Intro to Respiratory | Exam 1 review

chapters 1, 2, 16

What does Boyles Law say?

With constant temperature, the volume and pressure are identically proportional

What is the stated mission of the AARC

Provide for professional advancement, foster cooperation with physicians, and advance the knowledge of inhalation therapy through educational activities

Which agency establishes standards for the credentialing of respiratory therapists

NBRC

What 5 assessments are in included when evaluating the general overall appearance of the patient

Level of consciousness

facial expression

level of anxiety or distress

positioning

general appearance

What is Tripod positioning

a position in which patients support their forearms or elbows on a stationary object in front of them. This position immobilizes the shoulders and allows the accessory muscle to raise the anterior chest wall increasing the depth of a breath

What 4 steps are essential for evaluating patient’s problem and determining ongoing effects of provided therapy

Inspection(visually examining)

palpitation(touching)

percussion(tapping)

auscultation(listening with stethoscope

what is inspection when evaluating a patients and determining ongoing effects

visually examining

what is palpatation when evaluating a patients and determining ongoing effects

touching

what is percussion when evaluating a patients and determining ongoing effects

tapping

what is auscultation when evaluating a patients and determining ongoing effects

listening with a stethoscope

what are the different levels of consciousness

confused

delirious

lethargic

obtunded

stuporous

comatose

confused

The patient exhibits slight decrease of consciousness, has slow mental responses, has decreased or dulled perception, has incoherent thoughts

delirious

the patient is easily agitated, is irritable, exhibits hallucinations

lethargic

the patient is sleepy, arouses easily, responds appropriately when aroused

obtunded

the patient awakens only with difficulty, responds appropriately when aroused

stuporous

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

comatose

the patient is unconscious, does not respond to stimuli, does not move voluntarily, exhibits possible signs of upper motor neuron dysfunction such as Babinski reflex or hyperreflexia, loses reflexes with deep or prolonged coma

9. Scores range from ____-____ when using the Glasgow coma scale

3-15

what does 3 stand for when using the Glasgow scale

patients in a deep coma

what does 15 mean when using the Glasgow scale

patients with a normal sensorium

what is the normal value of body temperature

98.6 F (37C)

what is the normal value of pulse rate

60-100 beats/min

what is the normal value for respiratory rate

12-18 breaths/min

what is the normal value for blood pressure

120/80 mm Hg

hypothermia

body temperature below normal

What might cause hypothermia

prolonged exposure to the cold

What happens to a patient’s heart rate and respiratory rate if the patient is hypothermic

slow and shallow respiratory rate and a reduced pulse rate due to the reduction of O2 consumption and CO2 production

hyperthermia

elevated body temperature

What might cause hyperthermia

from disease or from normal strenuous activities

What happens to a patient’s heart rate and respiratory rate if the patient is hyperthermic

have increased heart and breathing rates due to increased metabolism, increased O2 consumption and CO2 production

Tachycardia

elevated/fast pulse rate that is greater than 100 beats/min

What are common causes of tachycardia

exercise, fear, anxiety, low blood pressure, anemia, fever, reduced arterial blood O2 levels (hypoxemia), elevated CO2 (hypercapnia) , and certain medications

Bradycardia

slow pulse rate that is lower than 60 beats/min

What are common causes of bradycardia

hypothermia, traumatic brain or cervical spinal cord injury, certain cardiac arrhythmias, and certain medications

location of brachial pulse point

midway up the inside of the arm

location of the radial pulse point

on the thumb side of the wrist, between the wrist bone and the tendon.

