sdas

adadasdsa

What is the purpose of the patient interview?

To establish a rapport between the clinician and patient, to obtain information essential for making a diagnosis, to help monitor changes in the patient's symptoms and response to therapy.

Social space

patient introduction (~4-12ft)

personal space

interview (~2-4ft)

Orthopnea

dyspnea that is triggered when the patient assumes the reclining position. Common in patients with CHF, mitral valve disease, and superior vena cava syndrome.

Platypnea

dyspnea triggered by assuming the upright position. Typically occurs in patients following pneumonectomy and in those with chronic liver disease (hepatopulmonary syndrome)

Orthodeoxia

oxygen desaturation on assuming an upright position. Accompanies platypnea.

Trepopnea

when lying on one side relieves dyspnea. Usually associated with either CHF or pleural effusion.

What scale do we use to quantify dyspnea? Be familiar with it and be able to use it

Modified Borg Scale

What is mucus from the tracheobronchial tree that has been contaminated by oral secretions referred to as?

sputum

What about mucus from the tracheobronchial tree that has not been contaminated

phlegm

Purulent secretions

sputum having pus cells

Fetid secretions

foul-smelling sputum

Define angina and why it is important to be aware of it in the patient assessment.

a spasmodic, cramp-like choking feeling and it is important to be aware of it because it can cause nonpleuritic chest pain located in the center of the chest and it is not affected by breathing.

Past medical history

previous diseases, surgeries, injuries, accidents, or major illnesses

Family History

potential genetic diseases

Social/ Environmental History

patient's current life situation

why are Past medical history, Family History, Social/ Environmental History important

They are important as it familiarizes the clinician with patient's condition.

Confused

exhibits slight decrease of consciousness, slow mental responses, has decreased or dulled perception

Delirious

easily agitated, is irritable, exhibits hallucinations

Lethargic

sleepy, arouses easily, responds appropriately when aroused

Obtunded

awakens only with difficulty, responds appropriately when aroused

Stuporous

does not awaken completely, has decreased mental and physical activity, responds to pain and exhibits deep tendon reflexes, responds slowly to verbal stimuli

Comatose

is unconscious, does not respond to stimuli, does not move voluntarily, exhibits possible signs of upper motor neuron, loses reflexes with deep or prolonged coma

Hyperthermia symptoms

elevation of body temperature, increased heart and breathing rates.

Hypothermia symptoms

decreased body temperature, slow shallow respiratory rate, reduced pulse rate.

Systolic blood pressure range

90 - 140 mmHg

Diastolic blood pressure range

60 - 90 mmHg.

During the physical assessment of the patient, what artery is most often used to assess arterial blood pressure

Brachial artery

What is the advantage of pursed lip breathing for the COPD patient?

Pursed-lip breathing prevents collapse of small airways by creating back pressure.

What is the importance of AP diameter

The AP diameter of the average adult thorax is less than the transverse diameter, evaluates thoracic configuration.

With what disease process will an increased AP diameter be noted?

Disease process that increases AP diameter: emphysema

Apnea

no breathing (caused by cardiac arrest, narcotic overdose, severe brain trauma)

Apneustic

deep, gasping inspiration with brief, partial expiration (caused by damage to upper medulla or pons from stroke or trauma)

Ataxic breathing

completely irregular breathing patten with variable periods of apnea (damage to medulla)

Asthmatic breathing

prolonged exhalation with recruitment of abdominal muscles (obstruction to airflow out of the lungs)

Biot respiration

clustering of rapid, shallow breaths coupled with regular or irregular periods of apnea (damage to medulla or pons)

Cheyne-Stokes respiration

breaths increase and decrease in depth and rate with periods of apnea; variant of "periodic breathing" (severe damage to bilateral cerebral hemispheres and basal ganglia, also seen in CHF patients).

Kussmaul breathing

deep and fast respirations (metabolic acidosis)

What is chest palpation

the art of touching the chest wall to evaluate underlying structure and function

Increase in tactile fremitus

pneumonia and atelectasis (consolidation).

Decrease in tactile fremitus

emphysema, pneumothorax, and pleural effusion.

What is subcutaneous emphysema

when fine bubbles collect in the subcutaneous tissues and produce a crackling sound and sensation when palpated

What can cause subcutaneous emphysema

Caused by lung rupture, which often causes air to leak into subcutaneous tissues of the chest and neck.

What is chest percussion?

performed systemically by consecutively testing comparable areas on both sides of the chest

Increased resonance

caused by emphysema or pneumothorax (air).

Decreased resonance

caused by pneumonia or pleural effusion (consolidation)

vesicular breath sounds

considered normal breath sounds characterized by a soft, muffled sound quality that is lower in pitch and intensity

adventitious breath sounds

Adventitious breath sounds are additional sounds and vibrations produced by air movement through diseased airways.

