonary atelectasis, pneumonectomy, and diaphragmatic paralysis

When is the trachea pushed to normal side (away from pathology)?

Massive pleural effusion, tension pneumothorax, neck or thyroid tumors, and large mediastinal mass

Crepitus

bubble of air between skin and muscle

The presence of crepitus indicates

subcutaneous emphysema

Percussion: Resonant

Normal

Percussion: Flat

heard over the sternum, muscle, or area of atelectasis (ie. less air)

Percussion: Dull

heard over fluid fill organs, pleural effusion, or pneumonia (ie. less air)

Percussion: Tympanic

heard over air filled stomach (ie. more air)

Percussion: Hyperresonant

Booming sounds, pneumothorax, or emphysema (ie. more air)

croup (laryngotracheobronchitis)

steeple sign

epiglottis

thumb sign

Radiolucent

Dark, pattern, air

Diagnosis: Radiolucent

Normal for lungs

Radiodense/opacity

Whitten patter, solid, fluid

Diagnosis: Radiodense/opacity

Normal for bones and organs

Infiltrate

Any ill-defined radiodensity

Diagnosis: Infiltrate

Atelectasis

Consolidation

Solid white area

Diagnosis: Consolidation

Pneumonia/pleural effusion

Hyperlucency

Extra pulmonary air

Diagnosis: Hyperlucency

COPD, asthma attack, pneumothorax

Vascular markings

Lymothatics, vessels, lung tissue

Diagnosis: Vascular markings

Increased with CHF, absent with pneumothorax

Diffuse

Spread throughout

Diagnosis: Diffuse

Atelectasis/pneumonia

Opaque

Fluid, solid

Diagnosis: Opaque

Consolidation