location of the femoral pulse point

at the top of your thigh in an area called the femoral triangle

Tachypnea

a respiratory rate greater than 20 breaths/min

What causes tachypnea

exertion, fever, hypoxemia, hypercarbia, metabolic acidosis, pulmonary edema, lung fibrosis, anxiety and pain

bradypnea

a respiratory rate less than 10 breaths/min

What causes bradypnea

traumatic brain injury, severe myocardial infarction, hypothermia, anesthetics, opiate narcotics, and recreational drug overdoses

hypertension

an arterial blood pressure persistently greater than 140/90 mmHg

If a patient has an acute hypertensive crisis what can it cause

neurologic, cardiac, and renal failure

True or False: Hypotension may cause a person to go into shock

true

How is tissue hypoxia from hypotension treated

supplemental oxygen

When examining the head what are signs the patient has increased work of breathing (WOB)

Nasal flaring

When performing neck inspection what are three abnormal findings you may visualize

Trachea shifted away from the midline

jugular venous distension(enlarged jugular vein)

enlarged lymph nodes

The chest should be visually inspected for 3 things, what are they

Thoracic configuration

thoracic expansion

the pattern and effort of breathing

What is an abnormal increase in AP diameter of the chest called

Barrel chest

True or False: Spinal deformities may cause changes in the shape of the thorax and affect how the lungs work

True

What is the main muscle we use to breathe

Diaphragm

Describe two broad categories of abnormal breathing patterns

Cardiopulmonary or chest wall diseases

neurological diseases

Name 3 causes of an increase in work of breathing (WOB)

airway obstruction

edematous(heavy) lungs

stiff chest wall

retractions

Inwards sinking of the chest wall during inspiration

What are two typical breathing patterns

Rapid shallow breathing pattern

abnormal prolonged exhalation

Apnea

no breathing

Asthmatic breathing

prolonged exhalation with recruitment of abdominal muscles(short breath, long expiration)

Biot respiration

clustering of rapid, shallow breaths coupled with regular or irregular period of apnea

Cheyenne-strokes

irregular type of breathing, increases, and decreases in depth, and rate with periods of apnea

Kussmaul

deep and fast respirations

What does Hoover sign refer to

inward movement of the lower lateral margins of the chest wall with each inspiration effort, owing to a low flat diaphragm as seen in emphysema

What information do we get from palpating the chest walls

confirm or rule out suspected problems suggested by the history and initial examination findings

Increased tactile fremitus occur with ____

consolidation(filled with inflammatory exudate) such as pneumonia and atelectasis

Reduced tactile fremitus occur with______

fluid or air collected in the plural space such as pleural effusion or pneumothoraces

Bilateral reduction in chest expansion may be seen in patients’ with____

Neuromuscular disorders or COPD

How does a pneumothorax affect chest expansion

there is large amounts of air in the plural space

What pathologies may cause tracheal deviation away from the affected lung

pleural effusion

neck and thyroid tumors, large

Mediastinal mass

pneumothorax

What pathologies may cause tracheal deviation toward the affected lung

Atelectasis

fibrosis

pneumonectomy

paralysis of hemidiaphragm

What are the causes of hyporesonant lung sounds

Pneumonia or pleural effusion ( consolidated or increase density of lung tissue)

What are the causes of hyperresonant lung sounds

emphysema, air trapping or pneumothorax

what area of the lungs would you hear tracheal breath sounds

directly over trachea or windpipe, and the upper part of the sternum or between the shoulder blades

what area of the lungs would you hear bronchial breath sounds

sternum

what area of the lungs would you hear vesicular breath sounds

over lung parenchyma

discontinuous breath sounds

intermittent crackling, or bubbling sounds of short duration reffered to as crackles

continuous breath sounds

referred to as wheezes, heard over the upper airway called stridor

Wheezing occurs from

consistent with increase resistance due to airway obstruction

True or False: wheezes caused by mucous may clear with coughing

true

What is most common cause of acute stridor

Croup

fine crackles

do not clear with coughing or indicate that air moving through fluid-filled airways

course crackles

are usually associated with airway, secretions often clear with coughing, or when airways are needing to be suctioned

what does fine crackles sound like

light sound of bubbles popping

what does course crackles sound like

louder sound of bubbles popping

What does digital clubbing look like

enlargement of the terminal phalanges of the fingers and toes