Diminished breath sounds

sound transmission through lung or chest wall is decreased. COPD or asthma

Wheezes

high pitched, quai musical sound, consistent with airway obstruction (monophonic one airway affected, polyphonic many airways are involved). Bronchitis or asthma.

Stridor

loud pitched sound associated with upper airway obstruction, heard when upper airway compromised, laryngomalacia (chronic), croup, inspiratory stridor narrowing above glottis, expiratory stridor narrowing of lower trachea

Coarse crackles (rhonchi)

airflow moves secretions or fluid in airways, usually clears when patient coughs or upper airway is suctioned. Severe pneumonia, bronchitis

Fine crackles

air moving through fluid filled airways that cannot be cleared with coughing, sudden opening of collapsed small airways during inhalation. Disease process: CHF, atelectasis, fibrosis, pulmonary edema

Pleural friction rub

creaking or grating sound caused by inflamed pleural spaces creating friction, not affected by coughing, intensity may increase with deep breathing.

What characteristic of wheezing indicates improvement in airway obstruction after providing bronchodilator therapy?

Decrease in the pitch and length of the wheezing.

Define a friction rub and when it will occur during the breathing cycle

Creaking or grating sound caused by inflamed pleural spaces creating friction. During the breathing cycle it is heard during inspiration.

What creates the S1 and S2 sounds?

S1: created by closure of AV valves. S2: created by closure of semilunar valves.

What might decrease the intensity of the heart sounds?

Pulmonary hyperinflation, pleural effusion, pneumothorax, and obesity, poor contractility or valvular disease

Digital Clubbing

enlargement of terminal phalanges of the fingers and toes. Significance is that it is seen in congenital heart disease, bronchiectasis, various cancers, and interstitial lung diseases.

Acrocyanosis

sign of poor perfusion, hands and feet typically cool to touch

Capillary refill

quick method to assess peripheral perfusion by pressing firmly against patient's fingernail until nailbed is blanched, then pressure is released. Good cardiac output and digital perfusion 3 seconds or less. Poor cardiac output or digital perfusion 5 seconds or more.

What are the components of chest inspection and why are they important?

Thoracic configuration, expansion, the pattern and effort of breathing and presence of lesions, scars, anatomical abnormalities and foreign bodies. Important for diagnosing a number of abnormalities.

What is the significance of jugular vein distention and why is it important?

JVD reflects venous blood and the pressure of the right heart, and it is increased in patients with CHF and cor pulmonale

Calculation for smoking history (pack years).

Packs smoked per day x number of years smoked

Reference range for RBC

4.0 - 6.0 x 10^6/mcl.

What is decrease in RBC referred to as

referred to as anemia.

Increase in RBC referred

polycythemia

Increase in RBC cause

infection stress, and trauma.

decrease in rbc cause

overwhelming infections and when immune system is depressed due to disease or certain cancer therapies, diseases of bone marrow.

What type of white blood cell increases with allergic reaction?

Eosinophils

What type of white blood cell increases in response to a viral infection

lymphocytes

What type of white blood cell increases in response to A bacterial infection

neutrophils

immature neutrophils

bands

mature neutrophils

segs

Define Critical Test range

A result significantly outside the reference range and represents a pathophysiologic condition.

What is the significance of hemoglobin?

the protein with the ability to bind O2

significance of hematocrit

Hematocrit is the ratio of RBC volume to whole blood

What does it signify when high Hb

means more O2 is needed (polycythemia

What does it signify when high HCT

polycythemia and dehydration

What does it signify when low Hb

anemia

What does it signify when low HCT

anemia or overhydration, indicates inadequate O2-carrying capacity of the blood.

Define Platelet count and what it is used for

measures the amount of platelets in blood, which measures the smallest component of blood that controls bleeding. It is used to assess how well the blood can clot for ABGs or nasotracheal suctioning.

reference range platelet count

150-400 x 10^3/mcL

Reference range for Na+

135 - 145 mEq/L

Reference range for K+

3.5 - 5.0 mEq/L

Reference range for Cl-

95 - 105 mEq/L

Reference range for Ca+

8.5 - 10.5 mEq/L

Reference range for CO2

22 - 29 mEq/L

Reference range for Glucose

< 100 mg/dL

Reference range for Cr

0.5 - 1.5 mg/dL

Reference range for blood urea nitrogen (BUN)

8 - 25 mg/dL

Reference range for Magnesium (Mg++)

1.5 - 2.0 mEq/L

Reference range for Phosphate (PO4^3-)

1.5 - 2.5 mEq/L

Reference range for Bicarbonate (HCO3-)

22 - 26 mEq/L

Medical terminology for high and low values of Na+

High: hypernatremia Low: hyponatremia

Medical terminology for high and low values of K+

High: hyperkalemia Low: hypokalemia